Three-Dimensional Printed Models in Anatomy Education of the Ventricular System: A Randomized Controlled Study

Development, implementation, and perceptions of a 3D-printed human skull in a large dental gross anatomy course

Skull anatomy is a difficult region for anatomy students to learn and understand but is necessary for a variety of health professional students. To improve learning, a 3D-printed human skull was developed, produced, and distributed to a course of 83 dental students for use as a take-home study tool over the 10-week anatomy course. The 70% scale human skull derived from CT data had a fully articulating mandible, simulated temporomandibular joint, and accurate cranial structures. At the course end, students completed a perception survey and responses were compared with those who made a grade of A, B, or C in the course. Students overall reported using the model less than 3 h per week, but those who scored an A in the course reported using the model more frequently than those who scored a B or C. Free responses revealed that students used the model in a variety of ways, but found that the model was quick and easily accessible to check understanding while studying at home in the absence of direct observation by faculty. Overall, this study provides evidence on the feasibility of large-scale 3D printing and the benefits of the use of a 3D-printed model as a take-home study aid.

From 2D slices to a 3D model: Training students in digital microanatomy analysis techniques through a 3D printed neuron project

The reconstruction of two-dimensional (2D) slices to three-dimensional (3D) digital anatomical models requires technical skills and software that are becoming increasingly important to the modern anatomist, but these skills are rarely taught in undergraduate science classrooms. Furthermore, learning opportunities that allow students to simultaneously explore anatomy in both 2D and 3D space are increasingly valuable. This report describes a novel learning activity that trains students to digitally trace a serially imaged neuron from a confocal stack and to model that neuron in 3D space for 3D printing. By engaging students in the production of a 3D digital model, this learning activity is designed to provide students a novel way to enhance their understanding of the content, including didactic knowledge of neuron morphology, technical research skills in image analysis, and career exploration of neuroanatomy research. Moreover, students engage with microanatomy in a way that starts in 2D but results in a 3D object they can see, touch, and keep. This discursive article presents the learning activity, including videos, instructional guides, and learning objectives designed to engage students on all six levels of Bloom's Taxonomy. Furthermore, this work is a proof of principle modeling workflow that is approachable, inexpensive, achievable, and adaptable to cell types in other organ systems. This work is designed to motivate the expansion of 3D printing technology into microanatomy and neuroanatomy education.

Cardiovascular Computed Tomography in the Diagnosis of Cardiovascular Disease: Beyond Lumen Assessment

Cardiovascular CT is being widely used in the diagnosis of cardiovascular disease due to the rapid technological advancements in CT scanning techniques. These advancements include the development of multi-slice CT, from early generation to the latest models, which has the capability of acquiring images with high spatial and temporal resolution. The recent emergence of photon-counting CT has further enhanced CT performance in clinical applications, providing improved spatial and contrast resolution. CT-derived fractional flow reserve is superior to standard CT-based anatomical assessment for the detection of lesion-specific myocardial ischemia. CT-derived 3D-printed patient-specific models are also superior to standard CT, offering advantages in terms of educational value, surgical planning, and the simulation of cardiovascular disease treatment, as well as enhancing doctor-patient communication. Three-dimensional visualization tools including virtual reality, augmented reality, and mixed reality are further advancing the clinical value of cardiovascular CT in cardiovascular disease. With the widespread use of artificial intelligence, machine learning, and deep learning in cardiovascular disease, the diagnostic performance of cardiovascular CT has significantly improved, with promising results being presented in terms of both disease diagnosis and prediction. This review article provides an overview of the applications of cardiovascular CT, covering its performance from the perspective of its diagnostic value based on traditional lumen assessment to the identification of vulnerable lesions for the prediction of disease outcomes with the use of these advanced technologies. The limitations and future prospects of these technologies are also discussed.

3D printing as a pedagogical tool for teaching normal human anatomy: a systematic review

BACKGROUND

Three-dimensional-printed anatomical models (3DPAMs) appear to be a relevant tool due to their educational value and their feasibility. The objectives of this review were to describe and analyse the methods utilised for creating 3DPAMs used in teaching human anatomy and for evaluating its pedagogical contribution.

METHODS

An electronic search was conducted on PubMed using the following terms: education, school, learning, teaching, learn, teach, educational, three-dimensional, 3D, 3-dimensional, printing, printed, print, anatomy, anatomical, anatomically, and anatomic. Data retrieved included study characteristics, model design, morphological evaluation, educational performance, advantages, and disadvantages.

RESULTS

Of the 68 articles selected, the cephalic region was the most studied (33 articles); 51 articles mentioned bone printing. In 47 articles, the 3DPAM was designed from CT scans. Five printing processes were listed. Plastic and its derivatives were used in 48 studies. The cost per design ranged from 1.25 USD to 2800 USD. Thirty-seven studies compared 3DPAM to a reference model. Thirty-three articles investigated educational performance. The main advantages were visual and haptic qualities, effectiveness for teaching, reproducibility, customizability and manipulability, time savings, integration of functional anatomy, better mental rotation ability, knowledge retention, and educator/student satisfaction. The main disadvantages were related to the design: consistency, lack of detail or transparency, overly bright colours, long printing time, and high cost.

CONCLUSION

This systematic review demonstrates that 3DPAMs are feasible at a low cost and effective for teaching anatomy. More realistic models require access to more expensive 3D printing technologies and substantially longer design time, which would greatly increase the overall cost. Choosing an appropriate image acquisition modality is key. From a pedagogical viewpoint, 3DPAMs are effective tools for teaching anatomy, positively impacting the learning outcomes and satisfaction level. The pedagogical effectiveness of 3DPAMs seems to be best when they reproduce complex anatomical areas, and they are used by students early in their medical studies.

Application of additional three-dimensional materials for education in pediatric anatomy

We conducted this study to investigate the effects of additional education using 3D visualization (3DV) and 3D printing (3DP) after applying 2D images for anatomical education in normal pediatric structures and congenital anomalies. For the production of 3DV and 3DP of the anatomical structures, computed tomography (CT) images of the four topics (the normal upper/lower abdomen, choledochal cyst, and imperforate anus) were used. Anatomical self-education and tests were administered to a total of 15 third-year medical students with these modules. Following the tests, surveys were conducted in order to evaluate satisfaction from students. In all four topics, there were significant increases in the test results with additional education with 3DV after initial self-study with CT (P < 0.05). The difference in scores was highest for the imperforate anus when 3DV supplemented the self-education. In the survey on the teaching modules, the overall satisfaction scores for 3DV and 3DP were 4.3 and 4.0 out of 5, respectively. When 3DV was added to pediatric abdominal anatomical education, we found an enhancement in understanding of normal structures and congenital anomalies. We can expect the application of 3D materials to become more widely used in anatomical education in various fields.

Twelve tips for teaching neuroanatomy, from the medical students' perspective

Neuroanatomy is a complex and fascinating subject that is often a daunting prospect for medical students. In fact, the fear of learning neuroanatomy has gained its own name - "neurophobia." This widespread phenomenon among medical students poses a challenge to medical teachers and educators. To tackle "neurophobia" by summarising tips for dynamic and engaging neuroanatomy teaching formulated based on our experiences as medical students and evidence-based techniques.Focusing on the anatomical, physiological, and clinical aspects of neurology and their integration, here we present 12 tips which are [1] Teach the basic structure before fine details, [2] Supplement teaching with annotated diagrams, [3] Use dissections for haptic learning, [4] Teach form and function together, [5] Group anatomy into systems, [6] Familiarise students with neuroimaging, [7] Teach from clinical cases, [8] Let the patient become the teacher, [9] Build from first principles, [10] Try working in reverse, [11] Let the student become the teacher, [12] Let the student become the examiner. These 12 tips can be used by teachers and students alike to provide a high-yield learning experience.

Efficacy of three-dimensional models for medical education: A systematic scoping review of randomized clinical trials

To estimate the efficacy of three-dimensional (3D) models for medical education.

METHODS

A systematic scoping review was performed containing diverse databases such as SCOPUS, PubMed/MEDLINE, SCIELO, and LILACS. MeSH terms and keywords were stipulated to explore randomized clinical trials (RCTs) in all languages. Solely RCTs that accomplished the eligibility criteria were admitted.

RESULTS

Fifteen RCTs including 1659 medical students were chosen. Five RCTs studied heart models, 3 RCTs explored facial, spinal and bone fractures and the rest of the trials investigated eye, arterial, pelvic, hepatic, chest, skull, and cleft lip and palate models. Regarding the efficacy of 3D models, in terms of learning skills and knowledge gained by medical students, most RCTs reported higher scores. Considering the test-taking times, the results were variable. Two RCTs showed less time for the 3D group, another RCT indicated variable results in the response times of the test depending on the anatomical zone evaluated, while another described that the students in the 3D group were slightly quicker to answer all questions when compared with the traditional group, but without statistical significance. The other 11 experiments did not present results about test-taking times. Most students in all RCTs indicated satisfaction, enjoyment, and interest in utilizing the 3D systems, and recognized that their abilities were enhanced.

CONCLUSIONS

Higher efficacy in terms of learning skills and knowledge gained was observed when the 3D systems were used by medical students. Undergraduates also expressed great satisfaction with the use of these technologies. Regarding the test-taking times, the results favored the 3D group.

Meta-analyzing the efficacy of 3D printed models in anatomy education

Three-dimensional printing models (3DPs) have been widely used in medical anatomy training. However, the 3DPs evaluation results differ depending on such factors as the training objects, experimental design, organ parts, and test content. Thus, this systematic evaluation was carried out to better understand the role of 3DPs in different populations and different experimental designs. Controlled (CON) studies of 3DPs were retrieved from PubMed and Web of Science databases, where the participants were medical students or residents. The teaching content is the anatomical knowledge of human organs. One evaluation indicator is the mastery of anatomical knowledge after training, and the other is the satisfaction of participants with 3DPs. On the whole, the performance of the 3DPs group was higher than that of the CON group; however, there was no statistical difference in the resident subgroup, and there was no statistical difference for 3DPs vs. 3D visual imaging (3DI). In terms of satisfaction rate, the summary data showed that the difference between the 3DPs group (83.6%) vs. the CON group (69.6%) (binary variable) was not statistically significant, with p > 0.05. 3DPs has a positive effect on anatomy teaching, although there are no statistical differences in the performance tests of individual subgroups; participants generally had good evaluations and satisfaction with 3DPs. 3DPs still faces challenges in production cost, raw material source, authenticity, durability, etc. The future of 3D-printing-model-assisted anatomy teaching is worthy of expectation.

Application of 3D printing technology combined with PBL teaching method in clinical teaching of cerebrovascular disease: An observational study

Traditional clinical teaching does not allow medical students to combine theoretical knowledge with practical knowledge. As such, we aimed to determine the effectiveness of three dimensional (3D) printing technology combined with problem-based learning (PBL) in the clinical teaching of cerebrovascular diseases. Medical interns were randomly divided into an experimental group (n = 136) that was taught using 3D printing technology + PBL method and a control group (n = 133) that was taught using traditional methods. We compared assessment results of theoretical and clinical practice skills and the subjective evaluation of teaching methods between the 2 groups. The assessment results of the experimental group were significantly higher than those in the control group (P < .05). The survey assessing the evaluation of teaching methods showed higher satisfaction with teaching methods, increased learning interest, and improvement in the spatial thinking ability of interns in the experimental group compared to the control group (P < .05). There was no significant difference when assessing which teaching method better improved the interns' understanding of cerebrovascular diseases (P < .05). The application of 3D printing technology combined with the PBL teaching method in neurosurgery clinical teaching can stimulate interest in learning and significantly improve academic performance and problem-analysis and solving skills.

Investigating the effectiveness of three-dimensionally printed anatomical models compared with plastinated human specimens in learning cardiac and neck anatomy: A randomized crossover study

Three-dimensional printing (3DP) technology has been increasingly applied in health profession education. Yet, 3DP anatomical models compared with the plastinated specimens as learning scaffolds are unclear. A randomized-controlled crossover study was used to evaluate the objective outcomes of 3DP models compared with the plastinated specimens through an introductory lecture and team study for learning relatively simple (cardiac) and complex (neck) anatomies. Given the novel multimaterial and multicolored 3DP models are replicas of the plastinated specimens, it is hypothesized that 3DP models have the same educational benefits to plastinated specimens. This study was conducted in two phases in which participants were randomly assigned to 3DP (n = 31) and plastinated cardiac groups (n = 32) in the first phase, whereas same groups (3DP, n = 15; plastinated, n = 18) used switched materials in the second phase for learning neck anatomy. The pretest, educational activities and posttest were conducted for each phase. Miller's framework was used to assess the cognitive outcomes. There was a significant improvement in students' baseline knowledge by 29.7% and 31.3% for Phase 1; 31.7% and 31.3% for Phase 2 plastinated and 3DP models. Posttest scores for cardiac (plastinated, 3DP mean ± SD: 57.0 ± 13.3 and 60.8 ± 13.6, P = 0.27) and neck (70.3 ± 15.6 and 68.3 ± 9.9, P = 0.68) phases showed no significant difference. In addition, no difference observed when cognitive domains compared for both cases. These results reflect that introductory lecture plus either the plastinated or 3DP modes were effective for learning cardiac and neck anatomy.

Effectiveness of 3D-printed models prepared from radiological data for anatomy education: A meta-analysis and trial sequential analysis of 22 randomized, controlled, crossover trials

BACKGROUND

Many academicians suggested the supplementary use of 3D-printed models reconstructed from radiological images for optimal anatomy education. 3D-printed model is newer technology available to us. The purpose of this systematic review was to capture the usefulness or effectiveness of this newer technology in anatomy education.

MATERIALS AND METHODS

Twenty-two studies met the inclusion and exclusion criteria for quantitative synthesis. The included studies were sub-grouped according to the interventions and participants. No restrictions were applied based on geographical location, language and publication years. Randomized, controlled trial, cross-sectional and cross-over designs were included. The effect size of each intervention in both participants was computed as a standardized mean difference (SMD).

RESULTS

Twenty-two randomized, controlled trials were included for quantitative estimation of effect size of knowledge acquisition as standardized mean difference in 1435 participants. The pooled effect size for 3D-printed model was 0.77 (0.45-1.09, 95% CI, P < 0.0001) with 86% heterogeneity. The accuracy score was measured in only three studies and estimated effect size was 2.81 (1.08-4.54, 95% CI, P = 0.001) with 92% heterogeneity. The satisfaction score was examined by questionnaire in 6 studies. The estimated effect size was 2.00 (0.69-3.32, 95% CI, P = 0.003) with significant heterogeneity.

CONCLUSION

The participants exposed to the 3D-printed model performed better than participants who used traditional methodologies. Thus, the 3D-printed model is a potential tool for anatomy education.

Outcomes, Measurement Instruments, and Their Validity Evidence in Randomized Controlled Trials on Virtual, Augmented, and Mixed Reality in Undergraduate Medical Education: Systematic Mapping Review

BACKGROUND

Extended reality, which encompasses virtual reality (VR), augmented reality (AR), and mixed reality (MR), is increasingly used in medical education. Studies assessing the effectiveness of these new educational modalities should measure relevant outcomes using outcome measurement tools with validity evidence.

OBJECTIVE

Our aim is to determine the choice of outcomes, measurement instruments, and the use of measurement instruments with validity evidence in randomized controlled trials (RCTs) on the effectiveness of VR, AR, and MR in medical student education.

METHODS

We conducted a systematic mapping review. We searched 7 major bibliographic databases from January 1990 to April 2020, and 2 reviewers screened the citations and extracted data independently from the included studies. We report our findings in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

Of the 126 retrieved RCTs, 115 (91.3%) were on VR and 11 (8.7%) were on AR. No RCT on MR in medical student education was found. Of the 115 studies on VR, 64 (55.6%) were on VR simulators, 30 (26.1%) on screen-based VR, 9 (7.8%) on VR patient simulations, and 12 (10.4%) on VR serious games. Most studies reported only a single outcome and immediate postintervention assessment data. Skills outcome was the most common outcome reported in studies on VR simulators (97%), VR patient simulations (100%), and AR (73%). Knowledge was the most common outcome reported in studies on screen-based VR (80%) and VR serious games (58%). Less common outcomes included participants' attitudes, satisfaction, cognitive or mental load, learning efficacy, engagement or self-efficacy beliefs, emotional state, competency developed, and patient outcomes. At least one form of validity evidence was found in approximately half of the studies on VR simulators (55%), VR patient simulations (56%), VR serious games (58%), and AR (55%) and in a quarter of the studies on screen-based VR (27%). Most studies used assessment methods that were implemented in a nondigital format, such as paper-based written exercises or in-person assessments where examiners observed performance (72%).

CONCLUSIONS

RCTs on VR and AR in medical education report a restricted range of outcomes, mostly skills and knowledge. The studies largely report immediate postintervention outcome data and use assessment methods that are in a nondigital format. Future RCTs should include a broader set of outcomes, report on the validity evidence of the measurement instruments used, and explore the use of assessments that are implemented digitally.

Technological resources for teaching and learning about human anatomy in the medical course: Systematic review of literature

The consolidation of technology as an alternative strategy to cadaveric dissection for teaching anatomy in medical courses was accelerated by the recent Covid-19 pandemic, which caused the need for social distance policies and the closure of laboratories and classrooms. Consequently, new technologies were created, and those already been developed started to be better explored. However, information about many of these instruments and resources is not available to anatomy teachers. This systematic review presents the technological means for teaching and learning about human anatomy developed and applied in medical courses in the last ten years, besides the infrastructure necessary to use them. Studies in English, Portuguese, and Spanish were searched in MEDLINE, Scopus, ERIC, LILACS, and SciELO databases, initially resulting in a total of 875 identified articles, from which 102 were included in the analysis. They were classified according to the type of technology used: three-dimensional (3D) printing (n = 22), extended reality (n = 49), digital tools (n = 23), and other technological resources (n = 8). It was made a detailed description of technologies, including the stage of the medical curriculum in which it was applied, the infrastructure utilized, and which contents were covered. The analysis shows that between all technologies, those related to the internet and 3D printing are the most applicable, both in student learning and the financial cost necessary for its structural implementation.

Three-Dimensional Printing Model Enhances Craniofacial Trauma Teaching by Improving Morphologic and Biomechanical Understanding: A Randomized Controlled Study

BACKGROUND

Teaching about craniofacial traumas is challenging given the complexity of the craniofacial anatomy and the necessity for good spatial representation skills. To solve these problems, three-dimensional printing seems to be an appropriate educative material. In this study, the authors conducted a randomized controlled trial. The authors' main objective was to compare the performance of the undergraduate medical students in an examination based on the teaching support: three-dimensionally printed models versus two-dimensional pictures.

METHODS

All participants were randomly assigned to one of two groups using a random number table: the three-dimensionally-printed support group (three-dimensional group) or the two-dimensionally-displayed support group (two-dimensional group). All participants completed a multiple-choice question evaluation questionnaire on facial traumatology (first, a zygomatic bone fracture; then, a double mandible fracture). Sex and potential confounding factors were evaluated.

RESULTS

Four hundred thirty-two fifth-year undergraduate medical students were enrolled in this study. Two hundred six students were allocated to the three-dimensional group, and 226 were allocated to the two-dimensional group. The three-dimensionally printed model was considered to be a better teaching material compared with two-dimensional support. The global mean score was 2.36 in the three-dimensional group versus 1.99 in the two-dimensional group (p = 0.008). Regarding teaching of biomechanical aspects, three-dimensionally-printed models provide better understanding (p = 0.015). Participants in both groups exhibited similar previous student educational achievements and visuospatial skills.

CONCLUSIONS

This prospective, randomized, controlled educational trial demonstrated that incorporation of three-dimensionally-printed models improves medical students' understanding. This trial reinforces previous studies highlighting academic benefits in using three-dimensionally-printed models mostly in the field of understanding complex structures.

Application of a three-dimensional printed model to localize a cranial cerebrospinal fluid leak: a case report

Localization of defect sites is a major challenge for surgical repair of cerebrospinal fluid (CSF) leaks. Here, we report a case in which we applied a 3-dimensional (3D) printed model to accurately identify the defect sites and facilitate the successful repair of a cranial CSF leak. A 37-year-old female patient diagnosed with recurrent nasopharyngeal carcinoma suffered CSF rhinorrhea and severe bacterial meningitis. Lumbar drainage and antibiotic administration failed to control the condition. In addition to high resolution computed tomography and magnetic resonance imaging, we applied a 3D printed model of the skull to improve the understanding of the osseous destruction at the skull base and aid in accurately localizing the defect sites of the right middle fossa. Accordingly, a right temporalis pedicled flap combined with an autogenous fascia lata flap was applied to cover the defect sites. The leak stopped postoperatively, and meningitis was relieved by enhanced antibacterial treatment. As a complement to high resolution computed tomography and magnetic resonance imaging, a 3D printed model may improve localization of complex defect sites and surgical planning by allowing preoperative visualization of the skull condition.

Investigation of Three-dimensional Printing Materials for Printing Aorta Model Replicating Type B Aortic Dissection

AIM

This study aims to determine a printing material that has both elastic property and radiology equivalence close to the real aorta for simulation of endovascular stent-graft repair of aortic dissection.

BACKGROUND

With the rapid development of Three-Dimensional (3D) printing technology, a patient- specific 3D printed model is able to help surgeons to make a better treatment plan for Type B aortic dissection patients. However, the radiological properties of most 3D printing materials have not been well characterized. This study aims to investigate the appropriate materials for printing human aorta with mechanical and radiological properties similar to the real aortic Computed Tomography (CT) attenuation.

OBJECTIVE

Quantitative assessment of CT attenuation of different materials used in 3D printed models of aortic dissection for developing patient-specific 3D printed aorta models to simulate type B aortic dissection.

METHODS

A 25-mm length of aorta model was segmented from a patient's image dataset with a diagnosis of type B aortic dissection. Four different elastic commercial 3D printing materials, namely Agilus A40 and A50, Visijet CE-NT A30 and A70 were selected and printed with different hardness. Totally four models were printed out and CT scanned twice on a 192-slice CT scanner using the standard aortic CT angiography protocol, with and without contrast inside the lumen. Five reference points with the Region Of Interest (ROI) of 1.77 mm2 were selected at the aortic wall, and intimal flap and their Hounsfield units (HU) were measured and compared with the CT attenuation of original CT images. The comparison between the patient's aorta and models was performed through a paired-sample t-test to determine if there is any significant difference.

RESULTS

The mean CT attenuation of the aortic wall of the original CT images was 80.7 HU. Analysis of images without using contrast medium showed that the material of Agilus A50 produced the mean CT attenuation of 82.6 HU, which is similar to that of original CT images. The CT attenuation measured at images acquired with the other three materials was significantly lower than that of the original images (p<0.05). After adding contrast medium, Visijet CE-NT A30 had an average CT attenuation of 90.6 HU, which is close to that of the original images without a statistically significant difference (p>0.05). In contrast, the CT attenuation measured at images acquired with other three materials (Agilus A40, A50 and Visiject CE-NT A70) was 129 HU, 135 HU and 129.6 HU, respectively, which is significantly higher than that of original CT images (p<0.05).

CONCLUSION

Both Visijet CE-NT and Agilus have tensile strength and elongation close to actual patient's tissue properties producing similar CT attenuation. Visijet CE-NT A30 is considered the appropriate material for printing aorta to simulate contrast-enhanced CT imaging of type B aortic dissection. Due to the lack of body phantoms in the experiments, further research with the simulation of realistic anatomical body environment should be conducted.

The role of 3D printed models in the teaching of human anatomy: a systematic review and meta-analysis

BACKGROUND

Three-dimensional (3D) printing is an emerging technology widely used in medical education. However, its role in the teaching of human anatomy needs further evaluation.

METHODS

PubMed, Embase, EBSCO, SpringerLink, and Nature databases were searched systematically for studies published from January 2011 to April 2020 in the English language. GRADEprofiler software was used to evaluate the quality of literature. In this study, a meta-analysis of continuous and binary data was conducted. Both descriptive and statistical analyses were used.

RESULTS

Comparing the post-training tests in neuroanatomy, cardiac anatomy, and abdominal anatomy, the standardized mean difference (SMD) of the 3D group and the conventional group were 1.27, 0.37, and 2.01, respectively (p < 0.05). For 3D vs. cadaver and 3D vs. 2D, the SMD were 0.69 and 1.05, respectively (p < 0.05). For answering time, the SMD of the 3D group vs. conventional group was - 0.61 (P < 0.05). For 3D print usefulness, RR = 2.29(P < 0.05). Five of the six studies showed that satisfaction of the 3D group was higher than that of the conventional group. Two studies showed that accuracy of answering questions in the 3D group was higher than that in the conventional group.

CONCLUSIONS

Compared with students in the conventional group, those in the 3D printing group had advantages in accuracy and answering time. In the test of anatomical knowledge, the test results of students in the 3D group were not inferior (higher or equal) to those in the conventional group. The post-training test results of the 3D group were higher than those in the cadaver or 2D group. More students in the 3D printing group were satisfied with their learning compared with the conventional group. The results could be influenced by the quality of the randomized controlled trials. In a framework of ethical rigor, the application of the 3D printing model in human anatomy teaching is expected to grow further.

Effectiveness of Three-Dimensionally Printed Models in Anatomy Education for Medical Students and Resident Physicians: Systematic Review and Meta-Analysis

INTRODUCTION

Despite a surge in the use of three-dimensional printing (3DP) in medical education, a comprehensive evaluation of randomized trials in its effectiveness is lacking. Radiologic studies play an integral role in affording educators the ability to create customized realistic anatomic models. This systematic review and meta-analysis sought to assess the effect of 3DP versus traditional 2-D methods for anatomy education.

METHODS

PubMed, Scopus, Cochrane Library, ERIC, and IEEE Xplore were queried to identify randomized controlled trials that quantitatively investigated anatomy education via postintervention assessments of medical students or resident physicians who were exposed to 3DP versus traditional methods. Criteria for the meta-analysis required that studies additionally included a pre-intervention assessment.

RESULTS

A total of 804 articles were reviewed, identifying 8 and 7 studies for systematic reviews of medical students and resident physicians, respectively, of which 4 and 7 were included in the meta-analyses. 3DP models were associated with higher anatomy examination scores for medical students (P < .0001), but for resident physicians were statistically not significant (P = .53).

DISCUSSION

The 3DP models are shown to positively impact medical students especially given their limited fund of knowledge in anatomy. It is postulated that the lack of a statistically significant result for the resident physicians was multifactorial, in part because of the small test group sizes introducing noise and nonrepresentative samples, as well as relative simplicity of the 3DP models used with resident physicians, which were below their level of training. More trials are required to evaluate the usefulness of highly customized 3DP models.

The utility of 3-dimensional-printed models for skull base meningioma surgery

Background

Skull base meningioma surgery is often difficult and complicated to perform. Therefore, this study aims to investigate the effectiveness of 3-dimensional (3D)-printed models of skull base meningioma in the representation of anatomical structures, the simulation of surgical plans, and patient education on surgical outcomes.

Methods

A retrospective study of 35 patients (3D group: 19 patients and non-3D group: 16 patients) with skull base meningioma was conducted. Mimics software was used to create 3D reconstructions (with the skull, blood vessels, nerves, and tumors set to different colors), and 3D solid models were printed to determine the surgical protocols and communication pathways with the patient.

Results

The 3D-printed model can visually display the relationship of different structures, including the skull, blood vessels, cranial nerves, and tumors. The surgeon should select the proper surgical approaches before surgery through the model and pay attention to protecting the important structures during the operation. According to the models, the surgeon should cut off the blood supply to the tumor to reduce intraoperative bleeding. For patients with skull base bone destruction, the skull base repair should be prepared in advance. Patients and their families should have a thorough understanding of the disease through the model, and there should be effective communication between doctors and patients.

Conclusions

The 3D-printed model of a skull base meningioma can present the structures in a detailed manner and facilitate in helping the surgeon to develop a surgical plan. At the same time, it helps patients and their families to understand the condition and the surgical plan, which is conducive to better patient education.