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Ali A, Morris JM, Decker SJ, Huang YH, Wake N, 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: neurosurgical and otolaryngologic conditions. 3D Print Med 2023; 9:33. [PMID: 38008795 PMCID: PMC10680204 DOI: 10.1186/s41205-023-00192-w] [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: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Medical three dimensional (3D) printing is performed for neurosurgical and otolaryngologic conditions, but without evidence-based guidance on clinical appropriateness. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness recommendations for neurologic 3D printing conditions. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with neurologic and otolaryngologic conditions. Each study was vetted by the authors and strength of evidence was assessed according to published guidelines. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for diseases of the calvaria and skull base, brain tumors and cerebrovascular disease. Recommendations are provided in accordance with strength of evidence of publications corresponding to each neurologic condition combined with expert opinion from members of the 3D printing SIG. CONCLUSIONS This consensus guidance document, created by the members of the 3D printing SIG, provides a reference for clinical standards of 3D printing for neurologic conditions.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | | | - Summer J Decker
- Division of Imaging Research and Applied Anatomy, Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, 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
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Little CD, Mackle EC, Maneas E, Chong D, Nikitichev D, Constantinou J, Tsui J, Hamilton G, Rakhit RD, Mastracci TM, Desjardins AE. A patient-specific multi-modality abdominal aortic aneurysm imaging phantom. Int J Comput Assist Radiol Surg 2022; 17:1611-1617. [PMID: 35397710 PMCID: PMC9463301 DOI: 10.1007/s11548-022-02612-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
Purpose Multimodality imaging of the vascular system is a rapidly growing area of innovation and research, which is increasing with awareness of the dangers of ionizing radiation. Phantom models that are applicable across multiple imaging modalities facilitate testing and comparisons in pre-clinical studies of new devices. Additionally, phantom models are of benefit to surgical trainees for gaining experience with new techniques. We propose a temperature-stable, high-fidelity method for creating complex abdominal aortic aneurysm phantoms that are compatible with both radiation-based, and ultrasound-based imaging modalities, using low cost materials. Methods Volumetric CT data of an abdominal aortic aneurysm were acquired. Regions of interest were segmented to form a model compatible with 3D printing. The novel phantom fabrication method comprised a hybrid approach of using 3D printing of water-soluble materials to create wall-less, patient-derived vascular structures embedded within tailored tissue-mimicking materials to create realistic surrounding tissues. A non-soluble 3-D printed spine was included to provide a radiological landmark. Results The phantom was found to provide realistic appearances with intravascular ultrasound, computed tomography and transcutaneous ultrasound. Furthermore, the utility of this phantom as a training model was demonstrated during a simulated endovascular aneurysm repair procedure with image fusion. Conclusion With the hybrid fabrication method demonstrated here, complex multimodality imaging patient-derived vascular phantoms can be successfully fabricated. These have potential roles in the benchtop development of emerging imaging technologies, refinement of novel minimally invasive surgical techniques and as clinical training tools.
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Affiliation(s)
- Callum D Little
- Wellcome Trust-EPSRC Centre for Interventional and Surgical Sciences, London, W1W 7TS, UK
- Department of Medical Physics and Bioengineering, University College London, London, WC1E 6BT, UK
- Department of Cardiology, Royal Free Hospital, London, NW3 2QG, UK
| | - Eleanor C Mackle
- Wellcome Trust-EPSRC Centre for Interventional and Surgical Sciences, London, W1W 7TS, UK
- Department of Medical Physics and Bioengineering, University College London, London, WC1E 6BT, UK
| | - Efthymios Maneas
- Wellcome Trust-EPSRC Centre for Interventional and Surgical Sciences, London, W1W 7TS, UK
- Department of Medical Physics and Bioengineering, University College London, London, WC1E 6BT, UK
| | - Debra Chong
- Wellcome Trust-EPSRC Centre for Interventional and Surgical Sciences, London, W1W 7TS, UK
- Department of Vascular Surgery, Royal Free Hospital, London, NW3 2QG, UK
| | - Daniil Nikitichev
- Wellcome Trust-EPSRC Centre for Interventional and Surgical Sciences, London, W1W 7TS, UK
| | - Jason Constantinou
- Department of Vascular Surgery, Royal Free Hospital, London, NW3 2QG, UK
| | - Janice Tsui
- Wellcome Trust-EPSRC Centre for Interventional and Surgical Sciences, London, W1W 7TS, UK
- Department of Vascular Surgery, Royal Free Hospital, London, NW3 2QG, UK
| | - George Hamilton
- Wellcome Trust-EPSRC Centre for Interventional and Surgical Sciences, London, W1W 7TS, UK
- Department of Vascular Surgery, Royal Free Hospital, London, NW3 2QG, UK
| | - Roby D Rakhit
- Department of Cardiology, Royal Free Hospital, London, NW3 2QG, UK
| | - Tara M Mastracci
- Division of Surgery and Interventional Science, University College London, London, W1W 7TY, UK
| | - Adrien E Desjardins
- Wellcome Trust-EPSRC Centre for Interventional and Surgical Sciences, London, W1W 7TS, UK.
- Department of Medical Physics and Bioengineering, University College London, London, WC1E 6BT, UK.
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Legnani E, Gallo P, Pezzotta F, Padelli F, Faragò G, Gioppo A, Gentili L, De Martin E, Fumagalli ML, Cavaliere F, Bruzzone MG, Milani P, Santaniello T. Additive Fabrication of a Vascular 3D Phantom for Stereotactic Radiosurgery of Arteriovenous Malformations. 3D PRINTING AND ADDITIVE MANUFACTURING 2021; 8:217-226. [PMID: 36654837 PMCID: PMC9828616 DOI: 10.1089/3dp.2020.0305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this study, an efficient methodology for manufacturing a realistic three-dimensional (3D) cerebrovascular phantom resembling a brain arteriovenous malformation (AVM) for applications in stereotactic radiosurgery is presented. The AVM vascular structure was 3D reconstructed from brain computed tomography (CT) data acquired from a patient. For the phantom fabrication, stereolithography was used to produce the AVM model and combined with silicone casting to mimic the brain parenchyma surrounding the vascular structure. This model was made with tissues-equivalent materials for radiology. The hollow vascular system of the phantom was filled with a contrast agent usually employed on patients for CT scans. The radiological response of the phantom was tested and compared with the one of the clinical case. The constructed model demonstrated to be a very accurate physical representation of the AVM and its vasculature and good morphological consistency was observed between the model and the patient-specific source anatomy. These results suggest that the proposed method has potential to be used to fabricate patient-specific phantoms for neurovascular radiosurgery applications and medical research.
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Affiliation(s)
- Elisa Legnani
- CIMAINA and Department of Physics, University of Milano, Milan, Italy
- Direct3D, Milan, Italy
| | - Pasqualina Gallo
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federico Pezzotta
- CIMAINA and Department of Physics, University of Milano, Milan, Italy
| | - Francesco Padelli
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Faragò
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Gioppo
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lorenzo Gentili
- CIMAINA and Department of Physics, University of Milano, Milan, Italy
| | - Elena De Martin
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | | | - Paolo Milani
- CIMAINA and Department of Physics, University of Milano, Milan, Italy
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Removal of Double Cavernous Angioma of the Frontal Lobe using a Three-Dimensional Printed Model: A Case Report. J UOEH 2020; 42:217-222. [PMID: 32507845 DOI: 10.7888/juoeh.42.217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cerebral cavernous angiomas are vascular anomalies with dilated spaces. We report the case of rare double cavernous angiomas causing higher brain dysfunction. A 74-year-old man exhibited cognitive dysfunction. Magnetic resonance imaging showed two tumors with hemorrhage in the left frontal lobe. Preoperative diagnosis was hemorrhage caused by cavernous angiomas. A 3D model of the double cavernous angioma was made to confirm their association with cortical veins and tumors. Tumors were removed using a single small corticotomy. This is the first report of a rare double cavernous angioma and the 3D printed model facilitated removal of the tumors.
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Rooney MK, Rosenberg DM, Braunstein S, Cunha A, Damato AL, Ehler E, Pawlicki T, Robar J, Tatebe K, Golden DW. Three-dimensional printing in radiation oncology: A systematic review of the literature. J Appl Clin Med Phys 2020; 21:15-26. [PMID: 32459059 PMCID: PMC7484837 DOI: 10.1002/acm2.12907] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose/objectives Three‐dimensional (3D) printing is recognized as an effective clinical and educational tool in procedurally intensive specialties. However, it has a nascent role in radiation oncology. The goal of this investigation is to clarify the extent to which 3D printing applications are currently being used in radiation oncology through a systematic review of the literature. Materials/methods A search protocol was defined according to preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines. Included articles were evaluated using parameters of interest including: year and country of publication, experimental design, sample size for clinical studies, radiation oncology topic, reported outcomes, and implementation barriers or safety concerns. Results One hundred and three publications from 2012 to 2019 met inclusion criteria. The most commonly described 3D printing applications included quality assurance phantoms (26%), brachytherapy applicators (20%), bolus (17%), preclinical animal irradiation (10%), compensators (7%), and immobilization devices (5%). Most studies were preclinical feasibility studies (63%), with few clinical investigations such as case reports or series (13%) or cohort studies (11%). The most common applications evaluated within clinical settings included brachytherapy applicators (44%) and bolus (28%). Sample sizes for clinical investigations were small (median 10, range 1–42). A minority of articles described basic or translational research (11%) and workflow or cost evaluation studies (3%). The number of articles increased over time (P < 0.0001). While outcomes were heterogeneous, most studies reported successful implementation of accurate and cost‐effective 3D printing methods. Conclusions Three‐dimensional printing is rapidly growing in radiation oncology and has been implemented effectively in a diverse array of applications. Although the number of 3D printing publications has steadily risen, the majority of current reports are preclinical in nature and the few clinical studies that do exist report on small sample sizes. Further dissemination of ongoing investigations describing the clinical application of developed 3D printing technologies in larger cohorts is warranted.
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Affiliation(s)
- Michael K Rooney
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - David M Rosenberg
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Steve Braunstein
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Adam Cunha
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Antonio L Damato
- Department Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Ehler
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Todd Pawlicki
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - James Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada.,Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.,Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Ken Tatebe
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
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Abstract
PURPOSE This paper examines the application of 3D printing technology in the endoscopic endonasal approach for the treatment of macroadenomas. METHODS We have retrospectively analysed 20 patients who diagnosed with macroadenoma underwent endoscopic transsphenoidal surgery in Wuhan Union hospital from January 2017 to May 2017. Among the 20 patients, 10 patients received the service of 3D printing technology preoperatively. The data of 3D processing and clinical result were recorded for further evaluation. RESULTS The 10 patients who received the service had a successful 3D printed model of their tumors, it shows the anatomy of sphenoid sinus, tumor location which were in good agreement with our intraoperative observations. The 10 patients who received the service had a less operation time (127.0 ± 15.53 vs. 143.40 ± 17.89), blood loss (159.90 ± 12.31 vs. 170.00 ± 29.06) and less postoperative complication rate (20% vs. 40%). the design time of the 3D images varies 2 h 10 min to 4 h 32 min. the printing time of the 3D models varies 10 h 12 min to 22 h 34 min. CONCLUSIONS The use of 3D printing technology has unquestionable potential applications to endoscopic endonasal approach for macroadenomas, in particular reflecting the complicated anatomy of sphenoid sinus and tumor location. Owing to the advantages of 3D printing technology, it may help the patients get a good prognosis.
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Affiliation(s)
- Xing Huang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Zhen Liu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xuan Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xu-Dong Li
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Kai Cheng
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yan Zhou
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xiao-Bing Jiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, 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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Anwar S, Singh GK, Miller J, Sharma M, Manning P, Billadello JJ, Eghtesady P, Woodard PK. 3D Printing is a Transformative Technology in Congenital Heart Disease. JACC Basic Transl Sci 2018; 3:294-312. [PMID: 30062215 PMCID: PMC6059001 DOI: 10.1016/j.jacbts.2017.10.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/08/2017] [Accepted: 10/11/2017] [Indexed: 12/26/2022]
Abstract
Survival in congenital heart disease has steadily improved since 1938, when Dr. Robert Gross successfully ligated for the first time a patent ductus arteriosus in a 7-year-old child. To continue the gains made over the past 80 years, transformative changes with broad impact are needed in management of congenital heart disease. Three-dimensional printing is an emerging technology that is fundamentally affecting patient care, research, trainee education, and interactions among medical teams, patients, and caregivers. This paper first reviews key clinical cases where the technology has affected patient care. It then discusses 3-dimensional printing in trainee education. Thereafter, the role of this technology in communication with multidisciplinary teams, patients, and caregivers is described. Finally, the paper reviews translational technologies on the horizon that promise to take this nascent field even further.
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Key Words
- 3D printing
- 3D, three-dimensional
- ACHD, adults with congenital heart disease
- APC, aortopulmonary collaterals
- ASD, atrial septal defect
- CHD, congenital heart disease
- CT, computed tomography
- DORV, double outlet right ventricle
- MAPCAs, multiple aortopulmonary collaterals
- MRI, magnetic resonance imaging
- OR, operating room
- VSD, ventricular septal defect
- cardiac imaging
- cardiothoracic surgery
- congenital heart disease
- simulation
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Affiliation(s)
- Shafkat Anwar
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Gautam K. Singh
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jacob Miller
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Monica Sharma
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Peter Manning
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph J. Billadello
- Division of Cardiovascular Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Pirooz Eghtesady
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Pamela K. Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Foley TA, El Sabbagh A, Anavekar NS, Williamson EE, Matsumoto JM. 3D-Printing: Applications in Cardiovascular Imaging. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0239-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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10
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Chen KK, Guo WY, Yang HC, Lin CJ, Wu CHF, Gehrisch S, Kowarschik M, Wu YT, Chung WY. Application of Time-Resolved 3D Digital Subtraction Angiography to Plan Cerebral Arteriovenous Malformation Radiosurgery. AJNR Am J Neuroradiol 2017; 38:740-746. [PMID: 28126751 DOI: 10.3174/ajnr.a5074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/18/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Time-resolved 3D-DSA (4D-DSA) enables viewing vasculature from any desired angle and time frame. We investigated whether these advantages may facilitate treatment planning and the feasibility of using 4D-DSA as a single imaging technique in AVM/dural arteriovenous fistula radiosurgery. MATERIALS AND METHODS Twenty consecutive patients (8 dural arteriovenous fistulas and 12 AVMs; 13 men and 7 women; mean age, 45 years; range, 18-64 years) who were scheduled for gamma knife radiosurgery were recruited (November 2014 to October 2015). An optimal volume of reconstructed time-resolved 3D volumes that defines the AVM nidus/dural arteriovenous fistula was sliced into 2D-CT-like images. The original radiosurgery treatment plan was overlaid retrospectively. The registration errors of stereotactic 4D-DSA were compared with those of integrated stereotactic imaging. AVM/dural arteriovenous fistula volumes were contoured, and disjoint and conjoint components were identified. The Wilcoxon signed rank test and the Wilcoxon rank sum test were adopted to evaluate registration errors and contoured volumes of stereotactic 4D-DSA and integration of stereotactic MR imaging and stereotactic 2D-DSA. RESULTS Sixteen of 20 patients were successfully registered in Advanced Leksell GammaPlan Program. The registration error of stereotactic 4D-DSA was smaller than that of integrated stereotactic imaging (P = .0009). The contoured AVM volume of 4D-DSA was smaller than that contoured on the integration of MR imaging and 2D-DSA, while major inconsistencies existed in cases of dural arteriovenous fistula (P = .042 and 0.039, respectively, for measurements conducted by 2 authors). CONCLUSIONS Implementation of stereotactic 4D-DSA data for gamma knife radiosurgery for brain AVM/dural arteriovenous fistula is feasible. The ability of 4D-DSA to demonstrate vascular morphology and hemodynamics in 4 dimensions potentially reduces the target volumes of irradiation in vascular radiosurgery.
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Affiliation(s)
- K-K Chen
- From the Department of Biomedical Imaging and Radiological Sciences (K.-K.C., Y.-T.W.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Guo
- Departments of Radiology (W.-Y.G., C.-J.L.)
- School of Medicine (W.-Y.G., C.-J.L.), National Yang-Ming University, Taipei, Taiwan
| | - H-C Yang
- Neurosurgery (H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
| | - C-J Lin
- Departments of Radiology (W.-Y.G., C.-J.L.)
- School of Medicine (W.-Y.G., C.-J.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-H F Wu
- Siemens Healthcare Ltd, Advanced Therapies (C.-H.F.W.), Taipei, Taiwan
| | - S Gehrisch
- Siemens, Advanced Therapies (S.G., M.K.), Forchheim, Germany
| | - M Kowarschik
- Siemens, Advanced Therapies (S.G., M.K.), Forchheim, Germany
| | - Y-T Wu
- From the Department of Biomedical Imaging and Radiological Sciences (K.-K.C., Y.-T.W.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Chung
- Neurosurgery (H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital, Taipei, Taiwan
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