Specification: Urology and General Surgery

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Aims: Alternative medical training tools are needed as adjuncts to those currently used. The primary drivers to develop new sources of training are limitations in traditional training methods, complexity of procedures, the rise of new procedures, and variance in human anatomy due to age and pathologies*. In MedTRain3DModsim Project, we aim extraction and reconstruction of 3D realistic anatomical models from CT/DICOM images with variable software packages and printing them three dimensionally for educational purposes.

Benefits:  

• Identify the international standards of 3D medical modeling and applications for solid organ models as a first time in the world (IEEE-SA 3D Based Medical Application WG Collaboration)

• Decrease the cost with using virtual based 3D printed and edited models for surgical implementation and simulation, learning anatomy in medical fields specifically on urology and general surgery, no more expensive machines and simulators

• Using technology and printed materials for better understanding 3D surgical anatomy 

• Creating 3D printed medical models for dry lab training (in laparoscopic/endoscopic/robotic surgeries)

• EBU (European Board of Urology) Curriculum for residency training will be used for creation useful 3D printed surgical and organ models in urological section

• Virtual training curriculum on medical models will be one of the target at the end of the Project

• Once digital definitions (STL files) are secured, the specimen can be reproduced in any quantity.

• A unique pathology can be imaged and then shared amongst multiple institutions. For biomodels, several studies also report the advantage of enlarging the specimen to increase visibility for hard-to-see structures.

• For simulation, a key advantage of 3D printing, versus in vivo training, is the ability to complete entire procedures in a no-risk environment.

• Without simulators, residents develop procedural skill in a step-wise fashion; obtaining competence in one step before advancing to the next step, at a later date on a different patient. 3D printed simulators do not suffer from these limitations, and therefore may accelerate resident training.

• 3D printed simulators affords trainees the ability to repetitively perform and perhaps master the basic maneuvers that are the cornerstone of the procedure.

• Do not forget that Simulators are an adjunct to in vivo training. Training solely on a simulator cannot ensure competence in the procedure and does not obviate the need for in vivo training or proctored cases

Methodology:  

Reconstruction of computer based 3D anatomical models from standardized DICOM images, firstly there will be used software packages such as MIMICS and DocDo for extracting adequate anatomical info to the model. Additional softwares will be used for volume rendering, texturing processes to create  realistic human models. These models will be shown as virtual reality view. These virtual models will be converted for producing real 3D printed educational materials, processing the printed organ/system models wil also be performed to mimics the surgical models in appropriate manner. 3D printing is the vehicle for production of anatomical replicas for two intents. One: study and visualization (static biomodels) and, two: simulation of medical procedures (physical simulators).  In our Project, we both use “static biomodels” and “physical simulators” for training purposes. For static biomodels, 3D printed training tools are compared to 2D radiographic imaging (computed tomography [CT]), 3D digital models, plastinated models and cadaveric specimens. For physical simulators, the comparisons are drawn against cadaveric dissection, virtual reality simulators and in vivo training during surgical procedures. We prefer to make comparisons with 2D CT and cadaveric models during the training activities.

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Workflow:

We will use a common workflow* (Figure 1)  for both static biomodels and physical simulators. The processes began with CT or magnetic resonance imaging (MRI) data, from patients or cadavers, that generated Digital Imaging and Communications in Medicine (DICOM) files. These were then imported into software programs where the anatomy was segmented to create the desired anatomic structures. Where needed, this data was further modified and repaired. Next, polygonal mesh (STL) files were generated for 3D printing. These data can be used for virtual reality model or printed model. Following 3D printing, the anatomical replicas were used as-is, coated, painted or dyed. For the physical simulators, we will use 3D printed replicas combined with other materials to imitate tissue, such as silicone, hydrogel etc. For urinary system replicas, all 3D printed models inluding lumen will be adaptable to endoscopic urologic devices. In this poject, we will use two types of 3D printed models; the first one, using 3D printing to create molds that are then used to cast anatomic structures in materials that better simulate human tissue, the second one is 3D printed anatomic replicas without using mold, directly one to one similar to STL file. The cast materials includes silicone, polyurethane, hydrogel, gelatin/ agar mixture and high-acyl gum. In Figure 2, 3D printing technology classes is summarized*.