3D imaging contribution in pediatric surgical oncology: a multi-stakeholder assessment study

Medical imaging is crucial for surgical planning, yet surgeons struggle with mental transformation of 2D images into 3D representations, particularly in complex pediatric pelvic anatomy. This study evaluated perceived benefits of 3D imaging with tractography compared to conventional 2D MRI in pediatric pelvic tumor surgery. A nationwide study assessed three groups: non-medical personnel (n = 30), medical trainees (residents and fellows; primary analysis n = 61, excluding 3 medical students), and senior pediatric surgeons (n = 12). Using 3-Tesla MRI with specialized protocols including high-resolution CoroT2cube and diffusion tensor imaging, participants evaluated five clinical cases in both 2D and 3D formats using 7-point Likert scales. Statistical analysis employed Wilcoxon paired tests with Bonferroni correction. All groups showed significant improvements in perceived understanding with 3D imaging. Non-medical personnel scores increased from 4.24 (± 0.69) to 6.27 (± 0.28) (p < 0.001), particularly in understanding disease and surgical objectives. Medical trainees improved from 5.08 (± 0.61) to 6.42 (± 0.49) (p < 0.001), with enhanced understanding of surgical objectives and anatomical relationships. Senior surgeons’ scores increased from 5.02 (± 0.69) to 6.33 (± 0.52) (p < 0.001), showing significant improvements in preoperative planning and family communication. Effect sizes were substantial across groups (Cohen’s d: 2.80, 1.90, and 1.52 respectively), though the within-subject design likely contributes to effect size inflation. This study provides preliminary evidence for perceived 3D imaging value in pediatric pelvic tumor surgery. Improved anatomical comprehension among non-medical personnel may benefit informed consent, while enhanced visualization aids surgical education and planning. High surgeon acceptance (92%) suggests strong acceptability, though these exploratory findings require validation before implementation recommendations can be made. Prospective studies evaluating objective clinical outcomes, workflow integration and cost-effectiveness require further study.