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Iannella G, Pace A, Mucchino A, Greco A, De Virgilio A, Lechien JR, Maniaci A, Cocuzza S, Perrone T, Messineo D, Magliulo G. A new 3D-printed temporal bone: 'the SAPIENS'-specific anatomical printed-3D-model in education and new surgical simulations. Eur Arch Otorhinolaryngol 2024; 281:4617-4626. [PMID: 38683361 PMCID: PMC11393115 DOI: 10.1007/s00405-024-08645-6] [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: 01/28/2024] [Accepted: 03/26/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Otology and neuro-otology surgeries pose significant challenges due to the intricate and variable anatomy of the temporal bone (TB), requiring extensive training. In the last years 3D-printed temporal bone models for otological dissection are becoming increasingly popular. In this study, we presented a new 3D-printed temporal bone model named 'SAPIENS', tailored for educational and surgical simulation purposes. METHODS The 'SAPIENS' model was a collaborative effort involving a multidisciplinary team, including radiologists, software engineers, ENT specialists, and 3D-printing experts. The development process spanned from June 2022 to October 2023 at the Department of Sense Organs, Sapienza University of Rome. Acquisition of human temporal bone images; temporal bone rendering; 3D-printing; post-printing phase; 3D-printed temporal bone model dissection and validation. RESULTS The 'SAPIENS' 3D-printed temporal bone model demonstrated a high level of anatomical accuracy, resembling the human temporal bone in both middle and inner ear anatomy. The questionnaire-based assessment by five experienced ENT surgeons yielded an average total score of 49.4 ± 1.8 out of 61, indicating a model highly similar to the human TB for both anatomy and dissection. Specific areas of excellence included external contour, sigmoid sinus contour, cortical mastoidectomy simulation, and its utility as a surgical practice simulator. CONCLUSION We have designed and developed a 3D model of the temporal bone that closely resembles the human temporal bone. This model enables the surgical dissection of the middle ear and mastoid with an excellent degree of similarity to the dissection performed on cadaveric temporal bones.
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Affiliation(s)
- Giannicola Iannella
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Annalisa Pace
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy.
| | - Alessandro Mucchino
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Antonio Greco
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Armando De Virgilio
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Jerome R Lechien
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons, Belgium
| | | | - Salvatore Cocuzza
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Tiziano Perrone
- Department of Otolaryngology, Civil Hospital of Alghero, Alghero, Italy
| | - Daniela Messineo
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Giuseppe Magliulo
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
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Ang AJY, Chee SP, Tang JZE, Chan CY, Tan VYJ, Lee JA, Schrepfer T, Ahamed NMN, Tan MB. Developing a production workflow for 3D-printed temporal bone surgical simulators. 3D Print Med 2024; 10:16. [PMID: 38814431 PMCID: PMC11138071 DOI: 10.1186/s41205-024-00218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION 3D-printed temporal bone models enable the training and rehearsal of complex otological procedures. To date, there has been no consolidation of the literature regarding the developmental process of 3D-printed temporal bone models. A brief review of the current literature shows that many of the key surgical landmarks of the temporal bone are poorly represented in models. This study aims to propose a novel design and production workflow to produce high-fidelity 3D-printed temporal bone models for surgical simulation. METHODS Developmental phases for data extraction, 3D segmentation and Computer Aided Design (CAD), and fabrication are outlined. The design and fabrication considerations for key anatomical regions, such as the mastoid air cells and course of the facial nerve, are expounded on with the associated strategy and design methods employed. To validate the model, radiological measurements were compared and a senior otolaryngologist performed various surgical procedures on the model. RESULTS Measurements between the original scans and scans of the model demonstrate sub-millimetre accuracy of the model. Assessment by the senior otologist found that the model was satisfactory in simulating multiple surgical procedures. CONCLUSION This study offers a systematic method for creating accurate 3D-printed temporal bone models for surgical training. Results show high accuracy and effectiveness in simulating surgical procedures, promising improved training and patient outcomes.
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Affiliation(s)
| | - Shu Ping Chee
- 3D Printing Centre Singapore General Hospital, Singapore, Singapore
| | - Joyce Zhi En Tang
- Department of Otorhinolaryngology- Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ching Yee Chan
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Vanessa Yee Jueen Tan
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jordan Adele Lee
- Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia
| | - Thomas Schrepfer
- Department of Otolaryngology, University of Florida, Florida, USA
| | | | - Mark Bangwei Tan
- Department of Neuroradiology & 3D Printing Centre Singapore General Hospital, Singapore, Singapore
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Lähde S, Hirsi Y, Salmi M, Mäkitie A, Sinkkonen ST. Integration of 3D-printed middle ear models and middle ear prostheses in otosurgical training. BMC MEDICAL EDUCATION 2024; 24:451. [PMID: 38658934 PMCID: PMC11044351 DOI: 10.1186/s12909-024-05436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND In otosurgical training, cadaveric temporal bones are primarily used to provide a realistic tactile experience. However, using cadaveric temporal bones is challenging due to their limited availability, high cost, and potential for infection. Utilizing current three-dimensional (3D) technologies could overcome the limitations associated with cadaveric bones. This study focused on how a 3D-printed middle ear model can be used in otosurgical training. METHODS A cadaveric temporal bone was imaged using microcomputed tomography (micro-CT) to generate a 3D model of the middle ear. The final model was printed from transparent photopolymers using a laser-based 3D printer (vat photopolymerization), yielding a 3D-printed phantom of the external ear canal and middle ear. The feasibility of this phantom for otosurgical training was evaluated through an ossiculoplasty simulation involving ten otosurgeons and ten otolaryngology-head and neck surgery (ORL-HNS) residents. The participants were tasked with drilling, scooping, and placing a 3D-printed partial ossicular replacement prosthesis (PORP). Following the simulation, a questionnaire was used to collect the participants' opinions and feedback. RESULTS A transparent photopolymer was deemed suitable for both the middle ear phantom and PORP. The printing procedure was precise, and the anatomical landmarks were recognizable. Based on the evaluations, the phantom had realistic maneuverability, although the haptic feedback during drilling and scooping received some criticism from ORL-HNS residents. Both otosurgeons and ORL-HNS residents were optimistic about the application of these 3D-printed models as training tools. CONCLUSIONS The 3D-printed middle ear phantom and PORP used in this study can be used for low-threshold training in the future. The integration of 3D-printed models in conventional otosurgical training holds significant promise.
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Affiliation(s)
- Sini Lähde
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center Tauno Palva Laboratory, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Yasmin Hirsi
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center Tauno Palva Laboratory, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- King's College London, London, UK
| | - Mika Salmi
- Department of Mechanical Engineering, Aalto University, Espoo, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center Tauno Palva Laboratory, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Saku T Sinkkonen
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center Tauno Palva Laboratory, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Cafino R, Soliven MMT, Velasco LC, Lopez KH. Evaluation of polyethylene terephthalate glycol (PETG), Simubone™, and photopolymer resin as 3D printed temporal bone models for surgical simulation. Asian J Surg 2024; 47:237-244. [PMID: 37633781 DOI: 10.1016/j.asjsur.2023.08.095] [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: 03/15/2023] [Revised: 07/29/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023] Open
Abstract
OBJECTIVES Among types of 3D printing, fused deposition modeling (FDM) and digital light processing (DLP) are the most accessible, making them attractive, low-cost options for simulating surgical procedures. This study characterized and compared inexpensive, synthetic temporal bone models printed using Resin, PETG, and Simubone™. MATERIALS AND METHODS This study compared models made of polyethylene terephthalate glycol (PETG), Simubone™ produced from a FDM printer, and photopolymer resin from a DLP printer. These temporal bone models were processed by: (1) DICOM files from a patient's CT scan were segmented to define critical parts expected in a temporal bone surgery. (2) The model was appended with a base that articulates with a 3D-printed temporal bone holder. (3) The refined, patient-specific model was manufactured using FDM and DLP printing technologies. (4) The models were sent to evaluators, who assessed the models based on anatomic accuracy, dissection experience, and its applicability as a surgical simulation tool for temporal bone dissection. RESULTS The photopolymer resin outperformed PETG and Simubone™ in terms of anatomical accuracy and dissection experience. Additionally, resin and PETG were evaluated to be appropriate for simple mastoidectomy and canal wall down mastoidectomy while Simubone™ was only suitable for simple mastoidectomy. All models were unsuitable for posterior tympanotomy and labyrinthectomy. CONCLUSIONS Photopolymer resin and PETG have shown to be suitable materials for dissection models with 3D-printed resin models showing more accuracy in replicating anatomical structures and dissection experience. Hence, the use of 3D-printed temporal bones may be a suitable low-cost alternative to cadaveric dissection.
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Affiliation(s)
- Rentor Cafino
- Zamboanga City Medical Center, Department of Otorhinolaryngology - Head and Neck Surgery, Zamboanga City, Republic of the Philippines; ENT HNS Medical Makerspace, Zamboanga City, Republic of the Philippines.
| | - Maria Monique Theresita Soliven
- Zamboanga City Medical Center, Department of Otorhinolaryngology - Head and Neck Surgery, Zamboanga City, Republic of the Philippines; ENT HNS Medical Makerspace, Zamboanga City, Republic of the Philippines
| | - Lemuel Clark Velasco
- ENT HNS Medical Makerspace, Zamboanga City, Republic of the Philippines; Mindanao State University-Iligan Institute of Technology, Department of Information Technology, Iligan City, Republic of the Philippines; Premiere Research Institute of Science and Mathematics - Center for Computational Analytics and Modelling, Iligan City, Republic of the Philippines
| | - Kim Harold Lopez
- University of the Philippines Diliman, Department of Mechanical Engineering, Quezon City, Republic of the Philippines
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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Hochman JB, Pisa J, Kazmerik K, Unger B. Hand Motion Analysis Illustrates Differences When Drilling Cadaveric and Printed Temporal Bone. Ann Otol Rhinol Laryngol 2021; 131:1224-1230. [PMID: 34872376 PMCID: PMC9452853 DOI: 10.1177/00034894211059310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Temporal bone simulation is now commonly used to augment cadaveric education. Assessment of these tools is ongoing, with haptic modeling illustrating dissimilar motion patterns compared to cadaveric opportunities. This has the potential to result in maladaptive skill development. It is hypothesized that trainee drill motion patterns during printed model dissection may likewise demonstrate dissimilar hand motion patterns. METHODS Resident surgeons dissected 3D-printed temporal bones generated from microCT data and cadaveric simulations. A magnetic position tracking system (TrakSTAR Ascension, Yarraville, Australia) captured drill position and orientation. Skill assessment included cortical mastoidectomy, thinning procedures (sigmoid sinus, dural plate, posterior canal wall) and facial recess development. Dissection was performed by 8 trainees (n = 5 < PGY3 > n = 3) using k-cos metrics to analyze drill strokes within position recordings. K-cos metrics define strokes by change in direction, providing metrics for stroke duration, curvature, and length. RESULTS T-tests between models showed no significant difference in drill stroke frequency (cadaveric = 1.36/s, printed = 1.50/s, P < .40) but demonstrate significantly shorter duration (cadaveric = 0.37 s, printed = 0.16 s, P < .01) and a higher percentage of curved strokes (cadaveric = 31, printed = 67, P < .01) employed in printed bone dissection. Junior staff used a higher number of short strokes (junior = 0.54, senior = 0.38, P < .01) and higher percentage of curved strokes (junior = 35%, senior = 21%, P < .01). CONCLUSIONS Significant differences in hand motions were present between simulations, however the significance is unclear. This may indicate that printed bone is not best positioned to be the principal training schema.
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Affiliation(s)
- Jordan B Hochman
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Justyn Pisa
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Otolaryngology - Head and Neck Surgery, Health Sciences Centre, Winnipeg, MB, Canada
| | - Katrice Kazmerik
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Family Medicine, Pure Lifestyle, Winnipeg, MB, Canada
| | - Bertram Unger
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Medical Education, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
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7
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Venchiarutti RL, Clark Am JR, Dusseldorp JR, Cheng K, Howes D, Fleming S, Maddern GJ, Mukherjee P. New regulatory changes in 3D printing: implementation in surgery and research at the point of care. ANZ J Surg 2021; 91:2249-2251. [PMID: 34766677 DOI: 10.1111/ans.17246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/18/2021] [Accepted: 09/21/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Rebecca L Venchiarutti
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan R Clark Am
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Joseph R Dusseldorp
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kai Cheng
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Dale Howes
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Oral Restorative Sciences, Westmead Centre for Oral Health, Sydney, New South Wales, Australia
| | - Sophie Fleming
- Prosthetic Art Technology Pty Ltd., Alstonville, New South Wales, Australia
| | - Guy J Maddern
- Department of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, The University of Adelaide, Woodville, South Australia, Australia
| | - Payal Mukherjee
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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Aussedat C, Venail F, Marx M, Boullaud L, Bakhos D. Training in temporal bone drilling. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:140-145. [PMID: 33722469 DOI: 10.1016/j.anorl.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acquiring surgical experience in the operating room is increasingly difficult. Simulation of temporal bone drilling is therefore essential, and more and more widely used. The aim of this review is to clarify the limitations of classical surgical training, and to describe the different types of simulation available for temporal bone drilling. Systematic Medline search used the terms: "temporal bone" and training and surgery; "temporal bone" and training and drilling. Seventy-one of the 467 articles identified were relevant for this review. Various temporal bone simulators have been created to get around the limitations (ethical, financial, cultural, working time) of temporal bone drilling. They can be classified as cadaver, animal, physical or virtual models. The main advantages of physical and virtual prototyping are their ease of access, the possibility of repeating gestures on a standardised model, and the absence of ethical issues. Validation is essential before these simulators can be included in the curriculum, to ensure efficacy and thus improve patient safety in the operating room.
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Affiliation(s)
- C Aussedat
- Service ORL et chirurgie cervicofaciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
| | - F Venail
- Service ORL et chirurgie cervicofaciale, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - M Marx
- Service ORL et chirurgie cervicofaciale, CHU de Toulouse, place du Docteur-Baylac, 31059 Toulouse, France
| | - L Boullaud
- Service ORL et chirurgie cervicofaciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - D Bakhos
- Service ORL et chirurgie cervicofaciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
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Frithioff A, Frendø M, Pedersen DB, Sørensen MS, Wuyts Andersen SA. 3D-Printed Models for Temporal Bone Surgical Training: A Systematic Review. Otolaryngol Head Neck Surg 2021; 165:617-625. [PMID: 33650897 DOI: 10.1177/0194599821993384] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE 3D-printed models hold great potential for temporal bone surgical training as a supplement to cadaveric dissection. Nevertheless, critical knowledge on manufacturing remains scattered, and little is known about whether use of these models improves surgical performance. This systematic review aims to explore (1) methods used for manufacturing and (2) how educational evidence supports using 3D-printed temporal bone models. DATA SOURCES PubMed, Embase, the Cochrane Library, and Web of Science. REVIEW METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were identified and data on manufacturing and validation and/or training extracted by 2 reviewers. Quality assessment was performed using the Medical Education Research Study Quality Instrument tool; educational outcomes were determined according to Kirkpatrick's model. RESULTS The search yielded 595 studies; 36 studies were found eligible and included for analysis. The described 3D-printed models were based on computed tomography scans from patients or cadavers. Processing included manual segmentation of key structures such as the facial nerve; postprocessing, for example, consisted of removal of print material inside the model. Overall, educational quality was low, and most studies evaluated their models using only expert and/or trainee opinion (ie, Kirkpatrick level 1). Most studies reported positive attitudes toward the models and their potential for training. CONCLUSION Manufacturing and use of 3D-printed temporal bones for surgical training are widely reported in the literature. However, evidence to support their use and knowledge about both manufacturing and the effects on subsequent surgical performance are currently lacking. Therefore, stronger educational evidence and manufacturing knowhow are needed for widespread implementation of 3D-printed temporal bones in surgical curricula.
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Affiliation(s)
- Andreas Frithioff
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - Martin Frendø
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
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McMillan A, Kocharyan A, Dekker SE, Kikano EG, Garg A, Huang VW, Moon N, Cooke M, Mowry SE. Comparison of Materials Used for 3D-Printing Temporal Bone Models to Simulate Surgical Dissection. Ann Otol Rhinol Laryngol 2020; 129:1168-1173. [DOI: 10.1177/0003489420918273] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To identify 3D-printed temporal bone (TB) models that most accurately recreate cortical mastoidectomy for use as a training tool by comparison of different materials and fabrication methods. Background: There are several different printers and materials available to create 3D-printed TB models for surgical planning and trainee education. Current reports using Acrylonitrile Butadiene Styrene (ABS) plastic generated via fused deposition modeling (FDM) have validated the capacity for 3D-printed models to serve as accurate surgical simulators. Here, a head-to-head comparison of models produced using different materials and fabrication processes was performed to identify superior models for application in skull base surgical training. Methods: High-resolution CT scans of normal TBs were used to create stereolithography files with image conversion for application in 3D-printing. The 3D-printed models were constructed using five different materials and four printers, including ABS printed on a MakerBot 2x printer, photopolymerizable polymer (Photo) using the Objet 350 Connex3 Printer, polycarbonate (PC) using the FDM-Fortus 400 mc printer, and two types of photocrosslinkable acrylic resin, white and blue (FLW and FLB, respectively), using the Formlabs Form 2 stereolithography printer. Printed TBs were drilled to assess the haptic experience and recreation of TB anatomy with comparison to the current paradigm of ABS. Results: Surgical drilling demonstrated that FLW models created by FDM as well as PC and Photo models generated using photopolymerization more closely recreated cortical mastoidectomy compared to ABS models. ABS generated odor and did not represent the anatomy accurately. Blue resin performed poorly in simulation, likely due to its dark color and translucent appearance. Conclusions: PC, Photo, and FLW models best replicated surgical drilling and anatomy as compared to ABS and FLB models. These prototypes are reliable simulators for surgical training.
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Affiliation(s)
- Alexandra McMillan
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Armine Kocharyan
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Simone E. Dekker
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Elias George Kikano
- Department of Diagnostic Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Anisha Garg
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Victoria W. Huang
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicholas Moon
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Malcolm Cooke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland OH, USA
| | - Sarah E. Mowry
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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3D printed temporal bone as a tool for otologic surgery simulation. Am J Otolaryngol 2020; 41:102273. [PMID: 32209234 DOI: 10.1016/j.amjoto.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE In this face validity study, we discuss the fabrication and utility of an affordable, computed tomography (CT)-based, anatomy-accurate, 3-dimensional (3D) printed temporal bone models for junior otolaryngology resident training. MATERIALS AND METHODS After IRB exemption, patient CT scans were anonymized and downloaded as Digital Imaging and Communications in Medicine (DICOM) files to prepare for conversion. These files were converted to stereolithography format for 3D printing. Important soft tissue structures were identified and labeled to be printed in a separate color than bone. Models were printed using a desktop 3D printer (Ultimaker 3 Extended, Ultimaker BV, Netherlands) and polylactic acid (PLA) filament. 10 junior residents with no previous drilling experience participated in the study. Each resident was asked to drill a simple mastoidectomy on both a cadaveric and 3D printed temporal bone. Following their experience, they were asked to complete a Likert questionnaire. RESULTS The final result was an anatomically accurate (XYZ accuracy = 12.5, 12.5, 5 μm) 3D model of a temporal bone that was deemed to be appropriate in tactile feedback using the surgical drill. The total cost of the material required to fabricate the model was approximately $1.50. Participants found the 3D models overall to be similar to cadaveric temporal bones, particularly in overall value and safety. CONCLUSIONS 3D printed temporal bone models can be used as an affordable and inexhaustible alternative, or supplement, to traditional cadaveric surgical simulation.
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Surgical Planning of Sacral Nerve Stimulation Procedure in Presence of Sacral Anomalies by Using Personalized Polymeric Prototypes Obtained with Additive Manufacturing Techniques. Polymers (Basel) 2020; 12:polym12030581. [PMID: 32150891 PMCID: PMC7182873 DOI: 10.3390/polym12030581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/19/2020] [Accepted: 02/28/2020] [Indexed: 12/16/2022] Open
Abstract
Sacral nerve stimulation or sacral neuromodulation involves the implantation of a stimulating electrode lead through the sacral foramina. In patients with anatomical sacral anomalies, it can constitute a challenging procedure due to a lack of common reference points present in the normal anatomy. In this study, we present an innovative application of additive manufacturing for the planning of sacral nerve stimulation techniques and related surgical procedures in complex cases, and we verify that the use of personalized patient models may help to manage the presence of sacral anomalies. The use of two alternative additive manufacturing technologies working with thermoplastic and thermoset polymers, including fused deposition modeling as low-cost alternative and laser stereolithography as industrial gold standard, is compared in terms of viability, precision and overall production costs. They pay special attention to fidelity in terms of the bone microstructure reconstruction, which is necessary for adequately planning electrode insertion. Advantages and limitations of the alternative approaches are discussed and ideas for future developments and for solving current challenges are presented.
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Chauvelot J, Laurent C, Le Coz G, Jehl JP, Tran N, Szczetynska M, Moufki A, Bonnet AS, Parietti-Winkler C. Morphological validation of a novel bi-material 3D-printed model of temporal bone for middle ear surgery education. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:304. [PMID: 32355748 PMCID: PMC7186742 DOI: 10.21037/atm.2020.03.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background A new model of 3D-printed temporal bone with an innovative distinction between soft and hard tissues is described and presented in the present study. An original method is reported to quantify the model's ability to reproduce the complex anatomy of this region. Methods A CT-scan of temporal bone was segmented and prepared to obtain 3D files adapted to multi-material printing technique. A final product was obtained with two different resins differentiating hard from soft tissues. The reliability of the anatomy was evaluated by comparing the original CT-scan and the pre-processed files sent to the printer in a first step, and by quantifying the printing technique in a second step. Firstly, we evaluated the segmentation and mesh correction steps by segmenting each anatomical region in the CT-scan by two different other operators without mesh corrections, and by computing distances between the obtained geometries and the pre-processed ones. Secondly, we evaluated the printing technique by comparing the printed geometry imaged using µCT with the pre-processed one. Results The evaluation of the segmentation and mesh correction steps revealed that the distance between both geometries was globally less that one millimeter for each anatomical region and close to zero for regions such as temporal bone, semicircular canals or facial nerve. The evaluation of the printing technique revealed mismatches of 0.045±0.424 mm for soft and -0.093±0.240 mm for hard tissues between the initial prepared geometry and the actual printed model. Conclusions While other reported models for temporal bone are simpler and have only been validated subjectively, we objectively demonstrated in the present study that our novel artificial bi-material temporal bone is consistent with the anatomy and thus could be considered into ENT surgical education programs. The methodology used in this study is quantitative, inspired by engineer sciences, making it the first of its kind. The validity of the manufacturing process has also been verified and could, therefore, be extended to other specialties, emphasizing the importance of cross-disciplinary collaborations concerning new technologies.
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Affiliation(s)
- Jordan Chauvelot
- ENT Department, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Cedric Laurent
- CNRS, LEM3, UMR 7239, University of Lorraine, Metz, France
| | - Gaël Le Coz
- CNRS, LEM3, UMR 7239, University of Lorraine, Metz, France
| | - Jean-Philippe Jehl
- CNRS, IJL, UMR 7198, University of Lorraine, Campus Artem, Nancy, France
| | - Nguyen Tran
- School of Surgery Nancy-Lorraine, Faculty of Medicine, Vandœuvre-Lès-Nancy, France
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Anschuetz L, Huwendiek S, Stricker D, Yacoub A, Wimmer W, Caversaccio M. Assessment of Middle Ear Anatomy Teaching Methodologies Using Microscopy versus Endoscopy: A Randomized Comparative Study. ANATOMICAL SCIENCES EDUCATION 2019; 12:507-517. [PMID: 30430760 DOI: 10.1002/ase.1837] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 06/09/2023]
Abstract
Teaching methodologies for the anatomy of the middle ear have not been investigated greatly due to the middle ear's highly complex structure and hidden location inside of the temporal bone. The aim of this randomized study was to quantitatively compare the suitability of using microscope- and endoscope-based methods for teaching the anatomy of the middle ear. We hypothesize that the endoscopic approach will be more efficient compared to the microscopic approach. To answer the study questions, 33 sixth-year medical students, residents and otorhinolaryngology specialists were randomized either into the endoscopy or the microscopy group. Their anatomical knowledge was assessed using a structured anatomical knowledge test before and after each session. Each participant received tutoring on a human cadaveric specimen using one of the two methods. They then performed a hands-on dissection. After 2-4 weeks, the same educational curriculum was repeated using the other technique. The mean gains in anatomical knowledge for the specialists, residents, and medical students were +19.0%, +34.6%, and +23.4%, respectively. Multivariate analyses identified a statistically significant increase in performance for the endoscopic method compared to the microscopic technique (P < 0.001). For the recall of anatomical structures during dissection, the endoscopic method outperformed the microscopic technique independently of the randomization or the prior training level of the attendees (P < 0.001). In conclusion, the endoscopic approach to middle ear anatomy education is associated to an improved gain in knowledge as compared to the microscopic approach. The participants subjectively preferred the endoscope for educational purposes.
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MESH Headings
- Adult
- Anatomy/education
- Cadaver
- Curriculum
- Dissection
- Ear, Middle/anatomy & histology
- Ear, Middle/diagnostic imaging
- Education, Medical, Continuing/methods
- Education, Medical, Continuing/statistics & numerical data
- Education, Medical, Undergraduate/methods
- Education, Medical, Undergraduate/statistics & numerical data
- Educational Measurement/statistics & numerical data
- Endoscopy
- Female
- Humans
- Internship and Residency/methods
- Internship and Residency/statistics & numerical data
- Male
- Mental Recall
- Microscopy
- Middle Aged
- Program Evaluation
- Random Allocation
- Students, Medical/statistics & numerical data
- Surgeons/education
- Surgeons/statistics & numerical data
- Teaching
- Young Adult
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Affiliation(s)
- Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute of Medical Education, University of Bern, Bern, Switzerland
| | - Daniel Stricker
- Institute of Medical Education, University of Bern, Bern, Switzerland
| | - Abraam Yacoub
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
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Olsson AB, Dillon J, Kolokythas A, Schlott BJ. Reconstructive Surgery. J Oral Maxillofac Surg 2019; 75:e264-e301. [PMID: 28728733 DOI: 10.1016/j.joms.2017.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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The OpenEar library of 3D models of the human temporal bone based on computed tomography and micro-slicing. Sci Data 2019; 6:180297. [PMID: 30620342 PMCID: PMC6326113 DOI: 10.1038/sdata.2018.297] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/08/2018] [Indexed: 01/22/2023] Open
Abstract
Virtual reality surgical simulation of temporal bone surgery requires digitized models of the full anatomical region in high quality and colour information to allow realistic texturization. Existing datasets which are usually based on microCT imaging are unable to fulfil these requirements as per the limited specimen size, and lack of colour information. The OpenEar Dataset provides a library consisting of eight three-dimensional models of the human temporal bone to enable surgical training including colour data. Each dataset is based on a combination of multimodal imaging including Cone Beam Computed Tomography (CBCT) and micro-slicing. 3D reconstruction of micro-slicing images and subsequent registration to CBCT images allowed for relatively efficient multimodal segmentation of inner ear compartments, middle ear bones, tympanic membrane, relevant nerve structures, blood vessels and the temporal bone. Raw data from the experiment as well as voxel data and triangulated models from the segmentation are provided in full for use in surgical simulators or any other application which relies on high quality models of the human temporal bone.
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Abstract
Surgeons typically rely on their past training and experiences as well as visual aids from medical imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) for the planning of surgical processes. Often, due to the anatomical complexity of the surgery site, two dimensional or virtual images are not sufficient to successfully convey the structural details. For such scenarios, a 3D printed model of the patient's anatomy enables personalized preoperative planning. This paper reviews critical aspects of 3D printing for preoperative planning and surgical training, starting with an overview of the process-flow and 3D printing techniques, followed by their applications spanning across multiple organ systems in the human body. State of the art in these technologies are described along with a discussion of current limitations and future opportunities.
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Canzi P, Magnetto M, Marconi S, Morbini P, Mauramati S, Aprile F, Avato I, Auricchio F, Benazzo M. New frontiers and emerging applications of 3D printing in ENT surgery: a systematic review of the literature. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:286-303. [PMID: 30197421 PMCID: PMC6146580 DOI: 10.14639/0392-100x-1984] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/14/2018] [Indexed: 12/22/2022]
Abstract
3D printing systems have revolutionised prototyping in the industrial field by lowering production time from days to hours and costs from thousands to just a few dollars. Today, 3D printers are no more confined to prototyping, but are increasingly employed in medical disciplines with fascinating results, even in many aspects of otorhinolaryngology. All publications on ENT surgery, sourced through updated electronic databases (PubMed, MEDLINE, EMBASE) and published up to March 2017, were examined according to PRISMA guidelines. Overall, 121 studies fulfilled specific inclusion criteria and were included in our systematic review. Studies were classified according to the specific field of application (otologic, rhinologic, head and neck) and area of interest (surgical and preclinical education, customised surgical planning, tissue engineering and implantable prosthesis). Technological aspects, clinical implications and limits of 3D printing processes are discussed focusing on current benefits and future perspectives.
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Affiliation(s)
- P. Canzi
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - M. Magnetto
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - S. Marconi
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - P. Morbini
- Department of Pathology, University of Pavia, Foundation IRCCS Policlinico S. Matteo, Pavia, Italy
| | - S. Mauramati
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - F. Aprile
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - I. Avato
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
- PhD in Experimental Medicine, University of Pavia, Italy
| | - F. Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - M. Benazzo
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
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Haffner M, Quinn A, Hsieh TY, Strong EB, Steele T. Optimization of 3D Print Material for the Recreation of Patient-Specific Temporal Bone Models. Ann Otol Rhinol Laryngol 2018; 127:338-343. [DOI: 10.1177/0003489418764987] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: Identify the 3D printed material that most accurately recreates the visual, tactile, and kinesthetic properties of human temporal bone Subjects and Methods: Fifteen study participants with an average of 3.6 years of postgraduate training and 56.5 temporal bone (TB) procedures participated. Each participant performed a mastoidectomy on human cadaveric TB and five 3D printed TBs of different materials. After drilling each unique material, participants completed surveys to assess each model’s appearance and physical likeness on a Likert scale from 0 to 10 (0 = poorly representative, 10 = completely life-like). The 3D models were acquired by computed tomography (CT) imaging and segmented using 3D Slicer software. Results: Polyethylene terephthalate (PETG) had the highest average survey response for haptic feedback (HF) and appearance, scoring 8.3 (SD = 1.7) and 7.6 (SD = 1.5), respectively. The remaining plastics scored as follows for HF and appearance: polylactic acid (PLA) averaged 7.4 and 7.6, acrylonitrile butadiene styrene (ABS) 7.1 and 7.2, polycarbonate (PC) 7.4 and 3.9, and nylon 5.6 and 6.7. Conclusion: A PETG 3D printed temporal bone models performed the best for realistic appearance and HF as compared with PLA, ABS, PC, and nylon. The PLA and ABS were reliable alternatives that also performed well with both measures.
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Affiliation(s)
- Max Haffner
- University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Austin Quinn
- University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Tsung-yen Hsieh
- Department of Otolaryngology–Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento, California, USA
| | - E. Bradley Strong
- Department of Otolaryngology–Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento, California, USA
| | - Toby Steele
- Department of Otolaryngology–Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento, California, USA
- Veterans Affairs Northern California Healthcare System, Sacramento, California, USA
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20
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CT image segmentation methods for bone used in medical additive manufacturing. Med Eng Phys 2018; 51:6-16. [DOI: 10.1016/j.medengphy.2017.10.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 09/22/2017] [Accepted: 10/09/2017] [Indexed: 01/07/2023]
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VanKoevering KK, Malloy KM. Emerging Role of Three-Dimensional Printing in Simulation in Otolaryngology. Otolaryngol Clin North Am 2017; 50:947-958. [DOI: 10.1016/j.otc.2017.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Modifications to a 3D-printed temporal bone model for augmented stapes fixation surgery teaching. Eur Arch Otorhinolaryngol 2017; 274:2733-2739. [DOI: 10.1007/s00405-017-4572-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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23
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Aussedat C, Venail F, Nguyen Y, Lescanne E, Marx M, Bakhos D. Usefulness of temporal bone prototype for drilling training: A prospective study. Clin Otolaryngol 2017; 42:1200-1205. [DOI: 10.1111/coa.12846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 11/26/2022]
Affiliation(s)
- C. Aussedat
- CHU de Tours, service ORL et Chirurgie Cervico-Faciale; Tours France
| | - F. Venail
- CHU de Montpellier, service ORL et Chirurgie Cervico-Faciale; Montpellier France
| | - Y. Nguyen
- AP-HP La Pitié Salpêtrière, service ORL et Chirurgie Cervico-Faciale; boulevard de l'hôpital; Paris France
| | - E. Lescanne
- CHU de Tours, service ORL et Chirurgie Cervico-Faciale; Tours France
| | - M. Marx
- CHU de Toulouse, service ORL et Chirurgie Cervico-Faciale; Toulouse France
| | - D. Bakhos
- CHU de Tours, service ORL et Chirurgie Cervico-Faciale; Tours France
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24
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Bhutta MF. A review of simulation platforms in surgery of the temporal bone. Clin Otolaryngol 2016; 41:539-45. [PMID: 26453455 DOI: 10.1111/coa.12560] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgery of the temporal bone is a high-risk activity in an anatomically complex area. Simulation enables rehearsal of such surgery. The traditional simulation platform is the cadaveric temporal bone, but in recent years other simulation platforms have been created, including plastic and virtual reality platforms. OBJECTIVE OF REVIEW To undertake a review of simulation platforms for temporal bone surgery, specifically assessing their educational value in terms of validity and in enabling transition to surgery. TYPE OF REVIEW Systematic qualitative review. SEARCH STRATEGY Search of the Pubmed, CINAHL, BEI and ERIC databases. EVALUATION METHOD Assessment of reported outcomes in terms of educational value. RESULTS A total of 49 articles were included, covering cadaveric, animal, plastic and virtual simulation platforms. Cadaveric simulation is highly rated as an educational tool, but there may be a ceiling effect on educational outcomes after drilling 8-10 temporal bones. Animal models show significant anatomical variation from man. Plastic temporal bone models offer much potential, but at present lack sufficient anatomical or haptic validity. Similarly, virtual reality platforms lack sufficient anatomical or haptic validity, but with technological improvements they are advancing rapidly. CONCLUSIONS At present, cadaveric simulation remains the best platform for training in temporal bone surgery. Technological advances enabling improved materials or modelling mean that in the future plastic or virtual platforms may become comparable to cadaveric platforms, and also offer additional functionality including patient-specific simulation from CT data.
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Affiliation(s)
- M F Bhutta
- Specialist Registrar, Royal National Throat Nose and Ear Hospital, London, UK.
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25
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Cohen J, Reyes SA. Creation of a 3D printed temporal bone model from clinical CT data. Am J Otolaryngol 2015; 36:619-24. [PMID: 26106016 DOI: 10.1016/j.amjoto.2015.02.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/12/2015] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Generate and describe the process of creating a 3D printed, rapid prototype temporal bone model from clinical quality CT images. MATERIALS AND METHODS We describe a technique to create an accurate, alterable, and reproducible rapid prototype temporal bone model using freely available software to segment clinical CT data and generate three different 3D models composed of ABS plastic. Each model was evaluated based on the appearance and size of anatomical structures and response to surgical drilling. RESULTS Mastoid air cells had retained scaffolding material in the initial versions. This required modifying the model to allow drainage of the scaffolding material. External auditory canal dimensions were similar to those measured from the clinical data. Malleus, incus, oval window, round window, promontory, horizontal semicircular canal, and mastoid segment of the facial nerve canal were identified in all models. The stapes was only partially formed in two models and absent in the third. Qualitative feel of the ABS plastic was softer than bone. The pate produced by drilling was similar to bone dust when appropriate irrigation was used. CONCLUSION We present a rapid prototype temporal bone model made based on clinical CT data using 3D printing technology. The model can be made quickly and inexpensively enough to have potential applications for educational training.
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Torres R, Kazmitcheff G, Bernardeschi D, De Seta D, Bensimon JL, Ferrary E, Sterkers O, Nguyen Y. Variability of the mental representation of the cochlear anatomy during cochlear implantation. Eur Arch Otorhinolaryngol 2015; 273:2009-18. [DOI: 10.1007/s00405-015-3763-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/21/2015] [Indexed: 11/29/2022]
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Pre-operative simulation of pediatric mastoid surgery with 3D-printed temporal bone models. Int J Pediatr Otorhinolaryngol 2015; 79:740-4. [PMID: 25794654 DOI: 10.1016/j.ijporl.2015.03.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/03/2015] [Accepted: 03/03/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES As the process of additive manufacturing, or three-dimensional (3D) printing, has become more practical and affordable, a number of applications for the technology in the field of pediatric otolaryngology have been considered. One area of promise is temporal bone surgical simulation. Having previously developed a model for temporal bone surgical training using 3D printing, we sought to produce a patient-specific model for pre-operative simulation in pediatric otologic surgery. Our hypothesis was that the creation and pre-operative dissection of such a model was possible, and would demonstrate potential benefits in cases of abnormal temporal bone anatomy. METHODS In the case presented, an 11-year-old boy underwent a planned canal-wall-down (CWD) tympano-mastoidectomy for recurrent cholesteatoma preceded by a pre-operative surgical simulation using 3D-printed models of the temporal bone. The models were based on the child's pre-operative clinical CT scan and printed using multiple materials to simulate both bone and soft tissue structures. To help confirm the models as accurate representations of the child's anatomy, distances between various anatomic landmarks were measured and compared to the temporal bone CT scan and the 3D model. RESULTS The simulation allowed the surgical team to appreciate the child's unusual temporal bone anatomy as well as any challenges that might arise in the safety of the temporal bone laboratory, prior to actual surgery in the operating room (OR). There was minimal variability, in terms of absolute distance (mm) and relative distance (%), in measurements between anatomic landmarks obtained from the patient intra-operatively, the pre-operative CT scan and the 3D-printed models. CONCLUSIONS Accurate 3D temporal bone models can be rapidly produced based on clinical CT scans for pre-operative simulation of specific challenging otologic cases in children, potentially reducing medical errors and improving patient safety.
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Rose AS, Kimbell JS, Webster CE, Harrysson OL, Formeister EJ, Buchman CA. Multi-material 3D Models for Temporal Bone Surgical Simulation. Ann Otol Rhinol Laryngol 2015; 124:528-36. [DOI: 10.1177/0003489415570937] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypothesis: A simulated, multicolor, multi-material temporal bone model can be created using 3-dimensional (3D) printing that will prove both safe and beneficial in training for actual temporal bone surgical cases. Background: As the process of additive manufacturing, or 3D printing, has become more practical and affordable, a number of applications for the technology in the field of Otolaryngology–Head and Neck Surgery have been considered. One area of promise is temporal bone surgical simulation. Methods: Three-dimensional representations of human temporal bones were created from temporal bone computed tomography (CT) scans using biomedical image processing software. Multi-material models were then printed and dissected in a temporal bone laboratory by attending and resident otolaryngologists. A 5-point Likert scale was used to grade the models for their anatomical accuracy and suitability as a simulation of cadaveric and operative temporal bone drilling. Results: The models produced for this study demonstrate significant anatomic detail and a likeness to human cadaver specimens for drilling and dissection. Conclusion: Simulated temporal bones created by this process have potential benefit in surgical training, preoperative simulation for challenging otologic cases, and the standardized testing of temporal bone surgical skills.
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Affiliation(s)
- Austin S. Rose
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Julia S. Kimbell
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Caroline E. Webster
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Ola L.A. Harrysson
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Eric J. Formeister
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Craig A. Buchman
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Coelho G, Zanon N, Warf B. The role of simulation in neurosurgery. Childs Nerv Syst 2014; 30:1997-2000. [PMID: 25249419 DOI: 10.1007/s00381-014-2548-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/02/2014] [Indexed: 01/22/2023]
Affiliation(s)
- Giselle Coelho
- Pediatric Neurosurgery Center, Beneficência Portuguesa Hospital, Rua Capitão Mor Roque Barreto nº 47 - Térreo, Bela Vista, São Paulo, 01323-030, Brazil,
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Evaluation of a temporal bone prototype by experts in otology. The Journal of Laryngology & Otology 2014; 128:586-90. [PMID: 24932528 DOI: 10.1017/s0022215114001297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Inexperienced otologists require training on the temporal bone drilling process, prior to any surgical activity. The shortage of cadaveric temporal bones exerts pressure to create realistic physical prototypes. This paper describes the evaluation by otology experts of a specially developed temporal bone resin model. METHODS Computed tomography images were transformed into digital files, and anatomically identical right temporal bone models were created using stereolithography. These hand-painted resin prototypes were sent to 25 otologists, accompanied by a 20-item questionnaire. RESULTS Satisfaction rate was 92 per cent. The overall prototype score was 48.87 out of 60. Average scores were: 12.63 out of 15 for anatomy-morphology, 6.98 out of 9 for quality of drilling, 16.74 out of 21 for identification of anatomical elements and 7.41 out of 9 for stages of drilling. Limitations of the model included an excessively vivid facial nerve colour and difficulty in identifying the posterior semicircular canal. Disadvantages related to the thickness of the resin and its residues were identified. CONCLUSION The prototype appears to provide an attractive solution to the shortage of cadaveric temporal bones. However, interest in the model for drilling technique training for inexperienced otologists has not yet been assessed.
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Registration of a validated mechanical atlas of middle ear for surgical simulation. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2014. [PMID: 24505778 DOI: 10.1007/978-3-642-40760-4_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
This paper is centered on the development of a new training and rehearsal simulation system for middle ear surgery. First, we have developed and validated a mechanical atlas based on finite element method of the human middle ear. The atlas is based on a microMRI. Its mechanical behavior computed in real-time has been successfully validated. In addition, we propose a method for the registration of the mechanical atlas on patient imagery. The simulation can be used for a rehearsal surgery with the geometrical anatomy of a given patient and with mechanical data that are validated. Moreover, this process does not necessitate a complete re-built of the model.
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Naik SM, Naik MS, Bains NK. Cadaveric temporal bone dissection: is it obsolete today? Int Arch Otorhinolaryngol 2013; 18:63-7. [PMID: 25992066 PMCID: PMC4296941 DOI: 10.1055/s-0033-1351681] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/10/2013] [Indexed: 11/03/2022] Open
Abstract
Introduction Traditionally, surgical training in otology, is imparted by dissecting harvested human cadaveric temporal bones. However, maintenance of a cadaveric temporal bone laboratory is expensive and carries risk of exposure to infection. In recent times, other modalities of training are gaining ground and are likely to eventually replace cadaveric temporal bone dissection altogether. Objectives Other alternative methods of training are emerging. New technology like simulation and virtual reality as high-fidelity, safer alternatives, are making rapid strides as teaching tools. Other options are the use of animal temporal bones as teaching tools. The advantages of these are compared. Data Synthesis None of these modalities can replicate the innumerable anatomical variations which are a characteristic feature of the human temporal bone. A novice surgeon not only needs exposure to surgical anatomy and it's variations but also needs to develop hand-eye coordination skills to gain expertise. Conclusion Deliberate practice on human cadaveric temporal bones only, will confer both mastery in anatomy and surgical technique. The human cadaveric temporal bone is ideal simulator for training in otology.
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Affiliation(s)
- Sulabha M Naik
- Department of ENT, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Mahendra S Naik
- Department of ENT, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Nainjot Kaur Bains
- Department of ENT, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
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Yao WC, Regone RM, Huyhn N, Butler EB, Takashima M. Three-dimensional sinus imaging as an adjunct to two-dimensional imaging to accelerate education and improve spatial orientation. Laryngoscope 2013; 124:596-601. [PMID: 23881572 DOI: 10.1002/lary.24316] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/27/2013] [Accepted: 06/27/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Develop a novel three-dimensional (3-D) anatomical model to assist in improving spatial knowledge of the skull base, paranasal sinuses, and adjacent structures, and validate the utilization of 3-D reconstruction to augment two-dimensional (2-D) computed tomography (CT) for the training of medical students and otolaryngology-head and neck surgery residents. STUDY DESIGN Prospective study. METHODS A study of 18 subjects studying sinus anatomy was conducted at a tertiary academic center during the 2011 to 2012 academic year. An image processing and 3-D modeling program was used to create a color coded 3-D scalable/layerable/rotatable model of key paranasal and skull base structures from a 2-D high-resolution sinus CT scan. Subjects received instruction of the sinus anatomy in two sessions, first through review of a 2-D CT sinus scan, followed by an educational module of the 3-D reconstruction. After each session, subjects rated their knowledge of the sinus and adjacent structures on a self-assessment questionnaire. RESULTS Significant improvement in the perceived understanding of the anatomy was noted after the 3-D educational module session when compared to the 2-D CT session alone (P < .01). Every subject believed the addition of 3-D imaging accelerated their education of sinus anatomy and recommended its use to others. CONCLUSIONS The impression of the learners was that a 3-D educational module, highlighting key structures, is a highly effective tool to enhance the education of medical students and otolaryngology residents in sinus and skull base anatomy and its adjacent structures, specifically in conceptualizing the spatial orientation of these structures.
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Affiliation(s)
- William C Yao
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
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Hsiao AY, Tung YC, Kuo CH, Mosadegh B, Bedenis R, Pienta KJ, Takayama S. Micro-ring structures stabilize microdroplets to enable long term spheroid culture in 384 hanging drop array plates. Biomed Microdevices 2012; 14:313-23. [PMID: 22057945 DOI: 10.1007/s10544-011-9608-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Using stereolithography, 20 different structural variations comprised of millimeter diameter holes surrounded by trenches, plateaus, or micro-ring structures were prepared and tested for their ability to stably hold arrays of microliter sized droplets within the structures over an extended period of time. The micro-ring structures were the most effective in stabilizing droplets against mechanical and chemical perturbations. After confirming the importance of micro-ring structures using rapid prototyping, we developed an injection molding tool for mass production of polystyrene 3D cell culture plates with an array of 384 such micro-ring surrounded through-hole structures. These newly designed and injection molded polystyrene 384 hanging drop array plates with micro-rings were stable and robust against mechanical perturbations as well as surface fouling-facilitated droplet spreading making them capable of long term cell spheroid culture of up to 22 days within the droplet array. This is a significant improvement over previously reported 384 hanging drop array plates which are susceptible to small mechanical shocks and could not reliably maintain hanging drops for longer than a few days. With enhanced droplet stability, the hanging drop array plates with micro-ring structures provide better platforms and open up new opportunities for high-throughput preparation of microscale 3D cell constructs for drug screening and cell analysis.
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Affiliation(s)
- Amy Y Hsiao
- Department of Biomedical Engineering, University of Michigan, 2215 Carl A Gerstacker Bldg, 2200 Bonisteel Blvd, Ann Arbor, MI 48109, USA
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Lantada AD, Morgado PL. Rapid prototyping for biomedical engineering: current capabilities and challenges. Annu Rev Biomed Eng 2012; 14:73-96. [PMID: 22524389 DOI: 10.1146/annurev-bioeng-071811-150112] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A new set of manufacturing technologies has emerged in the past decades to address market requirements in a customized way and to provide support for research tasks that require prototypes. These new techniques and technologies are usually referred to as rapid prototyping and manufacturing technologies, and they allow prototypes to be produced in a wide range of materials with remarkable precision in a couple of hours. Although they have been rapidly incorporated into product development methodologies, they are still under development, and their applications in bioengineering are continuously evolving. Rapid prototyping and manufacturing technologies can be of assistance in every stage of the development process of novel biodevices, to address various problems that can arise in the devices' interactions with biological systems and the fact that the design decisions must be tested carefully. This review focuses on the main fields of application for rapid prototyping in biomedical engineering and health sciences, as well as on the most remarkable challenges and research trends.
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Affiliation(s)
- Andrés Díaz Lantada
- Product Development Laboratory, Mechanical Engineering Department, Universidad Politécnica de Madrid, 28006 Madrid, Spain.
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