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Article

Exploring the Benefits of 3D Smart MRI in Resident Training and Surgical Planning for Transcervical Radiofrequency Ablation

by
Sepehr Janghorbani
1,†,
Victoria Weprinsky
2,†,
Alexandre Caprio
1,
Tamatha Fenster
2,* and
Bobak Mosadegh
1,*
1
Department of Radiology, Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, NY 10021, USA
2
Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY 10021, USA
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Surgeries 2025, 6(2), 46; https://doi.org/10.3390/surgeries6020046
Submission received: 18 April 2025 / Revised: 5 June 2025 / Accepted: 11 June 2025 / Published: 19 June 2025
Browse Figure
Versions Notes

Abstract

:
Background: Transcervical radiofrequency ablation (TRFA), particularly using the SONATA® System, is a minimally invasive and uterus-preserving treatment for uterine fibroids. While effective, its reliance on intrauterine ultrasound (IUS) with limited 2D visualization can present challenges, especially for trainees who must mentally reconstruct 3D anatomy in real-time from traditional radiology reports. Objective: This study explores the benefits of using 3D Smart MRI technology in improving procedural accuracy and user experience during simulated TRFA procedures performed by OB/GYN residents. Methods: In a randomized human subject study, 14 OB/GYN residents performed mock TRFA procedures on silicone uterine phantom models embedded with fibroids. The control group received standard written MRI reports, while the intervention group used the Smart MRI 3D visualization tool. We assessed quantitative outcomes including procedure time and fibroid miss rate. Additionally, participants completed post-procedure user experience questionnaires to assess the perceived utility and ease of use of the 3D tool. Results: While procedure time did not differ significantly between groups, there was a notable reduction in the miss rate for one of the fibroids (17% vs. 75%). Residents using Smart MRI reported higher confidence in identifying and treating all fibroids (83% vs. 43%) and rated their spatial understanding significantly higher on Likert-scale assessments (4.6 vs. 3.25). The technology also received high scores for its impact on clinical decision-making (4.8) and intraoperative efficiency (4.5). Conclusions: Overall, this study indicated that the use of 3D Smart MRI was well-received by residents, who reported enhanced intraoperative performance, including greater confidence, more informed decision-making, and improved procedural efficiency. Moreover, the notably lower miss rate observed in the Smart MRI group points to the tool’s potential in improving the detection and treatment of fibroids that may be missed otherwise.

1. Introduction

Transcervical radiofrequency ablation (TRFA) is an emerging, minimally invasive procedure for the treatment of uterine fibroids [1]. TRFA has recently been gaining prevalence and popularity due to its incision-free approach, faster recovery, minimal pain, and ability to preserve the uterus—making it an ideal option for many patients [2]. Unlike traditional surgical methods which require incision, TRFA is performed through the cervix using a specialized transcervical probe, most commonly the SONATA® System (Sonata® System, Gynesonics, Redwood City, CA, USA). This device is inserted through the vagina and cervix into the uterus, where it deploys a small needle-like array directly into the fibroid to deliver radiofrequency energy, heating and destroying the fibroid tissue. While the Sonata System is widely praised for its precision, safety, and minimally invasive technique, it can also present certain challenges. The procedure relies exclusively on intrauterine ultrasound (IUS) for guidance. Ultrasound is the first-line imaging modality for diagnosing uterine fibroids due to its wide availability, non-invasiveness, and cost-effectiveness [3]. However, ultrasound has a limited 2D field of view compared to other imaging modalities such as laparoscopic or magnetic resonance imaging (MRI)-based imaging. Moreover, in more complex cases—such as distinguishing uterine leiomyosarcoma, assessing atypical features like degeneration, or differentiating from other masses like adenomyosis and endometrial stromal sarcomas—ultrasound may not provide sufficient detail, and MRI is often required [4,5,6,7]. As a result, physicians performing Sonata procedures must identify and target fibroids solely using real-time ultrasound images, without the assistance of external anatomical landmarks. This limitation can make it difficult to detect fibroids that are small, close to each other, or obscured by surrounding tissue [8,9,10]. As a result, accurate targeting with the SONATA® System can require a high level of skill and experience, leading to the risk of incomplete treatment if fibroids are missed or misidentified [11]. This difficulty in imaging may contribute to a steeper learning curve for TRFA, particularly for trainees or less experienced practitioners. Residents must learn to mentally reconstruct the 3D anatomy of the uterus from 2D ultrasound images, maintain this mental map throughout the procedure, and use it to accurately locate and treat fibroids, including those that may be obscured or positioned in difficult-to-reach areas [12,13]. However, developing this spatial reasoning and procedural precision takes time and guided experience. For this reason, simulation-based training programs have proven essential in helping residents achieve proficiency with such procedures [14].
As an enhancement to traditional imaging methods, 3D visualization technologies have shown increasing value in medical education and practice, particularly within gynecologic procedures such as fibroid treatment [15,16,17]. Previous studies have demonstrated that 3D modeling can help reduce procedure time, improve accuracy, and/or minimize the need for repeat interventions [16,18,19,20,21,22]. Motivated by these findings, we sought to incorporate our 3D visualization technology, Smart MRI, into the TRFA procedure pipeline. By providing a detailed, patient-specific 3D map of the uterine anatomy and fibroid pathology, this technology has the potential to enhance both the planning and execution of Sonata procedures. Preoperatively, it helps physicians determine the best order of fibroid treatment and the most effective approach to access each target. Intraoperatively, the 3D model provides a clear spatial representation of the uterus and fibroids, helping surgeons understand the orientation, depth, and relationships between anatomical structures, and serving as a real-time reference for the ultrasound image. This added layer of spatial context may reduce the risk of missing obscured or overlapping fibroids, enhance targeting precision, and potentially reduce the miss rate of total fibroids treated and, as a result, repeat surgeries [22]. Furthermore, 3D visualization serves as a valuable educational tool for residents [23], helping them build spatial awareness and confidence with the Sonata System more efficiently by reducing the complexity of the task.
In this study, we explore the benefits of using the 3D Smart MRI technology over standard radiology reports through a randomized human subject study in which OB/GYN residents performed Sonata procedures on a silicone phantom model containing mock uterine leiomyomas. We evaluated both quantitative metrics, including operation time and fibroid miss rate, and qualitative outcomes such as residents’ experiences, confidence, and perceived ease of use through a post-procedure survey.

2. Materials and Methods

This study was conducted at the Weill Cornell Simulation Lab and involved 14 OB/GYN residents from New York-Presbyterian/Weill Cornell Medical College. Out of the 28 residents in the program (Years 1–4), those unavailable due to night shifts, rotations, or maternity leave were excluded, resulting in a final sample of 14 residents (2 males, 12 females). The study took place between March and April 2025.
The objective was to evaluate the benefits of a novel 3D Smart MRI visualization tool in assisting with transcervical radiofrequency ablation (TRFA) procedures. We used the same 3D Smart MRI tool developed by the authors, as described in [22], which provides interactive 3D visualizations of patient anatomy based on their MRIs. Three-dimensional Smart MRI displays anatomies including the uterus and endometrial canal, and pathologies such as fibroids, allowing surgeons to interact with, toggle, and rotate the anatomy to find the best viewing angle. Moreover, it can hide or show specific anatomical structures, which is particularly useful when certain structures obstruct the view of others. The tool also enables real-time tracking of fibroid treatment to assist with adherence to the presurgical plan. Although the tool supports XR integration, this feature was not utilized in this study.
All participants provided informed consent prior to participation. Residents were randomly assigned into two groups: a control group (n = 8) and an intervention group (n = 6). The control group received a standard written MRI radiology report, which included textual descriptions of the location and size of the three largest fibroids, reflecting typical clinical practice. The intervention group was given access to a 3D Smart MRI visualization tool (Figure 1A), displayed on a tablet, providing a fully interactive 3D model of the uterus and all fibroids. Both groups performed a mock TRFA procedure using the Sonata System 2.2 (Gynesonics, Redwood City, USA, 2021) on a custom-designed silicone uterine model containing five fibroids (Figure 1B). The phantom used in this study was a custom-made, anthropomorphic uterine model composed of tissue-mimicking materials, including silicone, provided by the same company. The fibroid inclusions within the phantom were constructed from slightly different materials to replicate the distinct imaging properties of uterine fibroids, ensuring realistic simulation of clinical scenarios. Gynesonics also supplied the Sonata System for the purposes of this study. All the fibroids in the phantom were intramural: three were located in the fundus and two in the mid-body posterior region. The cavity was not distorted by fibroids. The tablet remained accessible for the intervention group throughout the procedure to serve as a reference tool for fibroid targeting and navigation. Each procedure was monitored by a trained proctor, who ensured consistency in technique and data collection. The following quantitative performance metrics were recorded for each participant: total procedure time, time taken to locate each fibroid, and accuracy of fibroid identification and treatment. Residents were instructed to continue the procedure until they believed they had identified and treated all fibroids. After completing the procedure, participants filled out a post-procedure survey, which captured subjective measures such as ease of use, spatial understanding, and confidence in performing TRFA using the tools provided. This questionnaire was developed based on multiple validated system usability and confidence surveys, designed to measure system usability and resident confidence [24,25,26,27]. We used a 5-point Likert scale and customized the questions to better fit the specific application of ultrasound-guided ablation using the Sonata System.
This methodology was designed to simulate real-world conditions while allowing for controlled comparison of the two approaches. To perform statistical analysis, we used Fisher’s exact test for binary survey questions, the Wilcoxon rank-sum test for ordinal variables, and the t-test for continuous variables. Continuous variables included total and individual fibroid treatment procedure times, as well as the fibroid miss rate. The ordinal variable is the Likert scale used for the survey questions, ranging from 0 (strongly disagree) to 5 (totally agree). A significance threshold of p < 0.1 was selected due to the study’s exploratory nature, limited sample size, and statistical power—an approach consistent with other pilot studies of a similar scale and nature [28].

3. Results

We measured the procedure time as well as the miss rate for both the whole procedure and each fibroid. Table 1 includes the percentage of treated fibroids in each group. Statistically significant values (p < 0.1) are highlighted. Overall, the intervention group using the 3D Smart MRI visualization tool demonstrated a higher percentage of correctly treated fibroids (90% ± 11%) compared to the control group (75% ± 26%). Although this difference did not reach statistical significance, it suggests a trend toward improved accuracy with the 3D Smart MRI. Interestingly, when analyzing the success rate for individual fibroids, there was a notable improvement in treatment rates for one of the fibroids (i.e., Fibroid 2, shown as dark blue in Figure 1A) in the intervention group (83%) vs. the control group (25%). This indicates that 3D visualization may be particularly helpful in reducing the miss rate of fibroids that are more difficult to detect with standard imaging. For the remaining fibroids (1, 3, 4, and 5), treatment rates were similar between the two groups. Both groups achieved 100% accuracy in treating Fibroids 1 (light blue) and 4 (pink), suggesting these were likely easier to identify regardless of the visualization method. A minor, non-significant improvement was observed in the intervention group for Fibroid 3 (brown). Given the relatively smaller sample size in our study, we report not only p-values but also effect size measures. Hedges’ g was used for continuous variables, and Cohen’s h was calculated for binary variables along with their confidence intervals to provide a more comprehensive understanding of the observed effects. As expected, for Fibroid 2 we observed a rather large effect size.
Table 2 presents the time required to identify and treat each fibroid, as well as the overall procedure time. There was no statistically significant difference in total procedure time between the two groups. The intervention group using 3D Smart MRI completed the procedure in an average of 3.46 ± 2.09 min, compared to 2.69 ± 0.97 min for the control group. While the intervention group performed slightly slower on average, this difference was not statistically significant. Analysis of the individual fibroid localization times showed varying trends. Fibroids 3 and 5 were identified slightly more quickly by the intervention group, whereas Fibroids 1 and 4 were located somewhat more quickly by the control group. However, these differences were not statistically significant, suggesting that the 3D visualization tool did not consistently affect localization time across all fibroids. Since only two residents in the control group treated Fibroid 2, it is not included.
In addition to the quantitative metrics above, we also conducted a post-procedure survey to assess residents’ experiences and perceptions of the procedure. Table 3 presents the findings of this survey. Our survey responses indicated that the intervention group, using the 3D Smart MRI tool, generally reported higher levels of confidence and comfort across several domains compared to the control group. Both groups were similar in prior clinical experience, including number of TVUSs performed, prior Sonata procedures, and exposure to different attending physicians (Q. 1–5). There were no significant differences in baseline comfort with radiofrequency ablation (RFA) or TVUS (Q. 6–8).
Importantly, the intervention group reported a significantly higher level of confidence in their spatial understanding of fibroid locations in the uterus (Q. 10: 4.67 vs. 4.0, p = 0.08) as well as relative to each other (Q. 11: 4.6 vs. 3.25, p = 0.02), suggesting that the 3D Smart MRI tool helped improve participants’ mental mapping of the fibroid locations within the uterus. This is further confirmed by the large effect sizes observed, although we can see that the confidence intervals are rather large due to relatively small sample sizes. Furthermore, we see that the intervention group had a notably higher, although not statistically significant, rate of confidence in their self-reported ability to locate and treat all the fibroids (83% vs. 43%, p = 0.16). Furthermore, we evaluated the residents’ experience regarding the tool’s utility through a set of tool-specific survey questions. The responses were overwhelmingly positive. On a Likert scale of 1 to 5, the tool received high average scores, including 4.83 for helpfulness in surgical planning and decision-making, 4.50 for improving intraoperative efficiency, and 4.67 for aiding in complex decision-making. Additionally, most residents agreed that the tool enhanced their accuracy during treatment and boosted their confidence in treating all fibroids. These findings underscore the perceived educational and procedural benefits of incorporating 3D visualization into resident training for fibroid ablation.

4. Discussion

This study evaluated the impact of a novel 3D visualization tool on gynecology residents’ ability to locate and treat uterine fibroids during a simulated transcervical radiofrequency ablation (TRFA) procedure. The control group used standard radiology reports, as this is standard practice in many OB/GYN offices and clinics, rather than relying on raw imaging data such as MRI. This aims to emphasize the reality that OB/GYNs typically do not receive specialized training to interpret complex imaging data themselves and instead depend on radiology reports generated by radiologists. For instance, a study found that only 29% of OB/GYNs have received formal training in imaging studies, while 74% felt their training was insufficient [29]. Radiology reports are more accessible, easier to interpret, and offer time-efficient, standardized, and communicable clinically relevant interpretations of imaging data, providing actionable findings. In this case, such findings include the location, size, and other features of fibroids, as well as any other coexisting conditions such as adenomyosis. To simulate more real-world scenarios, we designed our study using radiology reports as the standard comparator. However, it would be highly beneficial and informative to further include 2D MRI imaging in future studies to better measure the incremental impact of advanced imaging on clinical outcomes. While the overall difference in total fibroid treatment rates between the test group and the control group showed only slight improvements, one of the fibroids showed a notable increase in treatment success (83% vs. 25%) when residents used the 3D tool. This suggests that interactive 3D enhanced spatial visualization may be particularly beneficial for identifying more difficult-to-detect fibroids. For instance, in this study, one potential reason for the high miss rate for Fibroid 2 could be that closely positioned fibroids are more challenging to distinguish clearly with standard imaging methods like ultrasound. Our visualization tool can significantly help in these cases, particularly when multiple small fibroids are present. Small fibroids are often difficult to detect clearly with ultrasound and may remain unnoticed during initial procedures; however, if left untreated, they can grow and cause recurrent symptoms. Studies have indicated that myomectomies can have up to a 36% repeat rate, commonly due to initially undetected or incompletely resected fibroids [30,31]. By employing advanced visualization technology, we can reduce the miss rate for these smaller fibroids, potentially preventing them from growing further and thereby decreasing the likelihood of repeat procedures, as demonstrated in prior research [22].
Furthermore, while using Smart MRI 3D visualization demonstrated a better treatment rate, the total procedure time did not reduce. One explanation for this finding is that the procedure time is defined as the duration until the participants believe they have treated all fibroids, regardless of actual completeness. For instance, Fibroid 2 was left untreated by the majority of the residents, resulting in a shorter procedure time that did not reflect a complete surgery. Another contributing factor is the inherent learning curve associated with our tool. We noted that it was common for residents to spend additional time familiarizing themselves with the tool and its navigation features during initial use, especially for initial fibroids treated. This also explains why some fibroids have longer treatment times in the test group. To address these limitations in future studies, we plan to include structured demonstration sessions to familiarize participants with the tool prior to data collection. This approach will help control for variability introduced by the learning curve and ensure more accurate measurement of the tool’s impact on clinical outcomes. While this technology did not universally reduce the overall procedure time for fibroid removal, we noticed variability in its effectiveness depending on fibroid characteristics and location. For instance, improvements in procedural speed were observed specifically for deeper intracavitary fibroids, such as Fibroids 3 and 5 in our analysis. This suggests that the technology could potentially be beneficial for cases involving more difficult-to-reach fibroids positioned deeper within the uterine cavity. However, further research is necessary to comprehensively evaluate its effectiveness across different fibroid types, sizes, and anatomical positions. These findings align with a previous study [22] using the same 3D visualization tool for myomectomies. A lower miss rate can directly impact patient outcomes, healthcare resource utilization and costs, and overall treatment efficacy. More comprehensive removal of fibroids directly improves the completeness of treatment, leading to better symptom control (e.g., reduced bleeding and pain) and enhancing patient satisfaction and postoperative quality of life [32]. Moreover, complete removal of fibroids is particularly beneficial for women seeking to conceive, as residual fibroids can impair fertility. Thorough excision increases the chances of successful conception and reduces miscarriage rates [33,34]. For instance, research has shown that untreated uterine fibroids can quadruple the likelihood of miscarriage [35]. Additionally, thorough removal minimizes the risk of residual fibroids, a common cause of recurrence, and reduces the need for reoperation, which can be as high as 36% [30]. This not only alleviates the burden on healthcare systems—leading to cost savings and more efficient use of medical resources—but also reduces patient exposure to the risks associated with multiple surgical interventions. This is especially significant given that the total economic burden of fibroids in the United States is estimated at $41.4 billion [36].
Furthermore, we observed improvements in confidence and comfort reported in post-procedure surveys. Residents who used the 3D visualization tool expressed greater confidence in their spatial understanding of fibroids and a higher self-reported ability to locate and treat all fibroids (83% vs. 43%). These results are important in the context of surgical training, as a clearer mental map of the uterus and fibroid locations can significantly enhance intraoperative decision-making and reduce uncertainty during procedures. By providing a more comprehensive internal representation of fibroid distribution and uterine anatomy, the 3D visualization tool may help trainees avoid missing smaller or deeply embedded fibroids—an issue that often contributes to the need for repeat interventions. This technology also addresses the issue with radiology reports often only listing the largest fibroids (i.e., 2–3), regardless of the total number. The results are further supported by the post-procedure survey results. The intervention group’s feedback on tool-specific survey items was overwhelmingly positive, with surgeons rating the tool 4.8 out of 5 for its “helpfulness in surgical planning” and 4.67 out of 5 for usefulness in complex decision-making and improving accuracy. These findings support the educational value of incorporating 3D visualization technologies into gynecology resident training, particularly for procedures where ultrasound interpretation and anatomical spatial reasoning are critical. Our study is among the growing body of work exploring the impact of 3D visualization in gynecology. Several studies have explored the application of 3D visualization in various gynecologic procedures, including fibroid treatment strategies [15,37], adenomyosis [38], cervical cancer [20], and a range of laparoscopic interventions [19,22,39]. While the feasibility of 3D visualization in gynecology is well established, evidence regarding its precise impact on clinical outcomes remains mixed. Some studies have reported improvements in operating time and reductions in blood loss [20,21], whereas others have not observed statistically significant differences in these metrics [22,40]. For instance, a study involving 67 patients undergoing laparoscopic surgery for cervical cancer found that 3D visualization not only reduced operative time and blood loss but also improved depth perception and reduced surgeon strain [20]. On the other hand, another study highlighted that, despite its surgical advantages, the use of 3D visualization may lead to higher rates of visually induced motion sickness [21]. Additional studies have reported minimal or no change in operative efficiency. A pilot study with 16 patients undergoing myomectomy [22] found no significant difference in operation time or blood loss but did observe a reduction in repeat procedures, possibly due to a lower fibroid miss rate—an outcome further supported by findings in [16]. Similarly, a study involving 97 patients undergoing laparoscopic hysterectomy reported no improvement in operative time but did find reductions in postoperative pain and complication rates [40]. Beyond its clinical applications, 3D and virtual reality technologies have demonstrated clear educational value in surgical training. One study showed that incorporating 3D VR into gynecologic laparoscopy training improved resident performance, reduced procedure time, and boosted confidence in instrument handling and spatial navigation [41]. Another study, involving 10 residents performing myomectomy with the aid of 3D augmented reality, found that although total operative time did not significantly change, both perceived procedural difficulty and localization error were significantly lower [42]. These findings suggest that 3D visualization can enhance surgical accuracy and trainee confidence even when it does not directly reduce procedure duration. Similar improvements in training outcomes have also been documented in other specialties, including appendectomy [43] and brachytherapy [44], and our study aligns with these findings. Finally, 3D visualization has also shown benefits in pre-surgical planning, reducing planning time, improving surgical mapping accuracy, and lowering the rate of missed fibroids during surgery [16,45].
Our study is the first to explore the role of 3D visualization technology in TRFA Sonata procedures. We evaluated both qualitative outcomes—such as resident-reported confidence—and quantitative metrics, including procedure time and per-fibroid miss rate. A novel aspect of this study is that it introduces the application of Smart MRI 3D visualization for Sonata procedures to improve fibroid localization—a common challenge for OB/GYN residents. Our hope is to provide a comprehensive evaluation of the technology’s effectiveness in simulated TRFA by utilizing silicone phantoms with realistic tissue and assessing both objective and subjective metrics.
However, several limitations should be acknowledged. The study’s sample size was relatively small—due in part to resident availability from a single center—which may limit the generalizability of the findings. Although p-values of 0.05 are more commonly chosen for full-scale clinical trials, achieving sufficient power in this study would have required approximately 30 residents, which was not feasible due to limited availability. It is recognized that for smaller, exploratory studies like this one, using alternative p-value thresholds (e.g., 0.1) can be acceptable when data are scarce, as demonstrated in [28]. Furthermore, several studies of similar scale have used comparable values [46,47,48]. We acknowledge that the small sample size may limit the statistical power of this study. As a result, future studies with larger and multicenter cohorts are needed to validate these results. The study also focused exclusively on intraoperative simulation, without assessing the potential value of Smart MRI in pre-surgical planning—a critical phase where enhanced spatial mapping could further impact clinical outcomes. In addition, the control group reviewed only written 2D MRI reports. While including conventional 2D MRI images could have offered additional insights, the phantom model lacked other surrounding organs and soft tissue structures, and might not have realistically reflected the complexity or interpretive challenges of clinical MRI in real-life scenarios. Furthermore, the simulated setting cannot fully replicate the complexity and variability of real-life surgical environments. Lastly, while the fibroid miss rate was evaluated, other relevant performance metrics such as spatial targeting accuracy and long-term retention of surgical skills were not measured.
Although Smart MRI supports XR integration, in this study, the 3D visualization was displayed on a tablet alongside ultrasound guidance. Users could interact with the anatomy by rotating, zooming, and toggling the visibility of relevant structures to find the optimal viewing angle or to guide fibroid treatment. Real-time tracking was possible after the treatment of each individual fibroid. In future iterations, a fully immersive 3D experience—such as using 3D holograms—could be explored, along with real-time updates of the ultrasound probe position by co-registering ultrasound landmarks with anatomical landmarks from MRI data. This will further enable surgeons to interact with a fully immersive 3D visualization intraoperatively. In addition, future studies can further explore the benefits of this 3D technology—compared to standard 2D MRI viewers—to assess its incremental impact on clinical outcomes.

5. Conclusions

This study explores the potential benefits of integrating a novel 3D visualization tool into gynecology resident training for TRFA of uterine fibroids. Residents who used the tool reported greater confidence and improved understanding of uterine and fibroid spatial anatomy—highlighting its potential educational value in surgical training. While overall procedure time and treatment rates did not show statistically significant differences between groups, the tool demonstrated a notable impact in specific scenarios, particularly in improving treatment success for fibroids that were more difficult to detect. These findings suggest that 3D visualization could be potentially useful for these procedures; however, more comprehensive trials are needed to further investigate its effectiveness and generalizability.

Author Contributions

Conceptualization, V.W. and T.F.; methodology, V.W., S.J. and A.C.; software, S.J., A.C. and B.M.; validation, V.W.; formal analysis, S.J.; investigation, V.W.; resources, T.F. and B.M.; data curation, V.W. and S.J.; writing—original draft preparation, S.J. and A.C.; writing—review and editing, B.M.; visualization, S.J.; supervision, T.F. and B.M. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was reviewed by the Weill Cornell Medicine Institutional Review Board (IRB), protocol number 24-01026914, 7 June 2024.

Informed Consent Statement

Informed consent was obtained from all participants involved in the study.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors on request.

Acknowledgments

All authors would like to thank Gynesonics for providing the phantom model and Sonata System for this study.

Conflicts of Interest

Corresponding authors Fenster and Mosadegh have a financial interest in SmartHER Inc., a pre-seed startup company aiming to commercialize this tool, which was disclosed and managed by WCM’s conflicts office. SmartHER Inc. had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Gynesonics had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Disclaimer: The views expressed in this publication are those of the author(s) and do not necessarily reflect the views of Weill Cornell Medicine. Competing Interests: This article was conducted and written in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Surgeries 06 00046 g001
Figure 1. (A) Screenshot of the interactive 3D Smart MRI rendering, displaying 5 fibroids. (B) Silicone phantom model with mock fibroids represented as blue spheres.
Figure 1. (A) Screenshot of the interactive 3D Smart MRI rendering, displaying 5 fibroids. (B) Silicone phantom model with mock fibroids represented as blue spheres.
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Table 1. Percentage of treated fibroids in control vs. test groups.
Table 1. Percentage of treated fibroids in control vs. test groups.
Fibroid TreatmentControl
(n = 8)		Test
(n = 6)		p-ValueEffect Size95% CI
All Fibroids75% ± 26%90% ± 11%0.190.67 [−0.36, 1.69]
  • Fibroid 1
100%100%———
  • Fibroid 2
25%83%0.101.25[0.25, 3.14]
  • Fibroid 3
75%83%0.990.20[−1.13, 1.57]
  • Fibroid 4
100%100%———
  • Fibroid 5
88%83%0.99−0.12[−1.47, 1.21]
Table 2. Comparison of fibroid localization/treatment times between the control and test groups.
Table 2. Comparison of fibroid localization/treatment times between the control and test groups.
Procedure TimeUnitControl
(n = 8)		Test
(n = 6)		p-ValueEffect
Size		95% CI
Total TimeMin2.69 ± 0.973.46 ± 2.090.330.47[−0.54, 1.47]
  • Fibroid 1
Sec17.7 ± 10.139.5 ± 36.50.130.82[−0.21, 1.86]
  • Fibroid 2
Sec—————
  • Fibroid 3
Sec40.5 ± 31.322.0 ± 6.90.23−0.71[−1.84, 0.41]
  • Fibroid 4
Sec28.0 ± 23.853.5 ± 70.50.350.49[0.52, 1.49]
  • Fibroid 5
Sec48.1 ± 45.227.8 ± 14.90.36−0.52[−1.60, 0.56]
Table 3. Results of post-procedure survey.
Table 3. Results of post-procedure survey.
QuestionControl
(n = 8)		Test
(n = 6)		p-ValueEffect
Size		95% CI
Prior Clinical Experience
Q1. Have you completed US/Family Planning elective?63%67%1.00.09[−1.2, 1.6]
Q2. How many TVUS have you performed?11.2 ± 7.213.5 ± 6.50.710.31[−0.7, 1.4]
Q3. How many US ablations performed as primary surgeon?2.8 ± 1.32.3 ± 1.30.65−0.36[−1.4, 0.6]
Q4. How many US-guided ablations have you assisted?2.4 ± 1.32.9 ± 2.50.990.25[−0.8, 1.2]
Q5. With how many attendings have you done ablations?1.4 ± 0.71.7 ± 0.50.560.45[−0.6, 1.5]
User Comfort
Q6. How comfortable are you with US-guided ablations?2.0 ± 1.22.5 ± 1.20.440.39[−0.6, 1.4]
Q7. How comfortable with identifying fibroids on TVUS?2.7 ± 1.33.2 ± 1.00.600.40[−0.6, 1.4]
Q8. Comfortable doing TVUS ablation w/o company rep?62%67%1.00.09[−1.2, 1.6]
Benefits of 3D Smart MRI vs. Reports
Q9. Did you locate and treat all the treatable fibroids?43%83%0.270.87[−0.3, 2.4]
Q10. I had a good understanding of fibroids’ location in the uterus.4.0 ± 0.54.7 ± 0.50.081.31[0.2, 2.4]
Q11. I am confident in my spatial understanding between the fibroids.3.3 ± 0.94.6 ± 0.60.021.50[0.3, 2.7]
Q12. I am confident in my spatial understanding of fibroids & uterus.3.8 ± 0.94.3 ± 0.80.270.54[−0.5, 1.6]
Clinical Utility of 3D Smart MRI
Q13. Smart MRI was helpful for surgery decision making.—4.8 ± 0.4———
Q14. Smart MRI made me more accurate in treating fibroids.—4.7 ± 0.8———
Q15. Smart MRI was helpful for intra-operative efficiency.—4.5 ± 0.8———
Q16. Smart MRI made me more confident treating all fibroids.—4.3 ± 1.2———
Q17. Smart MRI was helpful for complex decision-making.—4.7 ± 0.5———
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MDPI and ACS Style

Janghorbani, S.; Weprinsky, V.; Caprio, A.; Fenster, T.; Mosadegh, B. Exploring the Benefits of 3D Smart MRI in Resident Training and Surgical Planning for Transcervical Radiofrequency Ablation. Surgeries 2025, 6, 46. https://doi.org/10.3390/surgeries6020046

AMA Style

Janghorbani S, Weprinsky V, Caprio A, Fenster T, Mosadegh B. Exploring the Benefits of 3D Smart MRI in Resident Training and Surgical Planning for Transcervical Radiofrequency Ablation. Surgeries. 2025; 6(2):46. https://doi.org/10.3390/surgeries6020046

Chicago/Turabian Style

Janghorbani, Sepehr, Victoria Weprinsky, Alexandre Caprio, Tamatha Fenster, and Bobak Mosadegh. 2025. "Exploring the Benefits of 3D Smart MRI in Resident Training and Surgical Planning for Transcervical Radiofrequency Ablation" Surgeries 6, no. 2: 46. https://doi.org/10.3390/surgeries6020046

APA Style

Janghorbani, S., Weprinsky, V., Caprio, A., Fenster, T., & Mosadegh, B. (2025). Exploring the Benefits of 3D Smart MRI in Resident Training and Surgical Planning for Transcervical Radiofrequency Ablation. Surgeries, 6(2), 46. https://doi.org/10.3390/surgeries6020046

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