1
|
Hooftman J, Dijkstra AC, Suurmeijer I, van der Bij A, Paap E, Zwaan L. Common contributing factors of diagnostic error: A retrospective analysis of 109 serious adverse event reports from Dutch hospitals. BMJ Qual Saf 2024; 33:642-651. [PMID: 37558403 DOI: 10.1136/bmjqs-2022-015876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/20/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Although diagnostic errors have gained renewed focus within the patient safety domain, measuring them remains a challenge. They are often measured using methods that lack information on decision-making processes given by involved physicians (eg, record reviews). The current study analyses serious adverse event (SAE) reports from Dutch hospitals to identify common contributing factors of diagnostic errors in hospital medicine. These reports are the results of thorough investigations by highly trained, independent hospital committees into the causes of SAEs. The reports include information from involved healthcare professionals and patients or family obtained through interviews. METHODS All 71 Dutch hospitals were invited to participate in this study. Participating hospitals were asked to send four diagnostic SAE reports of their hospital. Researchers applied the Safer Dx Instrument, a Generic Analysis Framework, the Diagnostic Error Evaluation and Research (DEER) taxonomy and the Eindhoven Classification Model (ECM) to analyse reports. RESULTS Thirty-one hospitals submitted 109 eligible reports. Diagnostic errors most often occurred in the diagnostic testing, assessment and follow-up phases according to the DEER taxonomy. The ECM showed human errors as the most common contributing factor, especially relating to communication of results, task planning and execution, and knowledge. Combining the most common DEER subcategories and the most common ECM classes showed that clinical reasoning errors resulted from failures in knowledge, and task planning and execution. Follow-up errors and errors with communication of test results resulted from failures in coordination and monitoring, often accompanied by usability issues in electronic health record design and missing protocols. DISCUSSION Diagnostic errors occurred in every hospital type, in different specialties and with different care teams. While clinical reasoning errors remain a common problem, often caused by knowledge and skill gaps, other frequent errors in communication of test results and follow-up require different improvement measures (eg, improving technological systems).
Collapse
Affiliation(s)
- Jacky Hooftman
- Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Ilse Suurmeijer
- Faculty of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Akke van der Bij
- Department of Microbiology and Immunology, Diakonessenhuis, Utrecht, The Netherlands
| | - Ellen Paap
- Knowledge Institute, Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Laura Zwaan
- Institute of Medical Education Research Rotterdam, Erasmus Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Tappa K, Bird JE, Arribas EM, Santiago L. Multimodality Imaging for 3D Printing and Surgical Rehearsal in Complex Spine Surgery. Radiographics 2024; 44:e230116. [PMID: 38386600 PMCID: PMC10924222 DOI: 10.1148/rg.230116] [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: 05/04/2023] [Revised: 07/11/2023] [Accepted: 08/10/2023] [Indexed: 02/24/2024]
Abstract
Surgery is the mainstay treatment of symptomatic spinal tumors. It aids in restoring functionality, managing pain and tumor growth, and improving overall quality of life. Over the past decade, advancements in medical imaging techniques combined with the use of three-dimensional (3D) printing technology have enabled improvements in the surgical management of spine tumors by significantly increasing the precision, accuracy, and safety of the surgical procedures. For complex spine surgical cases, the use of multimodality imaging is necessary to fully visualize the extent of disease, including both soft-tissue and bone involvement. Integrating the information provided by these examinations in a cohesive manner to facilitate surgical planning can be challenging, particularly when multiple surgical specialties work in concert. The digital 3-dimensional (3D) model or 3D rendering and the 3D printed model created from imaging examinations such as CT and MRI not only facilitate surgical planning but also allow the placement of virtual and physical surgical or osteotomy planes, further enhancing surgical planning and rehearsal. The authors provide practical information about the 3D printing workflow, from image acquisition to postprocessing of a 3D printed model, as well as optimal material selection and incorporation of quality management systems, to help surgeons utilize 3D printing for surgical planning. The authors also highlight the process of surgical rehearsal, how to prescribe digital osteotomy planes, and integration with intraoperative surgical navigation systems through a case-based discussion. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
Collapse
Affiliation(s)
- Karthik Tappa
- From the Department of Breast Imaging, Division of Diagnostic Imaging
(K.T.), Department of Orthopedic Oncology, Division of Surgery (J.E.B.), and
Department of Breast Imaging, Division of Diagnostic Imaging (E.M.A., L.S.), The
University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX
77030
| | - Justin E. Bird
- From the Department of Breast Imaging, Division of Diagnostic Imaging
(K.T.), Department of Orthopedic Oncology, Division of Surgery (J.E.B.), and
Department of Breast Imaging, Division of Diagnostic Imaging (E.M.A., L.S.), The
University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX
77030
| | - Elsa M. Arribas
- From the Department of Breast Imaging, Division of Diagnostic Imaging
(K.T.), Department of Orthopedic Oncology, Division of Surgery (J.E.B.), and
Department of Breast Imaging, Division of Diagnostic Imaging (E.M.A., L.S.), The
University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX
77030
| | - Lumarie Santiago
- From the Department of Breast Imaging, Division of Diagnostic Imaging
(K.T.), Department of Orthopedic Oncology, Division of Surgery (J.E.B.), and
Department of Breast Imaging, Division of Diagnostic Imaging (E.M.A., L.S.), The
University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX
77030
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Ahmed M, Melaragno LE, Nyirjesy SC, von Windheim N, Fenberg R, Herster R, Sheldon A, Binzel K, Knopp MV, Herderick ED, VanKoevering KK. Higher Computed Tomography (CT) Scan Resolution Improves Accuracy of Patient-specific Mandibular Models When Compared to Cadaveric Gold Standard. J Oral Maxillofac Surg 2023; 81:1176-1185. [PMID: 37315925 DOI: 10.1016/j.joms.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND 3D-printed patient-specific anatomical models are becoming an increasingly popular tool for planning reconstructive surgeries to treat oral cancer. Currently there is a lack of information regarding model accuracy, and how the resolution of the computed tomography (CT) scan affects the accuracy of the final model. PURPOSE The primary objective of this study was to determine the CT z-axis resolution necessary in creating a patient specific mandibular model with clinically acceptable accuracy for global bony reconstruction. This study also sought to evaluate the effect of the digital sculpting and 3D printing process on model accuracy. STUDY DESIGN This was a cross-sectional study using cadaveric heads obtained from the Ohio State University Body Donation Program. INDEPENDENT VARIABLES The first independent variable is CT scan slice thickness of either 0.675 , 1.25, 3.00, or 5.00 mm. The second independent variable is the three produced models for analysis (unsculpted, digitally sculpted, 3D printed). MAIN OUTCOME VARIABLE The degree of accuracy of a model as defined by the root mean square (RMS) value, a measure of a model's discrepancy from its respective cadaveric anatomy. ANALYSES All models were digitally compared to their cadaveric bony anatomy using a metrology surface scan of the dissected mandible. The RMS value of each comparison evaluates the level of discrepancy. One-way ANOVA tests (P < .05) were used to determine statistically significant differences between CT scan resolutions. Two-way ANOVA tests (P < .05) were used to determine statistically significant differences between groups. RESULTS CT scans acquired for 8 formalin-fixed cadaver heads were processed and analyzed. The RMS for digitally sculpted models decreased as slice thickness decreased, confirming that higher resolution CT scans resulted in statistically more accurate model production when compared to the cadaveric gold standard. Furthermore, digitally sculpted models were significantly more accurate than unsculpted models (P < .05) at each slice thickness. CONCLUSIONS Our study demonstrated that CT scans with slice thicknesses of 3.00 mm or smaller created statistically significantly more accurate models than models created from slice thicknesses of 5.00 mm. The digital sculpting process statistically significantly increased the accuracy of models and no loss of accuracy through the 3D printing process was observed.
Collapse
Affiliation(s)
- Maariyah Ahmed
- Undergraduate Student, Center for Design and Manufacturing Excellence, College of Engineering, The Ohio State University, Columbus, OH; Undergraduate Student, The Ohio State University College of Engineering, Department of Biomedical Engineering, Columbus, OH
| | - Luigi E Melaragno
- Undergraduate Student, Center for Design and Manufacturing Excellence, College of Engineering, The Ohio State University, Columbus, OH; Undergraduate Student, The Ohio State University College of Engineering, Department of Biomedical Engineering, Columbus, OH
| | - Sarah C Nyirjesy
- Resident, The Ohio State University Department of Otolaryngology- Head and Neck Surgery, Columbus, OH
| | - Natalia von Windheim
- Post-Doctoral Fellow, Center for Design and Manufacturing Excellence, College of Engineering, The Ohio State University, Columbus, OH
| | - Rachel Fenberg
- Clinical Researcher, The Ohio State University Department of Otolaryngology- Head and Neck Surgery, Columbus, OH; Medical Student, Albert Einstein College of Medicine, College of Medicine, New York, NY
| | - Rachel Herster
- Research Specialist, Center for Design and Manufacturing Excellence, College of Engineering, The Ohio State University, Columbus, OH
| | - Alexandra Sheldon
- Medical Student, The Ohio State University College of Medicine, Columbus, OH
| | - Katherine Binzel
- Professor, Wright Center of Innovation in Biomedical Imaging, Department of Radiology, OSUWMC, Columbus, OH
| | - Michael V Knopp
- Professor, Wright Center of Innovation in Biomedical Imaging, Department of Radiology, OSUWMC, Columbus, OH
| | - Edward D Herderick
- Director of Additive Manufacturing, Center for Design and Manufacturing Excellence, College of Engineering, The Ohio State University, Columbus, OH
| | - Kyle K VanKoevering
- Assistant Professor, The Ohio State University Department of Otolaryngology- Head and Neck Surgery, Columbus, OH.
| |
Collapse
|
6
|
Ravi P, Rybicki FJ. Proper Registration of Image Sets to Ensure Quality of 3D Printed Anatomic Models. Radiographics 2023; 43:e230177. [PMID: 37616170 DOI: 10.1148/rg.230177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Prashanth Ravi
- Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, PO Box 670761, Cincinnati, OH 45267-0761
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, PO Box 670761, Cincinnati, OH 45267-0761
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Paxton NC. Navigating the intersection of 3D printing, software regulation and quality control for point-of-care manufacturing of personalized anatomical models. 3D Print Med 2023; 9:9. [PMID: 37024730 PMCID: PMC10080800 DOI: 10.1186/s41205-023-00175-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
3D printing technology has become increasingly popular in healthcare settings, with applications of 3D printed anatomical models ranging from diagnostics and surgical planning to patient education. However, as the use of 3D printed anatomical models becomes more widespread, there is a growing need for regulation and quality control to ensure their accuracy and safety. This literature review examines the current state of 3D printing in hospitals and FDA regulation process for software intended for use in producing 3D printed models and provides for the first time a comprehensive list of approved software platforms alongside the 3D printers that have been validated with each for producing 3D printed anatomical models. The process for verification and validation of these 3D printed products, as well as the potential for inaccuracy in these models, is discussed, including methods for testing accuracy, limits, and standards for accuracy testing. This article emphasizes the importance of regulation and quality control in the use of 3D printing technology in healthcare, the need for clear guidelines and standards for both the software and the printed products to ensure the safety and accuracy of 3D printed anatomical models, and the opportunity to expand the library of regulated 3D printers.
Collapse
Affiliation(s)
- Naomi C Paxton
- Phil & Penny Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR, USA.
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
|
12
|
George MJ, Dias-Neto M, Ramos Tenorio E, Skibber MA, Morris JM, Oderich GS. 3D printing in aortic endovascular therapies. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:597-605. [PMID: 35822744 DOI: 10.23736/s0021-9509.22.12407-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Endovascular treatment of aortic disease, including aneurysm or dissection, is expanding at a rapid pace. Often, the specific patient anatomy in these cases is complex. Additive manufacturing, also known as three-dimensional (3D) printing, is especially useful in the treatment of aortic disease, due to its ability to manufacture physical models of complex patient anatomy. Compared to other surgical procedures, endovascular aortic repair can readily exploit the advantages of 3D printing with regard to operative planning and preoperative training. To date, there have been numerous uses of 3D printing in the treatment of aortic pathology as an adjunct in presurgical planning and as a basis for training modules for fellows and residents. In this review, we summarize the current uses of 3D printing in the endovascular management of aortic disease. We also review the process of producing these models, the limitations of their applications, and future directions of 3D printing in this field.
Collapse
Affiliation(s)
- Mitchell J George
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA -
| | - Marina Dias-Neto
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Emanuel Ramos Tenorio
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Max A Skibber
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Jonathan M Morris
- Unit of Anatomic Modeling, Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Gustavo S Oderich
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| |
Collapse
|
13
|
Meyer-Szary J, Luis MS, Mikulski S, Patel A, Schulz F, Tretiakow D, Fercho J, Jaguszewska K, Frankiewicz M, Pawłowska E, Targoński R, Szarpak Ł, Dądela K, Sabiniewicz R, Kwiatkowska J. The Role of 3D Printing in Planning Complex Medical Procedures and Training of Medical Professionals-Cross-Sectional Multispecialty Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3331. [PMID: 35329016 PMCID: PMC8953417 DOI: 10.3390/ijerph19063331] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/18/2022] [Accepted: 03/05/2022] [Indexed: 12/19/2022]
Abstract
Medicine is a rapidly-evolving discipline, with progress picking up pace with each passing decade. This constant evolution results in the introduction of new tools and methods, which in turn occasionally leads to paradigm shifts across the affected medical fields. The following review attempts to showcase how 3D printing has begun to reshape and improve processes across various medical specialties and where it has the potential to make a significant impact. The current state-of-the-art, as well as real-life clinical applications of 3D printing, are reflected in the perspectives of specialists practicing in the selected disciplines, with a focus on pre-procedural planning, simulation (rehearsal) of non-routine procedures, and on medical education and training. A review of the latest multidisciplinary literature on the subject offers a general summary of the advances enabled by 3D printing. Numerous advantages and applications were found, such as gaining better insight into patient-specific anatomy, better pre-operative planning, mock simulated surgeries, simulation-based training and education, development of surgical guides and other tools, patient-specific implants, bioprinted organs or structures, and counseling of patients. It was evident that pre-procedural planning and rehearsing of unusual or difficult procedures and training of medical professionals in these procedures are extremely useful and transformative.
Collapse
Affiliation(s)
- Jarosław Meyer-Szary
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Marlon Souza Luis
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- First Doctoral School, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Szymon Mikulski
- Department of Head and Neck Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Agastya Patel
- First Doctoral School, Medical University of Gdańsk, 80-211 Gdańsk, Poland
- Department of General, Endocrine and Transplant Surgery, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Finn Schulz
- University Clinical Centre in Gdańsk, 80-952 Gdańsk, Poland
| | - Dmitry Tretiakow
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland
| | - Justyna Fercho
- Neurosurgery Department, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Kinga Jaguszewska
- Department of Gynecology, Obstetrics and Neonatology, Division of Gynecology and Obstetrics, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Mikołaj Frankiewicz
- Department of Urology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Ewa Pawłowska
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Radosław Targoński
- 1st Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Łukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Katarzyna Dądela
- Department of Pediatric Cardiology, University Children's Hospital, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Krakow, Poland
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Joanna Kwiatkowska
- Department of Pediatric Cardiology and Congenital Heart Defects, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| |
Collapse
|
14
|
3D printing units should be centrally managed in the radiology department. Eur J Radiol 2022; 148:110161. [DOI: 10.1016/j.ejrad.2022.110161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/20/2022]
|
15
|
Bastawrous S, Wu L, Liacouras PC, Levin DB, Ahmed MT, Strzelecki B, Amendola MF, Lee JT, Coburn J, Ripley B. Establishing 3D Printing at the Point of Care: Basic Principles and Tools for Success. Radiographics 2022; 42:451-468. [PMID: 35119967 DOI: 10.1148/rg.210113] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
As the medical applications of three-dimensional (3D) printing increase, so does the number of health care organizations in which adoption or expansion of 3D printing facilities is under consideration. With recent advancements in 3D printing technology, medical practitioners have embraced this powerful tool to help them to deliver high-quality patient care, with a focus on sustainability. The use of 3D printing in the hospital or clinic at the point of care (POC) has profound potential, but its adoption is not without unanticipated challenges and considerations. The authors provide the basic principles and considerations for building the infrastructure to support 3D printing inside the hospital. This process includes building a business case; determining the requirements for facilities, space, and staff; designing a digital workflow; and considering how electronic health records may have a role in the future. The authors also discuss the supported applications and benefits of medical 3D printing and briefly highlight quality and regulatory considerations. The information presented is meant to be a practical guide to assist radiology departments in exploring the possibilities of POC 3D printing and expanding it from a niche application to a fixture of clinical care. An invited commentary by Ballard is available online. ©RSNA, 2022.
Collapse
Affiliation(s)
- Sarah Bastawrous
- Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, Seattle, Wash; Departments of Radiology (S.B., L.W., B.R.) and Research and Development (B.S.), VA Puget Sound Health Care System, Mailbox S-114, Radiology, 1660 S Columbian Way, Seattle, WA 98108-1597; 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, University of Kentucky College of Medicine, Lexington, Ky (M.T.A., J.T.L.); Department of Surgery, Division of Vascular Surgery, Surgical Services (112), Virginia Commonwealth University School of Medicine, Richmond, Va (M.F.A.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - Lei Wu
- Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, Seattle, Wash; Departments of Radiology (S.B., L.W., B.R.) and Research and Development (B.S.), VA Puget Sound Health Care System, Mailbox S-114, Radiology, 1660 S Columbian Way, Seattle, WA 98108-1597; 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, University of Kentucky College of Medicine, Lexington, Ky (M.T.A., J.T.L.); Department of Surgery, Division of Vascular Surgery, Surgical Services (112), Virginia Commonwealth University School of Medicine, Richmond, Va (M.F.A.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - Peter C Liacouras
- Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, Seattle, Wash; Departments of Radiology (S.B., L.W., B.R.) and Research and Development (B.S.), VA Puget Sound Health Care System, Mailbox S-114, Radiology, 1660 S Columbian Way, Seattle, WA 98108-1597; 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, University of Kentucky College of Medicine, Lexington, Ky (M.T.A., J.T.L.); Department of Surgery, Division of Vascular Surgery, Surgical Services (112), Virginia Commonwealth University School of Medicine, Richmond, Va (M.F.A.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - Dmitry B Levin
- Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, Seattle, Wash; Departments of Radiology (S.B., L.W., B.R.) and Research and Development (B.S.), VA Puget Sound Health Care System, Mailbox S-114, Radiology, 1660 S Columbian Way, Seattle, WA 98108-1597; 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, University of Kentucky College of Medicine, Lexington, Ky (M.T.A., J.T.L.); Department of Surgery, Division of Vascular Surgery, Surgical Services (112), Virginia Commonwealth University School of Medicine, Richmond, Va (M.F.A.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - Mohamed Tarek Ahmed
- Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, Seattle, Wash; Departments of Radiology (S.B., L.W., B.R.) and Research and Development (B.S.), VA Puget Sound Health Care System, Mailbox S-114, Radiology, 1660 S Columbian Way, Seattle, WA 98108-1597; 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, University of Kentucky College of Medicine, Lexington, Ky (M.T.A., J.T.L.); Department of Surgery, Division of Vascular Surgery, Surgical Services (112), Virginia Commonwealth University School of Medicine, Richmond, Va (M.F.A.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - Brian Strzelecki
- Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, Seattle, Wash; Departments of Radiology (S.B., L.W., B.R.) and Research and Development (B.S.), VA Puget Sound Health Care System, Mailbox S-114, Radiology, 1660 S Columbian Way, Seattle, WA 98108-1597; 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, University of Kentucky College of Medicine, Lexington, Ky (M.T.A., J.T.L.); Department of Surgery, Division of Vascular Surgery, Surgical Services (112), Virginia Commonwealth University School of Medicine, Richmond, Va (M.F.A.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - Michael F Amendola
- Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, Seattle, Wash; Departments of Radiology (S.B., L.W., B.R.) and Research and Development (B.S.), VA Puget Sound Health Care System, Mailbox S-114, Radiology, 1660 S Columbian Way, Seattle, WA 98108-1597; 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, University of Kentucky College of Medicine, Lexington, Ky (M.T.A., J.T.L.); Department of Surgery, Division of Vascular Surgery, Surgical Services (112), Virginia Commonwealth University School of Medicine, Richmond, Va (M.F.A.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - James T Lee
- Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, Seattle, Wash; Departments of Radiology (S.B., L.W., B.R.) and Research and Development (B.S.), VA Puget Sound Health Care System, Mailbox S-114, Radiology, 1660 S Columbian Way, Seattle, WA 98108-1597; 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, University of Kentucky College of Medicine, Lexington, Ky (M.T.A., J.T.L.); Department of Surgery, Division of Vascular Surgery, Surgical Services (112), Virginia Commonwealth University School of Medicine, Richmond, Va (M.F.A.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - James Coburn
- Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, Seattle, Wash; Departments of Radiology (S.B., L.W., B.R.) and Research and Development (B.S.), VA Puget Sound Health Care System, Mailbox S-114, Radiology, 1660 S Columbian Way, Seattle, WA 98108-1597; 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, University of Kentucky College of Medicine, Lexington, Ky (M.T.A., J.T.L.); Department of Surgery, Division of Vascular Surgery, Surgical Services (112), Virginia Commonwealth University School of Medicine, Richmond, Va (M.F.A.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| | - Beth Ripley
- Department of Radiology (S.B., L.W., B.R.) and Department of Medicine, Division of Cardiology (D.B.L.), University of Washington School of Medicine, Seattle, Wash; Departments of Radiology (S.B., L.W., B.R.) and Research and Development (B.S.), VA Puget Sound Health Care System, Mailbox S-114, Radiology, 1660 S Columbian Way, Seattle, WA 98108-1597; 3D Medical Applications Center, Walter Reed National Military Medical Center, Bethesda, Md (P.C.L.); Department of Radiology, University of Kentucky College of Medicine, Lexington, Ky (M.T.A., J.T.L.); Department of Surgery, Division of Vascular Surgery, Surgical Services (112), Virginia Commonwealth University School of Medicine, Richmond, Va (M.F.A.); and Department of Bioengineering, University of Maryland, College Park, Md (J.C.)
| |
Collapse
|
16
|
Kairn T, Talkhani S, Charles PH, Chua B, Lin CY, Livingstone AG, Maxwell SK, Poroa T, Simpson-Page E, Spelleken E, Vo M, Crowe SB. Determining tolerance levels for quality assurance of 3D printed bolus for modulated arc radiotherapy of the nose. Phys Eng Sci Med 2021; 44:1187-1199. [PMID: 34529247 DOI: 10.1007/s13246-021-01054-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
Given the existing literature on the subject, there is obviously a need for specific advice on quality assurance (QA) tolerances for departments using or implementing 3D printed bolus for radiotherapy treatments. With a view to providing initial suggested QA tolerances for 3D printed bolus, this study evaluated the dosimetric effects of changes in bolus geometry and density, for a particularly common and challenging clinical situation: specifically, volumetric modulated arc therapy (VMAT) treatment of the nose. Film-based dose verification measurements demonstrated that both the AAA and the AXB algorithms used by the Varian Eclipse treatment planning system (Varian Medical Systems, Palo Alto, USA) were capable of providing sufficiently accurate dose calculations to allow this planning system to be used to evaluate the effects of bolus errors on dose distributions from VMAT treatments of the nose. Thereafter, the AAA and AXB algorithms were used to calculate the dosimetric effects of applying a range of simulated errors to the design of a virtual bolus, to identify QA tolerances that could be used to avoid clinically significant effects from common printing errors. Results were generally consistent, whether the treatment target was superficial and treated with counter-rotating coplanar arcs or more-penetrating and treated with noncoplanar arcs, and whether the dose was calculated using the AAA algorithm or the AXB algorithm. The results of this study suggest the following QA tolerances are advisable, when 3D printed bolus is fabricated for use in photon VMAT treatments of the nose: bolus relative electron density variation within [Formula: see text] (although an action level at [Formula: see text] may be permissible); bolus thickness variation within [Formula: see text] mm (or 0.5 mm variation on opposite sides); and air gap between bolus and skin [Formula: see text] mm. These tolerances should be investigated for validity with respect to other treatment modalities and anatomical sites. This study provides a set of baselines for future comparisons and a useful method for identifying additional or alternative 3D printed bolus QA tolerances.
Collapse
Affiliation(s)
- T Kairn
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. .,Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD, Australia. .,School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, QLD, Australia. .,School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia.
| | - S Talkhani
- School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia
| | - P H Charles
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD, Australia.,School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, QLD, Australia.,School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia
| | - B Chua
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - C Y Lin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - A G Livingstone
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - S K Maxwell
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - T Poroa
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - E Simpson-Page
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - E Spelleken
- GenesisCare Rockhampton, Rockhampton Hospital, Rockhampton, QLD, Australia
| | - M Vo
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - S B Crowe
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, QLD, Australia.,School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, QLD, Australia.,School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|