干预规划和培训的3D打印心血管幻影的开发与评估
1Department of Cardiac Surgery,Ludwig Maximilian University Munich, 2Chair of Medical Materials and Implants,Technical University of Munich, 3Department Pediatric Cardiology and Pediatric Intensive Care,Ludwig Maximilian University Munich, 4Department of Radiology,Ludwig Maximilian University Munich
Summary
在这里，我们介绍了一个模拟循环设置的开发，用于多式联运治疗评估、介入前规划和心血管解剖学的医生培训。通过应用患者特异性断层扫描，此设置非常适合治疗方法、培训和个性化医学教育。
Abstract
基于导管的干预措施是心血管病理学的标准治疗方案。因此，患者专用模型可以帮助培训医生的线技能，以及改进干预程序的规划。本研究的目的是开发用于心血管干预的患者专用3D打印模型的制造过程。
为了创建一个3D打印弹性幻象，不同的3D打印材料被比较为猪生物组织（即主动脉组织）的机械特性。根据比较拉伸测试选择合适的材料，并定义特定材料厚度。追溯性地收集了匿名对比增强 CT 数据集。从这些数据集中提取了患者特异性体积模型，随后进行了 3D 打印。构建了脉冲流回路，以模拟干预期间的发光血流。模型是否适合临床成像，通过X射线成像、CT、4D-MRI和（多普勒）超声波检查来评估。对比介质用于提高基于 X 射线的成像的可见性。在医生培训以及介入前治疗规划中应用了不同的导管技术来评估 3D 打印幻象。
印刷模型显示打印分辨率高（+30 μm），所选材料的机械性能可与生理生物力学相媲美。与底层放射数据集相比，物理和数字模型的解剖精度较高。打印模型适用于超声波成像和标准 X 射线。多普勒超声波和 4D-MRI 显示与本地数据匹配的流模式和地标特征（即湍流、壁切应力）。在基于导管的实验室环境中，患者特异性幻象很容易导管。有可能对具有挑战性的解剖（例如先天性心脏病）的介入程序进行治疗规划和培训。
灵活的患者特异性心血管幻影是3D打印的，并有可能应用常见的临床成像技术。这一新工艺是理想的导管（电生理）干预训练工具，可用于患者特定的治疗规划。
Introduction
个性化疗法在现代临床实践中越来越重要。从本质上讲，它们可以分为两组：遗传方法和近视方法。对于基于独特个人DNA的个性化疗法，无论是基因组测序还是基因表达水平的量化都是必要的。例如，在肿瘤学或代谢紊乱治疗中可以找到这些方法。每个人的独特形态学（即解剖学）在介入医学、外科医学和假肢医学中起着重要作用。个性化假肢的发展和介入前/手术前的治疗规划是当今研究小组研究的重点。
3D打印来自工业原型生产，是个性化医学领域的理想之选。3D 打印被归类为添加剂制造方法，通常基于材料的逐层沉积。如今，我们拥有多种具有不同打印技术的 3D 打印机，可加工聚合物、生物或金属材料。由于打印速度的提高以及 3D 打印机的持续普及，制造成本正逐渐降低。因此，在日常生活中使用3D打印进行干预前规划在经济上已变得可行。
本研究的目的是建立一种产生患者特异性或疾病特异性幻象的方法，用于心血管医学的个性化治疗规划。这些幻象应与常见的成像方法以及不同的治疗方法兼容。另一个目标是使用个性化解剖学作为医生的培训模型。
Protocol
路德维希-马克西米利安大学蒙琴大学伦理委员会审议了道德批准，并放弃了这一批准，因为这项研究中使用的放射性数据集是追溯收集的，并且完全匿名。 请参阅该研究所的 MRI 安全指南，特别是关于流量环的二手 LVAD 心室和金属部件。 1. 数据采集 在创建解剖幻象之前，选择合适的放射数据集，最好是从心血管学科的患者中选择。虚拟 3D 模型可…
Representative Results
所述的代表性结果侧重于规划、培训或测试环境中常用的一些心血管结构。这些数据是使用 ST 为 1.0 mm 和 voxel 大小为 1.0 mm 的同位素 CT 数据集创建的。主动脉瘤模型的壁厚设置为2.5毫米，符合印刷材料的比较拉伸测试结果（拉伸强度：0.62±0.01 N/mm2：最高： 1.55 ± 0.02 N：拉长： 9.01 ± 0.34%） 和猪主动脉样本 （宽度： 1 毫米：最高：1.62 ± 0.83 N：拉?…
Discussion
呈现的工作流程允许建立个性化模型，从而执行介入前治疗规划，以及医生关于个性化解剖学的培训。为此，患者特异性断层数据可用于柔性心血管幻象的分割和 3D 打印。通过在模拟循环中实现这些 3D 打印模型，可以现实地模拟不同的临床情况。
如今，许多治疗规划程序侧重于不同场景的数字模拟，以找出最有利的结果10，11。与…
Disclosures
The authors have nothing to disclose.
Acknowledgements
该出版物得到了德国心脏基金会/德国心脏研究基金会的支持。
Materials
| 3-matic | Materialise AB | Software Version 15.0 – Commercial 3D-Modeling Software | |
| Affiniti 50 | Philips Medical Systems GmbH | Ultrasonic Imaging System | |
| Agilista W3200 | Keyence Co. | Polyjet 3D-Printer with a spatial resolution of 30µm | |
| AR-G1L | Keyence Co. | flexible 3D-Printing material | |
| Artis Zee | Siemens Healthcare GmbH | Angiographic X-ray Scanner | |
| cvi42 | CCI Inc. | Software Version 5.12 – 4D Flow Analysis Software | |
| Diagnostic Catheter, Multipurpose MPA 2 | Cordis, A Cardinal Health company | Catheter for pediatric training models, Sizes 4F for infants and 5F for children, young adults | |
| Excor Ventricular Assist Device | Berlin Heart GmbH | 80 -100ml stroke volume | |
| Imeron 400 Contrast Agent | Bracco Imaging | CT – Contrast Agent | |
| IntroGuide F | Angiokard Medizintechnik GmbH | Guidewire with J-tip; diameter: 0.035" length: 220cm | |
| Lunderquist Guidewire | Cook Medical Inc. | (T)EVAR interventional guidewire | |
| MAGNETOM Aera | Siemens Healthcare GmbH | MRI Scanner | |
| Magnevist Contrast Agent | Bayer Vital GmbH | MRI – Contrast Agent | |
| Mimics | Materialise AB | Software Version 23.0 – Commercial Segmentation Software | |
| Modeling Studio | Keyence Co. | 3D-Printer Slicing Software | |
| PVC tubing | |||
| Radifocus Guide Wire M | Terumo Europe NV | Straight guidewire; diameter: 0.035" length: 260cm | |
| Really useful box 9L | Really useful products Ltd. | ||
| Rotigarose – Standard Agar | Carl Roth GmbH | 3810.4 | |
| Solidworks | Dassault Systemes SE | Software Version 2019-2020; CAD Design Software | |
| SOMATOM Force | Siemens Healthcare GmbH | Computed Tomography Scanner | |
| syngo via | Siemens Healthcare GmbH | Radiological Imaging Software |
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Cite This Article
Grab, M., Hopfner, C., Gesenhues, A., König, F., Haas, N. A., Hagl, C., Curta, A., Thierfelder, N. Development and Evaluation of 3D-Printed Cardiovascular Phantoms for Interventional Planning and Training. J. Vis. Exp. (167), e62063, doi:10.3791/62063 (2021).