The production of anatomical teaching resources using three-dimensional (3D) printing technology
TL;DR: 3D printing offers many advantages over plastination as it allows rapid production of multiple copies of any dissected specimen, at any size scale and should be suitable for any teaching facility in any country, thereby avoiding some of the cultural and ethical issues associated with cadaver specimens either in an embalmed or plastinated form.
Abstract: The teaching of anatomy has consistently been the subject of societal controversy, especially in the context of employing cadaveric materials in professional medical and allied health professional training. The reduction in dissection-based teaching in medical and allied health professional training programs has been in part due to the financial considerations involved in maintaining bequest programs, accessing human cadavers and concerns with health and safety considerations for students and staff exposed to formalin-containing embalming fluids. This report details how additive manufacturing or three-dimensional (3D) printing allows the creation of reproductions of prosected human cadaver and other anatomical specimens that obviates many of the above issues. These 3D prints are high resolution, accurate color reproductions of prosections based on data acquired by surface scanning or CT imaging. The application of 3D printing to produce models of negative spaces, contrast CT radiographic data using segmentation software is illustrated. The accuracy of printed specimens is compared with original specimens. This alternative approach to producing anatomically accurate reproductions offers many advantages over plastination as it allows rapid production of multiple copies of any dissected specimen, at any size scale and should be suitable for any teaching facility in any country, thereby avoiding some of the cultural and ethical issues associated with cadaver specimens either in an embalmed or plastinated form. Anat Sci Educ 7: 479–486. © 2014 American Association of Anatomists.
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TL;DR: The range of teaching resources and strategies used in anatomy education are reviewed with the aim of coming up with suggestions about the best teaching practices and it is suggested that certain professions would have more benefit from certain educational methods or strategies than others.
Abstract: In this report we review the range of teaching resources and strategies used in anatomy education with the aim of coming up with suggestions about the best teaching practices in this area. There is much debate about suitable methods of delivering anatomical knowledge. Competent clinicians, particularly surgeons, need a deep understanding of anatomy for safe clinical procedures. However, because students have had very limited exposure to anatomy during clinical training, there is a concern that medical students are ill-prepared in anatomy when entering clerkships and residency programs. Therefore, developing effective modalities for teaching anatomy is essential to safe medical practice. Cadaver-based instruction has survived as the main instructional tool for hundreds of years, however, there are differing views on whether full cadaver dissection is still appropriate for a modern undergraduate training. The limitations on curricular time, trained anatomy faculty and resources for gross anatomy courses in integrated or/and system-based curricula, have led many medical schools to abandon costly and time-consuming dissection-based instruction in favour of alternative methods of instruction including prosection, medical imaging, living anatomy and multimedia resources. To date, no single teaching tool has been found to meet curriculum requirements. The best way to teach modern anatomy is by combining multiple pedagogical resources to complement one another, students appear to learn more effectively when multimodal and system-based approaches are integrated. Our review suggests that certain professions would have more benefit from certain educational methods or strategies than others. Full body dissection would be best reserved for medical students, especially those with surgical career intentions, while teaching based on prosections and plastination is more suitable for dental, pharmacy and allied health science students. There is a need to direct future research towards evaluation of the suitability of the new teaching methodologies in new curricula and student perceptions of integrated and multimodal teaching paradigms, and the ability of these to satisfy learning outcomes.
457 citations
TL;DR: A review of hydrogel-based biomaterial inks and bioinks for 3D printing can be found in this paper, where the authors provide a comprehensive overview and discussion of the tailorability of material, mechanical, physical, chemical and biological properties.
Abstract: 3D printing alias additive manufacturing can transform 3D virtual models created by computer-aided design (CAD) into physical 3D objects in a layer-by-layer manner dispensing with conventional molding or machining. Since the incipiency, significant advancements have been achieved in understanding the process of 3D printing and the relationship of component, structure, property and application of the created objects. Because hydrogels are one of the most feasible classes of ink materials for 3D printing and this field has been rapidly advancing, this Review focuses on hydrogel designs and development of advanced hydrogel-based biomaterial inks and bioinks for 3D printing. It covers 3D printing techniques including laser printing (stereolithography, two-photon polymerization), extrusion printing (3D plotting, direct ink writing), inkjet printing, 3D bioprinting, 4D printing and 4D bioprinting. It provides a comprehensive overview and discussion of the tailorability of material, mechanical, physical, chemical and biological properties of hydrogels to enable advanced hydrogel designs for 3D printing. The range of hydrogel-forming polymers covered encompasses biopolymers, synthetic polymers, polymer blends, nanocomposites, functional polymers, and cell-laden systems. The representative biomedical applications selected demonstrate how hydrogel-based 3D printing is being exploited in tissue engineering, regenerative medicine, cancer research, in vitro disease modeling, high-throughput drug screening, surgical preparation, soft robotics and flexible wearable electronics. Incomparable by thermoplastics, thermosets, ceramics and metals, hydrogel-based 3D printing is playing a pivotal role in the design and creation of advanced functional (bio)systems in a customizable way. An outlook on future directions of hydrogel-based 3D printing is presented.
427 citations
TL;DR: The potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing intraoperative guidance tools, teaching patients and surgical trainees, and producing patient-specific prosthetics in everyday surgical practice is discussed.
Abstract: Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing intraoperative guidance tools, teaching patients and surgical trainees, and producing patient-specific prosthetics in everyday surgical practice.
285 citations
Cites background from "The production of anatomical teachi..."
...However, human cadavers are becoming relatively scarce from the anatomical education curricula due to high maintenance costs, cultural and social controversies, and safety issues associated with the formalin-containing embalming fluids (92, 140)....
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...Additionally, 3D printing has helped in making complex diagnoses in forensic medicine (91); reformed anatomy education (92); helped in planning repairs of Charcot’s foot in podiatry (93); permitted the fabrication of custom-made dental implants in dentistry (94–96); produced patient-specific 3D-printed medication in pharmaceutical industry (97, 98); and assembled custom-design tissue scaffolds in regenerative medicine (99, 100)....
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TL;DR: 3D may confer certain benefits to anatomy learning and supports their use and ongoing evaluation as supplements to cadaver‐based curriculums.
Abstract: Three-dimensional (3D) printing is an emerging technology capable of readily producing accurate anatomical models, however, evidence for the use of 3D prints in medical education remains limited. A study was performed to assess their effectiveness against cadaveric materials for learning external cardiac anatomy. A double blind randomized controlled trial was undertaken on undergraduate medical students without prior formal cardiac anatomy teaching. Following a pre-test examining baseline external cardiac anatomy knowledge, participants were randomly assigned to three groups who underwent self-directed learning sessions using either cadaveric materials, 3D prints, or a combination of cadaveric materials/3D prints (combined materials). Participants were then subjected to a post-test written by a third party. Fifty-two participants completed the trial; 18 using cadaveric materials, 16 using 3D models, and 18 using combined materials. Age and time since completion of high school were equally distributed between groups. Pre-test scores were not significantly different (P = 0.231), however, post-test scores were significantly higher for 3D prints group compared to the cadaveric materials or combined materials groups (mean of 60.83% vs. 44.81% and 44.62%, P = 0.010, adjusted P = 0.012). A significant improvement in test scores was detected for the 3D prints group (P = 0.003) but not for the other two groups. The finding of this pilot study suggests that use of 3D prints do not disadvantage students relative to cadaveric materials; maximally, results suggest that 3D may confer certain benefits to anatomy learning and supports their use and ongoing evaluation as supplements to cadaver-based curriculums. Anat Sci Educ 9: 213-221. © 2015 American Association of Anatomists.
278 citations
Cites background or methods from "The production of anatomical teachi..."
...…recent publication by McMenamin et al. describes methods of creating 3D prints of prosected specimens as well as prints of fluid or air filled “negative spaces” (i.e., blood vessels and paranasal sinuses) using data from computed tomog- raphy (CT) scans or surface scanning (McMenamin et al., 2014)....
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...The 3D prints shown in Figure 1 reflect the anatomical detail of the cadaveric originals to a much greater degree compared with plastic anatomical models, and were obtained at a much reduced overall cost compared to cadaveric materials (McMenamin et al., 2014)....
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...…identical 3D prints of a prosected heart that included the great vessels, two identical prints of a second heart without the great vessels, and three prints of coronary artery models derived from contrast CT angiography data printed using the technique previously described (McMenamin et al., 2014)....
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...Participants were randomly assigned to one of three groups that Example of models printed using protocol described by McMenamin et al. (2014)....
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...As described in a prior publication, 3D printing is markedly cheaper than purchasing or producing plastinated specimens (McMenamin et al., 2014) and is detailed enough to provide a suitable supplement or adjunct to a cadaver-based curriculum....
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TL;DR: The aim of the present study is to assess the impact of a traditional method like cadaveric dissection in teaching/learning anatomy at present times when medical schools are inclining towards student‐centered, integrated, clinical application models.
Abstract: Anatomical education has been undergoing reforms in line with the demands of medical profession. The aim of the present study is to assess the impact of a traditional method like cadaveric dissection in teaching/learning anatomy at present times when medical schools are inclining towards student-centered, integrated, clinical application models. The article undertakes a review of literature and analyzes the observations made therein reflecting on the relevance of cadaveric dissection in anatomical education of 21st century. Despite the advent of modern technology and evolved teaching methods, dissection continues to remain a cornerstone of anatomy curriculum. Medical professionals of all levels believe that dissection enables learning anatomy with relevant clinical correlates. Moreover dissection helps to build discipline independent skills which are essential requirements of modern health care setup. It has been supplemented by other teaching/learning methods due to limited availability of cadavers in some countries. However, in the developing world due to good access to cadavers, dissection based teaching is central to anatomy education till date. Its utility is also reflected in the perception of students who are of the opinion that dissection provides them with a foundation critical to development of clinical skills. Researchers have even suggested that time has come to reinstate dissection as the core method of teaching gross anatomy to ensure safe medical practice. Nevertheless, as dissection alone cannot provide uniform learning experience hence needs to be complemented with other innovative learning methods in the future education model of anatomy. Anat Sci Educ 10: 286-299. © 2016 American Association of Anatomists.
251 citations
References
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TL;DR: A new reproducibility index is developed and studied that is simple to use and possesses desirable properties and the statistical properties of this estimate can be satisfactorily evaluated using an inverse hyperbolic tangent transformation.
Abstract: A new reproducibility index is developed and studied. This index is the correlation between the two readings that fall on the 45 degree line through the origin. It is simple to use and possesses desirable properties. The statistical properties of this estimate can be satisfactorily evaluated using an inverse hyperbolic tangent transformation. A Monte Carlo experiment with 5,000 runs was performed to confirm the estimate's validity. An application using actual data is given.
6,916 citations
"The production of anatomical teachi..." refers methods in this paper
...In addition, the calculated mean measurements for the original and reproductions was used to calculate concordance correlation coefficients (Lin, 1989, 2000) to assess the reliability of the 3D printed reproductions against the original maxillary dentition....
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15 May 2010
TL;DR: Medical application of rapid prototyping is feasible for specialized surgical planning and prosthetics applications and has significant potential for development of new medical applications.
Abstract: Generation of graspable three-dimensional objects applied for surgical planning, prosthetics and related applications using 3D printing or rapid prototyping is summarized and evaluated. Graspable 3D objects overcome the limitations of 3D visualizations which can only be displayed on flat screens. 3D objects can be produced based on CT or MRI volumetric medical images. Using dedicated post-processing algorithms, a spatial model can be extracted from image data sets and exported to machine-readable data. That spatial model data is utilized by special printers for generating the final rapid prototype model. Patient–clinician interaction, surgical training, medical research and education may require graspable 3D objects. The limitations of rapid prototyping include cost and complexity, as well as the need for specialized equipment and consumables such as photoresist resins. Medical application of rapid prototyping is feasible for specialized surgical planning and prosthetics applications and has significant potential for development of new medical applications.
1,362 citations
"The production of anatomical teachi..." refers methods in this paper
...…the production of bespoke prefabricated bone models for presurgical planning or the creation of patient-specific prostheses for implantation (Tam et al., 2013), surgical simulation (Monfared et al., 2012, Waran et al., 2013) or as a patient educational tools (see review, Rengier et al., 2010)....
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TL;DR: This review of CT will proceed in chronological order focussing on technology, image quality and clinical applications, and briefly allude to novel uses of CT such as dual-source CT, C-arm flat-panel-detector CT and micro-CT.
Abstract: X-ray computed tomography (CT), introduced into clinical practice in 1972, was the first of the modern slice-imaging modalities. To reconstruct images mathematically from measured data and to display and to archive them in digital form was a novelty then and is commonplace today. CT has shown a steady upward trend with respect to technology, performance and clinical use independent of predictions and expert assessments which forecast in the 1980s that it would be completely replaced by magnetic resonance imaging. CT not only survived but exhibited a true renaissance due to the introduction of spiral scanning which meant the transition from slice-by-slice imaging to true volume imaging. Complemented by the introduction of array detector technology in the 1990s, CT today allows imaging of whole organs or the whole body in 5 to 20 s with sub-millimetre isotropic resolution. This review of CT will proceed in chronological order focussing on technology, image quality and clinical applications. In its final part it will also briefly allude to novel uses of CT such as dual-source CT, C-arm flat-panel-detector CT and micro-CT. At present CT possibly exhibits a higher innovation rate than ever before. In consequence the topical and most recent developments will receive the greatest attention.
815 citations
"The production of anatomical teachi..." refers background in this paper
...A modern 64 slice CT scanner typically involves lower resolutions; for example a CT scan of a limb segment would produce pixel sizes (i.e., X and Y resolutions) of 0.15– 0.5 mm and interslice distances (Z resolution) of 0.4–1.0 mm (Kalender, 2006)....
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TL;DR: Alternative resources and strategies are discussed in an attempt to tackle genuine concerns of diminished allotted dissection time and the number of qualified anatomy instructors, which will eventually deteriorate the quality of education.
Abstract: Anatomy has historically been a cornerstone in medical education regardless of nation or specialty. Until recently, dissection and didactic lectures were its sole pedagogy. Teaching methodology has been revolutionized with more reliance on models, imaging, simulation, and the Internet to further consolidate and enhance the learning experience. Moreover, modern medical curricula are giving less importance to anatomy education and to the acknowledged value of dissection. Universities have even abandoned dissection completely in favor of user-friendly multimedia, alternative teaching approaches, and newly defined priorities in clinical practice. Anatomy curriculum is undergoing international reformation but the current framework lacks uniformity among institutions. Optimal learning content can be categorized into the following modalities: (1) dissection/prosection, (2) interactive multimedia, (3) procedural anatomy, (4) surface and clinical anatomy, and (5) imaging. The importance of multimodal teaching, with examples suggested in this article, has been widely recognized and assessed. Nevertheless, there are still ongoing limitations in anatomy teaching. Substantial problems consist of diminished allotted dissection time and the number of qualified anatomy instructors, which will eventually deteriorate the quality of education. Alternative resources and strategies are discussed in an attempt to tackle these genuine concerns. The challenges are to reinstate more effective teaching and learning tools while maintaining the beneficial values of orthodox dissection. The UK has a reputable medical education but its quality could be improved by observing international frameworks. The heavy penalty of not concentrating on sufficient anatomy education will inevitably lead to incompetent anatomists and healthcare professionals, leaving patients to face dire repercussions. Anat Sci Educ 3: 83–93, 2010. © 2010 American Association of Anatomists.
739 citations
"The production of anatomical teachi..." refers background in this paper
...Many hold the view that cadaveric dissection is the key component of teaching anatomy (Ramsey-Stewart et al., 2010; Sugand et al., 2010) and the consequences for trainees/practitioners not having competent anatomical knowledge has recently been emphasized (Johnson et al., 2012)....
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TL;DR: Comparison between the data sets suggests several key points some of which include: decreased total hours in gross anatomy and neuroscience/neuroanatomy courses, increased use of virtual microscopy in microscopic anatomy courses, and decreased laboratory hours in embryology courses.
Abstract: At most institutions, education in the anatomical sciences has undergone several changes over the last decade. To identify the changes that have occurred in gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses, directors of these courses were asked to respond to a survey with questions pertaining to total course hours, hours of lecture, and hours of laboratory, whether the course was part of an integrated program or existed as a stand-alone course, and what type of laboratory experience occurred in the course. These data were compared to data obtained from a similar survey in 2002. Comparison between the data sets suggests several key points some of which include: decreased total hours in gross anatomy and neuroscience/neuroanatomy courses, increased use of virtual microscopy in microscopic anatomy courses, and decreased laboratory hours in embryology courses.
681 citations
"The production of anatomical teachi..." refers background in this paper
...In contrast, some institutions in the United Kingdom and Europe have abandoned dissection-based learning (McLachlan and Patten, 2006) and in the United States many rely on combinations of prosection and dissection (Drake et al., 2009)....
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