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Bonvini S, Raunig I, Demi L, Spadoni N, Tasselli S. Unsuspected Limitations of 3D Printed Model in Planning of Complex Aortic Aneurysm Endovascular Treatment. Vasc Endovascular Surg 2024; 58:645-650. [PMID: 38335135 DOI: 10.1177/15385744241232186] [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] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Static 3-dimensional (3D) printing became attractive for operative planning in cases that involve difficult anatomy. An interactive (low cost, fast) 3D print allowing deliberate surgical practice can be used to improve interventional simulation and planning. BACKGROUND Endovascular treatment of complex aortic aneurysms is technically challenging, especially in case of narrow aortic lumen or significant aortic angulation (hostile anatomy). The risk of complications such as graft kinking and target vessel occlusion is difficult to assess based solely on traditional software measuring methods and remain highly dependent on surgeon skills and expertise. METHODS A patient with juxtarenal AAA with hostile anatomy had a 3-dimensional printed model constructed preoperatively according to computed tomography images. Endovascular graft implantation in the 3D printed aorta with a standard T-Branch Cook (Cook® Medical, Bloomington, IN, USA) was performed preoperatively in the simulation laboratory enabling optimized feasibility, surgical planning and intraoperative decision making. RESULTS The 3D printed aortic model proved to be radio-opaque and allowed simulation of branched endovascular aortic repair (BREVAR). The assessment of intervention feasibility, as well as optimal branch position and orientation was found to be useful for surgeon confidence and the actual intervention in the patient. There was a remarkable agreement between the 3D printed model and both CT and X-ray angiographic images. Although the technical success was achieved as planned, a previously deployed renal stent caused unexpected difficulty in advancing the renal stent, which was not observed in the 3D model simulation. CONCLUSION The 3D printed aortic models can be useful for determining feasibility, optimizing planning and intraoperative decision making in hostile anatomy improving the outcome. Despite already offering satisfying accuracy at present, further advancements could enhance the 3D model capability to replicate minor anatomical deformities and variations in tissue density.
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Affiliation(s)
- Stefano Bonvini
- Department of Vascular Surgery, Santa Chiara Hospital, Trento, Italy
| | - Igor Raunig
- Department of Vascular Surgery, Santa Chiara Hospital, Trento, Italy
| | - Libertario Demi
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy
| | - Nicola Spadoni
- Department of Vascular Surgery, Santa Chiara Hospital, Trento, Italy
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2
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Gužvinec P, Muscogiuri G, Hrabak-Paar M. CT Assessment of Aortopulmonary Septal Defect: How to Approach It? J Clin Med 2024; 13:3513. [PMID: 38930042 PMCID: PMC11204932 DOI: 10.3390/jcm13123513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
An aortopulmonary septal defect or aortopulmonary window (APW) is a rare cardiovascular anomaly with direct communication between the ascending aorta and the main pulmonary artery leading to a left-to-right shunt. It is accompanied by other cardiovascular anomalies in approximately half of patients. In order to avoid irreversible sequelae, interventional or surgical treatment should be performed as soon as possible. Cardiovascular CT, as a fast, non-invasive technique with excellent spatial resolution, has an increasing role in the evaluation of patients with APW, enabling precise and detailed planning of surgical treatment of APW and associated anomalies if present. This article aims to review the anatomical and clinical features of aortopulmonary septal defect with special emphasis on its detection and characterization by a CT examination.
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Affiliation(s)
| | | | - Maja Hrabak-Paar
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- University Hospital Center Zagreb, 10000 Zagreb, Croatia
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3
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Joshua RJN, Raj SA, Hameed Sultan MT, Łukaszewicz A, Józwik J, Oksiuta Z, Dziedzic K, Tofil A, Shahar FS. Powder Bed Fusion 3D Printing in Precision Manufacturing for Biomedical Applications: A Comprehensive Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:769. [PMID: 38591985 PMCID: PMC10856375 DOI: 10.3390/ma17030769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 04/10/2024]
Abstract
Precision manufacturing requirements are the key to ensuring the quality and reliability of biomedical implants. The powder bed fusion (PBF) technique offers a promising solution, enabling the creation of complex, patient-specific implants with a high degree of precision. This technology is revolutionizing the biomedical industry, paving the way for a new era of personalized medicine. This review explores and details powder bed fusion 3D printing and its application in the biomedical field. It begins with an introduction to the powder bed fusion 3D-printing technology and its various classifications. Later, it analyzes the numerous fields in which powder bed fusion 3D printing has been successfully deployed where precision components are required, including the fabrication of personalized implants and scaffolds for tissue engineering. This review also discusses the potential advantages and limitations for using the powder bed fusion 3D-printing technology in terms of precision, customization, and cost effectiveness. In addition, it highlights the current challenges and prospects of the powder bed fusion 3D-printing technology. This work offers valuable insights for researchers engaged in the field, aiming to contribute to the advancement of the powder bed fusion 3D-printing technology in the context of precision manufacturing for biomedical applications.
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Affiliation(s)
- Rajan John Nekin Joshua
- Department of Manufacturing Engineering, School of Mechanical Engineering, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India;
| | - Sakthivel Aravind Raj
- Department of Manufacturing Engineering, School of Mechanical Engineering, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India;
| | - Mohamed Thariq Hameed Sultan
- Department of Aerospace Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
- Laboratory of Biocomposite Technology, Institute of Tropical Forestry and Forest Products (INTROP), Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Aerospace Malaysia Innovation Centre (944751-A), Prime Minister’s Department, MIGHT Partnership Hub, Jalan Impact, Cyberjaya 63000, Selangor, Malaysia
| | - Andrzej Łukaszewicz
- Institute of Mechanical Engineering, Faculty of Mechanical Engineering, Bialystok University of Technology, Wiejska 45C, 15-351 Bialystok, Poland;
| | - Jerzy Józwik
- Department of Production Engineering, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland;
- Institute of Technical Sciences and Aviation, University College of Applied Sciences in Chełm, Pocztowa 54, 22-100 Chełm, Poland;
| | - Zbigniew Oksiuta
- Institute of Biomedical Engineering, Faculty of Mechanical Engineering, Bialystok University of Technology, Wiejska 45C, 15-351 Bialystok, Poland;
| | - Krzysztof Dziedzic
- Institute of Computer Science, Electrical Engineering and Computer Science Faculty, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland;
| | - Arkadiusz Tofil
- Institute of Technical Sciences and Aviation, University College of Applied Sciences in Chełm, Pocztowa 54, 22-100 Chełm, Poland;
| | - Farah Syazwani Shahar
- Department of Aerospace Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
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Priya S, La Russa D, Walling A, Goetz S, Hartig T, Khayat A, Gupta P, Nagpal P, Ashwath R. "From Vision to Reality: Virtual Reality's Impact on Baffle Planning in Congenital Heart Disease". Pediatr Cardiol 2024; 45:165-174. [PMID: 37932525 DOI: 10.1007/s00246-023-03323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/04/2023] [Indexed: 11/08/2023]
Abstract
This study aims to evaluate the feasibility and utility of virtual reality (VR) for baffle planning in congenital heart disease (CHD), specifically by creating patient-specific 3D heart models and assessing a user-friendly VR interface. Patient-specific 3D heart models were created using high-resolution imaging data and a VR interface was developed for baffle planning. The process of model creation and the VR interface were assessed for their feasibility, usability, and clinical relevance. Collaborative and interactive planning within the VR space were also explored. The study findings demonstrate the feasibility and usefulness of VR in baffle planning for CHD. Patient-specific 3D heart models generated from imaging data provided valuable insights into complex spatial relationships. The developed VR interface allowed clinicians to interact with the models, simulate different baffle configurations, and assess their impact on blood flow. The VR space's collaborative and interactive planning enhanced the baffle planning process. This study highlights the potential of VR as a valuable tool in baffle planning for CHD. The findings demonstrate the feasibility of using patient-specific 3D heart models and a user-friendly VR interface to enhance surgical planning and patient outcomes. Further research and development in this field are warranted to harness the full benefits of VR technology in CHD surgical management.
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Affiliation(s)
- Sarv Priya
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Dan La Russa
- Realize Medical Inc., Ottawa, Canada
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Canada
| | - Abigail Walling
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Sawyer Goetz
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Tyler Hartig
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Pankaj Gupta
- Division of Pediatric Cardiology, The Royal Hospital for Children, Glasgow, UK
| | - Prashant Nagpal
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Ravi Ashwath
- Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Stieger-Vanegas SM, Scollan KF. Development of three-dimensional (3D) cardiac models from computed tomography angiography. J Vet Cardiol 2023; 51:195-206. [PMID: 38198977 DOI: 10.1016/j.jvc.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 01/12/2024]
Abstract
Three-dimensional (3D) modeling and printing is an emerging technology in veterinary cardiovascular medicine allowing the fabrication of anatomically correct patient-specific models. These patient-specific models can be used for a wide range of purposes including medical teaching, assessment of cardiac function and movement of valve leaflets, design and assessment of devices created for interventional procedures, and pre-surgical planning [1-3]. Additionally, these 3D models can facilitate communication between the clinical team and the patient's owner. The process of creating 3D models starts with acquiring volumetric imaging data sets of the area of interest. Three-dimensional modeling and printing are reliable when high-quality volumetric imaging data are used to create these models. Currently, only ungated- and electrocardiogram (ECG)-gated computed tomography (CT), cardiac magnetic resonance imaging (CMRI), and 3D echocardiography provide the volumetric data sets needed to create these 3D models. These imaging data sets are imported into a software or open-source freeware platform and then segmented to create a virtual 3D model. This virtual 3D model can be further refined using computer-aided design (CAD) software and then be printed to create a physical 3D model. Cardiovascular 3D modeling and printing is a new medical tool which allows us to expand the way we plan interventional procedures, practice interventional skills, communicate with the medical team and owner, and teach future veterinarians.
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Affiliation(s)
- S M Stieger-Vanegas
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, USA.
| | - K F Scollan
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, USA
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Kabirian F, Mozafari M, Mela P, Heying R. Incorporation of Controlled Release Systems Improves the Functionality of Biodegradable 3D Printed Cardiovascular Implants. ACS Biomater Sci Eng 2023; 9:5953-5967. [PMID: 37856240 DOI: 10.1021/acsbiomaterials.3c00559] [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] [Indexed: 10/21/2023]
Abstract
New horizons in cardiovascular research are opened by using 3D printing for biodegradable implants. This additive manufacturing approach allows the design and fabrication of complex structures according to the patient's imaging data in an accurate, reproducible, cost-effective, and quick manner. Acellular cardiovascular implants produced from biodegradable materials have the potential to provide enough support for in situ tissue regeneration while gradually being replaced by neo-autologous tissue. Subsequently, they have the potential to prevent long-term complications. In this Review, we discuss the current status of 3D printing applications in the development of biodegradable cardiovascular implants with a focus on design, biomaterial selection, fabrication methods, and advantages of implantable controlled release systems. Moreover, we delve into the intricate challenges that accompany the clinical translation of these groundbreaking innovations, presenting a glimpse of potential solutions poised to enable the realization of these technologies in the realm of cardiovascular medicine.
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Affiliation(s)
- Fatemeh Kabirian
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven 3000, Belgium
| | - Masoud Mozafari
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu FI-90014, Finland
| | - Petra Mela
- Medical Materials and Implants, Department of Mechanical Engineering, Munich Institute of Biomedical Engineering, and TUM School of Engineering and Design, Technical University of Munich, Munich 80333, Germany
| | - Ruth Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven 3000, Belgium
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7
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Mohanadas HP, Nair V, Doctor AA, Faudzi AAM, Tucker N, Ismail AF, Ramakrishna S, Saidin S, Jaganathan SK. A Systematic Analysis of Additive Manufacturing Techniques in the Bioengineering of In Vitro Cardiovascular Models. Ann Biomed Eng 2023; 51:2365-2383. [PMID: 37466879 PMCID: PMC10598155 DOI: 10.1007/s10439-023-03322-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
Additive Manufacturing is noted for ease of product customization and short production run cost-effectiveness. As our global population approaches 8 billion, additive manufacturing has a future in maintaining and improving average human life expectancy for the same reasons that it has advantaged general manufacturing. In recent years, additive manufacturing has been applied to tissue engineering, regenerative medicine, and drug delivery. Additive Manufacturing combined with tissue engineering and biocompatibility studies offers future opportunities for various complex cardiovascular implants and surgeries. This paper is a comprehensive overview of current technological advancements in additive manufacturing with potential for cardiovascular application. The current limitations and prospects of the technology for cardiovascular applications are explored and evaluated.
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Affiliation(s)
| | - Vivek Nair
- Computational Fluid Dynamics (CFD) Lab, Mechanical and Aerospace Engineering, University of Texas Arlington, Arlington, TX, 76010, USA
| | | | - Ahmad Athif Mohd Faudzi
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia
| | - Nick Tucker
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Ahmad Fauzi Ismail
- School of Chemical and Energy Engineering, Advanced Membrane Technology Research Centre (AMTEC), Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, Center for Nanofibers & Nanotechnology Initiative, National University of Singapore, Singapore, Singapore
| | - Syafiqah Saidin
- IJNUTM Cardiovascular Engineering Centre, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
| | - Saravana Kumar Jaganathan
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia.
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia.
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK.
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8
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Zhou J, See CW, Sreenivasamurthy S, Zhu D. Customized Additive Manufacturing in Bone Scaffolds-The Gateway to Precise Bone Defect Treatment. RESEARCH (WASHINGTON, D.C.) 2023; 6:0239. [PMID: 37818034 PMCID: PMC10561823 DOI: 10.34133/research.0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/07/2023] [Indexed: 10/12/2023]
Abstract
In the advancing landscape of technology and novel material development, additive manufacturing (AM) is steadily making strides within the biomedical sector. Moving away from traditional, one-size-fits-all implant solutions, the advent of AM technology allows for patient-specific scaffolds that could improve integration and enhance wound healing. These scaffolds, meticulously designed with a myriad of geometries, mechanical properties, and biological responses, are made possible through the vast selection of materials and fabrication methods at our disposal. Recognizing the importance of precision in the treatment of bone defects, which display variability from macroscopic to microscopic scales in each case, a tailored treatment strategy is required. A patient-specific AM bone scaffold perfectly addresses this necessity. This review elucidates the pivotal role that customized AM bone scaffolds play in bone defect treatment, while offering comprehensive guidelines for their customization. This includes aspects such as bone defect imaging, material selection, topography design, and fabrication methodology. Additionally, we propose a cooperative model involving the patient, clinician, and engineer, thereby underscoring the interdisciplinary approach necessary for the effective design and clinical application of these customized AM bone scaffolds. This collaboration promises to usher in a new era of bioactive medical materials, responsive to individualized needs and capable of pushing boundaries in personalized medicine beyond those set by traditional medical materials.
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Affiliation(s)
- Juncen Zhou
- Department of Biomedical Engineering,
Stony Brook University, Stony Brook, NY, USA
| | - Carmine Wang See
- Department of Biomedical Engineering,
Stony Brook University, Stony Brook, NY, USA
| | - Sai Sreenivasamurthy
- Department of Biomedical Engineering,
Stony Brook University, Stony Brook, NY, USA
| | - Donghui Zhu
- Department of Biomedical Engineering,
Stony Brook University, Stony Brook, NY, USA
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9
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Alhabshi MO, Aldhohayan H, BaEissa OS, Al Shehri MS, Alotaibi NM, Almubarak SK, Al Ahmari AA, Khan HA, Alowaimer HA. Role of Three-Dimensional Printing in Treatment Planning for Orthognathic Surgery: A Systematic Review. Cureus 2023; 15:e47979. [PMID: 38034130 PMCID: PMC10686238 DOI: 10.7759/cureus.47979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Three-dimensional (3D) printing refers to a wide range of additive manufacturing processes that enable the construction of structures and models. It has been rapidly adopted for a variety of surgical applications, including the printing of patient-specific anatomical models, implants and prostheses, external fixators and splints, as well as surgical instrumentation and cutting guides. In comparison to traditional methods, 3D-printed models and surgical guides offer a deeper understanding of intricate maxillofacial structures and spatial relationships. This review article examines the utilization of 3D printing in orthognathic surgery, particularly in the context of treatment planning. It discusses how 3D printing has revolutionized this sector by providing enhanced visualization, precise surgical planning, reduction in operating time, and improved patient communication. Various databases, including PubMed, Google Scholar, ScienceDirect, and Medline, were searched with relevant keywords. A total of 410 articles were retrieved, of which 71 were included in this study. This article concludes that the utilization of 3D printing in the treatment planning of orthognathic surgery offers a wide range of advantages, such as increased patient satisfaction and improved functional and aesthetic outcomes.
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Affiliation(s)
- Manaf O Alhabshi
- Oral and Maxillofacial Surgery, King Abdullah Medical City, Jeddah, SAU
| | | | - Olla S BaEissa
- General Dentistry, North of Riyadh Dental Clinic, Second Health Cluster, Riyadh, SAU
- General Dentistry, Ibn Sina National College, Jeddah, SAU
| | | | | | | | | | - Hayithm A Khan
- Oral and Maxillofacial Surgery, Ministry of Health, Jeddah, SAU
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Abstract
In 1971, the first patient CT examination by Ambrose and Hounsfield paved the way for not only volumetric imaging of the brain but of the entire body. From the initial 5-minute scan for a 180° rotation to today's 0.24-second scan for a 360° rotation, CT technology continues to reinvent itself. This article describes key historical milestones in CT technology from the earliest days of CT to the present, with a look toward the future of this essential imaging modality. After a review of the beginnings of CT and its early adoption, the technical steps taken to decrease scan times-both per image and per examination-are reviewed. Novel geometries such as electron-beam CT and dual-source CT have also been developed in the quest for ever-faster scans and better in-plane temporal resolution. The focus of the past 2 decades on radiation dose optimization and management led to changes in how exposure parameters such as tube current and tube potential are prescribed such that today, examinations are more customized to the specific patient and diagnostic task than ever before. In the mid-2000s, CT expanded its reach from gray-scale to color with the clinical introduction of dual-energy CT. Today's most recent technical innovation-photon-counting CT-offers greater capabilities in multienergy CT as well as spatial resolution as good as 125 μm. Finally, artificial intelligence is poised to impact both the creation and processing of CT images, as well as automating many tasks to provide greater accuracy and reproducibility in quantitative applications.
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Affiliation(s)
- Cynthia H. McCollough
- Department of Radiology, Mayo Clinic, 200 First St SW Rochester, MN, United States 55905
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Bharucha AH, Moore J, Carnahan P, MacCarthy P, Monaghan MJ, Baghai M, Deshpande R, Byrne J, Dworakowski R, Eskandari M. Three-dimensional printing in modelling mitral valve interventions. Echo Res Pract 2023; 10:12. [PMID: 37528494 PMCID: PMC10394816 DOI: 10.1186/s44156-023-00024-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/23/2023] [Indexed: 08/03/2023] Open
Abstract
Mitral interventions remain technically challenging owing to the anatomical complexity and heterogeneity of mitral pathologies. As such, multi-disciplinary pre-procedural planning assisted by advanced cardiac imaging is pivotal to successful outcomes. Modern imaging techniques offer accurate 3D renderings of cardiac anatomy; however, users are required to derive a spatial understanding of complex mitral pathologies from a 2D projection thus generating an 'imaging gap' which limits procedural planning. Physical mitral modelling using 3D printing has the potential to bridge this gap and is increasingly being employed in conjunction with other transformative technologies to assess feasibility of intervention, direct prosthesis choice and avoid complications. Such platforms have also shown value in training and patient education. Despite important limitations, the pace of innovation and synergistic integration with other technologies is likely to ensure that 3D printing assumes a central role in the journey towards delivering personalised care for patients undergoing mitral valve interventions.
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Affiliation(s)
- Apurva H Bharucha
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - John Moore
- Robarts Research Institute, Western University, London, ON, Canada
| | - Patrick Carnahan
- Robarts Research Institute, Western University, London, ON, Canada
| | - Philip MacCarthy
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Mark J Monaghan
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Max Baghai
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Ranjit Deshpande
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Jonathan Byrne
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Rafal Dworakowski
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Mehdi Eskandari
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK.
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12
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Kusk MW, Stowe J, Hess S, Gerke O, Foley S. Low-cost 3D-printed anthropomorphic cardiac phantom, for computed tomography automatic left ventricle segmentation and volumetry - A pilot study. Radiography (Lond) 2023; 29:131-138. [PMID: 36368249 DOI: 10.1016/j.radi.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/04/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Accurate cardiac left ventricle (LV) delineation is essential to CT-derived left ventricular ejection fraction (LVEF). To evaluate dose-reduction potential, an anatomically accurate heart phantom, with realistic X-ray attenuation is required. We demonstrated and tested a custom-made phantom using 3D-printing, and examined the influence of image noise on automatically measured LV volumes METHODS: A single coronary CT angiography (CCTA) dataset was segmented and converted to Standard Tessellation Language (STL) mesh, using open-source software. A 3D-printed model, with hollow left heart chambers, was printed and cavities filled with gelatinized contrast media. This was CT-scanned in an anthropomorphic chest phantom, at different exposure conditions. LV and "myocardium" noise and attenuation was measured. LV volume was automatically measured using two different methods. We calculated Spearmans' correlation of LV volume with noise and contrast-noise ratio respectively om 486 scans of the phantom. Source images were compared to one phantom series with similar parameters. This was done using Dice coefficient on LV short-axis segmentations. RESULTS Phantom "Myocardium" and LV attenuation was comparable to measurements on source images. Automatic volume measurement succeeded, with mean volume deviation to patient images less than 2 ml. There was a moderate correlation of volume with CNR, and strong correlation of volume with image noise. With papillary muscles included in LV volume, the correlation was positive, but negative when excluded. Variation of volumes was lowest at 90-100 kVp for both methods in the 486 repeat scans. The Dice coefficient was 0.87, indicating high overlap between the single phantom series and source scan. Cost of 3D-printer and materials was 400 and 30 Euro respectively. CONCLUSION Both anatomically and radiologically the phantom mimicked the source scans closely. LV volumetry was reliably performed with automatic algorithms. IMPLICATIONS FOR PRACTICE Patient-specific cardiac phantoms may be produced at minimal cost and can potentially be used for other anatomies and pathologies. This enables radiographic phantom studies without need for dedicated 3D-labs or expensive commercial phantoms.
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Affiliation(s)
- M W Kusk
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Ireland; Department of Radiology and Nuclear Medicine, University Hospital of Southern Denmark, Hospital South West Jutland Esbjerg, Denmark; IRIS - Imaging Research Initiative Southwest, Esbjerg, Denmark.
| | - J Stowe
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
| | - S Hess
- Department of Radiology and Nuclear Medicine, University Hospital of Southern Denmark, Hospital South West Jutland Esbjerg, Denmark; IRIS - Imaging Research Initiative Southwest, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - O Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
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Brüning J, Kramer P, Goubergrits L, Schulz A, Murin P, Solowjowa N, Kuehne T, Berger F, Photiadis J, Weixler VHM. 3D modeling and printing for complex biventricular repair of double outlet right ventricle. Front Cardiovasc Med 2022; 9:1024053. [PMID: 36531701 PMCID: PMC9748612 DOI: 10.3389/fcvm.2022.1024053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/07/2022] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Double outlet right ventricle (DORV) describes a group of congenital heart defects where pulmonary artery and aorta originate completely or predominantly from the right ventricle. The individual anatomy of DORV patients varies widely with multiple subtypes classified. Although the majority of morphologies is suitable for biventricular repair (BVR), complex DORV anatomy can render univentricular palliation (UVP) the only option. Thus, patient-specific decision-making is critical for optimal surgical treatment planning. The evolution of image processing and rapid prototyping techniques facilitate the generation of detailed virtual and physical 3D models of the patient-specific anatomy which can support this important decision process within the Heart Team. MATERILAS AND METHODS The individual cardiovascular anatomy of nine patients with complex DORV, in whom surgical decision-making was not straightforward, was reconstructed from either computed tomography or magnetic resonance imaging data. 3D reconstructions were used to characterize the morphologic details of DORV, such as size and location of the ventricular septal defect (VSD), atrioventricular valve size, ventricular volumes, relationship between the great arteries and their spatial relation to the VSD, outflow tract obstructions, coronary artery anatomy, etc. Additionally, physical models were generated. Virtual and physical models were used in the preoperative assessment to determine surgical treatment strategy, either BVR vs. UVP. RESULTS Median age at operation was 13.2 months (IQR: 9.6-24.0). The DORV transposition subtype was present in six patients, three patients had a DORV-ventricular septal defect subtype. Patient-specific reconstruction was feasible for all patients despite heterogeneous image quality. Complex BVR was feasible in 5/9 patients (55%). Reasons for unsuitability for BVR were AV valve chordae interfering with potential intraventricular baffle creation, ventricular hypoplasia and non-committed VSD morphology. Evaluation in particular of qualitative data from 3D models was considered to support comprehension of complex anatomy. CONCLUSION Image-based 3D reconstruction of patient-specific intracardiac anatomy provides valuable additional information supporting decision-making processes and surgical planning in complex cardiac malformations. Further prospective studies are required to fully appreciate the benefits of 3D technology.
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Affiliation(s)
- Jan Brüning
- Institute for Cardiovascular Computer-Assisted Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Peter Kramer
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Leonid Goubergrits
- Institute for Cardiovascular Computer-Assisted Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, Germany
| | - Antonia Schulz
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Peter Murin
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Natalia Solowjowa
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Titus Kuehne
- Institute for Cardiovascular Computer-Assisted Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Felix Berger
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Viktoria Heide-Marie Weixler
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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Buonamici F, Mussi E, Santarelli C, Carrabba N, Stefano P, Marchionni N, Carfagni M. Modelling and fabrication procedure for a 3D printed cardiac model - surgical planning of Left Ventricular Aneurysm. MethodsX 2022; 9:101822. [PMID: 36046734 PMCID: PMC9421386 DOI: 10.1016/j.mex.2022.101822] [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: 05/23/2022] [Accepted: 08/09/2022] [Indexed: 11/11/2022] Open
Abstract
The present paper describes a procedure for the development and production of a physical model for surgical planning of a Left Ventricular Aneurysm. The method is based on the general approach provided in Otton et al. (2017) and was customized to seek a reliable and fast procedure for the production of a specific type of cardiac model – i.e. chambers of the left side of the heart. The paper covers all the steps: processing of the data, segmentation, modelling and 3D printing; details are provided for all the phases, in order to allow the reproduction of the achieved results. The procedure relies on Computed Tomography - CT imaging as data source for the identification and modelling of the anatomy. Materialise Mimics was used as segmentation software to process the CT data. While its usefulness for the surgical needs was verified on a single clinical case (provided by the Careggi Hospital of Florence, Italy), the modelling procedure was tested twice, to produce a physical replica both ex-ante and ex-post surgical intervention.The tools used for segmentation and generation of the printable model were customized to reduce modelling time for the specific type of desired model. Detailed information on the use of modeling tools, not available in the literature, will be provided. The procedure allows fabrication of a physical model representing the heart chambers in a short time.
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Affiliation(s)
| | - Elisa Mussi
- Department of industrial Engineering of Florence, Italy
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Kim D, Wu Y, Oh YK. On-demand delivery of protein drug from 3D-printed implants. J Control Release 2022; 349:133-142. [PMID: 35787916 DOI: 10.1016/j.jconrel.2022.06.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/28/2022] [Accepted: 06/25/2022] [Indexed: 11/16/2022]
Abstract
Here, we constructed 3D-printed multiunit implants to enable remote light-controlled protein drug delivery in a spatiotemporal manner. Multiunit implants were designed to be 3D printed using polycaprolactone, lauric acid, and melanin as a matrix, and a polycaprolactone scaffold as a multiunit divider. As a model drug, insulin was loaded to each unit of the implant. The 3D printing yielded a rectangular matrix with multiunit sectors segregated by polycaprolactone lanes. Irradiation with near infrared light (NIR) triggered controlled release of insulin from the irradiated locus: Upon NIR irradiation, heat generated from the melanin melted the polycaprolactone/lauric acid matrix to release insulin from the scaffold. In the absence of melanin in the matrix, the implant did not show NIR-responsive insulin release. When lauric acid was absent from the matrix, the NIR-irradiated unit did not undergo dismantling. When the insulin-loaded multiunit implant was applied to a mouse diabetic model and irradiated with NIR, repetitive insulin release resulted in an efficient decrease of the blood glucose level over multiple days. Together, these results suggest that 3D printing technology-based multi-dosing of insulin on demand can enable convenient treatment of diabetes through external NIR irradiation, potentially avoiding the pain and discomfort of repeated insulin injections.
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Affiliation(s)
- Dongyoon Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Yina Wu
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Yu-Kyoung Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea.
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16
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Cardiovascular Computed Tomography in Pediatric Congenital Heart Disease: A State of the Art Review. J Cardiovasc Comput Tomogr 2022; 16:467-482. [DOI: 10.1016/j.jcct.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/04/2023]
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Illi J, Bernhard B, Nguyen C, Pilgrim T, Praz F, Gloeckler M, Windecker S, Haeberlin A, Gräni C. Translating Imaging Into 3D Printed Cardiovascular Phantoms. JACC Basic Transl Sci 2022; 7:1050-1062. [PMID: 36337920 PMCID: PMC9626905 DOI: 10.1016/j.jacbts.2022.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/03/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
3D printed patient specific phantoms can visualize complex cardiovascular anatomy Common imaging modalities for 3D printing are CCT and CMR Material jetting/PolyJet and stereolithography are widely used printing techniques Standardized validation is warranted to compare different 3D printing technologies
Translation of imaging into 3-dimensional (3D) printed patient-specific phantoms (3DPSPs) can help visualize complex cardiovascular anatomy and enable tailoring of therapy. The aim of this paper is to review the entire process of phantom production, including imaging, materials, 3D printing technologies, and the validation of 3DPSPs. A systematic review of published research was conducted using Embase and MEDLINE, including studies that investigated 3DPSPs in cardiovascular medicine. Among 2,534 screened papers, 212 fulfilled inclusion criteria and described 3DPSPs as a valuable adjunct for planning and guiding interventions (n = 108 [51%]), simulation of physiological or pathological conditions (n = 19 [9%]), teaching of health care professionals (n = 23 [11%]), patient education (n = 3 [1.4%]), outcome prediction (n = 6 [2.8%]), or other purposes (n = 53 [25%]). The most common imaging modalities to enable 3D printing were cardiac computed tomography (n = 131 [61.8%]) and cardiac magnetic resonance (n = 26 [12.3%]). The printing process was conducted mostly by material jetting (n = 54 [25.5%]) or stereolithography (n = 43 [20.3%]). The 10 largest studies that evaluated the geometric accuracy of 3DPSPs described a mean bias <±1 mm; however, the validation process was very heterogeneous among the studies. Three-dimensional printed patient-specific phantoms are highly accurate, used for teaching, and applied to guide cardiovascular therapy. Systematic comparison of imaging and printing modalities following a standardized validation process is warranted to allow conclusions on the optimal production process of 3DPSPs in the field of cardiovascular medicine.
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The Role of 3D Printing in Planning Complex Medical Procedures and Training of Medical Professionals-Cross-Sectional Multispecialty Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063331. [PMID: 35329016 PMCID: PMC8953417 DOI: 10.3390/ijerph19063331] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/18/2022] [Accepted: 03/05/2022] [Indexed: 12/19/2022]
Abstract
Medicine is a rapidly-evolving discipline, with progress picking up pace with each passing decade. This constant evolution results in the introduction of new tools and methods, which in turn occasionally leads to paradigm shifts across the affected medical fields. The following review attempts to showcase how 3D printing has begun to reshape and improve processes across various medical specialties and where it has the potential to make a significant impact. The current state-of-the-art, as well as real-life clinical applications of 3D printing, are reflected in the perspectives of specialists practicing in the selected disciplines, with a focus on pre-procedural planning, simulation (rehearsal) of non-routine procedures, and on medical education and training. A review of the latest multidisciplinary literature on the subject offers a general summary of the advances enabled by 3D printing. Numerous advantages and applications were found, such as gaining better insight into patient-specific anatomy, better pre-operative planning, mock simulated surgeries, simulation-based training and education, development of surgical guides and other tools, patient-specific implants, bioprinted organs or structures, and counseling of patients. It was evident that pre-procedural planning and rehearsing of unusual or difficult procedures and training of medical professionals in these procedures are extremely useful and transformative.
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Taking It Personally: 3D Bioprinting a Patient-Specific Cardiac Patch for the Treatment of Heart Failure. Bioengineering (Basel) 2022; 9:bioengineering9030093. [PMID: 35324782 PMCID: PMC8945185 DOI: 10.3390/bioengineering9030093] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 11/17/2022] Open
Abstract
Despite a massive global preventative effort, heart failure remains the major cause of death globally. The number of patients requiring a heart transplant, the eventual last treatment option, far outnumbers the available donor hearts, leaving many to deteriorate or die on the transplant waiting list. Treating heart failure by transplanting a 3D bioprinted patient-specific cardiac patch to the infarcted region on the myocardium has been investigated as a potential future treatment. To date, several studies have created cardiac patches using 3D bioprinting; however, testing the concept is still at a pre-clinical stage. A handful of clinical studies have been conducted. However, moving from animal studies to human trials will require an increase in research in this area. This review covers key elements to the design of a patient-specific cardiac patch, divided into general areas of biological design and 3D modelling. It will make recommendations on incorporating anatomical considerations and high-definition motion data into the process of 3D-bioprinting a patient-specific cardiac patch.
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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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Celi S, Gasparotti E, Capellini K, Vignali E, Fanni BM, Ali LA, Cantinotti M, Murzi M, Berti S, Santoro G, Positano V. 3D Printing in Modern Cardiology. Curr Pharm Des 2021; 27:1918-1930. [PMID: 32568014 DOI: 10.2174/1381612826666200622132440] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND 3D printing represents an emerging technology in the field of cardiovascular medicine. 3D printing can help to perform a better analysis of complex anatomies to optimize intervention planning. METHODS A systematic review was performed to illustrate the 3D printing technology and to describe the workflow to obtain 3D printed models from patient-specific images. Examples from our laboratory of the benefit of 3D printing in planning interventions were also reported. RESULTS 3D printing technique is reliable when applied to high-quality 3D image data (CTA, CMR, 3D echography), but it still needs the involvement of expert operators for image segmentation and mesh refinement. 3D printed models could be useful in interventional planning, although prospective studies with comprehensive and clinically meaningful endpoints are required to demonstrate the clinical utility. CONCLUSION 3D printing can be used to improve anatomy understanding and surgical planning.
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Affiliation(s)
- Simona Celi
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | | | - Katia Capellini
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | | | - Benigno M Fanni
- BioCardioLab, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Lamia A Ali
- Pediatric Cardiology Unit, Fondazione Toscana "G. Monasterio" Massa, Italy
| | | | - Michele Murzi
- Adult Cardiosurgery Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Sergio Berti
- Adult Interventional Cardiology Unit, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology Unit, Fondazione Toscana "G. Monasterio" Massa, Italy
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22
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Clifton W, Damon A, Nottmeier E, Pichelmann M. Establishing a Cost-Effective 3-Dimensional Printing Laboratory for Anatomical Modeling and Simulation: An Institutional Experience. Simul Healthc 2021; 16:213-220. [PMID: 32649586 DOI: 10.1097/sih.0000000000000476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
SUMMARY STATEMENT Three-dimensional (3D) printing is rapidly growing in popularity for anatomical modeling and simulation for medical organizations across the world. Although this technology provides a powerful means of creating accurately representative models of anatomic structures, there remains formidable financial and workforce barriers to understanding the fundamentals of technology use, as well as establishing a cost- and time-effective system for standardized incorporation into a workflow for simulator design and anatomical modeling. There are many factors to consider when choosing the appropriate printer and accompanying software to succeed in accomplishing the desired goals of the executing team. The authors have successfully used open-access software and desktop fused deposition modeling 3D printing methods to produce more than 1000 models for anatomical modeling and procedural simulation in a cost-effective manner. It is our aim to share our experience and thought processes of implementing 3D printing into our anatomical modeling and simulation workflow to encourage other institutions to comfortably adopt this technology into their daily routines.
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Affiliation(s)
- William Clifton
- From the Departments of Neurological Surgery (W.C., E.N.) and Education (A.D.), Mayo Clinic Florida; Jacksonville, FL; and Department of Neurosurgery (M.P.), Mayo Clinic Health Systems; Eau Claire, WI
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Parthasarathy J, Hatoum H, Flemister DC, Krull CM, Walter BA, Zhang W, Mery CM, Molossi S, Jadhav S, Dasi LP, Krishnamurthy R. Assessment of transfer of morphological characteristics of Anomalous Aortic Origin of a Coronary Artery from imaging to patient specific 3D Printed models: A feasibility study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 201:105947. [PMID: 33535084 DOI: 10.1016/j.cmpb.2021.105947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE This study aims to determine the accuracy of patient specific 3D printed models in capturing pathological anatomical characteristics derived from CT angiography (CTA) in children with anomalous aortic origin of a coronary artery (AAOCA). METHODS & MATERIALS Following institutional regulatory approval, a standardized protocol for CTA of AAOCA was utilized for imaging. Blood volume of the aorta and coronaries were segmented from the DICOM images. A total of 10 models from 8 AAOCA patients were created, including 2 post-operative models. Mechanical properties of Agilus30 a flexible photopolymer coated with a thin layer of parylene, polyurethane (PU) and silicone and native aortic tissue from a postmortem specimen were compared. AAOCA models with wall thicknesses of 2mm aorta and 1.5mm coronaries were 3D printed in Agilus30 and coated with PU. CT of the printed models was performed, and 3D virtual models were generated. Transfer of anatomical characteristics and geometric accuracy were compared between the patient model virtual models. RESULTS Dynamic modulus of Agilus30 at 2mm thickness was found to be close to native aortic tissue. Structured reporting of anatomical characteristics by imaging experts showed good concordance between patient and model CTA Comparative patient and virtual model measurements showed Pearson's correlation (r) of 0.9959 for aorta (n=70) and 0.9538 for coronaries (n=60) linear, and 0.9949 for aorta (n=30) and 0.9538 for coronaries (n=30) cross-sectional, dimensions. Surface contour map mean difference was 0.08 ± 0.29mm. CONCLUSIONS Geometrically accurate AAOCA models preserving morphological characteristics, essential for risk stratification and decision-making, can be 3D printed from a patient's CTA.
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Affiliation(s)
- Jayanthi Parthasarathy
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Dr, E4A Columbus, Columbus, OH 43205, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Dorma C Flemister
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Carly M Krull
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Benjamin A Walter
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Wei Zhang
- Department of Biostatistics & Data Science, University of Texas HSC, School of Public Health, Houston USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School / Dell Children's Medical Center, Austin, TX, USA
| | - Silvana Molossi
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School / Dell Children's Medical Center, Austin, TX, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Siddharth Jadhav
- Department of Radiology, Texas Children's Hospital, Baylor College of Medicine Houston, TX, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Dr, E4A Columbus, Columbus, OH 43205, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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Yildiz Y, Ulukan MO, Erkanli K, Unal O, Oztas DM, Beyaz MO, Ugurlucan M. Preoperative Arterial and Venous Cannulation in Redo Cardiac Surgery: From the Safety and Cost-effectiveness Points of View. Braz J Cardiovasc Surg 2020; 35:927-933. [PMID: 33306319 PMCID: PMC7731854 DOI: 10.21470/1678-9741-2019-0472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the safety and cost-effectiveness of preoperative cannulation and conventional approach techniques. METHODS Sixty-one patients who underwent redo open cardiac procedures between September 2015 and November 2018 were divided into two groups - Group A (n: 30), patients who underwent conventional cannulation after sternotomy, and Group B (n: 31), those who underwent cannulation before sternotomy. Patients were evaluated retrospectively for general complication rates and total hospital costs. RESULTS Mortality occurred in four patients from Group A and in one patient from Group B. Four patients required extracorporeal membrane oxygenation (ECMO) in Group A, whereas two required ECMO in Group B. Duration of total operation, cardiopulmonary bypass, and cross-clamp times were longer in the conventional surgery group than in the pre-sternotomy cannulation group (420.29±188.84 vs. 314.77±187.38, P=0.036; 171.87±85.59 vs. 141.7±82.47, P=0.089; and 102.94±70.67 vs. 60.97±52.81, P=0.009; respectively). Total blood and blood product usage were higher in Group A than in Group B. Postoperative intensive care unit stay was 62.77±145.3 hours vs. 25.13±73.11 hours, ventilation time was 5.16±5.09 hours vs. 3.03±2.78 hours, duration of ward stay was 5.23±2.52 days vs. 5.57±2.16 days, and duration of hospital stay was 9.58±5.85 days vs. 9.8±5.31 days in conventional sternotomy and pre-sternotomy cannulation groups, respectively. Total hospital costs were calculated 35863.52±20803.99 Turkish Liras (TL) in Group A and 25744.74±16472.03 TL in Group B (P=0,042). CONCLUSION Venous and arterial cannulations before sternotomy decreased myocardial injury and complication rates, blood and blood product usage, hospital stay, and, consequently, hospital costs in our modest cohort.
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Affiliation(s)
- Yahya Yildiz
- Department of Anesthesiology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Mustafa Ozer Ulukan
- Department of Cardiovascular Surgery, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Korhan Erkanli
- Department of Cardiovascular Surgery, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Orcun Unal
- Cardiovascular Surgery Clinic, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Didem Melis Oztas
- Cardiovascular Surgery Clinic, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Metin Onur Beyaz
- Turkey Department of Cardiovascular Surgery, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Murat Ugurlucan
- Department of Cardiovascular Surgery, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
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Clinical Applications of Patient-Specific 3D Printed Models in Cardiovascular Disease: Current Status and Future Directions. Biomolecules 2020; 10:biom10111577. [PMID: 33233652 PMCID: PMC7699768 DOI: 10.3390/biom10111577] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 01/09/2023] Open
Abstract
Three-dimensional (3D) printing has been increasingly used in medicine with applications in many different fields ranging from orthopaedics and tumours to cardiovascular disease. Realistic 3D models can be printed with different materials to replicate anatomical structures and pathologies with high accuracy. 3D printed models generated from medical imaging data acquired with computed tomography, magnetic resonance imaging or ultrasound augment the understanding of complex anatomy and pathology, assist preoperative planning and simulate surgical or interventional procedures to achieve precision medicine for improvement of treatment outcomes, train young or junior doctors to gain their confidence in patient management and provide medical education to medical students or healthcare professionals as an effective training tool. This article provides an overview of patient-specific 3D printed models with a focus on the applications in cardiovascular disease including: 3D printed models in congenital heart disease, coronary artery disease, pulmonary embolism, aortic aneurysm and aortic dissection, and aortic valvular disease. Clinical value of the patient-specific 3D printed models in these areas is presented based on the current literature, while limitations and future research in 3D printing including bioprinting of cardiovascular disease are highlighted.
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26
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Zhu Y, Zhang XE, Li Q, Yao H. Three-dimensional printing in a patient with pulmonary artery pseudoaneurysm and complex congenital heart disease-A case report. Clin Case Rep 2020; 8:2107-2110. [PMID: 33235737 PMCID: PMC7669418 DOI: 10.1002/ccr3.2950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/07/2019] [Accepted: 10/21/2019] [Indexed: 11/28/2022] Open
Abstract
3D-printing is a powerful tool in patients with complex anatomy undergoing cardiac surgery.
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Affiliation(s)
- Yueqian Zhu
- Cardiovascular CenterThe 2nd affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Xun E. Zhang
- Cardiovascular CenterThe 2nd affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Qingguo Li
- Cardiovascular CenterThe 2nd affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Hao Yao
- Cardiovascular CenterThe 2nd affiliated Hospital of Nanjing Medical UniversityNanjingChina
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27
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Spencer SR, Kay Watts L. Three-Dimensional Printing in Medical and Allied Health Practice: A Literature Review. J Med Imaging Radiat Sci 2020; 51:489-500. [DOI: 10.1016/j.jmir.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 02/08/2023]
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Ferrari E, Gallo M, Wang C, Zhang L, Taramasso M, Maisano F, Pirelli L, Berdajs D, von Segesser LK. Three-dimensional printing in adult cardiovascular medicine for surgical and transcatheter procedural planning, teaching and technological innovation. Interact Cardiovasc Thorac Surg 2020; 30:203-214. [PMID: 31633170 DOI: 10.1093/icvts/ivz250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/09/2019] [Accepted: 09/15/2019] [Indexed: 12/23/2022] Open
Abstract
Three-dimensional (3D)-printing technologies in cardiovascular surgery have provided a new way to tailor surgical and percutaneous treatments. Digital information from standard cardiac imaging is integrated into physical 3D models for an accurate spatial visualization of anatomical details. We reviewed the available literature and analysed the different printing technologies, the required procedural steps for 3D prototyping, the used cardiac imaging, the available materials and the clinical implications. We have highlighted different materials used to replicate aortic and mitral valves, vessels and myocardial properties. 3D printing allows a heuristic approach to investigate complex cardiovascular diseases, and it is a unique patient-specific technology providing enhanced understanding and tactile representation of cardiovascular anatomies for the procedural planning and decision-making process. 3D printing may also be used for medical education and surgical/transcatheter training. Communication between doctors and patients can also benefit from 3D models by improving the patient understanding of pathologies. Furthermore, medical device development and testing can be performed with rapid 3D prototyping. Additionally, widespread application of 3D printing in the cardiovascular field combined with tissue engineering will pave the way to 3D-bioprinted tissues for regenerative medicinal applications and 3D-printed organs.
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Affiliation(s)
- Enrico Ferrari
- Cardiovascular Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Michele Gallo
- Cardiovascular Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | | | - Lei Zhang
- Cardiovascular Surgery, Nanjing Jinling Hospital, Nanjing, China
| | | | - Francesco Maisano
- Cardiovascular Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Luigi Pirelli
- Cardiothoracic Surgery, Lenox Hill Heart and Vascular Institute, New York, NY, USA
| | - Denis Berdajs
- Cardiovascular Surgery, Basel University Hospital, Basel, Switzerland
| | - Ludwig Karl von Segesser
- Department of Surgery, Cardiovascular Research Unit, Lausanne University Hospital, Lausanne, Switzerland
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29
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Oliveira MABD, Santos CAD, Brandi AC, Botelho PHH, Braile DM. Three-Dimensional Printing: is it useful for Cardiac Surgery? Braz J Cardiovasc Surg 2020; 35:549-554. [PMID: 32864936 PMCID: PMC7454638 DOI: 10.21470/1678-9741-2019-0475] [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] [Indexed: 11/20/2022] Open
Abstract
Introduction The medical use of three-dimensional (3-D) images has been a topic in the literature since 1988, but 95% of papers on 3-D printing were published in the last six years. The increase in publications is the result of advances in 3-D printing methods, as well as of the increasing availability of these machines in different hospitals. This paper sought to review the literature on 3-D printing and to discuss thoughtful ideas regarding benefits and challenges to its incorporation into cardiothoracic surgeons’ routines. Methods A comprehensive and systematic search of the literature was performed in PubMed and included material published as of March 2020. Results Using this search strategy, 9,253 publications on 3-D printing and 497 on “heart” 3-D printing were retrieved. Conclusion 3-D printed models are already helping surgeons to plan their surgeries, helping patients and their families to understand complex anatomy, helping fellows and residents to practice surgery, even for rare cases, and helping nurses and other health care staff to better understand some conditions, such as heart diseases.
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Affiliation(s)
- Marcos Aurélio Barboza de Oliveira
- Department of Cardiac Surgery, Hospital Santo Antônio and Femina Cuiabá, Sinop, Mato Grosso, Brazil.,Department of Cardiovascular Surgery, Universidade Federal do Mato Grosso, Sinop, Mato Grosso, Brazil
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30
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Vukicevic M, Filippini S, Little SH. Patient-Specific Modeling for Structural Heart Intervention: Role of 3D Printing Today and Tomorrow CME. Methodist Debakey Cardiovasc J 2020; 16:130-137. [PMID: 32670473 DOI: 10.14797/mdcj-16-2-130] [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] [Indexed: 11/08/2022] Open
Abstract
Structural heart interventions (SHIs) are increasingly applicable in a wide range of heart defects, but the intricate and dynamic nature of cardiac structures can make SHIs challenging to perform. Three-dimensional (3D) printed modeling integrates advanced clinical imaging and 3D printing technology to replicate patient-specific anatomy for comprehensive planning and simulation of SHIs. This review discusses the basic principles of patient-specific 3D print model development, print material selection, and model fabrication and highlights how cardiovascular 3D printing can be used in preprocedural planning, device sizing, enhanced communication, and procedure simulation.
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Affiliation(s)
- Marija Vukicevic
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Stefano Filippini
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Stephen H Little
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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31
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Pather N, Blyth P, Chapman JA, Dayal MR, Flack NA, Fogg QA, Green RA, Hulme AK, Johnson IP, Meyer AJ, Morley JW, Shortland PJ, Štrkalj G, Štrkalj M, Valter K, Webb AL, Woodley SJ, Lazarus MD. Forced Disruption of Anatomy Education in Australia and New Zealand: An Acute Response to the Covid-19 Pandemic. ANATOMICAL SCIENCES EDUCATION 2020; 13:284-300. [PMID: 32306555 PMCID: PMC7264523 DOI: 10.1002/ase.1968] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 05/03/2023]
Abstract
Australian and New Zealand universities commenced a new academic year in February/March 2020 largely with "business as usual." The subsequent Covid-19 pandemic imposed unexpected disruptions to anatomical educational practice. Rapid change occurred due to government-imposed physical distancing regulations from March 2020 that increasingly restricted anatomy laboratory teaching practices. Anatomy educators in both these countries were mobilized to adjust their teaching approaches. This study on anatomy education disruption at pandemic onset within Australia and New Zealand adopts a social constructivist lens. The research question was "What are the perceived disruptions and changes made to anatomy education in Australia and New Zealand during the initial period of the Covid-19 pandemic, as reflected on by anatomy educators?." Thematic analysis to elucidate "the what and why" of anatomy education was applied to these reflections. About 18 anatomy academics from ten institutions participated in this exercise. The analysis revealed loss of integrated "hands-on" experiences, and impacts on workload, traditional roles, students, pedagogy, and anatomists' personal educational philosophies. The key opportunities recognized for anatomy education included: enabling synchronous teaching across remote sites, expanding offerings into the remote learning space, and embracing new pedagogies. In managing anatomy education's transition in response to the pandemic, six critical elements were identified: community care, clear communications, clarified expectations, constructive alignment, community of practice, ability to compromise, and adapt and continuity planning. There is no doubt that anatomy education has stepped into a yet unknown future in the island countries of Australia and New Zealand.
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Affiliation(s)
- Nalini Pather
- Department of Anatomy EducationSchool of Medical SciencesFaculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Phil Blyth
- Department of AnatomySchool of Biomedical SciencesUniversity of OtagoDunedinNew Zealand
| | - Jamie A. Chapman
- Tasmanian School of MedicineCollege of Health and MedicineUniversity of TasmaniaHobartTasmaniaAustralia
| | - Manisha R. Dayal
- School of ScienceWestern Sydney UniversitySydneyNew South WalesAustralia
| | - Natasha A.M.S. Flack
- Department of AnatomySchool of Biomedical SciencesUniversity of OtagoDunedinNew Zealand
| | - Quentin A. Fogg
- Department of Anatomy and NeuroscienceSchool of Biomedical SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Rodney A. Green
- Department of Pharmacy and Biomedical Sciences, College of Science, Health and EngineeringLa Trobe UniversityBendigoVictoriaAustralia
| | - Anneliese K. Hulme
- Department of Anatomy EducationSchool of Medical SciencesFaculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Ian P. Johnson
- Department of Biomedical SciencesFaculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Amanda J. Meyer
- School of Human SciencesFaculty of ScienceThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - John W. Morley
- School of MedicineWestern Sydney UniversitySydneyNew South WalesAustralia
| | - Peter J. Shortland
- School of ScienceWestern Sydney UniversitySydneyNew South WalesAustralia
| | - Goran Štrkalj
- Department of Anatomy EducationSchool of Medical SciencesFaculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Mirjana Štrkalj
- Department of Biomedical SciencesFaculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Krisztina Valter
- Medical Education UnitMedical SchoolCollege of Health and MedicineAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Alexandra L. Webb
- Medical Education UnitMedical SchoolCollege of Health and MedicineAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Stephanie J. Woodley
- Department of AnatomySchool of Biomedical SciencesUniversity of OtagoDunedinNew Zealand
| | - Michelle D. Lazarus
- Centre for Human Anatomy EducationDepartment of Anatomy and Developmental BiologyFaculty of Medicine Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
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32
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Leonardi B, D'Avenio G, Vitanovski D, Grigioni M, Perrone MA, Romeo F, Secinaro A, Everett AD, Pongiglione G. Patient-specific three-dimensional aortic arch modeling for automatic measurements: clinical validation in aortic coarctation. J Cardiovasc Med (Hagerstown) 2020; 21:517-528. [PMID: 32332378 DOI: 10.2459/jcm.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM A validated algorithm for automatic aortic arch measurements in aortic coarctation (CoA) patients could standardize procedures for clinical planning. METHODS The model-based assessment of the aortic arch anatomy consisted of three steps: first, machine-learning-based algorithms were trained on 212 three-dimensional magnetic resonance (MR) data to automatically allocate the aortic arch position in patients and segment the aortic arch; second, for each CoA patient (N = 33), the min/max aortic arch diameters were measured using the proposed software, manually and automatically, from noncontrast-enhanced three-dimensional steady-state free precession MRI sequence at five selected sites and compared ('internal comparison' referring to the same environment); third, moreover, the same min/max aortic arch diameters were compared, obtaining them independently, manually from common MR management software (MR Viewforum) and automatically from the model (external comparison). The measured sites were: aortic sinus, sino-tubular junction, mid-ascending aorta, transverse arch and thoracoabdominal aorta at the level of the diaphragm. RESULTS Manual and software-assisted measurements showed a good agreement: the difference between diameter measurements was not statistically significant (at α = 0.05), with only one exception, for both internal and external comparison. A high coefficient of correlation was attained for both maximum and minimum diameters in each site (for internal comparison, R > 0.73 for every site, with P < 2 × 10). Notably, in tricuspid aortic valve patients external comparison showed no statistically significant difference at any measurement sites. CONCLUSION The automatically derived aortic arch model, starting from three-dimensional MR images, could be a support to take the measurements in CoA patients and to quickly provide a patient-specific model of aortic arch anomalies.
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Affiliation(s)
- Benedetta Leonardi
- Department of Cardiology and Cardiosurgery, Bambino Gesù Children's Hospital, IRCCS
| | - Giuseppe D'Avenio
- Department of Technology and Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Mauro Grigioni
- Department of Technology and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marco A Perrone
- Department of Cardiology and Cardiosurgery, Bambino Gesù Children's Hospital, IRCCS.,Department of Cardiology, University of Rome Tor Vergata
| | | | - Aurelio Secinaro
- Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Allen D Everett
- Department of Pediatrics, Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Giacomo Pongiglione
- Department of Cardiology and Cardiosurgery, Bambino Gesù Children's Hospital, IRCCS
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33
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Gardin C, Ferroni L, Latremouille C, Chachques JC, Mitrečić D, Zavan B. Recent Applications of Three Dimensional Printing in Cardiovascular Medicine. Cells 2020; 9:E742. [PMID: 32192232 PMCID: PMC7140676 DOI: 10.3390/cells9030742] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/20/2022] Open
Abstract
Three dimensional (3D) printing, which consists in the conversion of digital images into a 3D physical model, is a promising and versatile field that, over the last decade, has experienced a rapid development in medicine. Cardiovascular medicine, in particular, is one of the fastest growing area for medical 3D printing. In this review, we firstly describe the major steps and the most common technologies used in the 3D printing process, then we present current applications of 3D printing with relevance to the cardiovascular field. The technology is more frequently used for the creation of anatomical 3D models useful for teaching, training, and procedural planning of complex surgical cases, as well as for facilitating communication with patients and their families. However, the most attractive and novel application of 3D printing in the last years is bioprinting, which holds the great potential to solve the ever-increasing crisis of organ shortage. In this review, we then present some of the 3D bioprinting strategies used for fabricating fully functional cardiovascular tissues, including myocardium, heart tissue patches, and heart valves. The implications of 3D bioprinting in drug discovery, development, and delivery systems are also briefly discussed, in terms of in vitro cardiovascular drug toxicity. Finally, we describe some applications of 3D printing in the development and testing of cardiovascular medical devices, and the current regulatory frameworks that apply to manufacturing and commercialization of 3D printed products.
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Affiliation(s)
- Chiara Gardin
- Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola (RA), Italy; (C.G.); (L.F.)
- Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Letizia Ferroni
- Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola (RA), Italy; (C.G.); (L.F.)
- Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Christian Latremouille
- Department of Cardiac Surgery Pompidou Hospital, Laboratory of Biosurgical Research, Carpentier Foundation, University Paris Descartes, 75105 Paris, France; (C.L.); (J.C.C.)
| | - Juan Carlos Chachques
- Department of Cardiac Surgery Pompidou Hospital, Laboratory of Biosurgical Research, Carpentier Foundation, University Paris Descartes, 75105 Paris, France; (C.L.); (J.C.C.)
| | - Dinko Mitrečić
- Laboratory for Stem Cells, Croatian Institute for Brain Research, School of Medicine University of Zagreb, Šalata 12, 10 000 Zagreb, Croatia;
| | - Barbara Zavan
- Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola (RA), Italy; (C.G.); (L.F.)
- Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 70, 44121 Ferrara, Italy
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Liddy S, McQuade C, Walsh KP, Loo B, Buckley O. The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning. Curr Cardiol Rep 2019; 21:103. [DOI: 10.1007/s11886-019-1196-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Abstract
Advances in biomedical engineering have led to three-dimensional (3D)-printed models being used for a broad range of different applications. Teaching medical personnel, communicating with patients and relatives, planning complex heart surgery, or designing new techniques for repair of CHD via cardiac catheterisation are now options available using patient-specific 3D-printed models. The management of CHD can be challenging owing to the wide spectrum of morphological conditions and the differences between patients. Direct visualisation and manipulation of the patients' individual anatomy has opened new horizons in personalised treatment, providing the possibility of performing the whole procedure in vitro beforehand, thus anticipating complications and possible outcomes. In this review, we discuss the workflow to implement 3D printing in clinical practice, the imaging modalities used for anatomical segmentation, the applications of this emerging technique in patients with structural heart disease, and its limitations and future directions.
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37
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Biglino G, Milano EG, Capelli C, Wray J, Shearn AI, Caputo M, Bucciarelli-Ducci C, Taylor AM, Schievano S. Three-dimensional printing in congenital heart disease: Considerations on training and clinical implementation from a teaching session. Int J Artif Organs 2019; 42:595-599. [PMID: 31104546 DOI: 10.1177/0391398819849074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In light of growing interest for three-dimensional printing technology in the cardiovascular community, this study focused on exploring the possibilities of providing training for cardiovascular three-dimensional printing in the context of a relevant international congress and providing considerations on the delivery of such courses. As a second objective, the study sought to capture preferences in relation to three-dimensional printing uses and set-ups from those attending the training session. A survey was administered to n = 30 professionals involved or interested in three-dimensional printing cardiovascular models following a specialised teaching session. Survey results suggest the potential for split training sessions, with a broader introduction for those with no prior experience in three-dimensional printing followed by a more in-depth and hands-on session. All participants agreed on the potential of the technology in all its applications, particularly for aiding decision-making around complex surgical or interventional cases. When exploring setting up an in-house three-dimensional printing service, the majority of participants reported that their centre was already equipped with an in-house facility or expressed a desire that such a facility should be available, with a minority preferring consigning models to an external third party for printing.
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Affiliation(s)
- Giovanni Biglino
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Elena G Milano
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Surgery, Dentistry, Paediatrics and Obstetrics/Gynaecology, University of Verona, Verona, Italy
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew Iu Shearn
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew M Taylor
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Silvia Schievano
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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38
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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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Lee M, Moharem-Elgamal S, Beckingham R, Hamilton M, Manghat N, Milano EG, Bucciarelli-Ducci C, Caputo M, Biglino G. Evaluating 3D-printed models of coronary anomalies: a survey among clinicians and researchers at a university hospital in the UK. BMJ Open 2019; 9:e025227. [PMID: 30852545 PMCID: PMC6430025 DOI: 10.1136/bmjopen-2018-025227] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of three-dimensional (3D) printing models of coronary artery anomalies based on cardiac CT data and explore their potential for clinical applications. DESIGN Cardiac CT datasets of patients with various coronary artery anomalies (n=8) were retrospectively reviewed and processed, reconstructing detailed 3D models to be printed in-house with a desktop 3D printer (Form 2, Formlabs) using white resin. SETTING A University Hospital (division of cardiology) in the UK. PARTICIPANTS The CT scans, first and then 3D-printed models were presented to groups of clinicians (n=8) and cardiovascular researchers (n=9). INTERVENTION Participants were asked to assess different features of the 3D models and to rate the models' overall potential usefulness. OUTCOME MEASURES Models were rated according to clarity of anatomical detail, insight into the coronary abnormality, overall perceived usefulness and comparison to CT scans. Assessment of model characteristics used Likert-type questions (5-point scale from 'strongly disagree' to 'strongly agree') or a 10-point rating (from 0, lowest, to 10, highest). The questionnaire included a feedback form summarising overall usefulness. Participants' imaging experience (in a number of years) was also recorded. RESULTS All models were reconstructed and printed successfully, with accurate details showing coronary anatomy (eg, anomalous coronary artery, coronary roofing or coronary aneurysm in a patient with Kawasaki syndrome). All clinicians and researchers provided feedback, with both groups finding the models helpful in displaying coronary artery anatomy and abnormalities, and complementary to viewing 3D CT scans. The clinicians' group, who had substantially more imaging expertise, provided more enthusiastic ratings in terms of models' clarity, usefulness and future use on average. CONCLUSIONS 3D-printed heart models can be feasibly used to recreate coronary artery anatomy and enhance understanding of coronary abnormalities. Future studies can evaluate their cost-effectiveness, as well as potentially explore other printing techniques and materials.
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Affiliation(s)
- Matthew Lee
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Moharem-Elgamal
- National Heart Institute, Giza, Egypt
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | | | - Mark Hamilton
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Nathan Manghat
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Elena Giulia Milano
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Giovanni Biglino
- Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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40
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3D printing anatomical models of head bones. Surg Radiol Anat 2018; 41:1205-1209. [PMID: 30547209 DOI: 10.1007/s00276-018-2148-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE In many medical schools, the study of Anatomy is becoming increasingly theoretical owing to the difficulty of having human body parts available, rather than offering the students the possibility of a more realistic and practical approach. We developed a project where we use a 3D printer to produce models of the human skull bones, with high quality and quantity to satisfy the needs for Anatomy classes and to be available for request to study at home. METHODS We selected regular and well-shaped bones of the head upon which we based the 3D models. These bones were scanned using a 64-channel Computed Tomography (high-resolution volumetric acquisition) and the resulting images were then processed with a segmentation software to isolate and reconstruct the structures of interest. The final digital three-dimensional objects were converted into a printable file that the 3D printer could read. We used two filament extrusion type 3D printers, the Prusa i3 and the Zortrax M200. RESULTS We have printed successfully several models of the skull bones, such as the temporal, occipital, and sphenoid. All the models have obtained good anatomical detail, thus demonstrating the practicality of this technology. Key aspects of the CT image post-processing are discussed. The production process is cost-effective and technically accessible. CONCLUSIONS These results confirm the potential of 3D printing to create more complex models (e.g. regional, vascular, nervous system structures) that would allow a similar experience compared with a dissection.
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Witowski J, Sitkowski M, Zuzak T, Coles-Black J, Chuen J, Major P, Pdziwiatr M. From ideas to long-term studies: 3D printing clinical trials review. Int J Comput Assist Radiol Surg 2018; 13:1473-1478. [PMID: 29790077 PMCID: PMC6132399 DOI: 10.1007/s11548-018-1793-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/09/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Although high costs are often cited as the main limitation of 3D printing (3DP) in the medical field, current lack of clinical evidence is asserting itself as an impost as the field begins to mature. The aim is to review clinical trials in the field of 3DP, an area of research which has grown dramatically in recent years. METHODS We surveyed clinical trials registered in 15 primary registries worldwide, including ClinicalTrials.gov. All trials which utilized 3DP in a clinical setting were included in this review. Our search was performed on December 15, 2017. Data regarding the purpose of the study, inclusion criteria, number of patients enrolled, primary outcomes, centers, start and estimated completion dates were extracted. RESULTS A total of 92 clinical trials with [Formula: see text]252 patients matched the criteria and were included in the study. A total of 42 (45.65%) studies cited China as their location. Only 10 trials were multicenter and 2 were registered as international. The discipline that most commonly utilized 3DP was Orthopedic Surgery, with 25 (27.17%) registered trials. At the time of data extraction, 17 (18.48%) clinical trials were complete. CONCLUSIONS After several years of case reports, feasibility studies and technical reports in the field, larger-scale studies are beginning to emerge. There are almost no international register entries. Although there are new emerging areas of study in disciplines that may benefit from 3DP, it is likely to remain limited to very specific applications.
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Affiliation(s)
- Jan Witowski
- 2nd Department of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
- Centre for Research, Training and Innovation and Surgery (CERTAIN Surgery), Kraków, Poland
| | - Mateusz Sitkowski
- 2nd Department of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Tomasz Zuzak
- Human Anatomy Department, Medical University of Lublin, Jaczewskiego 4, 20-090, Lublin, Poland
| | | | - Jason Chuen
- Department of Vascular Surgery, Austin Health, Melbourne, VIC, Australia
| | - Piotr Major
- 2nd Department of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
- Centre for Research, Training and Innovation and Surgery (CERTAIN Surgery), Kraków, Poland
| | - Michał Pdziwiatr
- 2nd Department of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland.
- Centre for Research, Training and Innovation and Surgery (CERTAIN Surgery), Kraków, Poland.
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Naghieh S, Sarker M, Izadifar M, Chen X. Dispensing-based bioprinting of mechanically-functional hybrid scaffolds with vessel-like channels for tissue engineering applications – A brief review. J Mech Behav Biomed Mater 2018; 78:298-314. [DOI: 10.1016/j.jmbbm.2017.11.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/14/2017] [Accepted: 11/21/2017] [Indexed: 12/15/2022]
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Rajiah P, Abbara S. Advances in cardiac CT. Cardiovasc Diagn Ther 2017; 7:429-431. [PMID: 29255686 DOI: 10.21037/cdt.2017.08.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Prabhakar Rajiah
- Associate Professor of Radiology, Associate Director, Cardiac CT and MRI, UT Southwestern Medical Center, Dallas, Texas 75390, USA.
| | - Suhny Abbara
- Professor, Department of Radiology, Chief Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas 75390, USA.
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Birbara NS, Otton JM, Pather N. 3D Modelling and Printing Technology to Produce Patient-Specific 3D Models. Heart Lung Circ 2017; 28:302-313. [PMID: 29655572 DOI: 10.1016/j.hlc.2017.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/09/2017] [Accepted: 10/25/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND A comprehensive knowledge of mitral valve (MV) anatomy is crucial in the assessment of MV disease. While the use of three-dimensional (3D) modelling and printing in MV assessment has undergone early clinical evaluation, the precision and usefulness of this technology requires further investigation. This study aimed to assess and validate 3D modelling and printing technology to produce patient-specific 3D MV models. METHODS A prototype method for MV 3D modelling and printing was developed from computed tomography (CT) scans of a plastinated human heart. Mitral valve models were printed using four 3D printing methods and validated to assess precision. Cardiac CT and 3D echocardiography imaging data of four MV disease patients was used to produce patient-specific 3D printed models, and 40 cardiac health professionals (CHPs) were surveyed on the perceived value and potential uses of 3D models in a clinical setting. RESULTS The prototype method demonstrated submillimetre precision for all four 3D printing methods used, and statistical analysis showed a significant difference (p<0.05) in precision between these methods. Patient-specific 3D printed models, particularly using multiple print materials, were considered useful by CHPs for preoperative planning, as well as other applications such as teaching and training. CONCLUSIONS This study suggests that, with further advances in 3D modelling and printing technology, patient-specific 3D MV models could serve as a useful clinical tool. The findings also highlight the potential of this technology to be applied in a variety of medical areas within both clinical and educational settings.
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Affiliation(s)
- Nicolette S Birbara
- School of Medical Sciences, Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James M Otton
- School of Medical Sciences, Medicine, University of New South Wales, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; Liverpool Hospital, Sydney, NSW, Australia
| | - Nalini Pather
- School of Medical Sciences, Medicine, University of New South Wales, Sydney, NSW, Australia.
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