This article describes a fully digital method of verifying and increasing the accuracy of the position of implants in extensive prosthetic restorations. This cost-effective, timesaving, and versatile procedure uses a laboratory scanner, a scannable implant analog, and a printed interim implant-supported prosthesis to refine the virtual definitive cast.
BACKGROUND: The objective of this study was to develop a novel method for creating highly detailed three-dimensional physical models of lung lobes, incorporating tumour morphology and surrounding structures, with the aim of improving the assessment of operability for central lung tumours. CASE PRESENTATION: A method was developed that uses standard computed tomography (CT) scans to mark the desired structures and generate a three-dimensional image for physical model creation. The generated STL files can be seamlessly integrated into virtual reality, allowing the sharing of selected CT scan data. Our approach has been successfully integrated into clinical practice, enabling multidisciplinary teams to make informed decisions for patients with central lung tumours. We have reduced the preparation time of physical models from 100 h to 18 h. CONCLUSIONS: The novel method, which employs 3D printing technology, has enhanced the assessment of operability for central lung tumours, thereby facilitating more precise decisions regarding patient management. This innovative approach has the potential to enhance patient outcomes by reducing complications and optimizing treatment planning.
- MeSH
- Printing, Three-Dimensional * MeSH
- Models, Anatomic * MeSH
- Humans MeSH
- Lung Neoplasms * diagnostic imaging surgery pathology MeSH
- Lung diagnostic imaging MeSH
- Tomography, X-Ray Computed MeSH
- Imaging, Three-Dimensional * methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
PURPOSE: The aim of this study was to compare the accuracy of two spine models: the broken curve model and a new four tangent circles model. The modification concerns the adaptation of data acquisition to kinematic methods used in, e.g., gait and running analysis. METHOD: Plastic, movable spine model of human with flexible intervertebral disks (manufactured by Erler Zimmer GE3014) was used as the study material. Markers with a diameter of 5 mm were glued to each spinous process (from C7 to L5). The recording was performed with a 6-camera Vicon system. Two spine models were created: a broken curve model used, among others, in the Diers scanner, and an own model of 4 circles, similar to the model of circles used in X-ray and CT analysis. RESULTS: The errors in the position of the spinous processes were significantly smaller in the 4-circle model than in the broken curve model. They ranged from 0.01 to 6.5 mm in the lumbar section, from 0.004 to 3.1 mm in the thoracic section. The practical possibilities of using the four-circle model during the cinematographic analysis of gait and run should be checked. CONCLUSION: The four-circle model is more accurate than the broken curve model and can be used in the cinematographic analysis of the human spine movement.
Súhrn Detská chirurgia je lekárska špecializácia, ktorá sa zameriava na diagnostiku, liečbu a pooperačnú starostlivosť o deti s vrodenými a získanými anomáliami a chorobami. Cieľom detských chirurgov je zabezpečiť, aby deti dostali najlepšiu možnú starostlivosť a aby sa minimalizovali riziká a komplikácie spojené s chirurgickými zákrokmi. Súčasní detskí chirurgovia čelia mnohým výzvam, vrátane malému počtu detí s vrodenými vývojovými chybami; ekonomické tlaky a snaha o zvýšenie efektivity vedú k znižovaniu času stráveného na jednotlivých operáciách, čo môže obmedzovať možnosť dôkladného tréningu mladých chirurgov. Tieto výzvy vyžadujú inovatívne prístupy a neustále zlepšovanie vzdelávacích a tréningových metód. Minimálne invazívna chirurgia sa stala významnou súčasťou detskej chirurgie, prinášajúc benefity ako rýchlejšie zotavenie, menšie operačné rany a nižšie riziko infekcie. Avšak, minimálne invazívna detská chirurgia je technicky náročná a vyžaduje excelentnú technickú zručnosť. Potreba udržiavať a zlepšovať chirurgické zručnosti vyžaduje neustály tréning. Súčasné vzdelávacie metódy sa čoraz viac spoliehajú na simulačné technológie, aby sa zlepšila kvalita a bezpečnosť tréningu s čo najnižším rizikom pre pacientov. Integrácia technológie 3D tlače a obrazových dát z CT a MR skenov priniesla nové možnosti na tvorbu vysoko realistických simulačných modelov pre minimálne invazívnu chirurgiu. Tieto modely presne replikujú prostredie, s ktorým sa stretávame napr. pri novorodeneckej chirurgii. V tomto článku uvádzame vlastné skúsenosti s vývojom a tvorbou 3D tlačených syntetických modelov určených na tréning torakoskopickej operácie atrézie pažeráka s tracheoezofageálnou fistulou. Cieľom tohto súhrnného článku je poskytnúť aktuálny prehľad literatúry venujúcej sa syntetickým 3D tlačeným modelom určeným pre tréning minimálne invazívnej detskej chirurgie.
Summary Pediatric surgery is a medical specialty focused on the diagnosis, treatment, and postoperative care of children with congenital and acquired anomalies and diseases. The goal of pediatric surgeons is to ensure that children receive the best possible care while minimizing the risks and complications associated with surgical procedures. Contemporary pediatric surgeons face many challenges, including a decline in the number of children with congenital developmental defects, economic pressures, and efforts to increase efficiency, leading to reduced time spent on individual surgeries. This can limit the opportunity for thorough training of young surgeons. These challenges require innovative approaches and continuous improvement in educational and training methods. Minimally invasive surgery has become a significant part of pediatric surgery, offering benefits such as faster recovery, smaller surgical wounds, and lower risk of infection. However, minimally invasive pediatric surgery is technically demanding and requires excellent technical skills. The need to maintain and improve surgical skills demands ongoing training. Current educational methods increasingly rely on simulation technologies to enhance the quality and safety of training without risk to patients. The integration of 3D printing technology and imaging data from CT and MRI scans has opened new possibilities for creating highly realistic simulation models for minimally invasive surgery. These models accurately replicate the environment encountered in procedures like neonatal surgery. In this article, we present our experience with the development and creation of 3D-printed synthetic models designed for training thoracoscopic surgery of esophageal atresia with tracheoesophageal fistula. The aim of this review article is to provide an up-to-date overview of the literature on synthetic 3D-printed models designed for training in minimally invasive pediatric surgery.
BACKGROUND: Cross-sectional anatomy is a challenging yet a vital foundation to clinical practice. The traditional teachings of gross anatomy cadaveric dissections do not cover adequate training of recognizing anatomical structures on CT, MRI and sonographic cross-sections. New modern technologies are emerging as teaching tools in anatomy aiming to deliver visual interactive experience. The Visible Human Project provides a library of cross-sectional images compiled from cryosectioned body donors that was utilized by modern technologies such as the virtual dissection table (Anatomage) in constructing 3D software applications visualizing the internal composition of the human body virtually. Hereby, this article explores an integrative approach utilizing the Visible Human Project based applications and basic radiological modalities. PURPOSE: The purpose of our newly implemented teaching approach was to test and assure technology fitness to the medical curriculum and its potential influence on students' performance in learning gross as well as cross-sectional anatomy in much depth. BASIC PROCEDURES: A three years (2021-2024) observational study was conducted by implanting a practical cross-sectional anatomy optional course by selectively utilizing Anatmage interactively beside CT, MRI and ultrasound practice. The performance of 50 participants was evaluated in the form of a written test comprised of labeling of ten cross-sectional images and drawing of two cross-section schemes. Their optional course test scores were compared to their obligatory anatomy subject test scores; and to a non-participants control group of 50 retrospective obligatory anatomy subject test scores. In addition, the participants' attitude toward the training lessons was assessed through a survey focused on satisfaction level, competence and ability to recognize structures on radiological images. MAIN FINDINGS: The participants reported a high level of practical engagement. The test scores in the anatomy obligatory subject were positively influenced by this implemented practical course. Students showed improved test scores in the standardized labeling keyword questions, while the scheme questions showed discrepancy. PRINCIPAL CONCLUSIONS: Integrating Visible Human Project based applications with radiological modalities showed positive efficacy on the students' engagement and learning performance. Inevitably, cadaveric dissection and prosection remain the cornerstone of gross anatomy education. Integrating both modalities of teaching would excel students' practical skills in applied clinical anatomy.
- MeSH
- Anatomy, Cross-Sectional * education MeSH
- Anatomy education MeSH
- Dissection education MeSH
- Adult MeSH
- Curriculum * MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Young Adult MeSH
- Cadaver MeSH
- Visible Human Projects * MeSH
- Cross-Sectional Studies MeSH
- Schools, Medical MeSH
- Students, Medical MeSH
- Education, Medical, Undergraduate methods MeSH
- Imaging, Three-Dimensional MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
Úvod: 3D tisk, koncept starý přes 40 let, nachází díky technologickému pokroku stále širší uplatnění v klinické praxi. Ve FN Ostrava je využíván k vytváření anatomických modelů konkrétních pacientů před chirurgickými výkony na základě dat ze zobrazovacích vyšetření. Kazuistiky: 3D tisk nachází uplatnění jako doplněk ke konvenčním zobrazovacím metodám s cílem zhotovit morfologicky přesné modely anatomických struktur konkrétních pacientů. Tyto modely slouží především pro předoperační přípravu v elektivní břišní, cévní a hrudní chirurgii. Využívají se rovněž při plánování osteosyntéz složitých zlomenin a korekčních osteotomií. Vícebarevný tisk, přestože zvyšuje časovou náročnost procesu, umožňuje lepší přehlednost a diferenciaci jednotlivých anatomických struktur v rámci jednoho modelu. Diskuze: 3D modely poskytují lepší prostorovou orientaci a rozpoznání operovaných struktur než 2D obrazy, což přispívá k lepším výsledkům zákroků. Jejich přínos je potvrzen studiemi napříč obory, od kardiochirurgie po traumatologii. Závěr: Po odstranění počátečních překážek se 3D tisk stal spolehlivou součástí arzenálu Chirurgické kliniky FN Ostrava pro elektivní chirurgii. I když 3D tisk nepředstavuje univerzální odpověď na všechny výzvy, kterým v medicíně čelíme, jeho role je v řadě indikovaných případů velmi přínosná a perspektivní.
Introduction: 3D printing, a concept over 40 years old, is finding broader application in clinical practice thanks to technological advancements. At University Hospital Ostrava, 3D printing is utilized to create anatomically accurate models of specific patients before surgical procedures based on imaging data. Case series: 3D printing is employed as a complement to conventional imaging methods to produce morphologically precise models of anatomical structures of individual patients. These models primarily serve for preoperative planning in elective abdominal, vascular, and thoracic surgery. They are also used in planning osteosynthesis of complex fractures and corrective osteotomies. Multicolor printing, although increasing the process‘s time demands, allows better clarity and differentiation of individual anatomical structures within a single model. Discussion: Compared to 2D images, 3D models provide better spatial orientation and awareness of the operated structures, contributing to improved surgical outcomes. The benefits of 3D printing in preoperative planning and patient education are confirmed by studies across the fields ranging from cardiac surgery to traumatology. Conclusion: After overcoming initial challenges, 3D printing has become a reliable component of the surgical arsenal at University Hospital Ostrava for elective surgery. While 3D printing does not represent a universal answer to all medical challenges, its role is highly beneficial and promising in many indicated cases.
PURPOSE: Endoscopically assisted sagittal strip craniotomy with subsequent cranial orthosis is a frequently used surgical approach for non-syndromic sagittal synostosis. Originally, this technique involved a wide sagittal strip craniectomy with bilateral wedge osteotomies. More recent studies suggest omitting wedge osteotomies, achieving similar outcomes. The controversy surrounding wedge osteotomies and our efforts to refine our technique led us to create models and evaluate the mechanical impact of wedge osteotomies. METHODS: We conducted a 3D-print study involving preoperative CT scans of non-syndromic scaphocephaly patients undergoing minimally invasive-assisted remodelation (MEAR) surgery. The sagittal strip collected during surgery underwent thickness measurement, along with a 3-point bending test. These results were used to determine printing parameters for accurately replicating the skull model. Model testing simulated gravitational forces during the postoperative course and assessed lateral expansion under various wedge osteotomy conditions. RESULTS: The median sagittal strip thickness was 2.00 mm (range 1.35-3.46 mm) and significantly positively correlated (p = 0.037) with the median force (21.05 N) of the 3-point bending test. Model testing involving 40 models demonstrated that biparietal wedge osteotomies significantly reduced the force required for lateral bone shift, with a trend up to 5-cm-long cuts (p = 0.007). Additional cuts beyond this length or adding the occipital cut did not provide further significant advantage (p = 0.1643; p = 9.6381). CONCLUSION: Biparietal wedge osteotomies reduce the force needed for lateral expansion, provide circumstances for accelerated head shape correction, and potentially reduce the duration of cranial orthosis therapy.
- MeSH
- Printing, Three-Dimensional * MeSH
- Models, Anatomic MeSH
- Endoscopy methods MeSH
- Infant MeSH
- Craniosynostoses * surgery MeSH
- Craniotomy methods MeSH
- Humans MeSH
- Osteotomy * methods MeSH
- Tomography, X-Ray Computed MeSH
- Check Tag
- Infant MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
The Achilles tendon (AT) is the strongest tendon of the human body. The knowledge of AT anatomy is a basic prerequisite for the successful treatment of acute and chronic lesions. The structure of the AT results from a complicated fusion of three parts: the tendons of the medial and lateral gastrocnemius and the soleus muscles. From proximal to distal, the tendon fibers twist in a long spiral into a roughly 90° internal rotation. The tendon is narrowest approximately 5-7 cm above its calcaneal insertion and from there it expands again. The topography of the footprints of the individual AT components reflects the tendon origins. The anterior (deep) AT fibers insert into the middle third of the posterior aspect of the calcaneal tuberosity, the posterior (superficial) fibers pass over the calcaneal tuberosity and fuse with the plantar aponeurosis. A deep calcaneal bursa is interposed between the calcaneal tuberosity and the AT anterior surface. The AT has no synovial sheath but is covered along its entire length with a sliding connective tissue, the paratenon which is, however, absent on its anterior surface. The AT is supplied by the posterior tibial artery (PTA) and the peroneal artery (PA). Motor innervation of the triceps surae muscle is provided by fibers of the tibial nerve which also gives off sensitive fibers for the AT. Sensitive innervation is also provided via the sural nerve. The sural nerve crosses the AT approximately 11 cm proximal to the calcaneal tuberosity. The forces acting on the AT during exercise may be up to 12 times the body weight. Physiological stretching of AT collagen fibers ranges between 2% and 4% of its length. Stretching of the tendon over 4% results in microscopic failure and stretching beyond 8% in macroscopic failure.
- MeSH
- Achilles Tendon * anatomy & histology MeSH
- Models, Anatomic MeSH
- Muscle, Skeletal anatomy & histology innervation MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Three-dimensional (3D) printing has gained popularity across various domains but remains less integrated into medical surgery due to its complexity. Existing literature primarily discusses specific applications, with limited detailed guidance on the entire process. The methodological details of converting Computed Tomography (CT) images into 3D models are often found in amateur 3D printing forums rather than scientific literature. To address this gap, we present a comprehensive methodology for converting CT images of bone fractures into 3D-printed models. This involves transferring files in Digital Imaging and Communications in Medicine (DICOM) format to stereolithography format, processing the 3D model, and preparing it for printing. Our methodology outlines step-by-step guidelines, time estimates, and software recommendations, prioritizing free open-source tools. We also share our practical experience and outcomes, including the successful creation of 72 models for surgical planning, patient education, and teaching. Although there are challenges associated with utilizing 3D printing in surgery, such as the requirement for specialized expertise and equipment, the advantages in surgical planning, patient education, and improved outcomes are evident. Further studies are warranted to refine and standardize these methodologies for broader adoption in medical practice.
- MeSH
- Printing, Three-Dimensional * MeSH
- Models, Anatomic MeSH
- Fractures, Bone * diagnostic imaging surgery MeSH
- Humans MeSH
- Tomography, X-Ray Computed * methods MeSH
- Radiology Information Systems organization & administration MeSH
- Traumatology MeSH
- Imaging, Three-Dimensional methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
