Multi-material 3D Models for Temporal Bone Surgical Simulation.

HYPOTHESIS: A simulated, multicolor, multi-material temporal bone model can be created using 3-dimensional (3D) printing that will prove both safe and beneficial in training for actual temporal bone surgical cases. BACKGROUND: As the process of additive manufacturing, or 3D printing, has become more practical and affordable, a number of applications for the technology in the field of Otolaryngology-Head and Neck Surgery have been considered. One area of promise is temporal bone surgical simulation. METHODS: Three-dimensional representations of human temporal bones were created from temporal bone computed tomography (CT) scans using biomedical image processing software. Multi-material models were then printed and dissected in a temporal bone laboratory by attending and resident otolaryngologists. A 5-point Likert scale was used to grade the models for their anatomical accuracy and suitability as a simulation of cadaveric and operative temporal bone drilling. RESULTS: The models produced for this study demonstrate significant anatomic detail and a likeness to human cadaver specimens for drilling and dissection. CONCLUSION: Simulated temporal bones created by this process have potential benefit in surgical training, preoperative simulation for challenging otologic cases, and the standardized testing of temporal bone surgical skills.

Evaluation of the geometric accuracy of computed tomography and microcomputed tomography of the articular surface of the distal portion of the radius of cats.

OBJECTIVE: To evaluate accuracy of articular surfaces determined by use of 2 perpendicular CT orientations, micro-CT, and laser scanning. SAMPLE: 23 cat cadavers. PROCEDURES: Images of antebrachia were obtained by use of CT (voxel size, 0.6 mm) in longitudinal orientation (CTLO images) and transverse orientation (CTTO images) and by use of micro-CT (voxel size, 0.024 mm) in a longitudinal orientation. Images were reconstructed. Craniocaudal and mediolateral length, radius of curvature, and deviation of the articular surface of the distal portion of the radius of 3-D renderings for CTLO, CTTO, and micro-CT images were compared with results of 3-D renderings acquired with a laser scanner (resolution, 0.025 mm). RESULTS: Measurement of CTLO and CTTO images overestimated craniocaudal and mediolateral length of the articular surface by 4% to 10%. Measurement of micro-CT images underestimated craniocaudal and mediolateral length by 1%. Measurement of CTLO and CTTO images underestimated mediolateral radius of curvature by 15% and overestimated craniocaudal radius of curvature by > 100%; use of micro-CT images underestimated them by 3% and 5%, respectively. Mean ± SD surface deviation was 0.26 ± 0.09 mm for CTLO images, 0.30 ± 0.28 mm for CTTO images, and 0.04 ± 0.02 mm for micro-CT images. CONCLUSIONS AND CLINICAL RELEVANCE: Articular surface models derived from CT images had dimensional errors that approximately matched the voxel size. Thus, CT cannot be used to plan conforming arthroplasties in small joints and could lack precision when used to plan the correction of a limb deformity or repair of a fracture.

Pre-operative simulation of pediatric mastoid surgery with 3D-printed temporal bone models.

OBJECTIVES: As the process of additive manufacturing, or three-dimensional (3D) printing, has become more practical and affordable, a number of applications for the technology in the field of pediatric otolaryngology have been considered. One area of promise is temporal bone surgical simulation. Having previously developed a model for temporal bone surgical training using 3D printing, we sought to produce a patient-specific model for pre-operative simulation in pediatric otologic surgery. Our hypothesis was that the creation and pre-operative dissection of such a model was possible, and would demonstrate potential benefits in cases of abnormal temporal bone anatomy. METHODS: In the case presented, an 11-year-old boy underwent a planned canal-wall-down (CWD) tympano-mastoidectomy for recurrent cholesteatoma preceded by a pre-operative surgical simulation using 3D-printed models of the temporal bone. The models were based on the child's pre-operative clinical CT scan and printed using multiple materials to simulate both bone and soft tissue structures. To help confirm the models as accurate representations of the child's anatomy, distances between various anatomic landmarks were measured and compared to the temporal bone CT scan and the 3D model. RESULTS: The simulation allowed the surgical team to appreciate the child's unusual temporal bone anatomy as well as any challenges that might arise in the safety of the temporal bone laboratory, prior to actual surgery in the operating room (OR). There was minimal variability, in terms of absolute distance (mm) and relative distance (%), in measurements between anatomic landmarks obtained from the patient intra-operatively, the pre-operative CT scan and the 3D-printed models. CONCLUSIONS: Accurate 3D temporal bone models can be rapidly produced based on clinical CT scans for pre-operative simulation of specific challenging otologic cases in children, potentially reducing medical errors and improving patient safety.