2.

Process Measures

	Criteria	Points
1	Diagnosis of liver diseases by preoperative imaging (ultrasound, CT or MRI)	+1
2	Patients fast for at least 4 hours prior to the CT scan, orally take 0.5 L-1.0 L of clear liquid 20 to 30 mins before the exam and take another 500 ml before the exam.	+1
3	Train the patient to hold their breath in full inspiration before scanning and instruct them to do so during each scan phase to achieve maximum management of artifacts due to respiratory motion.	+1
4	Select 64-slice or above spiral CT scanning with a slice thickness of 0.625 to 1.0 mm.	+1
5	CT scanning ranges from the top of the diaphragm to the lower level of both kidneys, and perform dynamic abdominal scan after intravenous contrast medium administration; perform CT celiac arteriography. The arterial phase, portal venous phase and delayed phase scans start at a delay of 20-25 s, 50-55 s, and 2 minutes, respectively.	+1
6	3D reconstruction should be performed by attending physicians or a level above who are engaged in the diagnosis and treatment of liver diseases.	+1
7	Evaluate the integrity of the course, shape and continuity of hepatic artery reconstructed by 3D visualization to determine whether a manual revision is required (manual revision is unnecessary when the tertiary branches of artery can be reconstructed).	+1 (no manual revision); -1 (manual revision required)
8	Evaluate the integrity of the course, morphology and continuity of hepatic vein reconstructed by 3D visualization to determine whether a manual revision is required (Manual revision is unnecessary if the tertiary branches of hepatic vein can be reconstructed).	+1 (no manual revision); -1(manual revision required)
9	Evaluate the integrity of the course, morphology and continuity of portal vein reconstructed by 3D visualization to determine whether a manual revision is required. The branches of the portal vein system with the diameter ≥5 mm should be reconstructed (it is unnecessary if the tertiary branches of portal vein can be reconstructed)	+1 (no manual revision); -1(manual revision required)
10	Evaluate its course, morphology, continuity and integrity of the 3D reconstructed biliary tract (manual revision is unnecessary if the tertiary branches of the biliary tree can be reconstructed).	+1 (biliary system reconstructed); -1 (no biliary system reconstructed)
11	Evaluate the morphology, size and distribution of lesions in the 3D reconstructed model and whether they are consistent with CT images.	+3 (basically consistent, no manual revision required); +2 (mostly consistent, manual revision required); -1 (inconsistent, manual revision required)
12	The overall 3D model should be validated by at least 2 abdominal imaging attendings and at least 2 attending hepatologists in comparison with the original CT images, and finally confirmed by a senior physician.	+1
13	Perform simulation surgery based on the 3D model. The simulation of various schemes should be carried out, and the optimal surgical approach and surgical resection plane should be selected by two attending physicians, and finally confirmed by a senior physician.	+2
14	A multi-disciplinary team (MDT) should be formed based on the individualized 3D model and the results of clinical examinations; liver surgeons undertake the main tasks, assisted by the departments of hepatology, oncology, endoscopy, interventional therapy and radiotherapy.	+2
15	The consistency between preoperative 3D models and intraoperative conditions (lesions, vascular variance and range of hepatectomy) should be assessed.	+3 (completely consistent); +2 (basically consistent); -1(inconsistent)
16	The volume of the virtual resected liver should be compared with that of the actual resected liver (reference standard is intraoperative dewatering method). The volume error (< 5%) is completely consistent, the volume error (< 10%) is basically consistent, and the volume error (> 10%) is inconsistent.	+3 (completely consistent); +2 (basically consistent); -1 (inconsistent)
Total score (24, 100%)