The impact of regulation, reimbursement, and research on the value of 3D printing and other 3D procedures in medicine.
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ABSTRACT:
SUBMITTER: Rybicki FJ
PROVIDER: S-EPMC8805272 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
Publications
The impact of regulation, reimbursement, and research on the value of 3D printing and other 3D procedures in medicine.
3D printing in medicine 20220131 1
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Project description:Congenital heart diseases causing significant hemodynamic and functional consequences require surgical repair. Understanding of the precise surgical anatomy is often challenging and can be inadequate or wrong. Modern high resolution imaging techniques and 3D printing technology allow 3D printing of the replicas of the patient's heart for precise understanding of the complex anatomy, hands-on simulation of surgical and interventional procedures, and morphology teaching of the medical professionals and patients. CT or MR images obtained with ECG-gating and breath-holding or respiration navigation are best suited for 3D printing. 3D echocardiograms are not ideal but can be used for printing limited areas of interest such as cardiac valves and ventricular septum. Although the print materials still require optimization for representation of cardiovascular tissues and valves, the surgeons find the models suitable for practicing closure of the septal defects, application of the baffles within the ventricles, reconstructing the aortic arch, and arterial switch procedure. Hands-on surgical training (HOST) on models may soon become a mandatory component of congenital heart disease surgery program. 3D printing will expand its utilization with further improvement of the use of echocardiographic data and image fusion algorithm across multiple imaging modalities and development of new printing materials. Bioprinting of implants such as stents, patches and artificial valves and tissue engineering of a part of or whole heart using the patient's own cells will open the door to a new era of personalized medicine.
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Project description:During the past 5 years, the body of literature surrounding the utilization of three-dimensional (3D) printing in the field of urology has grown exponentially. Incentivized by work hour restrictions, patient safety initiatives, and inspired by technical advances in biomaterials and rapid printing strategies, this emerging, and fascinating area of research has begun to make headway into clinical practice. However, concerns about cost, limited understanding of the technical processes involved, and lack of its potential uses remain barriers to its widespread adoption. We examined existing published literature on how 3D printing technologies have been utilized in the field of Urology to enhance pre-operative planning, revitalize surgical training, and modernize patient education, with particular focus on, robotic surgery. To date, 3D-printed models have been used and studied most commonly in the preoperative planning for nephron-sparing surgeries during the treatment of renal masses, where the challenges of complex renal anatomy and benefits of reducing renal ischemic injury create the most intuitive value. Prostate models are the second most common, particularly in the planning of nerve-sparing procedures. Early studies have demonstrated sufficient realism and educational effectiveness. Subsequent studies demonstrated improved surgeon confidence, operative performance, and optimized patient outcomes including high levels of patient satisfaction. Realistic, accurate, and reasonably priced models can currently be generated within hours using standard desktop 3D printers. While primarily utilized as anatomic replicas of diseased organs that restore a sense of haptic feedback lost in robotic procedures, innovations in polymers, improvements in 3D printer host and modeling software, and upgrades in printer hardware allow this technology to serve as a comprehensive, interactive, simulation platform that can be a critical surgical decision making as well as an effective teaching tool. As Urologists continue to rapidly diversify and iterate upon this adaptive modality, the benefits in patient outcomes will likely outpace the diminishing drawbacks, and we may well see the next revolution in surgical education, robotic techniques, and personalized medicine concurrently.
| S-EPMC7214988 | biostudies-literature
Project description:The construction of physical three-dimensional (3D) models of biomolecules can uniquely contribute to the study of the structure-function relationship. 3D structures are most often perceived using the two-dimensional and exclusively visual medium of the computer screen. Converting digital 3D molecular data into real objects enables information to be perceived through an expanded range of human senses, including direct stereoscopic vision, touch, and interaction. Such tangible models facilitate new insights, enable hypothesis testing, and serve as psychological or sensory anchors for conceptual information about the functions of biomolecules. Recent advances in consumer 3D printing technology enable, for the first time, the cost-effective fabrication of high-quality and scientifically accurate models of biomolecules in a variety of molecular representations. However, the optimization of the virtual model and its printing parameters is difficult and time consuming without detailed guidance. Here, we provide a guide on the digital design and physical fabrication of biomolecule models for research and pedagogy using open source or low-cost software and low-cost 3D printers that use fused filament fabrication technology.
| S-EPMC5408980 | biostudies-literature
Project description:ObjectiveDevelopments in 3-dimensional (3D) printing technology has made it possible to produce high quality, affordable 3D printed models for use in medicine. As a result, there is a growing assessment of this approach being published in the medical literature. The objective of this study was to outline the clinical applications of individualized 3D printing in gynecology through a scoping review.Data sourcesFour medical databases (Medline, Embase, Cochrane CENTRAL, Scopus) and grey literature were searched for publications meeting eligibility criteria up to 31 May 2021.Study eligibility criteriaPublications were included if they were published in English, had a gynecologic context, and involved production of patient specific 3D printed product(s).Study appraisal and synthesis methodsStudies were manually screened and assessed for eligibility by two independent reviewers and data were extracted using pre-established criteria using Covidence software.ResultsOverall, 32 studies (15 abstracts,17 full text articles) were included in the scoping review. Most studies were either case reports (12/32,38%) or case series (15/32,47%). Gynecologic sub-specialties in which the 3D printed models were intended for use included: gynecologic oncology (21/32,66%), benign gynecology (6/32,19%), pediatrics (2/32,6%), urogynecology (2/32,6%) and reproductive endocrinology and infertility (1/32,3%). Twenty studies (63%) printed 5 or less models, 6/32 studies (19%) printed greater than 5 (up to 50 models). Types of 3D models printed included: anatomical models (11/32,34%), medical devices, (2/32,6%) and template/guide/cylindrical applicators for brachytherapy (19/32,59%).ConclusionsOur scoping review has outlined novel clinical applications for individualized 3D printed models in gynecology. To date, they have mainly been used for production of patient specific 3D printed brachytherapy guides/applicators in patients with gynecologic cancer. However, individualized 3D printing shows great promise for utility in surgical planning, surgical education, and production of patient specific devices, across gynecologic subspecialties. Evidence supporting the clinical value of individualized 3D printing in gynecology is limited by studies with small sample size and non-standardized reporting, which should be the focus of future studies.
| S-EPMC10024374 | biostudies-literature
Project description:In this work, the use of fused deposition modeling (FDM) in a (bio)analytical/lab-on-a-chip research laboratory is described. First, the specifications of this 3D printing method that are important for the fabrication of (micro)devices were characterized for a benchtop FDM 3D printer. These include resolution, surface roughness, leakage, transparency, material deformation, and the possibilities for integration of other materials. Next, the autofluorescence, solvent compatibility, and biocompatibility of 12 representative FDM materials were tested and evaluated. Finally, we demonstrate the feasibility of FDM in a number of important applications. In particular, we consider the fabrication of fluidic channels, masters for polymer replication, and tools for the production of paper microfluidic devices. This work thus provides a guideline for (i) the use of FDM technology by addressing its possibilities and current limitations, (ii) material selection for FDM, based on solvent compatibility and biocompatibility, and (iii) application of FDM technology to (bio)analytical research by demonstrating a broad range of illustrative examples.
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Project description:Imine-based vitrimers were prepared from synthesized diimine-dimethacrylate monomer derived from biobased vanillin. First, a methacrylate derivative starting from vanillin was synthesized. The diimine derivative was synthesized by condensation of the aldehyde groups from two vanillin methacrylate units with the amine groups of hexamethylenediamine (HMDA). The synthesized product was used in formulations containing ethylene glycol phenyl ether methacrylate (EGPMA) as a reactive diluent for the customization of final material properties and cured by exposure to ultraviolet (UV)-light using suitable radical photoinitiators or else with temperature using a radical thermal initiator. Materials with glass transition temperatures (Tgs) ranging from 70 to 90 °C were prepared, showing good thermal stability and mechanical and thermomechanical properties. The evaluation of their vitrimeric characteristics revealed that all materials achieved a stress-relaxation factor (σ = 0.37σ0) in less than 130 s at 160 °C, with photocured materials exhibiting faster relaxation rates. The catalytic effect of phosphine oxide groups in imine metathesis has also been evidenced. All prepared materials could be mechanically recycled and completely solubilized in a two-step degradation process, putting evidence of their potential use for carbon fiber-reinforced composites (CFRCs). In addition, they demonstrated promising self-repairing abilities. Finally, as a proof of concept, it was established that these formulations could be effectively processed using a Digital Light Processing three-dimensional (3D) Printer (DLP), resulting in the fabrication of complex shapes with high resolution.
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Project description:Both three-dimensional (3D) printing and virtual reality (VR) are reported as being superior to the current visualization techniques in conveying more comprehensive visualization of congenital heart disease (CHD). However, little is known in terms of their clinical value in diagnostic assessment, medical education, and preoperative planning of CHD. This cross-sectional study aims to address these by involving 35 medical practitioners to subjectively evaluate VR visualization of four selected CHD cases in comparison with the corresponding 3D printed heart models (3DPHM). Six questionnaires were excluded due to incomplete sections, hence a total of 29 records were included for the analysis. The results showed both VR and 3D printed heart models were comparable in terms of the degree of realism. VR was perceived as more useful in medical education and preoperative planning compared to 3D printed heart models, although there was no significant difference in the ratings (p = 0.54 and 0.35, respectively). Twenty-one participants (72%) indicated both the VR and 3DPHM provided additional benefits compared to the conventional medical imaging visualizations. This study concludes the similar clinical value of both VR and 3DPHM in CHD, although further research is needed to involve more cardiac specialists for their views on the usefulness of these tools.
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Project description:BackgroundLaparoscopic hepatectomy (LH) has achieved rapid progress over the last decade. However, it is still challenging to apply laparoscopy to lesions located in segments I, VII, VIII, and IVa and the hepatic hilar region due to difficulty operating around complex anatomical structures. In this study, we applied three-dimensional printing (3DP) and indocyanine green (ICG) fluorescence imaging technology to complex laparoscopic hepatectomy (CLH) to explore the effects and value of the modified procedure.Materials and methodsFrom January 2019 to January 2021, 54 patients with complex hepatobiliary diseases underwent LH at our center. Clinical data were collected from these patients and retrospectively analyzed.ResultsA total of 30 patients underwent CLH using the conventional approach, whereas 24 cases received CLH with 3DP technology and ICG fluorescent navigation. Preoperative data were compared between the two groups. In the 3DP group, we modified the surgical strategy of four patients (4/24, 16.7%) due to real-time intraoperative navigation with 3DP and ICG fluorescent imaging technology. We did not modify the surgical strategy for any patient in the non-3DP group (P = 0.02). There were no significant differences between the non-3DP and 3DP groups regarding operating time (297.7±104.1 min vs. 328.8±110.9 min, P = 0.15), estimated blood loss (400±263.8 ml vs. 345.8±356.1 ml, P = 0.52), rate of conversion to laparotomy (3/30 vs. 2/24, P = 0.79), or pathological outcomes including the incidence of microscopical R0 margins (28/30 vs. 24/24, P = 0.57). Additionally, there were no significant differences in postoperative complications or recovery conditions between the two groups. No instances of 30- or 90-day mortality were observed.ConclusionThe optimal surgical strategy for CLH can be chosen with the help of 3DP technology and ICG fluorescent navigation. This modified procedure is both safe and effective, but without improvement of intraoperative and short-term outcomes.
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Project description:With growth of confectionery industry, there is a great demand for candy shape, and 3D printing technology is way to achieve it. The printing properties of gummy, which is formed of gelatin and low acyl gellan as gel, maltol, erythritol, sorbitol, and xylitol as sweeteners, were tested in this study. Gummies' rheological properties, 3D printing properties, and textural qualities were measured using a rheometer, FTIR, and SEM in this study. The strength of the hydrogen bonds will be affected by the addition of polyol, after which the excluded volume effect of polyol and viscosity will become the most important aspect. Polyols increased the gelation temperature (Tgelation), improved the gel network, and improved hydrogen bonding in the gel, according to the findings. Yield stress, shear recovery performance, and gel strength were initially increased, then decreased, when polyol concentration was increased. It had a 40.59 °C gelation temperature, an 82.99% recovery rate, noticeable shear thinning features, high self-supporting performance, and textural qualities when ink with 35 g maltitol and 30 g erythritol gave the best printing performance. This research serves as a foundation for the development of individualized, bespoke 3D printed gummies in the future.
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