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3D Printing in Nuclear Medicine and Radiation Therapy

Introduction Three-dimensional (3D) printing in medicine has gained increasing popularity over the past several years. In nuclear medicine and radiation therapy, where one of the main goals is to obtain quality images while keeping radiation exposure to a minimum, 3D printing is an ideal technology to help tailor many individual treatments. Additionally, 3D printing may be utilized to optimize radiopharmaceutical chemistry for nuclear medicine applications. This…

3D Printing in Interventional Radiology

Introduction Interventional radiology (IR) is a subspecialty of radiology in which radiologists perform minimally invasive operations to diagnose, treat, and cure a variety of conditions. As compared to traditional surgeries, IR procedures can reduce surgical risks, operating and recovery time, costs, and at times lead to improved patient outcomes. The range of diseases and organ systems amenable to IR procedures are extensive and include vascular, oncologic,…

3D Printing in Radiology Education

Introduction Diagnostic radiology programs currently encompass image-based diagnosis and image-guided therapeutic techniques using multiple available imaging modalities. Three-dimensional (3D) image post-processing of radiologic images routinely uses high-resolution computed tomography (CT) and magnetic resonance imaging (MRI) datasets for diagnostic evaluation and treatment planning. Dedicated training in 3D modeling may be incorporated into some radiology training programs, although it is not required, and formal training programs are limited.…

Regulatory Perspectives for 3D Printing in Hospitals

Introduction The United States (US) Food and Drug Administration (FDA) has overseen medical device marketing in the US since May 28, 1976, when the Medical Device Amendments to the Federal Food, Drug and Cosmetic Act were passed. The system that was established has first and foremost the public safety in mind, focusing on regulations for the marketing of medical devices in the US. While safety is…

Documentation and Reimbursement for 3D Printed Anatomic Models and Guides

Introduction In the American healthcare system, standardized documentation is critical to ensure accurate medical billing and coding for appropriate reimbursement. An encounter for radiology services starts with a test order from a referring physician which includes the patient’s signs/symptoms or a reason for performing the test. Once the imaging exam is performed, information about the exam and the diagnosis including the International Classification of Diseases-10 codes must…

Quality Assurance of 3D Printed Anatomic Models

Quality Assurance (QA), defined as the maintenance of a desired level of quality in a service or a product, is a subset of the quality management system (QMS) and provides the framework that ensures quality requirements are met. A proper QA program has many components that objectively demonstrate confidence in product or service quality to the user. A QA program includes components such as document controls,…

3D Printed Anatomic Models and Guides

Introduction Three-dimensional (3D) printed anatomic models and guides designed from volumetric medical imaging data are used clinically to provide increased comprehension of anatomy, more exact pathology evaluation, and more precise surgical intervention. Historically, obtaining a 3D printed patient-specific anatomic model was typically made possible through independent companies, several of which began building anatomic models for surgeons in the early to mid-1990s. Today, a variety of third…

3D Printing Principles and Technologies

Introduction Three-dimensional (3D) printing, also known as additive manufacturing or rapid prototyping, originated in the 1980s and encompasses various processes that create physical 3D objects by fabricating them layer by layer from a digital file. , Whether the 3D printed part begins with radiological images or is designed from the ground up, specialized software is necessary to help generate the appropriate digital computer-aided design (CAD) file…

Computer-Aided Design Principles for Anatomic Modeling

Introduction The process of creating a physical three-dimensional (3D) printed model from medical imaging data is complicated and involves numerous steps. In order for a patient-specific anatomic model to be suitable for 3D printing, segmented anatomical regions of interest must be designed, prepped, and then converted into 3D file types that are recognized by vendor-specific 3D printing slicing software. Common, vendor neutral file formats for printing…

Image Segmentation and Nonuniformity Correction Methods

Introduction In medical imaging, a three-dimensional (3D) image, or volume, is often acquired by stacking up a series of two-dimensional (2D) slice images. Just as 2D images are made up of pixels, 3D volumes such as computed tomography (CT) or magnetic resonance imaging (MRI) scans consist of voxels as the basic elements. The printing of a specific object (bone, tissue, etc.) from a medical image usually…

Medical Imaging Technologies and Imaging Considerations for 3D Printed Anatomic Models

Medical imaging technologies, which allow us to “see into” and understand living systems, play a significant role in biology and medicine. The X-ray has paved the way for many high-tech medical imaging technologies that are used today including computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and positron emission tomography (PET). It is possible a number of scientists inadvertently produced X-rays including William Morgan and Nicola…

An Abbreviated History of Medical 3D Printing

Introduction Three-dimensional (3D) printing technologies are now entering their fourth decade of use and many medical applications now are very well established and optimized. Despite this, many in the medical field are surprised to hear that 3D printing is not relatively new. This chapter is not an exhaustive look at every development along the timeline for medical 3D printing but instead meant to point out some…

Image-Guided Ablation of Liver Tumors

Treatment of primary or metastatic hepatic tumors includes surgical resection, hepatic transplantation (for hepatocellular carcinoma), systemic drug therapy, and transarterial chemo and radioembolic therapy. Limited disease may be amenable to surgical resection. However, only 10%-20% of patients with primary hepatocellular carcinoma (HCC) and colorectal metastatic liver tumors are candidates for curative surgical resection. Many patients are deemed unsuitable for potentially curative surgical techniques because of tumor…

Image-Guided Ablation as a Treatment Option for Thoracic Malignancies

Lung cancer is the leading cause of death in both men and women in the United States. It accounts for approximately 32% of deaths in males and 25% in females. Most patients with primary and secondary lung malignancies are nonsurgical candidates because of poor cardiopulmonary reserve, advanced stage at diagnosis, and severe medical comorbidity. Only about 15% of patients diagnosed with pulmonary malignancies are surgical candidates…

Image-Guided Ablation of Renal Tumors

Before the advent of tumor ablation, the curative treatment for primary renal cell cancer (RCC) was to perform laparoscopic or open nephrectomy or partial nephrectomy. Many patients are deemed unsuitable for potentially curative surgical techniques because of limited renal functional reserve, desire to avoid renal replacement therapy, and comorbid conditions. The development of needle applicators for tumor ablation has provided selected patients who are unsuitable or…

Image-Guided Tumor Ablation: Basic Principles

Tumor ablation techniques and applications have received increasing attention, research and experience over the past decade and have become an integral component of the treatment plans of some oncology patients. As techniques of application have become increasingly sophisticated, the patient population who may be considered candidates for thermal ablation has also continued to expand. Many malignancies are poorly responsive to systemic chemotherapy or local radiation therapy.…

Musculoskeletal Intervention

Musculoskeletal interventional procedures are a fast growing area for interventional radiology. The most commonly performed techniques and the most promising new techniques are described in this chapter. Image Guidance Percutaneous musculoskeletal interventions, like other interventional procedures, are usually performed with a single imaging technique: ultrasound, fluoroscopy, computed tomography (CT), or magnetic resonance imaging (MRI). Fluoroscopy and CT are the most frequently used guidance techniques. Fluoroscopy offers…

Image-Guided Breast Intervention

Breast cancer is the most common non–skin cancer in women in the developed world, with one in eight women expected to develop breast cancer in their lifetime. However, the vast majority of women presenting to breast clinics have benign disease. Breast imaging is generally performed in (1) asymptomatic women in age groups most at risk for cancer and (2) for diagnostic purposes in women who present…

Percutaneous Genitourinary Intervention

Although the first percutaneous genitourinary procedure was a renal cyst puncture reported in 1867, it wasn’t until approximately 100 years later that the first percutaneous nephrostomy using the Seldinger technique was described. Since then, percutaneous access to the kidney has been employed for a wide variety of renal and ureteric pathology. Relief of acute urinary obstruction remains the most common procedure of the genitourinary track performed…

Gallbladder Intervention

Gallbladder intervention in the form of gallbladder decompression was first proposed as a definite technique in the second half of the last century. However, percutaneous gallbladder intervention did not gain widespread acceptance because of the fear of bile leakage and life-threatening vagal reactions. It was not until the 1980s that percutaneous drainage of the gallbladder and other percutaneous therapies for gallstones became popular. Percutaneous gallbladder intervention…