3D Printed Liver Models as a Tool to Improve Pre-Surgical Consultation and Enhance Patient Consent

Background: 3D printing has recently emerged as an effective, cost-efficient tool for healthcare innovation. We propose the fabrication of 3D printed, patient-specific liver models as a pre-surgical planning and communication tool for liver resection surgery. Methods: Creation of the model began with the segmentation of the patient\u27s abdominal CT scan, where specific sections of their anatomy, including the blood vessels (portal and hepatic systems), gallbladder, and tumor (when applicable), were digitally segmented. Each structure was then printed in a unique color using polylactic acid (PLA) plastic filament on an Ultimaker 5s printer. Once printed the components were arranged anatomically and placed in clear silicone representing the liver parenchyma. The model was presented to the surgical team pre-operatively, as well as given to the patient during their pre-operative consultation. Results: Two models were successfully printed from patient scans, both providing an accurate full-scale representation validated by the surgical team. The 3D printing time totaled 51 hours and was completed in two consecutive days with the utilization of three printers. The complete fabrication process, including the silicone curing, was accomplished in four days. The cost of materials to produce each liver was estimated at 113USD. Conclusions: Our results show 3D printed models are promising emerging technologies for improving aspects of surgical care. Although limited in scale, our work suggests custom anatomic models are feasible and cost-efficient within the timeframe of liver resection surgery. Moreover, anecdotally, the surgical team and patient valued the model as a teaching and communication asset. Further studies will be needed to better quantify the effects of 3D printed models on pre-surgical utility, patient satisfaction, and, more broadly, on their health outcomes

Patient-specific 3D Printed Liver Models for Pre-operative Planning and Improved Patient Adherence

Project Background: 3D anatomical relationships in the liver are not always visually accessible for surgeons performing resections even with advanced imaging options. Firm understanding of these relationships is essential for timely procedures, which can improve patient outcomes and lower hospital expenses. Patient-specific 3D modeling has existed for some time, though it is costly. New cost-effective techniques have surfaced which may yield opportunities for more effective preoperative planning in liver surgery and improved patient adherence. Methods: Digital patient-specific 3D reconstruction of a liver was completed by interpolating data from MRI scans using 3D Slicer, a segmenting program. The liver model was processed and 3D printed as a shell to be used as a mold. The liver shell, associated vasculature, and tumor were printed using polylactic acid (PLA) filament on an Ultimaker S5 3D printer. Transparent silicone was used as a cast, giving the model a solid form yet still allowing examination of the inside contents. Results: One completed liver model was used in pre-surgical consultation of a patient with hepatocellular carcinoma undergoing liver resection and during the surgical procedure as a guide for the surgical team. A follow-up survey concerning qualitative aspects of the model administered to the surgical team suggested high accuracy of the model compared to the anatomy observed during the procedure. Conclusion: Cost-effective techniques in producing patient specific 3D anatomical models appears not only feasible, but highly effective in improving communication between the surgical team during the procedure and also between the surgeon and the patient during pre-surgical consultation. Future research may be conducted concerning the model’s visual clarity as well as impact on patient adherence post-op

Sound Dampening Headband for Infants

Background: Noise in the Intensive Care Nursery (ICN) has been linked to sleep disruption, vital sign destabilization, abnormal development, and stress response induction in infants. Specifically, a sound level ≥60 decibels (dB) was linked to sleep disruption in infants, and the American Academy of Pediatrics (AAP) set a maximum recommended sound level of 45dB in ICNs. The present work was conducted to confirm that the Jefferson ICN exceeds the 60dB and 45dB levels, like most hospitals do, and to conduct preliminary testing on materials for a wearable intervention to reduce infants’ exposure to noise. Methods: A group of 30 neonatologists, nurses, audiologists, music therapists, sound experts, and administrative staff were interviewed about noise in the ICN and the viability of potential solutions. A 24-hour sound recording was recorded in the Jefferson ICN using a REED-SD-4023 meter. The same meter was used to the sound dampening ability of several materials at 990Hz. Results: The 24-hour sound recording showed that the ICN spent 100% of the time above the AAP recommended level of 45dB, and 44% of the time above 60 dB, the level that disrupts sleep. The maximum sound level was 93dB, and the minimum was 49dB. In our preliminary testing of materials, both Sorbothane and mass-loaded vinyl were far superior to the seven other tested materials. Conclusions: Excessive noise in the Jefferson ICN is clearly a problem. Experts showed immense interest in our work to reduce their patients exposure to noise. Additionally, the team was able to identify a sound dampening material to focus on in creating a wearable noise-reducing apparatus for infants. The project was limited by lack of formal user surveys. Future studies can focus on a higher fidelity way of measuring the ability of the wearable apparatus to dampen noise at the level of the ear

Creating A Noise-Reducing, Wearable Intervention For Newborns In The NICU

Background: Excessive auditory stimulation can have negative effects on the growth and development of newborn babies. The American Academy of Pediatrics states that newborns should not be exposed to sounds in excess of 45dB while they are in the hospital, however noise levels in NICUs across the country are often between 50-100dB. A design project was conducted to develop an intervention that could reduce infant exposure to excessive noise. Methods: Neonatologists, nurses, audiologists, music therapists, sound designers, soft materials experts, and medical device designers were interviewed and consulted throughout the design process. A 24-hour sound recording using a REED-SD-4023 meter was performed in multiple areas within the Jefferson NICU where newborns are located. Market, patent, and materials research was also completed, in addition to preliminary sound testing on materials that were considered for use in the intervention. Feedback from primary stakeholders, including neonatologists and nurses, guided improvements to the prototypes. Results: The 24-hour sound recording showed that noise levels in the Jefferson NICU were above 45dB for 100% of the time, and above 60dB for 44% of the time. The maximum noise level reached 93dB. The preliminary sound testing on selected materials showed that a quarter-inch layer of Sorbothane (the primary sound-dampening layer of the earmuff component of the wearable intervention) reduced noise levels by approximately 15dB at 990Hz. Conclusions: Newborns in the Jefferson NICU are consistently exposed to noise levels above the recommended 45dB limit. The wearable intervention developed in this design project could be a solution. The amount of noise-reduction that the intervention provides will need to be tested with high fidelity. Next steps could also include a design validation test or a pilot study within the NICU. The project was limited by a lack of formal user survey data and an inability to obtain primary end-user (i.e., newborn) feedback