OBJECTIVE: In surgical procedures for cleft lip, surgeons attempt to use various skin incisions and small flaps to achieve a better and more natural shape postoperatively. They must understand the three-dimensional (3D) structure of the lips. However, they may have difficulty learning the surgical procedures precisely from normal textbooks with two-dimensional illustrations. Recent developments in 3D computed tomography (3D-CT) and laser stereolithography have enabled surgeons to visualize the structures of cleft lips from desired viewpoints. However, this method cannot reflect the advantages offered by specific surgical procedures. To solve this problem, we used the benefits offered by 3D computer graphics (3D-CG) and 3D animation. DESIGN AND RESULTS: By using scanning 3D-CT image data of patients with cleft lips, 3D-CG models of the cleft lips were created. Several animations for surgical procedures such as incision designs, rotation of small skin flaps, and sutures were made. This system can recognize the details of an operation procedure clearly from any viewpoint, which cannot be acquired from the usual textbook illustrations. This animation system can be used for developing new skin-flap design, understanding the operational procedure, and using tools in case presentations. The 3D animations can also be uploaded to the World Wide Web for use in teleconferencing.
"To our knowledge, the paucity of 3-D modeling for the purpose of neurosurgery education represents a gap in current training regimes and affords an opportunity for rich research. Such digital models have been used in cardiac surgery training , general surgery with inguinal hernia repairs  and plastic surgery (cleft lip) repairs . Some teams are working on larger virtual reality projects, with models in which the surgeon can actually use his/her hands and have an active feedback (haptic); however, those types of training programs require extremely expensive material, and are very specific to a small community. "
[Show abstract][Hide abstract] ABSTRACT: Although we live and work in 3 dimensional space, most of the anatomical teaching during medical school is done on 2-D (books, TV and computer screens, etc). 3-D spatial abilities are essential for a surgeon but teaching spatial skills in a non-threatening and safe educational environment is a much more difficult pedagogical task. Currently, initial anatomical knowledge formation or specific surgical anatomy techniques, are taught either in the OR itself, or in cadaveric labs; which means that the trainee has only limited exposure. 3-D computer models incorporated into virtual learning environments may provide an intermediate and key step in a blended learning approach for spatially challenging anatomical knowledge formation. Specific anatomical structures and their spatial orientation can be further clinically contextualized through demonstrations of surgical procedures in the 3-D digital environments. Recordings of digital models enable learner reviews, taking as much time as they want, stopping the demonstration, and/or exploring the model to understand the anatomical relation of each structure. We present here how a temporal lobectomy virtual model has been developed to aid residents and fellows conceptualization of the anatomical relationships between different cerebral structures during that procedure. We suggest in comparison to cadaveric dissection, such virtual models represent a cost effective pedagogical methodology providing excellent support for anatomical learning and surgical technique training.
Computers in Biology and Medicine 04/2012; 42(6):692-6. DOI:10.1016/j.compbiomed.2012.03.005 · 1.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the clinical application of three-dimensional (3D) imaging and morphological analysis with subsequent individual therapy planning and postoperative 3D symmetry control in comparison with data from non-cleft persons.
This was a prospective study using a 3D surface-imaging and evaluation system in cleft patients and non-cleft persons. The pre- and postoperative 3D facial profiles were recorded from the patients using a 3D laser scanner. The preoperative 3D image was analyzed qualitatively and quantitatively for an individual therapy planning. On the basis of ratios and scores, based on empirical regions of interest, the technique of cleft repair was designed individually. The postoperative result was evaluated regarding symmetry. The surgically created soft tissue shift was defined quantitatively and visualized with vectors. The postoperative symmetry was compared with 3D data from a group of non-cleft persons of the same ethnical group.
Eleven patients (mean age 13.8 years, median 13, minimum 2, maximum 41 years) with either a unilateral isolated cleft lip, a cleft lip and alveolus or a complete unilateral cleft lip, alveolus and palate and 25 non-cleft persons (8 children between 4 and 12 years, 17 adults (9 men, 8 women) between 18 and 50 years). All these persons investigated were Asians of Khmer origin.
The analysis permitted quantitative 3D evaluation. The 3D anthropometric data of the non-cleft Khmer persons were collected and named the gold standard of symmetry in this ethnical group. All postoperative 3D images reached symmetrical values within the range of the normal cohort. Soft tissue shifts from pre- to postoperative sites could be visualized.
A new method for registration was described enabling follow-up registration in patients when growing older. This 3D soft tissue analysis can be a useful tool in quantitative analysis and objective follow-up control in cleft patients. It offers deeper insight into the complex morphology to be treated and could contribute to individualisation of surgical procedures.
Journal of Cranio-Maxillofacial Surgery 09/2008; 36(8):431-8. DOI:10.1016/j.jcms.2008.05.003 · 2.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Medical students often have difficulty achieving a conceptual understanding of 3-dimensional (3D) anatomy, such as bone alignment, muscles, and complex movements, from 2-dimensional (2D) images. To this end, animated and interactive 3-dimensional computer graphics (3DCG) can provide better visual information to users. In medical fields, research on the advantages of 3DCG in medical education is relatively new.
To determine the educational effectiveness of interactive 3DCG.
We divided 100 participants (27 men, mean (SD) age 17.9 (0.6) years, and 73 women, mean (SD) age 18.1 (1.1) years) from the Health Sciences University of Mongolia (HSUM) into 3DCG (n = 50) and textbook-only (control) (n = 50) groups. The control group used a textbook and 2D images, while the 3DCG group was trained to use the interactive 3DCG shoulder model in addition to a textbook. We conducted a questionnaire survey via an encrypted satellite network between HSUM and Tokushima University. The questionnaire was scored on a 5-point Likert scale from strongly disagree (score 1) to strongly agree (score 5).
Interactive 3DCG was effective in undergraduate medical education. Specifically, there was a significant difference in mean (SD) scores between the 3DCG and control groups in their response to questionnaire items regarding content (4.26 (0.69) vs 3.85 (0.68), P = .001) and teaching methods (4.33 (0.65) vs 3.74 (0.79), P < .001), but no significant difference in the Web category. Participants also provided meaningful comments on the advantages of interactive 3DCG.
Interactive 3DCG materials have positive effects on medical education when properly integrated into conventional education. In particular, our results suggest that interactive 3DCG is more efficient than textbooks alone in medical education and can motivate students to understand complex anatomical structures.
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