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. 2026 Feb;39(1):20-33.
doi: 10.1007/s10278-025-01524-4. Epub 2025 May 13.

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

Sarra Kharbech  1 , Nabil Sherif Mahmood  2   3 , Ma'mon Qasem  2 , Julien Abinahed  2 , Amal Alobadli  2 , Mohamed Abunada  2 , Omar Aboumarzouk  2   4   5 , Abdulla Al Ansari  2   3 , Shidin Balakrishnan  2 , Nikhil Navkar  2 , Adham Darweesh  2   3   4
Affiliations

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

Sarra Kharbech et al. J Imaging Inform Med. 2026 Feb.

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 Mode 3 superseded both modes 1 and 2, meaning that surgeons prefer to see a 3D model along with a standardized report to plan a case's surgical intervention. Mode 1 superseded mode 2, which also shows surgeons preference to inspect a 3D model rather than inspecting cases the conventional way.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.

Keywords: Magnetic resonance imaging (MRI); Perianal fistula; Surgical planning; Three-dimensional (3D) visualization.

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Conflict of interest statement

Declarations. Ethical Approval: This article contains no studies with patients or living animals performed by the authors. Informed Consent: This article does not contain patient data. Conflict of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
a A typical representation of a 3D parametric model. b The difference between the reconstructed 3D models and the 3D parametric models for three cases
Fig. 2
Fig. 2
A screenshot from Fistula software showing the fistula tract creator module
Fig. 3
Fig. 3
A screenshot from Fistula software showing the pelvic model creator module
Fig. 4
Fig. 4
Three reporting modes used in the study. Mode (1) 3D, mode (2) MRI image + radiology report, and mode (3) 3D + standardized report
Fig. 5
Fig. 5
Experiments flow with outputs after each step
Fig. 6
Fig. 6
The input and output to surgeons for all fistula cases
Fig. 7
Fig. 7
Answers’ summary: the percentage of “Yes” and “No” answers by each surgeon for each question for all 10 cases, categorized per mode
Fig. 8
Fig. 8
A line graph where the x-axis is for the questions and the y-axis is the percentage of which surgeons are confirming the visualization of a fistula structure
Fig. 9
Fig. 9
A graph that shows the percentage of agreement between surgeons across cases. The x-axis is the questions, and the y-axis is the agreement percentage
Fig. 10
Fig. 10
NASA TLX-based cognitive load questionnaire results summary for each mode
See this image and copyright information in PMC

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