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Ganhewa AD, Seth I, Wu R, Chae MP, Tobin V, Smith JA, Hunter-Smith DJ, Rozen WM. Exploring Age-Related Variations in Carpal Bone Volume: Implications for Clinical Practice and Anatomical Understanding. Hand (N Y) 2024:15589447241242830. [PMID: 38606949 DOI: 10.1177/15589447241242830] [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] [Indexed: 04/13/2024]
Abstract
BACKGROUND Clinically recognizing the changes in carpal bone volumes and understanding their implications in predicting osteoarthritis (OA) is crucial in clinical practice This study aimed to explore age-related differences in carpal bone volumes across genders, leveraging computed tomography (CT) wrist scans to create 3D surface models of these bones. METHODS Carpal bone volumes were calculated using the 3D Slicer software from CT scans obtained from Frankston Hospital and additional datasets from Brown and Auckland Universities. The data were statistically processed using Stata V13. Double-sided P-values < .05 were considered statistically significant. The study was conducted in accordance with the ethical standards laid out in the Declaration of Helsinki. RESULTS A total of 181 patients were analyzed, and 48% of whom were female. A statistically significant positive Spearman correlation (rho = 0.37-0.611, P <.05) was observed between increasing age and the volume of all surveyed carpal bones (scaphoid, lunate, triquetrum, pisiform, hamate, capitate, and trapezium) across genders. Intrauser and interuser reliabilities for 3D Slicer-generated volumes of trapezium and pisiform bones were statistically significant, with Interclass Correlation Coefficient (ICC) values of 0.86 and 0.95, respectively. CONCLUSION Trapezial volumes increase with age, potentially due to the presence of OA and consequent osteophyte formation. This pattern is more prevalent among older individuals and women. However, the positive correlation between carpal bone volume and age was consistent across all carpal bones and both genders, regardless of OA presence. These findings suggest that carpal bone volume may naturally increase with age, independent of OA-related changes. LEVEL OF EVIDENCE III, cohort study.
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Affiliation(s)
- Aparna D Ganhewa
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, VIC, Australia
| | - Ishith Seth
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne, VIC, Australia
| | - Rui Wu
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, VIC, Australia
| | - Michael P Chae
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne, VIC, Australia
- Department of Surgery, School of Clinical Sciences, Monash Medical Centre, Clayton, VIC, Australia
| | - Vicky Tobin
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, VIC, Australia
| | - Julian A Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, VIC, Australia
| | - David J Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne, VIC, Australia
| | - Warren M Rozen
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, The Alfred Centre, Melbourne, VIC, Australia
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Schlegel L, Ho M, Fields JM, Backlund E, Pugliese R, Shine KM. Standardizing evaluation of patient-specific 3D printed models in surgical planning: development of a cross-disciplinary survey tool for physician and trainee feedback. BMC MEDICAL EDUCATION 2022; 22:614. [PMID: 35953840 PMCID: PMC9373487 DOI: 10.1186/s12909-022-03581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND 3D printed models are becoming increasingly popular in healthcare as visual and tactile tools to enhance understanding of anatomy and pathology in medical trainee education, provide procedural simulation training, and guide surgical procedures. Patient-specific 3D models are currently being used preoperatively for trainee medical education in planning surgical approaches and intraoperatively to guide decision-making in several specialties. Our study group utilized a modified Delphi process to create a standardized assessment for trainees using patient-specific 3D models as a tool in medical education during pre-surgical planning. METHODS A literature review was conducted to identify survey questions administered to clinicians in published surgical planning studies regarding the use of patient-specific 3D models. A core study team reviewed these questions, removed duplicates, categorized them, mapped them to overarching themes, and, where applicable, modified individual questions into a form generalizable across surgical specialties. The core study panel included a physician, physician-scientist, social scientist, engineer/medical student, and 3D printing lab manager. A modified Delphi process was then used to solicit feedback on the clarity and relevance of the individual questions from an expert panel consisting of 12 physicians from specialties including anesthesiology, emergency medicine, radiology, urology, otolaryngology, and obstetrics/gynecology. When the Radiological Society of North America (RSNA)/American College of Radiology (ACR) 3D Printing Registry Data Dictionary was released, additional survey questions were reviewed. A final cross-disciplinary survey of the utility of 3D printed models in surgical planning medical education was developed. RESULTS The literature review identified 100 questions previously published in surveys assessing patient-specific 3D models for surgical planning. Following the review, generalization, and mapping of survey questions from these studies, a list of 24 questions was generated for review by the expert study team. Five additional questions were identified in the RSNA/ACR 3D Printing Registry Data Dictionary and included for review. A final questionnaire consisting of 20 questions was developed. CONCLUSIONS As 3D printed models become more common in medical education, the need for standardized assessment is increasingly essential. The standardized questionnaire developed in this study reflects the interests of a variety of stakeholders in patient-specific 3D models across disciplines.
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Affiliation(s)
- Lauren Schlegel
- Jefferson Health Design Lab, 925 Chestnut Street Basement Level, Philadelphia, PA, 19107, USA.
- Sidney Kimmel Medical College of Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 100, Philadelphia, PA, 19107, USA.
| | - Michelle Ho
- Jefferson Health Design Lab, 925 Chestnut Street Basement Level, Philadelphia, PA, 19107, USA
- Department of Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, 800 Spruce Street, Philadelphia, PA, 19107, USA
| | - J Matthew Fields
- Department of Emergency Medicine, Thomas Jefferson University Hospitals, 1020 Sansom Street, Thompson Building, Suite 239, Philadelphia, PA, 19107, USA
| | - Erik Backlund
- Jefferson Health Design Lab, 925 Chestnut Street Basement Level, Philadelphia, PA, 19107, USA
| | - Robert Pugliese
- Jefferson Health Design Lab, 925 Chestnut Street Basement Level, Philadelphia, PA, 19107, USA
- Innovation Pillar, Thomas Jefferson University Hospitals, 925 Chestnut Street, Suite 110, Philadelphia, PA, 19107, USA
| | - Kristy M Shine
- Jefferson Health Design Lab, 925 Chestnut Street Basement Level, Philadelphia, PA, 19107, USA
- Sidney Kimmel Medical College of Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 100, Philadelphia, PA, 19107, USA
- Department of Emergency Medicine, Thomas Jefferson University Hospitals, 1020 Sansom Street, Thompson Building, Suite 239, Philadelphia, PA, 19107, USA
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Chae MP, Hunter-Smith DJ, Chung RD, Smith JA, Rozen WM. 3D-printed, patient-specific DIEP flap templates for preoperative planning in breast reconstruction: a prospective case series. Gland Surg 2021; 10:2192-2199. [PMID: 34422590 DOI: 10.21037/gs-21-263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 11/06/2022]
Abstract
Background Modern imaging technologies, such as computed tomographic angiography (CTA), can be useful for preoperative assessment in deep inferior epigastric artery perforator (DIEP) flap surgery. Planning perforator flap design can lead to improved surgical efficiency. However, current imaging modalities are limited by being displayed on a two-dimensional (2D) surface. In contrast, a 3D-printed model provides tactile feedback that facilitates superior understanding. Hence, we have 3D-printed patient-specific deep inferior epigastric artery perforator (DIEP) templates, in an affordable and convenient manner, for preoperative planning. Methods Twenty consecutive patients undergoing 25 immediate or delayed post-mastectomy autologous breast reconstruction with DIEP or muscle-sparing transverse rectus abdominis (MS-TRAM) flaps are recruited prospectively. Using free, open-source softwares (3D Slicer, Autodesk MeshMixer, and Cura) and desktop 3D printers (Ultimaker 3E and Moment), we created a template based on a patient's abdominal wall anatomy from CTA, with holes and lines indicating the position of perforators, their intramuscular course and the DIEA pedicle. Results The mean age of patients was 52 [38-67]. There were 15 immediate and 10 delayed reconstructions. 3D printing time took mean 18 hours and 123.7 g of plastic filament, which calculates to a mean material cost of AUD 8.25. DIEP templates accurately identified the perforators and reduced intraoperative perforator identification by 7.29 minutes (P=0.02). However, the intramuscular dissection time was not affected (P=0.34). Surgeons found the template useful for preoperative marking (8.6/10) and planning (7.9/10), but not for intramuscular dissection (5.9/10). There were no immediate flap-related complications. Conclusions Our 3D-printed, patient-specific DIEP template is accurate, significantly reduces intraoperative perforator identification time and, hence, may be a useful tool for preoperative planning in autologous breast reconstruction.
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Affiliation(s)
- Michael P Chae
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Level 5, E Block, Monash Medical Centre, Clayton, Victoria, Australia.,Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
| | - David J Hunter-Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Level 5, E Block, Monash Medical Centre, Clayton, Victoria, Australia.,Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
| | - Ru Dee Chung
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Level 5, E Block, Monash Medical Centre, Clayton, Victoria, Australia.,Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Level 5, E Block, Monash Medical Centre, Clayton, Victoria, Australia.,Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
| | - Warren Matthew Rozen
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Level 5, E Block, Monash Medical Centre, Clayton, Victoria, Australia.,Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
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Ballard DH, Trace AP, Ali S, Hodgdon T, Zygmont ME, DeBenedectis CM, Smith SE, Richardson ML, Patel MJ, Decker SJ, Lenchik L. Clinical Applications of 3D Printing: Primer for Radiologists. Acad Radiol 2018; 25:52-65. [PMID: 29030285 DOI: 10.1016/j.acra.2017.08.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 12/22/2022]
Abstract
Three-dimensional (3D) printing refers to a number of manufacturing technologies that create physical models from digital information. Radiology is poised to advance the application of 3D printing in health care because our specialty has an established history of acquiring and managing the digital information needed to create such models. The 3D Printing Task Force of the Radiology Research Alliance presents a review of the clinical applications of this burgeoning technology, with a focus on the opportunities for radiology. Topics include uses for treatment planning, medical education, and procedural simulation, as well as patient education. Challenges for creating custom implantable devices including financial and regulatory processes for clinical application are reviewed. Precedent procedures that may translate to this new technology are discussed. The task force identifies research opportunities needed to document the value of 3D printing as it relates to patient care.
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Chae MP, Rozen WM, McMenamin PG, Findlay MW, Spychal RT, Hunter-Smith DJ. Emerging Applications of Bedside 3D Printing in Plastic Surgery. Front Surg 2015; 2:25. [PMID: 26137465 PMCID: PMC4468745 DOI: 10.3389/fsurg.2015.00025] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/02/2015] [Indexed: 12/16/2022] Open
Abstract
Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing intraoperative guidance tools, teaching patients and surgical trainees, and producing patient-specific prosthetics in everyday surgical practice.
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Affiliation(s)
- Michael P Chae
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health , Frankston, VIC , Australia
| | - Warren M Rozen
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health , Frankston, VIC , Australia
| | - Paul G McMenamin
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University , Clayton, VIC , Australia
| | - Michael W Findlay
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Department of Surgery, Stanford University , Stanford, CA , USA
| | - Robert T Spychal
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia
| | - David J Hunter-Smith
- 3D PRINT Laboratory, Department of Surgery, Peninsula Health , Frankston, VIC , Australia ; Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health , Frankston, VIC , Australia
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