Generation of three-dimensional prototype models based on cone beam computed tomography

Purpose: The purpose of this study was to generate three-dimensional models based on digital volumetric data that can be used in basic and advanced education. Methods: Four sets of digital volumetric data were established by cone beam computed tomography (CBCT) (Accuitomo, J. Morita, Kyoto, Japan). Datasets were exported as Dicom formats and imported into Mimics and Magic software programs to separate the different tissues such as nerve, tooth and bone. These data were transferred to a Polyjet 3D Printing machine (Eden 330, Object, Israel) to generate the models. Results: Three-dimensional prototype models of certain limited anatomical structures as acquired volumetrically were fabricated. Conclusions: Generating three-dimensional models based on CBCT datasets is possible. Automated routine fabrication of these models, with the given infrastructure, is too time-consuming and therefore too expensiv

A Systematic Review of Three-Dimensional Printing in Liver Disease

The purpose of this review is to analyse current literature related to the clinical applications of 3D printed models in liver disease. A search of the literature was conducted to source studies from databases with the aim of determining the applications and feasibility of 3D printed models in liver disease. 3D printed model accuracy and costs associated with 3D printing, the ability to replicate anatomical structures and delineate important characteristics of hepatic tumours, and the potential for 3D printed liver models to guide surgical planning are analysed. Nineteen studies met the selection criteria for inclusion in the analysis. Seventeen of them were case reports and two were original studies. Quantitative assessment measuring the accuracy of 3D printed liver models was analysed in five studies with mean difference between 3D printed models and original source images ranging from 0.2 to 20%. Fifteen studies provided qualitative assessment with results showing the usefulness of 3D printed models when used as clinical tools in preoperative planning, simulation of surgical or interventional procedures, medical education, and training. The cost and time associated with 3D printed liver model production was reported in 11 studies, with costs ranging from US$13 to US$2000, duration of production up to 100 h. This systematic review shows that 3D printed liver models demonstrate hepatic anatomy and tumours with high accuracy. The models can assist with preoperative planning and may be used in the simulation of surgical procedures for the treatment of malignant hepatic tumours

Реконструкция трехмерных моделей анатомических объектов на основе анализа биомедицинских изображений

Медицинский анализ изображений, моделирование и технология печати 3D обеспечивает решение для медицинского исследования и конкретный путь для диагностики и анализа проблем со здоровьем человека. Практически обеспечивает новый метод обработки изображений с помощью инструмента компьютерного программного обеспечения, включая статистический анализ и алгоритм. Этот метод был разделен на две основные категории - моделирование изображений и обработка изображений. В этом докладе я описываю процедуру, как использовать данные DICOM, которые можно преобразовать в 3D печатные модели. В первой категории моделирования мы можем сделать модель и после этого 3D-печать через указанные программные средства.Medical image analysis, 3D modeling & printing technology provide a solution for medical research and a specific path to diagnose & analyze human health issues. The 3D Biomedical images of human body through CT scanning.Practically image analysis provides a new technique of image processing through computer software tool including statistical analysis and algorithm. It has been divided into two main categories as image modeling and image processing. In this report, I am describing the procedure that how to use the DICOM data can transform into 3D printed models. In the first category of modeling, we are able to make a model and after that 3D printing through the specified software tool

Generation of three-dimensional prototype models based on cone beam computed tomography

PURPOSE: The purpose of this study was to generate three-dimensional models based on digital volumetric data that can be used in basic and advanced education. METHODS: Four sets of digital volumetric data were established by cone beam computed tomography (CBCT) (Accuitomo, J. Morita, Kyoto, Japan). Datasets were exported as Dicom formats and imported into Mimics and Magic software programs to separate the different tissues such as nerve, tooth and bone. These data were transferred to a Polyjet 3D Printing machine (Eden 330, Object, Israel) to generate the models. RESULTS: Three-dimensional prototype models of certain limited anatomical structures as acquired volumetrically were fabricated. CONCLUSIONS: Generating three-dimensional models based on CBCT datasets is possible. Automated routine fabrication of these models, with the given infrastructure, is too time-consuming and therefore too expensive

Optimization of computer-assisted intraoperative guidance for complex oncological procedures

Mención Internacional en el título de doctorThe role of technology inside the operating room is constantly increasing, allowing surgical procedures previously considered impossible or too risky due to their complexity or limited access. These reliable tools have improved surgical efficiency and safety. Cancer treatment is one of the surgical specialties that has benefited most from these techniques due to its high incidence and the accuracy required for tumor resections with conservative approaches and clear margins. However, in many cases, introducing these technologies into surgical scenarios is expensive and entails complex setups that are obtrusive, invasive, and increase the operative time. In this thesis, we proposed convenient, accessible, reliable, and non-invasive solutions for two highly complex regions for tumor resection surgeries: pelvis and head and neck. We explored how the introduction of 3D printing, surgical navigation, and augmented reality in these scenarios provided high intraoperative precision. First, we presented a less invasive setup for osteotomy guidance in pelvic tumor resections based on small patient-specific instruments (PSIs) fabricated with a desktop 3D printer at a low cost. We evaluated their accuracy in a cadaveric study, following a realistic workflow, and obtained similar results to previous studies with more invasive setups. We also identified the ilium as the region more prone to errors. Then, we proposed surgical navigation using these small PSIs for image-to-patient registration. Artificial landmarks included in the PSIs substitute the anatomical landmarks and the bone surface commonly used for this step, which require additional bone exposure and is, therefore, more invasive. We also presented an alternative and more convenient installation of the dynamic reference frame used to track the patient movements in surgical navigation. The reference frame is inserted in a socket included in the PSIs and can be attached and detached without losing precision and simplifying the installation. We validated the setup in a cadaveric study, evaluating the accuracy and finding the optimal PSI configuration in the three most common scenarios for pelvic tumor resection. The results demonstrated high accuracy, where the main source of error was again incorrect placements of PSIs in regular and homogeneous regions such as the ilium. The main limitation of PSIs is the guidance error resulting from incorrect placements. To overcome this issue, we proposed augmented reality as a tool to guide PSI installation in the patient’s bone. We developed an application for smartphones and HoloLens 2 that displays the correct position intraoperatively. We measured the placement errors in a conventional and a realistic phantom, including a silicone layer to simulate tissue. The results demonstrated a significant reduction of errors with augmented reality compared to freehand placement, ensuring an installation of the PSI close to the target area. Finally, we proposed three setups for surgical navigation in palate tumor resections, using optical trackers and augmented reality. The tracking tools for the patient and surgical instruments were fabricated with low-cost desktop 3D printers and designed to provide less invasive setups compared to previous solutions. All setups presented similar results with high accuracy when tested in a 3D-printed patient-specific phantom. They were then validated in the real surgical case, and one of the solutions was applied for intraoperative guidance. Postoperative results demonstrated high navigation accuracy, obtaining optimal surgical outcomes. The proposed solution enabled a conservative surgical approach with a less invasive navigation setup. To conclude, in this thesis we have proposed new setups for intraoperative navigation in two complex surgical scenarios for tumor resection. We analyzed their navigation precision, defining the optimal configurations to ensure accuracy. With this, we have demonstrated that computer-assisted surgery techniques can be integrated into the surgical workflow with accessible and non-invasive setups. These results are a step further towards optimizing the procedures and continue improving surgical outcomes in complex surgical scenarios.Programa de Doctorado en Ciencia y Tecnología Biomédica por la Universidad Carlos III de MadridPresidente: Raúl San José Estépar.- Secretario: Alba González Álvarez.- Vocal: Simon Droui

Pressure drop and recovery in cases of cardiovascular disease: a computational study

The presence of disease in the cardiovascular system results in changes in flow and pressure patterns. Increased resistance to the flow observed in cases of aortic valve and coronary artery disease can have as a consequence abnormally high pressure gradients, which may lead to overexertion of the heart muscle, limited tissue perfusion and tissue damage. In the past, computational fluid dynamics (CFD) methods have been used coupled with medical imaging data to study haemodynamics, and it has been shown that CFD has great potential as a way to study patient-specific cases of cardiovascular disease in vivo, non-invasively, in great detail and at low cost. CFD can be particularly useful in evaluating the effectiveness of new diagnostic and treatment techniques, especially at early ‘concept’ stages. The main aim of this thesis is to use CFD to investigate the relationship between pressure and flow in cases of disease in the coronary arteries and the aortic valve, with the purpose of helping improve diagnosis and treatment, respectively. A transitional flow CFD model is used to investigate the phenomenon of pressure recovery in idealised models of aortic valve stenosis. Energy lost as turbulence in the wake of a diseased valve hinders pressure recovery, which occurs naturally when no energy losses are observed. A “concept” study testing the potential of a device that could maximise pressure recovery to reduce the pressure load on the heart muscle was conducted. The results indicate that, under certain conditions, such a device could prove useful. Fully patient-specific CFD studies of the coronary arteries are fewer than studies in larger vessels, mostly due to past limitations in the imaging and velocity data quality. A new method to reconstruct coronary anatomy from optical coherence tomography (OCT) data is presented in the thesis. The resulting models were combined with invasively acquired pressure and flow velocity data in transient CFD simulations, in order to test the ability of CFD to match the invasively measured pressure drop. A positive correlation and no bias were found between the calculated and measured results. The use of lower resolution reconstruction methods resulted in no correlation between the calculated and measured results, highlighting the importance of anatomical accuracy in the effectiveness of the CFD model. However, it was considered imperative that the limitations of CFD in predicting pressure gradients be further explored. It was found that the CFD-derived pressure drop is sensitive to changes in the volumetric flow rate, while bench-top experiments showed that the estimation of volumetric flow rate from invasively measured velocity data is subject to errors and uncertainties that may have a random effect on the CFD pressure result. This study demonstrated that the relationship between geometry, pressure and flow can be used to evaluate new diagnostic and treatment methods. In the case of aortic stenosis, further experimental work is required to turn the concept of a pressure recovery device into a potential clinical tool. In the coronary study it was shown that, though CFD has great power as a study tool, its limitations, especially those pertaining to the volumetric flow rate boundary condition, must be further studied and become fully understood before CFD can be reliably used to aid diagnosis in clinical practice.Open Acces