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      Rapid prototyping compliant arterial phantoms for in- vitro studies and device testing

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          Abstract

          Background

          Compliant vascular phantoms are desirable for in- vitro patient-specific experiments and device testing. TangoPlus FullCure 930® is a commercially available rubber-like material that can be used for PolyJet rapid prototyping. This work aims to gather preliminary data on the distensibility of this material, in order to assess the feasibility of its use in the context of experimental cardiovascular modelling.

          Methods

          The descending aorta anatomy of a volunteer was modelled in 3D from cardiovascular magnetic resonance (CMR) images and rapid prototyped using TangoPlus. The model was printed with a range of increasing wall thicknesses (0.6, 0.7, 0.8, 1.0 and 1.5 mm), keeping the lumen of the vessel constant. Models were also printed in both vertical and horizontal orientations, thus resulting in a total of ten specimens. Compliance tests were performed by monitoring pressure variations while gradually increasing and decreasing internal volume. Knowledge of distensibility was thus derived and then implemented with CMR data to test two applications. Firstly, a patient-specific compliant model of hypoplastic aorta suitable for connection in a mock circulatory loop for in- vitro tests was manufactured. Secondly, the right ventricular outflow tract (RVOT) of a patient necessitating pulmonary valve replacement was printed in order to physically test device insertion and assess patient’s suitability for percutaneous pulmonary valve intervention.

          Results

          The distensibility of the material was identified in a range from 6.5 × 10 -3 mmHg -1 for the 0.6 mm case, to 3.0 × 10 -3 mmHg -1 for the 1.5 mm case. The models printed in the vertical orientation were always more compliant than their horizontal counterpart. Rapid prototyping of a compliant hypoplastic aorta and of a RVOT anatomical model were both feasible. Device insertion in the RVOT model was successful.

          Conclusion

          Values of distensibility, compared with literature data, show that TangoPlus is suitable for manufacturing arterial phantoms, with the added benefit of being compatible with PolyJet printing, thus guaranteeing representative anatomical finishing, and quick and inexpensive fabrication. The appealing possibility of printing models of non-uniform wall thickness, resembling more closely certain physiological scenarios, can also be explored. However, this material appears to be too stiff for modelling the more compliant systemic venous system.

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          Most cited references37

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          Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension.

          Decreased total compliance of the pulmonary vascular bed is associated with increased mortality in patients with pulmonary arterial hypertension (PAH). We investigated whether proximal pulmonary artery stiffness, in terms of area distensibility and noninvasively assessed relative area change (RAC), calculated as relative cross-sectional area change, predicts mortality in patients with PAH. Eighty-six subjects underwent right-heart catheterization and MRI to assess area distensibility and RAC. Patients were followed up to 48 months. Kaplan-Meier plot and Cox proportional hazards regression analyses assessed the predictive value of area distensibility and RAC. In 70 patients, the diagnosis PAH was confirmed, and 16 subjects served as control subjects. In comparison with control subjects, proximal pulmonary arteries of patients were distended (685 +/- 214 mm2 vs 411 +/- 153 mm2, p 16% (log-rank p < 0.001). RAC predicted mortality better than area distensibility. Noninvasively measured pulmonary artery RAC predicts mortality in patients with PAH.
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            Dimensional error of selective laser sintering, three-dimensional printing and PolyJet models in the reproduction of mandibular anatomy.

            Selective laser sintering (SLS), three-dimensional printing (3DP) and PolyJet are rapid prototyping (RP) techniques to fabricate prototypes from virtual biomedical images. To be used in maxillofacial surgery, these models must accurately reproduce the craniofacial skeleton. To analyze the capacity of SLS, 3DP and PolyJet models to reproduce mandibular anatomy and their dimensional error. Dry mandible, helical CT images, SLS, 3DP and PolyJet prototypes, and digital electronic caliper. Helical CT images were acquired from a dry mandible (criterion standard) and manipulated with the InVesalius software. Prototypes were produced using SLS, 3DP and PolyJet techniques. Thirteen linear measurements of each prototype were made and compared with the dry mandible measurements. The results showed a dimensional error of 1.79%, 3.14% and 2.14% for SLS, 3DP and PolyJet models, respectively. The models satisfactorily reproduced anatomic details and the SLS and PolyJet prototypes showed greater dimensional precision and reproduced mandibular anatomy more accurately than the 3DP model. The SLS prototype had a greater dimensional accuracy than the PolyJet and 3DP models. The PolyJet technique reproduced anatomic details of the mandible more accurately.
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              Percutaneous pulmonary valve implantation based on rapid prototyping of right ventricular outflow tract and pulmonary trunk from MR data.

              To determine if magnetic resonance (MR) imaging data can be used to create rigid models that are accurate representations of the right ventricular outflow tract (RVOT) and pulmonary trunk anatomy and if such models can be used to refine the selection of patients for percutaneous pulmonary valve implantation (PPVI). Institutional review board approval and informed patient consent were obtained. Twelve patients' MR data were analyzed and elaborated for input into a rapid prototyping (RP) system. RP models were successfully built and presented to two experienced cardiologists, who were retrospectively asked if they would have attempted PPVI. Their responses were compared with the documented decisions and outcomes of PPVI. For four subjects, both cardiologists correctly determined, on the basis of MR image or three-dimensional (3D) RP model findings, that PPVI should not have been attempted. Two patients in whom PPVI was attempted were considered to be unsuitable for the procedure after balloon sizing, and in another two patients, implantation was unsuccessful because of device instability. For the four patients in whom PPVI was suitable and the four in whom it was unsuitable, observers 1 and 2 correctly determined suitability for PPVI in four and two patients, respectively, by using the MR images alone. Both observers correctly determined the suitability of five patients by using the 3D models alone. Using 3D RP models resulted in more accurate selection of patients for PPVI than did using MR images. (c) RSNA, 2007.
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                Author and article information

                Journal
                J Cardiovasc Magn Reson
                J Cardiovasc Magn Reson
                Journal of Cardiovascular Magnetic Resonance
                BioMed Central
                1097-6647
                1532-429X
                2013
                16 January 2013
                : 15
                : 1
                : 2
                Affiliations
                [1 ]Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, NHS Trust, London, UK
                [2 ]Materialise NV, Biomedical Engineering Business Unit, Leuven, Belgium
                Article
                1532-429X-15-2
                10.1186/1532-429X-15-2
                3564729
                23324211
                e7e4283c-f260-423f-a00f-0a2e6d232a99
                Copyright ©2013 Biglino et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 9 July 2012
                : 17 December 2012
                Categories
                Technical Notes

                Cardiovascular Medicine
                rapid prototyping,polyjet,phantoms,compliance,tangoplus fullcure®
                Cardiovascular Medicine
                rapid prototyping, polyjet, phantoms, compliance, tangoplus fullcure®

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