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Background Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. Methods Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. Results 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. Conclusion 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost–effectiveness analysis.

Purpose To evaluate the thermal profiles of the holmium laser at different laser parameters at different locations in an in vitro anatomic pelvicalyceal collecting system (PCS) model. Laser lithotripsy is the cornerstone of treatment for urolithiasis. With the prevalence of high-powered lasers, stone ablation efficiency has become more pronounced. Patient safety remains paramount during surgery. It is well recognized that the heat generated from laser lithotripsy has the potential to cause thermal tissue damage. Methods Utilizing high-fidelity, 3D printed hydrogel models of a PCS with a synthetic BegoStone implanted in the renal pelvis, laser lithotripsy was performed with the Moses 2.0 holmium laser. At a standard power (40 W) and irrigation pressure (100 cm H 2 O), we evaluated operator duty cycle (ODC) variations with different time-on intervals at four different laser settings. Temperature was measured at two separate locations—at the stone and away from the stone. Results Temperatures were highest closest to the laser tip with a decrease away from the laser. Fluid temperatures increased with longer laser-on times and higher ODCs. Thermal doses were greater with increased ODCs and the threshold for thermal injury was reached for ODCs of 75% and 100%. Conclusion Temperature generation and thermal dose delivered are greatest closer to the tip of the laser fiber and are not dependent on power alone. Significant temperature differences were noted between four laser settings at a standardized power (40 W). Temperatures can be influenced by a variety of factors, such as laser-on time, operator duty cycle, and location in the PCS.

Background Traditional anatomy education relies on lectures, visual aids, and cadaver dissections. However, limited cadaver availability often necessitates the use of plastic models to aid 3D understanding. Virtual reality (VR) presents an immersive alternative that may enhance spatial learning without requiring cadavers. Despite its potential, few studies have directly compared VR with traditional methods in anatomy education. Objective This study aimed to compare the learning outcomes of first-year anatomy students using either VR or plastic 3D models for anatomical instruction. Methods First-year anatomy students were divided into two groups: one using VR and the other using plastic models. They participated in weekly anatomy sessions consisting of 2-hour lectures followed by 2-hour laboratory sessions covering various anatomical systems. After the lectures, students engaged in laboratory activities using either plastic models or immersive virtual reality (iVR) for 3D spatial anatomy learning, with iVR participants capturing screenshots of assigned targets for verification. Each session concluded with an online image-based multiple-choice quiz to assess anatomical identification and understanding. Results Students from the Department of Nutrition and Health Sciences (NHS) and the Department of Medical Laboratory Science and Biotechnology (MLSB) at Taipei Medical University (TMU) participated in the study. Students in the VR group initially struggled due to the time required to adapt to the system, which was reflected in their significantly lower scores in week 2 for both NHS (80.35 ± 2.04 vs. 88.82 ± 1.64, p  < 0.0019) and MLSB (72.23 ± 1.81 vs. 88.55 ± 1.67, p  < 0.0001). However, in subsequent weeks, while iVR scores were slightly lower, the differences were not statistically significant, and by the later weeks, there was no significant difference in quiz performance between the two groups, with comparable scores observed in weeks 8 and 10 for NHS. Conclusions VR provides a viable alternative to plastic models for anatomy education. Although students require an adaptation period, their performance eventually matches that of students using traditional plastic models. This study is the first to quantitatively compare VR and plastic models in anatomy instruction.

Background Terrible triad of the elbow (TTE) is a complex dislocation associating radial head (RH) and coronoid process (CP) fractures. There is at present no reproducible anatomic model for TTE, and pathophysiology is unclear. The main aim of the present study was to create and validate an anatomic model of TTE. Secondary objectives were to assess breaking forces and relative forearm rotation with respect to the humerus before dislocation. Methods An experimental comparative study was conducted on 5 fresh human specimens aged 87.4 ± 8.6 years, testing 10 upper limbs. After dissection conserving the medial and lateral ligaments, interosseous membrane and joint capsule, elbows were reproducibly positioned in maximal pronation and 15° flexion, for axial compression on a rapid (100 mm/min) or slow (10 mm/min) protocol, applied by randomization between the two elbows of a given cadaver, measuring breaking forces and relative forearm rotation with respect to the humerus before dislocation. Results The rapid protocol reproduced 4 posterolateral and 1 divergent anteroposterior TTE, and the slow protocol 5 posterolateral TTE. Mean breaking forces were 3,126 ± 1,066 N for the lateral collateral ligament (LCL), 3,026 ± 1,308 N for the RH and 2,613 ± 1,120 N for the CP. Comparing mean breaking forces for all injured structures in a given elbow on the rapid protocol found a p-value of 0.033. Comparison of difference in breaking forces in the three structures (LCL, RH and CP) between the slow and rapid protocols found a mean difference of -4%. Mean relative forearm rotation with respect to the humerus before dislocation was 1.6 ± 1.2° in external rotation. Conclusions We create and validate an anatomic model of TTE by exerting axial compression on an elbow in 15° flexion and maximal pronation at speeds of 100 and 10 mm/min.

Background The increased and accelerating utilization of 3D printing in medicine opens up questions regarding safety and efficacy in the use of medical models. The authors recognize an important shift towards point-of-care manufacturing for medical models in a hospital environment. This change, and the role of the radiologist as a central facilitator of these services, opens discussion about topics ranging from clinical uses to patient safety to regulatory implications. Results This project first defines three groups of patients for whom 3D printing positively impacts patient care. The steps needed for each group are described. Conclusions We provide our opinions regarding the regulatory role that we feel is most appropriate, balancing safety and efficacy with the autonomy of individuals in the field to make the greatest positive impact on healthcare.

Purpose Intranasal deposition of aerosols is often studied using in vitro nasal cavity models. However, the relevance of these models to predict in vivo human deposition has not been validated. This study compared in vivo nasal aerosol deposition and in vitro deposition in a human plastinated head model (NC1) and its replica constructed from CT-scan (NC2). Methods Two nebulizers (Atomisor Sonique® and Easynose®) were used to administer a 5.6 μm aerosol of 99m Tc-DTPA to seven healthy volunteers and to the nasal models. Aerosol deposition was quantified by γ -scintigraphy in the nasal, upper nasal cavity and maxillary sinus (MS) regions. The distribution of aerosol deposition was determined along three nasal cavity axes (x, y and z). Results There was no significant difference regarding aerosol deposition between the volunteers and NC1. Aerosol deposition was significantly lower in NC2 than in volunteers regarding nasal region ( p  < 0.05) but was similar for the upper nasal cavity and MS regions. Mean aerosol distribution for NC1 came within the standard deviation (SD) of in vivo distribution, whereas that of NC2 was outside the in vivo SD for x and y axes. Conclusions In conclusion, nasal models can be used to predict aerosol deposition produced by nebulizers, but their performance depends on their design.

Introduction Surgical documentation has many implications. However, its primary function is to transfer information about surgical procedures to other medical professionals. Thereby, written reports describing procedures in detail are the current standard, impeding comprehensive understanding of patient-individual life-spanning surgical course, especially if surgeries are performed at a timely distance and in diverse facilities. Therefore, we developed a novel model-based approach for documentation of visceral surgeries, denoted as 'Surgical Documentation Markup-Modeling' (SDM-M). Material and methods For scientific evaluation, we developed a web-based prototype software allowing for creating hierarchical anatomical models that can be modified by individual surgery-related markup information. Thus, a patient's cumulated 'surgical load' can be displayed on a timeline deploying interactive anatomical 3D models. To evaluate the possible impact on daily clinical routine, we performed an evaluation study with 24 surgeons and advanced medical students, elaborating on simulated complex surgical cases, once with classic written reports and once with our prototypical SDM-M software. Results Leveraging SDM-M in an experimental environment reduced the time needed for elaborating simulated complex surgical cases from 354 ± 85 s with the classic approach to 277 ± 128 s. ( p  = 0.00109) The perceived task load measured by the Raw NASA-TLX was reduced significantly ( p  = 0.00003) with decreased mental ( p  = 0.00004) and physical ( p  = 0.01403) demand. Also, time demand ( p  = 0.00041), performance ( p  = 0.00161), effort ( p  = 0.00024), and frustration ( p  = 0.00031) were improved significantly. Discussion Model-based approaches for life-spanning surgical documentation could improve the daily clinical elaboration and understanding of complex cases in visceral surgery. Besides reduced workload and time sparing, even a more structured assessment of individual surgical cases could foster improved planning of further surgeries, information transfer, and even scientific evaluation, considering the cumulative 'surgical load.' Conclusion Life-spanning model-based documentation of visceral surgical cases could significantly improve surgery and workload.

Background Evidence suggests that Mental Practice (MP) could be used to finesse surgical skills. However, MP is cognitively demanding and may be dependent on the ability of individuals to produce mental images. In this study, we hypothesised that the provision of interactive 3D visual aids during MP could facilitate surgical skill performance. Methods 20 surgical trainees were case-matched to one of three different preparation methods prior to performing a simulated Laparoscopic Cholecystectomy (LC). Two intervention groups underwent a 25-minute MP session; one with interactive 3D visual aids depicting the relevant surgical anatomy (3D-MP group, n = 5) and one without (MP-Only, n = 5). A control group (n = 10) watched a didactic video of a real LC. Scores relating to technical performance and safety were recorded by a surgical simulator. Results The Control group took longer to complete the procedure relative to the 3D&MP condition (p = .002). The number of movements was also statistically different across groups (p = .001), with the 3D&MP group making fewer movements relative to controls (p = .001). Likewise, the control group moved further in comparison to the 3D&MP condition and the MP-Only condition ( p  = .004). No reliable differences were observed for safety metrics. Conclusion These data provide evidence for the potential value of MP in improving performance. Furthermore, they suggest that 3D interactive visual aids during MP could potentially enhance performance, beyond the benefits of MP alone. These findings pave the way for future RCTs on surgical preparation and performance.

The purpose of this study is to recreate live patient arterial anomalies using new recent application of three-dimensional (3D) printed anatomical models. Another purpose of building such models is to evaluate the effectiveness of angiographic data. With the help of the DICOM files from computed tomographic angiography (CT-A), we were able to build a printed model of variant course of the internal carotid artery (ICA). Images of coiling of the ICA taken by CT-A, were then converted into 3D images using Google SketchUp free software, and the images were saved in stereolithography format. Imaging helped us conduct the examination in details with reference to geometrical features of ICA, degree of curve, its extension, location and presence of loop. Challenging vascular anatomy was exposed with models of adverse curve of carotid anatomy, including highly angulated necks, conical necks, short necks, tortuous carotid arteries, and narrowed carotid lumens. It assisted us to comprehend spatial anatomy configuration of life-like models. 3D model can be very effective in cases when anatomical difficulties are detected through the CT-A, and therefore, a tactile approach is demanded preoperatively. 3D life-like models serve as an essential office-based tool in vascular surgery as they assist surgeons in preoperative planning, develop intraoperative guidance, teach both the patients and the surgical trainees, and simulate to show patient-specific procedures in medical field.

The Human Connectome Project consortium led by Washington University, University of Minnesota, and Oxford University is undertaking a systematic effort to map macroscopic human brain circuits and their relationship to behavior in a large population of healthy adults. This overview article focuses on progress made during the first half of the 5-year project in refining the methods for data acquisition and analysis. Preliminary analyses based on a finalized set of acquisition and preprocessing protocols demonstrate the exceptionally high quality of the data from each modality. The first quarterly release of imaging and behavioral data via the ConnectomeDB database demonstrates the commitment to making HCP datasets freely accessible. Altogether, the progress to date provides grounds for optimism that the HCP datasets and associated methods and software will become increasingly valuable resources for characterizing human brain connectivity and function, their relationship to behavior, and their heritability and genetic underpinnings. •The Human Connectome Project (HCP) will study brain connectivity in healthy adults.•Data acquisition: multiple imaging modalities, plus behavioral, and genetic data.•Imaging modalities: diffusion MRI, resting-fMRI, task-fMRI, and MEG/EEG.•Extensive refinement and optimization efforts are currently underway.•Data will be made freely available and will enable flexible data mining.