OBJECTIVE: Prior surgical studies have established functional neuroimaging as a validated method to examine brain activation patterns as well as distinctions between novice and expert surgeons during physical skills in surgery. The purpose of this study is to examine brain activation during cognitive surgical tasks. Our study utilizes simulated operative dictations to determine which brain regions are activated by this task and to distinguish different levels of expertise.
METHODS: Junior residents (PGY 1-3), senior residents (PGY 4-5), and attendings were recruited for this study. Demographic questions and case characteristics were obtained. Participants sat in a quiet room and baseline measurements were taken. Then, they were tasked to perform a simulated operative dictation of a routine, open inguinal hernia repair utilizing the Lichtenstein technique. Three trials were completed with a two-minute rest between repetitions. Functional near-infrared spectroscopy (fNIRS) was used to measure brain activation during salient events of the operative dictation. Optode montage (developed during preliminary testing) covered prefrontal, occipital, and sensorimotor regions. Measurement of the fluctuations in deoxyhemoglobin and oxyhemoglobin concentrations during the cognitive task was obtained for each participant. Homer3 and AtlasViewer toolboxes were used to process raw data and changes in deoxygenated hemoglobin were evaluated relative to baseline. A general linear model (p < 0.05 and q < 0.05) was used to evaluate group-level differences.
RESULTS: Ten participants were recruited for each group. Areas of increased and decreased brain activation were identified. Senior residents had significantly more activation in premotor areas, including supplementary motor area, parietal area, and right frontal area, compared to junior residents. Attendings demonstrated significantly less brain activation in medial frontal areas compared to the both junior and senior residents.
CONCLUSION: Functional neuroimaging can examine cognitive functions during simulated operative dictations (a cognitive surgical task) and discern differences for various levels of expertise. This study is the first to connect mental imagery to neuroimaging analysis of cognitive function.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/48278 |
| Date | 29 February 2024 |
| Creators | Jones, Cara Bougere |
| Contributors | Sanchez, Vivian |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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