Increased Accuracy, Confidence, and Efficiency in Anterior Ethmoidal Artery Identification with Segmented Image Guidance

Objective To determine whether using image guidance technology with 3-dimensional image segmentation increases the endoscopic surgeon’s accuracy, efficiency, and confidence in identifying the anterior ethmoidal artery. Methods This is a cross-sectional study of attending physicians and residents at an academic medical center. Because identification of the anterior ethmoidal artery during image-guided surgery can be challenging, we studied the effect of anterior ethmoidal artery image segmentation (ie, partitioning and coloring) on surgeon test performance. A computerized test was administered to 16 surgeons who were asked to identify the anterior ethmoidal artery on multiplanar computed tomographic images and to answer multiple-choice questions. Half the questions showed segmented images of the anterior ethmoidal artery, and half showed images without segmentation. Efficiency and accuracy of identification and subjective surgeon confidence were determined for each question. Descriptive statistics were used to compare test performance for identification of the anterior ethmoidal artery on images with or without segmentation. Results Percentage of correct answers (P < .001), efficiency (P < .001), and confidence (P < .001) in identification of the anterior ethmoidal artery were significantly better with segmented computed tomographic images. Discussion We demonstrated that use of segmented images improves surgeons’ accuracy, confidence, and efficiency for identification of the anterior ethmoidal artery. Implications for Practice We describe how segmentation can allow surgeons to improve the surgical course by increasing their accuracy, confidence, and efficiency in identifying the anterior ethmoidal artery.