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Gregg KW, Ruff C, Koenig G, Penev KI, Shepard A, Kreissler G, Amatuzio M, Owens C, Nagpal P, Glide-Hurst CK. Development and first implementation of a novel multi-modality cardiac motion and dosimetry phantom for radiotherapy applications. Med Phys 2024. [PMID: 39042362 DOI: 10.1002/mp.17315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/11/2024] [Accepted: 06/19/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Cardiac applications in radiation therapy are rapidly expanding including magnetic resonance guided radiation therapy (MRgRT) for real-time gating for targeting and avoidance near the heart or treating ventricular tachycardia (VT). PURPOSE This work describes the development and implementation of a novel multi-modality and magnetic resonance (MR)-compatible cardiac phantom. METHODS The patient-informed 3D model was derived from manual contouring of a contrast-enhanced Coronary Computed Tomography Angiography scan, exported as a Stereolithography model, then post-processed to simulate female heart with an average volume. The model was 3D-printed using Elastic50A to provide MR contrast to water background. Two rigid acrylic modules containing cardiac structures were designed and assembled, retrofitting to an MR-safe programmable motor to supply cardiac and respiratory motion in superior-inferior directions. One module contained a cavity for an ion chamber (IC), and the other was equipped with multiple interchangeable cavities for plastic scintillation detectors (PSDs). Images were acquired on a 0.35 T MR-linac for validation of phantom geometry, motion, and simulated online treatment planning and delivery. Three motion profiles were prescribed: patient-derived cardiac (sine waveform, 4.3 mm peak-to-peak, 60 beats/min), respiratory (cos4 waveform, 30 mm peak-to-peak, 12 breaths/min), and a superposition of cardiac (sine waveform, 4 mm peak-to-peak, 70 beats/min) and respiratory (cos4 waveform, 24 mm peak-to-peak, 12 breaths/min). The amplitude of the motion profiles was evaluated from sagittal cine images at eight frames/s with a resolution of 2.4 mm × 2.4 mm. Gated dosimetry experiments were performed using the two module configurations for calculating dose relative to stationary. A CT-based VT treatment plan was delivered twice under cone-beam CT guidance and cumulative stationary doses to multi-point PSDs were evaluated. RESULTS No artifacts were observed on any images acquired during phantom operation. Phantom excursions measured 49.3 ± 25.8%/66.9 ± 14.0%, 97.0 ± 2.2%/96.4 ± 1.7%, and 90.4 ± 4.8%/89.3 ± 3.5% of prescription for cardiac, respiratory, and cardio-respiratory motion profiles for the 2-chamber (PSD) and 12-substructure (IC) phantom modules respectively. In the gated experiments, the cumulative dose was <2% from expected using the IC module. Real-time dose measured for the PSDs at 10 Hz acquisition rate demonstrated the ability to detect the dosimetric consequences of cardiac, respiratory, and cardio-respiratory motion when sampling of different locations during a single delivery, and the stability of our phantom dosimetric results over repeated cycles for the high dose and high gradient regions. For the VT delivery, high dose PSD was <1% from expected (5-6 cGy deviation of 5.9 Gy/fraction) and high gradient/low dose regions had deviations <3.6% (6.3 cGy less than expected 1.73 Gy/fraction). CONCLUSIONS A novel multi-modality modular heart phantom was designed, constructed, and used for gated radiotherapy experiments on a 0.35 T MR-linac. Our phantom was capable of mimicking cardiac, cardio-respiratory, and respiratory motion while performing dosimetric evaluations of gated procedures using IC and PSD configurations. Time-resolved PSDs with small sensitive volumes appear promising for low-amplitude/high-frequency motion and multi-point data acquisition for advanced dosimetric capabilities. Illustrating VT planning and delivery further expands our phantom to address the unmet needs of cardiac applications in radiotherapy.
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Affiliation(s)
- Kenneth W Gregg
- Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Chase Ruff
- Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Grant Koenig
- Modus Medical Devices, Inc. (IBA QUASAR), London, Ontario, Canada
| | - Kalin I Penev
- Modus Medical Devices, Inc. (IBA QUASAR), London, Ontario, Canada
| | - Andrew Shepard
- Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Grace Kreissler
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Margo Amatuzio
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Cameron Owens
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Prashant Nagpal
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Carri K Glide-Hurst
- Department of Human Oncology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Manini C, Nemchyna O, Akansel S, Walczak L, Tautz L, Kolbitsch C, Falk V, Sündermann S, Kühne T, Schulz-Menger J, Hennemuth A. A simulation-based phantom model for generating synthetic mitral valve image data-application to MRI acquisition planning. Int J Comput Assist Radiol Surg 2024; 19:553-569. [PMID: 37679657 PMCID: PMC10881710 DOI: 10.1007/s11548-023-03012-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE Numerical phantom methods are widely used in the development of medical imaging methods. They enable quantitative evaluation and direct comparison with controlled and known ground truth information. Cardiac magnetic resonance has the potential for a comprehensive evaluation of the mitral valve (MV). The goal of this work is the development of a numerical simulation framework that supports the investigation of MRI imaging strategies for the mitral valve. METHODS We present a pipeline for synthetic image generation based on the combination of individual anatomical 3D models with a position-based dynamics simulation of the mitral valve closure. The corresponding images are generated using modality-specific intensity models and spatiotemporal sampling concepts. We test the applicability in the context of MRI imaging strategies for the assessment of the mitral valve. Synthetic images are generated with different strategies regarding image orientation (SAX and rLAX) and spatial sampling density. RESULTS The suitability of the imaging strategy is evaluated by comparing MV segmentations against ground truth annotations. The generated synthetic images were compared to ones acquired with similar parameters, and the result is promising. The quantitative analysis of annotation results suggests that the rLAX sampling strategy is preferable for MV assessment, reaching accuracy values that are comparable to or even outperform literature values. CONCLUSION The proposed approach provides a valuable tool for the evaluation and optimization of cardiac valve image acquisition. Its application to the use case identifies the radial image sampling strategy as the most suitable for MV assessment through MRI.
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Affiliation(s)
- Chiara Manini
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany.
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany.
| | - Olena Nemchyna
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
| | - Serdar Akansel
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
| | - Lars Walczak
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- Fraunhofer MEVIS, Berlin, Germany
| | | | - Christoph Kolbitsch
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Volkmar Falk
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Simon Sündermann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Titus Kühne
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jeanette Schulz-Menger
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology and Nephrology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Anja Hennemuth
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- Fraunhofer MEVIS, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Vernemmen I, Van Steenkiste G, Hauspie S, De Lange L, Buschmann E, Schauvliege S, Van den Broeck W, Decloedt A, Vanderperren K, van Loon G. Development of a three-dimensional computer model of the equine heart using a polyurethane casting technique and in vivo contrast-enhanced computed tomography. J Vet Cardiol 2023; 51:72-85. [PMID: 38101318 DOI: 10.1016/j.jvc.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION/OBJECTIVES Insight into the three-dimensional (3D) anatomy of the equine heart is essential in veterinary education and to develop minimally invasive intracardiac procedures. The aim was to create a 3D computer model simulating the in vivo anatomy of the adult equine heart. ANIMALS Ten horses and five ponies. MATERIALS AND METHODS Ten horses, euthanized for non-cardiovascular reasons, were used for in situ cardiac casting with polyurethane foam and subsequent computed tomography (CT) of the excised heart. In five anaesthetized ponies, a contrast-enhanced electrocardiogram-gated CT protocol was optimized to image the entire heart. Dedicated image processing software was used to create 3D models of all CT scans derived from both methods. Resulting models were compared regarding relative proportions, detail and ease of segmentation. RESULTS The casting protocol produced high detail, but compliant structures such as the pulmonary trunk were disproportionally expanded by the foam. Optimization of the contrast-enhanced CT protocol, especially adding a delayed phase for visualization of the cardiac veins, resulted in sufficiently detailed CT images to create an anatomically correct 3D model of the pony heart. Rescaling was needed to obtain a horse-sized model. CONCLUSIONS Three-dimensional computer models based on contrast-enhanced CT images appeared superior to those based on casted hearts to represent the in vivo situation and are preferred to obtain an anatomically correct heart model useful for education, client communication and research purposes. Scaling was, however, necessary to obtain an approximation of an adult horse heart as cardiac CT imaging is restricted by thoracic size.
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Affiliation(s)
- I Vernemmen
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
| | - G Van Steenkiste
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - S Hauspie
- Department of Morphology, Imaging, Orthopaedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - L De Lange
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - E Buschmann
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - S Schauvliege
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - W Van den Broeck
- Department of Morphology, Imaging, Orthopaedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - A Decloedt
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - K Vanderperren
- Department of Morphology, Imaging, Orthopaedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - G van Loon
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
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Bharucha AH, Moore J, Carnahan P, MacCarthy P, Monaghan MJ, Baghai M, Deshpande R, Byrne J, Dworakowski R, Eskandari M. Three-dimensional printing in modelling mitral valve interventions. Echo Res Pract 2023; 10:12. [PMID: 37528494 PMCID: PMC10394816 DOI: 10.1186/s44156-023-00024-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/23/2023] [Indexed: 08/03/2023] Open
Abstract
Mitral interventions remain technically challenging owing to the anatomical complexity and heterogeneity of mitral pathologies. As such, multi-disciplinary pre-procedural planning assisted by advanced cardiac imaging is pivotal to successful outcomes. Modern imaging techniques offer accurate 3D renderings of cardiac anatomy; however, users are required to derive a spatial understanding of complex mitral pathologies from a 2D projection thus generating an 'imaging gap' which limits procedural planning. Physical mitral modelling using 3D printing has the potential to bridge this gap and is increasingly being employed in conjunction with other transformative technologies to assess feasibility of intervention, direct prosthesis choice and avoid complications. Such platforms have also shown value in training and patient education. Despite important limitations, the pace of innovation and synergistic integration with other technologies is likely to ensure that 3D printing assumes a central role in the journey towards delivering personalised care for patients undergoing mitral valve interventions.
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Affiliation(s)
- Apurva H Bharucha
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - John Moore
- Robarts Research Institute, Western University, London, ON, Canada
| | - Patrick Carnahan
- Robarts Research Institute, Western University, London, ON, Canada
| | - Philip MacCarthy
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Mark J Monaghan
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Max Baghai
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Ranjit Deshpande
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Jonathan Byrne
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Rafal Dworakowski
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK
| | - Mehdi Eskandari
- The Cardiac Care Group, King's College Hospital, London, SE5 9RS, UK.
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Antoniou A, Nikolaou A, Georgiou A, Evripidou N, Damianou C. Development of an US, MRI, and CT imaging compatible realistic mouse phantom for thermal ablation and focused ultrasound evaluation. ULTRASONICS 2023; 131:106955. [PMID: 36854247 DOI: 10.1016/j.ultras.2023.106955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/09/2022] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
Tissue mimicking phantoms (TMPs) play an essential role in modern biomedical research as cost-effective quality assurance and training tools, simultaneously contributing to the reduction of animal use. Herein, we present the development and evaluation of an anatomically accurate mouse phantom intended for image-guided thermal ablation and Focused Ultrasound (FUS) applications. The proposed mouse model consists of skeletal and soft tissue mimics, whose design was based on the Computed tomography (CT) scans data of a live mouse. Advantageously, it is compatible with US, CT, and Magnetic Resonance Imaging (MRI). The compatibility assessment was focused on the radiological behavior of the phantom due to the lack of relevant literature. The X-ray linear attenuation coefficient of candidate materials was estimated to assess the one that matches best the radiological behavior of living tissues. The bone part was manufactured by Fused Deposition Modeling (FDM) printing using Acrylonitrile styrene acrylate (ASA) material. For the soft-tissue mimic, a special mold was 3D printed having a cavity with the unique shape of the mouse body and filled with an agar-based silica-doped gel. The mouse phantom accurately matched the size and reproduced the body surface of the imaged mouse. Tissue-equivalency in terms of X-ray attenuation was demonstrated for the agar-based soft-tissue mimic. The phantom demonstrated excellent MRI visibility of the skeletal and soft-tissue mimics. Good radiological contrast between the skeletal and soft-tissue models was also observed in the CT scans. The model was also able to reproduce realistic behavior during trans-skull sonication as proved by thermocouple measurements. Overall, the proposed phantom is inexpensive, ergonomic, and realistic. It could constitute a powerful tool for image-guided thermal ablation and FUS studies in terms of testing and optimizing the performance of relevant equipment and protocols. It also possess great potential for use in transcranial FUS applications, including the emerging topic of FUS-mediated blood brain barrier (BBB) disruption.
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Affiliation(s)
- Anastasia Antoniou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
| | - Anastasia Nikolaou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
| | - Andreas Georgiou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
| | - Nikolas Evripidou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
| | - Christakis Damianou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
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Arteaga-Marrero N, Villa E, Llanos González AB, Gómez Gil ME, Fernández OA, Ruiz-Alzola J, González-Fernández J. Low-Cost Pseudo-Anthropomorphic PVA-C and Cellulose Lung Phantom for Ultrasound-Guided Interventions. Gels 2023; 9:gels9020074. [PMID: 36826245 PMCID: PMC9957311 DOI: 10.3390/gels9020074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
A low-cost custom-made pseudo-anthropomorphic lung phantom, offering a model for ultrasound-guided interventions, is presented. The phantom is a rectangular solidstructure fabricated with polyvinyl alcohol cryogel (PVA-C) and cellulose to mimic the healthy parenchyma. The pathologies of interest were embedded as inclusions containing gaseous, liquid, or solid materials. The ribs were 3D-printed using polyethylene terephthalate, and the pleura was made of a bidimensional reticle based on PVA-C. The healthy and pathological tissues were mimicked to display acoustic and echoic properties similar to that of soft tissues. Theflexible fabrication process facilitated the modification of the physical and acoustic properties of the phantom. The phantom's manufacture offers flexibility regarding the number, shape, location, and composition of the inclusions and the insertion of ribs and pleura. In-plane and out-of-plane needle insertions, fine needle aspiration, and core needle biopsy were performed under ultrasound image guidance. The mimicked tissues displayed a resistance and recoil effect typically encountered in a real scenario for a pneumothorax, abscesses, and neoplasms. The presented phantom accurately replicated thoracic tissues (lung, ribs, and pleura) and associated pathologies providing a useful tool for training ultrasound-guided procedures.
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Affiliation(s)
- Natalia Arteaga-Marrero
- Grupo Tecnología Médica IACTEC, Instituto de Astrofísica de Canarias (IAC), 38205 San Cristóbal de La Laguna, Spain
| | - Enrique Villa
- Grupo Tecnología Médica IACTEC, Instituto de Astrofísica de Canarias (IAC), 38205 San Cristóbal de La Laguna, Spain
- Correspondence:
| | - Ana Belén Llanos González
- Departamento de Neumología, Complejo Universitario de Canarias (HUC), 38320 San Cristóbal de La Laguna, Spain
| | - Marta Elena Gómez Gil
- Departameto de Radiología, Complejo Universitario de Canarias (HUC), 38320 San Cristóbal de La Laguna, Spain
| | - Orlando Acosta Fernández
- Departamento de Neumología, Complejo Universitario de Canarias (HUC), 38320 San Cristóbal de La Laguna, Spain
| | - Juan Ruiz-Alzola
- Grupo Tecnología Médica IACTEC, Instituto de Astrofísica de Canarias (IAC), 38205 San Cristóbal de La Laguna, Spain
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Departamento de Señales y Comunicaciones, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Javier González-Fernández
- Departamento de Ingeniería Biomédica, Instituto Tecnológico de Canarias (ITC), 38009 Santa Cruz de Tenerife, Spain
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Capelli C, Bertolini M, Schievano S. 3D-printed and computational models: a combined approach for patient-specific studies. 3D Print Med 2023. [DOI: 10.1016/b978-0-323-89831-7.00011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Demonstration of Use of a Novel 3D Printed Simulator for Mitral Valve Transcatheter Edge-to-Edge Repair (TEER). MATERIALS 2022; 15:ma15124284. [PMID: 35744343 PMCID: PMC9227763 DOI: 10.3390/ma15124284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022]
Abstract
Mitral regurgitation is a common valvular disorder. Transcatheter edge-to-edge repair (TEER) is a minimally invasive technique which involves holding together the middle segments of the mitral valve leaflets, thereby reducing regurgitation. To date, MitraClip™ is the only Food and Drug Administration (FDA)-approved device for TEER. The MitraClip procedure is technically challenging, characterised by a steep learning curve. Training is generally performed on simplified models, which do not emphasise anatomical features, realistic materials, or procedural scenarios. The aim of this study is to propose a novel, 3D printed simulator, with a major focus on reproducing the anatomy and plasticity of all areas of the heart involved and specifically the ones of the mitral valve apparatus. A three-dimensional digital model of a heart was generated by segmenting computed tomography (CT). The model was subsequently modified for: (i) adding anatomical features not fully visible with CT; (ii) adapting the model to interact with the MitraClip procedural equipment; and (iii) ensuring modularity of the system. The model was manufactured with a Polyjet technology printer, with a differentiated material assignment among its portions. Polypropylene threads were stitched to replicate chordae tendineae. The proposed system was successfully tested with MitraClip equipment. The simulator was assessed to be feasible to practice in a realistic fashion, different procedural aspects including access, navigation, catheter steering, and leaflets grasping. In addition, the model was found to be compatible with clinical procedural imaging fluoroscopy equipment. Future studies will assess the effect of the proposed training system on improving TEER training.
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3D Printing Surgical Phantoms and their Role in the Visualization of Medical Procedures. ANNALS OF 3D PRINTED MEDICINE 2022. [DOI: 10.1016/j.stlm.2022.100057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Tibamoso-Pedraza G, Navarro I, Dion P, Raboisson MJ, Lapierre C, Miró J, Ratté S, Duong L. Design of heart phantoms for ultrasound imaging of ventricular septal defects. Int J Comput Assist Radiol Surg 2021; 17:177-184. [PMID: 34021458 DOI: 10.1007/s11548-021-02406-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/11/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Ventricular septal defects (VSDs) are common congenital heart malformations. Echocardiography used during VSD hybrid cardiac procedures requires extensive training for image acquisition and interpretation. Cardiac surgery simulators with heart phantoms have shown usefulness for such training, but they are limited in visualization and characterization of complex VSD. This study explores a new method to build patient-specific heart phantoms with VSD, with proper tissue echogenicity for ultrasound imaging. METHODS Heart phantoms were designed from preoperative imaging of three patients with complex VSDs. Each whole heart phantom, including atrial and ventricular septums, was obtained by manual segmentation and by surface reconstruction, then by molding and by casting in different materials. Heart phantoms in silicone and polyvinyl alcohol cryogel (PVA-C) were considered, and they were reconstructed in 3-D using 2-D freehand ultrasound imaging. RESULTS An electromagnetic measurement system was used to measure the mean VSD diameters from the heart phantoms. Errors were evaluated below 1.0 mm for mean VSD diameters between 6.2 and 7.5 mm. CONCLUSION Patient-specific heart phantoms promise for representing complex heart malformations such as VSDs. PVA-C showed better tissue echogenicity than silicone for VSDs visualization and characterization.
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Affiliation(s)
- Gerardo Tibamoso-Pedraza
- Interventional Imaging Lab, Department of Software and IT Engineering, École de technologie supérieure, 1100 Notre-Dame West, Montreal, H3C 1K3, Canada.
| | - Iñaki Navarro
- Cardiology, Department of Pediatrics, CHU Sainte-Justine, Montreal, H3T 1C5, Canada
| | - Patrice Dion
- Interventional Imaging Lab, Department of Software and IT Engineering, École de technologie supérieure, 1100 Notre-Dame West, Montreal, H3C 1K3, Canada
| | | | - Chantale Lapierre
- Cardiology, Department of Pediatrics, CHU Sainte-Justine, Montreal, H3T 1C5, Canada
| | - Joaquim Miró
- Cardiology, Department of Pediatrics, CHU Sainte-Justine, Montreal, H3T 1C5, Canada
| | - Sylvie Ratté
- Interventional Imaging Lab, Department of Software and IT Engineering, École de technologie supérieure, 1100 Notre-Dame West, Montreal, H3C 1K3, Canada
| | - Luc Duong
- Interventional Imaging Lab, Department of Software and IT Engineering, École de technologie supérieure, 1100 Notre-Dame West, Montreal, H3C 1K3, Canada
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Greenwood TE, Hatch SE, Colton MB, Thomson SL. 3D Printing Low-Stiffness Silicone Within a Curable Support Matrix. ADDITIVE MANUFACTURING 2021; 37:101681. [PMID: 33718006 PMCID: PMC7946128 DOI: 10.1016/j.addma.2020.101681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Embedded 3D printing processes involve extruding ink within a support matrix that supports the ink throughout printing and curing. In once class of embedded 3D printing, which we refer to as "removable embedded 3D printing," curable inks are printed, cured, then removed from the uncured support matrix. Removable embedded 3D printing is advantageous because low-viscosity inks can be patterned in freeform geometries which may not be feasible to create via casting and other printing processes. When printing solid-infill geometries, however, uncured support matrix becomes trapped within the prints, which may be undesirable. This study builds on previous work by formulating a support matrix for removable embedded 3D printing that cures when mixed with the printed silicone ink to solve the problem of trapped, uncured support matrix within solid-infill prints. Printed specimens are shown to have a nearly isotropic elastic modulus in directions perpendicular and parallel to the printed layers, and a decreased modulus and increased elongation at break compared to specimens cast from the ink. The rheological properties of the support matrix are reported. The capabilities of the printer and support matrix are demonstrated by printing a variety of geometries from four UV and addition-cure silicone inks. Shapes printed with these inks range by nearly two orders of magnitude in stiffness and have failure strains between approximately 50 and 250%, suggesting a wide range of potential applications for this printing process.
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Affiliation(s)
- Taylor E Greenwood
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, 84602, USA
| | - Serah E Hatch
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, 84602, USA
| | - Mark B Colton
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, 84602, USA
| | - Scott L Thomson
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, 84602, USA
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Azimbagirad M, Grillo FW, Hadadian Y, Carneiro AAO, Murta LO. Biomimetic phantom with anatomical accuracy for evaluating brain volumetric measurements with magnetic resonance imaging. J Med Imaging (Bellingham) 2021; 8:013503. [PMID: 33532513 PMCID: PMC7844423 DOI: 10.1117/1.jmi.8.1.013503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 01/11/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: Brain image volumetric measurements (BVM) methods have been used to quantify brain tissue volumes using magnetic resonance imaging (MRI) when investigating abnormalities. Although BVM methods are widely used, they need to be evaluated to quantify their reliability. Currently, the gold-standard reference to evaluate a BVM is usually manual labeling measurement. Manual volume labeling is a time-consuming and expensive task, but the confidence level ascribed to this method is not absolute. We describe and evaluate a biomimetic brain phantom as an alternative for the manual validation of BVM. Methods: We printed a three-dimensional (3D) brain mold using an MRI of a three-year-old boy diagnosed with Sturge-Weber syndrome. Then we prepared three different mixtures of styrene-ethylene/butylene-styrene gel and paraffin to mimic white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF). The mold was filled by these three mixtures with known volumes. We scanned the brain phantom using two MRI scanners, 1.5 and 3.0 Tesla. Our suggestion is a new challenging model to evaluate the BVM which includes the measured volumes of the phantom compartments and its MRI. We investigated the performance of an automatic BVM, i.e., the expectation-maximization (EM) method, to estimate its accuracy in BVM. Results: The automatic BVM results using the EM method showed a relative error (regarding the phantom volume) of 0.08, 0.03, and 0.13 ( ± 0.03 uncertainty) percentages of the GM, CSF, and WM volume, respectively, which was in good agreement with the results reported using manual segmentation. Conclusions: The phantom can be a potential quantifier for a wide range of segmentation methods.
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Affiliation(s)
- Mehran Azimbagirad
- University of Western Brittany, Faculty of Medicine and Health Sciences, Brest, France
- University of São Paulo, Department of Physics, Faculty of Philosophy, Science and Languages, Ribeirão Preto, São Paulo, Brazil
| | - Felipe Wilker Grillo
- University of São Paulo, Department of Physics, Faculty of Philosophy, Science and Languages, Ribeirão Preto, São Paulo, Brazil
| | - Yaser Hadadian
- University of São Paulo, Department of Physics, Faculty of Philosophy, Science and Languages, Ribeirão Preto, São Paulo, Brazil
| | | | - Luiz Otavio Murta
- University of São Paulo, Department of Computing and Mathematics, Faculty of Philosophy, Science and Languages, Ribeirão Preto, São Paulo, Brazil
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Bezek LB, Cauchi MP, De Vita R, Foerst JR, Williams CB. 3D printing tissue-mimicking materials for realistic transseptal puncture models. J Mech Behav Biomed Mater 2020; 110:103971. [PMID: 32763836 DOI: 10.1016/j.jmbbm.2020.103971] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 01/09/2023]
Abstract
Applications of additive manufacturing (commonly referred to as 3D printing) in direct fabrication of models for pre-surgical planning, functional testing, and medical training are on the rise. However, one current limitation to the accuracy of models for cardiovascular procedural training is a lack of printable materials that accurately mimic human tissue. Most of the available elastomeric materials lack mechanical properties representative of human tissues. To address the gap, the authors explore the multi-material capability of material jetting additive manufacturing to combine non-curing and photo-curing inks to achieve material properties that more closely replicate human tissues. The authors explore the impact of relative material concentration on tissue-relevant properties from puncture and tensile testing under submerged conditions. Further, the authors demonstrate the ability to mimic the mechanical properties of the fossa ovalis, which proves beneficial for accurately simulating transseptal punctures. A fossa ovalis mimic was printed and assembled within a full patient-specific heart model for validation, where it exhibited accuracy in both mechanical properties and geometry. The explored material combination provides the opportunity to fabricate future medical models that are more realistic and better suited for pre-surgical planning and medical student training. This will ultimately guide safer, more efficient practices.
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Affiliation(s)
- Lindsey B Bezek
- Department of Mechanical Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
| | | | - Raffaella De Vita
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Jason R Foerst
- Section of Interventional and Structural Cardiology, Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016, USA
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Lee HJ, Lee HJ, Lee JS, Kang YN, Koo JC. A built-up-type deformable phantom for target motion control to mimic human lung respiration. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2020; 91:054106. [PMID: 32486717 DOI: 10.1063/5.0003453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
Existing human lung-mimicking requirements in various radiology application fields have led to the development of many different phantoms. However, most are static apparatus designed for equipment calibration. Although there are a few dynamic phantoms that generate predefined motions, they have complicated mechanisms that hamper even simple modifications for various lung illness simulations. As a result, existing dynamic phantoms in which a target can be embedded normally generate rectilinear target motions with limited displacement. Nevertheless, volume changes in the human lungs during normal respiration are significant, and targets inside the lungs move along various random paths depending on their location, stiffness, and the properties of the surrounding tissues. In the present work, a novel phantom design is introduced and tested. The phantom mimics the human lung motion and its deformation is initiated by a diaphragm movement. The phantom provides a fairly large deformation and the capability to adjust target motion paths. The presented device has a simple mechanism that can be easily modified to generate various pulmonary diseases. To produce a large deformation by diaphragm compressive motion, polyurethane cubic blocks constitute the deformable part of the lung phantom and a tumor made with silicone is inserted in the structure. The assembled lung part is housed within an acrylic case that is filled with water. The phantom system consists of acrylic, plastic, and low-density polyurethane to minimize artifacts when it undergoes computed tomography (CT) scans. The lung part is organized with various density polyurethane blocks, making it possible to produce nonlinear motion paths of the tumor. The lung part is deformed by a silicon film that is driven by external hydraulic pressure. A finite element method simulation and two-dimensional target motion tests were performed to verify phantom performance. The functionality of the proposed phantom system was confirmed in a series of CT images.
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Affiliation(s)
- Hyuk Jin Lee
- School of Mechanical Engineering, Sungkyunkwan University, Suwon 16419, South Korea
| | - Hae Jin Lee
- School of Mechanical Engineering, Sungkyunkwan University, Suwon 16419, South Korea
| | - Jeong Su Lee
- School of Mechanical Engineering, Sungkyunkwan University, Suwon 16419, South Korea
| | - Yung-Nam Kang
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Ja Choon Koo
- School of Mechanical Engineering, Sungkyunkwan University, Suwon 16419, South Korea
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Stepniak K, Ursani A, Paul N, Naguib H. Development of a phantom network for optimization of coronary artery disease imaging using computed tomography. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab2696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Filippou V, Tsoumpas C. Recent advances on the development of phantoms using 3D printing for imaging with CT, MRI, PET, SPECT, and ultrasound. Med Phys 2018; 45. [PMID: 29933508 PMCID: PMC6849595 DOI: 10.1002/mp.13058] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/03/2018] [Accepted: 06/15/2018] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Printing technology, capable of producing three-dimensional (3D) objects, has evolved in recent years and provides potential for developing reproducible and sophisticated physical phantoms. 3D printing technology can help rapidly develop relatively low cost phantoms with appropriate complexities, which are useful in imaging or dosimetry measurements. The need for more realistic phantoms is emerging since imaging systems are now capable of acquiring multimodal and multiparametric data. This review addresses three main questions about the 3D printers currently in use, and their produced materials. The first question investigates whether the resolution of 3D printers is sufficient for existing imaging technologies. The second question explores if the materials of 3D-printed phantoms can produce realistic images representing various tissues and organs as taken by different imaging modalities such as computer tomography (CT), positron emission tomography (PET), single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), ultrasound (US), and mammography. The emergence of multimodal imaging increases the need for phantoms that can be scanned using different imaging modalities. The third question probes the feasibility and easiness of "printing" radioactive or nonradioactive solutions during the printing process. METHODS A systematic review of medical imaging studies published after January 2013 is performed using strict inclusion criteria. The databases used were Scopus and Web of Knowledge with specific search terms. In total, 139 papers were identified; however, only 50 were classified as relevant for this paper. In this review, following an appropriate introduction and literature research strategy, all 50 articles are presented in detail. A summary of tables and example figures of the most recent advances in 3D printing for the purposes of phantoms across different imaging modalities are provided. RESULTS All 50 studies printed and scanned phantoms in either CT, PET, SPECT, mammography, MRI, and US-or a combination of those modalities. According to the literature, different parameters were evaluated depending on the imaging modality used. Almost all papers evaluated more than two parameters, with the most common being Hounsfield units, density, attenuation and speed of sound. CONCLUSIONS The development of this field is rapidly evolving and becoming more refined. There is potential to reach the ultimate goal of using 3D phantoms to get feedback on imaging scanners and reconstruction algorithms more regularly. Although the development of imaging phantoms is evident, there are still some limitations to address: One of which is printing accuracy, due to the printer properties. Another limitation is the materials available to print: There are not enough materials to mimic all the tissue properties. For example, one material can mimic one property-such as the density of real tissue-but not any other property, like speed of sound or attenuation.
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Affiliation(s)
- Valeria Filippou
- Institute of Medical and Biological EngineeringFaculty of Mechanical EngineeringUniversity of LeedsLeedsLS2 9JTWest YorkshireUK
| | - Charalampos Tsoumpas
- Department of Biomedical Imaging ScienceSchool of MedicineUniversity of LeedsLeedsLS2 9NLWest YorkshireUK
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