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Use of 3D Prototypes for Complex Surgical Oncologic Cases

November 2015
World Journal of Surgery 40(4)

DOI:10.1007/s00268-015-3295-y

Authors:

Lucas Krauel

Hospital Sant Joan de Déu

F. Fenollosa

Polytechnic University of Catalonia

Lucía Riaza

Hospital Sant Joan de Déu

Martín Pérez

Polytechnic University of Catalonia

Show all 8 authorsHide

Introduction: Physical 3D models known by the industry as rapid prototyping involve the creation of a physical model from a 3D computer version. In recent years, there has been an increasing number of reports on the use of 3D models in medicine. Printing such 3D models with different materials integrating the many components of human anatomy is technically challenging. In this article, we report our technological developments along with our clinical implementation experience using high-fidelity 3D prototypes of tumors encasing major vessels in anatomically sensitive areas. Methods: Three patients with tumors encasing major vessels that implied complex surgery were selected for surgical planning using 3D prototypes. 3D virtual models were obtained from routine CT and MRI images. The models, with all their anatomical relations, were created by an expert pediatric radiologist and a surgeon, image by image, along with a computerized-aided design engineer. Results: Surgeons had the opportunity to practice on the model before the surgery. This allowed questions regarding surgical approach; feasibility and potential complications to be raised in advance of the actual procedure. All patients then successfully underwent surgery as planned. Conclusion: Having a tumor physically printed in its different main component parts with its anatomical relationships is technically feasible. Since a gross total resection is prognostic in a significant percentage of tumor types, refinements in planning may help achieve greater and safer resections therefore contributing to improve surgical management of complex tumors. In this early experience, 3D prototyping helped significantly in the many aspects of surgical oncology planning.

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ORIGINAL SCIENTIFIC REPORT

Use of 3D Prototypes for Complex Surgical Oncologic Cases

Lucas Krauel

•Felip Fenollosa

•Lucı

´a Riaza

•Martı

´nPe

´rez

•Xavier Tarrado

•

Andre

´s Morales

•Joan Goma

•Jaume Mora

ÓSocie

´te

´Internationale de Chirurgie 2015

Abstract

Introduction Physical 3D models known by the industry as rapid prototyping involve the creation of a physical

model from a 3D computer version. In recent years, there has been an increasing number of reports on the use of 3D

models in medicine. Printing such 3D models with different materials integrating the many components of human

anatomy is technically challenging. In this article, we report our technological developments along with our clinical

implementation experience using high-ﬁdelity 3D prototypes of tumors encasing major vessels in anatomically

sensitive areas.

Methods Three patients with tumors encasing major vessels that implied complex surgery were selected for surgical

planning using 3D prototypes. 3D virtual models were obtained from routine CT and MRI images. The models, with

all their anatomical relations, were created by an expert pediatric radiologist and a surgeon, image by image, along

with a computerized-aided design engineer.

Results Surgeons had the opportunity to practice on the model before the surgery. This allowed questions regarding

surgical approach; feasibility and potential complications to be raised in advance of the actual procedure. All patients

then successfully underwent surgery as planned.

Conclusion Having a tumor physically printed in its different main component parts with its anatomical rela-

tionships is technically feasible. Since a gross total resection is prognostic in a signiﬁcant percentage of tumor types,

reﬁnements in planning may help achieve greater and safer resections therefore contributing to improve surgical

management of complex tumors. In this early experience, 3D prototyping helped signiﬁcantly in the many aspects of

surgical oncology planning.

&Lucas Krauel

lkrauel@hsjdbcn.org

Felip Fenollosa

ffenollosa@fundaciocim.org

Lucı

´a Riaza

lriaza@hsjdbcn.org

Martı

´nPe

´rez

martinpereztorrents@gmail.com

Xavier Tarrado

xtarrado@hsjdbcn.org

Andre

´s Morales

amorales@hsjdbcn.org

Joan Goma

jgoma@fundaciocim.org

Jaume Mora

jmora@hsjdbcn.org

Pediatric Surgery Department, Hospital Sant Joan de De

´u,

Universitat de Barcelona, Passeig de Sant Joan de De

´u, 2,

08950 Barcelona, Spain

Fundacio

´CIM, Department of Mechanical Engineering,

ETSEIB, Universitat Polite

`cnica de Catalunya, Diagonal 647,

08028 Barcelona, Spain

123

World J Surg

DOI 10.1007/s00268-015-3295-y

Introduction

Physical 3D models known by the industry as rapid pro-

totyping involve the creation of a physical model from a

3D computer version. This technology started in 1987

when the ﬁrst stereolithography machine was commer-

cialized. In recent years, there has been an increasing

number of reports on the use of 3D models in medicine for

teaching, diagnosis, surgical planning, and bone recon-

structions [1–5]. Using 3D printing for boney structures is

very straightforward. Therefore most of the published lit-

erature in medicine is based on maxillofacial and ortho-

pedic cases. However, fewer experiences are being

described about soft tissue surgical planning 3D printing

[6–9]. Printing 3D models with different materials inte-

grating the many components of the anatomy is technically

more challenging. Surgical oncology dealing with tumors

encasing major vessels can be difﬁcult to perform and

careful planning is mandatory.

In this article, we report our technological developments

and clinical implementation experience gained from high-

ﬁdelity 3D prototypes of tumors encasing major vessels in

anatomically sensitive areas. The models were designed

from patients’ routine computed tomography (CT) and

magnetic resonance image (MRI) imaging studies.

Methods

Patients and tumors

Three patients with tumors encasing major vessels that

implied complex surgery were selected for surgical plan-

ning using 3D prototypes before the operation. A summary

of the patients and tumor characteristics are shown in

Table 1.

Case #1 is a 3-year-old male with stage 4 MYCN

ampliﬁed, high-risk, neuroblastoma (NB). After mN7

induction chemotherapy, the metastatic disease presented a

complete response. Imaging studies showed a suprarenal

tumor extending to the midline, encasing the right renal

artery, the right renal vein, the inferior vena cava (IVC),

and the superior mesenteric artery (SMA). Local control

with surgery was indicated.

Case #2 is a 5-year-old male with a stage 4 MYCN

ampliﬁed, high-risk, NB. After mN7 induction

Pediatric Radiology Department, Hospital Sant Joan de De

´u,

Universitat de Barcelona, Passeig de Sant Joan de De

´u, 2,

08950 Barcelona, Spain

Pediatric Oncology and Hematology Department, Hospital

Sant Joan de De

´u, Universitat de Barcelona, Passeig de Sant

Joan de De

´u, 2, 08950 Barcelona, Spain

Table 1 Patients Characteristics and 3D printing technology used

Age

(years)

Sex Diagnosis Imaging 3D prototype technology Surgical approach Tumor volume

removed correlated

with prototype tumor

volume

Clavien–Dindo

complications

Case 1 3 M High-risk stage 4

neuroblastoma

Right Suprarenal mass with

encasement of right renal artery,

right renal vein, IVC, and SMA

Polyjet 3D printing using a Connex 500

machine by Stratasys

Thoracoabdominal Yes None

Case 2 5 M High-risk stage 4

neuroblastoma

Right mass crossing the midline with

encasement of celiac trunk, SMA,

IMA, renal arteries, renal veins,

IVC, portal vein, and hepatic duct

Polyjet 3D printing using a Connex 500

machine by Stratasys

SLS 3D model made in a Vanguard

machine by 3D Systems

Surgical support on FFF open-source

technology

Thoracoabdominal Yes II (transfusion)

Case 3 11 M Mediastinal sinovial

sarcoma

Right mediastinal mass with invasion

of SVC and with no plane of

separation with trachea, main right

bronchus, right pulmonary vein,

and superior right lobule artery

Polyjet 3D printing using a Connex 500

machine by Stratasys

SLS 3D model made in a Vanguard

machine by 3D systems

Medium

sternotomy

yes I (collection)

II (transfusion)

World J Surg

123

chemotherapy, the metastatic disease was in complete

remission. A midline-centered mass remained encasing the

celiac trunk, SMA, inferior mesenteric artery (IMA), both

renal arteries, the renal veins, IVC, portal vein, the right

hepatic artery, and the hepatic duct. Local control was

advised with surgery.

Case #3 is an 11-year-old male with a primary medi-

astinal synovial sarcoma (SS) with part of the tumor mass

inﬁltrating the superior vena cava and the upper part of the

right atrium. The right pulmonary artery was also involved

as well as the right main bronchi with no separation plane

from the tumor.

The 3D models

To create the 3D models, a computerized-aided design

(CAD) engineer, along with an expert pediatric radiologist

and the leading surgeon, used CT images to delineate the

tumor, the anatomical relations and the major vessels

encased, working with tools that use color ranges (con-

trasting the vessels and bone mass) and manually (with the

soft tissues) selecting image by image the differentiated

parts. The software used for that purpose was VRMed

DICOM Platform [10], developed in the ViRVIG research

group (UPC University), and the resolution of the medical

images was 1.5 mm of layer thickness in Case #1 and Case

#2 and 0.3 mm in Case #3.

To ensure the right reproduction of the real anatomy, the

pediatric radiologist and the surgeon monitored all the

work with review meetings, and the team used MRI images

to compare and conﬁrm results.

The time spent on the 3D model generation was around

10 h per case.

In each case, speciﬁc measures were taken in response

to the acquired experience and the speciﬁc needs.

Case #1: a 3D virtual model was obtained from routine

abdomen CT and MRI images. When the virtual model was

created (Fig. 1a), it was again reviewed by the same radi-

ologist and the oncologic surgeon prior to 3D printing. The

objective was to create a model where the part representing

the tumor had an ‘‘operable’’ translucent and soft texture

that allowed visualization of the encased vessels and sur-

rounding anatomical structures so that the surgical team

could ‘‘operate’’ and ‘‘play’’ with it prior to the day of the

actual surgery. The technology applied was Polyjet 3D

Printing using a Connex 500 machine by Stratasys. Two

different 3D ﬁles were created. One including bones, ves-

sels and other parts was built using a white rigid opaque

epoxy photopolymer. A different material was used to print

the other ﬁle which reproduced the tumor that was soft and

translucent (Fig. 1b). Manufacturing a Polyjet 3D model

can take around 24 h.

Case #2: the DICOM images already anticipated that

the 3D-printed tumor would not be able to show the most

of the encased vessels. The anatomical positioning of the

vessels inside the tumor mass made it difﬁcult to

accomplish the main goal of the surgical planning using

this technology, which was to visualize before the real

surgery the vessels potentially in danger from the tumor

resection. Therefore, it was decided to complement the

Polyjet 3D model with a second model made by SLS in a

Vanguard machine by 3D Systems. It consisted of two

parts, the ﬁrst including the encased vessels with its

anatomical relations; and the second including the tumor

which could be removed so one could actually see the

vessels and the rest of the anatomy without the tumor

(Fig. 2).

Case #3: three prototypes were printed including the

same two as in Case #2 and a third one which represented

the tumor alone in order for the surgical team to have the

Fig. 1 a 3D virtual reconstruction of case 1 tumor encasing major vessels from CT and MRI fusion images. b3D-printed prototype of case 1.

Tumor is represented in a semitransparent, ‘‘operable’’ consistency

World J Surg

123

tumor volume ‘‘in hands’’ before the surgery (Fig. 3). The

third model was also made using SLS technology.

For Case #2, a 3D-customized support system was built

so the model was placed in the same position as the one

intended for the surgery (lateral decubitus). This

improvement was printed with FFF open-source technol-

ogy [11].

The models could be sterilized with Steam Formalde-

hyde at 60–80 °C, thus allowing the models to be ready

available for checking at any time during the surgical

procedure.

Results

The models were completed 1 week before the planned

surgery, so the surgical team was able to study the case and

operate on them well enough in advance. The prototypes

were to real scale of the patient’s organs thus giving an

impression of what to expect during surgery. Their soft

consistency allowed the use of the different surgical

instruments that would be used in the real surgery. The

models gave surgeons a new tool for the surgical planning.

This was especially of good use to residents, fellows, and

Fig. 2 a 3D-printed prototype of case 2. Right mass crossing the

midline with encasement of celiac trunk, SMA, IMA, renal arteries,

renal veins, IVC, portal vein, and hepatic duct. Tumor is also

represented in a semitransparent, ‘‘operable’’ consistency. bPrinted

prototype of the same case with the tumor removed allowing the view

of encased vessels

Fig. 3 a 3D-printed prototype of mediastinal tumor with invasion of

SVC and with no plane of separation with trachea, main right

bronchus, right pulmonary vein, and superior right lobule artery.

b3D-printed prototype of tumor volume. c3D-printed prototype of

the same case, tumor free

World J Surg

123

young surgeons. The fact that the selected tumors were

complicated and not very common, also gave the leading

surgeon more conﬁdence for the surgery. All patients

underwent surgery as planned successfully. A right thora-

coabdominal (TA) incision was used in Case #1. Gross

total resection (GTR) of the tumor encasing major vessels

was achieved with no complications. The volume of the

tumor correlated with the prototype (Fig. 4). A TA incision

was also used in Case #2. GTR was performed without

complications. For Case #3, a medium sternotomy was

performed. Cannulation of the heart and extracorporeal

circulation was performed as planned. The tumor was

totally removed along with a portion of the right atrium

(RA) and superior vena cava (SVC), both invaded by the

tumor. A tubularized dacron prosthesis was used to

reconstruct the defect in the RA and SVC. The 3D models

were used in real time during the surgeries to reassess the

steps to be taken in order to remove the tumor mass

preserving the encased vessels. All models predicted pre-

cisely the surgical ﬁndings in terms of tumor volume as

well as vascular relationships.

Discussion

Rapid prototyping is the creation of a physical 3D model

from computer design. The 3D printer uses the information

of a virtual 3D model (obtained from a scanner or a 3D

drawing) to print the ﬁnal structure [12,13]. Most of the

reported clinical applications are in maxillofacial surgery,

medical education, training, research, and lately, implant

and tissue designing [3,14]. Several studies have demon-

strated the efﬁcacy of 3D models for the planning of

maxillofacial surgeries [15–17]. A more accurate diagnosis

and better understanding of complex anatomy as well as

the possibility of preplanning are keys in the implementa-

tion of these technologies with better results [18]. Rapid

prototyping also enhances quick learning and the possi-

bility of case simulations [19–21] highlighting important

aspects in reducing risks during surgery and patient post-

operative complications [9].

In this study, we have explored new developments in

technology and clinical feasibility of newly designed 3D-

printed models of complex soft tissue tumors with their

anatomical relationships. By printing three different mod-

els of each tumor, the tumor and its relationships, the

anatomy without the tumor and the tumor volume, we were

able to explore different aspects required for detailed sur-

gical planning. The integrated model allowed us to practice

on the prototype and simulate the surgery before the

operation. The consistency of the tumor material allowed

us to dissect it with regular surgical instruments, cut it, and

peel it away from organs and vessels. We also could

practice different surgical approaches and weigh up the

risks and beneﬁts of each option in advance.

The printing of the tumor volume alone was also very

useful. Some tumors are capsulated and well deﬁned, but

with others, such as the majority of high-risk neuroblas-

tomas and sarcomas, tumor limits might be difﬁcult to

assess. So much so, that sometimes the removal of the

tumor has to be done piecemeal. In those cases, having the

tumor volume printed, deﬁnitely helps the surgeon to

evaluate the grade of resection and objectively quantify a

GTR.

The major technical drawback of the current models is

that the vessels and organs have a rigid consistency.

Despite the fact that their anatomical relations with the

tumor are very accurate, at the time of surgical dissection,

they did not behave in the same elastic way as in the real

anatomy. This is why having a prototype without the tumor

Fig. 4 Case 1 removed tumor and prototype. Main tumor volume is

the same as the 3D printed. Remaining tumor encasing major vessels

was removed piecemeal

World J Surg

123

was very useful so we could actually foresee the anatomy

of the blood vessels embedded within the tumor.

This is a new technological development in an early

stage with little data. Research is ongoing in our labora-

tories to improve the elasticity of the different densities of

soft tissues. Furthermore, since the cost of the models is a

determinant factor in making surgical planning with 3D-

printed prototypes a standard for challenging surgical

cases, further improvements in technology need to be

developed. We are using open-source based technology

and it is our belief that only open 3D printing can face this

challenge in the future. We welcome the surgical com-

munity to share its developments in order to improve to a

more realistic model.

Acknowledgments The authors would like to thank Margarita

Vancells MD, JM Caffarena MD, and Rosalia Carrasco MD PhD for

their technical expertise.

Compliance with ethical standards

Conﬂict of interest None.

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Chapter

Aug 2024

Neuroblastoma (NB) is a rare embryonic cancer that presents surgical challenges, particularly in high-risk cases. High-risk cases are those stratified according to image-defined risk factors (IDRFs) in medical imaging. In abdominal NB, common IDRFs include encasement of major vessels: the abdominal aorta and inferior vena cava (IVC) among others, which poses an increased surgical risk. With a surgical resection goal of over 90% for optimal survival, three-dimensional (3D) models derived from patient datasets have proven beneficial for pre-surgical planning. This chapter presents the framework used to create a prototype 3D neuroblastoma model within a virtual reality (VR) application for surgical planning and junior doctor education. The 3D VR model displays a large abdominal neuroblastoma with encasement of the IVC and inferior mesenteric artery (IMA), spatial relationship to the abdominal aorta, tributary vessels and abdominal organs. Key features of the VR development include (1) tumour transparency, (2) a customisable interactive toggle display, (3) CT dataset overlay, (4) 360-degree rotation of the model, (5) medical information relating to neuroblastoma, including tumour volume and (6) notation. User testing was conducted at the Royal Hospital for Children, Glasgow (RHCG) with 20 medical professionals participating. Results demonstrate the application had a good usability rating (SUS 79.75) and sense of presence (ITC-SOPI) rating, with resulting scores in each category: sense of presence (mean 3.75 ± 0.55 SD), engagement (mean 4.08 ± 0.4 SD), ecological validity (mean 3.72 ± 0.83 SD) and negative effect (mean 1.77 ± 0.78 SD). A counterbalanced anatomical identification experiment comparing the 2D dataset to the 3D VR model showed a significant difference (p < 0.05) in errors committed between the control and VR groups, demonstrating that participants performed better in VR (MVR = 0.35, σ = 0.59) compared to 2D (Mcontrol = 0.85, σ = 0.93). A significant difference (p < 0.05) was also noted in the evolution of error between groups, suggesting that group 1 participants who have first undertaken the control condition and then VR have seen the number of errors decreasing indicating that the VR condition promotes greater accuracy for anatomical identification. Limitations to this study include a small participant number (n = 20) and a broad spectrum of knowledge among participants. Future research could address such limitations by increasing participant numbers and narrowing the education-level demographic, focusing on one cohort of participants.

Enhancing surgical planning for abdominal tumors in children through advanced 3D visualization techniques: a systematic review of future prospects

Article

Full-text available

May 2024

Introduction Preoperative three-dimensional (3D) reconstruction using sectional imaging is increasingly used in challenging pediatric cases to aid in surgical planning. Many case series have described various teams' experiences, discussing feasibility and realism, while emphasizing the technological potential for children. Nonetheless, general knowledge on this topic remains limited compared to the broader research landscape. The aim of this review was to explore the current devices and new opportunities provided by preoperative Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI). Methods A systematic review was conducted to screen pediatric cases of abdominal and pelvic tumors with preoperative 3D reconstruction published between 2000 and 2023. Discussion Surgical planning was facilitated through virtual reconstruction or 3D printing. Virtual reconstruction of complex tumors enables precise delineation of solid masses, formulation of dissection plans, and suggests dedicated vessel ligation, optimizing tissue preservation. Vascular mapping is particularly relevant for liver surgery, large neuroblastoma with imaging-defined risk factors (IDRFs), and tumors encasing major vessels, such as complex median retroperitoneal malignant masses. 3D printing can facilitate specific tissue preservation, now accessible with minimally invasive procedures like partial nephrectomy. The latest advancements enable neural plexus reconstruction to guide surgical nerve sparing, for example, hypogastric nerve modelling, typically adjacent to large pelvic tumors. New insights will soon incorporate nerve plexus images into anatomical segmentation reconstructions, facilitated by non-irradiating imaging modalities like MRI. Conclusion Although not yet published in pediatric surgical procedures, the next anticipated advancement is augmented reality, enhancing real-time intraoperative guidance: the surgeon will use a robotic console overlaying functional and anatomical data onto a magnified surgical field, enhancing robotic precision in confined spaces.

Preoperative three-dimensional modelling and virtual reality planning aids nephron sparing surgery in a child with bilateral Wilms tumour

Article

Apr 2024

Avijit Banerjee

Bilateral Wilms tumour (BWT) is a surgically challenging condition. Virtual reality (VR) reconstruction aids surgeons to foresee the anatomy ahead of Nephron Sparing Surgery (NSS). Three-dimensional (3D) visualisation improves the anatomical orientation of surgeons performing NSS. We herewith report a case of BWT where VR planning and 3D printing were used to aid NSS. Conventional imaging is often found to be inadequate while assessing the tumour-organ-vascular anatomy. Advances like VR and 3D printing help surgeons plan better for complex surgeries like bilateral NSS. Next-generation extended reality tools will likely aid robotic-assisted precision NSS and improve patient outcomes.

Multimodality Imaging for 3D Printing and Surgical Rehearsal in Complex Spine Surgery

Article

Mar 2024
RADIOGRAPHICS

Surgery is the mainstay treatment of symptomatic spinal tumors. It aids in restoring functionality, managing pain and tumor growth, and improving overall quality of life. Over the past decade, advancements in medical imaging techniques combined with the use of three-dimensional (3D) printing technology have enabled improvements in the surgical management of spine tumors by significantly increasing the precision, accuracy, and safety of the surgical procedures. For complex spine surgical cases, the use of multimodality imaging is necessary to fully visualize the extent of disease, including both soft-tissue and bone involvement. Integrating the information provided by these examinations in a cohesive manner to facilitate surgical planning can be challenging, particularly when multiple surgical specialties work in concert. The digital 3-dimensional (3D) model or 3D rendering and the 3D printed model created from imaging examinations such as CT and MRI not only facilitate surgical planning but also allow the placement of virtual and physical surgical or osteotomy planes, further enhancing surgical planning and rehearsal. The authors provide practical information about the 3D printing workflow, from image acquisition to postprocessing of a 3D printed model, as well as optimal material selection and incorporation of quality management systems, to help surgeons utilize 3D printing for surgical planning. The authors also highlight the process of surgical rehearsal, how to prescribe digital osteotomy planes, and integration with intraoperative surgical navigation systems through a case-based discussion. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

3D Bioprinting of Tissues and Organs

Article

Full-text available

Aug 2014
NAT BIOTECHNOL

Additive manufacturing, otherwise known as three-dimensional (3D) printing, is driving major innovations in many areas, such as engineering, manufacturing, art, education and medicine. Recent advances have enabled 3D printing of biocompatible materials, cells and supporting components into complex 3D functional living tissues. 3D bioprinting is being applied to regenerative medicine to address the need for tissues and organs suitable for transplantation. Compared with non-biological printing, 3D bioprinting involves additional complexities, such as the choice of materials, cell types, growth and differentiation factors, and technical challenges related to the sensitivities of living cells and the construction of tissues. Addressing these complexities requires the integration of technologies from the fields of engineering, biomaterials science, cell biology, physics and medicine. 3D bioprinting has already been used for the generation and transplantation of several tissues, including multilayered skin, bone, vascular grafts, tracheal splints, heart tissue and cartilaginous structures. Other applications include developing high-throughput 3D-bioprinted tissue models for research, drug discovery and toxicology.

3D printing based on imaging data: Review of medical applications

Article

Full-text available

Jul 2010

Purpose: Generation of graspable three-dimensional objects applied for surgical planning, prosthetics and related applications using 3D printing or rapid prototyping is summarized and evaluated. Materials and methods: Graspable 3D objects overcome the limitations of 3D visualizations which can only be displayed on flat screens. 3D objects can be produced based on CT or MRI volumetric medical images. Using dedicated post-processing algorithms, a spatial model can be extracted from image data sets and exported to machine-readable data. That spatial model data is utilized by special printers for generating the final rapid prototype model. Results: Patient-clinician interaction, surgical training, medical research and education may require graspable 3D objects. The limitations of rapid prototyping include cost and complexity, as well as the need for specialized equipment and consumables such as photoresist resins. Conclusions: Medical application of rapid prototyping is feasible for specialized surgical planning and prosthetics applications and has significant potential for development of new medical applications.

Rapid prototyping: Principles and applications, third edition

Book

Jan 2010

Latest Edition: 3D Printing and Additive Manufacturing: Principles and Applications (with Companion Media Pack). Fourth edition of Rapid Prototyping. Rapid prototyping (RP) has revolutionized how prototypes are made and small batch manufacturing is carried out. With rapid prototyping, the strategies used to produce a part change a number of important considerations and limitations previously faced by tool designers and engineers. Now in its third edition, this textbook is still the definitive text on RP. It covers the key RP processes, the available models and specifications, and their principles, materials, advantages and disadvantages. Examples of application areas in design, planning, manufacturing, biomedical engineering, art and architecture are also given. The book includes several related problems so that the reader can test his or her understanding of the topics. New to this edition, the included CD-ROM presents animated illustrations of the working principles of today’s key RP processes. © 2010 by World Scientific Publishing Co. Pte. Ltd. All rights reserved.

Medical Applications for 3D Printing: Current and Projected Uses

Article

Oct 2014

C Lee Ventola

3D printing is expected to revolutionize health care through uses in tissue and organ fabrication; creation of customized prosthetics, implants, and anatomical models; and pharmaceutical research regarding drug dosage forms, delivery, and discovery.

Thoracoscopic anatomical subsegmentectomy of the right S2b+S3 using a 3D printing model with rapid prototyping

Article

Jul 2014

Thoracoscopic segmentectomies and subsegmentectomies are more difficult than lobectomy because of the complexity of the procedure; therefore, preoperative decision-making and surgical procedure planning are essential. In the literature, we could successfully perform thoracoscopic anatomical subsegmentectomy of the right S2b + S3 using a 3D printing model with rapid prototyping. This innovative surgical support model is extremely useful for planning a surgical procedure and identifying the surgical margin.

Utilizing Three-Dimensional Printing Technology to Assess the Feasibility of High-Fidelity Synthetic Ventricular Septal Defect Models for Simulation in Medical Education

Article

Jun 2014

Background: The current educational approach for teaching congenital heart disease (CHD) anatomy to students involves instructional tools and techniques that have significant limitations. This study sought to assess the feasibility of utilizing present-day three-dimensional (3D) printing technology to create high-fidelity synthetic heart models with ventricular septal defect (VSD) lesions and applying these models to a novel, simulation-based educational curriculum for premedical and medical students. Methods: Archived, de-identified magnetic resonance images of five common VSD subtypes were obtained. These cardiac images were then segmented and built into 3D computer-aided design models using Mimics Innovation Suite software. An Objet500 Connex 3D printer was subsequently utilized to print a high-fidelity heart model for each VSD subtype. Next, a simulation-based educational curriculum using these heart models was developed and implemented in the instruction of 29 premedical and medical students. Assessment of this curriculum was undertaken with Likert-type questionnaires. Results: High-fidelity VSD models were successfully created utilizing magnetic resonance imaging data and 3D printing. Following instruction with these high-fidelity models, all students reported significant improvement in knowledge acquisition (P < .0001), knowledge reporting (P < .0001), and structural conceptualization (P < .0001) of VSDs. Conclusions: It is feasible to use present-day 3D printing technology to create high-fidelity heart models with complex intracardiac defects. Furthermore, this tool forms the foundation for an innovative, simulation-based educational approach to teach students about CHD and creates a novel opportunity to stimulate their interest in this field.

Physical Models of Renal Malignancies Using Standard Cross-sectional Imaging and 3-Dimensional Printers: A Pilot Study

Article

Aug 2014

TRANSPLANTATION 3D printing of the liver in living donor liver transplantation

Article

Oct 2013
NAT REV GASTRO HEPAT

Advances in 3D printing techniques are gathering pace. With regard to living donor liver transplantation (LDLT), 3D printing could enable accurate assessment of liver volume and accurate visualization of liver anatomy, and could be particularly helpful for paediatric LDLT.

Multi-material processing by LENS{trademark}

Conference Paper

Oct 1997

During the past few years, solid freeform fabrication has evolved into direct fabrication of metallic components using computer aided design (CAD) solid models. Laser Engineered Net Shaping (LENS{trademark}) is one such technique being developed at Sandia to fabricate high strength, near net shape metallic components. In the past two years a variety of components have been fabricated using LENS{trademark} for applications ranging from prototype parts to injection mold tooling. To advance direct fabrication capabilities, a process must be able to accommodate a wide range of materials, including alloys and composites. This is important for tailoring certain physical properties critical to component performance. Examples include graded deposition for matching coefficient of thermal expansion between dissimilar materials, layered fabrication for novel mechanical properties, and new alloy design where elemental constituents and/or alloys are blended to create new materials. In this paper, the authors will discuss the development of precise powder feeding capabilities for the LENS{trademark} process to fabricate graded or layered material parts. They also present preliminary results from chemical and microstructural analysis.

Clinical Applications of Physical 3D Models Derived From MDCT Data and Created by Rapid Prototyping

Article

Jun 2011
AM J ROENTGENOL

Objective: In this article, we describe the production of physical models from CT data using rapid prototyping and present their clinical application. MDCT data acquisition of isotropic voxels and modern postprocessing techniques provide exquisite detail for clinicians and radiologists. Conclusion: In recent years, rapid prototyping technologies have provided new possibilities to visualize complex anatomic structures through the generation of physical models that can be used to assist with diagnosis, surgical planning, prosthesis design, and patient communication.