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Zhang X, Xu Z, Tan L, Li Y, Liu L, Chen N, Zhang S, Lamers WH, Wu C, Wu Y. Application of three-dimensional reconstruction and printing as an elective course for undergraduate medical students: an exploratory trial. Surg Radiol Anat 2019; 41:1193-1204. [PMID: 31030233 DOI: 10.1007/s00276-019-02248-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Medical three-dimensional (3D) digital reconstruction and printing have become common tools in medicine, but few undergraduate medical students understand its whole process and teaching and clinical application. Therefore, we designed an elective course of 3D reconstruction and printing for students and studied its significance and practicability. METHODS Thirty undergraduate medical students in their second-year of study volunteered to participate in the course. The course started with three lessons on the theory of 3D digital reconstruction and printing in medicine. The students were then randomly divided into ten groups. Each group randomly selected its own original data set, which could contain a series of 2D images including sectional anatomical images, histological images, CT and MRI. Amira software was used to segment the structures of interest, to 3D reconstruct them and to smooth and simplify the models. These models were 3D printed and post-processed. Finally, the 3D digital and printed models were scored, and the students produced brief reports of their work and knowledge acquisition and filled out an anonymous questionnaire about their study perceptions. RESULTS All the students finished this course. The average score of the 30 students was 83.1 ± 2.7. This course stimulated the students' learning interest and satisfied them. It was helpful for undergraduate students to understand anatomical structures and their spatial relationship more deeply. Students understood the whole process of 3D reconstruction and printing and its teaching and clinical applications through this course. CONCLUSION It is significant and necessary to develop this course for undergraduate medical students.
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Affiliation(s)
- Xiaoqin Zhang
- Institute of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Zhou Xu
- Institute of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Liwen Tan
- Institute of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Ying Li
- Institute of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Li Liu
- Institute of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Na Chen
- Institute of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Shaoxiang Zhang
- Institute of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Wouter H Lamers
- Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Chunling Wu
- Institute of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Yi Wu
- Institute of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
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Personalized Three-Dimensional Printed Models in Congenital Heart Disease. J Clin Med 2019; 8:jcm8040522. [PMID: 30995803 PMCID: PMC6517984 DOI: 10.3390/jcm8040522] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 12/24/2022] Open
Abstract
Patient-specific three-dimensional (3D) printed models have been increasingly used in cardiology and cardiac surgery, in particular, showing great value in the domain of congenital heart disease (CHD). CHD is characterized by complex cardiac anomalies with disease variations between individuals; thus, it is difficult to obtain comprehensive spatial conceptualization of the cardiac structures based on the current imaging visualizations. 3D printed models derived from patient's cardiac imaging data overcome this limitation by creating personalized 3D heart models, which not only improve spatial visualization, but also assist preoperative planning and simulation of cardiac procedures, serve as a useful tool in medical education and training, and improve doctor-patient communication. This review article provides an overall view of the clinical applications and usefulness of 3D printed models in CHD. Current limitations and future research directions of 3D printed heart models are highlighted.
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Bramlet M, Olivieri L, Farooqi K, Ripley B, Coakley M. Impact of Three-Dimensional Printing on the Study and Treatment of Congenital Heart Disease. Circ Res 2019; 120:904-907. [PMID: 28302738 DOI: 10.1161/circresaha.116.310546] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew Bramlet
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.).
| | - Laura Olivieri
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.)
| | - Kanwal Farooqi
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.)
| | - Beth Ripley
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.)
| | - Meghan Coakley
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.)
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Garner KH, Singla DK. 3D modeling: a future of cardiovascular medicine. Can J Physiol Pharmacol 2019; 97:277-286. [DOI: 10.1139/cjpp-2018-0472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cardiovascular disease resulting from atypical cardiac structures continues to be a leading health concern despite advancements in diagnostic imaging and surgical techniques. However, the ability to visualize spatial relationships using current technologies remains a challenge. Therefore, 3D modeling has gained significant interest to understand complex and atypical cardiovascular disorders. Moreover, 3D modeling can be personalized and patient-specific. 3D models have been demonstrated to aid surgical planning and simulation, enhance communication among surgeons and patients, optimize medical device design, and can be used as a potential teaching tool in medical schools. In this review, we discuss the key components needed to generate cardiac 3D models. We highlight prevalent structural conditions that have utilized 3D modeling in pre-operative planning. Furthermore, we discuss the current limitations of routine use of 3D models in the clinic as well as future directions for utilization of this technology in the cardiovascular field.
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Affiliation(s)
- Kaley H. Garner
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
| | - Dinender K. Singla
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
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Jonas RA. The Arterial Switch Operation in 2019: How to Do It and How to Teach It. World J Pediatr Congenit Heart Surg 2019; 10:90-97. [PMID: 30799718 DOI: 10.1177/2150135118811115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article presents technical aspects of the arterial switch procedure. The arterial switch procedure is a technically reproducible operation that involves less three-dimensional judgment and fewer difficult sequencing decisions than many other complex cardiac procedures. Hemostasis is the most important principal that must be adhered to mainly through meticulous surgical technique. Meticulous technique will also lead to successful transfer of the coronary arteries. Teaching a surgical trainee how to manage a child who requires an arterial switch procedure requires instruction in the technical aspects of the procedure. However, this is just one component of the overall management of babies requiring this procedure. Attention and training should be directed at all areas of competence that have been emphasized by bodies such as the American College of Surgeons. Simulation is playing an increasingly important role in the instruction of surgical trainees within the domain of congenital heart disease.
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Affiliation(s)
- Richard A Jonas
- 1 Department of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
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Qasim M, Haq F, Kang MH, Kim JH. 3D printing approaches for cardiac tissue engineering and role of immune modulation in tissue regeneration. Int J Nanomedicine 2019; 14:1311-1333. [PMID: 30863063 PMCID: PMC6388753 DOI: 10.2147/ijn.s189587] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Conventional tissue engineering, cell therapy, and current medical approaches were shown to be successful in reducing mortality rate and complications caused by cardiovascular diseases (CVDs). But still they have many limitations to fully manage CVDs due to complex composition of native myocardium and microvascularization. Fabrication of fully functional construct to replace infarcted area or regeneration of progenitor cells is important to address CVDs burden. Three-dimensional (3D) printed scaffolds and 3D bioprinting technique have potential to develop fully functional heart construct that can integrate with native tissues rapidly. In this review, we presented an overview of 3D printed approaches for cardiac tissue engineering, and advances in 3D bioprinting of cardiac construct and models. We also discussed role of immune modulation to promote tissue regeneration.
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Affiliation(s)
- Muhammad Qasim
- Department of Stem Cell and Regenerative Biotechnology, Humanized Pig Research Centre (SRC), Konkuk University, Seoul, South Korea,
| | - Farhan Haq
- Department of Biosciences, Comsats University, Islamabad, Pakistan
| | - Min-Hee Kang
- Department of Stem Cell and Regenerative Biotechnology, Humanized Pig Research Centre (SRC), Konkuk University, Seoul, South Korea,
| | - Jin-Hoi Kim
- Department of Stem Cell and Regenerative Biotechnology, Humanized Pig Research Centre (SRC), Konkuk University, Seoul, South Korea,
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57
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Sun Z. Insights into 3D printing in medical applications. Quant Imaging Med Surg 2019; 9:1-5. [PMID: 30788241 PMCID: PMC6351810 DOI: 10.21037/qims.2019.01.03] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 01/10/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
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58
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Javaid M, Haleem A. Current status and challenges of Additive manufacturing in orthopaedics: An overview. J Clin Orthop Trauma 2019; 10:380-386. [PMID: 30828212 PMCID: PMC6382947 DOI: 10.1016/j.jcot.2018.05.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/15/2018] [Indexed: 10/16/2022] Open
Abstract
Additive manufacturing is a rapidly emerging technology which is being successfully implemented in the various field of medicine as well as in orthopaedics, where it has applications in reducing cartilage defects and treatments of bones. The technology helps through systematic collection of information about the shape of the "defects" and precise fabrication of complex 3D constructs such as cartilage, heart valve, trachea, myocardial bone tissue and blood vessels. In this paper, a large number of the relevant research papers on the additive manufacturing and its application in medical specifically orthopaedics are identified through Scopus had been studied using Bibliometric analysis and application analysis is undertaken. The bibliometric analysis shows that there is an increasing trend in the research reports on additive manufacturing applications in the field of orthopaedics. Discussions are on using technological advancement like scanning techniques and various challenges of the orthopaedic being met by additive manufacturing technology. For patient-specific orthopaedic applications, these techniques incorporate clinical practice and use for effective planning. 3D printed models printed by this technology are accepted for orthopaedic surgery such as revision of lumbar discectomy, pelvic surgery and large scapular osteochondroma. The applications of additive manufacturing in orthopaedics will experience a rapid translation in future. An orthopaedic surgeon can convert need/idea into a reality by using computer-aided design (CAD) software, analysis software to facilitate the manufacturing. Thus, AM provides a comprehensive opportunity to manufacture orthopaedic implantable medical devices.
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Affiliation(s)
- Mohd. Javaid
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India,Corresponding author.
| | - Abid Haleem
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
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59
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Lau I, Wong YH, Yeong CH, Abdul Aziz YF, Md Sari NA, Hashim SA, Sun Z. Quantitative and qualitative comparison of low- and high-cost 3D-printed heart models. Quant Imaging Med Surg 2019; 9:107-114. [PMID: 30788252 DOI: 10.21037/qims.2019.01.02] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Current visualization techniques of complex congenital heart disease (CHD) are unable to provide comprehensive visualization of the anomalous cardiac anatomy as the medical datasets can essentially only be viewed from a flat, two-dimensional (2D) screen. Three-dimensional (3D) printing has therefore been used to replicate patient-specific hearts in 3D views based on medical imaging datasets. This technique has been shown to have a positive impact on the preoperative planning of corrective surgery, patient-doctor communication, and the learning experience of medical students. However, 3D printing is often costly, and this impedes the routine application of this technology in clinical practice. This technical note aims to investigate whether reducing 3D printing costs can have any impact on the clinical value of the 3D-printed heart models. Low-cost and a high-cost 3D-printed models based on a selected case of CHD were generated with materials of differing cost. Quantitative assessment of dimensional accuracy of the cardiac anatomy and pathology was compared between the 3D-printed models and the original cardiac computed tomography (CT) images with excellent correlation (r=0.99). Qualitative evaluation of model usefulness showed no difference between the two models in medical applications.
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Affiliation(s)
- Ivan Lau
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Yin How Wong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Chai Hong Yeong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre (UMRIC) University of Malaya, Kuala Lumpur, Malaysia
| | - Nor Ashikin Md Sari
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre (UMRIC) University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Amry Hashim
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
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60
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Allan A, Kealley C, Squelch A, Wong YH, Yeong CH, Sun Z. Patient-specific 3D printed model of biliary ducts with congenital cyst. Quant Imaging Med Surg 2019; 9:86-93. [PMID: 30788249 PMCID: PMC6351815 DOI: 10.21037/qims.2018.12.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND 3D printing has shown great promise in medical applications, with increasing reports in liver diseases. However, research on 3D printing in biliary disease is limited with lack of studies on validation of model accuracy. In this study, we presented our experience of creating a realistic 3D printed model of biliary ducts with congenital cyst. Measurements of anatomical landmarks were compared at different stages of model generation to determine dimensional accuracy. METHODS Contrast-enhanced computed tomography (CT) images of a patient diagnosed with congenital cyst in the common bile duct with dilated hepatic ducts were used to create the 3D printed model. The 3D printed model was scanned on a 64-slice CT scanner using the similar abdominal CT protocol. Measurements of anatomical structures including common hepatic duct (CHD), right hepatic duct (RHD), left hepatic duct (LHD) and the cyst at left to right and anterior to posterior dimensions were performed and compared between original CT images, the standard tessellation language (STL) image and CT images of the 3D model. RESULTS The 3D printing model was successfully generated with replication of biliary ducts and cyst. Significant differences in measurements of these landmarks were found between the STL and the original CT images, and the CT images of the 3D printed model and the original CT images (P<0.05). Measurements of the RHD and LHD diameters from the original CT images were significantly larger than those from the CT images of 3D model or STL file (P<0.05), while measurements of the CHD diameters were significantly smaller than those of the other two datasets (P<0.05). No significant differences were reached in measurements of the CHD, RHD, LHD and the biliary cyst between CT images of the 3D printed model and STL file (P=0.08-0.98). CONCLUSIONS This study shows our experience in producing a realistic 3D printed model of biliary ducts and biliary cyst. The model was found to replicate anatomical structures and cyst with high accuracy between the STL file and the CT images of the 3D model. Large discrepancy in dimensional measurements was noted between the original CT and STL file images, and the original CT and CT images of the 3D model, highlighting the necessity of further research with inclusion of more cases of biliary disease to validate accuracy of 3D printed biliary models.
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Affiliation(s)
- Amee Allan
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Catherine Kealley
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Andrew Squelch
- Discipline of Exploration Geophysics, Western Australian School of Mines, Minerals, Energy and Chemical Engineering, Curtin University, Perth, Western Australia, Australia
- Computational Image Analysis Group, Curtin Institute for Computation, Curtin University, Perth, Western Australia, Australia
| | - Yin How Wong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Malaysia
| | - Chai Hong Yeong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Malaysia
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
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Batteux C, Haidar MA, Bonnet D. 3D-Printed Models for Surgical Planning in Complex Congenital Heart Diseases: A Systematic Review. Front Pediatr 2019; 7:23. [PMID: 30805324 PMCID: PMC6378296 DOI: 10.3389/fped.2019.00023] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/21/2019] [Indexed: 01/29/2023] Open
Abstract
Background: 3D technology support is an emerging technology in the field of congenital heart diseases (CHD). The goals of 3D printings or models is mainly a better analysis of complex anatomies to optimize the surgical repair or intervention planning. Method: We performed a systematic review to evaluate the accuracy and reliability of CHD modelization and 3D printing, as well as the proof of concept of the benefit of 3D printing in planning interventions. Results: Correlation studies showed good results with anatomical measurements. This technique can therefore be considered reliable with the limit of the operator's subjectivity in modelizing the defect. In cases series, the benefits of the 3D technology have been shown for describing the vessels anatomy and guiding the surgical approach. For intra-cardiac complex anatomy, 3D models have been shown helpful for the planification of intracardiac repair. However, there is still lack of evidence based approach for the usefulness of 3D models in CHD in changing outcomes after surgery or interventional procedures due to the difficulty to design a prospective study with comprehensive and clinically meaningful end-points. Conclusion: 3D technology can be used to improve the understanding of anatomy of complex CHD and to guide surgical strategy. However, there is a need to design clinical studies to identify the place of this approach in the current clinical practice.
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Affiliation(s)
- Clément Batteux
- Department of Congenital and Pediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Moussa A Haidar
- Department of Congenital and Pediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Damien Bonnet
- Department of Congenital and Pediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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62
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Sun Z. 3D printing in medicine: current applications and future directions. Quant Imaging Med Surg 2018; 8:1069-1077. [PMID: 30701160 PMCID: PMC6328380 DOI: 10.21037/qims.2018.12.06] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/10/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
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63
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3D printing for congenital heart disease: a single site's initial three-yearexperience. 3D Print Med 2018; 4:10. [PMID: 30649650 PMCID: PMC6223396 DOI: 10.1186/s41205-018-0033-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/08/2018] [Indexed: 11/25/2022] Open
Abstract
Background 3D printing is an ideal manufacturing process for creating patient-matched models (anatomical models) for surgical and interventional planning. Cardiac anatomical models have been described in numerous case studies and journal publications. However, few studies attempt to describe wider impact of the novel planning augmentation tool. The work here presents the evolution of an institution’s first 3 full years of 3D prints following consistent integration of the technology into clinical workflow (2012–2014) - a center which produced 79 models for surgical planning (within that time frame). Patient outcomes and technology acceptance following implementation of 3D printing were reviewed. Methods A retrospective analysis was designed to investigate the anatomical model’s impact on time-based surgical metrics. A contemporaneous cohort of standard-of-care pre-procedural planning (no anatomical models) was identified for comparative analysis. A post-surgery technology acceptance assessment was also employed in a smaller subset to measure perceived efficacy of the anatomical models. The data was examined. Results Within the timeframe of the study, 928 primary-case cardiothoracic surgeries (encompassing both CHD and non-CHD surgeries) took place at the practicing pediatric hospital. One hundred sixty four anatomical models had been generated for various purposes. An inclusion criterion based on lesion type limited those with anatomic models to 33; there were 113 cases matching the same criterion that received no anatomical model. Time-based metrics such as case length-of-time showed a mean reduction in overall time for anatomical models. These reductions were not statistically significant. The technology acceptance survey did demonstrate strong perceived efficacy. Anecdotal vignettes further support the technology acceptance. Discussion & conclusion The anatomical models demonstrate trends for reduced operating room and case length of time when compared with similar surgeries in the same time-period; in turn, these reductions could have significant impact on patient outcomes and operating room economics. While analysis did not yield robust statistical powering, strong Cohen’s d values suggest poor powering may be more related to sample size than non-ideal outcomes. The utility of planning with an anatomical model is further supported by the technology acceptance study which demonstrated that surgeons perceive the anatomical models to be an effective tool in surgical planning for a complex CHD repair. A prospective multi-center trial is currently in progress to further validate or reject these findings.
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64
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Lau I, Sun Z. Three-dimensional printing in congenital heart disease: A systematic review. J Med Radiat Sci 2018; 65:226-236. [PMID: 29453808 PMCID: PMC6119737 DOI: 10.1002/jmrs.268] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 01/12/2018] [Accepted: 01/22/2018] [Indexed: 01/09/2023] Open
Abstract
Three-dimensional (3D) printing has shown great promise in medicine with increasing reports in congenital heart disease (CHD). This systematic review aims to analyse the main clinical applications and accuracy of 3D printing in CHD, as well as to provide an overview of the software tools, time and costs associated with the generation of 3D printed heart models. A search of different databases was conducted to identify studies investigating the application of 3D printing in CHD. Studies based on patient's medical imaging datasets were included for analysis, while reports on in vitro phantom or review articles were excluded from the analysis. A total of 28 studies met selection criteria for inclusion in the review. More than half of the studies were based on isolated case reports with inclusion of 1-12 cases (61%), while 10 studies (36%) focused on the survey of opinion on the usefulness of 3D printing by healthcare professionals, patients, parents of patients and medical students, and the remaining one involved a multicentre study about the clinical value of 3D printed models in surgical planning of CHD. The analysis shows that patient-specific 3D printed models accurately replicate complex cardiac anatomy, improve understanding and knowledge about congenital heart diseases and demonstrate value in preoperative planning and simulation of cardiac or interventional procedures, assist surgical decision-making and intra-operative orientation, and improve patient-doctor communication and medical education. The cost of 3D printing ranges from USD 55 to USD 810. This systematic review shows the usefulness of 3D printed models in congenital heart disease with applications ranging from accurate replication of complex cardiac anatomy and pathology to medical education, preoperative planning and simulation. The additional cost and time required to manufacture the 3D printed models represent the limitations which need to be addressed in future studies.
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Affiliation(s)
- Ivan Lau
- Department of Medical Radiation SciencesCurtin UniversityPerthAustralia
| | - Zhonghua Sun
- Department of Medical Radiation SciencesCurtin UniversityPerthAustralia
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Abstract
Surgeons typically rely on their past training and experiences as well as visual aids from medical imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) for the planning of surgical processes. Often, due to the anatomical complexity of the surgery site, two dimensional or virtual images are not sufficient to successfully convey the structural details. For such scenarios, a 3D printed model of the patient's anatomy enables personalized preoperative planning. This paper reviews critical aspects of 3D printing for preoperative planning and surgical training, starting with an overview of the process-flow and 3D printing techniques, followed by their applications spanning across multiple organ systems in the human body. State of the art in these technologies are described along with a discussion of current limitations and future opportunities.
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Su W, Xiao Y, He S, Huang P, Deng X. Three-dimensional printing models in congenital heart disease education for medical students: a controlled comparative study. BMC MEDICAL EDUCATION 2018; 18:178. [PMID: 30068323 PMCID: PMC6090870 DOI: 10.1186/s12909-018-1293-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/25/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND This study sought to assess, using subjective (self-assessment) and objective (MCQ) methods, the efficacy of using heart models with ventricular septal defect lesions produced with three-dimensional printing technology in a congenital heart disease curriculum for medical students. METHODS Three computed tomography datasets of three subtypes of ventricular septal defects (perimembranous, subarterial and muscular, one for each) were obtained and processed for building into and printing out 3D models. Then a total of 63 medical students in one class were randomly allocated to two groups (32 students in the experimental, and 31 the control). The two groups participated in a seminar with or without a 3D heart model, respectively. Assessment of this curriculum was carried out using Likert-type questionnaires as well as an objective multiple choice question test assessing both knowledge acquisition, and structural conceptualization. Open-ended questions were also provided for getting advice and suggestion on 3D model utilization in CHD education. RESULTS With these 3D models, feedback shown in the questionnaires from students in experimental group was significantly more positive than their classmates in the control. And the test results also showed a significant difference in structural conceptualization in favor of the experimental group. CONCLUSION It is effective to use heart models created using current 3D printing technology for congenital heart disease education. It stimulates students' interest in congenital heart disease and improves the outcomes of medical education.
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MESH Headings
- Academic Success
- Education, Medical, Undergraduate/methods
- Female
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/pathology
- Heart Septal Defects, Ventricular/diagnostic imaging
- Heart Septal Defects, Ventricular/pathology
- Humans
- Male
- Models, Anatomic
- Printing, Three-Dimensional
- Students, Medical
- Tomography, X-Ray Computed
- Young Adult
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Affiliation(s)
- Wei Su
- Research Unit for Pediatrics, Xiangnan University School of Medicine, Chenzhou, 423000 China
| | - Yunbin Xiao
- Heart Center, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha, 410007 China
| | - Siping He
- Department of Radiology, Hunan Children’s Hospital, Changsha, 410007 China
| | - Peng Huang
- Heart Center, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha, 410007 China
| | - Xicheng Deng
- Heart Center, Hunan Children’s Hospital, No. 86 Ziyuan Road, Changsha, 410007 China
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67
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Biglino G, Milano EG. Applications of 3D printing in paediatric cardiology: its potential and the need for gathering evidence. Transl Pediatr 2018; 7:219-221. [PMID: 30160260 PMCID: PMC6087831 DOI: 10.21037/tp.2018.07.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Giovanni Biglino
- Bristol Heart Institute, University of Bristol, Bristol, UK
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Elena G. Milano
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
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Yang T, Lin S, Xie Q, Ouyang W, Tan T, Li J, Chen Z, Yang J, Wu H, Pan J, Hu C, Zou Y. Impact of 3D printing technology on the comprehension of surgical liver anatomy. Surg Endosc 2018; 33:411-417. [PMID: 29943060 DOI: 10.1007/s00464-018-6308-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Surgical planning in liver resection depends on the precise understanding of the three-dimensional (3D) relation of tumors to the intrahepatic vascular trees. This study aimed to investigate the impact of 3D printing (3DP) technology on the understanding of surgical liver anatomy. METHODS We selected four hepatic tumors that were previously resected. For each tumor, a virtual 3D reconstruction (VIR) model was created from multi-detector computed tomography (MDCT) and was prototyped using a 3D printer. Forty-five surgical residents were evenly assigned to each group (3DP, VIR, and MDCT groups). After evaluation of the MDCT scans, VIR model, or 3DP model of each tumor, surgical residents were asked to assign hepatic tumor locations and state surgical resection proposals. The time used to specify the tumor location was recorded. The correct responses and time spent were compared between the three groups. RESULTS The assignment of tumor location improved steadily from MDCT, to VIR, and to 3DP, with a mean score of 34.50, 55.25, and 80.92, respectively. These scores were out of 100 points. The 3DP group had significantly higher scores compared with other groups (p < 0.001). Furthermore, 3DP significantly improved the accuracy of surgical resection proposal (p < 0.001). The mean accuracy of the surgical resection proposal for 3DP, VIR, and MDCT was 57, 25, and 25%, respectively. The 3DP group took significantly less time, compared with other groups (p < 0.005). The mean time spent on assessing the tumor location for 3DP, VIR, and MDCT groups was 93, 223, and 286 s, respectively. CONCLUSIONS 3D printing improves the understanding of surgical liver anatomy for surgical residents. The improved comprehension of liver anatomy may facilitate laparoscopy or open liver resection.
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Affiliation(s)
- Tianyou Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Shuwen Lin
- Department of Hepatobiliary Surgery, the Fifth People's Hospital of Dongguan City, Dongguan, China
| | - Qigen Xie
- First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wenwei Ouyang
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tianbao Tan
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Jiahao Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Zhiyuan Chen
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiliang Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Huiying Wu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jing Pan
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Chao Hu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China
| | - Yan Zou
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Rd., Tianhe District, Guangzhou, 510623, China.
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Abstract
PURPOSE OF REVIEW Advances in medical imaging and three-dimensional (3D) reconstruction software have enabled a proliferation of 3D modeling and 3D printing for clinical applications. In particular, 3D printing has garnered an extraordinary media presence over the past few years. There is growing optimism that 3D printing can address patient specificity and complexity for improved interventional and surgical planning. Will this relatively untested technology bring about a paradigm shift in the clinical environment, or is it just a transient fad? RECENT FINDINGS Case studies and series centered around 3D printing are omnipresent in clinical and engineering journals. These primarily qualitative studies support the potential efficacy of the emerging technology. Few studies analyze the value of 3D printing, weighing its potential benefits against increasing costs (e.g., institutional overhead, labor, and materials). SUMMARY Clinical integration of 3D printing is growing rapidly, and its adoption into clinical practice presents unique workflow challenges. There are numerous clinical trials on the horizon that will finally help to elucidate the measured impact of 3D printing on clinical outcomes through quantitative analyses of clinical and economic metrics. The contrived integration of 3D printing into clinical practice seems all but certain as the value of this technology becomes more and more evident.
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El Sabbagh A, Eleid MF, Al-Hijji M, Anavekar NS, Holmes DR, Nkomo VT, Oderich GS, Cassivi SD, Said SM, Rihal CS, Matsumoto JM, Foley TA. The Various Applications of 3D Printing in Cardiovascular Diseases. Curr Cardiol Rep 2018; 20:47. [PMID: 29749577 DOI: 10.1007/s11886-018-0992-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To highlight the various applications of 3D printing in cardiovascular disease and discuss its limitations and future direction. RECENT FINDINGS Use of handheld 3D printed models of cardiovascular structures has emerged as a facile modality in procedural and surgical planning as well as education and communication. Three-dimensional (3D) printing is a novel imaging modality which involves creating patient-specific models of cardiovascular structures. As percutaneous and surgical therapies evolve, spatial recognition of complex cardiovascular anatomic relationships by cardiologists and cardiovascular surgeons is imperative. Handheld 3D printed models of cardiovascular structures provide a facile and intuitive road map for procedural and surgical planning, complementing conventional imaging modalities. Moreover, 3D printed models are efficacious educational and communication tools. This review highlights the various applications of 3D printing in cardiovascular diseases and discusses its limitations and future directions.
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Affiliation(s)
- Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mohammed Al-Hijji
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Sameh M Said
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Thomas A Foley
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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Clinical value of patient-specific three-dimensional printing of congenital heart disease: Quantitative and qualitative assessments. PLoS One 2018; 13:e0194333. [PMID: 29561912 PMCID: PMC5862481 DOI: 10.1371/journal.pone.0194333] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/12/2018] [Indexed: 11/29/2022] Open
Abstract
Objective Current diagnostic assessment tools remain suboptimal in demonstrating complex morphology of congenital heart disease (CHD). This limitation has posed several challenges in preoperative planning, communication in medical practice, and medical education. This study aims to investigate the dimensional accuracy and the clinical value of 3D printed model of CHD in the above three areas. Methods Using cardiac computed tomography angiography (CCTA) data, a patient-specific 3D model of a 20-month-old boy with double outlet right ventricle was printed in Tango Plus material. Pearson correlation coefficient was used to evaluate correlation of the quantitative measurements taken at analogous anatomical locations between the CCTA images pre- and post-3D printing. Qualitative analysis was conducted by distributing surveys to six health professionals (two radiologists, two cardiologists and two cardiac surgeons) and three medical academics to assess the clinical value of the 3D printed model in these three areas. Results Excellent correlation (r = 0.99) was noted in the measurements between CCTA and 3D printed model, with a mean difference of 0.23 mm. Four out of six health professionals found the model to be useful in facilitating preoperative planning, while all of them thought that the model would be invaluable in enhancing patient-doctor communication. All three medical academics found the model to be helpful in teaching, and thought that the students will be able to learn the pathology quicker with better understanding. Conclusion The complex cardiac anatomy can be accurately replicated in flexible material using 3D printing technology. 3D printed heart models could serve as an excellent tool in facilitating preoperative planning, communication in medical practice, and medical education, although further studies with inclusion of more clinical cases are needed.
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72
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Shirakawa T, Yoshitatsu M, Koyama Y, Kurata A, Miyoshi T, Mizoguchi H, Masai T, Toda K, Sawa Y. To what extent can 3D model replicate dimensions of individual mitral valve prolapse? J Artif Organs 2018; 21:348-355. [PMID: 29556869 DOI: 10.1007/s10047-018-1033-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 02/27/2018] [Indexed: 11/25/2022]
Abstract
Determining the complex geometry of mitral valve prolapse is often difficult. We constructed 3D models of six prolapsed mitral valves for surgical assessment, and evaluated how accurately the models could replicate individual valve dimensions. 3D polygon data were constructed based on an original segmentation method for computed tomography images. The model's replication performance was confirmed via dimensional comparison between the actual hearts during surgery and those models. The results revealed that the prolapsed segments matched in all cases; however, torn chordae were replicated in four cases. The mean height differences were 0.0 mm (SD 1.6, range - 2 to + 2 mm) for the anterolateral side, 0.0 mm (SD 1.7, range - 2 to + 2 mm) for the prolapsed leaflet center, and - 1.5 mm (SD 0.6, range - 1 to - 2 mm) for the posteromedial side. Regression analysis showed a strong and positive correlation, and Bland-Altman plots indicated quantitative similarity of the models to the actual hearts. We concluded that our 3D valve models could replicate the actual mitral valve prolapses within acceptable dimensional differences. Our concepts are useful for better 3D valve creation and better surgical planning with reliable 3D valve models.
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Affiliation(s)
- Takashi Shirakawa
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Masao Yoshitatsu
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yasushi Koyama
- Department of Diagnostic Radiology and Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hiroki Mizoguchi
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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AlAli AB, Griffin MF, Calonge WM, Butler PE. Evaluating the Use of Cleft Lip and Palate 3D-Printed Models as a Teaching Aid. JOURNAL OF SURGICAL EDUCATION 2018; 75:200-208. [PMID: 28869160 DOI: 10.1016/j.jsurg.2017.07.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 07/18/2017] [Accepted: 07/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Visualization tools are essential for effective medical education, to aid students understanding of complex anatomical systems. Three dimensional (3D) printed models are showing a wide-reaching potential in the field of medical education, to aid the interpretation of 2D imaging. This study investigates the use of 3D-printed models in educational seminars on cleft lip and palate, by comparing integrated "hands-on" student seminars, with 2D presentation seminar methods. SETTING Cleft lip and palate models were manufactured using 3D-printing technology at the medical school. PARTICIPANTS Sixty-seven students from two medical schools participated in the study. DESIGN The students were randomly allocated to 2 groups. Knowledge was compared between the groups using a multiple-choice question test before and after the teaching intervention. Group 1 was the control group with a PowerPoint presentation-based educational seminar and group 2 was the test group, with the same PowerPoint presentation, but with the addition of a physical demonstration using 3D-printed models of unilateral and bilateral cleft lips and palate. RESULTS The level of knowledge gained was established using a preseminar and postseminar assessment, in 2 different institutions, where the addition of the 3D-printed model resulted in a significant improvement in the mean percentage of knowledge gained (44.65% test group; 32.16%; control group; p = 0.038). Student experience was assessed using a postseminar survey, where students felt the 3D-printed model significantly improved the learning experience (p = 0.005) and their visualization (p = 0.001). CONCLUSIONS This study highlights the benefits of the use of 3D-printed models as visualization tools in medical education and the potential of 3D-printing technology to become a standard and effective tool in the interpretation of 2D imaging.
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Affiliation(s)
- Ahmad B AlAli
- UCL Division of Surgery & Interventional Science, Centre for Nanotechnology & Regenerative Medicine, University College London, London, United Kingdom; Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.
| | - Michelle F Griffin
- UCL Division of Surgery & Interventional Science, Centre for Nanotechnology & Regenerative Medicine, University College London, London, United Kingdom; Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Wenceslao M Calonge
- UCL Division of Surgery & Interventional Science, Centre for Nanotechnology & Regenerative Medicine, University College London, London, United Kingdom; Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Peter E Butler
- UCL Division of Surgery & Interventional Science, Centre for Nanotechnology & Regenerative Medicine, University College London, London, United Kingdom; Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom; Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
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Langridge B, Momin S, Coumbe B, Woin E, Griffin M, Butler P. Systematic Review of the Use of 3-Dimensional Printing in Surgical Teaching and Assessment. JOURNAL OF SURGICAL EDUCATION 2018; 75:209-221. [PMID: 28729190 DOI: 10.1016/j.jsurg.2017.06.033] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/01/2017] [Accepted: 06/27/2017] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The use of 3-dimensional (3D) printing in medicine has rapidly expanded in recent years as the technology has developed. The potential uses of 3D printing are manifold. This article provides a systematic review of the uses of 3D printing within surgical training and assessment. METHODS A structured literature search of the major literature databases was performed in adherence to PRISMA guidelines. Articles that met predefined inclusion and exclusion criteria were appraised with respect to the key objectives of the review and sources of bias were analysed. RESULTS Overall, 49 studies were identified for inclusion in the qualitative analysis. Heterogeneity in study design and outcome measures used prohibited meaningful meta-analysis. 3D printing has been used in surgical training across a broad range of specialities but most commonly in neurosurgery and otorhinolaryngology. Both objective and subjective outcome measures have been studied, demonstrating the usage of 3D printed models in training and education. 3D printing has also been used in anatomical education and preoperative planning, demonstrating improved outcomes when compared to traditional educational methods and improved patient outcomes, respectively. CONCLUSIONS 3D printing technology has a broad range of potential applications within surgical education and training. Although the field is still in its relative infancy, several studies have already demonstrated its usage both instead of and in addition to traditional educational methods.
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Affiliation(s)
| | - Sheikh Momin
- University College London Medical School, London, United Kingdom
| | - Ben Coumbe
- University College London Medical School, London, United Kingdom
| | - Evelina Woin
- University College London Medical School, London, United Kingdom
| | - Michelle Griffin
- Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom; Division of Surgery & Interventional Science, University College London, London, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom; Centre for Rheumatology, Royal Free Hospital, University College London, London, United Kingdom.
| | - Peter Butler
- Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom; Division of Surgery & Interventional Science, University College London, London, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom; Centre for Rheumatology, Royal Free Hospital, University College London, London, United Kingdom
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75
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Lee J, Lee O. Usefulness of hard X-ray microscope using synchrotron radiation for the structure analysis of insects. Microsc Res Tech 2017; 81:292-297. [DOI: 10.1002/jemt.22978] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/27/2017] [Accepted: 12/05/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Jiwon Lee
- Department of Medical IT Engineering, College of Medical Sciences; Soonchunhyang University, 22, Soonchunhyang-ro; Asan City Chungnam 31538 Republic of Korea
| | - Onseok Lee
- Department of Medical IT Engineering, College of Medical Sciences; Soonchunhyang University, 22, Soonchunhyang-ro; Asan City Chungnam 31538 Republic of Korea
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Subat A, Goldberg A, Demaria S, Katz D. The Utility of Simulation in the Management of Patients With Congenital Heart Disease: Past, Present, and Future. Semin Cardiothorac Vasc Anesth 2017; 22:81-90. [PMID: 29231093 DOI: 10.1177/1089253217746243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Significant advancements have been made in the diagnosis and management of congenital heart disease (CHD). As a result, a higher percentage of these patients are surviving to adulthood. Despite this improvement in management, these patients remain at higher risk of morbidity and mortality, particularly in the perioperative setting. One new area of interest in these patients is the implementation of simulation-based medical education. Simulation has demonstrated various benefits across high-acuity scenarios encountered in the hospital. In CHD, simulation has been used in the training of pediatrics residents, assessment of intraoperative complications, echocardiography, and anatomic modeling with 3-dimensional printing. Here, we describe the current state of simulation in CHD, its role in training care providers for the management of this population, and future directions of CHD simulation.
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Affiliation(s)
- Ali Subat
- 1 Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | | | - Samuel Demaria
- 1 Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Daniel Katz
- 1 Icahn School of Medicine at Mt Sinai, New York, NY, USA
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Shinbane JS, Saxon LA. Virtual medicine: Utilization of the advanced cardiac imaging patient avatar for procedural planning and facilitation. J Cardiovasc Comput Tomogr 2017; 12:16-27. [PMID: 29198733 DOI: 10.1016/j.jcct.2017.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/08/2017] [Accepted: 11/12/2017] [Indexed: 01/17/2023]
Abstract
Advances in imaging technology have led to a paradigm shift from planning of cardiovascular procedures and surgeries requiring the actual patient in a "brick and mortar" hospital to utilization of the digitalized patient in the virtual hospital. Cardiovascular computed tomographic angiography (CCTA) and cardiovascular magnetic resonance (CMR) digitalized 3-D patient representation of individual patient anatomy and physiology serves as an avatar allowing for virtual delineation of the most optimal approaches to cardiovascular procedures and surgeries prior to actual hospitalization. Pre-hospitalization reconstruction and analysis of anatomy and pathophysiology previously only accessible during the actual procedure could potentially limit the intrinsic risks related to time in the operating room, cardiac procedural laboratory and overall hospital environment. Although applications are specific to areas of cardiovascular specialty focus, there are unifying themes related to the utilization of technologies. The virtual patient avatar computer can also be used for procedural planning, computational modeling of anatomy, simulation of predicted therapeutic result, printing of 3-D models, and augmentation of real time procedural performance. Examples of the above techniques are at various stages of development for application to the spectrum of cardiovascular disease processes, including percutaneous, surgical and hybrid minimally invasive interventions. A multidisciplinary approach within medicine and engineering is necessary for creation of robust algorithms for maximal utilization of the virtual patient avatar in the digital medical center. Utilization of the virtual advanced cardiac imaging patient avatar will play an important role in the virtual health care system. Although there has been a rapid proliferation of early data, advanced imaging applications require further assessment and validation of accuracy, reproducibility, standardization, safety, efficacy, quality, cost effectiveness, and overall value to medical care.
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Affiliation(s)
- Jerold S Shinbane
- Division of Cardiovascular Medicine/USC Center for Body Computing, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States.
| | - Leslie A Saxon
- Division of Cardiovascular Medicine/USC Center for Body Computing, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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Computational Fluid Dynamics and Additive Manufacturing to Diagnose and Treat Cardiovascular Disease. Trends Biotechnol 2017; 35:1049-1061. [PMID: 28942268 DOI: 10.1016/j.tibtech.2017.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 11/21/2022]
Abstract
Noninvasive engineering models are now being used for diagnosing and planning the treatment of cardiovascular disease. Techniques in computational modeling and additive manufacturing have matured concurrently, and results from simulations can inform and enable the design and optimization of therapeutic devices and treatment strategies. The emerging synergy between large-scale simulations and 3D printing is having a two-fold benefit: first, 3D printing can be used to validate the complex simulations, and second, the flow models can be used to improve treatment planning for cardiovascular disease. In this review, we summarize and discuss recent methods and findings for leveraging advances in both additive manufacturing and patient-specific computational modeling, with an emphasis on new directions in these fields and remaining open questions.
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Grant EK, Olivieri LJ. The Role of 3-D Heart Models in Planning and Executing Interventional Procedures. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Foley TA, El Sabbagh A, Anavekar NS, Williamson EE, Matsumoto JM. 3D-Printing: Applications in Cardiovascular Imaging. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0239-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Quantitative Prediction of Paravalvular Leak in Transcatheter Aortic Valve Replacement Based on Tissue-Mimicking 3D Printing. JACC Cardiovasc Imaging 2017; 10:719-731. [DOI: 10.1016/j.jcmg.2017.04.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/10/2017] [Accepted: 04/20/2017] [Indexed: 11/23/2022]
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82
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Letnikova G, Xu N. Academic library innovation through 3D printing services. LIBRARY MANAGEMENT 2017. [DOI: 10.1108/lm-12-2016-0094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
One of the most innovative library services recently introduced by public and academic libraries, the technology of 3D printing, has the potential to be used in multiple educational settings. The purpose of this paper is to examine how this novel library digital service motivates students’ learning, and to investigate managerial issues related to the introduction of 3D printing services at a medium-size urban community college library with restricted funding.
Design/methodology/approach
Since Fall 2014, the LaGuardia Library Media Resources Center has been offering a portable consumer-end 3D printer for classroom use. This paper provides historical context for the implementation of 3D printing as a service offered by librarians and discusses how the community college library managed 3D printing services to support class curriculum. At the end of the three-semester-long project students were asked to volunteer to take a survey conducted by the librarian and the class instructor.
Findings
The results of the student survey demonstrated that library 3D printing services significantly promoted students’ motivation to learn. The conceptual model of a makerspace should be an essential part of the twenty-first century academic library. To help make that possible this paper examines certain challenges and limitations faced by librarians when introducing 3D printing, including dedicated space management, professional education, and personnel availability.
Originality/value
During the project described students were able to use library services to print out and study complex engineering and biology models in 3D. The proper planning and management of this innovative service allows academic librarians to enhance class curriculum by providing the means of transforming theory into physical reality.
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Abstract
Medical 3-dimensional (3D) printing is emerging as a clinically relevant imaging tool in directing preoperative and intraoperative planning in many surgical specialties and will therefore likely lead to interdisciplinary collaboration between engineers, radiologists, and surgeons. Data from standard imaging modalities such as computed tomography, magnetic resonance imaging, echocardiography, and rotational angiography can be used to fabricate life-sized models of human anatomy and pathology, as well as patient-specific implants and surgical guides. Cardiovascular 3D-printed models can improve diagnosis and allow for advanced preoperative planning. The majority of applications reported involve congenital heart diseases and valvular and great vessels pathologies. Printed models are suitable for planning both surgical and minimally invasive procedures. Added value has been reported toward improving outcomes, minimizing perioperative risk, and developing new procedures such as transcatheter mitral valve replacements. Similarly, thoracic surgeons are using 3D printing to assess invasion of vital structures by tumors and to assist in diagnosis and treatment of upper and lower airway diseases. Anatomic models enable surgeons to assimilate information more quickly than image review, choose the optimal surgical approach, and achieve surgery in a shorter time. Patient-specific 3D-printed implants are beginning to appear and may have significant impact on cosmetic and life-saving procedures in the future. In summary, cardiothoracic 3D printing is rapidly evolving and may be a potential game-changer for surgeons. The imager who is equipped with the tools to apply this new imaging science to cardiothoracic care is thus ideally positioned to innovate in this new emerging imaging modality.
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Loke YH, Harahsheh AS, Krieger A, Olivieri LJ. Usage of 3D models of tetralogy of Fallot for medical education: impact on learning congenital heart disease. BMC MEDICAL EDUCATION 2017; 17:54. [PMID: 28284205 PMCID: PMC5346255 DOI: 10.1186/s12909-017-0889-0] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 02/20/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) is the most common human birth defect, and clinicians need to understand the anatomy to effectively care for patients with CHD. However, standard two-dimensional (2D) display methods do not adequately carry the critical spatial information to reflect CHD anatomy. Three-dimensional (3D) models may be useful in improving the understanding of CHD, without requiring a mastery of cardiac imaging. The study aimed to evaluate the impact of 3D models on how pediatric residents understand and learn about tetralogy of Fallot following a teaching session. METHODS Pediatric residents rotating through an inpatient Cardiology rotation were recruited. The sessions were randomized into using either conventional 2D drawings of tetralogy of Fallot or physical 3D models printed from 3D cardiac imaging data sets (cardiac MR, CT, and 3D echocardiogram). Knowledge acquisition was measured by comparing pre-session and post-session knowledge test scores. Learner satisfaction and self-efficacy ratings were measured with questionnaires filled out by the residents after the teaching sessions. Comparisons between the test scores, learner satisfaction and self-efficacy questionnaires for the two groups were assessed with paired t-test. RESULTS Thirty-five pediatric residents enrolled into the study, with no significant differences in background characteristics, including previous clinical exposure to tetralogy of Fallot. The 2D image group (n = 17) and 3D model group (n = 18) demonstrated similar knowledge acquisition in post-test scores. Residents who were taught with 3D models gave a higher composite learner satisfaction scores (P = 0.03). The 3D model group also had higher self-efficacy aggregate scores, but the difference was not statistically significant (P = 0.39). CONCLUSION Physical 3D models enhance resident education around the topic of tetralogy of Fallot by improving learner satisfaction. Future studies should examine the impact of models on teaching CHD that are more complex and elaborate.
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Affiliation(s)
- Yue-Hin Loke
- Division of Cardiology, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
| | - Ashraf S. Harahsheh
- Division of Cardiology, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
| | - Axel Krieger
- Bioengineering Institute, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
| | - Laura J. Olivieri
- Division of Cardiology, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
- Bioengineering Institute, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
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Yoo SJ, Spray T, Austin EH, Yun TJ, van Arsdell GS. Hands-on surgical training of congenital heart surgery using 3-dimensional print models. J Thorac Cardiovasc Surg 2017; 153:1530-1540. [PMID: 28268011 DOI: 10.1016/j.jtcvs.2016.12.054] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/07/2016] [Accepted: 12/29/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Patient-based congenital heart surgery (CHS) training is opportunity-based and difficult. Three-dimensional (3D) print models of the heart were used for hands-on surgical training (HOST) at the 2015 AATS and subsequently in 2 local institutions. We aim to introduce the process of 3D printing for surgical simulation and to present the attendee's responses. METHODS Using CT or MR angiograms, the models of congenital heart disease were created and printed with flexible rubberlike material. Altogether, 81 established surgeons or trainees performed simulated surgical procedures with the expert surgeons' guidance and supervision. At the completion of the session, 50 of 81 attendees participated in the questionnaire assessment of the program. RESULTS All responders found the course helpful in improving their surgical skills. All would consider including HOST sessions in the training programs. All found that the models showed the necessary pathologic findings. Most found that the consistency and elasticity of the model material were different from those of the human myocardium. However, the responders thought that the quality of the models was acceptable (88%) or manageable (12%) for surgical practice. The major weaknesses listed were related to the print material and poor representation of the cardiac valves. CONCLUSIONS HOST using 3D print heart models is achievable and allows surgical practice on pathological hearts without patients' risk. HOST is a highly applicable surgical simulation format for CHS. Incorporation of HOST in training programs could change the traditional opportunity-based education to the requirement-based standardized education.
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Affiliation(s)
- Shi-Joon Yoo
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Thomas Spray
- Division of Cardiothoracic Surgery, Department of Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Erle H Austin
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Norton Children's Hospital, Louisville, Ky
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, Seoul, South Korea
| | - Glen S van Arsdell
- Division of Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Update on the Role of Cardiac Magnetic Resonance Imaging in Congenital Heart Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:2. [PMID: 28144782 DOI: 10.1007/s11936-017-0504-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OPINION STATEMENT Cardiac magnetic resonance imaging (CMR) is an important imaging modality in the evaluation of congenital heart diseases (CHD). CMR has several strengths including good spatial and temporal resolutions, wide field-of-view, and multi-planar imaging capabilities. CMR provides significant advantages for imaging in CHD through its ability to measure function, flow and vessel sizes, create three-dimensional reconstructions, and perform tissue characterization, all in a single imaging study. Thus, CMR is the most comprehensive imaging modality available today for the evaluation of CHD. Newer MRI sequences and post-processing tools will allow further development of quantitative methods of analysis, and opens the door for risk stratification in CHD. CMR also can interface with computer modeling, 3D printing, and other methods of understanding the complex anatomic and physiologic relationships in CHD.
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Hoang D, Perrault D, Stevanovic M, Ghiassi A. Surgical applications of three-dimensional printing: a review of the current literature & how to get started. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:456. [PMID: 28090512 DOI: 10.21037/atm.2016.12.18] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Three dimensional (3D) printing involves a number of additive manufacturing techniques that are used to build structures from the ground up. This technology has been adapted to a wide range of surgical applications at an impressive rate. It has been used to print patient-specific anatomic models, implants, prosthetics, external fixators, splints, surgical instrumentation, and surgical cutting guides. The profound utility of this technology in surgery explains the exponential growth. It is important to learn how 3D printing has been used in surgery and how to potentially apply this technology. PubMed was searched for studies that addressed the clinical application of 3D printing in all surgical fields, yielding 442 results. Data was manually extracted from the 168 included studies. We found an exponential increase in studies addressing surgical applications for 3D printing since 2011, with the largest growth in craniofacial, oromaxillofacial, and cardiothoracic specialties. The pertinent considerations for getting started with 3D printing were identified and are discussed, including, software, printing techniques, printing materials, sterilization of printing materials, and cost and time requirements. Also, the diverse and increasing applications of 3D printing were recorded and are discussed. There is large array of potential applications for 3D printing. Decreasing cost and increasing ease of use are making this technology more available. Incorporating 3D printing into a surgical practice can be a rewarding process that yields impressive results.
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Affiliation(s)
- Don Hoang
- USC Plastic and Reconstructive Surgery, Los Angeles, CA, USA
| | - David Perrault
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Milan Stevanovic
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Olivieri LJ, Su L, Hynes CF, Krieger A, Alfares FA, Ramakrishnan K, Zurakowski D, Marshall MB, Kim PCW, Jonas RA, Nath DS. "Just-In-Time" Simulation Training Using 3-D Printed Cardiac Models After Congenital Cardiac Surgery. World J Pediatr Congenit Heart Surg 2016; 7:164-8. [PMID: 26957398 DOI: 10.1177/2150135115623961] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High-fidelity simulation using patient-specific three-dimensional (3D) models may be effective in facilitating pediatric cardiac intensive care unit (PCICU) provider training for clinical management of congenital cardiac surgery patients. METHODS The 3D-printed heart models were rendered from preoperative cross-sectional cardiac imaging for 10 patients undergoing congenital cardiac surgery. Immediately following surgical repair, a congenital cardiac surgeon and an intensive care physician conducted a simulation training session regarding postoperative care utilizing the patient-specific 3D model for the PCICU team. After the simulation, Likert-type 0 to 10 scale questionnaire assessed participant perception of impact of the training session. RESULTS Seventy clinicians participated in training sessions, including 22 physicians, 38 nurses, and 10 ancillary care providers. Average response to whether 3D models were more helpful than standard hand off was 8.4 of 10. Questions regarding enhancement of understanding and clinical ability received average responses of 9.0 or greater, and 90% of participants scored 8 of 10 or higher. Nurses scored significantly higher than other clinicians on self-reported familiarity with the surgery (7.1 vs. 5.8; P = .04), clinical management ability (8.6 vs. 7.7; P = .02), and ability enhancement (9.5 vs. 8.7; P = .02). Compared to physicians, nurses and ancillary providers were more likely to consider 3D models more helpful than standard hand off (8.7 vs. 7.7; P = .05). Higher case complexity predicted greater enhancement of understanding of surgery (P = .04). CONCLUSION The 3D heart models can be used to enhance congenital cardiac critical care via simulation training of multidisciplinary intensive care teams. Benefit may be dependent on provider type and case complexity.
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Affiliation(s)
- Laura J Olivieri
- Department of Cardiology, Children's National Health System, Washington, DC, USA
| | - Lillian Su
- Department of Critical Care Medicine and Board of Visitors Simulation Program, Children's National Health System, Washington, DC, USA
| | - Conor F Hynes
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
| | - Axel Krieger
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Fahad A Alfares
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
| | - Karthik Ramakrishnan
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
| | - David Zurakowski
- Department of Anesthesia and Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - M Blair Marshall
- Department of Thoracic Surgery, Georgetown University Hospital, Washington, DC, USA
| | - Peter C W Kim
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Richard A Jonas
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
| | - Dilip S Nath
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA
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Abstract
3D-printed models fabricated from CT, MRI, or echocardiography data provide the advantage of haptic feedback, direct manipulation, and enhanced understanding of cardiovascular anatomy and underlying pathologies. Reported applications of cardiovascular 3D printing span from diagnostic assistance and optimization of management algorithms in complex cardiovascular diseases, to planning and simulating surgical and interventional procedures. The technology has been used in practically the entire range of structural, valvular, and congenital heart diseases, and the added-value of 3D printing is established. Patient-specific implants and custom-made devices can be designed, produced, and tested, thus opening new horizons in personalized patient care and cardiovascular research. Physicians and trainees can better elucidate anatomical abnormalities with the use of 3D-printed models, and communication with patients is markedly improved. Cardiovascular 3D bioprinting and molecular 3D printing, although currently not translated into clinical practice, hold revolutionary potential. 3D printing is expected to have a broad influence in cardiovascular care, and will prove pivotal for the future generation of cardiovascular imagers and care providers. In this Review, we summarize the cardiovascular 3D printing workflow, from image acquisition to the generation of a hand-held model, and discuss the cardiovascular applications and the current status and future perspectives of cardiovascular 3D printing.
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Abstract
We used three-dimensional printing technology to create an anatomical three-dimensional model of a very rare and complex cyanotic CHD in a newborn, consisting of double-outlet left ventricle, ventricular septal defect, and pulmonary stenosis. This case demonstrates how this new innovative technology allows better understanding of the anatomy in complex CHDs and permits to better plan the surgical repair.
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Biglino G, Capelli C, Koniordou D, Robertshaw D, Leaver LK, Schievano S, Taylor AM, Wray J. Use of 3D models of congenital heart disease as an education tool for cardiac nurses. CONGENIT HEART DIS 2016; 12:113-118. [PMID: 27666734 DOI: 10.1111/chd.12414] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/17/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nurse education and training are key to providing congenital heart disease (CHD) patients with consistent high standards of care as well as enabling career progression. One approach for improving educational experience is the use of 3D patient-specific models. OBJECTIVES To gather pilot data to assess the feasibility of using 3D models of CHD during a training course for cardiac nurses; to evaluate the potential of 3D models in this context, from the nurses' perspective; and to identify possible improvements to optimise their use for teaching. DESIGN A cross-sectional survey. SETTING A national training week for cardiac nurses. PARTICIPANTS One hundred cardiac nurses (of which 65 pediatric and 35 adult). METHODS Nurses were shown nine CHD models within the context of a specialized course, following a lecture on the process of making the models themselves, starting from medical imaging. Participants were asked about their general learning experience, if models were more/less informative than diagrams/drawings and lesion-specific/generic models, and their overall reaction to the models. Possible differences between adult and pediatric nurses were investigated. Written feedback was subjected to content analysis and quantitative data were analyzed using nonparametric statistics. RESULTS Generally models were well liked and nurses considered them more informative than diagrams. Nurses found that 3D models helped in the appreciation of overall anatomy (86%), spatial orientation (70%), and anatomical complexity after treatment (66%). There was no statistically significant difference between adult and pediatric nurses' responses. Thematic analysis highlighted the need for further explanation, use of labels and use of colors to highlight the lesion of interest amongst improvements for optimizing 3D models for teaching/training purposes. CONCLUSION 3D patient-specific models are useful tools for training adult and pediatric cardiac nurses and are particularly helpful for understanding CHD anatomy after repair.
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Affiliation(s)
- Giovanni Biglino
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Claudio Capelli
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK
| | - Despina Koniordou
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK
| | - Di Robertshaw
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Lindsay-Kay Leaver
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Silvia Schievano
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK
| | - Andrew M Taylor
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, London, UK
| | - Jo Wray
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Yoo SJ, Thabit O, Kim EK, Ide H, Yim D, Dragulescu A, Seed M, Grosse-Wortmann L, van Arsdell G. 3D printing in medicine of congenital heart diseases. 3D Print Med 2016; 2:3. [PMID: 30050975 PMCID: PMC6036784 DOI: 10.1186/s41205-016-0004-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/04/2016] [Indexed: 11/10/2022] Open
Abstract
Congenital heart diseases causing significant hemodynamic and functional consequences require surgical repair. Understanding of the precise surgical anatomy is often challenging and can be inadequate or wrong. Modern high resolution imaging techniques and 3D printing technology allow 3D printing of the replicas of the patient’s heart for precise understanding of the complex anatomy, hands-on simulation of surgical and interventional procedures, and morphology teaching of the medical professionals and patients. CT or MR images obtained with ECG-gating and breath-holding or respiration navigation are best suited for 3D printing. 3D echocardiograms are not ideal but can be used for printing limited areas of interest such as cardiac valves and ventricular septum. Although the print materials still require optimization for representation of cardiovascular tissues and valves, the surgeons find the models suitable for practicing closure of the septal defects, application of the baffles within the ventricles, reconstructing the aortic arch, and arterial switch procedure. Hands-on surgical training (HOST) on models may soon become a mandatory component of congenital heart disease surgery program. 3D printing will expand its utilization with further improvement of the use of echocardiographic data and image fusion algorithm across multiple imaging modalities and development of new printing materials. Bioprinting of implants such as stents, patches and artificial valves and tissue engineering of a part of or whole heart using the patient’s own cells will open the door to a new era of personalized medicine.
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Affiliation(s)
- Shi-Joon Yoo
- Department of Diagnostic Imaging, University of Toronto, 555 University Avenue, Toronto, ON Canada.,Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Omar Thabit
- Department of Diagnostic Imaging, University of Toronto, 555 University Avenue, Toronto, ON Canada.,Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Eul Kyung Kim
- 3D HOPE (Human organ Printing and Engineering) Medical, 1008-65 Harbour Sqaure, Toronto, ON M5J2L4 Canada
| | - Haruki Ide
- Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Deane Yim
- Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Anreea Dragulescu
- Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Mike Seed
- Department of Diagnostic Imaging, University of Toronto, 555 University Avenue, Toronto, ON Canada.,Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Lars Grosse-Wortmann
- Department of Diagnostic Imaging, University of Toronto, 555 University Avenue, Toronto, ON Canada.,Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Glen van Arsdell
- Division of Cardiovascular Surgery - Department of Surgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G1X8 Canada
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Abstract
Supplemental Digital Content is available in the text.
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O’Brien EK, Wayne DB, Barsness KA, McGaghie WC, Barsuk JH. Use of 3D Printing for Medical Education Models in Transplantation Medicine: a Critical Review. CURRENT TRANSPLANTATION REPORTS 2016. [DOI: 10.1007/s40472-016-0088-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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O'Reilly MK, Reese S, Herlihy T, Geoghegan T, Cantwell CP, Feeney RNM, Jones JFX. Fabrication and assessment of 3D printed anatomical models of the lower limb for anatomical teaching and femoral vessel access training in medicine. ANATOMICAL SCIENCES EDUCATION 2016; 9:71-79. [PMID: 26109268 DOI: 10.1002/ase.1538] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/27/2015] [Accepted: 04/13/2015] [Indexed: 06/04/2023]
Abstract
For centuries, cadaveric dissection has been the touchstone of anatomy education. It offers a medical student intimate access to his or her first patient. In contrast to idealized artisan anatomical models, it presents the natural variation of anatomy in fine detail. However, a new teaching construct has appeared recently in which artificial cadavers are manufactured through three-dimensional (3D) printing of patient specific radiological data sets. In this article, a simple powder based printer is made more versatile to manufacture hard bones, silicone muscles and perfusable blood vessels. The approach involves blending modern approaches (3D printing) with more ancient ones (casting and lost-wax techniques). These anatomically accurate models can augment the approach to anatomy teaching from dissection to synthesis of 3D-printed parts held together with embedded rare earth magnets. Vascular simulation is possible through application of pumps and artificial blood. The resulting arteries and veins can be cannulated and imaged with Doppler ultrasound. In some respects, 3D-printed anatomy is superior to older teaching methods because the parts are cheap, scalable, they can cover the entire age span, they can be both dissected and reassembled and the data files can be printed anywhere in the world and mass produced. Anatomical diversity can be collated as a digital repository and reprinted rather than waiting for the rare variant to appear in the dissection room. It is predicted that 3D printing will revolutionize anatomy when poly-material printing is perfected in the early 21st century.
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Affiliation(s)
- Michael K O'Reilly
- Anatomy in the Biomedical Section, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Sven Reese
- Department of Veterinary Sciences, Section of Anatomy, Histology, and Embryology, Faculty of Veterinary Medicine, University of Munich, Munich, Germany
| | - Therese Herlihy
- Diagnostic Imaging, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Tony Geoghegan
- Department of Interventional Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Colin P Cantwell
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Robin N M Feeney
- Anatomy in the Biomedical Section, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - James F X Jones
- Anatomy in the Biomedical Section, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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Yao R, Xu G, Mao SS, Yang HY, Sang XT, Sun W, Mao YL. Three-dimensional printing: review of application in medicine and hepatic surgery. Cancer Biol Med 2016; 13:443-451. [PMID: 28154775 PMCID: PMC5250601 DOI: 10.20892/j.issn.2095-3941.2016.0075] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Three-dimensional (3D) printing (3DP) is a rapid prototyping technology that has gained increasing recognition in many different fields. Inherent accuracy and low-cost property enable applicability of 3DP in many areas, such as manufacturing, aerospace, medical, and industrial design. Recently, 3DP has gained considerable attention in the medical field. The image data can be quickly turned into physical objects by using 3DP technology. These objects are being used across a variety of surgical specialties. The shortage of cadaver specimens is a major problem in medical education. However, this concern has been solved with the emergence of 3DP model. Custom-made items can be produced by using 3DP technology. This innovation allows 3DP use in preoperative planning and surgical training. Learning is difficult among medical students because of the complex anatomical structures of the liver. Thus, 3D visualization is a useful tool in anatomy teaching and hepatic surgical training. However, conventional models do not capture haptic qualities. 3DP can produce highly accurate and complex physical models. Many types of human or animal differentiated cells can be printed successfully with the development of 3D bio-printing technology. This progress represents a valuable breakthrough that exhibits many potential uses, such as research on drug metabolism or liver disease mechanism. This technology can also be used to solve shortage of organs for transplant in the future.
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Affiliation(s)
- Rui Yao
- Biomanufacturing Center, Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China
| | - Gang Xu
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Shuang-Shuang Mao
- Biomanufacturing Center, Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China
| | - Hua-Yu Yang
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xin-Ting Sang
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wei Sun
- Biomanufacturing Center, Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China
| | - Yi-Lei Mao
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing 100730, China
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Krauel L, Fenollosa F, Riaza L, Pérez M, Tarrado X, Morales A, Gomà J, Mora J. Use of 3D Prototypes for Complex Surgical Oncologic Cases. World J Surg 2015; 40:889-94. [DOI: 10.1007/s00268-015-3295-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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