The authors acknowledge funding from National Natural Science Foundation of China (No. 81771971), Shanghai Pujiang Program (No. 14PJD008 and 17PJ1401500), &#34;Chen Guang&#34; Project Supported by Shanghai Municipal Education Commission and Shanghai Education Development Foundation (No. 14CG06), Natural Science Foundation of Shanghai (Nos. 17411962800 and 17ZR1432900), and Science and Technology Commission of Shanghai Municipality (17JC1400200). W.Z. acknowledges funding from the National Natural Science Foundation of China (31501555 and 81772007, and 21734003), the China&#39;s 1000 Young Talents Program, Education Commission of Shanghai Municipality (Young Eastern Professorship Award), and Science and Technology Commission of Shanghai Municipality (17JC1400200 and 16391903900).

The present study was approved by the ethics committee of Zhongshan Hospital Fudan University (B2016-142R) and all participants gave their informed consent.
1. Diagnosis of the Aortic Anomaly by Symptoms and Acquisition of Imaging Data
<ol>
	<li>Identify patients who have symptoms such as chest pain, dysphagia, or a blood pressure difference of the upper limbs in out-patient clinic. Exclude patients who may be intolerant of the operation.</li>
	<li>Perform CT angiography in these patients to diagnose Kommerell&#8217;s diverticulum8.</li>
</ol>
2. Segmentation of Regions of Interest
<ol>
	<li>Import all the CT angiography images into the software in a DICOM format. The resolution of these images was 512 &#215; 512 pixels, and the slice thickness was 1 mm.
	<ol>
		<li>Double click the patient case from case library and open it.</li>
		<li>Select the DICOM series and click Model Recon to open the model recon page.</li>
	</ol>
	</li>
	<li>Have an engineer and a team of cardiac surgeons review the DICOM formatted raw data to identify key anatomic features and region of interest (ROI).</li>
	<li>Use gray value-based thresholding to segment the ROI.
	<ol>
		<li>Click the Threshold Segmentation button and adjust the threshold range for the vascular mask. The default range is between 226 to 3071.</li>
		<li>Click the Confirm button for threshold segmentation and the vascular mask will show in the object list. Click the Recon button from the right of the mask and the 3-D vascular mask will be reconstructed and shown in 3-D viewer.</li>
		<li>Click the Threshold Segmentation button and adjust the threshold range for the trachea mask. Click the Marquee Segmentation button to limit the region of interest to the mediastinum and the lung. The default range is between -1024 to -520.</li>
		<li>Click the Mask Edit button and erase the connection between the trachea and the lung.</li>
		<li>Click the Region Grow button and select a seed by clicking any point/pixel at the mask in any one of the 2-D viewers. Check and confirm that the region grows as result, and that the trachea mask will show in the object list.</li>
		<li>Click the Recon button on the right of the mask, and the 3-D trachea will be reconstructed in the 3-D viewer.</li>
	</ol>
	</li>
	<li>Save the ROI as masks for 3-D reconstruction.</li>
</ol>
3. 3-D Reconstruction of the ROI
<ol>
	<li>Adopt the gray value interpolation algorithm to calculate the surface mesh of the 3-D model. Make the surface a triangle to match the outmost voxels of the mask.</li>
	<li>Click the Export button to export the 3-D model as an STL file.</li>
	<li>Place the model on the center of the building platform. Orient the model by aligning the tangent of the vessel centerline at its extremity to be parallel to the Z axis of the building platform. Supports were automatically generated to the overhangs using the default parameters.</li>
	<li>Click the Slice | Save to save as a file ready for 3-D printing.</li>
</ol>
4. 3-D Printing
<ol>
	<li>Perform stereolithographic printing with a 3-D printer. Use the following parameters: a slice distance of 1 mm, a resolution of 512 &#215; 512 pixels, a building layer thickness of 0.1 mm, and a laser spot diameter of 80 &#956;m.</li>
	<li>Use ultraviolet light at 405 nm to harden the photosensitive resin by scanning the contours sliced by the software. The ultraviolet light laser speed is 3 m/s. 
	NOTE: When one slice of the digital 3-D model was built, the building platform went up 0.1 mm for the next slice. The physical model was built layer by layer. The next layer was formed on top of the previous layer. The 3-D physical model was built layer by layer in this way.</li>
</ol>
5. Preoperative Planning and Intraoperative Review Using 3-D Printed Models
<ol>
	<li>Before the surgery, have surgeons make detailed and accurate surgical plans for each patient by learning the 3-D printed models.</li>
	<li>During the surgery, place the 3-D printed models in the operation room and have a nurse hold them. The anatomic details were reviewed by surgeons during the vascular location and separation. 
	NOTE: The surgical treatment included resection of diverticulum and reconstruction of aortic branches. The impregnated woven polyester tube graft was applied to replace the resected aorta1,2,3,9. All patients were sent to cardiac surgery intensive care unit after surgery.</li>
</ol>

<ol>
	<li>Tanaka, A., Milner, R., Ota, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Kommerell's+diverticulum+in+the+current+era:+a+comprehensive+review.">Kommerell's diverticulum in the current era: a comprehensive review.</a> General Thoracic and Cardiovascular Surgery. 63 (5), 245-259 (2015).</li><li>Rosu, C., Dorval, J. F., Abraham, C. Z., Cartier, R., Demers, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Single-stage+hybrid+repair+of+right+aortic+arch+with+Kommerell's+Diverticulum.">Single-stage hybrid repair of right aortic arch with Kommerell's Diverticulum.</a> The Annals of Thoracic Surgery. 103 (4), e381-e384 (2017).</li><li>Idrees, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hybrid+repair+of+Kommerell+diverticulum.">Hybrid repair of Kommerell diverticulum.</a> The Journal of Thoracic and Cardiovascular Surgery. 147 (3), 973-976 (2014).</li><li>Kankala, R. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fabrication+of+arbitrary+3-D+components+in+cardiac+surgery:+from+macro-,+micro-+to+nanoscale.">Fabrication of arbitrary 3-D components in cardiac surgery: from macro-, micro- to nanoscale.</a> Biofabrication. 9 (3), 032002 (2017).</li><li>Vukicevic, M., Mosadegh, B., Min, J. K., Little, S. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiac+3-D+printing+and+its+future+directions.">Cardiac 3-D printing and its future directions.</a> JACC Cardiovascular Imaging. 10 (2), 171-184 (2017).</li><li>Yoo, S. J., Spray, T., Austin, E. H., Yun, T. J., van Arsdell, G. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hands-on+surgical+training+of+congenital+heart+surgery+using+3-dimensional+print+models.">Hands-on surgical training of congenital heart surgery using 3-dimensional print models.</a> The Journal of Thoracic and Cardiovascular Surgery. 153 (6), 1530-1540 (2017).</li><li>Hermsen, J. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Scan,+print,+practice,+perform:+Development+and+use+of+a+patient-specific+3-dimensionalprinted+model+in+adult+cardiac+surgery.">Scan, print, practice, perform: Development and use of a patient-specific 3-dimensionalprinted model in adult cardiac surgery.</a> The Journal of Thoracic and Cardiovascular Surgery. 153 (1), 132-140 (2017).</li><li>Sun, X., Zhang, H., Zhu, K., Wang, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient-specific+three-dimensional+printing+for+Kommerell's+diverticulum.">Patient-specific three-dimensional printing for Kommerell's diverticulum.</a> International Journal of Cardiology. 255, 184-187 (2018).</li><li>Ota, T., Okada, K., Takanashi, S., Yamamoto, S., Okita, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+treatment+for+Kommerell's+diverticulum.">Surgical treatment for Kommerell's diverticulum.</a> The Journal of Thoracic and Cardiovascular Surgery. 131 (3), 574-578 (2006).</li><li>Agematsu, K., Ueda, T., Hoshino, S., Nishiya, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rupture+of+Kommerell+diverticulum+after+total+arch+replacement.">Rupture of Kommerell diverticulum after total arch replacement.</a> Interactive Cardiovascular and Thoracic Surgery. 11 (6), 800-802 (2010).</li></ol>

The authors have nothing to disclose.

Congenital aortic anomalies comprise a rare spectrum of cardiovascular diseases, which often show complex aortic anomalies. Medical imaging, such as CT and MR, are required to elucidate complex aortic arch anomalies, the abnormal branching pattern, their relationship with the trachea and the esophagus, and other associated pathologies. Both CT and MR angiography can provide 2-D information of aortic vessel locations. With 3-D digital reconstruction of 2-D imaging, the anatomical relationship of the aortic vessels can be ...

Congenital aortic anomalies are extremely rare congenital malformations of the aortic arch system. They can be diagnosed either by imaging analysis or by evaluation of entities like dysphagia or subclavian steal1. In clinical scenarios, it is important to identify the anatomical anomaly in the confined surgical space that has limited visualization during the surgery2,3. Currently, conventional planar two-dimensional (2-D) imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), are usually presented to surgeons before the surgery. However, it is difficult for surgeons to image the anomaly based on the 2-D imaging. Consequently, they could encounter unpredictable difficulties while trying to separate the complex aortic vessels during surgery. Unpredictable injury to the vessel, the trachea and the esophagus could occur and result in disastrous outcomes.
In the last decade, 3-D imaging modeling has been used in cardiac surgery to help surgeons understand the complex anatomic anomaly4,5,6,7. Three-dimensional (3-D) printing technology can help convert the modeling data into a physical model. Compared with the digital reconstruction, 3-D printed physical models could present a better understanding of the anatomical details and provide an intuitional view of the malformation. For aortic anomaly surgery, the printed intuitional 3-D model is significant because poor understanding of aortic locations could be disastrous to patients. During the surgery, any mistake could lead to unpredictable bleeding and injury. Using the printed models, surgeons can fully understand the spatial relationships of aortic branches. During the surgery, the surgeons can also perform real-time review of the 3-D models to avoid confusion of the complex vascular locations.
Here, we present a protocol to apply 3-D printed models for pre-operative planning and intra-operative guidance while dealing with congenital aortic diseases. Kommerell&#39;s diverticulum, a type of complex congenital aortic anomaly, was selected as a case study. The steps include diagnosis based on computed tomography angiography (CTA) imaging, partitioning regions of interest, building 3-D models, preoperative surgical planning, and intra-operative reviewing of 3-D printed models8. This 3-D printing strategy could substantially reduce the risk of unpredictable tissue injury during the surgery.

<table><tbody><tr><td>3D printer</td><td>Meditool Enterprise Co., Ltd</td><td></td><td>For 3D printing</td></tr><tr><td>Chaos Version 2.0</td><td>Meditool Enterprise Co., Ltd</td><td></td><td>For 3D segmentation and reconstruction</td></tr></tbody></table>

three-dimensional printing of a complex aortic anomaly

Complex congenital aortic anomalies include diverse types of malformations that may be clinically asymptomatic or present with respiratory or esophageal symptoms. These anomalies may be associated with other congenital heart diseases. It is hard to identify the accurate anatomic vessel location from two-dimensional imaging data, such as computed tomography. As an additive manufacturing method, three-dimensional (3-D) printing can covert the acquired imaging data into 3-D physical models. This protocol describes the procedure for modeling the volumetric DICOM imaging into 3-D data and printing it as an anatomically realistic 3-D model. Using this model, surgeons can identify the vessel location of complex aortic anomalies, which is helpful for pre-operative planning and intra-operative guidance.

Acquisition of CT angiography images, digital modeling and 3-D printing were all done in a hospital. Two hours were spent to get the 3-D model from the CT angiography image ready for the 3-D printing. Using the procedure and 3-D printer here, a patient-specific 3-D physical model can be sent to physicians quickly and the surgical decision can be made in time. The workflow from acquisition of CT angiography data to 3-D printing was shown in Figure 1. From the ...

Watch this Scientific Journal Video about Three-Dimensional Printing of a Complex Aortic Anomaly at JoVE.com

Three-Dimensional Printing of a Complex Aortic Anomaly

Here, we present a protocol to use three dimensional printed models for pre-operative planning and intra-operative reorganization of complicated vascular locations when handling a congenital aortic anomaly.

Complex congenital aortic anomalies include diverse types of malformations that may be clinically asymptomatic or present with respiratory or esophageal ...

three-dimensional-printing-of-a-complex-aortic-anomaly

Research

JoVE Journal

Medicine

6.6K Views.  Fudan University. Deze methode kan helpen bij het beantwoorden van belangrijke vragen in het complexe aorta-anomalieveld over de camera DICOM. Het belangrijkste voordeel van deze techniek is dat 3D-geprint model het risico op onvoorspelbare weefselletsels tijdens de complexe aortaoperatie kan verminderen. Voor de segmentatie van een interessegebied importeer je alle computertomografie- en geografieafbeeldingen in de software in een DICOM-formaat en dubbelklik je om de patiëntencase binnen de casebibliotheek t...

Video: Three-Dimensional Printing of a Complex Aortic Anomaly

Multimodal 3D Printing of Phantoms to Simulate Biological Tissue

Biomedical optical imaging is playing an important role in diagnosis and treatment of various diseases. However, the accuracy and the reproducibility of an optical imaging device are greatly affected by the performance characteristics of its components, the test environment, and the operations. Therefore, it is necessary to calibrate these devices by traceable phantom standards. However, most of the currently available phantoms are homogeneous phantoms that cannot simulate multimodal and dynamic characteristics of biological tissue. Here, we show the fabrication of heterogeneous tissue-simulating phantoms using a production line integrating a spin coating module, a polyjet module, a fused deposition modeling (FDM) module, and an automatic control framework. The structural information and the optical parameters of a &#34;digital optical phantom&#34; are defined in a prototype file, imported to the production line, and fabricated layer-by-layer with sequential switch between different printing modalities. Technical capability of such a production line is exemplified by the automatic printing of skin-simulating phantoms that comprise the epidermis, dermis, subcutaneous tissue, and an embedded tumor.

Spin coating, polyjet printing, and fused deposition modeling are integrated to produce multilayered heterogeneous phantoms that simulate structural and functional properties of biological tissue.

Biomedical optical imaging is playing an important role in diagnosis and treatment of various diseases. However, the accuracy and the reproducibility of ...

Engineering

Creation of Cardiac Tissue Exhibiting Mechanical Integration of Spheroids Using 3D Bioprinting

This protocol describes 3D bioprinting of cardiac tissue without the use of biomaterials, using only cells. Cardiomyocytes, endothelial cells and fibroblasts are first isolated, counted and mixed at desired cell ratios. They are co-cultured in individual wells in ultra-low attachment 96-well plates. Within 3 days, beating spheroids form. These spheroids are then picked up by a nozzle using vacuum suction and assembled on a needle array using a 3D bioprinter. The spheroids are then allowed to fuse on the needle array. Three days after 3D bioprinting, the spheroids are removed as an intact patch, which is already spontaneously beating. 3D bioprinted cardiac patches exhibit mechanical integration of component spheroids and are highly promising in cardiac tissue regeneration and as 3D models of heart disease.

This protocol describes 3D bioprinting of cardiac tissue without the use of biomaterials. 3D bioprinted cardiac patches exhibit mechanical integration of component spheroids and are highly promising in cardiac tissue regeneration and as 3D models of heart disease.

This protocol describes 3D bioprinting of cardiac tissue without the use of biomaterials, using only cells. Cardiomyocytes, endothelial cells and ...

Bioengineering

Manufacturing Abdominal Aorta Hydrogel Tissue-Mimicking Phantoms for Ultrasound Elastography Validation

Ultrasound (US) elastography, or elasticity imaging, is an adjunct imaging technique that utilizes sequential US images of soft tissues to measure the tissue motion and infer or quantify the underlying biomechanical characteristics. For abdominal aortic aneurysms (AAA), biomechanical properties such as changes in the tissue's elastic modulus and estimates of the tissue stress may be essential for assessing the need for the surgical intervention. Abdominal aortic aneurysms US elastography could be a useful tool to monitor AAA progression and identify changes in biomechanical properties characteristic of high-risk patients.
A preliminary goal in the development of an AAA US elastography technique is the validation of the method using a physically relevant model with known material properties. Here we present a process for the production of AAA tissue-mimicking phantoms with physically relevant geometries and spatially modulated material properties. These tissue phantoms aim to mimic the US properties, material modulus, and geometry of the abdominal aortic aneurysms. Tissue phantoms are made using a polyvinyl alcohol cryogel (PVA-c) and molded using 3D printed parts created using computer aided design (CAD) software. The modulus of the phantoms is controlled by altering the concentration of PVA-c and by changing the number of freeze-thaw cycles used to polymerize the cryogel. The AAA phantoms are connected to a hemodynamic pump, designed to deform the phantoms with the physiologic cyclic pressure and flows. Ultra sound image sequences of the deforming phantoms allowed for the spatial calculation of the pressure normalized strain and the identification of mechanical properties of the vessel wall. Representative results of the pressure normalized strain are presented.

Here we describe a method to manufacture aneurysmal, aortic tissue-mimicking phantoms for the use in testing ultrasound elastography. The combined use of computer-aided design (CAD) and 3-dimensional (3D) printing techniques produce aortic phantoms with predictable, complex geometries to validate the elastographic imaging algorithms with controlled experiments.

Ultrasound (US) elastography, or elasticity imaging, is an adjunct imaging technique that utilizes sequential US images of soft tissues to measure the ...

Creation of Patient-Specific Silicone Cardiac Models with Applications in Pre-surgical Plans and Hands-on Training

Three dimensional&#160;models can be a valuable tool for surgeons as they develop surgical plans and medical fellows as they learn about complex cases. In particular, 3D models can play an important role in the field of cardiology, where complex congenital heart diseases occur. While many 3D printers can provide anatomically correct and detailed models, existing 3D printing materials fail to replicate myocardial tissue properties and can be extremely costly. This protocol aims to develop a process for the creation of patient-specific models of complex congenital heart defects using a low-cost silicone that more closely matches cardiac muscle properties. With improved model fidelity, actual surgical procedural training could occur in advance of the procedure. Successful creation of cardiac models begins with the segmentation of radiologic images to generate a virtual blood pool (blood that fills the chambers of the heart) and myocardial tissue mold. The blood pool and myocardial mold are 3D printed in acrylonitrile butadiene styrene (ABS), a plastic dissolvable in acetone. The mold is assembled around the blood pool, creating a negative space simulating the myocardium. Silicone with a shore hardness of 2A is poured into the negative space and allowed to cure. The myocardial mold is removed, and the remaining silicone/blood pool model is submerged in acetone. The described process results in a physical model in which all cardiac features, including intra-cardiac defects, are represented with more realistic tissue properties and are more closely approximated than a direct 3D printing approach. The successful surgical correction of a model with a ventricular septal defect (VSD) using a GORE-TEX patch (standard surgical intervention for defect) demonstrates the utility of the method.

Patient-specific models improve surgeon and fellow confidence when developing or learning surgical plans. Three-dimensional (3D) printers generate adequate detail for surgical preparation, but fail to replicate tissue haptic fidelity. A protocol is presented detailing the creation of patient-specific, silicone cardiac models, combining 3D printing precision with simulated silicone tissue.

Three dimensional&#160;models can be a valuable tool for surgeons as they develop surgical plans and medical fellows as they learn about complex cases. In ...

Voxel Printing Anatomy: Design and Fabrication of Realistic, Presurgical Planning Models through Bitmap Printing

Most applications of 3-dimensional (3D) printing for presurgical planning have been limited to bony structures and simple morphological descriptions of complex organs due to the fundamental limitations in accuracy, quality, and efficiency of the current modeling paradigm. This has largely ignored the soft tissue critical to most surgical specialties where the interior of an object matters and anatomical boundaries transition gradually. Therefore, the needs of the biomedical industry to replicate human tissue, which displays multiple scales of organization and varying material distributions, necessitate new forms of representation. 
Presented here is a novel technique to create 3D models directly from medical images, which are superior in spatial and contrast resolution to current 3D modeling methods and contain previously unachievable spatial fidelity and soft tissue differentiation. Also presented are empirical measurements of novel, additively manufactured composites that span the gamut of material stiffnesses seen in soft biological tissues from MRI and CT. These unique volumetric design and printing methods allow for deterministic and continuous adjustment of material stiffness and color. This capability enables an entirely new application of additive manufacturing to presurgical planning: mechanical realism. As a natural complement to existing models that provide appearance matching, these new models also allow medical professionals to "feel" the spatially varying material properties of a tissue simulant-a critical addition to a field in which tactile sensation plays a key role.

This method demonstrates a voxel-based 3D printing workflow, which prints directly from medical images with exact spatial fidelity and spatial/contrast resolution. This enables the precise, graduated control of material distributions through morphologically complex, graduated materials correlated to radiodensity without loss or alteration of data.

Most applications of 3-dimensional (3D) printing for presurgical planning have been limited to bony structures and simple morphological descriptions of ...

Fabrication of Engineered Vascular Flaps Using 3D Printing Technologies

Engineering implantable, functional, thick tissues requires designing a hierarchical vascular network. 3D bioprinting is a technology used to create tissues by adding layer upon layer of printable biomaterials, termed bioinks, and cells in an orderly and automatic manner, which allows for creating highly intricate structures that traditional tissue engineering techniques cannot achieve. Thus, 3D bioprinting is an appealing in vitro approach to mimic the native vasculature complex structure, ranging from millimetric vessels to microvascular networks. 
Advances in 3D bioprinting in granular hydrogels enabled the high-resolution extrusion of low-viscosity extracellular matrix-based bioinks. This work presents a combined 3D bioprinting and sacrificial mold-based 3D printing approach for fabricating engineered vascularized tissue flaps. 3D bioprinting of endothelial and support cells using recombinant collagen-methacrylate bioink within a gelatin support bath is utilized for the fabrication of a self-assembled capillary network. This printed microvasculature is assembled around a mesoscale vessel-like porous scaffold, fabricated using a sacrificial 3D printed mold, and is seeded with endothelial cells. 
This assembly induces the endothelium of the mesoscale vessel to anastomose with the surrounding capillary network, establishing a hierarchical vascular network within an engineered tissue flap. The engineered flap is then directly implanted by surgical anastomosis to a rat femoral artery using a cuff technique. The described methods can be expanded for the fabrication of various vascularized tissue flaps for use in reconstruction surgery and vascularization studies.

Engineered flaps require an incorporated functional vascular network. In this protocol, we present a method of fabricating a 3D printed tissue flap containing a hierarchical vascular network and its direct microsurgical anastomoses to rat femoral artery.

Engineering implantable, functional, thick tissues requires designing a hierarchical vascular network. 3D bioprinting is a technology used to create ...

Multicolor 3D Printing of Complex Intracranial Tumors in Neurosurgery

Three-dimensional (3D) printing technologies offer the possibility of visualizing patient-specific pathologies in a physical model of correct dimensions. The model can be used for planning and simulating critical steps of a surgical approach. Therefore, it is important that anatomical structures such as blood vessels inside a tumor can be printed to be colored not only on their surface, but throughout their whole volume. During simulation this allows for the removal of certain parts (e.g., with a high-speed drill) and revealing internally located structures of a different color. Thus, diagnostic information from various imaging modalities (e.g., CT, MRI) can be combined in a single compact and tangible object.
However, preparation and printing of such a fully colored anatomical model remains a difficult task. Therefore, a step-by-step guide is provided, demonstrating the fusion of different cross-sectional imaging data sets, segmentation of anatomical structures, and creation of a virtual model. In a second step the virtual model is printed with volumetrically colored anatomical structures using a plaster-based color 3D binder jetting technique. This method allows highly accurate reproduction of patient-specific anatomy as shown in a series of 3D-printed petrous apex chondrosarcomas. Furthermore, the models created can be cut and drilled, revealing internal structures that allow for simulation of surgical procedures.

The protocol describes the fabrication of fully colored three-dimensional prints of patient-specific, anatomical skull models to be used for surgical simulation. The crucial steps of combining different imaging modalities, image segmentation, three-dimensional model extraction, and production of the prints are explained.

Three-dimensional (3D) printing technologies offer the possibility of visualizing patient-specific pathologies in a physical model of correct dimensions. ...

Development and Evaluation of 3D-Printed Cardiovascular Phantoms for Interventional Planning and Training

Catheter-based interventions are standard treatment options for cardiovascular pathologies. Therefore, patient-specific models could help training physicians&#39; wire-skills as well as improving planning of interventional procedures. The aim of this study was to develop a manufacturing process of patient-specific 3D-printed models for cardiovascular interventions.
To create a 3D-printed elastic phantom, different 3D-printing materials were compared to porcine biological tissues (i.e., aortic tissue) in terms of mechanical characteristics. A fitting material was selected based on comparative tensile tests and specific material thicknesses were defined. Anonymized contrast-enhanced CT-datasets were collected retrospectively. Patient-specific volumetric models were extracted from these datasets and subsequently 3D-printed. A pulsatile flow loop was constructed to simulate the intraluminal blood flow during interventions. Models&#39; suitability for clinical imaging was assessed by x-ray imaging, CT, 4D-MRI and (Doppler) ultrasonography. Contrast medium was used to enhance visibility in x-ray-based imaging. Different catheterization techniques were applied to evaluate the 3D-printed phantoms in physicians&#39; training as well as for pre-interventional therapy planning.
Printed models showed a high printing resolution (~30 &#181;m) and mechanical properties of the chosen material were comparable to physiological biomechanics. Physical and digital models showed high anatomical accuracy when compared to the underlying radiological dataset. Printed models were suitable for ultrasonic imaging as well as standard x-rays. Doppler ultrasonography and 4D-MRI displayed flow patterns and landmark characteristics (i.e., turbulence, wall shear stress) matching native data. In a catheter-based laboratory setting, patient-specific phantoms were easy to catheterize. Therapy planning and training of interventional procedures on challenging anatomies (e.g., congenital heart disease (CHD)) was possible.
Flexible patient-specific cardiovascular phantoms were 3D-printed, and the application of common clinical imaging techniques was possible. This new process is ideal as a training tool for catheter-based (electrophysiological) interventions and can be used in patient-specific therapy planning.

Here we present development of a mock circulation setup for multimodal therapy evaluation, pre-interventional planning, and physician-training on cardiovascular anatomies. With the application of patient-specific tomographic scans, this setup is ideal for therapeutic approaches, training, and education in individualized medicine.

Catheter-based interventions are standard treatment options for cardiovascular pathologies. Therefore, patient-specific models could help training ...

A Personalized 3D-Printed Model for Preoperative Evaluation in Thyroid Surgery

The anatomic structure of the surgical area of thyroid cancer is complex. It is very important to comprehensively and carefully evaluate the tumor location and its relation with the capsule, trachea, esophagus, nerves, and blood vessels before operation. This paper introduces an innovative 3D-printed model establishment method based on computerized tomography (CT) DICOM images. We established a personalized 3D-printed model of the cervical thyroid surgery field for each patient who needed thyroid surgery to help clinicians evaluate the key points and difficulties of the surgery and select the operation methods of key parts as a basis. The results showed that this model is conducive to preoperative discussion and the formulation of operation strategies. In particular, as a result of the clear display of the recurrent laryngeal nerve and parathyroid gland locations in the thyroid operation field, injury to them can be avoided during surgery, the difficulty of thyroid surgery reduced, and the incidence of postoperative hypoparathyroidism and complications related to recurrent laryngeal nerve injury reduced too. Moreover, this 3D-printed model is intuitive and aids communication for the signing of informed consent by patients before surgery.

Here, a new method of establishing a personalized 3D-printed model for preoperative evaluation of thyroid surgery is proposed. It is conducive to preoperative discussion, reducing the difficulty of thyroid surgery.

The anatomic structure of the surgical area of thyroid cancer is complex. It is very important to comprehensively and carefully evaluate the tumor ...

Three-Dimensional Printing Assisted Physician-Modified Fenestrated Endografts for Thoracic Endovascular Aortic Aneurysm Repair in Zone 1

Aortic arch aneurysm is a life-threatening cardiovascular disorder that requires timely medical intervention. Aneurysms in Zone 1 typically involve multiple branch arteries, making repair challenging. Open surgical repair often results in significant surgical trauma, massive blood loss, and prolonged operative time. With advancements in endovascular technology, fenestrated/branched thoracic endovascular aortic repair (F/B TEVAR) has been employed for aortic arch repair and branch artery reconstruction. Stent grafts for F/B TEVAR require personalized modification and fabrication based on patient anatomy. Physician-modified fenestrated endografts (PMEGs) offer a feasible approach for personalized aortic arch aneurysm repair in Zone 1. However, fabricating PMEGs demands a thorough understanding of anatomy and extensive experience, making it challenging for most surgeons. To simplify this process, three-dimensional printing is used to assist in precise fenestration. PMEGs guided by three-dimensional printing enhance branch artery patency and reduce post-operative endoleaks following F/B TEVAR. Further follow-up is necessary to assess the long-term benefits and efficacy of this technique.

This protocol describes an approach for repairing aortic arch aneurysms in Zone 1 using physician-modified fenestrated endografts with the assistance of three-dimensional printing.

Aortic arch aneurysm is a life-threatening cardiovascular disorder that requires timely medical intervention. Aneurysms in Zone 1 typically involve ...

Three-Dimensional Printing of a Complex Aortic Anomaly

Samenvatting

Meer video's verkennen