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Chytas D, Noussios G, Salmas M, Demesticha T, Vasiliadis AV, Troupis T. The effectiveness of three-dimensional printing in undergraduate and postgraduate anatomy education: A review of reviews. Morphologie 2024; 108:100759. [PMID: 38215686 DOI: 10.1016/j.morpho.2023.100759] [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: 10/30/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE Several reviews and meta-analyses about the value of three-dimensional (3D) printing in anatomy education have been published in the last years, with variable-and sometimes confusing- outcomes. We performed a review of those reviews, in order to shed light on the results concerning the effectiveness of 3D printing in anatomy education, compared to specific traditional methods and other technologies. METHODS The electronic databases PubMed, ERIC and Cochrane library were searched for reviews or meta-analyses with purpose to investigate the effectiveness of 3D printing in undergraduate and postgraduate anatomy education. RESULTS Seven papers were included: four systematic reviews with meta-analysis, one narrative, one scoping and one systematic review. Overall, it has been shown that 3D printing is more effective than two-dimensional (2D) images for undergraduate health science students, but not for medical residents. Also, it seems to be more effective than 2D methods for teaching anatomy of some relatively complex structures, such as the nervous system. However, there is generally lack of evidence about the effectiveness of 3D printing in comparison with other 3D visualization methods. CONCLUSIONS For students, the effectiveness of 3D printing in anatomy education is higher than 2D methods. There is need for studies to investigate the effectiveness of 3D printing in comparison with other 3D visualization methods, such as cadaveric dissection, prosection and virtual reality. There is also need for research to explore if 3D printing is effective as a supplementary tool in a blended anatomy learning approach.
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Affiliation(s)
- D Chytas
- Department of Physiotherapy, Basic Sciences Laboratory, University of Peloponnese, 20, Plateon Street, 23100 Sparta, Greece; European University of Cyprus, 6, Diogenous Street, 2404 Engomi, Nicosia, Cyprus.
| | - G Noussios
- Department of Physical Education and Sports Sciences of Serres, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - M Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 75, Mikras Asias Street, 11527 Athens, Greece
| | - T Demesticha
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 75, Mikras Asias Street, 11527 Athens, Greece
| | - A V Vasiliadis
- Department of Orthopaedic Surgery, Sports Trauma Unit, St. Luke's Hospital, Panorama, 55236 Thessaloniki, Greece
| | - T Troupis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 75, Mikras Asias Street, 11527 Athens, Greece
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Salmas M, Noussios G, Paraskevas G, Demesticha T, Chytas D. Letter to the Editor regarding: "3D Printed Cardiac Models as an Adjunct to Traditional Teaching of Anatomy in Congenital Heart Disease-A Randomised Controlled Study" by Tarca et al. Heart Lung Circ. 2023;32:1443-50. Heart Lung Circ 2024; 33:e27-e28. [PMID: 38702136 DOI: 10.1016/j.hlc.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/28/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527, Athens, Greece
| | - George Noussios
- Department of Physical Education and Sports Sciences of Serres, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Georgios Paraskevas
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Theano Demesticha
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 75, Mikras Asias Str., 11527, Athens, Greece
| | - Dimitrios Chytas
- Basic Sciences Laboratory, Department of Physiotherapy, University of Peloponnese, 20, Plateon Str., 23100, Sparta, Greece; European University of Cyprus, Engomi, Nicosia, Cyprus.
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Yim D. Reply to Letter to the Editor regarding: "3D Printed Cardiac Models as an Adjunct to Traditional Teaching of Anatomy in Congenital Heart Disease-A Randomised Controlled Study". Heart Lung Circ 2024; 33:e29-e30. [PMID: 38702137 DOI: 10.1016/j.hlc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Affiliation(s)
- Deane Yim
- Children's Cardiac Centre, Perth Children's Hospital, Perth, WA, Australia.
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Cattapan C, Guariento A, Bertelli F, Galliotto F, Vazzoler C, Magagna P, Gerosa G, Vida V. The introduction of surgical simulation on three-dimensional-printed models in the cardiac surgery curriculum: an experimental project. J Cardiovasc Med (Hagerstown) 2024; 25:165-172. [PMID: 38149703 PMCID: PMC10836787 DOI: 10.2459/jcm.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 11/01/2023] [Indexed: 12/28/2023]
Abstract
AIMS Training in congenital cardiac surgery has become more and more difficult because of the reduced opportunities for trainees in the operating room and the high patient anatomical variability. The aim of this study was to perform a pilot evaluation of surgical simulation on a simple 3D-printed heart model in training of young surgeons and its potential inclusion in the curriculum of residency programs. METHODS A group of 11 residents performed a surgical correction of aortic coarctation using a 3D-printed surgical model. After teaching the surgical procedure, a simulation was performed twice, at different times, and was evaluated quantitatively and qualitatively by a senior surgeon. A 3D model-based training program was then developed and incorporated into our cardiac surgery training program. RESULTS A significant improvement in surgical technique was observed between the first and second surgical simulations: median of 65% [interquartile range (IQR) = 61-70%] vs. 83% (IQR = 82-91%, P < 0.001). The median time required to run the simulation was significantly shorter during the second simulation: 39 min (IQR = 33-40) vs. 45 min (IQR = 37-48; P = 0.02). Regarding the simulation program, a basic and an advanced program were developed, including a total of 40 different simulated procedures divided into 12 sessions. CONCLUSION Surgical simulation using 3D-printing technology can be an extremely valuable tool to improve surgical training in congenital heart disease. Our pilot study can represent the first step towards the creation of an integrated training system on 3D-printed models of congenital and acquired heart diseases in other Italian residency programs.
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Affiliation(s)
- Claudia Cattapan
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
| | - Francesco Bertelli
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
| | - Francesco Galliotto
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
| | - Carlotta Vazzoler
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
| | - Paolo Magagna
- Cardiac Surgery Unit, Dipartimento Strutturale Cardio-vascolare, San Bortolo Hospital, Vicenza
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua
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Tarca A, Woo N, Bain S, Crouchley D, McNulty E, Yim D. 3D Printed Cardiac Models as an Adjunct to Traditional Teaching of Anatomy in Congenital Heart Disease-A Randomised Controlled Study. Heart Lung Circ 2023; 32:1443-1450. [PMID: 38007317 DOI: 10.1016/j.hlc.2023.09.021] [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: 01/11/2023] [Revised: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Three-dimensional (3D) printed cardiac models are increasingly being used for medical education, simulation and training, communication, surgical planning and research. Given the complexities of congenital cardiac anatomy, 3D printing is well suited as an adjunct to traditional teaching methods. This study aims to explore the influence of 3D printed cardiac models as a teaching aid for nurses and paediatric trainees. We hypothesise that using 3D models as an adjunct to didactic teaching methods improves knowledge and confidence levels of participants, regardless of their cardiology experience. METHOD A prospective randomised study was performed recruiting paediatric nurses and doctors at a tertiary paediatric hospital. All participants undertook traditional congenital cardiac teaching describing normal cardiac anatomy and seven congenital lesions of increasing complexity (atrial septal defect, ventricular septal defect, vascular ring, partial anomalous pulmonary venous return, tetralogy of Fallot, transposition of the great arteries, and double outlet right ventricle). The intervention group received an additional recorded demonstration while handling 3D printed models of a normal heart and the same lesions. Pre- and post-intervention assessments were completed using a subjective Likert-scale questionnaire and objective multiple-choice examination. RESULTS A total of 73 health practitioners (30 cardiac nurses and 43 paediatric trainees) were included. Subjective knowledge and confidence levels substantially improved in the intervention group (both p<0.001), with no differences observed in the control group. Greater improvement in both subjective and objective post-test scores was observed in the intervention group. A pronounced difference between pre- and post-teaching objective examination scores was found in both groups (p=0.002), with larger improvements observed in the intervention group. The mean score in the intervention group after teaching increased by 4.27 (21.4% improvement), as opposed to 2.28 (11.4% improvement) in the control group. There was no difference in pre-test score or post-test improvement based on previous cardiology experience. DISCUSSION Three-dimensional (3D) printed cardiac models, when used as an adjunct to traditional teaching methods, substantially improve knowledge and confidence levels of health professionals on a range of congenital cardiac lesions. These models enhance the learners' educational experience and understanding of cardiac anatomy by overcoming the limitation of two-dimensional representations of 3D structures.
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Affiliation(s)
- Adrian Tarca
- Children's Cardiac Centre, Perth Children's Hospital, Perth, WA, Australia
| | - Ngai Woo
- Children's Cardiac Centre, Perth Children's Hospital, Perth, WA, Australia
| | - Shahira Bain
- Nursing Education, Perth Children's Hospital, Perth, WA, Australia
| | - David Crouchley
- Children's Cardiac Centre, Perth Children's Hospital, Perth, WA, Australia
| | - Eamonn McNulty
- Medical Illustrations, Perth Children's Hospital, Perth, WA, Australia
| | - Deane Yim
- Children's Cardiac Centre, Perth Children's Hospital, Perth, WA, Australia.
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Luxford JC, Cheng TL, Mervis J, Anderson J, Clarke J, Croker S, Nusem E, Bray L, Gunasekera H, Scott KM. An Opportunity to See the Heart Defect Physically: Medical Student Experiences of Technology-Enhanced Learning with 3D Printed Models of Congenital Heart Disease. MEDICAL SCIENCE EDUCATOR 2023; 33:1095-1107. [PMID: 37886275 PMCID: PMC10597946 DOI: 10.1007/s40670-023-01840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 10/28/2023]
Abstract
Three-dimensional (3D) printing is increasingly used in medical education and paediatric cardiology. A technology-enhanced learning (TEL) module was designed to accompany 3D printed models of congenital heart disease (CHD) to aid in the teaching of medical students. There are few studies evaluating the attitudes and perceptions of medical students regarding their experience of learning about CHD using 3D printing. This study aimed to explore senior medical students' experiences in learning about paediatric cardiology through a workshop involving 3D printed models of CHD supported by TEL in the form of online case-based learning. A mixed-methods evaluation was undertaken involving a post-workshop questionnaire (n = 94 students), and focus groups (n = 16 students). Focus group and free-text questionnaire responses underwent thematic analysis. Questionnaire responses demonstrated widespread user satisfaction; 91 (97%) students agreed that the workshop was a valuable experience. The highest-level satisfaction was for the physical 3D printed models, the clinical case-based learning, and opportunity for peer collaboration. Thematic analysis identified five key themes: a variable experience of prior learning, interplay between physical and online models, flexible and novel workshop structure, workshop supported the learning outcomes, and future opportunities for learning using 3D printing. A key novel finding was that students indicated the module increased their confidence to teach others about CHD and recommended expansion to other parts of the curriculum. 3D printed models of CHD are a valuable learning resource and contribute to the richness and enjoyment of medical student learning, with widespread satisfaction. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01840-w.
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Affiliation(s)
- Jack C. Luxford
- Faculty of Medicine and Health, Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW Australia
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
| | - Tegan L. Cheng
- Sydney School of Health Sciences, The University of Sydney, Sydney, NSW Australia
- EPIC Lab, The Children’s Hospital at Westmead, Sydney, Australia
| | - Jonathan Mervis
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
| | - Jennifer Anderson
- Faculty of Medicine and Health, Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW Australia
| | - Jillian Clarke
- Discipline of Medical Imaging, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Sarah Croker
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Erez Nusem
- School of Architecture, The University of Queensland, Brisbane, QLD Australia
| | - Liam Bray
- Faculty of Architecture, Design and Planning, The University of Sydney, Sydney, NSW Australia
| | - Hasantha Gunasekera
- Faculty of Medicine and Health, Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW Australia
| | - Karen M. Scott
- Faculty of Medicine and Health, Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW Australia
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Youn JK, Park HS, Ko D, Yang HB, Kim HY, Yoon HB. Application of additional three-dimensional materials for education in pediatric anatomy. Sci Rep 2023; 13:9973. [PMID: 37340064 DOI: 10.1038/s41598-023-36912-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/12/2023] [Indexed: 06/22/2023] Open
Abstract
We conducted this study to investigate the effects of additional education using 3D visualization (3DV) and 3D printing (3DP) after applying 2D images for anatomical education in normal pediatric structures and congenital anomalies. For the production of 3DV and 3DP of the anatomical structures, computed tomography (CT) images of the four topics (the normal upper/lower abdomen, choledochal cyst, and imperforate anus) were used. Anatomical self-education and tests were administered to a total of 15 third-year medical students with these modules. Following the tests, surveys were conducted in order to evaluate satisfaction from students. In all four topics, there were significant increases in the test results with additional education with 3DV after initial self-study with CT (P < 0.05). The difference in scores was highest for the imperforate anus when 3DV supplemented the self-education. In the survey on the teaching modules, the overall satisfaction scores for 3DV and 3DP were 4.3 and 4.0 out of 5, respectively. When 3DV was added to pediatric abdominal anatomical education, we found an enhancement in understanding of normal structures and congenital anomalies. We can expect the application of 3D materials to become more widely used in anatomical education in various fields.
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Affiliation(s)
- Joong Kee Youn
- Department of Pediatric Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Pediatric Surgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Korea
| | - Han Sang Park
- Department of Pediatric Surgery, Seoul National University Hospital, Seoul, Korea
| | - Dayoung Ko
- Department of Pediatric Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hee-Beom Yang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyounggi, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Hospital, Seoul, Korea.
- Department of Pediatric Surgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Korea.
| | - Hyun Bae Yoon
- Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea
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Huang J, Wang H, Yang Y, Chen Q, Hu J, Shi H, Zhou Q. 3D printing of foetal vascular rings: feasibility and applicability. BMC Pregnancy Childbirth 2023; 23:355. [PMID: 37194003 DOI: 10.1186/s12884-023-05683-6] [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: 09/24/2022] [Accepted: 05/06/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Vascular rings (VRs) exhibit complex and diverse forms that are difficult to conceptualize using traditional two-dimensional (2D) schematic. Inexperienced medical students and parents who lack a medical technology background face significant challenges in understanding VRs. The purpose of this research is to develop three-dimensional (3D) printing models of VRs to provide new technical imaging support for medical education and parental consultation. METHODS This study included 42 fetuses diagnosed as VRs. Foetal echocardiography, modeling and 3D printing were performed, and the dimensional accuracy of models was analyzed. The value of 3D printing in the teaching of VRs was analyzed based on comparing the test results before and after the teaching intervention of 48 medical students and the satisfaction survey. A brief survey was conducted to 40 parents to assess the value of the 3D printed model in prenatal consultations. RESULTS Forty models of VRs were successfully obtained, which reproduced the anatomical shape of the VRs space with high dimensional accuracy. No differences in the prelecture test results were noted between the 3D printing group and the 2D image group. After the lecture, the knowledge of both groups improved, but the postlecture score and the change in the prelecture versus postlecture score were greater in the 3D printing group, and the subjective satisfaction survey feedback in the 3D printing group was also better (P < 0.05). Similar results were observed from the parental questionnaire, the vast majority of parents have an enthusiastic and positive attitude towards the use of 3D printed models and suggest using them in future prenatal consultations. CONCLUSIONS Three-dimensional printing technology providing a new tool for effectively displaying different types of foetal VRs. This tool helps physicians and families understand the complex structure of foetal great vessels, positively impacting medical instruction and prenatal counselling.
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Affiliation(s)
- Jia Huang
- Department of Obstetrics and Gynecology Ultrasound, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Hao Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yuanting Yang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Qian Chen
- Department of Obstetrics and Gynecology Ultrasound, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jiaqi Hu
- Department of Obstetrics and Gynecology Ultrasound, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Hua Shi
- Department of Obstetrics and Gynecology Ultrasound, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Adnan S, Xiao J. A scoping review on the trends of digital anatomy education. Clin Anat 2023; 36:471-491. [PMID: 36583721 DOI: 10.1002/ca.23995] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022]
Abstract
Digital technologies are changing the landscape of anatomy education. To reveal the trend of digital anatomy education across medical science disciplines, searches were performed using PubMed, EMBASE, and MEDLINE bibliographic databases for research articles published from January 2010 to June 2021 (inclusive). The search was restricted to publications written in English language and to articles describing teaching tools in undergraduate and postgraduate anatomy and pre-vocational clinical anatomy training courses. Among 156 included studies across six health disciplines, 35% used three-dimensional (3D) digital printing tools, 24.2% augmented reality (AR), 22.3% virtual reality (VR), 11.5% web-based programs, and 4.5% tablet-based apps. There was a clear discipline-dependent preference in the choice and employment of digital anatomy education. AR and VR were the more commonly adopted digital tools for medical and surgical anatomy education, while 3D printing is more broadly used for nursing, allied health and dental health education compared to other digital resources. Digital modalities were predominantly adopted for applied interactive anatomy education and primarily in advanced anatomy curricula such as regional anatomy and neuroanatomy. Moreover, there was a steep increase in VR anatomy combining digital simulation for surgical anatomy training. There is a consistent increase in the adoption of digital modalities in anatomy education across all included health disciplines. AR and VR anatomy incorporating digital simulation will play a more prominent role in medical education of the future. Combining multimodal digital resources that supports blended and interactive learning will further modernize anatomy education, moving medical education further away from its didactic history.
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Affiliation(s)
- Sharmeen Adnan
- Department of Health Sciences and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Junhua Xiao
- Department of Health Sciences and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia.,School of Allied Health, La Trobe University, Bundoora, Australia
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Virtual reality curriculum increases paediatric residents' knowledge of CHDs. Cardiol Young 2023; 33:410-414. [PMID: 35466894 DOI: 10.1017/s1047951122000890] [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: 11/06/2022]
Abstract
OBJECTIVES Virtual reality has emerged as a unique educational modality for medical trainees. However, incorporation of virtual reality curricula into formal training programmes has been limited. We describe a multi-centre effort to develop, implement, and evaluate the efficacy of a virtual reality curriculum for residents participating in paediatric cardiology rotations. METHODS A virtual reality software program ("The Stanford Virtual Heart") was utilised. Users are placed "inside the heart" and explore non-traditional views of cardiac anatomy. Modules for six common congenital heart lesions were developed, including narrative scripts. A prospective case-control study was performed involving three large paediatric residency programmes. From July 2018 to June 2019, trainees participating in an outpatient cardiology rotation completed a 27-question, validated assessment tool. From July 2019 to February 2020, trainees completed the virtual reality curriculum and assessment tool during their cardiology rotation. Qualitative feedback on the virtual reality experience was also gathered. Intervention and control group performances were compared using univariate analyses. RESULTS There were 80 trainees in the control group and 52 in the intervention group. Trainees in the intervention group achieved higher scores on the assessment (20.4 ± 2.9 versus 18.8 ± 3.8 out of 27 questions answered correctly, p = 0.01). Further analysis showed significant improvement in the intervention group for questions specifically testing visuospatial concepts. In total, 100% of users recommended integration of the programme into the residency curriculum. CONCLUSIONS Virtual reality is an effective and well-received adjunct to clinical curricula for residents participating in paediatric cardiology rotations. Our results support continued virtual reality use and expansion to include other trainees.
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Sun Z, Wong YH, Yeong CH. Patient-Specific 3D-Printed Low-Cost Models in Medical Education and Clinical Practice. MICROMACHINES 2023; 14:464. [PMID: 36838164 PMCID: PMC9959835 DOI: 10.3390/mi14020464] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
3D printing has been increasingly used for medical applications with studies reporting its value, ranging from medical education to pre-surgical planning and simulation, assisting doctor-patient communication or communication with clinicians, and the development of optimal computed tomography (CT) imaging protocols. This article presents our experience of utilising a 3D-printing facility to print a range of patient-specific low-cost models for medical applications. These models include personalized models in cardiovascular disease (from congenital heart disease to aortic aneurysm, aortic dissection and coronary artery disease) and tumours (lung cancer, pancreatic cancer and biliary disease) based on CT data. Furthermore, we designed and developed novel 3D-printed models, including a 3D-printed breast model for the simulation of breast cancer magnetic resonance imaging (MRI), and calcified coronary plaques for the simulation of extensive calcifications in the coronary arteries. Most of these 3D-printed models were scanned with CT (except for the breast model which was scanned using MRI) for investigation of their educational and clinical value, with promising results achieved. The models were confirmed to be highly accurate in replicating both anatomy and pathology in different body regions with affordable costs. Our experience of producing low-cost and affordable 3D-printed models highlights the feasibility of utilizing 3D-printing technology in medical education and clinical practice.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth 6845, Australia
- Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Perth 6845, Australia
- School of Medicine and Medical Advancement for Better Quality of Life Impact Lab, Taylor’s University, Subang Jaya 47500, Malaysia
| | - Yin How Wong
- School of Medicine and Medical Advancement for Better Quality of Life Impact Lab, Taylor’s University, Subang Jaya 47500, Malaysia
| | - Chai Hong Yeong
- School of Medicine and Medical Advancement for Better Quality of Life Impact Lab, Taylor’s University, Subang Jaya 47500, Malaysia
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Patient-Specific 3D-Printed Models in Pediatric Congenital Heart Disease. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020319. [PMID: 36832448 PMCID: PMC9955978 DOI: 10.3390/children10020319] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Three-dimensional (3D) printing technology has become increasingly used in the medical field, with reports demonstrating its superior advantages in both educational and clinical value when compared with standard image visualizations or current diagnostic approaches. Patient-specific or personalized 3D printed models serve as a valuable tool in cardiovascular disease because of the difficulty associated with comprehending cardiovascular anatomy and pathology on 2D flat screens. Additionally, the added value of using 3D-printed models is especially apparent in congenital heart disease (CHD), due to its wide spectrum of anomalies and its complexity. This review provides an overview of 3D-printed models in pediatric CHD, with a focus on educational value for medical students or graduates, clinical applications such as pre-operative planning and simulation of congenital heart surgical procedures, and communication between physicians and patients/parents of patients and between colleagues in the diagnosis and treatment of CHD. Limitations and perspectives on future research directions for the application of 3D printing technology into pediatric cardiology practice are highlighted.
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Cattapan C, Guariento A, Bifulco O, Caraffa R, Bertelli F, Reffo E, Padalino M, Di Salvo G, Vida V. Three-Dimensional-Enabled Surgical Planning for the Correction of Right Partial Anomalous Pulmonary Venous Return. J Clin Med 2023; 12:jcm12020472. [PMID: 36675399 PMCID: PMC9863474 DOI: 10.3390/jcm12020472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Objectives: The surgical technique for right partial anomalous pulmonary venous return (PAPVR) depends on the location of the anomalous pulmonary veins (PVs). With this in mind, we sought to evaluate the impact of 3D heart segmentation and reconstruction on preoperative surgical planning. Methods: A retrospective study was conducted on all patients who underwent PAPVR repair at our institution between January 2018 and October 2021; three-dimensional segmentations and reconstructions of all the heart anatomies were performed. A score (the PAPVR score) was established and calculated using two anatomical parameters (the distance between the most cranial anomalous PV and the superior rim of the sinus venosus defect/the sum of the latter and the distance between the PV and the azygos vein) to predict the type of correction. Results: A total of 30 patients were included in the study. The PAPVR score was found to be a good predictor of the type of surgery performed. A value > 0.68 was significantly associated with a Warden procedure (p < 0.001) versus single/double patch repair. Conclusions: Three-dimensional heart segmentations and reconstructions improve the quality of surgical planning in the case of PAPVR and allow for the introduction of a score that may facilitate surgical decisions on the type of repair required.
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Affiliation(s)
- Claudia Cattapan
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Olimpia Bifulco
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Raphael Caraffa
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Francesco Bertelli
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Elena Reffo
- Pediatric Cardiology, Department of Pediatric and Maternal Medicine, University of Padua, 35128 Padua, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology, Department of Pediatric and Maternal Medicine, University of Padua, 35128 Padua, Italy
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-049-8212427
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Ye Z, Jiang H, Bai S, Wang T, Yang D, Hou H, Zhang Y, Yi S. Meta-analyzing the efficacy of 3D printed models in anatomy education. Front Bioeng Biotechnol 2023; 11:1117555. [PMID: 36890917 PMCID: PMC9986435 DOI: 10.3389/fbioe.2023.1117555] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
Three-dimensional printing models (3DPs) have been widely used in medical anatomy training. However, the 3DPs evaluation results differ depending on such factors as the training objects, experimental design, organ parts, and test content. Thus, this systematic evaluation was carried out to better understand the role of 3DPs in different populations and different experimental designs. Controlled (CON) studies of 3DPs were retrieved from PubMed and Web of Science databases, where the participants were medical students or residents. The teaching content is the anatomical knowledge of human organs. One evaluation indicator is the mastery of anatomical knowledge after training, and the other is the satisfaction of participants with 3DPs. On the whole, the performance of the 3DPs group was higher than that of the CON group; however, there was no statistical difference in the resident subgroup, and there was no statistical difference for 3DPs vs. 3D visual imaging (3DI). In terms of satisfaction rate, the summary data showed that the difference between the 3DPs group (83.6%) vs. the CON group (69.6%) (binary variable) was not statistically significant, with p > 0.05. 3DPs has a positive effect on anatomy teaching, although there are no statistical differences in the performance tests of individual subgroups; participants generally had good evaluations and satisfaction with 3DPs. 3DPs still faces challenges in production cost, raw material source, authenticity, durability, etc. The future of 3D-printing-model-assisted anatomy teaching is worthy of expectation.
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Affiliation(s)
- Zhen Ye
- School of clinical and basic medicine, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Hanming Jiang
- School of clinical and basic medicine, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Suyun Bai
- School of clinical and basic medicine, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Tao Wang
- School of clinical and basic medicine, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Duxiao Yang
- School of clinical and basic medicine, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Haifeng Hou
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, China
| | - Yuanying Zhang
- School of clinical and basic medicine, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Shuying Yi
- School of clinical and basic medicine, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
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15
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Chytas D, Salmas M, Demesticha T, Troupis T. Three-dimensional printing in anatomy education: Is it similarly useful for teaching of all anatomical regions and structures? ANATOMICAL SCIENCES EDUCATION 2023; 16:5-6. [PMID: 35946089 DOI: 10.1002/ase.2216] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/24/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Dimitrios Chytas
- Basic Sciences Laboratory, Department of Physiotherapy, University of Peloponnese, Sparta, Greece
| | - Marios Salmas
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Theano Demesticha
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Troupis
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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16
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Jacob J, Stunden C, Zakani S. Exploring the value of three-dimensional printing and virtualization in paediatric healthcare: A multi-case quality improvement study. Digit Health 2023; 9:20552076231159988. [PMID: 36865771 PMCID: PMC9972041 DOI: 10.1177/20552076231159988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/09/2023] [Indexed: 03/02/2023] Open
Abstract
Background Three-dimensional printing is being utilized in clinical medicine to support activities including surgical planning, education, and medical device fabrication. To better understand the impacts of this technology, a survey was implemented with radiologists, specialist physicians, and surgeons at a tertiary care hospital in Canada, examining multidimensional value and considerations for uptake. Objectives To examine how three-dimensional printing can be integrated into the paediatric context and highlight areas of impact and value to the healthcare system using Kirkpatrick's Model. Secondarily, to explore the perspective of clinicians utilizing three-dimensional models and how they make decisions about whether or not to use the technology in patient care. Methods A post-case survey. Descriptive statistics are provided for Likert-style questions, and a thematic analysis was conducted to identify common patterns in open-ended responses. Results In total, 37 respondents were surveyed across 19 clinical cases, providing their perspectives on model reaction, learning, behaviour, and results. We found surgeons and specialists to consider the models more beneficial than radiologists. Results further showed that the models were more helpful when used to assess the likelihood of success or failure of clinical management strategies, and for intraoperative orientation. We demonstrate that three-dimensional printed models could improve perioperative metrics, including a reduction in operating room time, but with a reciprocal effect on pre-procedural planning time. Clinicians who shared the models with patients and families thought it increased understanding of the disease and surgical procedure, and had no effect on their consultation time. Conclusions Three-dimensional printing and virtualization were used in preoperative planning and for communication among the clinical care team, trainees, patients, and families. Three-dimensional models provide multidimensional value to clinical teams, patients, and the health system. Further investigation is warranted to assess value in other clinical areas, across disciplines, and from a health economics and outcomes perspective.
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Affiliation(s)
- John Jacob
- Faculty of Medicine, Department of Paediatrics, University of British
Columbia, Vancouver, BC, Canada
- Digital Lab, BC Children's Hospital, Vancouver, BC, Canada
- Bayes Business School, City, University of London, London, UK
| | - Chelsea Stunden
- Faculty of Medicine, Department of Paediatrics, University of British
Columbia, Vancouver, BC, Canada
- Digital Lab, BC Children's Hospital, Vancouver, BC, Canada
| | - Sima Zakani
- Faculty of Medicine, Department of Paediatrics, University of British
Columbia, Vancouver, BC, Canada
- Digital Lab, BC Children's Hospital, Vancouver, BC, Canada
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Asghar A, Naaz S, Patra A, Ravi KS, Khanal L. Effectiveness of 3D-printed models prepared from radiological data for anatomy education: A meta-analysis and trial sequential analysis of 22 randomized, controlled, crossover trials. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:353. [PMID: 36567994 PMCID: PMC9768753 DOI: 10.4103/jehp.jehp_199_22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/06/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Many academicians suggested the supplementary use of 3D-printed models reconstructed from radiological images for optimal anatomy education. 3D-printed model is newer technology available to us. The purpose of this systematic review was to capture the usefulness or effectiveness of this newer technology in anatomy education. MATERIALS AND METHODS Twenty-two studies met the inclusion and exclusion criteria for quantitative synthesis. The included studies were sub-grouped according to the interventions and participants. No restrictions were applied based on geographical location, language and publication years. Randomized, controlled trial, cross-sectional and cross-over designs were included. The effect size of each intervention in both participants was computed as a standardized mean difference (SMD). RESULTS Twenty-two randomized, controlled trials were included for quantitative estimation of effect size of knowledge acquisition as standardized mean difference in 1435 participants. The pooled effect size for 3D-printed model was 0.77 (0.45-1.09, 95% CI, P < 0.0001) with 86% heterogeneity. The accuracy score was measured in only three studies and estimated effect size was 2.81 (1.08-4.54, 95% CI, P = 0.001) with 92% heterogeneity. The satisfaction score was examined by questionnaire in 6 studies. The estimated effect size was 2.00 (0.69-3.32, 95% CI, P = 0.003) with significant heterogeneity. CONCLUSION The participants exposed to the 3D-printed model performed better than participants who used traditional methodologies. Thus, the 3D-printed model is a potential tool for anatomy education.
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Affiliation(s)
- Adil Asghar
- Department of Anatomy, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Shagufta Naaz
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Apurba Patra
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Kumar S. Ravi
- Department of Anatomy, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Laxman Khanal
- Department of Anatomy, BP Koirala Institute of Health Sciences, Nepal
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18
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Salazar D, Thompson M, Rosen A, Zuniga J. Using 3D Printing to Improve Student Education of Complex Anatomy: a Systematic Review and Meta-analysis. MEDICAL SCIENCE EDUCATOR 2022; 32:1209-1218. [PMID: 36276759 PMCID: PMC9583986 DOI: 10.1007/s40670-022-01595-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 05/29/2023]
Abstract
Objective Additive manufacturing has played an increasingly important role in the field of health care. One of the most recent applications has been the development of 3D printed anatomical models specifically to improve student education. The purpose of this review was to assess the potential for 3D printed models to improve understanding of complex anatomy in undergraduate and medical/professional students. Methods A systematic review was performed to investigate the different implementations of 3D printed anatomical models in educational curricula. In addition, a meta-analysis was conducted to assess the differences in comprehension between students who received 3D printed models as part of their instruction and those taught with traditional methods. Results Of the 10 groups included in the meta-analysis, students whose educational experience included a 3D printed model scored roughly 11% better on objective assessments compared to students who did not use such models (Hedge's g = 0.742, p < 0.001). Conclusion Based on these findings, the use of 3D printed anatomical models as a method of education is likely to improve students' understanding of complex anatomical structures.
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Affiliation(s)
- David Salazar
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Dr S, Omaha, NE 68182 USA
| | - Michael Thompson
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Dr S, Omaha, NE 68182 USA
| | - Adam Rosen
- School of Health and Kinesiology, University of Nebraska at Omaha, 6160 University Dr S, Omaha, NE 68182 USA
| | - Jorge Zuniga
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Dr S, Omaha, NE 68182 USA
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19
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Sun Z, Wee C. 3D Printed Models in Cardiovascular Disease: An Exciting Future to Deliver Personalized Medicine. MICROMACHINES 2022; 13:1575. [PMID: 36295929 PMCID: PMC9610217 DOI: 10.3390/mi13101575] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
3D printing has shown great promise in medical applications with increased reports in the literature. Patient-specific 3D printed heart and vascular models replicate normal anatomy and pathology with high accuracy and demonstrate superior advantages over the standard image visualizations for improving understanding of complex cardiovascular structures, providing guidance for surgical planning and simulation of interventional procedures, as well as enhancing doctor-to-patient communication. 3D printed models can also be used to optimize CT scanning protocols for radiation dose reduction. This review article provides an overview of the current status of using 3D printing technology in cardiovascular disease. Limitations and barriers to applying 3D printing in clinical practice are emphasized while future directions are highlighted.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth 6845, Australia
| | - Cleo Wee
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth 6845, Australia
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20
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Illi J, Bernhard B, Nguyen C, Pilgrim T, Praz F, Gloeckler M, Windecker S, Haeberlin A, Gräni C. Translating Imaging Into 3D Printed Cardiovascular Phantoms. JACC Basic Transl Sci 2022; 7:1050-1062. [PMID: 36337920 PMCID: PMC9626905 DOI: 10.1016/j.jacbts.2022.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/03/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
3D printed patient specific phantoms can visualize complex cardiovascular anatomy Common imaging modalities for 3D printing are CCT and CMR Material jetting/PolyJet and stereolithography are widely used printing techniques Standardized validation is warranted to compare different 3D printing technologies
Translation of imaging into 3-dimensional (3D) printed patient-specific phantoms (3DPSPs) can help visualize complex cardiovascular anatomy and enable tailoring of therapy. The aim of this paper is to review the entire process of phantom production, including imaging, materials, 3D printing technologies, and the validation of 3DPSPs. A systematic review of published research was conducted using Embase and MEDLINE, including studies that investigated 3DPSPs in cardiovascular medicine. Among 2,534 screened papers, 212 fulfilled inclusion criteria and described 3DPSPs as a valuable adjunct for planning and guiding interventions (n = 108 [51%]), simulation of physiological or pathological conditions (n = 19 [9%]), teaching of health care professionals (n = 23 [11%]), patient education (n = 3 [1.4%]), outcome prediction (n = 6 [2.8%]), or other purposes (n = 53 [25%]). The most common imaging modalities to enable 3D printing were cardiac computed tomography (n = 131 [61.8%]) and cardiac magnetic resonance (n = 26 [12.3%]). The printing process was conducted mostly by material jetting (n = 54 [25.5%]) or stereolithography (n = 43 [20.3%]). The 10 largest studies that evaluated the geometric accuracy of 3DPSPs described a mean bias <±1 mm; however, the validation process was very heterogeneous among the studies. Three-dimensional printed patient-specific phantoms are highly accurate, used for teaching, and applied to guide cardiovascular therapy. Systematic comparison of imaging and printing modalities following a standardized validation process is warranted to allow conclusions on the optimal production process of 3DPSPs in the field of cardiovascular medicine.
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21
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Three-Dimensional Printing Model Enhances Craniofacial Trauma Teaching by Improving Morphologic and Biomechanical Understanding: A Randomized Controlled Study. Plast Reconstr Surg 2022; 149:475e-484e. [PMID: 35196687 DOI: 10.1097/prs.0000000000008869] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Teaching about craniofacial traumas is challenging given the complexity of the craniofacial anatomy and the necessity for good spatial representation skills. To solve these problems, three-dimensional printing seems to be an appropriate educative material. In this study, the authors conducted a randomized controlled trial. The authors' main objective was to compare the performance of the undergraduate medical students in an examination based on the teaching support: three-dimensionally printed models versus two-dimensional pictures. METHODS All participants were randomly assigned to one of two groups using a random number table: the three-dimensionally-printed support group (three-dimensional group) or the two-dimensionally-displayed support group (two-dimensional group). All participants completed a multiple-choice question evaluation questionnaire on facial traumatology (first, a zygomatic bone fracture; then, a double mandible fracture). Sex and potential confounding factors were evaluated. RESULTS Four hundred thirty-two fifth-year undergraduate medical students were enrolled in this study. Two hundred six students were allocated to the three-dimensional group, and 226 were allocated to the two-dimensional group. The three-dimensionally printed model was considered to be a better teaching material compared with two-dimensional support. The global mean score was 2.36 in the three-dimensional group versus 1.99 in the two-dimensional group (p = 0.008). Regarding teaching of biomechanical aspects, three-dimensionally-printed models provide better understanding (p = 0.015). Participants in both groups exhibited similar previous student educational achievements and visuospatial skills. CONCLUSIONS This prospective, randomized, controlled educational trial demonstrated that incorporation of three-dimensionally-printed models improves medical students' understanding. This trial reinforces previous studies highlighting academic benefits in using three-dimensionally-printed models mostly in the field of understanding complex structures.
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22
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Wu C, Luo M, Liu Y, Dai R, Zhang M, Zhong Y, Chen Y. Application of a 3D-printed eye model for teaching direct ophthalmoscopy to undergraduates. Graefes Arch Clin Exp Ophthalmol 2022; 260:2361-2368. [PMID: 35038015 DOI: 10.1007/s00417-021-05538-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE This study aims to design an eye model that can simulate the fundus for teaching direct ophthalmoscopy and to evaluate its effectiveness. METHODS We first used 3D printing materials to make an eye model and then randomly assigned 92 undergraduates into group A (model-assisted training group) and group B (traditional training group) to test our model. After the same training time, real patients were used to test the students, with 120 s as the examination time limit. We recorded the students' ability to clearly see the optic disk, the time to determine the cup-to-disk ratio, and whether they were correct. RESULTS Forty-three students in group A (93.48%) successfully saw the fundus, while 21 in group B (45.65%) succeeded. The difference between the two groups was 47.83% (95% confidence interval, 29.59-66.07%, P < 0.0001). The median time to see the fundus was 29s (95% confidence interval 23-45 s) in group A, while an estimated minimum time in group B was 80 s, indicating that group A was significantly faster than group B (P < 0.0001). CONCLUSIONS This 3D-printed eye model significantly improved the students' study interest, study efficiency, and study results and is worthy of being promoted.
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Affiliation(s)
- Chan Wu
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingyue Luo
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yutong Liu
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Rongping Dai
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Meifen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. .,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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Bui I, Bhattacharya A, Wong SH, Singh HR, Agarwal A. Role of Three-Dimensional Visualization Modalities in Medical Education. Front Pediatr 2021; 9:760363. [PMID: 34950617 PMCID: PMC8691210 DOI: 10.3389/fped.2021.760363] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/25/2021] [Indexed: 01/26/2023] Open
Abstract
For the past two decades, slide-based presentation has been the method of content delivery in medical education. In recent years, other teaching modalities involving three-dimensional (3D) visualization such as 3D printed anatomical models, virtual reality (VR), and augmented reality (AR) have been explored to augment the education experience. This review article will analyze the use of slide-based presentation, 3D printed anatomical models, AR, and VR technologies in medical education, including their benefits and limitations.
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Affiliation(s)
- Ivy Bui
- Department of Clinical and Applied Sciences Education, School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX, United States
- Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Arunabh Bhattacharya
- Department of Clinical and Applied Sciences Education, School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX, United States
| | - Si Hui Wong
- Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Harinder R. Singh
- Children's Hospital of San Antonio, San Antonio, TX, United States
- Baylor College of Medicine, Houston, TX, United States
| | - Arpit Agarwal
- Children's Hospital of San Antonio, San Antonio, TX, United States
- Baylor College of Medicine, Houston, TX, United States
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Asif A, Lee E, Caputo M, Biglino G, Shearn AIU. Role of 3D printing technology in paediatric teaching and training: a systematic review. BMJ Paediatr Open 2021; 5:10.1136/bmjpo-2021-001050. [PMID: 35290958 PMCID: PMC8655595 DOI: 10.1136/bmjpo-2021-001050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/15/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In the UK, undergraduate paediatric training is brief, resulting in trainees with a lower paediatric knowledge base compared with other aspects of medicine. With congenital conditions being successfully treated at childhood, adult clinicians encounter and will need to understand these complex pathologies. Patient-specific 3D printed (3DP) models have been used in clinical training, especially for rarer, complex conditions. We perform a systematic review to evaluate the evidence base in using 3DP models to train paediatricians, surgeons, medical students and nurses. METHODS Online databases PubMed, Web of Science and Embase were searched between January 2010 and April 2020 using search terms relevant to "paediatrics", "education", "training" and "3D printing". Participants were medical students, postgraduate trainees or clinical staff. Comparative studies (patient-specific 3DP models vs traditional teaching methods) and non-comparative studies were included. Outcomes gauged objective and subjective measures: test scores, time taken to complete tasks, self-reported confidence and personal preferences on 3DP models. If reported, the cost of and time taken to produce the models were noted. RESULTS From 587 results, 15 studies fit the criteria of the review protocol, with 5/15 being randomised controlled studies and 10/15 focussing on cardiovascular conditions. Participants using 3DP models demonstrated improved test scores and faster times to complete procedures and identify anatomical landmarks compared with traditional teaching methods (2D diagrams, lectures, videos and supervised clinical events). User feedback was positive, reporting greater user self-confidence in understanding concepts with users wishing for integrated use of 3DP in regular teaching. Four studies reported the costs and times of production, which varied depending on model complexity and printer. 3DP models were cheaper than 'off-the-shelf' models available on the market and had the benefit of using real-world pathologies. These mostly non-randomised and single-centred studies did not address bias or report long-term or clinically translatable outcomes. CONCLUSIONS 3DP models were associated with greater user satisfaction and good short-term educational outcomes, with low-quality evidence. Multicentred, randomised studies with long-term follow-up and clinically assessed outcomes are needed to fully assess their benefits in this setting. PROSPERO REGISTRATION NUMBER CRD42020179656.
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Affiliation(s)
- Ashar Asif
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Elgin Lee
- Children's Services Directorate, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - Giovanni Biglino
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust, Bristol, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Ian Underwood Shearn
- Bristol Medical School, University of Bristol, Bristol, UK .,Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust, Bristol, UK
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Crain CL, Winfrey OK, Jackson WL, Pauley A, Yoost JL. Teaching Pediatric Straddle Injury Repair with Use of a 3D Printed Model. J Pediatr Adolesc Gynecol 2021; 34:862-864. [PMID: 34044178 DOI: 10.1016/j.jpag.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To determine the utility of a 3D vulvar model for teaching pediatric straddle injury repair. DESIGN Prospective study. SETTING Two academic hospitals. PARTICIPANTS Twenty obstetrics and gynecology residents INTERVENTIONS AND MAIN OUTCOME MEASURES: Knowledge score on the basis of a 7-question pre/post test. Likert scale questions evaluated the 3D model as a teaching tool. RESULTS Twenty residents participated; 2 (10%) had ever repaired a straddle injury. Knowledge scores increased after model use and didactic session from 3.05 of possible 7 to 6.35; P = .001. Only 2/20 (10%) residents "agreed" or "strongly agreed" with the statement, "I am comfortable repairing a straddle injury" before the intervention, compared with 19/20 (95%) afterward (P < .001). Of 20 residents, 19 (95%) believed that it simulated surgical experience "very well" or "well." CONCLUSION The use of a 3D pediatric vulvar model can simulate surgical experience and can be an effective teaching tool when combined with a didactic session on pediatric straddle injury.
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Affiliation(s)
- Courtney L Crain
- Department of Obstetrics and Gynecology, Marshall University, Huntington, West Virginia
| | - Olivia K Winfrey
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, Kentucky
| | - Wendy L Jackson
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, Kentucky
| | - Amanda Pauley
- Department of Obstetrics and Gynecology, Marshall University, Huntington, West Virginia
| | - Jennie L Yoost
- Department of Obstetrics and Gynecology, Marshall University, Huntington, West Virginia.
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Micheli L, Durante M, Lucarini E, Sgambellone S, Lucarini L, Di Cesare Mannelli L, Ghelardini C, Masini E. The Histamine H 4 Receptor Participates in the Anti-Neuropathic Effect of the Adenosine A 3 Receptor Agonist IB-MECA: Role of CD4 + T Cells. Biomolecules 2021; 11:biom11101447. [PMID: 34680083 PMCID: PMC8533073 DOI: 10.3390/biom11101447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022] Open
Abstract
A3 adenosine receptor (A3AR) agonists have emerged as potent relievers of neuropathic pain by a T cell-mediated production of IL-10. The H4 histamine receptor (H4R), also implicated in pain modulation, is expressed on T cells playing a preeminent role in its activation and release of IL-10. To improve the therapeutic opportunities, this study aimed to verify the hypothesis of a possible cross-talk between A3AR and H4R in the resolution of neuropathic pain. In the mouse model of Chronic Constriction Injury (CCI), the acute intraperitoneal co-administration of the A3AR agonist IB-MECA (0.5 mg/kg) and the H4R agonist VUF 8430 (10 mg/kg), were additive in counteracting mechano-allodynia increasing IL-10 plasma levels. In H4R−/− mice, IB-MECA activity was reduced, lower pain relief and lower modulation of plasma IL-1β, TNF-α, IL-6 and IL-10 were shown. The complete anti-allodynia effect of IB-MECA in H4R−/− mice was restored after intravenous administration of CD4+ T cells obtained from naïve wild type mice. In conclusion, a role of the histaminergic system in the mechanism of A3AR-mediated neuropathic pain relief was suggested highlighting the driving force evoked by CD4+ T cells throughout IL-10 up-regulation.
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Karsenty C, Guitarte A, Dulac Y, Briot J, Hascoet S, Vincent R, Delepaul B, Vignaud P, Djeddai C, Hadeed K, Acar P. The usefulness of 3D printed heart models for medical student education in congenital heart disease. BMC MEDICAL EDUCATION 2021; 21:480. [PMID: 34496844 PMCID: PMC8424617 DOI: 10.1186/s12909-021-02917-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/28/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Three-dimensional (3D) printing technology enables the translation of 2-dimensional (2D) medical imaging into a physical replica of a patient's individual anatomy and may enhance the understanding of congenital heart defects (CHD). We aimed to evaluate the usefulness of a spectrum of 3D-printed models in teaching CHD to medical students. RESULTS We performed a prospective, randomized educational procedure to teach fifth year medical students four CHDs (atrial septal defect (ASD, n = 74), ventricular septal defect (VSD, n = 50), coarctation of aorta (CoA, n = 118) and tetralogy of Fallot (ToF, n = 105)). Students were randomized into printing groups or control groups. All students received the same 20 min lecture with projected digital 2D images. The printing groups also manipulated 3D printed models during the lecture. Both groups answered an objective survey (Multiple-choice questionnaire) twice, pre- and post-test, and completed a post-lecture subjective survey. Three hundred forty-seven students were included and both teaching groups for each CHD were comparable in age, sex and pre-test score. Overall, objective knowledge improved after the lecture and was higher in the printing group compared to the control group (16.3 ± 2.6 vs 14.8 ± 2.8 out of 20, p < 0.0001). Similar results were observed for each CHD (p = 0.0001 ASD group; p = 0.002 VSD group; p = 0.0005 CoA group; p = 0.003 ToF group). Students' opinion of their understanding of CHDs was higher in the printing group compared to the control group (respectively 4.2 ± 0.5 vs 3.8 ± 0.4 out of 5, p < 0.0001). CONCLUSION The use of 3D printed models in CHD lectures improve both objective knowledge and learner satisfaction for medical students. The practice should be mainstreamed.
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Affiliation(s)
- Clement Karsenty
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France.
- Institut Des Maladies Métaboliques Et Cardiovasculaires, Université de Toulouse, INSERM U1048, I2MC, 1, Avenue Jean Poulhès-BP84225, Toulouse, France.
| | - Aitor Guitarte
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Yves Dulac
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Jerome Briot
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Sebastien Hascoet
- Department of Pediatric and Adult Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph Reference Center of Complex Congenital Heart Diseases M3C, Le Plessis Robinson, France
| | - Remi Vincent
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Benoit Delepaul
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Paul Vignaud
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Camelia Djeddai
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Khaled Hadeed
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Philippe Acar
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
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Sun Z, Ng CKC, Wong YH, Yeong CH. 3D-Printed Coronary Plaques to Simulate High Calcification in the Coronary Arteries for Investigation of Blooming Artifacts. Biomolecules 2021; 11:biom11091307. [PMID: 34572520 PMCID: PMC8468360 DOI: 10.3390/biom11091307] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
The diagnostic value of coronary computed tomography angiography (CCTA) is significantly affected by high calcification in the coronary arteries owing to blooming artifacts limiting its accuracy in assessing the calcified plaques. This study aimed to simulate highly calcified plaques in 3D-printed coronary models. A combination of silicone + 32.8% calcium carbonate was found to produce 800 HU, representing extensive calcification. Six patient-specific coronary artery models were printed using the photosensitive polyurethane resin and a total of 22 calcified plaques with diameters ranging from 1 to 4 mm were inserted into different segments of these 3D-printed coronary models. The coronary models were scanned on a 192-slice CT scanner with 70 kV, pitch of 1.4, and slice thickness of 1 mm. Plaque attenuation was measured between 1100 and 1400 HU. Both maximum-intensity projection (MIP) and volume rendering (VR) images (wide and narrow window widths) were generated for measuring the diameters of these calcified plaques. An overestimation of plaque diameters was noticed on both MIP and VR images, with measurements on the MIP images close to those of the actual plaque sizes (<10% deviation), and a large measurement discrepancy observed on the VR images (up to 50% overestimation). This study proves the feasibility of simulating extensive calcification in coronary arteries using a 3D printing technique to develop calcified plaques and generate 3D-printed coronary models.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6845, Australia;
- Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
- Correspondence: ; Tel.: +61-8-9266-7509; Fax: +61-8-9266-2377
| | - Curtise Kin Cheung Ng
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6845, Australia;
- Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
| | - Yin How Wong
- Faculty of Health & Medical Sciences, School of Medicine, Taylor’s University, No. 1, Jalan Taylor’s, Subang Jaya 47500, Malaysia; (Y.H.W.); (C.H.Y.)
| | - Chai Hong Yeong
- Faculty of Health & Medical Sciences, School of Medicine, Taylor’s University, No. 1, Jalan Taylor’s, Subang Jaya 47500, Malaysia; (Y.H.W.); (C.H.Y.)
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Use of rotational angiography in congenital cardiac catheterisations to generate three-dimensional-printed models. Cardiol Young 2021; 31:1407-1411. [PMID: 33597057 DOI: 10.1017/s1047951121000275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Three-dimensional printing is increasingly utilised for congenital heart defect procedural planning. CT or MR datasets are typically used for printing, but similar datasets can be obtained from three-dimensional rotational angiography. We sought to assess the feasibility and accuracy of printing three-dimensional models of CHD from rotational angiography datasets. METHODS Retrospective review of CHD catheterisations using rotational angiography was performed, and patient and procedural details were collected. Imaging data from rotational angiography were segmented, cleaned, and printed with polylactic acid on a Dremel® 3D Idea Builder (Dremel, Mount Prospect, IL, USA). Printing time and materials' costs were captured. CT scans of printed models were compared objectively to the original virtual models. Two independent, non-interventional paediatric cardiologists provided subjective ratings of the quality and accuracy of the printed models. RESULTS Rotational angiography data from 15 catheterisations on vascular structures were printed. Median print time was 3.83 hours, and material costs were $2.84. The CT scans of the printed models highly matched with the original digital models (root mean square for Hausdorff distance 0.013 ± 0.003 mesh units). Independent reviewers correctly described 80 and 87% of the models (p = 0.334) and reported high quality and accuracy (5 versus 5, p = NS; κ = 0.615). CONCLUSION Imaging data from rotational angiography can be converted into accurate three-dimensional-printed models of CHD. The cost of printing the models was negligible, but the print time was prohibitive for real-time use. As the speed of three-dimensional printing technology increases, novel future applications may allow for printing patient-specific devices based on rotational angiography datasets.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, GPO Box U1987, Perth, Australia
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Tan H, Huang E, Deng X, Ouyang S. Application of 3D printing technology combined with PBL teaching model in teaching clinical nursing in congenital heart surgery: A case-control study. Medicine (Baltimore) 2021; 100:e25918. [PMID: 34011060 PMCID: PMC8137022 DOI: 10.1097/md.0000000000025918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/19/2021] [Indexed: 01/05/2023] Open
Abstract
We aimed to explore the application of three-dimensional (3D) printing technology with problem-based learning (PBL) teaching model in clinical nursing education of congenital heart surgery, and to further improve the teaching quality of clinical nursing in congenital heart surgery. In this study, a total of 132 trainees of clinical nursing in congenital heart surgery from a grade-A tertiary hospital in 2019 were selected and randomly divided into 3D printing group or traditional group. The 3D printing group was taught with 3D printed heart models combined with PBL teaching technique, while the traditional group used conventional teaching aids combined with PBL technique for teaching. After the teaching process, the 2 groups of nursing students were assessed and surveyed separately to evaluate the results. Compared to the traditional group, the theoretical scores, clinical nursing thinking ability, self-evaluation for comprehensive ability, and teaching satisfaction from the questionnaires filled by the 3D printing group were all higher than the traditional group. The difference was found to be statistically significant (P < .05). Our study has shown the 3D printing technology combined with the PBL teaching technique in the clinical nursing teaching of congenital heart surgery achieved good results.
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Affiliation(s)
- Hui Tan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China; Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Erjia Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China; Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Xicheng Deng
- Heart Center, Hunan Children's Hospital, Changsha, China
| | - Shayuan Ouyang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China; Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
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Applicability of 3D-printed models in hepatobiliary surgey: results from "LIV3DPRINT" multicenter study. HPB (Oxford) 2021; 23:675-684. [PMID: 33071150 DOI: 10.1016/j.hpb.2020.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 05/26/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatobiliary resections are challenging due to the complex liver anatomy. Three-dimensional printing (3DP) has gained popularity due to its ability to produce anatomical models based on the characteristics of each patient. METHODS A multicenter study was conducted on complex hepatobiliary tumours. The endpoint was to validate 3DP model accuracy from original image sources for application in the teaching, patient-communication, and planning of hepatobiliary surgery. RESULTS Thirty-five patients from eight centers were included. Process testing between 3DP and CT/MRI presented a considerable degree of similarity in vascular calibers (0.22 ± 1.8 mm), and distances between the tumour and vessel (0.31 ± 0.24 mm). The Dice Similarity Coefficient was 0.92, with a variation of 2%. Bland-Altman plots also demonstrated an agreement between 3DP and the surgical specimen with the distance of the resection margin (1.15 ± 1.52 mm). Professionals considered 3DP at a positive rate of 0.89 (95%CI; 0.73-0.95). According to student's distribution a higher success rate was reached with 3DP (median:0.9, IQR: 0.8-1) compared with CT/MRI or 3D digital imaging (P = 0.01). CONCLUSION 3DP hepatic models present a good correlation compared with CT/MRI and surgical pathology and they are useful for education, understanding, and surgical planning, but does not necessarily affect the surgical outcome.
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Wang H, Song H, Yang Y, Wu Z, Hu R, Chen J, Guo J, Wang Y, Jia D, Cao S, Zhou Q, Guo R. Hemodynamic testing using three-dimensional printing and computational fluid dynamics preoperatively may provide more information in mitral repair than traditional image dataset. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:632. [PMID: 33987330 PMCID: PMC8106081 DOI: 10.21037/atm-20-7960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Mitral valve repair (MVR) has been considered superior to mitral replacement for degenerative MV disease and even rheumatic diseases. However, the repair rate varies widely depending on the medical center and the surgeons’ experience. The aim of our study was to apply three-dimensional printing (3DP) and computational fluid dynamics (CFD) in surgical simulation to provide reference for surgical decision-making, especially for inexperienced surgeons. Methods Our study included retrospective and prospective cohorts. We first enrolled the retrospective cohort of 35 patients who were prepared to have MVR, aiming at exploring the feasibility of surgical simulation using 3DP and CFD. Three-dimensional transesophageal echocardiography (3D-TEE) and computed tomography angiography (CTA) were performed for all patients, and imaging data were fused to construct a 3D digital model. Next, the model was used to make the 3DP dynamic model and for CFD analysis. Mitral repair was simulated in both the 3DP dynamic model and CFD to predict surgical outcomes (grade of regurgitation and vena contracta width) and possible complications (systolic anterior motion, left ventricular outflow tract obstruction). Second, a prospective cohort of 20 patients was studied with 10 patients placed in a 3DP-guided group and 10 in an image-guided group. Rate of transformation to mitral replacement, surgery time, surgical outcomes, and surgical complications were compared between groups. Results Of the 35 patients retrospectively enrolled, 14 underwent MVR and 21 were transferred to mitral replacement. Surgical simulation for the 14 MVR patients showed high consistency with in vivo results. The result of surgical simulation for the 21 patients transferred to mitral replacement showed that 7 might have benefited from MVR. In the prospective cohort, the rate of transformation to mitral replacement and surgery time in the 3DP-guided group were significantly lower than those in the image-guided group. Conclusions 3DP and CFD models based on image data can be used for in vitro surgical simulation. These emerging technologies are now changing traditional models of diagnosis and treatment, and the role of imaging data will no longer be limited to diagnosis but will contribute more to assisting surgeons in choosing treatment strategies.
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Affiliation(s)
- Hao Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongning Song
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuanting Yang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhiyong Wu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rui Hu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jinling Chen
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Juan Guo
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yijia Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dan Jia
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Sheng Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ruiqiang Guo
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
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Abstract
Principles of surgical training have not changed, but methods of training are evolving very fast. Online tools are being adopted in both knowledge and skills training for surgical residents. As a result, to evaluate the outcome of these tools, online assessment is also developing. Knowledge resources are very diverse ranging from lectures, webinars, surgical videos to three-dimensional planning and printing. Skills resources include virtual reality simulators, remote skills training and interdisciplinary teamwork. Assessment of E-learning tools can be performed using online questions, task-based simulations, branching scenarios and online interviews/discussions. In thoracic surgery, video assisted thoracic surgery (VATS) lobectomy simulator has been developed and it appears to be an important tool for minimally invasive thoracic surgery education. Training programs incorporate e-Learning in their curriculum and online training and assessment will become an important part of thoracic surgical training as well.
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Affiliation(s)
| | - Jalal Assouad
- Sorbonne University, Tenon University Hospital, Department of Thoracic and Vascular Surgery, Paris, France
| | - Harry Etienne
- Sorbonne University, Tenon University Hospital, Department of Thoracic and Vascular Surgery, Paris, France
| | - Xavier Benoit D'Journo
- Aix-Marseille University, Thoracic surgery department, North Hospital, Marseille, France
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Lee S, Squelch A, Sun Z. Quantitative Assessment of 3D Printed Model Accuracy in Delineating Congenital Heart Disease. Biomolecules 2021; 11:biom11020270. [PMID: 33673159 PMCID: PMC7917618 DOI: 10.3390/biom11020270] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Three-dimensional (3D) printing is promising in medical applications, especially presurgical planning and the simulation of congenital heart disease (CHD). Thus, it is clinically important to generate highly accurate 3D-printed models in replicating cardiac anatomy and defects. The present study aimed to investigate the accuracy of the 3D-printed CHD model by comparing them with computed tomography (CT) images and standard tessellation language (STL) files. Methods: Three models were printed, comprising different CHD pathologies, including the tetralogy of Fallot (ToF), ventricular septal defect (VSD) and double-outlet right-ventricle (DORV). The ten anatomical locations were measured in each comparison. Pearson’s correlation coefficient, Bland–Altman analysis and intra-class correlation coefficient (ICC) determined the model accuracy. Results: All measurements with three printed models showed a strong correlation (r = 0.99) and excellent reliability (ICC = 0.97) when compared to original CT images, CT images of the 3D-printed models, STL files and 3D-printed CHD models. Conclusion: This study demonstrated the high accuracy of 3D-printed heart models with excellent correlation and reliability when compared to multiple source data. Further investigation into 3D printing in CHD should focus on the clinical value and the benefits to patients.
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Affiliation(s)
- Shenyuan Lee
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, GPO Box, U1987, Perth, WA 6845, Australia;
| | - Andrew Squelch
- Discipline of Exploration Geophysics, Western Australian School of Mines, Minerals, Energy and Chemical Engineering, Curtin University, Perth, WA 6845, Australia;
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, GPO Box, U1987, Perth, WA 6845, Australia;
- Correspondence: ; Tel.: +61-8-9266-7509; Fax: +61-8-9266-2377
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Gehrsitz P, Rompel O, Schöber M, Cesnjevar R, Purbojo A, Uder M, Dittrich S, Alkassar M. Cinematic Rendering in Mixed-Reality Holograms: A New 3D Preoperative Planning Tool in Pediatric Heart Surgery. Front Cardiovasc Med 2021; 8:633611. [PMID: 33634174 PMCID: PMC7900175 DOI: 10.3389/fcvm.2021.633611] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
Cinematic rendering (CR) is based on a new algorithm that creates a photo-realistic three-dimensional (3D) picture from cross-sectional images. Previous studies have shown its positive impact on preoperative planning. To date, CR presentation has only been possible on 2D screens which limited natural 3D perception. To depict CR-hearts spatially, we used mixed-reality technology and mapped corresponding hearts as holograms in 3D space. Our aim was to assess the benefits of CR-holograms in the preoperative planning of cardiac surgery. Including 3D prints allowed a direct comparison of two spatially resolved display methods. Twenty-six patients were recruited between February and September 2019. CT or MRI was used to visualize the patient's heart preoperatively. The surgeon was shown the anatomy in cross-sections on a 2D screen, followed by spatial representations as a 3D print and as a high-resolution hologram. The holographic representation was carried out using mixed-reality glasses (HoloLens®). To create the 3D prints, corresponding structures were segmented to create STL files which were printed out of resin. In 22 questions, divided in 5 categories (3D-imaging effect, representation of pathology, structure resolution, cost/benefit ratio, influence on surgery), the surgeons compared each spatial representation with the 2D method, using a five-level Likert scale. The surgical preparation time was assessed by comparing retrospectively matched patient pairs, using a paired t-test. CR-holograms surpassed 2D-monitor imaging in all categories. CR-holograms were superior to 3D prints in all categories (mean Likert scale 4.4 ± 1.0 vs. 3.7 ± 1.3, P < 0.05). Compared to 3D prints it especially improved the depth perception (4.7 ± 0.7 vs. 3.7 ± 1.2) and the representation of the pathology (4.4 ± 0.9 vs. 3.6 ± 1.2). 3D imaging reduced the intraoperative preparation time (n = 24, 59 ± 23 min vs. 73 ± 43 min, P < 0.05). In conclusion, the combination of an extremely photo-realistic presentation via cinematic rendering and the spatial presentation in 3D space via mixed-reality technology allows a previously unattained level of comprehension of anatomy and pathology in preoperative planning.
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Affiliation(s)
- Pia Gehrsitz
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Oliver Rompel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Martin Schöber
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robert Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Muhannad Alkassar
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Yoo SJ, Hussein N, Peel B, Coles J, van Arsdell GS, Honjo O, Haller C, Lam CZ, Seed M, Barron D. 3D Modeling and Printing in Congenital Heart Surgery: Entering the Stage of Maturation. Front Pediatr 2021; 9:621672. [PMID: 33614554 PMCID: PMC7892770 DOI: 10.3389/fped.2021.621672] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/06/2021] [Indexed: 12/05/2022] Open
Abstract
3D printing allows the most realistic perception of the surgical anatomy of congenital heart diseases without the requirement of physical devices such as a computer screen or virtual headset. It is useful for surgical decision making and simulation, hands-on surgical training (HOST) and cardiovascular morphology teaching. 3D-printed models allow easy understanding of surgical morphology and preoperative surgical simulation. The most common indications for its clinical use include complex forms of double outlet right ventricle and transposition of the great arteries, anomalous systemic and pulmonary venous connections, and heterotaxy. Its utility in congenital heart surgery is indisputable, although it is hard to "scientifically" prove the impact of its use in surgery because of many confounding factors that contribute to the surgical outcome. 3D-printed models are valuable resources for morphology teaching. Educational models can be produced for almost all different variations of congenital heart diseases, and replicated in any number. HOST using 3D-printed models enables efficient education of surgeons in-training. Implementation of the HOST courses in congenital heart surgical training programs is not an option but an absolute necessity. In conclusion, 3D printing is entering the stage of maturation in its use for congenital heart surgery. It is now time for imagers and surgeons to find how to effectively utilize 3D printing and how to improve the quality of the products for improved patient outcomes and impact of education and training.
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Affiliation(s)
- Shi Joon Yoo
- Department of Diagnostic Imaging, The University of Toronto, Toronto, ON, Canada
- Department of Paediatrics–Division of Cardiology, The University of Toronto, Toronto, ON, Canada
- Center for Image Guided Innovation and Therapeutic Intervention, The University of Toronto, Toronto, ON, Canada
| | - Nabil Hussein
- Center for Image Guided Innovation and Therapeutic Intervention, The University of Toronto, Toronto, ON, Canada
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
| | - Brandon Peel
- Center for Image Guided Innovation and Therapeutic Intervention, The University of Toronto, Toronto, ON, Canada
| | - John Coles
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
| | - Glen S. van Arsdell
- Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- Department of Surgery, Mattel Children's Hospital at UCLA, Los Angeles, CA, United States
| | - Osami Honjo
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
| | - Christoph Haller
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
| | - Christopher Z. Lam
- Department of Diagnostic Imaging, The University of Toronto, Toronto, ON, Canada
| | - Mike Seed
- Department of Diagnostic Imaging, The University of Toronto, Toronto, ON, Canada
- Department of Paediatrics–Division of Cardiology, The University of Toronto, Toronto, ON, Canada
| | - David Barron
- Department of Surgery-Division of Cardiovascular Surgery, Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
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Clinical Applications of Patient-Specific 3D Printed Models in Cardiovascular Disease: Current Status and Future Directions. Biomolecules 2020; 10:biom10111577. [PMID: 33233652 PMCID: PMC7699768 DOI: 10.3390/biom10111577] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 01/09/2023] Open
Abstract
Three-dimensional (3D) printing has been increasingly used in medicine with applications in many different fields ranging from orthopaedics and tumours to cardiovascular disease. Realistic 3D models can be printed with different materials to replicate anatomical structures and pathologies with high accuracy. 3D printed models generated from medical imaging data acquired with computed tomography, magnetic resonance imaging or ultrasound augment the understanding of complex anatomy and pathology, assist preoperative planning and simulate surgical or interventional procedures to achieve precision medicine for improvement of treatment outcomes, train young or junior doctors to gain their confidence in patient management and provide medical education to medical students or healthcare professionals as an effective training tool. This article provides an overview of patient-specific 3D printed models with a focus on the applications in cardiovascular disease including: 3D printed models in congenital heart disease, coronary artery disease, pulmonary embolism, aortic aneurysm and aortic dissection, and aortic valvular disease. Clinical value of the patient-specific 3D printed models in these areas is presented based on the current literature, while limitations and future research in 3D printing including bioprinting of cardiovascular disease are highlighted.
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Utility of three-dimensional printed heart models for education on complex congenital heart diseases. Cardiol Young 2020; 30:1637-1642. [PMID: 33161936 DOI: 10.1017/s1047951120003753] [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: 11/07/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the feasibility and effects of education on complex congenital heart diseases using patient-specific three-dimensional printed heart models. METHODS Three-dimensional printed heart models were created using computed tomography data obtained from 11 patients with complex congenital heart disease. Fourteen kinds of heart models, encompassing nine kinds of complex congenital heart disease were printed. Using these models, a series of educational hands-on seminars, led by an experienced paediatric cardiac surgeon and a paediatric cardiologist, were conducted for medical personnel who were involved in the care of congenital heart disease patients. Contents of the seminars included anatomy, three-dimensional structure, pathophysiology, and surgery for each diagnosis. Likert-type (10-point scale) questionnaires were used before and after each seminar to evaluate the effects of education. RESULTS Between November 2019 and June 2020, a total of 16 sessions of hands-on seminar were conducted. The total number of questionnaire responses was 75. Overall, participants reported subjective improvement in understanding anatomy (4.8 ± 2.1 versus 8.4 ± 1.1, p < 0.001), three-dimensional structure (4.6 ± 2.2 versus 8.9 ± 1.0, p < 0.001), pathophysiology (4.8 ± 2.2 versus 8.5 ± 1.0, p < 0.001), and surgery (4.9 ± 2.3 versus 8.8 ± 0.9, p < 0.001) of the congenital heart disease investigated. CONCLUSIONS The utilisation of three-dimensional printed heart models for education on complex congenital heart disease was feasible and improved medical personnel's understanding of complex congenital heart disease. This education tool may be an effective alternative to conventional education tools for complex congenital heart disease.
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Wang H, Song H, Yang Y, Cao Q, Hu Y, Chen J, Guo J, Wang Y, Jia D, Cao S, Zhou Q. Three-dimensional printing for cardiovascular diseases: from anatomical modeling to dynamic functionality. Biomed Eng Online 2020; 19:76. [PMID: 33028306 PMCID: PMC7542711 DOI: 10.1186/s12938-020-00822-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022] Open
Abstract
Three-dimensional (3D) printing is widely used in medicine. Most research remains focused on forming rigid anatomical models, but moving from static models to dynamic functionality could greatly aid preoperative surgical planning. This work reviews literature on dynamic 3D heart models made of flexible materials for use with a mock circulatory system. Such models allow simulation of surgical procedures under mock physiological conditions, and are; therefore, potentially very useful to clinical practice. For example, anatomical models of mitral regurgitation could provide a better display of lesion area, while dynamic 3D models could further simulate in vitro hemodynamics. Dynamic 3D models could also be used in setting standards for certain parameters for function evaluation, such as flow reserve fraction in coronary heart disease. As a bridge between medical image and clinical aid, 3D printing is now gradually changing the traditional pattern of diagnosis and treatment.
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Affiliation(s)
- Hao Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Hongning Song
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yuanting Yang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Quan Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yugang Hu
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jinling Chen
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Juan Guo
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yijia Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Dan Jia
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Sheng Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Boshra M, Godbout J, Perry JJ, Pan A. 3D printing in critical care: a narrative review. 3D Print Med 2020; 6:28. [PMID: 32997313 PMCID: PMC7525075 DOI: 10.1186/s41205-020-00081-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 3D printing (3DP) has gained interest in many fields of medicine including cardiology, plastic surgery, and urology due to its versatility, convenience, and low cost. However, critical care medicine, which is abundant with high acuity yet infrequent procedures, has not embraced 3DP as much as others. The discrepancy between the possible training or therapeutic uses of 3DP in critical care and what is currently utilized in other fields needs to be addressed. OBJECTIVE This narrative literature review describes the uses of 3DP in critical care that have been documented. It also discusses possible future directions based on recent technological advances. METHODS A literature search on PubMed was performed using keywords and Mesh terms for 3DP, critical care, and critical care skills. RESULTS Our search found that 3DP use in critical care fell under the major categories of medical education (23 papers), patient care (4 papers) and clinical equipment modification (4 papers). Medical education showed the use of 3DP in bronchoscopy, congenital heart disease, cricothyroidotomy, and medical imaging. On the other hand, patient care papers discussed 3DP use in wound care, personalized splints, and patient monitoring. Clinical equipment modification papers reported the use of 3DP to modify stethoscopes and laryngoscopes to improve their performance. Notably, we found that only 13 of the 31 papers were directly produced or studied by critical care physicians. CONCLUSION The papers discussed provide examples of the possible utilities of 3DP in critical care. The relative scarcity of papers produced by critical care physicians may indicate barriers to 3DP implementation. However, technological advances such as point-of-care 3DP tools and the increased demand for 3DP during the recent COVID-19 pandemic may change 3DP implementation across the critical care field.
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Affiliation(s)
- Mina Boshra
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd., Ottawa, ON K1H8M5 Canada
| | - Justin Godbout
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9 Canada
| | - Jeffrey J. Perry
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9 Canada
- Department of Emergency Medicine, The Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9 Canada
| | - Andy Pan
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9 Canada
- Department of Emergency Medicine, The Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9 Canada
- Division of Critical Care Medicine, Department of Medicine, Montfort Hospital, 713 Montreal Road, Ottawa, ON K1K 0T2 Canada
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Sun Z. 3D Printed Coronary Models Offer Potential Value in Visualising Coronary Anatomy and Coronary Stents for Investigation of Coronary CT Protocols. Curr Med Imaging 2020; 16:625-628. [PMID: 32723233 DOI: 10.2174/157340561606200523215058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Sciences Curtin University Perth, Australia
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Fleming C, Sadaghiani MS, Stellon MA, Javan R. Effectiveness of Three-Dimensionally Printed Models in Anatomy Education for Medical Students and Resident Physicians: Systematic Review and Meta-Analysis. J Am Coll Radiol 2020; 17:1220-1229. [PMID: 32603662 DOI: 10.1016/j.jacr.2020.05.030] [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: 04/17/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Despite a surge in the use of three-dimensional printing (3DP) in medical education, a comprehensive evaluation of randomized trials in its effectiveness is lacking. Radiologic studies play an integral role in affording educators the ability to create customized realistic anatomic models. This systematic review and meta-analysis sought to assess the effect of 3DP versus traditional 2-D methods for anatomy education. METHODS PubMed, Scopus, Cochrane Library, ERIC, and IEEE Xplore were queried to identify randomized controlled trials that quantitatively investigated anatomy education via postintervention assessments of medical students or resident physicians who were exposed to 3DP versus traditional methods. Criteria for the meta-analysis required that studies additionally included a pre-intervention assessment. RESULTS A total of 804 articles were reviewed, identifying 8 and 7 studies for systematic reviews of medical students and resident physicians, respectively, of which 4 and 7 were included in the meta-analyses. 3DP models were associated with higher anatomy examination scores for medical students (P < .0001), but for resident physicians were statistically not significant (P = .53). DISCUSSION The 3DP models are shown to positively impact medical students especially given their limited fund of knowledge in anatomy. It is postulated that the lack of a statistically significant result for the resident physicians was multifactorial, in part because of the small test group sizes introducing noise and nonrepresentative samples, as well as relative simplicity of the 3DP models used with resident physicians, which were below their level of training. More trials are required to evaluate the usefulness of highly customized 3DP models.
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Affiliation(s)
- Cullen Fleming
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Michael A Stellon
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ramin Javan
- George Washington University Hospital, Department of Radiology, Washington, DC.
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Illmann CF, Hosking M, Harris KC. Utility and Access to 3-Dimensional Printing in the Context of Congenital Heart Disease: An International Physician Survey Study. CJC Open 2020; 2:207-213. [PMID: 32695970 PMCID: PMC7365821 DOI: 10.1016/j.cjco.2020.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/23/2020] [Indexed: 11/26/2022] Open
Abstract
Background Three-dimensional (3D) printing is a new technology capable of producing patient-specific 3D cardiac models. Methods A cross-sectional survey of pediatric cardiologists was conducted. Members of the Canadian Pediatric Cardiology Association and Congenital Cardiac Interventional Study Consortium were invited to participate. A questionnaire was distributed using Research Electronic Data Capture between May and September 2019. Results were analyzed using descriptive statistics, Fisher exact test, and odds ratio. Results A total of 71 pediatric cardiologists responded. Some 85% (60/71) agreed that patient-specific 3D printed cardiac models are a beneficial tool in treating children with congenital heart disease (CHD); 80% of those (48/60) believe 3D models facilitate communication with colleagues; 49% (35/71) of respondents had access to 3D printing technology; and 77% (27/35) of those were using models for clinical care. Access differed according to geographic location (P = 0.004). Of respondents, Americans were 5.5 times more likely (confidence interval, 1.6-19.2) than Canadians to have access to 3D printing technology. The primary reason for lack of access was financial barriers (50%, 18/36). In clinical practice, surgical planning is the primary use of models (96%, 26/27), followed by interventional catheterization planning (52%, 14/27). Double outlet right ventricle was the most commonly modelled lesion (70%, 19/27). Conclusion 3D printing is a new technology that is beneficial in the care of children with CHD. Access to 3D printing varies by geographic location. In pediatric cardiology, 3D models are primarily used for procedural planning for CHD lesions with complex 3D spatial relationships.
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Affiliation(s)
- Caroline F Illmann
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Hosking
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin C Harris
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Lau IWW, Sun Z. Dimensional Accuracy and Clinical Value of 3D Printed Models in Congenital Heart Disease: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8091483. [PMID: 31540421 PMCID: PMC6780783 DOI: 10.3390/jcm8091483] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 12/24/2022] Open
Abstract
The aim of this paper is to summarize and evaluate results from existing studies on accuracy and clinical value of three-dimensional printed heart models (3DPHM) for determining whether 3D printing can significantly improve on how the congenital heart disease (CHD) is managed in current clinical practice. Proquest, Google Scholar, Scopus, PubMed, and Medline were searched for relevant studies until April 2019. Two independent reviewers performed manual data extraction and assessed the risk of bias of the studies using the tools published on National Institutes of Health (NIH) website. The following data were extracted from the studies: author, year of publication, study design, imaging modality, segmentation software, utility of 3DPHM, CHD types, and dimensional accuracy. R software was used for the meta-analysis. Twenty-four articles met the inclusion criteria and were included in the systematic review. However, only 7 studies met the statistical requirements and were eligible for meta-analysis. Cochran's Q test demonstrated significant variation among the studies for both of the meta-analyses of accuracy of 3DPHM and the utility of 3DPHM in medical education. Analysis of all included studies reported the mean deviation between the 3DPHM and the medical images is not significant, implying that 3DPHM are highly accurate. As for the utility of the 3DPHM, it is reported in all relevant studies that the 3DPHM improve the learning experience and satisfaction among the users, and play a critical role in facilitating surgical planning of complex CHD cases. 3DPHM have the potential to enhance communication in medical practice, however their clinical value remains debatable. More studies are required to yield a more meaningful meta-analysis.
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Affiliation(s)
- Ivan Wen Wen Lau
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth 6845, Western Australia, Australia.
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth 6845, Western Australia, Australia.
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Smerling J, Marboe CC, Lefkowitch JH, Pavlicova M, Bacha E, Einstein AJ, Naka Y, Glickstein J, Farooqi KM. Utility of 3D Printed Cardiac Models for Medical Student Education in Congenital Heart Disease: Across a Spectrum of Disease Severity. Pediatr Cardiol 2019; 40:1258-1265. [PMID: 31240370 DOI: 10.1007/s00246-019-02146-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
The most common modes of medical education for congenital heart disease (CHD) rely heavily on 2-dimensional imaging. Three-dimensional (3D) printing technology allows for the creation of physical cardiac models that can be used for teaching trainees. 3D printed cardiac models were created for the following lesions: pulmonic stenosis, atrial septal defect, tetralogy of Fallot, d-transposition of the great arteries, coarctation of the aorta, and hypoplastic left heart syndrome. Medical students participated in a workshop consisting of different teaching stations. At the 3D printed station, students completed a pre- and post-intervention survey assessing their knowledge of each cardiac lesion on a Likert scale. Students were asked to rank the educational benefit of each modality. Linear regression was utilized to assess the correlation of the mean increase in knowledge with increasing complexity of CHD based on the Aristotle Basic Complexity Level. 45 medical students attended the CHD workshop. Students' knowledge significantly improved for every lesion (p < 0.001). A strong positive correlation was found between mean increase in knowledge and increasing complexity of CHD (R2 = 0.73, p < 0.05). The 3D printed models, pathology specimens and spoken explanation were found to be the most helpful modalities. Students "strongly agreed" the 3D printed models made them more confident in explaining congenital cardiac anatomy to others (mean = 4.23, ± 0.69), and that they recommend the use of 3D models for future educational sessions (mean = 4.40, ± 0.69). 3D printed cardiac models should be included in medical student education particularly for lesions that require a complex understanding of spatial relationships.
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Affiliation(s)
- Jennifer Smerling
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Charles C Marboe
- Department of Pathology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jay H Lefkowitch
- Department of Pathology, Columbia University Irving Medical Center, New York, NY, USA
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Emile Bacha
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Julie Glickstein
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, 3959 Broadway, CHN-2, New York, NY, 10023, USA
| | - Kanwal M Farooqi
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, 3959 Broadway, CHN-2, New York, NY, 10023, USA.
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Personalized Three-Dimensional Printed Models in Congenital Heart Disease. J Clin Med 2019; 8:jcm8040522. [PMID: 30995803 PMCID: PMC6517984 DOI: 10.3390/jcm8040522] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 12/24/2022] Open
Abstract
Patient-specific three-dimensional (3D) printed models have been increasingly used in cardiology and cardiac surgery, in particular, showing great value in the domain of congenital heart disease (CHD). CHD is characterized by complex cardiac anomalies with disease variations between individuals; thus, it is difficult to obtain comprehensive spatial conceptualization of the cardiac structures based on the current imaging visualizations. 3D printed models derived from patient's cardiac imaging data overcome this limitation by creating personalized 3D heart models, which not only improve spatial visualization, but also assist preoperative planning and simulation of cardiac procedures, serve as a useful tool in medical education and training, and improve doctor-patient communication. This review article provides an overall view of the clinical applications and usefulness of 3D printed models in CHD. Current limitations and future research directions of 3D printed heart models are highlighted.
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Aldosari S, Jansen S, Sun Z. Patient-specific 3D printed pulmonary artery model with simulation of peripheral pulmonary embolism for developing optimal computed tomography pulmonary angiography protocols. Quant Imaging Med Surg 2019; 9:75-85. [PMID: 30788248 PMCID: PMC6351806 DOI: 10.21037/qims.2018.10.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/26/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Computed tomography pulmonary angiography (CTPA) is the preferred imaging modality for diagnosis of patients with suspected pulmonary embolism (PE). Radiation dose associated with CTPA has been significantly reduced due to the use of dose-reduction strategies, however, investigation of low-dose CTPA with use of different kVp and pitch values has not been systematically studied. The aim of this study was to utilize a 3D printed pulmonary model with simulation of small thrombus in the pulmonary arteries for development of optimal CTPA protocols. METHODS Animal blood clots were inserted into the pulmonary arteries to simulate peripheral embolism based on a realistic 3D printed pulmonary artery model. The 3D printed model was scanned with 192-slice 3rd generation dual-source CT with 1 mm slice thickness and 0.5 mm reconstruction interval. All images were reconstructed with advanced modelled iterative reconstruction (IR) at a strength level of 3. CTPA scanning parameters were as follows: 70, 80, 100 and 120 kVp, 0.9, 2.2 and 3.2 pitch values. Quantitative assessment of image quality was determined by measuring signal-to-noise ratio (SNR) in both main pulmonary arteries, while qualitative analysis of images was scored by two experienced radiologists (score of 1 indicates poor visualization of thrombus with no confidence, and score of 5 excellent visualization of thrombus with high confidence) to determine the image quality in relation to different scanning protocols for detection of thrombus in the pulmonary arteries. RESULTS No significant differences were found in SNR measurements among all CTPA protocols (P>0.05), regardless of kVp or pitch values used, although SNR was higher with 120 kVp and 0.9 and 2.2 pitch protocols than that in other protocols. The thrombi were detected in all images, with 70 kVp and 3.2 pitch protocol scored the lowest with a score of 3 by two observers, and images with other protocols were scored 4 or 5. Lowering kVp from 120 to 70 with use of high-pitch 2.2 or 3.2 protocol resulted in up to 80% dose reduction without significantly affecting image quality. CONCLUSIONS Low-dose CT pulmonary angiography protocols comprising 70 kVp and high pitch 2.2 or 3.2 allow for detection of peripheral PE with significant reduction in radiation dose while images are still considered diagnostic.
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Affiliation(s)
- Sultan Aldosari
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Australia
| | - Shirley Jansen
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Australia
- Curtin Medical School, Curtin University, Perth, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Australia
- Heart and Vascular Research Institute, Harry Perkins Medical Research Institute, Perth, Australia
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Australia
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Sun Z. Insights into 3D printing in medical applications. Quant Imaging Med Surg 2019; 9:1-5. [PMID: 30788241 PMCID: PMC6351810 DOI: 10.21037/qims.2019.01.03] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 01/10/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
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50
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Sun Z. 3D printing in medicine: current applications and future directions. Quant Imaging Med Surg 2018; 8:1069-1077. [PMID: 30701160 PMCID: PMC6328380 DOI: 10.21037/qims.2018.12.06] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/10/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
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