Use of a virtual 3D anterolateral thigh model in medical education: Augmentation and not replacement of traditional teaching?
- 作者列表："Lo S","Abaker ASS","Quondamatteo F","Clancy J","Rea P","Marriott M","Chapman P
:There is a pressing need for simulated forms of medical, and in particular, anatomical learning. Current modalities of teaching are limited to either traditional 2-dimensional forms of learning, such as textbook, research papers and lectures, or more costly 3-dimensional modes including cadaveric dissection. Despite the overwhelmingly 3-dimensional nature of plastic surgery, virtual 3D models are limited. Here, we provide the first description of the development and utilisation of a virtual 3D flap model in medical education in the undergraduate curriculum. Methods and results: A 3D anterolateral (ALT) model was developed with close integration of specialists in simulation and visualisation, anatomists and clinicians, allowing 'virtual dissection' of the anatomy of the ALT flap. This was utilised in a B.Sc. Anatomy undergraduate course in 2017/18 and 2018/19. Student feedback noted an overwhelming preference for the 3D model (74%) as the first choice of educational methodology, versus lectures (26%), textbooks (0%) and research papers (0%) (p = 0.0035). Extraneous cognitive load may be reduced with 3D models, with students rating these as easier to learn from than textbook or research papers (p = 0.00014 and p < 0.00001, respectively). Notably, no statistically significant difference was found in the perceived ease of learning between 3D models and lectures. Conclusions: This study highlights a striking user preference for virtual 3D models as compared to for traditional teaching methods. Nonetheless, 3D models are likely to enhance rather than replace lectures, with this study suggesting that teaching by experts is likely to remain an essential part of medical education.
: 迫切需要模拟形式的医学，特别是解剖学学习。目前的教学方式仅限于传统的二维学习形式，如教科书，研究论文和讲座，或更昂贵的三维模式，包括尸体解剖。尽管整形手术具有压倒性的3维性质，但虚拟3D模型是有限的。在这里，我们提供了虚拟3D皮瓣模型在本科课程医学教育中的开发和利用的第一个描述。方法和结果: 开发了3D前外侧 (ALT) 模型，紧密结合了模拟和可视化专家、解剖学家和临床医生，允许ALT皮瓣解剖的 “虚拟解剖”。这在B.Sc中使用。解剖学本科在2017/18和2018/19。学生反馈指出，与讲座 (74%) 、教科书 (26%) 和研究论文 (0%) 相比，3D模型 (0%) 是教育方法的首选 (p = 0.0035)。使用3D模型可以减少无关的认知负荷，学生认为这些模型比教科书或研究论文更容易学习 (分别为p = 0.00014和p <0.00001)。值得注意的是，在3D模型和讲座之间的感知学习容易程度没有发现统计学上的显著差异。结论: 与传统教学方法相比，本研究突出了用户对虚拟3D模型的显著偏好。尽管如此，3D模型可能会增强而不是取代讲座，这项研究表明，专家的教学可能仍然是医学教育的重要组成部分。
METHODS:OBJECTIVES:The aim was to evaluate the image quality and sensitivity to artifacts of compressed sensing (CS) acceleration technique, applied to 3D or breath-hold sequences in different clinical applications from brain to knee. METHODS:CS with an acceleration from 30 to 60% and conventional MRI sequences were performed in 10 different applications in 107 patients, leading to 120 comparisons. Readers were blinded to the technique for quantitative (contrast-to-noise ratio or functional measurements for cardiac cine) and qualitative (image quality, artifacts, diagnostic findings, and preference) image analyses. RESULTS:No statistically significant difference in image quality or artifacts was found for each sequence except for the cardiac cine CS for one of both readers and for the wrist 3D proton density (PD)-weighted CS sequence which showed less motion artifacts due to the reduced acquisition time. The contrast-to-noise ratio was lower for the elbow CS sequence but not statistically different in all other applications. Diagnostic findings were similar between conventional and CS sequence for all the comparisons except for four cases where motion artifacts corrupted either the conventional or the CS sequence. CONCLUSIONS:The evaluated CS sequences are ready to be used in clinical daily practice except for the elbow application which requires a lower acceleration. The CS factor should be tuned for each organ and sequence to obtain good image quality. It leads to 30% to 60% acceleration in the applications evaluated in this study which has a significant impact on clinical workflow. KEY POINTS:• Clinical implementation of compressed sensing (CS) reduced scan times of at least 30% with only minor penalty in image quality and no change in diagnostic findings. • The CS acceleration factor has to be tuned separately for each organ and sequence to guarantee similar image quality than conventional acquisition. • At least 30% and up to 60% acceleration is feasible in specific sequences in clinical routine.
METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.
METHODS:OBJECTIVE:The primary purpose of this study was to evaluate the effectiveness of a three-dimensional (3D) software tool (smart planes) for displaying fetal brain planes, and the secondary purpose was to evaluate its accuracy in performing automatic measurements. MATERIAL AND METHODS:This prospective study included singleton fetuses with a gestational age (GA) greater than 18 weeks. Transabdominal two-dimensional ultrasound (2DUS) and 3D smart planes images were respectively used to obtain the basic planes of the fetal brain, with five parameters measured. The images, by either two-dimensional (2D) manual or 3D automatic operation, were reviewed by two experienced sonographers. The agreements between two measurements were analyzed. RESULTS:A total of 226 cases were included. The rates of successful detection by automatic display were as high as 80%. There was substantial agreement between the measurements of the biparietal diameter, head circumference and transcerebellar diameter, but poor agreement between the measurements of cisterna magna and lateral ventricle width. CONCLUSIONS:Smart Planes might be valuable for the rapid evaluation of fetal brain, because it simplifies the evaluation process. However, the technology requires improvement. In addition, this technology cannot replace the conventional manual US scans; it can only be used as an additional approach.