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Bandyopadhyay A, Ghibhela B, Mandal BB. Current advances in engineering meniscal tissues: insights into 3D printing, injectable hydrogels and physical stimulation based strategies. Biofabrication 2024; 16:022006. [PMID: 38277686 DOI: 10.1088/1758-5090/ad22f0] [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: 09/15/2023] [Accepted: 01/26/2024] [Indexed: 01/28/2024]
Abstract
The knee meniscus is the cushioning fibro-cartilage tissue present in between the femoral condyles and tibial plateau of the knee joint. It is largely avascular in nature and suffers from a wide range of tears and injuries caused by accidents, trauma, active lifestyle of the populace and old age of individuals. Healing of the meniscus is especially difficult due to its avascularity and hence requires invasive arthroscopic approaches such as surgical resection, suturing or implantation. Though various tissue engineering approaches are proposed for the treatment of meniscus tears, three-dimensional (3D) printing/bioprinting, injectable hydrogels and physical stimulation involving modalities are gaining forefront in the past decade. A plethora of new printing approaches such as direct light photopolymerization and volumetric printing, injectable biomaterials loaded with growth factors and physical stimulation such as low-intensity ultrasound approaches are being added to the treatment portfolio along with the contemporary tear mitigation measures. This review discusses on the necessary design considerations, approaches for 3D modeling and design practices for meniscal tear treatments within the scope of tissue engineering and regeneration. Also, the suitable materials, cell sources, growth factors, fixation and lubrication strategies, mechanical stimulation approaches, 3D printing strategies and injectable hydrogels for meniscal tear management have been elaborated. We have also summarized potential technologies and the potential framework that could be the herald of the future of meniscus tissue engineering and repair approaches.
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Affiliation(s)
- Ashutosh Bandyopadhyay
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Baishali Ghibhela
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Biman B Mandal
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
- Jyoti and Bhupat Mehta School of Health Sciences and Technology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
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Hatamikia S, Gulyas I, Birkfellner W, Kronreif G, Unger A, Oberoi G, Lorenz A, Unger E, Kettenbach J, Figl M, Patsch J, Strassl A, Georg D, Renner A. Realistic 3D printed CT imaging tumor phantoms for validation of image processing algorithms. Phys Med 2023; 105:102512. [PMID: 36584415 DOI: 10.1016/j.ejmp.2022.102512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/06/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
Medical imaging phantoms are widely used for validation and verification of imaging systems and algorithms in surgical guidance and radiation oncology procedures. Especially, for the performance evaluation of new algorithms in the field of medical imaging, manufactured phantoms need to replicate specific properties of the human body, e.g., tissue morphology and radiological properties. Additive manufacturing (AM) technology provides an inexpensive opportunity for accurate anatomical replication with customization capabilities. In this study, we proposed a simple and cheap protocol using Fused Deposition Modeling (FDM) technology to manufacture realistic tumor phantoms based on the filament 3D printing technology. Tumor phantoms with both homogenous and heterogeneous radiodensity were fabricated. The radiodensity similarity between the printed tumor models and real tumor data from CT images of lung cancer patients was evaluated. Additionally, it was investigated whether a heterogeneity in the 3D printed tumor phantoms as observed in the tumor patient data had an influence on the validation of image registration algorithms. A radiodensity range between -217 to 226 HUs was achieved for 3D printed phantoms using different filament materials; this range of radiation attenuation is also observed in the human lung tumor tissue. The resulted HU range could serve as a lookup-table for researchers and phantom manufactures to create realistic CT tumor phantoms with the desired range of radiodensities. The 3D printed tumor phantoms also precisely replicated real lung tumor patient data regarding morphology and could also include life-like heterogeneity of the radiodensity inside the tumor models. An influence of the heterogeneity on accuracy and robustness of the image registration algorithms was not found.
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Affiliation(s)
- Sepideh Hatamikia
- Austrian Center for Medical Innovation and Technology, Wiener Neustadt, Austria; Research Center for Medical Image Analysis and Artificial Intelligence (MIAAI), Department of Medicine, Danube Private University, Krems, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
| | - Ingo Gulyas
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Birkfellner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Gernot Kronreif
- Austrian Center for Medical Innovation and Technology, Wiener Neustadt, Austria
| | - Alexander Unger
- Austrian Center for Medical Innovation and Technology, Wiener Neustadt, Austria
| | - Gunpreet Oberoi
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Andrea Lorenz
- Austrian Center for Medical Innovation and Technology, Wiener Neustadt, Austria
| | - Ewald Unger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Joachim Kettenbach
- Institute of Diagnostic, Interventional Radiology and Nuclear Medicine, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Michael Figl
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Janina Patsch
- Department of Radiology and Nuclear Medicine, Medical University Vienna, Austria
| | - Andreas Strassl
- Department of Radiology and Nuclear Medicine, Medical University Vienna, Austria
| | - Dietmar Georg
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Andreas Renner
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
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Okkalidis N, Bliznakova K. A voxel-by-voxel method for mixing two filaments during a 3D printing process for soft-tissue replication in an anthropomorphic breast phantom. Phys Med Biol 2022; 67. [PMID: 36541511 DOI: 10.1088/1361-6560/aca640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 11/25/2022] [Indexed: 11/26/2022]
Abstract
Objective. In this study, a novel voxel-by-voxel mixing method is presented, according to which two filaments of different material are combined during the three dimensional (3D) printing process.Approach. In our approach, two types of filaments were used for the replication of soft-tissues, a polylactic acid (PLA) filament and a polypropylene (PP) filament. A custom-made software was used, while a series of breast patient CT scan images were directly associated to the 3D printing process. Each phantom´s layer was printed twice, once with the PLA filament and a second time with the PP filament. For each material, the filament extrusion rate was controlled voxel-by-voxel and was based on the Hounsfield units (HU) of the imported CT images. The phantom was scanned at clinical CT, breast tomosynthesis and micro CT facilities, as the major processing was performed on data from the CT. A side by side comparison between patient´s and phantom´s CT slices by means of profile and histogram comparison was accomplished. Further, in case of profile comparison, the Pearson´s coefficients were calculated.Main results. The visual assessment of the distribution of the glandular tissue in the CT slices of the printed breast anatomy showed high degree of radiological similarity to the corresponding patient´s glandular distribution. The profile plots´ comparison showed that the HU of the replicated and original patient soft tissues match adequately. In overall, the Pearson´s coefficients were above 0.91, suggesting a close match of the CT images of the phantom with those of the patient. The overall HU were close in terms of HU ranges. The HU mean, median and standard deviation of the original and the phantom CT slices were -149, -167, ±65 and -121, -130, ±91, respectively.Significance. The results suggest that the proposed methodology is appropriate for manufacturing of anthropomorphic soft tissue phantoms for x-ray imaging and dosimetry purposes, since it may offer an accurate replication of these tissues.
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Affiliation(s)
- Nikiforos Okkalidis
- Research Institute, Medical University of Varna, Bulgaria.,Morphé, Praxitelous 1, Thessaloniki, Greece
| | - Kristina Bliznakova
- Department of Medical Equipment, Electronic and Information Technologies in Healthcare, Medical University of Varna, Varna, Bulgaria
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Okkalidis N, Bliznakova K, Kolev N. A filament 3D printing approach for CT-compatible bone tissues replication. Phys Med 2022; 102:96-102. [PMID: 36162230 DOI: 10.1016/j.ejmp.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE The aim of this study is the development of a methodology for manufacturing 3D printed anthropomorphic structures, which mimic the X-ray properties of the human bone tissue. METHODS A mixing approach of two different materials is proposed for the fabrication of a radiologically equivalent hip bone for an anthropomorphic abdominal phantom. The materials employed for the phantom were polylactic acid (PLA) and Stonefil, while a custom-made dual motor filament extrusion setup and a custom-made software associating medical images directly with the 3D printing process were employed. RESULTS Three phantoms representing the hip bone were 3D printed utilizing two filaments under three different printing scenarios. The phantoms are based on a patient's abdominal CT scan images. Histograms of CT scans of the printed hip bone phantoms were calculated and compared to the original patient's hip bone histogram, demonstrating that a constant mixing composition of 30% Stonefil and 70% PLA with 0.0375 extrusion rate per voxel (93.75% flow for fulfilling a single voxel) for the cancellous bone, and using 100% Stonefil with 0.04 extrusion rate per voxel (100% flow) for the cortical bone results in a realistic anatomy replication of the hip bone. Reproduced HU varied between 700 and 800, which are close to those of the hip bone. CONCLUSIONS The study demonstrated that it is possible to mix two different filaments in real-time during the printing process to obtain phantoms with realistic and radiographically bone tissue equivalent attenuation. The results will be explored for manufacturing a CT-compatible abdominal phantom.
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Affiliation(s)
- Nikiforos Okkalidis
- Medical University of Varna, Bulgaria; Morphé, Praxitelous 1, Thessaloniki, Greece.
| | | | - Nikola Kolev
- Medical University of Varna, Bulgaria; First Clinic of Surgery in UMHAT "Saint Marina", Varna, Bulgaria
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Mettivier G, Sarno A, Varallo A, Russo P. Attenuation coefficient in the energy range 14–36 keV of 3D printing materials for physical breast phantoms. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac8966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. To measure the monoenergetic x-ray linear attenuation coefficient, μ, of fused deposition modeling (FDM) colored 3D printing materials (ABS, PLAwhite, PLAorange, PET and NYLON), used as adipose, glandular or skin tissue substitutes for manufacturing physical breast phantoms. Approach. Attenuation data (at 14, 18, 20, 24, 28, 30 and 36 keV) were acquired at Elettra synchrotron radiation facility, with step-wedge objects, using the Lambert–Beer law and a CCD imaging detector. Test objects were 3D printed using the Ultimaker 3 FDM printer. PMMA, Nylon-6 and high-density polyethylene step objects were also investigated for the validation of the proposed methodology. Printing uniformity was assessed via monoenergetic and polyenergetic imaging (32 kV, W/Rh). Main results. Maximum absolute deviation of μ for PMMA, Nylon-6 and HD-PE was 5.0%, with reference to literature data. For ABS and NYLON, μ differed by less than 6.1% and 7.1% from that of adipose tissue, respectively; for PET and PLAorange the difference was less than 11.3% and 6.3% from glandular tissue, respectively. PLAorange is a good substitute of skin (differences from −9.4% to +1.2%). Hence, ABS and NYLON filaments are suitable adipose tissue substitutes, while PET and PLAorange mimick the glandular tissue. PLAwhite could be printed at less than 100% infill density for matching the attenuation of glandular tissue, using the measured density calibration curve. The printing mesh was observed for sample thicknesses less than 60 mm, imaged in the direction normal to the printing layers. Printing dimensional repeatability and reproducibility was less 1%. Significance. For the first time an experimental determination was provided of the linear attenuation coefficient of common 3D printing filament materials with estimates of μ at all energies in the range 14–36 keV, for their use in mammography, breast tomosynthesis and breast computed tomography investigations.
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Okkalidis N. 3D printing methods for radiological anthropomorphic phantoms. Phys Med Biol 2022; 67. [PMID: 35830787 DOI: 10.1088/1361-6560/ac80e7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/13/2022] [Indexed: 01/06/2023]
Abstract
Three dimensional (3D) printing technology has been widely evaluated for the fabrication of various anthropomorphic phantoms during the last couple of decades. The demand for such high quality phantoms is constantly rising and gaining an ever-increasing interest. Although, in a short time 3D printing technology provided phantoms with more realistic features when compared to the previous conventional methods, there are still several aspects to be explored. One of these aspects is the further development of the current 3D printing methods and software devoted to radiological applications. The current 3D printing software and methods usually employ 3D models, while the direct association of medical images with the 3D printing process is needed in order to provide results of higher accuracy and closer to the actual tissues' texture. Another aspect of high importance is the development of suitable printing materials. Ideally, those materials should be able to emulate the entire range of soft and bone tissues, while still matching the human's anatomy. Five types of 3D printing methods have been mainly investigated so far: (a) solidification of photo-curing materials; (b) deposition of melted plastic materials; (c) printing paper-based phantoms with radiopaque ink; (d) melting or binding plastic powder; and (e) bio-printing. From the first and second category, polymer jetting technology and fused filament fabrication (FFF), also known as fused deposition modelling (FDM), are the most promising technologies for the fulfilment of the requirements of realistic and radiologically equivalent anthropomorphic phantoms. Another interesting approach is the fabrication of radiopaque paper-based phantoms using inkjet printers. Although, this may provide phantoms of high accuracy, the utilized materials during the fabrication process are restricted to inks doped with various contrast materials. A similar condition applies to the polymer jetting technology, which despite being quite fast and very accurate, the utilized materials are restricted to those capable of polymerization. The situation is better for FFF/FDM 3D printers, since various compositions of plastic filaments with external substances can be produced conveniently. Although, the speed and accuracy of this 3D printing method are lower compared to the others, the relatively low-cost, constantly improving resolution, sufficient printing volume and plethora of materials are quite promising for the creation of human size heterogeneous phantoms and their adaptation to the treatment procedures of patients in the current health systems.
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Affiliation(s)
- Nikiforos Okkalidis
- Research Institute, Medical University of Varna, Bulgaria.,Morphé, Praxitelous 1, Thessaloniki, Greece
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Varallo A, Sarno A, Castriconi R, Mazzilli A, Loria A, Del Vecchio A, Orientale A, Pilotti IAM, D'Andria P, Bliznakova K, Ricciardi R, Mettivier G, Russo P. Fabrication of 3D printed patient-derived anthropomorphic breast phantoms for mammography and digital breast tomosynthesis: Imaging assessment with clinical X-ray spectra. Phys Med 2022; 98:88-97. [PMID: 35526373 DOI: 10.1016/j.ejmp.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To design, fabricate and characterize 3D printed, anatomically realistic, compressed breast phantoms for digital mammography (DM) and digital breast tomosynthesis (DBT) x-ray imaging. MATERIALS We realized 3D printed phantoms simulating healthy breasts, via fused deposition modeling (FDM), with a layer resolution of 0.1 mm and 100% infill density, using a dual extruder printer. The digital models were derived from a public dataset of segmented clinical breast computed tomography scans. Three physical phantoms were printed in polyethylene terephthalate (PET), acrylonitrile-butadiene-styrene (ABS), or in polylactic-acid (PLA) materials, using ABS as a substitute for adipose tissue, and PLA or PET filaments for replicating glandular and skin tissues. 3D printed phantoms were imaged at three clinical centers with DM and DBT scanners, using typical spectra. Anatomical noise of the manufactured phantoms was evaluated via the estimates of the β parameter both in DM images and in images acquired via a clinical computed tomography (CT) scanner. RESULTS DM and DBT phantom images showed an inner texture qualitatively similar to the images of a clinical DM or DBT exam, suitably reproducing the glandular structure of their computational phantoms. β parameters evaluated in DM images of the manufactured phantoms ranged between 2.84 and 3.79; a lower β was calculated from the CT scan. CONCLUSIONS FDM 3D printed compressed breast phantoms have been fabricated using ABS, PLA and PET filaments. DM and DBT images with clinical x-ray spectra showed realistic textures. These phantoms appear promising for clinical applications in quality assurance, image quality and dosimetry assessments.
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Affiliation(s)
- Antonio Varallo
- University of Naples Federico II, Dept. of Physics "Ettore Pancini", Naples, Italy; INFN Division of Naples, Naples, Italy; University of Naples Federico II, Specialty School of Medical Physics, Naples, Italy
| | - Antonio Sarno
- University of Naples Federico II, Dept. of Physics "Ettore Pancini", Naples, Italy; INFN Division of Naples, Naples, Italy
| | - Roberta Castriconi
- Medical Physics Dept, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Aldo Mazzilli
- Medical Physics Dept, IRCCS San Raffaele Scientific Institute, Milan, Italy; University Hospital of Parma, Parma, Italy
| | - Alessandro Loria
- Medical Physics Dept, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Antonio Orientale
- University Hospital "San Giovanni di Dio Ruggi D'Aragona", Salerno, Italy
| | | | - Pasquale D'Andria
- University Hospital "San Giovanni di Dio Ruggi D'Aragona", Salerno, Italy
| | | | - Roberta Ricciardi
- University of Naples Federico II, Dept. of Physics "Ettore Pancini", Naples, Italy; INFN Division of Naples, Naples, Italy; University of Naples Federico II, Specialty School of Medical Physics, Naples, Italy
| | - Giovanni Mettivier
- University of Naples Federico II, Dept. of Physics "Ettore Pancini", Naples, Italy; INFN Division of Naples, Naples, Italy.
| | - Paolo Russo
- University of Naples Federico II, Dept. of Physics "Ettore Pancini", Naples, Italy; INFN Division of Naples, Naples, Italy
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