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Lakhani DA, Sabsevitz DS, Chaichana KL, Quiñones-Hinojosa A, Middlebrooks EH. Current State of Functional MRI in the Pre surgical Planning of Brain Tumors. Radiol Imaging Cancer 2023; 5:e230078. [PMID: 37861422 DOI: 10.1148/rycan.230078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Surgical resection of brain tumors is challenging because of the delicate balance between maximizing tumor removal and preserving vital brain functions. Functional MRI (fMRI) offers noninvasive preoperative mapping of widely distributed brain areas and is increasingly used in presurgical functional mapping. However, its impact on survival and functional outcomes is still not well-supported by evidence. Task-based fMRI (tb-fMRI) maps blood oxygen level-dependent (BOLD) signal changes during specific tasks, while resting-state fMRI (rs-fMRI) examines spontaneous brain activity. rs-fMRI may be useful for patients who cannot perform tasks, but its reliability is affected by tumor-induced changes, challenges in data processing, and noise. Validation studies comparing fMRI with direct cortical stimulation (DCS) show variable concordance, particularly for cognitive functions such as language; however, concordance for tb-fMRI is generally greater than that for rs-fMRI. Preoperative fMRI, in combination with MRI tractography and intraoperative DCS, may result in improved survival and extent of resection and reduced functional deficits. fMRI has the potential to guide surgical planning and help identify targets for intraoperative mapping, but there is currently limited prospective evidence of its impact on patient outcomes. This review describes the current state of fMRI for preoperative assessment in patients undergoing brain tumor resection. Keywords: MR-Functional Imaging, CNS, Brain/Brain Stem, Anatomy, Oncology, Functional MRI, Functional Anatomy, Task-based, Resting State, Surgical Planning, Brain Tumor © RSNA, 2023.
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Affiliation(s)
- Dhairya A Lakhani
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - David S Sabsevitz
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Kaisorn L Chaichana
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Alfredo Quiñones-Hinojosa
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Erik H Middlebrooks
- From the Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); and Departments of Psychiatry and Psychology (D.S.S.), Neurosurgery (K.L.C., A.Q.H., E.H.M.), and Radiology (E.H.M.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
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Ibelli TJ, Chennareddy S, Mandelbaum M, Henderson PW. Vascular Mapping for Abdominal-Based Breast Reconstruction: A Comprehensive Review of Current and Upcoming Imaging Modalities. Eplasty 2023; 23:e44. [PMID: 37664815 PMCID: PMC10472443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background Preoperative vascular imaging is a very common element of surgical planning for abdominal-based breast reconstruction (ABBR). Surgeons must tailor which flap is best suited for each respective patient based on the patient's health and vascular anatomy. The goal of this review is to give surgeons practical tools for choosing which imaging technology best suits their patient's needs for successful breast reconstruction. Methods A review of literature was undertaken on Google scholar to assess preoperative imaging modalities used for ABBR. Search terms included breast reconstruction, deep inferior epigastric perforator (DIEP) flap, and abdominal imaging. Articles were included based on relevance and significance to ABBR. Advantages and disadvantages of each imaging modality were then classified according to clinically relevant utility. Results Overall, imaging technologies that produce 3-dimensional images were found to have greater resolution for identifying perforators and the pedicle network than 2- dimensional images. Conclusions This paper addresses the strengths and weaknesses of the currently used imaging modalities described and also discusses new technologies that may be helpful in the future for planning of ABBR.
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Affiliation(s)
- Taylor J Ibelli
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sumanth Chennareddy
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Max Mandelbaum
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter W Henderson
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Ballesteros-Herrera D, Yagmurlu K, Guinto-Nishimura GY, Ramirez-Stubbe V, Nathal-Vera E, Baldoncini M, Forlizzi V, Gomez-Amador JL, Moreno-Jiménez S, Vázquez-Gregorio R, Giotta Lucifero A, Campero A, Luzzi S. Photo-Stacking Technique for Neuroanatomical High-Definition Photography and 3D Modeling. World Neurosurg 2023:S1878-8750(23)00801-X. [PMID: 37331475 DOI: 10.1016/j.wneu.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND three-dimensional neuroanatomical knowledge is vital in neurosurgery. Technological advances improved 3D anatomical perception, but they are usually expensive and not widely available. The aim of the present study was to provide a detailed description of the photo-stacking technique for high-resolution neuroanatomical photography and 3D modeling. METHODS The photo-stacking technique was described in a step-by-step approach. The time for image acquisition, file conversion, processing, and final production was measured using two processing methods. The toral number and file size of images are presented. Measures of central tendency and dispersion report the measured values. RESULTS Ten models were used in both methods achieving 20 models with high-definition images. The mean number of acquired images was 40.6 (14-67), image acquisition time 51.50 ± 18.8s, file conversion time 250 ± 134.6 s, processing time 50.46 ± 21.46 s and 41.97 ± 20.84 s, and 3D reconstruction time was 4.29 ± 0.74 s and 3.89 ± 0.60 s for methods B and C, respectively. The mean file size of RAW files is 1010 ± 452 MB and 101.06 ± 38.09 MB for JPG files after conversion. The mean size of the final image means size is 71.9 ± 0.126 MB, and the mean file size of the 3D model means is 37.4 ± 0.516 MB for both methods. The total equipment used was less expensive than other reported systems. CONCLUSION The photo-stacking technique is a simple and inexpensive method to create 3D models and high-definition images that could prove valuable in neuroanatomy training.
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Affiliation(s)
- Daniel Ballesteros-Herrera
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
| | - Kaan Yagmurlu
- Neurosurgery department University of Tennessee Health Science Center. Ut College Of Medicine, 920 Madison Avenue Suite C 50, Memphis Tennessee, 38163-0001. USA
| | - Gerardo Y Guinto-Nishimura
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
| | - Viviana Ramirez-Stubbe
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
| | - Edgar Nathal-Vera
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
| | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires/ Department of Neurological Surgery, Hospital San Fernando, Buenos Aires, Argentina
| | - Valeria Forlizzi
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires/ Department of Neurological Surgery, Hospital San Fernando, Buenos Aires, Argentina
| | - Juan Luis Gomez-Amador
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
| | - Sergio Moreno-Jiménez
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
| | - Rafael Vázquez-Gregorio
- Pediatric Neurosurgery department. Instituto Nacional de Pediatría. Address: Insurgentes Sur 3700, Letra C, Coyoacán C.P. 04530. Mexico City, Mexico
| | - Alice Giotta Lucifero
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Alvaro Campero
- Department of Neurological Surgery, Hospital Padilla, Tucumán, Argentina
| | - Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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Pedrosa FC, Feizi N, Zhang R, Delaunay R, Sacco D, Jagadeesan J, Patel R. On Surgical Planning of Percutaneous Nephrolithotomy with Patient-Specific CTRs. Med Image Comput Comput Assist Interv 2022; 13437:626-635. [PMID: 37252091 PMCID: PMC10217565 DOI: 10.1007/978-3-031-16449-1_60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Percutaneous nephrolithotomy (PCNL) is considered a first-choice minimally invasive procedure for treating kidney stones larger than 2 cm. It yields higher stone-free rates than other minimally invasive techniques and is employed when extracorporeal shock wave lithotripsy or uteroscopy are, for instance, infeasible. Using this technique, surgeons create a tract through which a scope is inserted for gaining access to the stones. Traditional PCNL tools, however, present limited maneuverability, may require multiple punctures and often lead to excessive torquing of the instruments which can damage the kidney parenchyma and thus increase the risk of hemorrhage. We approach this problem by proposing a nested optimization-driven scheme for determining a single tract surgical plan along which a patient-specific concentric-tube robot (CTR) is deployed so as to enhance manipulability along the most dominant directions of the stone presentations. The approach is illustrated with seven sets of clinical data from patients who underwent PCNL. The simulated results may set the stage for achieving higher stone-free rates through single tract PCNL interventions while decreasing blood loss.
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Affiliation(s)
- Filipe C Pedrosa
- Western University, ON, Canada
- Canadian Surgical Technologies and Advanced Robotics, ON, Canada
| | - Navid Feizi
- Western University, ON, Canada
- Canadian Surgical Technologies and Advanced Robotics, ON, Canada
| | - Ruisi Zhang
- Brigham and Women's Hospital, MA, USA
- Harvard Medical School, MA, USA
| | - Remi Delaunay
- Brigham and Women's Hospital, MA, USA
- Harvard Medical School, MA, USA
| | - Dianne Sacco
- Harvard Medical School, MA, USA
- Massachusetts General Hospital, MA, USA
| | | | - Rajni Patel
- Western University, ON, Canada
- Canadian Surgical Technologies and Advanced Robotics, ON, Canada
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Onoda S, Satake T, Kinoshita M. Relationship Between Lymphaticovenular Anastomosis Outcomes and The Number and Types of Anastomoses. J Surg Res 2021; 269:103-109. [PMID: 34547586 DOI: 10.1016/j.jss.2021.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/25/2021] [Accepted: 08/01/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lymphaticovenular anastomosis (LVA) is the first-line treatment for lymphedema in many hospitals. However, many aspects of its effects remain unclear. This study aimed to analyze problems with regard to the relationship between lymphaticovenular anastomosis and outcomes of surgery for lymphedema in the upper and lower extremities. METHODS Eighteen articles were selected for review. The following information was extracted from these articles as factors associated with LVA for lymphedema in the upper and lower extremities: number of cases, average patient age, mean number of bypasses, lymphedema stage, duration and type of lymphedema, anastomotic technique, follow-up period, type of scale, and treatment outcomes. RESULTS Upper extremity lymphedema: The average age of patients was 54.2 (range: 41.3-60.1) years. The mean number of anastomoses was 3.91 (range: 1.0-7.2). Six of nine articles provided data for volume change, and the mean volume change was 29% (-5%-50%). Lower extremity lymphedema: The average age of patients was 50.3 (range: 34-64 years). The mean number of anastomoses was 4.6 (range: 2.1-9.3). Comparison was difficult as different methods were used for postoperative evaluation (lower extremity lymphedema index in three patients, limb circumference in one, volume change in two, and restaging in three). CONCLUSIONS We obtained useful information with regard to the effects of LVA in this review. An increased number of anastomoses between the lymphatic ducts and veins did not seem to improve the effectiveness of LVA. With regard to the stage of lymphedema, LVA may be useful for both early and advanced stages.
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Affiliation(s)
- Satoshi Onoda
- Department of Plastic and Reconstructive Surgery, Kagawa Rosai Hospital, Kagawa, Japan.
| | - Toshihiko Satake
- Department of Plastic and Reconstructive Surgery, Toyama University Hospital, Toyama, Japan
| | - Masahito Kinoshita
- Department of Plastic and Reconstructive Surgery, Kagawa Rosai Hospital, Kagawa, Japan
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Abstract
BACKGROUND A preoperative planning system facilitates improving surgical outcomes that depend on the experience of the surgeons, thanks to real-time interaction between the system and surgeons. It visualizes intermediate surgical planning results to help surgeons discuss the planning. The purpose of this study was to demonstrate the use of a newly-developed preoperative planning system for surgeons less experienced in pedicle-screw fixation in spinal surgery, especially on patients with anatomical variations. METHODS The marching cubes algorithm, a typical surface extraction technique, was applied to computed tomography (CT) images of vertebrae to enable three-dimensional (3D) reconstruction of a spinal mesh. Real-time processing of such data is difficult, as the surface mesh extracted from high-resolution CT data is rough, and the size of the mesh is large. To mitigate these factors, Laplacian smoothing was applied, followed by application of a quadric error metric-based mesh simplification to reduce the mesh size for the level-of-detail (LOD) image. Taubin smoothing was applied to smooth out the rough surface. On a multiplanar reconstruction (MPR) cross-sectional image or a 3D model view, the insertion position and orientation of the pedicle screw were manipulated using a mouse. The results after insertion were then visualized in each image. RESULTS The system was used for pre-planning pedicle-screw fixation in spinal surgery. Using any pointing device such as a mouse, surgeons can manipulate the position and angle of the screws. The pedicle screws were easy to manipulate intuitively on the MPR images, and the accuracy of screw fixation was confirmed on a trajectory view and 3D images. After surgery, CT scans were performed again, and the CT images were checked to ensure that the screws were inserted properly. CONCLUSION The preoperative planning system allows surgeons and students who are not familiar with pedicle-screw fixation to safely undertake surgery following preoperative planning. It also provides opportunities for screw-fixation training and simulation.
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Affiliation(s)
- Woochan Wi
- Department of Computer Engineering, Inha University, Incheon, Korea
| | - Sang Min Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung Seok Shin
- Department of Computer Engineering, Inha University, Incheon, Korea.
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Meess KM, Izzo RL, Dryjski ML, Curl RE, Harris LM, Springer M, Siddiqui AH, Rudin S, Ionita CN. 3D Printed Abdominal Aortic Aneurysm Phantom for Image Guided Surgical Planning with a Patient Specific Fenestrated Endovascular Graft System. Proc SPIE Int Soc Opt Eng 2017. [PMID: 28638171 DOI: 10.1117/12.2253902] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit (VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR) was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme. RESULTS With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical environment. The actual patient procedure went without complications. CONCLUSIONS With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with 3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging.
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Affiliation(s)
- Karen M Meess
- The Jacobs Institute, Buffalo, NY 14203.,CUBRC Inc., Buffalo, NY 14225.,Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203
| | - Richard L Izzo
- The Jacobs Institute, Buffalo, NY 14203.,Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203
| | - Maciej L Dryjski
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Richard E Curl
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Linda M Harris
- Department of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | | | - Adnan H Siddiqui
- The Jacobs Institute, Buffalo, NY 14203.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Stephen Rudin
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203.,Department of Radiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228.,Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203
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Izzo RL, O'Hara RP, Iyer V, Hansen R, Meess KM, Nagesh SVS, Rudin S, Siddiqui AH, Springer M, Ionita CN. 3D Printed Cardiac Phantom for Procedural Planning of a Transcatheter Native Mitral Valve Replacement. Proc SPIE Int Soc Opt Eng 2016; 9789. [PMID: 28615797 DOI: 10.1117/12.2216952] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
3D printing an anatomically accurate, functional flow loop phantom of a patient's cardiac vasculature was used to assist in the surgical planning of one of the first native transcatheter mitral valve replacement (TMVR) procedures. CTA scans were acquired from a patient about to undergo the first minimally-invasive native TMVR procedure at the Gates Vascular Institute in Buffalo, NY. A python scripting library, the Vascular Modeling Toolkit (VMTK), was used to segment the 3D geometry of the patient's cardiac chambers and mitral valve with severe stenosis, calcific in nature. A stereolithographic (STL) mesh was generated and AutoDesk Meshmixer was used to transform the vascular surface into a functioning closed flow loop. A Stratasys Objet 500 Connex3 multi-material printer was used to fabricate the phantom with distinguishable material features of the vasculature and calcified valve. The interventional team performed a mock procedure on the phantom, embedding valve cages in the model and imaging the phantom with a Toshiba Infinix INFX-8000V 5-axis C-arm bi-Plane angiography system. RESULTS After performing the mock-procedure on the cardiac phantom, the cardiologists optimized their transapical surgical approach. The mitral valve stenosis and calcification were clearly visible. The phantom was used to inform the sizing of the valve to be implanted. CONCLUSION With advances in image processing and 3D printing technology, it is possible to create realistic patient-specific phantoms which can act as a guide for the interventional team. Using 3D printed phantoms as a valve sizing method shows potential as a more informative technique than typical CTA reconstruction alone.
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Affiliation(s)
- Richard L Izzo
- The Jacobs Institute, 875 Ellicott Street, 5 Floor, Buffalo, NY.,Biomedical Engineering, University at Buffalo, 332 Bonner Hall, Buffalo, NY
| | - Ryan P O'Hara
- The Jacobs Institute, 875 Ellicott Street, 5 Floor, Buffalo, NY.,Biomedical Engineering, University at Buffalo, 332 Bonner Hall, Buffalo, NY
| | - Vijay Iyer
- The Jacobs Institute, 875 Ellicott Street, 5 Floor, Buffalo, NY.,Interventional Cardiology, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY
| | - Rose Hansen
- Interventional Cardiology, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY
| | - Karen M Meess
- The Jacobs Institute, 875 Ellicott Street, 5 Floor, Buffalo, NY.,Biomedical Engineering, University at Buffalo, 332 Bonner Hall, Buffalo, NY
| | - S V Setlur Nagesh
- Toshiba Stroke and Vascular Research Center, 875 Ellicott Street, 8 Floor, Buffalo, NY
| | - Stephen Rudin
- Toshiba Stroke and Vascular Research Center, 875 Ellicott Street, 8 Floor, Buffalo, NY
| | - Adnan H Siddiqui
- The Jacobs Institute, 875 Ellicott Street, 5 Floor, Buffalo, NY.,University at Buffalo Neurosurgery, 100 High Street, Section B4, Buffalo, NY
| | | | - Ciprian N Ionita
- Biomedical Engineering, University at Buffalo, 332 Bonner Hall, Buffalo, NY.,Toshiba Stroke and Vascular Research Center, 875 Ellicott Street, 8 Floor, Buffalo, NY
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