Ultrasound‐based three‐dimensional printed medical model for multispecialty team surgical rehearsal prior to fetoscopic myelomeningocele repair

Miller, Jena L.; Ahn, Edward S.; García, Juan Ruiz; Miller, G. R.; Satin, Andrew J.; Baschat, Ahmet

doi:10.1002/uog.18891

Cited by 22 publications

(25 citation statements)

References 5 publications

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“…13 Some centers have adopted the technology and have published case reports to share their experiences with heart models. [6][7][8][9] Our study complements information on the feasibility of 3D printed fetal hearts and presents a series of complex cases of CHD, including conotruncal malformations and vascular ring abnormalities, among others. In addition, the accuracy of the 3D printed model was qualitatively evaluated, and the dimensional accuracy was quantitatively evaluated.…”

Section: Discussionmentioning

confidence: 75%

“…However, as the application of 3D printing technology in the field of prenatal medicine represents a relatively new development, the current reports on 3D printing in prenatal CHD are mainly of isolated cases, and accuracy evaluations of 3D printed heart models are lacking. [6][7][8][9] Our study complements information on the feasibility of 3D printed fetal hearts and presents a series of complex cases of CHD. Compared with the previously published research, we sought to demonstrate the innovation and feasibility of 3D printing in a broader range of normal and pathologic cardiac conditions qualitatively with a 3D printed model showing the 3D anatomic structure combined with echocardiographic or autopsy results, to determine the accuracy of the model, and quantitatively by comparing the 3D model and echocardiographic measurement data, to determine the 3D printing size precision.…”

mentioning

confidence: 74%

“…This technology can provide a better understanding of the normal and abnormal anatomy of the fetal heart in the prenatal stage. However, as the application of 3D printing technology in the field of prenatal medicine represents a relatively new development, the current reports on 3D printing in prenatal CHD are mainly of isolated cases, and accuracy evaluations of 3D printed heart models are lacking 6–9 . Our study complements information on the feasibility of 3D printed fetal hearts and presents a series of complex cases of CHD.…”

mentioning

confidence: 88%

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Three‐Dimensional Printed Model Fabrication and Effectiveness Evaluation in Fetuses With Congenital Heart Disease or With a Normal Heart

Huang

Shi

Chen

et al. 2020

J of Ultrasound Medicine

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Objectives-The purpose of this study was to investigate the technical feasibility and accuracy of applying 3-dimensional (3D) printing of normal and abnormal fetal hearts based on spatiotemporal image correlation (STIC) volume-rendered data. Methods-Spatiotemporal image correlation volume images of 15 healthy fetuses and 15 fetuses with cardiac abnormalities were collected, and Mimics software (Materialise NV, Leuven, Belgium) was used to postprocess the volume data to obtain a 3D digital model of fetal heart and large blood vessel morphologic characteristics and to output the file to a 3D printer for printing the 3D model of the fetal heart and large blood vessels. The effect accuracy of the 3D printed model was qualitatively evaluated by showing the 3D anatomic structure of the model combined with echocardiographic or autopsy results, and the dimensional accuracy of the 3D printed model was quantitatively evaluated by comparing the measured data of the model and echocardiography. Results-In all 30 fetuses, STIC volume data of the fetal heart were successfully reprocessed and printed out, which could visually display the morphologic characteristics of the fetal heart chamber and passage of the great vessels under normal and abnormal pathologic conditions. No significant differences in all of the heart size parameters were found between the 3D digital model, 3D printed model, and routine echocardiographic images (all P > .05). Moreover, the size parameters were concordant well between the methods, and all of the data points fell within the limits of agreement. Conclusions-It is feasible to 3D print the fetal heart using STIC volumetric images as the data source, and the 3D printed model can fully and accurately display abnormal anatomic structures of the heart.

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Section: Discussionmentioning

confidence: 75%

mentioning

confidence: 74%

mentioning

confidence: 88%

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Three‐Dimensional Printed Model Fabrication and Effectiveness Evaluation in Fetuses With Congenital Heart Disease or With a Normal Heart

Huang

Shi

Chen

et al. 2020

J of Ultrasound Medicine

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“…A remedy toward achieving and maintaining proficiency may be adequate training models. 26 Assisted nowadays by 3D-printed models, it is possible to create case-specific models to prepare for complex procedures such as fetoscopic surgery. Another debatable subject is the position of fetoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Neurosurgeons’ opinions on the prenatal management of myelomeningocele

Gadjradj

Spoor

Eggink

et al. 2019

Neurosurgical Focus

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OBJECTIVEImprovements in imaging and surgical technological innovations have led to the increasing implementation of fetal surgical techniques. Open fetal surgery has demonstrated more favorable clinical outcomes in children born with open myelomeningocele (MMC) than those following postnatal repair. However, primarily because of maternal risks but also because of fetal risks, fetal surgery for MMC remains controversial. Here, the authors evaluated the contemporary management of MMC in the hope of identifying barriers and facilitators for neurosurgeons in providing fetal surgery for MMC.METHODSAn online survey was emailed to members of the Congress of Neurological Surgeons (CNS) and the International Society for Pediatric Neurosurgery (ISPN) in March 2019. The survey focused on 1) characteristics of the respondents, 2) the practice of counseling on and managing prenatally diagnosed MMC, and 3) barriers, facilitators, and expectations of fetal surgery for MMC. Reminders were sent to improve the response rate.RESULTSA total of 446 respondents filled out the survey, most (59.2%) of whom specialized in pediatric neurosurgery. The respondents repaired an average of 9.6 MMC defects per year, regardless of technique. Regardless of the departments in which respondents were employed, 91.0% provided postnatal repair of MMC, 13.0% open fetal repair, and 4.9% fetoscopic repair. According to the surgeons, the most important objections to performing open fetal surgery were a lack of cases available to become proficient in the technique (33.8%), the risk of maternal complications (23.6%), and concern for fetal complications (15.2%). The most important facilitators according to advocates of prenatal closure are a decreased rate of shunt dependency (37.8%), a decreased rate of hindbrain herniation (27.0%), and an improved rate of motor function (18.9%). Of the respondents, only 16.9% agreed that open fetal surgery should be the standard of care.CONCLUSIONSThe survey results showed diversity in the management of patients with MMC. In addition, significant diversity remains regarding fetal surgery for MMC closure. Despite the apparent benefits of open fetal surgery in selected pregnancies, only a minority of centers and providers offer this technique. As a more technically demanding technique that requires multidisciplinary effort with less well-established long-term outcomes, fetoscopic surgery may face similar limited implementation, although the surgery may pose fewer maternal risks than open fetal surgery. Centralization of prenatal treatment to tertiary care referral centers, as well as the use of sophisticated training models, may help to augment the most commonly cited objection to the implementation of prenatal closure, which is the overall limited caseload.

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“…verified the accuracy of models created from 3D ultrasound data of CHD patients. Currently, while 3D ultrasound‐derived 3D prints have been used to produce physical models of whole fetuses and for surgical rehearsal prior to fetoscopic repair of spina bifida, the majority of prints have been created for fetal structures with a rest period, such as the face or the back. Here, we demonstrate the feasibility of 3D printing of a small fast‐moving fetal anatomical structure without a rest period, i.e.…”

mentioning

confidence: 91%

3D printing of fetal heart using 3D ultrasound imaging data

Chen

Ong

Hibino

et al. 2018

Ultrasound in Obstet & Gyne

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Conventional two-dimensional (2D) ultrasonography is the gold standard for diagnosing congenital heart disease (CHD). However, characterization of complex CHD may be limited by 2D imaging methods that lack crucial spatial information, as these images are generated as individual 'slices' without orientation and with a limited field of view lacking depth, and therefore they are not ideal for three-dimensional (3D) modeling and printing. While approximately 90% of 3D printed models of the cardiovascular system are derived from computed tomography (CT) or magnetic resonance imaging (MRI) 1 , these modalities are used sparingly in clinical practice. Advances in 3D and four-dimensional (4D) ultrasound have expanded the capabilities for assessing the fetal heart and have paved the way for creating ultrasound-derived 3D printed models.Medical 3D printing applications of 3D ultrasound-derived imaging data have been demonstrated for cardiac models of valvular and septal CHD 2 . Olivieri et al. verified the accuracy of models created from 3D ultrasound data of CHD patients 3 . Currently, while 3D ultrasound-derived 3D prints have been used to produce physical models of whole fetuses 4 and for surgical rehearsal prior to fetoscopic repair of spina bifida 5 , the majority of prints have been created for fetal structures with a rest period, such as the face or the back. Here, we demonstrate the feasibility of 3D printing of a small fast-moving fetal anatomical structure without a rest period, i.e. the fetal heart, using only 3D ultrasound data.To create a 3D model of a fetal heart, 3D fetal ultrasound data were obtained from a Voluson E10 ultrasound machine (GE Healthcare, Chicago, IL, USA).

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Ultrasound‐based three‐dimensional printed medical model for multispecialty team surgical rehearsal prior to fetoscopic myelomeningocele repair

Cited by 22 publications

References 5 publications

Three‐Dimensional Printed Model Fabrication and Effectiveness Evaluation in Fetuses With Congenital Heart Disease or With a Normal Heart

Three‐Dimensional Printed Model Fabrication and Effectiveness Evaluation in Fetuses With Congenital Heart Disease or With a Normal Heart

Neurosurgeons’ opinions on the prenatal management of myelomeningocele

3D printing of fetal heart using 3D ultrasound imaging data

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