3D Printing for Perioperative Planning: Breast Cancer, Brain Tumor, Microtia

3D printing for perioperative planning has been around since the birth of STL. However, the medical community has gone through many milestones, and this β€œFrom Academia” blog highlights three recent publications demonstrating how the surgical communities are reinventing old surgical techniques using new 3D technologies, racing from 3D printed soft anatomical models, new 3D software tools, finite element analysis, to artificial intelligence and cloud computing. The first one is a review article focusing on different applications of 3D printing in breast cancer management, ranging from visualization help to surgical guides that may be more superior to conventional guidance, to post-surgical radiation treatment guidance. The second article is a research paper focusing on creating streamlined workflow leveraging improved more automated segmentation processes (for soft tissues) and soft material 3D printing technologies to create better neurosurgical planning by creating 3D printed patient-specific brain tumor models. The final paper describes the use of affordable 3D printing technology to produce ready-to-use, sterilizable auricular carving, and framework sizing templates to guide in the perioperative sculpture of the cartilaginous framework during microtia reconstruction, which is considered one of the most challenging procedures in the field of reconstruction surgery.

β€œFrom Academia” features recent, relevant, close to commercialization academic publications. Subjects include but not limited to healthcare 3D printing, 3D bioprinting, and related emerging technologies.

Email: Rance Tino (tino.rance@gmail.com) if you want to share relevant academic publications with us.

Applications of 3D printing in breast cancer management

– Authored by Arpine Galstyan, Michael J. Bunker, Fluvio Lobo, Robert Sims, James Inziello, Jack Stubbs, Rita Mukthar & Tatiana Kelil. 3D printing in Medicine. February 9 2021

3D Printing for Breast Cancer
a. Sagittal 3D maximum intensity projection (MIP) image from a contrast enhanced MRI showing extent of abnormal non –mass enhancement in the right upper breast (white ellipse) and surrounding vessels (arrow). b. A 3D printed model derived from this breast MRI. c. A breast surgeon using the 3D printed model intraoperatively to visualize the location of the tumor as well as its relationship to adjacent vessels. d. Side by side comparison of the excised specimen and the 3D model. Copyright.3D printing in Medicine

Abstract:

Three-dimensional (3D) printing is a method by which two-dimensional (2D) virtual data is converted to 3D objects by depositing various raw materials into successive layers. Even though the technology was invented almost 40 years ago, a rapid expansion in medical applications of 3D printing has only been observed in the last few years. 3D printing has been applied in almost every subspecialty of medicine for pre-surgical planning, production of patient-specific surgical devices, simulation, and training.

3D Printing for Perioperative Planning
a. Axial Maximum intensity Projection (MIP) image from a CTA demonstrating the deep inferior epigastric perforating vessels (arrow). b. Coronal and c axial projections of a 3D rendering obtained from the CTA images showing the subfascial intramuscular course of the vascular tree. Copyright. 3D printing in Medicine

While there are multiple review articles describing the utilization of 3D printing in various disciplines, there is a paucity of literature addressing applications of 3D printing in breast cancer management. Herein, we review the current applications of 3D printing in breast cancer management and discuss the potential impact on future practices.

3D Printing for Perioperative Planning
a. Coronal, b a.xial, and c S.agittal images from a preoperative CTA are used to create a 3D model depicting the deep inferior epigastric vascular tree. A segmentation software (MIMICS; Materialise, Belgium) is used to isolate vessels of interest and the abdominal muscle inorder to highlight the intramuscular course of these vessels (d, e). The virtual model is subsequently printed using the Stratasys Connex J735 3D printer (Eden Prairie, Minn) and is shown in the coronal (f) and (g) sagittal projection. This model can be used intraoperatively to guide dissection of vessels. Copyright. 3D printing in Medicine

Keywords: 3D printing, breast cancer, management, , education and simulation, quality control

Clinical application of patient-specific 3D printing brain tumor model production system for neurosurgery

– Authored by Yun-Sik Dho, Doohee Lee, Teahyun Ha, So Young Ji, Kyung Min Kim, Ho Kang, Min-Sung Kim, Jin Wook Kim, Won-Sang Cho, Yong Hwy Kim, Young Gyu Kim, Sang Joon Park & Chul-Kee Park. Nature Scientific Reports. March 26 2021

3D Printing for Perioperative Planning
(A) Graph-cut algorithm. (B) Multiplanar reconstruction (MPR) function of MEDIP during the segmentation process. Copyright. Nature Scientific Reports

Abstract:

The usefulness of 3-dimensional (3D)-printed disease models has been recognized in various medical fields. This study aims to introduce a production platform for patient-specific 3D-printed brain tumor models in clinical practice and evaluate its effectiveness.

A full-cycle platform was created for the clinical application of a 3D-printed brain tumor model (3D-printed model) production system. Essential elements included automated segmentation software, cloud-based interactive communication tools, customized brain models with an exquisite expression of brain anatomy in a transparent material, adjunctive devices for surgical simulation, and swift process cycles to meet practical needs.

A simulated clinical usefulness validation was conducted in which neurosurgeons assessed the usefulness of the 3D-printed models in 10 cases. We successfully produced clinically applicable patient-specific models within 4 days using the established platform. The simulated clinical usefulness validation results revealed the significant superiority of the 3D-printed models in surgical planning regarding surgical posture (p = 0.0147) and craniotomy design (p = 0.0072) compared to conventional magnetic resonance images. The benefit was more noticeable for neurosurgeons with less experience. We established a 3D-printed brain tumor model production system that is ready to use in daily clinical practice for neurosurgery.

3D Printing for Perioperative Planning
(A) The final 3D-printed brain model of right insular glioma. Normal brain parenchyma with expression of the gyri and sulci was reconstructed using transparent silicon material. The tumor is colored light red, the ventricle system is light gray, the caudate nucleus is yellow-green, the thalamus is light blue, and the major venous system is blue. The soft real brain-like texture of the model enables the neurosurgeon to simulate surgery by incising and excavating the area of interest. (B) The internal structure of the model can be clearly observed, and diffuse reflections can be eliminated by placing the model in the water tank. (C) The surgical approach can be fine-tuned with a dedicated fixator that can determine the rotation angle of the model in all directions. (D) The closure view of the model shows the details of gyri and sulci. Copyright. Nature Scientific Reports

Keywords: Brain, Brain imaging, CNS cancer, Surgery, Surgical oncology, Three-dimensional imaging

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Clinical application flow of the 3D-printed brain tumor model.

Multiscale sterilizable 3D printed auricular templates to guide cartilaginous framework sizing and sculpture during autologous microtia reconstruction

– Authored by Bushra Alhazmi, Feras Alshomer, Bassam Alawirdhi. JPRAS open. March 19 2021

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A. Shows an example of the produced 3D-printed auricular templates of variable sizes. B. Intact template following sterilization. Copyright. JPRAS open

Abstract:

Microtia reconstruction using autologous costal cartilage can be one of the most challenging tasks in reconstructive surgery. An intraoperative guide using a 2-dimensional drawing of the contralateral ear on an x-ray film remains the current standard of care. In this paper, we present the use of computer-aided design and desktop 3D printing to fabricate low-cost, sterilizable auricular carving templates to serve as a perioperative reference for microtia reconstruction.

The design was made as a single component that incorporated the usual anatomic reference points of the ear based on the Nagata technique as a Stereolithography file format (. STL) for 3D printing. The templates were created in sizes ranging from 55 mm to 70 mm with a 2 mm increment with an average production cost of 0.26 US dollars per material per template and about 4.5 US dollars for the whole set. Individual templates were then 3D-printed using thermoplastic polyurethane (TPU 95A) semi-flexible filament on a desktop fused deposition modeling, Ultimaker 2 + 3D printer. The produced template tolerated the sterilization process with no structural changes as compared to its pre-sterilization condition. In conclusion, we present cost-effective, sterilizable, multiscale auricular templates to guide the pre-and intra-operative carving of the cartilaginous framework during microtia reconstruction with more accuracy in a time-efficient manner, thereby overcoming the drawbacks of using the traditional x-ray film. The templates are readily accessible and shareable for free through open-source software and can be directly 3D-printed using an affordable desktop 3D printer.

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A. Shows the utility of the produced template in guiding the size choice of the planned framework that was selected based on the size of the unaffected ear in the preoperative visit with the feasibility of adjusting that size to anticipate future growth B. Shows the same patient with the selected template based on the normal side reflected on the affected side. Copyright. JPRAS open

Keywords: Microtia, Reconstruction, Template, Three-dimensional printing, Computer-aided design

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