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Davies J, Thai MT, Sharma B, Hoang TT, Nguyen CC, Phan PT, Vuong TNAM, Ji A, Zhu K, Nicotra E, Toh YC, Stevens M, Hayward C, Phan HP, Lovell NH, Do TN. Soft robotic artificial left ventricle simulator capable of reproducing myocardial biomechanics. Sci Robot 2024; 9:eado4553. [PMID: 39321276 DOI: 10.1126/scirobotics.ado4553] [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: 02/02/2024] [Accepted: 08/30/2024] [Indexed: 09/27/2024]
Abstract
The heart's intricate myocardial architecture has been called the Gordian knot of anatomy, an impossible tangle of intricate muscle fibers. This complexity dictates equally complex cardiac motions that are difficult to mimic in physical systems. If these motions could be generated by a robotic system, then cardiac device testing, cardiovascular disease studies, and surgical procedure training could reduce their reliance on animal models, saving time, costs, and lives. This work introduces a bioinspired soft robotic left ventricle simulator capable of reproducing the minutiae of cardiac motion while providing physiological pressures. This device uses thin-filament artificial muscles to mimic the multilayered myocardial architecture. To demonstrate the device's ability to follow the cardiac motions observed in the literature, we used canine myocardial strain data as input signals that were subsequently applied to each artificial myocardial layer. The device's ability to reproduce physiological volume and pressure under healthy and heart failure conditions, as well as effective simulation of a cardiac support device, were experimentally demonstrated in a left-sided mock circulation loop. This work also has the potential to deliver faithful simulated cardiac motion for preclinical device and surgical procedure testing, with the potential to simulate patient-specific myocardial architecture and motion.
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Affiliation(s)
- James Davies
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Mai Thanh Thai
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Bibhu Sharma
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Trung Thien Hoang
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Chi Cong Nguyen
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Phuoc Thien Phan
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Thao Nhu Anne Marie Vuong
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Adrienne Ji
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Kefan Zhu
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Emanuele Nicotra
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Yi-Chin Toh
- School of Mechanical, Medical, and Process Engineering, Queensland University of Technology, Brisbane, Queensland 4000, Australia
| | - Michael Stevens
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
- Tyree Institute of Health Engineering (IHealthE), UNSW Sydney, Sydney, NSW 2052, Australia
| | - Christopher Hayward
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW 2010, Australia
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Hoang-Phuong Phan
- Tyree Institute of Health Engineering (IHealthE), UNSW Sydney, Sydney, NSW 2052, Australia
- School of Mechanical and Manufacturing Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Nigel Hamilton Lovell
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
- Tyree Institute of Health Engineering (IHealthE), UNSW Sydney, Sydney, NSW 2052, Australia
| | - Thanh Nho Do
- Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
- Tyree Institute of Health Engineering (IHealthE), UNSW Sydney, Sydney, NSW 2052, Australia
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Mayr T, Riazy L, Trauzeddel RF, Bassenge JP, Wiesemann S, Blaszczyk E, Prothmann M, Hadler T, Schmitter S, Schulz-Menger J. Hypertrophic obstructive cardiomyopathy-left ventricular outflow tract shapes and their hemodynamic influences applying CMR. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03242-4. [PMID: 39302632 DOI: 10.1007/s10554-024-03242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 09/08/2024] [Indexed: 09/22/2024]
Abstract
Hypertrophic cardiomyopathy (HCM) is one of the most common genetic cardiac disorders and is characterized by different phenotypes of left ventricular hypertrophy with and without obstruction. The effects of left ventricular outflow tract (LVOT) obstruction based on different anatomies may be hemodynamically relevant and influence therapeutic decision making. Cardiovascular magnetic resonance (CMR) provides anatomical information. We aimed to identify different shapes of LVOT-obstruction using Cardiovascular Magnetic Resonance (CMR). The study consisted of two parts: An in-vivo experiment for shape analysis and in-vitro part for the assessment of its hemodynamic consequences. In-vivo a 3D depiction of the LVOT was created using a 3D multi-slice reconstruction from 2D-slices (full coverage cine stack with 7 slices and a thickness of 5-6 mm with no gap) in 125 consecutive HOCM patients (age = 64.17 +/- 12.655; female n = 42). In-vitro an analysis of the LVOT regarding shape and flow behavior was conducted. For this purpose, 2D and 4D measurements were performed on 3D printed phantoms which were based on the anatomical characteristics of the in-vivo study, retrospectively. The in-vivo study identified three main shapes named K- (28.8%), X- (51.2%) and V-shape (10.4%) and a mixed one (9.6%). By analyzing the in-vitro flow measurements every shape showed an individual flow profile in relation to the maximum velocity in cm/s. Here, the V-shape showed the highest value of velocity (max. 138.87 cm/s). The X-shape was characterized by a similar profile but with lower velocity values (max. 125.39 cm/s), whereas the K-shape had an increase of the velocity without decrease (max. 137.11 cm/s). For the first time three different shapes of LVOT-obstruction could be identified. These variants seem to affect the hemodynamics in HOCM.
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Affiliation(s)
- T Mayr
- ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
| | - L Riazy
- ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Partner Site Berlin, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - R F Trauzeddel
- ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - J P Bassenge
- ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
| | - S Wiesemann
- ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Partner Site Berlin, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - E Blaszczyk
- ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Partner Site Berlin, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - M Prothmann
- HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - T Hadler
- ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
| | - S Schmitter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
| | - Jeanette Schulz-Menger
- ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.
- HELIOS Hospital Berlin-Buch, Berlin, Germany.
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3
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Kearns EC, Moynihan A, Dalli J, Khan MF, Singh S, McDonald K, O'Reilly J, Moynagh N, Myles C, Brannigan A, Mulsow J, Shields C, Jones J, Fenlon H, Lawler L, Cahill RA. Clinical validation of 3D virtual modelling for laparoscopic complete mesocolic excision with central vascular ligation for proximal colon cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108597. [PMID: 39173461 DOI: 10.1016/j.ejso.2024.108597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/26/2024] [Accepted: 08/09/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Laparoscopic Complete Mesocolic Excision (CME) with Central Vascular Ligation (CVL) in colon cancer surgery has not been broadly adopted in part because of safety concerns. Pre-operative 3-D virtual modelling (3DVM) may help but needs validation. METHODS 3DVM were routinely constructed from CT mesenteric angiograms (CTMA) using a commercial service (Visible Patient, Strasbourg, France) for consecutive patients during our CMECVL learning curve over three years. 3DVMs were independently checked versus CTMA and operative findings. CMECVL outcomes were compared versus other patients undergoing standard mesocolic excision (SME) surgery laparoscopically in the same hospital as control. Stakeholders were studied regarding 3DVM use and usefulness (including detail retention) versus CTMA and a physical 3D-printed model. RESULTS 26 patients underwent 3DVM with intraoperative display during laparoscopic CMECVL within existing workflows. 3DVM accuracy was 96 % re arteriovenous variations at patient level versus CTMA/intraoperative findings including accessory middle colic artery identification in three patients. Twenty-two laparoscopic CMECVL with 3DVM cases were compared with 49 SME controls (age 69 ± 10 vs 70.9 ± 11 years, 55 % vs 53 % males). There were no intraoperative complications with CMECVL and similar 30-day postoperative morbidity (30 % vs 29 %), hospital stay (9 ± 3 vs 12 ± 13 days), 30-day readmission (6 % vs 4 %) and reoperation (0 % vs 4 %) rates. Intraoperative times were longer (215.7 ± 43.9 vs 156.9 ± 52.9 min, p=<0.01) but decreased significantly over time. 3DVM surveys (n = 98, 20 surgeons, 48 medical students, 30 patients/patient relatives) and comparative study revealed majority endorsement (90 %) and favour (87 %). CONCLUSION 3DVM use was positively validated for laparoscopic CMECVL and valued by clinicians, students, and patients alike.
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Affiliation(s)
- Emma C Kearns
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | - Alice Moynihan
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | - Jeffrey Dalli
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | | | - Sneha Singh
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Katherine McDonald
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jessica O'Reilly
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Niamh Moynagh
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | | | - Ann Brannigan
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jurgen Mulsow
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Conor Shields
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Helen Fenlon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Leo Lawler
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, University College Dublin, Ireland; Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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Akça Sümengen A, İsmailoğlu AV, İsmailoğlu P, Gümüş T, Çeliker A, Namlısesli D, Poyraz E, Özçevik Subaşı D, Zeren Erdem C, Çakır GN. The effect of 3D modeling on family quality of life, surgical success, and patient outcomes in congenital heart diseases: objectives and design of a randomized controlled trial. Turk J Pediatr 2024; 66:237-250. [PMID: 38814302 DOI: 10.24953/turkjpediatr.2024.4574] [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: 09/18/2023] [Accepted: 04/30/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Understanding the severity of the disease from the parents' perspective can lead to better patient outcomes, improving both the child's health-related quality of life and the family's quality of life. The implementation of 3-dimensional (3D) modeling technology in care is critical from a translational science perspective. AIM The purpose of this study is to determine the effect of 3D modeling on family quality of life, surgical success, and patient outcomes in congenital heart diseases. Additionally, we aim to identify challenges and potential solutions related to this innovative technology. METHODS The study is a two-group pretest-posttest randomized controlled trial protocol. The sample size is 15 in the experimental group and 15 in the control group. The experimental group's heart models will be made from their own computed tomography (CT) images and printed using a 3D printer. The experimental group will receive surgical simulation and preoperative parent education with their 3D heart model. The control group will receive the same parent education using the standard anatomical model. Both groups will complete the Sociodemographic Information Form, the Surgical Simulation Evaluation Form - Part I-II, and the Pediatric Quality of Life Inventory (PedsQL) Family Impacts Module. The primary outcome of the research is the average PedsQL Family Impacts Module score. Secondary outcome measurement includes surgical success and patient outcomes. Separate analyses will be conducted for each outcome and compared between the intervention and control groups. CONCLUSIONS Anomalies that can be clearly understood by parents according to the actual size and dimensions of the child's heart will affect the preoperative preparation of the surgical procedure and the recovery rate in the postoperative period.
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Affiliation(s)
- Aylin Akça Sümengen
- Department of Nursing, Faculty of Health Sciences, Yeditepe University, İstanbul, Türkiye
- Capstone College of Nursing, The University of Alabama, Alabama, United States of America
| | - Abdul Veli İsmailoğlu
- Department of Anatomy, School of Medicine, Acıbadem University, İstanbul, Türkiye
- Department of Anatomy, School of Medicine, Marmara University, İstanbul, Türkiye
| | - Pelin İsmailoğlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Fenerbahce University, İstanbul, Türkiye
- Department of Anatomy, School of Medicine, Recep Tayyip Erdoğan University, Rize, Türkiye
| | - Terman Gümüş
- Department of Radiology, School of Medicine, Koç University Research and Training Hospital, İstanbul, Türkiye
| | - Alpay Çeliker
- Pediatric Cardiology Department, American Hospital, İstanbul, Türkiye
| | - Deniz Namlısesli
- Department of Electrical and Electronics Engineering, Faculty of Engineering, Yeditepe University, İstanbul, Türkiye
| | - Ezgi Poyraz
- Pediatric Cardiology Department, American Hospital, İstanbul, Türkiye
| | | | - Ceren Zeren Erdem
- Department of Nursing, Faculty of Health Sciences, Yeditepe University, İstanbul, Türkiye
| | - Gökçe Naz Çakır
- Department of Nursing, Faculty of Health Sciences, Yeditepe University, İstanbul, Türkiye
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Monaco C, Kronenberger R, Talevi G, Pannone L, Cappello IA, Candelari M, Ramak R, Della Rocca DG, Bori E, Terryn H, Baert K, Laha P, Krasniqi A, Gharaviri A, Bala G, Chierchia GB, La Meir M, Innocenti B, de Asmundis C. Advancing Surgical Arrhythmia Ablation: Novel Insights on 3D Printing Applications and Two Biocompatible Materials. Biomedicines 2024; 12:869. [PMID: 38672223 PMCID: PMC11048352 DOI: 10.3390/biomedicines12040869] [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: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
To date, studies assessing the safety profile of 3D printing materials for application in cardiac ablation are sparse. Our aim is to evaluate the safety and feasibility of two biocompatible 3D printing materials, investigating their potential use for intra-procedural guides to navigate surgical cardiac arrhythmia ablation. Herein, we 3D printed various prototypes in varying thicknesses (0.8 mm-3 mm) using a resin (MED625FLX) and a thermoplastic polyurethane elastomer (TPU95A). Geometrical testing was performed to assess the material properties pre- and post-sterilization. Furthermore, we investigated the thermal propagation behavior beneath the 3D printing materials during cryo-energy and radiofrequency ablation using an in vitro wet-lab setup. Moreover, electron microscopy and Raman spectroscopy were performed on biological tissue that had been exposed to the 3D printing materials to assess microparticle release. Post-sterilization assessments revealed that MED625FLX at thicknesses of 1 mm, 2.5 mm, and 3 mm, along with TPU95A at 1 mm and 2.5 mm, maintained geometrical integrity. Thermal analysis revealed that material type, energy source, and their factorial combination with distance from the energy source significantly influenced the temperatures beneath the 3D-printed material. Electron microscopy revealed traces of nitrogen and sulfur underneath the MED625FLX prints (1 mm, 2.5 mm) after cryo-ablation exposure. The other samples were uncontaminated. While Raman spectroscopy did not detect material release, further research is warranted to better understand these findings for application in clinical settings.
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Affiliation(s)
- Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Rani Kronenberger
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (R.K.)
| | - Giacomo Talevi
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Ida Anna Cappello
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Mara Candelari
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Edoardo Bori
- BEAMS Department, Bio Electro and Mechanical Systems, École Polytechnique de Bruxelles, Université Libre de Bruxelles, 1050 Brussels, Belgium (B.I.)
| | - Herman Terryn
- Research Group Electrochemical and Surface Engineering (SURF), Department Materials and Chemistry, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Kitty Baert
- Research Group Electrochemical and Surface Engineering (SURF), Department Materials and Chemistry, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Priya Laha
- Research Group Electrochemical and Surface Engineering (SURF), Department Materials and Chemistry, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Ahmet Krasniqi
- In Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Ali Gharaviri
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
| | - Mark La Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (R.K.)
| | - Bernardo Innocenti
- BEAMS Department, Bio Electro and Mechanical Systems, École Polytechnique de Bruxelles, Université Libre de Bruxelles, 1050 Brussels, Belgium (B.I.)
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium; (C.M.)
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Luxford JC, Cheng TL, Mervis J, Anderson J, Clarke J, Croker S, Nusem E, Bray L, Gunasekera H, Scott KM. An Opportunity to See the Heart Defect Physically: Medical Student Experiences of Technology-Enhanced Learning with 3D Printed Models of Congenital Heart Disease. MEDICAL SCIENCE EDUCATOR 2023; 33:1095-1107. [PMID: 37886275 PMCID: PMC10597946 DOI: 10.1007/s40670-023-01840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 10/28/2023]
Abstract
Three-dimensional (3D) printing is increasingly used in medical education and paediatric cardiology. A technology-enhanced learning (TEL) module was designed to accompany 3D printed models of congenital heart disease (CHD) to aid in the teaching of medical students. There are few studies evaluating the attitudes and perceptions of medical students regarding their experience of learning about CHD using 3D printing. This study aimed to explore senior medical students' experiences in learning about paediatric cardiology through a workshop involving 3D printed models of CHD supported by TEL in the form of online case-based learning. A mixed-methods evaluation was undertaken involving a post-workshop questionnaire (n = 94 students), and focus groups (n = 16 students). Focus group and free-text questionnaire responses underwent thematic analysis. Questionnaire responses demonstrated widespread user satisfaction; 91 (97%) students agreed that the workshop was a valuable experience. The highest-level satisfaction was for the physical 3D printed models, the clinical case-based learning, and opportunity for peer collaboration. Thematic analysis identified five key themes: a variable experience of prior learning, interplay between physical and online models, flexible and novel workshop structure, workshop supported the learning outcomes, and future opportunities for learning using 3D printing. A key novel finding was that students indicated the module increased their confidence to teach others about CHD and recommended expansion to other parts of the curriculum. 3D printed models of CHD are a valuable learning resource and contribute to the richness and enjoyment of medical student learning, with widespread satisfaction. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01840-w.
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Affiliation(s)
- Jack C. Luxford
- Faculty of Medicine and Health, Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW Australia
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
| | - Tegan L. Cheng
- Sydney School of Health Sciences, The University of Sydney, Sydney, NSW Australia
- EPIC Lab, The Children’s Hospital at Westmead, Sydney, Australia
| | - Jonathan Mervis
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
| | - Jennifer Anderson
- Faculty of Medicine and Health, Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW Australia
| | - Jillian Clarke
- Discipline of Medical Imaging, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Sarah Croker
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Erez Nusem
- School of Architecture, The University of Queensland, Brisbane, QLD Australia
| | - Liam Bray
- Faculty of Architecture, Design and Planning, The University of Sydney, Sydney, NSW Australia
| | - Hasantha Gunasekera
- Faculty of Medicine and Health, Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW Australia
| | - Karen M. Scott
- Faculty of Medicine and Health, Children’s Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW Australia
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7
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Patient-Specific 3D-Printed Models in Pediatric Congenital Heart Disease. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020319. [PMID: 36832448 PMCID: PMC9955978 DOI: 10.3390/children10020319] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Three-dimensional (3D) printing technology has become increasingly used in the medical field, with reports demonstrating its superior advantages in both educational and clinical value when compared with standard image visualizations or current diagnostic approaches. Patient-specific or personalized 3D printed models serve as a valuable tool in cardiovascular disease because of the difficulty associated with comprehending cardiovascular anatomy and pathology on 2D flat screens. Additionally, the added value of using 3D-printed models is especially apparent in congenital heart disease (CHD), due to its wide spectrum of anomalies and its complexity. This review provides an overview of 3D-printed models in pediatric CHD, with a focus on educational value for medical students or graduates, clinical applications such as pre-operative planning and simulation of congenital heart surgical procedures, and communication between physicians and patients/parents of patients and between colleagues in the diagnosis and treatment of CHD. Limitations and perspectives on future research directions for the application of 3D printing technology into pediatric cardiology practice are highlighted.
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8
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Goyal S, Chua C, Chen YS, Murphy D, O 'Neill GK. Utility of 3D printed models as adjunct in acetabular fracture teaching for Orthopaedic trainees. BMC MEDICAL EDUCATION 2022; 22:595. [PMID: 35918716 PMCID: PMC9344721 DOI: 10.1186/s12909-022-03621-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the use of 3-D printed models as compared to didactic lectures in the teaching of acetabular fractures for Orthopaedic trainees. METHODS This was a randomised prospective study conducted in a tertiary hospital setting which consisted of 16 Orthopaedic residents. Ten different cases of acetabular fracture patterns were identified and printed as 3-D models. The baseline knowledge of orthopaedic residents regarding acetabular fracture classification and surgical approach was determined by an x-ray based pre-test. Trainees were then randomly assigned into two groups. Group I received only lectures. Group II were additionally provided with 3-D printed models during the lecture. Participants were then assessed for comprehension and retention of teaching. RESULTS Sixteen trainees participated in the trial. Both Group 1 and 2 improved post teaching with a mean score of 2.5 and 1.9 to 4.4 and 6 out of 10 respectively. The post test score for fracture classification and surgical approach were significantly higher for 3-D model group (p < 0.05). Trainees felt that the physical characteristics of the 3-D models were a good representation of acetabular fracture configuration, and should be used routinely for teaching and surgical planning. CONCLUSION 3-D printed model of real clinical cases have significant educational impact compared to lecture-based learning towards improving young trainees' understanding of complex acetabular fractures.
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Affiliation(s)
- S Goyal
- Department of Orthopaedics, University Orthopaedics and Hand & Reconstructive Microsurgery Centre, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Cxk Chua
- Department of Orthopaedics, University Orthopaedics and Hand & Reconstructive Microsurgery Centre, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Y S Chen
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - D Murphy
- Department of Orthopaedics, University Orthopaedics and Hand & Reconstructive Microsurgery Centre, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - G K O 'Neill
- Department of Orthopaedics, University Orthopaedics and Hand & Reconstructive Microsurgery Centre, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
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9
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Bernhard B, Illi J, Gloeckler M, Pilgrim T, Praz F, Windecker S, Haeberlin A, Gräni C. Imaging-Based, Patient-Specific Three-Dimensional Printing to Plan, Train, and Guide Cardiovascular Interventions: A Systematic Review and Meta-Analysis. Heart Lung Circ 2022; 31:1203-1218. [PMID: 35680498 DOI: 10.1016/j.hlc.2022.04.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND To tailor cardiovascular interventions, the use of three-dimensional (3D), patient-specific phantoms (3DPSP) encompasses patient education, training, simulation, procedure planning, and outcome-prediction. AIM This systematic review and meta-analysis aims to investigate the current and future perspective of 3D printing for cardiovascular interventions. METHODS We systematically screened articles on Medline and EMBASE reporting the prospective use of 3DPSP in cardiovascular interventions by using combined search terms. Studies that compared intervention time depending on 3DPSP utilisation were included into a meta-analysis. RESULTS We identified 107 studies that prospectively investigated a total of 814 3DPSP in cardiovascular interventions. Most common settings were congenital heart disease (CHD) (38 articles, 6 comparative studies), left atrial appendage (LAA) occlusion (11 articles, 5 comparative, 1 randomised controlled trial [RCT]), and aortic disease (10 articles). All authors described 3DPSP as helpful in assessing complex anatomic conditions, whereas poor tissue mimicry and the non-consideration of physiological properties were cited as limitations. Compared to controls, meta-analysis of six studies showed a significant reduction of intervention time in LAA occlusion (n=3 studies), and surgery due to CHD (n=3) if 3DPSPs were used (Cohen's d=0.54; 95% confidence interval, 0.13 to 0.95; p=0.001), however heterogeneity across studies should be taken into account. CONCLUSIONS 3DPSP are helpful to plan, train, and guide interventions in patients with complex cardiovascular anatomy. Benefits for patients include reduced intervention time with the potential for lower radiation exposure and shorter mechanical ventilation times. More evidence and RCTs including clinical endpoints are needed to warrant adoption of 3DPSP into routine clinical practice.
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Affiliation(s)
- Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joël Illi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Swiss MedTech Center, Switzerland Innovation Park Biel/Bienne AG, Switzerland
| | - Martin Gloeckler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, Sitem Center, University of Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, Sitem Center, University of Bern, Switzerland.
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10
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El Haddi SJ, Brito A, Subramanian S, Han X, Menzel W, Fontaine E, Appleman ML, Garay JP, Child D, Nonas S, Schreiber MA, Chi A. CRISIS Ventilator: Pilot Study of a Three-Dimensional-Printed Gas-Powered Resuscitator in a Porcine Model. J Med Device 2022. [DOI: 10.1115/1.4054147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
The coronavirus disease of 2019 (COVID-19) has altered medical practice around the globe and revealed critical deficiencies in hospital supply chains ranging from adequate personal protective equipment to life-sustaining ventilators for critically ill hospitalized patients. We developed the CRISIS ventilator, a gas-powered resuscitator that functions without electricity, and which can be manufactured using hobby-level three-dimensional (3D) printers and standard off-the-shelf equipment available at the local hardware store. CRISIS ventilators were printed and used to ventilate sedated female Yorkshire pigs over 24-h. Pulmonary and hemodynamic values were recorded throughout the 24-h run, and serial arterial blood samples were obtained to assess ventilation and oxygenation. Lung tissue was obtained from each pig to evaluate for signs of inflammatory stress. All five female Yorkshire pigs survived the 24-h study period without suffering from hypoxemia, hypercarbia, or severe hypotension requiring intervention. One animal required rescue at the beginning of the experiment with a traditional ventilator due to leakage around a defective tracheostomy balloon. The wet/dry ratio was 6.74 ± 0.19 compared to historical controls of 7.1 ± 4.2 (not significantly different). This proof-of-concept study demonstrates that our 3D-printed CRISIS ventilator can ventilate and oxygenate a porcine model over the course of 24-h with stable pulmonary and hemodynamic function with similar levels of ventilation-related inflammation when compared with a previous control porcine model. Our work suggests that virtual stockpiling with just-in-time 3D-printed equipment, like the CRISIS ventilator, can temporize shortages of critical infrastructure needed to sustain life for hospitalized patients.
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Affiliation(s)
- S. James El Haddi
- Division of General Surgery, Oregon Health and Science University, Portland, OR 97239
| | - Alex Brito
- Division of Trauma, Acute Care, Critical Care, Oregon Health and Science University, Portland, OR 97239
| | - Sarayu Subramanian
- Division of General Surgery, Oregon Health and Science University, Portland, OR 97239
| | - XiaoYue Han
- Division of General Surgery, Oregon Health and Science University, Portland, OR 97239
| | - Whitney Menzel
- Division of Trauma, Acute Care, Critical Care, Oregon Health and Science University, Portland, OR 97239
| | - Evan Fontaine
- Division of Trauma, Acute Care, Critical Care, Oregon Health and Science University, Portland, OR 97239
| | - Maria Luisa Appleman
- Division of Trauma, Acute Care, Critical Care, Oregon Health and Science University, Portland, OR 97239
| | - Joseph P. Garay
- Division of Trauma, Acute Care, Critical Care, Oregon Health and Science University, Portland, OR 97239
| | - Dennis Child
- Department of Respiratory Care, Oregon Health and Science University, Portland, OR 97239
| | - Stephanie Nonas
- Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR 97239
| | - Martin A. Schreiber
- Division of Trauma, Acute Care, Critical Care, Oregon Health and Science University, Portland, OR 97239
| | - Albert Chi
- Division of Trauma, Acute Care, Critical Care, Oregon Health and Science University, Portland, OR 97239
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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.
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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.)
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12
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Clanner-Engelshofen BM, Frommherz L, Mitwalli M, Stadler PC, French LE, Reinholz M. 3D‐Druck‐ und Silikonmodelle der Primäreffloreszenzen für die dermatologische Lehre im Fernstudium. J Dtsch Dermatol Ges 2022; 20:177-184. [PMID: 35146884 DOI: 10.1111/ddg.14656_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hintergrund und Ziele: Die Corona-Pandemie betrifft eine Fülle von verschiedenen Lebensaspekten - Herausforderungen in der medizinischen Behandlung sind hier unzweifelhaft von höchster Wichtigkeit. Allerdings muss auch, um die Ausbildung von Studierenden zu gewährleisten, fortlaufende medizinische Lehre stattfinden. Während eines Semesters mit Lockdown-Phasen und eingeschränktem Patientenkontakt für die Studierenden schickten wir jedem Studierenden ein Silikonmodell zu und baten um die Evaluation dieses Lernwerkzeugs. Methoden: Mittels zweier vollständig und irreversibel anonymisierter Online-Fragebögen befragten wir Studierende des Dermatologie-Semesters (n = 222) an der Medizinischen Fakultät der Ludwig-Maximilians-Universität in München im Wintersemester 2020/2021 - anschließend an Online-Lehre - zu ihrem Verständnis und der Eigeneinschätzung zu Primäreffloreszenzen vor und nach Erhalt der Silikonübungsmodelle. Diese wurden durch Schichtung verschiedener Silikontypen in negative 3D-Polylactid-Formen hergestellt, um bestimmte Festigkeiten und Farben darzustellen. Ergebnisse: Insgesamt wurden Fragebögen von 211 (95,0 %) und 213 (95,9 %) der 222 Studierenden analysiert, jeweils vor und nach dem Erhalt der Silikonmodelle. Die Studierenden gaben eine statistisch signifikante Zunahme ihrer Fähigkeiten an (P < 0,001). Ein Großteil der Studierenden evaluierte die Silikonmodelle positiv und berichtete von einem besseren Verständnis und Lernen der Primäreffloreszenzen. Schlussfolgerungen: Diese Lehrstudie zeigt die Vorzüge der haptischen Erfahrung in der dermatologischen Lehre auf - nicht nur in Zeiten von COVID-19, sondern auch danach.
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Affiliation(s)
- Benjamin M Clanner-Engelshofen
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Leonie Frommherz
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Mohammed Mitwalli
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Pia-Charlotte Stadler
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany.,Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, USA
| | - Markus Reinholz
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
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13
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Clanner‐ Engelshofen BM, Frommherz L, Mitwalli M, Stadler P, French LE, Reinholz M. 3D printing and silicone models of primary skin lesions for dermatological education as remote learning tool. J Dtsch Dermatol Ges 2022; 20:177-183. [DOI: 10.1111/ddg.14656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 09/12/2021] [Indexed: 01/31/2023]
Affiliation(s)
| | - Leonie Frommherz
- Department of Dermatology and Allergy University Hospital Ludwig Maximilian University of Munich (LMU) Munich Germany
| | - Mohammed Mitwalli
- Department of Dermatology and Allergy University Hospital Ludwig Maximilian University of Munich (LMU) Munich Germany
| | - Pia‐Charlotte Stadler
- Department of Dermatology and Allergy University Hospital Ludwig Maximilian University of Munich (LMU) Munich Germany
| | - Lars E. French
- Department of Dermatology and Allergy University Hospital Ludwig Maximilian University of Munich (LMU) Munich Germany
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery Miller School of Medicine University of Miami Miami USA
| | - Markus Reinholz
- Department of Dermatology and Allergy University Hospital Ludwig Maximilian University of Munich (LMU) Munich Germany
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14
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Pollak U, Feinstein Y, Mannarino CN, McBride ME, Mendonca M, Keizman E, Mishaly D, van Leeuwen G, Roeleveld PP, Koers L, Klugman D. The horizon of pediatric cardiac critical care. Front Pediatr 2022; 10:863868. [PMID: 36186624 PMCID: PMC9523119 DOI: 10.3389/fped.2022.863868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Pediatric Cardiac Critical Care (PCCC) is a challenging discipline where decisions require a high degree of preparation and clinical expertise. In the modern era, outcomes of neonates and children with congenital heart defects have dramatically improved, largely by transformative technologies and an expanding collection of pharmacotherapies. Exponential advances in science and technology are occurring at a breathtaking rate, and applying these advances to the PCCC patient is essential to further advancing the science and practice of the field. In this article, we identified and elaborate on seven key elements within the PCCC that will pave the way for the future.
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Affiliation(s)
- Uri Pollak
- Section of Pediatric Critical Care, Hadassah University Medical Center, Jerusalem, Israel.,Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Feinstein
- Pediatric Intensive Care Unit, Soroka University Medical Center, Be'er Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Candace N Mannarino
- Divisions of Cardiology and Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Mary E McBride
- Divisions of Cardiology and Critical Care Medicine, Departments of Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Malaika Mendonca
- Pediatric Intensive Care Unit, Children's Hospital, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Eitan Keizman
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - David Mishaly
- Pediatric and Congenital Cardiac Surgery, Edmond J. Safra International Congenital Heart Center, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Tel Hashomer, Israel
| | - Grace van Leeuwen
- Pediatric Cardiac Intensive Care Unit, Sidra Medicine, Ar-Rayyan, Qatar.,Department of Pediatrics, Weill Cornell Medicine, Ar-Rayyan, Qatar
| | - Peter P Roeleveld
- Department of Pediatric Intensive Care, Leiden University Medical Center, Leiden, Netherlands
| | - Lena Koers
- Department of Pediatric Intensive Care, Leiden University Medical Center, Leiden, Netherlands
| | - Darren Klugman
- Pediatrics Cardiac Critical Care Unit, Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Johns Hopkins Medicine, Baltimore, MD, United States
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15
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Karsenty C, Guitarte A, Dulac Y, Briot J, Hascoet S, Vincent R, Delepaul B, Vignaud P, Djeddai C, Hadeed K, Acar P. The usefulness of 3D printed heart models for medical student education in congenital heart disease. BMC MEDICAL EDUCATION 2021; 21:480. [PMID: 34496844 PMCID: PMC8424617 DOI: 10.1186/s12909-021-02917-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/28/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Three-dimensional (3D) printing technology enables the translation of 2-dimensional (2D) medical imaging into a physical replica of a patient's individual anatomy and may enhance the understanding of congenital heart defects (CHD). We aimed to evaluate the usefulness of a spectrum of 3D-printed models in teaching CHD to medical students. RESULTS We performed a prospective, randomized educational procedure to teach fifth year medical students four CHDs (atrial septal defect (ASD, n = 74), ventricular septal defect (VSD, n = 50), coarctation of aorta (CoA, n = 118) and tetralogy of Fallot (ToF, n = 105)). Students were randomized into printing groups or control groups. All students received the same 20 min lecture with projected digital 2D images. The printing groups also manipulated 3D printed models during the lecture. Both groups answered an objective survey (Multiple-choice questionnaire) twice, pre- and post-test, and completed a post-lecture subjective survey. Three hundred forty-seven students were included and both teaching groups for each CHD were comparable in age, sex and pre-test score. Overall, objective knowledge improved after the lecture and was higher in the printing group compared to the control group (16.3 ± 2.6 vs 14.8 ± 2.8 out of 20, p < 0.0001). Similar results were observed for each CHD (p = 0.0001 ASD group; p = 0.002 VSD group; p = 0.0005 CoA group; p = 0.003 ToF group). Students' opinion of their understanding of CHDs was higher in the printing group compared to the control group (respectively 4.2 ± 0.5 vs 3.8 ± 0.4 out of 5, p < 0.0001). CONCLUSION The use of 3D printed models in CHD lectures improve both objective knowledge and learner satisfaction for medical students. The practice should be mainstreamed.
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Affiliation(s)
- Clement Karsenty
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France.
- Institut Des Maladies Métaboliques Et Cardiovasculaires, Université de Toulouse, INSERM U1048, I2MC, 1, Avenue Jean Poulhès-BP84225, Toulouse, France.
| | - Aitor Guitarte
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Yves Dulac
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Jerome Briot
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Sebastien Hascoet
- Department of Pediatric and Adult Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph Reference Center of Complex Congenital Heart Diseases M3C, Le Plessis Robinson, France
| | - Remi Vincent
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Benoit Delepaul
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Paul Vignaud
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Camelia Djeddai
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Khaled Hadeed
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
| | - Philippe Acar
- Pediatric cardiology unit, Children Hospital, CHU Toulouse, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse cedex 9, France
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Awori J, Friedman SD, Chan T, Howard C, Seslar S, Soriano BD, Buddhe S. 3D models improve understanding of congenital heart disease. 3D Print Med 2021; 7:26. [PMID: 34471999 PMCID: PMC8411549 DOI: 10.1186/s41205-021-00115-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/27/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Understanding congenital heart disease (CHD) is vital for medical personnel and parents of affected children. While traditional 2D schematics serve as the typical approach used, several studies have shown these models to be limiting in understanding complex structures. Recent world-emphasis has shifted to 3D printed models as a complement to 2D imaging to bridge knowledge and create new opportunities for experiential learning. We sought to systematically compare 3D digital and physical models for medical personnel and parent education compared to traditional methods. Methods 3D printed and digital models were made out of MRI and CT data for 20 common CHD. Fellows and nurse practitioners used these models to explore intra-cardiac pathologies following traditional teaching. The models were also used for parent education in outpatient settings after traditional education. The participants were then asked to fill out a Likert scale questionnaire to assess their understanding and satisfaction with different teaching techniques. These ratings were compared using paired t-tests and Pearson’s correlation. Results Twenty-five medical personnel (18 fellows; 2 nurses; 4 nurse practitioners and one attending) and twenty parents participated in the study. The diagnosis varied from simple mitral valve pathology to complex single ventricle palliation. Parent and medical personnel perceived understanding with digital models was significantly higher than traditional (p = 0.01). Subjects also felt that physical models were overall more useful than digital ones (p = 0.001). Physicians using models for parent education also perceived the models to be useful, not significantly impacting their clinical workflow. Conclusions 3D models, both digital and printed, enhance medical personnel and parental perceived understanding of CHD. Supplementary Information The online version contains supplementary material available at 10.1186/s41205-021-00115-7.
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Affiliation(s)
- Jonathan Awori
- Division of Pediatric Cardiology and Radiology, Seattle Children's Hospital, Seattle, WA, USA.
| | - Seth D Friedman
- Division of Pediatric Cardiology and Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Titus Chan
- Division of Pediatric Cardiology and Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Christopher Howard
- Division of Pediatric Cardiology and Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Steve Seslar
- Division of Pediatric Cardiology and Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Brian D Soriano
- Division of Pediatric Cardiology and Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Sujatha Buddhe
- Division of Pediatric Cardiology and Radiology, Seattle Children's Hospital, Seattle, WA, USA
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Hopfner C, Jakob A, Tengler A, Grab M, Thierfelder N, Brunner B, Thierij A, Haas NA. Design and 3D printing of variant pediatric heart models for training based on a single patient scan. 3D Print Med 2021; 7:25. [PMID: 34463879 PMCID: PMC8406574 DOI: 10.1186/s41205-021-00116-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background 3D printed models of pediatric hearts with congenital heart disease have been proven helpful in simulation training of diagnostic and interventional catheterization. However, anatomically accurate 3D printed models are traditionally based on real scans of clinical patients requiring specific imaging techniques, i.e., CT or MRI. In small children both imaging technologies are rare as minimization of radiation and sedation is key. 3D sonography does not (yet) allow adequate imaging of the entire heart for 3D printing. Therefore, an alternative solution to create variant 3D printed heart models for teaching and hands-on training has been established. Methods In this study different methods utilizing image processing and computer aided design software have been established to overcome this shortage and to allow unlimited variations of 3D heart models based on single patient scans. Patient-specific models based on a CT or MRI image stack were digitally modified to alter the original shape and structure of the heart. Thereby, 3D hearts showing various pathologies were created. Training models were adapted to training level and aims of hands-on workshops, particularly for interventional cardiology. Results By changing the shape and structure of the original anatomy, various training models were created of which four examples are presented in this paper: 1. Design of perimembranous and muscular ventricular septal defect on a heart model with patent ductus arteriosus, 2. Series of heart models with atrial septal defect showing the long-term hemodynamic effect of the congenital heart defect on the right atrial and ventricular wall, 3. Implementation of simplified heart valves and addition of the myocardium to a right heart model with pulmonary valve stenosis, 4. Integration of a constructed 3D model of the aortic valve into a pulsatile left heart model with coarctation of the aorta. All presented models have been successfully utilized and evaluated in teaching or hands-on training courses. Conclusions It has been demonstrated that non-patient-specific anatomical variants can be created by modifying existing patient-specific 3D heart models. This way, a range of pathologies can be modeled based on a single CT or MRI dataset. Benefits of designed 3D models for education and training purposes have been successfully applied in pediatric cardiology but can potentially be transferred to simulation training in other medical fields as well.
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Affiliation(s)
- Carina Hopfner
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Andre Jakob
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Anja Tengler
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximilian Grab
- Department of Cardiac Surgery, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Nikolaus Thierfelder
- Department of Cardiac Surgery, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Barbara Brunner
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Alisa Thierij
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care, LMU Klinikum, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
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Bonz JW, Pope JK, Wong AH, Ray JM, Evans LV. Just-in-time clinical video review improves successful placement of Sengstaken-Blakemore tube by emergency medicine resident physicians: A randomized control simulation-based study. AEM EDUCATION AND TRAINING 2021; 5:e10573. [PMID: 34124519 PMCID: PMC8171783 DOI: 10.1002/aet2.10573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Successful completion of life-saving procedures may benefit from a concise just-in-time (JIT) intervention. Video is an optimal medium for JIT training, but currently available video-based references are not optimized for a JIT format, especially in time-pressured situations prior to high-risk clinical contexts. We aimed to create and evaluate the efficacy of a brief video review of emergent Sengstaken-Blakemore tube (SBT) insertion for acutely decompensating variceal hemorrhage when used just prior to clinical performance in a simulated setting. METHODS We created a less than 3-minute audio-optional JIT training video on SBT insertion. We recruited emergency medicine resident physicians to participate in a simulation scenario in which they had to quickly place an SBT. Participants were randomized to either a 3-minute procedure review by any media they chose (control) or review of the JIT video (intervention). Performance on a checklist created by a multidisciplinary group of SBT experts (passing score > 18 and maximum = 28) served as the primary outcome. We analyzed performance in checklist scores controlling level of training through a one-way analysis of covariance (ANCOVA). We analyzed rates of passing scores via a chi-square analysis. RESULTS We randomized 32 participants to media review (control) or JIT video (intervention). The intervention group had an overall mean (±SD) performance of 19.8 (±9.0) and the control group had a mean (±SD) score of 6.6 (±7.4). After adjusting for postgraduate year, we found a significant difference in final checklist scores between the two groups (mean difference = 12.8, 95% confidence interval [CI] = 7.6 to 18.0). Percentages of participants reaching a minimum passing score were two of 16 (12.5%) in the control group and 10 of 16 (62.5%) in the intervention group (odds ratio = 11.7, 95% CI = 9.9 to 13.5). Cohen's kappa indicated substantial agreement (κ = 0.714) between reviewer scores. CONCLUSIONS A readily available, focused, audio-optional JIT video increased performance for SBT insertion in a simulated setting. Future work may include testing of this format for more commonly performed emergency procedures and determination of effect on bedside performance in the clinical setting.
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Affiliation(s)
- James W. Bonz
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Joshua K. Pope
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Ambrose H. Wong
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Jessica M. Ray
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Leigh V. Evans
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
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19
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Gharleghi R, Dessalles CA, Lal R, McCraith S, Sarathy K, Jepson N, Otton J, Barakat AI, Beier S. 3D Printing for Cardiovascular Applications: From End-to-End Processes to Emerging Developments. Ann Biomed Eng 2021; 49:1598-1618. [PMID: 34002286 PMCID: PMC8648709 DOI: 10.1007/s10439-021-02784-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/24/2021] [Indexed: 12/16/2022]
Abstract
3D printing as a means of fabrication has seen increasing applications in medicine in the last decade, becoming invaluable for cardiovascular applications. This rapidly developing technology has had a significant impact on cardiovascular research, its clinical translation and education. It has expanded our understanding of the cardiovascular system resulting in better devices, tools and consequently improved patient outcomes. This review discusses the latest developments and future directions of generating medical replicas ('phantoms') for use in the cardiovascular field, detailing the end-to-end process from medical imaging to capture structures of interest, to production and use of 3D printed models. We provide comparisons of available imaging modalities and overview of segmentation and post-processing techniques to process images for printing, detailed exploration of latest 3D printing methods and materials, and a comprehensive, up-to-date review of milestone applications and their impact within the cardiovascular domain across research, clinical use and education. We then provide an in-depth exploration of future technologies and innovations around these methods, capturing opportunities and emerging directions across increasingly realistic representations, bioprinting and tissue engineering, and complementary virtual and mixed reality solutions. The next generation of 3D printing techniques allow patient-specific models that are increasingly realistic, replicating properties, anatomy and function.
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Affiliation(s)
- Ramtin Gharleghi
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia
| | | | - Ronil Lal
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia
| | - Sinead McCraith
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia
| | | | - Nigel Jepson
- Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School of Medicine, UNSW, Sydney, Australia
| | - James Otton
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
| | | | - Susann Beier
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia.
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20
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Rinaldi A, Katsaros D, Hawthorne J, D'Auria M, Brigham K, Bajars E, Franzese C, Coyne M. The current paradigm for biologic initiation: a mixed-methods exploration of practices, unmet needs, and innovation opportunities in self-injection training. Expert Opin Drug Deliv 2021; 18:1151-1168. [PMID: 33896303 DOI: 10.1080/17425247.2021.1912009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Self-injection, particularly of biologics, has become a mainstay of chronic disease management. Despite labeling requirement for healthcare provider (HCP) training, current injection initiation experiences have been shown to be suboptimal. This study characterizes gaps in training and support during initiation and identifies rationales to inform solutions. METHODS We enrolled HCPs (n = 18) performing routine biologic initiation and patients (n = 24) currently self-injecting biologics. Participants completed activities through an online, remote ethnography tool. We conducted two focus groups with biologic-naïve patients (n = 5). Data was analyzed using thematic frameworks, Q methodology, and quantitative assessments. RESULTS Our results suggest considerable gaps exist. Analysis revealed five common themes that could explain these gaps: 1) minimal biologic-specific professional instruction is provided to HCPs; 2) nuanced injection use-steps are not universally understood; 3) no one stakeholder currently 'owns' training; 4) support offered by HCPs and manufacturers is perceived as biased; and 5) emotional burden is not accounted for. CONCLUSIONS Our study suggests optimizing several elements to facilitate successful initiations, including structured sessions, improved HCP injection device knowledge, demo-device practice, and focus on both emotional and mechanical aspects. Aligning these factors has potential to increase patient confidence, reduce burden on HCPs, and improve probability of success on therapy.
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Affiliation(s)
| | - Dimos Katsaros
- Matchstick LLC, Boonton, NJ, USA.,College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - James Hawthorne
- Matchstick LLC, Boonton, NJ, USA.,College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | | | | | | | - Chris Franzese
- Matchstick LLC, Boonton, NJ, USA.,College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Marty Coyne
- Matchstick LLC, Boonton, NJ, USA.,College of Pharmacy, University of Rhode Island, Kingston, RI, USA
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21
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Simulation as an Educational Tool in the Pediatric Cardiac Intensive Care Unit. CURRENT PEDIATRICS REPORTS 2021; 9:52-59. [PMID: 34055476 PMCID: PMC8144691 DOI: 10.1007/s40124-021-00241-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 10/25/2022]
Abstract
Purpose of Review This review highlights the use of simulation as an educational tool in the highly specialized pediatric cardiac intensive care unit (PCICU). Recent Findings Healthcare simulation is used in high acuity medical environments to test healthcare systems. Healthcare simulation can improve team training, patient safety, and improve medical decision-making. Complex physiologies in the PCICU demand effective teamwork to consistently deliver high-quality patient care. Simulation-based PCICU learning objectives depend on a structured cognitive load framework to account for individual learner abilities, team constructs, and healthcare resources. Summary PCICU simulation programs are strengthened by utilizing traditional education theory, with careful consideration of complex physiologies, interprofessional personnel, and center-specific resources. Virtual platforms should continue to evolve to provide additional, more convenient venues for individual learners and teams. Healthcare systems should frequently intersect with simulation educators to create relevant learning objectives that will contribute to patient safety, improve team performance, and patient outcomes.
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22
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Noël GPJC, Ding W, Steinmetz P. 3D Printed Heart Models Illustrating Myocardial Perfusion Territories to Augment Echocardiography and Electrocardiography Interpretation. MEDICAL SCIENCE EDUCATOR 2021; 31:439-446. [PMID: 34457902 PMCID: PMC8368875 DOI: 10.1007/s40670-020-01177-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 06/13/2023]
Abstract
Visualizing the vascular territories of coronary arteries during echocardiography or electrocardiography (ECG) requires trainees to mentally relate and overlay 2D sonographic images or cardiac lead projections with 3D anatomical representations of the ventricular walls and their respective blood supply. To facilitate the acquisition of these competencies, this study focuses on the feasibility of developing low-cost, open-sourced 3D printed heart models with standard ultrasound views or ECG lead projections illustrating the myocardial perfusion territories. A 3D digital heart model was cut to reflect the typical cardiac ultrasound views. The 4-chamber view model was further punctured for the paths of the precordial and limb leads of an ECG. Painting coronary arteries on the surface and internal views of the 3D prints illustrated vessel territories. Students, residents, and staff were surveyed during bedside ultrasound simulation sessions and ECG teaching half-days. Results demonstrated clear appreciation of 3D printed models, which suggests such models can easily be implemented by other institutions to augment trainees' experience during skill acquisition.
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Affiliation(s)
- Geoffroy P. J. C. Noël
- Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, Strathcona Anatomy Building, 3640 University Street, Montreal, QC H3A 0C7 Canada
- Institute of Health Science Education, Faculty of Medicine, McGill University, Montreal, Canada
| | - Weimeng Ding
- Undergraduate Education, Faculty of Medicine, McGill University, Montreal, Canada
| | - Peter Steinmetz
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC Canada
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23
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Patel N, Costa A, Sanders SP, Ezon D. Stereoscopic virtual reality does not improve knowledge acquisition of congenital heart disease. Int J Cardiovasc Imaging 2021; 37:2283-2290. [PMID: 33677745 DOI: 10.1007/s10554-021-02191-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
Advances in virtual reality have made it possible for clinicians and trainees to interact with 3D renderings of hearts with congenital heart disease in 3D stereoscopic vision. No study to date has assessed whether this technology improved instruction compared to standard 2D interfaces. The purpose of this study was to assess whether stereoscopic virtual reality improves congenital heart disease anatomy education. Subjects in a prospective, blinded, randomized trial completed a pre-test assessing factual and visuospatial knowledge of common atrioventricular canal and were randomized to an intervention or control group based on their score. The intervention group used a 3D virtual reality (VR) headset to visualize a lecture with 3D heart models while the control group used a desktop (DT) computer interface with the same models. Subjects took a post-test and provided subjective feedback. 51 subjects were enrolled, 24 in the VR group & 27 in the DT group. The median score difference for VR subjects was 12 (IQR 9-13.3), compared to 10 (IQR 7.5-12) in the DT group. No difference in score improvement was found (p = 0.11). VR subjects' impression of the ease of use of their interface was higher than DT subjects (median 8 vs 7, respectively, p = 0.01). VR subjects' impression of their understanding of the subject matter was higher than desktop subjects (median 7 vs 5, respectively, p = 0.01). There was no statistically significant difference in the knowledge acquisition observed between the stereoscopic virtual reality group and the monoscopic desktop-based group. Participants in virtual reality reported a better learning experience and self-assessment suggesting virtual reality may increase learner engagement in understanding congenital heart disease.
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Affiliation(s)
- Neil Patel
- Icahn School of Medicine at Mount Sinai, Children's Heart Center, Mt. Sinai Hospital, 1 Gustave L Levy Place, Box 1201, New York, NY, 10029, USA
| | - Anthony Costa
- Icahn School of Medicine at Mount Sinai, Children's Heart Center, Mt. Sinai Hospital, 1 Gustave L Levy Place, Box 1201, New York, NY, 10029, USA
| | | | - David Ezon
- Icahn School of Medicine at Mount Sinai, Children's Heart Center, Mt. Sinai Hospital, 1 Gustave L Levy Place, Box 1201, New York, NY, 10029, USA.
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Oshiro K, Endo K, Morishima K, Kaneda Y, Koizumi M, Sasanuma H, Sakuma Y, Lefor AK, Sata N. A structured program for teaching pancreatojejunostomy to surgical residents and fellows outside the operating room: a pilot study. BMC Surg 2021; 21:102. [PMID: 33632184 PMCID: PMC7908720 DOI: 10.1186/s12893-021-01101-w] [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: 10/02/2020] [Accepted: 02/14/2021] [Indexed: 11/22/2022] Open
Abstract
Background Pancreatojejunostomy (PJ) is one of the most difficult and challenging abdominal surgical procedures. There are no appropriate training systems available outside the operating room (OR). We developed a structured program for teaching PJ outside the OR. We describe its development and results of a pilot study. Methods We have created this structured program to help surgical residents and fellows acquire both didactic knowledge and technical skills to perform PJ. A manual was created to provide general knowledge about PJ and the specific PJ procedure used in our institution. Based on questionnaires completed by trainers and trainees, the procedure for PJ was divided into twelve steps and described in detail. After creating the manual, we developed organ models, needles and a frame box for simulation training. Three residents (PGY3-5) and three fellows (PGY6 or above) participated in a pilot study. Objective and subjective evaluations were performed. Results Trainees learn about PJ by reading the procedure manual, acquiring both general and specific knowledge. We conducted simulation training outside the OR using the training materials created for this system. They simulate the procedure with surgical instruments as both primary and assistant surgeon. In this pilot study, as objective assessments, the fellow-group took less time to complete one anastomosis (36 min vs 48 min) and had higher scores in the objective structured assessment of technical skill (average score: 4.1 vs 2.0) compared to the resident-group. As a subjective assessment, the confidence to perform a PJ anastomosis increased after simulation training (from 1.6 to 2.6). Participants considered that this structured teaching program is useful. Conclusion We developed a structured program for teaching PJ. By implementing this program, learning opportunities for surgical residents and fellows can be increased as a complement to training in the OR.
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Affiliation(s)
- Kenichi Oshiro
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kazuhiro Endo
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Kazue Morishima
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yuji Kaneda
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Masaru Koizumi
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hideki Sasanuma
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yasunaru Sakuma
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Quality Control in 3D Printing: Accuracy Analysis of 3D-Printed Models of Patient-Specific Anatomy. MATERIALS 2021; 14:ma14041021. [PMID: 33670038 PMCID: PMC7926654 DOI: 10.3390/ma14041021] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023]
Abstract
As comparative data on the precision of 3D-printed anatomical models are sparse, the aim of this study was to evaluate the accuracy of 3D-printed models of vascular anatomy generated by two commonly used printing technologies. Thirty-five 3D models of large (aortic, wall thickness of 2 mm, n = 30) and small (coronary, wall thickness of 1.25 mm, n = 5) vessels printed with fused deposition modeling (FDM) (rigid, n = 20) and PolyJet (flexible, n = 15) technology were subjected to high-resolution CT scans. From the resulting DICOM (Digital Imaging and Communications in Medicine) dataset, an STL file was generated and wall thickness as well as surface congruency were compared with the original STL file using dedicated 3D engineering software. The mean wall thickness for the large-scale aortic models was 2.11 µm (+5%), and 1.26 µm (+0.8%) for the coronary models, resulting in an overall mean wall thickness of +5% for all 35 3D models when compared to the original STL file. The mean surface deviation was found to be +120 µm for all models, with +100 µm for the aortic and +180 µm for the coronary 3D models, respectively. Both printing technologies were found to conform with the currently set standards of accuracy (<1 mm), demonstrating that accurate 3D models of large and small vessel anatomy can be generated by both FDM and PolyJet printing technology using rigid and flexible polymers.
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Francoisse CA, Sescleifer AM, King WT, Lin AY. Three-dimensional printing in medicine: a systematic review of pediatric applications. Pediatr Res 2021; 89:415-425. [PMID: 32503028 DOI: 10.1038/s41390-020-0991-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Three-dimensional printing (3DP) addresses distinct clinical challenges in pediatric care including: congenital variants, compact anatomy, high procedural risk, and growth over time. We hypothesized that patient-specific applications of 3DP in pediatrics could be categorized into concise, discrete categories of use. METHODS Terms related to "three-dimensional printing" and "pediatrics" were searched on PubMed, Scopus, Ovid MEDLINE, Cochrane CENTRAL, and Web of Science. Initial search yielded 2122 unique articles; 139 articles characterizing 508 patients met full inclusion criteria. RESULTS Four categories of patient-specific 3DP applications were identified: Teaching of families and medical staff (9.3%); Developing intervention strategies (33.9%); Procedural applications, including subtypes: contour models, guides, splints, and implants (43.0%); and Material manufacturing of shaping devices or prosthetics (14.0%). Procedural comparative studies found 3DP devices to be equivalent or better than conventional methods, with less operating time and fewer complications. CONCLUSION Patient-specific applications of Three-Dimensional Printing in Medicine can be elegantly classified into four major categories: Teaching, Developing, Procedures, and Materials, sharing the same TDPM acronym. Understanding this schema is important because it promotes further innovation and increased implementation of these devices to improve pediatric care. IMPACT This article classifies the pediatric applications of patient-specific three-dimensional printing. This is a first comprehensive review of patient-specific three-dimensional printing in both pediatric medical and surgical disciplines, incorporating previously described classification schema to create one unifying paradigm. Understanding these applications is important since three-dimensional printing addresses challenges that are uniquely pediatric including compact anatomy, unique congenital variants, greater procedural risk, and growth over time. We identified four classifications of patient-specific use: teaching, developing, procedural, and material uses. By classifying these applications, this review promotes understanding and incorporation of this expanding technology to improve the pediatric care.
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Affiliation(s)
- Caitlin A Francoisse
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Anne M Sescleifer
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Wilson T King
- Division of Pediatric Cardiology, Saint Louis University School of Medicine, St. Louis, MO, USA.,SSM Health Cardinal Glennon Children's Hospital at SLU, St. Louis, MO, USA
| | - Alexander Y Lin
- Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA. .,SSM Health Cardinal Glennon Children's Hospital at SLU, St. Louis, MO, USA.
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Utility of three-dimensional printed heart models for education on complex congenital heart diseases. Cardiol Young 2020; 30:1637-1642. [PMID: 33161936 DOI: 10.1017/s1047951120003753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the feasibility and effects of education on complex congenital heart diseases using patient-specific three-dimensional printed heart models. METHODS Three-dimensional printed heart models were created using computed tomography data obtained from 11 patients with complex congenital heart disease. Fourteen kinds of heart models, encompassing nine kinds of complex congenital heart disease were printed. Using these models, a series of educational hands-on seminars, led by an experienced paediatric cardiac surgeon and a paediatric cardiologist, were conducted for medical personnel who were involved in the care of congenital heart disease patients. Contents of the seminars included anatomy, three-dimensional structure, pathophysiology, and surgery for each diagnosis. Likert-type (10-point scale) questionnaires were used before and after each seminar to evaluate the effects of education. RESULTS Between November 2019 and June 2020, a total of 16 sessions of hands-on seminar were conducted. The total number of questionnaire responses was 75. Overall, participants reported subjective improvement in understanding anatomy (4.8 ± 2.1 versus 8.4 ± 1.1, p < 0.001), three-dimensional structure (4.6 ± 2.2 versus 8.9 ± 1.0, p < 0.001), pathophysiology (4.8 ± 2.2 versus 8.5 ± 1.0, p < 0.001), and surgery (4.9 ± 2.3 versus 8.8 ± 0.9, p < 0.001) of the congenital heart disease investigated. CONCLUSIONS The utilisation of three-dimensional printed heart models for education on complex congenital heart disease was feasible and improved medical personnel's understanding of complex congenital heart disease. This education tool may be an effective alternative to conventional education tools for complex congenital heart disease.
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Teaching medical applications and workflow of three-dimensional printing to medical students: Results of a pilot elective course. Cardiol J 2020; 27:894-896. [PMID: 33001424 DOI: 10.5603/cj.a2020.0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
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Boshra M, Godbout J, Perry JJ, Pan A. 3D printing in critical care: a narrative review. 3D Print Med 2020; 6:28. [PMID: 32997313 PMCID: PMC7525075 DOI: 10.1186/s41205-020-00081-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 3D printing (3DP) has gained interest in many fields of medicine including cardiology, plastic surgery, and urology due to its versatility, convenience, and low cost. However, critical care medicine, which is abundant with high acuity yet infrequent procedures, has not embraced 3DP as much as others. The discrepancy between the possible training or therapeutic uses of 3DP in critical care and what is currently utilized in other fields needs to be addressed. OBJECTIVE This narrative literature review describes the uses of 3DP in critical care that have been documented. It also discusses possible future directions based on recent technological advances. METHODS A literature search on PubMed was performed using keywords and Mesh terms for 3DP, critical care, and critical care skills. RESULTS Our search found that 3DP use in critical care fell under the major categories of medical education (23 papers), patient care (4 papers) and clinical equipment modification (4 papers). Medical education showed the use of 3DP in bronchoscopy, congenital heart disease, cricothyroidotomy, and medical imaging. On the other hand, patient care papers discussed 3DP use in wound care, personalized splints, and patient monitoring. Clinical equipment modification papers reported the use of 3DP to modify stethoscopes and laryngoscopes to improve their performance. Notably, we found that only 13 of the 31 papers were directly produced or studied by critical care physicians. CONCLUSION The papers discussed provide examples of the possible utilities of 3DP in critical care. The relative scarcity of papers produced by critical care physicians may indicate barriers to 3DP implementation. However, technological advances such as point-of-care 3DP tools and the increased demand for 3DP during the recent COVID-19 pandemic may change 3DP implementation across the critical care field.
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Affiliation(s)
- Mina Boshra
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd., Ottawa, ON K1H8M5 Canada
| | - Justin Godbout
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9 Canada
| | - Jeffrey J. Perry
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9 Canada
- Department of Emergency Medicine, The Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9 Canada
| | - Andy Pan
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9 Canada
- Department of Emergency Medicine, The Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9 Canada
- Division of Critical Care Medicine, Department of Medicine, Montfort Hospital, 713 Montreal Road, Ottawa, ON K1K 0T2 Canada
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Goo HW, Park SJ, Yoo SJ. Advanced Medical Use of Three-Dimensional Imaging in Congenital Heart Disease: Augmented Reality, Mixed Reality, Virtual Reality, and Three-Dimensional Printing. Korean J Radiol 2020; 21:133-145. [PMID: 31997589 PMCID: PMC6992436 DOI: 10.3348/kjr.2019.0625] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/24/2019] [Indexed: 12/15/2022] Open
Abstract
Three-dimensional (3D) imaging and image reconstruction play a prominent role in the diagnosis, treatment planning, and post-therapeutic monitoring of patients with congenital heart disease. More interactive and realistic medical experiences take advantage of advanced visualization techniques like augmented, mixed, and virtual reality. Further, 3D printing is now used in medicine. All these technologies improve the understanding of the complex morphologies of congenital heart disease. In this review article, we describe the technical advantages and disadvantages of various advanced visualization techniques and their medical applications in the field of congenital heart disease. In addition, unresolved issues and future perspectives of these evolving techniques are described.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Sang Joon Park
- Department of Radiology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Shi Joon Yoo
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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Personalized Three-Dimensional Printing and Echoguided Procedure Facilitate Single Device Closure for Multiple Atrial Septal Defects. J Interv Cardiol 2020; 2020:1751025. [PMID: 32410914 PMCID: PMC7201835 DOI: 10.1155/2020/1751025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate the feasibility of using a single device to close multiple atrial septal defects (ASDs) under the guidance of transthoracic echocardiography (TTE) and with the aid of three-dimensional (3D) printing models. Methods Sixty-two patients with multiple ASDs were retrospectively analyzed. Thirty of these patients underwent TTE-guided closure (3D printing and TTE group) after a simulation of occlusion in 3D printing models. The remaining 32 patients underwent ASD closure under fluoroscopic guidance (conventional group). Closure status was assessed immediately and at 6 months after device closure. Results Successful transcatheter closure with a single device was achieved in 26 patients in the 3D printing and TTE group and 27 patients in the conventional group. Gender, age [18.8 ± 15.9 (3–51) years in the 3D printing and TTE group; 14.0 ± 11.6 (3–50) years in the conventional group], mean maximum distance between defects, prevalence of 3 atrial defects and large defect distance (defined as distance ≥7 mm), and occluder size used were similarly distributed between groups. However, the 3D printing and TTE group had lower frequency of occluder replacement (3.8% vs 59.3%, p < 0.0001), prevalence of mild residual shunts (defined as <5 mm) immediately (19.2% vs 44.4%, p < 0.05) and at 6 months (7.7% vs 29.6%, p < 0.05) after the procedure, and cost (32960.8 ± 2018.7 CNY vs 41019.9 ± 13758.2 CNY, p < 0.01). Conclusion The combination of the 3D printing technology and ultrasound-guided interventional procedure provides a reliable new therapeutic approach for multiple ASDs, especially for challenging cases with large defect distance.
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Illmann CF, Hosking M, Harris KC. Utility and Access to 3-Dimensional Printing in the Context of Congenital Heart Disease: An International Physician Survey Study. CJC Open 2020; 2:207-213. [PMID: 32695970 PMCID: PMC7365821 DOI: 10.1016/j.cjco.2020.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/23/2020] [Indexed: 11/26/2022] Open
Abstract
Background Three-dimensional (3D) printing is a new technology capable of producing patient-specific 3D cardiac models. Methods A cross-sectional survey of pediatric cardiologists was conducted. Members of the Canadian Pediatric Cardiology Association and Congenital Cardiac Interventional Study Consortium were invited to participate. A questionnaire was distributed using Research Electronic Data Capture between May and September 2019. Results were analyzed using descriptive statistics, Fisher exact test, and odds ratio. Results A total of 71 pediatric cardiologists responded. Some 85% (60/71) agreed that patient-specific 3D printed cardiac models are a beneficial tool in treating children with congenital heart disease (CHD); 80% of those (48/60) believe 3D models facilitate communication with colleagues; 49% (35/71) of respondents had access to 3D printing technology; and 77% (27/35) of those were using models for clinical care. Access differed according to geographic location (P = 0.004). Of respondents, Americans were 5.5 times more likely (confidence interval, 1.6-19.2) than Canadians to have access to 3D printing technology. The primary reason for lack of access was financial barriers (50%, 18/36). In clinical practice, surgical planning is the primary use of models (96%, 26/27), followed by interventional catheterization planning (52%, 14/27). Double outlet right ventricle was the most commonly modelled lesion (70%, 19/27). Conclusion 3D printing is a new technology that is beneficial in the care of children with CHD. Access to 3D printing varies by geographic location. In pediatric cardiology, 3D models are primarily used for procedural planning for CHD lesions with complex 3D spatial relationships.
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Affiliation(s)
- Caroline F Illmann
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Hosking
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin C Harris
- Children's Heart Centre, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Lau IWW, Sun Z. Dimensional Accuracy and Clinical Value of 3D Printed Models in Congenital Heart Disease: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8091483. [PMID: 31540421 PMCID: PMC6780783 DOI: 10.3390/jcm8091483] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 12/24/2022] Open
Abstract
The aim of this paper is to summarize and evaluate results from existing studies on accuracy and clinical value of three-dimensional printed heart models (3DPHM) for determining whether 3D printing can significantly improve on how the congenital heart disease (CHD) is managed in current clinical practice. Proquest, Google Scholar, Scopus, PubMed, and Medline were searched for relevant studies until April 2019. Two independent reviewers performed manual data extraction and assessed the risk of bias of the studies using the tools published on National Institutes of Health (NIH) website. The following data were extracted from the studies: author, year of publication, study design, imaging modality, segmentation software, utility of 3DPHM, CHD types, and dimensional accuracy. R software was used for the meta-analysis. Twenty-four articles met the inclusion criteria and were included in the systematic review. However, only 7 studies met the statistical requirements and were eligible for meta-analysis. Cochran's Q test demonstrated significant variation among the studies for both of the meta-analyses of accuracy of 3DPHM and the utility of 3DPHM in medical education. Analysis of all included studies reported the mean deviation between the 3DPHM and the medical images is not significant, implying that 3DPHM are highly accurate. As for the utility of the 3DPHM, it is reported in all relevant studies that the 3DPHM improve the learning experience and satisfaction among the users, and play a critical role in facilitating surgical planning of complex CHD cases. 3DPHM have the potential to enhance communication in medical practice, however their clinical value remains debatable. More studies are required to yield a more meaningful meta-analysis.
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Affiliation(s)
- Ivan Wen Wen Lau
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth 6845, Western Australia, Australia.
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth 6845, Western Australia, Australia.
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Bohl MA, McBryan S, Nakaji P, Chang SW, Turner JD, Kakarla UK. Development and first clinical use of a novel anatomical and biomechanical testing platform for scoliosis. JOURNAL OF SPINE SURGERY (HONG KONG) 2019; 5:329-336. [PMID: 31663044 PMCID: PMC6787359 DOI: 10.21037/jss.2019.09.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have demonstrated that, by using various three-dimensional (3D) printing technologies, synthetic spine models can be manufactured to mimic a human spine in its gross and radiographic anatomy and the biomechanical performance of bony and ligamentous tissue. These manufacturing processes have not, however, been used in combination to create a long-segment, biomimetic model of a patient with scoliosis. The purpose of this study was to describe the development of a biomimetic scoliosis model and early clinical experience using this model as a surgical planning and education platform. METHODS Synthetic spine models were printed to mimic the anatomy and biomechanical performance of 2 adult patients with scoliosis. Preoperatively, the models were surgically corrected by the attending surgeon of each patient. Patients then underwent surgical correction of their spinal deformities. Correction of the models was compared to the surgical correction in the patients. RESULTS Patient 1 had a preoperative coronal Cobb angle of 40° from L1 to S1, as did the patient's synthetic spine model. The patient's spine model was corrected to 17.6°, and the patient achieved a correction of 17.3°. Patient 2 had a preoperative mid-thoracic Cobb angle of 88° and an upper thoracic Cobb angle of 43°. Preoperatively, the patient's spine model was corrected to 19.5° and 9.2° for the mid-thoracic and upper thoracic curves, respectively. Immediately after surgery, the patient's mid-thoracic and upper thoracic Cobb angles measured 18.7° and 9.5°, respectively. In both cases, the use of the spine models preoperatively changed the attending surgeon's operative plan. CONCLUSIONS A novel synthetic spine model for corrective scoliosis procedures is presented, along with early clinical experience using this model as a surgical planning platform. This model has tremendous potential not only as a surgical planning platform but also as an adjunct to patient consent, surgical education, and biomechanical research.
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Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Sarah McBryan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Smerling J, Marboe CC, Lefkowitch JH, Pavlicova M, Bacha E, Einstein AJ, Naka Y, Glickstein J, Farooqi KM. Utility of 3D Printed Cardiac Models for Medical Student Education in Congenital Heart Disease: Across a Spectrum of Disease Severity. Pediatr Cardiol 2019; 40:1258-1265. [PMID: 31240370 DOI: 10.1007/s00246-019-02146-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
The most common modes of medical education for congenital heart disease (CHD) rely heavily on 2-dimensional imaging. Three-dimensional (3D) printing technology allows for the creation of physical cardiac models that can be used for teaching trainees. 3D printed cardiac models were created for the following lesions: pulmonic stenosis, atrial septal defect, tetralogy of Fallot, d-transposition of the great arteries, coarctation of the aorta, and hypoplastic left heart syndrome. Medical students participated in a workshop consisting of different teaching stations. At the 3D printed station, students completed a pre- and post-intervention survey assessing their knowledge of each cardiac lesion on a Likert scale. Students were asked to rank the educational benefit of each modality. Linear regression was utilized to assess the correlation of the mean increase in knowledge with increasing complexity of CHD based on the Aristotle Basic Complexity Level. 45 medical students attended the CHD workshop. Students' knowledge significantly improved for every lesion (p < 0.001). A strong positive correlation was found between mean increase in knowledge and increasing complexity of CHD (R2 = 0.73, p < 0.05). The 3D printed models, pathology specimens and spoken explanation were found to be the most helpful modalities. Students "strongly agreed" the 3D printed models made them more confident in explaining congenital cardiac anatomy to others (mean = 4.23, ± 0.69), and that they recommend the use of 3D models for future educational sessions (mean = 4.40, ± 0.69). 3D printed cardiac models should be included in medical student education particularly for lesions that require a complex understanding of spatial relationships.
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Affiliation(s)
- Jennifer Smerling
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Charles C Marboe
- Department of Pathology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jay H Lefkowitch
- Department of Pathology, Columbia University Irving Medical Center, New York, NY, USA
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Emile Bacha
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Julie Glickstein
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, 3959 Broadway, CHN-2, New York, NY, 10023, USA
| | - Kanwal M Farooqi
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, 3959 Broadway, CHN-2, New York, NY, 10023, USA.
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XU J, SHU Q. [Application of 3D printing techniques in treatment of congenital heart disease]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:573-579. [PMID: 31901034 PMCID: PMC8800709 DOI: 10.3785/j.issn.1008-9292.2019.10.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/07/2019] [Indexed: 01/24/2023]
Abstract
Congenital heart disease (CHD) is the most common birth defect at present. In recent years, the application of 3D printing in the diagnosis and treatment of CHD has been widely recognized, which presents CHD lesions in 3D solid model and provides a better understanding of the anatomy of CHD. In the future, 3D printing technology would improve the surgical proficiency, shorten the operation time, reduce the occurrence of perioperative complications, and create more personalized cardiovascular implants, therefore promote the precision of diagnosis and treatment for congenital heart disease. This article reviews the application of 3D printing technology in preoperative planning, intraoperative navigation and personalized implants of CHD, in surgical training and medical education, as well as in promoting doctor-patient communication and better understanding their condition for patients.
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Affiliation(s)
| | - Qiang SHU
- 舒强(1965-), 男, 博士, 教授, 博士生导师, 主要从事出生缺陷防治和小儿心胸外科研究; E-mail:
;
https://orcid.org/0000-0002-4106-6255
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Ochoa S, Segal J, Garcia N, Fischer EA. Three-Dimensional Printed Cardiac Models for Focused Cardiac Ultrasound Instruction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1405-1409. [PMID: 30246888 DOI: 10.1002/jum.14818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Focused cardiac ultrasonography (FCU) is an increasingly integral component of routine medical training and practice. While various instructional methods have been described, few attempts have been made to incorporate a physical 3-dimensional (3D) instructional aid. OBJECTIVE The aim of this study was to determine if a 3D printed heart model workshop for FCU instruction leads to equivalent structure recognition and scanning ability compared to traditional didactic FCU instruction. INTERVENTION Twenty first-year medical students with no point-of-care ultrasonography experience were randomly assigned to a traditional lecture (n = 10) or a 3D printed heart model workshop (n = 10). Written examinations at 0 and 3 months as well as image acquisition at 3 months were compared. RESULTS The median scores from the initial written structure identification in the traditional and 3D heart groups were 74% and 90%, respectively (P = 0.7). The second written exam at 3 months yielded median scores of 56% and 58% in the traditional and 3D heart groups, respectively (P = 0.8). The average scores on the image acquisition practical at 3 months were 3.3 of 5 and 2.7 of 5 (P = 0.1) in the traditional and 3D heart groups, respectively. CONCLUSIONS Utilizing 3D heart models in an FCU workshop format results in similar skill acquisition and knowledge retention as traditional didactics. The 3D heart models are relatively inexpensive, portable, and reusable, enabling learners to practice repeatedly and at flexible intervals. The reduction in ongoing expenses and the ability to teach large groups may decrease training costs as well as the need for local faculty expertise.
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Affiliation(s)
| | | | - Noah Garcia
- Gertler & Wente Architects LLP, New York, New York, USA
| | - Ernest A Fischer
- Georgetown University Medical Center
- MedStar Georgetown University Hospital, Washington, DC, USA
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Personalized Three-Dimensional Printed Models in Congenital Heart Disease. J Clin Med 2019; 8:jcm8040522. [PMID: 30995803 PMCID: PMC6517984 DOI: 10.3390/jcm8040522] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 12/24/2022] Open
Abstract
Patient-specific three-dimensional (3D) printed models have been increasingly used in cardiology and cardiac surgery, in particular, showing great value in the domain of congenital heart disease (CHD). CHD is characterized by complex cardiac anomalies with disease variations between individuals; thus, it is difficult to obtain comprehensive spatial conceptualization of the cardiac structures based on the current imaging visualizations. 3D printed models derived from patient's cardiac imaging data overcome this limitation by creating personalized 3D heart models, which not only improve spatial visualization, but also assist preoperative planning and simulation of cardiac procedures, serve as a useful tool in medical education and training, and improve doctor-patient communication. This review article provides an overall view of the clinical applications and usefulness of 3D printed models in CHD. Current limitations and future research directions of 3D printed heart models are highlighted.
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Bramlet M, Olivieri L, Farooqi K, Ripley B, Coakley M. Impact of Three-Dimensional Printing on the Study and Treatment of Congenital Heart Disease. Circ Res 2019; 120:904-907. [PMID: 28302738 DOI: 10.1161/circresaha.116.310546] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew Bramlet
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.).
| | - Laura Olivieri
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.)
| | - Kanwal Farooqi
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.)
| | - Beth Ripley
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.)
| | - Meghan Coakley
- From the Pediatric Cardiology, University of Illinois College of Medicine at Peoria (M.B.); Advanced Imaging and Modeling Initiative, Jump Trading Simulation and Education Center, Peoria, IL (M.B.); Division of Cardiology, Children's National Medical Center, Northwest, Washington, DC (L.O.); Rutgers, Division of Pediatric Cardiology, Department of Pediatrics, New Jersey Medical School, Newark (K.F.); Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY (K.F.); Radiology, VA Puget Sound Health Care System and University of Washington Medical School, Seattle (B.R.); and Bioinformatics and Computational Biosciences Branch, Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (M.C.)
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Garner KH, Singla DK. 3D modeling: a future of cardiovascular medicine. Can J Physiol Pharmacol 2019; 97:277-286. [DOI: 10.1139/cjpp-2018-0472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cardiovascular disease resulting from atypical cardiac structures continues to be a leading health concern despite advancements in diagnostic imaging and surgical techniques. However, the ability to visualize spatial relationships using current technologies remains a challenge. Therefore, 3D modeling has gained significant interest to understand complex and atypical cardiovascular disorders. Moreover, 3D modeling can be personalized and patient-specific. 3D models have been demonstrated to aid surgical planning and simulation, enhance communication among surgeons and patients, optimize medical device design, and can be used as a potential teaching tool in medical schools. In this review, we discuss the key components needed to generate cardiac 3D models. We highlight prevalent structural conditions that have utilized 3D modeling in pre-operative planning. Furthermore, we discuss the current limitations of routine use of 3D models in the clinic as well as future directions for utilization of this technology in the cardiovascular field.
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Affiliation(s)
- Kaley H. Garner
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
| | - Dinender K. Singla
- Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32816, USA
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Qasim M, Haq F, Kang MH, Kim JH. 3D printing approaches for cardiac tissue engineering and role of immune modulation in tissue regeneration. Int J Nanomedicine 2019; 14:1311-1333. [PMID: 30863063 PMCID: PMC6388753 DOI: 10.2147/ijn.s189587] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Conventional tissue engineering, cell therapy, and current medical approaches were shown to be successful in reducing mortality rate and complications caused by cardiovascular diseases (CVDs). But still they have many limitations to fully manage CVDs due to complex composition of native myocardium and microvascularization. Fabrication of fully functional construct to replace infarcted area or regeneration of progenitor cells is important to address CVDs burden. Three-dimensional (3D) printed scaffolds and 3D bioprinting technique have potential to develop fully functional heart construct that can integrate with native tissues rapidly. In this review, we presented an overview of 3D printed approaches for cardiac tissue engineering, and advances in 3D bioprinting of cardiac construct and models. We also discussed role of immune modulation to promote tissue regeneration.
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Affiliation(s)
- Muhammad Qasim
- Department of Stem Cell and Regenerative Biotechnology, Humanized Pig Research Centre (SRC), Konkuk University, Seoul, South Korea,
| | - Farhan Haq
- Department of Biosciences, Comsats University, Islamabad, Pakistan
| | - Min-Hee Kang
- Department of Stem Cell and Regenerative Biotechnology, Humanized Pig Research Centre (SRC), Konkuk University, Seoul, South Korea,
| | - Jin-Hoi Kim
- Department of Stem Cell and Regenerative Biotechnology, Humanized Pig Research Centre (SRC), Konkuk University, Seoul, South Korea,
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Ratinam R, Quayle M, Crock J, Lazarus M, Fogg Q, McMenamin P. Challenges in creating dissectible anatomical 3D prints for surgical teaching. J Anat 2019; 234:419-437. [PMID: 30710355 DOI: 10.1111/joa.12934] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 01/17/2023] Open
Abstract
Three-dimensional (3D) printing, or additive manufacturing, is now a widely used tool in pre-operative planning, surgical teaching and simulator training. However, 3D printing technology that produces models with accurate haptic feedback, biomechanics and visuals for the training surgeon is not currently available. Challenges and opportunities in creating such surgical models will be discussed in this review paper. Surgery requires proper tissue handling as well as knowledge of relevant anatomy. To prepare doctors properly, training models need to take into account the biomechanical properties of the anatomical structures that will be manipulated in any given operation. This review summarises and evaluates the current biomechanical literature as it relates to human tissues and correlates the impact of this knowledge on developing high fidelity 3D printed surgical training models. We conclude that, currently, a printer technology has not yet been developed which can replicate many of the critical qualities of human tissue. Advances in 3D printing technology will be required to allow the printing of multi-material products to achieve the mechanical properties required.
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Affiliation(s)
- Ratheesraj Ratinam
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia
| | - Michelle Quayle
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia
| | - John Crock
- Department of Surgery, Monash University, Clayton, Vic., Australia
| | - Michelle Lazarus
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia
| | - Quentin Fogg
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia.,Department of Anatomy and Neuroscience, The University of Melbourne, Melbourne, Vic., Australia
| | - Paul McMenamin
- Department of Anatomy and Developmental Biology, Centre for Human Anatomy Education, Monash University, Clayton, Vic., Australia
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Lau I, Wong YH, Yeong CH, Abdul Aziz YF, Md Sari NA, Hashim SA, Sun Z. Quantitative and qualitative comparison of low- and high-cost 3D-printed heart models. Quant Imaging Med Surg 2019; 9:107-114. [PMID: 30788252 DOI: 10.21037/qims.2019.01.02] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Current visualization techniques of complex congenital heart disease (CHD) are unable to provide comprehensive visualization of the anomalous cardiac anatomy as the medical datasets can essentially only be viewed from a flat, two-dimensional (2D) screen. Three-dimensional (3D) printing has therefore been used to replicate patient-specific hearts in 3D views based on medical imaging datasets. This technique has been shown to have a positive impact on the preoperative planning of corrective surgery, patient-doctor communication, and the learning experience of medical students. However, 3D printing is often costly, and this impedes the routine application of this technology in clinical practice. This technical note aims to investigate whether reducing 3D printing costs can have any impact on the clinical value of the 3D-printed heart models. Low-cost and a high-cost 3D-printed models based on a selected case of CHD were generated with materials of differing cost. Quantitative assessment of dimensional accuracy of the cardiac anatomy and pathology was compared between the 3D-printed models and the original cardiac computed tomography (CT) images with excellent correlation (r=0.99). Qualitative evaluation of model usefulness showed no difference between the two models in medical applications.
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Affiliation(s)
- Ivan Lau
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Yin How Wong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Chai Hong Yeong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre (UMRIC) University of Malaya, Kuala Lumpur, Malaysia
| | - Nor Ashikin Md Sari
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaya Research Imaging Centre (UMRIC) University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Amry Hashim
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
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44
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Haleem A, Javaid M, Saxena A. Additive manufacturing applications in cardiology: A review. Egypt Heart J 2018; 70:433-441. [PMID: 30591768 PMCID: PMC6303383 DOI: 10.1016/j.ehj.2018.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/28/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Additive manufacturing (AM) has emerged as a serious planning, strategy, and education tool in cardiovascular medicine. This review describes and illustrates the application, development and associated limitation of additive manufacturing in the field of cardiology by studying research papers on AM in medicine/cardiology. METHODS Relevant research papers till August 2018 were identified through Scopus and examined for strength, benefits, limitation, contribution and future potential of AM. With the help of the existing literature & bibliometric analysis, different applications of AM in cardiology are investigated. RESULTS AM creates an accurate three-dimensional anatomical model to explain, understand and prepare for complex medical procedures. A prior study of patient's 3D heart model can help doctors understand the anatomy of the individual patient, which may also be used create training modules for institutions and surgeons for medical training. CONCLUSION AM has the potential to be of immense help to the cardiologists and cardiac surgeons for intervention and surgical planning, monitoring and analysis. Additive manufacturing creates a 3D model of the heart of a specific patient in lesser time and cost. This technology is used to create and analyse 3D model before starting actual surgery on the patient. It can improve the treatment outcomes for patients, besides saving their lives. Paper summarised additive manufacturing applications particularly in the area of cardiology, especially manufacturing of a patient-specific artificial heart or its component. Model printed by this technology reduces risk, improves the quality of diagnosis and preoperative planning and also enhanced team communication. In cardiology, patient data of heart varies from patient to patient, so AM technologies efficiently produce 3D models, through converting the predesigned virtual model into a tangible object. Companies explore additive manufacturing for commercial medical applications.
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Affiliation(s)
- Abid Haleem
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Mohd Javaid
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Anil Saxena
- Cardiac Pacing & Electrophysiology, Fortis Escorts, New Delhi, India
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45
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Chen SA, Ong CS, Malguria N, Vricella LA, Garcia JR, Hibino N. Digital Design and 3D Printing of Aortic Arch Reconstruction in HLHS for Surgical Simulation and Training. World J Pediatr Congenit Heart Surg 2018; 9:454-458. [PMID: 29945510 DOI: 10.1177/2150135118771323] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Patients with hypoplastic left heart syndrome (HLHS) present a diverse spectrum of aortic arch morphology. Suboptimal geometry of the reconstructed aortic arch may result from inappropriate size and shape of an implanted patch and may be associated with poor outcomes. Meanwhile, advances in diagnostic imaging, computer-aided design, and three-dimensional (3D) printing technology have enabled the creation of 3D models. The purpose of this study is to create a surgical simulation and training model for aortic arch reconstruction. DESCRIPTION Specialized segmentation software was used to isolate aortic arch anatomy from HLHS computed tomography scan images to create digital 3D models. Three-dimensional modeling software was used to modify the exported segmented models and digitally design printable customized patches that were optimally sized for arch reconstruction. EVALUATION Life-sized models of HLHS aortic arch anatomy and a digitally derived customized patch were 3D printed to allow simulation of surgical suturing and reconstruction. The patient-specific customized patch was successfully used for surgical simulation. CONCLUSIONS Feasibility of digital design and 3D printing of patient-specific patches for aortic arch reconstruction has been demonstrated. The technology facilitates surgical simulation. Surgical training that leads to an understanding of optimal aortic patch geometry is one element that may potentially influence outcomes for patients with HLHS.
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Affiliation(s)
- Sarah A Chen
- 1 Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.,2 Department of Art as Applied to Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,3 University of California Davis School of Medicine, Sacramento, CA, USA
| | - Chin Siang Ong
- 1 Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nagina Malguria
- 4 Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Luca A Vricella
- 1 Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Juan R Garcia
- 2 Department of Art as Applied to Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Narutoshi Hibino
- 1 Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Lau I, Sun Z. Three-dimensional printing in congenital heart disease: A systematic review. J Med Radiat Sci 2018; 65:226-236. [PMID: 29453808 PMCID: PMC6119737 DOI: 10.1002/jmrs.268] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 01/12/2018] [Accepted: 01/22/2018] [Indexed: 01/09/2023] Open
Abstract
Three-dimensional (3D) printing has shown great promise in medicine with increasing reports in congenital heart disease (CHD). This systematic review aims to analyse the main clinical applications and accuracy of 3D printing in CHD, as well as to provide an overview of the software tools, time and costs associated with the generation of 3D printed heart models. A search of different databases was conducted to identify studies investigating the application of 3D printing in CHD. Studies based on patient's medical imaging datasets were included for analysis, while reports on in vitro phantom or review articles were excluded from the analysis. A total of 28 studies met selection criteria for inclusion in the review. More than half of the studies were based on isolated case reports with inclusion of 1-12 cases (61%), while 10 studies (36%) focused on the survey of opinion on the usefulness of 3D printing by healthcare professionals, patients, parents of patients and medical students, and the remaining one involved a multicentre study about the clinical value of 3D printed models in surgical planning of CHD. The analysis shows that patient-specific 3D printed models accurately replicate complex cardiac anatomy, improve understanding and knowledge about congenital heart diseases and demonstrate value in preoperative planning and simulation of cardiac or interventional procedures, assist surgical decision-making and intra-operative orientation, and improve patient-doctor communication and medical education. The cost of 3D printing ranges from USD 55 to USD 810. This systematic review shows the usefulness of 3D printed models in congenital heart disease with applications ranging from accurate replication of complex cardiac anatomy and pathology to medical education, preoperative planning and simulation. The additional cost and time required to manufacture the 3D printed models represent the limitations which need to be addressed in future studies.
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Affiliation(s)
- Ivan Lau
- Department of Medical Radiation SciencesCurtin UniversityPerthAustralia
| | - Zhonghua Sun
- Department of Medical Radiation SciencesCurtin UniversityPerthAustralia
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Hermsen JL, Yang R, Burke TM, Dardas T, Jacobs LM, Verrier ED, Mokadam NA. Development of a 3-D printing-based cardiac surgical simulation curriculum to teach septal myectomy. J Thorac Cardiovasc Surg 2018; 156:1139-1148.e3. [DOI: 10.1016/j.jtcvs.2017.09.136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/28/2017] [Accepted: 09/13/2017] [Indexed: 10/28/2022]
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48
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Olivieri LJ, Zurakowski D, Ramakrishnan K, Su L, Alfares FA, Irwin MR, Heichel J, Krieger A, Nath DS. Novel, 3D Display of Heart Models in the Postoperative Care Setting Improves CICU Caregiver Confidence. World J Pediatr Congenit Heart Surg 2018; 9:206-213. [PMID: 29544410 DOI: 10.1177/2150135117745005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Postoperative care delivered in the pediatric cardiac intensive care unit (CICU) relies on providers' understanding of patients' congenital heart defects (CHDs) and procedure performed. Novel, bedside use of virtual, three-dimensional (3D) heart models creates access to patients' CHD to improve understanding. This study evaluates the impact of patient-specific virtual 3D heart models on CICU provider attitudes and care delivery. METHODS Virtual 3D heart models were created from standard preoperative cardiac imaging of ten patients with CHD undergoing repair and displayed on a bedside tablet in the CICU. Providers completed a Likert questionnaire evaluating the models' value in understanding anatomy and improving care delivery. Responses were compared using two-tailed t test and Mann-Whitney U test and were also compared to previously collected CICU provider responses regarding use of printed 3D heart models. RESULTS Fifty-three clinicians (19 physicians, 34 nurses/trainees) participated; 49 (92%) of 53 and 44 (83%) of 53 reported at least moderate to high satisfaction with the virtual 3D heart's ability to enhance understanding of anatomy and surgical repair, respectively. Seventy-one percent of participants felt strongly that virtual 3D models improved their ability to manage postoperative problems. The majority of both groups (63% physicians, 53% nurses) felt that virtual 3D heart models improved CICU handoffs. Virtual 3D heart models were as effective as printed models in improving understanding and care delivery, with a noted provider preference for printed 3D heart models. CONCLUSIONS Virtual 3D heart models depicting patient-specific CHDs are perceived to improve understanding and postoperative care delivery in the CICU.
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Affiliation(s)
- Laura J Olivieri
- 1 Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - David Zurakowski
- 2 Department of Anesthesia, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, USA.,3 Department of Surgery, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, USA
| | - Karthik Ramakrishnan
- 1 Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Lillian Su
- 4 Division of Critical Care, Children's National Medical Center, Washington, DC, USA
| | - Fahad A Alfares
- 1 Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | | | - Jenna Heichel
- 4 Division of Critical Care, Children's National Medical Center, Washington, DC, USA
| | - Axel Krieger
- 6 Department of Bioengineering, Sheikh Zayed Institute for Surgical Innovation, Children's National Medical Center, Washington, DC, USA.,7 Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Dilip S Nath
- 8 Division of Cardiovascular Surgery, Children's National Medical Center, Washington, DC, USA
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El Sabbagh A, Eleid MF, Al-Hijji M, Anavekar NS, Holmes DR, Nkomo VT, Oderich GS, Cassivi SD, Said SM, Rihal CS, Matsumoto JM, Foley TA. The Various Applications of 3D Printing in Cardiovascular Diseases. Curr Cardiol Rep 2018; 20:47. [PMID: 29749577 DOI: 10.1007/s11886-018-0992-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To highlight the various applications of 3D printing in cardiovascular disease and discuss its limitations and future direction. RECENT FINDINGS Use of handheld 3D printed models of cardiovascular structures has emerged as a facile modality in procedural and surgical planning as well as education and communication. Three-dimensional (3D) printing is a novel imaging modality which involves creating patient-specific models of cardiovascular structures. As percutaneous and surgical therapies evolve, spatial recognition of complex cardiovascular anatomic relationships by cardiologists and cardiovascular surgeons is imperative. Handheld 3D printed models of cardiovascular structures provide a facile and intuitive road map for procedural and surgical planning, complementing conventional imaging modalities. Moreover, 3D printed models are efficacious educational and communication tools. This review highlights the various applications of 3D printing in cardiovascular diseases and discusses its limitations and future directions.
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Affiliation(s)
- Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mohammed Al-Hijji
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Sameh M Said
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Thomas A Foley
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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50
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Marino BS, Tabbutt S, MacLaren G, Hazinski MF, Adatia I, Atkins DL, Checchia PA, DeCaen A, Fink EL, Hoffman GM, Jefferies JL, Kleinman M, Krawczeski CD, Licht DJ, Macrae D, Ravishankar C, Samson RA, Thiagarajan RR, Toms R, Tweddell J, Laussen PC. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e691-e782. [PMID: 29685887 DOI: 10.1161/cir.0000000000000524] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiac arrest occurs at a higher rate in children with heart disease than in healthy children. Pediatric basic life support and advanced life support guidelines focus on delivering high-quality resuscitation in children with normal hearts. The complexity and variability in pediatric heart disease pose unique challenges during resuscitation. A writing group appointed by the American Heart Association reviewed the literature addressing resuscitation in children with heart disease. MEDLINE and Google Scholar databases were searched from 1966 to 2015, cross-referencing pediatric heart disease with pertinent resuscitation search terms. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. The recommendations in this statement concur with the critical components of the 2015 American Heart Association pediatric basic life support and pediatric advanced life support guidelines and are meant to serve as a resuscitation supplement. This statement is meant for caregivers of children with heart disease in the prehospital and in-hospital settings. Understanding the anatomy and physiology of the high-risk pediatric cardiac population will promote early recognition and treatment of decompensation to prevent cardiac arrest, increase survival from cardiac arrest by providing high-quality resuscitations, and improve outcomes with postresuscitation care.
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