Imaging Pearls ❯ 3D and Workflow ❯ 3D Printing
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- Key Points
• A personalized 3D-printed pancreatic cancer model provides more intuitive information than CT, allowing surgeons to better visualize the tumor’s location and relationship to neighboring organs.
• In particular, the survey score was higher among staff who performed the surgery than among residents.
• Individual patient pancreatic cancer models have the potential to be used for personalized patient education as well as resident education.
Use of individualized 3D‑printed models of pancreatic cancer to improve surgeons’ anatomic understanding and surgical planning
Chorog Song et al.
European Radiology https://doi.org/10.1007/s00330-023-09756-0 - Objectives Three-dimensional (3D) printing has been increasingly used to create accurate patient-specific 3D-printed models from medical imaging data. We aimed to evaluate the utility of 3D-printed models in the localization and understanding of pancreatic cancer for surgeons before pancreatic surgery.
Conclusion The 3D-printed model of pancreatic cancer improved surgeons’ understanding of individual patients’ pancreatic cancer and surgical planning.
Clinical relevance statement The 3D-printed model of pancreatic cancer can be created using a preoperative CT image, which not only assists surgeons in surgical planning but also serves as a valuable educational resource for patients and students.
Use of individualized 3D‑printed models of pancreatic cancer to improve surgeons’ anatomic understanding and surgical planning
Chorog Song et al.
European Radiology https://doi.org/10.1007/s00330-023-09756-0 - “The limitations of the present study are as follows. First, owing to technical limitations, the model is firm and stiff, which differs from the tactile sensation of actual biological tissue. There is still a lack of 3D printing technology for the formation of soft tissue structures. Therefore, when used as a preoperative simulation, there are disadvantages such as cutting and suturing, surgery, malleability, and a decrease in vitality, making it less competitive than augmented or virtual reality. Second, there was a small sample size of 10 patients and no direct survey of patients.”
Use of individualized 3D‑printed models of pancreatic cancer to improve surgeons’ anatomic understanding and surgical planning
Chorog Song et al.
European Radiology https://doi.org/10.1007/s00330-023-09756-0
- OBJECTIVE. Three-dimensional printing is being used for surgical assistance, particularly for robot-assisted partial nephrectomy (RAPN). The objective of this study was to assess the anatomic accuracy of the 3D model used for 3D model–guided RAPN.
CONCLUSION. Three-dimensional printed models are accurate with respect to anatomic reality. The reliability of surgical assistance with 3D printed models must be evaluated.
Measurement of the Accuracy of 3D-Printed Medical Models to Be Used for Robot-Assisted Partial Nephrectomy
Michiels C et al.
AJR 2019; 213:1–6 - “Our 3D models are accurate with respect to the anatomic reality of the different measurements and arterial distribution. These 3D models allow use of a clampless technique or segmental renal artery clamping to minimize renal ischemia and to preserve postoperative renal function. The reliability of surgical assistance with 3D printing must be prospectively evaluated.”
Measurement of the Accuracy of 3D-Printed Medical Models to Be Used for Robot-Assisted Partial Nephrectomy
Michiels C et al.
AJR 2019; 213:1–6 - Three-dimensional printing is appreciated because surgeons can have a tactile experience with the renal tumor and re- nal system and thus determine better surgical plans and treatment strategies. Marconi et al. found that 3D printed models assisted medical students, surgeons, and radiologists in identifying anatomic structures.”
Measurement of the Accuracy of 3D-Printed Medical Models to Be Used for Robot-Assisted Partial Nephrectomy
Michiels C et al.
AJR 2019; 213:1–6
- “The visual and tactile inspection of 3D models allowed the best anatomical understanding, with faster and clearer comprehension of the surgical anatomy. As expected, less experienced medical students perceived the highest benefit (53.9% ± 4.14 of correct answers with 3D-printed models, compared to 53.4 % ± 4.6 with virtual models and 45.5% ± 4.6 with MDCT), followed by surgeons and radiologists. The average time spent by participants in 3D model assessing was shorter (60.67 ± 25.5 s) than the one of the corresponding virtual 3D reconstruction (70.8 ± 28.18 s) or conventional MDCT scan (127.04 ± 35.91 s).”
Value of 3D printing for the comprehension of surgical anatomy.
Marconi S et al. Surg Endosc. 2017 Mar 9. doi: 10.1007/s00464-017-5457-5. [Epub ahead of print] 
What is 3D printing?
3D printing, also known as additive manufacturing (AM), refers to processes used to create a three-dimensional object in which layers of material are formed under computer control to create an object. Objects can be of almost any shape or geometry and are produced using digital model data from a 3D model or another electronic data source such as an Additive Manufacturing File (AMF) file.- What has been the early use of 3D Printing in Medicine?
• Physician education and training
• Patient education and communication
• Custom design of prosthesis
• Surgical simulation and rehearsal
• Medical devise prototyping - RESULTS: Accurate life-sized 3D cardiac prototypes were successfully created for all patients. The models enabled radically improved 3D understanding of anatomy, identification of specific technical challenges, and precise surgical planning. Augmentation of existing clinical and imaging data by 3D prototypes allowed successful execution of complex surgeries for all five patients, in accordance with the preoperative planning.
CONCLUSIONS: 3D-printed cardiac prototypes can radically assist decision-making, planning, and safe execution of complex congenital heart surgery by improving understanding of 3D anatomy and allowing anticipation of technical challenges Three-dimensional-printed cardiac prototypes aid surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases: Early experience and proof of concept in a resource-limited environment.
Kappanayil M et al. Ann Pediatr Cardiol. 2017 May-Aug;10(2):117-125. - BACKGROUND: Rapid growth of three-dimensional (3D) printing in recent years has led to new applications of this technology across all medical fields. This review article presents a broad range of examples on how 3D printing is facilitating liver surgery, including models for preoperative planning, education, and simulation.
CONCLUSIONS: Although the technology is still in its early stages, presented models are considered useful in preoperative planning and patient and student education. There are multiple factors limiting the use of 3D printing in everyday healthcare, the most important being high costs and the time-consuming process of development. Promising early results need to be verified in larger randomized trials, which will provide more statistically significant results.
3D Printing in Liver Surgery: A Systematic Review. Witowski JS et al. Telemed J E Health. 2017 May 22. doi: 10.1089/tmj.2017.0049. [Epub ahead of print] - PURPOSE: Three-dimensional (3D) printing for preoperative planning has been intensively developed in the recent years. However, the implementation of these solutions in hospitals is still difficult due to high costs, extremely expensive industrial-grade printers, and software that is difficult to obtain and learn along with a lack of a defined process. This paper presents a cost-effective technique of preparing 3D-printed liver models that preserves the shape and all of the structures, including the vessels and the tumor, which in the present case is colorectal liver metastasis.
CONCLUSIONS: The increased accessibility of 3D models for physicians before complex laparoscopic surgical procedures such as hepatic resections could lead to beneficial breakthroughs in these sophisticated surgeries, as many reports show that these models reduce operative time and improve short term outcomes. Cost-effective, personalized, 3D-printed liver model for preoperative planning before laparoscopic liver hemihepatectomy for colorectal cancer metastases.
Witowski JS et al. Int J Comput Assist Radiol Surg. 2017 Jan 31. doi: 10.1007/s11548-017-1527-3. [Epub ahead of print] - “This study aims to examine the educational value of the 3DP model from the learner's point of view. Students (n = 15) compared the developed 3DP models with the plastinated prosections, and provided their views on their learning experience using 3DP models using a survey and focus group discussion. Anatomical features in 3DP models were rated as accurate by all students. Several positive aspects of 3DP models were highlighted, such as the color coding by tissue type, flexibility and that less care was needed in the handling and examination of the specimen than plastinated specimens which facilitated the appreciation of relations between the anatomical structures.”
Evaluation by medical students of the educational value of multi-material and multi-colored three-dimensional printed models of the upper limb for anatomical education. Mogali SR et al. Anat Sci Educ. 2017 May 19. doi: 10.1002/ase.1703. [Epub ahead of print] - “The authors identified the need for an educational aid when teaching acetabular fracture classifications, given the complex spatial anatomy and the nonintuitive classification system that is commonly used. Three-dimensional (3D) printing is an evolving technique that has applications as an educational aid, providing the student with a tangible object to interact with and learn from.”
Creating Three-dimensional Printed Models of Acetabular Fractures for Use as Educational Tools Matthew S. Manganaro, Yoav Morag, William J. Weadock, Corrie M. Yablon, Kara Gaetke-Udager, and Erica B. Stein RadioGraphics 2017 37:3, 871-880 - “Printing was performed by using an additive manufacturing principle, with approximately 36–48 hours needed for printing, postprocessing, and drying.The cost to print a 1:1 scale model was approximately $100–$200, depending on the amount of plastic material used.These models can then be painted according to the two-column theory regarding acetabular fractures.” Creating Three-dimensional Printed Models of Acetabular Fractures for Use as Educational Tools Matthew S. Manganaro, Yoav Morag, William J. Weadock, Corrie M. Yablon, Kara Gaetke-Udager, and Erica B. Stein RadioGraphics 2017 37:3, 871-880
- “Three-dimensional models that enhance our understanding of common diagnostically challenging issues encountered in routine clinical practice and that facilitate improved diagnosis and treatments are likely to yield the greatest educational benefits. Rarely encountered variants and pathologic entities may not be suitable for 3D model projects; however, a model that depicts a unique abnormality may be useful for patient education.”
Creating Three-dimensional Printed Models of Acetabular Fractures for Use as Educational Tools Matthew S. Manganaro, Yoav Morag, William J. Weadock, Corrie M. Yablon, Kara Gaetke-Udager, and Erica B. Stein RadioGraphics 2017 37:3, 871-880 - “The visual and tactile inspection of 3D models allowed the best anatomical understanding, with faster and clearer comprehension of the surgical anatomy. As expected, less experienced medical students perceived the highest benefit (53.9% ± 4.14 of correct answers with 3D-printed models, compared to 53.4 % ± 4.6 with virtual models and 45.5% ± 4.6 with MDCT), followed by surgeons and radiologists. The average time spent by participants in 3D model assessing was shorter (60.67 ± 25.5 s) than the one of the corresponding virtual 3D reconstruction (70.8 ± 28.18 s) or conventional MDCT scan (127.04 ± 35.91 s).”
Value of 3D printing for the comprehension of surgical anatomy. Marconi S et al. Surg Endosc. 2017 Mar 9. doi: 10.1007/s00464-017-5457-5. [Epub ahead of print] - “Newly developed 3D printing technologies can recreate patient-specific anatomy, but the stiffness of the materials limits delity to real-life surgical situations. Hollywood special effects techniques can create ultrarealistic features, including lifelike tactile properties, to enhance accuracy and effectiveness of the surgical models.”
Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects Weinstock P et al. J Neurosurg Pediatr April 25, 2017 (in press) - “A plug-and-play lifelike ETV training model was developed through a combination of 3D printing and special effects techniques, providing both anatomical and haptic accuracy. Such simulators offer opportunities to accelerate the development of expertise with respect to new and novel procedures as well as iterate new surgical approaches and innovations, thus allowing novice neurosurgeons to gain valuable experience in surgical techniques without exposing patients to risk of harm.”
Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects Weinstock P et al. J Neurosurg Pediatr April 25, 2017 (in press) - What does it take to get started with 3D Printing?
• Consider a focused question and start there
• Do you need to buy a printer and if so how much will it cost?
• Who pays for the 3D models? (patient, insurance, research funds)
• What’s the turnaround time for the studies and what turnaround tie do you need?
- BACKGROUND: In a preliminary experience, we claimed the potential value of 3D printing technology for pre-operative counseling and surgical planning. However, no objective analysis has ever assessed its additional benefit in transferring anatomical information from radiology to final users. We decided to validate the pre-operative use of 3D-printed anatomical models in patients with solid organs' diseases as a new tool to deliver morphological information.
CONCLUSIONS: 3D-printed models help to transfer complex anatomical information to clinicians, resulting useful in the pre-operative planning, for intra-operative navigation and for surgical training purposes.
Value of 3D printing for the comprehension of surgical anatomy. Marconi S et al. Surg Endosc. 2017 Mar 9. doi: 10.1007/s00464-017-5457-5. [Epub ahead of print] - “The visual and tactile inspection of 3D models allowed the best anatomical understanding, with faster and clearer comprehension of the surgical anatomy. As expected, less experienced medical students perceived the highest benefit (53.9% ± 4.14 of correct answers with 3D-printed models, compared to 53.4 % ± 4.6 with virtual models and 45.5% ± 4.6 with MDCT), followed by surgeons and radiologists. The average time spent by participants in 3D model assessing was shorter (60.67 ± 25.5 s) than the one of the corresponding virtual 3D reconstruction (70.8 ± 28.18 s) or conventional MDCT scan (127.04 ± 35.91 s).”
Value of 3D printing for the comprehension of surgical anatomy. Marconi S et al. Surg Endosc. 2017 Mar 9. doi: 10.1007/s00464-017-5457-5. [Epub ahead of print]
- “3D printing is an emerging technology that is primarily used for aiding the design and prototyping of implants. As this technology has evolved it has now become possible to produce functional and definitive implants manufactured using a 3D printing process. This process, however, previously required a large financial investment in complex machinery and professionals skilled in 3D product design. Our pilot study's aim was to design and create a 3D printed custom orthopaedic implant using only freely available consumer hardware and software.”
DIY 3D Printing of Custom Orthopaedic Implants: A Proof of Concept Study.
Frame M, Leach W.
Surg Technol Int. 2014 Mar;24:314-8. - “3D printing is a method of manufacturing in which materials, such as plastic or metal, are deposited onto one another in layers to produce a three dimensional object, such as a pair of eye glasses or other 3D objects. This process contrasts with traditional ink-based printers which produce a two dimensional object (ink on paper). To date, 3D printing has primarily been used in engineering to create engineering prototypes. However, recent advances in printing materials have now enabled 3D printers to make objects that are comparable with traditionally manufactured items. In contrast with conventional printers, 3D printing has the potential to enable mass customisation of goods on a large scale and has relevance in medicine including ophthalmology.”
Innovations in 3D printing: a 3D overview from optics to organs.
Schubert C, van Langeveld MC, Donoso LA.
Br J Ophthalmol. 2014 Feb;98(2):159-61 - “3D printing has already been proved viable in several medical applications including the manufacture of eyeglasses, custom prosthetic devices and dental implants. In this review, we discuss the potential for 3D printing to revolutionise manufacturing in the same way as the printing press revolutionised conventional printing. The applications and limitations of 3D printing are discussed; the production process is demonstrated by producing a set of eyeglass frames from 3D blueprints.”
Innovations in 3D printing: a 3D overview from optics to organs.
Schubert C, van Langeveld MC, Donoso LA.
Br J Ophthalmol. 2014 Feb;98(2):159-61 - “ The advent of multimaterial 3D printers allows the creation of neurosurgical models of a more realistic nature, mimicking real tissues. The authors used the latest generation of 3D printer to create a model, with an inbuilt pathological entity, of varying consistency and density. Using this model the authors were able to take trainees through the basic steps, from navigation and planning of skin flap to performing initial steps in a craniotomy and simple tumor excision. As the technology advances, models of this nature may be able to supplement the training of neurosurgeons in a simulated operating theater environment, thus improving the training experience.”
Utility of multimaterial 3D printers in creating models with pathological entities to enhance the training experience of neurosurgeons.
Waran V1, Narayanan V, Karuppiah R, Owen SL, Aziz T.J Neurosurg. 2014 Feb;120(2):489-92. - “This report concerns a 67 year old male patient with known advanced relapsing polychondritis complicated by tracheobronchial chondromalacia who is increasingly symptomatic and therapeutic options such as tracheostomy and stenting procedures are being considered. The DICOM files from the patient's dynamic chest CT in its inspiratory and expiratory phases were used to generate stereolithography (STL) files and hence print out 3-D models of the patient's trachea and central airways. The 4 full-sized models allowed better understanding of the extent and location of any stenosis or malacic change and should aid any planned future stenting procedures. The future possibility of using the models as scaffolding to generate a new cartilaginous upper airway using regenerative medical techniques is also discussed.”
3-D printouts of the tracheobronchial tree generated from CT images as an aid to management in a case of tracheobronchial chondromalacia caused by relapsing polychondritis.
Tam MD, Laycock SD, Jayne D, Babar J, Noble B
J Radiol Case Rep. 2013 Aug 1;7(8):34-43. - “ The DICOM files from the patient's dynamic chest CT in its inspiratory and expiratory phases were used to generate stereolithography (STL) files and hence print out 3-D models of the patient's trachea and central airways. The 4 full-sized models allowed better understanding of the extent and location of any stenosis or malacic change and should aid any planned future stenting procedures. The future possibility of using the models as scaffolding to generate a new cartilaginous upper airway using regenerative medical techniques is also discussed.”
3-D printouts of the tracheobronchial tree generated from CT images as an aid to management in a case of tracheobronchial chondromalacia caused by relapsing polychondritis.
Tam MD, Laycock SD, Jayne D, Babar J, Noble B
J Radiol Case Rep. 2013 Aug 1;7(8):34-43. - 3D printing has been used to print patient specific implant and device for medical use. Successful operations include a titanium pelvic implanted into a British patient, titanium lower jaw transplanted to a Dutch patient [citation needed] and a plastic tracheal splint for an American infant.The hearing aid and dental industries are expected to be the biggest area of future development using the custom 3D printing technology. In March 2014, surgeons in Swansea used 3D printed parts to rebuild the face of a motorcyclist who had been seriously injured in a road accident.
3D printing
Wikipedia - 3D Printing in Radiology
- Custom stents for biliary tree and pancreatic duct
- Pre-operative planning in complex craniofacial surgery and in plastic surgery
- Role in planning optimal radiation therapy
- Patient communication tool 
