背景:尿道下裂的阴茎表型目前是通过视觉或手动评估的(例如,尺子,测角仪)用于临床,教育,和研究应用。然而,这些方法在评估者之间缺乏精确性和准确性,无法在手术修复后进行回顾性评估.该项目的目的是评估从数字和三维(3D)打印模型获得的阴茎尺寸的精度和可靠性,这些模型是在初级儿科阴茎手术过程中从术中(OR)结构光扫描(SLS)创建的。
方法:本前瞻性研究(IRB#20-000143)纳入1个月至6岁男孩在单一机构接受首次或单期阴茎手术。对于每个病人来说,在一致的手动张力下放置留缝后立即,使用尺子进行术中尺寸测量。在阴茎重新定位之前,使用ArtecSpaceSpider扫描仪和ArtecStudio13软件创建了数字3D模型。在案件之后,两个不同的评估者在AutodeskFusion360中完成了每个生成模型的10个数字测量。这些数字模型随后被3D打印,两个不同的评估者使用标尺完成了每个3D打印模型的10次手动尺寸测量。单向随机效应组内相关系数(ICC)评估了评估者之间和内部的一致性度量,分别。在R版本4.2中进行了分析。
结果:获得了6次扫描(尿道下裂:4次,包皮环切术:2次)。内部评估人员在重复数字测量中显示出出色的精度;3D打印模型的手动测量在龟头宽度和阴茎长度方面具有出色的可靠性,但在龟头高度方面具有良好的可靠性。评估者间的可靠性对于龟头宽度(0.77-0.95)和阴茎长度(0.71-0.88)是良好的。然而,龟头高度的评分者间可靠性差(0-0.14)。在关于龟头高度位置的训练之后,手动和数字测量的精度和可重复性都有所提高。
结论:对OR衍生的3D模型进行数字测量,使每个评估者都具有出色的可重复性,并且与仅对3D打印模型进行手动测量相比,提高了评估者之间的可靠性。确保图像可以由不同的外科医生现在和未来进行比较。SLS有望成为一种数字化生成3D模型的新模式,从而为研究和教育提供表型分析。计划进一步开发数字测量方法,以确保评估者之间的一致性,以定量评估其他参数,并在手术计划的术前环境中评估技术。
BACKGROUND: Penile phenotype in hypospadias is currently assessed visually or manually (e.g., ruler, goniometer) for clinical, education, and research applications. However, these methods lack precision and accuracy across raters and cannot be reevaluated retrospectively following a surgical repair. The project aim was to evaluate the precision and reliability of penile dimensions obtained from digital and three dimensional (3D) printed models created from intraoperative (OR) structured light scans (SLS) during primary pediatric penile procedures.
METHODS: Boys ages 1 month to 6 years underwent first- or single-stage penile surgery at a single institution were enrolled in this prospective study (IRB #20-000143). For each patient, immediately following placement of a stay suture under consistent manual tension, intra-operative dimension measurements with a ruler were obtained. A digital 3D model was created prior to penile repositioning using an Artec Space Spider scanner and Artec Studio 13 software. Following the case, two different raters completed 10 digital measurements of each generated model in Autodesk Fusion 360. These digital models were subsequently 3D printed and two different raters completed 10 manual dimension measurements of each 3D printed model using a ruler. A one-way random effects intraclass correlation coefficient (ICC) evaluated measures of agreement between and within raters, respectively. Analyses were conducted in R version 4.2.
RESULTS: Six scans were obtained (hypospadias: 4, circumcision: 2). Intra-rater assessments showed excellent precision across repeated digital measurements; manual measurements of 3D printed models had excellent reliability for glans width and penile length but poor to good reliability for glans height. Inter-rater reliability was good to excellent for glans width (0.77-0.95) and good for penile length (0.71-0.88). However, there was poor inter-rater reliability for glans height (0-0.14). Following training regarding glans height location, there was an improvement in precision and repeatability of manual and digital measurements.
CONCLUSIONS: Digital measurement of OR-derived 3D models resulted in excellent repeatability for each rater and improved between-rater reliability over manual measurement of 3D printed models alone, ensuring that images can be compared by various surgeons both now and in the future. SLS is promising as a novel modality to digitally generate 3D models, thereby informing phenotypic analysis for research and education. Further development of digital measurement methods to ensure consistency between raters for quantitative assessment of additional parameters and assessment of the technology within the pre-operative environment for surgical planning is planned.