Current Practice in Preoperative Virtual and Physical Simulation in Neurosurgery

In brain tumor surgery, an appropriate and careful surgical planning process is crucial for surgeons and can determine the success or failure of the surgery. A deep comprehension of spatial relationships between tumor borders and surrounding healthy tissues enables accurate surgical planning that leads to the identification of the optimal and patient-specific surgical strategy. A physical replica of the region of interest is a valuable aid for preoperative planning and simulation, allowing the physician to directly handle the patient’s anatomy and easily study the volumes involved in the surgery. In the literature, different anatomical models, produced with 3D technologies, are reported and several methodologies were proposed. Many of them share the idea that the employment of 3D printing technologies to produce anatomical models can be introduced into standard clinical practice since 3D printing is now considered to be a mature technology. Therefore, the main aim of the paper is to take into account the literature best practices and to describe the current workflow and methodology used to standardize the pre-operative virtual and physical simulation in neurosurgery. The main aim is also to introduce these practices and standards to neurosurgeons and clinical engineers interested in learning and implementing cost-effective in-house preoperative surgical planning processes. To assess the validity of the proposed scheme, four clinical cases of preoperative planning of brain cancer surgery are reported and discussed. Our preliminary results showed that the proposed methodology can be applied effectively in the neurosurgical clinical practice both in terms of affordability and in terms of simulation realism and efficacy.

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3D MODELLING AND RAPID PROTOTYPING FOR CARDIOVASCULAR SURGICAL PLANNING – TWO CASE STUDIES

ISPRS - International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences ◽

10.5194/isprsarchives-xli-b5-887-2016 ◽

2016 ◽

Vol XLI-B5 ◽

pp. 887-893 ◽

Cited By ~ 6

Author(s):

E. Nocerino ◽

F. Remondino ◽

F. Uccheddu ◽

M. Gallo ◽

G. Gerosa

Keyword(s):

3D Printing ◽

Rapid Prototyping ◽

Case Studies ◽

Surgical Planning ◽

Heart Diseases ◽

Coronary Vessels ◽

3D Modelling ◽

Patient Specific ◽

Surface Model ◽

Medical Imagery

In the last years, cardiovascular diagnosis, surgical planning and intervention have taken advantages from 3D modelling and rapid prototyping techniques. The starting data for the whole process is represented by medical imagery, in particular, but not exclusively, computed tomography (CT) or multi-slice CT (MCT) and magnetic resonance imaging (MRI). On the medical imagery, regions of interest, i.e. heart chambers, valves, aorta, coronary vessels, etc., are segmented and converted into 3D models, which can be finally converted in physical replicas through 3D printing procedure. In this work, an overview on modern approaches for automatic and semiautomatic segmentation of medical imagery for 3D surface model generation is provided. The issue of accuracy check of surface models is also addressed, together with the critical aspects of converting digital models into physical replicas through 3D printing techniques. A patient-specific 3D modelling and printing procedure (Figure 1), for surgical planning in case of complex heart diseases was developed. The procedure was applied to two case studies, for which MCT scans of the chest are available. In the article, a detailed description on the implemented patient-specific modelling procedure is provided, along with a general discussion on the potentiality and future developments of personalized 3D modelling and printing for surgical planning and surgeons practice.

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The Role of 3D-Printed Phantoms and Devices for Organ-specified Appliances in Urology

International Journal of Bioprinting ◽

10.18063/ijb.v7i2.333 ◽

2021 ◽

Vol 7 (2) ◽

Author(s):

Natanael Parningotan Agung ◽

Muhammad Hanif Nadhif ◽

Gampo Alam Irdam ◽

Chaidir Arif Mochtar

Keyword(s):

Clinical Practice ◽

Disease Management ◽

Surgical Planning ◽

Literature Search ◽

Anatomical Models ◽

Current Role ◽

Genitourinary System ◽

Planning Strategy ◽

3D Printed

Urology is one of the fields that are always at the frontline of bringing scientific advancements into clinical practice, including 3D printing (3DP). This study aims to discuss and presents the current role of 3D-printed phantoms and devices for organ-specified applications in urology. The discussion started with a literature search regarding the two mentionedtopics within PubMed, Embase, Scopus, and EBSCOhost databases. 3D-printed urological organ phantoms are reported for providing residents new insight regarding anatomical characteristics of organs, either normal or diseased, in a tangible manner. Furthermore, 3D-printed organ phantoms also helped urologists to prepare a pre-surgical planning strategy with detailed anatomical models of the diseased organs. In some centers, 3DP technology also contributed to developing specified devicesfor disease management. To date, urologists have been benefitted by 3D-printed phantoms and devices in the education and disease management of organs of in the genitourinary system, including kidney, bladder, prostate, ureter, urethra, penis, and adrenal. It is safe to say that 3DP technology can bring remarkable changes to daily urological practices.

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Beneath the Skin: Emulating human physiology using a novel bitmap-based “voxel” 3D-printing workflow.

10.26686/wgtn.17151335 ◽

2021 ◽

Author(s):

◽

Ana Morris

Keyword(s):

Medical Education ◽

3D Printing ◽

Biomedical Imaging ◽

Human Anatomy ◽

Patient Specific ◽

Imaging Data ◽

Anatomical Models ◽

Medical Communication ◽

Medical Models ◽

3D Printed

<p>Novel technologies that produce medical models which are synthetic equivalents to human tissue may forever change the way human anatomy and medicine are explored. Medical modelling using a bitmap-based additive manufacturing workflow offers exciting opportunities for medical education, informed consent practices, skills acquisition, pre-operative planning and surgical simulation. Moving medical data from the 2D-world to tactile, highly detailed 3D-printed anatomical models may significantly change how we comprehend the body; revamping everything – from medical education to clinical practice. Research Problem The existing workflow for producing patient-specific anatomical models from biomedical imaging data involves image thresholding and iso-surface extraction techniques that result in surface meshes (also known as objects or parts). This process restricts shape specification to one colour and density, limiting material blending and resulting in anatomically inequivalent medical models. So, how can the use of 3D-printing go beyond static anatomical replication? Imagine pulling back the layers of tissue to reveal the complexity of a procedure, allowing a family to understand and discuss their diagnosis. Overcoming the disadvantages of static medical models could be a breakthrough in the areas of medical communication and simulation. Currently, patient specific models are either rigid or mesh-based and, therefore, are not equivalents of physiology. Research Aim The aim of this research is to create tangible and visually compelling patient-specific prototypes of human anatomy, offering an insight into the capabilities of new bitmap-based 3D-printing technology. It proposes that full colour, multi-property, voxel-based 3D-printing can emulate physiology, creating a new format of visual and physical medical communication. Data Collection and Procedure For this study, biomedical imaging data was converted into multi-property 3D-printed synthetic anatomy by bypassing the conversion steps of traditional segmentation. Bitmap-based 3D-printing allows for the precise control over every 14-micron material droplet or “voxel”. Control over each voxel involves a process of sending bitmap images to a high-resolution and multi-property 3D-printer. Bitmap-based 3D-printed synthetic medical models – which mimicked the colour and density of human anatomy – were successfully produced. Findings This research presented a novel and streamlined bitmap-based medical modelling workflow with the potential to save manufacturing time and labour cost. Moreover, this workflow produced highly accurate models with graduated densities, translucency, colour and flexion – overcoming complexities that arise due to our body’s opaqueness. The presented workflow may serve as an incentive for others to investigate bitmap-based 3D-printing workflows for different manufacturing applications.</p>

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Comparing cost and print time estimates for six commercially-available 3D printers obtained through slicing software for clinically relevant anatomical models

10.21203/rs.3.rs-50148/v2 ◽

2020 ◽

Author(s):

Joshua Vic Chen ◽

Alan BC Dang ◽

Alexis Dang

Keyword(s):

Cost Effective ◽

Patient Specific ◽

Anatomical Models ◽

Worst Case ◽

Layer Height ◽

Orthopaedic Care ◽

Horizontal Orientation ◽

3D Printers ◽

The Difference ◽

Digital Anatomy

Abstract Background3D printed patient-specific anatomical models have been applied clinically to orthopaedic care for surgical planning and patient education. The estimated cost and print time per model for 3D printers have not yet been compared with clinically representative models across multiple printing technologies. This study investigates six commercially-available 3D printers: Prusa i3 MK3S, Formlabs Form 2, Formlabs Form 3, LulzBot TAZ 6, Stratasys F370, and Stratasys J750 Digital Anatomy.MethodsSeven representative orthopaedic standard tessellation models derived from CT scans were imported into the respective slicing software for each 3D printer. For each printer and corresponding print setting, the slicing software provides a print time and material use estimate. Material quantity was used to calculate estimated model cost. Print settings investigated were infill percentage, layer height, and model orientation on the print bed. The slicing software investigated are Cura LulzBot Edition 3.6.20, GrabCAD Print 1.43, PreForm 3.4.6, and PrusaSlicer 2.2.0.ResultsThe effect of changing infill between 15% and 20% on estimated print time and material use was negligible. Orientation of the model has considerable impact on time and cost with worst-case differences being as much as 39.30% added print time and 34.56% added costs. Averaged across all investigated settings, horizontal model orientation on the print bed minimizes estimated print time for all 3D printers, while vertical model orientation minimizes cost with the exception of Stratasys J750 Digital Anatomy, in which horizontal orientation also minimized cost. Decreasing layer height for all investigated printers increased estimated print time and decreased estimated cost with the exception of Stratasys F370, in which cost increased. The difference in material cost was two orders of magnitude between the least and most-expensive printers. The difference in build rate (cm3/min) was one order of magnitude between the fastest and slowest printers.ConclusionsAll investigated 3D printers in this study have the potential for clinical utility. Print time and print cost are dependent on orientation of anatomy and the printers and settings selected. Cost-effective clinical 3D printing of anatomic models should consider an appropriate printer for the complexity of the anatomy and the experience of the printer technicians.

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3D Printing of Human Anatomical Models for Preoperative Surgical Planning

Procedia Manufacturing ◽

10.1016/j.promfg.2020.05.100 ◽

2020 ◽

Vol 48 ◽

pp. 684-690

Author(s):

V. Paramasivam ◽

Sindhu ◽

G. Singh ◽

S. Santhanakrishnan

Keyword(s):

3D Printing ◽

Surgical Planning ◽

Anatomical Models

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Pre-Surgical Planning Using Patient-Specific 3D Printed Anatomical Models for Women with Uterine Fibroids

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2020.08.596 ◽

2020 ◽

Vol 27 (7) ◽

pp. S71-S72

Author(s):

T. Flaxman ◽

C.M. Cooke ◽

A. Sheikh ◽

O. Miguel ◽

L. Chepelev ◽

...

Keyword(s):

Surgical Planning ◽

Uterine Fibroids ◽

Patient Specific ◽

Anatomical Models ◽

3D Printed

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Pre-surgical planning using patient-specific 3D printed anatomical models for women with uterine fibroids

Journal of Obstetrics and Gynaecology Canada ◽

10.1016/j.jogc.2021.02.071 ◽

2021 ◽

Vol 43 (5) ◽

pp. 670

Author(s):

Carly Cooke ◽

Teresa Flaxman ◽

Adnan Sheikh ◽

Olivier Miguel ◽

Matthew McInnes ◽

...

Keyword(s):

Surgical Planning ◽

Uterine Fibroids ◽

Patient Specific ◽

Anatomical Models ◽

3D Printed

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3D Bioprinted Cardiac Tissues and Devices for Tissue Maturation

Cells Tissues Organs ◽

10.1159/000512792 ◽

2021 ◽

pp. 1-14

Author(s):

Veronika Sedlakova ◽

Christopher McTiernan ◽

David Cortes ◽

Erik J. Suuronen ◽

Emilio I. Alarcon

Keyword(s):

3D Printing ◽

Tissue Repair ◽

Surgical Planning ◽

Cardiac Tissue ◽

Treatment Options ◽

Cardiac Regeneration ◽

Patient Specific ◽

Cardiac Tissues ◽

Cardiovascular Tissue ◽

Custom Made

Cardiovascular diseases are the leading cause of mortality worldwide. Given the limited endogenous regenerative capabilities of cardiac tissue, patient-specific anatomy, challenges in treatment options, and shortage of donor tissues for transplantation, there is an urgent need for novel approaches in cardiac tissue repair. 3D bioprinting is a technology based on additive manufacturing which allows for the design of precisely controlled and spatially organized structures, which could possibly lead to solutions in cardiac tissue repair. In this review, we describe the basic morphological and physiological specifics of the heart and cardiac tissues and introduce the readers to the fundamental principles underlying 3D printing technology and some of the materials/approaches which have been used to date for cardiac repair. By summarizing recent progress in 3D printing of cardiac tissue and valves with respect to the key features of cardiovascular tissue (such as contractility, conductivity, and vascularization), we highlight how 3D printing can facilitate surgical planning and provide custom-fit implants and properties that match those from the native heart. Finally, we also discuss the suitability of this technology in the design and fabrication of custom-made devices intended for the maturation of the cardiac tissue, a process that has been shown to increase the viability of implants. Altogether this review shows that 3D printing and bioprinting are versatile and highly modulative technologies with wide applications in cardiac regeneration and beyond.

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Clinical efficacy and effectiveness of 3D printing: a systematic review

BMJ Open ◽

10.1136/bmjopen-2017-016891 ◽

2017 ◽

Vol 7 (12) ◽

pp. e016891 ◽

Cited By ~ 47

Author(s):

Laura E Diment ◽

Mark S Thompson ◽

Jeroen H M Bergmann

Keyword(s):

Systematic Review ◽

3D Printing ◽

Clinical Efficacy ◽

Musculoskeletal System ◽

Preoperative Planning ◽

Maxillofacial Surgery ◽

Oral And Maxillofacial Surgery ◽

Level Of Evidence ◽

Standard Clinical Practice ◽

3D Printed

ObjectiveTo evaluate the clinical efficacy and effectiveness of using 3D printing to develop medical devices across all medical fields.DesignSystematic review compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Data sourcesPubMed, Web of Science, OVID, IEEE Xplore and Google Scholar.MethodsA double-blinded review method was used to select all abstracts up to January 2017 that reported on clinical trials of a three-dimensional (3D)-printed medical device. The studies were ranked according to their level of evidence, divided into medical fields based on the International Classification of Diseases chapter divisions and categorised into whether they were used for preoperative planning, aiding surgery or therapy. The Downs and Black Quality Index critical appraisal tool was used to assess the quality of reporting, external validity, risk of bias, risk of confounding and power of each study.ResultsOf the 3084 abstracts screened, 350 studies met the inclusion criteria. Oral and maxillofacial surgery contained 58.3% of studies, and 23.7% covered the musculoskeletal system. Only 21 studies were randomised controlled trials (RCTs), and all fitted within these two fields. The majority of RCTs were 3D-printed anatomical models for preoperative planning and guides for aiding surgery. The main benefits of these devices were decreased surgical operation times and increased surgical accuracy.ConclusionsAll medical fields that assessed 3D-printed devices concluded that they were clinically effective. The fields that most rigorously assessed 3D-printed devices were oral and maxillofacial surgery and the musculoskeletal system, both of which concluded that the 3D-printed devices outperformed their conventional comparators. However, the efficacy and effectiveness of 3D-printed devices remain undetermined for the majority of medical fields. 3D-printed devices can play an important role in healthcare, but more rigorous and long-term assessments are needed to determine if 3D-printed devices are clinically relevant before they become part of standard clinical practice.

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Augmented Reality, Surgical Navigation, and 3D Printing for Transcanal Endoscopic Approach to the Petrous Apex

OTO Open ◽

10.1177/2473974x18804492 ◽

2018 ◽

Vol 2 (4) ◽

pp. 2473974X1880449 ◽

Cited By ~ 8

Author(s):

Samuel R. Barber ◽

Kevin Wong ◽

Vivek Kanumuri ◽

Ruwan Kiringoda ◽

Judith Kempfle ◽

...

Keyword(s):

Augmented Reality ◽

Skull Base ◽

Surgical Planning ◽

Preoperative Planning ◽

Endoscopic Approach ◽

Physical Models ◽

Petrous Apex ◽

Patient Specific ◽

Lateral Skull Base ◽

3D Printed

Otolaryngologists increasingly use patient-specific 3-dimensional (3D)–printed anatomic physical models for preoperative planning. However, few reports describe concomitant use with virtual models. Herein, we aim to (1) use a 3D-printed patient-specific physical model with lateral skull base navigation for preoperative planning, (2) review anatomy virtually via augmented reality (AR), and (3) compare physical and virtual models to intraoperative findings in a challenging case of a symptomatic petrous apex cyst. Computed tomography (CT) imaging was manually segmented to generate 3D models. AR facilitated virtual surgical planning. Navigation was then coupled to 3D-printed anatomy to simulate surgery using an endoscopic approach. Intraoperative findings were comparable to simulation. Virtual and physical models adequately addressed details of endoscopic surgery, including avoidance of critical structures. Complex lateral skull base cases may be optimized by surgical planning via 3D-printed simulation with navigation. Future studies will address whether simulation can improve patient outcomes.

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