Application of three-dimensional reconstruction and printing as an elective course for undergraduate medical students: an exploratory trial

Application of artificial intelligence-assisted image diagnosis software based on volume data reconstruction technique in medical imaging practice teaching

BACKGROUND

In medical imaging courses, due to the complexity of anatomical relationships, limited number of practical course hours and instructors, how to improve the teaching quality of practical skills and self-directed learning ability has always been a challenge for higher medical education. Artificial intelligence-assisted diagnostic (AISD) software based on volume data reconstruction (VDR) technique is gradually entering radiology. It converts two-dimensional images into three-dimensional images, and AI can assist in image diagnosis. However, the application of artificial intelligence in medical education is still in its early stages. The purpose of this study is to explore the application value of AISD software based on VDR technique in medical imaging practical teaching, and to provide a basis for improving medical imaging practical teaching.

METHODS

Totally 41 students majoring in clinical medicine in 2017 were enrolled as the experiment group. AISD software based on VDR was used in practical teaching of medical imaging to display 3D images and mark lesions with AISD. Then annotations were provided and diagnostic suggestions were given. Also 43 students majoring in clinical medicine from 2016 were chosen as the control group, who were taught with the conventional film and multimedia teaching methods. The exam results and evaluation scales were compared statistically between groups.

RESULTS

The total skill scores of the test group were significantly higher compared with the control group (84.51 ± 3.81 vs. 80.67 ± 5.43). The scores of computed tomography (CT) diagnosis (49.93 ± 3.59 vs. 46.60 ± 4.89) and magnetic resonance (MR) diagnosis (17.41 ± 1.00 vs. 16.93 ± 1.14) of the experiment group were both significantly higher. The scores of academic self-efficacy (82.17 ± 4.67) and self-directed learning ability (235.56 ± 13.50) of the group were significantly higher compared with the control group (78.93 ± 6.29, 226.35 ± 13.90).

CONCLUSIONS

Applying AISD software based on VDR to medical imaging practice teaching can enable students to timely obtain AI annotated lesion information and 3D images, which may help improve their image reading skills and enhance their academic self-efficacy and self-directed learning abilities.

From 2D slices to a 3D model: Training students in digital microanatomy analysis techniques through a 3D printed neuron project

The reconstruction of two-dimensional (2D) slices to three-dimensional (3D) digital anatomical models requires technical skills and software that are becoming increasingly important to the modern anatomist, but these skills are rarely taught in undergraduate science classrooms. Furthermore, learning opportunities that allow students to simultaneously explore anatomy in both 2D and 3D space are increasingly valuable. This report describes a novel learning activity that trains students to digitally trace a serially imaged neuron from a confocal stack and to model that neuron in 3D space for 3D printing. By engaging students in the production of a 3D digital model, this learning activity is designed to provide students a novel way to enhance their understanding of the content, including didactic knowledge of neuron morphology, technical research skills in image analysis, and career exploration of neuroanatomy research. Moreover, students engage with microanatomy in a way that starts in 2D but results in a 3D object they can see, touch, and keep. This discursive article presents the learning activity, including videos, instructional guides, and learning objectives designed to engage students on all six levels of Bloom's Taxonomy. Furthermore, this work is a proof of principle modeling workflow that is approachable, inexpensive, achievable, and adaptable to cell types in other organ systems. This work is designed to motivate the expansion of 3D printing technology into microanatomy and neuroanatomy education.

Are 3D-printed anatomical models of the ear effective for teaching anatomy? A comparative pilot study versus cadaveric models

PURPOSE

Despite the combination of chalkboard lectures and cadaveric models, the ear remains a complex anatomical structure that is difficult for medical students to grasp. The aim of this study was to evaluate the contribution of a 3D-printed ear model for educating undergraduate medical students by comparing it with a conventional cadaveric model.

METHODS

Models of the ear comprising the outer ear, tympanic membrane, ossicles and inner ear were modeled and then 3D-printed at 6:1 and 10:1 scales based on cadaveric dissection and CT, cone-beam CT and micro/nano CT scans. Cadaveric models included two partially dissected dry temporal bones and ossicles. Twenty-four 3rd year medical students were given separate access to cadaveric models (n = 12) or 3D-printed models (n = 12). A pre-test and two post-tests were carried out to assess knowledge (n = 24). A satisfaction questionnaire focusing solely on the 3D-printed model, comprising 17 items assessed on a 5-point Likert scale, was completed by all study participants. A 5-point Likert scale questionnaire comprising four items (realism, color, quality and satisfaction with the 3D-printed ear model) was given to three expert anatomy Professors.

RESULTS

The test scores on the first post-test were higher for the students who had used the 3D-printed models (p < 0.05). Overall satisfaction among the students and the experts was very high, averaging 4.7 on a 5-point Likert-type satisfaction scale.

CONCLUSION

This study highlights the overall pedagogical value of a 3D-printed model for learning ear anatomy.

Assessing the impact of 3D image segmentation workshops on anatomical education and image interpretation: A prospective pilot study

Three-dimensional (3D) segmentation, a process involving digitally marking anatomical structures on cross-sectional images such as computed tomography (CT), and 3D printing (3DP) are being increasingly utilized in medical education. Exposure to this technology within medical schools and hospitals remains limited in the United Kingdom. M3dicube UK, a national medical student, and junior doctor-led 3DP interest group piloted a 3D image segmentation workshop to gauge the impact of incorporating 3D segmentation technology on anatomical education. The workshop, piloted with medical students and doctors within the United Kingdom between September 2020 and 2021, introduced participants to 3D segmentation and offered practical experience segmenting anatomical models. Thirty-three participants were recruited, with 33 pre-workshop and 24 post-workshop surveys completed. Two-tailed t-tests were used to compare mean scores. From pre- to post-workshop, increases were noted in participants' confidence in interpreting CT scans (2.36 to 3.13, p = 0.010) and interacting with 3D printing technology (2.15 to 3.33, p = 0.00053), perceived utility of creating 3D models to aid image interpretation (4.18 to 4.45, p = 0.0027), improved anatomical understanding (4.2 to 4.7, p = 0.0018), and utility in medical education (4.45 to 4.79, p = 0.077). This pilot study provides early evidence of the utility of exposing medical students and healthcare professionals in the United Kingdom to 3D segmentation as part of their anatomical education, with additional benefit in imaging interpretation ability.

3D printing as a pedagogical tool for teaching normal human anatomy: a systematic review

BACKGROUND

Three-dimensional-printed anatomical models (3DPAMs) appear to be a relevant tool due to their educational value and their feasibility. The objectives of this review were to describe and analyse the methods utilised for creating 3DPAMs used in teaching human anatomy and for evaluating its pedagogical contribution.

METHODS

An electronic search was conducted on PubMed using the following terms: education, school, learning, teaching, learn, teach, educational, three-dimensional, 3D, 3-dimensional, printing, printed, print, anatomy, anatomical, anatomically, and anatomic. Data retrieved included study characteristics, model design, morphological evaluation, educational performance, advantages, and disadvantages.

RESULTS

Of the 68 articles selected, the cephalic region was the most studied (33 articles); 51 articles mentioned bone printing. In 47 articles, the 3DPAM was designed from CT scans. Five printing processes were listed. Plastic and its derivatives were used in 48 studies. The cost per design ranged from 1.25 USD to 2800 USD. Thirty-seven studies compared 3DPAM to a reference model. Thirty-three articles investigated educational performance. The main advantages were visual and haptic qualities, effectiveness for teaching, reproducibility, customizability and manipulability, time savings, integration of functional anatomy, better mental rotation ability, knowledge retention, and educator/student satisfaction. The main disadvantages were related to the design: consistency, lack of detail or transparency, overly bright colours, long printing time, and high cost.

CONCLUSION

This systematic review demonstrates that 3DPAMs are feasible at a low cost and effective for teaching anatomy. More realistic models require access to more expensive 3D printing technologies and substantially longer design time, which would greatly increase the overall cost. Choosing an appropriate image acquisition modality is key. From a pedagogical viewpoint, 3DPAMs are effective tools for teaching anatomy, positively impacting the learning outcomes and satisfaction level. The pedagogical effectiveness of 3DPAMs seems to be best when they reproduce complex anatomical areas, and they are used by students early in their medical studies.

Impact of patient-specific three-dimensional printed liver models on hepatic surgery safety: a pilot study

BACKGROUND

Simulation and navigation technologies in hepatobiliary surgery have been developed recently. In this prospective clinical trial, we evaluated the accuracy and utility of our patient-specific three dimensional (3D)-printed liver models as an intraoperative navigation system to ensure surgical safety.

METHOD

Patients requiring advanced hepatobiliary surgeries during the study period were enrolled. Three cases were selected for comparison of the computed tomography (CT) scan data of the models with the patients' original data. Questionnaires were completed after surgeries to evaluate the utility of the models. Psychological stress was used as subjective data and operation time and blood loss as objective data.

RESULTS

Thirteen patients underwent surgery using the patient-specific 3D liver models. The difference between patient-specific 3D liver models and the original data was less than 0.6 mm in the 90% area. The 3D model assisted with intra-liver hepatic vein recognition and the definition of the cutting line. According to the post-operative subjective evaluation, surgeons found the models improved safety and reduced psychological stress during operations. However, the models did not reduce operative time or blood loss.

CONCLUSION

The patient-specific 3D-printed liver models accurately reflected patients' original data and were an effective intraoperative navigation tool for meticulously difficult liver surgeries.

CLINICAL TRIAL REGISTRATION

This study was registered in the UMIN Clinical Trial Registry (UMIN000025732).

A comparative analysis of lecturers' satisfaction with Anatomage and Pirogov virtual dissection tables during clinical and topographic anatomy courses in Russian universities

Anatomy is increasingly taught using computer-assisted learning tools, including electronic interactive anatomy dissection tables. Anatomage was he first virtual anatomy dissection table introduced in Russian medical universities and gained popularity among lecturers and students. The Pirogov interactive anatomy table was recently released, but the strengths and weakness of each platform is currently unknown. The objective of this article is to survey lecturers in anatomy to understand their perspectives on the Pirogov versus Anatomage virtual dissection tables' application to teaching in medical universities. A total of 80 anatomy educators from 12 Russian universities, using Anatomage (n = 40) and Pirogov (n = 40) tables were surveyed regarding their satisfaction with the application of the respective tables. Using a five-point Likert scale, both tables were assessed, and responses were statistically analyzed. In addition, qualitative analysis was performed on free response comments provided by survey respondents. There was no significant difference in overall satisfaction ratings between Pirogov (4.38 ± 0.53) and Anatomage (3.94 ± 0.60) interactive tables (p > 0.05). The Anatomage table ranked significantly higher on the accuracy of displayed anatomical details, resolution of the images, and its suitability for teaching senior medical and postgraduate students. Pirogov table performed significantly better on survey items measuring ergonomics, ability to assess students' performance, and teaching basic anatomy to junior first- and second-year medical students. Thus, in summary, anatomists' responses indicated that while both tables are suitable for teaching anatomy, the Pirogov table was superior in undergraduate medical education and the Anatomage table was more beneficial for teaching more senior trainees.

Creation and application of war trauma treatment simulation software for first aid on the battlefield based on undeformed high-resolution sectional anatomical image (Chinese Visible Human dataset)

BACKGROUND

Effective first aid on the battlefield is vital to minimize deaths caused by war trauma and improve combat effectiveness. However, it is difficult for junior medical students, which have relatively poor human anatomy knowledge and first aid experience. Therefore, we aim to create a treatment simulation software for war trauma, and to explore its application for first aid training. METHODS : This study is a quantitative post-positivist study using a survey for data collection. First, high-resolution, thin-sectional anatomical images (Chinese Visible Human (CVH) dataset) were used to reconstruct three-dimensional (3D) wound models. Then, the simulation system and the corresponding interactive 3D-PDF, including 3D models, graphic explanation, and teaching videos, were built, and used for first aid training in army medical college. Finally, the interface, war trauma modules, and training effects were evaluated using a five-point Likert scale questionnaire. All measurements are represented as mean and standard deviations. Moreover, free text comments from questionnaires were collected and aggregated.

RESULTS

The simulation software and interactive 3D-PDF were established. This included pressure hemostasis of the vertex, face, head-shoulder, shoulder-arm, upper forearm, lower limb, foot, and punctures of the cricothyroid membrane, pneumothorax, and marrow cavity. Seventy-eight medical students participated in the training and completed the questionnaire, including 66 junior college students and 12 graduate students. The results indicated that they were highly satisfied with the software (score: 4.64 ± 0.56). The systems were user-friendly (score: 4.40 ± 0.61) and easy to operate (score: 4.49 ± 0.68). The 3D models, knowledge of hemostasis, and puncture were accurate (scores: 4.41 ± 0.67, and 4.53 ± 0.69) and easily adopted (scores: 4.54 ± 0.635, and 4.40 ± 0.648). They provided information about hemostasis and puncture (all scores > 4.40), except for cricothyroid membrane puncture (scores: 4.39 ± 0.61), improved the learning enthusiasm of medical students (score: 4.55 ± 0.549), and increased learning interest (score: 4.54 ± 0.57).

CONCLUSION

Our software can effectively help medical students master first aid skills including hemostasis, cricothyroid membrane and bone marrow puncture, and its anatomy. This may also be used for soldiers and national first aid training.

Development and implementation of a three-dimensional (3D) printing elective course for health science students

Three-dimensional (3D) printing technology has become more affordable, accessible, and relevant in healthcare, however, the knowledge of transforming medical images to physical prints still requires some level of training. Anatomy educators can play a pivotal role in introducing learners to 3D printing due to the spatial context inherent to learning anatomy. To bridge this knowledge gap and decrease the intimidation associated with learning 3D printing technology, an elective was developed through a collaboration between the Department of Anatomy and the Makers Lab at the University of California, San Francisco. A self-directed digital resource was created for the elective to guide learners through the 3D printing workflow, which begins with a patient's computed tomography digital imaging and communication in medicine (DICOM) file to a physical 3D printed model. In addition to practicing the 3D printing workflow during the elective, a series of guest speakers presented on 3D printing applications they utilize in their clinical practice and/or research laboratories. Student evaluations indicated that their intimidation associated with 3D printing decreased, the clinical and research topics were directly applicable to their intended careers, and they enjoyed the autonomy associated with the elective format. The elective and the associated digital resource provided students with the foundational knowledge of 3D printing, including the ability to extract, edit, manipulate, and 3D print from DICOM files, making 3D printing more accessible. The aim of disseminating this work is to help other anatomy educators adopt this curriculum at their institution.

Creation of a three-dimensional printed spine model for training in pain procedures

OBJECTIVE

Technological developments have made it possible to create simulation models to educate clinicians on surgical techniques and patient preparation. In this study, we created an inexpensive lumbar spine phantom using patient data and analyzed its usefulness in clinical education.

METHODS

This randomized comparative study used computed tomography and magnetic resonance imaging data from a single patient to print a three-dimensional (3D) bone framework and create a mold. The printed bones and structures made from the mold were placed in a simulation model that was used to train residents. The residents were divided into two groups: Group L, which received only an audiovisual lecture, and Group P, which received an additional 1 hour of training using the 3D phantom. The performance of both groups was evaluated using pretest and post-test analyses.

RESULTS

Both the checklist and global rating scores increased after training in both groups. However, some variables improved significantly only in Group P. The overall satisfaction score was also higher in Group P than in Group L.

CONCLUSIONS

We have described a method by which medical doctors can create a spine simulation phantom and have demonstrated its efficiency for procedural education.

Application of 3D modeling and printing technology in accurate resection of complicated thoracic tumors

Background

To explore the application value of three-dimensional (3D) reconstruction and 3D printing in preoperative evaluation of precise resection of complicated thoracic tumors.

Methods

A retrospective analysis of 34 patients with complicated thoracic tumors who were treated by radical surgery from March 2016 to June 2019 was made. According to whether 3D reconstruction and 3D printing was used, the patients were divided into research group and control group. In the control group, preoperative evaluation was performed according to CT image data, and the operation plan was drawn up; in the research group, preoperative simulation and preoperative operation plan design were carried out according to 3D reconstruction and 3D printing technology. The operation time, change of operation approach, intraoperative blood loss, hospitalization time and postoperative complications were compared between the two groups. We also retrospectively reviewed additional 12 cases of unresectable complicated thoracic tumors. The above 34 patients who were treated by radical surgery were set as the resectable group. Three-dimensional reconstruction was performed for all cases. The tumor size, location, smoothness of tumor-vascular contact surface, close contact with adjacent organs were compared between these two groups.

Results

The 3D reconstruction and 3D printing model were successfully established. The indexes of operation time, change of incision approach and blood loss in the research group were lower than those in the control group (P<0.05). All the patients were followed up for 6 months, and there was no death, no tumor recurrence and metastasis in the two groups. In the unresectable group, the score of position and smoothness of tumor-vascular contact surface were significantly higher than that in the resectable group.

Conclusions

3D reconstruction and 3D printing can effectively help surgeons carry out accurate surgical treatment, reduce the operation time and bleeding, reduce the risk of surgery, and facilitate the postoperative rehabilitation of patients, which has the value of promotion and application.