Application Of Three-dimensional Visualization In Case Teaching And Doctor-patient Communication

Objective: Three-dimensional visualization(3DV)is an important part of digital medical technology,and significant achievements have been made in precision surgical treatment,basic research and learning.The purpose of this study was to construct a 3DV digital model of polycystic kidney,and to apply it in clinical case teaching and doctor-patient communication.Methods: We recruited a patient with autosomal dominant polycystic kidney disease(ADPKD).After 256 rows of thin CT scan and plain MRI scan of the kidney,the data were imported into the modeling software.After 3d reconstruction including segmentation,intelligent filling,dynamic expansion,real-time modification and spatial position transformation,A 3DV digital model of polycystic kidney was obtained.Then 60 interns of grade 14 clinical medicine undergraduate were selected and divided into the control group A(n=30)and the experimental group B(n=30)using a randomized controlled trial.Students in group A were taught by case explanation through internal medicine books,CT and MRI.On the basis of teaching in group A,students in group B added 3DV virtual digital model for case teaching.Subjective and objective evaluations were performed separately.A total of 6 professors from the department of nephrology and urology of our hospital were selected to make subjective evaluation on the vitality,intuition,clinical practicability and overall satisfaction of the digital model.Then,families of 32 ADPKD patients hospitalized in our hospital from November 2018 to January 2019 were selected,and they were divided into two groups,control group A(n=16)and experimental group B(n=16).Group A used teaching pictures and group B used the established 3DV polycystic kidney digital model to communicate with doctors and patients,and made objective evaluation respectively.Results: In this study,a 3DV digital model of polycystic kidney was successfully constructed,which was highly consistent with the original CT and MRI images,and truly restored the polycystic kidney morphology of the patient.The renal arteries,veins,cysts and cortex are distinguished by specific colors.It can be arbitrarily enlarge,contracted,rotate and viewed in various angles,The renal cortex can be transparent and the morphology of each cyst can be visualized.The internal renal artery was grade 5,and the internal renal vein was grade 3.Artery or vein can be hidden alone to observe the adjacent relationship of the cyst and blood vessels.The objective evaluation results of teaching showed that although the post-test scores of students in both groups were improved,there was no statistical difference between the pre-test scores and the post-test scores of students in the two groups(P>0.05).The subjective evaluation results showed that although the two groups of students thought that there was no significant difference in their respective teaching methods in terms of knowledge acquisition efficiency and overall satisfaction(P>0.05).However,the students in group B believed that the addition of 3DV digital model directly showed the relationship between cyst and vascular adjoining(P<0.001),and the relationship between cyst and renal parenchyma(P=0.022),formed a correct spatial understanding of cyst shape and size(P=0.001),promoted creative thinking(P<0.05),and was conducive to improving the learning curve of polycystic kidney(P<0.001),and the difference was statistically significant.The results of expert subjective evaluation showed that the expert’s evaluation of 3DV digital model was better than that of CT and MRI in terms of vitality(P=0.012),intuition(P=0.007)and overall satisfaction(P=0.042).Objective evaluation by family members showed that the addition of 3DV digital model significantly improved the ability to understand the anatomical structure(P<0.001),clinical manifestations(P<0.001),complications(P<0.001)and treatment(P<0.001)of polycystic kidney.Conclusion: This study successfully established a 3DV digital model of polycystic kidney,and its accuracy and specificity provide a basis for further study of polycystic kidney.It is helpful to improve the learning curve of polycystic kidney and is an effective supplement to traditional teaching.Using it in doctor-patient communication can improve the family members’ understanding of the disease.