Three-dimensional visualisation improves understanding of surgical liver anatomy.
OBJECTIVE
Three-dimensional (3-D) representation is thought to improve understanding of complex spatial interactions and is being used more frequently in diagnostic and therapeutic procedures. It has been suggested that males benefit more than females from 3-D presentations. There have been few randomised trials to confirm these issues. We carried out a randomised trial, based on the identification of complex surgical liver anatomy, to evaluate whether 3-D presentation has a beneficial impact and if gender differences were evident.


METHODS
A computer-based teaching module (TM) was developed to test whether two-dimensional (2-D) computed tomography (CT) images or 3-D presentations result in better understanding of liver anatomy. Following a PowerPoint lecture, students were randomly selected to participate in computer-based testing which used either 2-D images presented as consecutive transversal slices, or one of two 3-D variations. In one of these the vessel tree of portal and hepatic veins was shown in one colour (3-D) and in the other the two vessel systems were coloured differently (3-Dc). Participants were asked to answer 11 medical questions concerning surgical anatomy and four questions on their subjective assessment of the TM.


RESULTS
Of the 160 Year 4 and 5 medical students (56.8% female) who participated in this prospective randomised trial, students exposed to 3-D presentation performed significantly better than those exposed to 2-D images (p < 0.001). Comparison of the number of correct answers revealed no significant differences between the 3-D and 3-Dc modalities p > 0.1). Male students gave significantly more correct answers in the 3-D and 3-Dc modalities than female students (p < 0.03). The gender difference observed in both 3-D modalities was not evident in the 2-D group (p = 0.21).


CONCLUSIONS
This study showed that 3-D imaging significantly improved the identification of complex surgical liver anatomy. Male students benefited significantly more than female students from 3-D presentations. Use of colour in 3-D presentation did not improve student performance.
Beermann
Judith
J
Department of Surgery, University of Heidelberg, Heidelberg, GermanyDepartment of Medical Imaging, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, GermanyInstitute for Medical Biometry and Informatics, Heidelberg, Germany.
Tetzlaff
Ralf
R
Department of Surgery, University of Heidelberg, Heidelberg, GermanyDepartment of Medical Imaging, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, GermanyInstitute for Medical Biometry and Informatics, Heidelberg, Germany.
Bruckner
Thomas
T
Department of Surgery, University of Heidelberg, Heidelberg, GermanyDepartment of Medical Imaging, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, GermanyInstitute for Medical Biometry and Informatics, Heidelberg, Germany.
Schöebinger
Max
M
Department of Surgery, University of Heidelberg, Heidelberg, GermanyDepartment of Medical Imaging, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, GermanyInstitute for Medical Biometry and Informatics, Heidelberg, Germany.
Müller-Stich
Beat P
BP
Department of Surgery, University of Heidelberg, Heidelberg, GermanyDepartment of Medical Imaging, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, GermanyInstitute for Medical Biometry and Informatics, Heidelberg, Germany.
Gutt
Carsten N
CN
Department of Surgery, University of Heidelberg, Heidelberg, GermanyDepartment of Medical Imaging, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, GermanyInstitute for Medical Biometry and Informatics, Heidelberg, Germany.
Meinzer
Hans-Peter
HP
Department of Surgery, University of Heidelberg, Heidelberg, GermanyDepartment of Medical Imaging, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, GermanyInstitute for Medical Biometry and Informatics, Heidelberg, Germany.
Kadmon
Martina
M
Department of Surgery, University of Heidelberg, Heidelberg, GermanyDepartment of Medical Imaging, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, GermanyInstitute for Medical Biometry and Informatics, Heidelberg, Germany.
Fischer
Lars
L
Department of Surgery, University of Heidelberg, Heidelberg, GermanyDepartment of Medical Imaging, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, GermanyInstitute for Medical Biometry and Informatics, Heidelberg, Germany.
D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement / Q000379:methods; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D011859:Radiography; D012737:Sex Factors; D013223:Statistics as Topic; D013337:Students, Medical / Q000523:psychology*; D013663:Teaching / Q000379:methods