Paediatric orthopaedic surgery with 3D printing: Improvements and cost reduction

This paper presents a a novel alghorithm of diagnosis and treatment of rigid flatfoot due to tarsal coalition. It introduces a workflow based on 3D printed models, that ensures more efficiency, not only by reducing costs and time, but also by improving procedures in the preoperative clinical phase. Since this paper concerns the development of a new methodology that integrates both engineering and medical fields, it highlights symmetry. An economic comparison is made between the traditional method and the innovative one; the results demonstrate a reduction in costs with the latter. The current, traditional method faces critical issues in diagnosing the pathologies of a limb (such as the foot) and taking decisions for further treatment of the same limb. The proposed alternative methodology thus uses new technologies that are part of the traditional workflow, only replacing the most obsolete ones. In fact, it is increasingly becoming necessary to introduce new technologies in orthopedics, as in other areas of medicine, to offer improved healthcare services for patients. Similar clinical treatments can be performed using the aforementioned technologies, offering greater effectiveness, more simplicity of approach, shorter times, and lower costs. An important technology that fits into this proposed methodology is 3D printing

Description of the cad-am process for 3d bone printing: The case study of a flat foot

This work is focused on the study of 3D prints applied in the orthopedic-pediatric field. The focus is therefore on all the processes that lead to obtaining 3D bone printing starting from the three-dimensional digital CAD model. Specifically, the case study concerns patients with flat foot pathology from tarsal synostosis. The final result of the printing process is a three-dimensional bone model reflecting the original anatomical structure. This is a useful tool for surgeons who can carry out a preventive analytical evaluation of the relative intervention methods. 3D printing can be useful both in the preoperative planning phase and during the operation. Depending on the case, it may be more convenient to use one material than another. For this reason, another goal set by this work concerns the study of materials used for 3D printing of bones

What is the sensitivity of mammography and dynamic MR imaging for DCIS if the whole-breast histopathology is used as a reference standard?

PURPOSE: Our purpose was to compare mammography and dynamic contrast-enhanced magnetic resonance imaging (MRI) in the detection of ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: Ninety patients (aged 58.6+/-16.1 years) who were candidates for unilateral (n=81) or bilateral (n=9) mastectomy underwent mammography and dynamic contrast-enhanced breast MRI using a coronal three-dimensional gradient-echo sequence with slice thickness or =5 and or =10 and or =20 mm (n=2); not assessed (n=10). Sensitivity was 35% (9/26) for mammography and 38% (10/26) for MRI (not significant difference, McNemar test). Both mammography and MRI provided a true positive result in seven cases (four of them measured at pathology, with a diameter of 20.0+/-12.9 mm; median 20 mm) and a false negative result in 14 cases (10 of them measured at pathology, with a diameter of 4.2+/-1.9 mm; median 4.6 mm) (p=0.024, Mann-Whitney U test). Only 46% (12/26) of DCIS were detected at mammography and/or MRI; the remaining 54% (14/26) were diagnosed only at pathological examination. CONCLUSIONS: When the whole breast is used as the histopathological reference standard, both mammography and MRI show low sensitivity for DCIS

Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in fatty and dense breasts using the whole-breast pathologic examination as a gold standard

OBJECTIVE. Our aim was to compare the effectiveness of mammography and MRI in the detection of multifocal, multicentric breast cancer. SUBJECTS AND METHODS. Ninety patients with planned mastectomies (nine bilateral) underwent mammography and dynamic gadolinium-enhanced MRI. Off-site reviewers aware of the entry criterion (planned mastectomy) evaluated both examinations for the presence of malignant foci, recording the density pattern on mammography. The gold standard was pathologic examination of the whole excised breast (slice thickness, 5 turn). RESULTS. Of 99 breasts, pathologic findings revealed 52 unifocal, 29 multifocal, and 18 multicentric cancers for a total of 188 malignant foci (158 invasive and 30 in situ). Overall sensitivity was 66% (124/188) for mammography and 81% (152/188) for MRI (p 0.05, not significant), respectively. Mammography and MRI missed 64 and 36 malignant foci, respectively, with median diameters of 8 and 5 mm (p = 0.033) and an invasive-noninvasive ratio of 2.4:1 (45:19) and 1.0:1 (18:18) (p = 0.043), respectively. The overall positive predictive value (PPV) was 76% (124/164) for mammography and 68% (152/222) for MRI (not significant). In breasts with an almost entirely fatty pattern, sensitivity was 75% for mammography and 80% for MRI (not significant), and the PPV was 73% and 65% (not significant), respectively. In breasts with fibroglandular or dense pattern, the sensitivity was 60% and 81% (p < 0.001), and the PPV was 78% and 71% (not significant), respectively. CONCLUSION. MRI was more sensitive than mammography for the detection of multiple malignant foci in fibroglandular or dense breasts. Mammography missed larger and more invasive cancer foci than MRI. A relatively low PPV was a problem for both techniques