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Ghasroddashti A, Guyn C, Martou G, Edmunds RW. Utility of 3D-printed vascular modeling in microsurgical breast reconstruction: a systematic review. J Plast Reconstr Aesthet Surg 2024; 96:95-104. [PMID: 39067229 DOI: 10.1016/j.bjps.2024.07.026] [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: 05/28/2024] [Accepted: 07/08/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Microsurgical breast reconstruction presents a technical challenge in preoperative planning and flap harvest. Given the limitations of computed tomographic angiography as a preoperative aid, 3D printing has emerged as an avenue for creating patient-specific anatomical models for pre- and intraoperative use. This systematic review assesses the current use and utility of 3D-printed vascular models (3DVMs) in microsurgical breast reconstruction. METHODS MEDLINE, Embase, and CENTRAL were searched for English articles published from 1946 to 2024. Studies utilizing 3D-printed vascular modeling in the context of microsurgical breast reconstruction were included if they reported surgical, model-, or user-related outcomes. The Newcastle-Ottawa Scale and Joanna Briggs Institute checklists were used for quality assessment. Results were reported according to PRISMA guidelines. RESULTS Six hundred and nineteen records were retrieved. Following specific inclusion and exclusion criteria, 29 studies underwent full-text review. Eight studies totaling 181 patients and 261 flaps were included in the final analysis. 3DVMs were used to model deep inferior epigastric perforator (DIEP) and muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap perforator origin, course, distribution, and surrounding anatomy. They were used for perforator selection, flap harvest, and training. Use of 3DVMs reduced harvest time by up to 23 min per case. No complications or preoperative plan deviations were reported in 3DVM-guided cases. Surgeons endorsed significant model utility in anatomical visualization, preoperative planning, and flap harvest. Model cost, production time, and adoption were identified as barriers to use. CONCLUSIONS 3DVMs can enhance preoperative planning, intraoperative decision-making, and operative efficiency in unilateral DIEP and bilateral MS-TRAM flap breast reconstructions.
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Affiliation(s)
| | - Colm Guyn
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Glykeria Martou
- Division of Plastic Surgery, Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Robert Wesley Edmunds
- Division of Plastic Surgery, Department of Surgery, Queen's University, Kingston, ON, Canada
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Buchvald P, Capek L. Pre-selection blade size choice for the microsurgical clipping of cerebral artery aneurysms: A numerical study. J Clin Neurosci 2024; 122:25-31. [PMID: 38447246 DOI: 10.1016/j.jocn.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Brain strokes comprise the third leading cause of death worldwide. Microsurgical clipping is recognized as being one of the most effective approaches to the treatment of brain aneurysms. The incomplete closure of the distal-side aneurysm neck is the most common cause of the persistent filling of the dome. Since the diameter of the neck increases when the neck of the aneurysm is squeezed closed by the blades of the clip, the blades should be correspondingly longer. This study provided an assessment of whether the presurgical selection of clips using a 3D planning system is feasible in terms of selecting the most suitable clip for aneurysm occlusion. METHODS The computational model was created based on computer tomography data obtained from nine brain aneurysms. The closing of the aneurysm was provided in two steps. The first the length of the blades used for closing corresponded to the length of the aneurysm neck as confirmed by the radiological measurements. The second the length of the blades was adjusted according to stage one, so as to determine the minimum required for the closure of all the gaps in the interior space of the aneurysm neck. RESULTS No differences were detected between the radiological measurement of the aneurysm neck size and the measurements obtained from the reconstructed stereolithographic 3D models. It was observed that the size of the aneurysm neck increased following clipping by 40% to 60% of its original size. The larger the aneurysm neck, the greater the deformation of the aneurysm. CONCLUSION Firstly, the 3D reconstruction of CT/MRI data did not result in any loss of accuracy and the measurement of the neck of the aneurysm was the same for both of the methods employed. The second, and more important, outcome was that the deformation of the neck of the cerebral aneurysm is at least 1.4x greater than its original size. This information is essential in terms of the pre-selection of the size of the clip.
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Affiliation(s)
- Pavel Buchvald
- Dep. of Neurosurgery, Regional Hospital in Liberec, Czech Republic
| | - Lukas Capek
- Dep. Of Clinical Biomechanics, Regional Hospital in Liberec, Czech Republic; Technical University of Liberec, Czech Republic.
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Ali A, Morris JM, Decker SJ, Huang YH, Wake N, Rybicki FJ, Ballard DH. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: neurosurgical and otolaryngologic conditions. 3D Print Med 2023; 9:33. [PMID: 38008795 PMCID: PMC10680204 DOI: 10.1186/s41205-023-00192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Medical three dimensional (3D) printing is performed for neurosurgical and otolaryngologic conditions, but without evidence-based guidance on clinical appropriateness. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness recommendations for neurologic 3D printing conditions. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with neurologic and otolaryngologic conditions. Each study was vetted by the authors and strength of evidence was assessed according to published guidelines. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for diseases of the calvaria and skull base, brain tumors and cerebrovascular disease. Recommendations are provided in accordance with strength of evidence of publications corresponding to each neurologic condition combined with expert opinion from members of the 3D printing SIG. CONCLUSIONS This consensus guidance document, created by the members of the 3D printing SIG, provides a reference for clinical standards of 3D printing for neurologic conditions.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | | | - Summer J Decker
- Division of Imaging Research and Applied Anatomy, Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Xu G, Ba Y, Zhang K, Cai D, Yang B, Zhao T, Xue J. Application of microcatheter shaping based on computational fluid dynamics simulation of cerebral blood flow in the intervention of posterior communicating aneurysm of the internal carotid artery. Front Neurol 2023; 14:1221686. [PMID: 37645601 PMCID: PMC10460907 DOI: 10.3389/fneur.2023.1221686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction The present study aimed to investigate the application of the aneurysm embolization microcatheter plasticity method based on computational fluid dynamics (CFD) to simulate cerebral blood flow in the interventional treatment of posterior communicating aneurysms in the internal carotid artery and to evaluate its practicality and safety. Methods A total of 20 patients with posterior internal carotid artery communicating aneurysms who used CFD to simulate cerebral flow lines from January 2020 to December 2022 in our hospital were analyzed. Microcatheter shaping and interventional embolization were performed according to the main cerebral flow lines, and the success rate, stability, and effect of the microcatheter being in place were analyzed. Results Among the 20 patients, the microcatheters were all smoothly placed and the catheters were stable during the in vitro model test. In addition, the microcatheters were all smoothly placed during the operation, with a success rate of 100%. The catheter tips were stable and well-supported intraoperatively, and no catheter prolapse was registered. The aneurysm was completely embolized in 19 cases immediately after surgery, and a small amount of the aneurysm neck remained in one case. There were no intraoperative complications related to the embolization catheter operation. Conclusion Microcatheter shaping based on CFD simulation of cerebral blood flow, with precise catheter shaping, leads to a high success rate in catheter placing, stability, and good support, and greatly reduces the difficulty of catheter shaping. This catheter-shaping method is worthy of further study and exploration.
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Affiliation(s)
| | | | | | | | | | | | - Jiangyu Xue
- Cerebrovascular Division of Interventional Therapy Center, Zhengzhou University People's Hospital, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Zhengzhou, China
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Rehearsals using patient-specific 3D-printed aneurysm models for simulation of endovascular embolization of complex intracranial aneurysms: 3D SIM study. J Neuroradiol 2023; 50:86-92. [PMID: 34914933 DOI: 10.1016/j.neurad.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND In neurovascular treatment planning, endovascular devices to manage complex intracranial aneurysms requiring intervention are often selected based on conventional measurements and interventional neuroradiologist experience. A recently developed technology allows a patient-specific 3D-printed model to mimic the navigation experience. The goal of this study was to assess the effect of pre-procedure 3D simulation on procedural and clinical outcomes for wide-neck aneurysm embolization. MATERIALS & METHODS In this unblinded, non-randomized, prospective, multicenter study conducted from November 18 through December 20, patients with complex intracranial aneurysms (neck > 4 mm or ratio < 21) were treated by WEB or flow diverter stents (FDS). The primary endpoint was concordance between simulation and procedure, 3D-printed model accuracy as well as embolization outcomes including complications, procedure times, and radiation dose were also assessed. Secondary endpoint was to compare versus a retrospective WEB cohort. RESULTS Twenty-one patients were treated, 76% of cases by WEB and 24% by FDS. Concordance between post-simulation and real procedure efficiency was 0.85 [0.69 - 1.00] for size device selection and 0.93 [0.79 - 1.00] for wall-apposition/aneurysm neck closure. Geometrical accuracy of the 3D-printed model showed a mean absolute shift of 0.11 mm. Two complications without major clinical impact were reported with a post-operative mRS similar to pre-procedure mRS for all patients. CONCLUSIONS Rehearsal using accurate 3D-printed patient-specific aneurysm models enabled optimization of embolization strategy, resulting in reduced procedure duration and cumulative fluoroscopy time which translated to reduced radiation exposure compared to procedures performed without simulation.
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Patient-Specific 3D-Print Extracranial Vascular Simulators and Infrared Imaging Platform for Diagnostic Cerebral Angiography Training. Healthcare (Basel) 2022; 10:healthcare10112277. [DOI: 10.3390/healthcare10112277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Tortuous aortic arch is always challenging for beginner neuro-interventionalists. Herein, we share our experience of using 3D-printed extracranial vascular simulators (VSs) and the infrared imaging platform (IRIP) in two training courses for diagnostic cerebral angiography in the past 4 years. A total of four full-scale patient-specific carotid-aortic-iliac models were fabricated, including one type I arch, one bovine variant, and two type III arches. With an angiography machine (AM) as the imaging platform for the practice and final test, the first course was held in March 2018 had 10 participants, including three first-year residents (R1), three second-year residents (R2), and four third-year residents (R3). With introduction of the IRIP as the imaging platform for practice, the second course in March 2022 had nine participants, including 3 R1s, 3 R2s, and 3 R3s. The total manipulation time (TMT) to complete type III aortic arch navigation was recorded. In the first course, the average TMT of the first trial was 13.1 min. Among 3 R1s and 3 R2s attending the second trial, the average TMT of the second trial was 3.4 min less than that of the first trial. In the second course using IRIP, the average TMT of the first and second trials was 6.7 min and 4.8 min, respectively. The TMT of the second trial (range 2.2~14.4 min; median 5.9 min) was significantly shorter than that of the first trial (range 3.6~18 min; median 8.7 min), regardless of whether AM or IRIP was used (p = 0.001). Compared with first trial, the TMT of the second trial was reduced by an average of 3.7 min for 6 R1s, which was significantly greater than the 1.7 min of R2 and R3 (p = 0.049). Patient-specific VSs with radiation-free IRIP could be a useful training platform for junior residents with little experience in neuroangiography.
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You Y, Niu Y, Sun F, Huang S, Ding P, Wang X, Zhang X, Zhang J. Three-dimensional printing and 3D slicer powerful tools in understanding and treating neurosurgical diseases. Front Surg 2022; 9:1030081. [PMCID: PMC9614074 DOI: 10.3389/fsurg.2022.1030081] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
With the development of the 3D printing industry, clinicians can research 3D printing in preoperative planning, individualized implantable materials manufacturing, and biomedical tissue modeling. Although the increased applications of 3D printing in many surgical disciplines, numerous doctors do not have the specialized range of abilities to utilize this exciting and valuable innovation. Additionally, as the applications of 3D printing technology have increased within the medical field, so have the number of printable materials and 3D printers. Therefore, clinicians need to stay up-to-date on this emerging technology for benefit. However, 3D printing technology relies heavily on 3D design. 3D Slicer can transform medical images into digital models to prepare for 3D printing. Due to most doctors lacking the technical skills to use 3D design and modeling software, we introduced the 3D Slicer to solve this problem. Our goal is to review the history of 3D printing and medical applications in this review. In addition, we summarized 3D Slicer technologies in neurosurgery. We hope this article will enable many clinicians to leverage the power of 3D printing and 3D Slicer.
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Affiliation(s)
- Yijie You
- Department of Neurosurgery, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Yunlian Niu
- Department of Neurology, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Fengbing Sun
- Department of Neurosurgery, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Sheng Huang
- Department of Neurosurgery, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Peiyuan Ding
- Department of Neurosurgery, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Xuhui Wang
- Department of Neurosurgery, Xinhua Hospital Chongming Branch, Shanghai, China,Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, The Cranial Nerve Disease Center of Shanghai JiaoTong University, Shanghai, China
| | - Xin Zhang
- Educational Administrative Department, Shanghai Chongming Health School, Shanghai, China,Correspondence: Xin Zhang Jian Zhang
| | - Jian Zhang
- Department of Neurosurgery, Xinhua Hospital Chongming Branch, Shanghai, China,Correspondence: Xin Zhang Jian Zhang
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Ganapathy A, Chen D, Elumalai A, Albers B, Tappa K, Jammalamadaka U, Hoegger MJ, Ballard DH. Guide for starting or optimizing a 3D printing clinical service. Methods 2022; 206:41-52. [PMID: 35964862 DOI: 10.1016/j.ymeth.2022.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022] Open
Abstract
Three-dimensional (3D) printing has applications in many fields and has gained substantial traction in medicine as a modality to transform two-dimensional scans into three-dimensional renderings. Patient-specific 3D printed models have direct patient care uses in surgical and procedural specialties, allowing for increased precision and accuracy in developing treatment plans and guiding surgeries. Medical applications include surgical planning, surgical guides, patient and trainee education, and implant fabrication. 3D printing workflow for a laboratory or clinical service that produces anatomic models and guides includes optimizing imaging acquisition and post-processing, segmenting the imaging, and printing the model. Quality assurance considerations include supervising medical imaging expert radiologists' guidance and self-implementing in-house quality control programs. The purpose of this review is to provide a workflow and guide for starting or optimizing laboratories and clinical services that 3D-print anatomic models or guides for clinical use.
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Affiliation(s)
- Aravinda Ganapathy
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - David Chen
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Anusha Elumalai
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Brian Albers
- 3D Printing Center, Barnes Jewish Hospital, St. Louis, MO, USA.
| | - Karthik Tappa
- Anatomic 3D Printing and Visualization Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | - Mark J Hoegger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - David H Ballard
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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Zeng Y, Lin Z. Shaping and application of microcatheters based on 3D-printed hollow aneurysm model: a pilot feasibility study. Clin Neurol Neurosurg 2022; 218:107277. [DOI: 10.1016/j.clineuro.2022.107277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/24/2022] [Accepted: 05/01/2022] [Indexed: 11/03/2022]
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Artificial intelligence-assisted microcatheter shaping for intracranial aneurysm coiling: A preliminary study. Ann Vasc Surg 2022; 85:228-236. [PMID: 35339597 DOI: 10.1016/j.avsg.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/18/2022] [Accepted: 03/05/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy of artificial intelligence (AI) technology-assisted microcatheter shaping for coil embolization of intracranial aneurysms. METHODS From June 2019 to May 2021, 30 aneurysms in 24 patients were treated with coiling embolization using computer software-assisted microcatheter shaping at our institute. All patients underwent digital subtraction angiography (DSA) before coiling embolization. After three-dimensional (3D) rotational angiography, digital imaging and communications in medicine (DICOM) data were extracted and imported into computer software based on an artificial intelligence algorithm. 3D images of the parent artery and aneurysm were constructed with the software, and data including the central axis of the parent artery, aneurysm location, aneurysm size, and 3D structure were automatically obtained. The optimal microcatheter path was calculated and the shape of the mandrel was automatically generated. Surgeons shaped the mandrel and microcatheter following the artificial intelligence-generated template and completed the endovascular procedure. RESULTS All patients successfully completed the endovascular procedure without peri-operative complications. The microcatheters shaped according to the artificial intelligence template accurately entered the aneurysm sacs in one attempt, 15 aneurysms required no micro-guidewire assistance in catheterizing the aneurysm sac, and 15 did. The stability of the microcatheters during the procedures was satisfactory. No rebound incidence was observed and no re-shaping was necessary. CONCLUSION Artificial intelligence-assisted microcatheter shaping technology provides a new method to generate the optimal shape for the mandrel and microcatheter during endovascular procedures. The technology facilitates microcatheter accuracy and stability during coiling embolization and provides technical support for surgeons.
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Material design of soft biological tissue replicas using viscoelastic micromechanical modelling. J Mech Behav Biomed Mater 2021; 125:104875. [PMID: 34695662 DOI: 10.1016/j.jmbbm.2021.104875] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/17/2021] [Accepted: 09/29/2021] [Indexed: 01/17/2023]
Abstract
Anatomical models for research and education are often made of artificial materials that attempt to mimic biological tissues in terms of their mechanical properties. Recent developments in additive manufacturing allow tuning mechanical properties with microstructural designs. We propose a strategy for designing material microstructures to mimic soft tissue viscoelastic behaviour, based on a micromechanical Mori-Tanaka model. The model was applied to predict homogenised viscoelastic properties of materials, exhibiting a matrix-inclusion microstructure with varying inclusion volume fractions. The input properties were thereby obtained from compression relaxation tests on silicone elastomers. Validation of the model was done with experimental results for composite samples. Finally, different combinations of silicones were compared to mechanical properties of soft tissues (hepatic, myocardial, adipose, cervical, and prostate tissue), found in literature, in order to design microstructures for replicating these tissues in terms of viscoelasticity. The viscoelastic Mori-Tanaka model showed good agreement with the corresponding experimental results for low inclusion volume fractions, while high fractions lead to underestimation of the complex modulus by the model. Predictions for the loss tangent were reasonably accurate, even for higher inclusion volume fractions. Based on the model, designs for 3D printed microstructures can be extracted in order to replicate the viscoelastic properties of soft tissues.
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Guarino S, Marchese E, Ponticelli GS, Scerrati A, Tagliaferri V, Trovalusci F. Additive Manufacturing for Neurosurgery: Digital Light Processing of Individualized Patient-Specific Cerebral Aneurysms. MATERIALS 2021; 14:ma14206057. [PMID: 34683649 PMCID: PMC8539393 DOI: 10.3390/ma14206057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/25/2021] [Accepted: 10/07/2021] [Indexed: 12/27/2022]
Abstract
This study aims at demonstrating the feasibility of reproducing individualized patient-specific three-dimensional models of cerebral aneurysms by using the direct light processing (DLP) 3D printing technique in a low-time and inexpensive way. Such models were used to help neurosurgeons understand the anatomy of the aneurysms together with the surrounding vessels and their relationships, providing, therefore, a tangible supporting tool with which to train and plan surgical operations. The starting 3D models were obtained by processing the computed tomography angiographies and the digital subtraction angiographies of three patients. Then, a 3D DLP printer was used to print the models, and, if acceptable, on the basis of the neurosurgeon’s opinion, they were used for the planning of the neurosurgery operation and patient information. All the models were printed within three hours, providing a comprehensive representation of the cerebral aneurysms and the surrounding structures and improving the understanding of their anatomy and simplifying the planning of the surgical operation.
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Affiliation(s)
- Stefano Guarino
- Department of Engineering, University of Rome “Niccolò Cusano”, Via Don Carlo Gnocchi 3, 00166 Rome, Italy; (S.G.); (G.S.P.)
| | - Enrico Marchese
- Department of Neurosurgery, Catholic University of Rome, L.go A. Gemelli 8, 00100 Rome, Italy;
| | - Gennaro Salvatore Ponticelli
- Department of Engineering, University of Rome “Niccolò Cusano”, Via Don Carlo Gnocchi 3, 00166 Rome, Italy; (S.G.); (G.S.P.)
| | - Alba Scerrati
- Department of Transalational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
- Correspondence:
| | - Vincenzo Tagliaferri
- Department of Enterprise Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy; (V.T.); (F.T.)
| | - Federica Trovalusci
- Department of Enterprise Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy; (V.T.); (F.T.)
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Jin Z, Li Y, Yu K, Liu L, Fu J, Yao X, Zhang A, He Y. 3D Printing of Physical Organ Models: Recent Developments and Challenges. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2101394. [PMID: 34240580 PMCID: PMC8425903 DOI: 10.1002/advs.202101394] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/14/2021] [Indexed: 05/05/2023]
Abstract
Physical organ models are the objects that replicate the patient-specific anatomy and have played important roles in modern medical diagnosis and disease treatment. 3D printing, as a powerful multi-function manufacturing technology, breaks the limitations of traditional methods and provides a great potential for manufacturing organ models. However, the clinical application of organ model is still in small scale, facing the challenges including high cost, poor mimicking performance and insufficient accuracy. In this review, the mainstream 3D printing technologies are introduced, and the existing manufacturing methods are divided into "directly printing" and "indirectly printing", with an emphasis on choosing suitable techniques and materials. This review also summarizes the ideas to address these challenges and focuses on three points: 1) what are the characteristics and requirements of organ models in different application scenarios, 2) how to choose the suitable 3D printing methods and materials according to different application categories, and 3) how to reduce the cost of organ models and make the process simple and convenient. Moreover, the state-of-the-art in organ models are summarized and the contribution of 3D printed organ models to various surgical procedures is highlighted. Finally, current limitations, evaluation criteria and future perspectives for this emerging area are discussed.
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Affiliation(s)
- Zhongboyu Jin
- State Key Laboratory of Fluid Power and Mechatronic SystemsSchool of Mechanical EngineeringZhejiang UniversityHangzhouZhejiang310027China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang ProvinceSchool of Mechanical EngineeringZhejiang UniversityHangzhouZhejiang310027China
| | - Yuanrong Li
- State Key Laboratory of Fluid Power and Mechatronic SystemsSchool of Mechanical EngineeringZhejiang UniversityHangzhouZhejiang310027China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang ProvinceSchool of Mechanical EngineeringZhejiang UniversityHangzhouZhejiang310027China
| | - Kang Yu
- State Key Laboratory of Fluid Power and Mechatronic SystemsSchool of Mechanical EngineeringZhejiang UniversityHangzhouZhejiang310027China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang ProvinceSchool of Mechanical EngineeringZhejiang UniversityHangzhouZhejiang310027China
| | - Linxiang Liu
- Zhejiang University HospitalZhejiang UniversityHangzhouZhejiang310027China
| | - Jianzhong Fu
- State Key Laboratory of Fluid Power and Mechatronic SystemsSchool of Mechanical EngineeringZhejiang UniversityHangzhouZhejiang310027China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang ProvinceSchool of Mechanical EngineeringZhejiang UniversityHangzhouZhejiang310027China
| | - Xinhua Yao
- State Key Laboratory of Fluid Power and Mechatronic SystemsSchool of Mechanical EngineeringZhejiang UniversityHangzhouZhejiang310027China
| | - Aiguo Zhang
- Department of OrthopedicsWuxi Children's Hospital affiliated to Nanjing Medical UniversityWuxiJiangsu214023China
| | - Yong He
- State Key Laboratory of Fluid Power and Mechatronic SystemsSchool of Mechanical EngineeringZhejiang UniversityHangzhouZhejiang310027China
- Key Laboratory of Materials Processing and MoldZhengzhou UniversityZhengzhou450002China
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Chae MP, Chung RD, Smith JA, Hunter-Smith DJ, Rozen WM. The accuracy of clinical 3D printing in reconstructive surgery: literature review and in vivo validation study. Gland Surg 2021; 10:2293-2303. [PMID: 34422600 PMCID: PMC8340329 DOI: 10.21037/gs-21-264] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/23/2021] [Indexed: 01/17/2023]
Abstract
A growing number of studies demonstrate the benefits of 3D printing in improving surgical efficiency and subsequently clinical outcomes. However, the number of studies evaluating the accuracy of 3D printing techniques remains scarce. All publications appraising the accuracy of 3D printing between 1950 and 2018 were reviewed using well-established databases, including PubMed, Medline, Web of Science and Embase. An in vivo validation study of our 3D printing technique was undertaken using unprocessed chicken radius bones (Gallus gallus domesticus). Calculating its maximum length, we compared the measurements from computed tomography (CT) scans (CT group), image segmentation (SEG group) and 3D-printed (3DP) models (3DP group). Twenty-eight comparison studies in 19 papers have been identified. Published mean error of CT-based 3D printing techniques were 0.46 mm (1.06%) in stereolithography, 1.05 mm (1.78%) in binder jet technology, 0.72 mm (0.82%) in PolyJet technique, 0.20 mm (0.95%) in fused filament fabrication (FFF) and 0.72 mm (1.25%) in selective laser sintering (SLS). In the current in vivo validation study, mean errors were 0.34 mm (0.86%) in CT group, 1.02 mm (2.51%) in SEG group and 1.16 mm (2.84%) in 3DP group. Our Peninsula 3D printing technique using a FFF 3D printer thus produced accuracy similar to the published studies (1.16 mm, 2.84%). There was a statistically significant difference (P<10-4) between the CT group and the latter SEG and 3DP groups indicating that most of the error is introduced during image segmentation stage.
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Affiliation(s)
- Michael P. Chae
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Ru Dee Chung
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Julian A. Smith
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - David J. Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Warren Matthew Rozen
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
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15
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Polymer 3D Printing Review: Materials, Process, and Design Strategies for Medical Applications. Polymers (Basel) 2021; 13:polym13091499. [PMID: 34066639 PMCID: PMC8124560 DOI: 10.3390/polym13091499] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
Polymer 3D printing is an emerging technology with recent research translating towards increased use in industry, particularly in medical fields. Polymer printing is advantageous because it enables printing low-cost functional parts with diverse properties and capabilities. Here, we provide a review of recent research advances for polymer 3D printing by investigating research related to materials, processes, and design strategies for medical applications. Research in materials has led to the development of polymers with advantageous characteristics for mechanics and biocompatibility, with tuning of mechanical properties achieved by altering printing process parameters. Suitable polymer printing processes include extrusion, resin, and powder 3D printing, which enable directed material deposition for the design of advantageous and customized architectures. Design strategies, such as hierarchical distribution of materials, enable balancing of conflicting properties, such as mechanical and biological needs for tissue scaffolds. Further medical applications reviewed include safety equipment, dental implants, and drug delivery systems, with findings suggesting a need for improved design methods to navigate the complex decision space enabled by 3D printing. Further research across these areas will lead to continued improvement of 3D-printed design performance that is essential for advancing frontiers across engineering and medicine.
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16
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Marciuc EA, Dobrovat BI, Popescu RM, Dobrin N, Chiriac A, Marciuc D, Eva L, Haba D. 3D Printed Models-A Useful Tool in Endovascular Treatment of Intracranial Aneurysms. Brain Sci 2021; 11:brainsci11050598. [PMID: 34066604 PMCID: PMC8148564 DOI: 10.3390/brainsci11050598] [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] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022] Open
Abstract
Many developments were made in the area of endovascular treatment of intracranial aneurysms, but this procedure also requires a good assessment of vascular anatomy prior to intervention. Seventy-six cases with brain aneurysms were selected and 1:1 scale 3D printed models were created. We asked three interventional neurosurgeons with different degrees of experience (ten years, four years, and a fourth-year resident) to review the cases using CTA (computed tomography angiogram) with MPR (multiplanar reconstructions) and VRT (volume rendering technique) and make a decision: coil embolization or stent-assisted coil embolization. After we provided them with the 3D printed models, they were asked to review their treatment plan. Statistical analysis was performed and the endovascular approach changed in 11.84% of cases for ten-year experienced neurosurgeons, 13.15% for four years experienced neurosurgeon, and 21.05% for residents. The interobserver agreement was very good between the ten years experienced interventionist and four years experienced interventionist when they analyzed the data set that included the 3D printed model. The agreement was higher between all physicians after they examined the printed model. 3D patient-specific printed models may be useful in choosing between two different endovascular techniques and also help the residents to better understand the vascular anatomy and the overall procedure.
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Affiliation(s)
- Emilia Adriana Marciuc
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (E.A.M.); (R.M.P.); (D.H.)
| | - Bogdan Ionut Dobrovat
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (E.A.M.); (R.M.P.); (D.H.)
- Correspondence: ; Tel.: +40-752-173-839
| | - Roxana Mihaela Popescu
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (E.A.M.); (R.M.P.); (D.H.)
| | - Nicolaie Dobrin
- Department of Neurosurgery, Emergency Hospital “Prof. Dr. N. Oblu”, 700309 Iasi, Romania; (N.D.); (A.C.); (L.E.)
| | - Alexandru Chiriac
- Department of Neurosurgery, Emergency Hospital “Prof. Dr. N. Oblu”, 700309 Iasi, Romania; (N.D.); (A.C.); (L.E.)
| | - Daniel Marciuc
- Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Lucian Eva
- Department of Neurosurgery, Emergency Hospital “Prof. Dr. N. Oblu”, 700309 Iasi, Romania; (N.D.); (A.C.); (L.E.)
| | - Danisia Haba
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (E.A.M.); (R.M.P.); (D.H.)
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Dho YS, Lee D, Ha T, Ji SY, Kim KM, Kang H, Kim MS, Kim JW, Cho WS, Kim YH, Kim YG, Park SJ, Park CK. Clinical application of patient-specific 3D printing brain tumor model production system for neurosurgery. Sci Rep 2021; 11:7005. [PMID: 33772092 PMCID: PMC7998007 DOI: 10.1038/s41598-021-86546-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/17/2021] [Indexed: 12/15/2022] Open
Abstract
The usefulness of 3-dimensional (3D)-printed disease models has been recognized in various medical fields. This study aims to introduce a production platform for patient-specific 3D-printed brain tumor model in clinical practice and evaluate its effectiveness. A full-cycle platform was created for the clinical application of a 3D-printed brain tumor model (3D-printed model) production system. Essential elements included automated segmentation software, cloud-based interactive communication tools, customized brain models with exquisite expression of brain anatomy in transparent material, adjunctive devices for surgical simulation, and swift process cycles to meet practical needs. A simulated clinical usefulness validation was conducted in which neurosurgeons assessed the usefulness of the 3D-printed models in 10 cases. We successfully produced clinically applicable patient-specific models within 4 days using the established platform. The simulated clinical usefulness validation results revealed the significant superiority of the 3D-printed models in surgical planning regarding surgical posture (p = 0.0147) and craniotomy design (p = 0.0072) compared to conventional magnetic resonance images. The benefit was more noticeable for neurosurgeons with less experience. We established a 3D-printed brain tumor model production system that is ready to use in daily clinical practice for neurosurgery.
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Affiliation(s)
- Yun-Sik Dho
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Doohee Lee
- MEDICALIP Co. Ltd., Changgyeong Building, 174, Yulgok-ro, Jongno-gu, Seoul, 03127, Republic of Korea
| | - Teahyun Ha
- MEDICALIP Co. Ltd., Changgyeong Building, 174, Yulgok-ro, Jongno-gu, Seoul, 03127, Republic of Korea
| | - So Young Ji
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyung Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Min-Sung Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Young Gyu Kim
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sang Joon Park
- MEDICALIP Co. Ltd., Changgyeong Building, 174, Yulgok-ro, Jongno-gu, Seoul, 03127, Republic of Korea. .,Department of Radiology, Seoul National University Hospital, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea.
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18
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Błaszczyk M, Jabbar R, Szmyd B, Radek M. 3D Printing of Rapid, Low-Cost and Patient-Specific Models of Brain Vasculature for Use in Preoperative Planning in Clipping of Intracranial Aneurysms. J Clin Med 2021; 10:jcm10061201. [PMID: 33805774 PMCID: PMC8000886 DOI: 10.3390/jcm10061201] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 12/23/2022] Open
Abstract
We developed a practical and cost-effective method of production of a 3D-printed model of the arterial Circle of Willis of patients treated because of an intracranial aneurysm. We present and explain the steps necessary to produce a 3D model from medical image data, and express the significant value such models have in patient-specific pre-operative planning as well as education. A Digital Imaging and Communications in Medicine (DICOM) viewer is used to create 3D visualization from a patient’s Computed Tomography Angiography (CTA) images. After generating the reconstruction, we manually remove the anatomical components that we wish to exclude from the print by utilizing tools provided with the imaging software. We then export this 3D reconstructions file into a Standard Triangulation Language (STL) file which is then run through a “Slicer” software to generate a G-code file for the printer. After the print is complete, the supports created during the printing process are removed manually. The 3D-printed models we created were of good accuracy and scale. The median production time used for the models described in this manuscript was 4.4 h (range: 3.9–4.5 h). Models were evaluated by neurosurgical teams at local hospital for quality and practicality for use in urgent and non-urgent care. We hope we have provided readers adequate insight into the equipment and software they would require to quickly produce their own accurate and cost-effective 3D models from CT angiography images. It has become quite clear to us that the cost-benefit ratio in the production of such a simplified model is worthwhile.
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19
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Waqas M, Mokin M, Lim J, Vakharia K, Springer ME, Meess KM, Ducharme RW, Ionita CN, Nagesh SVS, Gutierrez LC, Snyder KV, Davies JM, Levy EI, Siddiqui AH. Design and Physical Properties of 3-Dimensional Printed Models Used for Neurointervention: A Systematic Review of the Literature. Neurosurgery 2021; 87:E445-E453. [PMID: 32392300 DOI: 10.1093/neuros/nyaa134] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 03/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) printing has revolutionized training, education, and device testing. Understanding the design and physical properties of 3D-printed models is important. OBJECTIVE To systematically review the design, physical properties, accuracy, and experimental outcomes of 3D-printed vascular models used in neurointervention. METHODS We conducted a systematic review of the literature between January 1, 2000 and September 30, 2018. Public/Publisher MEDLINE (PubMed), Web of Science, Compendex, Cochrane, and Inspec databases were searched using Medical Subject Heading terms for design and physical attributes of 3D-printed models for neurointervention. Information on design and physical properties like compliance, lubricity, flow system, accuracy, and outcome measures were collected. RESULTS A total of 23 articles were included. Nine studies described 3D-printed models for stroke intervention. Tango Plus (Stratasys) was the most common material used to develop these models. Four studies described a population-representative geometry model. All other studies reported patient-specific vascular geometry. Eight studies reported complete reconstruction of the circle of Willis, anterior, and posterior circulation. Four studies reported a model with extracranial vasculature. One prototype study reported compliance and lubricity. Reported circulation systems included manual flushing, programmable pistons, peristaltic, and pulsatile pumps. Outcomes included thrombolysis in cerebral infarction, post-thrombectomy flow restoration, surgical performance, and qualitative feedback. CONCLUSION Variations exist in the material, design, and extent of reconstruction of vasculature of 3D-printed models. There is a need for objective characterization of 3D-printed vascular models. We propose the development of population representative 3D-printed models for skill improvement or device testing.
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Affiliation(s)
- Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | | | | | | | - Ciprian N Ionita
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
| | - Swetadri Vasan Setlur Nagesh
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
| | - Liza C Gutierrez
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Jacobs Institute, Buffalo, New York.,Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Jacobs Institute, Buffalo, New York.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Jacobs Institute, Buffalo, New York.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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20
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Tian X, Cai G, Zhi D, Fan K, Song ZL, Qiu B, Jia L, Gao R. A Transparent Vessel-on-a-Chip Device for Hemodynamic Analysis and Early Diagnosis of Intracranial Aneurysms by CFD and PC-MRI. ACS Sens 2020; 5:4064-4071. [PMID: 33289559 DOI: 10.1021/acssensors.0c02164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hemodynamics plays a critical role in early diagnosis and investigating the growth mechanism of intracranial aneurysms (IAs), which usually induce hemorrhagic stroke, serious neurological diseases, and even death. We developed a transparent blood vessel-on-a-chip (VOC) device for magnetic resonance imaging (MRI) to provide characteristic flow fields of early IAs as the reference for early diagnosis. This VOC device takes advantage of the transparent property to clearly exhibit the internal structure and identify the needless air bubbles in the biomimetic fluid experiment, which significantly affects the MRI image quality. Furthermore, the device was miniaturized and easily assembled with arbitrary direction using a 3D-printed scaffold in a radiofrequency coil. Computational fluid dynamics (CFD) simulations of the flow field were greatly consistent with those data from MRI. Both internal flow and wall shear stress (WSS) exhibited very low levels during the IA growth, thus leading to the growth and rupture of IAs. PC-MRI images can also provide a reasonable basis for the early diagnosis of IAs. Therefore, we believed that this proposed VOC-based MR imaging technique has great potential for early diagnostic of intracranial aneurysms.
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Affiliation(s)
- Xin Tian
- School of Instrument Science and Opto-electronic Engineering, Hefei University of Technology, Hefei 230009, China
- Department of Medical Imaging and Neurology, Jincheng People’s Hospital, Jincheng 048000, China
| | - Guochao Cai
- School of Instrument Science and Opto-electronic Engineering, Hefei University of Technology, Hefei 230009, China
| | - Debo Zhi
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, China
| | - Ka Fan
- Department of Medical Imaging and Neurology, Jincheng People’s Hospital, Jincheng 048000, China
| | - Zhi-ling Song
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, Shandong Key Laboratory of Biochemical Analysis, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Bensheng Qiu
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, China
| | - Longbin Jia
- Department of Medical Imaging and Neurology, Jincheng People’s Hospital, Jincheng 048000, China
| | - Rongke Gao
- School of Instrument Science and Opto-electronic Engineering, Hefei University of Technology, Hefei 230009, China
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21
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Faraj MK, Hoz SS, Mohammad AJ. The use of three-dimensional anatomical patient-specific printed models in surgical clipping of intracranial aneurysm: A pilot study. Surg Neurol Int 2020; 11:381. [PMID: 33408915 PMCID: PMC7771404 DOI: 10.25259/sni_361_2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/22/2020] [Indexed: 11/04/2022] Open
Abstract
Background In the present study, we aim to develop simulation models based on computed tomography angiography images of intracranial aneurysms (IAs) and their parent vessels using three-dimensional (3D) printing technology. The study focuses on the value of these 3D models in presurgical planning and intraoperative navigation and ultimately their impact on patient outcomes. To the best of our knowledge, this is the first report of its kind from a war-torn country, like Iraq. Methods This is a prospective study of a series of 11, consecutively enrolled, patients suffering from IAs for the period between February and September 2019. The study represents a collaboration between the two major neurosurgical centers in Baghdad/Iraq; Neurosciences Teaching Hospital and Neurosurgery Teaching Hospital. We analyzed the data of eleven patients with IAs treated by microsurgical clipping. These data include patient demographics, clinical, surgical, and outcomes along with the data of the 3D-printed replica used in these surgeries. All cases were operated on by one surgeon. Results Our study included 11 patients, with a total of 11 aneurysms clipped. The mean age was 44 ± 8, with a median of 42.5 and a range of 35-61 years. About 60% of our patients were female with a female-to-male ratio of 1:5. About 60% of the aneurysms were located at the anterior communicating artery (Acom) while the remaining 40% were equally distributed between the posterior communicating and internal carotid arteries bifurcation. The standard pterional approach was followed in 50% of cases, whereas the other 50% of patients were treated through the lateral supraorbital approach. About 90% (n = 9) of the patients had a Glasgow Outcome Scale (GOS) of 5 and 10% had a GOS of 4. The 3D-printed models successfully replicated the aneurysm size, location, and relation to the parent vessel with 100% accuracy and were used for intraoperative guidance. The average production time was 24-48 h and the production cost was 10-20 US dollars. Conclusion 3D printing is a promising technology that is rapidly penetrating the field of neurosurgery. In particular, the use of 3D-printed patient-matched, anatomically accurate replicas of the cerebral vascular tree is valuable adjunct to the microsurgical clipping of IAs, and our study conclusions support this concept. However, both the feasibility and clinical utility of 3D printing remain the subject of much, ongoing investigations.
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Affiliation(s)
- Moneer K Faraj
- Department of Neurosurgery, College of Medicine, Neurosciences Hospital, University of Baghdad, Iraq
| | - Samer S Hoz
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
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22
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The utility of three-dimensional models in complex microsurgical reconstruction. Arch Plast Surg 2020; 47:428-434. [PMID: 32971594 PMCID: PMC7520243 DOI: 10.5999/aps.2020.00829] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/29/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) model printing improves visualization of anatomical structures in space compared to two-dimensional (2D) data and creates an exact model of the surgical site that can be used for reference during surgery. There is limited evidence on the effects of using 3D models in microsurgical reconstruction on improving clinical outcomes. METHODS A retrospective review of patients undergoing reconstructive breast microsurgery procedures from 2017 to 2019 who received computed tomography angiography (CTA) scans only or with 3D models for preoperative surgical planning were performed. Preoperative decision-making to undergo a deep inferior epigastric perforator (DIEP) versus muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap, as well as whether the decision changed during flap harvest and postoperative complications were tracked based on the preoperative imaging used. In addition, we describe three example cases showing direct application of 3D mold as an accurate model to guide intraoperative dissection in complex microsurgical reconstruction. RESULTS Fifty-eight abdominal-based breast free-flaps performed using conventional CTA were compared with a matched cohort of 58 breast free-flaps performed with 3D model print. There was no flap loss in either group. There was a significant reduction in flap harvest time with use of 3D model (CTA vs. 3D, 117.7±14.2 minutes vs. 109.8±11.6 minutes; P=0.001). In addition, there was no change in preoperative decision on type of flap harvested in all cases in 3D print group (0%), compared with 24.1% change in conventional CTA group. CONCLUSIONS Use of 3D print model improves accuracy of preoperative planning and reduces flap harvest time with similar postoperative complications in complex microsurgical reconstruction.
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Cogswell PM, Rischall MA, Alexander AE, Dickens HJ, Lanzino G, Morris JM. Intracranial vasculature 3D printing: review of techniques and manufacturing processes to inform clinical practice. 3D Print Med 2020; 6:18. [PMID: 32761490 PMCID: PMC7409717 DOI: 10.1186/s41205-020-00071-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background In recent years, three-dimensional (3D) printing has been increasingly applied to the intracranial vasculature for patient-specific surgical planning, training, education, and research. Unfortunately, though, much of the prior literature regarding 3D printing has focused on the end-product and not the process. In addition, for 3D printing/manufacturing to occur on a large scale, challenges and bottlenecks specific to each modeled anatomy must be overcome. Main body In this review article, limitations and considerations of each 3D printing processing step, as they relate to printing individual intracranial vasculature models and providing an active clinical service for a quaternary care center, are discussed. Relevant advantages and disadvantages of the available acquisition techniques (computed tomography, magnetic resonance, and digital subtraction angiography) are reviewed. Specific steps in segmentation, processing, and creation of a printable file may impede the workflow or degrade the fidelity of the printed model and are, therefore, given added attention. The various available printing techniques are compared with respect to printing the intracranial vasculature. Finally, applications are discussed, and a variety of example models are shown. Conclusion In this review we provide insight into the manufacturing of 3D models of the intracranial vasculature that may facilitate incorporation into or improve utility of 3D vascular models in clinical practice.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Matthew A Rischall
- Suburban Imaging, 4801 West 81st Street, Suite 108, Bloomington, MN, 55437, USA
| | - Amy E Alexander
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Hunter J Dickens
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jonathan M Morris
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Geng J, Hu P, Ji Z, Li C, Li L, Shen J, Feng X, Wang W, Yang G, Li J, Zhang H. Accuracy and reliability of computer-assisted semi-automated morphological analysis of intracranial aneurysms: an experimental study with digital phantoms and clinical aneurysm cases. Int J Comput Assist Radiol Surg 2020; 15:1749-1759. [DOI: 10.1007/s11548-020-02218-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
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Yamaki VN, Cancelliere NM, Nicholson P, Rodrigues M, Radovanovic I, Sungur JM, Krings T, Pereira VM. Biomodex patient-specific brain aneurysm models: the value of simulation for first in-human experiences using new devices and robotics. J Neurointerv Surg 2020; 13:272-277. [PMID: 32601259 PMCID: PMC7892376 DOI: 10.1136/neurintsurg-2020-015990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 12/29/2022]
Abstract
Background With the recent advent of advanced technologies in the field, treatment of neurovascular diseases using endovascular techniques is rapidly evolving. Here we describe our experience with pre-surgical simulation using the Biomodex EVIAS patient-specific 3D-printed models to plan aneurysm treatment using endovascular robotics and novel flow diverter devices. Methods Pre-procedural rehearsals with 3D-printed patient-specific models of eight cases harboring brain aneurysms were performed before the first in-human experiences. To assess the reliability of the experimental model, the characteristics of the aneurysms were compared between the patient and 3D models. The rehearsals were used to define the patient treatment plan, including technique, device sizing, and operative working projections. Results The study included eight patients with their respective EVIAS 3D aneurysm models. Pre-operative simulation was performed for the first in-human robotic-assisted neurovascular interventions (n=2) and new generation flow-diverter stents (n=6). Aneurysms were located in both the anterior (n=5) and posterior (n=3) circulation and were on average 11.0±6.5 mm in size. We found reliable reproduction of the aneurysm features and similar dimensions of the parent vessel anatomy between the 3D models and patient anatomy. Information learned from pre-surgical in vitro simulation are described in detail, including an improved patient treatment plan, which contributed to successful first in-world procedures with no intraprocedural complications. Conclusions Pre-procedural rehearsal using patient-specific 3D models provides precise procedure planning, which can potentially lead to greater operator confidence, decreased radiation dose and improvements in patient safety, particularly in first in-human experiences.
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Affiliation(s)
- Vitor Nagai Yamaki
- Division of Neurosurgery, Department of Neurology, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
| | | | - Patrick Nicholson
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marta Rodrigues
- Imagiology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
| | - Ivan Radovanovic
- Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Timo Krings
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
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Huang C, Lan Y, Chen S, Liu Q, Luo X, Xu G, Zhou W, Lin F, Peng Y, Ng EYK, Cheng Y, Zeng N, Zhang G, Che W. Patient-Specific Coronary Artery 3D Printing Based on Intravascular Optical Coherence Tomography and Coronary Angiography. COMPLEXITY 2019; 2019:1-10. [DOI: 10.1155/2019/5712594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Despite the new ideas were inspired in medical treatment by the rapid advancement of three-dimensional (3D) printing technology, there is still rare research work reported on 3D printing of coronary arteries being documented in the literature. In this work, the application value of 3D printing technology in the treatment of cardiovascular diseases has been explored via comparison study between the 3D printed vascular solid model and the computer aided design (CAD) model. In this paper, a new framework is proposed to achieve a 3D printing vascular model with high simulation. The patient-specific 3D reconstruction of the coronary arteries is performed by the detailed morphological information abstracted from the contour of the vessel lumen. In the process of reconstruction which has 5 steps, the morphological details of the contour view of the vessel lumen are merged along with the curvature and length information provided by the coronary angiography. After comparing with the diameter of the narrow section and the diameter of the normal section in CAD models and 3D printing model, it can be concluded that there is a high correlation between the diameter of vascular stenosis measured in 3D printing models and computer aided design models. The 3D printing model has high-modeling ability and high precision, which can represent the original coronary artery appearance accurately. It can be adapted for prevascularization planning to support doctors in determining the surgical procedures.
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Affiliation(s)
- Chenxi Huang
- School of Informatics, Xiamen University, Xiamen, China
| | - Yisha Lan
- Department of Computer Science and Technology, Tongji University, Shanghai, China
| | - Sirui Chen
- Department of Computer Science and Technology, Tongji University, Shanghai, China
| | - Qing Liu
- School of Informatics, Xiamen University, Xiamen, China
| | - Xin Luo
- Department of Computer Science and Technology, Tongji University, Shanghai, China
| | - Gaowei Xu
- Department of Computer Science and Technology, Tongji University, Shanghai, China
| | - Wen Zhou
- School of Computer and Information, Anhui Normal University, Wuhu, China
| | - Fan Lin
- School of Informatics, Xiamen University, Xiamen, China
| | - Yonghong Peng
- Faculty of Computer Science, University of Sunderland, Sunderland, UK
| | - Eddie Y. K. Ng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798
| | - Yongqiang Cheng
- School of Engineering and Computer Science, University of Hull, Hull HU6 7RX, UK
| | - Nianyin Zeng
- Department of Instrumental and Electrical Engineering, Xiamen University, Xiamen, China
| | - Guokai Zhang
- School of Software, Tongji University, Shanghai, China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
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Tejo-Otero A, Buj-Corral I, Fenollosa-Artés F. 3D Printing in Medicine for Preoperative Surgical Planning: A Review. Ann Biomed Eng 2019; 48:536-555. [DOI: 10.1007/s10439-019-02411-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/11/2019] [Indexed: 12/12/2022]
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Xu Y, Tian W, Wei Z, Li Y, Gao X, Li W, Dong B. Microcatheter shaping using three-dimensional printed models for intracranial aneurysm coiling. J Neurointerv Surg 2019; 12:308-310. [DOI: 10.1136/neurintsurg-2019-015346] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 11/04/2022]
Abstract
Background and purposeMicrocatheterization is an important, but also difficult, technique used for the embolization of intracranial aneurysms. The purpose of this study was to investigate the application of three-dimensional (3D) printing technology in microcatheter shaping.MethodsNine cases of internal carotid artery posterior communicating artery aneurysm diagnosed by CT angiography were selected, and 3D printing technology was used to build a 3D model including the aneurysm and the parent artery. The hollow and translucent model had certain flexibility; it was immersed in water and the microcatheter was introduced into the water to the target position in the aneurysm, followed by heating the water temperature to 50°C. After soaking for 5 min, the microcatheter was taken out and the shaping was completed. After sterilization, the shaped microcatheter was used for arterial aneurysm embolization and evaluation was conducted.ResultsNine cases of microcatheter shaping were satisfactory and shaping the needle was not necessary; no rebound was observed. The microcatheter was placed in an ideal position, and the stent-assisted method was used in three cases of wide-neck aneurysm. There were no complications related to surgery.ConclusionA new microcatheter shaping method using 3D printing technology makes intracranial artery aneurysm embolization more stable and efficient.
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Bockhorn L, Gardner SS, Dong D, Karmonik C, Elias S, Gwathmey FW, Harris JD. Application of three-dimensional printing for pre-operative planning in hip preservation surgery. J Hip Preserv Surg 2019; 6:164-169. [PMID: 31660202 PMCID: PMC6662895 DOI: 10.1093/jhps/hnz023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/29/2019] [Accepted: 05/05/2019] [Indexed: 12/14/2022] Open
Abstract
Three-dimensional printing is a valuable modality with broad clinical applications. Hip preservation surgery outcomes are dependent on correction of morphological abnormalities that may be optimally visualized with three-dimensional models. To assess the efficacy of three-dimensional models for patient and trainee education and to determine its benefits during pre-operative planning in hip preservation surgery. Sixteen patients with hip pathology were selected. Computed tomography was utilized to generate three-dimensional models. Customized Likert-style questionnaires were given to 10 hip preservation surgeons, 11 orthopedic surgery residents and 10 patients. All residents strongly agreed or agreed that the three-dimensional hip models helped them to understand patients’ pathology. All but one patient agreed that the models assisted in their understanding of the treatment plan. Surgeons concurred that although they do not routinely order three-dimensional models, their use would improve trainee and patient education, especially when treating atypical osseous pathomorphologies. Three-dimensional models are tools that can help surgeon, trainee and patient understanding and participation in treatment of complex hip disorders. Patients and trainees agree that the prototypes enhanced their educational experience, as the surgeon can directly demonstrate complex morphological abnormalities. Trainees can therefore gain a better understanding of hip pathologies and treatment. As patients better understand their hip disorder, they can more fully participate in shared treatment decision-making. Level of Evidence Level IV, Retrospective Case Series
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Affiliation(s)
- Lauren Bockhorn
- Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | | | - David Dong
- Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | | | - Saba Elias
- Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Joshua D Harris
- Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
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Man H, Bi W. Expression of a Novel Long Noncoding RNA (lncRNA), GASL1, is Downregulated in Patients with Intracranial Aneurysms and Regulates the Proliferation of Vascular Smooth Muscle Cells In Vitro. Med Sci Monit 2019; 25:1133-1139. [PMID: 30742604 PMCID: PMC6381810 DOI: 10.12659/msm.912204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Preliminary microarray data in our laboratory indicated that the novel long noncoding RNA (lncRNA), GASL1, was downregulated in patients with intracranial aneurysms. This study aimed to investigate the expression of lncRNA GASL1 in patients with intracranial aneurysms and its role in the regulation of vascular smooth muscle cell (VSMC) proliferation by transforming growth factor-β1 (TGF-β1). MATERIAL AND METHODS The study included 68 patients with unruptured intracranial aneurysms and 56 healthy volunteers. In both groups, serum levels of TGF-β1 were measured using an enzyme-linked immunoassay (ELISA) and Western blot. Human VSMCs in vitro underwent lncRNA GASL1 overexpression using the insertion of an EcoRI-EcoRI fragment into the pIRSE2 vector. Cell viability and proliferation were measured by a cell counting kit-8 (CCK-8) assay. RNA extraction and quantitative real-time polymerase chain reaction (qRT-PCR) determined GASL1 expression. RESULTS ROC curve analysis showed that downregulation of GASL1 effectively distinguished patients with intracranial aneurysm from healthy controls. Blood GASL1 and TGF-β1 were negatively correlated in patients with intracranial aneurysm but not in healthy people. GASL1 overexpression promoted proliferation of human vascular smooth muscle cells (VSMCs) and downregulated TGF-β1 expression, while exogenous TGF-β1 reduced VSMCs proliferation but showed no effects on GASL1 expression. CONCLUSIONS Expression of the novel lncRNA, GASL1, was downregulated in patients with intracranial aneurysms and regulated the proliferation of VSMCs in vitro by targeting TGF-β1.
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Affiliation(s)
- Huibin Man
- Department of Neurosurgery, Centre Hospital of Weihai, Weihai, Shandong, China (mainland)
| | - Weiping Bi
- Department of Gastroenterology, Centre Hospital of Weihai, Weihai, Shandong, China (mainland)
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Abstract
PURPOSE This paper examines the application of 3D printing technology in the endoscopic endonasal approach for the treatment of macroadenomas. METHODS We have retrospectively analysed 20 patients who diagnosed with macroadenoma underwent endoscopic transsphenoidal surgery in Wuhan Union hospital from January 2017 to May 2017. Among the 20 patients, 10 patients received the service of 3D printing technology preoperatively. The data of 3D processing and clinical result were recorded for further evaluation. RESULTS The 10 patients who received the service had a successful 3D printed model of their tumors, it shows the anatomy of sphenoid sinus, tumor location which were in good agreement with our intraoperative observations. The 10 patients who received the service had a less operation time (127.0 ± 15.53 vs. 143.40 ± 17.89), blood loss (159.90 ± 12.31 vs. 170.00 ± 29.06) and less postoperative complication rate (20% vs. 40%). the design time of the 3D images varies 2 h 10 min to 4 h 32 min. the printing time of the 3D models varies 10 h 12 min to 22 h 34 min. CONCLUSIONS The use of 3D printing technology has unquestionable potential applications to endoscopic endonasal approach for macroadenomas, in particular reflecting the complicated anatomy of sphenoid sinus and tumor location. Owing to the advantages of 3D printing technology, it may help the patients get a good prognosis.
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Affiliation(s)
- Xing Huang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Zhen Liu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xuan Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xu-Dong Li
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Kai Cheng
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yan Zhou
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xiao-Bing Jiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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Xu J, Zhang Y, Chu L, Chen W, Du Y, Gu J. Long non-coding RNA HIF1A-AS1 is upregulated in intracranial aneurysms and participates in the regulation of proliferation of vascular smooth muscle cells by upregulating TGF-β1. Exp Ther Med 2018; 17:1797-1801. [PMID: 30867687 PMCID: PMC6395997 DOI: 10.3892/etm.2018.7144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/05/2018] [Indexed: 12/29/2022] Open
Abstract
Long non-coding (lnc)RNA hypoxia inducible factor 1α-antisense RNA 1 (HIF1A-AS1) not only participates in different types of malignancies, but also serves pivotal roles in thoracic aortic aneurysms, which suggests its possible involvement in intracranial aneurysms. Therefore, the present study aimed to investigate its involvement in intracranial aneurysms. Expression levels of HIF1A-AS1 and transforming growth factor (TGF)-β1 in the blood of patients with intracranial aneurysms and healthy controls were detected using reverse transcription-quantitative polymerase chain reaction. The diagnostic value of blood HIF1A-AS1 for intracranial aneurysms was analyzed using receiver operating characteristic curve analysis. A HIF1A-AS1 expression vector was constructed and transfected into human vascular smooth muscle cells (VSMCs) and the effects on cell proliferation and TGF-β1 expression were explored using the Cell Counting kit-8 assay and western blot analysis, respectively. Upregulated HIF1A-AS1 expression levels in blood were observed in patients with intracranial aneurysms when compared with controls. Notably, upregulated HIF1A-AS1 expression effectively distinguished patients with intracranial aneurysms from healthy controls. Furthermore, HIF1A-AS1 and TGF-β1 expression levels were positively correlated with intracranial aneurysms. HIF1A-AS1 overexpression also upregulated TGF-β1 expression and inhibited VSMC proliferation. Although TGF-β1 treatment had no significant effect on HIF1A-AS1 expression, TGF-β inhibitor significantly reduced the effects of HIF1A-AS1 overexpression on cell proliferation. It was therefore concluded that HIF1A-AS1 may participate in intracranial aneurysms by regulating VSMC proliferation through the upregulation of TGF-β1.
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Affiliation(s)
- Jiaming Xu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, P.R. China
| | - Yang Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, P.R. China
| | - Lisheng Chu
- Department of Pathology and Pathophysiology, School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310009, P.R. China
| | - Weiyan Chen
- Department of Pathology and Pathophysiology, School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310009, P.R. China
| | - Yueguang Du
- Department of Pathology and Pathophysiology, School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310009, P.R. China
| | - Jingjing Gu
- Department of Pathology and Pathophysiology, School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310009, P.R. China
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Marturello DM, Wei F, Déjardin LM. Characterization of the torsional structural properties of feline femurs and surrogate bone models for mechanical testing of orthopedic implants. Vet Surg 2018; 48:229-236. [DOI: 10.1111/vsu.13136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/27/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Danielle M. Marturello
- Department of Small Animal Clinical SciencesMichigan State University East Lansing Michigan
| | - Feng Wei
- Orthopaedic Biomechanics LaboratoriesCollege of Osteopathic Medicine, Michigan State University East Lansing Michigan
| | - Loïc M. Déjardin
- Department of Small Animal Clinical SciencesMichigan State University East Lansing Michigan
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Reconstructing patient-specific cerebral aneurysm vasculature for in vitro investigations and treatment efficacy assessments. J Clin Neurosci 2018; 61:153-159. [PMID: 30470652 DOI: 10.1016/j.jocn.2018.10.103] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/27/2018] [Indexed: 11/27/2022]
Abstract
Perianeurysmal hemodynamics play a vital role in the initiation, growth and rupture of intracranial aneurysms. In vitro investigations of aneurysmal hemodynamics are helpful to visualize and measure blood flow, and aiding surgical planning approaches. Improving in vitro model creation can improve the feasibility and accuracy of hemodynamic investigations and surgical planning, improving clinical value. In this study, in vitro models were created from three-dimensional rotational angiography (3DRA) of six patients harboring intracranial aneurysms using a multi-step process involving 3D printing, index of refraction matching and silicone casting that renders the models transparent for flow visualization. Each model was treated with the same commercially-available, patient-specific, endovascular devices (coils and/or stents). All models were scanned by synchrotron X-ray microtomography to obtain high-resolution imaging of the vessel lumen, aneurysmal sac and endovascular devices. Dimensional accuracy was compared by quantifying the differences between the microtomographic reconstructions of the fabricated phantoms and the original 3DRA obtained during patient treatment. True-scale in vitro flow phantoms were successfully created for all six patients. Optical transparency was verified by using an index of refraction matched working fluid that replicated the mechanical behavior of blood. Synchrotron imaging of vessel lumen, aneurysmal sac and endovascular devices was successfully obtained, and dimensional errors were found to be O(100 μm). The creation of dimensionally-accurate, optically-transparent flow phantoms of patient-specific intracranial aneurysms is feasible using 3D printing technology. Such models may enable in vitro investigations of aneurysmal hemodynamics to aid in treatment planning and outcome prediction to devise optimal patient-specific neurointerventional strategies.
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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Dumas BM, Nava A, Law HZ, Smartt J, Derderian C, Seaward JR, Kane AA, Hallac RR. Three-Dimensional Printing for Craniofacial Surgery: A Single Institution’s 5-Year Experience. Cleft Palate Craniofac J 2018; 56:729-734. [DOI: 10.1177/1055665618798292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Blaike M. Dumas
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ana Nava
- Analytical Imaging and Modeling Center, Children’s Medical Center, Dallas, TX, USA
| | - Huay-Zong Law
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - James Smartt
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - James R. Seaward
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children’s Medical Center, Dallas, TX, USA
| | - Alex A. Kane
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children’s Medical Center, Dallas, TX, USA
| | - Rami R. Hallac
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children’s Medical Center, Dallas, TX, USA
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Pakzaban P. A 3-Dimensional-Printed Spine Localizer: Introducing the Concept of Online Dissemination of Novel Surgical Instruments. Neurospine 2018; 15:242-248. [PMID: 30126266 PMCID: PMC6226123 DOI: 10.14245/ns.1836068.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/16/2018] [Indexed: 11/21/2022] Open
Abstract
Background/Aims To date, applications of 3-dimensional (3D) printing in neurosurgery have been limited to the creation of anatomical models for training and simulation, fabrication of customized implants, and production of patient-specific surgical tool guides. We aim to demonstrate a new application of this technology for the online dissemination of novel surgical instrument designs across the world.
Methods A link to a 3D printing file and instructions for assembly of a spine localizer are included in this article. This device was used to determine the optimal location of skin incision in lumbar microsurgery in 43 consecutive patients. Data regarding the accuracy of the surgeon's initial estimate of the target site based on palpation of anatomical landmarks and the accuracy of the localizer device in locating the target spine segment were prospectively collected.
Results In 35 cases (81%), the surgeon’s initial estimate of the target site was correct. In the remaining 8 cases (19%), the initial estimate was off by 1 motion segment. Inaccuracy of the surgeon’s estimate was found to be associated with a higher body mass index and the presence of transitional lumbosacral anatomy, but not with age, sex, or location of the target segment. In all patients, the location of the incision guided by the localizer was found to overlie the target segment, yielding a device accuracy of 100%. There was no need to extend the incision or modify the surgical trajectory.
Conclusion This 3D-printable localizer serves as an example of a device that can be disseminated online and printed at the point of use, thus promoting online tool-sharing by neurosurgeons.
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Filippou V, Tsoumpas C. Recent advances on the development of phantoms using 3D printing for imaging with CT, MRI, PET, SPECT, and ultrasound. Med Phys 2018; 45. [PMID: 29933508 PMCID: PMC6849595 DOI: 10.1002/mp.13058] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/03/2018] [Accepted: 06/15/2018] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Printing technology, capable of producing three-dimensional (3D) objects, has evolved in recent years and provides potential for developing reproducible and sophisticated physical phantoms. 3D printing technology can help rapidly develop relatively low cost phantoms with appropriate complexities, which are useful in imaging or dosimetry measurements. The need for more realistic phantoms is emerging since imaging systems are now capable of acquiring multimodal and multiparametric data. This review addresses three main questions about the 3D printers currently in use, and their produced materials. The first question investigates whether the resolution of 3D printers is sufficient for existing imaging technologies. The second question explores if the materials of 3D-printed phantoms can produce realistic images representing various tissues and organs as taken by different imaging modalities such as computer tomography (CT), positron emission tomography (PET), single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), ultrasound (US), and mammography. The emergence of multimodal imaging increases the need for phantoms that can be scanned using different imaging modalities. The third question probes the feasibility and easiness of "printing" radioactive or nonradioactive solutions during the printing process. METHODS A systematic review of medical imaging studies published after January 2013 is performed using strict inclusion criteria. The databases used were Scopus and Web of Knowledge with specific search terms. In total, 139 papers were identified; however, only 50 were classified as relevant for this paper. In this review, following an appropriate introduction and literature research strategy, all 50 articles are presented in detail. A summary of tables and example figures of the most recent advances in 3D printing for the purposes of phantoms across different imaging modalities are provided. RESULTS All 50 studies printed and scanned phantoms in either CT, PET, SPECT, mammography, MRI, and US-or a combination of those modalities. According to the literature, different parameters were evaluated depending on the imaging modality used. Almost all papers evaluated more than two parameters, with the most common being Hounsfield units, density, attenuation and speed of sound. CONCLUSIONS The development of this field is rapidly evolving and becoming more refined. There is potential to reach the ultimate goal of using 3D phantoms to get feedback on imaging scanners and reconstruction algorithms more regularly. Although the development of imaging phantoms is evident, there are still some limitations to address: One of which is printing accuracy, due to the printer properties. Another limitation is the materials available to print: There are not enough materials to mimic all the tissue properties. For example, one material can mimic one property-such as the density of real tissue-but not any other property, like speed of sound or attenuation.
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Affiliation(s)
- Valeria Filippou
- Institute of Medical and Biological EngineeringFaculty of Mechanical EngineeringUniversity of LeedsLeedsLS2 9JTWest YorkshireUK
| | - Charalampos Tsoumpas
- Department of Biomedical Imaging ScienceSchool of MedicineUniversity of LeedsLeedsLS2 9NLWest YorkshireUK
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Qiu K, Haghiashtiani G, McAlpine MC. 3D Printed Organ Models for Surgical Applications. ANNUAL REVIEW OF ANALYTICAL CHEMISTRY (PALO ALTO, CALIF.) 2018; 11:287-306. [PMID: 29589961 PMCID: PMC6082023 DOI: 10.1146/annurev-anchem-061417-125935] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Medical errors are a major concern in clinical practice, suggesting the need for advanced surgical aids for preoperative planning and rehearsal. Conventionally, CT and MRI scans, as well as 3D visualization techniques, have been utilized as the primary tools for surgical planning. While effective, it would be useful if additional aids could be developed and utilized in particularly complex procedures involving unusual anatomical abnormalities that could benefit from tangible objects providing spatial sense, anatomical accuracy, and tactile feedback. Recent advancements in 3D printing technologies have facilitated the creation of patient-specific organ models with the purpose of providing an effective solution for preoperative planning, rehearsal, and spatiotemporal mapping. Here, we review the state-of-the-art in 3D printed, patient-specific organ models with an emphasis on 3D printing material systems, integrated functionalities, and their corresponding surgical applications and implications. Prior limitations, current progress, and future perspectives in this important area are also broadly discussed.
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Affiliation(s)
- Kaiyan Qiu
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, USA;
| | - Ghazaleh Haghiashtiani
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, USA;
| | - Michael C McAlpine
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, USA;
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Feldman H, Kamali P, Lin SJ, Halamka JD. Clinical 3D printing: A protected health information (PHI) and compliance perspective. Int J Med Inform 2018; 115:18-23. [PMID: 29779716 DOI: 10.1016/j.ijmedinf.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 03/15/2018] [Accepted: 04/12/2018] [Indexed: 12/17/2022]
Abstract
Advanced manufacturing techniques such as 3-dimensional (3D) printing, while mature in other industries, are starting to become more commonplace in clinical care. Clinicians are producing physical objects based on patient clinical data for use in planning care and educating patients, all of which should be managed like any other healthcare system data, except it exists in the "real" world. There are currently no provisions in the Health Insurance Portability and Accountability Act (HIPAA) either in its original 1996 form or in more recent updates that address the nature of physical representations of clinical data. We submit that if we define the source data as protected health information (PHI), then the objects 3D printed from that data need to be treated as both (PHI), and if used clinically, part of the clinical record, and propose some basic guidelines for quality and privacy like all documentation until regulatory frameworks can catch up to this technology. Many of the mechanisms designed in the paper and film chart era will work well with 3D printed patient data.
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Affiliation(s)
- Henry Feldman
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
| | - Parisa Kamali
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - John D Halamka
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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Parimi M, Buelter J, Thanugundla V, Condoor S, Parkar N, Danon S, King W. Feasibility and Validity of Printing 3D Heart Models from Rotational Angiography. Pediatr Cardiol 2018; 39:653-658. [PMID: 29305642 DOI: 10.1007/s00246-017-1799-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/22/2017] [Indexed: 01/17/2023]
Abstract
Rotational angiography (RA) has proven to be an excellent method for evaluating congenital disease (CHD) in the cardiac cath lab, permitting acquisition of 3D datasets with superior spatial resolution. This technique has not been routinely implemented for 3D printing in CHD. We describe our case series of models printed from RA and validate our technique. All patients with models printed from RA were selected. RA acquisitions from a Toshiba Infinix-I system were postprocessed and printed with a Stratasys Eden 260. Two independent observers measured 5-10 points of interest on both the RA and the 3D model. Bland Altman plot was used to compare the measurements on rotational angiography to the printed model. Models were printed from RA in 5 patients (age 2 months-1 year). Diagnoses included (a) coronary artery aneurysm, (b) Glenn shunt, (c) coarctation of the aorta, (d) tetralogy of Fallot with MAPCAs, and (e) pulmonary artery stenosis. There was no significant measurement difference between RA and the printed model (r = 0.990, p < 0.01, Bland Altman p = 0.987). There was also no significant inter-observer variability. The MAPCAs model was referenced by the surgeon intraoperatively and was accurate. Rotational angiography can generate highly accurate 3D models in congenital heart disease, including in small vascular structures. These models can be extremely useful in patient evaluation and management.
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Affiliation(s)
- Manoj Parimi
- Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA
| | - John Buelter
- Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA
| | - Vignan Thanugundla
- Saint Louis University Parks College of Engineering, 3450 Lindell Blvd, St. Louis, MO, 63103, USA
| | - Sri Condoor
- Saint Louis University Parks College of Engineering, 3450 Lindell Blvd, St. Louis, MO, 63103, USA
| | - Nadeem Parkar
- Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA
| | - Saar Danon
- Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA
| | - Wilson King
- Saint Louis University School of Medicine, 1402 South Grand Blvd, St. Louis, MO, 63104, USA.
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Ballard DH, Trace AP, Ali S, Hodgdon T, Zygmont ME, DeBenedectis CM, Smith SE, Richardson ML, Patel MJ, Decker SJ, Lenchik L. Clinical Applications of 3D Printing: Primer for Radiologists. Acad Radiol 2018; 25:52-65. [PMID: 29030285 DOI: 10.1016/j.acra.2017.08.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 12/22/2022]
Abstract
Three-dimensional (3D) printing refers to a number of manufacturing technologies that create physical models from digital information. Radiology is poised to advance the application of 3D printing in health care because our specialty has an established history of acquiring and managing the digital information needed to create such models. The 3D Printing Task Force of the Radiology Research Alliance presents a review of the clinical applications of this burgeoning technology, with a focus on the opportunities for radiology. Topics include uses for treatment planning, medical education, and procedural simulation, as well as patient education. Challenges for creating custom implantable devices including financial and regulatory processes for clinical application are reviewed. Precedent procedures that may translate to this new technology are discussed. The task force identifies research opportunities needed to document the value of 3D printing as it relates to patient care.
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Thawani JP, Singh N, Pisapia JM, Abdullah KG, Parker D, Pukenas BA, Zager EL, Verma R, Brem S. Three-Dimensional Printed Modeling of Diffuse Low-Grade Gliomas and Associated White Matter Tract Anatomy. Neurosurgery 2017; 80:635-645. [PMID: 28362934 DOI: 10.1093/neuros/nyx009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/23/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diffuse low-grade gliomas (DLGGs) represent several pathological entities that infiltrate and invade cortical and subcortical structures in the brain. OBJECTIVE To describe methods for rapid prototyping of DLGGs and surgically relevant anatomy. METHODS Using high-definition imaging data and rapid prototyping technologies, we were able to generate 3 patient DLGGs to scale and represent the associated white matter tracts in 3 dimensions using advanced diffusion tensor imaging techniques. RESULTS This report represents a novel application of 3-dimensional (3-D) printing in neurosurgery and a means to model individualized tumors in 3-D space with respect to subcortical white matter tract anatomy. Faculty and resident evaluations of this technology were favorable at our institution. CONCLUSION Developing an understanding of the anatomic relationships existing within individuals is fundamental to successful neurosurgical therapy. Imaging-based rapid prototyping may improve on our ability to plan for and treat complex neuro-oncologic pathology.
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Affiliation(s)
- Jayesh P Thawani
- Department of Neurosurgery, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania.,School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nickpreet Singh
- Department of Neurosurgery, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania.,Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jared M Pisapia
- Department of Neurosurgery, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania.,Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kalil G Abdullah
- School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Drew Parker
- Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bryan A Pukenas
- Department of Neurosurgery, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania.,Department of Radiology, Division of Neuroradiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric L Zager
- Department of Neurosurgery, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania
| | - Ragini Verma
- Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven Brem
- Department of Neurosurgery, Univer-sity of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
Three-dimensional printing has evolved dramatically in recent years and is now available for clinical use. Technical operations of 2 of the most common rapid prototyping processes (stereolithography and fused deposition modeling) and the steps involved in the creation of a prototype are discussed. Current applications in human neurosurgery including presurgical planning and educational opportunities are reviewed before focusing on the current applications in veterinary neurology.
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Four-Dimensional Phase Contrast Magnetic Resonance Imaging Protocol Optimization Using Patient-Specific 3-Dimensional Printed Replicas for In Vivo Imaging Before and After Flow Diverter Placement. World Neurosurg 2017. [DOI: 10.1016/j.wneu.2017.06.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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George E, Liacouras P, Rybicki FJ, Mitsouras D. Measuring and Establishing the Accuracy and Reproducibility of 3D Printed Medical Models. Radiographics 2017; 37:1424-1450. [PMID: 28800287 PMCID: PMC5621728 DOI: 10.1148/rg.2017160165] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/25/2016] [Accepted: 12/21/2016] [Indexed: 12/20/2022]
Abstract
Despite the rapid growth of three-dimensional (3D) printing applications in medicine, the accuracy and reproducibility of 3D printed medical models have not been thoroughly investigated. Although current technologies enable 3D models to be created with accuracy within the limits of clinical imaging spatial resolutions, this is not always achieved in practice. Inaccuracies are due to errors that occur during the imaging, segmentation, postprocessing, and 3D printing steps. Radiologists' understanding of the factors that influence 3D printed model accuracy and the metrics used to measure this accuracy is key in directing appropriate practices and establishing reference standards and validation procedures. The authors review the various factors in each step of the 3D model printing process that contribute to model inaccuracy, including the intrinsic limitations of each printing technology. In addition, common sources of model inaccuracy are illustrated. Metrics involving comparisons of model dimensions and morphology that have been developed to quantify differences between 3D models also are described and illustrated. These metrics can be used to define the accuracy of a model, as compared with the reference standard, and to measure the variability of models created by different observers or using different workflows. The accuracies reported for specific indications of 3D printing are summarized, and potential guidelines for quality assurance and workflow assessment are discussed. Online supplemental material is available for this article. ©RSNA, 2017.
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Affiliation(s)
- Elizabeth George
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (E.G., D.M.); 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L.); and Department of Radiology, University of Ottawa Faculty of Medicine and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (F.J.R.)
| | - Peter Liacouras
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (E.G., D.M.); 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L.); and Department of Radiology, University of Ottawa Faculty of Medicine and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (F.J.R.)
| | - Frank J. Rybicki
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (E.G., D.M.); 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L.); and Department of Radiology, University of Ottawa Faculty of Medicine and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (F.J.R.)
| | - Dimitrios Mitsouras
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (E.G., D.M.); 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L.); and Department of Radiology, University of Ottawa Faculty of Medicine and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (F.J.R.)
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Wang L, Ye X, Hao Q, Chen Y, Chen X, Wang H, Wang R, Zhao Y, Zhao J. Comparison of Two Three-Dimensional Printed Models of Complex Intracranial Aneurysms for Surgical Simulation. World Neurosurg 2017; 103:671-679. [DOI: 10.1016/j.wneu.2017.04.098] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/13/2017] [Accepted: 04/15/2017] [Indexed: 11/30/2022]
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Takao H, Amemiya S, Shibata E, Ohtomo K. 3D Printing of Preoperative Simulation Models of a Splenic Artery Aneurysm: Precision and Accuracy. Acad Radiol 2017; 24:650-653. [PMID: 28130050 DOI: 10.1016/j.acra.2016.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE AND OBJECTIVES Three-dimensional (3D) printing is attracting increasing attention in the medical field. This study aimed to apply 3D printing to the production of hollow splenic artery aneurysm models for use in the simulation of endovascular treatment, and to evaluate the precision and accuracy of the simulation model. MATERIALS AND METHODS From 3D computed tomography (CT) angiography data of a splenic artery aneurysm, 10 hollow models reproducing the vascular lumen were created using a fused deposition modeling-type desktop 3D printer. After filling with water, each model was scanned using T2-weighted magnetic resonance imaging for the evaluation of the lumen. All images were coregistered, binarized, and then combined to create an overlap map. The cross-sectional area of the splenic artery aneurysm and its standard deviation (SD) were calculated perpendicular to the x- and y-axes. RESULTS Most voxels overlapped among the models. The cross-sectional areas were similar among the models, with SDs <0.05 cm2. The mean cross-sectional areas of the splenic artery aneurysm were slightly smaller than those calculated from the original mask images. The maximum mean cross-sectional areas calculated perpendicular to the x- and y-axes were 3.90 cm2 (SD, 0.02) and 4.33 cm2 (SD, 0.02), whereas those calculated from the original mask images were 4.14 cm2 and 4.66 cm2, respectively. The mean cross-sectional areas of the afferent artery were, however, almost the same as those calculated from the original mask images. CONCLUSION The results suggest that 3D simulation modeling of a visceral artery aneurysm using a fused deposition modeling-type desktop 3D printer and computed tomography angiography data is highly precise and accurate.
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Eley K. Centralised 3D printing in the NHS: a radiological review. Clin Radiol 2017; 72:269-275. [DOI: 10.1016/j.crad.2016.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 12/06/2016] [Accepted: 12/19/2016] [Indexed: 01/17/2023]
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