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Bone Screws, Cadaver, Humans, Minimally Invasive Surgical Procedures methods, Sampling Studies, Sensitivity and Specificity, Spinal Fusion methods, Zygapophyseal Joint diagnostic imaging, Imaging, Three-Dimensional, Lumbar Vertebrae surgery, Surgery, Computer-Assisted methods, Tomography, X-Ray Computed methods, and Zygapophyseal Joint surgery

It is technically demanding and requires rich experience to insert the translaminar facet screw(TFS) via the paramedian mini-incision approach. It seems that it is easy to place the TFS using computer-assisted design and rapid prototyping(RP) techniques. However, the accuracy and safety of these techniques is still unknown. The aim of this study is to assess the accuracy and safety of translaminar facet screw placement in multilevel unilateral transforaminal lumbar interbody fusion using a rapid prototyping drill guide template system. A patient-matched rapid prototyping translaminar facet screw guide was examined in fourteen cadaveric lumbar spine specimens. A three-dimensional (3D) preoperative screw trajectory was constructed using spinal computed tomography scans, from which individualized guides were developed for the placement of translaminar facet screws. Following bone tunnel establishment, the 3D positioning of the entry point and trajectory of the screws was compared to the preoperative plan as found in the Mimics software.Among 60 trajectories eligible for assessment, no cases of clinically significant laminar perforation were found. The mean deviation between the planned and the actual starting points on spinous process was 1.22 mm. The mean tail and submergence angle deviation was found to be 0.68°and 1.46°, respectively. Among all the deviations, none were found to have any statistical significance. These results indicate that translaminar facet screw placement using the guide system is both accurate and safe.

Animals, Dogs, Algorithms, Imaging, Three-Dimensional, Skull diagnostic imaging, and Tomography, X-Ray Computed

This study's objective was to determine the accuracy of using current computed tomography (CT) scan and software techniques for rapid prototyping by quantifying the margin of error between CT models and laser scans of canine skull specimens. Twenty canine skulls of varying morphology were selected from an anatomy collection at a veterinary school. CT scans (bone and standard algorithms) were performed for each skull, and data segmented (testing two lower threshold settings of 226HU and -650HU) into 3-D CT models. Laser scans were then performed on each skull. The CT models were compared to the corresponding laser scan to determine the error generated from the different types of CT model parameters. This error was then compared between the different types of CT models to determine the most accurate parameters. The mean errors for the 226HU CT models, both bone and standard algorithms, were not significant from zero error (p = 0.1076 and p = 0.0580, respectively). The mean errors for both -650HU CT models were significant from zero error (p < 0.001). Significant differences were detected between CT models for 3 CT model comparisons: Bone (p < 0.0001); Standard (p < 0.0001); and -650HU (p < 0.0001). For 226HU CT models, a significant difference was not detected between CT models (p = 0.2268). Independent of the parameters tested, the 3-D models derived from CT imaging accurately represent the real skull dimensions, with CT models differing less than 0.42 mm from the real skull dimensions. The 226HU threshold was more accurate than the -650HU threshold. For the 226HU CT models, accuracy was not dependent on the CT algorithm. For the -650 CT models, bone was more accurate than standard algorithms. Knowing the inherent error of this procedure is important for use in 3-D printing for surgical planning and medical education.

Blood Loss, Surgical, Child, Humans, Male, Operative Time, Pedicle Screws, Imaging, Three-Dimensional methods, Kyphosis diagnostic imaging, Kyphosis surgery, Scoliosis diagnostic imaging, and Scoliosis surgery

Rationale: This study describes the technique of combined Orbic 3D navigation (O3DN) and 3D rapid prototyping (3DRP) to assist surgical correction of congenital scoliosis.
Patient Concerns: A 12-year-old boy with congenital scoliosis. His father brought him to our hospital upon noticing the boy's asymmetry of the trunk.
Diagnoses: Congenital scoliosis.
Interventions: O3DN and 3DRP were used to assist correction surgery in this patient.
Outcomes: The Cobb angle of segmental scoliosis (T8-L2) was 46.9° preoperatively and 2.3° at the last postoperative follow-up; correction was 95.1%. The average segmental kyphosis (T5-T12) was 45.2° preoperatively and 18.6° at the postoperative follow-up; correction was 58.9%. The preoperative sagittal imbalance of 56.2 mm was improved to 9.7 mm. The mean distance between the center sacral vertical line and the C7 plumb line was reduced from 5.7 to 4.1 mm. Operative time and bleeding volume was impressively little, with no misplacement of pedicle screws or other surgical complications.
Lessons: Combined 3DRP and O3DN helped achieve satisfactory correction for this case of congenital scoliosis. The application of 3DRP aided by O3DN in surgical treatment of congenital scoliosis can reduce operative time, lessen blood loss, reduce screw misplacement, and avoid neurovascular damage. However, patients' hospital costs were greater. Our lessons learnt are that the relative position between the tracker and the pedicle must be static to ensure the accuracy of the whole system during the entire operation.

Computer-Aided Design, Dental Models, Dimensional Measurement Accuracy, Humans, Image Processing, Computer-Assisted instrumentation, Imaging, Three-Dimensional instrumentation, Orthodontics methods, Printing, Three-Dimensional, Reproducibility of Results, Software, Stereolithography, Dental Impression Technique instrumentation, Image Processing, Computer-Assisted methods, Imaging, Three-Dimensional methods, and Tooth diagnostic imaging

Objective: To determine the accuracy (trueness and precision) of two different rapid prototyping (RP) techniques for the physical reproduction of three-dimensional (3D) digital orthodontic study casts, a comparative assessment using two 3D STL files of two different maxillary dentitions (two cases) as a reference was accomplished.
Materials and Methods: Five RP replicas per case were fabricated using both stereolithography (SLA) and the PolyJet system. The 20 reproduced casts were digitized with a highly accurate reference scanner, and surface superimpositions were performed. Precision was measured by superimposing the digitized replicas within each case with themselves. Superimposing the digitized replicas with the corresponding STL reference files assessed trueness. Statistical significance between the two tested RP procedures was evaluated with independent-sample t-tests (P < .05).
Results: The SLA and PolyJet replicas showed statistically significant differences for trueness and precision. The precision of both tested RP systems was high, with mean deviations in stereolithographic models of 23 (±6) μm and in PolyJet replicas of 46 (±13) μm. The mean deviation for trueness in stereolithographic replicas was 109 (±4) μm, while in PolyJet replicas, it was 66 (±14) μm.
Conclusions: Comparing the STL reference files, the PolyJet replicas showed higher trueness than the SLA models. But the precision measurements favored the SLA technique. The dimensional errors observed in this study were a maximum of 127 μm. In the present study, both types of reproduced digital orthodontic models are suitable for diagnostics and treatment planning.

Humans, Radiotherapy methods, Imaging, Three-Dimensional methods, Radiotherapy instrumentation, and Workflow

Computer-Aided Design, Humans, Anatomy, Dentistry methods, Image Processing, Computer-Assisted methods, Imaging, Three-Dimensional, and Models, Anatomic

Rapid prototyping is a method which makes it possible to produce a three-dimensional model based on two-dimensional imaging. Various rapid prototyping methods are available for modelling, such as stereolithography, selective laser sintering, direct laser metal sintering, two-photon polymerization, laminated object manufacturing, three-dimensional printing, three-dimensional plotting, polyjet inkjet technology,fused deposition modelling, vacuum casting and milling. The various methods currently being used in the biomedical sector differ in production, materials and properties of the three-dimensional model which is produced. Rapid prototyping is mainly usedforpreoperative planning, simulation, education, and research into and development of bioengineering possibilities.

Aged, 80 and over, Atrial Appendage surgery, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Humans, Male, Preoperative Period, Printing, Three-Dimensional, Stroke etiology, Atrial Appendage diagnostic imaging, Atrial Fibrillation surgery, Cardiac Surgical Procedures methods, Echocardiography, Transesophageal methods, Imaging, Three-Dimensional, Multidetector Computed Tomography methods, and Stroke prevention control

Aged, Catheterization, Equipment Design, Female, Humans, Intracranial Aneurysm therapy, Male, Middle Aged, Embolization, Therapeutic, Endovascular Procedures instrumentation, Endovascular Procedures methods, Imaging, Three-Dimensional, Intracranial Aneurysm surgery, and Printing, Three-Dimensional

Objective: An optimal microcatheter is necessary for successful coiling of an intracranial aneurysm. The optimal shape may be predetermined before the endovascular surgery via the use of a 3-dimensional (3D) printing rapid prototyping technology. We report a preliminary series of intracranial aneurysms treated with a microcatheter shape determined by the patient's anatomy and configuration of the aneurysm, which was fabricated with a 3D printer aneurysm model.
Methods: A solid aneurysm model was fabricated with a 3D printer based on the data acquired from the 3D rotational angiogram. A hollow aneurysm model with an identical vessel and aneurysm lumen to the actual anatomy was constructed with use of the solid model as a mold. With use of the solid model, a microcatheter shaping mandrel was formed to identically line the 3D curvature of the parent vessel and the long axis of the aneurysm. With use of the mandrel, a test microcatheter was shaped and validated for the accuracy with the hollow model. All the planning processes were undertaken at least 1 day before treatment. The preshaped mandrel was then applied in the endovascular procedure. Ten consecutive intracranial aneurysms were coiled with the pre-planned shape of the microcatheter and evaluated for the clinical and anatomical outcomes and microcatheter accuracy and stability.
Results: All of pre-planned microcatheters matched the vessel and aneurysm anatomy. Seven required no microguidewire assistance in catheterizing the aneurysm whereas 3 required guiding of a microguidewire. All of the microcatheters accurately aligned the long axis of the aneurysm. The pre-planned microcatheter shapes demonstrated stability in all except in 1 large aneurysm case.
Conclusion: When a 3D printing rapid type prototyping technology is used, a patient-specific and optimal microcatheter shape may be determined preoperatively.
(Copyright © 2015 Elsevier Inc. All rights reserved.)

Dental Prosthesis Design instrumentation, Humans, Imaging, Three-Dimensional instrumentation, Dental Implants, Dental Prosthesis Design methods, and Imaging, Three-Dimensional methods

Aim: This study proposes the replacement of all the physical devices used in the manufacturing of conventional prostheses through the use of digital tools, such as 3D scanners, CAD design software, 3D implants files, rapid prototyping machines or reverse engineering software, in order to develop laboratory work models from which to finish coatings for dental prostheses. Different types of dental prosthetic structures are used, which were adjusted by a non-rotatory threaded fixing system.
Method: From a digital process, the relative positions of dental implants, soft tissue and adjacent teeth of edentulous or partially edentulous patients has been captured, and a maser working model which accurately replicates data relating to the patients oral cavity has been through treatment of three-dimensional digital data.
Results: Compared with the conventional master cast, the results show a significant cost savings in attachments, as well as an increase in the quality of reproduction and accuracy of the master cast, with the consequent reduction in the number of patient consultation visits. The combination of software and hardware three-dimensional tools allows the optimization of the planning of dental implant-supported rehabilitations protocol, improving the predictability of clinical treatments and the production cost savings of master casts for restorations upon implants.

Anatomic Landmarks, Dental Models, Equipment Design, Humans, In Vitro Techniques, Maxilla abnormalities, Printing, Three-Dimensional, Software, Computer-Aided Design, Dental Articulators, Imaging, Three-Dimensional, Maxilla surgery, Orthognathic Surgical Procedures instrumentation, and Tomography, X-Ray Computed

Objective: We examined the precision of a computer-aided design/computer-aided manufacturing-engineered, manufactured, facebow-based surgical guide template (facebow wafer) by comparing it with a bite splint-type orthognathic computer-aided design/computer-aided manufacturing-engineered surgical guide template (bite wafer).
Study Design: We used 24 rapid prototyping (RP) models of the craniofacial skeleton with maxillary deformities. Twelve RP models each were used for the facebow wafer group and the bite wafer group (experimental group). Experimental maxillary orthognathic surgery was performed on the RP models of both groups. Errors were evaluated through comparisons with surgical simulations. We measured the minimum distances from 3 planes of reference to determine the vertical, lateral, and anteroposterior errors at specific measurement points. The measured errors were compared between experimental groups using a t test.
Results: There were significant intergroup differences in the lateral error when we compared the absolute values of the 3-D linear distance, as well as vertical, lateral, and anteroposterior errors between experimental groups. The bite wafer method exhibited little lateral error overall and little error in the anterior tooth region. The facebow wafer method exhibited very little vertical error in the posterior molar region.
Conclusions: The clinical precision of the facebow wafer method did not significantly exceed that of the bite wafer method.
(Copyright © 2015 Elsevier Inc. All rights reserved.)

Adult, Femur, Humans, Male, Metals, Models, Theoretical, Prosthesis Implantation, Software, Tomography, Spiral Computed, Tomography, X-Ray Computed, Computer-Aided Design, Imaging, Three-Dimensional, Printing, Three-Dimensional, and Prosthesis Design

Objective: To study the feasibility of preparation of the individualized femoral prosthesis through computer assisted design and electron beammelting rapid prototyping (EBM-RP) metal three-dimensional (3D) printing technology.
Methods: One adult male left femur specimen was used for scanning with 64-slice spiral CT; tomographic image data were imported into Mimics15.0 software to reconstruct femoral 3D model, then the 3D model of individualized femoral prosthesis was designed through UG8.0 software. Finally the 3D model data were imported into EBM-RP metal 3D printer to print the individualized sleeve.
Results: According to the 3D model of individualized prosthesis, customized sleeve was successfully prepared through the EBM-RP metal 3D printing technology, assembled with the standard handle component of SR modular femoral prosthesis to make the individualized femoral prosthesis.
Conclusion: Customized femoral prosthesis accurately matching with metaphyseal cavity can be designed through the thin slice CT scanning and computer assisted design technology. Titanium alloy personalized prosthesis with complex 3D shape, pore surface, and good matching with metaphyseal cavity can be manufactured by the technology of EBM-RP metal 3D printing, and the technology has convenient, rapid, and accurate advantages.

Adolescent, Child, Female, Humans, Male, Retrospective Studies, Imaging, Three-Dimensional, Orthopedic Procedures, Preoperative Care, and Scoliosis surgery

A retrospective study to evaluate the effectiveness of 3-dimensional rapid prototyping (3DRP) technology in corrective surgery for Lenke 1 adolescent idiopathic scoliosis (AIS) patients. 3DRP technology has been widely used in medical field; however, no study has been performed on the effectiveness of 3DRP technology in corrective surgery for Lenke 1 AIS patients. Lenke 1 AIS patients who were preparing to undergo posterior corrective surgery from a single center between January 2010 and January 2012 were included in this analysis. Patients were divided into 2 groups. In group A, 3-dimensional (3D) printing technology was used to create subject-specific spine models in the preoperative planning process. Group B underwent posterior corrective surgery as usual (by free hand without image guidance). Perioperative and postoperative clinical outcomes were compared between 2 groups, including operation time, perioperative blood loss, transfusion volume, postoperative hemoglobin (Hb), postoperative complications, and length of hospital stay. Radiological outcomes were also compared, including the assessment of screw placement, postoperative Cobb angle, coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis. Subgroup was also performed according to the preoperative Cobb angle: mean Cobb angle <50° and mean Cobb angle >50°. Besides, economic evaluation was also compared between 2 groups. A total of 126 patients were included in this study (group A, 50 and group B, 76). Group A had significantly shorter operation time, significantly less blood loss and transfusion volume, and higher postoperative Hb (all, P < 0.001). However, no significant differences were observed in complication rate, length of hospital stay, and postoperative radiological outcomes between 2 groups (all, P>0.05). There was also no significant difference in misplacement of screws in total populations (16.90% vs 18.82%, P = 0.305), whereas a low misplacement rate of pedicle screws was observed in patients whose mean Cobb angle was >50° (9.15% vs 13.03%, P = 0.02). Besides, using 3DRP increased the economic burden of patients (157,000 ± 9948.85 Ren Min Bi (RMB) vs 152,500 ± 11,445.52 RMB, P = 0.03). Using the 3D printing technology before posterior corrective surgery might reduce the operation time, perioperative blood loss, and transfusion volume. There did not appear to be a benefit to using this technology with respect to complication rate and postoperative radiological outcomes; however, 3D technology could reduce the misplacement rate in patients whose preoperative mean Cobb angle was >50°. Besides, it also increased the patients' hospital cost. Therefore, future prospective studies are needed to elucidate the efficacy of this emerging technology.

Computer Simulation, Cranial Sutures anatomy histology, Cranial Sutures diagnostic imaging, Humans, Image Processing, Computer-Assisted methods, Radiographic Image Interpretation, Computer-Assisted, Imaging, Three-Dimensional methods, Models, Anatomic, Skull anatomy histology, and Skull diagnostic imaging

This paper presents the effects of building mesh models of the human skull and the cranial bones from a series of CT-scans. With the aid of computer so ware, 3D reconstructions of the whole skull and segmented cranial bones were performed and visualized by surface rendering techniques. The article briefly discusses clinical and educational applications of 3D cranial models created using stereolitographic reproduction.

Humans, Head and Neck Neoplasms surgery, Imaging, Three-Dimensional, and Reconstructive Surgical Procedures

Humans, Models, Anatomic, Tomography, X-Ray Computed, Bronchi anatomy histology, Bronchoscopy methods, Computer Simulation, and Imaging, Three-Dimensional methods

Objective: The authors used rapid prototyping (RP) technology to create anatomically congruent models of tracheo-bronchial tree for teaching relevant bronchoscopic anatomy.
Design: Pilot study.
Setting: A single level tertiary academic medical center.
Interventions: Two 3 dimensional (3D) models of tracheo-bronchial tree (one showing normal anatomy and another with an early take off of right apical bronchus) were recreated from Computed Tomographic images using RP technology. These images were then attached to mannequins and examined with a flexible fiberoptic bronchoscope (FFB). These images were then compared with the actual FFB images obtained during lung isolation.
Measurements and Main Results: The images obtained through the 3D models were found to be congruent to actual patient anatomy.
Conclusions: RP can be successfully used to create anatomically accurate models from imaging studies. There is potential for RP to become a valuable educational tool in the future.
(© 2013 Elsevier Inc. All rights reserved.)

Computer Simulation, Feasibility Studies, Preoperative Care methods, Software, Technology Assessment, Biomedical, User-Computer Interface, Imaging, Three-Dimensional methods, Models, Anatomic, Models, Biological, Printing, Three-Dimensional, and Surgery, Computer-Assisted methods

AYRA is software of virtual reality for training, planning and optimizing surgical procedures. AYRA was developed under a research, development and innovation project financed by the Andalusian Ministry of Health, called VirSSPA. Nowadays AYRA has been successfully used in more than 1160 real cases and after proving its efficiency it has been introduced in the clinical practice at the Virgen del Rocío University Hospital . Furthermore, AYRA allows generating physical 3D biomodels using rapid prototyping technology. They are used for surgical planning support, intraoperative reference or defect reconstruction. In this paper, some of these tools and some real cases are presented.

Equipment Design, Equipment Failure Analysis, Pilot Projects, Algorithms, Holography instrumentation, Image Interpretation, Computer-Assisted instrumentation, Image Interpretation, Computer-Assisted methods, Imaging, Three-Dimensional instrumentation, Microwaves, and Terahertz Radiation

Computer-generated volume holograms (CGVHs) are gradient refractive index (GRIN) devices that consist of a superposition of multiple periodic diffraction gratings. Fabrication of these components for the visible range is difficult due to the small length-scale requirements but is more tenable in the terahertz (THz), as the length scales become more practical (≥ 10^-5 m). We successfully utilized polymer-based 3D additive rapid-prototyping technology to fabricate, to our knowledge, the world's first 3D THz CGVH in approximately 50 minutes, using $12 of consumables. This demonstration suggests that this technique could be extended to fabricate THz volumetric optics with arbitrary electromagnetic profiles.

Child, Equipment Design, Equipment Failure Analysis, Humans, Computer Peripherals, Computer-Aided Design, Image Interpretation, Computer-Assisted methods, Imaging, Three-Dimensional instrumentation, Models, Anatomic, and Musculoskeletal Diseases pathology

Three-dimensional printing called rapid prototyping, a technology that is used to create physical models based on a 3-D computer representation, is now commercially available and can be created from CT or MRI datasets. This technical innovation paper reviews the specific requirements and steps necessary to apply biomedical 3-D printing of pediatric musculoskeletal disorders. We discuss its role for the radiologist, orthopedist and patient.