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Pérez-Cualtán CE, Vargas-Acevedo C, Sánchez-Posada J, Castro-Páez C, Gutiérrez-Vargas R, Forero-Melo JF, Pérez JM, Briceño JC, Medina HM, Umaña JP, Navarro-Rueda J, Guerrero-Chalela CE. Surgical planning aided with 3D technologies for management of complex paracardiac tumors. J Cardiothorac Surg 2024; 19:548. [PMID: 39342312 PMCID: PMC11438039 DOI: 10.1186/s13019-024-03096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 09/15/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Accurate diagnosis and treatment of complex cardiac tumors poses challenges, particularly when surgical resection is considered. 3D reconstruction and printing appear as a novel approach to allow heart teams for optimal surgical and post operative care. METHODS We report two patients with uncommon masses including a cardiac angiosarcoma (CAS) and a IgG4-related disease (IgG4-RD) with exclusive cardiac involvement. In both cases, three-dimensional (3D) reconstruction and 3D-printed models were utilized to aid the surgical team achieve optimal pre-operative planning. Both patients underwent ECG-gated cardiac computed tomography angiography (CCTA) imaging and, due to the complex anatomy of the masses, their large dimensions, proximity to vital cardiac and vascular structures, and unclear etiology, computational and 3D-printed models were created for surgical planning. An exploratory literature review of studies using 3D-printed models in surgical planning was performed. RESULTS In case 1 (CAS), due to the size and extension of the mass to the right ventricular free wall, surgical intervention was not considered curative and, during thoracotomy, an open biopsy confirmed the imaging suspicion of CAS which guided the initiation of optimal medical treatment with chemotherapy and, after clear tumor retraction, the patient underwent a second surgical intervention, and during the 18 months of follow-up showed no signs of recurrence. In Case 2 (IgG4-RD), the patient underwent uncomplicated total surgical resection; this allowed directed treatment and, at 12 months follow-up, there are no signs of recurrence. Computational and 3D-printed models were used to plan the surgery and to confirm the findings. Limited studies have explored the use of 3D printing in the surgical planning of tumors. CONCLUSIONS We present two patients with uncommon cardiac tumors, highlighting the significant value of 3D models in the anatomical characterization and assessment of their extension. These models may be essential in surgical planning for complex cardiovascular cases and could provide more information than conventional imaging modalities. Further studies are needed to demonstrate the impact of 3D technologies in studying cardiac tumors.
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Affiliation(s)
- Camilo E Pérez-Cualtán
- Department of Biomedical Engineering, Universidad de los Andes, Bogotá, Colombia
- Center for 3D Modeling and Printing, Fundación Cardioinfantil - LaCardio, Bogotá, Colombia
| | | | | | - Camila Castro-Páez
- Department of Biomedical Engineering, Universidad de los Andes, Bogotá, Colombia
- Center for 3D Modeling and Printing, Fundación Cardioinfantil - LaCardio, Bogotá, Colombia
| | - Roberto Gutiérrez-Vargas
- Center for 3D Modeling and Printing, Fundación Cardioinfantil - LaCardio, Bogotá, Colombia
- School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Julián F Forero-Melo
- Center for 3D Modeling and Printing, Fundación Cardioinfantil - LaCardio, Bogotá, Colombia
- Department of Radiology and Diagnostic Imaging, Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia
| | - Juan Manuel Pérez
- Center for 3D Modeling and Printing, Fundación Cardioinfantil - LaCardio, Bogotá, Colombia
- Department of Radiology and Diagnostic Imaging, Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia
| | - Juan Carlos Briceño
- Department of Biomedical Engineering, Universidad de los Andes, Bogotá, Colombia
- Center for 3D Modeling and Printing, Fundación Cardioinfantil - LaCardio, Bogotá, Colombia
| | - Héctor M Medina
- Department of Cardiac Imaging, The Texas Heart Institute, Baylor College of Medicine, Houston, TX, USA
| | - Juan Pablo Umaña
- Department of Cardiac Surgery, Cleveland Clinic, Weston, FL, USA
| | - Javier Navarro-Rueda
- Center for 3D Modeling and Printing, Fundación Cardioinfantil - LaCardio, Bogotá, Colombia
- Department of Industrial Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Eduardo Guerrero-Chalela
- Center for 3D Modeling and Printing, Fundación Cardioinfantil - LaCardio, Bogotá, Colombia.
- Fundación Cardioinfantil - Instituto de Cardiología, Calle 163A # 13B - 60 Bogotá, Bogotá, 1113111, Colombia.
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Zhang C, Hallbeck MS, Salehinejad H, Thiels C. The integration of artificial intelligence in robotic surgery: A narrative review. Surgery 2024; 176:552-557. [PMID: 38480053 DOI: 10.1016/j.surg.2024.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/26/2023] [Accepted: 02/09/2024] [Indexed: 08/18/2024]
Abstract
BACKGROUND The rise of high-definition imaging and robotic surgery has independently been associated with improved postoperative outcomes. However, steep learning curves and finite human cognitive ability limit the facility in imaging interpretation and interaction with the robotic surgery console interfaces. This review presents innovative ways in which artificial intelligence integrates preoperative imaging and surgery to help overcome these limitations and to further advance robotic operations. METHODS PubMed was queried for "artificial intelligence," "machine learning," and "robotic surgery." From the 182 publications in English, a further in-depth review of the cited literature was performed. RESULTS Artificial intelligence boasts efficiency and proclivity for large amounts of unwieldy and unstructured data. Its wide adoption has significant practice-changing implications throughout the perioperative period. Assessment of preoperative imaging can augment preoperative surgeon knowledge by accessing pathology data that have been traditionally only available postoperatively through analysis of preoperative imaging. Intraoperatively, the interaction of artificial intelligence with augmented reality through the dynamic overlay of preoperative anatomical knowledge atop the robotic operative field can outline safe dissection planes, helping surgeons make critical real-time intraoperative decisions. Finally, semi-independent artificial intelligence-assisted robotic operations may one day be performed by artificial intelligence with limited human intervention. CONCLUSION As artificial intelligence has allowed machines to think and problem-solve like humans, it promises further advancement of existing technologies and a revolution of individualized patient care. Further research and ethical precautions are necessary before the full implementation of artificial intelligence in robotic surgery.
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Affiliation(s)
- Chi Zhang
- Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, MN. https://twitter.com/ChiZhang_MD
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, MN; Division of Health Care Delivery Research, Mayo Clinic Rochester, MN; Department of Surgery, Mayo Clinic Rochester, MN
| | - Hojjat Salehinejad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, MN; Division of Health Care Delivery Research, Mayo Clinic Rochester, MN. https://twitter.com/SalehinejadH
| | - Cornelius Thiels
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, MN; Department of Surgery, Mayo Clinic Rochester, MN.
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Wolf C, Juchem D, Koster A, Pilloy W. Generation of Customized Bone Implants from CT Scans Using FEA and AM. MATERIALS (BASEL, SWITZERLAND) 2024; 17:4241. [PMID: 39274630 PMCID: PMC11396358 DOI: 10.3390/ma17174241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 09/16/2024]
Abstract
Additive manufacturing (AM) allows the creation of customized designs for various medical devices, such as implants, casts, and splints. Amongst other AM technologies, fused filament fabrication (FFF) facilitates the production of intricate geometries that are often unattainable through conventional methods like subtractive manufacturing. This study aimed to develop a methodology for substituting a pathological talus bone with a personalized one created using additive manufacturing. The process involved generating a numerical parametric solid model of the specific anatomical region using computed tomography (CT) scans of the corresponding healthy organ from the patient. The healthy talus served as a mirrored template to replace the defective one. Structural simulation of the model through finite element analysis (FEA) helped compare and select different materials to identify the most suitable one for the replacement bone. The implant was then produced using FFF technology. The developed procedure yielded commendable results. The models maintained high geometric accuracy, while significantly reducing the computational time. PEEK emerged as the optimal material for bone replacement among the considered options and several specimens of talus were successfully printed.
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Affiliation(s)
- Claude Wolf
- Department of Engineering, University of Luxembourg, 6 Rue Coudenhove-Kalergi, L-1359 Luxembourg, Luxembourg
| | - Deborah Juchem
- Department of Engineering, University of Luxembourg, 6 Rue Coudenhove-Kalergi, L-1359 Luxembourg, Luxembourg
| | - Anna Koster
- Department of Engineering, University of Luxembourg, 6 Rue Coudenhove-Kalergi, L-1359 Luxembourg, Luxembourg
| | - Wilfrid Pilloy
- Department of Nuclear Medicine, Sefako Makgatho University, Ga-Rankuwa 0208, South Africa
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Wang KC, Ryan JR, Chepelev L, Wake N, Quigley EP, Santiago L, Wentworth A, Alexander A, Morris JM, Fleischmann D, Ballard DH, Ravi P, Hirsch JD, Sturgeon GM, Huang YH, Decker SJ, von Windheim N, Pugliese RS, Hidalgo RV, Patel P, Colon J, Thieringer FM, Rybicki FJ. Demographics, Utilization, Workflow, and Outcomes Based on Observational Data From the RSNA-ACR 3D Printing Registry. J Am Coll Radiol 2024:S1546-1440(24)00684-7. [PMID: 39117182 DOI: 10.1016/j.jacr.2024.07.019] [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: 05/20/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE The aim of this study was to report data from the first 3 years of operation of the RSNA-ACR 3D Printing Registry. METHODS Data from June 2020 to June 2023 were extracted, including demographics, indications, workflow, and user assessments. Clinical indications were stratified by 12 organ systems. Imaging modalities, printing technologies, and numbers of parts per case were assessed. Effort data were analyzed, dividing staff members into provider and nonprovider categories. The opinions of clinical users were evaluated using a Likert scale questionnaire, and estimates of procedure time saved were collected. RESULTS A total of 20 sites and 2,637 cases were included, consisting of 1,863 anatomic models and 774 anatomic guides. Mean patient ages for models and guides were 42.4 ± 24.5 years and 56.3 ± 18.5 years, respectively. Cardiac models were the most common type of model (27.2%), and neurologic guides were the most common type of guide (42.4%). Material jetting, vat photopolymerization, and material extrusion were the most common printing technologies used overall (85.6% of all cases). On average, providers spent 92.4 min and nonproviders spent 335.0 min per case. Providers spent most time on consultation (33.6 min), while nonproviders focused most on segmentation (148.0 min). Confidence in treatment plans increased after using 3-D printing (P < .001). Estimated procedure time savings for 155 cases was 40.5 ± 26.1 min. CONCLUSIONS Three-dimensional printing is performed at health care facilities for many clinical indications. The registry provides insight into the technologies and workflows used to create anatomic models and guides, and the data show clinical benefits from 3-D printing.
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Affiliation(s)
- Kenneth C Wang
- Imaging Service, Baltimore VA Medical Center, Baltimore, Maryland; Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland; and Co-chair, 3D Printing Registry Committee, American College of Radiology.
| | - Justin R Ryan
- 3D Innovations Lab, Rady Children's Hospital, San Diego, California; and Department of Neurological Surgery, University of California San Diego Health, San Diego, California
| | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Wake
- Director, Department of Research and Scientific Affairs, GE Healthcare, New York, New York; and Department of Radiology, NYU Grossman School of Medicine, New York, New York. https://twitter.com/Wake_Imaging
| | - Edward P Quigley
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah
| | - Lumarie Santiago
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas. https://twitter.com/LumarieSantiago
| | - Adam Wentworth
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Amy Alexander
- Division of Engineering, Mayo Clinic, Rochester, Minnesota. https://twitter.com/AmyAlexanderMC
| | - Jonathan M Morris
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Leadership roles: Executive Medical Director, Immersive and Experiential Learning, Mayo Clinic; Medical Director, Anatomic Modeling Unit, Mayo Clinic; and Medical Director, Biomedical and Scientific Visualization, Mayo Clinic
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Palo Alto, California; Director, Computed Tomography, Stanford University; Chief, Cardiovascular Imaging, Stanford University; and Medical Director, 3DQ Lab, Stanford University
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri. https://twitter.com/DavidBallardMD
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeffrey D Hirsch
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gregory M Sturgeon
- Duke Children's Pediatric and Congenital Heart Center, Durham, North Carolina
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota. https://twitter.com/yuhuihuang
| | - Summer J Decker
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Radiology, University of South Florida, Morsani College of Medicine, Tampa, Florida; and Director, Center for Advanced Visualization Technologies in Medicine, University of Southern California
| | - Natalia von Windheim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio; and KLS Martin, Jacksonville, Florida
| | - Robert S Pugliese
- Health Design Lab, Thomas Jefferson University, Philadelphia, Pennsylvania. https://twitter.com/RSPugliese
| | - Ronald V Hidalgo
- Imagineering Lab, Southern Illinois University School of Medicine, Springfield, Illinois; and Department of Radiology, Springfield Clinic, Springfield, Illinois
| | | | - Joseb Colon
- Atrium Health Levine Children's HEARTest Yard Congenital Heart Center, Charlotte, North Carolina
| | - Florian M Thieringer
- Chair, Department of Oral and Cranio-Maxillofacial Surgery, and 3D Print Lab, University Hospital Basel, Basel, Switzerland; and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Frank J Rybicki
- Chair, Department of Radiology, University of Arizona College of Medicine, Phoenix, Arizona; Department of Radiology, Banner University Medical Group, Phoenix, Arizona; and Co-chair, 3D Printing Registry Committee, American College of Radiology. https://twitter.com/FrankRybicki
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Krishnaswamy A, Kassab J, Harb SC. Beyond Simple Visualization: A New Reality for Structural Heart Interventions? J Am Heart Assoc 2024; 13:e036238. [PMID: 39041623 DOI: 10.1161/jaha.124.036238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Affiliation(s)
| | - Joseph Kassab
- Heart and Vascular Institute, Cleveland Clinic Cleveland OH USA
| | - Serge C Harb
- Heart and Vascular Institute, Cleveland Clinic Cleveland OH USA
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Lewandrowski KU, Vira S, Elfar JC, Lorio MP. Advancements in Custom 3D-Printed Titanium Interbody Spinal Fusion Cages and Their Relevance in Personalized Spine Care. J Pers Med 2024; 14:809. [PMID: 39202002 PMCID: PMC11355268 DOI: 10.3390/jpm14080809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/17/2024] [Accepted: 07/24/2024] [Indexed: 09/03/2024] Open
Abstract
3D-printing technology has revolutionized spinal implant manufacturing, particularly in developing personalized and custom-fit titanium interbody fusion cages. These cages are pivotal in supporting inter-vertebral stability, promoting bone growth, and restoring spinal alignment. This article reviews the latest advancements in 3D-printed titanium interbody fusion cages, emphasizing their relevance in modern personalized surgical spine care protocols applied to common clinical scenarios. Furthermore, the authors review the various printing and post-printing processing technologies and discuss how engineering and design are deployed to tailor each type of implant to its patient-specific clinical application, highlighting how anatomical and biomechanical considerations impact their development and manufacturing processes to achieve optimum osteoinductive and osteoconductive properties. The article further examines the benefits of 3D printing, such as customizable geometry and porosity, that enhance osteointegration and mechanical compatibility, offering a leap forward in patient-specific solutions. The comparative analysis provided by the authors underscores the unique challenges and solutions in designing cervical, and lumbar spine implants, including load-bearing requirements and bioactivity with surrounding bony tissue to promote cell attachment. Additionally, the authors discuss the clinical outcomes associated with these implants, including the implications of improvements in surgical precision on patient outcomes. Lastly, they address strategies to overcome implementation challenges in healthcare facilities, which often resist new technology acquisitions due to perceived cost overruns and preconceived notions that hinder potential savings by providing customized surgical implants with the potential for lower complication and revision rates. This comprehensive review aims to provide insights into how modern 3D-printed titanium interbody fusion cages are made, explain quality standards, and how they may impact personalized surgical spine care.
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona, Division Personalized Pain Research and Education, Tucson, AZ 85712, USA
- Department of Orthopaedics, Fundación Universitaria Sanitas Bogotá, Bogotá 111321, Colombia
| | - Shaleen Vira
- Orthopedic and Sports Medicine Institute, Banner-University Tucson Campus, 755 East McDowell Road, Floor 2, Phoenix, AZ 85006, USA;
| | - John C. Elfar
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, AZ 85721, USA
| | - Morgan P. Lorio
- Advanced Orthopedics, 499 East Central Parkway, Altamonte Springs, FL 32701, USA;
- Orlando College of Osteopathic Medicine, Orlando, FL 34787, USA
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Ahmed M, Garzanich M, Melaragno LE, Nyirjesy S, Windheim NV, Marquardt M, Luttrull M, Quails N, VanKoevering KK. Exploring CT pixel and voxel size effect on anatomic modeling in mandibular reconstruction. 3D Print Med 2024; 10:21. [PMID: 38922481 PMCID: PMC11202317 DOI: 10.1186/s41205-024-00223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Computer-aided modeling and design (CAM/CAD) of patient anatomy from computed tomography (CT) imaging and 3D printing technology enable the creation of tangible, patient-specific anatomic models that can be used for surgical guidance. These models have been associated with better patient outcomes; however, a lack of CT imaging guidelines risks the capture of unsuitable imaging for patient-specific modeling. This study aims to investigate how CT image pixel size (X-Y) and slice thickness (Z) impact the accuracy of mandibular models. METHODS Six cadaver heads were CT scanned at varying slice thicknesses and pixel sizes and turned into CAD models of the mandible for each scan. The cadaveric mandibles were then dissected and surface scanned, producing a CAD model of the true anatomy to be used as the gold standard for digital comparison. The root mean square (RMS) value of these comparisons, and the percentage of points that deviated from the true cadaveric anatomy by over 2.00 mm were used to evaluate accuracy. Two-way ANOVA and Tukey-Kramer post-hoc tests were used to determine significant differences in accuracy. RESULTS Two-way ANOVA demonstrated significant difference in RMS for slice thickness but not pixel size while post-hoc testing showed a significant difference in pixel size only between pixels of 0.32 mm and 1.32 mm. For slice thickness, post-hoc testing revealed significantly smaller RMS values for scans with slice thicknesses of 0.67 mm, 1.25 mm, and 3.00 mm compared to those with a slice thickness of 5.00 mm. No significant differences were found between 0.67 mm, 1.25 mm, and 3.00 mm slice thicknesses. Results for the percentage of points deviating from cadaveric anatomy greater than 2.00 mm agreed with those for RMS except when comparing pixel sizes of 0.75 mm and 0.818 mm against 1.32 mm in post-hoc testing, which showed a significant difference as well. CONCLUSION This study suggests that slice thickness has a more significant impact on 3D model accuracy than pixel size, providing objective validation for guidelines favoring rigorous standards for slice thickness while recommending isotropic voxels. Additionally, our results indicate that CT scans up to 3.00 mm in slice thickness may provide an adequate 3D model for facial bony anatomy, such as the mandible, depending on the clinical indication.
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Affiliation(s)
- Maariyah Ahmed
- Center for Design and Manufacturing Excellence, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus, OH, USA
| | - Myra Garzanich
- Center for Design and Manufacturing Excellence, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus, OH, USA
| | - Luigi E Melaragno
- Center for Design and Manufacturing Excellence, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus, OH, USA
| | - Sarah Nyirjesy
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, 460 W 10th Ave 5th Floor Clinic, Columbus, OH, 43220, USA
| | - Natalia Von Windheim
- Center for Design and Manufacturing Excellence, The Ohio State University, Columbus, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, 460 W 10th Ave 5th Floor Clinic, Columbus, OH, 43220, USA
| | - Matthew Marquardt
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, 460 W 10th Ave 5th Floor Clinic, Columbus, OH, 43220, USA
| | - Michael Luttrull
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nathan Quails
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, 460 W 10th Ave 5th Floor Clinic, Columbus, OH, 43220, USA.
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Grigoroiu M, Paul JF, Brian E, Aegerter P, Boddaert G, Mariolo A, Jorrot P, Bellahoues M, Seguin-Givelet A, Perduca V. 3D printing in anatomical lung segmentectomies: A randomized pilot trial. Heliyon 2024; 10:e31842. [PMID: 38867971 PMCID: PMC11168317 DOI: 10.1016/j.heliyon.2024.e31842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/04/2024] [Accepted: 05/22/2024] [Indexed: 06/14/2024] Open
Abstract
Objective This pilot study evaluated the impact of using a 3D printed model of the patient's bronchovascular lung anatomy on the mental workload and fatigue of surgeons during full thoracoscopic segmentectomy. Design We performed a feasibility pilot study of a prospective randomized controlled trial with 2 parallel arms. All included patients underwent digital 3D visual reconstruction of their bronchovascular anatomy and were randomized into the following two groups: Digital arm (only a virtual 3D model was available) and Digital + Object arm (both virtual and printed 3D models were available). The primary end-point was the surgeons' mental workload measured using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) score. Setting Between October 28, 2020 and October 05, 2021, we successively investigated all anatomic segmentectomies performed via thoracoscopy in the Thoracic Department of the Montsouris Mutualiste Institute, except for S6 segmentectomies and S4+5 left bi-segmentectomies. Participants We assessed 102 patients for anatomical segmentectomy. Among the, 40 were randomly assigned, and 34 were deemed analysable, with 17 patients included in each arm. Results Comparison of the two groups, each comprising 17 patients, revealed no statistically significant difference in primary or secondary end-points. The consultation of the visual digital model was significantly less frequent when a 3D printed model was available (6 versus 54 consultations, p = 0.001). Notably, both arms exhibited high NASA-TLX scores, particularly in terms of mental demand, temporal demand, and effort scores. Conclusion In our pilot study, 3D printed models and digital 3D reconstructions for pre-operative planning had an equivalent effect on thoracoscopic anatomic segmentectomy for experienced surgeons. The originality of this study lies in its focus on the impact of 3D printing of bronchovascular anatomy on surgeons, rather than solely on the surgical procedure.
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Affiliation(s)
- Madalina Grigoroiu
- Institut Mutualiste Montsouris, Institut Du Thorax Curie-Montsouris, 42, Boulevard Jourdan, 75014, Paris, France
| | - Jean-François Paul
- Institut Mutualiste Montsouris, Département de Radiologie, 42, Boulevard Jourdan, 75014, Paris, France
| | - Emmanuel Brian
- Institut Mutualiste Montsouris, Institut Du Thorax Curie-Montsouris, 42, Boulevard Jourdan, 75014, Paris, France
| | - Philippe Aegerter
- GIRCI-IDF, Cellule Méthodologie, 4, Av Richerand, 75010, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP U1018, 12, Av Paul-Couturier 94807, Villejuif, France
| | - Guillaume Boddaert
- Institut Mutualiste Montsouris, Institut Du Thorax Curie-Montsouris, 42, Boulevard Jourdan, 75014, Paris, France
| | - Alessio Mariolo
- Institut Mutualiste Montsouris, Institut Du Thorax Curie-Montsouris, 42, Boulevard Jourdan, 75014, Paris, France
| | - Pierre Jorrot
- Institut Mutualiste Montsouris, Département de Rythmologie, 42, Boulevard Jourdan, 75014. Paris, France
| | - Mouloud Bellahoues
- Institut Mutualiste Montsouris, Département de Recherche Clinique, 42, Boulevard Jourdan, 75014, Paris, France
| | - Agathe Seguin-Givelet
- Institut Mutualiste Montsouris, Institut Du Thorax Curie-Montsouris, 42, Boulevard Jourdan, 75014, Paris, France
| | - Vittorio Perduca
- Université Paris Cité, CNRS, MAP5, 44, Rue des Saint Pères, 75006, Paris, France
- Université Paris Saclay, UVSQ, INSERM, CESP U1018, « Exposome, Heredity, Cancer and Health » Team, Gustave Roussy, 12, Av Paul-Couturier, 94807, Villejuif, France
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9
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Ravi P, Burch MB, Giannopoulos AA, Liu I, Kondor S, Chepelev LL, Danesi TH, Rybicki FJ, Panza A. Desktop 3D printed anatomic models for minimally invasive direct coronary artery bypass. 3D Print Med 2024; 10:19. [PMID: 38864937 PMCID: PMC11167900 DOI: 10.1186/s41205-024-00222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 06/06/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Three-dimensional (3D) printing technology has impacted many clinical applications across medicine. However, 3D printing for Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) has not yet been reported in the peer-reviewed literature. The current observational cohort study aimed to evaluate the impact of half scaled (50% scale) 3D printed (3DP) anatomic models in the pre-procedural planning of MIDCAB. METHODS Retrospective analysis included 12 patients who underwent MIDCAB using 50% scale 3D printing between March and July 2020 (10 males, 2 females). Distances measured from CT scans and 3DP anatomic models were correlated with Operating Room (OR) measurements. The measurements were compared statistically using Tukey's test. The correspondence between the predicted (3DP & CT) and observed best InterCostal Space (ICS) in the OR was recorded. Likert surveys from the 3D printing registry were provided to the surgeon to assess the utility of the model. The OR time saved by planning the procedure using 3DP anatomic models was estimated subjectively by the cardiothoracic surgeon. RESULTS All 12 patients were successfully grafted. The 3DP model predicted the optimal ICS in all cases (100%). The distances measured on the 3DP model corresponded well to the distances measured in the OR. The measurements were significantly different between the CT and 3DP (p < 0.05) as well as CT and OR (p < 0.05) groups, but not between the 3DP and OR group. The Likert responses suggested high clinical utility of 3D printing. The mean subjectively estimated OR time saved was 40 min. CONCLUSION The 50% scaled 3DP anatomic models demonstrated high utility for MIDCAB and saved OR time while being resource efficient. The subjective benefits over routine care that used 3D visualization for surgical planning warrants further investigation.
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Affiliation(s)
- Prashanth Ravi
- Department of Radiology, University of Cincinnati, 3188 Bellevue Ave, PO Box 670761, Cincinnati, OH, 45267-0761, USA.
| | - Michael B Burch
- Department of Radiology, University of Cincinnati, 3188 Bellevue Ave, PO Box 670761, Cincinnati, OH, 45267-0761, USA
| | | | - Isabella Liu
- Department of Radiology, University of Cincinnati, 3188 Bellevue Ave, PO Box 670761, Cincinnati, OH, 45267-0761, USA
| | - Shayne Kondor
- Department of Radiology, University of Cincinnati, 3188 Bellevue Ave, PO Box 670761, Cincinnati, OH, 45267-0761, USA
| | | | - Tommaso H Danesi
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Frank J Rybicki
- Department of Radiology, University of Arizona, Phoenix, AZ, USA
| | - Antonio Panza
- Division of Cardiac Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
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10
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Kanmaz YA, Baygeldi SB, Güzel BC, Yılmaz Y, Karan M, Hark BD, Yılmaz S. Evaluation and 3D imaging of mineral structure changes of the rabbit (New Zealand) skull during developmental periods. Anat Histol Embryol 2024; 53:e13053. [PMID: 38735036 DOI: 10.1111/ahe.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
This study aimed to determine the morphometric measurements anatomically and CT images of skulls of healthy male and female rabbits during postnatal development, to analyse the data statistically and to demonstrate the structural changes in bone. A total of 40 rabbits (20 females and 20 males) were divided into four groups including prepubertal period (group I (0-1 month)), period between adolescence and adulthood (group II (3-5 month)) and later (young adult period as group III (1-3 years) and old adult period as group IV (3-5 years)), with five animals in each group. After the morphometric measurements, the surface area and volume values of the skull were calculated. The skulls were reconstructed using a 3D Slicer (5.0.2), which is used for 3D modelling. The cranial bones in each group were then crushed using a grinder so that the powdered samples were obtained for XRF (X-ray fluorescence technique). The p-value was statistically highly significant between group and gender (p < 0.001). In morphometric measurements, males were generally higher than females. Only PL, GBOC and GNB measurements were higher in females. The p-value between groups (in all measurements), between genders (in TL, GLN, FL, VL, OZB and GBN parameters) and between groups and genders (in TL, DL and VL parameters) was statistically highly significant (p < 0.001). The p-value between the groups, p-value between sexes and p-value between group and sex in Si, P, K, Ca, Ni, Zn, Sr, Sr and Ca/P elements were statistically significant (p < 0.001). Consequently, metric, volume and surface area measurements were taken through 3D modelling of skull bone in prepubertal period (group I), period between adolescence and adulthood (group II) and later (young adult period as group III and old adult period as group IV) of rabbits and the change in the mineral structure during postnatal development and effect of sex on this change were investigated. This might be the first study to assess both metric and mineral changes at four age intervals taken during the life span of rabbits.
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Affiliation(s)
- Yeşim Aslan Kanmaz
- Department of Anatomy, Faculty of Veterinary Medicine, University of Fırat, Elazığ, Turkey
| | - Saime Betül Baygeldi
- Department of Anatomy, Faculty of Veterinary Medicine, University of Fırat, Elazığ, Turkey
| | - Barış Can Güzel
- Department of Veterinary Anatomy, University of Siirt, Siirt, Turkey
| | - Yücehan Yılmaz
- Department of Physiology, Faculty of Medicine, University of Adıyaman, Adıyaman, Turkey
| | - Meryem Karan
- Department of Anatomy, Faculty of Veterinary Medicine, University of Fırat, Elazığ, Turkey
| | - Betül Dağoğlu Hark
- Department of Medicine Biostatistics, University of Firat, Elazığ, Turkey
| | - Sadık Yılmaz
- Department of Anatomy, Faculty of Veterinary Medicine, University of Fırat, Elazığ, Turkey
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11
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Reisman Y, van Renterghem K, Meijer B, Ricapito A, Fode M, Bettocchi C. Development and validation of 3-dimensional simulators for penile prosthesis surgery. J Sex Med 2024; 21:494-499. [PMID: 38477106 DOI: 10.1093/jsxmed/qdae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/02/2024] [Accepted: 01/21/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The acquisition of skills in penile prosthesis surgery has many limitations mainly due to the absence of simulators and models for training. Three-dimensional (3D) printed models can be utilized for surgical simulations, as they provide an opportunity to practice before entering the operating room and provide better understanding of the surgical approach. AIM This study aimed to evaluate and validate a 3D model of human male genitalia for penile prosthesis surgery. METHODS This study included 3 evaluation and validation stages. The first stage involved verification of the 3D prototype model for anatomic landmarks compared with a cadaveric pelvis. The second stage involved validation of the improved model for anatomic accuracy and teaching purposes with the Rochester evaluation score. The third stage comprised validation of the suitability of the 3D prototype model as a surgical simulator and for skill acquisition. The third stage was performed at 3 centers using a modified version of a pre-existing, validated questionnaire and correlated with the Rochester evaluation score. OUTCOME We sought to determine the suitability of 3D model for training in penile prosthesis surgery in comparison with the available cadaveric model. RESULTS The evaluation revealed a high Pearson correlation coefficient (0.86) between questions of the Rochester evaluation score and modified validated questionnaire. The 3D model scored 4.33 ± 0.57 (on a Likert scale from 1 to 5) regarding replication of the relevant human anatomy for the penile prosthesis surgery procedure. The 3D model scored 4.33 ± 0.57 (on a Likert scale from 1 to 5) regarding its ability to improve technical skills, teach and practice the procedure, and assess a surgeon's ability. Furthermore, the experts stated that compared with the cadaver, the 3D model presented greater ethical suitability, reduced costs, and easier accessibility. CLINICAL IMPLICATIONS A validated 3D model is a suitable alternative for penile prosthesis surgery training. STRENGTHS AND LIMITATIONS This is the first validated 3D hydrogel model for penile prosthesis surgery teaching and training that experts consider suitable for skill acquisition. Because specific validated guidelines and questionnaires for the validation and verifications of 3D simulators for penile surgery are not available, a modified questionnaire was used. CONCLUSION The current 3D model for penile prosthesis surgery shows promising results regarding anatomic properties and suitability to train surgeons to perform penile implant surgery. The possibility of having an ethical, easy-to-use model with lower costs and limited consequences for the environment is encouraging for further development of the models.
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Affiliation(s)
- Yacov Reisman
- Flare-Health, Amsterdam, the Netherlands
- Reuth Rehabilitation Hospital, Tel-Aviv 67062, Israel
| | | | - Boaz Meijer
- Department of Urology, Acibadem Medical Center, 1043, HP Amsterdam, the Netherlands
| | - Anna Ricapito
- Andrology and Male Genitalia Reconstructive Surgery Unit, University of Foggia, 71122, Foggia FG, Italy
| | - Mikkel Fode
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, 13DK-2730, Herlev, Denmark
| | - Carlo Bettocchi
- Andrology and Male Genitalia Reconstructive Surgery Unit, University of Foggia, 71122, Foggia FG, Italy
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12
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Zabala-Travers S, García-Bayce A. Setting up a biomodeling, virtual planning, and three-dimensional printing service in Uruguay. Pediatr Radiol 2024; 54:438-449. [PMID: 38324089 DOI: 10.1007/s00247-024-05864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
Virtual surgical planning and three-dimensional (D) printing are rapidly becoming essential for challenging and complex surgeries around the world. An Ibero-American survey reported a lack of awareness of technology benefits and scarce financial resources as the two main barriers to widespread adoption of 3-D technologies. The Pereira Rossell Hospital Center is a publicly funded maternal and pediatric academic clinical center in Uruguay, a low-resource Latin American country, that successfully created and has been running a 3-D unit for 4 years. The present work is a step-by-step review of the 3-D technology implementation process in a hospital with minimal financial investment. References to training, software, hardware, and the management of human resources are included. Difficulties throughout the process and future challenges are also discussed.
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Affiliation(s)
- Silvina Zabala-Travers
- Departamento de Imagenología, Centro Hospitalario Pereira Rossell, Bulevar Artigas 1550, 11300, Montevideo, Uruguay.
| | - Andrés García-Bayce
- Departamento de Imagenología, Centro Hospitalario Pereira Rossell, Bulevar Artigas 1550, 11300, Montevideo, Uruguay
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13
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Eveland R, Antloga K, Meyer A, Tuscano L. Low temperature vaporized hydrogen peroxide sterilization of 3D printed devices. 3D Print Med 2024; 10:6. [PMID: 38416324 PMCID: PMC10900786 DOI: 10.1186/s41205-024-00206-1] [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: 09/01/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Low temperature vaporized hydrogen peroxide sterilization (VH2O2) is used in hospitals today to sterilize reusable medical devices. VH2O2 sterilized 3D printed materials were evaluated for sterilization, biocompatibility and material compatibility. MATERIALS & METHODS Test articles were printed at Formlabs with BioMed Clear™ and BioMed Amber™, and at Stratasys with MED610™, MED615™ and MED620™. Sterilization, biocompatibility and material compatibility studies with 3D printed materials were conducted after VH2O2 sterilization in V-PRO™ Sterilizers. The overkill method was used to evaluate sterilization in a ½ cycle. Biocompatibility testing evaluated the processed materials as limited contact (< 24-hours) surface or externally communicating devices. Material compatibility after VH2O2 sterilization (material strength and dimensionality) was evaluated via ASTM methods and dimensional analysis. RESULTS 3D printed devices, within a specific design window, were sterile after VH2O2 ½ cycles. After multiple cycle exposure, the materials were not cytotoxic, not sensitizing, not an irritant, not a systemic toxin, not pyrogenic and were hemo-compatible. Material compatibility via ASTM testing and dimensionality evaluations did not indicate any significant changes to the 3D printed materials after VH2O2 sterilization. CONCLUSION Low temperature vaporized hydrogen peroxide sterilization is demonstrated as a suitable method to sterilize 3D printed devices. The results are a subset of the data used in a regulatory submission with the US FDA to support claims for sterilization of 3D printed devices with specified materials, printers, and device design 1.
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Affiliation(s)
| | | | - Ashley Meyer
- STERIS, 5960 Heisley Road, Mentor, OH, 44060, USA
| | - Lori Tuscano
- STERIS, 5960 Heisley Road, Mentor, OH, 44060, USA
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14
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Kopačin V, Zubčić V, Mumlek I, Mužević D, Rončević A, Lazar AM, Pavić AK, Koruga AS, Krivdić Z, Martinović I, Koruga N. Personalized 3D-printed cranial implants for complex cranioplasty using open-source software. Surg Neurol Int 2024; 15:39. [PMID: 38468644 PMCID: PMC10927182 DOI: 10.25259/sni_906_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/19/2024] [Indexed: 03/13/2024] Open
Abstract
Background Cranioplasty is a routine neurosurgery treatment used to correct cranial vault abnormalities. Utilization of 3D printing technology in the field of cranioplasty involving the reconstruction of cranial defects emerged as an advanced possibility of anatomical reshaping. The transformative impact of patient-specific 3D printed implants, focuses on their remarkable accuracy, customization capabilities, and enhanced biocompatibility. Methods The precise adaptation of implants to patient-specific anatomies, even in complex cases we presented, result in improved aesthetic outcomes and reduced surgical complications. The ability to create highly customized implants addresses the functional aspects of cranial defects and considers the psychological impact on patients. Results By combining technological innovation with personalized patient care, 3D printed cranioplasty emerges as a transformative avenue in cranial reconstruction, ultimately redefining the standards of success in neurosurgery. Conclusion 3D printing allows an excellent cranioplasty cosmesis achieved at a reasonable price without sacrificing patient outcomes. Wider implementation of this strategy can lead to significant healthcare cost savings.
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Affiliation(s)
- Vjekoslav Kopačin
- Department of Diagnostic and Interventional Radiology, University Hospital Center, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
| | - Vedran Zubčić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Maxillofacial and Oral Surgery, University Hospital Center, Osijek, Croatia
| | - Ivan Mumlek
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Maxillofacial and Oral Surgery, University Hospital Center, Osijek, Croatia
| | - Dario Mužević
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Neurosurgery, University Hospital Center, Osijek, Croatia
| | - Alen Rončević
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Neurosurgery, University Hospital Center, Osijek, Croatia
| | - Ana-Maria Lazar
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Maxillofacial and Oral Surgery, University Hospital Center, Osijek, Croatia
| | - Ana Kvolik Pavić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Maxillofacial and Oral Surgery, University Hospital Center, Osijek, Croatia
| | - Anamarija Soldo Koruga
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Neurology, University Hospital Center, Osijek, Croatia
| | - Zdravka Krivdić
- Department of Diagnostic and Interventional Radiology, University Hospital Center, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
| | - Ivana Martinović
- Department of Information Sciences, Faculty of Humanities and Social Sciences, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Nenad Koruga
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Neurosurgery, University Hospital Center, Osijek, Croatia
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15
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Giannopoulos AA, Tan TC. Three-dimensional models for coronary artery fistulas: to print, or not to print-that is the question. Eur Heart J Case Rep 2024; 8:ytae069. [PMID: 38374986 PMCID: PMC10875926 DOI: 10.1093/ehjcr/ytae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Affiliation(s)
- Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Raemistrasse 100, CH-8091, Switzerland
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, University of Western Sydney, Blacktown Road, Blacktown, NSW 2148, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia
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16
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Wood L, Ahmed Z. Does using 3D printed models for pre-operative planning improve surgical outcomes of foot and ankle fracture fixation? A systematic review and meta-analysis. Eur J Trauma Emerg Surg 2024; 50:21-35. [PMID: 36418394 PMCID: PMC10924018 DOI: 10.1007/s00068-022-02176-7] [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: 08/15/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The systematic review aims to establish the value of using 3D printing-assisted pre-operative planning, compared to conventional planning, for the operative management of foot and ankle fractures. METHODS The systematic review was performed according to PRISMA guidelines. Two authors performed searches on three electronic databases. Studies were included if they conformed to pre-established eligibility criteria. Primary outcome measures included intraoperative blood loss, operation duration, and fluoroscopy time. The American orthopaedic foot and ankle score (AOFAS) was used as a secondary outcome. Quality assessment was completed using the Cochrane RoB2 form and a meta-analysis was performed to assess heterogeneity. RESULTS Five studies met the inclusion and exclusion criteria and were eventually included in the review. A meta-analysis established that using 3D printed models for pre-operative planning resulted in a significant reduction in operation duration (mean difference [MD] = - 23.52 min, 95% CI [- 39.31, - 7.74], p = 0.003), intraoperative blood loss (MD = - 30.59 mL, 95% CI [- 46.31, - 14.87], p = 0.0001), and number of times fluoroscopy was used (MD = - 3.20 times, 95% CI [- 4.69, - 1.72], p < 0.0001). Using 3D printed models also significantly increased AOFAS score results (MD = 2.24, 95% CI [0.69, 3.78], p = 0.005), demonstrating improved ankle health. CONCLUSION The systematic review provides promising evidence that 3D printing-assisted surgery significantly improves treatment for foot and ankle fractures in terms of operation duration, intraoperative blood loss, number of times fluoroscopy was used intraoperatively, and improved overall ankle health as measured by the AOFAS score.
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Affiliation(s)
- Lea Wood
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Zubair Ahmed
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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17
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Ma S, Ma B, Yang Y, Mu Y, Wei P, Yu X, Zhao B, Zou Z, Liu Z, Wang M, Deng J. Functionalized 3D Hydroxyapatite Scaffold by Fusion Peptides-Mediated Small Extracellular Vesicles of Stem Cells for Bone Tissue Regeneration. ACS APPLIED MATERIALS & INTERFACES 2024; 16:3064-3081. [PMID: 38215277 DOI: 10.1021/acsami.3c13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
3D printing technology offers extensive applications in tissue engineering and regenerative medicine (TERM) because it can create a three-dimensional porous structure with acceptable porosity and fine mechanical qualities that can mimic natural bone. Hydroxyapatite (HA) is commonly used as a bone repair material due to its excellent biocompatibility and osteoconductivity. Small extracellular vesicles (sEVs) derived from bone marrow mesenchymal stem cells (BMSCs) can regulate bone metabolism and stimulate the osteogenic differentiation of stem cells. This study has designed a functionalized bone regeneration scaffold (3D H-P-sEVs) by combining the biological activity of BMSCs-sEVs and the 3D-HA scaffold to improve bone regeneration. The scaffold utilizes the targeting of fusion peptides to increase the loading efficiency of sEVs. The composition, structure, mechanical properties, and in vitro degradation performance of the 3D H-P-sEVs scaffolds were examined. The composite scaffold demonstrated good biocompatibility, substantially increased the expression of osteogenic-related genes and proteins, and had a satisfactory bone integration effect in the critical skull defect model of rats. In conclusion, the combination of EVs and 3D-HA scaffold via fusion peptide provides an innovative composite scaffold for bone regeneration and repair, improving osteogenic performance.
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Affiliation(s)
- Shiqing Ma
- Department of Stomatology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin 300211, China
| | - Beibei Ma
- School and Hospital of Stomatology, Tianjin Medical University, 12 Observatory Road, Tianjin 300070, China
| | - Yilin Yang
- School and Hospital of Stomatology, Tianjin Medical University, 12 Observatory Road, Tianjin 300070, China
| | - Yuzhu Mu
- School and Hospital of Stomatology, Tianjin Medical University, 12 Observatory Road, Tianjin 300070, China
| | - Pengfei Wei
- Beijing Biosis Healing Biological Technology Co., Ltd., No. 6 Plant West, Valley No. 1 Bio-medicine Industry Park, Beijing 102600, China
| | - Xueqiao Yu
- Beijing Biosis Healing Biological Technology Co., Ltd., No. 6 Plant West, Valley No. 1 Bio-medicine Industry Park, Beijing 102600, China
| | - Bo Zhao
- Beijing Biosis Healing Biological Technology Co., Ltd., No. 6 Plant West, Valley No. 1 Bio-medicine Industry Park, Beijing 102600, China
| | - Zhenyu Zou
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing 100043, China
| | - Zihao Liu
- Tianjin Zhongnuo Dental Hospital, Dingfu Building at the intersection of Nanma Road and Nankai Sanma Road in Nankai District, Tianjin 300100, China
| | - Minggang Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing 100043, China
| | - Jiayin Deng
- School and Hospital of Stomatology, Tianjin Medical University, 12 Observatory Road, Tianjin 300070, China
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18
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Lee J, Chadalavada SC, Ghodadra A, Ali A, Arribas EM, Chepelev L, Ionita CN, Ravi P, Ryan JR, Santiago L, Wake N, Sheikh AM, 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: vascular conditions. 3D Print Med 2023; 9:34. [PMID: 38032479 PMCID: PMC10688120 DOI: 10.1186/s41205-023-00196-6] [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: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Medical three-dimensional (3D) printing has demonstrated utility and value in anatomic models for vascular conditions. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (3DPSIG) provides appropriateness recommendations for vascular 3D printing indications. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with vascular indications. Each study was vetted by the authors and strength of evidence was assessed according to published appropriateness ratings. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for the following areas: aneurysm, dissection, extremity vascular disease, other arterial diseases, acute venous thromboembolic disease, venous disorders, lymphedema, congenital vascular malformations, vascular trauma, vascular tumors, visceral vasculature for surgical planning, dialysis access, vascular research/development and modeling, and other vasculopathy. Recommendations are provided in accordance with strength of evidence of publications corresponding to each vascular condition combined with expert opinion from members of the 3DPSIG. CONCLUSION This consensus appropriateness ratings document, created by the members of the 3DPSIG, provides an updated reference for clinical standards of 3D printing for the care of patients with vascular conditions.
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Affiliation(s)
- Joonhyuk Lee
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | - Anish Ghodadra
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | - Elsa M Arribas
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Justin R Ryan
- Webster Foundation 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, USA
- Department of Neurological Surgery, University of California San Diego Health, San Diego, CA, USA
| | - Lumarie Santiago
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 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
| | - Adnan M Sheikh
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Arizona - Phoenix, Phoenix, AZ, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Senderovich N, Shah S, Ow TJ, Rand S, Nosanchuk J, Wake N. Assessment of Staphylococcus Aureus growth on biocompatible 3D printed materials. 3D Print Med 2023; 9:30. [PMID: 37914942 PMCID: PMC10621153 DOI: 10.1186/s41205-023-00195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023] Open
Abstract
The customizability of 3D printing allows for the manufacturing of personalized medical devices such as laryngectomy tubes, but it is vital to establish the biocompatibility of printing materials to ensure that they are safe and durable. The goal of this study was to assess the presence of S. aureus biofilms on a variety of 3D printed materials (two surgical guide resins, a photopolymer, an elastomer, and a thermoplastic elastomer filament) as compared to standard, commercially available laryngectomy tubes.C-shaped discs (15 mm in height, 20 mm in diameter, and 3 mm in thickness) were printed with five different biocompatible 3D printing materials and S. aureus growth was compared to Shiley™ laryngectomy tubes made from polyvinyl chloride. Discs of each material were inoculated with S. aureus cultures and incubated overnight. All materials were then removed from solution, washed in phosphate-buffered saline to remove planktonic bacteria, and sonicated to detach biofilms. Some solution from each disc was plated and colony-forming units were manually counted the following day. The resulting data was analyzed using a Kruskal-Wallis and Wilcoxon Rank Sum test to determine pairwise significance between the laryngectomy tube material and the 3D printed materials.The Shiley™ tube grew a median of 320 colonies (IQR 140-520), one surgical guide resin grew a median of 640 colonies (IQR 356-920), the photopolymer grew a median of 340 colonies (IQR 95.5-739), the other surgical guide resin grew a median of 431 colonies (IQR 266.5-735), the thermoplastic elastomer filament grew a median of 188 colonies (IQR 113.5-335), and the elastomer grew a median of 478 colonies (IQR 271-630). Using the Wilcoxon Rank Sum test, manual quantification showed a significant difference between biofilm formation only between the Shiley™ tube and a surgical guide resin (p = 0.018).This preliminary study demonstrates that bacterial colonization was comparable among most 3D printed materials as compared to the conventionally manufactured device. Continuation of this work with increased replicates will be necessary to determine which 3D printing materials optimally resist biofilm formation.
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Affiliation(s)
- Nicole Senderovich
- Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA.
| | - Sharan Shah
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Thomas J Ow
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pathology, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Stephanie Rand
- Department of Physical Medicine & Rehabilitation, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joshua Nosanchuk
- Department of Infectious Disease, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research (CAI²R) and Bernard and Irene, Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
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Wang C, Cheng Y, Song Y, Lei J, Li Y, Li X, Shi H. Dosimetric parameters and safety analysis of 3D-printing non-coplanar template-assisted interstitial brachytherapy for non-centrally recurrent cervical cancer. Front Oncol 2023; 13:1174470. [PMID: 37954084 PMCID: PMC10637940 DOI: 10.3389/fonc.2023.1174470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction The prognosis of patients with non-central recurrent cervical cancer (NRCC) remains poor, and treatment options are limited. We aimed to explore the accuracy and safety of the 3D-printed non-coplanar template (3D-PNCT)-assisted 192Ir interstitial brachytherapy (ISBT) in the treatment of NRCC. Material and methods A total of 36 patients with NRCC who received 3D-PNCT-guided 192Ir ISBT in the First Affiliated Hospital of Zhengzhou University from January 2021 to July 2022 were included in this study. There were 36 3D-PNCTs that were designed and printed. The prescribed dose was 30-36 Gy, divided into five to six times, once a week. To evaluate whether the actual parameters were consistent with the preoperative design, the dosimetric parameters of pre- and postoperative treatment plans were compared, including dose of 90% high-risk clinical target volume (HR-CTV D90), volume percentage of 100% and 150% prescribed dose V100% and V150%, homogeneity index (HI), conformal index (CI), external index (EI), and dose received by 2 cm3 (D2cm3) of the rectum, colon, bladder, and ileum. The safety parameters including occurrence of bleeding, infection, pain, radiation enteritis, and radiation cystitis within 3 months after operation were recorded. Results All patients successfully completed the treatment and achieved the goals of the preoperative plan. There was no significant difference in the accuracy (HRCTVD90, V100%, EI, CI, and HI) and safety (D2cm3 of rectum, colon, bladder, and ileum) parameters of the postoperative plan compared with the preoperative plan (all p>0.05). Major side effects included bleeding at the puncture site (13.9%), postoperative pain (8.3%), acute radiation cystitis (13.9%), and radiation enteritis (19.4%). There were no serious perioperative complications and no grade 3-4 acute radiotherapy side effects. Conclusion 3D-PNCT-assisted 192Ir ISBT can be accurately and safely applied in the treatment of patients with NRCC.
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Affiliation(s)
- Cong Wang
- Department of Gynecological Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Cheng
- Department of Gynecological Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yadong Song
- Department of Gynecological Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia Lei
- Department of Gynecological Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yiqian Li
- Department of Gynecological Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xia Li
- Department of Gynecological Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huirong Shi
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Christou CD, Vasileiadou S, Sotiroudis G, Tsoulfas G. Three-Dimensional Printing and Bioprinting in Renal Transplantation and Regenerative Medicine: Current Perspectives. J Clin Med 2023; 12:6520. [PMID: 37892658 PMCID: PMC10607284 DOI: 10.3390/jcm12206520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
For patients with end-stage kidney disease (ESKD), renal transplantation is the treatment of choice, constituting the most common solid organ transplantation. This study aims to provide a comprehensive review regarding the application of three-dimensional (3D) printing and bioprinting in renal transplantation and regenerative medicine. Specifically, we present studies where 3D-printed models were used in the training of surgeons through renal transplantation simulations, in patient education where patients acquire a higher understanding of their disease and the proposed operation, in the preoperative planning to facilitate decision-making, and in fabricating customized, tools and devices. Three-dimensional-printed models could transform how surgeons train by providing surgical rehearsal platforms across all surgical specialties, enabling training with tissue realism and anatomic precision. The use of 3D-printed models in renal transplantations has shown a positive impact on surgical outcomes, including the duration of the operation and the intraoperative blood loss. Regarding 3D bioprinting, the technique has shown promising results, especially in the field of microfluidic devices, with the development of tissue demonstrating proximal tubules, glomerulus, and tubuloinerstitium function, and in renal organoid development. Such models can be applied for renal disease modeling, drug development, and renal regenerative medicine.
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Affiliation(s)
- Chrysanthos D. Christou
- Department of Transplantation Surgery, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (S.V.); (G.S.); (G.T.)
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Graffeo CS, Bhandarkar AR, Carlstrom LP, Perry A, Nguyen B, Daniels DJ, Link MJ, Morris JM. That which is unseen: 3D printing for pediatric cerebrovascular education. Childs Nerv Syst 2023; 39:2449-2457. [PMID: 37272936 DOI: 10.1007/s00381-023-05987-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/06/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Pediatric cerebrovascular lesions are very rare and include aneurysms, arteriovenous malformations (AVM), and vein of Galen malformations (VOGM). OBJECTIVE To describe and disseminate a validated, reproducible set of 3D models for optimization of neurosurgical training with respect to pediatric cerebrovascular diseases METHODS: All pediatric cerebrovascular lesions treated at our institution with adequate imaging studies during the study period 2015-2020 were reviewed by the study team. Three major diagnostic groups were identified: aneurysm, AVM, and VOGM. For each group, a case deemed highly illustrative of the core diagnostic and therapeutic principles was selected by the lead and senior investigators for printing (CSG/JM). Files for model reproduction and free distribution were prepared for inclusion as Supplemental Materials. RESULTS Representative cases included a 7-month-old female with a giant left MCA aneurysm; a 3-day-old male with a large, complex, high-flow, choroidal-type VOGM, supplied from bilateral thalamic, choroidal, and pericallosal perforators, with drainage into a large prosencephalic vein; and a 7-year-old male with a left frontal AVM with one feeding arterial vessel from the anterior cerebral artery and one single draining vein into the superior sagittal sinus CONCLUSION: Pediatric cerebrovascular lesions are representative of rare but important neurosurgical diseases that require creative approaches for training optimization. As these lesions are quite rare, 3D-printed models and open source educational materials may provide a meaningful avenue for impactful clinical teaching with respect to a wide swath of uncommon or unusual neurosurgical diseases.
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Affiliation(s)
- Christopher S Graffeo
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, OU Health University of Oklahoma Medical Center, Oklahoma City, OK, USA
| | | | | | - Avital Perry
- Department of Neurosurgery, Sheba Hospital, Tel Aviv, Israel
| | - Bachtri Nguyen
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - David J Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jonathan M Morris
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
- Department of Neurosurgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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23
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Cavaliere C, Baldi D, Brancato V, Aiello M, Salvatore M. A customized anthropomorphic 3D-printed phantom to reproducibility assessment in computed tomography: an oncological case study. Front Oncol 2023; 13:1123796. [PMID: 37700836 PMCID: PMC10493384 DOI: 10.3389/fonc.2023.1123796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction Studies on computed tomography (CT) reproducibility at different acquisition parameters have to take into account radiation dose administered and related ethical issues. 3D-printed phantoms provide the possibility to investigate these features deeply and to foster CT research, also taking advantage by outperforming new generation scanners. The aim of this study is to propose a new anthropomorphic 3D-printed phantom for chest lesions, tailored on a real patient CT scan, to investigate the variability of volume and Hounsfield Unit (HU) measurements at different CT acquisition parameters. Methods The chest CT of a 75-year-old patient with a paramediastinal lung lesion was segmented based on an eight-compartment approach related to HU ranges (air lung, lung interstitium, fat, muscle, vascular, skin, bone, and lesion). From each mask produced, the 3D.stl model was exported and linked to a different printing infill value, based on a preliminary test and HU ratios derived from the patient scan. Fused deposition modeling (FDM) technology printing was chosen with filament materials in polylactic acid (PLA). Phantom was acquired at 50 mAs and three different tube voltages of 80, 100, and 120 kVp on two different scanners, namely, Siemens Somatom Force (Siemens Healthineers, Erlangen, Germany; same setting of real patient for 80 kVp acquisition) and GE 750 HD CT (GE Healthcare, Chicago, IL). The same segmentation workflow was then applied on each phantom acquisition after coregistration pipeline, and Dice Similarity Coefficient (DSC) and HU averages were extracted and compared for each compartment. Results DSC comparison among real patient versus phantom scans at different kVp, and on both CT scanners, demonstrated a good overlap of different compartments and lesion vascularization with a higher similarity for lung and lesion masks for each setting (about 0.9 and 0.8, respectively). Although mean HU was not comparable with real data, due to the PLA material, the proportion of intensity values for each compartment remains respected. Discussion The proposed approach demonstrated the reliability of 3D-printed technology for personalized approaches in CT research, opening to the application of the same workflow to other oncological fields.
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Bharucha AH, Moore J, Carnahan P, MacCarthy P, Monaghan MJ, Baghai M, Deshpande R, Byrne J, Dworakowski R, Eskandari M. Three-dimensional printing in modelling mitral valve interventions. Echo Res Pract 2023; 10:12. [PMID: 37528494 PMCID: PMC10394816 DOI: 10.1186/s44156-023-00024-x] [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: 01/26/2023] [Accepted: 06/23/2023] [Indexed: 08/03/2023] Open
Abstract
Mitral interventions remain technically challenging owing to the anatomical complexity and heterogeneity of mitral pathologies. As such, multi-disciplinary pre-procedural planning assisted by advanced cardiac imaging is pivotal to successful outcomes. Modern imaging techniques offer accurate 3D renderings of cardiac anatomy; however, users are required to derive a spatial understanding of complex mitral pathologies from a 2D projection thus generating an 'imaging gap' which limits procedural planning. Physical mitral modelling using 3D printing has the potential to bridge this gap and is increasingly being employed in conjunction with other transformative technologies to assess feasibility of intervention, direct prosthesis choice and avoid complications. Such platforms have also shown value in training and patient education. Despite important limitations, the pace of innovation and synergistic integration with other technologies is likely to ensure that 3D printing assumes a central role in the journey towards delivering personalised care for patients undergoing mitral valve interventions.
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Affiliation(s)
- Apurva H Bharucha
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - John Moore
- Robarts Research Institute, Western University, London, ON, Canada
| | - Patrick Carnahan
- Robarts Research Institute, Western University, London, ON, Canada
| | - Philip MacCarthy
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Mark J Monaghan
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Max Baghai
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Ranjit Deshpande
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Jonathan Byrne
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Rafal Dworakowski
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Mehdi Eskandari
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK.
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Morris JM, Wentworth A, Houdek MT, Karim SM, Clarke MJ, Daniels DJ, Rose PS. The Role of 3D Printing in Treatment Planning of Spine and Sacral Tumors. Neuroimaging Clin N Am 2023; 33:507-529. [PMID: 37356866 DOI: 10.1016/j.nic.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Three-dimensional (3D) printing technology has proven to have many advantages in spine and sacrum surgery. 3D printing allows the manufacturing of life-size patient-specific anatomic and pathologic models to improve preoperative understanding of patient anatomy and pathology. Additionally, virtual surgical planning using medical computer-aided design software has enabled surgeons to create patient-specific surgical plans and simulate procedures in a virtual environment. This has resulted in reduced operative times, decreased complications, and improved patient outcomes. Combined with new surgical techniques, 3D-printed custom medical devices and instruments using titanium and biocompatible resins and polyamides have allowed innovative reconstructions.
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Affiliation(s)
- Jonathan M Morris
- Division of Neuroradiology, Department of Radiology, Anatomic Modeling Unit, Biomedical and Scientific Visualization, Mayo Clinic, 200 1st Street, Southwest, Rochester, MN, 55905, USA.
| | - Adam Wentworth
- Department of Radiology, Anatomic Modeling Unit, Mayo Clinic, Rochester, MN, USA
| | - Matthew T Houdek
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - S Mohammed Karim
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Peter S Rose
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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26
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Gill H, Fernandes JF, Nio A, Dockerill C, Shah N, Ahmed N, Raymond J, Wang S, Sotelo J, Urbina J, Uribe S, Rajani R, Rhode K, Lamata P. Aortic Stenosis: Haemodynamic Benchmark and Metric Reliability Study. J Cardiovasc Transl Res 2023; 16:862-873. [PMID: 36745287 PMCID: PMC10480252 DOI: 10.1007/s12265-022-10350-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/21/2022] [Indexed: 02/07/2023]
Abstract
Aortic stenosis is a condition which is fatal if left untreated. Novel quantitative imaging techniques which better characterise transvalvular pressure drops are being developed but require refinement and validation. A customisable and cost-effective workbench valve phantom circuit capable of replicating valve mechanics and pathology was created. The reproducibility and relationship of differing haemodynamic metrics were assessed from ground truth pressure data alongside imaging compatibility. The phantom met the requirements to capture ground truth pressure data alongside ultrasound and magnetic resonance image compatibility. The reproducibility was successfully tested. The robustness of three different pressure drop metrics was assessed: whilst the peak and net pressure drops provide a robust assessment of the stenotic burden in our phantom, the peak-to-peak pressure drop is a metric that is confounded by non-valvular factors such as wave reflection. The peak-to-peak pressure drop is a metric that should be reconsidered in clinical practice. The left panel shows manufacture of low cost, functional valves. The central section demonstrates circuit layout, representative MRI and US images alongside gross valve morphologies. The right panel shows the different pressure drop metrics that were assessed for reproducibility.
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Affiliation(s)
- Harminder Gill
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK.
- Cardiology Department, Guy's and St, Thomas's Hospital, London, UK.
| | - Joao Filipe Fernandes
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Amanda Nio
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Cameron Dockerill
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Nili Shah
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Naajia Ahmed
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | | | - Shu Wang
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
| | - Jesus Urbina
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
- Department of Radiology, Schools of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Uribe
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
- Department of Radiology, Schools of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
- Cardiology Department, Guy's and St, Thomas's Hospital, London, UK
| | - Kawal Rhode
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
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27
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Barnhill J, Gaston JD, Deffenbaugh PI, Wagner L, Liacouras PC, Ho VB. Additive Manufacturing for Fabrication of Point-of-Care Therapies in Austere Environments. Mil Med 2023; 188:e1847-e1853. [PMID: 36734042 DOI: 10.1093/milmed/usad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/27/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Known as the "golden hour," survival of most critically injured patients is highly dependent on providing the required treatment within the first hour of injury. Recent technological advances in additive manufacturing (also known as three-dimensional [3D] printing) allow for austere deployment and point-of-care rapid fabrication of a variety of medical supplies, including human tissues and bioactive bandages, in prolonged field care scenarios. In this pilot project, our aim was to investigate the ability to 3D print a range of potential biomedical supplies and solutions in an austere field environment. MATERIALS AND METHODS We specifically designed and fabricated novel surgical tools, bioactive bandages, objects (screw and anatomic models), and human meniscal tissue in an austere African desert environment. A total of seven packages were sent using a commercial carrier directly to the end destination. A multi-tool ruggedized 3D printer was used as the manufacturing platform for all objects fabricated downrange. Human mesenchymal stem cells were shipped for 3D bioprinting of human menisci and bioactive bandages. Design and fabrication for all 3D-printed products utilized computer-aided design (CAD) tools. RESULTS Initial shipment from a single U.S. site to the sub-Saharan Africa location was relatively prompt, taking an average of 4.7 days to deliver three test packages. However, the actual delivery of the seven packages from Orlando, FL, to the same sub-Saharan Africa site took an average of 16 days (range 7-23 days). The ruggedized printer successfully fabricated relevant medical supplies using biocompatible filament, bioink hydrogels, and stem cell-loaded bioinks. This prototype did not, however, have the capacity to provide a sterile environment. A multi-material complete bandage was 3D printed using polyamide polyolefin and cellulose, live cells, neomycin salve, and adhesive. The bandage, wound covering backing, and adhesive backing print took under 2 min to 3D print. Surgical instrument CAD files were based on commercially available medical-grade stainless-steel instruments. The screw CAD file was downloaded from the NIH 3D Print Exchange website. The prints of the two surgical tools and screw using thermoplastic material were successful. Menisci, relatively complex forms of the cartilage, were 3D bioprinted with a gel that held their form well after printing and were then solidified slightly using a cross-linking solution. After 2 min of solidification, it was possible to remove and handle the menisci. CONCLUSION The current and future challenges of prolonged field care need to be addressed with new techniques, training, and technology. Ruggedized, deployable 3D printers allow for the direct fabrication of medical tools, supplies, and biological solutions for austere use. Delivery of packages can vary, and attention to routes and location is key, especially for transit of time-sensitive perishable supplies such as live cells. The significance of this study provides the real possibility to 3D print "just-in-time" medical solutions tailored to the need of an individual service member in any environment. This is a potentially exciting opportunity to bring critical products to the war front.
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Affiliation(s)
- Jason Barnhill
- Department of Chemistry and Life Science, United States Military Academy, West Point, NY 10996, USA
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Joel D Gaston
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- The Geneva Foundation, Tacoma, WA 98402, USA
| | | | | | - Peter C Liacouras
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Vincent B Ho
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Soh CL, Pandiaraja M, Powar MP. 3D-Printing Applications in Ostomy Device Creation and Complex Intestinal Fistula Management: A Scoping Review. Surg J (N Y) 2023; 9:e97-e106. [PMID: 37876379 PMCID: PMC10522416 DOI: 10.1055/s-0043-1775748] [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: 11/29/2022] [Accepted: 05/26/2023] [Indexed: 10/26/2023] Open
Abstract
Background This scoping review aims to provide a summary of the use of three-dimensional (3D) printing in colorectal surgery for the management of complex intestinal fistula and ostomy creation. Methods A systematic database search was conducted of original articles that explored the use of 3D printing in colorectal surgery in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to March 2022. Original articles and case reports that discussed 3D printing in colorectal surgery relating to complex intestinal fistulae and ostomies were identified and analyzed. Results There were 8 articles identified which discussed the use of 3D printing in colorectal surgery, of which 2 discussed ostomy creation, 4 discussed complex fistulae management, and 2 discussed patient models. Conclusion 3D printing has a promising role in terms of management of these conditions and can improve outcomes in terms of recovery, fluid loss, and function with no increase in complications. The use of 3D printing is still in its early stages of development in colorectal surgery. Further research in the form of randomized control trials to improve methodological robustness will reveal its true potential.
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Affiliation(s)
- Chien Lin Soh
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Michael P. Powar
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
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Patel P, Dhal K, Gupta R, Tappa K, Rybicki FJ, Ravi P. Medical 3D Printing Using Desktop Inverted Vat Photopolymerization: Background, Clinical Applications, and Challenges. Bioengineering (Basel) 2023; 10:782. [PMID: 37508810 PMCID: PMC10376892 DOI: 10.3390/bioengineering10070782] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Medical 3D printing is a complex, highly interdisciplinary, and revolutionary technology that is positively transforming the care of patients. The technology is being increasingly adopted at the Point of Care (PoC) as a consequence of the strong value offered to medical practitioners. One of the key technologies within the medical 3D printing portfolio enabling this transition is desktop inverted Vat Photopolymerization (VP) owing to its accessibility, high quality, and versatility of materials. Several reports in the peer-reviewed literature have detailed the medical impact of 3D printing technologies as a whole. This review focuses on the multitude of clinical applications of desktop inverted VP 3D printing which have grown substantially in the last decade. The principles, advantages, and challenges of this technology are reviewed from a medical standpoint. This review serves as a primer for the continually growing exciting applications of desktop-inverted VP 3D printing in healthcare.
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Affiliation(s)
- Parimal Patel
- Department of Mechanical & Aerospace Engineering, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Kashish Dhal
- Department of Mechanical & Aerospace Engineering, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Rajul Gupta
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Karthik Tappa
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati, Cincinnati, OH 45219, USA
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Zhu Y, Gong S, Dai J, Zhou L. Elbow hemiarthroplasty with a 3D-printed prosthesis for distal humeral bone defects after tumor excision: a case report. 3D Print Med 2023; 9:18. [PMID: 37314590 DOI: 10.1186/s41205-023-00178-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION The distal humerus is a rare site for primary and metastatic bone tumors. Due to the scarcity of cases and lack of standardized surgical strategies, it is often difficult for surgeons to choose the right choice. The application of a 3D-printed prosthesis with hemiarthroplasty for the treatment of the distal humerus after tumor resection can be a very effective option. CASE PRESENTATION We present a clinical case of a 3D-printed distal humeral prosthesis for the treatment of bone defects caused by metastatic bone tumors. The preoperative evaluation was aggressively performed, and the decision was made to distal humeral hemiarthroplasty (DHH) after wide resection of the tumor segment bone. Processing of the Digital Imaging and Communications in Medicine (DICOM) data from CT scans performed after mirror conversion using CT data of the contralateral humerus, we designed a 3D-printed distal humeral prosthesis with hemiarthroplasty. After reconstruction of bone and surrounding soft tissue by the 3D-printed prosthesis combined with the LARS ligament and regular follow-up for 12 months, the patient had an MSTS-93 score of 29 and an MEP of 100, which reached a good level, and the patient was fully competent in normal daily activities. CONCLUSIONS Our results show that the 3D-printed modular prosthesis with hemiarthroplasty is a very effective option for cases of large elbow bone defects due to primary bone tumors or metastatic disease. However, careful preoperative preparation is required for the best outcome. Careful preoperative preparation and long-term follow-up are essential for the best outcome.
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Affiliation(s)
- Yingkang Zhu
- Department of orthopedic and soft tissue surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Shuo Gong
- Department of orthopedic and soft tissue surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Jin Dai
- Department of orthopedic and soft tissue surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Lei Zhou
- Department of orthopedic and soft tissue surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China.
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Valls-Esteve A, Tejo-Otero A, Lustig-Gainza P, Buj-Corral I, Fenollosa-Artés F, Rubio-Palau J, Barber-Martinez de la Torre I, Munuera J, Fondevila C, Krauel L. Patient-Specific 3D Printed Soft Models for Liver Surgical Planning and Hands-On Training. Gels 2023; 9:gels9040339. [PMID: 37102951 PMCID: PMC10138006 DOI: 10.3390/gels9040339] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/28/2023] Open
Abstract
Background: Pre-surgical simulation-based training with three-dimensional (3D) models has been intensively developed in complex surgeries in recent years. This is also the case in liver surgery, although with fewer reported examples. The simulation-based training with 3D models represents an alternative to current surgical simulation methods based on animal or ex vivo models or virtual reality (VR), showing reported advantages, which makes the development of realistic 3D-printed models an option. This work presents an innovative, low-cost approach for producing patient-specific 3D anatomical models for hands-on simulation and training. Methods: The article reports three paediatric cases presenting complex liver tumours that were transferred to a major paediatric referral centre for treatment: hepatoblastoma, hepatic hamartoma and biliary tract rhabdomyosarcoma. The complete process of the additively manufactured liver tumour simulators is described, and the different steps for the correct development of each case are explained: (1) medical image acquisition; (2) segmentation; (3) 3D printing; (4) quality control/validation; and (5) cost. A digital workflow for liver cancer surgical planning is proposed. Results: Three hepatic surgeries were planned, with 3D simulators built using 3D printing and silicone moulding techniques. The 3D physical models showed highly accurate replications of the actual condition. Additionally, they proved to be more cost-effective in comparison with other models. Conclusions: It is demonstrated that it is possible to manufacture accurate and cost-effective 3D-printed soft surgical planning simulators for treating liver cancer. The 3D models allowed for proper pre-surgical planning and simulation training in the three cases reported, making it a valuable aid for surgeons.
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Affiliation(s)
- Arnau Valls-Esteve
- Innovation Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Carrer de Casanova, 143, 08036 Barcelona, Spain
- 3D Unit (3D4H), Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
| | - Aitor Tejo-Otero
- Centre CIM, Universitat Politècnica de Catalunya (CIM UPC), Carrer de Llorens i Artigas, 12, 08028 Barcelona, Spain
| | - Pamela Lustig-Gainza
- Centre CIM, Universitat Politècnica de Catalunya (CIM UPC), Carrer de Llorens i Artigas, 12, 08028 Barcelona, Spain
| | - Irene Buj-Corral
- Department of Mechanical Engineering, Barcelona School of Industrial Engineering (ETSEIB), Universitat Politècnica de Catalunya, Av. Diagonal, 647, 08028 Barcelona, Spain
| | - Felip Fenollosa-Artés
- Centre CIM, Universitat Politècnica de Catalunya (CIM UPC), Carrer de Llorens i Artigas, 12, 08028 Barcelona, Spain
- Department of Mechanical Engineering, Barcelona School of Industrial Engineering (ETSEIB), Universitat Politècnica de Catalunya, Av. Diagonal, 647, 08028 Barcelona, Spain
| | - Josep Rubio-Palau
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Carrer de Casanova, 143, 08036 Barcelona, Spain
- 3D Unit (3D4H), Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
- Pediatric Surgical Oncology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
- Maxillofacial Unit, Department of Pediatric Surgery, Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
| | | | - Josep Munuera
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Carrer de Casanova, 143, 08036 Barcelona, Spain
- 3D Unit (3D4H), Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
- Department of Diagnostic Imaging, Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
| | - Constantino Fondevila
- Hepatopancreatobiliary Surgery and Transplantation, General and Digestive Surgery, Metabolic and Digestive Diseases Institute (ICMDM), Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, 08950 Esplugues de Llobregat, Spain
| | - Lucas Krauel
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Carrer de Casanova, 143, 08036 Barcelona, Spain
- 3D Unit (3D4H), Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
- Pediatric Surgical Oncology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, 08950 Esplugues de Llobregat, Spain
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Richards L, Dalla S, Fitzgerald S, Walter C, Ash R, Miller K, Alli A, Rohr A. Utilizing 3D printing to assist pre-procedure planning of transjugular intrahepatic portosystemic shunt (TIPS) procedures: a pilot study. 3D Print Med 2023; 9:10. [PMID: 37052816 PMCID: PMC10099647 DOI: 10.1186/s41205-023-00176-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND 3D (three-dimensional) printing has been adopted by the medical community in several ways, procedure planning being one example. This application of technology has been adopted by several subspecialties including interventional radiology, however the planning of transjugular intrahepatic portosystemic shunt (TIPS) placement has not yet been described. The impact of a 3D printed model on procedural measures such as procedure time, radiation exposure, intravascular contrast dosage, fluoroscopy time, and provider confidence has also not been reported. METHODS This pilot study utilized a quasi-experimental design including patients who underwent TIPS. For the control group, retrospective data was collected on patients who received a TIPS prior to Oct 1, 2020. For the experimental group, patient-specific 3D printed models were integrated in the care of patients that received TIPS between Oct 1, 2020 and April 15, 2021. Data was collected on patient demographics and procedural measures. The interventionalists were surveyed on their confidence level and model usage following each procedure in the experimental group. RESULTS 3D printed models were created for six TIPS. Procedure time (p = 0.93), fluoroscopy time (p = 0.26), and intravascular contrast dosage (p = 0.75) did not have significant difference between groups. Mean radiation exposure was 808.8 mGy in the group with a model compared to 1731.7 mGy without, however this was also not statistically significant (p = 0.09). Out of 11 survey responses from interventionists, 10 reported "increased" or "significantly increased" confidence after reviewing the 3D printed model and all responded that the models were a valuable tool for trainees. CONCLUSIONS 3D printed models of patient anatomy can consistently be made using consumer-level, desktop 3D printing technology. This study was not adequately powered to measure the impact that including 3D printed models in the planning of TIPS procedures may have on procedural measures. The majority of interventionists reported that patient-specific models were valuable tools for teaching trainees and that confidence levels increased as a result of model inclusion in procedure planning.
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Affiliation(s)
- Lucas Richards
- University of Kansas School of Medicine, 3901 Rainbow Boulevard, 66160, Kansas City, KS, USA.
| | - Shiv Dalla
- University of Kansas School of Medicine, 3901 Rainbow Boulevard, 66160, Kansas City, KS, USA
| | - Sharon Fitzgerald
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1008, 66160, Kansas City, KS, USA
| | - Carissa Walter
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 4032, 66160, Kansas City, KS, USA
| | - Ryan Ash
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 4032, 66160, Kansas City, KS, USA
| | - Kirk Miller
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 4032, 66160, Kansas City, KS, USA
| | - Adam Alli
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 4032, 66160, Kansas City, KS, USA
| | - Aaron Rohr
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 4032, 66160, Kansas City, KS, USA
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Nkhwa S, Montshiwa T, de Beer D, Booysen G, van den Heever C, Els J, Heydenrych A, Kebaetse M. Local design and manufacturing of patient-specific implant using Anatomage Medical Design Studio software: proof of concept - Botswana's 1st case report. 3D Print Med 2023; 9:7. [PMID: 36952034 PMCID: PMC10035237 DOI: 10.1186/s41205-023-00170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/17/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Botswana, like most sub-Sahara African nations, uses conventional orthopaedic implants that are sourced from major manufactures in the West. The implants are mass-produced and designed with universal configurations to fit an average patient. During surgery, surgeons thus sometimes bend the implants to match the individual bone anatomy, especially for paediatric patients and those with unique deformities, thus risking implant failure. The purpose of this project was to show the feasibility of developing safe and effective patient-specific orthopaedic implants in a low-resourced market. METHODS CT Scan slice files of a paediatric patient with Ollier's disease were used to reconstruct the lower limb anatomy. The resultant files were 3D printed into prototypes that showed severe right knee valgus deformity. The surgeon used the prototype to plan for corrective femoral osteotomy and the required implant. The implant design and planned surgery were subsequently simulated on the Medical Design Studio software for proper fitting before final implant printing. Surgery was then performed, followed by 12 weeks of physiotherapy. RESULTS Post-surgical x-rays demonstrated good implant positioning and knee joint alignment. At 18 months of post-surgical follow-up, the child was pain-free, could perform full squats, and ambulation was near-normal, without the use of an assistive device. CONCLUSIONS It is feasible to develop effective, patient-specific implants for selected orthopaedic cases in a low-resourced country. This work could improve surgical and rehabilitation outcomes for selected paediatric patients and those with severe bone deformities.
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Affiliation(s)
- Shathani Nkhwa
- Faculty of Medicine, Department of Biomedical Sciences, University of Botswana, Corner of Notwane and Mobuto Road, Pvt Bag, 00713, Gaborone, Botswana
| | - Thapelo Montshiwa
- Sidilega Private Hospital, Orthopaedic Surgery, P.O. Box 70905, Gaborone, Botswana
| | - Deon de Beer
- Free State, Centre for Rapid Prototyping and Manufacturing, Central University of Technology, Private Bag X20539, Bloemfontein, 9300, South Africa
| | - Gerrie Booysen
- Free State, Centre for Rapid Prototyping and Manufacturing, Central University of Technology, Private Bag X20539, Bloemfontein, 9300, South Africa
| | - Cules van den Heever
- Free State, Centre for Rapid Prototyping and Manufacturing, Central University of Technology, Private Bag X20539, Bloemfontein, 9300, South Africa
| | - Johan Els
- Free State, Centre for Rapid Prototyping and Manufacturing, Central University of Technology, Private Bag X20539, Bloemfontein, 9300, South Africa
| | - Andre Heydenrych
- Free State, Centre for Rapid Prototyping and Manufacturing, Central University of Technology, Private Bag X20539, Bloemfontein, 9300, South Africa
| | - Maikutlo Kebaetse
- Faculty of Medicine, Department of Biomedical Sciences, University of Botswana, Corner of Notwane and Mobuto Road, Pvt Bag, 00713, Gaborone, Botswana.
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Chen JR, Morris J, Wentworth A, Sears V, Duit A, Erie E, McGee K, Leng S. Three-dimensional printing accuracy analysis for medical applications across a wide variety of printers. J Med Imaging (Bellingham) 2023; 10:026501. [PMID: 37020530 PMCID: PMC10068246 DOI: 10.1117/1.jmi.10.2.026501] [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: 09/16/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023] Open
Abstract
Purpose Three-dimensional (3D) printing has had a significant impact on patient care. However, there is a lack of standardization in quality assurance (QA) to ensure printing accuracy and precision given multiple printing technologies, variability across vendors, and inter-printer reliability issues. We investigated printing accuracy on a diverse selection of 3D printers commonly used in the medical field. Approach A specially designed 3D printing QA phantom was periodically printed on 16 printers used in our practice, covering five distinct printing technologies and eight different vendors. Longitudinal data were acquired over six months by printing the QA phantom monthly on each printer. Qualitative assessment and quantitative measurements were obtained for each printed phantom. Accuracy and precision were assessed by comparing quantitative measurements with reference values of the phantom. Data were then compared among printer models, vendors, and printing technologies; longitudinal trends were also analyzed. Results Differences in 3D printing accuracy across printers were observed. Material jetting and vat photopolymerization printers were found to be the most accurate. Printers using the same 3D printing technology but from different vendors also showed differences in accuracy, most notably between vat photopolymerization printers from two different vendors. Furthermore, differences in accuracy were found between printers from the same vendor using the same printing technology, but different models/generations. Conclusions These results show how factors such as printing technology, vendor, and printer model can impact 3D printing accuracy, which should be appropriately considered in practice to avoid potential medical or surgical errors.
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Affiliation(s)
- Joshua Ray Chen
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Jonathan Morris
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Adam Wentworth
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Victoria Sears
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Andrew Duit
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Eric Erie
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Kiaran McGee
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Shuai Leng
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
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Nace S, Tiernan J, Ní Annaidh A, Holland D. Development and evaluation of a facile mesh-to-surface tool for customised wheelchair cushions. 3D Print Med 2023; 9:3. [PMID: 36781509 PMCID: PMC9926538 DOI: 10.1186/s41205-022-00165-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/13/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Custom orthoses are becoming more commonly prescribed for upper and lower limbs. They require some form of shape-capture of the body parts they will be in contact with, which generates an STL file that designers prepare for manufacturing. For larger devices such as custom-contoured wheelchair cushions, the STL created during shape-capture can contain hundreds of thousands of tessellations, making them difficult to alter and prepare for manufacturing using mesh-editing software. This study covers the development and testing of a mesh-to-surface workflow in a parametric computer-aided design software using its visual programming language such that STL files of custom wheelchair cushions can be efficiently converted into a parametric single surface. METHODS A volunteer in the clinical space with expertise in computer-aided design aided was interviewed to understand and document the current workflow for creating a single surface from an STL file of a custom wheelchair cushion. To understand the user needs of typical clinical workers with little computer-aided design experience, potential end-users of the process were tasked with completing the workflow and providing feedback during the experience. This feedback was used to automate part of the computer-aided design process using a visual programming tool, creating a new semi-automated workflow for mesh-to-surface translation. Both the original and semi-automated process were then evaluated by nine volunteers with varying levels of computer-aided design experience. RESULTS The semi-automated process showed a 37% reduction in the total number of steps required to convert an STL model to a parametric surface. Regardless of previous computer-aided design experience, volunteers completed the semi-automated workflow 31% faster on average than the manual workflow. CONCLUSIONS The creation of a semi-automated process for creating a single parametric surface of a custom wheelchair cushion from an STL mesh makes mesh-to-surface conversion more efficient and more user-friendly to all, regardless of computer-aided design experience levels. The steps followed in this study may guide others in the development of their own mesh-to-surface tools in the wheelchair sector, as well as those creating other large custom prosthetic devices.
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Affiliation(s)
- Susan Nace
- grid.7886.10000 0001 0768 2743School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin Ireland
| | - John Tiernan
- SeatTech Posture and Mobility Services, Enable Ireland, Dublin, Ireland
| | - Aisling Ní Annaidh
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin, Ireland.
| | - Donal Holland
- grid.7886.10000 0001 0768 2743School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin Ireland
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Lo M, Mariconti E, Nakhaeizadeh S, Morgan RM. Preparing computed tomography images for machine learning in forensic and virtual anthropology. Forensic Sci Int Synerg 2023; 6:100319. [PMID: 36852172 PMCID: PMC9958428 DOI: 10.1016/j.fsisyn.2023.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Martin Lo
- UCL Department of Security and Crime Science, University College London, 35 Tavistock Square, London, WC1H 9EZ, UK,UCL Centre for the Forensic Sciences, University College London, 35 Tavistock Square, London, WC1H 9EZ, UK,Corresponding author. UCL Department of Security and Crime Science, University College London, 35 Tavistock Square, London, WC1H 9EZ, UK.
| | - Enrico Mariconti
- UCL Department of Security and Crime Science, University College London, 35 Tavistock Square, London, WC1H 9EZ, UK
| | - Sherry Nakhaeizadeh
- UCL Department of Security and Crime Science, University College London, 35 Tavistock Square, London, WC1H 9EZ, UK,UCL Centre for the Forensic Sciences, University College London, 35 Tavistock Square, London, WC1H 9EZ, UK
| | - Ruth M. Morgan
- UCL Department of Security and Crime Science, University College London, 35 Tavistock Square, London, WC1H 9EZ, UK,UCL Centre for the Forensic Sciences, University College London, 35 Tavistock Square, London, WC1H 9EZ, UK
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Nguyen P, Stanislaus I, McGahon C, Pattabathula K, Bryant S, Pinto N, Jenkins J, Meinert C. Quality assurance in 3D-printing: A dimensional accuracy study of patient-specific 3D-printed vascular anatomical models. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1097850. [PMID: 36824261 PMCID: PMC9941637 DOI: 10.3389/fmedt.2023.1097850] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/03/2023] [Indexed: 02/10/2023] Open
Abstract
3D printing enables the rapid manufacture of patient-specific anatomical models that substantially improve patient consultation and offer unprecedented opportunities for surgical planning and training. However, the multistep preparation process may inadvertently lead to inaccurate anatomical representations which may impact clinical decision making detrimentally. Here, we investigated the dimensional accuracy of patient-specific vascular anatomical models manufactured via digital anatomical segmentation and Fused-Deposition Modelling (FDM), Stereolithography (SLA), Selective Laser Sintering (SLS), and PolyJet 3D printing, respectively. All printing modalities reliably produced hand-held patient-specific models of high quality. Quantitative assessment revealed an overall dimensional error of 0.20 ± 3.23%, 0.53 ± 3.16%, -0.11 ± 2.81% and -0.72 ± 2.72% for FDM, SLA, PolyJet and SLS printed models, respectively, compared to unmodified Computed Tomography Angiograms (CTAs) data. Comparison of digital 3D models to CTA data revealed an average relative dimensional error of -0.83 ± 2.13% resulting from digital anatomical segmentation and processing. Therefore, dimensional error resulting from the print modality alone were 0.76 ± 2.88%, + 0.90 ± 2.26%, + 1.62 ± 2.20% and +0.88 ± 1.97%, for FDM, SLA, PolyJet and SLS printed models, respectively. Impact on absolute measurements of feature size were minimal and assessment of relative error showed a propensity for models to be marginally underestimated. This study revealed a high level of dimensional accuracy of 3D-printed patient-specific vascular anatomical models, suggesting they meet the requirements to be used as medical devices for clinical applications.
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Affiliation(s)
- Philip Nguyen
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Ivan Stanislaus
- Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Clover McGahon
- Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Krishna Pattabathula
- Vascular Surgery Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, QLD, Australia,Vascular Biofabrication Program, Herston Biofabrication Institute, Metro North Hospital and Health Services, Brisbane, QLD, Australia
| | - Samuel Bryant
- Vascular Surgery Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, QLD, Australia,Vascular Biofabrication Program, Herston Biofabrication Institute, Metro North Hospital and Health Services, Brisbane, QLD, Australia
| | - Nigel Pinto
- Vascular Surgery Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, QLD, Australia,Vascular Biofabrication Program, Herston Biofabrication Institute, Metro North Hospital and Health Services, Brisbane, QLD, Australia
| | - Jason Jenkins
- Vascular Surgery Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, QLD, Australia,Vascular Biofabrication Program, Herston Biofabrication Institute, Metro North Hospital and Health Services, Brisbane, QLD, Australia
| | - Christoph Meinert
- Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia,Vascular Biofabrication Program, Herston Biofabrication Institute, Metro North Hospital and Health Services, Brisbane, QLD, Australia,Faculty of Engineering, Architecture and Information Technology, University of Queensland, Brisbane, QLD, Australia,Correspondence: Christoph Meinert
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Huang YH, Nascene D, Spilseth B, Chuy JA. High-Fidelity Simulation Training for Nasal Bridle Placement with a 3D Printed Model. ANNALS OF 3D PRINTED MEDICINE 2023. [DOI: 10.1016/j.stlm.2023.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Ravi P, Burch MB, Farahani S, Chepelev LL, Yang D, Ali A, Joyce JR, Lawera N, Stringer J, Morris JM, Ballard DH, Wang KC, Mahoney MC, Kondor S, Rybicki FJ. Utility and Costs During the Initial Year of 3D Printing in an Academic Hospital. J Am Coll Radiol 2023; 20:193-204. [PMID: 35988585 DOI: 10.1016/j.jacr.2022.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There is a paucity of utility and cost data regarding the launch of 3D printing in a hospital. The objective of this project is to benchmark utility and costs for radiology-based in-hospital 3D printing of anatomic models in a single, adult academic hospital. METHODS All consecutive patients for whom 3D printed anatomic models were requested during the first year of operation were included. All 3D printing activities were documented by the 3D printing faculty and referring specialists. For patients who underwent a procedure informed by 3D printing, clinical utility was determined by the specialist who requested the model. A new metric for utility termed Anatomic Model Utility Points with range 0 (lowest utility) to 500 (highest utility) was derived from the specialist answers to Likert statements. Costs expressed in United States dollars were tallied from all 3D printing human resources and overhead. Total costs, focused costs, and outsourced costs were estimated. The specialist estimated the procedure room time saved from the 3D printed model. The time saved was converted to dollars using hospital procedure room costs. RESULTS The 78 patients referred for 3D printed anatomic models included 11 clinical indications. For the 68 patients who had a procedure, the anatomic model utility points had an overall mean (SD) of 312 (57) per patient (range, 200-450 points). The total operation cost was $213,450. The total cost, focused costs, and outsourced costs were $2,737, $2,180, and $2,467 per model, respectively. Estimated procedure time saved had a mean (SD) of 29.9 (12.1) min (range, 0-60 min). The hospital procedure room cost per minute was $97 (theoretical $2,900 per patient saved with model). DISCUSSION Utility and cost benchmarks for anatomic models 3D printed in a hospital can inform health care budgets. Realizing pecuniary benefit from the procedure time saved requires future research.
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Affiliation(s)
- Prashanth Ravi
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Michael B Burch
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Shayan Farahani
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Leonid L Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | | | - Arafat Ali
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Jennifer R Joyce
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Nathan Lawera
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Jimmy Stringer
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | | | - David H Ballard
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St Louis, Missouri
| | - Kenneth C Wang
- Department of Radiology, University of Maryland, Baltimore, Maryland; and Department of Radiology, Baltimore VA Medical Center, Baltimore, Maryland; and Co-Chair, ACR 3D Printing Registry Governance Committee
| | - Mary C Mahoney
- Chair, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shayne Kondor
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Frank J Rybicki
- Vice Chair of Operations & Quality, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio; and Co-Chair, ACR 3D Printing Registry Governance Committee.
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Advanced Image Segmentation and Modeling - A Review of the 2021-2022 Thematic Series. 3D Print Med 2023; 9:1. [PMID: 36692662 PMCID: PMC9872408 DOI: 10.1186/s41205-022-00163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 01/25/2023] Open
Abstract
Medical 3D printing is a form of manufacturing that benefits patient care, particularly when the 3D printed part is patient-specific and either enables or facilitates an intervention for a specific condition. Most of the patient-specific medical 3D printing begins with volume based medical images of the patient. Several digital manipulations are typically performed to prescribe a final anatomic representation that is then 3D printed. Among these are image segmentation where a volume of interest such as an organ or a set of tissues is digitally extracted from the volumetric imaging data. Image segmentation requires medical expertise, training, software, and effort. The theme of image segmentation has a broad intersection with medical 3D printing. The purpose of this editorial is to highlight different points of that intersection in a recent thematic series within 3D Printing in Medicine.
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Mechanical Properties of a 3 Dimensional-Printed Transparent Flexible Resin Used for Vascular Model Simulation Compared with Those of Porcine Arteries. J Vasc Interv Radiol 2023; 34:871-878.e3. [PMID: 36646207 DOI: 10.1016/j.jvir.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To develop a vascular intervention simulation model that replicates the characteristics of a human patient and to compare the mechanical properties of a 3-dimensional (3D)-printed transparent flexible resin with those of porcine arteries using the elastic modulus (E) and kinetic friction coefficient (μk). MATERIALS AND METHODS Resin plates were created from a transparent flexible resin using a 3D printer. Porcine artery plates were prepared by excising the aorta. E values and the adhesive strengths of the resin and arterial surfaces toward a polyethylene plate, were measured with a tensile-compressive mechanical tester. Resin transparency was measured using an ultraviolet-visible light spectrometer. The μk value of the resin plate surface after applying silicone spray for 1-5 seconds and that of the artery were measured using a translational friction tester. RESULTS E values differed significantly between the arteries and resin plates at each curing time (0.20 MPa ± 0.04 vs 8.53 MPa ± 2.37 for a curing time of 1 minute; P < .05). The resin was stiffer than the arteries, regardless of the curing times. The visible light transmittance and adhesive strength of the resin decreased as the curing time increased. The adhesive strength of the artery was the lowest. The μk value of the silicone-coated resin surface created by applying silicone for 2-3 seconds (thickness of the silicone layer, 1.6-2.0 μm) was comparable with that of the artery, indicating that the coating imparted a similar slippage to the resin as to the living artery. CONCLUSIONS A transparent flexible resin is useful for creating a transparent and slippery vascular model for vascular intervention simulation.
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Verykokou S, Ioannidis C. An Overview on Image-Based and Scanner-Based 3D Modeling Technologies. SENSORS (BASEL, SWITZERLAND) 2023; 23:596. [PMID: 36679393 PMCID: PMC9861742 DOI: 10.3390/s23020596] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 05/27/2023]
Abstract
Advances in the scientific fields of photogrammetry and computer vision have led to the development of automated multi-image methods that solve the problem of 3D reconstruction. Simultaneously, 3D scanners have become a common source of data acquisition for 3D modeling of real objects/scenes/human bodies. This article presents a comprehensive overview of different 3D modeling technologies that may be used to generate 3D reconstructions of outer or inner surfaces of different kinds of targets. In this context, it covers the topics of 3D modeling using images via different methods, it provides a detailed classification of 3D scanners by additionally presenting the basic operating principles of each type of scanner, and it discusses the problem of generating 3D models from scans. Finally, it outlines some applications of 3D modeling, beyond well-established topographic ones.
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Affiliation(s)
- Styliani Verykokou
- Laboratory of Photogrammetry, School of Rural, Surveying and Geoinformatics Engineering, National Technical University of Athens, 9 Iroon Polytechniou Str., 15780 Athens, Greece
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Marturello DM, James JC, Perry KL, Déjardin LM. Accuracy of anatomic 3-dimensionally printed canine humeral models. Vet Surg 2023; 52:116-126. [PMID: 36134757 DOI: 10.1111/vsu.13899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/19/2022] [Accepted: 09/05/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the accuracy of various three-dimensional print (3DP) technologies using morphometric measurements. STUDY DESIGN Experimental. SAMPLE POPULATION Cadaveric canine humeri and size-matched 3DP models. METHODS Fiduciary radiopaque markers were affixed to canine humeri of three different sizes (4, 13, 29 kg) at predetermined anatomical landmarks. 3DP models were created using one of three printers; desktop printers Form 3L and Ultimaker 5S, and industrial printer Objet Connex (n = 5/group/printer). Marker based morphometric dimensions between cadavers and 3DP models were statistically compared using 2-factor repeated measures ANOVA followed by Tukey's post-hoc test (p < .05). RESULTS Bone size and printer type both significantly affected 3DP accuracy, with size having the larger effect (p < .0001 and p < .02, respectively). Regardless of printing technology, model size was smaller than native bone in most cases. At the humeral condylar level, the best accuracy was seen in the medium-sized humerus with the Ultimaker printer ([0.09 mm], p < .03). Accuracy was reduced in the proximal humerus in all groups. CONCLUSION Desktop printers were overall more accurate than the industrial printer. Although significant differences were identified between models of different sizes, the submillimetric magnitude of these differences is unlikely to be clinically relevant. CLINICAL SIGNIFICANCE While preoperative planning using 3DP models is becoming mainstream, accurate representation of the actual bone is critical. This study demonstrates that common desktop printers are suitable for this purpose.
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Affiliation(s)
- Danielle M Marturello
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Jordan C James
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Karen L Perry
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Loïc M Déjardin
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
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AlRawi A, Basha T, Elmeligy AO, Mousa NA, Mohammed G. The Role of Three-dimensional Printed Models in Women's Health. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231199040. [PMID: 37688305 PMCID: PMC10493061 DOI: 10.1177/17455057231199040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023]
Abstract
Three-dimensional printing is an innovative technology that has gained prominence in recent years due to its attractive features such as affordability, efficiency, and quick production. The technology is used to produce a three-dimensional model by depositing materials in layers using specific printers. In the medical field, it has been increasingly used in various specialties, including neurosurgery, cardiology, and orthopedics, most commonly for the pre-planning of complex surgeries. In addition, it has been applied in therapeutic treatments, patient education, and training wof medical professionals. In the field of obstetrics and gynecology, there is a limited number of studies in which three-dimensional printed models were applied. In this review, we aim to provide an overview of three-dimensional printing applications in the medical field, highlighting the few reported applications in obstetrics and gynecology. We also review all relevant studies and discuss the current challenges and limitations of adopting the technology in routine clinical practice. The technology has the potential to expand for wider applications related to women's health, including patient counseling, surgical training, and medical education.
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Affiliation(s)
- Afnan AlRawi
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Tasneem Basha
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Ahmed O Elmeligy
- Department of Electrical and Computer Engineering, Faculty of Engineering, McGill University, Montreal, QC, Canada
| | - Noha A Mousa
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Ghada Mohammed
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Fidvi S, Holder J, Li H, Parnes GJ, Shamir SB, Wake N. Advanced 3D Visualization and 3D Printing in Radiology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1406:103-138. [PMID: 37016113 DOI: 10.1007/978-3-031-26462-7_6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Since the discovery of X-rays in 1895, medical imaging systems have played a crucial role in medicine by permitting the visualization of internal structures and understanding the function of organ systems. Traditional imaging modalities including Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Ultrasound (US) present fixed two-dimensional (2D) images which are difficult to conceptualize complex anatomy. Advanced volumetric medical imaging allows for three-dimensional (3D) image post-processing and image segmentation to be performed, enabling the creation of 3D volume renderings and enhanced visualization of pertinent anatomic structures in 3D. Furthermore, 3D imaging is used to generate 3D printed models and extended reality (augmented reality and virtual reality) models. A 3D image translates medical imaging information into a visual story rendering complex data and abstract ideas into an easily understood and tangible concept. Clinicians use 3D models to comprehend complex anatomical structures and to plan and guide surgical interventions more precisely. This chapter will review the volumetric radiological techniques that are commonly utilized for advanced 3D visualization. It will also provide examples of 3D printing and extended reality technology applications in radiology and describe the positive impact of advanced radiological image visualization on patient care.
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Affiliation(s)
- Shabnam Fidvi
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA.
| | - Justin Holder
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Hong Li
- Department of Radiology, Jacobi Medical Center, Bronx, NY, USA
| | | | | | - Nicole Wake
- GE Healthcare, Aurora, OH, USA
- Center for Advanced Imaging Innovation and Research, NYU Langone Health, New York, NY, USA
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Okkalidis N, Bliznakova K. A voxel-by-voxel method for mixing two filaments during a 3D printing process for soft-tissue replication in an anthropomorphic breast phantom. Phys Med Biol 2022; 67. [PMID: 36541511 DOI: 10.1088/1361-6560/aca640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 11/25/2022] [Indexed: 11/26/2022]
Abstract
Objective. In this study, a novel voxel-by-voxel mixing method is presented, according to which two filaments of different material are combined during the three dimensional (3D) printing process.Approach. In our approach, two types of filaments were used for the replication of soft-tissues, a polylactic acid (PLA) filament and a polypropylene (PP) filament. A custom-made software was used, while a series of breast patient CT scan images were directly associated to the 3D printing process. Each phantom´s layer was printed twice, once with the PLA filament and a second time with the PP filament. For each material, the filament extrusion rate was controlled voxel-by-voxel and was based on the Hounsfield units (HU) of the imported CT images. The phantom was scanned at clinical CT, breast tomosynthesis and micro CT facilities, as the major processing was performed on data from the CT. A side by side comparison between patient´s and phantom´s CT slices by means of profile and histogram comparison was accomplished. Further, in case of profile comparison, the Pearson´s coefficients were calculated.Main results. The visual assessment of the distribution of the glandular tissue in the CT slices of the printed breast anatomy showed high degree of radiological similarity to the corresponding patient´s glandular distribution. The profile plots´ comparison showed that the HU of the replicated and original patient soft tissues match adequately. In overall, the Pearson´s coefficients were above 0.91, suggesting a close match of the CT images of the phantom with those of the patient. The overall HU were close in terms of HU ranges. The HU mean, median and standard deviation of the original and the phantom CT slices were -149, -167, ±65 and -121, -130, ±91, respectively.Significance. The results suggest that the proposed methodology is appropriate for manufacturing of anthropomorphic soft tissue phantoms for x-ray imaging and dosimetry purposes, since it may offer an accurate replication of these tissues.
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Affiliation(s)
- Nikiforos Okkalidis
- Research Institute, Medical University of Varna, Bulgaria.,Morphé, Praxitelous 1, Thessaloniki, Greece
| | - Kristina Bliznakova
- Department of Medical Equipment, Electronic and Information Technologies in Healthcare, Medical University of Varna, Varna, Bulgaria
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Mantilla DE, Ferrara R, Ortiz AF, Vera DD, Nicoud F, Costalat V. Validation of three-dimensional printed models of intracranial aneurysms. Interv Neuroradiol 2022:15910199221143254. [PMID: 36503318 DOI: 10.1177/15910199221143254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Three-dimensional (3D) printing has evolved for medical applications as it can produce customized 3D models of devices and implants that can improve patient care. In this study, we aimed to validate the geometrical accuracy of the 3D models of intracranial aneurysms printed using Stereolithography 3D printing technology. MATERIALS AND METHODS To compare the unruptured intracranial aneurysm mesh between the five patients and 3D printed models, we opened the DICOM files in the Sim&Size® simulation software, selected the region of interest, and performed the threshold check. We juxtaposed the 3D reconstructions and manually rotated the images to get the same orientation when needed and measured deviations at different nodes of the patient and 3D printed model meshes. RESULTS In the first patient, 80% of the nodes were separated by <0.56 mm and 0.17 mm. In the second patient, the deviations were below 0.17 mm for 80% of the meshes' nodes. In the next three patients, the deviations were below 0.21, 0.23, and 0.11 mm for 80% of the meshes' nodes. Finally, the overall deviation was below 0.21 mm for 80% of the mesh nodes of the five aneurysms. CONCLUSIONS 3D printed models of intracranial aneurysms are accurate, having surfaces that resemble that of patients' angiographies with an 80% cumulative deviation below 0.21 mm.
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Affiliation(s)
- Daniel E Mantilla
- Interventional Radiology Department, Fundación oftalmológica de Santander Clínica Ardila Lülle, Floridablanca, Colombia
- Interventional Radiology Department, 27968Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
- Faculté de Sciencies, Université de Montpellier, Montpellier, France
| | | | - Andrés F Ortiz
- Interventional Radiology Department, Fundación oftalmológica de Santander Clínica Ardila Lülle, Floridablanca, Colombia
- Interventional Radiology Department, 27968Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Daniela D Vera
- Physician. Radiology Department, Fundación oftalmológica de Santander, Clínica Ardila Lülle, Floridablanca, Colombia
| | - Franck Nicoud
- Institut Montpelliérain Alexander, Grothendieck, CNRS, Univ. Montpellier, Montpellier, France
| | - Vincent Costalat
- Neuroradiology, Hôpital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
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Establishing a Point-of-Care Virtual Planning and 3D Printing Program. Semin Plast Surg 2022; 36:133-148. [PMID: 36506280 PMCID: PMC9729064 DOI: 10.1055/s-0042-1754351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Virtual surgical planning (VSP) and three-dimensional (3D) printing have become a standard of care at our institution, transforming the surgical care of complex patients. Patient-specific, anatomic models and surgical guides are clinically used to improve multidisciplinary communication, presurgical planning, intraoperative guidance, and the patient informed consent. Recent innovations have allowed both VSP and 3D printing to become more accessible to various sized hospital systems. Insourcing such work has several advantages including quicker turnaround times and increased innovation through collaborative multidisciplinary teams. Centralizing 3D printing programs at the point-of-care provides a greater cost-efficient investment for institutions. The following article will detail capital equipment needs, institutional structure, operational personnel, and other considerations necessary in the establishment of a POC manufacturing program.
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Dai S, Wang Q, Jiang Z, Liu C, Teng X, Yan S, Xia D, Tuo Z, Bi L. Application of three-dimensional printing technology in renal diseases. Front Med (Lausanne) 2022; 9:1088592. [PMID: 36530907 PMCID: PMC9755183 DOI: 10.3389/fmed.2022.1088592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/21/2022] [Indexed: 10/15/2023] Open
Abstract
Three-dimensional (3D) printing technology involves the application of digital models to create 3D objects. It is used in construction and manufacturing and has gradually spread to medical applications, such as implants, drug development, medical devices, prosthetic limbs, and in vitro models. The application of 3D printing has great prospects for development in orthopedics, maxillofacial plastic surgery, cardiovascular conditions, liver disease, and other fields. With in-depth research on 3D printing technology and the continuous update of printing materials, this technology also shows broad development prospects in renal medicine. In this paper, the author mainly summarizes the basic theory of 3D printing technology, its research progress, application status, and development prospect in renal diseases.
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Affiliation(s)
- Shuxin Dai
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qi Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhiwei Jiang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chang Liu
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiangyu Teng
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Songbai Yan
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Dian Xia
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhouting Tuo
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Liangkuan Bi
- Peking University Shenzhen Hospital, Shenzhen, China
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Chai Y, Simic R, Smith PN, Valter K, Limaye A, Li RW. Comparison of 2 open-sourced 3-dimensional modeling techniques for orthopaedic application. OTA Int 2022; 5:e213. [PMID: 36569106 PMCID: PMC9782327 DOI: 10.1097/oi9.0000000000000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/08/2022] [Indexed: 12/27/2022]
Abstract
Objectives: Although 3-dimensional (3D) printing is becoming more widely adopted for clinical applications, it is yet to be accepted as part of standard practice. One of the key applications of this technology is orthopaedic surgical planning for urgent trauma cases. Anatomically accurate replicas of patients' fracture models can be produced to guide intervention. These high-quality models facilitate the design and printing of patient-specific implants and surgical devices. Therefore, a fast and accurate workflow will help orthopaedic surgeons to generate high-quality 3D printable models of complex fractures. Currently, there is a lack of access to an uncomplicated and inexpensive workflow. Methods: Using patient DICOM data sets (n = 13), we devised a novel, simple, open-source, and rapid modeling process using Drishti software and compared its efficacy and data storage with the 3D Slicer image computing platform. We imported the computed tomography image directory acquired from patients into the software to isolate the model of bone surface from surrounding soft tissue using the minimum functions. One pelvic fracture case was further integrated into the customized implant design practice to demonstrate the compatibility of the 3D models generated from Drishti. Results: The data sizes of the generated 3D models and the processing files that represent the original DICOM of Drishti are on average 27% and 12% smaller than that of 3D Slicer, respectively (both P < 0.05). The time frame needed to reach the stage of viewing the 3D bone model and the exporting of the data of Drishti is 39% and 38% faster than that of 3D Slicer, respectively (both P < 0.05). We also constructed a virtual model using third-party software to trial the implant design. Conclusions: Drishti is more suitable for urgent trauma cases that require fast and efficient 3D bone reconstruction with less hardware requirement. 3D Slicer performs better at quantitative preoperative planning and multilayer segmentation. Both software platforms are compatible with third-party programs used to produce customized implants that could be useful for surgical training. Level of Evidence: Level V.
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Affiliation(s)
- Yuan Chai
- Trauma and Orthopaedic Research Laboratory, Department of Surgery, The Medical School, The Australian National University, Canberra, ACT, Australia
| | - Robert Simic
- Trauma and Orthopaedic Research Laboratory, Department of Surgery, The Medical School, The Australian National University, Canberra, ACT, Australia
| | - Paul N. Smith
- Trauma and Orthopaedic Research Unit, Clinical Orthopaedic Surgery, The Canberra Hospital, Garran, ACT, Australia
| | - Krisztina Valter
- The Medical School, and John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
| | - Ajay Limaye
- National Computational Infrastructure, The Australian National University, Canberra, ACT, Australia; and
| | - Rachel W. Li
- The Medical School, and John Curtin School of Medical Research, The Australian National University, Acton, ACT, Australia
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