scholarly journals A Comparison of the Accuracy of WATCHMAN and WATCHMAN FLX Device Sizing between CT, TEE, and Patient Specific 3D Models

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Ivette Troitino ◽  
T. Eric White ◽  
John Lozo
Keyword(s):  
3D Model ◽  
Intraoperative Complications ◽  
Statistical Significance ◽  
3D Models ◽  
Ct Scans ◽  
Orifice Diameter ◽  
Patient Specific ◽  
Accuracy Of Measurements ◽  
Device Size ◽  
Actual Size

Background and Hypothesis: In patients with Atrial fibrillation (AF), the Left Atrial Appendage (LAA) is the most common site of thrombus formation. The LAA occlusion procedure using the WATCHMAN device implant is an alternative for stroke prevention in AF patients. Transesophageal echocardiogram (TEE) and Computed tomography (CT) scans aid in measuring the LAA to predict implant device sizes. However, due to varying LAA anatomy and limited spatial resolution, the current imaging techniques often predict one of two sized devices. The objective of this retrospective study is to compare the accuracy of measurements made preoperatively of the LAA with those on 3D models to determine if they can be used in preoperative planning. We hypothesize 3D models will be more accurate in predicting device size and any anatomical impediments than traditional TEE planning. Project Methods: There were 21 subjects selected who underwent the WATCHMAN FLX procedure at Parkview Heart Institute in 2021. 3D models of LAA were created from CT scans using a Form 2 3D printer. The device sizes predicted for the procedure were determined from Boston Scientific FLX guidelines based on the maximum LAA orifice diameter from TEE, CT, and 3D models. Results: Two-proportion z-test between the 3D model predicted sizes to the actual size deployed demonstrated no statistical significance (p=0.298) demonstrating no difference between 3D model predicted sizes and actual size deployed. Two-proportion z-test between TEE vs actual size and CT vs actual size demonstrated statistical significance, suggesting a difference between the group's predictions. 3D models predicted the accurate device size for 20/21(95%) subjects. TEE measurements of maximum orifice diameter were, on average, lower compared to CT and 3D model measurements. Conclusion and Potential Impact: 3D printed models provide the most accurate device size predictions and can be used to optimize presurgical planning while reducing intraoperative complications.

The use of 3D printed models on trainee and patient experience for partial nephrectomies.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 363-363
Author(s):  
E. Reilly Scott ◽  
Samuel Morano ◽  
Andrea Quinn ◽  
Erica Mann ◽  
Michelle Ho ◽  
...  
Keyword(s):  
3D Model ◽  
Standard Of Care ◽  
3D Models ◽  
University Hospital ◽  
Preoperative Imaging ◽  
Patient Specific ◽  
Tumor Characteristics ◽  
Educational Tool ◽  
Before And After ◽  
3D Printed

363 Background: 3D printing is a growing tool in surgical education due to the ability to visualize organs, tissue, and masses from multiple angles before operating on a patient. Previous studies using highly detailed and expensive 3D models costing between $1,000-250 per model have been shown to enhance patient and trainee comprehension of tumor characteristics, goals of surgery, and planned surgical procedure for partial nephrectomies. In our study we aim to use simpler and less expensive models in a greater range of patients receiving partial nephrectomies to determine the use of 3D models in patient, resident, and fellow education. Methods: 3D models of the effected kidney, mass, renal artery, and renal vein were created using preoperative imaging of undergoing partial nephrectomies at Thomas Jefferson University Hospital (TJUH) costing $35 per model. Residents and fellows filled out 3 surveys assessing their surgical plan and their confidence in the chosen plan at 3 time points: 1) Before seeing the model, 2) After seeing the model before surgery, and 3) After surgery. Ten patients filled out 2 surveys about their understanding of the kidney, their disease, the surgery they will undergo, and the risks involved with surgery before and after seeing the model. Results: Based on surveys to assess for surgical plan and confidence given to resident and fellow surgeons before and after seeing the 3D model, confidence significantly increased. Surveys given after surgery assessing anatomic and surgical comprehension found that resident and fellow surgeons rated the helpfulness of the models on their anatomical comprehension 7.6 out of 10 and the help of the models on their surgical confidence 7 out of 10. Patient understanding of their kidney, disease, and surgery significantly increased after seeing the 3D model, but the risks associated with surgery did not significantly increase. The extent that the model helped the patients learn about the kidney, their disease, the surgery, and the risks related to surgery were rated an average of 8.33, 9.67, 9.5, and 8.83 out of 10, respectively. Conclusions: Patient-specific 3D models for partial nephrectomies increase resident and fellow confidence in surgical approach and helped patients learn about their disease and feel comfortable going into surgery. Thus, it is important to continue to explore 3D models as an educational tool for both trainees and patients and potentially include 3D models as part of the standard of care. Further research could continue to explore the utility of 3D models as a pre-operative educational tool for both patients and trainees in other surgical fields.

Fabrication of 3D Models for Microtia Reconstruction Using Smartphone-Based Technology

2021 ◽  
pp. 000348942110240
Author(s):  
Peng You ◽  
Yi-Chun Carol Liu ◽  
Rodrigo C. Silva
Keyword(s):  
3D Model ◽  
Low Cost ◽  
Tertiary Care ◽  
Three Dimensional ◽  
Basic Research ◽  
3D Models ◽  
University Hospital ◽  
Patient Specific ◽  
Surface Scanning ◽  
Barrier To Entry

Objective: Microtia reconstruction is technically challenging due to the intricate contours of the ear. It is common practice to use a two-dimensional tracing of the patient’s normal ear as a template for the reconstruction of the affected side. Recent advances in three-dimensional (3D) surface scanning and printing have expanded the ability to create surgical models preoperatively. This study aims to describe a simple and affordable process to fabricate patient-specific 3D ear models for use in the operating room. Study design: Applied basic research on a novel 3D optical scanning and fabrication pathway for microtia reconstruction. Setting: Tertiary care university hospital. Methods: Optical surface scanning of the patient’s normal ear was completed using a smartphone with facial recognition capability. The Heges application used the phone’s camera to capture the 3D image. The 3D model was digitally isolated and mirrored using the Meshmixer software and printed with a 3D printer (MonopriceTM Select Mini V2) using polylactic acid filaments. Results: The 3D model of the ear served as a helpful intraoperative reference and an adjunct to the traditional 2D template. Collectively, time for imaging acquisition, editing, and fabrication was approximately 3.5 hours. The upfront cost was around $210, and the recurring cost was approximately $0.35 per ear model. Conclusion: A novel, low-cost approach to fabricate customized 3D models of the ear is introduced. It is feasible to create individualized 3D models using currently available consumer technology. The low barrier to entry raises the possibility for clinicians to incorporate 3D printing into various clinical applications.

scholarly journals Patient-Specific Templates for Pedicle Screw Insertion in Spinal Fixation Surgery

10.29007/kbf7 ◽  
2018 ◽  
Author(s):  
Mahmoud Hafez ◽  
Mohamed Fouda
Keyword(s):  
Pedicle Screw ◽  
3D Model ◽  
Pedicle Screws ◽  
Ct Scans ◽  
Patient Specific ◽  
Scoliosis Surgery ◽  
Spinal Fixation ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Surgery Patient

The increased use of pedicle screws in scoliosis creates a challenge for accurate and safe placement ofscrew within the pedicle during the scoliosis surgery. Patient-specific templates (PST) is a novelmethod to guide the surgeons for allocating and detecting the positions and trajectories of pediclescrews in scoliosis surgery. Based on CT-scans and according to certain protocol, this technique willallow the surgeon to construct a 3D model of spine and present the stage and vertebrae which containthe most deformed bone. With preplanned surgery on specific software, we can develop an accurateand safe position of pedicle screws and its trajectories. This method has the ability to customize theplacement and the size of each pedicle screw based on the unique morphology and landmarks of thevertebrae.

scholarly journals Information Recall in Pre-Operative Consultation for Glioma Surgery Using Actual Size Three-Dimensional Models

2020 ◽  
Vol 9 (11) ◽  
pp. 3660
Author(s):  
Sümeyye Sezer ◽  
Vitoria Piai ◽  
Roy P.C. Kessels ◽  
Mark ter Laan
Keyword(s):  
3D Model ◽  
Three Dimensional ◽  
3D Models ◽  
Patient Specific ◽  
Mr Images ◽  
Glioma Surgery ◽  
Information Recall ◽  
Cohen’S D ◽  
Real Size ◽  
Cohen's D

Three-dimensional (3D) technologies are being used for patient education. For glioma, a personalized 3D model can show the patient specific tumor and eloquent areas. We aim to compare the amount of information that is understood and can be recalled after a pre-operative consult using a 3D model (physically printed or in Augmented Reality (AR)) versus two-dimensional (2D) MR images. In this explorative study, healthy individuals were eligible to participate. Sixty-one participants were enrolled and assigned to either the 2D (MRI/fMRI), 3D (physical 3D model) or AR groups. After undergoing a mock pre-operative consultation for low-grade glioma surgery, participants completed two assessments (one week apart) testing information recall using a standardized questionnaire. The 3D group obtained the highest recall scores on both assessments (Cohen’s d = 1.76 and Cohen’s d = 0.94, respectively, compared to 2D), followed by AR and 2D, respectively. Thus, real-size 3D models appear to improve information recall as compared to MR images in a pre-operative consultation for glioma cases. Future clinical studies should measure the efficacy of using real-size 3D models in actual neurosurgery patients.

SURGICAL DECISION OF CORONARY ARTERY BYPASS GRAFTING FOR NORMAL LEFT ANTERIOR DESCENDING ARTERY (LAD) AND LAD WITH STENOSIS: SEQUENTIAL GRAFT OR NOT

2016 ◽  
Vol 16 (07) ◽  
pp. 1650090
Author(s):  
XI ZHAO ◽  
YOUJUN LIU ◽  
JINSHENG XIE ◽  
ZHOU ZHAO ◽  
AIKE QIAO
Keyword(s):  
3D Model ◽  
Artery Bypass ◽  
3D Models ◽  
Hemodynamic Effect ◽  
Lumped Parameter Model ◽  
Patient Specific ◽  
Short Term ◽  
Diagonal Branch ◽  
Left Anterior Descending Artery

Sequential graft was used frequently in clinical studies. In this study, the hemodynamic effect of one kind of sequential graft in two different conditions of the lesion was discussed and some recommendations on the surgical procedures were made. A patient-specific three-dimensional (3D) model of left anterior descending artery (LAD) was reconstructed. A moderate stenosis exist in the trunk of LAD between the first and the second diagonal branch (D1 and D2). Another 3D model without stenosis was also reconstructed based on the patient-specific model. Sequential graft and single graft were applied on these two 3D model. Thus four 3D models were built so that the hemodynamic effect of sequential graft can be discussed. The zero-dimensional (0D)/3D coupling method was used to perform the numerical simulation by coupling the 3D artery model with a 0D lumped parameter model of the cardiovascular system. The flow rates in the branches of LAD and the graft flow were calculated and illustrated in this paper. The wall shear stress (WSS) and oscillatory shear index (OSI) were also calculated and depicted. If the native LAD is stenosis, sequential graft should be applied for the short-term outcomes. Moreover, the long-term patency of the sequential graft applied on the stenosis LAD is good. The long-term patency of the single graft was bad. But the short-term outcomes are almost the same when LAD is not stenosis. If no stenosis exist in the native LAD, a graft with smaller diameter should be applied to improve the long-term patency.

scholarly journals 3D Patient-Specific Virtual Models for Presurgical Planning in Patients with Recto-Sigmoid Endometriosis Nodules: A Pilot Study

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 86
Author(s):  
Giulia Borghese ◽  
Francesca Coppola ◽  
Diego Raimondo ◽  
Antonio Raffone ◽  
Antonio Travaglino ◽  
...  
Keyword(s):  
Pilot Study ◽  
Surgical Planning ◽  
3D Model ◽  
Preoperative Planning ◽  
3D Models ◽  
Patient Specific ◽  
Pelvic Organs ◽  
Virtual Models ◽  
Magnetic Resonance Imaging Mri ◽  
Operative Findings

Background and Objective: In recent years, 3D printing has been used to support surgical planning or to guide intraoperative procedures in various surgical specialties. An improvement in surgical planning for recto-sigmoid endometriosis (RSE) excision might reduce the high complication rate related to this challenging surgery. The aim of this study was to build novel presurgical 3D models of RSE nodules from magnetic resonance imaging (MRI) and compare them with intraoperative findings. Materials and Methods: A single-center, observational, prospective, cohort, pilot study was performed by enrolling consecutive symptomatic women scheduled for minimally invasive surgery for RSE between November 2019 and June 2020 at our institution. Preoperative MRI were used for building 3D models of RSE nodules and surrounding pelvic organs. 3D models were examined during multi-disciplinary preoperative planning, focusing especially on three domains: degree of bowel stenosis, nodule’s circumferential extension, and bowel angulation induced by the RSE nodule. After surgery, the surgeon was asked to subjectively evaluate the correlation of the 3D model with the intra-operative findings and to express his evaluation as “no correlation”, “low correlation”, or “high correlation” referring to the three described domains. Results: seven women were enrolled and 3D anatomical virtual models of RSE nodules and surrounding pelvic organs were generated. In all cases, surgeons reported a subjective “high correlation” with the surgical findings. Conclusion: Presurgical 3D models could be a feasible and useful tool to support surgical planning in women with recto-sigmoidal endometriotic involvement, appearing closely related to intraoperative findings.

HEMODYNAMICS-BASED LONG-TERM PATENCY OF DIFFERENT SEQUENTIAL GRAFTING: A PATIENT-SPECIFIC MULTI-SCALE STUDY

2017 ◽  
Vol 17 (01) ◽  
pp. 1750017 ◽  
Author(s):  
WENXIN WANG ◽  
YOUJUN LIU ◽  
XI ZHAO ◽  
JINSHENG XIE ◽  
AIKE QIAO
Keyword(s):  
Cardiovascular System ◽  
3D Model ◽  
Artery Bypass ◽  
3D Models ◽  
Coupling Method ◽  
Lumped Parameter Model ◽  
Patient Specific ◽  
Physiological Data ◽  
Multi Scale

Background and aims: Sequential grafting is one of the common coronary artery bypass grafting (CABG) surgery. But the influence of the sequential grafting position on hemodynamics and the graft patency is still unclear. Materials and methods: The zero-dimensional/three-dimensional (0D/3D) coupling method was used to finalize the multi-scale simulation of two different sequential grafting models. First, a patient-specific 3D model was reconstructed based on coronary computed tomography angiography (CCTA) images. Two different sequential grafts were implemented on this patient-specific 3D model by using virtual surgery. Thus, two different postoperative 3D models were built. Then, a lumped parameter model (LPM; 0D) was built based on the patient physiological data to simulate the cardiovascular system. Finally, the 0D/3D coupling method was used to perform the numerical simulation by coupling a 0D LPM of the cardiovascular system and the patient-specific 3D models. Moreover, the long-term patency of these two different sequential grafts was discussed in this paper. Results: The coronary flow rate and the graft flow were calculated and illustrated. The instantaneous wave-free ratio (iFR) were calculated. Postoperative iFR values increase to over 0.90 for both sequential grafts. Some hemodynamics parameters were also illustrated, such as wall shear stress (WSS), oscillatory shear index (OSI). The area of low WSS in Model 1 was much less than that in Model 2. Two regions of high OSI exist in Model 2, while only one in Model 1. Conclusions: No significant differences exist on the short-term outcomes of two models. But the long-term patency of Model 2 was worse. The Model 1 may enhance long-term patency of grafting and should be priority when the sequential grafting need to be carried out.

scholarly journals The “springform” technique in cranioplasty: custom made 3D-printed templates for intraoperative modelling of polymethylmethacrylate cranial implants

2021 ◽  
Author(s):  
Johannes P. Pöppe ◽  
Mathias Spendel ◽  
Christoph Schwartz ◽  
Peter A. Winkler ◽  
Jörn Wittig
Keyword(s):  
3D Printing ◽  
Computer Aided Design ◽  
Intraoperative Complications ◽  
Operating Time ◽  
Epidural Haematoma ◽  
Ct Scans ◽  
Patient Specific ◽  
Cosmetic Results ◽  
Skull Shape ◽  
Custom Made

Abstract Background Manual moulding of cranioplasty implants after craniectomy is feasible, but does not always yield satisfying cosmetic results. In contrast, 3D printing can provide precise templates for intraoperative moulding of polymethylmethacrylate (PMMA) implants in cranioplasty. Here, we present a novel and easily implementable 3D printing workflow to produce patient-specific, sterilisable templates for PMMA implant moulding in cranioplastic neurosurgery. Methods 3D printable templates of patients with large skull defects before and after craniectomy were designed virtually from cranial CT scans. Both templates — a mould to reconstruct the outer skull shape and a ring representing the craniectomy defect margins — were printed on a desktop 3D printer with biocompatible photopolymer resins and sterilised after curing. Implant moulding and implantation were then performed intraoperatively using the templates. Clinical and radiological data were retrospectively analysed. Results Sixteen PMMA implants were performed on 14 consecutive patients within a time span of 10 months. The median defect size was 83.4 cm2 (range 57.8–120.1 cm2). Median age was 51 (range 21–80) years, and median operating time was 82.5 (range 52–152) min. No intraoperative complications occurred; PMMA moulding was uneventful and all implants fitted well into craniectomy defects. Excellent skull reconstruction could be confirmed in all postoperative computed tomography (CT) scans. In three (21.4%) patients with distinct risk factors for postoperative haematoma, revision surgery for epidural haematoma had to be performed. No surgery-related mortality or new and permanent neurologic deficits were recorded. Conclusion Our novel 3D printing-aided moulding workflow for elective cranioplasty with patient-specific PMMA implants proved to be an easily implementable alternative to solely manual implant moulding. The “springform” principle, focusing on reconstruction of the precraniectomy skull shape and perfect closure of the craniectomy defect, was feasible and showed excellent cosmetic results. The proposed method combines the precision and cosmetic advantages of computer-aided design (CAD) implants with the cost-effectiveness of manually moulded PMMA implants.

scholarly journals Quality Control in 3D Printing: Accuracy Analysis of 3D-Printed Models of Patient-Specific Anatomy

Materials ◽  
2021 ◽  
Vol 14 (4) ◽  
pp. 1021
Author(s):  
Bernhard Dorweiler ◽  
Pia Elisabeth Baqué ◽  
Rayan Chaban ◽  
Ahmed Ghazy ◽  
Oroa Salem
Keyword(s):  
Wall Thickness ◽  
Large Scale ◽  
Fused Deposition Modeling ◽  
Vascular Anatomy ◽  
3D Models ◽  
Patient Specific ◽  
Stl File ◽  
Fused Deposition ◽  
3D Printed ◽  
The Mean

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.

scholarly journals Complex wall modeling for hemodynamic simulations of intracranial aneurysms based on histologic images

2021 ◽  
Vol 16 (4) ◽  
pp. 597-607
Author(s):  
Annika Niemann ◽  
Samuel Voß ◽  
Riikka Tulamo ◽  
Simon Weigand ◽  
Bernhard Preim ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Geometric Model ◽  
Image Data ◽  
Outer Wall ◽  
3D Models ◽  
Patient Specific ◽  
Intracranial Vessel ◽  
Hemodynamic Simulations

Abstract Purpose For the evaluation and rupture risk assessment of intracranial aneurysms, clinical, morphological and hemodynamic parameters are analyzed. The reliability of intracranial hemodynamic simulations strongly depends on the underlying models. Due to the missing information about the intracranial vessel wall, the patient-specific wall thickness is often neglected as well as the specific physiological and pathological properties of the vessel wall. Methods In this work, we present a model for structural simulations with patient-specific wall thickness including different tissue types based on postmortem histologic image data. Images of histologic 2D slices from intracranial aneurysms were manually segmented in nine tissue classes. After virtual inflation, they were combined into 3D models. This approach yields multiple 3D models of the inner and outer wall and different tissue parts as a prerequisite for subsequent simulations. Result We presented a pipeline to generate 3D models of aneurysms with respect to the different tissue textures occurring in the wall. First experiments show that including the variance of the tissue in the structural simulation affect the simulation result. Especially at the interfaces between neighboring tissue classes, the larger influence of stiffer components on the stability equilibrium became obvious. Conclusion The presented approach enables the creation of a geometric model with differentiated wall tissue. This information can be used for different applications, like hemodynamic simulations, to increase the modeling accuracy.

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