Treatment planning for image-guided neuro-vascular interventions using patient-specific 3D printed phantoms

Abstract

Minimally invasive endovascular image-guided interventions (EIGIs) are the preferred procedures for treatment of a wide range of vascular disorders. Despite benefits including reduced trauma and recovery time, EIGIs have their own challenges. Remote catheter actuation and challenging anatomical morphology may lead to erroneous endovascular device selections, delays or even complications such as vessel injury. EIGI planning using 3D phantoms would allow interventionists to become familiarized with the patient vessel anatomy by first performing the planned treatment on a phantom under standard operating protocols. In this study the optimal workflow to obtain such phantoms from 3D data for interventionist to practice on prior to an actual procedure was investigated. Patient-specific phantoms and phantoms presenting a wide range of challenging geometries were created. Computed Tomographic Angiography (CTA) data was uploaded into a Vitrea 3D station which allows segmentation and resulting stereo-lithographic files to be exported. The files were uploaded using processing software where preloaded vessel structures were included to create a closed-flow vasculature having structural support. The final file was printed, cleaned, connected to a flow loop and placed in an angiographic room for EIGI practice. Various Circle of Willis and cardiac arterial geometries were used. The phantoms were tested for ischemic stroke treatment, distal catheter navigation, aneurysm stenting and cardiac imaging under angiographic guidance. This method should allow for adjustments to treatment plans to be made before the patient is actually in the procedure room and enabling reduced risk of peri-operative complications or delays.

3D printed cardiovascular patient specific phantoms used for clinical validation of a CT-derived FFR diagnostic software

“…The inner lumen was combined to the solid mesh to form a hollow 3D printable vasculature. 1,6,8 The inlets and outlets of the model were finally cut to allow for interior flow immersion (Figure 4d). …”

A Patient Dose-Reduction Technique for Neuroendovascular Image-Guided Interventions: Image-Quality Comparison Study

“…Details of the additive printing process are found in earlier publications. 7, 8 A 21 mm thick aluminum block was placed in the FOV to simulate the attenuation offered by the cranium. For a 70–76kVp input x-ray spectrum, the beam quality reaching the detector with a 21 mm Al block in the FOV is similar to the average beam quality with a head.…”

“…4–6 Spatially different temporal filtering is a mathematical filter that reduces noise in the fluoroscopic image. Our research team has fabricated 3D-printed models 7, 8 that simulate patient-specific cerebrovascular anatomy and have been used to assess neuroendovascular techniques for stroke intervention, aneurysm coiling, and parametric imaging. 8–12 …”

A simulation platform using 3D printed neurovascular phantoms for clinical utility evaluation of new imaging technologies

“…The human cerebrovasculature is simulated by 3D printing models based on a patient CT angiogram. The process of generation of 3D printed models was previously described in [3,4]. The bone attenuation was simulated by placing the model inside a human skull.…”