3D PRINTING IN CARDIOLOGY

Group 8
Group Members:
1. MOHAMAD AIZAL IZWAN BIN MD DIRIS KIB170024
2. MUHAMMAD HAFIZ BIN AB PATAH KIB170026
3. MUHAMMAD HAJAZI BIN MD ZIN KIB170027
 INTRODUCTION
The concept of 3D printing has been in existence since the 1980s.
3D printing readily available:
1. Relatively low capital cost .
2. Little additional equipment needed.
• 3D printing can better represent intuitively the anatomy to the clinician when planning a surgery or a
procedure.
• 3D printing can also aide in gauging how well devices fit, especially as more compliant printing
materials are available and processing correction methods make models dimension-accurate.
• The process of producing a model :
1) acquiring the images using a modality suited to the anatomy.
2) processing and segmentation.
3) producing a STereoLithography (STL) printable file.
4) Printing that file using one of several types of printers.
Initial Image Acquisition
• Advancement in computer aided design (CAD) and computer aided manufacturing (CAM)
along with better modeling techniques permitted iterative improvements in quality and
expansion of additive manufacturing.

• Utilises different types of polymers :

1. For the purposes of producing small dimension-accurate models.
2. Low cost.

• Producing a quality print requires adequate imaging typically in the form of CT scans or MRI.

• The majority of software available to operators requires a 3D dataset.

1) Starting with a data-set, extraneous anatomy is cropped out.

2) Next, multi-planar imaging is used to identify the specific

anatomy desired for printing and flaws in the series.

3) The region of interest (ROI) is set to a predefined Hounsfield

unit.

4) Additional reprocessing and manipulation may be needed to

create the best ROI map of the desired structure.

5) A 3D digital model is then created and converted to an STL file.

6) Smoothing and additional cropping may be done at this point

with care so as not to distort the anatomy.

7) The completed STL file is then sent to the printer for model
production.
Segmentation of the multi-planar
gated CT scan
(A) CT scan focusing on the dual right ventricular
outflow tract (RVOT).

(B) 3D reconstruction showing the upper homograft

which had become both stenotic and regurgitant.
The native valve is the lower RVOT and is in close
proximity to the coronary arteries.

(C) Fluoroscopy of the RVOT at the time of the

intervention showing severe regurgitation through
the homograft, followed by implantation of a
Melody valve and resolution of the retrograde
flow.
PROCESSING METHODS

• DICOM - (Digital Imaging and Communications in

Medicine) is a standard for handling, storing,
printing, and transmitting information in medical
imaging.

• STL - a file format native to the stereolithography

CAD software created by 3D Systems.
• Once the images are acquired, the DICOM files are then input into segmentation software to produce a
STereoLithography(SL) format file which contains surface geometry data and its position in space.
• The unnecessary anatomy trimmed by Hounsfield unit range.
• Then, all surrounding anatomy or tissue in three dimensions is cropped before attempting to identify
the region of interest.
• Set Hounsfield unit ranges tightly to avoid fragments of tissue appearing in the SL file.
• Producing a hollow model is considerably more involved due to :
 the similarity of tissue density between the myocardium and surrounding structures.
• CT speckle noise noted within pools of contrast inside a chamber can result in substantial noise and
printing errors inside a cavity.
• Using gradient smoothing algorithms can save significant time and effort since minimizing that noise allows
the software to perform better segmentation and treat the contrast pool as a single density volume.
• In preparing the model, the walls have to be continuous and of a minimum thickness based on the materials
used to ensure model integrity during production.
• More efficient with the use of professional software such as Mimics (Materialize Medical, Belgium).
• When producing hollow prints, it is important to slice and orient the processed file to see into the model.
• support filaments are added to preserve the relative relationships of each layer printed until the entirety of the
model.
CURRENT WIDELY AVAILABLE 3D PRINTING
TECHNOLOGIES
 MATERIAL

• Using the appropriate material not only can expand the utility of the model, but can bring about
more advanced uses of these models.
• A clear material, for example, allows the operator to see through the structure and assess
relationships of different chambers.
• Resins with ceramic like-properties or biocompatible resins can simulate hard tissue such as teeth
and bones to allow the operator to practice procedure-specific interventions or drill guide pilot
holes.
 CLINICAL EXAMPLE

Paediatric
• Most 3D printing applications related to congenital heart disease.
- Due to fact that children have smaller chest cavity than adults.
• Surgical treatment much more difficult.
• Helps surgeon in spatial orientation inside the cavities of small infant heart.
- Simulating the surgical approach and steps of operation.
- Leads to shorter intraoperative time that has significant impact on
complication rate, blood loss and reduced costs.
• 15 years old boy with aortic arch hypoplasia.
- Development of 3D heart to improve interventional simulation and
planning in patient.
- Assessment of optimal stent position, size and length was found to be
useful for actual intervention in patient.
 FUTURE APPLICATIONS
• Possible application used today:
Building anatomically accurate models to guide interventions.

• 3D prints made with appropriate materials can be used directly as prosthesis,

positioners or molds to make implants.
- Tissue engineering or bio-printing where complex microporous scaffold is
printed from resin or polylactic acid, polluted by cells derived from patient.
- Cells suspended in hospitable medium can directly printed on scaffold and
allowed to mature.
- Anti-microbial resins allow prosthesis to resist infection.

• Multi-material 3D printing of highly accurate models shown to be

representative hemodynamically of in-vivo anatomy.
- Used to assess implant and valve performance, pressure gradients and flow
velocities.
- Requires careful printing material selection and not validated clinically.
 LIMITATION
• In planning to print a model, available resources, operator involvement and
experience may limited.
- Small volume may better off outsourced to certain companies (that involve in
segmentation and printing).

• 3D model give impression that they highly representative of actual anatomy.

- However, they not validated and not clear how good they match up with changing
in-vivo anatomy.
- So, rigid model not always accurate size or shape representation.
 CONCLUSION

• Applying the technology to introduce previously unavailable avenue for procedural

planning and device development.
- But no common pathway to generate models.

• Barriers to start a program become lower every year with educational activities
specifically aim at promoting this technology.

• Largest limitation would be the time invested in analyzing the images and processing the
model.
- No standardized method to generate the model, make the process more variable.
 REFERENCES

1. https://onlinelibrary.wiley.com/doi/full/10.1111/joic.12446

2. https://journals.viamedica.pl/cardiology_journal/article/view/CJ.a2017.0056/41302

3. https://www.youtube.com/watch?v=6MEz4SE-SU8

4. https://www.hindawi.com/journals/jhe/2019/5340616/
THANK YOU