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3D Rapid Prototyping for Otolaryngology-Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling.

Chan HH, Siewerdsen JH, Vescan A, Daly MJ, Prisman E, Irish JC - PLoS ONE (2015)

Bottom Line: In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases.No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room.The applicability of common model design and fabrication techniques across a variety of otolaryngological sub-specialties suggests an emerging role for rapid prototyping technology in surgical education, procedure simulation, and clinical practice.

View Article: PubMed Central - PubMed

Affiliation: TECHNA Institute, University Health Network, Toronto, Ontario, Canada.

ABSTRACT
The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i) a mono-material paranasal sinus phantom for endoscopy training ii) a multi-material skull base simulator and iii) 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and fabrication techniques across a variety of otolaryngological sub-specialties suggests an emerging role for rapid prototyping technology in surgical education, procedure simulation, and clinical practice.

No MeSH data available.


Related in: MedlinePlus

Illustration of a high-fidelity sinus and skull base phantom for surgical simulation.(a) Bone module with realistic sinus structures. (b) Soft-tissue module printed with flexible material that imitates cartilaginous structures. (c) Assembly of bone and soft-tissue with designed joints. (d) CT images of the phantom show appropriate X-ray attenuation number.
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pone.0136370.g003: Illustration of a high-fidelity sinus and skull base phantom for surgical simulation.(a) Bone module with realistic sinus structures. (b) Soft-tissue module printed with flexible material that imitates cartilaginous structures. (c) Assembly of bone and soft-tissue with designed joints. (d) CT images of the phantom show appropriate X-ray attenuation number.

Mentions: The septum and turbinates were categorized as elastic cartilaginous tissue which required a stiff yet flexible material to represent connective tissue. The material selection for soft tissue used a similar approach as described above. After iterating a number of materials and post-processing techniques, ZP-15 plaster powder combined with a post-processing infiltrant elastomeric applied for 30 minutes achieved realistic flexibility. During the post-processing procedure, a ~5–10% expansion was observed in some of the soft tissue components. The final assembly of these components was modified with the aid of surgical tools to reduce the width and length in order to compensate for the expansion. The 3D printer employed for prototyping was a ZPrinter 310 (ZCorp, Burlington MA). The layer thickness is 0.127mm with resolution 300 x 450 dpi. The resulting surgical phantom is shown in Fig 3. Assembly of the modules is incorporated in an anthropomorphic head/torso phantom (Rando, The Phantom Laboratory, Greenwich NY). The cost of rapid prototyping including the bone and soft tissue module is $900 USD.


3D Rapid Prototyping for Otolaryngology-Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling.

Chan HH, Siewerdsen JH, Vescan A, Daly MJ, Prisman E, Irish JC - PLoS ONE (2015)

Illustration of a high-fidelity sinus and skull base phantom for surgical simulation.(a) Bone module with realistic sinus structures. (b) Soft-tissue module printed with flexible material that imitates cartilaginous structures. (c) Assembly of bone and soft-tissue with designed joints. (d) CT images of the phantom show appropriate X-ray attenuation number.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4557980&req=5

pone.0136370.g003: Illustration of a high-fidelity sinus and skull base phantom for surgical simulation.(a) Bone module with realistic sinus structures. (b) Soft-tissue module printed with flexible material that imitates cartilaginous structures. (c) Assembly of bone and soft-tissue with designed joints. (d) CT images of the phantom show appropriate X-ray attenuation number.
Mentions: The septum and turbinates were categorized as elastic cartilaginous tissue which required a stiff yet flexible material to represent connective tissue. The material selection for soft tissue used a similar approach as described above. After iterating a number of materials and post-processing techniques, ZP-15 plaster powder combined with a post-processing infiltrant elastomeric applied for 30 minutes achieved realistic flexibility. During the post-processing procedure, a ~5–10% expansion was observed in some of the soft tissue components. The final assembly of these components was modified with the aid of surgical tools to reduce the width and length in order to compensate for the expansion. The 3D printer employed for prototyping was a ZPrinter 310 (ZCorp, Burlington MA). The layer thickness is 0.127mm with resolution 300 x 450 dpi. The resulting surgical phantom is shown in Fig 3. Assembly of the modules is incorporated in an anthropomorphic head/torso phantom (Rando, The Phantom Laboratory, Greenwich NY). The cost of rapid prototyping including the bone and soft tissue module is $900 USD.

Bottom Line: In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases.No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room.The applicability of common model design and fabrication techniques across a variety of otolaryngological sub-specialties suggests an emerging role for rapid prototyping technology in surgical education, procedure simulation, and clinical practice.

View Article: PubMed Central - PubMed

Affiliation: TECHNA Institute, University Health Network, Toronto, Ontario, Canada.

ABSTRACT
The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i) a mono-material paranasal sinus phantom for endoscopy training ii) a multi-material skull base simulator and iii) 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and fabrication techniques across a variety of otolaryngological sub-specialties suggests an emerging role for rapid prototyping technology in surgical education, procedure simulation, and clinical practice.

No MeSH data available.


Related in: MedlinePlus