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Mokryk I, Batsak B, Nechai I, Stetsyuk I, Todurov B. A personalized aortic valve replacement using computed tomography-guided aortic valve neocuspidization. Analysis of mid-term results compared to standard Ozaki technique. J Cardiovasc Comput Tomogr 2024; 18:345-351. [PMID: 38553401 DOI: 10.1016/j.jcct.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND The original Ozaki technique involves sizing the neovalve cusps during cross-clamp. It leads to prolonging the ischemic time compared to standard surgical AVR. Measurements taken on the collapsed Aortic Root (AR) may also be inaccurate. We use preoperative Computed Tomography (CT) to perform more accurate sizing in physiological conditions and shorten the ischemic time. This study analyzes the results of the CT-guided Aortic Valve Neocuspidization (AVNeo) compared with the Ozaki technique. METHODS The validity of the concept was evaluated ex vivo. Experimental valves underwent geometric, CT, and hydrodynamic controls. In the clinical phase of the study, we prospectively analyzed patients who received CT-guided AVNeo (N = 7, Group 1). The control group enrolled patients who were operated on after the standard AVNeo technique (N = 15, Group 2). RESULTS In Group 1, Aortic Cross-Clamp (70.3 ± 17.0 vs. 91 ± 21.3 min, ρ = 0.026) and Bypass times (92.9 ± 21.0 vs. 123 ± 24.8 min, ρ = 0.011) were significantly shorter. At discharge, the peak (11.7 ± 2.75 vs. 15.4 ± 4.66 mm Hg, ρ = 0.032) and mean Aortic Valve (AV) gradient (6.29 ± 1.25 vs. 7.87 ± 2.33 mm Hg, ρ = 0.052) were lower in Group 1. Only one patient in Group 2 had Aortic Insufficiency (AI) greater than mild. The mean follow-up was 49.6 ± 6.9 months in both groups. There were no late deaths or any valve-related events detected in any patient. EchoCG revealed that peak (10.0 ± 2.65 vs. 12.6 ± 4.05 mm Hg, ρ = 0.090) and mean AV gradient (5.14 ± 1.35 vs. 6.73 ± 2.25 mm Hg, ρ = 0.054) also were lower in Group 1. AI indexes were stable in both Groups. CONCLUSIONS CT-guided AVNeo is an example of personalized medicine in the surgical treatment of heart valve pathology. It allows the development of a biological AV that adapts to the patient's anatomy, shortens ischemic time, and results in better hemodynamics. A more significant number of clinical observations and longer follow-up are warranted to prove the viability of the concept.
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Affiliation(s)
- Igor Mokryk
- Department of Adult Cardiac Surgery, Heart Institute, Kyiv, Ukraine.
| | - Bogdan Batsak
- University Clinic of Taras Shevchenko National University, Kyiv, Ukraine
| | - Illia Nechai
- Department of Adult Cardiac Surgery, Heart Institute, Kyiv, Ukraine.
| | - Ihor Stetsyuk
- Department of Adult Cardiac Surgery, Heart Institute, Kyiv, Ukraine
| | - Borys Todurov
- Department of Adult Cardiac Surgery, Heart Institute, Kyiv, Ukraine
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Stepanenko A, Perez LM, Ferre JC, Ybarra Falcón C, Pérez de la Sota E, San Roman JA, Redondo Diéguez A, Baladron C. 3D Virtual modelling, 3D printing and extended reality for planning of implant procedure of short-term and long-term mechanical circulatory support devices and heart transplantation. Front Cardiovasc Med 2023; 10:1191705. [PMID: 37663417 PMCID: PMC10473250 DOI: 10.3389/fcvm.2023.1191705] [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: 03/22/2023] [Accepted: 06/19/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The use of three-dimensional (3D) reconstruction and printing technology, together with extended reality applied to advanced heart failure adult patients with complex anatomy, is rapidly spreading in clinical practice. We report practical experience with application to acute and chronic heart failure: planning and performing mechanical circulatory device insertion or heart transplantation. Methods From November 2019 until February 2022, 53 3D virtual biomodels were produced for intervention planning (using Virtual/Augmented Reality and/or 3D printing), following a specific segmentation and preprocessing workflow for biomodelling, in patients with advanced heart failure due to structural heart disease or cardiomyopathies. Four of those patients were complex cases requiring mechanical circulatory support implant procedures in our center. Results One short-term and three long-term ventricular assist device system were successfully clinically implanted after application of this technique. In other two cases with extremely high procedural risk, visualized after application of this multimodality imaging, heart transplantation was elected. Conclusion 3D printing based planning and virtual procedure simulation, are of great importance to select appropriate candidates for mechanical circulatory support in case of complex patient anatomy and may help to diminish periprocedural complications. Extended reality represents a perspective tool in planification of complex surgical procedures or ventricular assist device insertion in this setting.
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Affiliation(s)
- Alexander Stepanenko
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Laura Maroto Perez
- Cardiovascular Surgery, Hospital Recoletas Campo Grande, Valladolid, Spain
| | - Jordi Candela Ferre
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Jose Alberto San Roman
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Vall3DLab, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alfredo Redondo Diéguez
- Vall3DLab, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Cardiology Department, University Hospital of Santiago, Santiago de Compostela, Spain
| | - Carlos Baladron
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Vall3DLab, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Bernhard B, Illi J, Gloeckler M, Pilgrim T, Praz F, Windecker S, Haeberlin A, Gräni C. Imaging-Based, Patient-Specific Three-Dimensional Printing to Plan, Train, and Guide Cardiovascular Interventions: A Systematic Review and Meta-Analysis. Heart Lung Circ 2022; 31:1203-1218. [PMID: 35680498 DOI: 10.1016/j.hlc.2022.04.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND To tailor cardiovascular interventions, the use of three-dimensional (3D), patient-specific phantoms (3DPSP) encompasses patient education, training, simulation, procedure planning, and outcome-prediction. AIM This systematic review and meta-analysis aims to investigate the current and future perspective of 3D printing for cardiovascular interventions. METHODS We systematically screened articles on Medline and EMBASE reporting the prospective use of 3DPSP in cardiovascular interventions by using combined search terms. Studies that compared intervention time depending on 3DPSP utilisation were included into a meta-analysis. RESULTS We identified 107 studies that prospectively investigated a total of 814 3DPSP in cardiovascular interventions. Most common settings were congenital heart disease (CHD) (38 articles, 6 comparative studies), left atrial appendage (LAA) occlusion (11 articles, 5 comparative, 1 randomised controlled trial [RCT]), and aortic disease (10 articles). All authors described 3DPSP as helpful in assessing complex anatomic conditions, whereas poor tissue mimicry and the non-consideration of physiological properties were cited as limitations. Compared to controls, meta-analysis of six studies showed a significant reduction of intervention time in LAA occlusion (n=3 studies), and surgery due to CHD (n=3) if 3DPSPs were used (Cohen's d=0.54; 95% confidence interval, 0.13 to 0.95; p=0.001), however heterogeneity across studies should be taken into account. CONCLUSIONS 3DPSP are helpful to plan, train, and guide interventions in patients with complex cardiovascular anatomy. Benefits for patients include reduced intervention time with the potential for lower radiation exposure and shorter mechanical ventilation times. More evidence and RCTs including clinical endpoints are needed to warrant adoption of 3DPSP into routine clinical practice.
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Affiliation(s)
- Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joël Illi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Swiss MedTech Center, Switzerland Innovation Park Biel/Bienne AG, Switzerland
| | - Martin Gloeckler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, Sitem Center, University of Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, Sitem Center, University of Bern, Switzerland.
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Yao XW, Ai K, Li Y. Presurgical planning of 3D printing for a large abdominal pheochromocytoma and paraganglioma. Urology 2022; 165:356-358. [DOI: 10.1016/j.urology.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
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Salewski C, Nemeth A, Sandoval Boburg R, Berger R, Hamdoun H, Frenz H, Spintzyk S, Hahn JK, Schlensak C, Krüger T. The impact of 3D printed models on spatial orientation in echocardiography teaching. BMC MEDICAL EDUCATION 2022; 22:180. [PMID: 35291993 PMCID: PMC8923966 DOI: 10.1186/s12909-022-03242-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE During our transthoracic echocardiography (TTE) courses, medical students showed difficulty in spatial orientation. We implemented the use of 3D printed cardiac models of standard TTE views PLAX, PSAX, and A4C and assessed their efficacy in TTE-teaching. METHODS One hundred fifty-three participants were split into two groups. A pre-test-retest of anatomy, 2D -, and 3D orientation was conducted. The intervention group (n = 77) was taught using 3D models; the control group (n = 76) without. Both were comparable with respect to baseline parameters. Besides test-scores, a Likert scale recorded experiences, difficulties, and evaluation of teaching instruments. RESULTS From the 153 students evaluated, 123 improved, 20 did worse, and ten achieved the same result after the course. The median overall pre-test score was 29 of 41 points, and the retest score was 35 (p < 0.001). However, the intervention group taught with the 3D models, scored significantly better overall (p = 0.016), and in 2D-thinking (p = 0.002) and visual thinking (p = 0.006) subtests. A backward multivariate linear regression model revealed that the 3D models are a strong individual predictor of an excellent visual thinking score. In addition, our study showed that students with difficulty in visual thinking benefited considerably from the 3D models. CONCLUSION Students taught using the 3D models significantly improved when compared with conventional teaching. Students regarded the provided models as most helpful in their learning process. We advocate the implementation of 3D-printed heart models featuring the standard views for teaching echocardiography. These findings may be transferable to other evidence based medical and surgical teaching interventions.
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Affiliation(s)
- Christoph Salewski
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
| | - Attila Nemeth
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Rodrigo Sandoval Boburg
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Rafal Berger
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Hasan Hamdoun
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Hannes Frenz
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Sebastian Spintzyk
- Section for Medical Material Science and Technology at the Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Julia Kelley Hahn
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Tobias Krüger
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
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Talanki VR, Peng Q, Shamir SB, Baete SH, Duong TQ, Wake N. Three-Dimensional Printed Anatomic Models Derived From Magnetic Resonance Imaging Data: Current State and Image Acquisition Recommendations for Appropriate Clinical Scenarios. J Magn Reson Imaging 2021; 55:1060-1081. [PMID: 34046959 DOI: 10.1002/jmri.27744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022] Open
Abstract
Three-dimensional (3D) printing technologies have been increasingly utilized in medicine over the past several years and can greatly facilitate surgical planning thereby improving patient outcomes. Although still much less utilized compared to computed tomography (CT), magnetic resonance imaging (MRI) is gaining traction in medical 3D printing. The purpose of this study was two-fold: 1) to determine the prevalence in the existing literature of using MRI to create 3D printed anatomic models for surgical planning and 2) to provide image acquisition recommendations for appropriate clinical scenarios where MRI is the most suitable imaging modality. The workflow for creating 3D printed anatomic models from medical imaging data is complex and involves image segmentation of the regions of interest and conversion of that data into 3D surface meshes, which are compatible with printing technologies. CT is most commonly used to create 3D printed anatomic models due to the high image quality and relative ease of performing image segmentation from CT data. As compared to CT datasets, 3D printing using MRI data offers advantages since it provides exquisite soft tissue contrast needed for accurate organ segmentation and it does not expose patients to unnecessary ionizing radiation. MRI, however, often requires complicated imaging techniques and time-consuming postprocessing procedures to generate high-resolution 3D anatomic models needed for 3D printing. Despite these challenges, 3D modeling and printing from MRI data holds great clinical promises thanks to emerging innovations in both advanced MRI imaging and postprocessing techniques. EVIDENCE LEVEL: 2 TECHNICAL EFFICATCY: 5.
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Affiliation(s)
- Varsha R Talanki
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Qi Peng
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephanie B Shamir
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Steven H Baete
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Timothy Q Duong
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nicole Wake
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
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Noël GPJC, Ding W, Steinmetz P. 3D Printed Heart Models Illustrating Myocardial Perfusion Territories to Augment Echocardiography and Electrocardiography Interpretation. MEDICAL SCIENCE EDUCATOR 2021; 31:439-446. [PMID: 34457902 PMCID: PMC8368875 DOI: 10.1007/s40670-020-01177-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 06/13/2023]
Abstract
Visualizing the vascular territories of coronary arteries during echocardiography or electrocardiography (ECG) requires trainees to mentally relate and overlay 2D sonographic images or cardiac lead projections with 3D anatomical representations of the ventricular walls and their respective blood supply. To facilitate the acquisition of these competencies, this study focuses on the feasibility of developing low-cost, open-sourced 3D printed heart models with standard ultrasound views or ECG lead projections illustrating the myocardial perfusion territories. A 3D digital heart model was cut to reflect the typical cardiac ultrasound views. The 4-chamber view model was further punctured for the paths of the precordial and limb leads of an ECG. Painting coronary arteries on the surface and internal views of the 3D prints illustrated vessel territories. Students, residents, and staff were surveyed during bedside ultrasound simulation sessions and ECG teaching half-days. Results demonstrated clear appreciation of 3D printed models, which suggests such models can easily be implemented by other institutions to augment trainees' experience during skill acquisition.
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Affiliation(s)
- Geoffroy P. J. C. Noël
- Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, Strathcona Anatomy Building, 3640 University Street, Montreal, QC H3A 0C7 Canada
- Institute of Health Science Education, Faculty of Medicine, McGill University, Montreal, Canada
| | - Weimeng Ding
- Undergraduate Education, Faculty of Medicine, McGill University, Montreal, Canada
| | - Peter Steinmetz
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC Canada
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Wang H, Song H, Yang Y, Cao Q, Hu Y, Chen J, Guo J, Wang Y, Jia D, Cao S, Zhou Q. Three-dimensional printing for cardiovascular diseases: from anatomical modeling to dynamic functionality. Biomed Eng Online 2020; 19:76. [PMID: 33028306 PMCID: PMC7542711 DOI: 10.1186/s12938-020-00822-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022] Open
Abstract
Three-dimensional (3D) printing is widely used in medicine. Most research remains focused on forming rigid anatomical models, but moving from static models to dynamic functionality could greatly aid preoperative surgical planning. This work reviews literature on dynamic 3D heart models made of flexible materials for use with a mock circulatory system. Such models allow simulation of surgical procedures under mock physiological conditions, and are; therefore, potentially very useful to clinical practice. For example, anatomical models of mitral regurgitation could provide a better display of lesion area, while dynamic 3D models could further simulate in vitro hemodynamics. Dynamic 3D models could also be used in setting standards for certain parameters for function evaluation, such as flow reserve fraction in coronary heart disease. As a bridge between medical image and clinical aid, 3D printing is now gradually changing the traditional pattern of diagnosis and treatment.
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Affiliation(s)
- Hao Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Hongning Song
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yuanting Yang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Quan Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yugang Hu
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jinling Chen
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Juan Guo
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yijia Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Dan Jia
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Sheng Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Ali A, Ballard DH, Althobaity W, Christensen A, Geritano M, Ho M, Liacouras P, Matsumoto J, Morris J, Ryan J, Shorti R, Wake N, Rybicki FJ, Sheikh A. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: adult cardiac conditions. 3D Print Med 2020; 6:24. [PMID: 32965536 PMCID: PMC7510265 DOI: 10.1186/s41205-020-00078-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Medical 3D printing as a component of care for adults with cardiovascular diseases has expanded dramatically. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness criteria for adult cardiac 3D printing indications. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with a number of adult cardiac indications, physiologic, and pathologic processes. Each study was vetted by the authors and graded according to published guidelines. RESULTS Evidence-based appropriateness guidelines are provided for the following areas in adult cardiac care; cardiac fundamentals, perioperative and intraoperative care, coronary disease and ischemic heart disease, complications of myocardial infarction, valve disease, cardiac arrhythmias, cardiac neoplasm, cardiac transplant and mechanical circulatory support, heart failure, preventative cardiology, cardiac and pericardial disease and cardiac trauma. CONCLUSIONS Adoption of common clinical standards regarding appropriate use, information and material management, and quality control are needed to ensure the greatest possible clinical benefit from 3D printing. This consensus guideline document, created by the members of the RSNA 3D printing Special Interest Group, will provide a reference for clinical standards of 3D printing for adult cardiac indications.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Waleed Althobaity
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Michelle Ho
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Jane Matsumoto
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Justin Ryan
- Rady Children's Hospital, San Diego, CA, USA
| | - Rami Shorti
- Intermountain Healthcare, South Jordan, UT, USA
| | - Nicole Wake
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Ballance WC, Karthikeyan V, Oh I, Qin EC, Seo Y, Spearman-White T, Bashir R, Hu Y, Phillips H, Kong H. Preoperative vascular surgery model using a single polymer tough hydrogel with controllable elastic moduli. SOFT MATTER 2020; 16:8057-8068. [PMID: 32789332 DOI: 10.1039/d0sm00981d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Materials used in organ mimics for medial simulation and education require tissue-like softness, toughness, and hydration to give clinicians and students accurate tactile feedback. However, there is a lack of materials that satisfy these requirements. Herein, we demonstrate that a stretchable and tough polyacrylamide hydrogel is useful to build organ mimics that match softness, crack growth resistance, and interstitial water of real organs. Varying the acrylamide concentration between 29 or 62% w/w with a molar ratio between cross-linker and acrylamide of 1 : 10 800 resulted in a fracture energy around ∼2000 J m-2. More interestingly, this tough gel permitted variation of the elastic modulus from 8 to 62 kPa, which matches the softness of brain to vascular and muscle tissue. According to the rheological frequency sweep, the tough polyacrylamide hydrogels had a greatly decreased number of flow units, indicating that when deformed, stress was dispersed over a greater area. We propose that such molecular dissipation results from the increased number of entangled polymers between distant covalent cross-links. The gel was able to undergo various manipulations including stretching, puncture, delivery through a syringe tip, and suturing, thus enabling the use of the gel as a blood vessel model for microsurgery simulation.
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Affiliation(s)
- William C Ballance
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
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Vidakis N, Petousis M, Velidakis E, Liebscher M, Tzounis L. Three-Dimensional Printed Antimicrobial Objects of Polylactic Acid (PLA)-Silver Nanoparticle Nanocomposite Filaments Produced by an In-Situ Reduction Reactive Melt Mixing Process. Biomimetics (Basel) 2020; 5:biomimetics5030042. [PMID: 32887263 PMCID: PMC7559372 DOI: 10.3390/biomimetics5030042] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 12/18/2022] Open
Abstract
In this study, an industrially scalable method is reported for the fabrication of polylactic acid (PLA)/silver nanoparticle (AgNP) nanocomposite filaments by an in-situ reduction reactive melt mixing method. The PLA/AgNP nanocomposite filaments have been produced initially reducing silver ions (Ag+) arising from silver nitrate (AgNO3) precursor mixed in the polymer melt to elemental silver (Ag0) nanoparticles, utilizing polyethylene glycol (PEG) or polyvinyl pyrrolidone (PVP), respectively, as macromolecular blend compound reducing agents. PEG and PVP were added at various concentrations, to the PLA matrix. The PLA/AgNP filaments have been used to manufacture 3D printed antimicrobial (AM) parts by Fused Filament Fabrication (FFF). The 3D printed PLA/AgNP parts exhibited significant AM properties examined by the reduction in Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) bacteria viability (%) experiments at 30, 60, and 120 min duration of contact (p < 0.05; p-value (p): probability). It could be envisaged that the 3D printed parts manufactured and tested herein mimic nature’s mechanism against bacteria and in terms of antimicrobial properties, contact angle for their anti-adhesive behavior and mechanical properties could create new avenues for the next generation of low-cost and on-demand additive manufacturing produced personal protective equipment (PPE) as well as healthcare and nosocomial antimicrobial equipment.
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Affiliation(s)
- Nectarios Vidakis
- Mechanical Engineering Department, Hellenic Mediterranean University, Estavromenos, 71004 Heraklion, Crete, Greece; (N.V.); (E.V.)
| | - Markos Petousis
- Mechanical Engineering Department, Hellenic Mediterranean University, Estavromenos, 71004 Heraklion, Crete, Greece; (N.V.); (E.V.)
- Correspondence: ; Tel.: +30-2810-37-9227
| | - Emmanouel Velidakis
- Mechanical Engineering Department, Hellenic Mediterranean University, Estavromenos, 71004 Heraklion, Crete, Greece; (N.V.); (E.V.)
| | - Marco Liebscher
- Institute of Construction Materials, Technische Universität Dresden, DE-01062 Dresden, Germany;
| | - Lazaros Tzounis
- Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece;
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Tzounis L, Bangeas PI, Exadaktylos A, Petousis M, Vidakis N. Three-Dimensional Printed Polylactic Acid (PLA) Surgical Retractors with Sonochemically Immobilized Silver Nanoparticles: The Next Generation of Low-Cost Antimicrobial Surgery Equipment. NANOMATERIALS 2020; 10:nano10050985. [PMID: 32455641 PMCID: PMC7279541 DOI: 10.3390/nano10050985] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/09/2020] [Accepted: 05/17/2020] [Indexed: 01/17/2023]
Abstract
A versatile method is reported for the manufacturing of antimicrobial (AM) surgery equipment utilising fused deposition modelling (FDM), three-dimensional (3D) printing and sonochemistry thin-film deposition technology. A surgical retractor was replicated from a commercial polylactic acid (PLA) thermoplastic filament, while a thin layer of silver (Ag) nanoparticles (NPs) was developed via a simple and scalable sonochemical deposition method. The PLA retractor covered with Ag NPs (PLA@Ag) exhibited vigorous AM properties examined by a reduction in Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa (P. aeruginosa) and Escherichia coli (E. coli) bacteria viability (%) experiments at 30, 60 and 120 min duration of contact (p < 0.05). Scanning electron microscopy (SEM) showed the surface morphology of bare PLA and PLA@Ag retractor, revealing a homogeneous and full surface coverage of Ag NPs. X-Ray diffraction (XRD) analysis indicated the crystallinity of Ag nanocoating. Ultraviolent-visible (UV-vis) spectroscopy and transmission electron microscopy (TEM) highlighted the AgNP plasmonic optical responses and average particle size of 31.08 ± 6.68 nm. TEM images of the PLA@Ag crossection demonstrated the thickness of the deposited Ag nanolayer, as well as an observed tendency of AgNPs to penetrate though the outer surface of PLA. The combination of 3D printing and sonochemistry technology could open new avenues in the manufacturing of low-cost and on-demand antimicrobial surgery equipment.
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Affiliation(s)
- Lazaros Tzounis
- Composite and Smart Materials Laboratory (CSML), Department of Materials Science & Engineering, University of Ioannina, GR-45110 Ioannina, Greece
- Correspondence: (L.T.); (N.V.); Tel.: +30-26510-09024 (L.T.); +30-2810-379833 (N.V.)
| | - Petros I. Bangeas
- Department of emergency medicine, INSELSPITAL, Universitätsspital Bern, 18, 3010 Bern, Switzerland; (P.I.B.); (A.E.)
| | - Aristomenis Exadaktylos
- Department of emergency medicine, INSELSPITAL, Universitätsspital Bern, 18, 3010 Bern, Switzerland; (P.I.B.); (A.E.)
| | - Markos Petousis
- Mechanical Engineering Department, Hellenic Mediterranean University, Estavromenos, 71004 Heraklion, Crete, Greece;
| | - Nectarios Vidakis
- Mechanical Engineering Department, Hellenic Mediterranean University, Estavromenos, 71004 Heraklion, Crete, Greece;
- Correspondence: (L.T.); (N.V.); Tel.: +30-26510-09024 (L.T.); +30-2810-379833 (N.V.)
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13
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Wang L, Guo T, Zhang H, Yang S, Liang J, Guo Y, Shao Q, Cao T, Li X, Huang L. Three-dimensional printing flexible models: a novel technique for Nuss procedure planning of pectus excavatum repair. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:110. [PMID: 32175403 DOI: 10.21037/atm.2019.12.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Pectus excavatum (PE), one of the most common congenital chest wall deformities, is characterized by posterior depression of the sternum and lower costal cartilages. In this study, we demonstrated the application of flexible three-dimensional printing thoracic models for surgical approach planning of extrapleural Nuss procedure for patients with pectus excavatum. Methods Six patients with pectus excavatum were referred to our hospital for extrapleural Nuss procedure. Each patient's chest was reconstructed based on their computed tomography imaging data, and the three-dimensional (3D) thoracic model was manufactured with flexible material using 3D printing technique. The individual surgical approach and custom-made steel bars were designed and produced using these models. Results The surgical approach was evaluated by using the three-dimensional thoracic model. In all patients received extrapleural Nuss surgery, it has been proven the uniformity of repair efficacy in both models and patients. Moreover, an individualized and well-fitting steel bar can be fabricated once the surgical approach was confirmed. All the steel bars were loaded against the ribs rigorously and seamlessly. Conclusions The flexible three-dimensional thoracic models were very helpful for the preoperative planning of extrapleural Nuss procedure.
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Affiliation(s)
- Lei Wang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Ting Guo
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.,Department of Pain Management, The Affiliated Hospital of Northwest University (Xi'an No. 3 Hospital), Xi'an 710082, China
| | - Hao Zhang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Sanhu Yang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Jiahe Liang
- Department of Ultrasound Diagnosis, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Yitong Guo
- 3D Printing Research Center of the Fourth Military Medical University, Xi'an 710038, China
| | - Qiuya Shao
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710043, China
| | - Tiesheng Cao
- Department of Ultrasound Diagnosis, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.,3D Printing Research Center of the Fourth Military Medical University, Xi'an 710038, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Lijun Huang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
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14
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Bangeas P, Tsioukas V, Papadopoulos VN, Tsoulfas G. Role of innovative 3D printing models in the management of hepatobiliary malignancies. World J Hepatol 2019; 11:574-585. [PMID: 31388399 PMCID: PMC6669192 DOI: 10.4254/wjh.v11.i7.574] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/12/2019] [Accepted: 06/27/2019] [Indexed: 02/06/2023] Open
Abstract
Three-dimensional (3D) printing has recently emerged as a new technique in various liver-related surgical fields. There are currently only a few systematic reviews that summarize the evidence of its impact. In order to construct a systematic literature review of the applications and effects of 3D printing in liver surgery, we searched the PubMed, Embase and ScienceDirect databases for relevant titles, according to the PRISMA statement guidelines. We retrieved 162 titles, of which 32 met the inclusion criteria and are reported. The leading application of 3D printing in liver surgery is for preoperative planning. 3D printing techniques seem to be beneficial for preoperative planning and educational tools, despite their cost and time requirements, but this conclusion must be confirmed by additional randomized controlled trials.
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Affiliation(s)
- Peter Bangeas
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Vassilios Tsioukas
- Department of School of Rural and Surveying Engineering, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | | | - Georgios Tsoulfas
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
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15
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Brovold M, Almeida JI, Pla-Palacín I, Sainz-Arnal P, Sánchez-Romero N, Rivas JJ, Almeida H, Dachary PR, Serrano-Aulló T, Soker S, Baptista PM. Naturally-Derived Biomaterials for Tissue Engineering Applications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1077:421-449. [PMID: 30357702 PMCID: PMC7526297 DOI: 10.1007/978-981-13-0947-2_23] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Naturally-derived biomaterials have been used for decades in multiple regenerative medicine applications. From the simplest cell microcarriers made of collagen or alginate, to highly complex decellularized whole-organ scaffolds, these biomaterials represent a class of substances that is usually first in choice at the time of electing a functional and useful biomaterial. Hence, in this chapter we describe the several naturally-derived biomaterials used in tissue engineering applications and their classification, based on composition. We will also describe some of the present uses of the generated tissues like drug discovery, developmental biology, bioprinting and transplantation.
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Affiliation(s)
- Matthew Brovold
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, USA
| | - Joana I Almeida
- Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
| | - Iris Pla-Palacín
- Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
| | - Pilar Sainz-Arnal
- Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
- Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | | | - Jesus J Rivas
- Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
| | - Helen Almeida
- Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
| | - Pablo Royo Dachary
- Instituto de Investigación Sanitária de Aragón (IIS Aragón), Zaragoza, Spain
- Liver Transplant Unit, Gastroenterology Department, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Trinidad Serrano-Aulló
- Instituto de Investigación Sanitária de Aragón (IIS Aragón), Zaragoza, Spain
- Liver Transplant Unit, Gastroenterology Department, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Shay Soker
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, USA.
| | - Pedro M Baptista
- Instituto de Investigación Sanitária de Aragón (IIS Aragón), Zaragoza, Spain.
- Center for Biomedical Research Network Liver and Digestive Diseases (CIBERehd), Zaragoza, Spain.
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain.
- Biomedical and Aerospace Engineering Department, Universidad Carlos III de Madrid, Madrid, Spain.
- Fundación ARAID, Zaragoza, Spain.
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16
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Boll LFC, Rodrigues GO, Rodrigues CG, Bertollo FL, Irigoyen MC, Goldmeier S. Using a 3D printer in cardiac valve surgery: a systematic review. ACTA ACUST UNITED AC 2019; 65:818-824. [PMID: 31340310 DOI: 10.1590/1806-9282.65.6.818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/10/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND The use of the 3D printer in complex cardiac surgery planning. OBJECTIVES To analyze the use and benefits of 3D printing in heart valve surgery through a systematic review of the literature. METHODS This systematic review was reported following the Preferred Reporting Items for Systematic Review and registered in the Prospero (International Prospective Register of Systematic Reviews) database under the number CRD42017059034. We used the following databases: PubMed, EMBASE, Scopus, Web of Science and Lilacs. We included articles about the keywords "Heart Valves", "Heart Valve Prosthesis Implantation", "Heart Valve Prosthesis", "Printing, Three-Dimensional", and related entry terms. Two reviewers independently conducted data extraction and a third reviewer solved disagreements. All tables used for data extraction are available at a separate website. We used the Cochrane Collaboration tool to assess the risk of bias of the studies included. RESULTS We identified 301 articles and 13 case reports and case series that met the inclusion criteria. Our studies included 34 patients aged from 3 months to 94 years. CONCLUSIONS Up to the present time, there are no studies including a considerable number of patients. A 3D-printed model produced based on the patient enables the surgeon to plan the surgical procedure and choose the best material, size, format, and thickness to be used. This planning leads to reduced surgery time, exposure, and consequently, lower risk of infection.
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Affiliation(s)
| | | | - Clarissa Garcia Rodrigues
- Institute of Cardiology / University Foundation of Cardiology; Av. Princesa Isabel, 370 - Porto Alegre, RS, Brasil
| | - Felipe Luiz Bertollo
- Institute of Cardiology / University Foundation of Cardiology; Av. Princesa Isabel, 370 - Porto Alegre, RS, Brasil
| | | | - Silvia Goldmeier
- Institute of Cardiology / University Foundation of Cardiology; Av. Princesa Isabel, 370 - Porto Alegre, RS, Brasil
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17
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Ochoa S, Segal J, Garcia N, Fischer EA. Three-Dimensional Printed Cardiac Models for Focused Cardiac Ultrasound Instruction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1405-1409. [PMID: 30246888 DOI: 10.1002/jum.14818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Focused cardiac ultrasonography (FCU) is an increasingly integral component of routine medical training and practice. While various instructional methods have been described, few attempts have been made to incorporate a physical 3-dimensional (3D) instructional aid. OBJECTIVE The aim of this study was to determine if a 3D printed heart model workshop for FCU instruction leads to equivalent structure recognition and scanning ability compared to traditional didactic FCU instruction. INTERVENTION Twenty first-year medical students with no point-of-care ultrasonography experience were randomly assigned to a traditional lecture (n = 10) or a 3D printed heart model workshop (n = 10). Written examinations at 0 and 3 months as well as image acquisition at 3 months were compared. RESULTS The median scores from the initial written structure identification in the traditional and 3D heart groups were 74% and 90%, respectively (P = 0.7). The second written exam at 3 months yielded median scores of 56% and 58% in the traditional and 3D heart groups, respectively (P = 0.8). The average scores on the image acquisition practical at 3 months were 3.3 of 5 and 2.7 of 5 (P = 0.1) in the traditional and 3D heart groups, respectively. CONCLUSIONS Utilizing 3D heart models in an FCU workshop format results in similar skill acquisition and knowledge retention as traditional didactics. The 3D heart models are relatively inexpensive, portable, and reusable, enabling learners to practice repeatedly and at flexible intervals. The reduction in ongoing expenses and the ability to teach large groups may decrease training costs as well as the need for local faculty expertise.
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Affiliation(s)
| | | | - Noah Garcia
- Gertler & Wente Architects LLP, New York, New York, USA
| | - Ernest A Fischer
- Georgetown University Medical Center
- MedStar Georgetown University Hospital, Washington, DC, USA
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18
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Tuncay V, van Ooijen PMA. 3D printing for heart valve disease: a systematic review. Eur Radiol Exp 2019; 3:9. [PMID: 30771098 PMCID: PMC6377684 DOI: 10.1186/s41747-018-0083-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/27/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Current developments showed a fast-increasing implementation and use of three-dimensional (3D) printing in medical applications. Our aim was to review the literature regarding the application of 3D printing to cardiac valve disease. METHODS A PubMed search for publications in English with the terms "3D printing" AND "cardiac valve", performed in January 2018, resulted in 64 items. After the analysis of the abstract and text, 27 remained related to the topic. From the references of these 27 papers, 7 papers were added resulting in a total of 34 papers. Of these, 5 were review papers, thus reducing the papers taken into consideration to 29. RESULTS The 29 papers showed that about a decade ago, the interest in 3D printing for this application area was emerging, but only in the past 2 to 3 years it really gained interest. Computed tomography is the most common imaging modality taken into consideration (62%), followed by ultrasound (28%), computer-generated models (computer-aided design) (7%), and magnetic resonance imaging (3%). Acrylonitrile butadiene styrene (4/14, 29%) and TangoPlus FullCure 930 (5/14, 36%) are the most used printing materials. Stereolithography (40%) and fused deposition modeling (30%) are the preferred printing techniques, while PolyJet (25%) and laser sintering (4%) are used in a minority of cases. The reported time ranges from 30 min to 3 days. The most reported application area is preoperative planning (63%), followed by training (19%), device testing (11%), and retrospective procedure evaluation (7%). CONCLUSIONS In most cases, CT datasets are used and models are printed for preoperative planning.
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Affiliation(s)
- Volkan Tuncay
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
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Abstract
Surgeons typically rely on their past training and experiences as well as visual aids from medical imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) for the planning of surgical processes. Often, due to the anatomical complexity of the surgery site, two dimensional or virtual images are not sufficient to successfully convey the structural details. For such scenarios, a 3D printed model of the patient's anatomy enables personalized preoperative planning. This paper reviews critical aspects of 3D printing for preoperative planning and surgical training, starting with an overview of the process-flow and 3D printing techniques, followed by their applications spanning across multiple organ systems in the human body. State of the art in these technologies are described along with a discussion of current limitations and future opportunities.
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20
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Jamróz W, Szafraniec J, Kurek M, Jachowicz R. 3D Printing in Pharmaceutical and Medical Applications - Recent Achievements and Challenges. Pharm Res 2018; 35:176. [PMID: 29998405 PMCID: PMC6061505 DOI: 10.1007/s11095-018-2454-x] [Citation(s) in RCA: 302] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/30/2018] [Indexed: 12/23/2022]
Abstract
Growing demand for customized pharmaceutics and medical devices makes the impact of additive manufacturing increased rapidly in recent years. The 3D printing has become one of the most revolutionary and powerful tool serving as a technology of precise manufacturing of individually developed dosage forms, tissue engineering and disease modeling. The current achievements include multifunctional drug delivery systems with accelerated release characteristic, adjustable and personalized dosage forms, implants and phantoms corresponding to specific patient anatomy as well as cell-based materials for regenerative medicine. This review summarizes the newest achievements and challenges of additive manufacturing in the field of pharmaceutical and biomedical research that have been published since 2015. Currently developed techniques of 3D printing are briefly described while comprehensive analysis of extrusion-based methods as the most intensively investigated is provided. The issue of printlets attributes, i.e. shape and size is described with regard to personalized dosage forms and medical devices manufacturing. The undeniable benefits of 3D printing are highlighted, however a critical view resulting from the limitations and challenges of the additive manufacturing is also included. The regulatory issue is pointed as well.
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Affiliation(s)
- Witold Jamróz
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688, Krakow, Poland
| | - Joanna Szafraniec
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688, Krakow, Poland
| | - Mateusz Kurek
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688, Krakow, Poland
| | - Renata Jachowicz
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688, Krakow, Poland.
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21
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Parimi M, Buelter J, Thanugundla V, Condoor S, Parkar N, Danon S, King W. Feasibility and Validity of Printing 3D Heart Models from Rotational Angiography. Pediatr Cardiol 2018; 39:653-658. [PMID: 29305642 DOI: 10.1007/s00246-017-1799-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/22/2017] [Indexed: 01/17/2023]
Abstract
Rotational angiography (RA) has proven to be an excellent method for evaluating congenital disease (CHD) in the cardiac cath lab, permitting acquisition of 3D datasets with superior spatial resolution. This technique has not been routinely implemented for 3D printing in CHD. We describe our case series of models printed from RA and validate our technique. All patients with models printed from RA were selected. RA acquisitions from a Toshiba Infinix-I system were postprocessed and printed with a Stratasys Eden 260. Two independent observers measured 5-10 points of interest on both the RA and the 3D model. Bland Altman plot was used to compare the measurements on rotational angiography to the printed model. Models were printed from RA in 5 patients (age 2 months-1 year). Diagnoses included (a) coronary artery aneurysm, (b) Glenn shunt, (c) coarctation of the aorta, (d) tetralogy of Fallot with MAPCAs, and (e) pulmonary artery stenosis. There was no significant measurement difference between RA and the printed model (r = 0.990, p < 0.01, Bland Altman p = 0.987). There was also no significant inter-observer variability. The MAPCAs model was referenced by the surgeon intraoperatively and was accurate. Rotational angiography can generate highly accurate 3D models in congenital heart disease, including in small vascular structures. These models can be extremely useful in patient evaluation and management.
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Affiliation(s)
- Manoj Parimi
- Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA
| | - John Buelter
- Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA
| | - Vignan Thanugundla
- Saint Louis University Parks College of Engineering, 3450 Lindell Blvd, St. Louis, MO, 63103, USA
| | - Sri Condoor
- Saint Louis University Parks College of Engineering, 3450 Lindell Blvd, St. Louis, MO, 63103, USA
| | - Nadeem Parkar
- Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA
| | - Saar Danon
- Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA
| | - Wilson King
- Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA.
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Cox BL, Ludwig KD, Adamson EB, Eliceiri KW, Fain SB. An open source, 3D printed preclinical MRI phantom for repeated measures of contrast agents and reference standards. Biomed Phys Eng Express 2018; 4. [PMID: 29399370 PMCID: PMC5790173 DOI: 10.1088/2057-1976/aa9491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In medical imaging, clinicians, researchers and technicians have begun to use 3D printing to create specialized phantoms to replace commercial ones due to their customizable and iterative nature. Presented here is the design of a 3D printed open source, reusable magnetic resonance imaging (MRI) phantom, capable of flood-filling, with removable samples for measurements of contrast agent solutions and reference standards, and for use in evaluating acquisition techniques and image reconstruction performance. The phantom was designed using SolidWorks, a computer-aided design software package. The phantom consists of custom and off-the-shelf parts and incorporates an air hole and Luer Lock system to aid in flood filling, a marker for orientation of samples in the filled mode and bolt and tube holes for assembly. The cost of construction for all materials is under $90. All design files are open-source and available for download. To demonstrate utility, B0 field mapping was performed using a series of gadolinium concentrations in both the unfilled and flood-filled mode. An excellent linear agreement (R2>0.998) was observed between measured relaxation rates (R1/R2) and gadolinium concentration. The phantom provides a reliable setup to test data acquisition and reconstruction methods and verify physical alignment in alternative nuclei MRI techniques (e.g. carbon-13 and fluorine-19 MRI). A cost-effective, open-source MRI phantom design for repeated quantitative measurement of contrast agents and reference standards in preclinical research is presented. Specifically, the work is an example of how the emerging technology of 3D printing improves flexibility and access for custom phantom design.
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Affiliation(s)
- B L Cox
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave., Madison, WI 53705.,Morgridge Institute for Research, 330 N. Orchard St., Madison, WI 53715.,Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, 1675 Observatory Dr., Madison, WI 53706
| | - K D Ludwig
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave., Madison, WI 53705
| | - E B Adamson
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave., Madison, WI 53705
| | - K W Eliceiri
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave., Madison, WI 53705.,Morgridge Institute for Research, 330 N. Orchard St., Madison, WI 53715.,Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, 1675 Observatory Dr., Madison, WI 53706.,Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr., Madison, WI 53706
| | - S B Fain
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave., Madison, WI 53705.,Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr., Madison, WI 53706.,Department of Radiology, University of Wisconsin-Madison, E3/366 Clinical Science Center, 600 Highland Ave., Madison, WI 53792
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23
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El Sabbagh A, Eleid MF, Matsumoto JM, Anavekar NS, Al‐Hijji MA, Said SM, Nkomo VT, Holmes DR, Rihal CS, Foley TA. Three‐dimensional prototyping for procedural simulation of transcatheter mitral valve replacement in patients with mitral annular calcification. Catheter Cardiovasc Interv 2018; 92:E537-E549. [DOI: 10.1002/ccd.27488] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/01/2017] [Accepted: 12/23/2017] [Indexed: 12/22/2022]
Affiliation(s)
| | - Mackram F. Eleid
- Department of Cardiovascular DiseasesMayo ClinicRochester Minnesota
| | | | | | | | - Sameh M. Said
- Division of Cardiovascular SurgeryMayo ClinicRochester Minnesota
| | | | - David R. Holmes
- Department of Cardiovascular DiseasesMayo ClinicRochester Minnesota
| | | | - Thomas A. Foley
- Department of Cardiovascular DiseasesMayo ClinicRochester Minnesota
- Department of RadiologyMayo ClinicRochester Minnesota
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24
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Al Najjar M, Mehta SS, Monga P. Three dimensional scapular prints for evaluating glenoid morphology: An exploratory study. J Clin Orthop Trauma 2018; 9:230-235. [PMID: 30202154 PMCID: PMC6128808 DOI: 10.1016/j.jcot.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/07/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Computerised Tomography (CT) scans are conventionally employed to assess the glenoid morphology prior to total shoulder arthroplasty (TSA). This study explores the role of three-dimensional (3D) models for assessing glenoid morphology. METHODS CT scans of 32 patients scheduled for TSA were reconstructed to scapular models using customised software and a desktop 3D printer. The size and aspect ratios were maintained. Glenoid version, glenoid maximum height and width, and the maximum acromion antero-posterior (AP) length were compared between the models and CT scans. RESULTS The models were an accurate qualitative reflection of scapular anatomy. The average retroversion in 3D models was 8.19°±30.8° compared to 10.26°±42.5° in scan images. The mean difference was 2.07°±24.6° (p=0.408). However, the mean absolute error was 5.02°±12.3°. The mean difference of the glenoid maximum width and the acromion maximum AP length was 0.22±3.33mm (p=0.862) and 0.32±14.12mm (p=0.213) respectively. However, the mean difference was significant for the glenoid maximum height measuring 3.67±12.04mm with p=0.004. The correlation between the examiners was high for all parameters, with intraclass correlation ranging between 0.94 and 0.99. CONCLUSION 3D printing technology promises to be a useful tool for preoperative planning with accurate reproduction of transverse plane anatomy. 3D prints represent superior definition of reconstructed anatomical measures such as glenoid height as compared to conventional CT Scans.
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Ballard DH, Trace AP, Ali S, Hodgdon T, Zygmont ME, DeBenedectis CM, Smith SE, Richardson ML, Patel MJ, Decker SJ, Lenchik L. Clinical Applications of 3D Printing: Primer for Radiologists. Acad Radiol 2018; 25:52-65. [PMID: 29030285 DOI: 10.1016/j.acra.2017.08.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 12/22/2022]
Abstract
Three-dimensional (3D) printing refers to a number of manufacturing technologies that create physical models from digital information. Radiology is poised to advance the application of 3D printing in health care because our specialty has an established history of acquiring and managing the digital information needed to create such models. The 3D Printing Task Force of the Radiology Research Alliance presents a review of the clinical applications of this burgeoning technology, with a focus on the opportunities for radiology. Topics include uses for treatment planning, medical education, and procedural simulation, as well as patient education. Challenges for creating custom implantable devices including financial and regulatory processes for clinical application are reviewed. Precedent procedures that may translate to this new technology are discussed. The task force identifies research opportunities needed to document the value of 3D printing as it relates to patient care.
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Shinbane JS, Saxon LA. Virtual medicine: Utilization of the advanced cardiac imaging patient avatar for procedural planning and facilitation. J Cardiovasc Comput Tomogr 2017; 12:16-27. [PMID: 29198733 DOI: 10.1016/j.jcct.2017.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/08/2017] [Accepted: 11/12/2017] [Indexed: 01/17/2023]
Abstract
Advances in imaging technology have led to a paradigm shift from planning of cardiovascular procedures and surgeries requiring the actual patient in a "brick and mortar" hospital to utilization of the digitalized patient in the virtual hospital. Cardiovascular computed tomographic angiography (CCTA) and cardiovascular magnetic resonance (CMR) digitalized 3-D patient representation of individual patient anatomy and physiology serves as an avatar allowing for virtual delineation of the most optimal approaches to cardiovascular procedures and surgeries prior to actual hospitalization. Pre-hospitalization reconstruction and analysis of anatomy and pathophysiology previously only accessible during the actual procedure could potentially limit the intrinsic risks related to time in the operating room, cardiac procedural laboratory and overall hospital environment. Although applications are specific to areas of cardiovascular specialty focus, there are unifying themes related to the utilization of technologies. The virtual patient avatar computer can also be used for procedural planning, computational modeling of anatomy, simulation of predicted therapeutic result, printing of 3-D models, and augmentation of real time procedural performance. Examples of the above techniques are at various stages of development for application to the spectrum of cardiovascular disease processes, including percutaneous, surgical and hybrid minimally invasive interventions. A multidisciplinary approach within medicine and engineering is necessary for creation of robust algorithms for maximal utilization of the virtual patient avatar in the digital medical center. Utilization of the virtual advanced cardiac imaging patient avatar will play an important role in the virtual health care system. Although there has been a rapid proliferation of early data, advanced imaging applications require further assessment and validation of accuracy, reproducibility, standardization, safety, efficacy, quality, cost effectiveness, and overall value to medical care.
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Affiliation(s)
- Jerold S Shinbane
- Division of Cardiovascular Medicine/USC Center for Body Computing, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States.
| | - Leslie A Saxon
- Division of Cardiovascular Medicine/USC Center for Body Computing, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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Birbara NS, Otton JM, Pather N. 3D Modelling and Printing Technology to Produce Patient-Specific 3D Models. Heart Lung Circ 2017; 28:302-313. [PMID: 29655572 DOI: 10.1016/j.hlc.2017.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/09/2017] [Accepted: 10/25/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND A comprehensive knowledge of mitral valve (MV) anatomy is crucial in the assessment of MV disease. While the use of three-dimensional (3D) modelling and printing in MV assessment has undergone early clinical evaluation, the precision and usefulness of this technology requires further investigation. This study aimed to assess and validate 3D modelling and printing technology to produce patient-specific 3D MV models. METHODS A prototype method for MV 3D modelling and printing was developed from computed tomography (CT) scans of a plastinated human heart. Mitral valve models were printed using four 3D printing methods and validated to assess precision. Cardiac CT and 3D echocardiography imaging data of four MV disease patients was used to produce patient-specific 3D printed models, and 40 cardiac health professionals (CHPs) were surveyed on the perceived value and potential uses of 3D models in a clinical setting. RESULTS The prototype method demonstrated submillimetre precision for all four 3D printing methods used, and statistical analysis showed a significant difference (p<0.05) in precision between these methods. Patient-specific 3D printed models, particularly using multiple print materials, were considered useful by CHPs for preoperative planning, as well as other applications such as teaching and training. CONCLUSIONS This study suggests that, with further advances in 3D modelling and printing technology, patient-specific 3D MV models could serve as a useful clinical tool. The findings also highlight the potential of this technology to be applied in a variety of medical areas within both clinical and educational settings.
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Affiliation(s)
- Nicolette S Birbara
- School of Medical Sciences, Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James M Otton
- School of Medical Sciences, Medicine, University of New South Wales, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; Liverpool Hospital, Sydney, NSW, Australia
| | - Nalini Pather
- School of Medical Sciences, Medicine, University of New South Wales, Sydney, NSW, Australia.
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Development of a Patient-specific Tumor Mold Using Magnetic Resonance Imaging and 3-Dimensional Printing Technology for Targeted Tissue Procurement and Radiomics Analysis of Renal Masses. Urology 2017; 112:209-214. [PMID: 29056576 DOI: 10.1016/j.urology.2017.08.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 05/19/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To implement a platform for colocalization of in vivo quantitative multiparametric magnetic resonance imaging features with ex vivo surgical specimens of patients with renal masses using patient-specific 3-dimensional (3D)-printed tumor molds, which may aid in targeted tissue procurement and radiomics and radiogenomic analyses. MATERIALS AND METHODS Volumetric segmentation of 6 renal masses was performed with 3D Slicer (http://www.slicer.org) to create a 3D tumor model. A slicing guide template was created with specialized software, which included notches corresponding to the anatomic locations of the magnetic resonance images. The tumor model was subtracted from the slicing guide to create a depression in the slicing guide corresponding to the exact size and shape of the tumor. A customized, tumor-specific, slicing guide was then printed using a 3D printer. After partial nephrectomy, the surgical specimen was bivalved through the preselected magnetic resonance imaging (MRI) plane. A thick slab of the tumor was obtained, fixed, and processed as a whole-mount slide and was correlated to multiparametric MRI findings. RESULTS All patients successfully underwent partial nephrectomy and adequate fitting of the tumor specimens within the 3D mold was achieved in all tumors. Distinct in vivo MRI features corresponded to unique pathologic characteristics in the same tumor. The average cost of printing each mold was US$160.7 ± 111.1 (range: US$20.9-$350.7). CONCLUSION MRI-based preoperative 3D printing of tumor-specific molds allow for accurate sectioning of the tumor after surgical resection and colocalization of in vivo imaging features with tissue-based analysis in radiomics and radiogenomic studies.
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Otton JM, Birbara NS, Hussain T, Greil G, Foley TA, Pather N. 3D printing from cardiovascular CT: a practical guide and review. Cardiovasc Diagn Ther 2017; 7:507-526. [PMID: 29255693 DOI: 10.21037/cdt.2017.01.12] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Current cardiovascular imaging techniques allow anatomical relationships and pathological conditions to be captured in three dimensions. Three-dimensional (3D) printing, or rapid prototyping, has also become readily available and made it possible to transform virtual reconstructions into physical 3D models. This technology has been utilised to demonstrate cardiovascular anatomy and disease in clinical, research and educational settings. In particular, 3D models have been generated from cardiovascular computed tomography (CT) imaging data for purposes such as surgical planning and teaching. This review summarises applications, limitations and practical steps required to create a 3D printed model from cardiovascular CT.
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Affiliation(s)
- James M Otton
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.,Liverpool Hospital, Sydney, NSW, Australia.,UNSW Sydney, NSW, Australia
| | | | - Tarique Hussain
- University of Texas Southwestern Medical Centre, Dallas, TX, USA
| | - Gerald Greil
- University of Texas Southwestern Medical Centre, Dallas, TX, USA
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Kankala RK, Zhu K, Li J, Wang CS, Wang SB, Chen AZ. Fabrication of arbitrary 3D components in cardiac surgery: from macro-, micro- to nanoscale. Biofabrication 2017; 9:032002. [PMID: 28770811 DOI: 10.1088/1758-5090/aa8113] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fabrication of tissue-/organ-like structures at arbitrary geometries by mimicking the properties of the complex material offers enormous interest to the research and clinical applicability in cardiovascular diseases. Patient-specific, durable, and realistic three-dimensional (3D) cardiac models for anatomic consideration have been developed for education, pro-surgery planning, and intra-surgery guidance. In cardiac tissue engineering (TE), 3D printing technology is the most convenient and efficient microfabrication method to create biomimetic cardiovascular tissue for the potential in vivo implantation. Although booming rapidly, this technology is still in its infancy. Herein, we provide an emphasis on the application of this technology in clinical practices, micro- and nanoscale fabrications by cardiac TE. Initially, we will give an overview on the fabrication methods that can be used to synthesize the arbitrary 3D components with controlled features and will subsequently highlight the current limitations and future perspective of 3D printing used for cardiovascular diseases.
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Affiliation(s)
- Ranjith Kumar Kankala
- Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen 361021, People's Republic of China. Fujian Provincial Key Laboratory of Biochemical Technology, Xiamen 361021, People's Republic of China
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Facilitating surgeon understanding of complex anatomy using a three-dimensional printed model. J Surg Res 2017; 216:18-25. [DOI: 10.1016/j.jss.2017.04.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 04/03/2017] [Accepted: 04/11/2017] [Indexed: 12/18/2022]
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Yusa K, Yamanochi H, Takagi A, Iino M. Three-Dimensional Printing Model as a Tool to Assist in Surgery for Large Mandibular Tumour: a Case Report. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2017; 8:e4. [PMID: 28791080 PMCID: PMC5541989 DOI: 10.5037/jomr.2017.8204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/24/2017] [Indexed: 01/17/2023]
Abstract
Objectives Recently, three-dimensional printing models based on preoperative computed tomography and magnetic resonance imaging images have been widely used in medical fields. This study presents an effective use of the three-dimensional printing model in exploring complex spatial relationship between the tumour and surrounding tissue and in simulation surgery based planning of the operative procedure. Material and Methods The patient was a 7-year-old boy with ameloblastic fibro-odontoma. Prior to surgery, a hybrid three-dimensional printing model consisting of the jaw bone, the tumour and the inferior alveolar nerve was fabricated. After the simulation surgery based on this model, enucleation of the tumour, leaving tooth 46 intact (Universal Numbering System by ADA) safe, was planned. Results Enucleation of the tumour was successfully carried out. One year later, healing was found to be satisfactory both clinically and radiographically. Conclusions The study presented an effective application of a novel hybrid three-dimensional printing model composed of hard and soft tissues. Such innovations can bring significant benefits, especially to the field of oncological surgery.
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Affiliation(s)
- Kazuyuki Yusa
- Department of Dentistry, Oral and Maxillofacial - Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, YamagataJapan
| | - Hideyuki Yamanochi
- Department of Dentistry and Oral Surgery, Shinjo Tokushukai Hospital, Yamagata, Japan
| | - Akira Takagi
- Department of Dentistry, Oral and Maxillofacial - Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, YamagataJapan
| | - Mitsuyoshi Iino
- Department of Dentistry, Oral and Maxillofacial - Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, YamagataJapan
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George I, Guglielmetti LC, Bettinger N, Moss A, Wang C, Kheysin N, Hahn R, Kodali S, Leon M, Bapat V, Borger MA, Williams M, Smith C, Khalique OK. Aortic Valve Annular Sizing: Intraoperative Assessment Versus Preoperative Multidetector Computed Tomography. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005968. [PMID: 28487320 DOI: 10.1161/circimaging.116.005968] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/09/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Appropriate valve sizing is critical in aortic valve replacement. We hypothesized that direct intraoperative valve sizing results in smaller aortic annular diameters compared with sizing based on systolic-phase multidetector computerized tomographic (MDCT) imaging. METHODS AND RESULTS We retrospectively analyzed 78 patients undergoing surgical aortic valve replacement for severe aortic stenosis between 2012 and 2014 at our institution. Preoperative MDCT measurements of the aortic annulus served as basis for assignment to a theoretical surgical valve size, which was then (1) compared to the implanted valve size and (2) to a theoretical transcatheter aortic valve replacement valve size. To quantify the resulting differences, geometric orifice areas (GOA) were calculated. MDCT-based sizing produced the same valve size for n=34 patients (group CT-same), a larger valve with a 25% increased GOA in n=32 patients (group CT-Lg) and a smaller GOA by 22% in n=12 patients (group CT-Sm). On the basis of MDCT measurements, 41% of valves implanted were undersized. The comparison of intraoperative implanted to a theoretical transcatheter aortic valve replacement valve size resulted in GOAs 25% larger for patients in group CT-same, 40.6% larger in group CT-Lg and 14.6% larger in group CT-Sm. CONCLUSIONS Preoperative MDCT measurements differ substantially from direct intraoperative assessment of the aortic annulus. Implanted surgical aortic valve replacement valves were smaller relative to MDCT-based sizing in 41% of patients, and the potential GOA was between 25% and 40.6% larger if patients had undergone transcatheter aortic valve replacement.
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Affiliation(s)
- Isaac George
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.).
| | - Laura C Guglielmetti
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Nicolas Bettinger
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Andrew Moss
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Catherine Wang
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Nathan Kheysin
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Rebecca Hahn
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Susheel Kodali
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Martin Leon
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Vinayak Bapat
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Michael A Borger
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Mathew Williams
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Craig Smith
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
| | - Omar K Khalique
- From the Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY (I.G., A.M., C.W., N.K., C.S.); Division of Thoracic Surgery, University Hospital of Zurich, Switzerland (L.C.G.); Division of Cardiology, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, NY (N.B., R.H., S.K., M.L., M.A.B., O.K.K.); Division of Cardiothoracic Surgery, Guys and St. Thomas Hospital Trust, London, United Kingdom (V.B.); and Department of Cardiothoracic Surgery, New York University, NY (M.W.)
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Jones TW, Seckeler MD. Use of 3D models of vascular rings and slings to improve resident education. CONGENIT HEART DIS 2017; 12:578-582. [PMID: 28608434 DOI: 10.1111/chd.12486] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/05/2017] [Accepted: 05/11/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Three-dimensional (3D) printing is a manufacturing method by which an object is created in an additive process, and can be used with medical imaging data to generate accurate physical reproductions of organs and tissues for a variety of applications. We hypothesized that using 3D printed models of congenital cardiovascular lesions to supplement an educational lecture would improve learners' scores on a board-style examination. DESIGN AND INTERVENTION Patients with normal and abnormal aortic arches were selected and anonymized to generate 3D printed models. A cohort of pediatric and combined pediatric/emergency medicine residents were then randomized to intervention and control groups. Each participant was given a subjective survey and an objective board-style pretest. Each group received the same 20-minutes lecture on vascular rings and slings. During the intervention group's lecture, 3D printed physical models of each lesion were distributed for inspection. After each lecture, both groups completed the same subjective survey and objective board-style test to assess their comfort with and postlecture knowledge of vascular rings. RESULTS There were no differences in the basic demographics of the two groups. After the lectures, both groups' subjective comfort levels increased. Both groups' scores on the objective test improved, but the intervention group scored higher on the posttest. CONCLUSIONS This study demonstrated a measurable gain in knowledge about vascular rings and pulmonary artery slings with the addition of 3D printed models of the defects. Future applications of this teaching modality could extend to other congenital cardiac lesions and different learners.
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Affiliation(s)
- Trahern W Jones
- Department of Pediatrics, University of Arizona College of Medicine, Arizona, USA
| | - Michael D Seckeler
- Department of Pediatrics, University of Arizona College of Medicine, Arizona, USA
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Abstract
Medical 3-dimensional (3D) printing is emerging as a clinically relevant imaging tool in directing preoperative and intraoperative planning in many surgical specialties and will therefore likely lead to interdisciplinary collaboration between engineers, radiologists, and surgeons. Data from standard imaging modalities such as computed tomography, magnetic resonance imaging, echocardiography, and rotational angiography can be used to fabricate life-sized models of human anatomy and pathology, as well as patient-specific implants and surgical guides. Cardiovascular 3D-printed models can improve diagnosis and allow for advanced preoperative planning. The majority of applications reported involve congenital heart diseases and valvular and great vessels pathologies. Printed models are suitable for planning both surgical and minimally invasive procedures. Added value has been reported toward improving outcomes, minimizing perioperative risk, and developing new procedures such as transcatheter mitral valve replacements. Similarly, thoracic surgeons are using 3D printing to assess invasion of vital structures by tumors and to assist in diagnosis and treatment of upper and lower airway diseases. Anatomic models enable surgeons to assimilate information more quickly than image review, choose the optimal surgical approach, and achieve surgery in a shorter time. Patient-specific 3D-printed implants are beginning to appear and may have significant impact on cosmetic and life-saving procedures in the future. In summary, cardiothoracic 3D printing is rapidly evolving and may be a potential game-changer for surgeons. The imager who is equipped with the tools to apply this new imaging science to cardiothoracic care is thus ideally positioned to innovate in this new emerging imaging modality.
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Abstract
Objective: The application of 3-D printing has been increasingly used in medicine, with research showing many applications in cardiovascular disease. This systematic review analyzes those studies published about the applications of 3-D printed, patient-specific models in cardiovascular and cerebrovascular diseases. Methods: A search of PubMed/Medline and Scopus databases was performed to identify studies investigating the 3-D printing in cardiovascular and cerebrovascular diseases. Only studies based on patient’s medical images were eligible for review, while reports on in vitro phantom or review articles were excluded. Results: A total of 48 studies met selection criteria for inclusion in the review. A range of patient-specific 3-D printed models of different cardiovascular and cerebrovascular diseases were generated in these studies with most of them being developed using cardiac CT and MRI data, less commonly with 3-D invasive angiographic or echocardiographic images. The review of these studies showed high accuracy of 3-D printed, patient-specific models to represent complex anatomy of the cardiovascular and cerebrovascular system and depict various abnormalities, especially congenital heart diseases and valvular pathologies. Further, 3-D printing can serve as a useful education tool for both parents and clinicians, and a valuable tool for pre-surgical planning and simulation. Conclusion: This systematic review shows that 3-D printed models based on medical imaging modalities can accurately replicate complex anatomical structures and pathologies of the cardiovascular and cerebrovascular system. 3-D printing is a useful tool for both education and surgical planning in these diseases.
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Valverde I. Impresión tridimensional de modelos cardiacos: aplicaciones en el campo de la educación médica, la cirugía cardiaca y el intervencionismo estructural. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.09.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Valverde I. Three-dimensional Printed Cardiac Models: Applications in the Field of Medical Education, Cardiovascular Surgery, and Structural Heart Interventions. ACTA ACUST UNITED AC 2017; 70:282-291. [PMID: 28189544 DOI: 10.1016/j.rec.2017.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/29/2016] [Indexed: 01/17/2023]
Abstract
In recent years, three-dimensional (3D) printed models have been incorporated into cardiology because of their potential usefulness in enhancing understanding of congenital heart disease, surgical planning, and simulation of structural percutaneous interventions. This review provides an introduction to 3D printing technology and identifies the elements needed to construct a 3D model: the types of imaging modalities that can be used, their minimum quality requirements, and the kinds of 3D printers available. The review also assesses the usefulness of 3D printed models in medical education, specialist physician training, and patient communication. We also review the most recent applications of 3D models in surgical planning and simulation of percutaneous structural heart interventions. Finally, the current limitations of 3D printing and its future directions are discussed to explore potential new applications in this exciting medical field.
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Affiliation(s)
- Israel Valverde
- Sección de Cardiología y Hemodinámica Pediátrica, Servicio de Pediatría, Hospital Virgen del Rocío, Sevilla, Spain; Grupo de Fisiopatología Cardiovascular, Instituto de Biomedicina de Sevilla, IBIS, Hospital Virgen de Rocío/CSIC/Universidad de Sevilla, Seville, Spain; Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, United Kingdom; Paediatric Cardiology, Evelina London Children's Hospital at Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
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Dundie A, Hayes G, Scrivani P, Campoy L, Fletcher D, Ash K, Oxford E, Moïse NS. Use of 3D printer technology to facilitate surgical correction of a complex vascular anomaly with esophageal entrapment in a dog. J Vet Cardiol 2017; 19:196-204. [PMID: 28094152 DOI: 10.1016/j.jvc.2016.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 10/20/2016] [Accepted: 10/25/2016] [Indexed: 01/17/2023]
Abstract
A 10 week old female intact Staffordshire terrier was presented with a total of five congenital cardio-thoracic vascular anomalies consisting of a patent ductus arteriosus (PDA) with an aneurysmic dilation, pulmonic stenosis, persistent right aortic arch, aberrant left subclavian artery and persistent left cranial vena cava. These abnormalities were identified with a combination of echocardiogram and computed tomography angiography (CTA). The abnormalities were associated with esophageal entrapment, regurgitation, and volume overload of the left heart with left atrial and ventricular enlargement. A 2 cm diameter aneurysmic dilation at the junction of the PDA, right aortic arch and aberrant left subclavian artery presented an unusual surgical challenge and precluded simple circumferential ligation and transection of the structure. A full scale three dimensional model of the heart and vasculature was constructed from the CTA and plasma sterilized. The model was used preoperatively to facilitate surgical planning and enhance intraoperative communication and coordination between the surgical and anesthesia teams. Intraoperatively the model facilitated spatial orientation, atraumatic vascular dissection, instrument sizing and positioning. A thoracoabdominal stapler was used to close the PDA aneurysm prior to transection. At the four-month postoperative follow-up the patient was doing well. This is the first reported application of new imaging and modeling technology to enhance surgical planning when approaching correction of complex cardiovascular anomalies in a dog.
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Affiliation(s)
- A Dundie
- Cornell University, College of Veterinary Medicine, Ithaca NY 14853, USA
| | - G Hayes
- Section of Small Animal Surgery, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca NY 14853, USA.
| | - P Scrivani
- Section of Diagnostic Imaging, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca NY 14853, USA
| | - L Campoy
- Section of Anesthesia and Analgesia, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca NY 14853, USA
| | - D Fletcher
- Section of Emergency and Critical Care, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca NY 14853, USA
| | - K Ash
- Section of Small Animal Surgery, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca NY 14853, USA
| | - E Oxford
- Section of Cardiology, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca NY 14853, USA
| | - N S Moïse
- Section of Cardiology, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca NY 14853, USA
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Hoang D, Perrault D, Stevanovic M, Ghiassi A. Surgical applications of three-dimensional printing: a review of the current literature & how to get started. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:456. [PMID: 28090512 DOI: 10.21037/atm.2016.12.18] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Three dimensional (3D) printing involves a number of additive manufacturing techniques that are used to build structures from the ground up. This technology has been adapted to a wide range of surgical applications at an impressive rate. It has been used to print patient-specific anatomic models, implants, prosthetics, external fixators, splints, surgical instrumentation, and surgical cutting guides. The profound utility of this technology in surgery explains the exponential growth. It is important to learn how 3D printing has been used in surgery and how to potentially apply this technology. PubMed was searched for studies that addressed the clinical application of 3D printing in all surgical fields, yielding 442 results. Data was manually extracted from the 168 included studies. We found an exponential increase in studies addressing surgical applications for 3D printing since 2011, with the largest growth in craniofacial, oromaxillofacial, and cardiothoracic specialties. The pertinent considerations for getting started with 3D printing were identified and are discussed, including, software, printing techniques, printing materials, sterilization of printing materials, and cost and time requirements. Also, the diverse and increasing applications of 3D printing were recorded and are discussed. There is large array of potential applications for 3D printing. Decreasing cost and increasing ease of use are making this technology more available. Incorporating 3D printing into a surgical practice can be a rewarding process that yields impressive results.
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Affiliation(s)
- Don Hoang
- USC Plastic and Reconstructive Surgery, Los Angeles, CA, USA
| | - David Perrault
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Milan Stevanovic
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Mitsouras D, Liacouras P, Imanzadeh A, Giannopoulos AA, Cai T, Kumamaru KK, George E, Wake N, Caterson EJ, Pomahac B, Ho VB, Grant GT, Rybicki FJ. Medical 3D Printing for the Radiologist. Radiographics 2016; 35:1965-88. [PMID: 26562233 DOI: 10.1148/rg.2015140320] [Citation(s) in RCA: 360] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
While use of advanced visualization in radiology is instrumental in diagnosis and communication with referring clinicians, there is an unmet need to render Digital Imaging and Communications in Medicine (DICOM) images as three-dimensional (3D) printed models capable of providing both tactile feedback and tangible depth information about anatomic and pathologic states. Three-dimensional printed models, already entrenched in the nonmedical sciences, are rapidly being embraced in medicine as well as in the lay community. Incorporating 3D printing from images generated and interpreted by radiologists presents particular challenges, including training, materials and equipment, and guidelines. The overall costs of a 3D printing laboratory must be balanced by the clinical benefits. It is expected that the number of 3D-printed models generated from DICOM images for planning interventions and fabricating implants will grow exponentially. Radiologists should at a minimum be familiar with 3D printing as it relates to their field, including types of 3D printing technologies and materials used to create 3D-printed anatomic models, published applications of models to date, and clinical benefits in radiology. Online supplemental material is available for this article.
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Affiliation(s)
- Dimitris Mitsouras
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Peter Liacouras
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Amir Imanzadeh
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Andreas A Giannopoulos
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Tianrun Cai
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Kanako K Kumamaru
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Elizabeth George
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Nicole Wake
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Edward J Caterson
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Bohdan Pomahac
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Vincent B Ho
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Gerald T Grant
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
| | - Frank J Rybicki
- From the Applied Imaging Science Laboratory, Department of Radiology (D.M., A.I., A.A.G., T.C., K.K.K., E.G., F.J.R.), and Division of Plastic Surgery, Department of Surgery (E.J.C., B.P.), Brigham and Women's Hospital, Boston, Mass; 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L., V.B.H., G.T.G.); Center for Advanced Imaging Innovation and Research, Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, NY (N.W.); and Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY (N.W.)
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Lin JC, Myers E. Three-dimensional printing for preoperative planning of renal artery aneurysm surgery. J Vasc Surg 2016; 64:810. [DOI: 10.1016/j.jvs.2015.12.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/30/2015] [Indexed: 01/17/2023]
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Dugas CM, Schussler JM. Advanced technology in interventional cardiology: A roadmap for the future of precision coronary interventions. Trends Cardiovasc Med 2016; 26:466-73. [DOI: 10.1016/j.tcm.2016.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/14/2016] [Accepted: 02/17/2016] [Indexed: 01/17/2023]
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Affiliation(s)
- Karima Addetia
- Section of Cardiology, Department of Medicine, University of Chicago, 5758 S. Maryland Avenue, MC9067, Chicago, IL 60637, USA
| | - Roberto M Lang
- Section of Cardiology, Department of Medicine, University of Chicago, 5758 S. Maryland Avenue, MC9067, Chicago, IL 60637, USA
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Three-Dimensional Printing: An Enabling Technology for IR. J Vasc Interv Radiol 2016; 27:859-65. [DOI: 10.1016/j.jvir.2016.02.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 01/14/2023] Open
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Abstract
AIMS OF THE STUDY Laparoscopic simulation has transformed skills acquisition for many procedures. However, realistic nonbiological simulators for complex reconstructive surgery are rare. Life-like tactile feedback is particularly difficult to reproduce. Technological innovations may contribute novel solutions to these shortages. We describe a hybrid model, harnessing 3D technology to simulate laparoscopic choledochal surgery for the first time. METHODS Digital hepatic anatomy images and standard laparoscopic trainer dimensions were employed to create an entry level laparoscopic choledochal surgery model. The information was fed into a 3D systems project 660pro with visijet pxl core powder to create a free standing liver mold. This included a cuboid portal in which to slot disposable hybrid components representing hepatic and pancreatic ducts and choledochal cyst. The mold was used to create soft silicone replicas with T28 resin and T5 fast catalyst. The model was assessed at a national pediatric surgery training day. RESULTS The 10 delegates that trialed the simulation felt that the tactile likeness was good (5.6/10±1.71, 10=like the real thing), was not too complex (6.2/10±1.35; where 1=too simple, 10=too complicated), and generally very useful (7.36/10±1.57, 10=invaluable). 100% stated that they felt they could reproduce this in their own centers, and 100% would recommend this simulation to colleagues. CONCLUSION Though this first phase choledochal cyst excision simulation requires further development, 3D printing provides a useful means of creating specific and detailed simulations for rare and complex operations with huge potential for development.
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State-of-the-Art Review of 3D Bioprinting for Cardiovascular Tissue Engineering. Ann Biomed Eng 2016; 45:195-209. [DOI: 10.1007/s10439-016-1607-5] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/02/2016] [Indexed: 12/24/2022]
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Shafiee A, Atala A. Printing Technologies for Medical Applications. Trends Mol Med 2016; 22:254-265. [DOI: 10.1016/j.molmed.2016.01.003] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/06/2016] [Accepted: 01/10/2016] [Indexed: 01/17/2023]
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Martelli N, Serrano C, van den Brink H, Pineau J, Prognon P, Borget I, El Batti S. Advantages and disadvantages of 3-dimensional printing in surgery: A systematic review. Surgery 2016; 159:1485-1500. [PMID: 26832986 DOI: 10.1016/j.surg.2015.12.017] [Citation(s) in RCA: 345] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/02/2015] [Accepted: 12/11/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Three-dimensional (3D) printing is becoming increasingly important in medicine and especially in surgery. The aim of the present work was to identify the advantages and disadvantages of 3D printing applied in surgery. METHODS We conducted a systematic review of articles on 3D printing applications in surgery published between 2005 and 2015 and identified using a PubMed and EMBASE search. Studies dealing with bioprinting, dentistry, and limb prosthesis or those not conducted in a hospital setting were excluded. RESULTS A total of 158 studies met the inclusion criteria. Three-dimensional printing was used to produce anatomic models (n = 113, 71.5%), surgical guides and templates (n = 40, 25.3%), implants (n = 15, 9.5%) and molds (n = 10, 6.3%), and primarily in maxillofacial (n = 79, 50.0%) and orthopedic (n = 39, 24.7%) operations. The main advantages reported were the possibilities for preoperative planning (n = 77, 48.7%), the accuracy of the process used (n = 53, 33.5%), and the time saved in the operating room (n = 52, 32.9%); 34 studies (21.5%) stressed that the accuracy was not satisfactory. The time needed to prepare the object (n = 31, 19.6%) and the additional costs (n = 30, 19.0%) were also seen as important limitations for routine use of 3D printing. CONCLUSION The additional cost and the time needed to produce devices by current 3D technology still limit its widespread use in hospitals. The development of guidelines to improve the reporting of experience with 3D printing in surgery is highly desirable.
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Affiliation(s)
- Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France; University Paris-Sud, GRADES, Faculty of Pharmacy, Châtenay-Malabry, France.
| | - Carole Serrano
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | | | - Judith Pineau
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Patrice Prognon
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Isabelle Borget
- University Paris-Sud, GRADES, Faculty of Pharmacy, Châtenay-Malabry, France; Department of Health Economics, Gustave Roussy Institute, Villejuif, France
| | - Salma El Batti
- Department of Cardiac and Vascular Surgery, Georges Pompidou European Hospital, Paris, France; URDIA - Unité de Recherche en Développement, Imagerie et Anatomie - EA 4465, Université Paris Descartes, Paris, France
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