3D-printed heart models for hands-on training in pediatric cardiology - the future of modern learning and teaching?

The impact of 3D printed vs. 3D virtual congenital heart models on patient and family knowledge

Introduction

Congenital heart defects (CHDs) often involve complex anatomical structures that can be challenging for patients and their families to understand. While physicians utilize various imaging techniques such as cardiac echocardiograms, CT scans, and MRIs to comprehend these complexities, the information is typically conveyed to patients and families through two-dimensional (2D) images and drawings. Traditional methods often fail to fully capture the intricate nature of CHDs. This study compared the effectiveness of 2D imaging with three-dimensional (3D) virtual and 3D printed models in enhancing the understanding of CHDs among patients and their families.

Methods

Family members of patients with congenital heart disease, as well as patients aged 15 years or older, were recruited for the study. Participants were presented with an echocardiogram of their specific cardiac defect alongside an echocardiogram of a structurally normal heart for comparison. They were then randomly assigned to receive education using a 3D printed model or a 3D virtual model of their heart defect. Participants' knowledge of normal cardiac anatomy and the anatomy of their specific cardiac defect was assessed after viewing the echocardiogram (2D image) and again after reviewing the 3D models.

Results

One-hundred-nine subjects participated in the study, comprising 79 family members (72.5%) and 30 patients (27.5%). Subjects showed significant improvement in their understanding of normal cardiac anatomy with both 3D printed and 3D virtual models compared to the 2D image (p = 0.022 and p = 0.012, respectively). Among the subjects, 70% in the 3D printed group and 84% in the 3D virtual group indicated a preference for the 3D models over the 2D image. Both the 3D printed, and 3D virtual model groups rated themselves as having an increased understanding of normal cardiac anatomy compared to the 2D images (p = 0.009 and p < 0.001, respectively).

Discussion

These findings suggest that incorporating 3D models into the educational process for patients with congenital heart disease can lead to improved comprehension and greater satisfaction.

Realistic 3D-Printed Lumbar Spine Model for Non-cadaveric Surgical Training: A Proof of Concept Study

Surgical simulation plays a crucial role in modern neurosurgical training, allowing surgeons to develop and refine their skills in a controlled and risk-free environment. Traditional methods, such as cadaveric dissections, and virtual reality (VR) simulations more recently have their advantages and limitations. While cadaveric models offer high anatomical accuracy, they are expensive, difficult to access, and non-reusable. VR simulations provide customizable training experiences but lack the realistic haptic feedback necessary for hands-on procedures. With advancements in 3D printing technology, anatomically accurate and cost-effective physical models have emerged as a viable alternative for surgical training. This study aims to develop and validate a realistic 3D-printed lumbar spine model for non-cadaveric surgical education. The proposed model replicates the anatomical and biomechanical properties of the L1-S1 segment and is produced using fused deposition modeling (FDM) 3D printing technology with polylactic acid (PLA) vertebrae, PolyFlex TPU95 intervertebral discs, and an elastic TPU (thermoplastic polyurethane) rod to mimic physiological movement. The model is based on DICOM imaging data from a CT scan of a patient's spine, optimized for biomechanical resistance and realistic pedicle screw placement training. It was tested in hands-on neurosurgical workshops at St. Ivan Rilski University Hospital in Sofia. Post-training X-ray analysis confirmed the accuracy of screw positioning and the anatomical fidelity of the model. The results demonstrate that this 3D-printed lumbar spine model provides an accessible, customizable, and reliable training tool for spine surgery. Future improvements may include multi-material printing, augmented reality (AR) integration, and adaptations for pathological conditions.

Patient-Specific 3D-Printed Low-Cost Models in Medical Education and Clinical Practice

3D printing has been increasingly used for medical applications with studies reporting its value, ranging from medical education to pre-surgical planning and simulation, assisting doctor-patient communication or communication with clinicians, and the development of optimal computed tomography (CT) imaging protocols. This article presents our experience of utilising a 3D-printing facility to print a range of patient-specific low-cost models for medical applications. These models include personalized models in cardiovascular disease (from congenital heart disease to aortic aneurysm, aortic dissection and coronary artery disease) and tumours (lung cancer, pancreatic cancer and biliary disease) based on CT data. Furthermore, we designed and developed novel 3D-printed models, including a 3D-printed breast model for the simulation of breast cancer magnetic resonance imaging (MRI), and calcified coronary plaques for the simulation of extensive calcifications in the coronary arteries. Most of these 3D-printed models were scanned with CT (except for the breast model which was scanned using MRI) for investigation of their educational and clinical value, with promising results achieved. The models were confirmed to be highly accurate in replicating both anatomy and pathology in different body regions with affordable costs. Our experience of producing low-cost and affordable 3D-printed models highlights the feasibility of utilizing 3D-printing technology in medical education and clinical practice.

Clinical Applications of Mixed Reality and 3D Printing in Congenital Heart Disease

Understanding the anatomical features and generation of realistic three-dimensional (3D) visualization of congenital heart disease (CHD) is always challenging due to the complexity and wide spectrum of CHD. Emerging technologies, including 3D printing and mixed reality (MR), have the potential to overcome these limitations based on 2D and 3D reconstructions of the standard DICOM (Digital Imaging and Communications in Medicine) images. However, very little research has been conducted with regard to the clinical value of these two novel technologies in CHD. This study aims to investigate the usefulness and clinical value of MR and 3D printing in assisting diagnosis, medical education, pre-operative planning, and intraoperative guidance of CHD surgeries through evaluations from a group of cardiac specialists and physicians. Two cardiac computed tomography angiography scans that demonstrate CHD of different complexities (atrial septal defect and double outlet right ventricle) were selected and converted into 3D-printed heart models (3DPHM) and MR models. Thirty-four cardiac specialists and physicians were recruited. The results showed that the MR models were ranked as the best modality amongst the three, and were significantly better than DICOM images in demonstrating complex CHD lesions (mean difference (MD) = 0.76, p = 0.01), in enhancing depth perception (MD = 1.09, p = 0.00), in portraying spatial relationship between cardiac structures (MD = 1.15, p = 0.00), as a learning tool of the pathology (MD = 0.91, p = 0.00), and in facilitating pre-operative planning (MD = 0.87, p = 0.02). The 3DPHM were ranked as the best modality and significantly better than DICOM images in facilitating communication with patients (MD = 0.99, p = 0.00). In conclusion, both MR models and 3DPHM have their own strengths in different aspects, and they are superior to standard DICOM images in the visualization and management of CHD.

3D Printed Models in Cardiovascular Disease: An Exciting Future to Deliver Personalized Medicine

3D printing has shown great promise in medical applications with increased reports in the literature. Patient-specific 3D printed heart and vascular models replicate normal anatomy and pathology with high accuracy and demonstrate superior advantages over the standard image visualizations for improving understanding of complex cardiovascular structures, providing guidance for surgical planning and simulation of interventional procedures, as well as enhancing doctor-to-patient communication. 3D printed models can also be used to optimize CT scanning protocols for radiation dose reduction. This review article provides an overview of the current status of using 3D printing technology in cardiovascular disease. Limitations and barriers to applying 3D printing in clinical practice are emphasized while future directions are highlighted.