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Deane AS, Byers KT. A review of the ethical considerations for the use of 3D printed materials in medical and allied health education and a proposed collective path forward. ANATOMICAL SCIENCES EDUCATION 2024; 17:1164-1173. [PMID: 39001638 DOI: 10.1002/ase.2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 08/30/2024]
Abstract
3D scanning and printing technologies are quickly evolving and offer great potential for use in gross anatomical education. The use of human body donors to create digital scans and 3D printed models raises ethical concerns about donor informed consent, potential commodification, and access to and storage of potentially identifiable anatomical reproductions. This paper reviews available literature describing ethical implications for the application of these emerging technologies, existing published best practices for managing and sharing 2D imaging, and current adherence to these best practices by academic body donation programs. We conclude that informed consent is paramount for all uses of human donor and human donor-derived materials and that currently there is considerable diversity in adherence to established best practices for the management and sharing of 3D digital content derived from human donors. We propose a new and simplified framework for categorizing donor-derived teaching materials and the corresponding level of consent required for digital sharing. This framework proposes an equivalent minimum level of specific consent for human donor and human donor-derived materials relative to generalized, nonidentical teaching materials (i.e., artificial plastic models). Likewise, we propose that the collective path forward should involve the creation of a centralized, secure repository for digital human donor 3D content as a mechanism for accumulating, regulating, and controlling the distribution of properly consented human donor-derived 3D digital content that will also increase the availability of ethically created human-derived teaching materials while discouraging commodification.
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Affiliation(s)
- Andrew S Deane
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Anthropology, Indiana University, Indianapolis, Indiana, USA
- Centre for the Exploration of the Deep Human Journey, University of Witwatersrand, Johannesburg, South Africa
| | - Kelsey T Byers
- University of California, Office of the President Anatomical Donation Program, Oakland, CA, USA
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Piazza A, Corvino S, Colosso GQ, Campeggi A, Agosti E, Serioli S, Frati A, Santoro A. 3-Dimensional Printed Model of the Temporal Bone for Neurosurgical Training. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01234. [PMID: 38967429 DOI: 10.1227/ons.0000000000001213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/26/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The development of neurosurgical skills stands out as a paramount objective for neurosurgery residents during their formative years. Mastery of intricate and complex procedures is a time-intensive process marked by a gradually ascending learning curve. Consequently, the study and simulation on surgical models assume significant importance. One of the most intricate neuroanatomical regions includes the petrous and mastoid portions of the temporal bone. These regions host critical, highly functional, and vital neurovascular structures, including the facial nerve, cochlea, semicircular canals, internal carotid artery, and middle ear. This fully open-source 3-dimensional (3D) model of the temporal bone, created for educational purposes, should be easily and economically reproducible using a 3D printer, offering all residents the opportunity to understand the spatial location, three-dimensional anatomical structures, and fundamental intricacies of mastoidectomy. METHODS A 3D model of the temporal bone was fabricated using a computed tomography (CT) scan derived from an actual human body. The CT scan of the model was meticulously juxtaposed with the reference sample CT scan. Neurosurgical residents were recruited as participants for this study. Each participant was tasked with executing a mastoidectomy on 2 separate occasions, with a 2-week interval between attempts. Throughout these sessions, various parameters, including the time taken for task completion, the volume of bone removal, and any potential complications, were systematically registered. RESULTS The mean volume of bone removed increased by 34.5%, and the mean task time and the mean number of complications decreased by 10.3% and 25%, respectively, during the training. CONCLUSION Engaging in training with cost-effective anatomical models constitutes a valuable tool for refining technical skills during residency. We posit that this type of model training should be incorporated as part of the trainee's curriculum during the residency program because of the myriad advantages evidenced by the findings of this study.
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Affiliation(s)
- Amedeo Piazza
- Department of Neurosurgery, University of Rome, Rome, Italy
- Department of Neurosurgery, Papa Giovanni XXIII University Hospital, Bari, Italy
| | - Sergio Corvino
- Division of Neurosurgery, Department of Neuroscience, Reproductive and Odontostomatological Sciences, "Università Federico II", Naples, Italy
| | | | - Alice Campeggi
- Surgical and Medical Sciences and Translational Medicine, University of Rome "Sapienza", Rome, Italy
| | - Edoardo Agosti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Simona Serioli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Ali A, Morris JM, Decker SJ, Huang YH, Wake N, Rybicki FJ, Ballard DH. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: neurosurgical and otolaryngologic conditions. 3D Print Med 2023; 9:33. [PMID: 38008795 PMCID: PMC10680204 DOI: 10.1186/s41205-023-00192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Medical three dimensional (3D) printing is performed for neurosurgical and otolaryngologic conditions, but without evidence-based guidance on clinical appropriateness. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness recommendations for neurologic 3D printing conditions. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with neurologic and otolaryngologic conditions. Each study was vetted by the authors and strength of evidence was assessed according to published guidelines. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for diseases of the calvaria and skull base, brain tumors and cerebrovascular disease. Recommendations are provided in accordance with strength of evidence of publications corresponding to each neurologic condition combined with expert opinion from members of the 3D printing SIG. CONCLUSIONS This consensus guidance document, created by the members of the 3D printing SIG, provides a reference for clinical standards of 3D printing for neurologic conditions.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | | | - Summer J Decker
- Division of Imaging Research and Applied Anatomy, Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Brumpt E, Bertin E, Tatu L, Louvrier A. 3D printing as a pedagogical tool for teaching normal human anatomy: a systematic review. BMC MEDICAL EDUCATION 2023; 23:783. [PMID: 37864193 PMCID: PMC10589929 DOI: 10.1186/s12909-023-04744-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/03/2023] [Indexed: 10/22/2023]
Abstract
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.
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Affiliation(s)
- Eléonore Brumpt
- University of Franche-Comté, 19 rue Ambroise Paré, Besançon, 25000, France.
- Radiologie, CHU de Besançon, Besançon, 25000, France.
- Laboratoire Nano Médecine, Imagerie, Thérapeutique, EA 4662, University of Franche-Comté, 16 Route de Gray, Besançon, F-25000, France.
- Anatomy Department, UFR Santé, 19 Rue Ambroise Paré, CS 71806, Besançon, F25030, France.
| | - Eugénie Bertin
- University of Franche-Comté, 19 rue Ambroise Paré, Besançon, 25000, France
- Chirurgie Maxillo-Faciale, Stomatologie Et Odontologie Hospitalière, CHU de Besançon, Besançon, 25000, France
| | - Laurent Tatu
- University of Franche-Comté, 19 rue Ambroise Paré, Besançon, 25000, France
- Neurologie, CHU de Besançon, Besançon, 25000, France
- Laboratoire de Neurosciences Intégratives Et Cliniques, University Franche-Comté, EA 481, Besançon, F-25000, France
| | - Aurélien Louvrier
- University of Franche-Comté, 19 rue Ambroise Paré, Besançon, 25000, France
- Chirurgie Maxillo-Faciale, Stomatologie Et Odontologie Hospitalière, CHU de Besançon, Besançon, 25000, France
- Plateforme I3DM (Impression 3D Médicale), CHU Besançon, Besançon, 25000, France
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Giacomini GO, Dotto GN, Mello WM, Dutra V, Liedke GS. Three-Dimensional printed model for preclinical training in oral radiology. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:280-286. [PMID: 35403342 DOI: 10.1111/eje.12801] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/09/2022] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION 3D printing is experiencing significant growth in the teaching and learning process. This study aims to present a 3D printed skull model for preclinical intraoral radiographic practice. MATERIALS AND METHODS Two 3D printed mannequins were created. One mannequin used an STL file of a skull that was edited using two 3D modelling software (Meshmixer and Netfabb). The second mannequin was designed directly from a patient's segmented CBCT data and then converted into an STL file. Both mannequins were printed using fused deposition modelling (FDM) technology and polylactic acid (PLA) filament; teeth for the second mannequin were also printed using digital light processing (DLP). The printed skull bones were attached, the mandible was articulated to the articular fossa of the temporal bone, and the teeth were inserted into the alveoli. Intraoral radiographs of both mannequins were taken using a digital sensor (RVG 5100, Carestream). RESULTS Both 3D printed mannequins showed satisfactory radiographic appearance, allowing geometric representation of each intraoral radiographic projection, regardless of STL file origin. Anatomical structures, such as the periodontal ligament space, zygomatic process of the maxilla and intermaxillary suture, were represented. The material cost of the first and second printed prototype was $34.00 and $39.00, respectively. CONCLUSIONS The use of 3D printed models is presented as an alternative to artificial commercial phantoms for the preclinical training of intraoral radiographic techniques through the combined benefits of superior radiographic projection quality, the possibility of model manipulation and an affordable price.
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Affiliation(s)
- Giuliano O Giacomini
- Postgraduate Program in Dental Sciences, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Gustavo N Dotto
- e-Health Unit, University Hospital of Santa Maria, Santa Maria, Brazil
| | - Wislem M Mello
- Dental School, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Vinícius Dutra
- Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Gabriela S Liedke
- Department of Stomatology, Universidade Federal de Santa Maria, Santa Maria, Brazil
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Kurt S, Selviler-Sizer S, Onuk B, Kabak M. Comparison of sheep scapula models created with polylactic acid and thermoplastic polyurethane filaments by three-dimensional modelling. Anat Histol Embryol 2022; 51:244-249. [PMID: 35014052 DOI: 10.1111/ahe.12784] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/24/2021] [Accepted: 12/31/2021] [Indexed: 11/29/2022]
Abstract
Three-dimensional (3D) printing technology is a rapid prototyping method that has recently been increasingly used in anatomy education. Magnetic resonance imaging, computed tomography, and 3D scanners are generally used to create 3D models. The aim of this study, which was performed without using the aforementioned devices, is to design sheep scapula models in a computer environment and compare bone models created with different filaments printed by a 3D printer with real bone. Photographs of sheep scapula were taken for modelling, and measurements were made from certain points. After the photographs were transferred to a computer environment, they were transformed into 3D using the Cinema 4D software, a computer-aided design program. Models were created using a 3D printer employing polylactic acid (PLA) and thermoplastic polyurethane (TPU) filaments. By comparing the models created with PLA and TPU filaments to the real bone, it was found that they have a similar anatomical structure, with dimensional-morphometric differences found at some points. It was also observed that the scapula model created with PLA filaments was more resistant to impacts than the real bone and that the model created with TPU filaments was more flexible, with very low fragility as compared to PLA and real bone. Therefore, this method allows obtaining a large number of durable models as an alternative to the real bone without the need for much manpower or equipment and without the need for a 3D reconstruction device.
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Affiliation(s)
- Semih Kurt
- Department of Anatomy, Faculty of Veterinary Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sedef Selviler-Sizer
- Department of Anatomy, Faculty of Veterinary Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Burcu Onuk
- Department of Anatomy, Faculty of Veterinary Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Murat Kabak
- Department of Anatomy, Faculty of Veterinary Medicine, Ondokuz Mayis University, Samsun, Turkey
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Omari A, Frendø M, Sørensen MS, Andersen SAW, Frithioff A. The cutting edge of customized surgery: 3D-printed models for patient-specific interventions in otology and auricular management-a systematic review. Eur Arch Otorhinolaryngol 2022; 279:3269-3288. [PMID: 35166908 DOI: 10.1007/s00405-022-07291-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/24/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE 3D-printing (three-dimensional printing) is an emerging technology with promising applications for patient-specific interventions. Nonetheless, knowledge on the clinical applicability of 3D-printing in otology and research on its use remains scattered. Understanding these new treatment options is a prerequisite for clinical implementation, which could improve patient outcomes. This review aims to explore current applications of 3D-printed patient-specific otologic interventions, including state of the evidence, strengths, limitations, and future possibilities. METHODS Following the PRISMA statement, relevant studies were identified through Pubmed, EMBASE, the Cochrane Library, and Web of Science. Data on the manufacturing process and interventions were extracted by two reviewers. Study quality was assessed using Joanna Briggs Institute's critical appraisal tools. RESULTS Screening yielded 590 studies; 63 were found eligible and included for analysis. 3D-printed models were used as guides, templates, implants, and devices. Outer ear interventions comprised 73% of the studies. Overall, optimistic sentiments on 3D-printed models were reported, including increased surgical precision/confidence, faster manufacturing/operation time, and reduced costs/complications. Nevertheless, study quality was low as most studies failed to use relevant objective outcomes, compare new interventions with conventional treatment, and sufficiently describe manufacturing. CONCLUSION Several clinical interventions using patient-specific 3D-printing in otology are considered promising. However, it remains unclear whether these interventions actually improve patient outcomes due to lack of comparison with conventional methods and low levels of evidence. Further, the reproducibility of the 3D-printed interventions is compromised by insufficient reporting. Future efforts should focus on objective, comparative outcomes evaluated in large-scale studies.
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Affiliation(s)
- Adam Omari
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen Hearing and Balance Center, Copenhagen, Denmark.
| | - Martin Frendø
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen Hearing and Balance Center, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, Region H, Copenhagen, Denmark
| | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen Hearing and Balance Center, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen Hearing and Balance Center, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, Region H, Copenhagen, Denmark
| | - Andreas Frithioff
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen Hearing and Balance Center, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, Region H, Copenhagen, Denmark
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Yuan ZM, Zhang XD, Wu SW, Nian ZZ, Liao J, Lin W, Zhuang LM. A simple and convenient 3D printed temporal bone model for drilling simulating surgery. Acta Otolaryngol 2022; 142:19-22. [PMID: 34928778 DOI: 10.1080/00016489.2021.2015079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND It is still far away from most of us in that it requires complex 3D modeling. AIMS/OBJECTIVES To investigate a more precision, simple, convenient and economical three-dimensional (3D) printed temporal bone model printed by a commercial desktop 3D printer, which can be widely promoted and applied in the training of beginners in otology. MATERIAL AND METHODS The CT data of the temporal bone were imported into Mimics to construct a 3D digital model of the temporal bone. After loaded into a high-precision 3D printer, a high-precision temporal bone model was printed at a scale of 1:1. Then, the model was evaluated by 5 senior attending physicians, including its morphological accuracy, simulation about surgery, advantages and educational value, using the 7-point Likert scale. RESULTS A life-like temporal bone model was successfully printed out. Five senior attending physicians all thought that the printed model was similar to the natural temporal bone in physical properties and the haptic sensation of bone drilling, and was accurate, simple, convenient and effective. In addition, the model was considered to be of high application value in the teaching of temporal bone anatomy and surgery simulation, which had a material cost of only 3 dollars. CONCLUSIONS The high-precision 3D printed temporal bone model is highly similar to the natural temporal bone, and can be conveniently and effectively used in the training of simulating temporal bone surgery for beginners in otology. Its production is simple and economical, so it can be popularized on a large scale.
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Affiliation(s)
- Zhi-Ming Yuan
- Department of Plastic Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, P.R. China
| | - Xiao-Dong Zhang
- Department of Otolaryngology-Head and Neck Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, P.R. China
| | - Shou-Wu Wu
- Department of Otolaryngology-Head and Neck Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, P.R. China
| | - Zhong-Zhu Nian
- Department of Otolaryngology-Head and Neck Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, P.R. China
| | - Jun Liao
- Department of Otolaryngology-Head and Neck Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, P.R. China
| | - Wen Lin
- Department of Otolaryngology-Head and Neck Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, P.R. China
| | - Li-Ming Zhuang
- Department of Otolaryngology-Head and Neck Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, P.R. China
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Frithioff A, Frendø M, Weiss K, Foghsgaard S, Pedersen DB, Sørensen MS, Wuyts Andersen SA. Effect of 3D-Printed Models on Cadaveric Dissection in Temporal Bone Training. OTO Open 2021; 5:2473974X211065012. [PMID: 34926973 PMCID: PMC8671684 DOI: 10.1177/2473974x211065012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Mastoidectomy is a cornerstone in the surgical management of middle and inner ear diseases. Unfortunately, training is challenged by insufficient access to human cadavers. Three-dimensional (3D) printing of temporal bones could alleviate this problem, but evidence on their educational effectiveness is lacking. It is largely unknown whether training on 3D-printed temporal bones improves mastoidectomy performance, including on cadavers, and how this training compares with virtual reality (VR) simulation. To address this knowledge gap, this study investigated whether training on 3D-printed temporal bones improves cadaveric dissection performance, and it compared this training with the already-established VR simulation. Study Design Prospective cohort study of an educational intervention. Setting Tertiary university hospital, cadaver dissection laboratory, and simulation center in Copenhagen, Denmark. Methods Eighteen otorhinolaryngology residents (intervention) attending the national temporal bone dissection course received 3 hours of mastoidectomy training on 3D-printed temporal bones. Posttraining cadaver mastoidectomy performances were rated by 3 experts using a validated assessment tool and compared with those of 66 previous course participants (control) who had received time-equivalent VR training prior to dissection. Results The intervention cohort outperformed the controls during cadaver dissection by 29% (P < .001); their performances were largely similar across training modalities but remained at a modest level (~50% of the maximum score). Conclusion Mastoidectomy skills improved from training on 3D-printed temporal bone and seemingly more so than on time-equivalent VR simulation. Importantly, these skills transferred to cadaveric dissection. Training on 3D-printed temporal bones can effectively supplement cadaver training when learning mastoidectomy.
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Affiliation(s)
- Andreas Frithioff
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark
| | - Martin Frendø
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark.,Department of Plastic and Reconstructive Surgery, Herlev Hospital, Copenhagen, Denmark
| | - Kenneth Weiss
- Department of Mechanical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Søren Foghsgaard
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Mads Sølvsten Sørensen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark
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Hochman JB, Pisa J, Kazmerik K, Unger B. Hand Motion Analysis Illustrates Differences When Drilling Cadaveric and Printed Temporal Bone. Ann Otol Rhinol Laryngol 2021; 131:1224-1230. [PMID: 34872376 PMCID: PMC9452853 DOI: 10.1177/00034894211059310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Temporal bone simulation is now commonly used to augment cadaveric education. Assessment of these tools is ongoing, with haptic modeling illustrating dissimilar motion patterns compared to cadaveric opportunities. This has the potential to result in maladaptive skill development. It is hypothesized that trainee drill motion patterns during printed model dissection may likewise demonstrate dissimilar hand motion patterns. METHODS Resident surgeons dissected 3D-printed temporal bones generated from microCT data and cadaveric simulations. A magnetic position tracking system (TrakSTAR Ascension, Yarraville, Australia) captured drill position and orientation. Skill assessment included cortical mastoidectomy, thinning procedures (sigmoid sinus, dural plate, posterior canal wall) and facial recess development. Dissection was performed by 8 trainees (n = 5 < PGY3 > n = 3) using k-cos metrics to analyze drill strokes within position recordings. K-cos metrics define strokes by change in direction, providing metrics for stroke duration, curvature, and length. RESULTS T-tests between models showed no significant difference in drill stroke frequency (cadaveric = 1.36/s, printed = 1.50/s, P < .40) but demonstrate significantly shorter duration (cadaveric = 0.37 s, printed = 0.16 s, P < .01) and a higher percentage of curved strokes (cadaveric = 31, printed = 67, P < .01) employed in printed bone dissection. Junior staff used a higher number of short strokes (junior = 0.54, senior = 0.38, P < .01) and higher percentage of curved strokes (junior = 35%, senior = 21%, P < .01). CONCLUSIONS Significant differences in hand motions were present between simulations, however the significance is unclear. This may indicate that printed bone is not best positioned to be the principal training schema.
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Affiliation(s)
- Jordan B Hochman
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Justyn Pisa
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Otolaryngology - Head and Neck Surgery, Health Sciences Centre, Winnipeg, MB, Canada
| | - Katrice Kazmerik
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Family Medicine, Pure Lifestyle, Winnipeg, MB, Canada
| | - Bertram Unger
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Medical Education, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Bartling ML, Rohani SA, Ladak HM, Agrawal SK. Micro-CT of the human ossicular chain: Statistical shape modeling and implications for otologic surgery. J Anat 2021; 239:771-781. [PMID: 34057736 PMCID: PMC8450485 DOI: 10.1111/joa.13457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 12/01/2020] [Accepted: 04/28/2021] [Indexed: 11/29/2022] Open
Abstract
The ossicular chain is a middle ear structure consisting of the small incus, malleus and stapes bones, which transmit tympanic membrane vibrations caused by sound to the inner ear. Despite being shown to be highly variable in shape, there are very few morphological studies of the ossicles. The objective of this study was to use a large sample of cadaveric ossicles to create a set of three-dimensional models and study their statistical variance. Thirty-three cadaveric temporal bone samples were scanned using micro-computed tomography (μCT) and segmented. Statistical shape models (SSMs) were then made for each ossicle to demonstrate the divergence of morphological features. Results revealed that ossicles were most likely to vary in overall size, but that more specific feature variability was found at the manubrium of the malleus, the long process and lenticular process of the incus, and the crura and footplate of the stapes. By analyzing samples as whole ossicular chains, it was revealed that when fixed at the malleus, changes along the chain resulted in a wide variety of final stapes positions. This is the first known study to create high-quality, three-dimensional SSMs of the human ossicles. This information can be used to guide otological surgical training and planning, inform ossicular prosthesis development, and assist with other ossicular studies and applications by improving automated segmentation algorithms. All models have been made publicly available.
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Affiliation(s)
| | - Seyed A. Rohani
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonCanada
| | - Hanif M. Ladak
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonCanada
- Department of Medical BiophysicsWestern UniversityLondonCanada
- Department of Electrical and Computer EngineeringWestern UniversityLondonCanada
- National Centre for AudiologyWestern UniversityLondonCanada
| | - Sumit K. Agrawal
- Department of Otolaryngology–Head and Neck SurgeryWestern UniversityLondonCanada
- National Centre for AudiologyWestern UniversityLondonCanada
- Cochlear Implant ProgramLondon Health Sciences CentreLondonCanada
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12
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Objective structured assessment of technical skill in temporal bone dissection: validation of a novel tool. The Journal of Laryngology & Otology 2021; 135:518-528. [PMID: 33975664 DOI: 10.1017/s0022215121001201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study developed an assessment tool that was based on the objective structured assessment for technical skills principles, to be used for evaluation of surgical skills in cortical mastoidectomy. The objective structured assessment of technical skill is a well-established tool for evaluation of surgical ability. This study also aimed to identify the best material and printing method to make a three-dimensional printed temporal bone model. METHODS Twenty-four otolaryngologists in training were asked to perform a cortical mastoidectomy on a three-dimensional printed temporal bone (selective laser sintering resin). They were scored according to the objective structured assessment of technical skill in temporal bone dissection tool developed in this study and an already validated global rating scale. RESULTS Two external assessors scored the candidates, and it was concluded that the objective structured assessment of technical skill in temporal bone dissection tool demonstrated some main aspects of validity and reliability that can be used in training and performance evaluation of technical skills in mastoid surgery. CONCLUSION Apart from validating the new tool for temporal bone dissection training, the study showed that evolving three-dimensional printing technologies is of high value in simulation training with several advantages over traditional teaching methods.
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13
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Aussedat C, Venail F, Marx M, Boullaud L, Bakhos D. Training in temporal bone drilling. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:140-145. [PMID: 33722469 DOI: 10.1016/j.anorl.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acquiring surgical experience in the operating room is increasingly difficult. Simulation of temporal bone drilling is therefore essential, and more and more widely used. The aim of this review is to clarify the limitations of classical surgical training, and to describe the different types of simulation available for temporal bone drilling. Systematic Medline search used the terms: "temporal bone" and training and surgery; "temporal bone" and training and drilling. Seventy-one of the 467 articles identified were relevant for this review. Various temporal bone simulators have been created to get around the limitations (ethical, financial, cultural, working time) of temporal bone drilling. They can be classified as cadaver, animal, physical or virtual models. The main advantages of physical and virtual prototyping are their ease of access, the possibility of repeating gestures on a standardised model, and the absence of ethical issues. Validation is essential before these simulators can be included in the curriculum, to ensure efficacy and thus improve patient safety in the operating room.
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Affiliation(s)
- C Aussedat
- Service ORL et chirurgie cervicofaciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
| | - F Venail
- Service ORL et chirurgie cervicofaciale, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - M Marx
- Service ORL et chirurgie cervicofaciale, CHU de Toulouse, place du Docteur-Baylac, 31059 Toulouse, France
| | - L Boullaud
- Service ORL et chirurgie cervicofaciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - D Bakhos
- Service ORL et chirurgie cervicofaciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
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14
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Frithioff A, Frendø M, Pedersen DB, Sørensen MS, Wuyts Andersen SA. 3D-Printed Models for Temporal Bone Surgical Training: A Systematic Review. Otolaryngol Head Neck Surg 2021; 165:617-625. [PMID: 33650897 DOI: 10.1177/0194599821993384] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE 3D-printed models hold great potential for temporal bone surgical training as a supplement to cadaveric dissection. Nevertheless, critical knowledge on manufacturing remains scattered, and little is known about whether use of these models improves surgical performance. This systematic review aims to explore (1) methods used for manufacturing and (2) how educational evidence supports using 3D-printed temporal bone models. DATA SOURCES PubMed, Embase, the Cochrane Library, and Web of Science. REVIEW METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were identified and data on manufacturing and validation and/or training extracted by 2 reviewers. Quality assessment was performed using the Medical Education Research Study Quality Instrument tool; educational outcomes were determined according to Kirkpatrick's model. RESULTS The search yielded 595 studies; 36 studies were found eligible and included for analysis. The described 3D-printed models were based on computed tomography scans from patients or cadavers. Processing included manual segmentation of key structures such as the facial nerve; postprocessing, for example, consisted of removal of print material inside the model. Overall, educational quality was low, and most studies evaluated their models using only expert and/or trainee opinion (ie, Kirkpatrick level 1). Most studies reported positive attitudes toward the models and their potential for training. CONCLUSION Manufacturing and use of 3D-printed temporal bones for surgical training are widely reported in the literature. However, evidence to support their use and knowledge about both manufacturing and the effects on subsequent surgical performance are currently lacking. Therefore, stronger educational evidence and manufacturing knowhow are needed for widespread implementation of 3D-printed temporal bones in surgical curricula.
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Affiliation(s)
- Andreas Frithioff
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - Martin Frendø
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
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15
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Freiser ME, Ghodadra A, McCall AA, Shaffer AD, Magnetta M, Jabbour N. Operable, Low-Cost, High-Resolution, Patient-Specific 3D Printed Temporal Bones for Surgical Simulation and Evaluation. Ann Otol Rhinol Laryngol 2021; 130:1044-1051. [PMID: 33554632 DOI: 10.1177/0003489421993733] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Three-dimensional printed models created on a consumer level printer can be used to practice mastoidectomy and to discern mastoidectomy experience level. Current models in the literature for mastoidectomy are limited by expense or operability. The aims of this study were (1) to investigate the utility of an inexpensive model for mastoidectomy and (2) to assess whether the model can be used as an evaluation tool to discern the experience level of the surgeon performing mastoidectomy. METHODS Three-dimensional printed temporal bone models from the CT scan of a 7-year old patient were created using a consumer-level stereolithography 3D printer for a raw material cost of $10 each. Mastoidectomy with facial recess approach was performed by 4 PGY-2 residents, 4 PGY-5 residents, and 4 attending surgeons on the models who then filled out an evaluation. The drilled models were collected and then graded in a blinded fashion by 6 attending otolaryngologists. RESULTS Both residents and faculty felt the model was useful for training (mean score 4.7 out of 5; range: 4-5) and case preparation (mean score: 4.3; range: 3-5). Grading of the drilled models revealed significant differences between junior resident, senior resident, and attending surgeon scores (P = .012) with moderate to excellent interrater agreement (ICC = 0.882). CONCLUSION The described operable model that is patient-specific was rated favorably for pediatric mastoidectomy case preparation and training by residents and faculty. The model may be used to differentiate between experience levels and has promise for use in formative and summative evaluations.
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Affiliation(s)
- Monika E Freiser
- Department of Otolaryngology, University of Pittsburgh Medical Center, PA, USA
| | - Anish Ghodadra
- Department of Radiology, University of Pittsburgh Medical Center, PA, USA
| | - Andrew A McCall
- Department of Otolaryngology, University of Pittsburgh Medical Center, PA, USA
| | | | | | - Noel Jabbour
- Department of Otolaryngology, University of Pittsburgh Medical Center, PA, USA.,Children's Hospital of Pittsburgh, PA, USA
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16
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Chien WW, da Cruz MJ, Francis HW. Validation of a 3D-printed human temporal bone model for otology surgical skill training. World J Otorhinolaryngol Head Neck Surg 2021; 7:88-93. [PMID: 33997717 PMCID: PMC8103535 DOI: 10.1016/j.wjorl.2020.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022] Open
Abstract
Hypothesis Three-dimensional (3D) printed temporal bones are comparable to cadaveric temporal bones as a training tool for otologic surgery. Background Cadaveric temporal bone dissection is an integral part of otology surgical training. Unfortunately, availability of cadaveric temporal bones is becoming much more limited and concern regarding chemical and biological risks persist. In this study, we examine the validity of 3D-printed temporal bone model as an alternative training tool for otologic surgery. Methods Seventeen otolaryngology trainees participated in the study. They were asked to complete a series of otologic procedures using 3D-printed temporal bones. A semi-structured questionnaire was used to evaluate their dissection experience on the 3D-printed temporal bones. Results Participants found that the 3D-printed temporal bones were anatomically realistic compared to cadaveric temporal bones. They found that the 3D-printed temporal bones were useful as a surgical training tool in general and also for specific otologic procedures. Overall, participants were enthusiastic about incorporation of 3D-printed temporal bones in temporal bone dissection training courses and would recommend them to other trainees. Conclusion 3D-printed temporal bone model is a viable alternative to human cadaveric temporal bones as a teaching tool for otologic surgery.
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Affiliation(s)
- Wade W Chien
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Melville J da Cruz
- Department of Otolaryngology, Westmead Hospital, Sydney, Australia.,Department of Surgery, University of Sydney, Sydney, Australia
| | - Howard W Francis
- Department of Otolaryngology-Head & Neck Surgery, Duke University School of Medicine, Durham, NC, USA
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17
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Qureshi UA, Calaguas S, Frank E, Inman J. Implications of Applying New Technology in Cosmetic and Reconstructive Facial Plastic Surgery. Facial Plast Surg 2020; 36:760-767. [PMID: 33368133 DOI: 10.1055/s-0040-1721116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The field of facial plastic and reconstructive surgery is privy to a myriad of technological advancements. As innovation in areas such as imaging, computer applications, and biomaterials progresses at breakneck speed, the potential for clinical application is endless. This review of recent progress in the implementation of new technologies in facial plastic surgery highlights some of the most innovative and impactful developments in the past few years of literature. Patient-specific surgical modeling has become the gold standard for oncologic and posttraumatic reconstructive surgery, with demonstrated improvements in operative times, restoration of anatomical structure, and patient satisfaction. Similarly, reductions in revision rates with improvements in learner technical proficiency have been noted with the use of patient-specific models in free flap reconstruction. In the cosmetic realm, simulation-based rhinoplasty implants have drastically reduced operative times while concurrently raising patient postoperative ratings of cosmetic appearance. Intraoperative imaging has also seen recent expansion in its adoption driven largely by reports of eradication of postoperative imaging and secondary-often complicated-revision reconstructions. A burgeoning area likely to deliver many advances in years to come is the integration of bioprinting into reconstructive surgery. Although yet to clearly make the translational leap, the implications of easily generatable induced pluripotent stem cells in replacing autologous, cadaveric, or synthetic tissues in surgical reconstruction are remarkable.
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Affiliation(s)
| | - Shannon Calaguas
- Department of Otolaryngology, Loma Linda University, Loma Linda, California
| | - Ethan Frank
- Department of Otolaryngology, Loma Linda University, Loma Linda, California
| | - Jared Inman
- Department of Otolaryngology, Loma Linda University, Loma Linda, California
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18
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Meglioli M, Naveau A, Macaluso GM, Catros S. 3D printed bone models in oral and cranio-maxillofacial surgery: a systematic review. 3D Print Med 2020; 6:30. [PMID: 33079298 PMCID: PMC7574578 DOI: 10.1186/s41205-020-00082-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
AIM This systematic review aimed to evaluate the use of three-dimensional (3D) printed bone models for training, simulating and/or planning interventions in oral and cranio-maxillofacial surgery. MATERIALS AND METHODS A systematic search was conducted using PubMed® and SCOPUS® databases, up to March 10, 2019, by following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol. Study selection, quality assessment (modified Critical Appraisal Skills Program tool) and data extraction were performed by two independent reviewers. All original full papers written in English/French/Italian and dealing with the fabrication of 3D printed models of head bone structures, designed from 3D radiological data were included. Multiple parameters and data were investigated, such as author's purpose, data acquisition systems, printing technologies and materials, accuracy, haptic feedback, variations in treatment time, differences in clinical outcomes, costs, production time and cost-effectiveness. RESULTS Among the 1157 retrieved abstracts, only 69 met the inclusion criteria. 3D printed bone models were mainly used as training or simulation models for tumor removal, or bone reconstruction. Material jetting printers showed best performance but the highest cost. Stereolithographic, laser sintering and binder jetting printers allowed to create accurate models with adequate haptic feedback. The cheap fused deposition modeling printers exhibited satisfactory results for creating training models. CONCLUSION Patient-specific 3D printed models are known to be useful surgical and educational tools. Faced with the large diversity of software, printing technologies and materials, the clinical team should invest in a 3D printer specifically adapted to the final application.
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Affiliation(s)
- Matteo Meglioli
- University Center of Dentistry, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Adrien Naveau
- Department of Prosthodontics, Dental Science Faculty, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France.,Dental and Periodontal Rehabilitation Unit, Saint Andre Hospital, Bordeaux University Hospital, 46 rue Léo-Saignat, 33076, Bordeaux, France.,Biotis Laboratory, Inserm U1026, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France
| | - Guido Maria Macaluso
- University Center of Dentistry, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy.,IMEM-CNR, Parco Area delle Scienze 37/A, 43124, Parma, Italy
| | - Sylvain Catros
- Biotis Laboratory, Inserm U1026, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France. .,Department of Oral Surgery, UFR d'Odontologie, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France. .,Service de Chirurgie Orale, CHU de Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France.
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19
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Stavrakas M, Triaridis S, Bamidis P, Constantinidis J, Karkos PD. A 3D Printed Model for Myringotomy and Grommet Insertion. EAR, NOSE & THROAT JOURNAL 2020; 100:1008S-1009S. [PMID: 32527168 DOI: 10.1177/0145561320933963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Panagiotis Bamidis
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, Greece
| | | | - Petros D Karkos
- ENT Department, AHEPA University Hospital, Thessaloniki, Greece
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20
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Carew RM, Errickson D. An Overview of 3D Printing in Forensic Science: The Tangible Third-Dimension. J Forensic Sci 2020; 65:1752-1760. [PMID: 32401341 DOI: 10.1111/1556-4029.14442] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 11/28/2022]
Abstract
There has been a rapid development and utilization of three-dimensional (3D) printing technologies in engineering, health care, and dentistry. Like many technologies in overlapping disciplines, these techniques have proved to be useful and hence incorporated into the forensic sciences. Therefore, this paper describes how the potential of using 3D printing is being recognized within the various sub-disciplines of forensic science and suggests areas for future applications. For instance, the application can create a permanent record of an object or scene that can be used as demonstrative evidence, preserving the integrity of the actual object or scene. Likewise, 3D printing can help with the visualization of evidential spatial relationships within a scene and increase the understanding of complex terminology within a courtroom. However, while the application of 3D printing to forensic science is beneficial, currently there is limited research demonstrated in the literature and a lack of reporting skewing the visibility of the applications. Therefore, this article highlights the need to create good practice for 3D printing across the forensic science process, the need to develop accurate and admissible 3D printed models while exploring the techniques, accuracy and bias within the courtroom, and calls for the alignment of future research and agendas perhaps in the form of a specialist working group.
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Affiliation(s)
- Rachael M Carew
- Department of Security and Crime Science, University College London, 35 Tavistock Square, London, WC1H 9EZ, U.K.,Centre for the Forensic Sciences, University College London, 35 Tavistock Square, London, WC1H 9EZ, U.K
| | - David Errickson
- Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, SN6 8LA, U.K
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21
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McMillan A, Kocharyan A, Dekker SE, Kikano EG, Garg A, Huang VW, Moon N, Cooke M, Mowry SE. Comparison of Materials Used for 3D-Printing Temporal Bone Models to Simulate Surgical Dissection. Ann Otol Rhinol Laryngol 2020; 129:1168-1173. [DOI: 10.1177/0003489420918273] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To identify 3D-printed temporal bone (TB) models that most accurately recreate cortical mastoidectomy for use as a training tool by comparison of different materials and fabrication methods. Background: There are several different printers and materials available to create 3D-printed TB models for surgical planning and trainee education. Current reports using Acrylonitrile Butadiene Styrene (ABS) plastic generated via fused deposition modeling (FDM) have validated the capacity for 3D-printed models to serve as accurate surgical simulators. Here, a head-to-head comparison of models produced using different materials and fabrication processes was performed to identify superior models for application in skull base surgical training. Methods: High-resolution CT scans of normal TBs were used to create stereolithography files with image conversion for application in 3D-printing. The 3D-printed models were constructed using five different materials and four printers, including ABS printed on a MakerBot 2x printer, photopolymerizable polymer (Photo) using the Objet 350 Connex3 Printer, polycarbonate (PC) using the FDM-Fortus 400 mc printer, and two types of photocrosslinkable acrylic resin, white and blue (FLW and FLB, respectively), using the Formlabs Form 2 stereolithography printer. Printed TBs were drilled to assess the haptic experience and recreation of TB anatomy with comparison to the current paradigm of ABS. Results: Surgical drilling demonstrated that FLW models created by FDM as well as PC and Photo models generated using photopolymerization more closely recreated cortical mastoidectomy compared to ABS models. ABS generated odor and did not represent the anatomy accurately. Blue resin performed poorly in simulation, likely due to its dark color and translucent appearance. Conclusions: PC, Photo, and FLW models best replicated surgical drilling and anatomy as compared to ABS and FLB models. These prototypes are reliable simulators for surgical training.
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Affiliation(s)
- Alexandra McMillan
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Armine Kocharyan
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Simone E. Dekker
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Elias George Kikano
- Department of Diagnostic Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Anisha Garg
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Victoria W. Huang
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicholas Moon
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Malcolm Cooke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland OH, USA
| | - Sarah E. Mowry
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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22
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Replicating Skull Base Anatomy With 3D Technologies: A Comparative Study Using 3D-scanned and 3D-printed Models of the Temporal Bone. Otol Neurotol 2020; 41:e392-e403. [DOI: 10.1097/mao.0000000000002524] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Mooney MA, Cavallo C, Zhou JJ, Bohl MA, Belykh E, Gandhi S, McBryan S, Stevens SM, Lawton MT, Almefty KK, Nakaji P. Three-Dimensional Printed Models for Lateral Skull Base Surgical Training: Anatomy and Simulation of the Transtemporal Approaches. Oper Neurosurg (Hagerstown) 2020; 18:193-201. [PMID: 31172189 DOI: 10.1093/ons/opz120] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/21/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) printing holds great potential for lateral skull base surgical training; however, studies evaluating the use of 3D-printed models for simulating transtemporal approaches are lacking. OBJECTIVE To develop and evaluate a 3D-printed model that accurately represents the anatomic relationships, surgical corridor, and surgical working angles achieved with increasingly aggressive temporal bone resection in lateral skull base approaches. METHODS Cadaveric temporal bones underwent thin-slice computerized tomography, and key anatomic landmarks were segmented using 3D imaging software. Corresponding 3D-printed temporal bone models were created, and 4 stages of increasingly aggressive transtemporal approaches were performed (40 total approaches). The surgical exposure and working corridor were analyzed quantitatively, and measures of face validity, content validity, and construct validity in a cohort of 14 participants were assessed. RESULTS Stereotactic measurements of the surgical angle of approach to the mid-clivus, residual bone angle, and 3D-scanned infill volume demonstrated comparable changes in both the 3D temporal bone models and cadaveric specimens based on the increasing stages of transtemporal approaches (PANOVA <.003, <.007, and <.007, respectively), indicating accurate representation of the surgical corridor and working angles in the 3D-printed models. Participant assessment revealed high face validity, content validity, and construct validity. CONCLUSION The 3D-printed temporal bone models highlighting key anatomic structures accurately simulated 4 sequential stages of transtemporal approaches with high face validity, content validity, and construct validity. This strategy may provide a useful educational resource for temporal bone anatomy and training in lateral skull base approaches.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Claudio Cavallo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - James J Zhou
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Evgenii Belykh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sirin Gandhi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sarah McBryan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Shawn M Stevens
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Freiser ME, Ghodadra A, Hart L, Griffith C, Jabbour N. Safety of Drilling 3-Dimensional-Printed Temporal Bones. JAMA Otolaryngol Head Neck Surg 2019; 144:797-801. [PMID: 30335883 DOI: 10.1001/jamaoto.2018.1516] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Three-dimensional (3-D) printing of temporal bones is becoming more prevalent. However, there has been no measure of the safety of drilling these models to date. It is unknown whether the heat and sheer from the drill may create harmful volatile organic compounds (VOCs). Objective To determine the level of exposure to airborne contaminants when conducting high-speed drilling on 3-D-printed models and to explore whether there is a need for exposure control measures. Design, Setting, and Participants In this occupational safety assessment carried out in a temporal bone laboratory, 3 individual 3-D-printed temporal bones were made using 3 different materials commonly cited in the literature: polylactic acid (PLA), photoreactive acrylic resin (PAR), and acrylonitrile butadiene styrene (ABS). Each model was drilled for 40 minutes while the surgeon wore a sampling badge. Sampling was conducted for airborne concentrations of VOCs and total particulate (TP). Monitoring for VOCs was conducted using Assay Technology 521-25 organic vapor badge worn at the surgeon's neckline. Monitoring for TP was conducted using a polyvinyl chloride filter housed inside a cassette and coupled with an SKC AirChek 52 personal air-sampling pump. Samples were collected and analyzed in accordance with NIOSH Method 500. Main Outcomes and Measures Presence of VOCs and TP count exposures at Occupational Safety and Health Administration (OSHA) actionable levels. Results Results of the VOC sample were less than detection limits except for isopropyl alcohol at 0.24 ppm for PAR. The TP samples were less than the detection limit of 1.4 mg/m3. The results are below all applicable OSHA Action Levels and Permissible Exposure Limits for all contaminants sampled for. Conclusions and Relevance Drilling 3-D-printed models made from PLA, ABS, and PAR was safe by OSHA standards. Continued monitoring and safety testing are needed as 3-D-printed technologies are introduced to our specialty.
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Affiliation(s)
- Monika E Freiser
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anish Ghodadra
- Department of Radiology, Yale Medical Center, New Haven, Connecticut
| | - Lindsay Hart
- Office of Environmental Safety, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christopher Griffith
- Office of Environmental Safety, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Noel Jabbour
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Bohl MA, McBryan S, Nakaji P, Chang SW, Turner JD, Kakarla UK. Development and first clinical use of a novel anatomical and biomechanical testing platform for scoliosis. JOURNAL OF SPINE SURGERY (HONG KONG) 2019; 5:329-336. [PMID: 31663044 PMCID: PMC6787359 DOI: 10.21037/jss.2019.09.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have demonstrated that, by using various three-dimensional (3D) printing technologies, synthetic spine models can be manufactured to mimic a human spine in its gross and radiographic anatomy and the biomechanical performance of bony and ligamentous tissue. These manufacturing processes have not, however, been used in combination to create a long-segment, biomimetic model of a patient with scoliosis. The purpose of this study was to describe the development of a biomimetic scoliosis model and early clinical experience using this model as a surgical planning and education platform. METHODS Synthetic spine models were printed to mimic the anatomy and biomechanical performance of 2 adult patients with scoliosis. Preoperatively, the models were surgically corrected by the attending surgeon of each patient. Patients then underwent surgical correction of their spinal deformities. Correction of the models was compared to the surgical correction in the patients. RESULTS Patient 1 had a preoperative coronal Cobb angle of 40° from L1 to S1, as did the patient's synthetic spine model. The patient's spine model was corrected to 17.6°, and the patient achieved a correction of 17.3°. Patient 2 had a preoperative mid-thoracic Cobb angle of 88° and an upper thoracic Cobb angle of 43°. Preoperatively, the patient's spine model was corrected to 19.5° and 9.2° for the mid-thoracic and upper thoracic curves, respectively. Immediately after surgery, the patient's mid-thoracic and upper thoracic Cobb angles measured 18.7° and 9.5°, respectively. In both cases, the use of the spine models preoperatively changed the attending surgeon's operative plan. CONCLUSIONS A novel synthetic spine model for corrective scoliosis procedures is presented, along with early clinical experience using this model as a surgical planning platform. This model has tremendous potential not only as a surgical planning platform but also as an adjunct to patient consent, surgical education, and biomechanical research.
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Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Sarah McBryan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Ospina JC, Fandiño A, Hernández S, Uriza LF, Aragonéz D, Mondragón IF, Durán D, Magness J. 3D-printed pediatric temporal bone models for surgical training: a patient-specific and low-cost alternative. ACTA ACUST UNITED AC 2019. [DOI: 10.2217/3dp-2019-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To determine the usefulness of low-cost 3D-printed pediatric temporal bone models and to define if they could be used as a tool for large-scale surgical training based on their affordability. Materials & methods: Prototypes of a pediatric temporal bone were printed using fused deposition modeling 3D printing technique. The prototypes were drilled. The surgical simulation experience was registered by means of a Likert scale questionnaire. Results: The prototypes adequately simulated a cadaveric temporal bone. The costs associated with production were low compared with other commercial models making it a cost-effective alternative for a temporal bone laboratory. Conclusion: Printed temporal bones created by means of fused deposition modeling are useful for surgical simulation and training in otolaryngology, and it is possible to achieve detailed low-cost models.
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Affiliation(s)
- Juan C Ospina
- Otolaryngology & Maxillofacial Surgery Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Cra. 7 No. 40–62, 110231 Bogotá, Colombia
| | - Alejandro Fandiño
- Otolaryngology & Maxillofacial Surgery Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Cra. 7 No. 40–62, 110231 Bogotá, Colombia
| | - Santiago Hernández
- Otolaryngology & Maxillofacial Surgery Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Cra. 7 No. 40–62, 110231 Bogotá, Colombia
| | - Luis F Uriza
- Radiology Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Cra. 7 No. 40–62, 110231 Bogotá, Colombia
| | - Diego Aragonéz
- Technological Center of Industrial Automation (CTAI), Department of Engineering, Pontificia Universidad Javeriana, Cra. 7 No. 40–69, 110231 Bogotá, Colombia
| | - Iván F Mondragón
- Technological Center of Industrial Automation (CTAI), Department of Engineering, Pontificia Universidad Javeriana, Cra. 7 No. 40–69, 110231 Bogotá, Colombia
| | - Deivy Durán
- Technological Center of Industrial Automation (CTAI), Department of Engineering, Pontificia Universidad Javeriana, Cra. 7 No. 40–69, 110231 Bogotá, Colombia
| | - Jay Magness
- Radiology Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Cra. 7 No. 40–62, 110231 Bogotá, Colombia
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Evaluation of 3D Printed Temporal Bone Models in Preparation for Middle Cranial Fossa Surgery. Otol Neurotol 2019; 40:246-253. [DOI: 10.1097/mao.0000000000002073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ratinam R, Quayle M, Crock J, Lazarus M, Fogg Q, McMenamin P. Challenges in creating dissectible anatomical 3D prints for surgical teaching. J Anat 2019; 234:419-437. [PMID: 30710355 DOI: 10.1111/joa.12934] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 01/17/2023] Open
Abstract
Three-dimensional (3D) printing, or additive manufacturing, is now a widely used tool in pre-operative planning, surgical teaching and simulator training. However, 3D printing technology that produces models with accurate haptic feedback, biomechanics and visuals for the training surgeon is not currently available. Challenges and opportunities in creating such surgical models will be discussed in this review paper. Surgery requires proper tissue handling as well as knowledge of relevant anatomy. To prepare doctors properly, training models need to take into account the biomechanical properties of the anatomical structures that will be manipulated in any given operation. This review summarises and evaluates the current biomechanical literature as it relates to human tissues and correlates the impact of this knowledge on developing high fidelity 3D printed surgical training models. We conclude that, currently, a printer technology has not yet been developed which can replicate many of the critical qualities of human tissue. Advances in 3D printing technology will be required to allow the printing of multi-material products to achieve the mechanical properties required.
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Affiliation(s)
- Ratheesraj Ratinam
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia
| | - Michelle Quayle
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia
| | - John Crock
- Department of Surgery, Monash University, Clayton, Vic., Australia
| | - Michelle Lazarus
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia
| | - Quentin Fogg
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia.,Department of Anatomy and Neuroscience, The University of Melbourne, Melbourne, Vic., Australia
| | - Paul McMenamin
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia
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Canzi P, Magnetto M, Marconi S, Morbini P, Mauramati S, Aprile F, Avato I, Auricchio F, Benazzo M. New frontiers and emerging applications of 3D printing in ENT surgery: a systematic review of the literature. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:286-303. [PMID: 30197421 PMCID: PMC6146580 DOI: 10.14639/0392-100x-1984] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/14/2018] [Indexed: 12/22/2022]
Abstract
3D printing systems have revolutionised prototyping in the industrial field by lowering production time from days to hours and costs from thousands to just a few dollars. Today, 3D printers are no more confined to prototyping, but are increasingly employed in medical disciplines with fascinating results, even in many aspects of otorhinolaryngology. All publications on ENT surgery, sourced through updated electronic databases (PubMed, MEDLINE, EMBASE) and published up to March 2017, were examined according to PRISMA guidelines. Overall, 121 studies fulfilled specific inclusion criteria and were included in our systematic review. Studies were classified according to the specific field of application (otologic, rhinologic, head and neck) and area of interest (surgical and preclinical education, customised surgical planning, tissue engineering and implantable prosthesis). Technological aspects, clinical implications and limits of 3D printing processes are discussed focusing on current benefits and future perspectives.
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Affiliation(s)
- P. Canzi
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - M. Magnetto
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - S. Marconi
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - P. Morbini
- Department of Pathology, University of Pavia, Foundation IRCCS Policlinico S. Matteo, Pavia, Italy
| | - S. Mauramati
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - F. Aprile
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - I. Avato
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
- PhD in Experimental Medicine, University of Pavia, Italy
| | - F. Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - M. Benazzo
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
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Haleem A, Javaid M. Role of CT and MRI in the design and development of orthopaedic model using additive manufacturing. J Clin Orthop Trauma 2018; 9:213-217. [PMID: 30202151 PMCID: PMC6128794 DOI: 10.1016/j.jcot.2018.07.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To study the role of Computed tomography (CT) and Magnetic resonance imaging (MRI) for design and development of orthopaedic model using additive manufacturing (AM) technologies. METHODS A significant number of research papers in this area are studied to provide the direction of development along with the future scope. RESULTS Briefly discussed various steps used to create a 3D model by Additive Manufacturing using CT and MRI scan. These scanning technologies are used to produce medical as well as orthopaedic implants by using AM technologies. The images so produced are exported in different software like OsiriX Imaging Software, 3D slicer, Mimics, Magics, 3D doctor and InVesalius to produce a 3D digital model. Various criteria's achieved by CT and MRI scan for design and development of orthopaedic implant using additive manufacturing are also discussed briefly. AM model created by this process show exact shape, size, dimensions, textures, colour and features. CONCLUSION AM technologies help to convert the digital model into a 3D physical object, thereby improving the understanding of patient anatomy for treatment as well as for educational purpose. These scanning technologies have various applications to enhance the AM in the field of orthopaedic. In orthopaedic every patient model is a customised unit, sourced from the individual patient. 3D CAD data captured by these scanning technologies are directly exported in standard triangulate language (STL) format for printing by AM technologies. Crossestion of the physical model fabricated by this process shows a patient's anatomy if the model prepared by using the bone-like material.
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Affiliation(s)
| | - Mohd Javaid
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
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A novel three-dimensional-printed paranasal sinus-skull base anatomical model. Eur Arch Otorhinolaryngol 2018; 275:2045-2049. [PMID: 29959564 DOI: 10.1007/s00405-018-5051-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE A novel precision three-dimensional (3D)-printed paranasal sinus-skull base anatomical model was generated with a commercial grade desktop 3D printer. A specific page-turning pattern was employed in this model, to display the internal spatial structure of the paranasal sinus. METHODS The CT image data of paranasal sinus were imported into the Mimics software to construct a 3D digital paranasal sinus-skull base model. Then, the model was sliced in the coronal position and loaded into the 3D printer to print each slice of the paranasal sinus-skull base model at a ratio of 1:1 in size. Based on CT image data, nine senior doctors assessed the simulation and accuracy of the anatomical structure features of the paranasal sinus-skull base, and the advantages and educational value of the 3D printing model using a seven-point Likert scale. RESULTS A life-like 3D paranasal sinus-skull base structural model was successfully printed, with its internal spatial details clearly displayed. Nine senior doctors all thought that the profile of the printed anatomical structure was similar to that displayed by CT scan; however, the model provided more 3D spatial visual information. In addition, the model was considered to be of great value in the anatomy teaching and complicated surgery of the paranasal sinus-skull base, which had a material cost of only 3 dollars. CONCLUSIONS The 3D printed paranasal sinus-skull base model has 3D visual functions, which provides a novel tool for anatomical studies on paranasal sinus, resident training, pre-surgical education and surgical planning.
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Bose S, Robertson SF, Bandyopadhyay A. Surface modification of biomaterials and biomedical devices using additive manufacturing. Acta Biomater 2018; 66:6-22. [PMID: 29109027 PMCID: PMC5785782 DOI: 10.1016/j.actbio.2017.11.003] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 12/15/2022]
Abstract
The demand for synthetic biomaterials in medical devices, pharmaceutical products and, tissue replacement applications are growing steadily due to aging population worldwide. The use for patient matched devices is also increasing due to availability and integration of new technologies. Applications of additive manufacturing (AM) or 3D printing (3DP) in biomaterials have also increased significantly over the past decade towards traditional as well as innovative next generation Class I, II and III devices. In this review, we have focused our attention towards the use of AM in surface modified biomaterials to enhance their in vitro and in vivo performances. Specifically, we have discussed the use of AM to deliberately modify the surfaces of different classes of biomaterials with spatial specificity in a single manufacturing process as well as commented on the future outlook towards surface modification using AM. STATEMENT OF SIGNIFICANCE It is widely understood that the success of implanted medical devices depends largely on favorable material-tissue interactions. Additive manufacturing has gained traction as a viable and unique approach to engineered biomaterials, for both bulk and surface properties that improve implant outcomes. This review explores how additive manufacturing techniques have been and can be used to augment the surfaces of biomedical devices for direct clinical applications.
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Affiliation(s)
- Susmita Bose
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States.
| | - Samuel Ford Robertson
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States
| | - Amit Bandyopadhyay
- W. M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, United States
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Garcia J, Yang Z, Mongrain R, Leask RL, Lachapelle K. 3D printing materials and their use in medical education: a review of current technology and trends for the future. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2017; 4:27-40. [PMID: 29354281 PMCID: PMC5765850 DOI: 10.1136/bmjstel-2017-000234] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/07/2017] [Accepted: 09/02/2017] [Indexed: 01/15/2023]
Abstract
3D printing is a new technology in constant evolution. It has rapidly expanded and is now being used in health education. Patient-specific models with anatomical fidelity created from imaging dataset have the potential to significantly improve the knowledge and skills of a new generation of surgeons. This review outlines five technical steps required to complete a printed model: They include (1) selecting the anatomical area of interest, (2) the creation of the 3D geometry, (3) the optimisation of the file for the printing and the appropriate selection of (4) the 3D printer and (5) materials. All of these steps require time, expertise and money. A thorough understanding of educational needs is therefore essential in order to optimise educational value. At present, most of the available printing materials are rigid and therefore not optimum for flexibility and elasticity unlike biological tissue. We believe that the manipuation and tuning of material properties through the creation of composites and/or blending materials will eventually allow for the creation of patient-specific models which have both anatomical and tissue fidelity.
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Affiliation(s)
- Justine Garcia
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada
| | - ZhiLin Yang
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada
| | - Rosaire Mongrain
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada
| | - Richard L Leask
- Department of Chemical Engineering, McGill University, Montreal, Quebec, Canada
| | - Kevin Lachapelle
- Department of Cardiovascular Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Mouser VHM, Levato R, Bonassar LJ, D’Lima DD, Grande DA, Klein TJ, Saris DBF, Zenobi-Wong M, Gawlitta D, Malda J. Three-Dimensional Bioprinting and Its Potential in the Field of Articular Cartilage Regeneration. Cartilage 2017; 8:327-340. [PMID: 28934880 PMCID: PMC5613889 DOI: 10.1177/1947603516665445] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Three-dimensional (3D) bioprinting techniques can be used for the fabrication of personalized, regenerative constructs for tissue repair. The current article provides insight into the potential and opportunities of 3D bioprinting for the fabrication of cartilage regenerative constructs. Although 3D printing is already used in the orthopedic clinic, the shift toward 3D bioprinting has not yet occurred. We believe that this shift will provide an important step forward in the field of cartilage regeneration. Three-dimensional bioprinting techniques allow incorporation of cells and biological cues during the manufacturing process, to generate biologically active implants. The outer shape of the construct can be personalized based on clinical images of the patient's defect. Additionally, by printing with multiple bio-inks, osteochondral or zonally organized constructs can be generated. Relevant mechanical properties can be obtained by hybrid printing with thermoplastic polymers and hydrogels, as well as by the incorporation of electrospun meshes in hydrogels. Finally, bioprinting techniques contribute to the automation of the implant production process, reducing the infection risk. To prompt the shift from nonliving implants toward living 3D bioprinted cartilage constructs in the clinic, some challenges need to be addressed. The bio-inks and required cartilage construct architecture need to be further optimized. The bio-ink and printing process need to meet the sterility requirements for implantation. Finally, standards are essential to ensure a reproducible quality of the 3D printed constructs. Once these challenges are addressed, 3D bioprinted living articular cartilage implants may find their way into daily clinical practice.
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Affiliation(s)
- Vivian H. M. Mouser
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Riccardo Levato
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Darryl D. D’Lima
- Shiley Center for Orthopaedic Research, Scripps Health, La Jolla, CA, USA
| | - Daniel A. Grande
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Northwell Health System, Manhasset, NY, USA
| | - Travis J. Klein
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Daniel B. F. Saris
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Debby Gawlitta
- Department of Oral and Maxillofacial Surgery & Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jos Malda
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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VanKoevering KK, Malloy KM. Emerging Role of Three-Dimensional Printing in Simulation in Otolaryngology. Otolaryngol Clin North Am 2017; 50:947-958. [DOI: 10.1016/j.otc.2017.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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3D printing for clinical application in otorhinolaryngology. Eur Arch Otorhinolaryngol 2017; 274:4079-4089. [DOI: 10.1007/s00405-017-4743-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/12/2017] [Indexed: 12/12/2022]
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Abstract
HYPOTHESIS Computed tomographic (CT) scans of the 3-D printed temporal bone models will be within 15% accuracy of the CT scans of the cadaveric temporal bones. BACKGROUND Previous studies have evaluated the face validity of 3-D-printed temporal bone models designed to train otolaryngology residents. The purpose of the study was to determine the content validity of temporal bone models printed using inexpensive printers and materials. METHODS Four cadaveric temporal bones were randomly selected and clinical temporal bone CT scans were obtained. Models were generated using previously described methods in acrylonitrile butadiene styrene (ABS) plastic using the Makerbot Replicator 2× and Hyrel printers. Models were radiographically scanned using the same protocol as the cadaveric bones. Four images from each cadaveric CT series and four corresponding images from the model CT series were selected, and voxel values were normalized to black or white. Scan slices were compared using PixelDiff software. Gross anatomic structures were evaluated in the model scans by four board certified otolaryngologists on a 4-point scale. RESULTS Mean pixel difference between the cadaver and model scans was 14.25 ± 2.30% at the four selected CT slices. Mean cortical bone width difference and mean external auditory canal width difference were 0.58 ± 0.66 mm and 0.55 ± 0.46 mm, respectively. Expert raters felt the mastoid air cells were well represented (2.5 ± 0.5), while middle ear and otic capsule structures were not accurately rendered (all averaged <1.8). CONCLUSION These results suggest that these models would be sufficient adjuncts to cadaver temporal bones for training residents in cortical mastoidectomies, but less effective for middle ear procedures.
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Utility of 3D printed temporal bones in pre-surgical planning for complex BoneBridge cases. Eur Arch Otorhinolaryngol 2017; 274:3021-3028. [DOI: 10.1007/s00405-017-4618-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
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Creating an Optimal 3D Printed Model for Temporal Bone Dissection Training. Ann Otol Rhinol Laryngol 2017; 126:530-536. [DOI: 10.1177/0003489417705395] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Making a 3-dimensional (3D) temporal bone model is simple using a plaster powder bed and an inkjet printer. However, it is difficult to reproduce air-containing spaces and precise middle ear structures. The objective of this study was to overcome these problems and create a temporal bone model that would be useful both as a training tool and for preoperative simulation. Methods: Drainage holes were made to remove excess materials from air-containing spaces, ossicle ligaments were manually changed to bony structures, and small and/or soft tissue structures were colored differently while designing the 3D models. The outcomes were evaluated by 3 procedures: macroscopic and endoscopic inspection of the model, comparison of computed tomography (CT) images of the model to the original CT, and assessment of tactile sensation and reproducibility by 20 surgeons performing surgery on the model. Results: Macroscopic and endoscopic inspection, CT images, and assessment by surgeons were in agreement in terms of reproducibility of model structures. Most structures could be reproduced, but the stapes, tympanic sinus, and mastoid air cells were unsatisfactory. Perioperative tactile sensation of the model was excellent. Conclusions: Although this model still does not embody perfect reproducibility, it proved sufficiently practical for use in surgical training.
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Aussedat C, Venail F, Nguyen Y, Lescanne E, Marx M, Bakhos D. Usefulness of temporal bone prototype for drilling training: A prospective study. Clin Otolaryngol 2017; 42:1200-1205. [DOI: 10.1111/coa.12846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 11/26/2022]
Affiliation(s)
- C. Aussedat
- CHU de Tours, service ORL et Chirurgie Cervico-Faciale; Tours France
| | - F. Venail
- CHU de Montpellier, service ORL et Chirurgie Cervico-Faciale; Montpellier France
| | - Y. Nguyen
- AP-HP La Pitié Salpêtrière, service ORL et Chirurgie Cervico-Faciale; boulevard de l'hôpital; Paris France
| | - E. Lescanne
- CHU de Tours, service ORL et Chirurgie Cervico-Faciale; Tours France
| | - M. Marx
- CHU de Toulouse, service ORL et Chirurgie Cervico-Faciale; Toulouse France
| | - D. Bakhos
- CHU de Tours, service ORL et Chirurgie Cervico-Faciale; Tours France
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Mafeld S, Nesbitt C, McCaslin J, Bagnall A, Davey P, Bose P, Williams R. Three-dimensional (3D) printed endovascular simulation models: a feasibility study. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:42. [PMID: 28251121 DOI: 10.21037/atm.2017.01.16] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Three-dimensional (3D) printing is a manufacturing process in which an object is created by specialist printers designed to print in additive layers to create a 3D object. Whilst there are initial promising medical applications of 3D printing, a lack of evidence to support its use remains a barrier for larger scale adoption into clinical practice. Endovascular virtual reality (VR) simulation plays an important role in the safe training of future endovascular practitioners, but existing VR models have disadvantages including cost and accessibility which could be addressed with 3D printing. METHODS This study sought to evaluate the feasibility of 3D printing an anatomically accurate human aorta for the purposes of endovascular training. RESULTS A 3D printed model was successfully designed and printed and used for endovascular simulation. The stages of development and practical applications are described. Feedback from 96 physicians who answered a series of questions using a 5 point Likert scale is presented. CONCLUSIONS Initial data supports the value of 3D printed endovascular models although further educational validation is required.
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Affiliation(s)
- Sebastian Mafeld
- Department of Interventional Radiology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - Craig Nesbitt
- Department of Vascular Surgery, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - James McCaslin
- Department of Vascular Surgery, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - Alan Bagnall
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - Philip Davey
- Department of Vascular Surgery, University Hospital of North Durham, Durham, DH1 5TW, UK
| | - Pentop Bose
- Department of Interventional Radiology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Rob Williams
- Department of Interventional Radiology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
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Crafts TD, Ellsperman SE, Wannemuehler TJ, Bellicchi TD, Shipchandler TZ, Mantravadi AV. Three-Dimensional Printing and Its Applications in Otorhinolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg 2016; 156:999-1010. [PMID: 28421875 DOI: 10.1177/0194599816678372] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective Three-dimensional (3D)-printing technology is being employed in a variety of medical and surgical specialties to improve patient care and advance resident physician training. As the costs of implementing 3D printing have declined, the use of this technology has expanded, especially within surgical specialties. This article explores the types of 3D printing available, highlights the benefits and drawbacks of each methodology, provides examples of how 3D printing has been applied within the field of otolaryngology-head and neck surgery, discusses future innovations, and explores the financial impact of these advances. Data Sources Articles were identified from PubMed and Ovid MEDLINE. Review Methods PubMed and Ovid Medline were queried for English articles published between 2011 and 2016, including a few articles prior to this time as relevant examples. Search terms included 3-dimensional printing, 3 D printing, otolaryngology, additive manufacturing, craniofacial, reconstruction, temporal bone, airway, sinus, cost, and anatomic models. Conclusions Three-dimensional printing has been used in recent years in otolaryngology for preoperative planning, education, prostheses, grafting, and reconstruction. Emerging technologies include the printing of tissue scaffolds for the auricle and nose, more realistic training models, and personalized implantable medical devices. Implications for Practice After the up-front costs of 3D printing are accounted for, its utilization in surgical models, patient-specific implants, and custom instruments can reduce operating room time and thus decrease costs. Educational and training models provide an opportunity to better visualize anomalies, practice surgical technique, predict problems that might arise, and improve quality by reducing mistakes.
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Affiliation(s)
- Trevor D Crafts
- 1 Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Susan E Ellsperman
- 1 Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Todd J Wannemuehler
- 1 Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Travis D Bellicchi
- 2 Department of Prosthodontics and Facial Prosthetics, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Taha Z Shipchandler
- 1 Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Avinash V Mantravadi
- 1 Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Bhutta MF. A review of simulation platforms in surgery of the temporal bone. Clin Otolaryngol 2016; 41:539-45. [PMID: 26453455 DOI: 10.1111/coa.12560] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgery of the temporal bone is a high-risk activity in an anatomically complex area. Simulation enables rehearsal of such surgery. The traditional simulation platform is the cadaveric temporal bone, but in recent years other simulation platforms have been created, including plastic and virtual reality platforms. OBJECTIVE OF REVIEW To undertake a review of simulation platforms for temporal bone surgery, specifically assessing their educational value in terms of validity and in enabling transition to surgery. TYPE OF REVIEW Systematic qualitative review. SEARCH STRATEGY Search of the Pubmed, CINAHL, BEI and ERIC databases. EVALUATION METHOD Assessment of reported outcomes in terms of educational value. RESULTS A total of 49 articles were included, covering cadaveric, animal, plastic and virtual simulation platforms. Cadaveric simulation is highly rated as an educational tool, but there may be a ceiling effect on educational outcomes after drilling 8-10 temporal bones. Animal models show significant anatomical variation from man. Plastic temporal bone models offer much potential, but at present lack sufficient anatomical or haptic validity. Similarly, virtual reality platforms lack sufficient anatomical or haptic validity, but with technological improvements they are advancing rapidly. CONCLUSIONS At present, cadaveric simulation remains the best platform for training in temporal bone surgery. Technological advances enabling improved materials or modelling mean that in the future plastic or virtual platforms may become comparable to cadaveric platforms, and also offer additional functionality including patient-specific simulation from CT data.
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Affiliation(s)
- M F Bhutta
- Specialist Registrar, Royal National Throat Nose and Ear Hospital, London, UK.
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Carlos C, Parkes W, James AL. Application of 3-dimensional Modeling to Plan Totally Endoscopic Per-Meatal Drainage of Petrous Apex Cholesterol Granuloma. Otolaryngol Head Neck Surg 2015; 153:1074-5. [DOI: 10.1177/0194599815607851] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/02/2015] [Indexed: 11/15/2022]
Affiliation(s)
| | - William Parkes
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Adrian L. James
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Canada
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Naftulin JS, Kimchi EY, Cash SS. Streamlined, Inexpensive 3D Printing of the Brain and Skull. PLoS One 2015; 10:e0136198. [PMID: 26295459 PMCID: PMC4546422 DOI: 10.1371/journal.pone.0136198] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/31/2015] [Indexed: 12/12/2022] Open
Abstract
Neuroimaging technologies such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) collect three-dimensional data (3D) that is typically viewed on two-dimensional (2D) screens. Actual 3D models, however, allow interaction with real objects such as implantable electrode grids, potentially improving patient specific neurosurgical planning and personalized clinical education. Desktop 3D printers can now produce relatively inexpensive, good quality prints. We describe our process for reliably generating life-sized 3D brain prints from MRIs and 3D skull prints from CTs. We have integrated a standardized, primarily open-source process for 3D printing brains and skulls. We describe how to convert clinical neuroimaging Digital Imaging and Communications in Medicine (DICOM) images to stereolithography (STL) files, a common 3D object file format that can be sent to 3D printing services. We additionally share how to convert these STL files to machine instruction gcode files, for reliable in-house printing on desktop, open-source 3D printers. We have successfully printed over 19 patient brain hemispheres from 7 patients on two different open-source desktop 3D printers. Each brain hemisphere costs approximately $3–4 in consumable plastic filament as described, and the total process takes 14–17 hours, almost all of which is unsupervised (preprocessing = 4–6 hr; printing = 9–11 hr, post-processing = <30 min). Printing a matching portion of a skull costs $1–5 in consumable plastic filament and takes less than 14 hr, in total. We have developed a streamlined, cost-effective process for 3D printing brain and skull models. We surveyed healthcare providers and patients who confirmed that rapid-prototype patient specific 3D models may help interdisciplinary surgical planning and patient education. The methods we describe can be applied for other clinical, research, and educational purposes.
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Affiliation(s)
- Jason S. Naftulin
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Eyal Y. Kimchi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Sydney S. Cash
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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