IO-1 3D Anatomical Models Reconstruction and Printing from Radiological Data

Specification: Urology and General Surgery

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.

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*.

Figure 1: Generating a 3D model of patient-specific image data

Figure 2: Summary of 3D Printing Technology Classes

MedTRain3DModsim Urology 3D Printed Models

(Adapted from European Urology Residency Curriculum written by European Board of Urology- EBU)

(Static biomodels/physical simulators)

European Board of Urology suggested 14 urologic procedures that need to make an assessment for evaluation resident’s skills. We selected important urologic procedures that were included to the list of EBU to create 3D printed static biomodels or physical simulators as training purposes.

 

1st Set: Standard 3D Anatomic Urinary System Model

 

Procedures for 1st Set

  • Standard Cystoscopy (flexible/rigid) (available as VR/AR formation)

  • Standard Retrograde pyelography/Double J Stenting

  • Standard Ureteroscopy

  • Standard Retrograde Intrarenal Surgery (inspection of pelvicaliciel system/relocation of stone with basket/disintegration of stone with laser) (available as VR/AR formation)

 

2nd Set: Standard 3D Bladder and Prostate Model

 

Procedures for 2nd Set

 

  • Standard Percutaneous Suprapubic Cystostomy

  • Standard Cystoscopy (flexible/rigid)

  • Standard Transurethral Resection of Bladder Tumor (TUR-B)

  • Standard Transurethral Resection of Prostate (TUR-P)

  • Standard Bladder Neck Incision

 

3rd Set: Standard 3D Kidney and Vascular Model

 

Procedures for 3rd Set

 

  • Standard Percutaneous Nephrostomy

  • Standard Laparoscopic Nephrectomy (partial/total) (available as VR/AR formation)

  • Standard Percutanous Nephrolithotomy (C-Arm Depended)

 

4th Set: Standard 3D Pelvic Model (male/female)

 

Procedures for 4th Set

 

  • Standard Anti-incontinence Surgery (Transobturator Route, Retropubic Route)

  • Pelvic-Perineal Deatiled Anatomy

 

5th Set: Standard 3D Prostate Biomodel

Procedures for 5th Set

 

  • Only for 3D prostate anatomy training

  • Diagnosis for prostate cancer/nodul

 

 

6th Set: Standard 3D Sacral Neuromodulation (SNS) Model 

 

Procedures for 6th Set

  • Sacrum

  • Sacral plexus

  • Posterior surface muscle

  • SNS Tools

MedTRain3DModsim Urology Standard Education Plan

 

Rules:

  • Each set will have minimum 10 maximum 15 participants (medical students/residents/young urologists)

 

  • Appropriate basic and surgical anatomy training based on surgical model will be included to each set (for medical students/residents/young urologists).

 

  • Each surgical model will be evaluated by its own techniqual properties due to the surgical procedure with phsycometric analysis and pre-post SET knowledge evaluation (only for residents and young urologists)

 

  • 3D printed models will be evaluated based on  (a 5-point Likert scale); cost, time to create models, impact and effectiveness of 3D printing as an educational tool, realistic anatomic structures, haptic feedback, efficacy

 

  • Comparison with 2D- CT and cadaveric specimens will be done after all completed training sets (optional).

MedTRain3DModsim General Surgery Models

The general surgery models will be focused on oncosurgery. The models will cover a spectrum of common tumors found in the abdominal cavity (including primary tumors as well as metastases) in varying surgical complexity.

The main goal of the educational program will be to show the principles of surgical approaches and solutions in complicated clinical scenarios, where the tumors are colliding with major anatomical structures.

The models will be used for visualization and demonstration, physical training and practice will be performed in large animals (piglets).

 

1st Set: Simple tumors of abdominal organs:

  • Liver hemangioma

  • Liver adenoma

  • Liver FNH – focal nodular hyperplasia

  • Hepatocellular carcinoma – single lesion in peripheral location

  • Colorectal Liver Metastasis – easily accessible

  • Gall bladder carcinoma – localized disease

  • Spleen cyst

  • Spleen metastases

  • Splenomegaly with portal hypertension

 

2nd Set: Tumors in complex anatomical situations:

  • Colorectal Liver Metastases in close vicinity of major blood vessels

  • Colorectal Liver Metastases requiring large resection

  • Multilocular hepatocellular carcinoma

  • Centrally localized hepatocellular carcinoma – relation to pedicles

  • Cholangiocellular carcinoma – extended liver resection

  • Gall bladder carcinoma – progressive disease with infiltration of hepatoduodenal ligament

  • Gall bladder carcinoma spreading into liver parenchyma

  • Klatskin tumor – stage I–IV Bismuth

  • Pancreatic cancer – T1

  • Pancreatic cancer – T2

  • Pancreatic cancer – T3, with infiltration of vascular structures

  • Pancreatic cancer – T4, with infiltration of vascular structures

  • Pancreatic cancer with liver metastases

  • Pancreatic cancer with dilatation of biliary tract

 

 

MedTRain3DModsim General Surgery Education Plan

Rules:

  • Each course will include between 10 and 15 participants (medical students/residents/young specialist)

 

  • Two different course programs will be made, (1. Elementary program for medical students; 2. Advanced program for Ph.D. students and residents).

 

  • Virtual and 3D printed models will be used for explanation and demonstration during lectures and dry-practice. Practical training on large animals will follow.

 

  • At the end of the course, each student will be given a clinical scenario presented with a model as well as imaging data and will be tested for his/her ability to devise a surgical solution of the situation.