Surgeons Prefer Cinematic Rendering of Ankle Injuries

A new study suggests that photorealistic, cinematically rendered ankle scans depict relevant findings better than conventional volume-rendered three-dimensional (3D) reconstructions.

Researchers at the University of Zurich (UZH; Switzerland) first acquired computerized tomography (CT) imaging data from 10 patients who underwent scanning for different types of ankle injuries. They then reconstructed the CT datasets, once as 3D images using a conventional volume-rendering technique, and then again via cinematic-rendering, using the Siemens Healthineers syngo.via Frontier prototype software. All 3D reconstructions had similar field-of-view, perspective, and opacity settings.


After randomizing both sets of images, the researchers presented them to 12 radiologists and 10 orthopedic surgeons for subjective evaluation. The physicians compared the volume-rendered and cinematically rendered images, and chose which one offered the best visualization for each type of injury. Overall, the radiologists and surgeons preferred the cinematically rendered images for the majority of the 10 ankle injuries. Conventional volume-rendered images were favored mainly in injuries not involving fractures, and in some cases, both imaging techniques were considered as equally good.

The physicians' preference for cinematically rendered images stemmed from various advantages of the technique over conventional volume rendering, including realistic shadowing, which provides a more natural depth and more clearly depicts the individual bony structures; depth-of-field effects, which help to minimize distractions; and enhanced perception of soft tissue, which could help in the representation of ligament or muscle ruptures in radiology reports. The study was published on August 14, 2018, in the American Journal of Roentgenology (AJR).

“Cinematic rendering is an advanced visualization method involving complex lighting models that simulate light and shadow to photorealistically display the anatomical structures of CT scans,” said senior author Florian Berger, MD. “Various groups have demonstrated the technique's potential to improve the clinical management of intricate cases such as acute aortic injury and highly vascularized kidney aneurysms. Cinematic-rendering technique may play an integral part in preoperative 3D examination of fractures and dislocations in clinical routine.”

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