Title Page
Abstract
Contents
List of Abbreviations 14
1. Introduction 15
1.1. Motivations 15
1.2. Contribution 16
2. Backgrounds 17
2.1. 3D printing technology 17
2.2. 3D printing in medicine 18
3. Case study 20
3.1. Imaging phantom: Chest computed tomography imaging phantom 20
3.1.1. Subjects 20
3.1.2. Methods 21
3.1.3. Results 27
3.2. Education phantom: Video thoracoscopic surgery simulation phantom study 30
3.2.1. Subjects 30
3.2.2. Methods 31
3.2.3. Results 39
3.3. Rehearsal phantom: Left atrial appendage occlusion phantom study 46
3.3.1. Subjects 46
3.3.2. Methods 47
3.3.3. Results 59
4. Discussions 62
5. Conclusions 71
Abstract (In Korean) 72
Reference 73
Table 3-1-1. Summary of the silicone materials used for the chest imaging phantom 25
Table 3-1-2. Lung structures matched with the HU of the FlexFoam-iT 27
Table 3-1-3. Comparison of the HU values between the CT image and 3D-printed phantom 28
Table 3-2-1. Comparison of two types of 3D printing: FDM and PolyJet. 37
Table 3-2-2. Comparison of FDM and PolyJet phantoms. 41
Table 3-2-3. Comparison of the reference measurements between the two types of 3D-printed phantoms. 44
Table 3-3-1. Descriptions of two types of 3D printing techniques, including FDM and SLA. 49
Table 3-3-2. Comparison of two types of 3D printing, including FDM and SLA. 54
Table 3-3-3. Rehearsal simulation results of 10 patients. 61
Table 4-1. The comparison of 3 types of imaging phantom. 62
Figure 3-1-1. Overall workflow for fabricating a chest imaging phantom using three- dimensional printing and silicone casting. 21
Figure 3-1-2. 3D modeling of chest CT image phantom based in CT images of a patient. (A) Spine and rib, (B) left and right lungs, (C) molder of the skin, fat, and muscle, (D) heart, and... 23
Figure 3-1-3. 3D-modeled and CT of 3D-printed phantom with landmarks specified for evaluating measurement error. (A) Inner diameter of the right ventricle, (B) solid nodule, (C)... 26
Figure 3-1-4. Various CT image settings of the phantoms. (A) CT volume-rendering image of the phantom, (B) CT image of the phantom with lung window setting, and (C) CT image of... 28
Figure 3-1-5. Bland-Altman analysis used to evaluate differences between the 3D-modeled STL (standard) and the CT from the printed phantom. (a) Inner diameter of the right... 29
Figure 3-2-1. Flowchart of the procedure for making 3D-printed infant VATS phantom. 32
Figure 3-2-2. 3D modeling for 3D rehearsal simulation phantom: (A) Right lung lobe, skin, muscle, bone, airway and lung (B) Detachable structure in which lung and airway structures... 35
Figure 3-2-3. STL file with four landmarks specified for evaluating measurement error: (a) height, (b) width, (c) diameter of the VATS hole, and (d) diameter of another VATS hole. (3-... 38
Figure 3-2-4. Comparison of mechanical properties of 3D printing materials. The gray zone in both graphs is human skin to shore A hardness (mean) ranging from 0 to 65. (A) Hardness... 40
Figure 3-2-5. Bland-Altman analysis used to evaluate differences between the STL file (standard) and the two 3D-printed phantoms. (A) STL vs FDM, (B) STL vs PolyJet. The... 41
Figure 3-2-6. Pediatric thoracic phantom from 3D modeling and made with two types of 3D printers: (A) 3D modeling, (B) FDM, and (C) PolyJet. (3-matic 12.0, Materialise NV,... 43
Figure 3-2-7. VATS simulation with esophageal atresia with a tracheoesophageal fistula using 3D-printed phantom: (A) a surgeon's simulation of the 3D-printed phantom and (B)... 45
Figure 3-3-1. Overall workflow for developing rehearsal phantom for LAAO with 3D printing and CT image. 3D, three-dimensional; CTA, computed tomography angiography; LAAO, left... 48
Figure 3-3-2. Segmentation based on cardiac anatomy by cardiac CT angiography, including: (A) CT image based cardiac anatomy: (a) cavoatrial junction, (b) ascending aorta, (c) main... 51
Figure 3-3-3. Comparison of mechanical properties of 3D printing materials. The gray zone in both graphs is human cardiac tissue to shore A hardness (mean) of about 40. (A) Hardness... 52
Figure 3-3-4. LAAO phantom made with two types of 3D printers. (A) 3D modeling (B) FDM, (C) SLA. 3D, three-dimensional; FDM, fused deposition modeling; LAAO, left atrial... 53
Figure 3-3-5. Measurements of shape accuracy between 3D model and 3D-printed phantom. (A) The 3D model (STL) with three landmarks specified for evaluating measurement error. (B)... 56
Figure 3-3-6. The Bland-Altman analysis to evaluate differences between the 3D model (STL) and the 3D-printed phantom. (A) Diameter of the horizontal zone, (B) LAA ostium, (C)... 58
Figure 3-3-7. LAAO was performed using a device of the predicted size. (A) A cardiologist performing TEE during the procedure. (B) Another cardiologist injecting saline, medicine, and... 59