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      The Use of 3D Printed Vasculature for Simulation-based Medical Education Within Interventional Radiology

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          Abstract

          Three-dimensional (3D) printing has become a useful tool within the field of medicine as a way to produce custom anatomical models for teaching, surgical planning, and patient education. This technology is quickly becoming a key component in simulation-based medical education (SBME) to teach hands-on spatial perception and tactile feedback. Within fields such as interventional radiology (IR), this approach to SBME is also thought to be an ideal instructional method, providing an accurate and economical means to study human anatomy and vasculature. Such anatomical details can be extracted from patient-specific and anonymized CT or MRI scans for the purpose of teaching or analyzing patient-specific anatomy. There is evidence that 3D printing in IR can also optimize procedural training, so learners can rehearse procedures under fluoroscopy while receiving immediate supervisory feedback. Such training advancements in IR hold the potential to reduce procedural operating time, thus reducing the amount of time a patient is exposed to radiation and anaesthetia.

          Using a program evaluation approach, the purpose of this technical report is to describe the development and application of 3D-printed vasculature models within a radiology interest group to determine their efficacy as supplementary learning tools to traditional, lecture-based teaching. The study involved 30 medical students of varying years in their education, involved in the interest group at Memorial University of Newfoundland (MUN). The session was one hour in length and began with a Powerpoint presentation demonstrating the insertion of guide wires and stents using 3D-printed vasculature models. Participants had the opportunity to use the models to attempt several procedures demonstrated during the lecture. These attempts were supervised by an educational expert/facilitator.

          A survey was completed by all 30 undergraduate medical students and returned to the facilitators, who compiled the quantitative data to evaluate the efficacy of the 3D-printed models as an adjunct to the traditional didactic teaching within IR. The majority of feedback was positive, supporting the use of 3D=printed vasculature as an additional tactile training method for medical students within an IR academic setting. The hands-on experience provides a valuable training approach, with more opportunities for the rehearsal of high-acuity, low-occurrence (HALO) procedures performed in IR.

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          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.
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            Randomised, controlled study investigating the optimal instructor: student ratios for teaching suturing skills.

            Recently, there has been a shift away from practising procedures on patients for the first time and towards bench model teaching of clinical skills to undergraduate medical students. However, guidelines for the most effective instructor : student ratio for technical skills training are unclear. This has important implications for staffing laboratory based teaching sessions. The purpose of this study was to assess the optimal ratio of teachers to learners during the teaching of a simulated wound closure. A total of 108 undergraduate medical students participated in a 1-hour course on wound closure. They were randomised to 3 groups, each with a different instructor:student ratio (Group A: 6-12; Group B: 3-12; Group C: 1-12). Students were evaluated on a pre-test, an immediate post-test and a delayed retention test using an objective, computer-based technical skills assessment method. Collectively termed the "economy of movements", the total time taken to complete the task and the number of movements executed were the primary outcome measures. Improvements in the economy of movements were the same for Groups A and B and were better than in Group C (P < 0.005). The optimal instructor:student ratio was 1 instructor for 4 students. Higher ratios of instructors to students resulted in no improvements in learning, and lower ratios of instructors to students resulted in significantly less learning. These findings are in keeping with current motor learning theories.
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              Precise treatment of aortic aneurysm by three-dimensional printing and simulation before endovascular intervention

              In this study, three-dimensional printing (3Dp) models and simulation surgeries (SSs) were applied in two challenging aortic cases. The first was an abdominal aortic aneurysm with a complex neck, and the second was a thoracic aortic dissection aneurysm (TADA) with an angled arch. In order to avoid unpredictable obstacles and difficulties, we made optimal surgical plans by using 3D models and virtual simulations. Based on preoperative evaluation system, the surgical plans seemed more reasonable and time-saving.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                3 April 2019
                April 2019
                : 11
                : 4
                : e4381
                Affiliations
                [1 ] Medical Education and Simulation, Memorial University of Newfoundland, St. John's, CAN
                [2 ] Radiology, University of Saskatchewan College of Medicine, Saskatoon, USA
                [3 ] Otolaryngology, University of Ottawa, Ottawa, CAN
                [4 ] Radiology, Memorial University of Newfoundland, St. John's, CAN
                [5 ] Emergency Medicine, Memorial University of Newfoundland, St. John's, CAN
                Author notes
                Article
                10.7759/cureus.4381
                6553672
                ad358a24-d8a8-4e4c-ab17-24e2c9f5c1ed
                Copyright © 2019, Goudie et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 24 October 2018
                : 2 April 2019
                Categories
                Medical Education
                Medical Simulation
                Radiology

                simulation,vasculature,3d printing,medical education,radiology,interventional radiology,simulation based medical education,point of care,health care

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