scholarly journals Point-of-Care 3D Printing: a Low-Cost Approach to Teaching Carotid Artery Stenting

2021 ◽  
Author(s):  
Pieter De Backer ◽  
Charlotte Allaeys ◽  
Charlotte Debbaut ◽  
Roel Beelen
Keyword(s):  
3D Printing ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
3D Model ◽  
Point Of Care ◽  
Low Cost ◽  
Patient Specific ◽  
Stent Deployment ◽  
Invasive Approach ◽  
Minimal Invasive Approach

Abstract Background Carotid Artery Stenting (CAS) is increasingly being used in selected patients as a minimal invasive approach to carotid endarterectomy. Despite the abundance of performed endovascular treatments, the concept of stent-placement is still unclear to many patients. Furthermore, visual feedback on stent-deployment is difficult to obtain as it is always performed under radiographic feedback. Three-Dimensional (3D) printing might tackle both challenges. A particular use case of Point-of-Care 3D Printing is the pretreatment printing of vascular anatomy in support of endovascular procedures. Purpose This study reports the first use of a low-cost patient-specific 3D printed model for CAS education to both experienced surgeons and patients. Methodology An angio computed tomography (CT) scan was segmented and converted to STL format using Mimics inPrint™ software. The carotid arteries were bilaterally truncated to fit the whole model on a Formlabs 2 printer without omitting the internal vessel diameter. Next, this model was offset using a 1 mm margin. A ridge was modelled on the original vessel anatomy which was subsequently subtracted from the offset model in order to obtain a deroofed 3D model. All vessels were truncated as to facilitate flow on the inside. Results Date-expired carotid artery stents were successfully deployed inside the vessel. The deroofing allows for clear visualization of the bottlenecks and characteristics of CAS deployment and positioning, including foreshortening and tapering of the stent. This low-cost 3D model provides insights in stent deployment and positioning, and allows for patient-specific procedure planning. Conclusion Printing patient-specific 3D models preoperatively could assist in accurate patient selection, a better preoperative planning and case-specific training. Furthermore, this 3D model also allows for better patient education and informed consent. However, more research is warranted to evaluate the added value of these models.

scholarly journals Point-of-care 3D printing: a low-cost approach to teaching carotid artery stenting

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Pieter De Backer ◽  
Charlotte Allaeys ◽  
Charlotte Debbaut ◽  
Roel Beelen
Keyword(s):  
Patient Education ◽  
3D Printing ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
3D Model ◽  
Low Cost ◽  
Patient Specific ◽  
Stent Deployment ◽  
Invasive Approach ◽  
3D Printed

Abstract Background Carotid Artery Stenting (CAS) is increasingly being used in selected patients as a minimal invasive approach to carotid endarterectomy. Despite the long standing tradition of endovascular treatments, visual feedback during stent-deployment is impossible to obtain as deployment is performed under fluoroscopic imaging. Furthermore, the concept of stent-placement is often still unclear to patients. 3D Printing allows to replicate patient-specific anatomies and deploy stents inside them to simulate procedures. As such these models are being used for endovascular training as well as patient education. Purpose To our knowledge, this study reports the first use of a low-cost patient-specific 3D printed model for teaching CAS deployment under direct visualization, without fluoroscopy. Methodology A CT-angiogram was segmented and converted to STL format using Mimics inPrint™ software. The carotid arteries were bilaterally truncated to fit the whole model on a Formlabs 2 printer without omitting the internal vessel diameter. Next, this model was offset using a 1 mm margin. A ridge was modelled on the original vessel anatomy which was subsequently subtracted from the offset model in order to obtain a deroofed 3D model. All vessels were truncated to facilitate post-processing, flow and guide wire placement. Results Carotid artery stents were successfully deployed inside the vessel. The deroofing allows for clear visualization of the bottlenecks and characteristics of CAS deployment and positioning, including stent foreshortening, tapering and recoil. This low-cost 3D model provides visual insights in stent deployment and positioning, and can allow for patient-specific procedure planning. Conclusions The presented approach demonstrates the use of low-cost 3D Printed CAS models in teaching complex stent behavior as observed during deployment. Two main findings are illustrated. On one hand, the feasibility of low-cost in-hospital model production is shown. On the other hand, the teaching of CAS deployment bottlenecks at the carotid level without the need for fluoroscopic guidance, is illustrated. The observed stent characteristics as shown during deployment are difficult to assess in radiologic models. Furthermore, printing patient-specific 3D models preoperatively could possibly assist in accurate patient selection, preoperative planning, case-specific training and patient education.

scholarly journals In-Hospital 3D Printed Scaphoid Prosthesis Using Medical-Grade Polyetheretherketone (PEEK) Biomaterial

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Philipp Honigmann ◽  
Neha Sharma ◽  
Ralf Schumacher ◽  
Jasmine Rueegg ◽  
Mathias Haefeli ◽  
...  
Keyword(s):  
3D Printing ◽  
Point Of Care ◽  
Low Cost ◽  
Three Dimensional ◽  
Patient Specific ◽  
Fused Filament Fabrication ◽  
Patient Specific Implants ◽  
Surgical Guides ◽  
3D Printed ◽  
Medical Grade

Recently, three-dimensional (3D) printing has become increasingly popular in the medical sector for the production of anatomical biomodels, surgical guides, and prosthetics. With the availability of low-cost desktop 3D printers and affordable materials, the in-house or point-of-care manufacturing of biomodels and Class II medical devices has gained considerable attention in personalized medicine. Another projected development in medical 3D printing for personalized treatment is the in-house production of patient-specific implants (PSIs) for partial and total bone replacements made of medical-grade material such as polyetheretherketone (PEEK). We present the first in-hospital 3D printed scaphoid prosthesis using medical-grade PEEK with fused filament fabrication (FFF) 3D printing technology.

scholarly journals Accessing 3D Printed Vascular Phantoms for Procedural Simulation

2021 ◽  
Vol 7 ◽  
Author(s):  
Jasamine Coles-Black ◽  
Damien Bolton ◽  
Jason Chuen
Keyword(s):  
3D Printing ◽  
Endovascular Procedures ◽  
Low Cost ◽  
3D Models ◽  
Routine Care ◽  
Aortic Aneurysms ◽  
Patient Specific ◽  
Ct Angiogram ◽  
Abdominal Aortic ◽  
3D Printed

Introduction: 3D printed patient-specific vascular phantoms provide superior anatomical insights for simulating complex endovascular procedures. Currently, lack of exposure to the technology poses a barrier for adoption. We offer an accessible, low-cost guide to producing vascular anatomical models using routine CT angiography, open source software packages and a variety of 3D printing technologies.Methods: Although applicable to all vascular territories, we illustrate our methodology using Abdominal Aortic Aneurysms (AAAs) due to the strong interest in this area. CT aortograms acquired as part of routine care were converted to representative patient-specific 3D models, and then printed using a variety of 3D printing technologies to assess their material suitability as aortic phantoms. Depending on the technology, phantoms cost $20–$1,000 and were produced in 12–48 h. This technique was used to generate hollow 3D printed thoracoabdominal aortas visible under fluoroscopy.Results: 3D printed AAA phantoms were a valuable addition to standard CT angiogram reconstructions in the simulation of complex cases, such as short or very angulated necks, or for positioning fenestrations in juxtarenal aneurysms. Hollow flexible models were particularly useful for device selection and in planning of fenestrated EVAR. In addition, these models have demonstrated utility other settings, such as patient education and engagement, and trainee and anatomical education. Further study is required to establish a material with optimal cost, haptic and fluoroscopic fidelity.Conclusion: We share our experiences and methodology for developing inexpensive 3D printed vascular phantoms which despite material limitations, successfully mimic the procedural challenges encountered during live endovascular surgery. As the technology continues to improve, 3D printed vascular phantoms have the potential to disrupt how endovascular procedures are planned and taught.

scholarly journals Retrograde three-dimensional rotational angiography: A novel method for the detection of plaque protrusion during carotid artery stenting under continuous distal balloon protection

2020 ◽  
Vol 26 (3) ◽  
pp. 316-320
Author(s):  
Hisayuki Hosoo ◽  
Wataro Tsuruta ◽  
Yusuke Hamada ◽  
Masahiro Katsumata ◽  
Daiichiro Ishigami ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Balloon Dilatation ◽  
Three Dimensional ◽  
Additional Treatment ◽  
Stent Deployment ◽  
Ischemic Complications ◽  
Novel Method ◽  
Stent Lumen ◽  
Balloon Protection

Background To prevent ischemic complications during carotid artery stenting, accurate detection of plaque protrusion and appropriate additional treatment are essential. Here, we introduce a novel method for the detection of plaque protrusion under distal balloon protection using three-dimensional rotation angiography—“retrograde 3DRA.” We evaluated the safety and efficacy of this method. Materials and methods We retrospectively analyzed 28 consecutive carotid artery stenting procedures under distal balloon protection at our hospital between July 2017 and August 2019. The first line of protection was dual balloon protection (proximal and distal balloon). After stent deployment, balloon dilatation, and subsequent blood aspiration, 3DRA was performed with the injection of diluted contrast medium from the aspiration catheter positioned just proximal to the distal protection balloon. The stent lumen was analyzed by obtaining the reconstruction maximum intensity projection image. Results Among the 28 cases, all cases could be assessed for in-stent plaque protrusion using “retrograde 3DRA.” We were able to evaluate the stent lumen clearly. There were three cases (10.7%) in which plaque protrusion could be confirmed. Since additional balloon dilatation was performed for all protrusion cases under continuing balloon protection, no ischemic complications occurred. Conclusion Retrograde 3DRA could be safe and useful for the detection of plaque protrusions and to avoid ischemic complication for tolerable cases of internal carotid artery transient balloon protection.

scholarly journals 855 Patient Specific Digital Modelling And 3D Printing of Abdominal Anatomy- The Next Frontier in Surgical Simulation?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Fletcher ◽  
C Myles ◽  
D Miskovic ◽  
J Jones ◽  
R Cahill
Keyword(s):  
3D Printing ◽  
Injection Moulding ◽  
Surgical Simulation ◽  
Low Cost ◽  
Physical Models ◽  
Patient Specific ◽  
Phase Imaging ◽  
Imaging Data ◽  
Digital Models ◽  
Operative Planning

Abstract Introduction Innovations in digital technologies afford new opportunities in surgical education. We describe a novel method of combining medical imaging data with virtual 3D modelling and printing techniques that could facilitate patient specific pre-operative planning and rehearsal. Method A series of silicone castings was produced to simulate upper abdominal viscera using a novel polyvinyl alcohol (PVA) injection moulding method. Digital models were generated by segmenting CT dual phase imaging in ITK-SNAP. A 3D polygon mesh was exported and optimised in the computer graphics software: Blender. Two 3D printers were used to manufacture a dissolvable mould of the digital models. Moulds were injected with coloured silicones and dissolved in water to reveal the multicolour/multi-material models. Results The silicone models retained the anatomical detail of the digitally segmented CT data sets. The multi-colour models were achieved with a single print and at very low cost (approx. £248/ model) and possessed varying shore hardness between viscera recreating lifelike fidelity. Conclusions The hybrid 3D printing/injection moulding method offers an avenue to realistic surgical and anatomical simulation. A combination of both virtual models and 3D physical models may provide an enhanced surgical experience for preoperative and intraoperative planning allowing patient specific rehearsal.

scholarly journals Multiscale Modeling of Endothelium Derived Wall Shear Stress Regulation in Common Carotid Artery

2019 ◽  
Vol 35 (6) ◽  
pp. 901-914
Author(s):  
Saeed Siri ◽  
Malikeh Nabaei ◽  
Nasser Fatouraee
Keyword(s):  
Mechanical Properties ◽  
Shear Stress ◽  
Carotid Artery ◽  
Wall Shear Stress ◽  
Common Carotid Artery ◽  
3D Model ◽  
Stable Condition ◽  
Patient Specific ◽  
Local Flow ◽  
Wall Shear

ABSTRACTShear induced autoregulation is the natural ability of organs to maintain the local hemodynamic stresses in a stable condition in spite of altering perfusion rate. Endothelium cells are shear sensitive mechanoreceptors that are responsible for regulating the arterial wall architecture and mechanical properties in order to maintain homeostasis. This occurs by means of vasoactive mediators, which cause vasodilation or vasoconstriction. In this paper we presented a multiscale model of local flow regulation. First, a lumped parameter model of the whole cardiovascular system was implemented. Then a 3D numerical model of human common carotid artery was constructed considering fluid-structure interaction. The CCA inflow waveform obtained from the extended 0D model was applied to the 3D model as the boundary condition. After applying the Head-Up Tilt test, the local hemodynamics were disturbed. By considering the wall shear stress as the regulation criterion, then altering the arterial mechanical properties and the following vasodilation, shear forces exerted on the inner lining of the vessel were regulated and returned to the normal range. The resulting 0D/3D model can be considered as a plat-form for a more complete model containing local and systemic cardiovascular control mechanisms and patient-specific geometries which can be used for clinical purposes.

scholarly journals 3D Printing Endobronchial Models for Surgical Training and Simulation

2018 ◽  
Vol 4 (11) ◽  
pp. 135 ◽  
Author(s):  
Zhuo Zhao ◽  
Sheng Xu ◽  
Bradford Wood ◽  
Zion Tse
Keyword(s):  
Lung Cancer ◽  
3D Printing ◽  
Low Cost ◽  
Complex Structure ◽  
Patient Specific ◽  
Ablation Catheter ◽  
Phantom Model ◽  
Lung Phantom ◽  
Navigation Software ◽  
Localization Information

Lung cancer is the leading cause of cancer-related deaths. Many methods and devices help acquire more accurate clinical and localization information during lung interventions and may impact the death rate for lung cancer. However, there is a learning curve for operating these tools due to the complex structure of the airway. In this study, we first discuss the creation of a lung phantom model from medical images, which is followed by a comparison of 3D printing in terms of quality and consistency. Two tests were conducted to test the performance of the developed phantom, which was designed for training simulations of the target and ablation processes in endochonchial interventions. The target test was conducted through an electromagnetic tracking catheter with navigation software. An ablation catheter with a recently developed thermochromic ablation gel conducted the ablation test. The results of two tests show that the phantom was very useful for target and ablation simulation. In addition, the thermochromic gel allowed doctors to visualize the ablation zone. Many lung interventions may benefit from custom training or accuracy with the proposed low-cost and patient-specific phantom.

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