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Flaxman TE, Cooke CM, Miguel OX, Sheikh A, McInnes M, Duigenan S, Singh SS. The Value of Using Patient-Specific 3D-Printed Anatomical Models in Surgical Planning for Patients With Complex Multifibroid Uteri. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102435. [PMID: 38458270 DOI: 10.1016/j.jogc.2024.102435] [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: 10/02/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES To compare surgeon responses regarding their surgical plan before and after receiving a patient-specific three-dimensional (3D)-printed model of a patient's multifibroid uterus created from their magnetic resonance imaging. METHODS 3D-printed models were derived from standard-of-care pelvic magnetic resonance images of patients scheduled for surgical intervention for multifibroid uterus. Relevant anatomical structures were printed using a combination of transparent and opaque resin types. 3D models were used for 7 surgical cases (5 myomectomies, 2 hysterectomies). A staff surgeon and 1 or 2 surgical fellow(s) were present for each case. Surgeons completed a questionnaire before and after receiving the model documenting surgical approach, perceived difficulty, and confidence in surgical plan. A postoperative questionnaire was used to assess surgeon experience using 3D models. RESULTS Two staff surgeons and 3 clinical fellows participated in this study. A total of 15 surgeon responses were collected across the 7 cases. After viewing the models, an increase in perceived surgical difficulty and confidence in surgical plan was reported in 12/15 and 7/15 responses, respectively. Anticipated surgical time had a mean ± SD absolute change of 44.0 ± 47.9 minutes and anticipated blood loss had an absolute change of 100 ± 103.5 cc. 2 of 15 responses report a change in pre-surgical approach. Intra-operative model reference was reported to change the dissection route in 8/15 surgeon responses. On average, surgeons rated their experience using 3D models 8.6/10 for pre-surgical planning and 8.1/10 for intra-operative reference. CONCLUSIONS Patient-specific 3D anatomical models may be a useful tool to increase a surgeon's understanding of complex gynaecologic anatomy and to improve their surgical plan. Future work is needed to evaluate the impact of 3D models on surgical outcomes in gynaecology.
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Affiliation(s)
- Teresa E Flaxman
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON; University of Ottawa, Faculty of Medicine, Department of Radiology, Radiation Oncology and Medical Physics, Ottawa, ON
| | - Carly M Cooke
- University of Ottawa, Faculty of Medicine, Department of Obstetrics and Gynecology, Ottawa, ON
| | - Olivier X Miguel
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON
| | - Adnan Sheikh
- University of British Columbia, Faculty of Medicine, Department of Radiology, Vancouver, BC
| | - Matthew McInnes
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON; University of Ottawa, Faculty of Medicine, Department of Radiology, Radiation Oncology and Medical Physics, Ottawa, ON; The Ottawa Hospital, Department of Medical Imaging, Ottawa, ON
| | - Shauna Duigenan
- University of Ottawa, Faculty of Medicine, Department of Radiology, Radiation Oncology and Medical Physics, Ottawa, ON; The Ottawa Hospital, Department of Medical Imaging, Ottawa, ON
| | - Sukhbir Sony Singh
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON; University of Ottawa, Faculty of Medicine, Department of Obstetrics and Gynecology, Ottawa, ON; The Ottawa Hospital, Department of Obstetrics, Gynecology and Newborn Care, Ottawa, ON.
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Iqbal H, Fernandes Q, Idoudi S, Basineni R, Billa N. Status of Polymer Fused Deposition Modeling (FDM)-Based Three-Dimensional Printing (3DP) in the Pharmaceutical Industry. Polymers (Basel) 2024; 16:386. [PMID: 38337275 DOI: 10.3390/polym16030386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Additive manufacturing (AM) or 3D printing (3DP) is arguably a versatile and more efficient way for the production of solid dosage forms such as tablets. Of the various 3DP technologies currently available, fused deposition modeling (FDM) includes unique characteristics that offer a range of options in the production of various types of tablets. For example, amorphous solid dispersions (ASDs), enteric-coated tablets or poly pills can be produced using an appropriate drug/polymer combination during FDM 3DP. The technology offers the possibility of evolving personalized medicines into cost-effective production schemes at pharmacies and hospital dispensaries. In this review, we highlight key FDM features that may be exploited for the production of tablets and improvement of therapy, with emphasis on gastrointestinal delivery. We also highlight current constraints that must be surmounted to visualize the deployment of this technology in the pharmaceutical and healthcare industries.
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Affiliation(s)
- Heba Iqbal
- Pharmaceutical Sciences Department, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Queenie Fernandes
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Sourour Idoudi
- Pharmaceutical Sciences Department, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Renuka Basineni
- Pharmaceutical Sciences Department, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Nashiru Billa
- Pharmaceutical Sciences Department, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
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Mian SY, Jayasangaran S, Qureshi A, Hughes MA. Exploring the Impact of Using Patient-Specific 3D Prints during Consent for Skull Base Neurosurgery. J Neurol Surg B Skull Base 2023; 84:463-469. [PMID: 37671293 PMCID: PMC10477011 DOI: 10.1055/a-1885-1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022] Open
Abstract
Objectives Informed consent is fundamental to good practice. We hypothesized that a personalized three-dimensional (3D)-printed model of skull base pathology would enhance informed consent and reduce patient anxiety. Design Digital images and communication in medicine (DICOM) files were 3D printed. After a standard pre-surgery consent clinic, patients completed part one of a two-part structured questionnaire. They then interacted with their personalized 3D printed model and completed part two. This explored their perceived involvement in decision-making, anxiety, concerns and also their understanding of lesion location and surgical risks. Descriptive statistics were used to report responses and text classification tools were used to analyze free text responses. Setting and Participants In total,14 patients undergoing elective skull base surgery (with pathologies including skull base meningioma, craniopharyngioma, pituitary adenoma, Rathke cleft cyst, and olfactory neuroblastoma) were prospectively identified at a single unit. Results After 3D model exposure, there was a net trend toward reduced patient-reported anxiety and enhanced patient-perceived involvement in treatment. Thirteen of 14 patients (93%) felt better about their operation and 13/14 patients (93%) thought all patients should have access to personalized 3D models. After exposure, there was a net trend toward improved patient-reported understanding of surgical risks, lesion location, and extent of feeling informed. Thirteen of 14 patients (93%) felt the model helped them understand the surgical anatomy better. Analysis of free text responses to the model found mixed sentiment: 47% positive, 35% neutral, and 18% negative. Conclusion In the context of skull base neurosurgery, personalized 3D-printed models of skull base pathology can inform the surgical consent process, impacting the levels of patient understanding and anxiety.
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Affiliation(s)
- Shan Y. Mian
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, London, United Kingdom
| | | | - Aishah Qureshi
- School of Medicine, The University of Edinburgh, Edinburgh, United Kingdom
| | - Mark A. Hughes
- Edinburgh Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Santona G, Madoglio A, Mattavelli D, Rigante M, Ferrari M, Lauretti L, Mattogno P, Parrilla C, De Bonis P, Galli J, Olivi A, Fontanella MM, Fiorentino A, Serpelloni M, Doglietto F. Training models and simulators for endoscopic transsphenoidal surgery: a systematic review. Neurosurg Rev 2023; 46:248. [PMID: 37725193 PMCID: PMC10509294 DOI: 10.1007/s10143-023-02149-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023]
Abstract
Endoscopic transsphenoidal surgery is a novel surgical technique requiring specific training. Different models and simulators have been recently suggested for it, but no systematic review is available. To provide a systematic and critical literature review and up-to-date description of the training models or simulators dedicated to endoscopic transsphenoidal surgery. A search was performed on PubMed and Scopus databases for articles published until February 2023; Google was also searched to document commercially available. For each model, the following features were recorded: training performed, tumor/arachnoid reproduction, assessment and validation, and cost. Of the 1199 retrieved articles, 101 were included in the final analysis. The described models can be subdivided into 5 major categories: (1) enhanced cadaveric heads; (2) animal models; (3) training artificial solutions, with increasing complexity (from "box-trainers" to multi-material, ct-based models); (4) training simulators, based on virtual or augmented reality; (5) Pre-operative planning models and simulators. Each available training model has specific advantages and limitations. Costs are high for cadaver-based solutions and vary significantly for the other solutions. Cheaper solutions seem useful only for the first stages of training. Most models do not provide a simulation of the sellar tumor, and a realistic simulation of the suprasellar arachnoid. Most artificial models do not provide a realistic and cost-efficient simulation of the most delicate and relatively common phase of surgery, i.e., tumor removal with arachnoid preservation; current research should optimize this to train future neurosurgical generations efficiently and safely.
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Affiliation(s)
- Giacomo Santona
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Alba Madoglio
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Davide Mattavelli
- Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Mario Rigante
- Otorhinolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua - Azienda Ospedaliera di Padova, Padua, Italy
| | - Liverana Lauretti
- Neurosurgery, Department of Neurosciences, Sensory Organs and Thorax, Università Cattolica del Sacro Cuore, Rome, Italy
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pierpaolo Mattogno
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Parrilla
- Otorhinolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pasquale De Bonis
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Jacopo Galli
- Otorhinolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Otorhinolaryngology, Department of Neurosciences, Sensory Organs and Thorax, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Alessandro Olivi
- Neurosurgery, Department of Neurosciences, Sensory Organs and Thorax, Università Cattolica del Sacro Cuore, Rome, Italy
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Maria Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia - ASST Spedali Civili di Brescia, Brescia, Italy
| | - Antonio Fiorentino
- Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Mauro Serpelloni
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Neurosurgery, Department of Neurosciences, Sensory Organs and Thorax, Università Cattolica del Sacro Cuore, Rome, Italy.
- Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Graffeo CS, Bhandarkar AR, Carlstrom LP, Perry A, Nguyen B, Daniels DJ, Link MJ, Morris JM. That which is unseen: 3D printing for pediatric cerebrovascular education. Childs Nerv Syst 2023; 39:2449-2457. [PMID: 37272936 DOI: 10.1007/s00381-023-05987-0] [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: 01/26/2023] [Accepted: 05/06/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Pediatric cerebrovascular lesions are very rare and include aneurysms, arteriovenous malformations (AVM), and vein of Galen malformations (VOGM). OBJECTIVE To describe and disseminate a validated, reproducible set of 3D models for optimization of neurosurgical training with respect to pediatric cerebrovascular diseases METHODS: All pediatric cerebrovascular lesions treated at our institution with adequate imaging studies during the study period 2015-2020 were reviewed by the study team. Three major diagnostic groups were identified: aneurysm, AVM, and VOGM. For each group, a case deemed highly illustrative of the core diagnostic and therapeutic principles was selected by the lead and senior investigators for printing (CSG/JM). Files for model reproduction and free distribution were prepared for inclusion as Supplemental Materials. RESULTS Representative cases included a 7-month-old female with a giant left MCA aneurysm; a 3-day-old male with a large, complex, high-flow, choroidal-type VOGM, supplied from bilateral thalamic, choroidal, and pericallosal perforators, with drainage into a large prosencephalic vein; and a 7-year-old male with a left frontal AVM with one feeding arterial vessel from the anterior cerebral artery and one single draining vein into the superior sagittal sinus CONCLUSION: Pediatric cerebrovascular lesions are representative of rare but important neurosurgical diseases that require creative approaches for training optimization. As these lesions are quite rare, 3D-printed models and open source educational materials may provide a meaningful avenue for impactful clinical teaching with respect to a wide swath of uncommon or unusual neurosurgical diseases.
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Affiliation(s)
- Christopher S Graffeo
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, OU Health University of Oklahoma Medical Center, Oklahoma City, OK, USA
| | | | | | - Avital Perry
- Department of Neurosurgery, Sheba Hospital, Tel Aviv, Israel
| | - Bachtri Nguyen
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - David J Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jonathan M Morris
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
- Department of Neurosurgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Yang MY, Tseng HC, Liu CH, Tsai SY, Chen JH, Chu YH, Li ST, Lee JJ, Liao WC. Effects of the individual three-dimensional printed craniofacial bones with a quick response code on the skull spatial knowledge of undergraduate medical students. ANATOMICAL SCIENCES EDUCATION 2023; 16:858-869. [PMID: 36905326 DOI: 10.1002/ase.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Understanding the three-dimensional (3D) structure of the human skull is imperative for medical courses. However, medical students are overwhelmed by the spatial complexity of the skull. Separated polyvinyl chloride (PVC) bone models have advantages as learning tools, but they are fragile and expensive. This study aimed to reconstruct 3D-printed skull bone models (3D-PSBs) using polylactic acid (PLA) with anatomical characteristics for spatial recognition of the skull. Student responses to 3D-PSB application were investigated through a questionnaire and tests to understand the requirement of these models as a learning tool. The students were randomly divided into 3D-PSB (n = 63) and skull (n = 67) groups to analyze pre- and post-test scores. Their knowledge was improved, with the gain scores of the 3D-PSB group (50.0 ± 3.0) higher than that of the skull group (37.3 ± 5.2). Most students agreed that using 3D-PSBs with quick response codes could improve immediate feedback on teaching (88%; 4.41 ± 0.75), while 85.9% of the students agreed that individual 3D-PSBs clarified the structures hidden within the skull (4.41 ± 0.75). The ball drop test revealed that the mechanical strength of the cement/PLA model was significantly greater than that of the cement or PLA model. The prices of the PVC, cement, and cement/PLA models were 234, 1.9, and 10 times higher than that of the 3D-PSB model, respectively. These findings imply that low-cost 3D-PSB models could revolutionize skull anatomical education by incorporating digital technologies like the QR system into the anatomical teaching repertoire.
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Affiliation(s)
- Mao-Yi Yang
- Department of Medical Education, Changhua Christian Hospital, Changhua City, Taiwan
- Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Hsien-Chun Tseng
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Radiation Oncology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chiung-Hui Liu
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shao-Yu Tsai
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jyun-Hsiung Chen
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yin-Hung Chu
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shao-Ti Li
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jian-Jr Lee
- Faculty of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
- Department of Plastic & Reconstruction Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Chieh Liao
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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Jimenez JE, Shaffer AD, Hammersley E, Ghodadra A, Stapleton AL. Use of patient-specific 3D printed models in pre-operative counseling for pediatric skull base surgery. Int J Pediatr Otorhinolaryngol 2023; 171:111655. [PMID: 37459769 DOI: 10.1016/j.ijporl.2023.111655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/09/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES Pediatric cranial base pathology is anatomically complex and surgical treatment is oftentimes difficult to conceptualize for patients and their families. Three-dimensional (3D) models of the sinuses and cranial base have the potential to enhance patient understanding in numerous domains. Our objective is to assess the use of 3D models in pre-operative parental and patient counseling prior to endoscopic endonasal skull base surgery in the pediatric population. METHODS A survey was designed to assess parent and patient-perceived utility of 3D-printed models in surgical counseling prior to pediatric skull base surgery. RESULTS A total of 10 patients were included. The median age was 9 years (range = 5 months-15 years). Pathology included juvenile nasopharyngeal angiofibroma (JNA) (N = 4), fibrous dysplasia of the maxilla and sphenoid (N = 1), juvenile ossifying fibroma (N = 1), nasal dermoid (N = 2, one with intracranial extension), encephalocele (N = 1), and parapharyngeal ectopic glial tissue (N = 1). Nearly all parents agreed or strongly agreed that 3D printed models were helpful in explaining the patient's skull base pathology (N = 10), surgical plan (N = 10), and possible complications (N = 9). All parents strongly agreed that 3D models should be used routinely in pre-operative counseling for endoscopic endonasal surgery. According to a majority of parents, patients older than 4 years old found the models helpful in understanding their pathology (75%) and surgery (88%). CONCLUSION By allowing direct three-dimensional visualization of the target pathology, 3D models serve as a useful adjunct in enhancing patient comprehension of the pathologic entity, planned surgery, and potential complications prior to pediatric endoscopic endonasal skull base surgery.
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Affiliation(s)
- Joaquin E Jimenez
- Department of Otolaryngology, University of Pittsburgh Medical Center, UPMC Eye & Ear Institute, 203 Lothrop Street, Suite 519, Pittsburgh, PA, 15213, United States.
| | - Amber D Shaffer
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Faculty Pavilion, 7th Floor, Pittsburgh, PA, 15224, United States.
| | - Elliott Hammersley
- 3D Printing Program, Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite E204, Pittsburgh, PA, 15213, United States.
| | - Anish Ghodadra
- 3D Printing Program, Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite E204, Pittsburgh, PA, 15213, United States
| | - Amanda L Stapleton
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Faculty Pavilion, 7th Floor, Pittsburgh, PA, 15224, United States.
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Sidabutar R, Yudha TW, Sutiono AB, Huda F, Faried A. Low-cost and open-source three-dimensional (3D) printing in neurosurgery: A pilot experiment using direct drive modification to produce multi-material neuroanatomical models. Clin Neurol Neurosurg 2023; 228:107684. [PMID: 36996673 DOI: 10.1016/j.clineuro.2023.107684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND 3-dimensional (3D) printing carries a genuine potential for pre-operative planning in neurosurgery. Entry-level 3D printers offer practicality in low resource settings, but are often limited by the range of filament materials as well as the capability of open-source segmentation software. OBJECTIVE We intended to demonstrate that 3D printing of neuroanatomical structures is possible using an entry-level 3D printer equipped with the direct drive (DD) modification, which supported flexible filaments, with the models segmented using an open-source software. METHODS A DD system was installed onto the Ender 3 Pro printer. An attempt to print neurosurgical models using a low-cost 3D printer was conducted, where four patient-based neuroanatomical models were printed: skull base-vasculature, skull base-tumour, cervical spine, and ventricular system. The results were discussed and compared to similar endeavours in past literature. RESULTS Although DD installation was challenging and led to vibration and longer print time, which ultimately warranted an inferior printing speed, DD system enabled the printing with thermoplastic polyurethane (TPU), a versatile elastomer; in addition to producing equal amount of detail to those printed with high-end printers and advanced image segmentation software. Fitting the frame well, changing infill type, and avoiding warping and stringing will improve print quality with the DD system. CONCLUSION 3D printing with entry-level 3D printers equipped with DD system has been proven to be a reliable way of accurately reproducing patient-specific neuroanatomical constructs. Follow-up studies are necessary to implement 3D printing for neurosurgical planning in low-resource settings.
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Cooke CM, Flaxman TE, Sikora L, Miguel O, Singh SS. Individualized medicine using 3D printing technology in gynecology: a scoping review. 3D Print Med 2023; 9:6. [PMID: 36932284 PMCID: PMC10024374 DOI: 10.1186/s41205-023-00169-9] [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: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE Developments in 3-dimensional (3D) printing technology has made it possible to produce high quality, affordable 3D printed models for use in medicine. As a result, there is a growing assessment of this approach being published in the medical literature. The objective of this study was to outline the clinical applications of individualized 3D printing in gynecology through a scoping review. DATA SOURCES Four medical databases (Medline, Embase, Cochrane CENTRAL, Scopus) and grey literature were searched for publications meeting eligibility criteria up to 31 May 2021. STUDY ELIGIBILITY CRITERIA Publications were included if they were published in English, had a gynecologic context, and involved production of patient specific 3D printed product(s). STUDY APPRAISAL AND SYNTHESIS METHODS Studies were manually screened and assessed for eligibility by two independent reviewers and data were extracted using pre-established criteria using Covidence software. RESULTS Overall, 32 studies (15 abstracts,17 full text articles) were included in the scoping review. Most studies were either case reports (12/32,38%) or case series (15/32,47%). Gynecologic sub-specialties in which the 3D printed models were intended for use included: gynecologic oncology (21/32,66%), benign gynecology (6/32,19%), pediatrics (2/32,6%), urogynecology (2/32,6%) and reproductive endocrinology and infertility (1/32,3%). Twenty studies (63%) printed 5 or less models, 6/32 studies (19%) printed greater than 5 (up to 50 models). Types of 3D models printed included: anatomical models (11/32,34%), medical devices, (2/32,6%) and template/guide/cylindrical applicators for brachytherapy (19/32,59%). CONCLUSIONS Our scoping review has outlined novel clinical applications for individualized 3D printed models in gynecology. To date, they have mainly been used for production of patient specific 3D printed brachytherapy guides/applicators in patients with gynecologic cancer. However, individualized 3D printing shows great promise for utility in surgical planning, surgical education, and production of patient specific devices, across gynecologic subspecialties. Evidence supporting the clinical value of individualized 3D printing in gynecology is limited by studies with small sample size and non-standardized reporting, which should be the focus of future studies.
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Affiliation(s)
- Carly M Cooke
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Teresa E Flaxman
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Olivier Miguel
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada
| | - Sukhbir S Singh
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, Ontario, Canada.
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Riverside Campus, 1967 Riverside Dr., 7th Floor, Ottawa, Ontario, K1H 7W9, Canada.
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A Review of the Benefits 3D Printing Brings to Patients with Neurological Diseases. Pharmaceutics 2023; 15:pharmaceutics15030892. [PMID: 36986752 PMCID: PMC10051330 DOI: 10.3390/pharmaceutics15030892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
This interdisciplinary review focuses on how flexible three-dimensional printing (3DP) technology can aid patients with neurological diseases. It covers a wide variety of current and possible applications ranging from neurosurgery to customizable polypill along with a brief description of the various 3DP techniques. The article goes into detail about how 3DP technology can aid delicate neurosurgical planning and its consequent outcome for patients. It also covers areas such as how the 3DP model can be utilized in patient counseling along with designing specific implants involved in cranioplasty and customization of a specialized instrument such as 3DP optogenetic probes. Furthermore, the review includes how a 3DP nasal cast can contribute to the development of nose-to-brain drug delivery along with looking into how bioprinting could be used for regenerating nerves and how 3D-printed drugs could offer practical benefits to patients suffering from neurological diseases via polypill.
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Jacob J, Stunden C, Zakani S. Exploring the value of three-dimensional printing and virtualization in paediatric healthcare: A multi-case quality improvement study. Digit Health 2023; 9:20552076231159988. [PMID: 36865771 PMCID: PMC9972041 DOI: 10.1177/20552076231159988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/09/2023] [Indexed: 03/02/2023] Open
Abstract
Background Three-dimensional printing is being utilized in clinical medicine to support activities including surgical planning, education, and medical device fabrication. To better understand the impacts of this technology, a survey was implemented with radiologists, specialist physicians, and surgeons at a tertiary care hospital in Canada, examining multidimensional value and considerations for uptake. Objectives To examine how three-dimensional printing can be integrated into the paediatric context and highlight areas of impact and value to the healthcare system using Kirkpatrick's Model. Secondarily, to explore the perspective of clinicians utilizing three-dimensional models and how they make decisions about whether or not to use the technology in patient care. Methods A post-case survey. Descriptive statistics are provided for Likert-style questions, and a thematic analysis was conducted to identify common patterns in open-ended responses. Results In total, 37 respondents were surveyed across 19 clinical cases, providing their perspectives on model reaction, learning, behaviour, and results. We found surgeons and specialists to consider the models more beneficial than radiologists. Results further showed that the models were more helpful when used to assess the likelihood of success or failure of clinical management strategies, and for intraoperative orientation. We demonstrate that three-dimensional printed models could improve perioperative metrics, including a reduction in operating room time, but with a reciprocal effect on pre-procedural planning time. Clinicians who shared the models with patients and families thought it increased understanding of the disease and surgical procedure, and had no effect on their consultation time. Conclusions Three-dimensional printing and virtualization were used in preoperative planning and for communication among the clinical care team, trainees, patients, and families. Three-dimensional models provide multidimensional value to clinical teams, patients, and the health system. Further investigation is warranted to assess value in other clinical areas, across disciplines, and from a health economics and outcomes perspective.
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Affiliation(s)
- John Jacob
- Faculty of Medicine, Department of Paediatrics, University of British
Columbia, Vancouver, BC, Canada
- Digital Lab, BC Children's Hospital, Vancouver, BC, Canada
- Bayes Business School, City, University of London, London, UK
- John Jacob, Faculty of Medicine, Department
of Paediatrics, University of British Columbia, 2D19 – 4480 Oak Street,
Vancouver, BC V6H 3V4, Canada.
| | - Chelsea Stunden
- Faculty of Medicine, Department of Paediatrics, University of British
Columbia, Vancouver, BC, Canada
- Digital Lab, BC Children's Hospital, Vancouver, BC, Canada
| | - Sima Zakani
- Faculty of Medicine, Department of Paediatrics, University of British
Columbia, Vancouver, BC, Canada
- Digital Lab, BC Children's Hospital, Vancouver, BC, Canada
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12
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Jendritza P, Klein FJ, Fries P. Multi-area recordings and optogenetics in the awake, behaving marmoset. Nat Commun 2023; 14:577. [PMID: 36732525 PMCID: PMC9895452 DOI: 10.1038/s41467-023-36217-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
The common marmoset has emerged as a key model in neuroscience. Marmosets are small in size, show great potential for genetic modification and exhibit complex behaviors. Thus, it is necessary to develop technology that enables monitoring and manipulation of the underlying neural circuits. Here, we describe a novel approach to record and optogenetically manipulate neural activity in awake, behaving marmosets. Our design utilizes a light-weight, 3D printed titanium chamber that can house several high-density silicon probes for semi-chronic recordings, while enabling simultaneous optogenetic stimulation. We demonstrate the application of our method in male marmosets by recording multi- and single-unit data from areas V1 and V6 with 192 channels simultaneously, and show that optogenetic activation of excitatory neurons in area V6 can influence behavior in a detection task. This method may enable future studies to investigate the neural basis of perception and behavior in the marmoset.
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Affiliation(s)
- Patrick Jendritza
- Ernst Strüngmann Institute (ESI) for Neuroscience in Cooperation with Max Planck Society, Frankfurt, Germany.
- International Max Planck Research School for Neural Circuits, Frankfurt, Germany.
| | - Frederike J Klein
- Ernst Strüngmann Institute (ESI) for Neuroscience in Cooperation with Max Planck Society, Frankfurt, Germany
| | - Pascal Fries
- Ernst Strüngmann Institute (ESI) for Neuroscience in Cooperation with Max Planck Society, Frankfurt, Germany
- International Max Planck Research School for Neural Circuits, Frankfurt, Germany
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
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13
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Mantilla DE, Ferrara R, Ortiz AF, Vera DD, Nicoud F, Costalat V. Validation of three-dimensional printed models of intracranial aneurysms. Interv Neuroradiol 2022:15910199221143254. [PMID: 36503318 DOI: 10.1177/15910199221143254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Three-dimensional (3D) printing has evolved for medical applications as it can produce customized 3D models of devices and implants that can improve patient care. In this study, we aimed to validate the geometrical accuracy of the 3D models of intracranial aneurysms printed using Stereolithography 3D printing technology. MATERIALS AND METHODS To compare the unruptured intracranial aneurysm mesh between the five patients and 3D printed models, we opened the DICOM files in the Sim&Size® simulation software, selected the region of interest, and performed the threshold check. We juxtaposed the 3D reconstructions and manually rotated the images to get the same orientation when needed and measured deviations at different nodes of the patient and 3D printed model meshes. RESULTS In the first patient, 80% of the nodes were separated by <0.56 mm and 0.17 mm. In the second patient, the deviations were below 0.17 mm for 80% of the meshes' nodes. In the next three patients, the deviations were below 0.21, 0.23, and 0.11 mm for 80% of the meshes' nodes. Finally, the overall deviation was below 0.21 mm for 80% of the mesh nodes of the five aneurysms. CONCLUSIONS 3D printed models of intracranial aneurysms are accurate, having surfaces that resemble that of patients' angiographies with an 80% cumulative deviation below 0.21 mm.
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Affiliation(s)
- Daniel E Mantilla
- Interventional Radiology Department, Fundación oftalmológica de Santander Clínica Ardila Lülle, Floridablanca, Colombia
- Interventional Radiology Department, 27968Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
- Faculté de Sciencies, Université de Montpellier, Montpellier, France
| | | | - Andrés F Ortiz
- Interventional Radiology Department, Fundación oftalmológica de Santander Clínica Ardila Lülle, Floridablanca, Colombia
- Interventional Radiology Department, 27968Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Daniela D Vera
- Physician. Radiology Department, Fundación oftalmológica de Santander, Clínica Ardila Lülle, Floridablanca, Colombia
| | - Franck Nicoud
- Institut Montpelliérain Alexander, Grothendieck, CNRS, Univ. Montpellier, Montpellier, France
| | - Vincent Costalat
- Neuroradiology, Hôpital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
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14
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Gutmann S, Flegel T, Müller M, Möbius R, Matiasek K, König F, Winkler D, Grunert R. Case Report: Clinical Use of a Patient-Individual Magnetic Resonance Imaging-Based Stereotactic Navigation Device for Brain Biopsies in Three Dogs. Front Vet Sci 2022; 9:876741. [PMID: 35915727 PMCID: PMC9337988 DOI: 10.3389/fvets.2022.876741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
Three-dimensional (3D) printing techniques for patient-individual medicine has found its way into veterinary neurosurgery. Because of the high accuracy of 3D printed specific neurosurgical navigation devices, it seems to be a safe and reliable option to use patient-individual constructions for sampling brain tissue. Due to the complexity and vulnerability of the brain a particularly precise and safe procedure is required. In a recent cadaver study a better accuracy for the 3D printed MRI-based patient individual stereotactic brain biopsy device for dogs is determined compared to the accuracies of other biopsy systems which are currently used in veterinary medicine. This case report describes the clinical use of this 3D printed MRI-based patient individual brain biopsy device for brain sampling in three dogs. The system was characterized by a simple handling. Furthermore, it was an effective and reliable tool to gain diagnostic brain biopsy samples in dogs with no significant side effects.
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Affiliation(s)
- Sarah Gutmann
- Department for Small Animals, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
- *Correspondence: Sarah Gutmann
| | - Thomas Flegel
- Department for Small Animals, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Marcel Müller
- Medical Engineering, Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany
| | - Robert Möbius
- Department for Neurosurgery, University Hospital Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Kaspar Matiasek
- Section of Clinical and Comparative Neuropathology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Florian König
- Small Animal Practice, Neurology, Wiesbaden, Germany
| | - Dirk Winkler
- Department for Neurosurgery, University Hospital Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Ronny Grunert
- Medical Engineering, Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany
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15
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Bartella AK, Hoshal SG, Lethaus B, Strong EB. Computer assisted skull base surgery: a contemporary review. Innov Surg Sci 2022. [DOI: 10.1515/iss-2021-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Skull base surgery has evolved significantly since Harvey Cushing‘s first descriptions in the early 1900s. Computer aided surgery (CAS) applications continue to expand; they include virtual surgical planning, augmented and virtual reality, 3D printing of models/cutting guides/implants, surgical navigation, and intraoperative imaging. The authors will review the current skull base CAS literature and propose a computer aided surgical workflow categorizing these applications into 3 phases: 1) Virtual planning, 2) Surgical execution, 3) Intraoperative verification.
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Affiliation(s)
| | - Steven G. Hoshal
- Department of Otolaryngology – Head and Neck Surgery , University of California, Davis , Sacramento , CA , USA
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery , Leipzig University Leipzig , Germany
| | - E. Bradley Strong
- Department of Otolaryngology – Head and Neck Surgery , University of California, Davis , Sacramento , CA , USA
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16
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Brunner BS, Thierij A, Jakob A, Tengler A, Grab M, Thierfelder N, Leuner CJ, Haas NA, Hopfner C. 3D-printed heart models for hands-on training in pediatric cardiology - the future of modern learning and teaching? GMS JOURNAL FOR MEDICAL EDUCATION 2022; 39:Doc23. [PMID: 35692357 PMCID: PMC9174069 DOI: 10.3205/zma001544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/05/2021] [Accepted: 01/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND This project aims to develop a new concept in training pediatric cardiologists to meet the requirements of interventional cardiac catheterizations today in terms of complexity and importance. This newly developed hands-on training program is supposed to enable the acquisition of certain skills which are necessary when investigating and treating patients in a catheter laboratory. METHODS Based on anonymous CT-scans of pediatric patients' digital 3D heart models with or without cardiac defects were developed and printed three-dimensionally in a flexible material visible under X-ray. Hands-on training courses were offered using models of a healthy heart and the most common congenital heart defects (CHD). An evaluation was performed by quantifying fluoroscopy times (FL-time) and a questionnaire. RESULTS The acceptance of theoretical and practical contents within the hands-on training was very positive. It was demonstrated that it is possible to master various steps of a diagnostic procedure and an intervention as well as to practice and repeat them independently which significantly reduced FL-time. The participants stated that the hands-on training led to more confidence in interventions on real patients. CONCLUSION With the development of a training module using 3D-printed heart models, basic and advanced training in the field of diagnostic cardiac examinations as well as interventional therapies of CHD is possible. The learning effect for both, practical skills and theoretical understanding, was significant which underlines the importance of integrating such hands-on trainings on 3D heart models in education and practical training.
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Affiliation(s)
- Barbara S. Brunner
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Alisa Thierij
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Andre Jakob
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Anja Tengler
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Maximilian Grab
- LMU Klinikum, Clinic and Polyclinic for Cardiac Surgery, Munich, Germany
| | | | | | - Nikolaus A. Haas
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
| | - Carina Hopfner
- LMU Klinikum, Department of Pediatric Cardiology and Pediatric Intensive Care, Munich, Germany
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Cornejo J, Cornejo-Aguilar JA, Vargas M, Helguero CG, Milanezi de Andrade R, Torres-Montoya S, Asensio-Salazar J, Rivero Calle A, Martínez Santos J, Damon A, Quiñones-Hinojosa A, Quintero-Consuegra MD, Umaña JP, Gallo-Bernal S, Briceño M, Tripodi P, Sebastian R, Perales-Villarroel P, De la Cruz-Ku G, Mckenzie T, Arruarana VS, Ji J, Zuluaga L, Haehn DA, Paoli A, Villa JC, Martinez R, Gonzalez C, Grossmann RJ, Escalona G, Cinelli I, Russomano T. Anatomical Engineering and 3D Printing for Surgery and Medical Devices: International Review and Future Exponential Innovations. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6797745. [PMID: 35372574 PMCID: PMC8970887 DOI: 10.1155/2022/6797745] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
Three-dimensional printing (3DP) has recently gained importance in the medical industry, especially in surgical specialties. It uses different techniques and materials based on patients' needs, which allows bioprofessionals to design and develop unique pieces using medical imaging provided by computed tomography (CT) and magnetic resonance imaging (MRI). Therefore, the Department of Biology and Medicine and the Department of Physics and Engineering, at the Bioastronautics and Space Mechatronics Research Group, have managed and supervised an international cooperation study, in order to present a general review of the innovative surgical applications, focused on anatomical systems, such as the nervous and craniofacial system, cardiovascular system, digestive system, genitourinary system, and musculoskeletal system. Finally, the integration with augmented, mixed, virtual reality is analyzed to show the advantages of personalized treatments, taking into account the improvements for preoperative, intraoperative planning, and medical training. Also, this article explores the creation of devices and tools for space surgery to get better outcomes under changing gravity conditions.
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Affiliation(s)
- José Cornejo
- Facultad de Ingeniería, Universidad San Ignacio de Loyola, La Molina, Lima 15024, Peru
- Department of Medicine and Biology & Department of Physics and Engineering, Bioastronautics and Space Mechatronics Research Group, Lima 15024, Peru
| | | | | | | | - Rafhael Milanezi de Andrade
- Robotics and Biomechanics Laboratory, Department of Mechanical Engineering, Universidade Federal do Espírito Santo, Brazil
| | | | | | - Alvaro Rivero Calle
- Department of Oral and Maxillofacial Surgery, Hospital 12 de Octubre, Madrid, Spain
| | - Jaime Martínez Santos
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Aaron Damon
- Department of Neurosurgery, Mayo Clinic, FL, USA
| | | | | | - Juan Pablo Umaña
- Cardiovascular Surgery, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotá DC, Colombia
| | | | - Manolo Briceño
- Villamedic Group, Lima, Peru
- Clínica Internacional, Lima, Peru
| | | | - Raul Sebastian
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA
| | | | - Gabriel De la Cruz-Ku
- Universidad Científica del Sur, Lima, Peru
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jiakai Ji
- Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, Bronx, NY, USA
| | - Laura Zuluaga
- Department of Urology, Fundación Santa Fe de Bogotá, Colombia
| | | | - Albit Paoli
- Howard University Hospital, Washington, DC, USA
| | | | | | - Cristians Gonzalez
- Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut of Image-Guided Surgery (IHU-Strasbourg), Strasbourg, France
| | | | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Ilaria Cinelli
- Aerospace Human Factors Association, Aerospace Medical Association, VA, USA
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18
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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: 35] [Impact Index Per Article: 17.5] [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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19
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Rackson CM, Toombs JT, De Beer MP, Cook CC, Shusteff M, Taylor HK, McLeod RR. Latent image volumetric additive manufacturing. OPTICS LETTERS 2022; 47:1279-1282. [PMID: 35230346 DOI: 10.1364/ol.449220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/29/2022] [Indexed: 06/14/2023]
Abstract
Volumetric additive manufacturing (VAM) enables rapid printing into a wide range of materials, offering significant advantages over other printing technologies, with a lack of inherent layering of particular note. However, VAM suffers from striations, similar in appearance to layers, and similarly limiting applications due to mechanical and refractive index inhomogeneity, surface roughness, etc. We hypothesize that these striations are caused by a self-written waveguide effect, driven by the gelation material nonlinearity upon which VAM relies, and that they are not a direct recording of non-uniform patterning beams. We demonstrate a simple and effective method of mitigating striations via a uniform optical exposure added to the end of any VAM printing process. We show this step to additionally shorten the period from initial gelation to print completion, mitigating the problem of partially gelled parts sinking before print completion, and expanding the range of resins printable in any VAM printer.
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20
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Pöppe JP, Spendel M, Schwartz C, Winkler PA, Wittig J. The "springform" technique in cranioplasty: custom made 3D-printed templates for intraoperative modelling of polymethylmethacrylate cranial implants. Acta Neurochir (Wien) 2022; 164:679-688. [PMID: 34873659 PMCID: PMC8913485 DOI: 10.1007/s00701-021-05077-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/23/2021] [Indexed: 12/19/2022]
Abstract
Background Manual moulding of cranioplasty implants after craniectomy is feasible, but does not always yield satisfying cosmetic results. In contrast, 3D printing can provide precise templates for intraoperative moulding of polymethylmethacrylate (PMMA) implants in cranioplasty. Here, we present a novel and easily implementable 3D printing workflow to produce patient-specific, sterilisable templates for PMMA implant moulding in cranioplastic neurosurgery. Methods 3D printable templates of patients with large skull defects before and after craniectomy were designed virtually from cranial CT scans. Both templates — a mould to reconstruct the outer skull shape and a ring representing the craniectomy defect margins — were printed on a desktop 3D printer with biocompatible photopolymer resins and sterilised after curing. Implant moulding and implantation were then performed intraoperatively using the templates. Clinical and radiological data were retrospectively analysed. Results Sixteen PMMA implants were performed on 14 consecutive patients within a time span of 10 months. The median defect size was 83.4 cm2 (range 57.8–120.1 cm2). Median age was 51 (range 21–80) years, and median operating time was 82.5 (range 52–152) min. No intraoperative complications occurred; PMMA moulding was uneventful and all implants fitted well into craniectomy defects. Excellent skull reconstruction could be confirmed in all postoperative computed tomography (CT) scans. In three (21.4%) patients with distinct risk factors for postoperative haematoma, revision surgery for epidural haematoma had to be performed. No surgery-related mortality or new and permanent neurologic deficits were recorded. Conclusion Our novel 3D printing-aided moulding workflow for elective cranioplasty with patient-specific PMMA implants proved to be an easily implementable alternative to solely manual implant moulding. The “springform” principle, focusing on reconstruction of the precraniectomy skull shape and perfect closure of the craniectomy defect, was feasible and showed excellent cosmetic results. The proposed method combines the precision and cosmetic advantages of computer-aided design (CAD) implants with the cost-effectiveness of manually moulded PMMA implants. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-05077-7.
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Affiliation(s)
- Johannes P Pöppe
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.
| | - Mathias Spendel
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Peter A Winkler
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria
| | - Jörn Wittig
- Department of Oral and Maxillofacial Surgery, University Hospital Salzburg, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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21
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Saleh Y, Piper R, Richard M, Jeyaretna S, Cosker T. Designing a 3D Printed Model of the Skull-Base: A Collaboration Between Clinicians and Industry. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221080703. [PMID: 35280123 PMCID: PMC8905218 DOI: 10.1177/23821205221080703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The role of three dimensional (3D) printing in neurosurgical education is becoming increasingly common. Notably, 3D printing can simulate complex anatomical pathways that may be difficult to regularly and accurately reproduce in cadavers. One such example is the course of the facial nerve within the temporal bone and its relation to the labyrinth. This can aid pre-surgical planning and minimise surgical complications. Here we aim to develop a novel anatomically accurate model of the skull base which demonstrates key neuro vascular components and the course of the facial nerve within the temporal bone by developing a 3D printed model of the skull-base that can be used for medical education and pre-surgical planning. MATERIALS AND METHODS We utilised a combination of Computed Tomography (CT) and angiography scans to reconstruct the skull base and its vascular contents. Neural components were digitally incorporated under the guidance of the Oxford neurosurgical team and the anatomy department. The model was integrated and printed using polymer jetting. RESULTS The model was successfully printed, with all neurovascular components included. Notably we were able to highlight the intra-temporal course of the facial nerve by creating a bony window within the temporal bone. CONCLUSION Through a collaboration with industry and a multidisciplinary team, we were able to reproduce the base of the skull from patient neuro-imaging. Our model is both cost-effective, reproducible and can aid both medical students and neurosurgical trainees in their training/education.
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Affiliation(s)
- Youssuf Saleh
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Rory Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals, UK
| | - Michael Richard
- 3D Life Prints, Nuffield Orthopaedic Centre, Oxford, United kingdom
| | - Sanjeeva Jeyaretna
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals, UK
| | - Thomas Cosker
- Department of Physiology Anatomy and Genetics, University of Oxford, UK
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22
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Rackson CM, Champley KM, Toombs JT, Fong EJ, Bansal V, Taylor HK, Shusteff M, McLeod RR. Object-Space Optimization of Tomographic Reconstructions for Additive Manufacturing. ADDITIVE MANUFACTURING 2021; 48:102367. [PMID: 34900610 PMCID: PMC8656269 DOI: 10.1016/j.addma.2021.102367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Volumetric 3D printing motivated by computed axial lithography enables rapid printing of homogeneous parts but requires a high dimensionality gradient-descent optimization to calculate image sets. Here we introduce a new, simpler approach to image-computation that algebraically optimizes a model of the printed object, significantly improving print accuracy of complex parts under imperfect material and optical precision by improving optical dose contrast between the target and surrounding regions. Quality metrics for volumetric printing are defined and shown to be significantly improved by the new algorithm. The approach is extended beyond binary printing to grayscale control of conversion to enable functionally graded materials. The flexibility of the technique is digitally demonstrated with realistic projector point spread functions, printing around occluding structures, printing with restricted angular range, and incorporation of materials chemistry such as inhibition. Finally, simulations show that the method facilitates new printing modalities such as printing into flat, rather than cylindrical packages to extend the applications of volumetric printing.
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Affiliation(s)
- Charles M. Rackson
- Department of Electrical, Computer, and Energy Engineering, University of Colorado, Boulder, CO 80309, USA
| | - Kyle M. Champley
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - Joseph T. Toombs
- Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Erika J. Fong
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - Vishal Bansal
- Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Hayden K. Taylor
- Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Maxim Shusteff
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - Robert R. McLeod
- Department of Electrical, Computer, and Energy Engineering, University of Colorado, Boulder, CO 80309, USA
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da Silveira EE, da Silva Lisboa Neto AF, Carlos Sabino Pereira H, Ferreira JS, Dos Santos AC, Siviero F, da Fonseca R, de Assis Neto AC. Canine Skull Digitalization and Three-Dimensional Printing as an Educational Tool for Anatomical Study. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021; 48:649-655. [PMID: 33226900 DOI: 10.3138/jvme-2019-0132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article aims to standardize 3D scanning and printing of dog skulls for educational use and evaluate the effectiveness of these anatomical printed models for a veterinary anatomy course. Skulls were selected for scanning and creating 3D-printed models through Fused Deposition Modeling using acrylonitrile-butadiene-styrene. After a lecture on skull anatomy, the 3D-printed and real skull models were introduced during the practical bone class to 140 students. A bone anatomy practical test was conducted after a month; it consisted in identifying previously marked anatomical structures of the skull bones. The students were divided into two groups for the exam; the first group of students took the test on the real skulls, whereas the second group of students took the test on 3D-printed skulls. The students' performance was evaluated using similar practical examination questions. At the end of the course, these students were asked to answer a brief questionnaire about their individual experiences. The results showed that the anatomical structures of the 3D-printed skulls were similar to the real skulls. There was no significant difference between the test scores of the students that did their test using the real skulls and those using 3D prints. In conclusion, it was possible to construct a dynamic and printed digital 3D collection for studies of the comparative anatomy of canine skull species from real skulls, suggesting that 3D-digitalized and-printed skulls can be used as tools in veterinary anatomy teaching.
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da Silveira EE, da Silva AF, Neto L, Sabino Pereira HC, Santos Ferreira J, Cesar Dos Santos A, Siviero F, da Fonseca R, de Assis Neto AC. Digitalização e Impressão Tridimensional de Crânio Canino como Ferramenta Educacional para Estudo Anatômico. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021; 48:774-780. [PMID: 34898395 DOI: 10.3138/jvme-2019-0132.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Este trabalho teve como objetivo padronizar a digitalização e impressão 3D de crânios de cães para uso educacional e avaliar a eficácia de modelos anatômicos impressos na disciplina de anatomia do curso de medicina veterinária. Os crânios foram selecionados para escaneamento e criação dos modelos impressos 3D modelados por fusão de deposição (FDM) utilizando acrilonitrila butadieno estireno. Após uma aula teórica sobre anatomia do crânio os modelos impressos 3D e os modelos reais do crânio de cães foram apresentados aos 140 alunos durante a aula prática de ossos. Uma avaliação prática de osteologia foi realizada após um mês que consistiu na identificação de estruturas anatômicas dos ossos do crânio identificados por alfinetes. Os alunos foram divididos em duas turmas para a realização da avaliação; o primeiro grupo fez os testes usando os crânios reais, enquanto o segundo grupo os crânios impressos 3D. O desempenho dos alunos foi avaliado conforme as suas performances no exame prático. No final da disciplina, eles foram convidados a responder a um breve questionário sobre suas experiências individuais. Os resultados do estudo demonstram que as estruturas anatômicas dos crânios impressos 3D eram semelhantes aos crânios reais. Não houve diferença significativa quando se analisou o grau de acertos e erros durante a realização do exame entre aqueles que identificaram as estruturas nos crânios reais ou nos impressos 3D. Conclui-se que é possível construir um acervo dinâmico digital e impresso tridimensional (3D) para estudos da anatomia comparada da espécie canina a partir de crânios reais, e que os crânios 3D podem ser usados como uma excelente ferramenta alternativa ao ensino na anatomia veterinária.
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Patera E, Rust PA. Creation of 3D anatomical models illustrating an intact and centrally torn triangular fibrocartilage complex for patient education prior treatment. Ann Anat 2021; 240:151854. [PMID: 34774665 DOI: 10.1016/j.aanat.2021.151854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The triangular fibrocartilage complex (TFCC) is a composite structure located in the human wrist and is made up from fibrocartilage and ligaments. It consists of eight distinct structures, with the ligamentous structures acting as the major stabilizer of the distal radioulnar joint and with the articular disc acting as a shock absorber at the ulnocarpal joint. The articular disc can be called the triangular fibrocartilage (TFC). Thus, traumatic injuries of the TFCC ligamentous structures cause instability of the joint and a centrally torn TFC disc causes ulnar sided wrist pain. TFCC pathologies can be difficult for patients to understand in clinic, due to their complex three-dimensional (3D) nature. The purpose of this study was to produce 3D anatomical models illustrating the normal anatomy of the wrist joint with the TFCC structure and a pathological model with a centrally torn TFC. These models would be used in a hand clinic to aid explanation of this complex three-dimensional anatomical structure and their injury to patients and trainee doctors. MATERIALS Three fresh frozen forearm and hand specimens were dissected, 3D scanned, 3D printed and painted. These models were introduced into a hand clinic to aid explanation of the complex anatomical structures, with the first 50 patients being asked, on a visual analog scale of 0-10, to state how much the models helped their understanding of the condition. RESULTS Three 3D printed anatomical models were produced to illustrate the (1) forearm muscles and wrist tendons, (2) an intact TFC and (3) a centrally torn TFC. 48 of 50 patients surveyed completed the scale, with an average rating of 8.7 increase in understanding with the models. CONCLUSION Patient education and understanding is crucial as it enhances decision making between surgeon and patient. These 3D anatomical models were shown to increase patient's understanding of the pathology. This should consequentially improve discussions on corresponding treatment options during consultation.
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Affiliation(s)
- Eleni Patera
- Anatomy, School of Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Philippa Ann Rust
- Anatomy, School of Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom; The Hooper Hand Unit, Department of Plastic Surgery, St John's Hospital, Livingston, United Kingdom
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26
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Xu W, Jambhulkar S, Ravichandran D, Zhu Y, Kakarla M, Nian Q, Azeredo B, Chen X, Jin K, Vernon B, Lott DG, Cornella JL, Shefi O, Miquelard-Garnier G, Yang Y, Song K. 3D Printing-Enabled Nanoparticle Alignment: A Review of Mechanisms and Applications. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2021; 17:e2100817. [PMID: 34176201 DOI: 10.1002/smll.202100817] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/05/2021] [Indexed: 05/12/2023]
Abstract
3D printing (additive manufacturing (AM)) has enormous potential for rapid tooling and mass production due to its design flexibility and significant reduction of the timeline from design to manufacturing. The current state-of-the-art in 3D printing focuses on material manufacturability and engineering applications. However, there still exists the bottleneck of low printing resolution and processing rates, especially when nanomaterials need tailorable orders at different scales. An interesting phenomenon is the preferential alignment of nanoparticles that enhance material properties. Therefore, this review emphasizes the landscape of nanoparticle alignment in the context of 3D printing. Herein, a brief overview of 3D printing is provided, followed by a comprehensive summary of the 3D printing-enabled nanoparticle alignment in well-established and in-house customized 3D printing mechanisms that can lead to selective deposition and preferential orientation of nanoparticles. Subsequently, it is listed that typical applications that utilized the properties of ordered nanoparticles (e.g., structural composites, heat conductors, chemo-resistive sensors, engineered surfaces, tissue scaffolds, and actuators based on structural and functional property improvement). This review's emphasis is on the particle alignment methodology and the performance of composites incorporating aligned nanoparticles. In the end, significant limitations of current 3D printing techniques are identified together with future perspectives.
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Affiliation(s)
- Weiheng Xu
- The Polytechnic School (TPS), Ira A. Fulton Schools for Engineering, Arizona State University, 6075 S. Innovation Way West, Mesa, AZ, 85212, USA
| | - Sayli Jambhulkar
- The Polytechnic School (TPS), Ira A. Fulton Schools for Engineering, Arizona State University, 6075 S. Innovation Way West, Mesa, AZ, 85212, USA
| | - Dharneedar Ravichandran
- The Polytechnic School (TPS), Ira A. Fulton Schools for Engineering, Arizona State University, 6075 S. Innovation Way West, Mesa, AZ, 85212, USA
| | - Yuxiang Zhu
- The Polytechnic School (TPS), Ira A. Fulton Schools for Engineering, Arizona State University, 6075 S. Innovation Way West, Mesa, AZ, 85212, USA
| | - Mounika Kakarla
- Department of Materials Science and Engineering, Ira A. Fulton Schools for Engineering, Arizona State University, Tempe, 501 E. Tyler Mall, Tempe, AZ, 85287, USA
| | - Qiong Nian
- Department of Mechanical Engineering, and Multi-Scale Manufacturing Material Processing Lab (MMMPL), Ira A. Fulton Schools for Engineering, Arizona State University, 501 E. Tyler Mall, Tempe, AZ, 85287, USA
| | - Bruno Azeredo
- The Polytechnic School (TPS), Ira A. Fulton Schools for Engineering, Arizona State University, 6075 S. Innovation Way West, Mesa, AZ, 85212, USA
| | - Xiangfan Chen
- Advanced Manufacturing and Functional Devices (AMFD) Laboratory, Ira A. Fulton Schools for Engineering, Arizona State University, 6075 Innovation Way W., Mesa, AZ, 85212, USA
| | - Kailong Jin
- Department of Chemical Engineering, School for Engineering Matter, Transport and Energy (SEMTE), and Biodesign Institute Center for Sustainable Macromolecular Materials and Manufacturing (BCSM3), Arizona State University, 501 E. Tyler St., Tempe, AZ, 85287, USA
| | - Brent Vernon
- Department of Biomedical Engineering, Biomaterials Lab, School of Biological and Health Systems Engineering, Arizona State University, 427 E Tyler Mall, Tempe, AZ, 85281, USA
| | - David G Lott
- Department Otolaryngology, Division of Laryngology, College of Medicine, and Mayo Clinic Arizona Center for Regenerative Medicine, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Jeffrey L Cornella
- Professor of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Division of Gynecologic Surgery, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Orit Shefi
- Department of Engineering, Neuro-Engineering and Regeneration Laboratory, Bar Ilan Institute of Nanotechnologies and Advanced Materials, Bar-Ilan University, Building 1105, Ramat Gan, 52900, Israel
| | - Guillaume Miquelard-Garnier
- laboratoire PIMM, UMR 8006, Arts et Métiers Institute of Technology, CNRS, CNAM, Hesam University, 151 boulevard de l'Hôpital, Paris, 75013, France
| | - Yang Yang
- Additive Manufacturing & Advanced Materials Lab, Department of Mechanical Engineering, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-1323, USA
| | - Kenan Song
- Department of Manufacturing Engineering, Advanced Materials Advanced Manufacturing Laboratory (AMAML), Ira A. Fulton Schools for Engineering, Arizona State University, 6075 Innovation Way W., Mesa, AZ, 85212, USA
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Guarino S, Marchese E, Ponticelli GS, Scerrati A, Tagliaferri V, Trovalusci F. Additive Manufacturing for Neurosurgery: Digital Light Processing of Individualized Patient-Specific Cerebral Aneurysms. MATERIALS 2021; 14:ma14206057. [PMID: 34683649 PMCID: PMC8539393 DOI: 10.3390/ma14206057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/25/2021] [Accepted: 10/07/2021] [Indexed: 12/27/2022]
Abstract
This study aims at demonstrating the feasibility of reproducing individualized patient-specific three-dimensional models of cerebral aneurysms by using the direct light processing (DLP) 3D printing technique in a low-time and inexpensive way. Such models were used to help neurosurgeons understand the anatomy of the aneurysms together with the surrounding vessels and their relationships, providing, therefore, a tangible supporting tool with which to train and plan surgical operations. The starting 3D models were obtained by processing the computed tomography angiographies and the digital subtraction angiographies of three patients. Then, a 3D DLP printer was used to print the models, and, if acceptable, on the basis of the neurosurgeon’s opinion, they were used for the planning of the neurosurgery operation and patient information. All the models were printed within three hours, providing a comprehensive representation of the cerebral aneurysms and the surrounding structures and improving the understanding of their anatomy and simplifying the planning of the surgical operation.
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Affiliation(s)
- Stefano Guarino
- Department of Engineering, University of Rome “Niccolò Cusano”, Via Don Carlo Gnocchi 3, 00166 Rome, Italy; (S.G.); (G.S.P.)
| | - Enrico Marchese
- Department of Neurosurgery, Catholic University of Rome, L.go A. Gemelli 8, 00100 Rome, Italy;
| | - Gennaro Salvatore Ponticelli
- Department of Engineering, University of Rome “Niccolò Cusano”, Via Don Carlo Gnocchi 3, 00166 Rome, Italy; (S.G.); (G.S.P.)
| | - Alba Scerrati
- Department of Transalational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
- Correspondence:
| | - Vincenzo Tagliaferri
- Department of Enterprise Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy; (V.T.); (F.T.)
| | - Federica Trovalusci
- Department of Enterprise Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy; (V.T.); (F.T.)
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Legnani E, Gallo P, Pezzotta F, Padelli F, Faragò G, Gioppo A, Gentili L, De Martin E, Fumagalli ML, Cavaliere F, Bruzzone MG, Milani P, Santaniello T. Additive Fabrication of a Vascular 3D Phantom for Stereotactic Radiosurgery of Arteriovenous Malformations. 3D PRINTING AND ADDITIVE MANUFACTURING 2021; 8:217-226. [PMID: 36654837 PMCID: PMC9828616 DOI: 10.1089/3dp.2020.0305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this study, an efficient methodology for manufacturing a realistic three-dimensional (3D) cerebrovascular phantom resembling a brain arteriovenous malformation (AVM) for applications in stereotactic radiosurgery is presented. The AVM vascular structure was 3D reconstructed from brain computed tomography (CT) data acquired from a patient. For the phantom fabrication, stereolithography was used to produce the AVM model and combined with silicone casting to mimic the brain parenchyma surrounding the vascular structure. This model was made with tissues-equivalent materials for radiology. The hollow vascular system of the phantom was filled with a contrast agent usually employed on patients for CT scans. The radiological response of the phantom was tested and compared with the one of the clinical case. The constructed model demonstrated to be a very accurate physical representation of the AVM and its vasculature and good morphological consistency was observed between the model and the patient-specific source anatomy. These results suggest that the proposed method has potential to be used to fabricate patient-specific phantoms for neurovascular radiosurgery applications and medical research.
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Affiliation(s)
- Elisa Legnani
- CIMAINA and Department of Physics, University of Milano, Milan, Italy
- Direct3D, Milan, Italy
| | - Pasqualina Gallo
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federico Pezzotta
- CIMAINA and Department of Physics, University of Milano, Milan, Italy
| | - Francesco Padelli
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Faragò
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Gioppo
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lorenzo Gentili
- CIMAINA and Department of Physics, University of Milano, Milan, Italy
| | - Elena De Martin
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | | | - Paolo Milani
- CIMAINA and Department of Physics, University of Milano, Milan, Italy
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Gosal JS, Tiwari S, Sharma T, Agrawal M, Garg M, Mahal S, Bhaskar S, Sharma RK, Janu V, Jha DK. Simulation of surgery for supratentorial gliomas in virtual reality using a 3D volume rendering technique: a poor man's neuronavigation. Neurosurg Focus 2021; 51:E23. [PMID: 34333461 DOI: 10.3171/2021.5.focus21236] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Different techniques of performing image-guided neurosurgery exist, namely, neuronavigation systems, intraoperative ultrasound, and intraoperative MRI, each with its limitations. Except for ultrasound, other methods are expensive. Three-dimensional virtual reconstruction and surgical simulation using 3D volume rendering (VR) is an economical and excellent technique for preoperative surgical planning and image-guided neurosurgery. In this article, the authors discuss several nuances of the 3D VR technique that have not yet been described. METHODS The authors included 6 patients with supratentorial gliomas who underwent surgery between January 2019 and March 2021. Preoperative clinical data, including patient demographics, preoperative planning details (done using the VR technique), and intraoperative details, including relevant photos and videos, were collected. RadiAnt software was used for generating virtual 3D images using the VR technique on a computer running Microsoft Windows. RESULTS The 3D VR technique assists in glioma surgery with a preoperative simulation of the skin incision and craniotomy, virtual cortical surface marking and navigation for deep-seated gliomas, preoperative visualization of morbid cortical surface and venous anatomy in surfacing gliomas, identifying the intervenous surgical corridor in both surfacing and deep-seated gliomas, and pre- and postoperative virtual 3D images highlighting the exact spatial geometric residual tumor location and extent of resection for low-grade gliomas (LGGs). CONCLUSIONS Image-guided neurosurgery with the 3D VR technique using RadiAnt software is an economical, easy-to-learn, and user-friendly method of simulating glioma surgery, especially in resource-constrained countries where expensive neuronavigation systems are not readily available. Apart from cortical sulci/gyri anatomy, FLAIR sequences are ideal for the 3D visualization of nonenhancing diffuse LGGs using the VR technique. In addition to cortical vessels (especially veins), contrast MRI sequences are perfect for the 3D visualization of contrast-enhancing high-grade gliomas.
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Affiliation(s)
| | - Sarbesh Tiwari
- 2Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | | | | | | | - Sayani Mahal
- 2Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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30
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McGuire LS, Fuentes A, Alaraj A. Three-Dimensional Modeling in Training, Simulation, and Surgical Planning in Open Vascular and Endovascular Neurosurgery: A Systematic Review of the Literature. World Neurosurg 2021; 154:53-63. [PMID: 34293525 DOI: 10.1016/j.wneu.2021.07.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The expanding use of three-dimensional (3D) printing in open vascular and endovascular neurosurgery presents a promising new tool in resident learning as well as operative planning. Recent studies have investigated the accuracy, efficacy, and practicality of 3D-printed models of patient-specific disease. OBJECTIVE To review the literature exploring 3D modeling in neurovascular and endovascular surgery for training, simulation, and surgical preparation. METHODS A systematic search of the PubMed database was conducted using keywords relating to 3D printing and neurovascular or endovascular surgery. Articles were manually screened to include those that focused on resident training, surgical simulation, or preoperative planning. Information on fabrication method, materials, cost, and validation measures was collected. RESULTS A total of 27 articles were identified that met inclusion criteria. Twenty-one studies used 3D printing to produce aneurysm models, 5 produced arteriovenous malformation models, and 1 produced aneurysm and arteriovenous malformation models. Stereolithography was the most common fabrication method used, with acrylonitrile butadiene styrene and VeroClearTangoPlus (Stratasys) being the most frequently used materials. The mean manufacturing cost per model was U.S. $624.83. Outcomes included model measurement accuracy, concordance of intraoperative devices with those selected preoperatively, and qualitative feedback. CONCLUSIONS Models generated by 3D printing are anatomically accurate and aid in resident learning as well as operative planning in open vascular and endovascular neurosurgery. As advancements in printing methods are made and manufacturing costs decrease, this tool may supplement training on a wider scale in a field in which direct exposure to cases is limited.
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Affiliation(s)
- Laura Stone McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Angelica Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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31
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Flaxman TE, Cooke CM, Miguel OX, Sheikh AM, Singh SS. A review and guide to creating patient specific 3D printed anatomical models from MRI for benign gynecologic surgery. 3D Print Med 2021; 7:17. [PMID: 34224043 PMCID: PMC8256564 DOI: 10.1186/s41205-021-00107-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patient specific three-dimensional (3D) models can be derived from two-dimensional medical images, such as magnetic resonance (MR) images. 3D models have been shown to improve anatomical comprehension by providing more accurate assessments of anatomical volumes and better perspectives of structural orientations relative to adjacent structures. The clinical benefit of using patient specific 3D printed models have been highlighted in the fields of orthopaedics, cardiothoracics, and neurosurgery for the purpose of pre-surgical planning. However, reports on the clinical use of 3D printed models in the field of gynecology are limited. Main text This article aims to provide a brief overview of the principles of 3D printing and the steps required to derive patient-specific, anatomically accurate 3D printed models of gynecologic anatomy from MR images. Examples of 3D printed models for uterine fibroids and endometriosis are presented as well as a discussion on the barriers to clinical uptake and the future directions for 3D printing in the field of gynecological surgery. Conclusion Successful gynecologic surgery requires a thorough understanding of the patient’s anatomy and burden of disease. Future use of patient specific 3D printed models is encouraged so the clinical benefit can be better understood and evidence to support their use in standard of care can be provided.
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Affiliation(s)
- Teresa E Flaxman
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada. .,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Carly M Cooke
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Olivier X Miguel
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada.,Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Adnan M Sheikh
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada.,Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sukhbir S Singh
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
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32
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Bainier M, Su A, Redondo RL. 3D printed rodent skin-skull-brain model: A novel animal-free approach for neurosurgical training. PLoS One 2021; 16:e0253477. [PMID: 34161366 PMCID: PMC8221494 DOI: 10.1371/journal.pone.0253477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/06/2021] [Indexed: 11/18/2022] Open
Abstract
In neuroscience, stereotactic brain surgery is a standard yet challenging technique for which laboratory and veterinary personnel must be sufficiently and properly trained. There is currently no animal-free training option for neurosurgeries; stereotactic techniques are learned and practiced on dead animals. Here we have used three-dimensional (3D) printing technologies to create rat and mouse skin-skull-brain models, specifically conceived for rodent stereotaxic surgery training. We used 3D models obtained from microCT pictures and printed them using materials that would provide the most accurate haptic feedback for each model—PC-ABS material for the rat and Durable resin for the mouse. We filled the skulls with Polyurethane expanding foam to mimic the brain. In order to simulate rodent skin, we added a rectangular 1mm thick clear silicone sheet on the skull. Ten qualified rodent neurosurgeons then performed a variety of stereotaxic surgeries on these rat and mouse 3D printed models. Participants evaluated models fidelity compared to cadaveric skulls and their appropriateness for educational use. The 3D printed rat and mouse skin-skull-brain models received an overwhelmingly positive response. They were perceived as very realistic, and considered an excellent alternative to cadaveric skulls for training purposes. They can be made rapidly and at low cost. Our real-size 3D printed replicas could enable cost- and time-efficient, animal-free neurosurgery training. They can be absolute replacements for stereotaxic surgery techniques practice including but not limited to craniotomies, screw placement, brain injections, implantations and cement applications. This project is a significant step forward in implementing the replacement, reduction, and refinement (3Rs) principles to animal experimentation. These 3D printed models could lead the way to the complete replacement of live animals for stereotaxic surgery training in laboratories and veterinary studies.
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Affiliation(s)
- Marie Bainier
- Roche Pharmaceutical Research and Early Development (pRED), Neuroscience and Rare Diseases, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
- * E-mail:
| | - Arel Su
- Roche Pharmaceutical Research and Early Development (pRED), Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Roger L. Redondo
- Roche Pharmaceutical Research and Early Development (pRED), Neuroscience and Rare Diseases, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
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Small C, Nwafor D, Patel D, Dawoud F, Dagra A, Ciporen J, Lucke-Wold B. Crisis Management Simulation: Review of Current Experience. SUNTEXT REVIEW OF NEUROSCIENCE & PSYCHOLOGY 2021; 2:126. [PMID: 33928268 PMCID: PMC8081329 DOI: 10.51737/2766-4503.2021.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Crisis management simulation is important in training the next generation of surgeons. In this review, we highlight our experiences with the cavernous carotid injury model. We then delve into other crisis simulation models available for the neurosurgical specialty. The discussion focuses upon how these trainings can continue to evolve. Much work is yet to be done in this exciting arena and we present several avenues for future discovery. Simulation continues to be an important training tool for the surgical learner.
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Affiliation(s)
| | | | - Devan Patel
- College of Medicine, Florida State University
| | - Fakhry Dawoud
- College of Medicine, East Tennessee State University
| | | | - Jeremy Ciporen
- Department of Neurosurgery, Oregon Health and Science University
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Dho YS, Lee D, Ha T, Ji SY, Kim KM, Kang H, Kim MS, Kim JW, Cho WS, Kim YH, Kim YG, Park SJ, Park CK. Clinical application of patient-specific 3D printing brain tumor model production system for neurosurgery. Sci Rep 2021; 11:7005. [PMID: 33772092 PMCID: PMC7998007 DOI: 10.1038/s41598-021-86546-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/17/2021] [Indexed: 12/15/2022] Open
Abstract
The usefulness of 3-dimensional (3D)-printed disease models has been recognized in various medical fields. This study aims to introduce a production platform for patient-specific 3D-printed brain tumor model in clinical practice and evaluate its effectiveness. A full-cycle platform was created for the clinical application of a 3D-printed brain tumor model (3D-printed model) production system. Essential elements included automated segmentation software, cloud-based interactive communication tools, customized brain models with exquisite expression of brain anatomy in transparent material, adjunctive devices for surgical simulation, and swift process cycles to meet practical needs. A simulated clinical usefulness validation was conducted in which neurosurgeons assessed the usefulness of the 3D-printed models in 10 cases. We successfully produced clinically applicable patient-specific models within 4 days using the established platform. The simulated clinical usefulness validation results revealed the significant superiority of the 3D-printed models in surgical planning regarding surgical posture (p = 0.0147) and craniotomy design (p = 0.0072) compared to conventional magnetic resonance images. The benefit was more noticeable for neurosurgeons with less experience. We established a 3D-printed brain tumor model production system that is ready to use in daily clinical practice for neurosurgery.
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Affiliation(s)
- Yun-Sik Dho
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Doohee Lee
- MEDICALIP Co. Ltd., Changgyeong Building, 174, Yulgok-ro, Jongno-gu, Seoul, 03127, Republic of Korea
| | - Teahyun Ha
- MEDICALIP Co. Ltd., Changgyeong Building, 174, Yulgok-ro, Jongno-gu, Seoul, 03127, Republic of Korea
| | - So Young Ji
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyung Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Min-Sung Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Young Gyu Kim
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sang Joon Park
- MEDICALIP Co. Ltd., Changgyeong Building, 174, Yulgok-ro, Jongno-gu, Seoul, 03127, Republic of Korea. .,Department of Radiology, Seoul National University Hospital, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea.
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Thiong'o GM, Bernstein M, Drake JM. 3D printing in neurosurgery education: a review. 3D Print Med 2021; 7:9. [PMID: 33759067 PMCID: PMC7989093 DOI: 10.1186/s41205-021-00099-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/15/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The objectives of this manuscript were to review the literature concerning 3D printing of brain and cranial vault pathology and use these data to define the gaps in global utilization of 3D printing technology for neurosurgical education. METHODS Using specified criteria, literature searching was conducted to identify publications describing engineered neurosurgical simulators. Included in the study were manuscripts highlighting designs validated for neurosurgical skill transfer. Purely anatomical designs, lacking aspects of surgical simulation, were excluded. Eligible manuscripts were analyzed. Data on the types of simulators, representing the various modelled neurosurgical pathologies, were recorded. Authors' countries of affiliation were also recorded. RESULTS A total of thirty-six articles, representing ten countries in five continents were identified. Geographically, Africa as a continent was not represented in any of the publications. The simulation-modelling encompassed a variety of neurosurgical subspecialties including: vascular, skull base, ventriculoscopy / ventriculostomy, craniosynostosis, skull lesions / skull defects, intrinsic brain tumor and other. Finally, the vascular and skull base categories together accounted for over half (52.8 %) of the 3D printed simulated neurosurgical pathology. CONCLUSIONS Despite the growing body of literature supporting 3D printing in neurosurgical education, its full potential has not been maximized. Unexplored areas of 3D printing for neurosurgical simulation include models simulating the resection of intrinsic brain tumors or of epilepsy surgery lesions, as these require complex models to accurately simulate fine dissection techniques. 3D printed surgical phantoms offer an avenue for the advancement of global-surgery education initiatives.
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Affiliation(s)
- Grace M Thiong'o
- Center for Image Guided Innovation and Therapeutic Intervention, Toronto, Canada.
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Ontario, M5G 1X8, Toronto, Canada.
| | - Mark Bernstein
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Toronto, Canada
| | - James M Drake
- Center for Image Guided Innovation and Therapeutic Intervention, Toronto, Canada
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Ontario, M5G 1X8, Toronto, Canada
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Błaszczyk M, Jabbar R, Szmyd B, Radek M. 3D Printing of Rapid, Low-Cost and Patient-Specific Models of Brain Vasculature for Use in Preoperative Planning in Clipping of Intracranial Aneurysms. J Clin Med 2021; 10:jcm10061201. [PMID: 33805774 PMCID: PMC8000886 DOI: 10.3390/jcm10061201] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 12/23/2022] Open
Abstract
We developed a practical and cost-effective method of production of a 3D-printed model of the arterial Circle of Willis of patients treated because of an intracranial aneurysm. We present and explain the steps necessary to produce a 3D model from medical image data, and express the significant value such models have in patient-specific pre-operative planning as well as education. A Digital Imaging and Communications in Medicine (DICOM) viewer is used to create 3D visualization from a patient’s Computed Tomography Angiography (CTA) images. After generating the reconstruction, we manually remove the anatomical components that we wish to exclude from the print by utilizing tools provided with the imaging software. We then export this 3D reconstructions file into a Standard Triangulation Language (STL) file which is then run through a “Slicer” software to generate a G-code file for the printer. After the print is complete, the supports created during the printing process are removed manually. The 3D-printed models we created were of good accuracy and scale. The median production time used for the models described in this manuscript was 4.4 h (range: 3.9–4.5 h). Models were evaluated by neurosurgical teams at local hospital for quality and practicality for use in urgent and non-urgent care. We hope we have provided readers adequate insight into the equipment and software they would require to quickly produce their own accurate and cost-effective 3D models from CT angiography images. It has become quite clear to us that the cost-benefit ratio in the production of such a simplified model is worthwhile.
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Segaran N, Saini G, Mayer JL, Naidu S, Patel I, Alzubaidi S, Oklu R. Application of 3D Printing in Preoperative Planning. J Clin Med 2021; 10:jcm10050917. [PMID: 33652844 PMCID: PMC7956651 DOI: 10.3390/jcm10050917] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/07/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
Preoperative planning is critical for success in the surgical suite. Current techniques for surgical planning are limited; clinicians often rely on prior experience and medical imaging to guide the decision-making process. Furthermore, two-dimensional (2D) presentations of anatomical structures may not accurately portray their three-dimensional (3D) complexity, often leaving physicians ill-equipped for the procedure. Although 3D postprocessed images are an improvement on traditional 2D image sets, they are often inadequate for surgical simulation. Medical 3D printing is a rapidly expanding field and could provide an innovative solution to current constraints of preoperative planning. As 3D printing becomes more prevalent in medical settings, it is important that clinicians develop an understanding of the technologies, as well as its uses. Here, we review the fundamentals of 3D printing and key aspects of its workflow. The many applications of 3D printing for preoperative planning are discussed, along with their challenges.
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Affiliation(s)
- Nicole Segaran
- Minimally Invasive Therapeutics Laboratory, Department of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (N.S.); (G.S.)
| | - Gia Saini
- Minimally Invasive Therapeutics Laboratory, Department of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (N.S.); (G.S.)
| | - Joseph L. Mayer
- 3D Innovations Laboratory, Mayo Clinic Arizona, 5711 E. Mayo Blvd. Support Services Building, Phoenix, AZ 85054, USA;
| | - Sailen Naidu
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (S.N.); (I.P.); (S.A.)
| | - Indravadan Patel
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (S.N.); (I.P.); (S.A.)
| | - Sadeer Alzubaidi
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (S.N.); (I.P.); (S.A.)
| | - Rahmi Oklu
- Minimally Invasive Therapeutics Laboratory, Department of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (N.S.); (G.S.)
- 3D Innovations Laboratory, Mayo Clinic Arizona, 5711 E. Mayo Blvd. Support Services Building, Phoenix, AZ 85054, USA;
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (S.N.); (I.P.); (S.A.)
- Correspondence: ; Tel.: +1-480-342-5664
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Raza M, Murphy D, Gelfer Y. The effect of three-dimensional (3D) printing on quantitative and qualitative outcomes in paediatric orthopaedic osteotomies: a systematic review. EFORT Open Rev 2021; 6:130-138. [PMID: 33828856 PMCID: PMC8022016 DOI: 10.1302/2058-5241.6.200092] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Three-dimensional (3D) printing technology is increasingly being utilized in various surgical specialities. In paediatric orthopaedics it has been applied in the pre-operative and intra-operative stages, allowing complex deformities to be replicated and patient-specific instrumentation to be used. This systematic review analyses the literature on the effect of 3D printing on paediatric orthopaedic osteotomy outcomes.A systematic review of several databases was conducted according to PRISMA guidelines. Studies evaluating the use of 3D printing technology in orthopaedic osteotomy procedures in children (aged ≤ 16 years) were included. Spinal and bone tumour surgery were excluded. Data extracted included demographics, disease pathology, target bone, type of technology, imaging modality used, qualitative/quantitative outcomes and follow-up. Articles were further categorized as either 'pre-operative' or 'intra-operative' applications of the technology.Twenty-two articles fitting the inclusion criteria were included. The reported studies included 212 patients. There were five articles of level of evidence 3 and 17 level 4.A large variety of outcomes were reported with the most commonly used being operating time, fluoroscopic exposure and intra-operative blood loss.A significant difference in operative time, fluoroscopic exposure, blood loss and angular correction was found in the 'intra-operative' application group. No significant difference was found in the 'pre-operative' category.Despite a relatively low evidence base pool of studies, our aggregate data demonstrate a benefit of 3D printing technology in various deformity correction applications, especially when used in the 'intra-operative' setting. Further research including paediatric-specific core outcomes is required to determine the potential benefit of this novel addition. Cite this article: EFORT Open Rev 2021;6:130-138. DOI: 10.1302/2058-5241.6.200092.
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Affiliation(s)
- Mohsen Raza
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Daniel Murphy
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Yael Gelfer
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK.,St George's, University of London, London, UK
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Waqas M, Mokin M, Lim J, Vakharia K, Springer ME, Meess KM, Ducharme RW, Ionita CN, Nagesh SVS, Gutierrez LC, Snyder KV, Davies JM, Levy EI, Siddiqui AH. Design and Physical Properties of 3-Dimensional Printed Models Used for Neurointervention: A Systematic Review of the Literature. Neurosurgery 2021; 87:E445-E453. [PMID: 32392300 DOI: 10.1093/neuros/nyaa134] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 03/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) printing has revolutionized training, education, and device testing. Understanding the design and physical properties of 3D-printed models is important. OBJECTIVE To systematically review the design, physical properties, accuracy, and experimental outcomes of 3D-printed vascular models used in neurointervention. METHODS We conducted a systematic review of the literature between January 1, 2000 and September 30, 2018. Public/Publisher MEDLINE (PubMed), Web of Science, Compendex, Cochrane, and Inspec databases were searched using Medical Subject Heading terms for design and physical attributes of 3D-printed models for neurointervention. Information on design and physical properties like compliance, lubricity, flow system, accuracy, and outcome measures were collected. RESULTS A total of 23 articles were included. Nine studies described 3D-printed models for stroke intervention. Tango Plus (Stratasys) was the most common material used to develop these models. Four studies described a population-representative geometry model. All other studies reported patient-specific vascular geometry. Eight studies reported complete reconstruction of the circle of Willis, anterior, and posterior circulation. Four studies reported a model with extracranial vasculature. One prototype study reported compliance and lubricity. Reported circulation systems included manual flushing, programmable pistons, peristaltic, and pulsatile pumps. Outcomes included thrombolysis in cerebral infarction, post-thrombectomy flow restoration, surgical performance, and qualitative feedback. CONCLUSION Variations exist in the material, design, and extent of reconstruction of vasculature of 3D-printed models. There is a need for objective characterization of 3D-printed vascular models. We propose the development of population representative 3D-printed models for skill improvement or device testing.
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Affiliation(s)
- Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | | | | | | | - Ciprian N Ionita
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
| | - Swetadri Vasan Setlur Nagesh
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
| | - Liza C Gutierrez
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Jacobs Institute, Buffalo, New York.,Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Jacobs Institute, Buffalo, New York.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Jacobs Institute, Buffalo, New York.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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Shannon A, O'Connell A, O'Sullivan A, Byrne M, Clifford S, O'Sullivan KJ, O'Sullivan L. A Radiopaque Nanoparticle-Based Ink Using PolyJet 3D Printing for Medical Applications. 3D PRINTING AND ADDITIVE MANUFACTURING 2020; 7:259-268. [PMID: 36654671 PMCID: PMC9586492 DOI: 10.1089/3dp.2019.0160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The aim of this study was to develop a 3D printable radiopaque ink and successfully print a finished artifact. Radiopaque 3D printing would be hugely beneficial to improve the visibility of medical devices and implants, as well as allowing more realistic phantoms and calibration aids to be produced. Most 3D printing technologies are polymer based. Polymers are naturally radiolucent, allowing X-rays to pass through, showing up as faint dark gray regions on X-ray detectors, as for soft tissues. During this study, a 3D printable ultraviolet (UV) curable resin containing zirconium oxide (ZrO2) nanoparticles was developed. 5 wt.% ZrO2 was dispersed in a base resin using a high-shear mixer. Particles remained in suspension for 6-8 h at room temperature, allowing time for 3D printing. A model of a hand including radiopaque bones and a test block demonstrating a range of internal radiopaque features were successfully 3D printed. Radiopacity was demonstrated in the 3D-printed models, and there was good dispersion of ZrO2 within the resin matrix. The impregnated resin remained UV curable and viscosity was not compromised. In this study, 3D-printed radiopaque features demonstrated clear radiopacity under X-ray and microcomputed tomography imaging.
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Affiliation(s)
- Alice Shannon
- Design Factors Research Group, School of Design, University of Limerick, Limerick, Ireland
| | - Aine O'Connell
- Radiology Department, University Hospital Limerick, Limerick, Ireland
| | - Aidan O'Sullivan
- Design Factors Research Group, School of Design, University of Limerick, Limerick, Ireland
- Health Research Institute and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
| | - Michael Byrne
- School of Engineering, University of Limerick, Limerick, Ireland
| | - Seamus Clifford
- School of Engineering, University of Limerick, Limerick, Ireland
| | - Kevin J. O'Sullivan
- Design Factors Research Group, School of Design, University of Limerick, Limerick, Ireland
- Health Research Institute and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
| | - Leonard O'Sullivan
- Design Factors Research Group, School of Design, University of Limerick, Limerick, Ireland
- Health Research Institute and Confirm Smart Manufacturing Centre, University of Limerick, Limerick, Ireland
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Faraj MK, Hoz SS, Mohammad AJ. The use of three-dimensional anatomical patient-specific printed models in surgical clipping of intracranial aneurysm: A pilot study. Surg Neurol Int 2020; 11:381. [PMID: 33408915 PMCID: PMC7771404 DOI: 10.25259/sni_361_2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/22/2020] [Indexed: 11/04/2022] Open
Abstract
Background In the present study, we aim to develop simulation models based on computed tomography angiography images of intracranial aneurysms (IAs) and their parent vessels using three-dimensional (3D) printing technology. The study focuses on the value of these 3D models in presurgical planning and intraoperative navigation and ultimately their impact on patient outcomes. To the best of our knowledge, this is the first report of its kind from a war-torn country, like Iraq. Methods This is a prospective study of a series of 11, consecutively enrolled, patients suffering from IAs for the period between February and September 2019. The study represents a collaboration between the two major neurosurgical centers in Baghdad/Iraq; Neurosciences Teaching Hospital and Neurosurgery Teaching Hospital. We analyzed the data of eleven patients with IAs treated by microsurgical clipping. These data include patient demographics, clinical, surgical, and outcomes along with the data of the 3D-printed replica used in these surgeries. All cases were operated on by one surgeon. Results Our study included 11 patients, with a total of 11 aneurysms clipped. The mean age was 44 ± 8, with a median of 42.5 and a range of 35-61 years. About 60% of our patients were female with a female-to-male ratio of 1:5. About 60% of the aneurysms were located at the anterior communicating artery (Acom) while the remaining 40% were equally distributed between the posterior communicating and internal carotid arteries bifurcation. The standard pterional approach was followed in 50% of cases, whereas the other 50% of patients were treated through the lateral supraorbital approach. About 90% (n = 9) of the patients had a Glasgow Outcome Scale (GOS) of 5 and 10% had a GOS of 4. The 3D-printed models successfully replicated the aneurysm size, location, and relation to the parent vessel with 100% accuracy and were used for intraoperative guidance. The average production time was 24-48 h and the production cost was 10-20 US dollars. Conclusion 3D printing is a promising technology that is rapidly penetrating the field of neurosurgery. In particular, the use of 3D-printed patient-matched, anatomically accurate replicas of the cerebral vascular tree is valuable adjunct to the microsurgical clipping of IAs, and our study conclusions support this concept. However, both the feasibility and clinical utility of 3D printing remain the subject of much, ongoing investigations.
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Affiliation(s)
- Moneer K Faraj
- Department of Neurosurgery, College of Medicine, Neurosciences Hospital, University of Baghdad, Iraq
| | - Samer S Hoz
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
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Chytas D, Piagkou M, Salmas M, Johnson EO. Is Cadaveric Dissection The "Gold Standard" For Neuroanatomy Education? ANATOMICAL SCIENCES EDUCATION 2020; 13:804-805. [PMID: 32159930 DOI: 10.1002/ase.1957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/07/2020] [Accepted: 03/08/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Dimitrios Chytas
- Department of Anatomy, School of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elizabeth O Johnson
- Department of Anatomy, School of Medicine, European University of Cyprus, Nicosia, Cyprus
- Dean's Office, School of Medicine, European University of Cyprus, Nicosia, Cyprus
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Arnold J, Sarkar K, Smith D. 3D printed bismuth oxide-polylactic acid composites for radio-mimetic computed tomography spine phantoms. J Biomed Mater Res B Appl Biomater 2020; 109:789-796. [PMID: 33103853 DOI: 10.1002/jbm.b.34744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/03/2020] [Accepted: 10/12/2020] [Indexed: 11/08/2022]
Abstract
Polylactic acid (PLA) composite filaments with varying concentrations of bismuth oxide microparticle additives were fabricated for use with commercially available fused filament fabrication (FFF) printing systems for the production of spine phantoms that mimic the radiopacity of bone. Thermal analysis showed that the additives had limited impact on the glass transition temperature and melting point of the filaments, allowing for their use in commercial FFF systems with standard printer settings. The ultimate strength of the printed test specimens was found to reduce slightly when bismuth oxide was added in high concentrations, with a moderate reduction of 12% compared to PLA at the highest concentration of 30 wt%. The modulus of the specimens increased by up to 24% with the addition of the additive. The radiopacity of specimens printed with the composite filaments were measured by X-ray microcomputed tomography (micro-CT) and clinical computed tomography (CT). The CT number was found to increase by approximately 196 HU per wt% of bismuth oxide added to the filaments. A phantom model of a cervical spine deformity was successfully printed by FFF with a composite filament which was calibrated to mimic the radiopacity of cervical and cortical bone. The results indicate that the composite filaments have direct applicability for the production of phantoms used for education and preoperative planning.
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Affiliation(s)
- John Arnold
- Department of Mechanical Engineering, University of New Orleans, New Orleans, Louisiana, USA
| | - Korak Sarkar
- Ochsner Neurosciences Medical 3D Lab, Ochsner Health, New Orleans, Louisiana, USA
| | - Damon Smith
- Department of Mechanical Engineering, University of New Orleans, New Orleans, Louisiana, USA
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3D printing in pharmaceuticals: An emerging technology full of challenges. ANNALES PHARMACEUTIQUES FRANÇAISES 2020; 79:107-118. [PMID: 32853575 DOI: 10.1016/j.pharma.2020.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/28/2022]
Abstract
Although in its infancy, when compared with the other sectors, year 2005 marked the rapid evolution of 3 Dimensional printing (3DP) technologies in pharma sector with a huge potential in the dosage form designing and personalisation of the medication. 3DP is an innovative and highly promising way for the instant manufacturing in contrast with the tailored made conventional manufacturing. Various 3DP technologies are categorized into the various areas on the basis of the type of material used, deposition techniques and the solidification/fusion techniques. 3DP technologies have multiple pharmaceutical applications including formulation of the precise and unique dosage forms, medical research, personalization of medicine, tissues engineering and surgical application. In the present article, we have accentuated the comparative merits and demerits of various 3DP technologies used in the pharmaceutical sector. An insight in to the challenges, apropos availability and the choice of the excipients, as well as the printer, regulatory and safety concern of the product is provided.
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45
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Cogswell PM, Rischall MA, Alexander AE, Dickens HJ, Lanzino G, Morris JM. Intracranial vasculature 3D printing: review of techniques and manufacturing processes to inform clinical practice. 3D Print Med 2020; 6:18. [PMID: 32761490 PMCID: PMC7409717 DOI: 10.1186/s41205-020-00071-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background In recent years, three-dimensional (3D) printing has been increasingly applied to the intracranial vasculature for patient-specific surgical planning, training, education, and research. Unfortunately, though, much of the prior literature regarding 3D printing has focused on the end-product and not the process. In addition, for 3D printing/manufacturing to occur on a large scale, challenges and bottlenecks specific to each modeled anatomy must be overcome. Main body In this review article, limitations and considerations of each 3D printing processing step, as they relate to printing individual intracranial vasculature models and providing an active clinical service for a quaternary care center, are discussed. Relevant advantages and disadvantages of the available acquisition techniques (computed tomography, magnetic resonance, and digital subtraction angiography) are reviewed. Specific steps in segmentation, processing, and creation of a printable file may impede the workflow or degrade the fidelity of the printed model and are, therefore, given added attention. The various available printing techniques are compared with respect to printing the intracranial vasculature. Finally, applications are discussed, and a variety of example models are shown. Conclusion In this review we provide insight into the manufacturing of 3D models of the intracranial vasculature that may facilitate incorporation into or improve utility of 3D vascular models in clinical practice.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Matthew A Rischall
- Suburban Imaging, 4801 West 81st Street, Suite 108, Bloomington, MN, 55437, USA
| | - Amy E Alexander
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Hunter J Dickens
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jonathan M Morris
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Salmas M, Fiska A, Vassiou A, Demesticha T, Paraskevas G, Chytas D. Letter to the Editor Regarding "Recruiting Medical Students to Neurosurgery Through a Focused Neuroanatomy Lab Initiative". World Neurosurg 2020; 139:707. [PMID: 32689693 DOI: 10.1016/j.wneu.2020.04.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aliki Fiska
- Department of Anatomy, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Aikaterini Vassiou
- Department of Anatomy, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Theano Demesticha
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Paraskevas
- Department of Anatomy and Surgical Anatomy, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Chytas
- Department of Anatomy, School of Medicine, European University of Cyprus, Nicosia, Cyprus; 2(nd) Orthopedic Department, School of Medicine, National and Kapodistrian University of Athens, Nea Ionia, Greece.
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Karakas AB, Govsa F, Ozer MA, Eraslan C. 3D Brain Imaging in Vascular Segmentation of Cerebral Venous Sinuses. J Digit Imaging 2020; 32:314-321. [PMID: 30242780 DOI: 10.1007/s10278-018-0125-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The three-dimensional (3D) visualization of dural venous sinuses (DVS) networks is desired by surgical trainers to create a clear mental picture of the neuroanatomical orientation of the complex cerebral anatomy. Our purpose is to document those identified during routine 3D venography created through 3D models using two-dimensional axial images for teaching and learning neuroanatomy. Anatomical data were segmented and extracted from imaging of the DVS of healthy people. The digital data of the extracted anatomical surfaces was then edited and smoothed, resulting in a set of digital 3D models of the superior sagittal, inferior sagittal, transverse, and sigmoid, rectus sinuses, and internal jugular veins. A combination of 3D printing technology and casting processes led to the creation of realistic neuroanatomical models that include high-fidelity reproductions of the neuroanatomical features of DVS. The life-size DVS training models were provided good detail and representation of the spatial distances. Geometrical details between the neighboring of DVS could be easily manipulated and explored from different angles. A graspable, patient-specific, 3D-printed model of DVS geometry could provide an improved understanding of the complex brain anatomy. These models have various benefits such as the ability to adjust properties, to convert two-dimension images of the patient into three-dimension images, to have different color options, and to be economical. Neuroanatomy experts can model such as the reliability and validity of the designed models, enhance patient satisfaction with improved clinical examination, and demonstrate clinical interventions by simulation; thus, they teach neuroanatomy training with effective teaching styles.
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Affiliation(s)
- Asli Beril Karakas
- Digital Imaging and 3D Modelling Laboratory, Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Figen Govsa
- Digital Imaging and 3D Modelling Laboratory, Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey.
- Department of Anatomy, Faculty of Medicine, Ege University, TR-35100, Izmir, Turkey.
| | - Mehmet Asım Ozer
- Digital Imaging and 3D Modelling Laboratory, Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Cenk Eraslan
- Department of Radiology Faculty of Medicine, Ege University, Izmir, Turkey
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Hales S, Tokita E, Neupane R, Ghosh U, Elder B, Wirthlin D, Kong YL. 3D printed nanomaterial-based electronic, biomedical, and bioelectronic devices. NANOTECHNOLOGY 2020; 31:172001. [PMID: 31805540 DOI: 10.1088/1361-6528/ab5f29] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The ability to seamlessly integrate functional materials into three-dimensional (3D) constructs has been of significant interest, as it can enable the creation of multifunctional devices. Such integration can be achieved with a multiscale, multi-material 3D printing strategy. This technology has enabled the creation of unique devices such as personalized tissue regenerative scaffolds, biomedical implants, 3D electronic devices, and bionic constructs which are challenging to realize with conventional manufacturing processes. In particular, the incorporation of nanomaterials into 3D printed devices can endow a wide range of constructs with tailorable mechanical, chemical, and electrical functionalities. This review highlights the advances and unique possibilities in the fabrication of novel electronic, biomedical, and bioelectronic devices that are realized by the synergistic integration of nanomaterials with 3D printing technologies.
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Affiliation(s)
- Samuel Hales
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT 84112, United States of America
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Clifton W, Damon A, Soares C, Nottmeier E, Pichelmann M. Investigation of a three-dimensional printed dynamic cervical spine model for anatomy and physiology education. Clin Anat 2020; 34:30-39. [PMID: 32315475 DOI: 10.1002/ca.23607] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Three-dimensional (3D) printing of anatomical structures is a growing method of education for students and medical trainees. These models are generally produced as static representations of gross surface anatomy. In order to create a model that provides educators with a tool for demonstration of kinematic and physiologic concepts in addition to surface anatomy, a high-resolution segmentation and 3D-printingtechnique was investigated for the creation of a dynamic educational model. METHODS An anonymized computed tomography scan of the cervical spine with a diagnosis of ossification of the posterior longitudinal ligament was acquired. Using a high-resolution thresholding technique, the individual facet and intervertebral spaces were separated, and models of the C3-7 vertebrae were 3D-printed. The models were placed on a myelography simulator and subjected to flexion and extension under fluoroscopy, and measurements of the spinal canal diameter were recorded and compared to in-vivo measurements. The flexible 3D-printed model was then compared to a static 3D-printed model to determine the educational benefit of demonstrating physiologic concepts. RESULTS The canal diameter changes on the flexible 3D-printed model accurately reflected in-vivo measurements during dynamic positioning. The flexible model also was also more successful in teaching the physiologic concepts of spinal canal changes during flexion and extension than the static 3D-printed model to a cohort of learners. CONCLUSIONS Dynamic 3D-printed models can provide educators with a cost-effective and novel educational tool for not just instruction of surface anatomy, but also physiologic concepts through 3D ex-vivo modeling of case-specific physiologic and pathologic conditions.
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Affiliation(s)
- William Clifton
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Aaron Damon
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Christy Soares
- Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Eric Nottmeier
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Mark Pichelmann
- Department of Neurosurgery, Mayo Clinic Health Systems, Eau Claire, Wisconsin, USA
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Environmental and Economic Analysis of FDM, SLS and MJF Additive Manufacturing Technologies. MATERIALS 2019; 12:ma12244161. [PMID: 31835783 PMCID: PMC6947159 DOI: 10.3390/ma12244161] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/24/2019] [Accepted: 12/06/2019] [Indexed: 12/24/2022]
Abstract
In this study, the authors present a comparative analysis of different additive manufacturing (AM) technologies for high-performance components. Four 3D printers, currently available on the Italian national manufacturing market and belonging to three different AM technologies, were considered. The analysis focused on technical aspects to highlight the characteristics and performance limits of each technology, economic aspects to allow for an assessment of the costs associated with the different processes, and environmental aspects to focus on the impact of the production cycles associated with these technologies on the ecosystem, resources and human health. This study highlighted the current limits of additive manufacturing technologies in terms of production capacity in the case of large-scale production of plastic components, especially large ones. At the same time, this study highlights how the geometry of the object to be developed greatly influences the optimal choice between the various AM technologies, in both technological and economic terms. Fused deposition modeling (FDM) is the technology that exhibits the greatest limitations hindering mass production due to production times and costs, but also due to the associated environmental impact.
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