Date: Tuesday, April 27th 2010
Location: Department of Surgical Oncology Conference Room, Princess Margaret Hospital
Time: 9am - 10:15am
Attendance:
Dr. Tulin Cil (Medical Content advisor)
Dr. Gordon Tait (Non-voting member)
Prof. Jodie Jenkinson (Supervisor)
Prof. Michael Corrin (Supervisor)
Albert Fung
Update on project progress
- During the course of storyboarding, it seemed that separating the project into two aspects (anatomy and surgery) was a better idea, as including an overview of the axillary anatomy in addition to the surgery would be quite an ambitious goal.
- A separate website will be set-up to provide a detailed orientation of the axillary anatomy. The website would feature a interactive, rotatable 3D model of the human axilla, and textual information about each component.
- The surgery will be made into a computer animation, guiding students through key steps of the procedure, as well as provide a number of 'surgical pearls' to help students understand details of the surgery.
Presentation of work so far
- A series of 3D models built during the term were shown. Comments for the models are listed below:
- Baby-Jackon/Wide ribbon retractors are used instead of Doyen retractors.
- Underarm area in surface model seems a bit unfinished; surface markers are not prominent.
- Skeleton seems very robust for a female; same with pectoral muscles.
- A few inaccuracies with muscle texture found in the pectoralis major muscle.
- Include the 'pointer vessel' that branches off the thoracodorsal bundle.
- Since last meeting, numerous visits to the OR to observe surgery were made. Based on the information gathered, a 2D animatic was presented to the committee for feedback. These comments are summarized below:
Factual information
- Level III lymph nodes should be included in the introduction.
- Only 1 skin incision is made; the latter incision is made from the medial wall of the inferior surgical flap, effectively 'peeling the skin' off the axillary fat pad.
- Retraction should be more superior, close to where the pectoralis major muscle meets the axillary vein.
- 'Superficial to serratus anterior', instead of 'above serratus anterior'.
- Axillary fat has a different appearance compared to subdermal fat (e.g. color and smoother texture).
- The surgical field is at no time 'closed'.
- The fat pad is pulled laterally before palpating the long thoracic nerve.
- The thoracodorsdal bundle and the long thoracic nerve lie on the same plane.
- The animation should show the apex, as certain nodes that need to be cleared are present in that area.
- The patient's arm is raised to allow access to the apex.
Suggestions for better communication
- Anatomy of the area could be put in the beginning; that way users can access the information easily, and there would be no need for transitions between surgery and anatomy.
- An alternate solution is to show the relevant anatomical structure with transparencies (i.e. when the surgical field can only show a portion of a vessel, use transparencies to show the entire course of the vessel in the patient).
- When showing anatomy, try not to interrupt the flow of the surgery.
- After the initial incision, the camera can zoom in to the surgical field; the surface anatomy is irrelevant after the incision.
- Keep the camera stationary, as this is how surgeons would see the field in real life.
Other comments
- Have in mind the size of the web content; it is not always 1024 x 768 as browser toolbars take up space in the monitor.
- The active voice in the animatic is effective, but it must be consistent throughout.
Future directions
- Based on feedback/comments gathered today, a refined animatic will be produced during the first week of May.
- An anatomist (Dr. Mike Wiley) will be consulted for the accuracies of the 3D models.
- A timeline will be set-up to allow committee members to follow progress of the project.
- More O.R. observations can be set up during the month of May.
- Following the timeline suggestion, I will update committee members through email and this blog weekly, with relevant material available to download.
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