1
|
Emiliani N, Porcaro R, Pisaneschi G, Bortolani B, Ferretti F, Fontana F, Campana G, Fiorini M, Marcelli E, Cercenelli L. Post-printing processing and aging effects on Polyjet materials intended for the fabrication of advanced surgical simulators. J Mech Behav Biomed Mater 2024; 156:106598. [PMID: 38815435 DOI: 10.1016/j.jmbbm.2024.106598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/06/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
Material Jetting (MJ) 3D printing technology is promising for the fabrication of highly realistic surgical simulators, however, the changes in the mechanical properties of MJ materials after post-printing treatments and over time remain quite unknown. In this study, we investigate the effect of different post-printing processes and aging on the mechanical properties of a white opaque and rigid MJ photopolymer, a white flexible MJ photopolymer and on a combination of them. Tensile and Shore hardness tests were conducted on homogeneous 3D-printed specimens: two different post-printing procedures for support removal (dry and water) and further surface treatment (with glycerol solution) were compared. The specimens were tested within 48 h from printing and after aging (30-180 days) in a controlled environment. All groups of specimens treated with different post-printing processes (dry, water, glycerol) exhibited a statistically significant difference in mechanical properties (i.e. elongation at break, elastic modulus, ultimate tensile strength). Particularly, the treatment with glycerol makes the flexible photopolymer more rigid, but then with aging the initial elongation of the material tends to be restored. For the rigid photopolymer, an increase in deformability was observed as a major effect of aging. The hardness tests on the printed specimens highlighted a significant overestimation of the Shore values declared by the manufacturer. The study findings are useful for guiding the material selection and post-printing processing techniques to manufacture realistic and durable models for surgical training.
Collapse
Affiliation(s)
- Nicolas Emiliani
- eDIMES Lab - Laboratory of Bioengineering, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138, Bologna, Italy
| | - Rita Porcaro
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), University of Bologna, Via Terracini 28, 40131, Bologna, Italy
| | - Gregorio Pisaneschi
- Department of Industrial Engineering (DIN), University of Bologna, Viale del Risorgimento, 40136, Bologna, Italy
| | - Barbara Bortolani
- eDIMES Lab - Laboratory of Bioengineering, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138, Bologna, Italy
| | - Fabrizio Ferretti
- eDIMES Lab - Laboratory of Bioengineering, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138, Bologna, Italy
| | - Francesco Fontana
- Department of Industrial Engineering (DIN), University of Bologna, Viale del Risorgimento, 40136, Bologna, Italy
| | - Giampaolo Campana
- Department of Industrial Engineering (DIN), University of Bologna, Viale del Risorgimento, 40136, Bologna, Italy
| | - Maurizio Fiorini
- Department of Civil, Chemical, Environmental and Materials Engineering (DICAM), University of Bologna, Via Terracini 28, 40131, Bologna, Italy
| | - Emanuela Marcelli
- eDIMES Lab - Laboratory of Bioengineering, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138, Bologna, Italy
| | - Laura Cercenelli
- eDIMES Lab - Laboratory of Bioengineering, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138, Bologna, Italy.
| |
Collapse
|
2
|
Muñoz-Leija D, Díaz González-Colmenero F, Ramiréz-Mendoza DA, López-Cabrera NG, Llanes-Garza HA, Palacios-Ríos D, Negreros-Osuna AA. Development and Evaluation of An In-House Lumbar Puncture Simulator for First-Year Resident Lumbar Puncture Procedure Learning. Cureus 2024; 16:e56567. [PMID: 38510522 PMCID: PMC10954365 DOI: 10.7759/cureus.56567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Lumbar puncture (LP) is a common invasive technique considered an essential learning milestone for anesthesiologists due to its application in spinal anesthesia. We aimed to develop an in-house LP simulator, test its effectiveness in learning the steps to perform an LP and analyze its impact on the first-year residents' self-confidence at our hospital. METHODS We used 3D printing and silicone casting to create an LP simulator based on a lumbar spine computed tomography (CT). We divided 12 first-year anesthesiology residents into control and experimental groups. The control group received traditional training, while the experimental group practiced with the simulator for three months. We used a procedure checklist and a Likert scale survey to evaluate their procedural knowledge and self-confidence at baseline, three, and six months. Eighteen months later, we evaluated their LP performance skills. RESULTS Both groups showed a significant improvement in their knowledge scores over time. After three months, the experimental group had a higher median knowledge score (10 (10 - 10) median (min-max)) than the control group (9 (8 - 9.5) median (min-max)) (p = 0.03). While there were no apparent differences in median self-confidence scores between the groups at any time point, the experimental group had a significant increase in their self-confidence for performing an unassisted LP, with a median score of 1/5 (1 - 2.3) at baseline and 5/5 (4.8 - 5) after six months (p = 0.006). In contrast, the control group's self-confidence scores decreased from 4/5 (3 - 4) after three months to 3/5 (2 - 5) after six months. The evaluation of performance skills did not yield statistically significant results. CONCLUSION Our study demonstrates that an in-house LP simulator is an effective and practical approach for first-year anesthesiology residents to learn the LP procedure. This approach could be particularly useful in settings with limited resources and a lack of sufficient patients to practice on, as it provides an opportunity for faster learning and increased self-confidence.
Collapse
Affiliation(s)
- David Muñoz-Leija
- Radiology Department, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, MEX
| | - Fernando Díaz González-Colmenero
- Radiology Department, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, MEX
| | - Diego A Ramiréz-Mendoza
- Radiology Department, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, MEX
| | - Norma G López-Cabrera
- Anesthesiology Service, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, MEX
| | - Hilda A Llanes-Garza
- Anesthesiology Service, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, MEX
| | - Dionicio Palacios-Ríos
- Anesthesiology Service, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, MEX
| | - Adrián A Negreros-Osuna
- Radiology Department, Hospital Regional Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Monterrey, Universidad Autónoma de Nuevo León, Monterrey, MEX
- Radiology Department, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, MEX
| |
Collapse
|
3
|
Mao Y, Liu L, Zhong J, Qin P, Ma R, Zuo M, Zhang L, Yang L. Tracheal intubation in patients with Pierre Robin sequence: development, application, and clinical value based on a 3-dimensional printed simulator. Front Physiol 2024; 14:1292523. [PMID: 38374871 PMCID: PMC10875733 DOI: 10.3389/fphys.2023.1292523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/11/2023] [Indexed: 02/21/2024] Open
Abstract
Background: The main clinical manifestations of patients with Pierre Robin sequence (PRS) include micrognathia, the glossoptosis and dyspnoea. The difficulty of tracheal intubation (TI) in such patients is increased. Objective: The purpose of the study was to evaluate the reliability and efficacy of the PRS simulator. Methods: A PRS simulator was developed by using 3-dimensional (3D) printing technology under computer-aided design. A total of 12 anaesthesiologists each trained 5 times for TI on the PRS Training Simulator-1 and recorded the simulation time. After the training, they were randomly divided into three groups with a total of 12 nontrained anaesthesiologists, and the simulation was completed on PRS Simulator-2, 3 and 4. The simulation time was recorded, and the performance was evaluated by three chief anaesthesiologists. Then, all 24 anaesthesiologists completed the questionnaire. Results: A PRS simulator developed by 3D printing was used to simulate the important aspects of TI. The average number of years worked was 6.3 ± 3.1 years, and 66.7% were female. The time for the 12 anaesthesiologists to complete the training gradually decreased (p < 0.01). Compared with the trained anaesthesiologists, the simulation time of TI in the nontrained anaesthesiologists was much longer (all p < 0.01). In addition, the simulation performance of the trained anaesthesiologists was relatively better (all p < 0.01). Conclusion: The reliability and efficacy of the PRS simulator is herein preliminarily validated, and it has potential to become a teaching and training tool for anaesthesiologists.
Collapse
Affiliation(s)
- Yu Mao
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Lu Liu
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - John Zhong
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Pei Qin
- Department of Anesthesiology, Xi’an Children Hospital, Xi’an, China
| | - Rui Ma
- Department of Anesthesiology, Xi’an Children Hospital, Xi’an, China
| | - Mingzhang Zuo
- Department of Anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Zhang
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Lifang Yang
- Department of Anesthesiology, Xi’an Children Hospital, Xi’an, China
| |
Collapse
|
4
|
Shaylor R, Golden E, Goren O, Verenkin V, Cohen B. Development and Validation of a Hybrid Bronchoscopy Trainer Using Three-Dimensional Printing. Simul Healthc 2024; 19:52-55. [PMID: 36194854 DOI: 10.1097/sih.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Simulation is an essential component of medical education. Commercially available intubation simulators often lack anatomical fidelity of the lower airway and are therefore not suitable for teaching bronchoscopy or lung isolation. By using a desktop 3-dimensional (3D) printer, we aimed to create and validate a hybrid simulator from an existing mannequin with a 3D-printed lower airway that has anatomical fidelity and is financially affordable compared with commercially available models. METHODS Using an anonymized computed tomography scan of an adult male patient, we developed a 3D model of the airway from below the larynx to the 3rd generation bronchi, which was then printed on a desktop 3D printer. The printed airway was attached to an existing mannequin below the larynx via a universal adaptor. Ten anesthesiology attendings performed a blinded comparison of the hybrid mannequin with a commercially available mannequin for tactile and visual fidelity when performing intubation, bronchoscopy, and lung isolation. They were also asked to assess the models for educational suitability. RESULTS The 3D printed model was judged more suitable for teaching double-lumen tube insertion to novice physicians compared with the commercial model, with median (interquartile range) scores of 5 (4-5) versus 3 (2-4), P = 0.017. Similar results were found for bronchial blocker insertion and bronchoscopy. The visual fidelity of the bronchial anatomy was scored as 5 (4-5) and 2 (1-3) for the 3D-printed and the commercial models, respectively ( P = 0.007). CONCLUSION By creating a hybrid model combining an existing commercially available mannequin with a 3D-printed trachea and bronchial tree, we have created an affordable training simulator suitable for teaching lung isolation and bronchoscopy. Enhancing existing mannequins with 3D-printed parts may be of particular interest to institutions that do not have the funds to buy models with anatomical fidelity but do have access to a 3D printer.
Collapse
Affiliation(s)
- Ruth Shaylor
- From the Division of Anesthesia, Intensive Care, and Pain Medicine (R.S., O.G., V.V., B.C.), Surgical 3D Printing Laboratory (E.G.), Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; and Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic (B.C.), Cleveland, OH
| | | | | | | | | |
Collapse
|
5
|
Oh M, Ban J, Lee Y, Lee M, Kim S, Kim U, Park J, Han J, Chang J, Kim B, Yun H, Lee N, Chang D. Development of three-dimensional canine hepatic tumor model based on computed tomographic angiography for simulation of transarterial embolization. Front Vet Sci 2024; 10:1280028. [PMID: 38352169 PMCID: PMC10861713 DOI: 10.3389/fvets.2023.1280028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/13/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction Transarterial embolization (TAE) is one of the treatment options for liver masses that are not suitable for surgery and they have been applied in veterinary medicine for about 20 years, but surgical resection is considered as the first treatment option, and only a few case reports and articles about TAE in dogs have been published. Although understanding of vascular anatomy for the procedure is important, previous studies lack of the information about hepatic artery anatomy in small and toy-breed dogs. Due to the introduction of 3D print in veterinary medicine, it is now possible to make 3D models for preoperative planning. The purpose of this study is to understand the hepatic arterial vascular structure of various sizes and breeds of dogs, and to develop 3D-printed canine artery models with and without hepatic tumors to simulate TAE procedure. Methods CT images of a total of 84 dogs with normal hepatic arteries were analyzed, and the mean value and standard deviation of body weight, celiac artery size, and hepatic artery size were 6.47 ± 4.44 kg, 3.28 ± 0.77 mm, and 2.14 ± 0.43 mm, respectively. Results It was established that type 2-2-1, which has two separate hepatic branches-the right medial and left branch and the right lateral branch that runs to the right lateral lobe and caudate process-is the most prevalent of the hepatic artery branch types, as it was in the previous study. The review of 65 CT images of dogs with hepatic tumors showed that 44.6% (29/65) had multifocal lesions in multiple lobes, for which TAE can be recommended. Discussion Based on the result, a 3D model of the normal canine hepatic artery and the hepatic tumor was made using one representative case from each group, and despite the models having some limitations in reflecting the exact tactile and velocity of blood vessels, TAE procedure was successfully simulated using both models.
Collapse
Affiliation(s)
- Miju Oh
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jiyoung Ban
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Yooyoung Lee
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Minju Lee
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Sojin Kim
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Uhjin Kim
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jiwoon Park
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jaepung Han
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jinhwa Chang
- Korea Animal Medical Center, Cheongju, Republic of Korea
| | - Byungjin Kim
- Bon Animal Medical Center, Suwon, Republic of Korea
| | - Hyeongrok Yun
- SKY Animal Medical Center, Cheonan, Republic of Korea
| | - Namsoon Lee
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Dongwoo Chang
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| |
Collapse
|
6
|
Parab SY, Ranganathan P, Shetmahajan M, Malde A. Role of simulation-based training in thoracic anaesthesia. Indian J Anaesth 2024; 68:58-64. [PMID: 38406334 PMCID: PMC10893814 DOI: 10.4103/ija.ija_1235_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/26/2023] [Accepted: 12/31/2023] [Indexed: 02/27/2024] Open
Abstract
Simulation-based training (SBT) aims to acquire technical and non-technical skills in a simulated fashion without harming the patient. Simulation helps the anaesthesiologist acquire procedural competence and non-technical abilities. In thoracic anaesthesia, various simulators are available with varying degrees of fidelity and costs. Apart from improving bronchoscopy-related skills, other potential applications of SBT include the practice of lung isolation in normal and difficult airway scenarios, troubleshooting complications during surgeries, and certification of the proficiency of anaesthesiologists. A pragmatic approach is required for choosing the simulator based on its availability, cost, and benefits. Although the literature supports SBT to improve procedural skills, retention of the skills and their translation into improving clinical outcomes remain largely unproven. Randomised, controlled studies targeting the effect of SBT on the improvement of clinical outcomes of patients are needed to prove their worth.
Collapse
Affiliation(s)
- Swapnil Y. Parab
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National University, Dr. E Borges Road, Parel, Mumbai, Maharashtra, India
| | - Priya Ranganathan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National University, Dr. E Borges Road, Parel, Mumbai, Maharashtra, India
| | - Madhavi Shetmahajan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National University, Dr. E Borges Road, Parel, Mumbai, Maharashtra, India
| | - Anila Malde
- Department of Anaesthesiology, Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, Maharashtra, India
| |
Collapse
|
7
|
Maurya I, Ahmed SM, Garg R. Simulation in airway management teaching and training. Indian J Anaesth 2024; 68:52-57. [PMID: 38406347 PMCID: PMC10893796 DOI: 10.4103/ija.ija_1234_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/25/2023] [Accepted: 12/31/2023] [Indexed: 02/27/2024] Open
Abstract
There is a gradual shift in training and teaching methods in the medical field. We are slowly moving from the traditional model and adopting active learning methods like simulation-based training. Airway management is an essential clinical skill for any anaesthesiologist, and a trained anaesthesiologist must perform quick and definitive airway management using various techniques. Airway simulations have been used for the past few decades. It ensures active involvement, upgrading the trainees' airway management knowledge and skills, including basic airway skills, invasive procedures, and difficult clinical scenarios. Trainees also learn non-technical skills such as communication, teamwork, and coordination. A wide range of airway simulators are available. However, texture surface characteristics vary from one type to another. The simulation-based airway management training requires availability, understanding, faculty development, and a structured curriculum for effective delivery. This article explored the available evidence on simulation-based airway management teaching and training.
Collapse
Affiliation(s)
- Indubala Maurya
- Department of Anaesthesiology, Kalyan Singh Super Specialty Cancer Institute, Lucknow, Uttar Pradesh, India
| | - Syed M. Ahmed
- Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia, Pain and Palliative Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| |
Collapse
|
8
|
Żukowska M, Rad MA, Górski F. Additive Manufacturing of 3D Anatomical Models-Review of Processes, Materials and Applications. MATERIALS (BASEL, SWITZERLAND) 2023; 16:880. [PMID: 36676617 PMCID: PMC9861235 DOI: 10.3390/ma16020880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
The methods of additive manufacturing of anatomical models are widely used in medical practice, including physician support, education and planning of treatment procedures. The aim of the review was to identify the area of additive manufacturing and the application of anatomical models, imitating both soft and hard tissue. The paper outlines the most commonly used methodologies, from medical imaging to obtaining a functional physical model. The materials used to imitate specific organs and tissues, and the related technologies used to produce, them are included. The study covers publications in English, published by the end of 2022 and included in the Scopus. The obtained results emphasise the growing popularity of the issue, especially in the areas related to the attempt to imitate soft tissues with the use of low-cost 3D printing and plastic casting techniques.
Collapse
Affiliation(s)
- Magdalena Żukowska
- Faculty of Mechanical Engineering, Poznan University of Technology, Piotrowo 3, 61-138 Poznan, Poland
| | - Maryam Alsadat Rad
- School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology, Sydney, NSW 2007, Australia
| | - Filip Górski
- Faculty of Mechanical Engineering, Poznan University of Technology, Piotrowo 3, 61-138 Poznan, Poland
| |
Collapse
|
9
|
Teaching Radial Endobronchial Ultrasound with a Three-Dimensional–printed Radial Ultrasound Model. ATS Sch 2021; 2:606-619. [PMID: 35083464 PMCID: PMC8787737 DOI: 10.34197/ats-scholar.2020-0152oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 08/13/2021] [Indexed: 12/04/2022] Open
Abstract
Background Peripheral pulmonary lesion (PPL) incidence is rising because of increased
chest imaging sensitivity and frequency. For PPLs suspicious for lung
cancer, current clinical guidelines recommend tissue diagnosis. Radial
endobronchial ultrasound (R-EBUS) is a bronchoscopic technique used for this
purpose. It has been observed that diagnostic yield is impacted by the
ability to accurately manipulate the radial probe. However, such skills can
be acquired, in part, from simulation training. Three-dimensional (3D)
printing has been used to produce training simulators for standard
bronchoscopy but has not been specifically used to develop similar tools for
R-EBUS. Objective We report the development of a novel ultrasound-compatible, anatomically
accurate 3D-printed R-EBUS simulator and evaluation of its utility as a
training tool. Methods Computed tomography images were used to develop 3D-printed airway models with
ultrasound-compatible PPLs of “low” and “high”
technical difficulty. Twenty-one participants were allocated to two groups
matched for prior R-EBUS experience. The intervention group received 15
minutes to pretrain R-EBUS using a 3D-printed model, whereas the
nonintervention group did not. Both groups then performed R-EBUS on
3D-printed models and were evaluated using a specifically developed
assessment tool. Results For the “low-difficulty” model, the intervention group achieved
a higher score (21.5 ± 2.02) than the nonintervention
group (17.1 ± 5.7), reflecting 26% improvement
in performance (P = 0.03). For the
“high-difficulty” model, the intervention group scored
20.2 ± 4.21 versus 13.3 ± 7.36,
corresponding to 52% improvement in performance
(P = 0.02). Participants derived
benefit from pretraining with the 3D-printed model, regardless of prior
experience level. Conclusion 3D-printing can be used to develop simulators for R-EBUS education. Training
using these models significantly improves procedural performance and is
effective in both novice and experienced trainees.
Collapse
|
10
|
Huybrechts I, Tuna T, Szegedi LL. Lung separation in adult thoracic anesthesia. Saudi J Anaesth 2021; 15:272-279. [PMID: 34764834 PMCID: PMC8579504 DOI: 10.4103/sja.sja_78_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/14/2022] Open
Abstract
Thoracic anesthesia is mainly the world of OLV during anesthesia. The indications for OLV, classified as absolute or relative are more representative of the new concepts in OLV: It includes either the separation or the isolation of the lungs. Modern DLTs are most widely employed worldwide to perform OLV including the concept of one lung separation. Endobronchial blockers are a valid alternative to DLTs, and they are mandatory in the education of lung separation and in case of predicted difficult airways as they are the safest approach (with an awake intubation with an SLT through a FOB). Every general anesthesiologist should know how to insert a left-sided DLT, but he/she should also have in his technical luggage and toolbox, basic knowledge and minimal expertise with BBs, this option being considered a suitable alternative, particularly in emergency situation where the patient is already intubated and/or in case of difficult airways. One should keep in mind that extubation or re-intubation after DLT might be difficult too, and additional intubation tools are necessary for the safety conditions.
Collapse
Affiliation(s)
- Isabelle Huybrechts
- Consulting Anesthesiologist, Service d'Anesthésiologie-Réanimation, C.U.B. Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Turgay Tuna
- Chair of the Medical Council, Service d'Anesthésiologie-Réanimation, C.U.B. Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Laszlo L Szegedi
- Clinical Director, Past-Chairman and Member of the Thoracic Scientific Subcommittee and Member of the Educational Committee of the European Society of Cardiothoracic Anesthesiologists (EACTA), Service d'Anesthésiologie-Réanimation, C.U.B. Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| |
Collapse
|
11
|
Pugalendhi A, Ranganathan R. A review of additive manufacturing applications in ophthalmology. Proc Inst Mech Eng H 2021; 235:1146-1162. [PMID: 34176362 DOI: 10.1177/09544119211028069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Additive Manufacturing (AM) capabilities in terms of product customization, manufacture of complex shape, minimal time, and low volume production those are very well suited for medical implants and biological models. AM technology permits the fabrication of physical object based on the 3D CAD model through layer by layer manufacturing method. AM use Magnetic Resonance Image (MRI), Computed Tomography (CT), and 3D scanning images and these data are converted into surface tessellation language (STL) file for fabrication. The applications of AM in ophthalmology includes diagnosis and treatment planning, customized prosthesis, implants, surgical practice/simulation, pre-operative surgical planning, fabrication of assistive tools, surgical tools, and instruments. In this article, development of AM technology in ophthalmology and its potential applications is reviewed. The aim of this study is nurturing an awareness of the engineers and ophthalmologists to enhance the ophthalmic devices and instruments. Here some of the 3D printed case examples of functional prototype and concept prototypes are carried out to understand the capabilities of this technology. This research paper explores the possibility of AM technology that can be successfully executed in the ophthalmology field for developing innovative products. This novel technique is used toward improving the quality of treatment and surgical skills by customization and pre-operative treatment planning which are more promising factors.
Collapse
Affiliation(s)
- Arivazhagan Pugalendhi
- Department of Mechanical Engineering, Coimbatore Institute of Technology, Coimbatore, Tamil Nadu, India
| | - Rajesh Ranganathan
- Department of Mechanical Engineering, Coimbatore Institute of Technology, Coimbatore, Tamil Nadu, India
| |
Collapse
|
12
|
Abeysekera N, Whitmore KA, Abeysekera A, Pang G, Laupland KB. Applications of 3D printing in critical care medicine: A scoping review. Anaesth Intensive Care 2021; 49:164-172. [PMID: 33789504 DOI: 10.1177/0310057x20976655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although a wide range of medical applications for three-dimensional printing technology have been recognised, little has been described about its utility in critical care medicine. The aim of this review was to identify three-dimensional printing applications related to critical care practice. A scoping review of the literature was conducted via a systematic search of three databases. A priori specified themes included airway management, procedural support, and simulation and medical education. The search identified 1544 articles, of which 65 were included. Ranging across many applications, most were published since 2016 in non - critical care discipline-specific journals. Most studies related to the application of three-dimensional printed models of simulation and reported good fidelity; however, several studies reported that the models poorly represented human tissue characteristics. Randomised controlled trials found some models were equivalent to commercial airway-related skills trainers. Several studies relating to the use of three-dimensional printing model simulations for spinal and neuraxial procedures reported a high degree of realism, including ultrasonography applications three-dimensional printing technologies. This scoping review identified several novel applications for three-dimensional printing in critical care medicine. Three-dimensional printing technologies have been under-utilised in critical care and provide opportunities for future research.
Collapse
Affiliation(s)
- Natasha Abeysekera
- Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Kirsty A Whitmore
- Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Australia.,Faculty of Medicine, University of Queensland, Herston, Australia
| | - Ashvini Abeysekera
- Otolaryngology and Head and Neck Surgery, Royal Brisbane and Women's Hospital, Herston, Australia
| | - George Pang
- Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Kevin B Laupland
- Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Australia.,Faculty of Health, Queensland University of Technology (QUT), Kelvin Grove, Australia
| |
Collapse
|
13
|
Boshra M, Godbout J, Perry JJ, Pan A. 3D printing in critical care: a narrative review. 3D Print Med 2020; 6:28. [PMID: 32997313 PMCID: PMC7525075 DOI: 10.1186/s41205-020-00081-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 3D printing (3DP) has gained interest in many fields of medicine including cardiology, plastic surgery, and urology due to its versatility, convenience, and low cost. However, critical care medicine, which is abundant with high acuity yet infrequent procedures, has not embraced 3DP as much as others. The discrepancy between the possible training or therapeutic uses of 3DP in critical care and what is currently utilized in other fields needs to be addressed. OBJECTIVE This narrative literature review describes the uses of 3DP in critical care that have been documented. It also discusses possible future directions based on recent technological advances. METHODS A literature search on PubMed was performed using keywords and Mesh terms for 3DP, critical care, and critical care skills. RESULTS Our search found that 3DP use in critical care fell under the major categories of medical education (23 papers), patient care (4 papers) and clinical equipment modification (4 papers). Medical education showed the use of 3DP in bronchoscopy, congenital heart disease, cricothyroidotomy, and medical imaging. On the other hand, patient care papers discussed 3DP use in wound care, personalized splints, and patient monitoring. Clinical equipment modification papers reported the use of 3DP to modify stethoscopes and laryngoscopes to improve their performance. Notably, we found that only 13 of the 31 papers were directly produced or studied by critical care physicians. CONCLUSION The papers discussed provide examples of the possible utilities of 3DP in critical care. The relative scarcity of papers produced by critical care physicians may indicate barriers to 3DP implementation. However, technological advances such as point-of-care 3DP tools and the increased demand for 3DP during the recent COVID-19 pandemic may change 3DP implementation across the critical care field.
Collapse
Affiliation(s)
- Mina Boshra
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd., Ottawa, ON K1H8M5 Canada
| | - Justin Godbout
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9 Canada
| | - Jeffrey J. Perry
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9 Canada
- Department of Emergency Medicine, The Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9 Canada
| | - Andy Pan
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9 Canada
- Department of Emergency Medicine, The Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9 Canada
- Division of Critical Care Medicine, Department of Medicine, Montfort Hospital, 713 Montreal Road, Ottawa, ON K1K 0T2 Canada
| |
Collapse
|
14
|
Leong TL, Li J. 3D printed airway simulators: Adding a dimension to bronchoscopy training. Respirology 2020; 25:1126-1128. [PMID: 32830872 DOI: 10.1111/resp.13933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Tracy L Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jasun Li
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,3dMedLab, Austin Health, Melbourne, Victoria, Australia
| |
Collapse
|
15
|
Ghazy A, Chaban R, Vahl CF, Dorweiler B. Development and evaluation of 3-dimensional printed models of the human tracheobronchial system for training in flexible bronchoscopy. Interact Cardiovasc Thorac Surg 2019; 28:137-143. [PMID: 30020450 DOI: 10.1093/icvts/ivy215] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/05/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Training and assessment of proper skills in flexible bronchoscopy are major educational goals for cardiothoracic residents. Therefore, we developed 3-dimensional (3D) printed models of the human tracheobronchial system for training and assessment of cardiothoracic residents in flexible bronchoscopy. METHODS Three models of normal (size/shape) human tracheobronchial anatomy were generated using a commercially available 3D printer. Ten residents (inexperienced: Group 1; experienced: Group 2) participated in this study with an experimental setting of initial assessment (Model 1), training (15 min, Model 2) and post-training assessment (Model 3). The time needed for flexible bronchoscopy assessment of randomly assigned ostia was recorded before and after training. Additionally, the time for retrieval of a foreign body from the tracheobronchial system was measured before and after training. RESULTS The average time for intubation of a given ostium (Model 1) at initial assessment was 88 s for Group 1 and 38 s for Group 2 (P < 0.0001). Following training, there was a significant reduction in time for intubation of a given ostium (Model 3) in both groups (P < 0.0001). However, the initial difference between experienced and inexperienced residents was no longer present following training. Additionally, the time for retrieval of a foreign body (cotton wool plug) from the tracheobronchial system was significantly reduced following training in both groups. CONCLUSIONS Accurate models of the human tracheobronchial system can be generated from representative patient images using 3D engineering software and 3D printing technology. With these models, residents can be effectively trained in flexible bronchoscopy with significant improvement in their proficiency and handling capability.
Collapse
Affiliation(s)
- Ahmed Ghazy
- Department of Cardiothoracic and Vascular Surgery and BiomaTiCS research platform, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Rayan Chaban
- Department of Cardiothoracic and Vascular Surgery and BiomaTiCS research platform, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Christian-Friedrich Vahl
- Department of Cardiothoracic and Vascular Surgery and BiomaTiCS research platform, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Bernhard Dorweiler
- Department of Cardiothoracic and Vascular Surgery and BiomaTiCS research platform, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
16
|
Ho BHK, Chen CJ, Tan GJS, Yeong WY, Tan HKJ, Lim AYH, Ferenczi MA, Mogali SR. Multi-material three dimensional printed models for simulation of bronchoscopy. BMC MEDICAL EDUCATION 2019; 19:236. [PMID: 31248397 PMCID: PMC6598282 DOI: 10.1186/s12909-019-1677-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/19/2019] [Indexed: 05/22/2023]
Abstract
Background Bronchoscopy involves exploration of a three-dimensional (3D) bronchial tree environment using just two-dimensional (2D) images, visual cues and haptic feedback. Sound knowledge and understanding of tracheobronchial anatomy as well as ample training experience is mandatory for technical mastery. Although simulated modalities facilitate safe training for inexperienced operators, current commercial training models are expensive or deficient in anatomical accuracy, clinical fidelity and patient representation. The advent of Three-dimensional (3D) printing technology may resolve the current limitations with commercial simulators. The purpose of this report is to develop and test the novel multi-material three-dimensional (3D) printed airway models for bronchoscopy simulation. Methods Using material jetting 3D printing and polymer amalgamation, human airway models were created from anonymized human thoracic computed tomography images from three patients: one normal, a second with a tumour obstructing the right main bronchus and third with a goitre causing external tracheal compression. We validated their efficacy as airway trainers by expert bronchoscopists. Recruited study participants performed bronchoscopy on the 3D printed airway models and then completed a standardized evaluation questionnaire. Results The models are flexible, life size, anatomically accurate and patient specific. Five expert respiratory physicians participated in validation of the airway models. All the participants agreed that the models were suitable for training bronchoscopic anatomy and access. Participants suggested further refinement of colour and texture of the internal surface of the airways. Most respondents felt that the models are suitable simulators for tracheal pathology, have a learning value and recommend it to others for use in training. Conclusion Using material jetting 3D printing to create patient-specific anatomical models is a promising modality of simulation training. Our results support further evaluation of the printed airway model as a bronchoscopic trainer, and suggest that pathological airways may be simulated using this technique.
Collapse
Affiliation(s)
- Brian Han Khai Ho
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232 Singapore
| | - Cecilia Jiayu Chen
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232 Singapore
| | | | - Wai Yee Yeong
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Heang Kuan Joel Tan
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Albert Yick Hou Lim
- Respiratory and Critical Care Medicine Clinic, Tan Tock Seng Hospital, Singapore, Singapore
| | - Michael Alan Ferenczi
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232 Singapore
| | - Sreenivasulu Reddy Mogali
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232 Singapore
| |
Collapse
|
17
|
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.
Collapse
|
18
|
Qiu K, Haghiashtiani G, McAlpine MC. 3D Printed Organ Models for Surgical Applications. ANNUAL REVIEW OF ANALYTICAL CHEMISTRY (PALO ALTO, CALIF.) 2018; 11:287-306. [PMID: 29589961 PMCID: PMC6082023 DOI: 10.1146/annurev-anchem-061417-125935] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Medical errors are a major concern in clinical practice, suggesting the need for advanced surgical aids for preoperative planning and rehearsal. Conventionally, CT and MRI scans, as well as 3D visualization techniques, have been utilized as the primary tools for surgical planning. While effective, it would be useful if additional aids could be developed and utilized in particularly complex procedures involving unusual anatomical abnormalities that could benefit from tangible objects providing spatial sense, anatomical accuracy, and tactile feedback. Recent advancements in 3D printing technologies have facilitated the creation of patient-specific organ models with the purpose of providing an effective solution for preoperative planning, rehearsal, and spatiotemporal mapping. Here, we review the state-of-the-art in 3D printed, patient-specific organ models with an emphasis on 3D printing material systems, integrated functionalities, and their corresponding surgical applications and implications. Prior limitations, current progress, and future perspectives in this important area are also broadly discussed.
Collapse
Affiliation(s)
- Kaiyan Qiu
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, USA;
| | - Ghazaleh Haghiashtiani
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, USA;
| | - Michael C McAlpine
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, USA;
| |
Collapse
|
19
|
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.
Collapse
|
20
|
Subat A, Goldberg A, Demaria S, Katz D. The Utility of Simulation in the Management of Patients With Congenital Heart Disease: Past, Present, and Future. Semin Cardiothorac Vasc Anesth 2017; 22:81-90. [PMID: 29231093 DOI: 10.1177/1089253217746243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Significant advancements have been made in the diagnosis and management of congenital heart disease (CHD). As a result, a higher percentage of these patients are surviving to adulthood. Despite this improvement in management, these patients remain at higher risk of morbidity and mortality, particularly in the perioperative setting. One new area of interest in these patients is the implementation of simulation-based medical education. Simulation has demonstrated various benefits across high-acuity scenarios encountered in the hospital. In CHD, simulation has been used in the training of pediatrics residents, assessment of intraoperative complications, echocardiography, and anatomic modeling with 3-dimensional printing. Here, we describe the current state of simulation in CHD, its role in training care providers for the management of this population, and future directions of CHD simulation.
Collapse
Affiliation(s)
- Ali Subat
- 1 Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | | | - Samuel Demaria
- 1 Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Daniel Katz
- 1 Icahn School of Medicine at Mt Sinai, New York, NY, USA
| |
Collapse
|
21
|
Kim HD, Amirthalingam S, Kim SL, Lee SS, Rangasamy J, Hwang NS. Biomimetic Materials and Fabrication Approaches for Bone Tissue Engineering. Adv Healthc Mater 2017; 6. [PMID: 29171714 DOI: 10.1002/adhm.201700612] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 10/09/2017] [Indexed: 01/14/2023]
Abstract
Various strategies have been explored to overcome critically sized bone defects via bone tissue engineering approaches that incorporate biomimetic scaffolds. Biomimetic scaffolds may provide a novel platform for phenotypically stable tissue formation and stem cell differentiation. In recent years, osteoinductive and inorganic biomimetic scaffold materials have been optimized to offer an osteo-friendly microenvironment for the osteogenic commitment of stem cells. Furthermore, scaffold structures with a microarchitecture design similar to native bone tissue are necessary for successful bone tissue regeneration. For this reason, various methods for fabricating 3D porous structures have been developed. Innovative techniques, such as 3D printing methods, are currently being utilized for optimal host stem cell infiltration, vascularization, nutrient transfer, and stem cell differentiation. In this progress report, biomimetic materials and fabrication approaches that are currently being utilized for biomimetic scaffold design are reviewed.
Collapse
Affiliation(s)
- Hwan D. Kim
- School of Chemical and Biological Engineering; The Institute of Chemical Processes; Seoul National University; Seoul 151-742 Republic of Korea
| | | | - Seunghyun L. Kim
- Interdisciplinary Program in Bioengineering; Seoul National University; Seoul 151-742 Republic of Korea
| | - Seunghun S. Lee
- Interdisciplinary Program in Bioengineering; Seoul National University; Seoul 151-742 Republic of Korea
| | - Jayakumar Rangasamy
- Centre for Nanosciences and Molecular Medicine; Amrita University; Kochi 682041 India
| | - Nathaniel S. Hwang
- School of Chemical and Biological Engineering; The Institute of Chemical Processes; Seoul National University; Seoul 151-742 Republic of Korea
- Interdisciplinary Program in Bioengineering; Seoul National University; Seoul 151-742 Republic of Korea
- The BioMax Institute of Seoul National University; Seoul 151-742 Republic of Korea
| |
Collapse
|
22
|
Kim GB, Park JH, Song HY, Kim N, Song HK, Kim MT, Kim KY, Tsauo J, Jun EJ, Kim DH, Lee GH. 3D-printed phantom study for investigating stent abutment during gastroduodenal stent placement for gastric outlet obstruction. 3D Print Med 2017; 3:10. [PMID: 29782574 PMCID: PMC5954787 DOI: 10.1186/s41205-017-0017-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/05/2017] [Indexed: 01/17/2023] Open
Abstract
Background Placing a self-expandable metallic stent (SEMS) is safe and effective for the palliative treatment of malignant gastroduodenal (GD) strictures. SEMS abutment in the duodenal wall is associated with increased food impaction, resulting in higher stent malfunction and shorter stent patency. The desire to evaluate the mechanism and significance of stent abutment led us to design an in vitro experiment using a flexible anthropomorphic three-dimensional (3D)-printed GD phantom model. Results A GD phantom was fabricated using 3D printer data after performing computed tomography gastrography. A partially covered (PC) or fully covered (FC) stent was placed so that its distal end abutted onto the duodenal wall in groups PC-1 and FC-1 or its distal end was sufficiently directed caudally in groups PC-2 and FC-2. The elapsed times of the inflowing of three diets (liquid, soft, and solid) were measured in the GD phantom under fluoroscopic guidance. There was no significant difference in the mean elapsed times for the liquid diet among the four groups. For the soft diet, the mean elapsed times in groups PC-1 and FC-1 were longer than those in groups PC-2 and FC-2 (P = 0.018 and P < 0.001, respectively). For the solid diet, the mean elapsed time in group PC-1 was longer than that in group PC-2 (P < 0.001). The solid diet could not pass in group FC-1 due to food impaction. The mean elapsed times were significantly longer in groups FC-1 and FC-2 than in groups PC-1 and PC-2 for soft and solid diets (all P < 0.001). Conclusions This flexible anthropomorphic 3D-printed GD phantom study revealed that stent abutment can cause prolonged passage of soft and solid diets through the stent as well as impaction of solid diets into the stent.
Collapse
Affiliation(s)
- Guk Bae Kim
- 1Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Jung-Hoon Park
- 2Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Ho-Young Song
- 2Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea.,6Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Namkug Kim
- 2Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea.,3Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea.,5Department of Radiology and Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Hyun Kyung Song
- 1Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Min Tae Kim
- 2Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Kun Yung Kim
- 2Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Jiaywei Tsauo
- 2Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Eun Jung Jun
- 2Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Do Hoon Kim
- 4Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Gin Hyug Lee
- 4Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea
| |
Collapse
|
23
|
Abstract
Simulation is an emerging and viable means to increase pediatric airway surgical training. A variety of simulators currently exist that may be used or modified for laryngoscopy, bronchoscopy, and endoscopic intervention, although anatomic realism and utility for complex procedures are limited. There is a need for further development of improved endoscopic and anatomic models. Innovative techniques are enabling small-scale manufacturing of generalizable and patient-specific simulators. The high acuity of the pediatric airway patient makes the use of simulation an attractive modality for training, competency maintenance, and patient safety quality-improvement studies.
Collapse
Affiliation(s)
- Charles M Myer
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229-3026, USA.
| | - Noel Jabbour
- Department of Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 7th Floor, Pittsburgh, PA 15224, USA
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Abstract
Three-dimensional (3D) printing enables the production of anatomically matched and patient-specific devices and constructs with high tunability and complexity. It also allows on-demand fabrication with high productivity in a cost-effective manner. As a result, 3D printing has become a leading manufacturing technique in healthcare and medicine for a wide range of applications including dentistry, tissue engineering and regenerative medicine, engineered tissue models, medical devices, anatomical models and drug formulation. Today, 3D printing is widely adopted by the healthcare industry and academia. It provides commercially available medical products and a platform for emerging research areas including tissue and organ printing. In this review, our goal is to discuss the current and emerging applications of 3D printing in medicine. A brief summary on additive manufacturing technologies and available printable materials is also given. The technological and regulatory barriers that are slowing down the full implementation of 3D printing in the medical field are also discussed.
Collapse
Affiliation(s)
- Chya-Yan Liaw
- Instructive Biomaterials and Additive Manufacturing Laboratory, Otto H. York Department of Chemical, Biological and Pharmaceutical Engineering, and Department of Bioengineering, New Jersey Institute of Technology, Newark, United States of America
| | | |
Collapse
|
26
|
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.
Collapse
|
27
|
Pucci JU, Christophe BR, Sisti JA, Connolly ES. Three-dimensional printing: technologies, applications, and limitations in neurosurgery. Biotechnol Adv 2017; 35:521-529. [PMID: 28552791 DOI: 10.1016/j.biotechadv.2017.05.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 05/01/2017] [Accepted: 05/22/2017] [Indexed: 01/17/2023]
Abstract
Three-dimensional (3D) printers are a developing technology penetrating a variety of markets, including the medical sector. Since its introduction to the medical field in the late 1980s, 3D printers have constructed a range of devices, such as dentures, hearing aids, and prosthetics. With the ultimate goals of decreasing healthcare costs and improving patient care and outcomes, neurosurgeons are utilizing this dynamic technology, as well. Digital Imaging and Communication in Medicine (DICOM) can be translated into Stereolithography (STL) files, which are then read and methodically built by 3D Printers. Vessels, tumors, and skulls are just a few of the anatomical structures created in a variety of materials, which enable surgeons to conduct research, educate surgeons in training, and improve pre-operative planning without risk to patients. Due to the infancy of the field and a wide range of technologies with varying advantages and disadvantages, there is currently no standard 3D printing process for patient care and medical research. In an effort to enable clinicians to optimize the use of additive manufacturing (AM) technologies, we outline the most suitable 3D printing models and computer-aided design (CAD) software for 3D printing in neurosurgery, their applications, and the limitations that need to be overcome if 3D printers are to become common practice in the neurosurgical field.
Collapse
Affiliation(s)
- Josephine U Pucci
- Columbia University Medical Center Department of Neurological Surgery, 710 W 168th Street, New York, NY 10032, United States.
| | - Brandon R Christophe
- Columbia University Medical Center Department of Neurological Surgery, 710 W 168th Street, New York, NY 10032, United States.
| | - Jonathan A Sisti
- Columbia University Medical Center Department of Neurological Surgery, 710 W 168th Street, New York, NY 10032, United States.
| | - Edward S Connolly
- Columbia University Medical Center Department of Neurological Surgery, 710 W 168th Street, New York, NY 10032, United States.
| |
Collapse
|
28
|
Volumetric Analysis of Alveolar Bone Defect Using Three-Dimensional-Printed Models Versus Computer-Aided Engineering. J Craniofac Surg 2017; 28:383-386. [DOI: 10.1097/scs.0000000000003301] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
29
|
Chao I, Young J, Coles-Black J, Chuen J, Weinberg L, Rachbuch C. The application of three-dimensional printing technology in anaesthesia: a systematic review. Anaesthesia 2017; 72:641-650. [DOI: 10.1111/anae.13812] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 01/17/2023]
Affiliation(s)
- I. Chao
- Department of Anaesthesia; Box Hill Hospital; Eastern Health; Melbourne Victoria Australia
| | - J. Young
- Department of Anaesthesia and Acute Pain Medicine; St Vincent's Hospital; Melbourne Victoria Australia
| | - J. Coles-Black
- Melbourne Medical School; The University of Melbourne; Parkville Victoria Australia
| | - J. Chuen
- Austin Health; Melbourne Victoria Australia
| | | | - C. Rachbuch
- Department of Anaesthesia; Box Hill Hospital; Eastern Health; Melbourne Victoria Australia
| |
Collapse
|
30
|
Cheng GZ, Folch E, Wilson A, Brik R, Garcia N, Estepar RSJ, Onieva JO, Gangadharan S, Majid A. 3D Printing and Personalized Airway Stents. Pulm Ther 2017. [DOI: 10.1007/s41030-016-0026-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
|
31
|
Crafts TD, Ellsperman SE, Wannemuehler TJ, Bellicchi TD, Shipchandler TZ, Mantravadi AV. Three-Dimensional Printing and Its Applications in Otorhinolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg 2016; 156:999-1010. [PMID: 28421875 DOI: 10.1177/0194599816678372] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective Three-dimensional (3D)-printing technology is being employed in a variety of medical and surgical specialties to improve patient care and advance resident physician training. As the costs of implementing 3D printing have declined, the use of this technology has expanded, especially within surgical specialties. This article explores the types of 3D printing available, highlights the benefits and drawbacks of each methodology, provides examples of how 3D printing has been applied within the field of otolaryngology-head and neck surgery, discusses future innovations, and explores the financial impact of these advances. Data Sources Articles were identified from PubMed and Ovid MEDLINE. Review Methods PubMed and Ovid Medline were queried for English articles published between 2011 and 2016, including a few articles prior to this time as relevant examples. Search terms included 3-dimensional printing, 3 D printing, otolaryngology, additive manufacturing, craniofacial, reconstruction, temporal bone, airway, sinus, cost, and anatomic models. Conclusions Three-dimensional printing has been used in recent years in otolaryngology for preoperative planning, education, prostheses, grafting, and reconstruction. Emerging technologies include the printing of tissue scaffolds for the auricle and nose, more realistic training models, and personalized implantable medical devices. Implications for Practice After the up-front costs of 3D printing are accounted for, its utilization in surgical models, patient-specific implants, and custom instruments can reduce operating room time and thus decrease costs. Educational and training models provide an opportunity to better visualize anomalies, practice surgical technique, predict problems that might arise, and improve quality by reducing mistakes.
Collapse
Affiliation(s)
- Trevor D Crafts
- 1 Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Susan E Ellsperman
- 1 Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Todd J Wannemuehler
- 1 Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Travis D Bellicchi
- 2 Department of Prosthodontics and Facial Prosthetics, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Taha Z Shipchandler
- 1 Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Avinash V Mantravadi
- 1 Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
32
|
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.
Collapse
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.)
| |
Collapse
|
33
|
Farooqi KM, Gonzalez-Lengua C, Shenoy R, Sanz J, Nguyen K. Use of a Three Dimensional Printed Cardiac Model to Assess Suitability for Biventricular Repair. World J Pediatr Congenit Heart Surg 2016; 7:414-6. [PMID: 27009890 DOI: 10.1177/2150135115610285] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/11/2015] [Indexed: 11/16/2022]
Abstract
Three dimensional (3D) printing is rapidly gaining interest in the medical field for use in presurgical planning. We present the case of a seven-year-old boy with double outlet right ventricle who underwent a bidirectional Glenn anastomosis. We used a 3D cardiac model to assess his suitability for a biventricular repair. He underwent a left ventricle-to-aorta baffle with a right ventricle-to-pulmonary artery conduit placement. He did well postoperatively and was discharged home with no evidence of baffle obstruction and good biventricular function. A 3D printed model can provide invaluable intracardiac spatial information in these complex patients.
Collapse
Affiliation(s)
- Kanwal M Farooqi
- Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA Division of Pediatric Cardiology, Rutgers-New Jersey Medical School, Newark, NJ, USA Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlos Gonzalez-Lengua
- Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajesh Shenoy
- Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Javier Sanz
- Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Khanh Nguyen
- Department of Pediatric Cardiac Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
34
|
Cheng GZ, San Jose Estepar R, Folch E, Onieva J, Gangadharan S, Majid A. Three-dimensional Printing and 3D Slicer: Powerful Tools in Understanding and Treating Structural Lung Disease. Chest 2016; 149:1136-42. [PMID: 26976347 DOI: 10.1016/j.chest.2016.03.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Recent advances in the three-dimensional (3D) printing industry have enabled clinicians to explore the use of 3D printing in preprocedural planning, biomedical tissue modeling, and direct implantable device manufacturing. Despite the increased adoption of rapid prototyping and additive manufacturing techniques in the health-care field, many physicians lack the technical skill set to use this exciting and useful technology. Additionally, the growth in the 3D printing sector brings an ever-increasing number of 3D printers and printable materials. Therefore, it is important for clinicians to keep abreast of this rapidly developing field in order to benefit. In this Ahead of the Curve, we review the history of 3D printing from its inception to the most recent biomedical applications. Additionally, we will address some of the major barriers to wider adoption of the technology in the medical field. Finally, we will provide an initial guide to 3D modeling and printing by demonstrating how to design a personalized airway prosthesis via 3D Slicer. We hope this information will reduce the barriers to use and increase clinician participation in the 3D printing health-care sector.
Collapse
Affiliation(s)
- George Z Cheng
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Raul San Jose Estepar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Erik Folch
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jorge Onieva
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sidhu Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA
| |
Collapse
|
35
|
Samuelson ST, Burnett G, Sim AJ, Hofer I, Weinberg AD, Goldberg A, Chang TS, DeMaria S. Simulation as a set-up for technical proficiency: can a virtual warm-up improve live fibre-optic intubation? Br J Anaesth 2016; 116:398-404. [PMID: 26821699 DOI: 10.1093/bja/aev436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fibre-optic intubation (FOI) is an advanced technical skill, which anaesthesia residents must frequently perform under pressure. In surgical subspecialties, a virtual 'warm-up' has been used to prime a practitioner's skill set immediately before performance of challenging procedures. This study examined whether a virtual warm-up improved the performance of elective live patient FOI by anaesthesia residents. METHODS Clinical anaesthesia yr 1 and 2 (CA1 and CA2) residents were recruited to perform elective asleep oral FOI. Residents either underwent a 5 min, guided warm-up (using a bronchoscopy simulator) immediately before live FOI on patients with predicted normal airways or performed live FOI on similar patients without the warm-up. Subjects were timed performing FOI (from scope passing teeth to viewing the carina) and were graded on a 45-point skill scale by attending anaesthetists. After a washout period, all subjects were resampled as members of the opposite cohort. Multivariate analysis was performed to control for variations in previous FOI experience of the residents. RESULTS Thirty-three anaesthesia residents were recruited, of whom 22 were CA1 and 11 were CA2. Virtual warm-up conferred a 37% reduction in time for CA1s (mean 35.8 (SD 3.2) s vs. 57 (SD 3.2) s, P<0.0002) and a 26% decrease for CA2s (mean 23 (SD 1.7) s vs. 31 (SD 1.7) s, P=0.0118). Global skill score increased with warm-up by 4.8 points for CA1s (mean 32.8 (SD 1.2) vs. 37.6 (SD 1.2), P=0.0079) and 5.1 points for CA2s (37.7 (SD 1.1) vs. 42.8 (SD 1.1), P=0.0125). Crossover period and sequence did not show a statistically significant association with performance. CONCLUSIONS Virtual warm-up significantly improved performance by residents of FOI in live patients with normal airway anatomy, as measured both by speed and by a scaled evaluation of skills.
Collapse
Affiliation(s)
| | | | - A J Sim
- Department of Anesthesiology
| | - I Hofer
- Department of Anesthesiology, UCLA David Geffen School of Medicine, 757 Westwood Plaza #3325, Los Angeles, CA 90024, USA
| | - A D Weinberg
- Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA, and
| | | | | | | |
Collapse
|
36
|
O’Brien EK, Wayne DB, Barsness KA, McGaghie WC, Barsuk JH. Use of 3D Printing for Medical Education Models in Transplantation Medicine: a Critical Review. CURRENT TRANSPLANTATION REPORTS 2016. [DOI: 10.1007/s40472-016-0088-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
37
|
Han B, Liu Y, Zhang X, Wang J. Three-dimensional printing as an aid to airway evaluation after tracheotomy in a patient with laryngeal carcinoma. BMC Anesthesiol 2016; 16:6. [PMID: 26781803 PMCID: PMC4717551 DOI: 10.1186/s12871-015-0170-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 12/23/2015] [Indexed: 11/16/2022] Open
Abstract
Background Difficult airway may result in significant morbidity and mortality. Proficient airway evaluation, therefore, is one of the key elements in the safe conduct of anesthesia. A three-dimensional (3D) printing model was recently introduced for medical application. 3D printing is a fast, convenient, and relatively affordable technique. We present a case in which a 3D-printed airway model was successfully used for airway evaluation. Case presentation A 77-year-old man who had previously undergone total laryngectomy was scheduled for resection of a pelvic mass. The condition of his airway, however, complicated the procedure. Routine methods to evaluate his airway were not suitable. Therefore, the patient’s computed tomography imaging data were used to generate stereolithography files and then to print out 3D models of his trachea. These 3D models enhanced our understanding of his tracheal morphology. They helped us devise a preanesthesia plan and effectively execute it without complications. Conclusion 3D printing models allow better understanding of morphological changes in the airway and aid preanesthesia planning. The successful outcome of our case suggests 3D printing is a potent tool for evaluating difficult and more widespread use is encouraged.
Collapse
Affiliation(s)
- Bin Han
- Department of Anesthesiology, Peking University Third Hospital, No. 49 North Garden Street, Haidian District, Beijing, 100191, China.
| | - Yajie Liu
- Department of Anesthesiology, Peking University Third Hospital, No. 49 North Garden Street, Haidian District, Beijing, 100191, China.
| | - Xiaoqing Zhang
- Department of Anesthesiology, Peking University Third Hospital, No. 49 North Garden Street, Haidian District, Beijing, 100191, China.
| | - Jun Wang
- Department of Anesthesiology, Peking University Third Hospital, No. 49 North Garden Street, Haidian District, Beijing, 100191, China.
| |
Collapse
|
38
|
Farooqi KM, Sengupta PP. Echocardiography and three-dimensional printing: sound ideas to touch a heart. J Am Soc Echocardiogr 2015; 28:398-403. [PMID: 25839152 DOI: 10.1016/j.echo.2015.02.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Kanwal M Farooqi
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai Medical Center, New York, New York
| | - Partho P Sengupta
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| |
Collapse
|
39
|
Chae MP, Rozen WM, McMenamin PG, Findlay MW, Spychal RT, Hunter-Smith DJ. Emerging Applications of Bedside 3D Printing in Plastic Surgery. Front Surg 2015; 2:25. [PMID: 26137465 PMCID: PMC4468745 DOI: 10.3389/fsurg.2015.00025] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/02/2015] [Indexed: 12/16/2022] Open
Abstract
Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing intraoperative guidance tools, teaching patients and surgical trainees, and producing patient-specific prosthetics in everyday surgical practice.
Collapse
Affiliation(s)
- Michael P Chae
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health , Frankston, VIC , Australia
| | - Warren M Rozen
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health , Frankston, VIC , Australia
| | - Paul G McMenamin
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University , Clayton, VIC , Australia
| | - Michael W Findlay
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Department of Surgery, Stanford University , Stanford, CA , USA
| | - Robert T Spychal
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia
| | - David J Hunter-Smith
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health , Frankston, VIC , Australia
| |
Collapse
|
40
|
Miyazaki T, Yamasaki N, Tsuchiya T, Matsumoto K, Takagi K, Nagayasu T. Airway stent insertion simulated with a three-dimensional printed airway model. Ann Thorac Surg 2015; 99:e21-3. [PMID: 25555984 DOI: 10.1016/j.athoracsur.2014.10.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/22/2014] [Accepted: 10/03/2014] [Indexed: 01/17/2023]
Abstract
A 30-year-old man underwent right single-lung transplantation for chronic obstructive pulmonary disease. The bronchial anastomosis developed ischemic change, resulting in stenosis of the intermediate bronchus. A modified Y-shaped airway stent with the fabricated orifice of the upper lobe was inserted by rigid bronchoscopy. Before the operation, a three-dimensional printed bronchial model of this patient was made for surgical simulation. This model enabled us to perform the operation easily, quickly, and successfully. The patient's condition improved after airway stent insertion. The three-dimensional printed airway model provided sufficient preoperative understanding of the patient's anatomy for planning the surgical procedure.
Collapse
Affiliation(s)
- Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoya Yamasaki
- Department of Surgical Oncology, Nagasaki Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Medical-Engineering, Hybrid Professional Development Center, Nagasaki Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsunori Takagi
- Department of Surgical Oncology, Nagasaki Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Medical-Engineering, Hybrid Professional Development Center, Nagasaki Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Medical-Engineering, Hybrid Professional Development Center, Nagasaki Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
41
|
Yang M, Li C, Li Y, Zhao Y, Wei X, Zhang G, Fan J, Ni H, Chen Z, Bai Y, Li M. Application of 3D rapid prototyping technology in posterior corrective surgery for Lenke 1 adolescent idiopathic scoliosis patients. Medicine (Baltimore) 2015; 94:e582. [PMID: 25715261 PMCID: PMC4554159 DOI: 10.1097/md.0000000000000582] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A retrospective study to evaluate the effectiveness of 3-dimensional rapid prototyping (3DRP) technology in corrective surgery for Lenke 1 adolescent idiopathic scoliosis (AIS) patients. 3DRP technology has been widely used in medical field; however, no study has been performed on the effectiveness of 3DRP technology in corrective surgery for Lenke 1 AIS patients. Lenke 1 AIS patients who were preparing to undergo posterior corrective surgery from a single center between January 2010 and January 2012 were included in this analysis. Patients were divided into 2 groups. In group A, 3-dimensional (3D) printing technology was used to create subject-specific spine models in the preoperative planning process. Group B underwent posterior corrective surgery as usual (by free hand without image guidance). Perioperative and postoperative clinical outcomes were compared between 2 groups, including operation time, perioperative blood loss, transfusion volume, postoperative hemoglobin (Hb), postoperative complications, and length of hospital stay. Radiological outcomes were also compared, including the assessment of screw placement, postoperative Cobb angle, coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis. Subgroup was also performed according to the preoperative Cobb angle: mean Cobb angle <50° and mean Cobb angle >50°. Besides, economic evaluation was also compared between 2 groups. A total of 126 patients were included in this study (group A, 50 and group B, 76). Group A had significantly shorter operation time, significantly less blood loss and transfusion volume, and higher postoperative Hb (all, P < 0.001). However, no significant differences were observed in complication rate, length of hospital stay, and postoperative radiological outcomes between 2 groups (all, P>0.05). There was also no significant difference in misplacement of screws in total populations (16.90% vs 18.82%, P = 0.305), whereas a low misplacement rate of pedicle screws was observed in patients whose mean Cobb angle was >50° (9.15% vs 13.03%, P = 0.02). Besides, using 3DRP increased the economic burden of patients (157,000 ± 9948.85 Ren Min Bi (RMB) vs 152,500 ± 11,445.52 RMB, P = 0.03). Using the 3D printing technology before posterior corrective surgery might reduce the operation time, perioperative blood loss, and transfusion volume. There did not appear to be a benefit to using this technology with respect to complication rate and postoperative radiological outcomes; however, 3D technology could reduce the misplacement rate in patients whose preoperative mean Cobb angle was >50°. Besides, it also increased the patients' hospital cost. Therefore, future prospective studies are needed to elucidate the efficacy of this emerging technology.
Collapse
Affiliation(s)
- Mingyuan Yang
- From the Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Bustamante S, Bose S, Kraenzler E. The Teaching on Wheels Cart (TowCart) Portable Simulator to Improve Resident Training in Lung Isolation. J Cardiothorac Vasc Anesth 2015; 29:e29-30. [PMID: 25843357 DOI: 10.1053/j.jvca.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Sergio Bustamante
- Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Somnath Bose
- Critical Care Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Erik Kraenzler
- Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
| |
Collapse
|
43
|
Slinger P. Acquisition of Competence in Lung Isolation: Simulate One, Do One, Teach…Repeat PRN. J Cardiothorac Vasc Anesth 2014; 28:873-6. [DOI: 10.1053/j.jvca.2014.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Indexed: 11/11/2022]
|