Four-Dimensional (4D) Printing: A New Evolution in Computed Tomography-Guided Stereolithographic Modeling. Principles and Application

Abstract

).Modern imaging techniques have enabled accurate preoperative planning in plastic and reconstructive surgery, 1 with advances translated to superior clinical outcomes and reduced operative length. In perforator flap surgery for breast reconstruction, preoperative computed tomography angiography (CTA) reliably, maps the vascular supply enabling the selection of donor site, flap, and the perforator. However, the interpretation of CTA scan data displayed on a two- AbstractBackground Over the last decade, image-guided production of three-dimensional (3D) haptic biomodels, or rapid prototyping (RP), has transformed the way surgeons conduct preoperative planning. In contrast to earlier RP techniques such as stereolithography, 3D printing has introduced fast, affordable office-based manufacturing. We introduce the concept of 4D printing for the first time by introducing time as the fourth dimension to 3D printing. Methods The bones of the thumb ray are 3D printed during various movements to demonstrate four-dimensional (4D) printing. Principles and validation studies are presented here. Results 4D computed tomography was performed using "single volume acquisition" technology to reduce the exposure to radiation. Three representative scans of each thumb movement (i.e., abduction, opposition, and key pinch) were selected and then models were fabricated using a 3D printer. For validation, the angle between the first and the second metacarpals from the 4D imaging data and the 4D-printed model was recorded and compared. Conclusion We demonstrate how 4D printing accurately depicts the transition in the position of metacarpals during thumb movement. With a fourth dimension of time, 4D printing delivers complex spatiotemporal anatomical details effortlessly and may substantially improve preoperative planning.

Emerging Applications of Bedside 3D Printing in Plastic Surgery

“…Recently, we described for the first time the concept of applying 3D printing to 4D CT scans, or 4D printing, where time is added as the fourth dimension to the standard 3D printing (119). 4D CT is a novel imaging modality developed to remove motion artifacts from organs, such as lungs, in order to enhance the image quality and facilitate precise delivery of radiotherapy (136, 137).…”

Surgeon-Based 3D Printing for Microvascular Bone Flaps

“…Chae et al (2015) describe four-dimensional (4D) printing in which time acts as a fourth dimension to length, width, and height in perioperative planning. 9 The study examined the relationship of metacarpal bones during thumb movements from information obtained with 4D CT by creating printed models of different positions in time with the goal of providing anatomical spatiotemporal information for use in the operating room. Intraoperative medial femoral trochlea (MFT) flap based on the transverse branch of the descending geniculate artery with saphenous branch to the skin paddle.…”

4D printing applications in medical field: A brief review

“…These technologies are also used to analyse the defect and broken bone of the patient. 13,23 Transformation of data into a digital 3D model Scan data is essential to convert into a 3D model by using different software like OsiriX Imaging Software, 3D slicer, Mimics, Magics, 3D doctor, InVesalius. Before printing or design modification, it is essential to have transform data into a 3D model.…”

“…This technology can develop new methods and material to create implants. 13,14 In the medical field, doctors and researchers believe that 4D printing will evolve for the higher level of applications. It uses chameleonic materials in which, the material properties get changed according to temperature change.…”