Injecting Realism in Surgical Training—Initial Simulation Experience With Custom 3D Models

Waran, Vicknes; Narayanan, Vairavan; Karuppiah, Ravindran; Pancharatnam, Devaraj; Chandran, Hari; Raman, Rajagopalan; Rahman, Zainal Ariff Abdul; Owen, Sarah; Aziz, Tipu Z.

doi:10.1016/j.jsurg.2013.08.010

Cited by 112 publications

(79 citation statements)

References 13 publications

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“…3D printed models have been used for surgical training and education (6), creation of custom airway implants (7), surgical planning for congenital heart disease (8,9), and for aortic aneurysm repair (1). Unfortunately, these applications used proprietary software (1,7,8) or expensive on-site printers and printing services (6)(7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

Using 3D printed models for planning and guidance during endovascular intervention: a technical advance

Itagaki¹

2015

Diagn Interv Radiol

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T hree-dimensional (3D) printed vascular models have been manufactured for the heart and aorta and used preoperatively for planning and testing prior to surgery (1). Creation of intracranial vessel models has been described using 3D printing indirectly to create a scaffold, which aided in creation of hollow models using a manual painting process (2). Direct manufacture of hollow small vessel models using 3D printing has not been described, and it is unknown if it is possible with existing technology, or of any clinical utility.In a complex case of multiple splenic artery aneurysms, 3D printed vascular models were successfully created using free software and low-cost Internet 3D printing services, and were used for preoperative planning and intraoperative guidance. Two models were created. The first was a hollow model of the splenic artery. The second was a solid model of the splenic artery lumen. Both models were full-size, anatomically accurate, and derived from computed tomography (CT) scan data. The models enabled a complex endovascular procedure to be practiced and refined before the actual procedure on the patient, leading to a success that preserved the patient's spleen. Case backgroundA 62-year-old female presented with multiple asymptomatic splenic artery aneurysms that had been incidentally detected on a CT scan performed during a workup for a urinary tract infection. She was asymptomatic and had no known risk factors, including portal hypertension, liver cirrhosis, or current or past pregnancy. A contrast-enhanced CT scan revealed a significantly tortuous splenic artery, having a 360° loop followed by three 180° hairpin turns. Two 2 cm aneurysms were present, located at the second and third 180° hairpin turns, respectively (Fig. 1a, 1b). A smaller, low-risk 5 mm aneurysm was also present and located in the proximal artery. Because the distal-most aneurysm was at the splenic hilum, infarction of the spleen was likely if treated with conventional transcatheter embolization (3). The patient declined conventional treatment, including splenic artery embolization and surgical splenectomy, desiring to preserve splenic function. Flow-sparing aneurysm embolization and stent-graft placement were considered, but a consensus of three board-certified interventional radiologists and a board-certified vascular surgeon determined it was ABSTRACT Three-dimensional (3D) printing applications in medicine have been limited due to high cost and technical difficulty of creating 3D printed objects. It is not known whether patient-specific, hollow, small-caliber vascular models can be manufactured with 3D printing, and used for small vessel endoluminal testing of devices. Manufacture of anatomically accurate, patient-specific, small-caliber arterial models was attempted using data from a patient's CT scan, free open-source software, and lowcost Internet 3D printing services. Prior to endovascular treatment of a patient with multiple splenic artery aneurysms, a 3D printed model was used preoperatively to test catheter equipmen...

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Section: Discussionmentioning

confidence: 99%

Using 3D printed models for planning and guidance during endovascular intervention: a technical advance

Itagaki¹

2015

Diagn Interv Radiol

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“…As proposed by Burleson et al,5 3D‐printed exterior molds of a patient can be useful as a way to fit electron bolus before treatment for patients with open wounds or sensitive skin. 3D‐printed patient‐specific phantoms have also been found to be helpful in surgical planning6 and in the education of medical residents for surgeries of the liver7 and brain 8. In general, patient‐specific phantoms could be used not only for end‐to‐end QA of new radiation therapy techniques but also to perform QA for routine treatments on patients with highly atypical anatomy 9…”

Section: Introductionmentioning

confidence: 99%

Preparation and fabrication of a full‐scale, sagittal‐sliced, 3D‐printed, patient‐specific radiotherapy phantom

Craft

Howell

2017

J Applied Clin Med Phys

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PurposePatient‐specific 3D‐printed phantoms have many potential applications, both research and clinical. However, they have been limited in size and complexity because of the small size of most commercially available 3D printers as well as material warping concerns. We aimed to overcome these limitations by developing and testing an effective 3D printing workflow to fabricate a large patient‐specific radiotherapy phantom with minimal warping errors. In doing so, we produced a full‐scale phantom of a real postmastectomy patient.MethodsWe converted a patient's clinical CT DICOM data into a 3D model and then sliced the model into eleven 2.5‐cm‐thick sagittal slices. The slices were printed with a readily available thermoplastic material representing all body tissues at 100% infill, but with air cavities left open. Each slice was printed on an inexpensive and commercially available 3D printer. Once the printing was completed, the slices were placed together for imaging and verification. The original patient CT scan and the assembled phantom CT scan were registered together to assess overall accuracy.ResultsThe materials for the completed phantom cost $524. The printed phantom agreed well with both its design and the actual patient. Individual slices differed from their designs by approximately 2%. Registered CT images of the assembled phantom and original patient showed excellent agreement.ConclusionsThree‐dimensional printing the patient‐specific phantom in sagittal slices allowed a large phantom to be fabricated with high accuracy. Our results demonstrate that our 3D printing workflow can be used to make large, accurate, patient‐specific phantoms at 100% infill with minimal material warping error.

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“…19,20,22 In this context, the main aim of our study was to prove feasibility of creating a three-dimensional model of articular knee cartilage and a containing defect zone. Furthermore, we determined a setup and developed a process-chain for optimal results, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…20 In many surgical fields this new technology was already used to create 3D objects of patients anatomy. [19][20][21][22] Some health care sectors are already experiencing the impact of 3D printing: dentistry and orthodontics are two examples. 23 More than 19,000 metal copings used to create crowns and bridges are up to date manufactured on 3D printing equipment.…”

Section: Introductionmentioning

confidence: 99%

New approach for predictive measurement of knee cartilage defects with three-dimensional printing based on CT-arthrography: A feasibility study

Michalik

Schrading

Dirrichs

et al. 2017

Journal of Orthopaedics

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Injecting Realism in Surgical Training—Initial Simulation Experience With Custom 3D Models

Cited by 112 publications

References 13 publications

Using 3D printed models for planning and guidance during endovascular intervention: a technical advance

Using 3D printed models for planning and guidance during endovascular intervention: a technical advance

Preparation and fabrication of a full‐scale, sagittal‐sliced, 3D‐printed, patient‐specific radiotherapy phantom

New approach for predictive measurement of knee cartilage defects with three-dimensional printing based on CT-arthrography: A feasibility study

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