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Ang AJY, Chee SP, Tang JZE, Chan CY, Tan VYJ, Lee JA, Schrepfer T, Ahamed NMN, Tan MB. Developing a production workflow for 3D-printed temporal bone surgical simulators. 3D Print Med 2024; 10:16. [PMID: 38814431 PMCID: PMC11138071 DOI: 10.1186/s41205-024-00218-x] [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: 02/06/2024] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION 3D-printed temporal bone models enable the training and rehearsal of complex otological procedures. To date, there has been no consolidation of the literature regarding the developmental process of 3D-printed temporal bone models. A brief review of the current literature shows that many of the key surgical landmarks of the temporal bone are poorly represented in models. This study aims to propose a novel design and production workflow to produce high-fidelity 3D-printed temporal bone models for surgical simulation. METHODS Developmental phases for data extraction, 3D segmentation and Computer Aided Design (CAD), and fabrication are outlined. The design and fabrication considerations for key anatomical regions, such as the mastoid air cells and course of the facial nerve, are expounded on with the associated strategy and design methods employed. To validate the model, radiological measurements were compared and a senior otolaryngologist performed various surgical procedures on the model. RESULTS Measurements between the original scans and scans of the model demonstrate sub-millimetre accuracy of the model. Assessment by the senior otologist found that the model was satisfactory in simulating multiple surgical procedures. CONCLUSION This study offers a systematic method for creating accurate 3D-printed temporal bone models for surgical training. Results show high accuracy and effectiveness in simulating surgical procedures, promising improved training and patient outcomes.
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Affiliation(s)
| | - Shu Ping Chee
- 3D Printing Centre Singapore General Hospital, Singapore, Singapore
| | - Joyce Zhi En Tang
- Department of Otorhinolaryngology- Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ching Yee Chan
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Vanessa Yee Jueen Tan
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jordan Adele Lee
- Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia
| | - Thomas Schrepfer
- Department of Otolaryngology, University of Florida, Florida, USA
| | | | - Mark Bangwei Tan
- Department of Neuroradiology & 3D Printing Centre Singapore General Hospital, Singapore, Singapore
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Ock J, Choi Y, Lee DG, Chung JW, Kim N. Educational simulator for mastoidectomy considering mechanical properties using 3D printing and its usability evaluation. Sci Rep 2024; 14:7661. [PMID: 38561420 PMCID: PMC10984916 DOI: 10.1038/s41598-024-58359-2] [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: 12/18/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
Complex temporal bone anatomy complicates operations; thus, surgeons must engage in practice to mitigate risks, improving patient safety and outcomes. However, existing training methods often involve prohibitive costs and ethical problems. Therefore, we developed an educational mastoidectomy simulator, considering mechanical properties using 3D printing. The mastoidectomy simulator was modeled on computed tomography images of a patient undergoing a mastoidectomy. Infill was modeled for each anatomical part to provide a realistic drilling sensation. Bone and other anatomies appear in assorted colors to enhance the simulator's educational utility. The mechanical properties of the simulator were evaluated by measuring the screw insertion torque for infill specimens and cadaveric temporal bones and investigating its usability with a five-point Likert-scale questionnaire completed by five otolaryngologists. The maximum insertion torque values of the sigmoid sinus, tegmen, and semicircular canal were 1.08 ± 0.62, 0.44 ± 0.42, and 1.54 ± 0.43 N mm, displaying similar-strength infill specimens of 40%, 30%, and 50%. Otolaryngologists evaluated the quality and usability at 4.25 ± 0.81 and 4.53 ± 0.62. The mastoidectomy simulator could provide realistic bone drilling feedback for educational mastoidectomy training while reinforcing skills and comprehension of anatomical structures.
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Affiliation(s)
- Junhyeok Ock
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea
| | - Yeonjoo Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea
| | - Dong-Gyu Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea.
| | - Namkug Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea.
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea.
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Wang X, Shujaat S, Shaheen E, Jacobs R. Quality and haptic feedback of three-dimensionally printed models for simulating dental implant surgery. J Prosthet Dent 2024; 131:660-667. [PMID: 35513918 DOI: 10.1016/j.prosdent.2022.02.027] [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: 11/24/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
STATEMENT OF PROBLEM A model offering anatomic replication and haptic feedback similar to that of real bone is essential for hands-on surgical dental implant training. Patient-specific skeletal models can be produced with 3-dimensional (3D) printing, but whether these models can offer optimal haptic feedback for simulating implant surgery is unknown. PURPOSE The purpose of this trial was to compare the haptic feedback of different 3D printed models for simulating dental implant surgery. MATERIAL AND METHODS A cone beam computed tomography image of a 60-year-old man with a partially edentulous mandible was manipulated to segment the mandible and isolated from the rest of the scan. Three-dimensional models were printed with 6 different printers and materials: material jetting-based printer (MJ, acrylic-based resin); digital light processing-based printer (DLP, acrylic-based resin); fused filament fabrication-based printer (FFF1, polycarbonate filament; FFF2, polylactic acid filament); stereolithography-based printer (SLA, acrylic-based resin); and selective laser sintering-based printer (SLS, polyamide filament). Five experienced maxillofacial surgeons performed a simulated implant surgery on the models. A 5-point Likert scale questionnaire was established to assess the haptic feedback. The Friedman test and cumulative logit models were applied to evaluate differences among the models (α=.05). RESULTS The median score for drilling perception and implant insertion was highest for the MJ-based model and lowest for the SLS-based model. In relation to the drill chips, a median score of ≥3 was observed for all models. The score for corticotrabecular transition was highest for the MJ-based model and lowest for the FFF2-based model. Overall, the MJ-based model offered the highest score compared with the other models. CONCLUSIONS The 3D printed model with MJ technology and acrylic-based resin provided the best haptic feedback for performing implant surgery. However, none of the models were able to completely replicate the haptic perception of real bone.
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Affiliation(s)
- Xiaotong Wang
- Doctoral Candidate, OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Clinical Surgeon, Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Sohaib Shujaat
- Postdoctoral Researcher, OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Eman Shaheen
- Clinical Engineer, OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Professor, OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Professor, Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden.
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Cafino R, Soliven MMT, Velasco LC, Lopez KH. Evaluation of polyethylene terephthalate glycol (PETG), Simubone™, and photopolymer resin as 3D printed temporal bone models for surgical simulation. Asian J Surg 2024; 47:237-244. [PMID: 37633781 DOI: 10.1016/j.asjsur.2023.08.095] [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: 03/15/2023] [Revised: 07/29/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023] Open
Abstract
OBJECTIVES Among types of 3D printing, fused deposition modeling (FDM) and digital light processing (DLP) are the most accessible, making them attractive, low-cost options for simulating surgical procedures. This study characterized and compared inexpensive, synthetic temporal bone models printed using Resin, PETG, and Simubone™. MATERIALS AND METHODS This study compared models made of polyethylene terephthalate glycol (PETG), Simubone™ produced from a FDM printer, and photopolymer resin from a DLP printer. These temporal bone models were processed by: (1) DICOM files from a patient's CT scan were segmented to define critical parts expected in a temporal bone surgery. (2) The model was appended with a base that articulates with a 3D-printed temporal bone holder. (3) The refined, patient-specific model was manufactured using FDM and DLP printing technologies. (4) The models were sent to evaluators, who assessed the models based on anatomic accuracy, dissection experience, and its applicability as a surgical simulation tool for temporal bone dissection. RESULTS The photopolymer resin outperformed PETG and Simubone™ in terms of anatomical accuracy and dissection experience. Additionally, resin and PETG were evaluated to be appropriate for simple mastoidectomy and canal wall down mastoidectomy while Simubone™ was only suitable for simple mastoidectomy. All models were unsuitable for posterior tympanotomy and labyrinthectomy. CONCLUSIONS Photopolymer resin and PETG have shown to be suitable materials for dissection models with 3D-printed resin models showing more accuracy in replicating anatomical structures and dissection experience. Hence, the use of 3D-printed temporal bones may be a suitable low-cost alternative to cadaveric dissection.
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Affiliation(s)
- Rentor Cafino
- Zamboanga City Medical Center, Department of Otorhinolaryngology - Head and Neck Surgery, Zamboanga City, Republic of the Philippines; ENT HNS Medical Makerspace, Zamboanga City, Republic of the Philippines.
| | - Maria Monique Theresita Soliven
- Zamboanga City Medical Center, Department of Otorhinolaryngology - Head and Neck Surgery, Zamboanga City, Republic of the Philippines; ENT HNS Medical Makerspace, Zamboanga City, Republic of the Philippines
| | - Lemuel Clark Velasco
- ENT HNS Medical Makerspace, Zamboanga City, Republic of the Philippines; Mindanao State University-Iligan Institute of Technology, Department of Information Technology, Iligan City, Republic of the Philippines; Premiere Research Institute of Science and Mathematics - Center for Computational Analytics and Modelling, Iligan City, Republic of the Philippines
| | - Kim Harold Lopez
- University of the Philippines Diliman, Department of Mechanical Engineering, Quezon City, Republic of the Philippines
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Kostas JC, Lee M, Rameau A. A Novel Low-Cost, Open-Source, Three-Dimensionally Printed Thyroplasty Simulator. J Voice 2023:S0892-1997(23)00376-4. [PMID: 38036381 PMCID: PMC11133763 DOI: 10.1016/j.jvoice.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Training of surgical procedures on awake patients, such as medialization thyroplasty, poses challenges to educators and trainees. Three-dimensionally (3D)-printed simulators provide opportunity to practice in low-stakes settings. We present the first 3D-printed thyroplasty simulator incorporating a cartilaginous framework, endolaryngeal soft tissue housed in a 3D-printed manikin with endoscopic visualization. METHODS Male and female laryngeal cartilages and endolarynx molds were 3D printed from an existing open-source design. Cartilage models were made of heat-treated polylactic acid (HTPLA), a material chosen for its thermal stability, allowing drilling. They were combined with molded silicone endolarynges modeling glottic insufficiency. Larynges were set in a 3D-printed head-and-neck manikin with an attached borescope for internal visualization similar to distal chip laryngoscopy. Eight laryngologists evaluated the simulator by drilling a thyroplasty window, inserting an implant for medialization, and rating the model using a modified Michigan Standard Simulation Experience Scale (1 = strongly disagree, 5 = strongly agree). RESULTS The model was well rated in educational value (mean 4.7, standard deviation [SD] 0.3), fidelity (mean 3.8, SD 0.2), and overall value (mean 4.8, SD 0.5). Qualitative assessment concluded the model was anatomically realistic and that HTPLA was a good approximation of the density and texture of thyroid cartilage. The materials for one larynx cost $4.09. CONCLUSION This high-fidelity 3D-printed simulator demonstrates educational value for thyroplasty training. The low-cost, open-source design has broad implications for universal access to this simulator platform.
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Affiliation(s)
- Julianna C Kostas
- Sean Parker Institute for the Voice, Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine, New York, New York
| | - Mark Lee
- Sean Parker Institute for the Voice, Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine, New York, New York
| | - Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine, New York, New York.
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Ali A, Morris JM, Decker SJ, Huang YH, Wake N, Rybicki FJ, Ballard DH. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: neurosurgical and otolaryngologic conditions. 3D Print Med 2023; 9:33. [PMID: 38008795 PMCID: PMC10680204 DOI: 10.1186/s41205-023-00192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Medical three dimensional (3D) printing is performed for neurosurgical and otolaryngologic conditions, but without evidence-based guidance on clinical appropriateness. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness recommendations for neurologic 3D printing conditions. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with neurologic and otolaryngologic conditions. Each study was vetted by the authors and strength of evidence was assessed according to published guidelines. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for diseases of the calvaria and skull base, brain tumors and cerebrovascular disease. Recommendations are provided in accordance with strength of evidence of publications corresponding to each neurologic condition combined with expert opinion from members of the 3D printing SIG. CONCLUSIONS This consensus guidance document, created by the members of the 3D printing SIG, provides a reference for clinical standards of 3D printing for neurologic conditions.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | | | - Summer J Decker
- Division of Imaging Research and Applied Anatomy, Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Shay A, Zaniletti I, Coffman H, Mehta S, Richter G. Comparing Feedback Techniques in Bilobe Flap Simulation Using 3D-Printed Facial Models. OTO Open 2023; 7:e90. [PMID: 38020044 PMCID: PMC10631012 DOI: 10.1002/oto2.90] [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: 08/22/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To compare live versus delayed feedback on trainee performance of bilobe flaps using 3-dimensional (3D)-printed facial simulators and determine whether these effects are sustained on repeat performance. Study Design Cohort study. Setting University of Arkansas for Medical Sciences. Methods 3D-printed facial models with a nasal ala defect were provided to 18 subjects. Subjects were stratified and randomized based on their training level into 1 of 3 groups corresponding to live feedback (Group 1), delayed feedback (Group 2), and no feedback (Group 3). Subjects performed a bilobe flap following a structured lecture. Four weeks later, subjects independently repeated the exercise on the contralateral ala. Likert surveys were used to assess subjective parameters. Objective grading was performed by a plastic surgeon, which included a point system and score for the overall appearance. Results Following exercise 1, Group 1 reported a significant improvement in knowledge (P < .001), which was sustained after exercise 2 (P < .001); Group 2 reported a significant improvement after exercise 1 (P = .03) but was not sustained (P = .435). After the second exercise, Group 1 and Group 2 improved their confidence in bilobed repair (P = .001 and P = .003, respectively), but this was greater for Group 1. Group 1 showed a significant improvement in their design time following exercise 2 (P = .007). There were no significant differences between groups on total time for repair, total score, and appearance. Conclusion 3D-printed models are valuable in teaching the bilobe flap for nasal defects, with live feedback providing the greatest level of improvement in self-reported knowledge and confidence.
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Affiliation(s)
- Aryan Shay
- Department of Otolaryngology–Head and Neck Surgery, Arkansas Children's HospitalUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | | | - Hannah Coffman
- Department of Otolaryngology–Head and Neck Surgery, Arkansas Children's HospitalUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Sagar Mehta
- Department of Surgery–Division of Plastic and Reconstructive Surgery, Arkansas Children's HospitalUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Gresham Richter
- Department of Otolaryngology–Head and Neck Surgery, Arkansas Children's HospitalUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
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Dissanayaka N, Maclachlan LR, Alexander H, Redmond M, Carluccio D, Jules-Vandi L, Novak JI. Evaluation of 3D Printed Burr Hole Simulation Models Using 8 Different Materials. World Neurosurg 2023; 176:e651-e663. [PMID: 37295464 DOI: 10.1016/j.wneu.2023.05.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE 3D printing is increasingly used to fabricate three-dimensional neurosurgical simulation models, making training more accessible and economical. 3D printing includes various technologies with different capabilities for reproducing human anatomy. This study evaluated different materials across a broad range of 3D printing technologies to identify the combination that most precisely represents the parietal region of the skull for burr hole simulation. METHODS Eight different materials (polyethylene terephthalate glycol, Tough PLA, FibreTuff, White Resin, BoneSTN, SkullSTN, polymide [PA12], glass-filled polyamide [PA12-GF]) across 4 different 3D printing processes (fused filament fabrication, stereolithography, material jetting, selective laser sintering) were produced as skull samples that fit into a larger head model derived from computed tomography imaging. Five neurosurgeons conducted burr holes on each sample while blinded to the details of manufacturing method and cost. Qualities of mechanical drilling, visual appearance, skull exterior, and skull interior (i.e., diploë) and overall opinion were documented, and a final ranking activity was performed along with a semistructured interview. RESULTS The study found that 3D printed polyethylene terephthalate glycol (using fused filament fabrication) and White Resin (using stereolithography) were the best models to replicate the skull, surpassing advanced multimaterial samples from a Stratasys J750 Digital Anatomy Printer. The interior (e.g., infill) and exterior structures strongly influenced the overall ranking of samples. All neurosurgeons agreed that practical simulation with 3D printed models can play a vital role in neurosurgical training. CONCLUSIONS The study findings reveal that widely accessible desktop 3D printers and materials can play a valuable role in neurosurgical training.
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Affiliation(s)
- Nalinda Dissanayaka
- School of Chemical Engineering, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, Brisbane, Australia; Centre for Advanced Materials Processing and Manufacturing (AMPAM), The University of Queensland, Brisbane, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia
| | - Liam R Maclachlan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Hamish Alexander
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia; Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Michael Redmond
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia; Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Danilo Carluccio
- School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia
| | - Luigi Jules-Vandi
- School of Mechanical and Mining Engineering, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, Brisbane, Australia; Centre for Advanced Materials Processing and Manufacturing (AMPAM), The University of Queensland, Brisbane, Australia
| | - James I Novak
- School of Architecture, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, Brisbane, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia.
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Gharibshahian M, Salehi M, Beheshtizadeh N, Kamalabadi-Farahani M, Atashi A, Nourbakhsh MS, Alizadeh M. Recent advances on 3D-printed PCL-based composite scaffolds for bone tissue engineering. Front Bioeng Biotechnol 2023; 11:1168504. [PMID: 37469447 PMCID: PMC10353441 DOI: 10.3389/fbioe.2023.1168504] [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: 02/17/2023] [Accepted: 06/05/2023] [Indexed: 07/21/2023] Open
Abstract
Population ageing and various diseases have increased the demand for bone grafts in recent decades. Bone tissue engineering (BTE) using a three-dimensional (3D) scaffold helps to create a suitable microenvironment for cell proliferation and regeneration of damaged tissues or organs. The 3D printing technique is a beneficial tool in BTE scaffold fabrication with appropriate features such as spatial control of microarchitecture and scaffold composition, high efficiency, and high precision. Various biomaterials could be used in BTE applications. PCL, as a thermoplastic and linear aliphatic polyester, is one of the most widely used polymers in bone scaffold fabrication. High biocompatibility, low cost, easy processing, non-carcinogenicity, low immunogenicity, and a slow degradation rate make this semi-crystalline polymer suitable for use in load-bearing bones. Combining PCL with other biomaterials, drugs, growth factors, and cells has improved its properties and helped heal bone lesions. The integration of PCL composites with the new 3D printing method has made it a promising approach for the effective treatment of bone injuries. The purpose of this review is give a comprehensive overview of the role of printed PCL composite scaffolds in bone repair and the path ahead to enter the clinic. This study will investigate the types of 3D printing methods for making PCL composites and the optimal compounds for making PCL composites to accelerate bone healing.
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Affiliation(s)
- Maliheh Gharibshahian
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Majid Salehi
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
- Tissue Engineering and Stem Cells Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Nima Beheshtizadeh
- Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amir Atashi
- Tissue Engineering and Stem Cells Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - Morteza Alizadeh
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
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Frithioff A, Weiss K, Frendø M, Senn P, Mikkelsen PT, Sieber D, Sørensen MS, Pedersen DB, Andersen SAW. 3D-printing a cost-effective model for mastoidectomy training. 3D Print Med 2023; 9:12. [PMID: 37062800 PMCID: PMC10108487 DOI: 10.1186/s41205-023-00174-y] [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: 11/11/2022] [Accepted: 03/24/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND 3D-printed temporal bone models can potentially provide a cost-effective alternative to cadaver surgery that can be manufactured locally at the training department. The objective of this study was to create a cost-effective 3D-printed model suitable for mastoidectomy training using entry level and commercially available print technologies, enabling individuals, without prior experience on 3D-printing, to manufacture their own models for basic temporal bone training. METHODS Expert technical professionals and an experienced otosurgeon identified the best material for replicating the temporal bone and created a cost-effective printing routine for the model using entry-level print technologies. Eleven participants at a temporal bone dissection course evaluated the model using a questionnaire. RESULTS The 3D-printed temporal bone model was printed using a material extrusion 3D-printer with a heat resistant filament, reducing melting during drilling. After printing, a few simple post-processing steps were designed to replicate the dura, sigmoid sinus and facial nerve. Modifying the 3D-printer by installing a direct-drive and ruby nozzle resulted in more successful prints and less need for maintenance. Upon evaluation by otorhinolaryngology trainees, unanimous feedback was that the model provided a good introduction to the mastoidectomy procedure, and supplementing practice to cadaveric temporal bones. CONCLUSION In-house production of a cost-effective 3D-printed model for temporal bone training is feasible and enables training institutions to manufacture their own models. Further, this work demonstrates the feasibility of creating new temporal bone models with anatomical variation to provide ample training opportunity.
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Affiliation(s)
- Andreas Frithioff
- Copenhagen Hearing and Balance Center, Dept. of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.
| | - Kenneth Weiss
- Department of Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Martin Frendø
- Copenhagen Hearing and Balance Center, Dept. of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
- Department of Plastic Surgery, Herlev & Gentofte Hospital, Copenhagen, Denmark
| | - Pascal Senn
- Department of Clinical Neurosciences, Service of ORL & Head and Neck Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Peter Trier Mikkelsen
- Copenhagen Hearing and Balance Center, Dept. of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Sieber
- Department of Medical & Health Technologies, MCI | The Entrepreneurial School, Innsbruck, Austria
| | - Mads Sølvsten Sørensen
- Copenhagen Hearing and Balance Center, Dept. of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Steven Arild Wuyts Andersen
- Copenhagen Hearing and Balance Center, Dept. of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
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Pipeline for Automated Processing of Clinical Cone-Beam Computed Tomography for Patient-Specific Temporal Bone Simulation: Validation and Clinical Feasibility. Otol Neurotol 2023; 44:e88-e94. [PMID: 36624596 DOI: 10.1097/mao.0000000000003771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Patient-specific simulation allows the surgeon to plan and rehearse the surgical approach ahead of time. Preoperative clinical imaging for this purpose requires time-consuming manual processing and segmentation of landmarks such as the facial nerve. We aimed to evaluate an automated pipeline with minimal manual interaction for processing clinical cone-beam computed tomography (CBCT) temporal bone imaging for patient-specific virtual reality (VR) simulation. STUDY DESIGN Prospective image processing of retrospective imaging series. SETTING Academic hospital. METHODS Eleven CBCTs were selected based on quality and used for validation of the processing pipeline. A larger naturalistic sample of 36 CBCTs were obtained to explore parameters for successful processing and feasibility for patient-specific VR simulation.Visual inspection and quantitative metrics were used to validate the accuracy of automated segmentation compared with manual segmentation. Range of acceptable rotational offsets and translation point selection variability were determined. Finally, feasibility in relation to image acquisition quality, processing time, and suitability for VR simulation was evaluated. RESULTS The performance of automated segmentation was acceptable compared with manual segmentation as reflected in the quantitative metrics. Total time for processing for new data sets was on average 8.3 minutes per data set; of this, it was less than 30 seconds for manual steps. Two of the 36 data sets failed because of extreme rotational offset, but overall the registration routine was robust to rotation and manual selection of a translational reference point. Another seven data sets had successful automated segmentation but insufficient suitability for VR simulation. CONCLUSION Automated processing of CBCT imaging has potential for preoperative VR simulation but requires further refinement.
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Mogan J, Harun WSW, Kadirgama K, Ramasamy D, Foudzi FM, Sulong AB, Tarlochan F, Ahmad F. Fused Deposition Modelling of Polymer Composite: A Progress. Polymers (Basel) 2022; 15:polym15010028. [PMID: 36616377 PMCID: PMC9823360 DOI: 10.3390/polym15010028] [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: 10/18/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022] Open
Abstract
Additive manufacturing (AM) highlights developing complex and efficient parts for various uses. Fused deposition modelling (FDM) is the most frequent fabrication procedure used to make polymer products. Although it is widely used, due to its low characteristics, such as weak mechanical properties and poor surface, the types of polymer material that may be produced are limited, affecting the structural applications of FDM. Therefore, the FDM process utilises the polymer composition to produce a better physical product. The review's objective is to systematically document all critical information on FDMed-polymer composite processing, specifically for part fabrication. The review covers the published works on the FDMed-polymer composite from 2011 to 2021 based on our systematic literature review of more than 150 high-impact related research articles. The base and filler material used, and the process parameters including layer height, nozzle temperature, bed temperature, and screw type are also discussed in this review. FDM is utilised in various biomedical, automotive, and other manufacturing industries. This study is expected to be one of the essential pit-stops for future related works in the FDMed-polymeric composite study.
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Affiliation(s)
- J Mogan
- Institute of Postgraduate Studies, Universiti Malaysia Pahang, Gambang, Kuantan 26300, Pahang, Malaysia
| | - W. S. W. Harun
- Department of Mechanical Engineering, College of Engineering, Universiti Malaysia Pahang, Gambang, Kuantan 26300, Pahang, Malaysia
- Correspondence:
| | - K. Kadirgama
- Faculty of Mechanical and Automotive Engineering Technology, Universiti Malaysia Pahang, Gambang, Kuantan 26300, Pahang, Malaysia
| | - D. Ramasamy
- Department of Mechanical Engineering, College of Engineering, Universiti Malaysia Pahang, Gambang, Kuantan 26300, Pahang, Malaysia
| | - F. M. Foudzi
- Department of Mechanical and Manufacturing Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
| | - A. B. Sulong
- Department of Mechanical and Manufacturing Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
| | - F. Tarlochan
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha P.O. Box 2713, Qatar
| | - F. Ahmad
- Department of Mechanical Engineering, Universiti Teknologi Petronas, Seri Iskandar 32610, Perak, Malaysia
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You Y, Niu Y, Sun F, Huang S, Ding P, Wang X, Zhang X, Zhang J. Three-dimensional printing and 3D slicer powerful tools in understanding and treating neurosurgical diseases. Front Surg 2022; 9:1030081. [PMCID: PMC9614074 DOI: 10.3389/fsurg.2022.1030081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
With the development of the 3D printing industry, clinicians can research 3D printing in preoperative planning, individualized implantable materials manufacturing, and biomedical tissue modeling. Although the increased applications of 3D printing in many surgical disciplines, numerous doctors do not have the specialized range of abilities to utilize this exciting and valuable innovation. Additionally, as the applications of 3D printing technology have increased within the medical field, so have the number of printable materials and 3D printers. Therefore, clinicians need to stay up-to-date on this emerging technology for benefit. However, 3D printing technology relies heavily on 3D design. 3D Slicer can transform medical images into digital models to prepare for 3D printing. Due to most doctors lacking the technical skills to use 3D design and modeling software, we introduced the 3D Slicer to solve this problem. Our goal is to review the history of 3D printing and medical applications in this review. In addition, we summarized 3D Slicer technologies in neurosurgery. We hope this article will enable many clinicians to leverage the power of 3D printing and 3D Slicer.
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Affiliation(s)
- Yijie You
- Department of Neurosurgery, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Yunlian Niu
- Department of Neurology, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Fengbing Sun
- Department of Neurosurgery, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Sheng Huang
- Department of Neurosurgery, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Peiyuan Ding
- Department of Neurosurgery, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Xuhui Wang
- Department of Neurosurgery, Xinhua Hospital Chongming Branch, Shanghai, China,Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, The Cranial Nerve Disease Center of Shanghai JiaoTong University, Shanghai, China
| | - Xin Zhang
- Educational Administrative Department, Shanghai Chongming Health School, Shanghai, China,Correspondence: Xin Zhang Jian Zhang
| | - Jian Zhang
- Department of Neurosurgery, Xinhua Hospital Chongming Branch, Shanghai, China,Correspondence: Xin Zhang Jian Zhang
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Vivarelli L, Govoni M, Attala D, Zoccali C, Biagini R, Dallari D. Custom Massive Allograft in a Case of Pelvic Bone Tumour: Simulation of Processing with Computerised Numerical Control vs. Robotic Machining. J Clin Med 2022; 11:jcm11102781. [PMID: 35628908 PMCID: PMC9143408 DOI: 10.3390/jcm11102781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023] Open
Abstract
The use of massive bone allografts after the resection of bone tumours is still a challenging process. However, to overcome some issues related to the processing procedures and guarantee the best three-dimensional matching between donor and recipient, some tissue banks have developed a virtual tissue database based on the scanning of the available allografts for using their 3D shape during virtual surgical planning (VSP) procedures. To promote the use of future VSP bone-shaping protocols useful for machining applications within a cleanroom environment, in our work, we simulate a massive bone allograft machining with two different machines: a four-axes (computer numerical control, CNC) vs. a five-axes (robot) milling machine. The allograft design was based on a real case of allograft reconstruction after pelvic tumour resection and obtained with 3D Slicer and Rhinoceros software. Machining simulations were performed with RhinoCAM and graphically and mathematically analysed with CloudCompare and R, respectively. In this case, the geometrical differences of the allograft design are not clinically relevant; however, the mathematical analysis showed that the robot performed better than the four-axes machine. The proof-of-concept presented here paves the way towards massive bone allograft cleanroom machining. Nevertheless, further studies, such as the simulation of different types of allografts and real machining on massive bone allografts, are needed.
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Affiliation(s)
- Leonardo Vivarelli
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
- Correspondence: (L.V.); (M.G.)
| | - Marco Govoni
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
- Correspondence: (L.V.); (M.G.)
| | - Dario Attala
- Department of Oncological Orthopaedics—Musculoskeletal Tissue Bank, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Carmine Zoccali
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Roberto Biagini
- Department of Oncological Orthopaedics, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
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Leung G, Pickett AT, Bartellas M, Milin A, Bromwich M, Shorr R, Caulley L. Systematic review and meta-analysis of 3D-printing in otolaryngology education. Int J Pediatr Otorhinolaryngol 2022; 155:111083. [PMID: 35219038 DOI: 10.1016/j.ijporl.2022.111083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Three-dimensional (3D) printing has received increased attention in recent years and has many applications. In the field of otolaryngology surgery, 3D-printed models have shown potential educational value and a high fidelity to actual tissues. This provides an opportunity for trainees to gain additional exposure, especially as conventional educational tools, such as cadavers, are expensive and in limited supply. The purpose of this study was to perform a meta-analysis of the uses of 3D-printing in otolaryngology education. The primary outcomes of investigation were surgical utility, anatomical similarity, and educational value of 3D-printed models. Secondary outcomes of interest included country of implementation, 3D-printer materials and costs, types of surgical simulators, and the levels of training of participants. METHODS MEDLINE, Embase, Web of Science, Google Scholar and previous reviews were searched from inception until June 2021 for eligible articles. Title, abstract, and data extraction were performed in duplicate. Data were analyzed using random-effects models. The National Institute of Health Quality Assessment Tool was used to rate the quality of the evidence. RESULTS A total of 570 abstracts were identified and screened by 2 independent reviewers. Of the 274 articles reviewed in full text, 46 articles met the study criteria and were included in the meta-analysis. Surgical skill utility was reported in 42 studies (563 participants) and had a high degree of acceptance (84.8%, 95% CI: 81.1%-88.4%). The anatomical similarity was reported in 39 studies (484 participants) and was received positively at 80.6% (95% CI: 77.0%-84.2%). Educational value was described in 36 studies (93 participants) and had the highest approval rating by participants at 90.04% (87.20%-92.88%). A subgroup analysis by year of publication demonstrated that studies published after 2015 had higher ratings across all outcomes compared to those published prior to 2015. CONCLUSION This study found that 3D-printing interventions in otolaryngology demonstrated surgical, anatomical, and educational value. In addition, the approval ratings of 3D-printed models indicate a positive trend over time. Future educational programs may consider implementing 3D-printing on a larger scale within the medical curriculum to enhance exposure to otolaryngology.
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Affiliation(s)
- Gareth Leung
- University of Ottawa, Faculty of Medicine, Ottawa, Canada.
| | | | | | | | - Matthew Bromwich
- University of Ottawa, Department of Otolaryngology, Ottawa, Canada
| | | | - Lisa Caulley
- University of Ottawa, Department of Otolaryngology, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Canada; Erasmus University Medical Center Rotterdam, Department of Epidemiology, Rotterdam, Netherlands
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16
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Frithioff A, Frendø M, Weiss K, Foghsgaard S, Pedersen DB, Sørensen MS, Wuyts Andersen SA. Effect of 3D-Printed Models on Cadaveric Dissection in Temporal Bone Training. OTO Open 2021; 5:2473974X211065012. [PMID: 34926973 PMCID: PMC8671684 DOI: 10.1177/2473974x211065012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Mastoidectomy is a cornerstone in the surgical management of middle and inner ear diseases. Unfortunately, training is challenged by insufficient access to human cadavers. Three-dimensional (3D) printing of temporal bones could alleviate this problem, but evidence on their educational effectiveness is lacking. It is largely unknown whether training on 3D-printed temporal bones improves mastoidectomy performance, including on cadavers, and how this training compares with virtual reality (VR) simulation. To address this knowledge gap, this study investigated whether training on 3D-printed temporal bones improves cadaveric dissection performance, and it compared this training with the already-established VR simulation. Study Design Prospective cohort study of an educational intervention. Setting Tertiary university hospital, cadaver dissection laboratory, and simulation center in Copenhagen, Denmark. Methods Eighteen otorhinolaryngology residents (intervention) attending the national temporal bone dissection course received 3 hours of mastoidectomy training on 3D-printed temporal bones. Posttraining cadaver mastoidectomy performances were rated by 3 experts using a validated assessment tool and compared with those of 66 previous course participants (control) who had received time-equivalent VR training prior to dissection. Results The intervention cohort outperformed the controls during cadaver dissection by 29% (P < .001); their performances were largely similar across training modalities but remained at a modest level (~50% of the maximum score). Conclusion Mastoidectomy skills improved from training on 3D-printed temporal bone and seemingly more so than on time-equivalent VR simulation. Importantly, these skills transferred to cadaveric dissection. Training on 3D-printed temporal bones can effectively supplement cadaver training when learning mastoidectomy.
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Affiliation(s)
- Andreas Frithioff
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark
| | - Martin Frendø
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark.,Department of Plastic and Reconstructive Surgery, Herlev Hospital, Copenhagen, Denmark
| | - Kenneth Weiss
- Department of Mechanical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Søren Foghsgaard
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Mads Sølvsten Sørensen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark
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Lamberti AG, Ujfalusi Z, Told R, Hanna D, Józsa G, Maróti P. Development of a Novel X-ray Compatible 3D-Printed Bone Model to Characterize Different K-Wire Fixation Methods in Support of the Treatment of Pediatric Radius Fractures. Polymers (Basel) 2021; 13:4179. [PMID: 34883682 PMCID: PMC8659769 DOI: 10.3390/polym13234179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
Additive manufacturing technologies are essential in biomedical modeling and prototyping. Polymer-based bone models are widely used in simulating surgical interventions and procedures. Distal forearm fractures are the most common pediatric fractures, in which the Kirschner wire fixation is the most widely used operative method. However, there is still lingering controversy throughout the published literature regarding the number of wires and sites of insertion. This study aims to critically compare the biomechanical stability of different K-wire fixation techniques. Different osteosyntheses were reconstructed on 189 novel standardized bone models, which were created using 3D printing and molding techniques, using PLA and polyurethane materials, and it has been characterized in terms of mechanical behavior and structure. X-ray imaging has also been performed. The validation of the model was successful: the relative standard deviations (RSD = 100 × SD × mean-1, where RSD is relative standard deviation, SD is the standard deviation) of the mechanical parameters varied between 1.1% (10° torsion; 6.52 Nm ± 0.07 Nm) and 5.3% (5° torsion; 4.33 Nm ± 0.23 Nm). The simulated fractures were fixed using two K-wires inserted from radial and dorsal directions (crossed wire fixation) or both from the radial direction, in parallel (parallel wire fixation). Single-wire fixations with shifted exit points were also included. Additionally, three-point bending tests with dorsal and radial load and torsion tests were performed. We measured the maximum force required for a 5 mm displacement of the probe under dorsal and radial loads (means for crossed wire fixation: 249.5 N and 355.9 N; parallel wire fixation: 246.4 N and 308.3 N; single wire fixation: 115.9 N and 166.5 N). We also measured the torque required for 5° and 10° torsion (which varied between 0.15 Nm for 5° and 0.36 Nm for 10° torsion). The crossed wire fixation provided the most stability during the three-point bending tests. Against torsion, both the crossed and parallel wire fixation were superior to the single-wire fixations. The 3D printed model is found to be a reliable, cost-effective tool that can be used to characterize the different fixation methods, and it can be used in further pre-clinical investigations.
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Affiliation(s)
- Anna Gabriella Lamberti
- Medical Centre, Department of Paediatrics, Division of Paediatric Surgery, Traumatology, Urology, and Paediatric Otolaryngology, UP Clinical Centre, 7 Jozsef Attila Str., HU-7623 Pecs, Hungary;
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pecs, 12 Szigeti Str., HU-7624 Pecs, Hungary
| | - Zoltan Ujfalusi
- Department of Biophysics, Medical School, University of Pecs, 12 Szigeti Str., HU-7624 Pecs, Hungary;
| | - Roland Told
- 3D Printing and Visualization Center, University of Pecs, 2 Boszorkany Str., HU-7624 Pecs, Hungary; (R.T.); (P.M.)
| | - Dániel Hanna
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pecs, 12 Szigeti Str., HU-7624 Pecs, Hungary;
- Research Group of Regenerative Science, Sport and Medicine, Szentagothai Research Centre, University of Pecs, 20 Ifjusag Str., HU-7624 Pecs, Hungary
| | - Gergő Józsa
- Medical Centre, Department of Paediatrics, Division of Paediatric Surgery, Traumatology, Urology, and Paediatric Otolaryngology, UP Clinical Centre, 7 Jozsef Attila Str., HU-7623 Pecs, Hungary;
| | - Péter Maróti
- 3D Printing and Visualization Center, University of Pecs, 2 Boszorkany Str., HU-7624 Pecs, Hungary; (R.T.); (P.M.)
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Bueno-López C, Tamarit-Martínez C, Alambiaga-Caravaca AM, Balaguer-Fernández C, Merino V, López-Castellano A, Rodilla V. 3D Printing of Temporary Prostheses for Controlled-Release of Drugs: Design, Physical Characterization and Preliminary Studies. Pharmaceuticals (Basel) 2021; 14:ph14121240. [PMID: 34959642 PMCID: PMC8708214 DOI: 10.3390/ph14121240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/15/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
In recent years, the use of 3D printing technologies in orthopedic surgery has markedly increased, as they offer the possibility of printing personalized prostheses. The work presented in this article is a preliminary study of a research project which aims to manufacture customized spacers containing antibiotics for use in joint replacement surgery. The objective of this work was to design and print different 3D constructs to evaluate the use of different materials, their properties after the process of 3D printing, such as resistance, and the release kinetics of drugs from the constructs. Different designs and different materials were analyzed to obtain a 3D construct with suitable properties. Our design takes advantage of the micropores created between the layers of the 3D printed filaments to release the contained drug. Using polylactic acid (PLA) we were able to print cylindrical structures with interconnected micropores and a hollow chamber capable of releasing methylene blue, which was selected as a model drug. The final PLA 3D construct was printed with a 10% infill. The physical and technological characteristics, morphological changes at body temperature and interaction with water were considered to be acceptable. The PLA 3D printed constructs were found to have sufficient strength to withstand a force of 500 kg. The results obtained allow to continue research in this project, with the aim of manufacturing prostheses containing a reservoir of antibiotics or other drugs in their interior for their subsequent controlled release.
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Affiliation(s)
- Carlos Bueno-López
- Instituto de Ciencias Biomédicas, Departamento de Farmacia, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, C/Santiago Ramón y Cajal s/n, 46115 Valencia, Spain; (C.B.-L.); (C.T.-M.); (A.M.A.-C.); (C.B.-F.)
| | - Carlos Tamarit-Martínez
- Instituto de Ciencias Biomédicas, Departamento de Farmacia, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, C/Santiago Ramón y Cajal s/n, 46115 Valencia, Spain; (C.B.-L.); (C.T.-M.); (A.M.A.-C.); (C.B.-F.)
| | - Adrián M. Alambiaga-Caravaca
- Instituto de Ciencias Biomédicas, Departamento de Farmacia, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, C/Santiago Ramón y Cajal s/n, 46115 Valencia, Spain; (C.B.-L.); (C.T.-M.); (A.M.A.-C.); (C.B.-F.)
| | - Cristina Balaguer-Fernández
- Instituto de Ciencias Biomédicas, Departamento de Farmacia, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, C/Santiago Ramón y Cajal s/n, 46115 Valencia, Spain; (C.B.-L.); (C.T.-M.); (A.M.A.-C.); (C.B.-F.)
| | - Virginia Merino
- Departamento de Farmacia y Tecnología Farmacéutica y Parasitología, Facultad de Farmacia, Universitat de València, Av. Vicente Andrés Estellés s/n, 46100 Valencia, Spain;
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València, Universitat de València, 46005 Valencia, Spain
| | - Alicia López-Castellano
- Instituto de Ciencias Biomédicas, Departamento de Farmacia, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, C/Santiago Ramón y Cajal s/n, 46115 Valencia, Spain; (C.B.-L.); (C.T.-M.); (A.M.A.-C.); (C.B.-F.)
- Correspondence: (A.L.-C.); (V.R.); Tel.: +34-961-369-000 (ext. 64527) (V.R.)
| | - Vicent Rodilla
- Instituto de Ciencias Biomédicas, Departamento de Farmacia, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, C/Santiago Ramón y Cajal s/n, 46115 Valencia, Spain; (C.B.-L.); (C.T.-M.); (A.M.A.-C.); (C.B.-F.)
- Correspondence: (A.L.-C.); (V.R.); Tel.: +34-961-369-000 (ext. 64527) (V.R.)
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Mehrotra D, Markus A. Emerging simulation technologies in global craniofacial surgical training. J Oral Biol Craniofac Res 2021; 11:486-499. [PMID: 34345584 PMCID: PMC8319526 DOI: 10.1016/j.jobcr.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/22/2021] [Indexed: 12/14/2022] Open
Abstract
The last few decades have seen an exponential growth in the development and adoption of novel technologies in medical and surgical training of residents globally. Simulation is an active and innovative teaching method, and can be achieved via physical or digital models. Simulation allows the learners to repeatedly practice without the risk of causing any error in an actual patient and enhance their surgical skills and efficiency. Simulation may also allow the clinical instructor to objectively test the ability of the trainee to carry out the clinical procedure competently and independently prior to trainee's completion of the program. This review aims to explore the role of emerging simulation technologies globally in craniofacial training of students and residents in improving their surgical knowledge and skills. These technologies include 3D printed biomodels, virtual and augmented reality, use of google glass, hololens and haptic feedback, surgical boot camps, serious games and escape games and how they can be implemented in low and middle income countries. Craniofacial surgical training methods will probably go through a sea change in the coming years, with the integration of these new technologies in the surgical curriculum, allowing learning in a safe environment with a virtual patient, through repeated exercise. In future, it may also be used as an assessment tool to perform any specific procedure, without putting the actual patient on risk. Although these new technologies are being enthusiastically welcomed by the young surgeons, they should only be used as an addition to the actual curriculum and not as a replacement to the conventional tools, as the mentor-mentee relationship can never be replaced by any technology.
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Affiliation(s)
- Divya Mehrotra
- Department of Oral and Maxillofacial Surgery KGMU, Lucknow, India
| | - A.F. Markus
- Emeritus Consultant Maxillofacial Surgeon, Poole Hospital University of Bournemouth, University of Duisburg-Essen, Trinity College, Dublin, Ireland
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20
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Toro M, Cardona A, Restrepo D, Buitrago L. Does vaporized hydrogen peroxide sterilization affect the geometrical properties of anatomic models and guides 3D printed from computed tomography images? 3D Print Med 2021; 7:29. [PMID: 34519898 PMCID: PMC8439001 DOI: 10.1186/s41205-021-00120-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 08/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background Material extrusion is used to 3D print anatomic models and guides. Sterilization is required if a 3D printed part touches the patient during an intervention. Vaporized Hydrogen Peroxide (VHP) is one method of sterilization. There are four factors to consider when sterilizing an anatomic model or guide: sterility, biocompatibility, mechanical properties, and geometric fidelity. This project focuses on geometric fidelity for material extrusion of one polymer acrylonitrile butadiene styrene (ABS) using VHP. Methods De-identified computed tomography (CT) image data from 16 patients was segmented using Mimics Innovation Suite (Materialise NV, Leuven, Belgium). Eight patients had maxillary and mandibular defects depicted with the anatomic models, and eight had mandibular defects for the anatomic guides. Anatomic models and guides designed from the surfaces of CT scan reconstruction and segementation were 3D printed in medical-grade acrylonitrile butadiene styrene (ABS) material extrusion. The 16 parts underwent low-temperature sterilization with VHP. The dimensional error was estimated after sterilization by comparing scanned images of the 3D printed parts. Results The average of the estimated mean differences between the printed pieces before and after sterilization were − 0,011 ± 0,252 mm (95%CI − 0,011; − 0,010) for the models and 0,003 ± 0,057 mm (95%CI 0,002; 0,003) for the guides. Regarding the dimensional error of the sterilized parts compared to the original design, the estimated mean differences were − 0,082 ± 0,626 mm (95%CI − 0,083; − 0,081) for the models and 0,126 ± 0,205 mm (95%CI 0,126, 0,127) for the guides. Conclusion This project tested and verified dimensional stability, one of the four prerequisites for introducing vaporized hydrogen peroxide into 3D printing of anatomic models and guides; the 3D printed parts maintained dimensional stability after sterilization.
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Affiliation(s)
- Mauricio Toro
- TECHFIT Digital Surgery, Industrias Médicas Sampedro, Carrera 47 N° 100 Sur 40 Centro Industrial Portal del Sur, Bodega 14, variante a Caldas, La Estrella (Medellin), Colombia
| | - Aura Cardona
- R&D Department, TECHFIT Digital Surgery, Industrias Médicas Sampedro, La Estrella, Colombia
| | - Daniel Restrepo
- R&D Department, TECHFIT Digital Surgery, Industrias Médicas Sampedro, La Estrella, Colombia
| | - Laura Buitrago
- TECHFIT Digital Surgery, Industrias Médicas Sampedro, Carrera 47 N° 100 Sur 40 Centro Industrial Portal del Sur, Bodega 14, variante a Caldas, La Estrella (Medellin), Colombia.
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21
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Jiang M, Coles-Black J, Chen G, Alexander M, Chuen J, Hardidge A. 3D Printed Patient-Specific Complex Hip Arthroplasty Models Streamline the Preoperative Surgical Workflow: A Pilot Study. Front Surg 2021; 8:687379. [PMID: 34513912 PMCID: PMC8427196 DOI: 10.3389/fsurg.2021.687379] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/28/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: Surgical planning for complex total hip arthroplasty (THA) often presents a challenge. Definitive plans can be difficult to decide upon, requiring unnecessary equipment to be ordered and a long theatre list booked. We present a pilot study utilising patient-specific 3D printed models as a method of streamlining the pre-operative planning process. Methods: Complex patients presenting for THA were referred to the research team. Patient-specific 3D models were created from routine Computed Tomography (CT) imaging. Simulated surgery was performed to guide prosthesis selection, sizing and the surgical plan. Results: Seven patients were referred for this pilot study, presenting with complex conditions with atypical anatomy. Surgical plans provided by the 3D models were more detailed and accurate when compared to 2D CT and X ray imaging. Streamlined equipment selection was of great benefit, with augments avoided post simulation in three cases. The ability to tackle complex surgical problems outside of the operating theatre also flagged potential complications, while also providing teaching opportunities in a low risk environment. Conclusion: This study demonstrated that 3D printed models can improve the surgical plan and streamline operative logistics. Further studies investigating the optimal 3D printing material and workflow, along with cost-benefit analyses are required before this process is ready for routine use.
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Affiliation(s)
- Michael Jiang
- 3dMedLab, Austin Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - Jasamine Coles-Black
- 3dMedLab, Austin Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - Gordon Chen
- 3dMedLab, Austin Health, The University of Melbourne, Parkville, VIC, Australia
| | - Matthew Alexander
- Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - Jason Chuen
- 3dMedLab, Austin Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - Andrew Hardidge
- Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
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22
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Visual and haptic perceptibility of 3D printed skeletal models in orthognathic surgery. J Dent 2021; 109:103660. [PMID: 33848559 DOI: 10.1016/j.jdent.2021.103660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the anatomical and tactile quality of 3D printed models derived from medical printers for application in orthognathic surgery. METHODS A CBCT-scan of an 18 years old female patient was acquired with NewTom VGi evo (NewTom, Verona, Italy). Thereafter, mandibular bone was segmented and isolated from the scan using Mimics inPrint 2.0 software (Materialise NV, Leuven, Belgium). Six printers with different technologies were utilized for printing skeletal models, which included stereolithography (ProX800, 3D Systems, Rock Hill, SC, USA), digital light processing (Perfactory 4 mini XL, Envisiontec, Dearborn, MI, USA), fused deposition modeling (uPrint SE, Stratasys, Eden Prairie, MI, US), colorjet (ProJet CJP 660Pro, 3D Systems, Rock Hill, SC, USA), multijet (Objet Connex 350, Stratasys, Eden Prairie, MN, USA) and selective laser sintering (EOSINT P700, EOS GmbH, Munich, Germany). A questionnaire was designed, where 22 maxillofacial residents scored whether the printed models were able to mimic bone color, texture and anatomy. Five maxillofacial surgeons performed bone cutting with screw insertion/removal to assess the tactile perceptibility. RESULTS In relation to texture and cortical and medullary anatomy replication, Perfactory 4 mini XL printer showed the highest mean score, whereas, Objet Connex 350 scored highest for color replication. The haptic feedback for cutting and screw insertion/removal varied for each printer, however, overall it was found to be highest for ProX800, whereas, EOSINT P700 was found to be least favorable. CONCLUSIONS The digital light processing based Perfactory 4 mini XL printer offered the most acceptable anatomical model, whereas, deficiencies existed for the replication of haptic feedback to that of real bone with each printer. CLINICAL SIGNIFICANCE The study outcomes provide pearls and pitfalls of 3D printed models utilizing various printers and technologies. There is a need for research on multi-material printing as such to improve the haptic feedback of skeletal models and render the models more human bone-like to improve surgical planning and clinical training.
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23
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Frithioff A, Frendø M, Pedersen DB, Sørensen MS, Wuyts Andersen SA. 3D-Printed Models for Temporal Bone Surgical Training: A Systematic Review. Otolaryngol Head Neck Surg 2021; 165:617-625. [PMID: 33650897 DOI: 10.1177/0194599821993384] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE 3D-printed models hold great potential for temporal bone surgical training as a supplement to cadaveric dissection. Nevertheless, critical knowledge on manufacturing remains scattered, and little is known about whether use of these models improves surgical performance. This systematic review aims to explore (1) methods used for manufacturing and (2) how educational evidence supports using 3D-printed temporal bone models. DATA SOURCES PubMed, Embase, the Cochrane Library, and Web of Science. REVIEW METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were identified and data on manufacturing and validation and/or training extracted by 2 reviewers. Quality assessment was performed using the Medical Education Research Study Quality Instrument tool; educational outcomes were determined according to Kirkpatrick's model. RESULTS The search yielded 595 studies; 36 studies were found eligible and included for analysis. The described 3D-printed models were based on computed tomography scans from patients or cadavers. Processing included manual segmentation of key structures such as the facial nerve; postprocessing, for example, consisted of removal of print material inside the model. Overall, educational quality was low, and most studies evaluated their models using only expert and/or trainee opinion (ie, Kirkpatrick level 1). Most studies reported positive attitudes toward the models and their potential for training. CONCLUSION Manufacturing and use of 3D-printed temporal bones for surgical training are widely reported in the literature. However, evidence to support their use and knowledge about both manufacturing and the effects on subsequent surgical performance are currently lacking. Therefore, stronger educational evidence and manufacturing knowhow are needed for widespread implementation of 3D-printed temporal bones in surgical curricula.
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Affiliation(s)
- Andreas Frithioff
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - Martin Frendø
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
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24
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Freiser ME, Ghodadra A, McCall AA, Shaffer AD, Magnetta M, Jabbour N. Operable, Low-Cost, High-Resolution, Patient-Specific 3D Printed Temporal Bones for Surgical Simulation and Evaluation. Ann Otol Rhinol Laryngol 2021; 130:1044-1051. [PMID: 33554632 DOI: 10.1177/0003489421993733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Three-dimensional printed models created on a consumer level printer can be used to practice mastoidectomy and to discern mastoidectomy experience level. Current models in the literature for mastoidectomy are limited by expense or operability. The aims of this study were (1) to investigate the utility of an inexpensive model for mastoidectomy and (2) to assess whether the model can be used as an evaluation tool to discern the experience level of the surgeon performing mastoidectomy. METHODS Three-dimensional printed temporal bone models from the CT scan of a 7-year old patient were created using a consumer-level stereolithography 3D printer for a raw material cost of $10 each. Mastoidectomy with facial recess approach was performed by 4 PGY-2 residents, 4 PGY-5 residents, and 4 attending surgeons on the models who then filled out an evaluation. The drilled models were collected and then graded in a blinded fashion by 6 attending otolaryngologists. RESULTS Both residents and faculty felt the model was useful for training (mean score 4.7 out of 5; range: 4-5) and case preparation (mean score: 4.3; range: 3-5). Grading of the drilled models revealed significant differences between junior resident, senior resident, and attending surgeon scores (P = .012) with moderate to excellent interrater agreement (ICC = 0.882). CONCLUSION The described operable model that is patient-specific was rated favorably for pediatric mastoidectomy case preparation and training by residents and faculty. The model may be used to differentiate between experience levels and has promise for use in formative and summative evaluations.
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Affiliation(s)
- Monika E Freiser
- Department of Otolaryngology, University of Pittsburgh Medical Center, PA, USA
| | - Anish Ghodadra
- Department of Radiology, University of Pittsburgh Medical Center, PA, USA
| | - Andrew A McCall
- Department of Otolaryngology, University of Pittsburgh Medical Center, PA, USA
| | | | | | - Noel Jabbour
- Department of Otolaryngology, University of Pittsburgh Medical Center, PA, USA.,Children's Hospital of Pittsburgh, PA, USA
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25
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Meglioli M, Naveau A, Macaluso GM, Catros S. 3D printed bone models in oral and cranio-maxillofacial surgery: a systematic review. 3D Print Med 2020; 6:30. [PMID: 33079298 PMCID: PMC7574578 DOI: 10.1186/s41205-020-00082-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
AIM This systematic review aimed to evaluate the use of three-dimensional (3D) printed bone models for training, simulating and/or planning interventions in oral and cranio-maxillofacial surgery. MATERIALS AND METHODS A systematic search was conducted using PubMed® and SCOPUS® databases, up to March 10, 2019, by following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol. Study selection, quality assessment (modified Critical Appraisal Skills Program tool) and data extraction were performed by two independent reviewers. All original full papers written in English/French/Italian and dealing with the fabrication of 3D printed models of head bone structures, designed from 3D radiological data were included. Multiple parameters and data were investigated, such as author's purpose, data acquisition systems, printing technologies and materials, accuracy, haptic feedback, variations in treatment time, differences in clinical outcomes, costs, production time and cost-effectiveness. RESULTS Among the 1157 retrieved abstracts, only 69 met the inclusion criteria. 3D printed bone models were mainly used as training or simulation models for tumor removal, or bone reconstruction. Material jetting printers showed best performance but the highest cost. Stereolithographic, laser sintering and binder jetting printers allowed to create accurate models with adequate haptic feedback. The cheap fused deposition modeling printers exhibited satisfactory results for creating training models. CONCLUSION Patient-specific 3D printed models are known to be useful surgical and educational tools. Faced with the large diversity of software, printing technologies and materials, the clinical team should invest in a 3D printer specifically adapted to the final application.
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Affiliation(s)
- Matteo Meglioli
- University Center of Dentistry, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Adrien Naveau
- Department of Prosthodontics, Dental Science Faculty, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France.,Dental and Periodontal Rehabilitation Unit, Saint Andre Hospital, Bordeaux University Hospital, 46 rue Léo-Saignat, 33076, Bordeaux, France.,Biotis Laboratory, Inserm U1026, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France
| | - Guido Maria Macaluso
- University Center of Dentistry, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy.,IMEM-CNR, Parco Area delle Scienze 37/A, 43124, Parma, Italy
| | - Sylvain Catros
- Biotis Laboratory, Inserm U1026, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France. .,Department of Oral Surgery, UFR d'Odontologie, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France. .,Service de Chirurgie Orale, CHU de Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France.
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26
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McMillan A, Kocharyan A, Dekker SE, Kikano EG, Garg A, Huang VW, Moon N, Cooke M, Mowry SE. Comparison of Materials Used for 3D-Printing Temporal Bone Models to Simulate Surgical Dissection. Ann Otol Rhinol Laryngol 2020; 129:1168-1173. [DOI: 10.1177/0003489420918273] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To identify 3D-printed temporal bone (TB) models that most accurately recreate cortical mastoidectomy for use as a training tool by comparison of different materials and fabrication methods. Background: There are several different printers and materials available to create 3D-printed TB models for surgical planning and trainee education. Current reports using Acrylonitrile Butadiene Styrene (ABS) plastic generated via fused deposition modeling (FDM) have validated the capacity for 3D-printed models to serve as accurate surgical simulators. Here, a head-to-head comparison of models produced using different materials and fabrication processes was performed to identify superior models for application in skull base surgical training. Methods: High-resolution CT scans of normal TBs were used to create stereolithography files with image conversion for application in 3D-printing. The 3D-printed models were constructed using five different materials and four printers, including ABS printed on a MakerBot 2x printer, photopolymerizable polymer (Photo) using the Objet 350 Connex3 Printer, polycarbonate (PC) using the FDM-Fortus 400 mc printer, and two types of photocrosslinkable acrylic resin, white and blue (FLW and FLB, respectively), using the Formlabs Form 2 stereolithography printer. Printed TBs were drilled to assess the haptic experience and recreation of TB anatomy with comparison to the current paradigm of ABS. Results: Surgical drilling demonstrated that FLW models created by FDM as well as PC and Photo models generated using photopolymerization more closely recreated cortical mastoidectomy compared to ABS models. ABS generated odor and did not represent the anatomy accurately. Blue resin performed poorly in simulation, likely due to its dark color and translucent appearance. Conclusions: PC, Photo, and FLW models best replicated surgical drilling and anatomy as compared to ABS and FLB models. These prototypes are reliable simulators for surgical training.
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Affiliation(s)
- Alexandra McMillan
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Armine Kocharyan
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Simone E. Dekker
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Elias George Kikano
- Department of Diagnostic Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Anisha Garg
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Victoria W. Huang
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicholas Moon
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Malcolm Cooke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland OH, USA
| | - Sarah E. Mowry
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Bohl MA, McBryan S, Spear C, Pais D, Preul MC, Wilhelmi B, Yeskel A, Turner JD, Kakarla UK, Nakaji P. Evaluation of a Novel Surgical Skills Training Course: Are Cadavers Still the Gold Standard for Surgical Skills Training? World Neurosurg 2019; 127:63-71. [DOI: 10.1016/j.wneu.2019.03.230] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/24/2022]
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Kashikar TS, Kerwin TF, Moberly AC, Wiet GJ. A review of simulation applications in temporal bone surgery. Laryngoscope Investig Otolaryngol 2019; 4:420-424. [PMID: 31453352 PMCID: PMC6703115 DOI: 10.1002/lio2.277] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/07/2019] [Accepted: 03/17/2019] [Indexed: 01/04/2023] Open
Abstract
Background Temporal bone surgery is a technically challenging and high-risk procedure in an anatomically complex area. Safe temporal bone surgery emphasizes a consummate anatomic understanding and technique development that requires the guidance of an experienced otologic surgeon and years of practice. Temporal bone simulation can augment otologic surgical training and enable rehearsal of surgical procedures. Objectives The purpose of this article is to provide an updated review of temporal bone simulation platforms and their uses. Data Sources PubMed literature search. Search terms included temporal bone, temporal bone simulation, virtual reality (VR), and presurgical planning and rehearsal. Discussion Various simulation platforms such as cadaveric bone, three-dimensional (3D) printed models, and VR simulation have been used for temporal bone surgery training. However, each simulation method has its drawbacks. There is a need to improve upon current simulation platforms to enhance surgical training and skills assessment, as well as a need to explore other clinically significant applications of simulation, such as preoperative planning and rehearsal, in otologic surgery. Conclusions There is no replacement for actual surgical experience, but high-fidelity temporal bone models such as those produced with 3D printing and computer simulation have emerged as promising tools in otolaryngologic surgery. Improvements in the fidelity of both 3D printed and VR simulators as well as integration of a standardized assessment format would allow for an expansion in the use of these simulation platforms in training and assessment. Level of Evidence 5.
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Affiliation(s)
- Tanisha S Kashikar
- Ohio University Heritage College of Osteopathic Medicine Athens Ohio U.S.A
| | - Thomas F Kerwin
- Office of Research The Ohio State University Columbus Ohio U.S.A
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Columbus Ohio U.S.A
| | - Gregory J Wiet
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Columbus Ohio U.S.A.,Department of Pediatric Otolaryngology Nationwide Children's Hospital Columbus Ohio U.S.A
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