Educational Problems Clinical Trial
Official title:
Ethical Committee at Researches of Ege University
Background: Three-dimensional (3D) patient-specific anatomical model guidance is a reliable
tool in obtaining accurate bony cuts, precise implant placement, and satisfactory surgical
results. These can enhance surgeon's understanding of their patients' patho-anatomy also
helping in precise preoperative planning. So, the hypothesis of this study is that, in the
training of orthopaedic residency, 3D printed models reflecting the patient's individual
process provide a a foresight and a perception of the bone pathologies and osseous
relationships before orthopaedic intervention.
Methods: In this study, the investigators displayed our experience of creating realistic 3D
models in orthopaedic surgical case scenarios to evaluate the perceptions of fellows in
orthopaedic surgeon training. The investigators based our study on the comparision of the
perception of residents who were presented with four-step carousel consisting of different
scenarios as trauma (calcaneal fracture), deformity (hallux valgus), tumoral mass (sacral
chondrosarcoma), and reconstructive procedure (multidisciplinary cancer surgery). The X-ray
images, computed tomography (CT), and 1:1 solid models of the cases were included in each
step. The orthopaedic residents were asked to compare their perception level of the actual
scenarios in evaluating the effectiveness of each tool in terms of perceiving the orthopaedic
problem, understanding the bone pathology, classification of diagnosis and preoperative data
planning.
2.1. Study Group The study group consisted of 11 orthopaedic residents of University
Hospital. Ethics approval for this study was obtained from our university's Human Research
Ethics Committee (18-5/41). The work has been reported in line with the STROCSS criteria.
2.2. Selection of the sample cases The patients were chosen from the MRI examinations of the
ones who referred to same University Hospital Department of Orthopaedic and Traumatic Surgery
for diagnosis and treatment between the year of 2016 and 2018. Selection criteria for the 4
cases was the involved patients (age: 18-62 years) who required orthopaedic surgery, had no
previous orthopaedic nor traumatic operation, but on the other hand have bone pathology
leading to deformity, fracture, and suitable radiological imaging results for modeling. 4
cases that could serve as an example for orthopaedic surgical procedures were determined with
the consensus of experts in medical education, orthopaedic surgery and anatomy. The selected
cases were turned into real scenarios with history, medical examination findings, and imaging
methods. As data collection tool, descriptive grading scale was used to evaluate the
perceptions of each of these imaging methods in terms of their usefulness in seeing the
surgical problem, their efficiency in differential diagnosis and presurgical planning.
2.3.Image post-processing and segmentation Original CT images were converted into in Digital
Imaging and Communications in Medicine (DICOM) format. Files were transferred to a separate
workstation with Analyze 12.0 for post-processing and segmentation. Using free 3D Slicer
(version 4.10.1) software, a smoothing filter was also applied to the segmented volume data
to improve the surface quality of the model. The STL format for 3D printing was prepared.
2.4. Creating Life-size Patient-Specific 3D Model Mass Portal Pharaoh xd 20 printer was used
due to its documented accuracy for producing high-resolution 3D models of orthopaedic cases
from resin-based polymers.
2.5. Workshop Data collection shop A grading scale was developed for each case so that the
residents were able to make a comparison.
1. The grading scale developed for the trauma case (calcaneus fracture) consisted of 16
items including the appearance, classification and planning of the fracture surgery.
2. The scale for the case of deformity (hallux valgus) contained 7 items of classification,
questioning the degree of deformity and operation planning.
3. In the grading scale developed for the tumor case (chondrosarcoma), there were 13 items
questioning the location, size, spread and neighboring pelvic structures.
4. In the scale for the reconstructive case (thorax localized tumor), there were 13 items
questioning the location, size, spread and neighboring of intrathoracic structures, the
occurrence of a postoperative defect, and the reconstructive method in the presence of a
postoperative defect..
2.6. Survey A multi-item survey was prepared to assess fellow's perception of residency
training. The survey utilized by our group, addressed the issues in understanding patient
bone anatomy, seeing osseous pathology, independent decision-making, differential
pathological diagnosis, plan on key surgical steps, and preparation for unexpected events.
Residents who completed their examination in the stations evaluated each imaging method and
answered the questions on a scale of 10. Scoring in the scale (1 - 10) describes 0 = very low
and 10= the highest level.
2.7. Data collection Residents were asked to answer the grading scale by examining the X-ray,
CT and the 3D model from the first station. In addition, opinions about the models were
recorded and they were given an average of 10 minutes for each station.
2.8. Data Analysis Descriptive statistics and Friedman test were used for comparison
analysis. Data were analyzed using IBM SPSS Statistics, version 24 (IBM Corp., Armonk, NY).
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