Current State and Outlook in Medical 3D Printing and the Role of Radiology

Anna Streckenbach; Niklas Schubert; Felix Streckenbach; Tobias Dust; Ngoc Tuan Ngo; Jens Fiehler; Martin Munz; Ida Hueners; Philipp Schneider; Thorsten Frenzel; Elisabetta Gargioni; Marie Wegner; Shih-Jan Chin; Lennart Well; Gerhard Adam; Mathias Meyer

doi:10.1055/a-2436-7185

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Table of Contents

Rofo
DOI: 10.1055/a-2436-7185

Review

Current State and Outlook in Medical 3D Printing and the Role of Radiology

Article in several languages: English | deutsch

Anna Streckenbach

¹Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

²University Center of 3D printing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Niklas Schubert

¹Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Felix Streckenbach

³Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, Rostock University Medical Center, Rostock, Germany (Ringgold ID: RIN39071)

,

Tobias Dust

⁴Department Trauma Surgery and Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

²University Center of 3D printing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Ngoc Tuan Ngo

⁵Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

²University Center of 3D printing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Jens Fiehler

⁵Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Martin Munz

⁶University Heart & Vascular Center Hamburg, Children’s Heart Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

²University Center of 3D printing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Ida Hueners

⁶University Heart & Vascular Center Hamburg, Children’s Heart Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

²University Center of 3D printing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Philipp Schneider

⁶University Heart & Vascular Center Hamburg, Children’s Heart Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

²University Center of 3D printing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Thorsten Frenzel

⁷Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

²University Center of 3D printing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Elisabetta Gargioni

⁷Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

²University Center of 3D printing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Marie Wegner

⁷Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

⁸Institute of Product Development and Mechanical Engineering Design, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

²University Center of 3D printing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Shih-Jan Chin

⁹Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

²University Center of 3D printing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Lennart Well

¹Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Gerhard Adam

¹Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

²University Center of 3D printing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

,

Mathias Meyer

¹Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Ringgold ID: RIN37734)

› Author Affiliations

Abstract

Background

Medical three-dimensional (3D) printing is playing an increasingly important role in clinical practice. The use of 3D printed models in patient care offers a wide range of possibilities in terms of personalized medicine, training and education of medical professionals, and communication with patients. DICOM files from imaging modalities such as CT and MRI provide the basis for the majority of the 3D models in medicine. The image acquisition, processing, and interpretation of these lies within the responsibility of radiology, which can therefore play a key role in the application and further development of 3D printing.

The purpose of this review article is to provide an overview of the principles of 3D printing in medicine and summarize its most important clinical applications. It highlights the role of radiology as central to developing and administering 3D models in everyday clinical practice.

Methods

This is a narrative review article on medical 3D printing that incorporates expert opinions based on the current literature and practices from our own medical centers.

Results/Conclusion

While the use of 3D printing is becoming increasingly established in many medical specialties in Germany and is finding its way into everyday clinical practice, centralized “3D printing labs” are a rarity in Germany but can be found internationally. These labs are usually managed by radiology departments, as radiology is a connecting discipline that – thanks to the imaging technology used to produce data for 3D printing – can play a leading role in the application of medical 3D printing. Copying this approach should be discussed in Germany in order to efficiently use the necessary resources and promote research and development in the future.

Key Points

3D printing in medicine is a rapidly growing field.
Image acquisition and processing provides an important basis for high-quality 3D models.
Radiology, as the specialist discipline responsible for imaging, has a crucial role to play.
Radiology should play a leading role in the introduction of 3D printing in everyday clinical practice.

Citation Format

Streckenbach A, Schubert N, Streckenbach F et al. Current State and Outlook in Medical 3 D Printing and the Role of Radiology. Fortschr Röntgenstr 2024; DOI 10.1055/a-2436-7185

Keywords

radiology - three-dimensional printing - 3D-print - additive manufacturing - personalized medicine - preoperative planning

Full Text

References

References
1 Herzog J, Franke L, Lai Y. et al. 3D bioprinting of microorganisms: principles and applications. Bioprocess Biosyst Eng 2024; 47: 443-461
2 Sekar MP, Suresh S, Zennifer A. et al. Hyaluronic Acid as Bioink and Hydrogel Scaffolds for Tissue Engineering Applications. ACS Biomater Sci Eng 2023; 9: 3134-3159
3 van Eijnatten M, van Dijk R, Dobbe J. et al. CT image segmentation methods for bone used in medical additive manufacturing. Med Eng Phys 2018; 51: 6-16
4 Hussain T, Lossnitzer D, Bellsham-Revell H. et al. Three-dimensional dual-phase whole-heart MR imaging: Clinical implications for congenital heart disease. Radiology 2012; 263: 547-554
5 Well L, Weinrich JM, Meyer M. et al. Sensitivity of high-pitch dual-source computed tomography for the detection of anomalous pulmonary venous connection in infants. Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgeb. Verfahren 2021; 193: 551-558
6 Hussain T, Mathur S, Peel SA. et al. Coronary artery size and origin imaging in children: A comparative study of MRI and trans-thoracic echocardiography. BMC Med Imaging 2015; 15: 48
7 Byrne N, Velasco Forte M, Tandon A. et al. A systematic review of image segmentation methodology, used in the additive manufacture of patient-specific 3D printed models of the cardiovascular system. JRSM Cardiovasc Dis 2016; 5: 2048004016645467
8 Mahesh M. The AAPM/RSNA physics tutorial for residents: Search for isotropie resolution in CT from conventional through multiple-row detector. Radiographics 2002; 22: 949-962
9 Kozakiewicz M, Elgalal M, Loba P. et al. Clinical application of 3D pre-bent titanium implants for orbital floor fractures. J Craniomaxillofac Surg 2009; 37: 229-234
10 Boedeker KL, Cooper VN, McNitt-Gray MF. Application of the noise power spectrum in modern diagnostic MDCT: Part I. Measurement of noise power spectra and noise equivalent quanta. Phys Med Biol 2007; 52: 4027-4046
11 Leng S, McGee K, Morris J. et al. Anatomic modeling using 3D printing: Quality assurance and optimization. 3D Print Med 2017; 3: 6
12 McCollough CH, Leng S, Yu L. et al. Dual- and multi-energy CT: Principles, technical approaches, and clinical applications. Radiology 2015; 276: 637-653
13 Marcus RP, Morris JM, Matsumoto JM. et al. Implementation of iterative metal artifact reduction in the pre-planning-procedure of three-dimensional physical modeling. 3D Print Med 2017; 3: 5
14 Velasco Forte MN, Byrne N, Valverde I Perez. et al. 3D printed models in patients with coronary artery fistulae: Anatomical assessment and interventional planning. EuroIntervention 2017; 13: e1080-e1083
15 Velasco Forte MN, Byrne N, Valverde I. et al. Interventional Correction of Sinus Venosus Atrial Septal Defect and Partial Anomalous Pulmonary Venous Drainage: Procedural Planning Using 3D Printed Models. JACC Cardiovasc Imaging 2018; 11: 275-278
16 Haleem A, Javaid M, Suman R. et al. 3D Printing Applications for Radiology: An Overview. Indian J Radiol Imaging 2021; 31: 10-17
17 Kamio T, Suzuki M, Asaumi R. et al. DICOM segmentation and STL creation for 3D printing: A process and software package comparison for osseous anatomy. 3D Print Med 2020; 6: 17
18 Hiller JD, Lipson H. STL 2.0: A proposal for a universal multi-material Additive Manufacturing File format. 20th Annu. Int. Solid Free. Fabr. Symp. SFF 2009 2009; 266-278
19 Gardiner JD, Behnsen J, Brassey CA. Alpha shapes: Determining 3D shape complexity across morphologically diverse structures. BMC Evol Biol 2018; 18: 184
20 Rischen R, Jürgensen L, Schulze M. Erratum: Medizinischer 3D-Druck und die Rolle der Radiologie. Fortschritte auf dem Gebiet der Röntgenstrahlen und der Bildgeb. Verfahren 2022; 194: e1-e1
21 Wickramasinghe S, Do T, Tran P. FDM-Based 3D printing of polymer and associated composite: A review on mechanical properties, defects and treatments. Polymers (Basel) 2020; 12: 1529
22 Gurr M, Mülhaupt R. 8.04 – Rapid Prototyping. Polymer Science: A Comprehensive Reference 2012; 8: 77-99
23 Pravdivtseva MS, Peschke E, Lindner T. et al. 3D-printed, patient-specific intracranial aneurysm models: From clinical data to flow experiments with endovascular devices. Med Phys 2021; 48: 1469-1484
24 Li Z, Wang Q, Liu G. A Review of 3D Printed Bone Implants. Micromachines (Basel) 2022; 13: 528
25 Kono K, Shintani A, Okada H. et al. Preoperative simulations of endovascular treatment for a cerebral aneurysm using a patient-specific vascular silicone model. Neurol Med Chir (Tokyo) 2013; 53: 347-351
26 Waran V, Devaraj P, Hari Chandran T. et al. Three-dimensional anatomical accuracy of cranial models created by rapid prototyping techniques validated using a neuronavigation station. J Clin Neurosci 2012; 19: 574-577
27 Paetow H, Streckenbach F, Brandt-Wunderlich C. et al. Development of a bioresorbable self-expanding microstent for interventional applications – An innovative approach for stent-assisted coiling. Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgeb. Verfahren 2024; 196: 714-725
28 Pucci JU, Christophe BR, Sisti JA. et al. Three-dimensional printing: Technologies, applications, and limitations in neurosurgery. Biotechnol Adv 2017; 35: 521-529
29 Habib A, Jovanovich N, Muthiah N. et al. 3D printing applications in spine surgery: An evidence-based assessment toward personalized patient care. Eur Spine J 2022; 31: 1682-1690
30 Lee YC, Kim SG. Redefining precision and efficiency in orthognathic surgery through virtual surgical planning and 3D printing: A narrative review. Maxillofac Plast Reconstr Surg 2023; 45: 42
31 Zoabi A, Redenski I, Oren D. et al. 3D Printing and Virtual Surgical Planning in Oral and Maxillofacial Surgery. J Clin Med 2022; 11: 2385
32 Hsieh TY, Dedhia R, Cervenka B. et al. 3D Printing: Current use in facial plastic and reconstructive surgery. Curr Opin Otolaryngol Head Neck Surg 2017; 25: 291-299
33 Nyberg EL, Farris AL, Hung BP. et al. 3D-Printing Technologies for Craniofacial Rehabilitation, Reconstruction, and Regeneration. Ann Biomed Eng 2017; 45: 45-57
34 Shabbak A, Masoumkhani F, Fallah A. et al. 3D Printing for Cardiovascular Surgery and Intervention: A Review Article. Curr Probl Cardiol 2024; 49: 102086
35 Verghi E, Catanese V, Nenna A. et al. 3D Printing in Cardiovascular Disease: Current Applications and Future Perspectives. Surg Technol Int 2021; 38: 314-324
36 Shah D, Naik L, Paunipagar B. et al. Setting Up 3D Printing Services for Orthopaedic Applications: A Step-by-Step Guide and an Overview of 3DBioSphere. Indian J Orthop 2020; 54: 217-227
37 Du H, Tian XX, Li T Sen. et al. Use of patient-specific templates in hip resurfacing arthroplasty: Experience from sixteen cases. Int Orthop 2013; 37: 777-782
38 Dust T, Hartel MJ, Henneberg JE. et al. The influence of 3D printing on inter- and intrarater reliability on the classification of tibial plateau fractures. Eur J Trauma Emerg Surg 2023; 49: 189-199
39 Bellanova L, Paul L, Docquier PL. Surgical guides (Patient-Specific Instruments) for pediatric tibial bone sarcoma resection and allograft reconstruction. Sarcoma 2013; 2013: 787653
40 Wegner M, Frenzel T, Krause D. et al. Development and characterization of modular mouse phantoms for end-to-end testing and training in radiobiology experiments. Phys Med Biol 2023; 68
41 Wegner M, Gargioni E, Krause D. Indirectly additive manufactured deformable bladder model for a pelvic radiotherapy phantom. Transactions on Additive Manufacturing Meets Medicine 2021; 3: 498
42 Sands G, Clark CH, McGarry CK. A review of 3D printing utilisation in radiotherapy in the United Kingdom and Republic of Ireland. Physica Medica 2023; 115: 103143
43 Santoni S, Gugliandolo SG, Sponchioni M. et al. 3D bioprinting: Current status and trends—a guide to the literature and industrial practice. Bio-des. Manuf 2022; 5: 14-42
44 Zhu W, Ma X, Gou M. et al. 3D printing of functional biomaterials for tissue engineering. Curr Opin Biotechnol 2016; 40: 103-112
45 Bhandari S, Yadav V, Ishaq A. et al. Trends and Challenges in the Development of 3D-Printed Heart Valves and Other Cardiac Implants: A Review of Current Advances. Cureus 2023; 15: e43204
46 SME Medical Additive Manufacturing/3D Printing Workgroup. Society for Manufacturing Engineers website. Accessed January 30, 2024 at: https://www.sme.org/medical-am3dp-workgroup
47 RSNA 3D Printing Special Interest Group. Radiological Society of North America website. Accessed November 13, 2023 at: https://www.rsna.org
48 Edri R, Gal I, Noor N. et al. Personalized Hydrogels for Engineering Diverse Fully Autologous Tissue Implants. Adv Mater 2019; 31: e1803895
49 Trace AP, Ortiz D, Deal A. et al. Radiology’s Emerging Role in 3D Printing Applications in Health Care. J Am Coll Radiol 2016; 13: 856-862.e4
50 Ogden KM, Aslan C, Ordway N. et al. Factors Affecting Dimensional Accuracy of 3-D Printed Anatomical Structures Derived from CT Data. J Digit Imaging 2015; 28: 654-63