Patient specific 3D printed and augmented reality kidney

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Wake et al 3D Printing in Medicine 2019 5 4 Page 2 of 8. Background limitations of consultations performed with 2D images. Navigating a cancer diagnosis and making decisions All types of 3D models could be referred to during the. about cancer treatment can be challenging for many pa consultation and could be used to describe the anatomy. tients Individual treatment plans vary and depend on disease and treatment options allowing for improved. the type of cancer stage of the disease and other comor levels of patient understanding of anatomy and disease. bidities Recently there has been a clear move towards as well as facilitate better patient decisions regarding the. shared decision making and patients want to assume an treatment plan The aim of this study was two fold 1. increasing role in medical decision making with 92 5 to prospectively evaluate in a large cohort of patients. of men with newly diagnosed prostate cancer wanting to the usefulness of patient specific 3D urologic oncology. play either an active or a collaborative role in decision kidney and prostate cancer models for patient educa. making with their physician 1 tion and 2 to compare the usefulness of different types. For patients undergoing major urological procedures of 3D models in patient education. pre operative imaging plays a critical role in patient. counseling and shared surgical decision making 2 5 Materials and methods. At our institution urologic surgeons often use 2D im Patients with magnetic resonance imaging MRI visible. ages during patient consultation however we speculate prostate cancer PI RADS v2 score 3 and biopsy con. that many patients have a difficult time conceptualizing firmed cancer undergoing either robotic assisted radical. these images In order to make decisions regarding treat prostatectomy or focal ablative therapy or patients with. ment options it is imperative that patients are provided renal masses nephrometry score NS 7 diameter 4. with an adequate amount of information to understand cm or polar lesions undergoing partial nephrectomy. their disease and treatment plan were prospectively enrolled in this IRB approved study. To date experiences on the use of 3D models to facili n 200 Of the 200 total patients 151 had prostate. tate patient understanding in the context of urologic on cancer 104 patients with 146 lesions underwent prosta. cology are limited to the small 3D printing case studies tectomy and 47 patients with 69 lesions underwent focal. described below 6 8 For renal cancer Silberstein et al ablative therapy The breakdown of PI RADS scores was. anecdotally reported that for a set of five 3D printed as follows PI RADS 2 28 PI RADS 3 68 PI RADS. renal cancer models patients and their families felt that 4 82 PI RADS 5 28 and no PI RADS could be. 3D models enhanced their comprehension of the tumor assigned in 9 cases with biopsy confirmed prostate. anatomy in relation to the surrounding structures and cancer in the region of the MR defined lesion There. helped to improve the goals of the surgery 6 Next in a were 49 patients with kidney cancer 29 males and 20. pilot study of seven patients Bernard et al created per females with the following NS breakdown NS 4 2. sonalized 3D printed kidney tumor models as a useful NS 5 2 NS 6 7 NS 7 14 NS 8 13 NS 9 8 NS 10. tool for patient education and demonstrated an im 3 The mean age and range was 63 64 8 22 years. provement in understanding of basic kidney physiology Patients underwent routine clinical imaging protocols and. 16 5 kidney anatomy 50 tumor characteristics were randomized to receive pre operative planning with. 39 3 and the planned surgical procedure 44 6 7 imaging alone or imaging plus a patient specific 3D model. Porpiglia et al created 3D printed models for 8 patients which was either 3D printed visualized in AR or viewed. undergoing robotic assisted radical prostatectomy and in 3D on a 2D computer monitor. 10 undergoing robotic assisted radical partial nephrec. tomy and reported that patients responded favorably Image acquisition. about the use of the technology during case discussion Images for all patients were acquired according to the. with the surgeon 8 Finally Schmit et al evaluated the clinical protocol For prostate cancer patients multi para. use of 3D printed models on patients understanding of metric MRI was performed on a 3 T MRI system A 3D. renal cryoablation and although they found no improve turbo spin echo T2 weighted imaging sequence i e. ment of patients objective anatomy and procedural SPACE with a spatial resolution of 0 6 0 6 1 mm a. knowledge with 3D models patients perceived value of diffusion weighted imaging DWI sequence and a dy. the 3D models 9 namic contrast enhanced sequence were utilized for gen. While these small studies above support the added eration of the 3D model For kidney cancer patients. benefit of 3D models the role that 3D models can play images were acquired on a 1 5 T MR system Avanto. in shared decision making is yet to be defined We be Siemens Erlangen Germany using a phased array body. lieve that in addition to 3D printed models advanced coil or multi detector row computed tomography CT. visualization of medical images in 3D formats such as system Somatom Definition Edge or Force Siemens. virtual reality VR augmented reality AR or 3D com Erlangen Germany T1 weighted fat saturated gradient. puter models might also help to overcome the echo GRE images in different phases of contrast. Wake et al 3D Printing in Medicine 2019 5 4 Page 3 of 8. enhancement were used for model generation The converted to standard tessellation language stl. standard representative MR sequence parameters are format for multi colored 3D printing J750 Stra. TR 3 58 ms TE 1 3 ms FA 12 an interpolated tasys Eden Prairie MN or converted to Alias. spatial resolution of 1 4 mm 1 4 mm 2 mm and Wavefront obj format for AR programming and. breath hold acquisition time ranged from 13 to 20 s visualization using the Microsoft HoloLens AR device. The standard dual phase CT protocol included pre 11 Figure 1 shows representative 3D models of. and post contrast imaging in the nephrographic each type. phase Axial images were acquired with a 0 625 mm, slice thickness 120kVp 150mAs 512 512 matrix 3D model analysis. and sagittal and coronal images were reconstructed A 5 point Likert scale survey was administered to patients. with a slice thickness of 3 4 mm prior to the surgical procedure to determine understand. ing of the cancer and treatment plan as described in. 3D modeling Table 1 If randomized to receive a pre operative 3D. Image segmentation of the urologic cancer models model the survey was completed twice before and after. was performed using Mimics 20 0 Materialise viewing the 3D model. Leuven Belgium as described previously 10 For Survey responses for each of the 3D model groups. kidney cancer models the kidney tumor vein artery were compared to the group with just imaging using. and collecting system were segmented and for pros the Mann Whitney test The paired sample Wilcoxan. tate cancer models the prostate tumor rectal wall signed rank test was utilized to compare results for. urethra and bladder neck and neurovascular bundles patients who answered the surveys twice before and. were segmented Each segmented region of interest after seeing a 3D model In addition the cohort that. raster was converted to a surface mesh which could received 3D models completed additional questions to. be exported in 3D PDF format for direct visualization compare usefulness of the different forms of. Fig 1 a 3D printed b 3D computer and c AR kidney cancer models with the kidney clear tumor white 3D print and computer tumor. purple AR artery red vein blue collecting system yellow d 3D printed e 3D computer and f AR prostate cancer models sagittal. view with the prostate clear tumor blue rectal wall white bladder neck and urethra yellow and neurovascular bundles pink. Wake et al 3D Printing in Medicine 2019 5 4 Page 4 of 8. Table 1 Likert scale survey to assess patient understanding of cancer location 4 75 0 50 p 0 001 treatment plan. disease and procedure 4 78 0 45 p 0 001 and comfort level regarding the. Question Answer treatment plan 4 69 0 57 p 0 013 Patients also had. 1 How would you rate 1 Very poor a greater understanding of their anatomy and disease as. your understanding of your well as improved comfort level using 3D printed models. cancer disease, as compared to AR models range 4 60 4 70 5 vs 3 50. 4 23 5 p 0 05 There was no improvement in under,standing for any of the measures for the AR model. 5 Very good group as compared to the imaging group or the 3D. 2 I understand how big my 1 Strongly disagree printed versus computer model groups. cancer tumor is Stratified by cancer type both prostate cancer and. 2 Disagree, 3 Neutral kidney cancer patients had the highest level of under. standing with the 3D printed models Table 4 For the. prostate cancer patients there was statistical significance. 5 Strongly agree,with 3D printed models as compared to imaging for.
3 I understand where my 1 Strongly disagree understanding of disease p 0 001 cancer size p. cancer tumor is located, 2 Disagree 0 001 cancer location p 0 001 and treatment plan. 3 Neutral p 0 007 Patient understanding was greater regarding can. 4 Agree cer size p 0 018 and location p 0 011 with 3D com. puter models versus imaging For the kidney cancer patients. 5 Strongly agree, statistical significance was seen with 3D printed models as. 4 I understand why my surgeon 1 Strongly disagree,chose the treatment plan being. compared to imaging for questions regarding cancer size. 2 Disagree p 0 04 cancer location p 0 012 treatment plan p. 3 Neutral 0 014 and comfort level p 0 028 There was no differ. 4 Agree ence in level of understanding with the AR models as. 5 Strongly agree compared to imaging or with the 3D computer. models versus imaging for the kidney cancer cohort. 5 I feel comfortable with the 1 Strongly disagree, surgical plan Results for the second survey questions assessing. 2 Disagree,patient perceived usefulness of 3D models are.
3 Neutral shown in Fig 2 89 patients completed this add. 4 Agree itional survey 38 with 3D printed models 12 with. 5 Strongly agree AR models and 39 with 3D computer models All. models were reported to be useful on the 10 point,scale with results for 3D printed models ranging. from 8 45 9 21 10 AR models from 7 50 7 92 10 and, visualization of the 3D models Table 2 Results for 3D computer models from 7 95 8 92 10 Similar to the. the 3D printed models were compared to AR and 3D findings above the 3D printed models performed the best. computer models using the Mann Whitney test Statis for all questions Patients found the 3D printed models. tical analyses were performed in SPSS Statistics Version 23 to be more helpful than the AR models with respect. IBM Corp Armonk NY and Matlab R2017a The to their comprehension of anatomy 9 21 1 49 vs. Mathworks Inc Natick MA 7 92 2 84 p 0 04 In addition patients noted the 3D. printed models to be more valuable than both AR and 3D. Results computer models in regards to their disease understanding. All 200 patients completed the survey after reviewing 9 11 1 86 vs 7 50 3 35 vs 8 59 2 05 p 0 05 AR. their cases with their surgeons using imaging only 127 and 3D computer models were reported to be equally. patients completed the 5 point Likert scale survey re helpful with respect to all questions. garding understanding of disease and surgical procedure For this cohort of patients with renal cancer the 3D. twice once with imaging and again after reviewing im printed model helped one patient decide to undergo. aging plus a 3D model Overall the 3D printed models robotic assisted partial nephrectomy instead of forgoing. performed better than imaging 3D computer models the procedure and the 3D model helped a second patient. and AR models Table 3 Patients had a greater under to decide between radical and partial nephrectomy the. standing using 3D printed models versus imaging for all preferred procedure since part of the organ could be. measures including comprehension of disease 4 70 spared In general for prostate cancer patients if the. 0 54 p 0 001 cancer size 4 60 0 54 p 0 001 cancerous lesion was located in close proximity to the. Wake et al 3D Printing in Medicine 2019 5 4 Page 5 of 8. Table 2 Survey to assess patient perceived usefulness of 3D models. Please answer the following questions on a scale of 1 10 where 1 indicates no help and 10. indicates great help,No Help Mild Help Moderate Help Great Help. 1 2 3 4 5 6 7 8 9 10,1 How did the 3D,model help you to. learn about your,anatomy i e your,kidney or prostate.
2 How did the 3D,model help you to,learn about your. 3 How did the 3D,model help you to,understand the,surgery you will. 4 How did the 3D,model help you to,understand the,complications. related to the,procedure that you,will undergo, neurovascular bundles then the patient specific 3D that patient specific 3D printed models of renal. model helped the patient to better understand why the malignancies influence pre surgical planning decisions. nerve could not be preserved 12 In addition 3D printed models can facilitate. nerve sparing prostatectomy 13, Discussion conclusions Outside the field of urologic malignancies Biglino et al.
At our institution consultations for patients with kid showed that 3D models are useful tools for engaging. Keywords 3D printing Augmented reality Urologic oncology Kidney cancer Prostate cancer Correspondence nicole wake nyulangone org 1Center for Advanced Imaging Innovation and Research CAI2R and Bernard and Irene Schwartz Center for Biomedical Imaging Department of Radiology NYU Langone Health NYU School of Medicine 660 First Avenue

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