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Review
. 2022 Apr 6;7(10):1050-1062.
doi: 10.1016/j.jacbts.2022.01.002. eCollection 2022 Oct.

Translating Imaging Into 3D Printed Cardiovascular Phantoms: A Systematic Review of Applications, Technologies, and Validation

Joël Illi  1   2   3 , Benedikt Bernhard  1 , Christopher Nguyen  4   5   6   7 , Thomas Pilgrim  1 , Fabien Praz  1 , Martin Gloeckler  1 , Stephan Windecker  1 , Andreas Haeberlin  1   3 , Christoph Gräni  1   3
Affiliations
Review

Translating Imaging Into 3D Printed Cardiovascular Phantoms: A Systematic Review of Applications, Technologies, and Validation

Joël Illi et al. JACC Basic Transl Sci. .

Abstract

Translation of imaging into 3-dimensional (3D) printed patient-specific phantoms (3DPSPs) can help visualize complex cardiovascular anatomy and enable tailoring of therapy. The aim of this paper is to review the entire process of phantom production, including imaging, materials, 3D printing technologies, and the validation of 3DPSPs. A systematic review of published research was conducted using Embase and MEDLINE, including studies that investigated 3DPSPs in cardiovascular medicine. Among 2,534 screened papers, 212 fulfilled inclusion criteria and described 3DPSPs as a valuable adjunct for planning and guiding interventions (n = 108 [51%]), simulation of physiological or pathological conditions (n = 19 [9%]), teaching of health care professionals (n = 23 [11%]), patient education (n = 3 [1.4%]), outcome prediction (n = 6 [2.8%]), or other purposes (n = 53 [25%]). The most common imaging modalities to enable 3D printing were cardiac computed tomography (n = 131 [61.8%]) and cardiac magnetic resonance (n = 26 [12.3%]). The printing process was conducted mostly by material jetting (n = 54 [25.5%]) or stereolithography (n = 43 [20.3%]). The 10 largest studies that evaluated the geometric accuracy of 3DPSPs described a mean bias <±1 mm; however, the validation process was very heterogeneous among the studies. Three-dimensional printed patient-specific phantoms are highly accurate, used for teaching, and applied to guide cardiovascular therapy. Systematic comparison of imaging and printing modalities following a standardized validation process is warranted to allow conclusions on the optimal production process of 3DPSPs in the field of cardiovascular medicine.

Keywords: 3D printing; 3D, 3-dimensional; 3DPSP, 3-dimensional printed patient-specific phantom; AM, additive manufacturing; CCT, cardiac computed tomography; CMR, cardiac magnetic resonance; DICOM, Digital Imaging and Communications in Medicine; FDM, fused deposition modeling; PBF, powder bed fusion; SLA, stereolithography; TEE, transesophageal echocardiography; VP, voxel printing; additive manufacturing; cardiovascular disease; patient-specific phantoms; personalized medicine; silicone casting; voxel printing.

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Conflict of interest statement

Dr Nguyen has received funding from the National Institutes of Health and the American Heart Association. Dr Windecker has received research and educational grants to the institution from Abbott, Amgen, AstraZeneca, Bristol Myers Squibb, Bayer, Biotronik, Boston Scientific, Cardinal Health, Cardiovalve, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Guerbet, Infraredx, Johnson and Johnson, Medicure, Medtronic, Novartis, Polares, OrPha Suisse, Pfizer, Regeneron, Sanofi, Sinomed, Terumo, and V-Wave; serves as an unpaid advisory board member and/or unpaid member of the steering or executive groups of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Sinomed, Terumo, V-Wave, and Xeltis (but has not received personal payments from pharmaceutical companies or device manufacturers); and is a member of the steering or executive committee groups of several investigator-initiated trials that receive funding from industry, without impact on his personal remuneration. Dr Praz is a consultant for Edwards Lifesciences. Dr Haeberlin has received travel and educational grants from Medtronic and Philips/Spectranetics; is a consultant and advisor for DiNAQOR and Biotronik; and is a cofounder and head of Act-Inno, a device testing company. Dr Pilgrim has received research grants to the institution from Boston Scientific, Edwards Lifesciences, and Biotronik; has received speaker fees from Boston Scientific and Biotronik; is a proctor for Medtronic; and has received reimbursement for travel expenses from Medira. Dr Gräni has received research funding from the Swiss National Science Foundation and Innosuisse, outside the submitted work; and has received travel fees from Amgen and Bayer, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Different Steps in the Production of 3DPSPS 3D = 3-dimensional; 3DPSP = 3-dimensional printed patient-specific phantom; DICOM = Digital Imaging and Communications in Medicine.
Figure 2
Figure 2
Consort Diagram of the Study Selection 3D = 3-dimensional; CV = cardiovascular.
Figure 3
Figure 3
Number of Studies Investigating Three-Dimensional Printed Cardiovascular Phantoms and 3-Year Trend Line
Central Illustration
Central Illustration
Current Techniques to Print 3-Dimensional Cardiovascular Phantoms Across the Reviewed Studies 3DPSP = 3-dimensional printed patient-specific phantom.
Figure 4
Figure 4
Multimaterial 3-Dimensional Printed Patient-Specific Phantom Cardiac computed tomography–based compliant multimaterial three-dimensional printed patient-specific phantom of the left atrium and aortic root, including mitral annular calcification (asterisk) made by PolyJet printing. Materials: Agilus30 Clear and Agilus30 Clear and Vero Pure White (both Stratasys) mixture for calcifications.
Figure 5
Figure 5
Selected Single-Material 3-Dimensional Printed Patient-Specific Phantom (A) Cardiac computed tomography (CCT)–based fused deposition modeling (FDM) positive of the cardiac blood pool, including supporting structures. (B) CCT-based cardiac three-dimensional printed patient-specific phantom made from blood pool segmentation with FDM (green) or PolyJet (translucent), the latter one with additional adjusted wall thickness. (C) Silicone casted (indirect additive manufacturing) aortic root model made from an FDM printed negative.
Figure 6
Figure 6
State of the Art Work Flow for 3-Dimensional Printed Patient-Specific Phantom Printing Using Polyjet On the basis of attenuation values, different masks for different tissues are created in the region of interest. Voxels of the myocardium (red) and aortic valve annular calcification (yellow) are segmented and converted to a triangulated mesh. A specific material is assigned to each voxel type that has been segmented before, eg, solid (yellow) for the calcification and rubber-like (red) for myocardium. Software slices the models and converts them into layer-by-layer commands for the printer. 3D = 3-dimensional; DICOM = Digital Imaging and Communications in Medicine; IV = imaging voxel; PV = printing voxel.
See this image and copyright information in PMC

References

    1. Vukicevic M., Mosadegh B., Min J.K., Little S.H. Cardiac 3D printing and its future directions. J Am Coll Cardiol Img. 2017;10:171–184. - PMC - PubMed
    1. Sun L., Fukuda T., Tokuhara T., Yabuki N. Differences in spatial understanding between physical and virtual models. Front Architectural Res. 2014;3:28–35.
    1. Giannopoulos A.A., Mitsouras D., Yoo S.J., Liu P.P., Chatzizisis Y.S., Rybicki F.J. Applications of 3D printing in cardiovascular diseases. Nat Rev Cardiol. 2016;13:701–718. - PubMed
    1. Chepelev L., Wake N., Ryan J., et al. Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med. 2018;4:11. - PMC - PubMed
    1. Liberati A., Altman D.G., Tetzlaff J., et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:e1–e34. - PubMed