AccScience Publishing / IJB / Volume 9 / Issue 2 / DOI: 10.18063/ijb.v9i2.669
RESEARCH ARTICLE

Manufacturing flexible vascular models for cardiovascular surgery planning and endovascular procedure simulations: An approach to segmentation and post-processing with open-source software and end-user 3D printers

Reinhard Kaufmann1 Michael Deutschmann1 Matthias Meissnitze1 Bernhard Scharinger1 Klaus Hergan1 Andreas Vötsch2 Christian Dinges2 Stefan Hecht1 *
Show Less
1 Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
2 Clinic of Cardiac, Vascular and Endovascular Surgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
Submitted: 11 August 2023 | Accepted: 22 September 2023 | Published: 13 January 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Three-dimensional (3D)-printed vascular models for cardiovascular surgery planning and endovascular procedure simulations often lack realistic biological tissues mimicking material properties, including flexibility or transparency, or both. Transparent silicone or silicone-like vascular models were not available for end-user 3D printers and had to be fabricated using complex and cost-intensive workarounds. This limitation has now been overcome by novel liquid resins with biological tissue properties. These new materials enable simple and low-cost fabrication of transparent and flexible vascular models using end-user stereolithography 3D printers and are promising technological advances toward more realistic patient-specific, radiation-free procedure simulations and planning in cardiovascular surgery and interventional radiology. This paper presents our patient-specific manufacturing process of fabricating transparent and flexible vascular models using freely available open-source software for segmentation and 3D post-processing, aiming to facilitate the integration of 3D printing into clinical care.

Keywords
3D printing
Endovascular simulation
Flexible
Biological tissue
Resin
References

1. Jones T, Seckeler M, 2017, Use of 3D models of vascular rings and slings to improve resident education. Congen Heart Dis, 12(5):578–582. https://doi.org/10.1111/chd.12486 

2. White S, Sedler J, Jones, et al., 2018, Utility of three-dimensional models in resident education on simple and complex intracardiac congenital heart defects. Congen Heart Dis, 13(6):1045–1049. https://doi.org/10.1111/chd.12673 

3. Borràs-Novell C, García Causapié M, Murcia M, et al., 2022, Development of a 3D individualized mask for neonatal non-invasive ventilation. Int J Bioprint, 8(2): 516. https://doi.org/10.18063/ijb.v8i2.516 

4. Wagner M, Werther T, Unger E, et al., 2021, Development of a 3D printed patient-specific neonatal brain simulation model using multimodality imaging for perioperative management. Pediatr Res, 91(1):64–69. https://doi.org/10.1038/s41390-021-01421-w 

5. Chepelev L, Wake N, Ryan J, et al., 2018, Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): Guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med, 4(1): 11. https://doi.org/10.1186/s41205-018-0030-y 

6. Ballard D, Wake N, Witowski J, et al., 2020, Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: Abdominal, hepatobiliary, and gastrointestinal conditions. 3D Print Med, 6(1): 13. https://doi.org/10.1186/s41205-020-00065-6
 
7. Ali A, Ballard D, Althobaity W, et al., 2020, Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: Adult cardiac conditions. 3D Print Med, 6(1): 24. https://doi.org/10.1186/s41205-020-00078-1 

8. Bastawrous S, Wu L, Liacouras P, et al., 2022, Establishing 3D printing at the point of care: Basic principles and tools for success. Radiographics, 42(2):451–468. https://doi.org/10.1148/rg.210113 

9. Alexander A, Wake N, Chepelev L, et al., 2021, A guideline for 3D printing terminology in biomedical research utilizing ISO/ASTM standards. 3D Print Med, 7(1):8. https://doi.org/10.1186/s41205-021-00098-5 

10. Rueden C, Schindelin J, Hiner M, et al., 2017, ImageJ2: ImageJ for the next generation of scientific image data. BMC Bioinf, 18(1):529. https://doi.org/10.1186/s12859-017-1934-z 

11. Community, B.O., 2018, Blender - a 3D modelling and rendering package, Stichting Blender Foundation, Amsterdam. Available at: http://www.blender.org. 

12. Schmid B, Schindelin J, Cardona A, et al., 2010, A high-level 3D visualization API for Java and ImageJ. BMC Bioinf, 11(1): 274. https://doi.org/10.1186/1471-2105-11-274 

13. Perica E, Sun Z, 2018, A systematic review of three-dimensional printing in liver disease. J Digit Imaging, 31(5):692–701. https://doi.org/10.1007/s10278-018-0067-x 

14. Yang D, Park S, Lee K, et al., 2018, Applications of three-dimensional printing in cardiovascular surgery: A case-based review. Cardiovasc Imaging Asia, 2(4):166. https://doi.org/10.22468/cvia.2018.00199 

15. Oliveira-Santos M, Oliveira Santos E, Marinho A, et al., 2018, Patient-specific 3D printing simulation to guide complex coronary intervention. Rev Port Cardiol, 37(6):541.e1–541.e4. https://doi.org/10.1016/j.repc.2018.02.007
 
16. Shibata E, Takao H, Amemiya S, et al., 2020, Embolization of visceral arterial aneurysms: Simulation with 3D-printed models. Vascular, 28(3):259–266. https://doi.org/10.1177/1708538119900834
 
17. Kaufmann R, Zech C, Takes M, et al., 2022, Vascular 3D printing with a novel biological tissue mimicking resin for patient-specific procedure simulations in interventional radiology: A feasibility study. J Digit Imaging, 35(1):9–20. https://doi.org/10.1007/s10278-021-00553-z 

18. Kaufmann R, Zech C, Deutschmann M, et al., 2022, Endovascular embolization techniques in acute thoracic and abdominal bleedings can be technically reproduced and trained in a standardized simulation setting using SLA 3D printing: A 1-year single-center study. Insights Imaging, 13(1): 72. https://doi.org/10.1186/s13244-022-01206-7

Share
Back to top
International Journal of Bioprinting, Electronic ISSN: 2424-8002 Print ISSN: 2424-7723, Published by AccScience Publishing