Cinematic rendering in rheumatic diseases-Photorealistic depiction of pathologies improves disease understanding for patients

Milena L Pachowsky; Harriet Morf; David Simon; Verena Schönau; Larissa Valor-Mendez; Johannes Knitza; Filippo Fagni; Klaus Engel; Michael Uder; Axel Hueber; Christian Schmidkonz; Georg Schett; Arnd Kleyer

doi:10.3389/fmed.2022.946106

Cinematic rendering in rheumatic diseases-Photorealistic depiction of pathologies improves disease understanding for patients

Front Med (Lausanne). 2022 Aug 3:9:946106. doi: 10.3389/fmed.2022.946106. eCollection 2022.

Authors

Milena L Pachowsky^{1

2}, Harriet Morf^{1

2}, David Simon^{1

2}, Verena Schönau^{1

2}, Larissa Valor-Mendez^{1

2}, Johannes Knitza^{1

2}, Filippo Fagni^{1

2}, Klaus Engel³, Michael Uder⁴, Axel Hueber^{2

5}, Christian Schmidkonz^{6

7}, Georg Schett^{1

2}, Arnd Kleyer^{1

2}

Affiliations

¹ Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
² Deutsches Zentrum Immuntherapie, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
³ Siemens Healthineers, Erlangen, Germany.
⁴ Institute of Radiology, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
⁵ Division of Rheumatology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany.
⁶ Department of Nuclear Medicine, Friedrich-Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
⁷ Department of Industrial Engineering and Health, Technical University of Applied Sciences Amberg-Weiden, Weiden, Germany.

Abstract

Background: Patient education is crucial for successful chronic disease management. Current education material for rheumatic patients however rarely includes images of disease pathologies, limiting patients' disease understanding. Cinematic rendering (CR) is a new tool that allows segmentation of standard medical images (DICOMs) into pictures that illustrate disease pathologies in a photorealistic way. Thus CR has the potential to simplify and improve the explanation of disease pathologies, disease activity and disease consequences and could therefore be a valuable tool to effectively educate and inform patients about their rheumatic and musculoskeletal disease (RMD).

Objectives: To examine the feasibility of creating photorealistic images using CR from RMD patients depicting typical rheumatic disease pathologies and, in a second step to investigate the patient-perceived educational potential of these photorealistic images in clinical routine.

Methods: We selected conventional, high-resolution (HR) and positron emission tomography (PET) computed tomography (CT) images of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (axSpA), and giant cell arteritis (GCA) that showed typical respective disease pathologies. These images were segmented using CR technique. In a prospective study, physicians used CR-enhanced and conventional original images to explain the depicted pathognomonic pathologies to patients with the respective rheumatic disease. Patients were then asked to complete a questionnaire evaluating the perceived usefulness of being presented with CR-enhanced images to better understand their underlying disease.

Results: CR images were successfully generated from above mentioned CT methods. Pathologies such as bone erosions, bony spurs, bone loss, ankylosis, and PET-based inflammation could be visualized in photorealistic detail. A total of 79 patients (61% females) with rheumatic diseases (RA 29%, PsA 29%, axSpA 24%, GCA 18%) were interviewed and answered the quantitative questionnaire. Mean age was 55.4 ± 12.6 years. Irrespective of disease, all patients agreed or highly agreed that CR-based images help to improve disease understanding, should be shown at disease onset, provide a rationale to regularly take medication and would like to have access to their own CR-enhanced images.

Conclusion: Conventional disease images can successfully be turned into photorealistic disease depictions using CR. Patients perceived CR images as a valuable addition to current patient education, enabling personalized disease education and potentially increased medication adherence.

Keywords: axial spondyloarthritis (axSpA); cinematic rendering (CR); giant cell arteriitis (GCA); imaging; photorealistic; psoriatic arthritis (PsA); rheumatic and musculoskeletal diseases (RMDs); rheumatoid arthritis (RA).