# Evaluation of Reporting Methods for Assessment and Surgical Planning of Perianal Fistulas

## TL;DR

This paper evaluates how 3D models and different reporting methods affect surgeons' planning for perianal fistulas, finding that combining 3D models with standardized reports improves agreement and reduces mental effort.

## Contribution

The study introduces and evaluates a new reporting method combining 3D models and standardized radiology reports for surgical planning of perianal fistulas.

## Key findings

- Combining 3D models with standardized reports (mode 3) achieved 85% surgeon agreement, significantly higher than other methods.
- Mode 3 also resulted in the lowest cognitive load for surgeons compared to other reporting methods.
- 3D models alone (mode 1) outperformed conventional reports and PACS images (mode 2) in surgeon agreement and cognitive load.

## Abstract

Perianal fistula is a complex condition where surgeons conduct surgeries based on the mentally mapped images they created from the information found in the radiology report. If not properly treated, a fistula could reoccur. To reduce the chances of reoccurrence, a patient-specific, visual, and accurate depiction of the internal tracts in relation to the pelvic floor is required. A three-dimensional (3D) parametric model generation software was previously developed and evaluated successfully with radiologists. In this paper, the software output is evaluated with two colorectal surgeons for 10 fistula cases. The paper compares three reporting different modes: (1) 3D models only, (2) conventional radiology report and picture archiving and communication system (PACS) magnetic resonance (MR) images, and (3) 3D models + standardized radiology report. The percentage of agreement between surgeons across cases and cognitive load are the primary metrics used for evaluation. Mode 3 superseded both modes 1 and 2, meaning that surgeons prefer to see a 3D model along with a standardized report to plan a case’s surgical intervention. Mode 1 superseded mode 2, which also shows surgeons preference to inspect a 3D model rather than inspecting cases the conventional way. Surgeons’ agreement in opinions across cases in mode 3 was 85%, whereas it was 18% and 5% in mode 1 and mode 2, respectively. This shows that information was conveyed more consistently across surgeons in mode 3. NASA TLX tests show that surgeons had the least cognitive load while working with mode 3, followed by mode 1 and then mode 2. Overall, the findings indicate that 3D models, even without radiologists’ written input, outperform the current standard practice of delivering unstructured radiology reports alongside raw PACS images.