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      Medical 3D printing for vascular interventions and surgical oncology: a primer for the 2016 radiological society of North America (RSNA) hands-on course in 3D printing

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          Abstract

          Medical 3D printing holds the potential of transforming personalized medicine by enabling the fabrication of patient-specific implants, reimagining prostheses, developing surgical guides to expedite and transform surgical interventions, and enabling a growing multitude of specialized applications. In order to realize this tremendous potential in frontline medicine, an understanding of the basic principles of 3D printing by the medical professionals is required. This primer underlines the basic approaches and tools in 3D printing, starting from patient anatomy acquired through cross-sectional imaging, in this case Computed Tomography (CT). We describe the basic principles using the relatively simple task of separation of the relevant anatomy to guide aneurysm repair. This is followed by exploration of more advanced techniques in the creation of patient-specific surgical guides and prostheses for a patient with extensive pleomorphic sarcoma using Computer Aided Design (CAD) software.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s41205-016-0008-6) contains supplementary material, which is available to authorized users.

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          Most cited references14

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          The Cancer Imaging Archive (TCIA): maintaining and operating a public information repository.

          The National Institutes of Health have placed significant emphasis on sharing of research data to support secondary research. Investigators have been encouraged to publish their clinical and imaging data as part of fulfilling their grant obligations. Realizing it was not sufficient to merely ask investigators to publish their collection of imaging and clinical data, the National Cancer Institute (NCI) created the open source National Biomedical Image Archive software package as a mechanism for centralized hosting of cancer related imaging. NCI has contracted with Washington University in Saint Louis to create The Cancer Imaging Archive (TCIA)-an open-source, open-access information resource to support research, development, and educational initiatives utilizing advanced medical imaging of cancer. In its first year of operation, TCIA accumulated 23 collections (3.3 million images). Operating and maintaining a high-availability image archive is a complex challenge involving varied archive-specific resources and driven by the needs of both image submitters and image consumers. Quality archives of any type (traditional library, PubMed, refereed journals) require management and customer service. This paper describes the management tasks and user support model for TCIA.
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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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              Solitary aneurysms of the iliac arterial system: an estimate of their frequency of occurrence.

              Solitary iliac artery aneurysms are rare, and most reports have been presented as case reports. By combining autopsy records and operating records, a total of 13 cases were found: during a 15-year period (1971 to 1985), 42,010 of the inhabitants of Malmö died (population 230,000) and 35,265 (including 9014 forensic autopsies) underwent autopsy (84%). Solitary iliac artery aneurysms were found in seven (0.03%) of the 26,251 patients who underwent autopsy at the hospital; six of those had been asymptomatic and one was ruptured. Among the 9014 persons who underwent forensic medical autopsy, there were two with ruptured solitary iliac artery aneurysms. Four patients had clinically detected solitary iliac artery aneurysms, three of which were ruptured. All patients underwent surgery, and two of the three patients with ruptured solitary iliac artery aneurysms left the hospital well. The rupture rate of iliac aneurysm among those found at autopsy was one of seven (14%) and among those clinically detected three of four.
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                Author and article information

                Contributors
                leonid.chepelev@gmail.com
                Journal
                3D Print Med
                3D Print Med
                3d Printing in Medicine
                Springer International Publishing (Cham )
                2365-6271
                25 November 2016
                25 November 2016
                2015
                : 2
                : 1
                : 5
                Affiliations
                [1 ]The Ottawa Hospital Research Institute and the Department of Radiology, University of Ottawa, 501 Smyth Road, Box 232, Ottawa, Ontario K1H 8L6 Canada
                [2 ]Faculty of Medicine, University of Ottawa, Ottawa, Canada
                [3 ]Department of Radiology, Applied Imaging Science Lab, Brigham and Women’s Hospital, Boston, MA USA
                Author information
                http://orcid.org/0000-0001-7010-3812
                Article
                8
                10.1186/s41205-016-0008-6
                6036767
                fd4b88a9-e66d-438d-a653-ffa10ff6605c
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 12 October 2016
                : 21 October 2016
                Categories
                Technical Note
                Custom metadata
                © The Author(s) 2016

                3d printing,aneurysm repair,cancer,segmentation,computer-aided design,orthopedic surgery,implant,surgical guide,radiological society of north america,precision medicine

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