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Fischer N, Marzi C, Meisenbacher K, Kisilenko A, Davitashvili T, Wagner M, Mathis-Ullrich F. A sensorized modular training platform to reduce vascular damage in endovascular surgery. Int J Comput Assist Radiol Surg 2023; 18:1687-1695. [PMID: 37193935 PMCID: PMC10491519 DOI: 10.1007/s11548-023-02935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/21/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Endovascular interventions require intense practice to develop sufficient dexterity in catheter handling within the human body. Therefore, we present a modular training platform, featuring 3D-printed vessel phantoms with patient-specific anatomy and integrated piezoresistive impact force sensing of instrument interaction at clinically relevant locations for feedback-based skill training to detect and reduce damage to the delicate vascular wall. METHODS The platform was fabricated and then evaluated in a user study by medical ([Formula: see text]) and non-medical ([Formula: see text]) users. The users had to navigate a set of guidewire and catheter through a parkour of 3 modules including an aneurismatic abdominal aorta, while impact force and completion time were recorded. Eventually, a questionnaire was conducted. RESULTS The platform allowed to perform more than 100 runs in which it proved capable to distinguish between users of different experience levels. Medical experts in the fields of vascular and visceral surgery had a strong performance assessment on the platform. It could be shown, that medical students could improve runtime and impact over 5 runs. The platform was well received and rated as promising for medical education despite the experience of higher friction compared to real human vessels. CONCLUSION We investigated an authentic patient-specific training platform with integrated sensor-based feedback functionality for individual skill training in endovascular surgery. The presented method for phantom manufacturing is easily applicable to arbitrary patient-individual imaging data. Further work shall address the implementation of smaller vessel branches, as well as real-time feedback and camera imaging for further improved training experience.
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Affiliation(s)
- Nikola Fischer
- Health Robotics and Automation, Karlsruhe Institute of Technology, Institute for Anthropomatics and Robotics, 76131, Karlsruhe, Germany
| | - Christian Marzi
- Health Robotics and Automation, Karlsruhe Institute of Technology, Institute for Anthropomatics and Robotics, 76131, Karlsruhe, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Anna Kisilenko
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Tornike Davitashvili
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Martin Wagner
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
- Center for the Tactile Internet with Human in the Loop (CeTI), Technical University Dresden, 01062, Dresden, Germany
| | - Franziska Mathis-Ullrich
- Health Robotics and Automation, Karlsruhe Institute of Technology, Institute for Anthropomatics and Robotics, 76131, Karlsruhe, Germany.
- Department of Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander-University Erlangen-Nürnberg, 91052, Erlangen, Germany.
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2
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Kaufmann R, Zech CJ, Deutschmann M, Scharinger B, Hecht S, Hergan K, Rezar R, Hitzl W, Meissnitzer M. Endovascular embolization techniques in acute thoracic and abdominal bleedings can be technically reproduced and trained in a standardized simulation setting using SLA 3D printing: a 1-year single-center study. Insights Imaging 2022; 13:72. [PMID: 35397043 PMCID: PMC8994805 DOI: 10.1186/s13244-022-01206-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/13/2022] [Indexed: 12/29/2022] Open
Abstract
Background Endovascular embolization techniques are nowadays well established in the management of acute arterial bleedings. However, the education and training of the next generation of interventionalists are still based on the traditional apprenticeship model, where the trainee learns and practices directly at the patient, which potentially affects the patient’s safety. The objective of this study was to design and develop a standardized endovascular simulation concept for the training of acute bleeding embolizations, based on real-life cases. Results An adaptable and cost-effective endovascular simulator was developed using an in-house 3D print laboratory. All thoracic and abdominal acute bleeding embolizations over more than a year with appropriate pre-interventional computed tomography scans were included to manufacture 3D printed vascular models. A peristaltic pump was used to generate pulsatile flow curves. Forty embolization cases were engaged in this study, and 27 cases were fully reproduced in the simulation setting (69.23%). The simulation success was significantly lower in pulmonary embolizations (p = 0.031) and significantly higher in soft tissue (p = 0.032) and coil embolizations (p = 0.045). The overall simulation success was 7.8 out of 10 available points. Conclusions Using stereolithography 3D printing in a standardized simulation concept, endovascular embolization techniques for treating acute internal hemorrhages in the chest and abdomen can be simulated and trained based on the patient-specific anatomy in a majority of the cases and at a broad spectrum of different causes. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01206-7.
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Affiliation(s)
- Reinhard Kaufmann
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria. .,Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, 4031, Basel, Switzerland.
| | - Christoph J Zech
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, 4031, Basel, Switzerland
| | - Michael Deutschmann
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Bernhard Scharinger
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Stefan Hecht
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Klaus Hergan
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology and Internal Intensive Care Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020, Salzburg, Austria
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University of Salzburg, 5020, Salzburg, Austria
| | - Matthias Meissnitzer
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Cornejo J, Cornejo-Aguilar JA, Vargas M, Helguero CG, Milanezi de Andrade R, Torres-Montoya S, Asensio-Salazar J, Rivero Calle A, Martínez Santos J, Damon A, Quiñones-Hinojosa A, Quintero-Consuegra MD, Umaña JP, Gallo-Bernal S, Briceño M, Tripodi P, Sebastian R, Perales-Villarroel P, De la Cruz-Ku G, Mckenzie T, Arruarana VS, Ji J, Zuluaga L, Haehn DA, Paoli A, Villa JC, Martinez R, Gonzalez C, Grossmann RJ, Escalona G, Cinelli I, Russomano T. Anatomical Engineering and 3D Printing for Surgery and Medical Devices: International Review and Future Exponential Innovations. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6797745. [PMID: 35372574 PMCID: PMC8970887 DOI: 10.1155/2022/6797745] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
Three-dimensional printing (3DP) has recently gained importance in the medical industry, especially in surgical specialties. It uses different techniques and materials based on patients' needs, which allows bioprofessionals to design and develop unique pieces using medical imaging provided by computed tomography (CT) and magnetic resonance imaging (MRI). Therefore, the Department of Biology and Medicine and the Department of Physics and Engineering, at the Bioastronautics and Space Mechatronics Research Group, have managed and supervised an international cooperation study, in order to present a general review of the innovative surgical applications, focused on anatomical systems, such as the nervous and craniofacial system, cardiovascular system, digestive system, genitourinary system, and musculoskeletal system. Finally, the integration with augmented, mixed, virtual reality is analyzed to show the advantages of personalized treatments, taking into account the improvements for preoperative, intraoperative planning, and medical training. Also, this article explores the creation of devices and tools for space surgery to get better outcomes under changing gravity conditions.
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Affiliation(s)
- José Cornejo
- Facultad de Ingeniería, Universidad San Ignacio de Loyola, La Molina, Lima 15024, Peru
- Department of Medicine and Biology & Department of Physics and Engineering, Bioastronautics and Space Mechatronics Research Group, Lima 15024, Peru
| | | | | | | | - Rafhael Milanezi de Andrade
- Robotics and Biomechanics Laboratory, Department of Mechanical Engineering, Universidade Federal do Espírito Santo, Brazil
| | | | | | - Alvaro Rivero Calle
- Department of Oral and Maxillofacial Surgery, Hospital 12 de Octubre, Madrid, Spain
| | - Jaime Martínez Santos
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Aaron Damon
- Department of Neurosurgery, Mayo Clinic, FL, USA
| | | | | | - Juan Pablo Umaña
- Cardiovascular Surgery, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotá DC, Colombia
| | | | - Manolo Briceño
- Villamedic Group, Lima, Peru
- Clínica Internacional, Lima, Peru
| | | | - Raul Sebastian
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA
| | | | - Gabriel De la Cruz-Ku
- Universidad Científica del Sur, Lima, Peru
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jiakai Ji
- Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, Bronx, NY, USA
| | - Laura Zuluaga
- Department of Urology, Fundación Santa Fe de Bogotá, Colombia
| | | | - Albit Paoli
- Howard University Hospital, Washington, DC, USA
| | | | | | - Cristians Gonzalez
- Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut of Image-Guided Surgery (IHU-Strasbourg), Strasbourg, France
| | | | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Ilaria Cinelli
- Aerospace Human Factors Association, Aerospace Medical Association, VA, USA
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Rynio P, Wojtuń M, Wójcik Ł, Kawa M, Falkowski A, Gutowski P, Kazimierczak A. The accuracy and reliability of 3D printed aortic templates: a comprehensive three-dimensional analysis. Quant Imaging Med Surg 2022; 12:1385-1396. [PMID: 35111632 DOI: 10.21037/qims-21-529] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/13/2021] [Indexed: 12/21/2022]
Abstract
Background Advances in 3D printing technology allow us to continually find new medical applications. One of them is 3D printing of aortic templates to guide vascular surgeons or interventional radiologists to create fenestrations in the stent-graft surface for the implantation procedure called fenestrated endovascular aortic aneurysm repair. It is believed that the use of 3D printing significantly improves the quality of modified fenestrated stent-grafts. However, the accuracy and reliability of personalized 3D printed models of aortic templates are not well established. Methods Thirteen 3D printed templates of the visceral aorta and sixteen of the aortic arch and their corresponding computer tomography of angiography images were included in this accuracy study. The 3D models were scanned in the same conditions on computed tomography (CT) and evaluated by three physicians experienced in vascular CT assessment. Model and patient CT measurements were performed at key landmarks to maintain quality for stent-graft modification, including side branches and aortic diameters. CT-scanned aortic templates were segmented, aligned with sourced patient data, and evaluated for the Hausdorff matrix. Next, Bland-Altman plots determined the degree of agreement. Results The Intraclass Correlation Coefficients values were more than 0.9 for all measurements of aortic diameters and aortic branches diameter in all landmark locations. Therefore, the reliability of the aortic templates was considered excellent. The Bland-Altman plots analysis indicated measurement biases of 0.05 to 0.47 for aortic arch templates and 0.06 to 0.38 for reno-visceral aortic templates. The arithmetic mean of Hausdorff's mean distances of the aortic arch templates was 0.47 mm (SD =0.06) and ranged from 0.34 to 0.58. The mean metrics for abdominal models was 0.24 mm (SD =0.03) and ranged from 0.21 to 0.31. Conclusions The printed models of 3D aortic templates are accurate and reliable, thus can be widely used in endovascular surgery and interventional radiology departments as aortic templates to guide the physician-modified fenestrated stent-graft fabrication.
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Affiliation(s)
- Pawel Rynio
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Maciej Wojtuń
- Department of Radiology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Łukasz Wójcik
- Department of Radiology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Miłosz Kawa
- Department of Radiology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Aleksander Falkowski
- Department of Radiology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Piotr Gutowski
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Arkadiusz Kazimierczak
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Szczecin, Poland
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5
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Kaufmann R, Zech CJ, Takes M, Brantner P, Thieringer F, Deutschmann M, Hergan K, Scharinger B, Hecht S, Rezar R, Wernly B, Meissnitzer M. Vascular 3D Printing with a Novel Biological Tissue Mimicking Resin for Patient-Specific Procedure Simulations in Interventional Radiology: a Feasibility Study. J Digit Imaging 2022; 35:9-20. [PMID: 34997376 PMCID: PMC8854516 DOI: 10.1007/s10278-021-00553-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 10/31/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022] Open
Abstract
Three-dimensional (3D) printing of vascular structures is of special interest for procedure simulations in Interventional Radiology, but remains due to the complexity of the vascular system and the lack of biological tissue mimicking 3D printing materials a technical challenge. In this study, the technical feasibility, accuracy, and usability of a recently introduced silicone-like resin were evaluated for endovascular procedure simulations and technically compared to a commonly used standard clear resin. Fifty-four vascular models based on twenty-seven consecutive embolization cases were fabricated from preinterventional CT scans and each model was checked for printing success and accuracy by CT-scanning and digital comparison to its original CT data. Median deltas (Δ) of luminal diameters were 0.35 mm for clear and 0.32 mm for flexible resin (216 measurements in total) with no significant differences (p > 0.05). Printing success was 85.2% for standard clear and 81.5% for the novel flexible resin. In conclusion, vascular 3D printing with silicone-like flexible resin was technically feasible and highly accurate. This is the first and largest consecutive case series of 3D-printed embolizations with a novel biological tissue mimicking material and is a promising next step in patient-specific procedure simulations in Interventional Radiology.
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Affiliation(s)
- R. Kaufmann
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Clinic of Radiology & Nuclear Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - C. J. Zech
- Clinic of Radiology & Nuclear Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - M. Takes
- Clinic of Radiology & Nuclear Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - P. Brantner
- Clinic of Radiology & Nuclear Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - F. Thieringer
- Clinic for Oral and Maxillofacial Surgery, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - M. Deutschmann
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - K. Hergan
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - B. Scharinger
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - S. Hecht
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - R. Rezar
- Clinic of Internal Medicine II, Department of Cardiology and Internal Intensive Care Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - B. Wernly
- Clinic of Internal Medicine II, Department of Cardiology and Internal Intensive Care Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - M. Meissnitzer
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
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6
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Holm MA, Emfield K, Iles TL, Iaizzo PA. High-resolution 3D reconstructions of human vasculatures: creation of educational tools and benchtop models for transcatheter devices. Cardiovasc Interv Ther 2021; 37:519-525. [PMID: 34468961 DOI: 10.1007/s12928-021-00804-4] [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: 03/21/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
Transcatheter therapies are a common way to treat cardiovascular diseases. These therapies are complicated by significant anatomical patient-to-patient variations that exist in terms of transcatheter vascular pathways. Adding to the complexity of transcatheter procedures, the training tools used for physician education often overlook vast patient-to-patient variations and utilize idealized models of patient anatomy that may be unrealistic. In this study, anatomically accurate models were created from high-resolution images of real patient vasculatures. Using fourteen human cadavers donated for research, we collected high-resolution images to generate 3D computational renderings of various patient anatomies. These models make up the "Transcatheter Pathways Vasculature Database" that can be used for physician education and training, as well as improving transcatheter delivery system design. We performed multiple studies that emphasize the anatomical differences that exist in patient vasculatures. Using 3D printing and virtual reality, we developed educational materials and benchtop models to train physicians using true patient anatomies. These tools can also provide device designers with data to improve their products based on real patient vessels. The "Transcatheter Pathways Vasculature Database" highlights differences between patient vasculatures. By educating and training physicians with patient anatomies that accurately represent significant patient-to-patient variations, learning is more translatable to what is seen in the clinic.
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Affiliation(s)
- Mikayle A Holm
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Kendall Emfield
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Tinen L Iles
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Paul A Iaizzo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA. .,Department of Surgery, University of Minnesota, Minneapolis, MN, USA. .,Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA. .,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA.
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7
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Marciuc EA, Dobrovat BI, Popescu RM, Dobrin N, Chiriac A, Marciuc D, Eva L, Haba D. 3D Printed Models-A Useful Tool in Endovascular Treatment of Intracranial Aneurysms. Brain Sci 2021; 11:brainsci11050598. [PMID: 34066604 PMCID: PMC8148564 DOI: 10.3390/brainsci11050598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022] Open
Abstract
Many developments were made in the area of endovascular treatment of intracranial aneurysms, but this procedure also requires a good assessment of vascular anatomy prior to intervention. Seventy-six cases with brain aneurysms were selected and 1:1 scale 3D printed models were created. We asked three interventional neurosurgeons with different degrees of experience (ten years, four years, and a fourth-year resident) to review the cases using CTA (computed tomography angiogram) with MPR (multiplanar reconstructions) and VRT (volume rendering technique) and make a decision: coil embolization or stent-assisted coil embolization. After we provided them with the 3D printed models, they were asked to review their treatment plan. Statistical analysis was performed and the endovascular approach changed in 11.84% of cases for ten-year experienced neurosurgeons, 13.15% for four years experienced neurosurgeon, and 21.05% for residents. The interobserver agreement was very good between the ten years experienced interventionist and four years experienced interventionist when they analyzed the data set that included the 3D printed model. The agreement was higher between all physicians after they examined the printed model. 3D patient-specific printed models may be useful in choosing between two different endovascular techniques and also help the residents to better understand the vascular anatomy and the overall procedure.
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Affiliation(s)
- Emilia Adriana Marciuc
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (E.A.M.); (R.M.P.); (D.H.)
| | - Bogdan Ionut Dobrovat
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (E.A.M.); (R.M.P.); (D.H.)
- Correspondence: ; Tel.: +40-752-173-839
| | - Roxana Mihaela Popescu
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (E.A.M.); (R.M.P.); (D.H.)
| | - Nicolaie Dobrin
- Department of Neurosurgery, Emergency Hospital “Prof. Dr. N. Oblu”, 700309 Iasi, Romania; (N.D.); (A.C.); (L.E.)
| | - Alexandru Chiriac
- Department of Neurosurgery, Emergency Hospital “Prof. Dr. N. Oblu”, 700309 Iasi, Romania; (N.D.); (A.C.); (L.E.)
| | - Daniel Marciuc
- Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Lucian Eva
- Department of Neurosurgery, Emergency Hospital “Prof. Dr. N. Oblu”, 700309 Iasi, Romania; (N.D.); (A.C.); (L.E.)
| | - Danisia Haba
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (E.A.M.); (R.M.P.); (D.H.)
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Point-of-care manufacturing: a single university hospital's initial experience. 3D Print Med 2021; 7:11. [PMID: 33890198 PMCID: PMC8061881 DOI: 10.1186/s41205-021-00101-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
Background The integration of 3D printing technology in hospitals is evolving toward production models such as point-of-care manufacturing. This study aims to present the results of the integration of 3D printing technology in a manufacturing university hospital. Methods Observational, descriptive, retrospective, and monocentric study of 907 instances of 3D printing from November 2015 to March 2020. Variables such as product type, utility, time, or manufacturing materials were analyzed. Results Orthopedic Surgery and Traumatology, Oral and Maxillofacial Surgery, and Gynecology and Obstetrics are the medical specialties that have manufactured the largest number of processes. Working and printing time, as well as the amount of printing material, is different for different types of products and input data. The most common printing material was polylactic acid, although biocompatible resin was introduced to produce surgical guides. In addition, the hospital has worked on the co-design of custom-made implants with manufacturing companies and has also participated in tissue bio-printing projects. Conclusions The integration of 3D printing in a university hospital allows identifying the conceptual evolution to “point-of-care manufacturing.”
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9
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Yamaki VN, Cancelliere NM, Nicholson P, Rodrigues M, Radovanovic I, Sungur JM, Krings T, Pereira VM. Biomodex patient-specific brain aneurysm models: the value of simulation for first in-human experiences using new devices and robotics. J Neurointerv Surg 2020; 13:272-277. [PMID: 32601259 PMCID: PMC7892376 DOI: 10.1136/neurintsurg-2020-015990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 12/29/2022]
Abstract
Background With the recent advent of advanced technologies in the field, treatment of neurovascular diseases using endovascular techniques is rapidly evolving. Here we describe our experience with pre-surgical simulation using the Biomodex EVIAS patient-specific 3D-printed models to plan aneurysm treatment using endovascular robotics and novel flow diverter devices. Methods Pre-procedural rehearsals with 3D-printed patient-specific models of eight cases harboring brain aneurysms were performed before the first in-human experiences. To assess the reliability of the experimental model, the characteristics of the aneurysms were compared between the patient and 3D models. The rehearsals were used to define the patient treatment plan, including technique, device sizing, and operative working projections. Results The study included eight patients with their respective EVIAS 3D aneurysm models. Pre-operative simulation was performed for the first in-human robotic-assisted neurovascular interventions (n=2) and new generation flow-diverter stents (n=6). Aneurysms were located in both the anterior (n=5) and posterior (n=3) circulation and were on average 11.0±6.5 mm in size. We found reliable reproduction of the aneurysm features and similar dimensions of the parent vessel anatomy between the 3D models and patient anatomy. Information learned from pre-surgical in vitro simulation are described in detail, including an improved patient treatment plan, which contributed to successful first in-world procedures with no intraprocedural complications. Conclusions Pre-procedural rehearsal using patient-specific 3D models provides precise procedure planning, which can potentially lead to greater operator confidence, decreased radiation dose and improvements in patient safety, particularly in first in-human experiences.
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Affiliation(s)
- Vitor Nagai Yamaki
- Division of Neurosurgery, Department of Neurology, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
| | | | - Patrick Nicholson
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marta Rodrigues
- Imagiology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
| | - Ivan Radovanovic
- Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Timo Krings
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
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10
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Endovascular simulation training: a tool to increase enthusiasm for interventional radiology among medical students. Eur Radiol 2020; 30:4656-4663. [PMID: 32221683 DOI: 10.1007/s00330-019-06646-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Interventional radiology (IR) is a growing field but is underrepresented in most medical school curricula. We tested whether endovascular simulator training improves medical students' attitudes towards IR. MATERIALS AND METHODS We conducted this prospective study at two university medical centers; overall, 305 fourth-year medical students completed a 90-min IR course. The class consisted of theoretical and practical parts involving endovascular simulators. Students completed questionnaires before the course, after the theoretical and after the practical part. On a 7-point Likert scale, they rated their interest in IR, knowledge of IR, attractiveness of IR, and the likelihood to choose IR as subspecialty. We used a crossover design to prevent position-effect bias. RESULTS The seminar/simulator parts led to the improvement for all items compared with baseline: interest in IR (pre-course 5.2 vs. post-seminar/post-simulator 5.5/5.7), knowledge of IR (pre-course 2.7 vs. post-seminar/post-simulator 5.1/5.4), attractiveness of IR (pre-course 4.6 vs. post-seminar/post-simulator 4.8/5.0), and the likelihood of choosing IR as a subspecialty (pre-course 3.3 vs. post-seminar/post-simulator 3.8/4.1). Effect was significantly stronger for simulator training compared with that for seminar for all items (p < 0.05). For simulator training, subgroup analysis of students with pre-existing positive attitude showed considerable improvement regarding "interest in IR" (× 1.4), "knowledge of IR" (× 23), "attractiveness of IR" (× 2), and "likelihood to choose IR" (× 3.2) compared with pretest. CONCLUSION Endovascular simulator training significantly improves students' attitude towards IR regarding all items. Implementing such courses at a very early stage in the curriculum should be the first step to expose medical students to IR and push for IR. KEY POINTS • Dedicated IR-courses have a significant positive effect on students' attitudes towards IR. • Simulator training is superior to a theoretical seminar in positively influencing students' attitudes towards IR. • Implementing dedicated IR courses in medical school might ease recruitment problems in the field.
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