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

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

Geographic diversity of adult T-cell leukemia/lymphoma in Brazil

We describe 195 cases of adult T-cell leukemia/lymphoma (ATLL) reported to the national registry of T-cell malignancies in Brazil between 1994 and 1998. We compared the effect of demographic differences and clinical features of 150 consecutive ATLL cases in different regions of this diverse country. At diagnosis, the predominant clinical sub-type was the acute type (60%), followed by lymphoma (22%)(v) chronic (10%) and smoldering (8%) types. Although we expected that different sub-types would be present in different regions, on the basis of immunogenetic factors determined by ethnicity, we did not demonstrate these differences. There were no significant differences among ATLL subtypes by age or gender. No ethnic group predominated in the total population of patients, but significant differences were noted when examining ethnic distribution by region. Reflecting the general population distribution, white patients were seen more often in Sao Paulo and black patients in Bahia, than in other regions, In most regions, cases were equally distributed between blacks and mulattos, except in Pernambuco, where blacks were less frequent. The main clinical features were lymphadenopathy, skin lesions, hypercalcemia and hepatomegaly. Fourteen patients (9%) suffered from HTLV-I-associated myelopathy (HAM/TSP), either at diagnosis or during follow-up of ATLL. All cases but one had antibodies to HTLV-I, with concordant results with ELISA, WE and FCR analyses. For the antibody-negative case, pol and tax gene sequences were present in tumor cells when subjected to PCR analyses. The prognosis was generally poor, suggesting that the disease in Brazil behaves in similar fashion regardless of ethnic or geographical differences. (C) 1999 Wiley-Liss, Inc.Canc Hosp, Inst Nacl Canc, Cell Markers Lab, Rio De Janeiro, BrazilHEMOPE, Dept Hematol, Recife, PE, BrazilSch Med, Dept Pathol, Salvador, BA, BrazilUniv Fed Sao Paulo, Dept Hematol, Sao Paulo, BrazilMed Sch Santa Casa da Misercordia, Sao Paulo, BrazilInst Estadual Hematol, Immunol Lab, Rio De Janeiro, BrazilNew York Blood Ctr, New York, NY 10021 USAUniv Maryland, Inst Human Virol, Baltimore, MD 21201 USAUniv Fed Sao Paulo, Dept Hematol, Sao Paulo, BrazilWeb of Scienc