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

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

Publication History

Received: 29 March 2024

Accepted after revision: 28 September 2024

Article published online:
30 October 2024

• 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