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Setting up a biomodeling, virtual planning, and three-dimensional printing service in Uruguay

PEDIATRIC RADIOLOGY 2024年第3期54卷 438-449页

作者： Zabala-Travers, Silvina Garcia-Bayce, Andres Ctr Hosp Pereira Rossell Dept Imagenol Bulevar Artigas 1550 Montevideo 11300 Uruguay

Virtual surgical planning and three-dimensional (D) printing are rapidly becoming essential for challenging and complex surgeries around the world. An Ibero-American survey reported a lack of awareness of technology benefits and scarce financial resources as the two main barriers to widespread adoption of 3-D technologies. The Pereira Rossell Hospital Center is a publicly funded maternal and pediatric academic clinical center in Uruguay, a low-resource Latin American country, that successfully created and has been running a 3-D unit for 4 years. The present work is a step-by-step review of the 3-D technology implementation process in a hospital with minimal financial investment. References to training, software, hardware, and the management of human resources are included. Difficulties throughout the process and future challenges are also discussed.

关键词： Child computer-assisted three-dimensional imaging Latin America Point of care technology Printing Software Surgery

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computer-aided reconstruction of the facial skeleton. Planning and implementation in clinical routine

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HNO 2016年第9期64卷 641-649页

作者： Wilde, F. Schramm, A. Univ Ulm Akad Krankenhaus Bundeswehrkrankenhaus Ulm Mund Kiefer & Plast Gesichtschirurg Oberer Eselsberg 40 D-89081 Ulm Germany

In computer-aided reconstruction of the facial skeleton, a workflow has been established involving the following steps: > diagnosis -> planning and simulation -> surgical procedure -> validation and quality control <. In addition to clinical findings, the focus of diagnosis is on three-dimensional (3D) imaging, particularly computed tomography. Planning and simulation involves creation of a virtual model of the desired surgical outcome using special planning software. The accuracy of implant fit can be virtually verified before surgery. 3D models and virtual reconstructions can be used for manufacturing patient-specific implants. During the surgical procedure, planning must be transferred to the surgical site as accurately as possible. A number of techniques are available for this purpose, e. g., closed reduction, open reduction with the placement of anatomically preformed or patient-specific implants in combination with surgical guides, and the additional use of navigation. Validation and quality control require postprocedural 3D imaging. After reconstructions of the midface, 3D imaging should be performed even before surgery is completed. Malpositions can thus be directly corrected and unnecessary open reconstructions avoided. Mobile 3D c-arms are particularly useful for intraoperative 3D imaging. Whereas intraoperative imaging makes postoperative imaging after midface reconstruction unnecessary in many cases, postoperative 3D imaging in addition to intraoperative imaging may still be recommended after complex reconstructions of the facial skeleton.

关键词： computer-aided surgery Orbital implants Navigation CAD/CAM computer-assisted three-dimensional imaging

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Anterior loop of the mental nerve, mental foramen and incisive nerve emergency: tridimensional assessment and surgical applications

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SURGICAL AND RADIOLOGIC ANATOMY 2017年第2期39卷 169-175页

作者： Carlos Prados-Frutos, Juan Salinas-Goodier, Carmen Manchon, Angel Rojo, Rosa Rey Juan Carlos Univ Dept Med & Surg Fac Hlth Sci Stomatol Unit Avda Atenas S-N Madrid 28922 Spain

The aim of this study was to investigate the prevalence and length of the anterior loop (AL), the distance from this landmark to the alveolar crest and its relation with the shape of the foramen and emergency pattern in the Spanish population on helical computed tomography scan (helical CT scan) through tridimensional reconstructions. Helical CT scan images of 41 patients aged 65 or older were analyzed. A total of 82 human hemi-mandibles were examined in this study. A tridimensional reconstruction of each mandible and Inferior Alveolar Nerve canal was created in AMIRA(A (R)) software (AMIRA, Mercury computer Systems, Berlin, Germany). Prevalence, length and distance between the AL, mental foramen and alveolar ridge were measured. This retrospective observational study was performed according to the STROBE guidelines. Prevalence of the AL was 53.7 % (n = 44) and the mean length was 1.3 +/- 0.64 mm. The mean distance from the highest point of the loop to the alveolar ridge was 13.4 +/- 2.8 mm. The mean diameter of the mental foramen was 3.5 +/- 0.65 mm and the proportion of the oval-shaped was 62.2 % (n = 51) and round-shaped was 37.8 % (n = 31). The study found that patients with type 1 pattern emergency pattern had a higher prevalence of the AL (p = 0.03). Prevalence, location and length of the anterior loop can be overlooked if only two-dimensional pre-surgical studies are performed. Therefore, three-dimensional imaging and modeling of anatomic structures should be used for the pre-operative examination of the interforaminal area. Given the wide variability of the emergency pattern of the mental nerve and the prevalence and location of the anterior loop, it should be studied in every patient individually.

关键词： computer-assisted three-dimensional imaging Cross-sectional anatomy Inferior alveolar nerve Anterior loop Mental canal Preoperative implant planning

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Prevalence and location of accessory foramina in the human mandible

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ORAL RADIOLOGY 2016年第2期32卷 72-78页

作者： Salinas-Goodier, Carmen Manchon, Angel Rojo, Rosa Coquerelle, Michael Sammartino, Gilberto Carlos Prados-Frutos, Juan Rey Juan Carlos Univ Dept Stomatol Ave Atenas S-N Madrid 28922 Spain Univ Naples Federico II Dept Stomatol & Maxillofacial Surg Corso Umberto 140 I-80138 Naples Italy

Objective This study aimed to radiographically assess the prevalence and location of accessory foramina in the human mandible using helical computed tomography (CT) images and three-dimensional reconstructions. Methods Helical CT images from 24 males and 22 females aged 66-88 years (mean age: 73.7 +/- 5.3 years) were observed. Each image was assessed in the three anatomical planes, and three-dimensional reconstructions were performed with Amira 5.6 software. Results All subjects (n = 46) presented at least one accessory foramina. A lingual foramen was the most frequently observed foramen and present in 96 % (n = 44) of subjects. Mandibular anterior nutrient canals were clearly observed in 72 % (n = 33) of subjects (71 %, n = 17, of males;73 %, n = 16, of females). A retromolar foramen was present in 17 % (n = 8) of subjects (21 %, n = 5, of males;14 %, n = 3, of females). A double mental foramen (DMF) was present in only one subject (2 %). Fifty percent (n = 23) of subjects presented one or more inferior retromental foramen (IRF). No significant correlations were observed between prevalences of accessory foramina and sex. Conclusions The lingual foramen can be considered a constant finding, and mandibular anterior nutrient canal foramina and IRF were present in the majority of subjects. Retromolar foramina and DMF were less common but can be associated with anesthetic failures and oral surgery complications. three-dimensional reconstructions provided better understanding of the locations of foramina and their interrelations with the anatomy of the jaw.

关键词： Accessory foramina Anesthesia computer-assisted three-dimensional imaging Mandible Helical computed tomography

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Evaluation of reproducibility and reliability of 3D soft tissue analysis using 3D stereophotogrammetry

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INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY 2009年第3期38卷 267-273页

作者： Plooij, J. M. Swennen, G. R. J. Rangel, F. A. Maal, T. J. J. Schutyser, F. A. C. Bronkhorst, E. M. Kuijpers-Jagtman, A. M. Berge, S. J. Radboud Univ Nijmegen Med Ctr Dept Oral & Maxillofacial Surg Facial Imaging Res Grp Nijmegen Bruges 3D NL-6500 HB Nijmegen 590 Netherlands Radboud Univ Nijmegen Med Ctr Dept Orthodont & Oral Biol NL-6500 HB Nijmegen 590 Netherlands Gen Hosp St Jan Dept Surg Div Maxiilofacial Surg Brugge Belgium Radboud Univ Nijmegen Med Ctr Dept Prevent & Curat Dent NL-6500 HB Nijmegen 590 Netherlands

In 3D photographs the bony structures are neither available nor palpable, therefore, the bone-related landmarks, such as the soft tissue gonion, need to be redefined. The purpose of this study was to determine the reproducibility and reliability of 49 Soft tissue landmarks, including newly defined 3D bone-related soft tissue landmarks with the use of 3D stereophotogrammetric images. Two observers carried Out soft-tissue analysis on 3D photographs twice for 20 patients. A reference frame and 49 landmarks were identified on each 3D photograph. Paired Student's t-test was used to test the reproducibility and Pearson's Correlation coefficient to determine the reliability of the landmark identification. Intra- and interobserver reproducibility of the landmarks were high. The study showed a high reliability coefficient for intraobserver (0.97 (0.90 0.99)) and interobserver reliability (0.94 (0.69 0.99)), Identification of the landmarks in the midline was more precise than identification of the paired landmarks. In conclusion, the redefinition of bone-related soft tissue 3D landmarks in combination with the 3D photograph reference system resulted in an accurate and reliable 3D photograph based soft tissue analysis. This shows that hard tissue data are not needed to perform accurate soft tissue analysis.

关键词： cephalometry 3D stereophotogrammetry orthodontics maxillofacial surgery reproducibility computer-assisted three-dimensional imaging

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computer-assisted reconstruction of the facial skeleton

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HNO 2011年第8期59卷 800-806页

作者： Schramm, A. Wilde, F. Univ Ulm Bundeswehrkrankenhaus Ulm Akad Krankenhaus D-89081 Ulm Germany

Injury to the facial skeleton may result not only in aesthetic but also functional deficits. computer-assisted surgery promises predictable reconstructive results. In clinical routine the authors use the combination of preoperative planning, intraoperative navigation and intraoperative imaging to treat complex facial trauma. With preoperative planning the intended reconstructive results can be precisely preplanned and guided intraoperatively using navigational surgery. Intraoperative imaging achieves the final intraoperative validation. Using computer-assisted surgery dislocation and malformation of fragments and transplants can be avoided in facial reconstruction. This means reliable quality control of surgical outcome and the number of further surgeries can be reduced in this complex reconstructive surgery.

关键词： computer-assisted surgery Facial reconstruction Traumatology Intraoperative navigation computer-assisted three-dimensional imaging

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Evaluation of Swallowing Using 320-Detector-Row Multislice CT. Part I: Single- and Multiphase Volume Scanning for three-dimensional Morphological and Kinematic Analysis

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DYSPHAGIA 2011年第2期26卷 99-107页

作者： Fujii, Naoko Inamoto, Yoko Saitoh, Eiichi Baba, Mikoto Okada, Sumiko Yoshioka, Satoshi Nakai, Toshiaki Ida, Yoshihiro Katada, Kazuhiro Palmer, Jeffrey B. Fujita Hlth Univ Sch Med Dept Radiol Aichi 4701192 Japan Fujita Hlth Univ Sch Hlth Sci Fac Rehabil Aichi 4701192 Japan Fujita Hlth Univ Sch Med Dept Rehabil Aichi 4701192 Japan Fujita Hlth Univ Sch Med Dept Otorhinolaryngol Aichi 4701192 Japan Fujita Hlth Univ Hosp Dept Radiol Aichi Japan Johns Hopkins Univ Hosp Dept Phys Med & Rehabil Dept Otolaryngol Head & Neck Surg Baltimore MD 21287 USA Johns Hopkins Univ Ctr Funct Anat & Evolut Baltimore MD 21287 USA

A 320-detector-row multislice computed tomography (320-MSCT) scanner can acquire a volume data set covering a maximum range of 16 cm and can generate axial images 0.5-mm thick at 0.5-mm intervals. three-dimensional (3D) images reconstructed from the thin axial slices include multiplanar reconstruction and 3D-CT. Single-phase 3D images are reconstructed from 0.175-s data, and multiphase 3D images are created in 29 phases at intervals of 0.1 s. Continuous replay of these 3D images produces four-dimensional moving images. In order to determine the feasibility of the morphologic and kinematic analyses of swallowing using 320-MSCT, single-phase volume scanning was performed on three patients and multiphase volume scanning was performed on one healthy volunteer. The single-phase 3D images clearly and accurately showed the structures involved in swallowing, and the multiphase 3D images were able to show the oral stage to the early esophageal stage of swallowing, allowing a kinematic analysis of swallowing. We developed a reclining chair that allows scanning to be performed with the subject in a semisitting position, which makes swallowing evaluation by 320-MSCT applicable not only to research on healthy swallowing but also to the clinical examination of dysphagia patients.

关键词： Swallowing Computed tomography 320-detector row Volume scanning Multiplanar image reconstruction computer-assisted three-dimensional imaging Deglutition Deglutition disorders

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Facial landmark localization by curvature maps and profile analysis

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HEAD & FACE MEDICINE 2014年第1期10卷 1-7页

作者： Lippold, Carsten Liu, Xiang Wangdo, Kim Drerup, Burkhard Schreiber, Kristina Kirschneck, Christian Moiseenko, Tatjana Danesh, Gholamreza Univ Med Ctr Muenster Dept Orthodont D-48149 Munster Germany Nanyang Technol Univ MAE MOM Singapore 639798 Singapore Univ Tecn Lisboa Fac Motricidade Humana CIPER LBMFSPERTLAB P-1499002 Lisbon Portugal Bundesfachschule F Orthopaedietech BUFA D-44135 Dortmund Germany Dent Clin Witten Herdecke Dept Orthodont D-58448 Witten Germany Univ Med Ctr Regensburg Dept Orthodont D-93053 Regensburg Germany

Introduction: three-dimensional landmarks of the face are important for orthodontic examination, harmony assessment and treatment planning. Currently, facial landmarks are often measured by orthodontists via direct observation and manual soft tissue image analysis. This study wants to evaluate and present an objective method for measuring selected facial landmarks based on an analysis of curvature maps and of sagittal profile obtained by a laser-scanning method. Methods: The faces of 15 people were scanned in 3D by means of the laser scanner FastSCAN (TM). It allowed the recording of a curvature map of the face in under a minute, which depicted the distribution of Gaussian and mean curvatures. The median-sagittal profile line of the face was localized in this map, and a mathematical analysis comprising its first and second derivatives was performed. Anatomical landmarks were identified and facial measurements performed. To assess validity the obtained data were compared with manual measurements by orthodontists by means of Lin's concordance correlation CCC coefficient and reliability was determined by consecutive measurements. Results: Facial landmarks, such as the soft tissue glabella and nasal tip, could be easily and accurately identified and located. Lin's CCC showed substantial agreement between digital and manual measurements for 4 of the 7 distances evaluated. Larger discrepancies were due to inadequate image quality and scanning errors. Reliability of consecutive measurements by the same operator was excellent. Conclusions: In our pilot study the three-dimensional laser-scanning method FastSCAN (TM) allowed a reliable and accurate identification of anatomical landmarks of the face. The obtained distances between certain landmarks, such as the intercanthal distance, were largely consistent with those from manual measurements. Due to its easy and rapid implementation, the method facilitates facial analysis and could be a clinically valid alternative to manual

关键词： Orthodontics Feasibility studies Lasers Models Biological Image interpretation Reproducibility of results computer-assisted three-dimensional imaging Lasers/diagnostic use

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3D evaluation of the lingual fracture line after a bilateral sagittal split osteotomy of the mandible

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INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY 2009年第12期38卷 1244-1249页

作者： Plooij, J. M. Naphausen, M. T. P. Maal, T. J. J. Xi, T. Rangel, F. A. Swennnen, G. de Koning, M. Borstlap, W. A. Berge, S. J. Radboud Univ Nijmegen Facial Imaging Res Grp Nijmegen Bruges 3D Dept Oral & Maxillofacial Surg Med Ctr NL-6500 HB Nijmegen Netherlands Radboud Univ Nijmegen Dept Orthodont & Oral Biol Med Ctr NL-6500 HB Nijmegen Netherlands Gen Hosp St Jan Div Maxillofacial Surg Dept Surg Brugge Belgium

The purpose of this prospective observational study was to evaluate whether cone beam CT (CBCT) is a useful tool for analyzing the fracture line in a bilateral sagittal split osteotomy (BSSO). The patient group consisted of 40 consecutive patients (9 males and 31 females) with a mandibular hypoplasia who underwent a BSSO advancement (Hunsuck modification;n = 80 splits) between September 2006 and July 2008. The mean age at the time of surgery was 34 years (range 17-61 years). A newly developed lingual split scale was used to categorize the path of the fracture line on the lingual side of the ramus based on one-day postoperative data sets reconstructed from CBCT data. Although all splits (n = 80) were performed according to the standardized protocol, only 51% of the fracture lines run according to the Hunsuck's description, whereas 33% ran through the mandibular canal and 16% split otherwise. The split pattern was influenced by the length of the medial osteotomy (p = 0.01). In conclusion, 3D imaging is a useful tool for analyzing the surgical outcome of a BSSO and has the potential to provide Substantial data on the position of the proximal segments as a result of the lingual fracture line.

关键词： maxillofacial surgery computer-assisted three-dimensional imaging cone-beam CT dysgnathia bilateral sagittal split osteotomy hunsuck modification reliability

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Total resection of the right hepatic vein drainage area with the aid of three-dimensional computed tomography

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SURGERY TODAY 2012年第1期42卷 46-51页

作者： Taketomi, Akinobu Takeishi, Kazuki Mano, Yohei Toshima, Takeo Motomura, Takashi Aishima, Shinichi Uchiyama, Hideaki Yoshizumi, Tomoharu Shirabe, Ken Maehara, Yoshihiko Kyushu Univ Grad Sch Med Sci Dept Surg & Sci Higashi Ku Fukuoka 8128582 Japan Kyushu Univ Grad Sch Med Sci Dept Surg Pathol Higashi Ku Fukuoka 8128582 Japan

We analyzed the feasibility and safety of our preliminary surgical approach for total hepatic resection of the right hepatic vein drainage area (THR-RHV) with the aid of three-dimensional computed tomography (3D-CT) guidance. Clinical findings and 3D-CT volumetry results were investigated in five patients who underwent THR-RHV for a hepatic malignant tumor close to the right hepatic vein (RHV). The mean estimated remnant liver volume after a conventional right lobectomy was 474 ml, whereas that after THR-RHV was 614 ml, indicating that 140 ml (13.8%) of additional liver volume had been preserved by performing THR-RHV. The median operative time, mean ischemic time, and mean blood loss during surgery were 406 min, 51 min, and 587 ml, respectively. Histological examinations confirmed a negative surgical margin in all five patients. The mean liver volume estimated by 3D-CT was 458 ml, whereas the mean actual resected liver volume was 468 g, resulting in a mean error ratio of 3.1%. THR-RHV allowed for a higher remnant liver volume than that after conventional right lobectomy of the liver, and proved feasible with acceptable perioperative results. This technique thus promotes both safety and curability for patients with a tumor close to the RHV.

关键词： computer-assisted three-dimensional imaging Hepatectomy Hepatic vein

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