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Foresti R, Fornasari A, Bianchini Massoni C, Mersanne A, Martini C, Cabrini E, Freyrie A, Perini P. Surgical Medical Education via 3D Bioprinting: Modular System for Endovascular Training. Bioengineering (Basel) 2024; 11:197. [PMID: 38391683 PMCID: PMC10886183 DOI: 10.3390/bioengineering11020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
There is currently a shift in surgical training from traditional methods to simulation-based approaches, recognizing the necessity of more effective and controlled learning environments. This study introduces a completely new 3D-printed modular system for endovascular surgery training (M-SET), developed to allow various difficulty levels. Its design was based on computed tomography angiographies from real patient data with femoro-popliteal lesions. The study aimed to explore the integration of simulation training via a 3D model into the surgical training curriculum and its effect on their performance. Our preliminary study included 12 volunteer trainees randomized 1:1 into the standard simulation (SS) group (3 stepwise difficulty training sessions) and the random simulation (RS) group (random difficulty of the M-SET). A senior surgeon evaluated and timed the final training session. Feedback reports were assessed through the Student Satisfaction and Self-Confidence in Learning Scale. The SS group completed the training sessions in about half time (23.13 ± 9.2 min vs. 44.6 ± 12.8 min). Trainees expressed high satisfaction with the training program supported by the M-SET. Our 3D-printed modular training model meets the current need for new endovascular training approaches, offering a customizable, accessible, and effective simulation-based educational program with the aim of reducing the time required to reach a high level of practical skills.
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Affiliation(s)
- Ruben Foresti
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Center of Excellence for Toxicological Research (CERT), University of Parma, 43126 Parma, Italy
- Italian National Research Council, Institute of Materials for Electronics and Magnetism (CNR-IMEM), 43124 Parma, Italy
| | - Anna Fornasari
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Claudio Bianchini Massoni
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Arianna Mersanne
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Chiara Martini
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Diagnostic Department, University-Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Elisa Cabrini
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Antonio Freyrie
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Paolo Perini
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
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Oh M, Ban J, Lee Y, Lee M, Kim S, Kim U, Park J, Han J, Chang J, Kim B, Yun H, Lee N, Chang D. Development of three-dimensional canine hepatic tumor model based on computed tomographic angiography for simulation of transarterial embolization. Front Vet Sci 2024; 10:1280028. [PMID: 38352169 PMCID: PMC10861713 DOI: 10.3389/fvets.2023.1280028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/13/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction Transarterial embolization (TAE) is one of the treatment options for liver masses that are not suitable for surgery and they have been applied in veterinary medicine for about 20 years, but surgical resection is considered as the first treatment option, and only a few case reports and articles about TAE in dogs have been published. Although understanding of vascular anatomy for the procedure is important, previous studies lack of the information about hepatic artery anatomy in small and toy-breed dogs. Due to the introduction of 3D print in veterinary medicine, it is now possible to make 3D models for preoperative planning. The purpose of this study is to understand the hepatic arterial vascular structure of various sizes and breeds of dogs, and to develop 3D-printed canine artery models with and without hepatic tumors to simulate TAE procedure. Methods CT images of a total of 84 dogs with normal hepatic arteries were analyzed, and the mean value and standard deviation of body weight, celiac artery size, and hepatic artery size were 6.47 ± 4.44 kg, 3.28 ± 0.77 mm, and 2.14 ± 0.43 mm, respectively. Results It was established that type 2-2-1, which has two separate hepatic branches-the right medial and left branch and the right lateral branch that runs to the right lateral lobe and caudate process-is the most prevalent of the hepatic artery branch types, as it was in the previous study. The review of 65 CT images of dogs with hepatic tumors showed that 44.6% (29/65) had multifocal lesions in multiple lobes, for which TAE can be recommended. Discussion Based on the result, a 3D model of the normal canine hepatic artery and the hepatic tumor was made using one representative case from each group, and despite the models having some limitations in reflecting the exact tactile and velocity of blood vessels, TAE procedure was successfully simulated using both models.
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Affiliation(s)
- Miju Oh
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jiyoung Ban
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Yooyoung Lee
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Minju Lee
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Sojin Kim
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Uhjin Kim
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jiwoon Park
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jaepung Han
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jinhwa Chang
- Korea Animal Medical Center, Cheongju, Republic of Korea
| | - Byungjin Kim
- Bon Animal Medical Center, Suwon, Republic of Korea
| | - Hyeongrok Yun
- SKY Animal Medical Center, Cheonan, Republic of Korea
| | - Namsoon Lee
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Dongwoo Chang
- Section of Veterinary Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
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Lee J, Chadalavada SC, Ghodadra A, Ali A, Arribas EM, Chepelev L, Ionita CN, Ravi P, Ryan JR, Santiago L, Wake N, Sheikh AM, Rybicki FJ, Ballard DH. Clinical situations for which 3D Printing is considered an appropriate representation or extension of data contained in a medical imaging examination: vascular conditions. 3D Print Med 2023; 9:34. [PMID: 38032479 PMCID: PMC10688120 DOI: 10.1186/s41205-023-00196-6] [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: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Medical three-dimensional (3D) printing has demonstrated utility and value in anatomic models for vascular conditions. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (3DPSIG) provides appropriateness recommendations for vascular 3D printing indications. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with vascular indications. Each study was vetted by the authors and strength of evidence was assessed according to published appropriateness ratings. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for the following areas: aneurysm, dissection, extremity vascular disease, other arterial diseases, acute venous thromboembolic disease, venous disorders, lymphedema, congenital vascular malformations, vascular trauma, vascular tumors, visceral vasculature for surgical planning, dialysis access, vascular research/development and modeling, and other vasculopathy. Recommendations are provided in accordance with strength of evidence of publications corresponding to each vascular condition combined with expert opinion from members of the 3DPSIG. CONCLUSION This consensus appropriateness ratings document, created by the members of the 3DPSIG, provides an updated reference for clinical standards of 3D printing for the care of patients with vascular conditions.
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Affiliation(s)
- Joonhyuk Lee
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | - Anish Ghodadra
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | - Elsa M Arribas
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leonid Chepelev
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | - Prashanth Ravi
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Justin R Ryan
- Webster Foundation 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, USA
- Department of Neurological Surgery, University of California San Diego Health, San Diego, CA, USA
| | - Lumarie Santiago
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Adnan M Sheikh
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Arizona - Phoenix, Phoenix, AZ, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Mohanadas HP, Nair V, Doctor AA, Faudzi AAM, Tucker N, Ismail AF, Ramakrishna S, Saidin S, Jaganathan SK. A Systematic Analysis of Additive Manufacturing Techniques in the Bioengineering of In Vitro Cardiovascular Models. Ann Biomed Eng 2023; 51:2365-2383. [PMID: 37466879 PMCID: PMC10598155 DOI: 10.1007/s10439-023-03322-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
Additive Manufacturing is noted for ease of product customization and short production run cost-effectiveness. As our global population approaches 8 billion, additive manufacturing has a future in maintaining and improving average human life expectancy for the same reasons that it has advantaged general manufacturing. In recent years, additive manufacturing has been applied to tissue engineering, regenerative medicine, and drug delivery. Additive Manufacturing combined with tissue engineering and biocompatibility studies offers future opportunities for various complex cardiovascular implants and surgeries. This paper is a comprehensive overview of current technological advancements in additive manufacturing with potential for cardiovascular application. The current limitations and prospects of the technology for cardiovascular applications are explored and evaluated.
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Affiliation(s)
| | - Vivek Nair
- Computational Fluid Dynamics (CFD) Lab, Mechanical and Aerospace Engineering, University of Texas Arlington, Arlington, TX, 76010, USA
| | | | - Ahmad Athif Mohd Faudzi
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia
| | - Nick Tucker
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Ahmad Fauzi Ismail
- School of Chemical and Energy Engineering, Advanced Membrane Technology Research Centre (AMTEC), Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, Center for Nanofibers & Nanotechnology Initiative, National University of Singapore, Singapore, Singapore
| | - Syafiqah Saidin
- IJNUTM Cardiovascular Engineering Centre, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
| | - Saravana Kumar Jaganathan
- Faculty of Engineering, School of Electrical Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia.
- Centre for Artificial Intelligence and Robotics, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia.
- School of Engineering, College of Science, Brayford Pool, Lincoln, LN6 7TS, UK.
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Kreiser K, Sollmann N, Renz M. Importance and potential of simulation training in interventional radiology. ROFO-FORTSCHR RONTG 2023; 195:883-889. [PMID: 37137320 DOI: 10.1055/a-2066-8009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Simulation training is a common method in many medical disciplines and is used to teach content knowledge, manual skills, and team skills without potential patient danger. METHODS Simulation models and methods in interventional radiology are explained. Strengths and weaknesses of both simulators for non-vascular and vascular radiological interventions are highlighted and necessary future developments are addressed. RESULTS Both custom-made and commercially available phantoms are available for non-vascular interventions. Interventions are performed under ultrasound guidance, with computed tomography assistance, or using mixed-reality methods. The wear and tear of physical phantoms can be countered with in-house production of 3D-printed models. Vascular interventions can be trained on silicone models or hightech simulators. Increasingly, patient-specific anatomies are replicated and simulated pre-intervention. The level of evidence of all procedures is low. CONCLUSION Numerous simulation methods are available in interventional radiology. Training on silicone models and hightech simulators for vascular interventions has the potential to reduce procedural time. This is associated with reduced radiation dose for both patient and physician, which can also contribute to improved patient outcome, at least in endovascular stroke treatment. Although a higher level of evidence should be achieved, simulation training should already be integrated into the guidelines of the professional societies and accordingly into the curricula of the radiology departments. KEY POINTS · There are numerous simulation methods for nonvascular and vascular radiologic interventions.. · Puncture models can be purchased commercially or made using 3D printing.. · Silicone models and hightech simulators allow patient-specific training.. · Simulation training reduces intervention time, benefiting both the patient and the physician.. · A higher level of evidence is possible via proof of reduced procedural times.. CITATION FORMAT · Kreiser K, Sollmann N, Renz M. Importance and potential of simulation training in interventional radiology. Fortschr Röntgenstr 2023; 195: 883 - 889.
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Affiliation(s)
- Kornelia Kreiser
- RKU, Department of Neuroradiology, University Hospital Ulm, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Martin Renz
- Departement of Diagnostic and Interventional Neuroradiology, Technical University of Munich Hospital Rechts der Isar, Munchen, Germany
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Richards L, Dalla S, Fitzgerald S, Walter C, Ash R, Miller K, Alli A, Rohr A. Utilizing 3D printing to assist pre-procedure planning of transjugular intrahepatic portosystemic shunt (TIPS) procedures: a pilot study. 3D Print Med 2023; 9:10. [PMID: 37052816 PMCID: PMC10099647 DOI: 10.1186/s41205-023-00176-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND 3D (three-dimensional) printing has been adopted by the medical community in several ways, procedure planning being one example. This application of technology has been adopted by several subspecialties including interventional radiology, however the planning of transjugular intrahepatic portosystemic shunt (TIPS) placement has not yet been described. The impact of a 3D printed model on procedural measures such as procedure time, radiation exposure, intravascular contrast dosage, fluoroscopy time, and provider confidence has also not been reported. METHODS This pilot study utilized a quasi-experimental design including patients who underwent TIPS. For the control group, retrospective data was collected on patients who received a TIPS prior to Oct 1, 2020. For the experimental group, patient-specific 3D printed models were integrated in the care of patients that received TIPS between Oct 1, 2020 and April 15, 2021. Data was collected on patient demographics and procedural measures. The interventionalists were surveyed on their confidence level and model usage following each procedure in the experimental group. RESULTS 3D printed models were created for six TIPS. Procedure time (p = 0.93), fluoroscopy time (p = 0.26), and intravascular contrast dosage (p = 0.75) did not have significant difference between groups. Mean radiation exposure was 808.8 mGy in the group with a model compared to 1731.7 mGy without, however this was also not statistically significant (p = 0.09). Out of 11 survey responses from interventionists, 10 reported "increased" or "significantly increased" confidence after reviewing the 3D printed model and all responded that the models were a valuable tool for trainees. CONCLUSIONS 3D printed models of patient anatomy can consistently be made using consumer-level, desktop 3D printing technology. This study was not adequately powered to measure the impact that including 3D printed models in the planning of TIPS procedures may have on procedural measures. The majority of interventionists reported that patient-specific models were valuable tools for teaching trainees and that confidence levels increased as a result of model inclusion in procedure planning.
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Affiliation(s)
- Lucas Richards
- University of Kansas School of Medicine, 3901 Rainbow Boulevard, 66160, Kansas City, KS, USA.
| | - Shiv Dalla
- University of Kansas School of Medicine, 3901 Rainbow Boulevard, 66160, Kansas City, KS, USA
| | - Sharon Fitzgerald
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1008, 66160, Kansas City, KS, USA
| | - Carissa Walter
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 4032, 66160, Kansas City, KS, USA
| | - Ryan Ash
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 4032, 66160, Kansas City, KS, USA
| | - Kirk Miller
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 4032, 66160, Kansas City, KS, USA
| | - Adam Alli
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 4032, 66160, Kansas City, KS, USA
| | - Aaron Rohr
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 4032, 66160, Kansas City, KS, USA
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Mechanical Properties of a 3 Dimensional-Printed Transparent Flexible Resin Used for Vascular Model Simulation Compared with Those of Porcine Arteries. J Vasc Interv Radiol 2023; 34:871-878.e3. [PMID: 36646207 DOI: 10.1016/j.jvir.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To develop a vascular intervention simulation model that replicates the characteristics of a human patient and to compare the mechanical properties of a 3-dimensional (3D)-printed transparent flexible resin with those of porcine arteries using the elastic modulus (E) and kinetic friction coefficient (μk). MATERIALS AND METHODS Resin plates were created from a transparent flexible resin using a 3D printer. Porcine artery plates were prepared by excising the aorta. E values and the adhesive strengths of the resin and arterial surfaces toward a polyethylene plate, were measured with a tensile-compressive mechanical tester. Resin transparency was measured using an ultraviolet-visible light spectrometer. The μk value of the resin plate surface after applying silicone spray for 1-5 seconds and that of the artery were measured using a translational friction tester. RESULTS E values differed significantly between the arteries and resin plates at each curing time (0.20 MPa ± 0.04 vs 8.53 MPa ± 2.37 for a curing time of 1 minute; P < .05). The resin was stiffer than the arteries, regardless of the curing times. The visible light transmittance and adhesive strength of the resin decreased as the curing time increased. The adhesive strength of the artery was the lowest. The μk value of the silicone-coated resin surface created by applying silicone for 2-3 seconds (thickness of the silicone layer, 1.6-2.0 μm) was comparable with that of the artery, indicating that the coating imparted a similar slippage to the resin as to the living artery. CONCLUSIONS A transparent flexible resin is useful for creating a transparent and slippery vascular model for vascular intervention simulation.
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Patient-Specific 3D-Print Extracranial Vascular Simulators and Infrared Imaging Platform for Diagnostic Cerebral Angiography Training. Healthcare (Basel) 2022; 10:healthcare10112277. [DOI: 10.3390/healthcare10112277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Tortuous aortic arch is always challenging for beginner neuro-interventionalists. Herein, we share our experience of using 3D-printed extracranial vascular simulators (VSs) and the infrared imaging platform (IRIP) in two training courses for diagnostic cerebral angiography in the past 4 years. A total of four full-scale patient-specific carotid-aortic-iliac models were fabricated, including one type I arch, one bovine variant, and two type III arches. With an angiography machine (AM) as the imaging platform for the practice and final test, the first course was held in March 2018 had 10 participants, including three first-year residents (R1), three second-year residents (R2), and four third-year residents (R3). With introduction of the IRIP as the imaging platform for practice, the second course in March 2022 had nine participants, including 3 R1s, 3 R2s, and 3 R3s. The total manipulation time (TMT) to complete type III aortic arch navigation was recorded. In the first course, the average TMT of the first trial was 13.1 min. Among 3 R1s and 3 R2s attending the second trial, the average TMT of the second trial was 3.4 min less than that of the first trial. In the second course using IRIP, the average TMT of the first and second trials was 6.7 min and 4.8 min, respectively. The TMT of the second trial (range 2.2~14.4 min; median 5.9 min) was significantly shorter than that of the first trial (range 3.6~18 min; median 8.7 min), regardless of whether AM or IRIP was used (p = 0.001). Compared with first trial, the TMT of the second trial was reduced by an average of 3.7 min for 6 R1s, which was significantly greater than the 1.7 min of R2 and R3 (p = 0.049). Patient-specific VSs with radiation-free IRIP could be a useful training platform for junior residents with little experience in neuroangiography.
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Innovation, disruptive Technologien und Transformation in der Gefäßchirurgie. GEFÄSSCHIRURGIE 2022. [DOI: 10.1007/s00772-022-00943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Morita R, Abo D, Soyama T, Imai T, Takahashi B, Yoshino Y, Kinota N, Hamaguchi H, Kameda T, Kudo K. Usefulness of preoperative simulation with patient-specific hollow vascular models for high-flow renal arteriovenous fistula embolization using a preloading coil-in-plug technique. Radiol Case Rep 2022; 17:3578-3586. [PMID: 35923334 PMCID: PMC9340117 DOI: 10.1016/j.radcr.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
The development of three-dimensional printers has facilitated the creation of patient-specific hollow vessel models. Preoperative simulations using these types of models have improved our ability to select appropriate devices and embolic materials before performing complex endovascular procedures. This report describes 2 cases of high-flow renal arteriovenous fistulas (r-AVFs) that were successfully treated via short-segment embolization using the preloading coil-in-plug (p-CIP) technique. To our knowledge, this is the first report of r-AVF being treated using the p-CIP technique. Our findings demonstrate that preoperative simulation has the potential to improve the safety and reliability of complex vascular embolization procedures.
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Affiliation(s)
- Ryo Morita
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
- Corresponding author.
| | - Daisuke Abo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Takeshi Soyama
- Department of Diagnostic and Interventional Radiology, Kushiro City General Hospital, 1-12 Shunkodai, Kushiro, Hokkaido, 085-0822, Japan
| | - Tetsuaki Imai
- Department of Neurosurgery, Hakodate Central General Hospital, 33-2 Honcho, Hakodate, Hokkaido, 040-8585, Japan
| | - Bunya Takahashi
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Yuki Yoshino
- Department of Radiology, Hakodate Municipal Hospital, 1-10-1 Minatocho, Hakodate, Hokkaido, 041-8680, Japan
| | - Naoya Kinota
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Hiroyuki Hamaguchi
- Department of Radiological Technology, Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Takuto Kameda
- Department of Radiological Technology, Hokkaido University Hospital, N-14, W-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Faculty of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N-14, W-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
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Kang J, Yang M, Kwon Y, Jeong C, Kim N, Heo S. Case report: Application of three-dimensional technologies for surgical treatment of portosystemic shunt with segmental caudal vena cava aplasia in two dogs. Front Vet Sci 2022; 9:973541. [PMID: 36032305 PMCID: PMC9411943 DOI: 10.3389/fvets.2022.973541] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
This case report describes the application of three-dimensional (3D) technologies for the surgical treatment of portosystemic shunt (PSS) with segmental caudal vena cava (CVC) aplasia. Two client-owned dogs were diagnosed with PSS along with segmental CVC aplasia using computed tomography. Through 3D volume and surface rendering, the vascular anatomic anomaly of each patient was identified in detail. A patient-specific 3D vascular model was used for preoperative planning. According to the plan established based on the 3D rendered image and printed model, shunt occlusion was performed using cellophane banding in the first case. An ameroid constrictor was used in the second case. Both patients showed good recovery without any clinical symptoms or complications. The use of 3D technologies in small animals has many advantages, and its use in vascular surgery, as in these cases, is also a therapeutic option worth considering.
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Affiliation(s)
- Jinsu Kang
- Department of Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan-si, South Korea
| | - Myungryul Yang
- Department of Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan-si, South Korea
| | - Yonghwan Kwon
- Department of Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan-si, South Korea
| | - Chorok Jeong
- Department of Internal Medicine, College of Veterinary Medicine, Jeonbuk National University, Iksan-si, South Korea
| | - Namsoo Kim
- Department of Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan-si, South Korea
| | - Suyoung Heo
- Department of Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan-si, South Korea
- *Correspondence: Suyoung Heo
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12
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Ganapathy A, Chen D, Elumalai A, Albers B, Tappa K, Jammalamadaka U, Hoegger MJ, Ballard DH. Guide for starting or optimizing a 3D printing clinical service. Methods 2022; 206:41-52. [PMID: 35964862 DOI: 10.1016/j.ymeth.2022.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022] Open
Abstract
Three-dimensional (3D) printing has applications in many fields and has gained substantial traction in medicine as a modality to transform two-dimensional scans into three-dimensional renderings. Patient-specific 3D printed models have direct patient care uses in surgical and procedural specialties, allowing for increased precision and accuracy in developing treatment plans and guiding surgeries. Medical applications include surgical planning, surgical guides, patient and trainee education, and implant fabrication. 3D printing workflow for a laboratory or clinical service that produces anatomic models and guides includes optimizing imaging acquisition and post-processing, segmenting the imaging, and printing the model. Quality assurance considerations include supervising medical imaging expert radiologists' guidance and self-implementing in-house quality control programs. The purpose of this review is to provide a workflow and guide for starting or optimizing laboratories and clinical services that 3D-print anatomic models or guides for clinical use.
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Affiliation(s)
- Aravinda Ganapathy
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - David Chen
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Anusha Elumalai
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Brian Albers
- 3D Printing Center, Barnes Jewish Hospital, St. Louis, MO, USA.
| | - Karthik Tappa
- Anatomic 3D Printing and Visualization Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | - Mark J Hoegger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - David H Ballard
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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13
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Kaufmann R, Zech CJ, Takes M, Brantner P, Thieringer F, Deutschmann M, Hergan K, Scharinger B, Hecht S, Rezar R, Wernly B, Meissnitzer M. Vascular 3D Printing with a Novel Biological Tissue Mimicking Resin for Patient-Specific Procedure Simulations in Interventional Radiology: a Feasibility Study. J Digit Imaging 2022; 35:9-20. [PMID: 34997376 PMCID: PMC8854516 DOI: 10.1007/s10278-021-00553-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 10/31/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022] Open
Abstract
Three-dimensional (3D) printing of vascular structures is of special interest for procedure simulations in Interventional Radiology, but remains due to the complexity of the vascular system and the lack of biological tissue mimicking 3D printing materials a technical challenge. In this study, the technical feasibility, accuracy, and usability of a recently introduced silicone-like resin were evaluated for endovascular procedure simulations and technically compared to a commonly used standard clear resin. Fifty-four vascular models based on twenty-seven consecutive embolization cases were fabricated from preinterventional CT scans and each model was checked for printing success and accuracy by CT-scanning and digital comparison to its original CT data. Median deltas (Δ) of luminal diameters were 0.35 mm for clear and 0.32 mm for flexible resin (216 measurements in total) with no significant differences (p > 0.05). Printing success was 85.2% for standard clear and 81.5% for the novel flexible resin. In conclusion, vascular 3D printing with silicone-like flexible resin was technically feasible and highly accurate. This is the first and largest consecutive case series of 3D-printed embolizations with a novel biological tissue mimicking material and is a promising next step in patient-specific procedure simulations in Interventional Radiology.
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Affiliation(s)
- R. Kaufmann
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Clinic of Radiology & Nuclear Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - C. J. Zech
- Clinic of Radiology & Nuclear Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - M. Takes
- Clinic of Radiology & Nuclear Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - P. Brantner
- Clinic of Radiology & Nuclear Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - F. Thieringer
- Clinic for Oral and Maxillofacial Surgery, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - M. Deutschmann
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - K. Hergan
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - B. Scharinger
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - S. Hecht
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - R. Rezar
- Clinic of Internal Medicine II, Department of Cardiology and Internal Intensive Care Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - B. Wernly
- Clinic of Internal Medicine II, Department of Cardiology and Internal Intensive Care Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - M. Meissnitzer
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
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Norris NG, Merritt WC, Becker TA. Application of nondestructive mechanical characterization testing for creating in vitro vessel models with material properties similar to human neurovasculature. J Biomed Mater Res A 2021; 110:612-622. [PMID: 34617389 DOI: 10.1002/jbm.a.37314] [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: 04/19/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/09/2022]
Abstract
Vessel models are a first step in developing endovascular medical devices. However, these models, often made from glass or silicone, do not accurately represent the mechanical properties of human vascular tissue, limiting their use to basic training and proof-of-concept testing. This study outlines methods to quantify human vascular tissue mechanical properties and synthetic biomaterials for creating representative vessel models. Human vascular tissue was assessed and compared to silicone and new UV-cured polymers (VC-A30) using the following eight mechanical tests: compressive, shear, tensile dynamic elastic modulus, Poisson's ratio, hardness, radial force, compliance, and lubricity. Half of these testing methods were nondestructive, allowing for multiple mechanical and histological characterizations of the same human tissue sample. Histological evaluation of the cellular and extracellular matrix of the human vessels verified that the dynamic moduli and Poison's ratio tests were nondestructive. Fluid absorption by VC-A30 showed statistically significant softening of mechanical properties, stabilizing after 4 days in phosphate-buffered saline (PBS). Human vasculature exhibited notably similar results to VC-A30 in five of eight mechanical tests (≤30% difference) versus two of eight for standard silicone (≤38% difference). Results show that VC-A30 provides a new option for 3D-printing translucent in vitro vascular models with anatomically relevant mechanical properties. These new vessel analogs may simulate patient-specific vessel disease states, improve surgical training models, accelerate new endovascular device developments, and ultimately reduce the need for animal models.
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Affiliation(s)
- Nicholas G Norris
- Mechanical Engineering, Northern Arizona University, Flagstaff, Arizona, USA
| | - William C Merritt
- Mechanical Engineering, Northern Arizona University, Flagstaff, Arizona, USA
| | - Timothy A Becker
- Mechanical Engineering, Northern Arizona University, Flagstaff, Arizona, USA
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15
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Domsta V, Seidlitz A. 3D-Printing of Drug-Eluting Implants: An Overview of the Current Developments Described in the Literature. Molecules 2021; 26:4066. [PMID: 34279405 PMCID: PMC8272161 DOI: 10.3390/molecules26134066] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/15/2023] Open
Abstract
The usage of 3D-printing for drug-eluting implants combines the advantages of a targeted local drug therapy over longer periods of time at the precise location of the disease with a manufacturing technique that easily allows modifications of the implant shape to comply with the individual needs of each patient. Research until now has been focused on several aspects of this topic such as 3D-printing with different materials or printing techniques to achieve implants with different shapes, mechanical properties or release profiles. This review is intended to provide an overview of the developments currently described in the literature. The topic is very multifaceted and several of the investigated aspects are not related to just one type of application. Consequently, this overview deals with the topic of 3D-printed drug-eluting implants in the application fields of stents and catheters, gynecological devices, devices for bone treatment and surgical screws, antitumoral devices and surgical meshes, as well as other devices with either simple or complex geometry. Overall, the current findings highlight the great potential of the manufacturing of drug-eluting implants via 3D-printing technology for advanced individualized medicine despite remaining challenges such as the regulatory approval of individualized implants.
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Affiliation(s)
- Vanessa Domsta
- Department of Biopharmacy and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Center of Drug Absorption and Transport, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
| | - Anne Seidlitz
- Department of Biopharmacy and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Center of Drug Absorption and Transport, Felix-Hausdorff-Str. 3, 17487 Greifswald, Germany
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16
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Haleem A, Javaid M, Suman R, Singh RP. 3D Printing Applications for Radiology: An Overview. Indian J Radiol Imaging 2021; 31:10-17. [PMID: 34316106 PMCID: PMC8299499 DOI: 10.1055/s-0041-1729129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Three-dimensional (3D) printing technologies are part of additive manufacturing processes and are used to manufacture a 3D physical model from a digital computer-aided design model as per the required shape and size. These technologies are now used for advanced radiology applications by providing all information through 3D physical model. It provides innovation in radiology for clinical applications, treatment planning, procedural simulation, medical and patient education. Radiological advancements have been made in diagnosis and communication through medical digital imaging techniques like computed tomography, magnetic resonance imaging. These images are converted into Digital Imaging and Communications in Medicine in Standard Triangulate Language file format, easily printable in 3D printing technologies. This 3D model provides in-depth information about pathologic and anatomic states. It is useful to create new opportunities related to patient care. This article discusses the potential of 3D printing technology in radiology. The steps involved in 3D printing for radiology are discussed diagrammatically, and finally identified 12 significant applications of 3D printing technology for radiology with a brief description. A radiologist can incorporate this technology to fulfil different challenges such as training, planning, guidelines, and better communications.
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Affiliation(s)
- Abid Haleem
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Mohd Javaid
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Rajiv Suman
- Department of Industrial and Production Engineering, G.B. Pant University of Agriculture and Technology, Pantnagar, Uttarakhand, India
| | - Ravi Pratap Singh
- Department of Industrial and Production Engineering, Dr. B. R. Ambedkar National Institute of Technology, Jalandhar, Punjab, India
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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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18
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Quality Control in 3D Printing: Accuracy Analysis of 3D-Printed Models of Patient-Specific Anatomy. MATERIALS 2021; 14:ma14041021. [PMID: 33670038 PMCID: PMC7926654 DOI: 10.3390/ma14041021] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023]
Abstract
As comparative data on the precision of 3D-printed anatomical models are sparse, the aim of this study was to evaluate the accuracy of 3D-printed models of vascular anatomy generated by two commonly used printing technologies. Thirty-five 3D models of large (aortic, wall thickness of 2 mm, n = 30) and small (coronary, wall thickness of 1.25 mm, n = 5) vessels printed with fused deposition modeling (FDM) (rigid, n = 20) and PolyJet (flexible, n = 15) technology were subjected to high-resolution CT scans. From the resulting DICOM (Digital Imaging and Communications in Medicine) dataset, an STL file was generated and wall thickness as well as surface congruency were compared with the original STL file using dedicated 3D engineering software. The mean wall thickness for the large-scale aortic models was 2.11 µm (+5%), and 1.26 µm (+0.8%) for the coronary models, resulting in an overall mean wall thickness of +5% for all 35 3D models when compared to the original STL file. The mean surface deviation was found to be +120 µm for all models, with +100 µm for the aortic and +180 µm for the coronary 3D models, respectively. Both printing technologies were found to conform with the currently set standards of accuracy (<1 mm), demonstrating that accurate 3D models of large and small vessel anatomy can be generated by both FDM and PolyJet printing technology using rigid and flexible polymers.
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Russo M, Koenigshofer M, Stoiber M, Werner P, Gross C, Kocher A, Laufer G, Moscato F, Andreas M. Advanced three-dimensionally engineered simulation model for aortic valve and proximal aorta procedures. Interact Cardiovasc Thorac Surg 2020; 30:887-895. [PMID: 32285105 DOI: 10.1093/icvts/ivaa026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 12/10/2019] [Accepted: 01/06/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES A 3-dimensionally (3D) engineered model for simulation of aortic valve and proximal aortic procedures is a reliable tool both for training young surgeons and for simulating complex cases. To achieve a realistic simulation, the artificial model should reproduce the angles and orientations of the cardiac structures based on the patient's anatomical condition, reproduce tissue mechanical characteristics and be easy to obtain and easy to use. The goal of the study was the production and validation of realistic training models, based on the patient's actual anatomical characteristics, to provide training for aortic valve procedures. METHODS An anatomical model was manufactured using 3D printing and silicone casting. The digital anatomical model was obtained by segmenting computed tomography imaging. The segmented geometrical images were processed and a casting mould was designed. The mould was manufactured on a 3D printer. Silicone was cast into the mould; after curing, the finished model was ready. The realistic reproduction was evaluated by mechanical hardness tests and a survey by cardiac surgeons. RESULTS Six 3D silicone models were produced that represented the patient's anatomy including aortic valve leaflets, aortic root with coronary ostia, ascending aorta and proximal arch. Aortic valve replacement was performed, and 100% of the participants evaluated the model in a survey as perfectly reproducing anatomy and surgical handling. CONCLUSIONS We produced a realistic, cost-effective simulator for training purposes and for simulation of complex surgical cases. The model reproduced the real angulation and orientation of the aortic structures inside the mediastinum, permitting a real-life simulation of the desired procedure. This model offers opportunities to simulate various surgical procedures.
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Affiliation(s)
- Marco Russo
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Koenigshofer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Martin Stoiber
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Paul Werner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Gross
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesco Moscato
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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20
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A Brush-Spin-Coating Method for Fabricating In Vitro Patient-Specific Vascular Models by Coupling 3D-Printing. Cardiovasc Eng Technol 2020; 12:200-214. [PMID: 33263929 DOI: 10.1007/s13239-020-00504-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/18/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE In vitro patient-specific flexible vascular models are helpful for understanding the haemodynamic changes before and after endovascular treatment and for effective training of neuroendovascular interventionalists. However, it is difficult to fabricate models of overall unified or controllable thickness using existing manufacturing methods. In this study, we developed an improved and easily implemented method by combining 3D printing and brush-spin-coating processes to produce a transparent silicone model of uniform or varied thickness. METHODS First, a water-soluble inner-skeleton model, based on clinical data, was printed on a 3D printer. The skeleton model was subsequently fixed in a single-axis-rotation machine to enable continuous coating of silicone, the thickness of which was manually controlled by adsorption and removal of excess silicone in a brush-spinning operation. After the silicone layer was solidified, the inner skeleton was further dissolved in a hot water bath, affording a transparent vascular model with real geometry. To verify the controllability of the coating thickness by using this method, a straight tube, an idealised aneurysm model, a patient-specific aortic arch model, and an abdominal aortic aneurysm model were manufactured. RESULTS The different thicknesses of the manufactured tubes could be well controlled, with the relative standard deviations being 5.6 and 8.1% for the straight and aneurysm tubes, respectively. Despite of the diameter changing from 33 to 20 mm in the patient-specific aorta, the thickness of the fabricated aortic model remains almost the same along the longitudinal direction with a lower standard deviation of 3.1%. In the more complex patient-specific abdominal aneurysm model, varied thicknesses were realized to mimic the measured data from the CT images, where the middle of the aneurysm was with 2 mm and abdominal aorta as well as the iliac arteries had the normal thickness of 2.3 mm. CONCLUSION Through the brush-spin-coating method, models of different sizes and complexity with prescribed thickness can be manufactured, which will be helpful for developing surgical treatment strategies or training neuroendovascular interventionalists.
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21
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Khural M, Gullipalli R, Dubrowski A. Evaluating the Use of a Generic Three-Dimensionally (3D) Printed Abdominal Aortic Aneurysm Model as an Adjunct Patient Education Tool. Cureus 2020; 12:e8533. [PMID: 32665880 PMCID: PMC7352734 DOI: 10.7759/cureus.8533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
An abdominal aortic aneurysm (AAA) is a serious medical condition that requires invasive surgery or endovascular treatment with stent grafts. This procedure is primarily carried out by vascular surgeons and interventional radiologists. Current methods of educating patients about their procedure have been inadequate, causing unnecessary stress in patients who have this condition and seek treatment. In this study, we evaluate a three-dimensionally (3D) printed AAA model to use as an adjunct patient education tool, thus allowing patients to make a more knowledgeable decision when providing informed consent. The physical attributes and realism of the model are evaluated through the use of a quantitative and qualitative survey completed by physicians at St. Clare’s Mercy Hospital in St. John’s, Newfoundland. These physicians are referred to as “Experts” in our study and also rate and comment on the necessity of having patient-specific versus generic 3D AAA models for patient education purposes. The aim of this study is to determine whether our 3D printed AAA model is ready to be used as an adjunct patient education tool and to seek suggestions for improvements that can be made in the model. Furthermore, having generic 3D AAA models would significantly decrease healthcare costs as compared to patient-specific models. Thus, we also investigate if generic models would suffice from the perspective of the physicians.
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Affiliation(s)
- Manveer Khural
- Medicine, Memorial University of Newfoundland, St. John's, CAN
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22
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Rynio P, Falkowski A, Witowski J, Kazimierczak A, Wójcik Ł, Gutowski P. Simulation and Training of Needle Puncture Procedure with a Patient-Specific 3D Printed Gluteal Artery Model. J Clin Med 2020; 9:jcm9030686. [PMID: 32143426 PMCID: PMC7141337 DOI: 10.3390/jcm9030686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022] Open
Abstract
The puncture of the gluteal artery (GA) is a rare and difficult procedure. Less experienced clinicians do not always have the opportunity to practice and prepare for it, which creates a need for novel training tools. We aimed to investigate the feasibility of developing a 3D-printed, patient-specific phantom of the GA and its surrounding tissues to determine the extent to which the model can be used as an aid in needle puncture planning, simulation, and training. Computed tomography angiography scans of a patient with an endoleak to an internal iliac artery aneurysm with no intravascular antegrade access were processed. The arterial system, including the superior GA with its division branches, and pelvic area bones were 3D printed. The 3D model was embedded in the buttocks-shaped, patient-specific mold and cast. The manufactured, life-sized phantom was used to simulate the GA puncture procedure and was validated by 13 endovascular specialists. The printed GA was visible in the fluoroscopy, allowing for a needle puncture procedure simulation. The contrast medium was administered, simulating a digital subtraction angiography. Participating doctors suggested that the model could make a significant impact on preprocedural planning and resident training programs. Although the results are promising, we recommend that further studies be used to adjust the design and assess its clinical value.
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Affiliation(s)
- Paweł Rynio
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (P.G.)
- Correspondence:
| | - Aleksander Falkowski
- Department of Radiology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.F.); (Ł.W.)
| | - Jan Witowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501 Kraków, Poland;
| | - Arkadiusz Kazimierczak
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (P.G.)
| | - Łukasz Wójcik
- Department of Radiology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.F.); (Ł.W.)
| | - Piotr Gutowski
- Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (P.G.)
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Shibata E, Takao H, Amemiya S, Ohtomo K, Abe O. Embolization of visceral arterial aneurysms: Simulation with 3D-printed models. Vascular 2020; 28:259-266. [PMID: 31955665 PMCID: PMC7294531 DOI: 10.1177/1708538119900834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectives The present technical article aimed to describe the efficacy of three-dimensional (3D)-printed hollow vascular models as a tool in the preoperative simulation of endovascular embolization of visceral artery aneurysms. Methods From November 2015 to November 2016, four consecutive endovascular treatments of true visceral artery aneurysms were preoperatively simulated with 3D-printed hollow models. The mean age of the patients (one male and three females) was 54 (range: 40–71) years. Three patients presented with splenic artery aneurysm and one with anterior pancreaticoduodenal artery aneurysm. The average diameter of the aneurysms was 16.5 (range: 10–25) mm. The 3D-printed hollow models of the visceral artery aneurysms and involved arteries were created using computed tomography angiography data of the patients. After establishing treatment plans by simulations with the 3D-printed models, all patients received endovascular treatment. Results All four hollow aneurysm models were successfully fabricated and used in the preoperative simulation of endovascular treatment. In the preoperative simulations with 3D-printed hollow models, splenic aneurysms were embolized with coils and/or n-butyl-2-cyanoacrylate to establish the actual treatment plans, and a small arterial branch originating from an anterior pancreaticoduodenal artery aneurysm was selected to obtain feedback regarding the behavior of catheters and guidewires. After establishing treatment plans by simulations, the visceral artery aneurysms of all patients were successfully embolized without major complications and recanalization. Conclusions Simulation with 3D-printed hollow models can help establish an optimal treatment plan and may improve the safety and efficacy of endovascular treatment for visceral artery aneurysms.
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Affiliation(s)
- Eisuke Shibata
- Department of Radiology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Hidemasa Takao
- Department of Radiology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Shiori Amemiya
- Department of Radiology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Kuni Ohtomo
- Department of Radiology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan.,International University of Health and Welfare, Tochigi, Japan
| | - Osamu Abe
- Department of Radiology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
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Dorweiler B, El Beyrouti H, Vahl CF, Baqué PE, Ghazy A. [The Future of Vascular Medicine - Role of 3D Printing]. Zentralbl Chir 2019; 145:448-455. [PMID: 31820426 DOI: 10.1055/a-1025-2066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Digitalisation is one of the key challenges in current surgery and will impact the future of surgical care as well as upcoming generations of surgeons. 3D printing is a technology that has recently been transferred from industrial prototyping into cardiovascular medicine. The digital model of the anatomical structure which needs to be engineered represents the inherent link of 3D printing to digital medicine. 3D printing technology is able to provide the surgeon with patient-specific models of anatomy and disease for surgical planning and patient informed consent as well as training templates for students and residents, surgical templates and even ready-to-use surgical implants. In our service, we have established a full-inhouse workflow for 3D printing and we currently use this technology for the generation of patient-specific models, training templates and for patient education, as will be presented in this article. Future advances in software solutions, printing polymers and easy-to-handle printers will further propagate and expand the applicability of this technology in cardiovascular medicine.
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Affiliation(s)
- Bernhard Dorweiler
- Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Deutschland
| | - Hazem El Beyrouti
- Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Deutschland
| | - Christian Friedrich Vahl
- Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Deutschland
| | - Pia-Elisabeth Baqué
- Klinik und Poliklinik für Nuklearmedizin, Universitätsmedizin Mainz, Deutschland
| | - Ahmed Ghazy
- Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Deutschland
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Abstract
True splenic artery aneurysms (SAA) are a rare, but potentially fatal, pathology. They are the third most common type of abdominal aneurysm, after aneurysms of the aorta and of the iliac artery, and account for almost the all aneurysms of visceral arteries. True aneurysms account for 60% of SAA and affect four times as many women as men, generally related to increased incidental or symptomatic findings that coincide with use of ultrasonography in pregnancy. Among pregnant patients, mortality after rupture is 65-75%, with fetal mortality exceeding 90%. There are multiple etiologies and it is believed that hormonal influences and changes in portal flow during gestation play an important role in development of SAA. This review discusses their history, epidemiology, pathophysiology, and diagnosis and current treatment techniques.
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An overview on 3D printing for abdominal surgery. Surg Endosc 2019; 34:1-13. [PMID: 31605218 DOI: 10.1007/s00464-019-07155-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 09/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Three-dimensional (3D) printing is a disruptive technology that is quickly spreading to many fields, including healthcare. In this context, it allows the creation of graspable, patient-specific, anatomical models generated from medical images. The ability to hold and show a physical object speeds up and facilitates the understanding of anatomical details, eases patient counseling and contributes to the education and training of students and residents. Several medical specialties are currently exploring the potential of this technology, including general surgery. METHODS In this review, we provide an overview on the available 3D printing technologies, together with a systematic analysis of the medical literature dedicated to its application for abdominal surgery. Our experience with the first clinical laboratory for 3D printing in Italy is also reported. RESULTS There was a tenfold increase in the number of publications per year over the last decade. About 70% of these papers focused on kidney and liver models, produced primarily for pre-interventional planning, as well as for educational and training purposes. The most used printing technologies are material jetting and material extrusion. Seventy-three percent of publications reported on fewer than ten clinical cases. CONCLUSION The increasing application of 3D printing in abdominal surgery reflects the dawn of a new technology, although it is still in its infancy. The potential benefit of this technology is clear, however, and it may soon lead to the development of new hospital facilities to improve surgical training, research, and patient care.
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Marti P, Lampus F, Benevento D, Setacci C. Trends in use of 3D printing in vascular surgery: a survey. INT ANGIOL 2019; 38:418-424. [PMID: 31560185 DOI: 10.23736/s0392-9590.19.04148-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The purpose of the following research was to provide a systematic survey on the use of additive manufacturing in vascular surgery. The survey focuses on applications of 3D printing in endovascular surgery like endovascular aneurysm repair (EVAR), a quite unexplored application domain. 3D printing is an additive production process of three-dimensional objects starting from a three-dimensional digital model. This kind of manufacturing process is getting great attention in the medical field and new applications have emerged in recent years especially thanks to the combination of additive printing with 3D imaging techniques. The purpose of the study is to reflect on additive manufacturing and its potential as an inclusive manufacturing practice which can provide benefits at economic and societal level. EVIDENCE ACQUISITION The article first introduces the use of 3D printing in surgery by summarizing the results of previous reviews which reveal three main usages of 3D printing: anatomic models, surgical tools, implants and prostheses. These studies point out that vascular surgery is still an unexplored field of application of 3D printing. Starting from this result, a new survey was carried out in databases Pubmed, Elsevier, Research Gate and ACM Digital Library for terms related to 3D printing in vascular surgery using the following keywords: 3D printing, vascular surgery, EVAR, aneurysm. The search screened articles published up to 2019 for relevance and practical application of the technology in vascular surgery, in particular the topic is related to the treatment of complex abdominal aortic aneurysm. EVIDENCE SYNTHESIS Initially 437 records published up to 2019 were found, but then were narrowed down to 29 full-text articles. The findings reveal that in addition to the applications found in the previous studies, new experiments are ongoing related to the use of 3D printing in the "Off label" practice to manually fenestrate the stent to improve the accuracy of the EVAR. CONCLUSIONS Different applications of the use of 3D printing and digital imaging in vascular surgery have been experimented with a different maturity level. Whilst the technology has increased its potential in the latest years, the number of studies documented in the literature is still quite narrow. Further research is necessary to fully test the potential of 3D printing, also in combination with other technologies (e.g. 3D imaging and CNC cutting). Early experimentations show that these technologies have the potential to radically change the vascular surgery practice in the near future, in particular in treatment like EVAR, to improve the planning and therefore the success of the surgery.
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Affiliation(s)
- Patrizia Marti
- Department of Social Political and Cognitive Science, University of Siena, Siena, Italy -
| | - Flavio Lampus
- Department of Social Political and Cognitive Science, University of Siena, Siena, Italy
| | | | - Carlo Setacci
- Department of Medical, Surgical Science and Neuroscience, University of Siena, Siena, Italy
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Uccheddu F, Gallo M, Nocerino E, Remondino F, Stolocova M, Meucci F, Di Mario C, Gerosa G. Cardiovascular interventions planning through a three-dimensional printing patient-specific approach. J Cardiovasc Med (Hagerstown) 2019; 20:584-596. [DOI: 10.2459/jcm.0000000000000832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Spinelli D, Marconi S, Caruso R, Conti M, Benedetto F, De Beaufort HW, Auricchio F, Trimarchi S. 3D printing of aortic models as a teaching tool for improving understanding of aortic disease. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:582-588. [PMID: 31256581 DOI: 10.23736/s0021-9509.19.10841-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A geometrical understanding of the individual patient's disease morphology is crucial in aortic surgery. The aim of our study was to validate a questionnaire addressing understanding of aortic disease and use this questionnaire to investigate the value of 3D printing as a teaching tool for surgical trainees. METHODS Anonymized CT-angiography images of six different patients were selected as didactic cases of aortic disease and made into 3D models of transparent rigid resin with the Vat-photopolymerization technique. The 3D aortic models, which could be disassembled and reassembled, were displayed to 37 surgical trainees, immediately after a seminar on aortic disease. A questionnaire was developed to compare the trainees' understanding before (T0) and after (T1) demonstration of the 3D printed models. RESULTS A panel of 15 experts participated in evaluating face and content validity of the questionnaire. The questionnaire validity was established and therefore the information investigated by the questionnaire could be synthetized using the mean of the items to indicate the understanding. The participants (mean age 28 years, range 26-34, male 59%) showed a significant improvement in understanding from T0 (median=7.25; IQR=1.50) to T1 (median=8.00; IQR=1.50; P=0.002). CONCLUSIONS Preliminary data suggest that the use of 3D-printed aortic models as a teaching tool was feasible and improved the understanding of aortic disease among surgical trainees.
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Affiliation(s)
- Domenico Spinelli
- Thoracic Aortic Research Center, San Donato Polyclinic IRCCS, San Donato Milanese, Milan, Italy - .,Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy -
| | - Stefania Marconi
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Rosario Caruso
- Health Professions Research and Development Area, San Donato Polyclinic IRCCS, San Donato Milanese, Milan, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Filippo Benedetto
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Hector W De Beaufort
- Thoracic Aortic Research Center, San Donato Polyclinic IRCCS, San Donato Milanese, Milan, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Santi Trimarchi
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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31
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Feasibility and potential of three-dimensional printing in laryngotracheal stenosis. J Laryngol Otol 2019; 133:530-534. [DOI: 10.1017/s0022215119001208] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundThe use of three-dimensional printing has been rapidly expanding over the last several decades. Virtual surgical three-dimensional simulation and planning has been shown to increase efficiency and accuracy in various clinical scenarios.ObjectivesTo report the feasibility of three-dimensional printing in paediatric laryngotracheal stenosis and discuss potential applications of three-dimensional printed models in airway surgery.MethodRetrospective case series in a tertiary care aerodigestive centre.ResultsThree-dimensional printing was undertaken in two cases of paediatric laryngotracheal stenosis. One patient with grade 4 subglottic stenosis with posterior glottic involvement underwent an extended partial cricotracheal reconstruction. Another patient with grade 4 tracheal stenosis underwent tracheal resection and end-to-end anastomosis. Models of both tracheas were printed using PolyJet technology from a Stratasys Connex2 printer.ConclusionIt is feasible to demonstrate stenosis in three-dimensional printed models, allowing for patient-specific pre-operative surgical simulation. The models serve as an educational tool for patients’ understanding of the surgery, and for teaching residents and fellows.
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Kärkkäinen JM, Sandri G, Tenorio ER, Alexander A, Bjellum K, Matsumoto J, Morris J, Mendes BC, DeMartino RR, Oderich GS. Simulation of Endovascular Aortic Repair Using 3D Printed Abdominal Aortic Aneurysm Model and Fluid Pump. Cardiovasc Intervent Radiol 2019; 42:1627-1634. [PMID: 31197454 DOI: 10.1007/s00270-019-02257-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) models can be manufactured with 3D printing technology. This study describes detailed methodology and validation of endovascular aortic repair (EVAR) simulation using 3D printed AAA model connected to hemodynamic pump. METHOD The AAA model was printed with Objet500 Connex3 (Stratasys, Eden Prairie, MN) and connected to BDC PD-0500 fluid pump (BDC Laboratories, Wheat Ridge, CO). EVAR procedure metrics were benchmarked in two expert implanters and compared to 20 vascular surgical trainees with different levels of EVAR experience (< 20 or ≥ 20 cases). All simulations were performed using commercially available stent grafts, guidewires, catheters, fluoroscopic guidance and digital subtraction angiography. Studied outcomes included ability to complete the procedure independently, time to deploy aortic component, ability to cannulate contralateral gate and complete the repair, and total fluoroscopy and procedure times. RESULTS A total of 22 EVAR simulation procedures were performed with mean procedure time of 37 ± 12 min. Experienced trainees had significantly lower total procedural time (32 ± 9 vs. 44 ± 6 min, P = 0.003) and fluoroscopic time (13 ± 5 vs. 23 ± 8 min, P = 0.005). All experienced trainees completed the procedure independently in < 45 min, compared to six (46%) of those with less EVAR experience (P = 0.016). Among less experienced trainees, only two (15%) completed the entire procedure independently (P < 0.001). Benchmark implanters performed significantly better than both trainee groups in nearly all EVAR metrics. CONCLUSION EVAR simulation was feasible and simulated all procedural steps with high fidelity. This model may be applicable for assessment of technical competencies and standard endovascular skill acquisition within vascular surgery training curricula.
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Affiliation(s)
- Jussi M Kärkkäinen
- Mayo Clinic Aortic Center, Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Giuliano Sandri
- Mayo Clinic Aortic Center, Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Emanuel R Tenorio
- Mayo Clinic Aortic Center, Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Amy Alexander
- Department of Radiology, Anatomic Modeling Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Karen Bjellum
- Mayo Clinic Aortic Center, Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jane Matsumoto
- Department of Radiology, Anatomic Modeling Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Jonathan Morris
- Department of Radiology, Anatomic Modeling Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Bernardo C Mendes
- Mayo Clinic Aortic Center, Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Randall R DeMartino
- Mayo Clinic Aortic Center, Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gustavo S Oderich
- Mayo Clinic Aortic Center, Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA. .,Gonda Vascular Center, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Oliveira-Santos MD, Oliveira-Santos E, Gonçalves L, Silva Marques J. Cardiovascular Three-Dimensional Printing in Non-Congenital Percutaneous Interventions. Heart Lung Circ 2019; 28:1525-1534. [PMID: 31176626 DOI: 10.1016/j.hlc.2019.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/01/2019] [Accepted: 04/22/2019] [Indexed: 01/22/2023]
Abstract
Three-dimensional (3D) printing technology is emerging as a potential new tool for the planning of medical interventions. In the last few years, increasing data have accumulated on its ability to guide interventional cardiology procedures, going beyond initial reports in congenital heart disease settings. In fact, there is compelling evidence on the advantages of a 3D-printed guided strategy for left atrial appendage closure, suggesting a high success rate with optimal device selection and lower radiation load. Furthermore, there is emerging experience in aortic root printing, which may improve the success rate and safety of transcatheter aortic valve replacement and may be of particular interest for targeting low-risk populations. Additionally, there are stimulating reports in mitral valve intervention, setting the tone for this new field in cardiovascular percutaneous intervention. In this clinically oriented paper, we will review current 3D printing use in interventional cardiology and we will address future directions, with a focus on procedural planning and medical simulation.
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Affiliation(s)
- Manuel de Oliveira-Santos
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.
| | | | - Lino Gonçalves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - João Silva Marques
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Goudie C, Kinnin J, Bartellas M, Gullipalli R, Dubrowski A. The Use of 3D Printed Vasculature for Simulation-based Medical Education Within Interventional Radiology. Cureus 2019; 11:e4381. [PMID: 31218145 PMCID: PMC6553672 DOI: 10.7759/cureus.4381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/02/2019] [Indexed: 11/21/2022] Open
Abstract
Three-dimensional (3D) printing has become a useful tool within the field of medicine as a way to produce custom anatomical models for teaching, surgical planning, and patient education. This technology is quickly becoming a key component in simulation-based medical education (SBME) to teach hands-on spatial perception and tactile feedback. Within fields such as interventional radiology (IR), this approach to SBME is also thought to be an ideal instructional method, providing an accurate and economical means to study human anatomy and vasculature. Such anatomical details can be extracted from patient-specific and anonymized CT or MRI scans for the purpose of teaching or analyzing patient-specific anatomy. There is evidence that 3D printing in IR can also optimize procedural training, so learners can rehearse procedures under fluoroscopy while receiving immediate supervisory feedback. Such training advancements in IR hold the potential to reduce procedural operating time, thus reducing the amount of time a patient is exposed to radiation and anaesthetia. Using a program evaluation approach, the purpose of this technical report is to describe the development and application of 3D-printed vasculature models within a radiology interest group to determine their efficacy as supplementary learning tools to traditional, lecture-based teaching. The study involved 30 medical students of varying years in their education, involved in the interest group at Memorial University of Newfoundland (MUN). The session was one hour in length and began with a Powerpoint presentation demonstrating the insertion of guide wires and stents using 3D-printed vasculature models. Participants had the opportunity to use the models to attempt several procedures demonstrated during the lecture. These attempts were supervised by an educational expert/facilitator. A survey was completed by all 30 undergraduate medical students and returned to the facilitators, who compiled the quantitative data to evaluate the efficacy of the 3D-printed models as an adjunct to the traditional didactic teaching within IR. The majority of feedback was positive, supporting the use of 3D=printed vasculature as an additional tactile training method for medical students within an IR academic setting. The hands-on experience provides a valuable training approach, with more opportunities for the rehearsal of high-acuity, low-occurrence (HALO) procedures performed in IR.
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Affiliation(s)
- Christine Goudie
- Medical Education and Simulation, Memorial University of Newfoundland, St. John's, CAN
| | - Jason Kinnin
- Radiology, University of Saskatchewan College of Medicine, Saskatoon, USA
| | | | | | - Adam Dubrowski
- Emergency Medicine, Memorial University of Newfoundland, St. John's, CAN
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Ding CY, Yi XH, Jiang CZ, Xu H, Yan XR, Zhang YL, Kang DZ, Lin ZY. Development and validation of a multi-color model using 3-dimensional printing technology for endoscopic endonasal surgical training. Am J Transl Res 2019; 11:1040-1048. [PMID: 30899403 PMCID: PMC6413258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The teaching of endoscopic endonasal surgery has always been difficult because of the complex structure of the nasal cavity, and the unique endoscopic view angle and endoscopic surgical tools. In this study, we have designed a 3D printed multi-color model for training of endoscopic endonasal surgery, and obtained preliminary application results. METHODS The 3D printed model contained facial skin, bony skeleton, internal carotid artery, turbinate, optic chiasm, and a special sellar base with appropriate colors. After it was printed, six otolaryngologists and neurosurgeons assessed the model. Twenty graduate students and residents from otolaryngology or neurosurgery, without prior experience in endoscopic endonasal surgery were recruited and consented for the training. The training results were recorded. The subjective feeling of participants in terms of using 3D printed model in surgical training was investigated after training. RESULTS All experts strongly agreed or agreed that the 3D printed model has realistic anatomical structure of nasal passage and appropriate colors for different parts, and is a good teaching tool. As the trainees practiced more, the rate and quality of endoscopic operation increased gradually. Compared to the first practice, all recorded training parameters were improved significantly (all P < 0.05). All participants strongly agreed or agreed that they benefited from the training and the 3D printed model can inspire interest and enthusiasm of endoscopic endonasal surgical training. CONCLUSION This 3D printed model has realistic anatomical structure of nasal passage and appropriate colors for different parts, and could be a good teaching tool of endoscopic endonasal surgery.
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Affiliation(s)
- Chen-Yu Ding
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical UniversityFuzhou 350001, Fujian, People’s Republic of China
| | - Xue-Han Yi
- Department of Otolaryngology Head and Neck Surgery, Fujian Medical University Union HospitalFuzhou 350001, Fujian, People’s Republic of China
| | - Chang-Zhen Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical UniversityFuzhou 350001, Fujian, People’s Republic of China
| | - Hao Xu
- Department of Otolaryngology Head and Neck Surgery, Fujian Medical University Union HospitalFuzhou 350001, Fujian, People’s Republic of China
| | - Xiao-Rong Yan
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical UniversityFuzhou 350001, Fujian, People’s Republic of China
| | - Yuan-Long Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical UniversityFuzhou 350001, Fujian, People’s Republic of China
| | - De-Zhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical UniversityFuzhou 350001, Fujian, People’s Republic of China
| | - Zhang-Ya Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical UniversityFuzhou 350001, Fujian, People’s Republic of China
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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Finotello A, Marconi S, Pane B, Conti M, Gazzola V, Mambrini S, Auricchio F, Palombo D, Spinella G. Twelve-year Follow-up Post-Thoracic Endovascular Repair in Type B Aortic Dissection Shown by Three-dimensional Printing. Ann Vasc Surg 2018; 55:309.e13-309.e19. [PMID: 30287292 DOI: 10.1016/j.avsg.2018.07.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/22/2018] [Accepted: 07/07/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Thoracic endovascular repair (TEVAR) is currently considered the therapy of choice for complicated type B acute aortic dissection (TBAAD). Although several papers have reported good outcomes at short- and medium-term follow-up, some questions still remain regarding the long-term durability and re-intervention rate during follow-up. METHODS We describe a case of a patient originally treated with TEVAR for TBAAD complicated by impending aortic rupture. RESULTS Endovascular repair successfully excluded the flow through the primary entry tear but during the 12-year follow-up period the patient experienced several complications and re-interventions. Various full-size three-dimensional (3D) models of the patient-specific vasculature were printed to better explain the different interventional interventions over the 12 years of follow-up and as a hands-on tool for medical education. CONCLUSIONS The present case report, involving long-term follow-up, provides an example of the effectiveness and the safety of TEVAR for the treatment of complicated TBAAD shown at short and medium-term follow-up. However, the long-term complications that were observed in this patient during follow-up support the importance of lifelong CTA surveillance. Furthermore, this study confirms the capability of 3D printing technology as a powerful tool to support communication with patients and residents' education through the physical analysis of the real cases.
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Affiliation(s)
- Alice Finotello
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Stefania Marconi
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Bianca Pane
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Valerio Gazzola
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Simone Mambrini
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Giovanni Spinella
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
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Principles of three-dimensional printing and clinical applications within the abdomen and pelvis. Abdom Radiol (NY) 2018; 43:2809-2822. [PMID: 29619525 DOI: 10.1007/s00261-018-1554-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Improvements in technology and reduction in costs have led to widespread interest in three-dimensional (3D) printing. 3D-printed anatomical models contribute to personalized medicine, surgical planning, and education across medical specialties, and these models are rapidly changing the landscape of clinical practice. A physical object that can be held in one's hands allows for significant advantages over standard two-dimensional (2D) or even 3D computer-based virtual models. Radiologists have the potential to play a significant role as consultants and educators across all specialties by providing 3D-printed models that enhance clinical care. This article reviews the basics of 3D printing, including how models are created from imaging data, clinical applications of 3D printing within the abdomen and pelvis, implications for education and training, limitations, and future directions.
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Huff TJ, Ludwig PE, Zuniga JM. The potential for machine learning algorithms to improve and reduce the cost of 3-dimensional printing for surgical planning. Expert Rev Med Devices 2018; 15:349-356. [PMID: 29723481 DOI: 10.1080/17434440.2018.1473033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION 3D-printed anatomical models play an important role in medical and research settings. The recent successes of 3D anatomical models in healthcare have led many institutions to adopt the technology. However, there remain several issues that must be addressed before it can become more wide-spread. Of importance are the problems of cost and time of manufacturing. Machine learning (ML) could be utilized to solve these issues by streamlining the 3D modeling process through rapid medical image segmentation and improved patient selection and image acquisition. The current challenges, potential solutions, and future directions for ML and 3D anatomical modeling in healthcare are discussed. AREAS COVERED This review covers research articles in the field of machine learning as related to 3D anatomical modeling. Topics discussed include automated image segmentation, cost reduction, and related time constraints. EXPERT COMMENTARY ML-based segmentation of medical images could potentially improve the process of 3D anatomical modeling. However, until more research is done to validate these technologies in clinical practice, their impact on patient outcomes will remain unknown. We have the necessary computational tools to tackle the problems discussed. The difficulty now lies in our ability to collect sufficient data.
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Affiliation(s)
- Trevor J Huff
- a Creighton University School of Medicine , Omaha , USA
| | | | - Jorge M Zuniga
- b Department of Biomechanics , University of Nebraska at Omaha , USA.,c Facultad de Ciencias de la Salud , Universidad Autónoma de Chile , Chil
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Dumas BM, Nava A, Law HZ, Smartt J, Derderian C, Seaward JR, Kane AA, Hallac RR. Three-Dimensional Printing for Craniofacial Surgery: A Single Institution’s 5-Year Experience. Cleft Palate Craniofac J 2018; 56:729-734. [DOI: 10.1177/1055665618798292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Blaike M. Dumas
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ana Nava
- Analytical Imaging and Modeling Center, Children’s Medical Center, Dallas, TX, USA
| | - Huay-Zong Law
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - James Smartt
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - James R. Seaward
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children’s Medical Center, Dallas, TX, USA
| | - Alex A. Kane
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children’s Medical Center, Dallas, TX, USA
| | - Rami R. Hallac
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children’s Medical Center, Dallas, TX, USA
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Han W, Wu Q, Zhang X, Duan Z. Innovation for hepatotoxicity in vitro research models: A review. J Appl Toxicol 2018; 39:146-162. [PMID: 30182494 DOI: 10.1002/jat.3711] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 12/18/2022]
Abstract
Many categories of drugs can induce hepatotoxicity, so improving the prediction of toxic drugs is important. In vitro models using human hepatocytes are more accurate than in vivo animal models. Good in vitro models require an abundance of metabolic enzyme activities and normal cellular polarity. However, none of the in vitro models can completely simulate hepatocytes in the human body. There are two ways to overcome this limitation: enhancing the metabolic function of hepatocytes and changing the cultural environment. In this review, we summarize the current state of research, including the main characteristics of in vitro models and their limitations, as well as improved technology and developmental prospects. We hope that this review provides some new ideas for hepatotoxicity research.
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Affiliation(s)
- Weijia Han
- Artificial Liver Center, Beijing Youan Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Liver Failure; Artificial Liver Treatment and Research; Beijing China
| | - Qiao Wu
- Artificial Liver Center, Beijing Youan Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Liver Failure; Artificial Liver Treatment and Research; Beijing China
| | - Xiaohui Zhang
- Artificial Liver Center, Beijing Youan Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Liver Failure; Artificial Liver Treatment and Research; Beijing China
| | - Zhongping Duan
- Artificial Liver Center, Beijing Youan Hospital; Capital Medical University; Beijing China
- Beijing Key Laboratory of Liver Failure; Artificial Liver Treatment and Research; Beijing China
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The clinical use of 3D printing in surgery. Updates Surg 2018; 70:381-388. [DOI: 10.1007/s13304-018-0586-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/16/2018] [Indexed: 01/17/2023]
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Bundy JJ, Weadock WJ, Chick JFB, Srinivasa RN, Patel N, Johnson E, Khayat M, Jeffers B, Gemmete JJ, Srinivasa RN. Three-Dimensional Printing Facilitates Creation of a Biliary Endoscopy Phantom for Interventional Radiology-Operated Endoscopy Training. Curr Probl Diagn Radiol 2018; 48:456-461. [PMID: 30477812 DOI: 10.1067/j.cpradiol.2018.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/09/2018] [Accepted: 08/16/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE To create a three-dimensional endoscopic model of the biliary tract from magnetic-resonance cholangiopancreatography imaging and to evaluate its effectiveness as a tool for training in endoscopic biliary interventions. MATERIALS AND METHODS A magnetic-resonance cholangiopancreatography study was performed on a patient with biliary obstruction secondary to a distal bile duct cholangiocarcinoma. Using Vitrea, a three-dimensional volume-rendered image was created, and exported as a standard tessellated language file. The standard tessellated language model was then edited with MeshMixer. Three cylindrical entry ports were created. The ports were aligned and overlapped with the dominant ducts in three separate areas of the model and fused to the model. A 0.2 cm shell was created around the model and the model was hollowed. The ends of the ports were cut off, allowing access to the hollowed-out model. The model was printed at 125% scale to allow easy access with a 9.5-French (≤3.23 mm) endoscope. The model was printed using a Stratasys Dimension Elite Plus printer. After printing, the model was post-processed to remove support materials. A 10-question survey was administered to all trainees before and after use of the printed phantom to practice endoscopy skills. RESULTS 11 trainees participated in the three-dimensional endoscopy simulation with most of the trainees (73%) having no prior formal endoscopy training. Using a 10-point Likert scale, the mean comfort-level of the trainees to use endoscopy alone for cholecystostomy, percutaneous biliary drainage, percutaneous nephrostomy, and percutaneous gastrostomy increased by 38.9%, 32.8%, 32.8%, and 34.3%, respectively, following the training experience. CONCLUSION The use of a three-dimensionally printed endoscopic model as a simulation tool has the potential to improve trainee comfort using endoscopy during interventional radiology procedures.
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Affiliation(s)
- Jacob J Bundy
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - William J Weadock
- Department of Radiology, Division of Abdominal Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | | | - Rajiv N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Nishant Patel
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Evan Johnson
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Mamdouh Khayat
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Brian Jeffers
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Joseph J Gemmete
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Ravi N Srinivasa
- Department of Interventional Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095.
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A 3D Printed Aortic Arch Template to Facilitate Decision-Making Regarding the Use of an Externalized Transapical Wire during Thoracic Endovascular Aneurysm Repair. Ann Vasc Surg 2018; 54:336.e5-336.e8. [PMID: 30114499 DOI: 10.1016/j.avsg.2018.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/04/2018] [Accepted: 06/11/2018] [Indexed: 11/22/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) is an established treatment option, although some anatomical challenges require a through-and-through wire technique, and subsequently transapical access via minithoracotomy can be required. It is clear that an objective tool to facilitate decision-making is needed. A 3D print of a severely angulated aortic arch was used as a template to advance a stent graft, and this was achieved after pulling the top of the wire. This simulation assisted in decision-making relating to transapical access with a wire externalization. A 3D aortic print could be used in advance to simulate the TEVAR procedure and facilitate any other decisions regarding additional transapical access.
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Torres I, De Luccia N. Artificial vascular models for endovascular training (3D printing). Innov Surg Sci 2018; 3:225-234. [PMID: 31579786 PMCID: PMC6604582 DOI: 10.1515/iss-2018-0020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/17/2018] [Indexed: 12/27/2022] Open
Abstract
The endovascular technique has led to a revolution in the care of patients with vascular disease; however, acquiring and maintaining proficiency over a broad spectrum of procedures is challenging. Three-dimensional (3D) printing technology allows the production of models that can be used for endovascular training. This article aims to explain the process and technologies available to produce vascular models for endovascular training, using 3D printing technology. The data are based on the group experience and a review of the literature. Different 3D printing methods are compared, describing their advantages, disadvantages and potential roles in surgical training. The process of 3D printing a vascular model based on an imaging examination consists of the following steps: image acquisition, image post-processing, 3D printing and printed model post-processing. The entire process can take a week. Prospective studies have shown that 3D printing can improve surgical planning, especially in complex endovascular procedures, and allows the production of efficient simulators for endovascular training, improving residents’ surgical performance and self-confidence.
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Affiliation(s)
- Inez Torres
- Discipline of Vascular and Endovascular Surgery, Department of Surgery, São Paulo University Medical School, Rua Oscar Freire, 1546, ap 33, Pinheiros, São Paulo - SP 05409-010, Brazil
| | - Nelson De Luccia
- Discipline of Vascular and Endovascular Surgery, Department of Surgery, São Paulo University Medical School, São Paulo, Brazil
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Rynio P, Kazimierczak A, Jedrzejczak T, Gutowski P. A 3-Dimensional Printed Aortic Arch Template to Facilitate the Creation of Physician-Modified Stent-Grafts. J Endovasc Ther 2018; 25:554-558. [PMID: 30056789 DOI: 10.1177/1526602818792266] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To demonstrate the utility of a 3-dimensional (3D) printed template of the aortic arch in the construction of a fenestrated and scalloped physician-modified stent-graft (PMSG). CASE REPORT A 73-year-old woman with descending thoracic aneurysm was scheduled for thoracic endovascular aortic repair after being disqualified for open surgery. Computed tomography angiography (CTA) revealed no proximal landing zone as the aneurysm began from the level of the left subclavian artery, so a fenestrated/scalloped PMSG was planned. To facilitate accurate placement of the openings in the graft, a 3D printed aortic arch template was prepared from the CTA data and gas sterilized. In the operating room, a Valiant stent-graft was inserted into the 3D printed template and deployed. Using ophthalmic cautery, a fenestration and a scallop were created; radiopaque markers were added. The PMSG was successfully deployed with no discrepancy between the openings and the target vessels. CONCLUSION A 3D printed aortic arch template facilitates handmade fenestrations and scallops in PMSGs and may improve accuracy and quality.
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Affiliation(s)
- Pawel Rynio
- 1 Department of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland
| | | | - Tomasz Jedrzejczak
- 2 Department of Cardiosurgery, Pomeranian Medical University, Szczecin, Poland
| | - Piotr Gutowski
- 1 Department of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland
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Tam CHA, Chan YC, Law Y, Cheng SWK. The Role of Three-Dimensional Printing in Contemporary Vascular and Endovascular Surgery: A Systematic Review. Ann Vasc Surg 2018; 53:243-254. [PMID: 30053547 DOI: 10.1016/j.avsg.2018.04.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/16/2018] [Accepted: 04/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Three-dimensional (3D) printing, also known as rapid prototyping or additive manufacturing, is a novel adjunct in the medical field. The aim of this systematic review is to evaluate the role of 3D printing technology in the field of contemporary vascular surgery in terms of its technical aspect, practicability, and clinical outcome. METHODS A systematic search of literatures published from January 1, 1980 to July 15, 2017 was identified from the EMBASE, MEDLINE, and Cochrane library database with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The predefined selection inclusion criterion was clinical application of 3D printing technology in vascular surgery of large and small vessel pathology. RESULTS Forty-two articles were included in this systematic review, including 2 retrospective cohorts and 1 prospective case control study. 3D printing was mostly applied to abdominal aortic aneurysm (n = 20) and thoracic aorta pathology (n = 8), other vessels included celiac, splenic, carotid, subclavian, femoral artery, and portal vein (n = 10). The most commonly quoted materials were acrylonitrile-butadiene-styrene (n = 2), polylactic acid (n = 4), polyurethane resin (n = 3) and nylon (n = 3). The cost per replica ranged from USD $4-2,360. Cost for a commercial printer was around USD $2,210-50,000. CONCLUSION 3D printing was recognized and gradually incorporated as a useful adjunct in the field of vascular and endovascular surgery. The production of an accurate anatomic patient-specific replica was shown to bring significant impact in patient management in terms of anatomic understanding, procedural planning, and intraoperative navigation, education, and academic research as well as patient communication. Further analysis on cost-effectiveness was indicated to guide decisions on applicability of such promising technology on a routine basis.
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Affiliation(s)
- Chun Hei Adrian Tam
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
| | - Yuk Law
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
| | - Stephen Wing Keung Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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Oliveira-Santos M, Oliveira Santos E, Marinho AV, Leite L, Guardado J, Matos V, Pego GM, Marques JS. Patient-specific 3D printing simulation to guide complex coronary intervention. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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El Sabbagh A, Eleid MF, Al-Hijji M, Anavekar NS, Holmes DR, Nkomo VT, Oderich GS, Cassivi SD, Said SM, Rihal CS, Matsumoto JM, Foley TA. The Various Applications of 3D Printing in Cardiovascular Diseases. Curr Cardiol Rep 2018; 20:47. [PMID: 29749577 DOI: 10.1007/s11886-018-0992-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To highlight the various applications of 3D printing in cardiovascular disease and discuss its limitations and future direction. RECENT FINDINGS Use of handheld 3D printed models of cardiovascular structures has emerged as a facile modality in procedural and surgical planning as well as education and communication. Three-dimensional (3D) printing is a novel imaging modality which involves creating patient-specific models of cardiovascular structures. As percutaneous and surgical therapies evolve, spatial recognition of complex cardiovascular anatomic relationships by cardiologists and cardiovascular surgeons is imperative. Handheld 3D printed models of cardiovascular structures provide a facile and intuitive road map for procedural and surgical planning, complementing conventional imaging modalities. Moreover, 3D printed models are efficacious educational and communication tools. This review highlights the various applications of 3D printing in cardiovascular diseases and discusses its limitations and future directions.
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Affiliation(s)
- Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mohammed Al-Hijji
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Sameh M Said
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Thomas A Foley
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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Oliveira-Santos M, Oliveira Santos E, Marinho AV, Leite L, Guardado J, Matos V, Pego GM, Marques JS. Patient-specific 3D printing simulation to guide complex coronary intervention. Rev Port Cardiol 2018; 37:541.e1-541.e4. [PMID: 29748151 DOI: 10.1016/j.repc.2018.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/02/2018] [Accepted: 02/18/2018] [Indexed: 02/07/2023] Open
Abstract
The field of three-dimensional printing applied to patient-specific simulation is evolving as a tool to enhance intervention results. We report the first case of a fully simulated percutaneous coronary intervention in a three-dimensional patient-specific model to guide treatment. An 85-year-old female presented with symptomatic in-stent restenosis in the ostial circumflex and was scheduled for percutaneous coronary intervention. Considering the complexity of the anatomy, patient setting and intervention technique, we elected to replicate the coronary anatomy using a three-dimensional model. In this way, we simulated the intervention procedure beforehand in the catheterization laboratory using standard materials. The procedure was guided by optical coherence tomography, with pre-dilatation of the lesion, implantation of a single drug-eluting stent in the ostial circumflex and kissing balloon inflation to the left anterior descending artery and circumflex. Procedural steps were replicated in the real patient's treatment, with remarkable parallelism in angiographic outcome and luminal gain at intracoronary imaging. In this proof-of-concept report, we show that patient-specific simulation is feasible to guide the treatment strategy of complex coronary artery disease. It enables the surgical team to plan and practice the procedure beforehand, and possibly predict complications and gain confidence.
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Affiliation(s)
- Manuel Oliveira-Santos
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Eduardo Oliveira Santos
- Departamento de Engenharia Mecânica, Faculdade de Ciências e Tecnologia da Universidade de Coimbra, Coimbra, Portugal
| | - Ana Vera Marinho
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Luís Leite
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Jorge Guardado
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Vítor Matos
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Guilherme Mariano Pego
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Silva Marques
- Serviço de Cardiologia A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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