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Abstract

Introduction

Protocol

Representative Results

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Acknowledgements

Materials

References

Medicine

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

Published: January 18th, 2021

DOI:

10.3791/62063

1Department of Cardiac Surgery, Ludwig Maximilian University Munich, 2Chair of Medical Materials and Implants, Technical University of Munich, 3Department Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilian University Munich, 4Department of Radiology, Ludwig Maximilian University Munich

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 physicians' 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' 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' training as well as for pre-interventional therapy planning.

Printed models showed a high printing resolution (~30 µm) 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.

Individualized therapies are gaining increasing importance in modern clinical practice. Essentially, they can be classified in two groups: genetic and morphologic approaches. For individualized therapies based on unique personal DNA, either genome sequencing or the quantification of gene expression levels is necessary1. One can find these methods in oncology, for example, or in metabolic disorder treatment2. The unique morphology (i.e., anatomy) of each individual plays an important role in interventional, surgical, and prosthetic medicine. The development of individualized prostheses and pre-interventional/-operative th....

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Ethical approval was considered by the ethical committee of the Ludwig-Maximilians-Universität München and was waived given that the radiological datasets used in this study were retrospectively collected and fully anonymized.

Please refer to the institute's MRI safety guidelines, especially regarding the used LVAD ventricle and metal components of the flow loop.

1. Data acquisition

  1. Prior to creating the anatomical phantoms, select a s.......

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The described representative results focus on a few cardiovascular structures commonly used in planning, training, or testing settings. These were created using isotropic CT-datasets with a ST of 1.0 mm and a voxel size of 1.0 mm³. The aortic aneurysm models' wall thickness was set at 2.5 mm complying with comparative tensile testing results of the printing material (tensile strength: 0.62 ± 0.01 N/mm2; Fmax: 1. 55 ± 0.02 N; elongation: 9.01 ±.......

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The presented workflow allows to establish individualized models and thereby perform pre-interventional therapy planning, as well as physician training on individualized anatomies. To achieve this, patient-specific tomographic data can be used for segmentation and 3D-printing of flexible cardiovascular phantoms. By implementation of these 3D-printed models in a mock circulation, different clinical situations can be realistically simulated.

Nowadays, many therapy planning procedures focus upon .......

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This publication was supported by the German Heart Foundation/German Foundation of Heart Research.

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Name Company Catalog Number Comments
3-matic Materialise AB Software Version 15.0 - Commercial 3D-Modeling Software
Affiniti 50 Philips Medical Systems GmbH Ultrasonic Imaging System
Agilista W3200 Keyence Co. Polyjet 3D-Printer with a spatial resolution of 30µm
AR-G1L Keyence Co. flexible 3D-Printing material
Artis Zee Siemens Healthcare GmbH Angiographic X-ray Scanner
cvi42 CCI Inc. Software Version 5.12 - 4D Flow Analysis Software
Diagnostic Catheter, Multipurpose MPA 2 Cordis, A Cardinal Health company Catheter for pediatric training models, Sizes 4F for infants and 5F for children, young adults
Excor Ventricular Assist Device Berlin Heart GmbH 80 -100ml stroke volume
Imeron 400 Contrast Agent Bracco Imaging CT - Contrast Agent
IntroGuide F Angiokard Medizintechnik GmbH Guidewire with J-tip; diameter: 0.035" length: 220cm
Lunderquist Guidewire Cook Medical Inc. (T)EVAR interventional guidewire
MAGNETOM Aera Siemens Healthcare GmbH MRI Scanner
Magnevist Contrast Agent Bayer Vital GmbH MRI - Contrast Agent
Mimics Materialise AB Software Version 23.0 - Commercial Segmentation Software
Modeling Studio Keyence Co. 3D-Printer Slicing Software
PVC tubing
Radifocus Guide Wire M Terumo Europe NV Straight guidewire; diameter: 0.035" length: 260cm
Really useful box 9L Really useful products Ltd.
Rotigarose - Standard Agar Carl Roth GmbH 3810.4
Solidworks Dassault Systemes SE Software Version 2019-2020; CAD Design Software
SOMATOM Force Siemens Healthcare GmbH Computed Tomography Scanner
syngo via Siemens Healthcare GmbH Radiological Imaging Software

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