examples of utilising 3d technologies for clinical...

EXAMPLES OF UTILISING 3D TECHNOLOGIES FOR CLINICAL USE

3D LifePrints UK Ltd

3D LIFEPRINTS

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: TRI-PLANAR CT SCAN TECHNOLOGY USED: SLS 3D PRINTER USING STERILISABLE POLYAMIDE

3D FILAMENT DESCRIPTION: A 3D printed spinal model was used to assist with a complex

procedure to rectify a congenital spinal kyphoscoliosis on an eight-year-old patient. The model was used by the surgical team for pre-operative planning purposes, and subsequently sterilized using an autoclave container and brought into the operating theatre to be used for guidance.

OUTCOME / BENEFITS: Lead surgeon Neil Davidson remarked: “The model was invaluable for

use by the surgical team to undertake this complex procedure. It was useful both preoperatively and intraoperatively - the surgery would have been much more complicated and difficult without the model in theatre. Without the model, the surgical team would have had a higher chance of needing to carry out an anterior approach to the spine which would have increased time in the theatre and the surgical risks of complications to the patient.”


CLINICAL USE 1: PRE & INTRA SURGICAL PLANNING 3D PRINT MODEL TYPE: SPINAL KYPHOSCOLIOSIS

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: TRI-PLANAR CT SCAN TECHNOLOGY USED: FDM 3D PRINTER USING RIGID PLASTIC 3D MATERIAL DESCRIPTION: This 3D model was created for a neurosurgeon to help visualise

the child’s craniosynostosis where the bones of the skull had closed prematurely.

OUTCOME / BENEFITS: The planning done on the model prior to surgery allowed the team

to pre-plan their cutting on the model. This would normally be done intraoperatively increasing the surgery time and therefore overall operational costs.


CLINICAL USE 2: PRE & INTRA SURGICAL PLANNING 3D PRINT MODEL TYPE: CRANIAL DEFORMITY SKULL

3D PRINT MODEL TYPE: HEART CARDIOMYOPATHY LOCATION: LIVERPOOL CHEST & HEART HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: CONTRASTED TRI-PLANAR CT SCAN, ANGIOGRAM TECHNOLOGY USED: FDM 3D PRINTER, FLEXIBLE PLASTIC 3D MATERIAL DESCRIPTION: A 3D printed model was created to provide surgeon Robert Cooper

and his team with information on the heart wall thickness in both the relaxed and the contracted stages of the heartbeat for preparation for an alcohol septal ablation.

OUTCOME / BENEFITS: A study consisting of nine further models has been commissioned

based on the success of this model. Patients are currently being identified to participate in the study.


CLINICAL USE 3: PRE SURGICAL PLANNING 3D PRINT MODEL TYPE: HEART CARDIOMYOPATHY

LOCATION: SOUTHAMPTON HOSPITAL, SOUTHAMPTON, ENGLAND MODEL SOURCE: TRI-PLANAR CT SCAN TECHNOLOGY USED: FDM PRINTER DESCRIPTION: An acetabulum and femur head were 3D printed in white ABS to assist

with a complex bilateral pelvic procedure. OUTCOME / BENEFITS: Lead surgeon Alex Aarvold remarked: “With a difficult case such as

this one that needed a slightly bespoke pelvic osteotomy, the benefit was more in the surgical planning than in actual operative time saved. In this respect it was fantastic, and we could see what we needed to do very quickly on the model, which was not nearly so clear on the CT images. We could also trial the planned osteotomy on the model so we had more confidence in the surgical plan.”.


CLINICAL USE 4: PRE SURGICAL PLANNING 3D PRINT MODEL TYPE: HIP OSTEOTOMY

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: TRI-PLANAR CT SCAN TECHNOLOGY USED: FDM 3D PRINTER USING RIGID PLASTIC 3D MATERIAL DESCRIPTION: A number of 3D printed models of a one-year-old patient’s heart were

created as pre-surgical assessment tools for the surgical team in planning an operation on a heart that had a blocked pulmonary artery.

OUTCOME / BENEFITS: The pre-surgical planning process was enhanced by using the 3D

models which led to time savings in the operating theatre and an improved patient outcome. Lead surgeon Rafael Guerrero said: “This is a great use of 3D printing as it shows me exactly what we needed to see. The initial 3D model was used to plan for the successful provision of a pulmonary artery banding to rectify multiple holes in the baby’s heart. The subsequent 3D print showed that the right ventricle and the left ventricle were full of blood and that communication was occurring between the right side and the left ventricle. The patient’s multiple Ventricular Septal Defects have decreased in size from the first operation. The model is tremendously helpful as it shows we do not need to do any more surgery inside the small holes. So it is a great model.”


CLINICAL USE 5: PRE SURGICAL PLANNING 3D PRINT MODEL TYPE: BLOCKED PULMONARY ARTERY

LOCATION: VIRTUAL ENGINEERING CENTRE, LIVERPOOL UNIVERSITY, ENGLAND MODEL SOURCE: MRI SCAN TECHNOLOGY USED: FDM 3D PRINTER USING FLEXIBLE PLASTIC 3D MATERIAL

AND VR GOGGLES DESCRIPTION: This product allows a surgeon to manipulate a handheld and patient

specific 3D print of an organ, such as a heart, to virtually navigate its internal structure and external surroundings using a virtual reality headset.

OUTCOME / BENEFITS: The Virtual Engineering Centre commented: “We are developing an

exciting collaboration with 3D LifePrints, bringing together the specialist expertise of both organisations in 3D printing and immersive virtual reality to support the medical sector. We are looking forward to forging future developments with such an innovative organisation.”


CLINICAL USE 6: PRE SURGICAL PLANNING / TRAINING 3D PRINT MODEL TYPE: 3D VIRTUAL REALITY

LOCATION: ROYAL SICK CHILDREN’S HOSPITAL, EDINBURGH, SCOTLAND MODEL SOURCE: 3D MODELLED IN-HOUSE BY 3D LIFEPRINTS TECHNOLOGY USED: FDM 3D PRINTER USING FLEXIBLE 3D MATERIALS DESCRIPTION: A 3D model was printed to provide surgeons with a method

of practicing the suturing of veins during medical training. OUTCOME / BENEFITS: Feedback from the surgeon was positive in that the 3D printed model

provided a high level of realism for medical training which exceeded current training materials.


CLINICAL USE 7: SURGICAL TRAINING 3D PRINT MODEL TYPE: VEIN SUTURING

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: MRI SCAN TECHNOLOGY USED: SILICONE 3D PRINTER DESCRIPTION: This 3D model of part of an adult brain was created to show that

silicone 3D printing can provide a realistic replica for soft tissue and organs. The silicone is printed in a range of colours and densities and it is intended to be used in medical training for operations such as Lobe resection and Lesionectomy.

OUTCOME / BENEFITS: Feedback from the surgeons at Alder Hey was extremely positive

especially concerning the realism of the model and potential future use of medical training purposes. It is proposed to combine the silicone brain with a skull printed in polyamide to provide a high fidelity model for surgical simulation.


CLINICAL USE 8: SURGICAL TRAINING 3D PRINT MODEL TYPE: BRAIN

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: MRI SCAN TECHNOLOGY USED: SILICONE 3D PRINTER DESCRIPTION: A soft stomach 3D model was created to provide surgeons with a

realistic simulator for PEG insertion training. OUTCOME / BENEFITS: This training model will be used by theatre staff to practice stomach

tube insertions prior to undertaking the procedure on patients. Upwards of 180 of these operations are carried out every year at Alder Hey hospital alone. Feedback from the surgeon was positive in that the 3D printed training model was superior to any products previously available to the surgical team particularly in texture and density of tissue. The training model can also be easily reprinted to include specific anatomical features for particular patients.


CLINICAL USE 9: SURGICAL TRAINING 3D PRINT MODEL TYPE: PERCUTANEOUS ENDOSCOPIC GASTROSTOMY

LOCATION: MAIDSTONE HOSPITAL, KENT, ENGLAND MODEL SOURCE: TRI-PLANAR CT SCAN TECHNOLOGY USED: SLS PRINTER AND FDM PRINTER USING PLASTICS AND WOODFILL DESCRIPTION: 3D models showing congenital bone deformities were supplied to

surgeon Marcos Katchburian so that the surgery could be better planned and simulated on the models prior to the operation.

OUTCOME / BENEFITS: 3D printing in woodfill (which is a mix of PLA and wood fibers) allows

a surgeon to cut the model which responds in a manner similar to the cutting of bone. Simulation enables greater pre-operative planning thereby reducing the amount of time the surgeons spend in theatre and improves their understanding and accuracy.


CLINICAL USE 10: SURGICAL SIMULATION 3D PRINT MODEL TYPE: FOOT DEFORMITY

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: MRI SCAN TECHNOLOGY USED: SILICONE 3D PRINTER DESCRIPTION: A kidney with a tumor was dual-colour printed in soft silicone with

varying densities across sections of the model for surgical training use. OUTCOME / BENEFITS: A simulated partial nephrectomy was carried out on the model,

showing potential to simulate surgeries and thereby improve surgical skills. Feedback from the surgeon was positive in that the 3D model provided an accurate representation with high fidelity for simulating the removal of the tumour.


CLINICAL USE 11: SURGICAL SIMULATION 3D PRINT MODEL TYPE: KIDNEYS FOR PARTIAL NEPHRECTOMY TRAINING

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: TRI-PLANAR CT SCAN, BLACK BONE MRI IMAGING TECHNOLOGY USED: SLS 3D PRINTER USING POLYAMIDE 3D MATERIAL, FDM 3D PRINTER

USING PLA AND WOODFILL DESCRIPTION: A number of skulls were 3D printed in a variety of materials to

determine the best material for Craniofacial drilling simulation. OUTCOME / BENEFITS: Feedback from the neurosurgeon stated that the polyamide

responded best to the cutting methods in simulating skull bone cutting. The woodfill was found to be an accurate representation of young children’s cartilaginous skulls and had a similar pliability when drilled.


CLINICAL USE 12: SURGICAL SIMULATION 3D PRINT MODEL TYPE: SKULLS FOR CRANIOTOMY

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: TRI-PLANAR CT SCAN TECHNOLOGY USED: FDM 3D PRINTER USING RIGID PLASTIC 3D MATERIAL DESCRIPTION: A number of 3D models were created for a variety of complex tri-

planar ankle fractures. These models were used by the surgeon in workshops, where the model was separated along the fracture line so that the participating clinicians could see the exact topography of the break and understand how it could be treated.

OUTCOME / BENEFITS: The results of the workshops were incredibly positive with clinicians

confirming that the models improved their understanding the issues, as well as greatly improving their ability to describe the 3D configuration of the break for teaching purposes. Surgeon Roger Walton commented: “I believe the use of a 3D model could improve pre-operative planning and produce novel operative strategies for new cases.”


CLINICAL USE 13: MEDICAL RESEARCH 3D PRINT MODEL TYPE: COMPLEX ANKLE FRACTURES

LOCATION: JOHN MOORES UNIVERSITY, LIVERPOOL, ENGLAND MODEL SOURCE: MICRO CT SCANNER TECHNOLOGY USED: MULTI-JETTING 3D PRINTER DESCRIPTION: In this study a rabbit heart was micro CT scanned post-mortem with

the aim of identifying and isolating specific regions of the heart in a 3D space for further understanding of the heart’s electrical conduction system.

OUTCOME / BENEFITS: Feedback from Professor Robert Stephenson: “Working with 3D

LifePrints we have produced high resolution 3D prints of the heart of unprecedented quality and detail. Generated from high resolution micro-CT data sets such prints have brought our virtual data to life, and serve to improve our understanding of the 3D micro-anatomy of the heart.” A further series of 3D printed models based upon human hearts is planned which will increase the scope of this project.


CLINICAL USE 14 : MEDICAL RESEARCH 3D PRINT MODEL TYPE: RABBIT HEART ATRIAL WALL

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: TRI-PLANAR CT SCAN TECHNOLOGY USED: FDM 3D PRINTER USING RIGID PLASTIC 3D MATERIAL DESCRIPTION: A series of 3D printed models were created to investigate the following

“Can 3D printing replace an arthrogram for hip imaging?” Reconstructive surgery is frequently employed to improve the congruency of the hip, to prolong or obviate the time-to-arthroplasty. Surgical decisions regarding reconstructive surgery can be challenging. An arthrogram is the most dynamic investigation, however only offers two-dimensional imaging and necessitates a general anaesthetic and time in the operating theatre.

OUTCOME / BENEFITS: 3D printing offered an opportunity to produce bespoke dynamic

models of diseased hips, which enabled the surgeon to gain a greater insight into the surgery required. It was useful in the process of obtaining patient consent, enabling surgeons to perform ‘surgery’ on the printed model preoperatively as a ‘trial-run’ or when training trainee surgeons. By testing different materials, the models enabled surgeons to test optimal osteotomy positions (cuts in the bone), and enabled them to reliably template (size) the materials required for the procedure.


CLINICAL USE 15: MEDICAL RESEARCH 3D PRINT MODEL TYPE: HIP DYSPLASIA

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: TRI-PLANAR CT SCAN TECHNOLOGY USED: FDM 3D PRINTER USING PLASTIC RIGID MATERIAL DESCRIPTION: These 3D models were created as training aids for parents of patients

and NHS staff on the positioning and forming of a stoma in the esophagus in medical emergency situations.

OUTCOME / BENEFITS: Feedback from the medical education team within the hospital was

positive: “The detail level was more than sufficient. It allowed my trainees to visualise the structure and better understand the techniques used, and why they are performed that way.” Further design iterations are planned including a flexible and pierceable esophagus that will provide greater fidelity.


CLINICAL USE 16: MEDICAL EDUCATION 3D PRINT MODEL TYPE: RESPIRATORY TRAINING

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: 3D SCAN TECHNOLOGY USED: FDM 3D PRINTER USING PLASTIC RIGID MATERIAL,

ARTEC EVA HANDHELD 3D SCANNER DESCRIPTION: The 3D models were created to provide an exact replica of the plaster

of Paris dental moulds currently employed by the hospital. Once the existing dental moulds have been scanned the data can be stored electronically which eliminates the need to keep a physical mould in archives.

OUTCOME / BENEFITS: The projected outcome would remove the need to store the plaster of

Paris moulds as the virtual mould could be scanned and stored on a cloud based platform and retrieved and 3D printed when necessary. A further project would be to eliminate the need for a plaster of Paris mould by directly scanning the patient’s teeth.


CLINICAL USE 17: MEDICAL ARCHIVING 3D PRINT MODEL TYPE: DENTAL ARCHIVING

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: TRI-PLANAR CT SCAN TECHNOLOGY USED: FDM 3D PRINTER USING RIGID PLASTIC 3D MATERIAL DESCRIPTION: This 3D model was created to aid the surgeon in discussions with the

patient’s family about their child’s spinal deformity. OUTCOME / BENEFITS: From Dr. Neil Davidson: “I think the reproduction is excellent and

will benefit the patient from both the clinical perspective, and the family’s understanding of the nature of her pathology. I used the 3D reconstruction to help the family understand exactly the nature of the deformity. At the end of the consultation the patient’s mother admitted that it was the first time she really understood the complexity of the deformity.”


CLINICAL USE 18: IMPROVING DOCTOR-PATIENT COMMUNICATIONS 3D PRINT MODEL TYPE: SCOLIOTIC SPINE

LOCATION: ALDER HEY HOSPITAL, LIVERPOOL, ENGLAND MODEL SOURCE: EOS SCANNER TECHNOLOGY USED: EOS SCANNER, FDM 3D PRINTER USING RIGID PLASTIC 3D MATERIAL DESCRIPTION: This 3D printed model was produced from a stereo radiographic image

(i.e an x-ray) of a full pelvis and scoliotic spine. The EOS scanner creates 3D images from x-ray alone, using software algorithms.

OUTCOME / BENEFITS: Due to the nature of the scan the model was not used for surgical

assessment, rather it was used to provide reference to ascertain the load bearing capabilities on different vertebrae. Surgeons found the tactile model to be helpful in planning future medical treatment for the patient.


CLINICAL USE 19: PATIENT CARE 3D PRINT MODEL TYPE: SCOLIOSIS SPINE

LOCATION: KENYA, UGANDA, RWANDA, TANZANIA, SYRIA, LEBANON, MYANMAR, CAMBODIA

MODEL SOURCE: 3D SCAN AND CAD MODEL TECHNOLOGY USED: FDM 3D PRINTER USING FLEXIBLE 3D FILAMENT DESCRIPTION: 80% of the world’s estimated 30 million amputees live in developing

nations, who have little or no access to affordable and suitable prosthetics. 3DLP have developed the “LifeArm”, a functional and low cost 3D printed transradial prosthetic designed specifically for use in challenging environmental conditions.

OUTCOME / BENEFITS: The use of 3D printing here provided an extremely low cost prosthetic

for patients in the developing world. The “LifeArm” is designed to meet the requirements of the developing world and is, low-cost, lifelike, durable, and easy to maintain.


CLINICAL USE 20: PROSTHETICS 3D PRINT MODEL TYPE: UPPER EXTREMITY PROSTHETICS

Please contact us below for any further information

Paul Fotheringham [email protected]

Henry Pinchbeck [email protected]

www.3dlifeprints.com

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