A new production method of elastic silicone carotid phantom based on MRI acquisition using rapid prototyping technique

Design, manufacturing, and multi-modal imaging of stereolithography 3D printed flexible intracranial aneurysm phantoms

BACKGROUND

Physical vascular phantoms are instrumental in studying intracranial aneurysms and testing relevant imaging tools and training systems to provide improved clinical care. Current vascular phantom production methods have major limitations in capturing the biophysical and morphological characteristics of intracranial aneurysms with good fidelity and multi-modal imaging capacity. With stereolithography (SLA) 3D printing technology becoming more accessible, newer flexible and transparent printing materials with higher precision controls open the door for improving the efficiency and quality of producing anthropomorphic vascular phantoms but have rarely been explored for the application.

PURPOSE

This technical note intends to report the feasibility of using SLA 3D printing technology to manufacture flexible intracranial aneurysm phantoms with similar scales to the real anatomy, as well as their capacity for multi-modal flow imaging and analysis, including ultrasound flow imaging, high-speed filming, and particle image velocimetry analysis.

METHODS

We designed and 3D-printed two intracranial aneurysm phantoms with an SLA 3D printer using Formlabs Elastic 50A resin. By using a micropump to introduce cyclical flows in the phantoms, we first employed conventional Doppler and vector flow ultrasonography to observe and measure different fluidic properties. Then, a high-speed camera was used to record particles flowing within the phantom, and we further conducted a particle image velocimetry analysis, including the distribution of mean 2D velocity vectors, average velocity magnitudes, and the mean vorticity fields in the phantom for the high-speed imaging data.

RESULTS

We successfully 3D-printed flexible intracranial aneurysm phantoms with similar dimensions to the real anatomy. Additionally, we validated the phantoms' ability to allow visualization, measurement, and analysis of flow dynamics based on both real-time ultrasound and optical imaging.

CONCLUSIONS

Our proof-of-concept study illustrates that SLA 3D printing using commercial elastic resins can significantly contribute towards facilitating the fabrication of flexible intracranial aneurysms phantoms for training, research, and preoperative planning.

Fabrication, characterization and numerical validation of a novel thin-wall hydrogel vessel model for cardiovascular research based on a patient-specific stenotic carotid artery bifurcation

In vitro vascular models, primarily made of silicone, have been utilized for decades for studying hemodynamics and supporting the development of implants for catheter-based treatments of diseases such as stenoses and aneurysms. Hydrogels have emerged as prominent materials in tissue-engineering applications, offering distinct advantages over silicone models for fabricating vascular models owing to their viscoelasticity, low friction, and tunable mechanical properties. Our study evaluated the feasibility of fabricating thin-wall, anatomical vessel models made of polyvinyl alcohol hydrogel (PVA-H) based on a patient-specific carotid artery bifurcation using a combination of 3D printing and molding technologies. The model's geometry, elastic modulus, volumetric compliance, and diameter distensibility were characterized experimentally and numerically simulated. Moreover, a comparison with silicone models with the same anatomy was performed. A PVA-H vessel model was integrated into a mock circulatory loop for a preliminary ultrasound-based assessment of fluid dynamics. The vascular model's geometry was successfully replicated, and the elastic moduli amounted to 0.31 ± 0.007 MPa and 0.29 ± 0.007 MPa for PVA-H and silicone, respectively. Both materials exhibited nearly identical volumetric compliance (0.346 and 0.342% mmHg-1), which was higher compared to numerical simulation (0.248 and 0.290% mmHg-1). The diameter distensibility ranged from 0.09 to 0.20% mmHg-1 in the experiments and between 0.10 and 0.18% mmHg-1 in the numerical model at different positions along the vessel model, highlighting the influence of vessel geometry on local deformation. In conclusion, our study presents a method and provides insights into the manufacturing and mechanical characterization of hydrogel-based thin-wall vessel models, potentially allowing for a combination of fluid dynamics and tissue engineering studies in future cardio- and neurovascular research.

Reproduction of human blood pressure waveform using physiology-based cardiovascular simulator

This study presents a cardiovascular simulator that mimics the human cardiovascular system's physiological structure and properties to reproduce the human blood pressure waveform. Systolic, diastolic blood pressures, and its waveform are key indicators of cardiovascular health. The blood pressure waveform is closely related to the pulse wave velocity and the overlap of the forward and reflected pressure waves. The presented cardiovascular simulator includes an artificial aorta made of biomimetic silicone. The artificial aorta has the same shape and stiffness as the human standard and is encased with a compliance chamber. The compliance chamber prevents distortion of the blood pressure waveform from strain-softening by applying extravascular pressure. The blood pressure waveform reproduced by the simulator has a pressure range of 80-120 mmHg, a pulse wave velocity of 6.58 m/s, and an augmentation index of 13.3%. These values are in the middle of the human standard range, and the reproduced blood pressure waveform is similar to that of humans. The errors from the human standard values are less than 1 mmHg for blood pressure, 0.05 m/s for pulse wave velocity, and 3% for augmentation index. The changes in blood pressure waveform according to cardiovascular parameters, including heart rate, stroke volume, and peripheral resistance, were evaluated. The same pressure ranges and trends as in humans were observed for systolic and diastolic blood pressures according to cardiovascular parameters.

Fabrication of Compliant and Transparent Hollow Cerebral Vascular Phantoms for In Vitro Studies Using 3D Printing and Spin-Dip Coating

Endovascular surgery through flow diverters and coils is increasingly used for the minimally invasive treatment of intracranial aneurysms. To study the effectiveness of these devices, in vitro tests are performed in which synthetic vascular phantoms are typically used to reproduce in vivo conditions. In this paper, we propose a manufacturing process to obtain compliant and transparent hollow vessel replicas to assess the mechanical behaviour of endovascular devices and perform flow measurements. The vessel models were obtained in three main steps. First, a mould was 3D-printed in a water-soluble material; two techniques, fusion deposition modelling and stereolithography, were compared for this purpose. Then, the mould was covered with a thin layer of silicone through spin-dip coating, and finally, when the silicone layer solidified, it was dissolved in a hot water bath. The final models were tested in terms of the quality of the final results, the mechanical properties of the silicone, thickness uniformity, and transparency properties. The proposed approach makes it possible to produce models of different sizes and complexity whose transparency and mechanical properties are suitable for in vitro experiments. Its applicability is demonstrated through idealised and patient-specific cases.

Navigation of Microrobots by MRI: Impact of Gravitational, Friction and Thrust Forces on Steering Success

INTRODUCTION

Magnetic resonance navigation (MRN) uses MRI gradients to steer magnetic drug-eluting beads (MDEBs) across vascular bifurcations. We aim to experimentally verify our theoretical forces balance model (gravitational, thrust, friction, buoyant and gradient steering forces) to improve the MRN targeted success rate.

METHOD

A single-bifurcation phantom (3 mm inner diameter) made of poly-vinyl alcohol was connected to a cardiac pump at 0.8 mL/s, 60 beats/minutes with a glycerol solution to reproduce the viscosity of blood. MDEB aggregates (25 ± 6 particles, 200 [Formula: see text]) were released into the main branch through a 5F catheter. The phantom was tilted horizontally from - 10° to +25° to evaluate the MRN performance.

RESULTS

The gravitational force was equivalent to 71.85 mT/m in a 3T MRI. The gradient duration and amplitude had a power relationship (amplitude=78.717 [Formula: see text]). It was possible, in 15° elevated vascular branches, to steer 87% of injected aggregates if two MRI gradients are simultaneously activated ([Formula: see text] = +26.5 mT/m, [Formula: see text]= +18 mT/m for 57% duty cycle), the flow velocity was minimized to 8 cm/s and a residual pulsatile flow to minimize the force of friction.

CONCLUSION

Our experimental model can determine the maximum elevation angle MRN can perform in a single-bifurcation phantom simulating in vivo conditions.

A Brush-Spin-Coating Method for Fabricating In Vitro Patient-Specific Vascular Models by Coupling 3D-Printing

PURPOSE

In vitro patient-specific flexible vascular models are helpful for understanding the haemodynamic changes before and after endovascular treatment and for effective training of neuroendovascular interventionalists. However, it is difficult to fabricate models of overall unified or controllable thickness using existing manufacturing methods. In this study, we developed an improved and easily implemented method by combining 3D printing and brush-spin-coating processes to produce a transparent silicone model of uniform or varied thickness.

METHODS

First, a water-soluble inner-skeleton model, based on clinical data, was printed on a 3D printer. The skeleton model was subsequently fixed in a single-axis-rotation machine to enable continuous coating of silicone, the thickness of which was manually controlled by adsorption and removal of excess silicone in a brush-spinning operation. After the silicone layer was solidified, the inner skeleton was further dissolved in a hot water bath, affording a transparent vascular model with real geometry. To verify the controllability of the coating thickness by using this method, a straight tube, an idealised aneurysm model, a patient-specific aortic arch model, and an abdominal aortic aneurysm model were manufactured.

RESULTS

The different thicknesses of the manufactured tubes could be well controlled, with the relative standard deviations being 5.6 and 8.1% for the straight and aneurysm tubes, respectively. Despite of the diameter changing from 33 to 20 mm in the patient-specific aorta, the thickness of the fabricated aortic model remains almost the same along the longitudinal direction with a lower standard deviation of 3.1%. In the more complex patient-specific abdominal aneurysm model, varied thicknesses were realized to mimic the measured data from the CT images, where the middle of the aneurysm was with 2 mm and abdominal aorta as well as the iliac arteries had the normal thickness of 2.3 mm.

CONCLUSION

Through the brush-spin-coating method, models of different sizes and complexity with prescribed thickness can be manufactured, which will be helpful for developing surgical treatment strategies or training neuroendovascular interventionalists.

Evaluation of a Desktop 3D Printed Rigid Refractive-Indexed-Matched Flow Phantom for PIV Measurements on Cerebral Aneurysms

PURPOSE

Fabrication of a suitable flow model or phantom is critical to the study of biomedical fluid dynamics using optical flow visualization and measurement methods. The main difficulties arise from the optical properties of the model material, accuracy of the geometry and ease of fabrication.

METHODS

Conventionally an investment casting method has been used, but recently advancements in additive manufacturing techniques such as 3D printing have allowed the flow model to be printed directly with minimal post-processing steps. This study presents results of an investigation into the feasibility of fabrication of such models suitable for particle image velocimetry (PIV) using a common 3D printing Stereolithography process and photopolymer resin.

RESULTS

An idealised geometry of a cerebral aneurysm was printed to demonstrate its applicability for PIV experimentation. The material was shown to have a refractive index of 1.51, which can be refractive matched with a mixture of de-ionised water with ammonium thiocyanate (NH₄SCN). The images were of a quality that after applying common PIV pre-processing techniques and a PIV cross-correlation algorithm, the results produced were consistent within the aneurysm when compared to previous studies.

CONCLUSIONS

This study presents an alternative low-cost option for 3D printing of a flow phantom suitable for flow visualization simulations. The use of 3D printed flow phantoms reduces the complexity, time and effort required compared to conventional investment casting methods by removing the necessity of a multi-part process required with investment casting techniques.

Fabrication of Low-Cost Patient-Specific Vascular Models for Particle Image Velocimetry

PURPOSE

Particle image velocimetry (PIV), an in vitro experimentation technique that optically measures velocity components to analyze fluid velocity fields, has become increasingly popular to study flow dynamics in various vascular territories. However, it can be difficult and expensive to create patient-specific clear models for PIV due to the importance of refractive index matching of the model and the fluid. We aim to implement and test the use of poly-vinyl alcohol (PVA) in a lost-core casting technique to create low-cost, patient-specific models for PIV.

METHODS

Anonymized patient vascular anatomies were segmented and processed in Mimics/3Matic to create patient-specific cores from 3D digital subtraction angiographies. The cores were 3D-printed with PVA and post-processed with a 80:20 water:glue mixture to smooth the surface. Two silicones, Sylgard 184 and Solaris, were used to encapsulate the model and the PVA core was dissolved using warm water. Computed tomography scans were used to evaluate geometric accuracy using circumferences and surface differences in the model.

RESULTS

Mean geometric differences in circumference along the inlet centerline and the mean surface difference in the aneurysm between the final Silicone Model and the desired STL Print geometry were statistically insignificant (0.6 mm, 95% CI [- 1.4, 2.8] and 0.3 mm 95% CI [- 0.1, 0.7], respectively). Particle illumination within each model was successful. The cost of one 10 cm × 10 cm × 5 cm model was $69.

CONCLUSION

This technique was successful to implement and test the use of PVA in a lost-core casting technique to create low-cost, patient-specific in vitro models for PIV experimentation.

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios

Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.

Logistics of Three-dimensional Printing: Primer for Radiologists

The Association of University Radiologists Radiology Research Alliance Task Force on three-dimensional (3D) printing presents a review of the logistic considerations for establishing a clinical service using this new technology, specifically focused on implications for radiology. Specific topics include printer selection for 3D printing, software selection, creating a 3D model for printing, providing a 3D printing service, research directions, and opportunities for radiologists to be involved in 3D printing. A thorough understanding of the technology and its capabilities is necessary as the field of 3D printing continues to grow. Radiologists are in the unique position to guide this emerging technology and its use in the clinical arena.

Medical 3D Printing for the Radiologist

While use of advanced visualization in radiology is instrumental in diagnosis and communication with referring clinicians, there is an unmet need to render Digital Imaging and Communications in Medicine (DICOM) images as three-dimensional (3D) printed models capable of providing both tactile feedback and tangible depth information about anatomic and pathologic states. Three-dimensional printed models, already entrenched in the nonmedical sciences, are rapidly being embraced in medicine as well as in the lay community. Incorporating 3D printing from images generated and interpreted by radiologists presents particular challenges, including training, materials and equipment, and guidelines. The overall costs of a 3D printing laboratory must be balanced by the clinical benefits. It is expected that the number of 3D-printed models generated from DICOM images for planning interventions and fabricating implants will grow exponentially. Radiologists should at a minimum be familiar with 3D printing as it relates to their field, including types of 3D printing technologies and materials used to create 3D-printed anatomic models, published applications of models to date, and clinical benefits in radiology. Online supplemental material is available for this article.