Workflow to develop 3D designed personalized neonatal CPAP masks using iPhone structured light facial scanning.

Background: Continuous positive airway pressure (CPAP) is a common mode of respiratory support used in neonatal intensive care units. In preterm infants, nasal CPAP (nCPAP) therapy is often delivered via soft, biocompatible nasal mask suitable for long-term direct skin contact and held firmly against the face. Limited sizes of nCPAP mask contribute to mal-fitting related complications and adverse outcomes in this fragile population.

Surgical Simulation in East, Central, and Southern Africa: A Multinational Survey.

Background: High-income countries have increased the use of simulation-based training and assessment for surgical education. Learners in low- and middle-income countries may have different educational needs and levels of autonomy but they and their patients could equally benefit from the procedural training simulation provides. We sought to characterize the current state of surgical skills simulation in East, Central, and Southern Africa and determine residents' perception and future interest in such activities.

Three-Dimensional-Printed Liver Model Helps Learners Identify Hepatic Subsegments: A Randomized-Controlled Cross-Over Trial.

Introduction: The purpose of this study was to find out whether 3-dimensional (3D)-printed models improved the learners' ability to identify liver segments.

Methods: A total of 116 physicians from 3 disciplines were tested in a cross-over trial at baseline and after teaching with 3D models and 2-dimensional (2D) images. Adjusted multilevel-mixed models were used to compare scores at baseline and after 3D and 2D.

Coordinated approach to spinal and tracheal reconstruction in a patient with morquio syndrome.

Morquio syndrome (Mucopolysaccharidosis IVA) is an autosomal recessive lysosomal storage disease with manifestations ranging from mild to severe phenotype. Mechanical spinal cord injury and airway insufficiency are major causes of mortality. A 17-year-old male patient with severe Morquio syndrome presented with cervical and upper thoracic spinal stenosis with spinal cord myelopathy, and progressive severe tracheal stenosis.

3D printed modeling contributes to reconstruction of complex chest wall instability.

Background: Three-dimensional printed models are increasingly used in many fields including medicine and surgery, but their use in the planning and execution of complex chest wall reconstruction has not been adequately described. In cases of non-union or prior attempts at chest wall reconstruction which have failed, there can be substantial deviations from expected chest wall anatomy. We report a novel technique for pre-operative planning and surgical execution of complex chest wall reconstruction, assisted by 3D printing.

Imaging for Acute and Chronic Scaphoid Fractures.

The scaphoid is the most commonly fractured bone in the wrist but 20% to 40% of scaphoid fractures are radiographically occult. Delayed or misdiagnosis can have significant consequences with late complications such as nonunion, malunion, or the development of avascular necrosis in the proximal pole. After initial negative radiographs, advanced cross-sectional imaging, including CT and MRI, ultimately may provide more accurate and rapid diagnosis than conventional radiography.

Preoperative Planning Using 3-Dimensional Printing for Complex Paraspinal Schwannoma Resection: 2-Dimensional Operative Video.

Schwannomas are benign peripheral nerve sheath tumors that are typically round, smooth, and straightforward to resect. Occasionally they are more complicated to resect because of their size, location, degree of bony erosion, and vascular or neural compression. These complex lesions frequently require multidisciplinary surgical teams in order to decrease surgical morbidity.

The Various Applications of 3D Printing in Cardiovascular Diseases.

Purpose Of Review: To highlight the various applications of 3D printing in cardiovascular disease and discuss its limitations and future direction.

Recent Findings: Use of handheld 3D printed models of cardiovascular structures has emerged as a facile modality in procedural and surgical planning as well as education and communication. Three-dimensional (3D) printing is a novel imaging modality which involves creating patient-specific models of cardiovascular structures.

The breadth of the diaphragm: updates in embryogenesis and role of imaging.

The diaphragm is an unique skeletal muscle separating the thoracic and abdominal cavities with a primary function of enabling respiration. When abnormal, whether by congenital or acquired means, the consequences for patients can be severe. Abnormalities that affect the diaphragm are often first detected on chest radiographs as an alteration in position or shape.

Three-dimensional prototyping for procedural simulation of transcatheter mitral valve replacement in patients with mitral annular calcification.

Introduction: Three-dimensional (3D) prototyping is a novel technology which can be used to plan and guide complex procedures such as transcatheter mitral valve replacement (TMVR).

Methods: Eight patients with severe mitral annular calcification (MAC) underwent TMVR. 3D digital models with digital balloon expandable valves were created from pre-procedure CT scans using dedicated software.

Skull base plasmacytoma: A unique case of POEMS syndrome with a plasmacytoma causing craniocervical instability.

Introduction: Plasmacytomas, considered to be the solitary counterparts of multiple myeloma, are neoplastic monoclonal plasma cell proliferations within soft tissue or bone. Plasmacytomas often present as a collection of findings known as POEMS-syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, M-Protein spike, and Skin changes).

Case Description: We present a report of a 47 yo male diagnosed with POEMS-syndrome secondary to a skull base plasmacytoma.

Three-dimensional Printing for Renal Cancer and Surgical Planning.

Three-dimensional (3D) stereolithographic models provide tactile and anatomic information that offers advantages over digital 3D reconstructions alone. This technology has the potential to alter preoperative surgical planning and significantly enhance successful performance of complex nephron-sparing surgery.

Implementation of iterative metal artifact reduction in the pre-planning-procedure of three-dimensional physical modeling.

Background: To assess the impact of metal artifact reduction techniques in 3D printing by evaluating image quality and segmentation time in both phantom and patient studies with dental restorations and/or other metal implants. An acrylic denture apparatus (Kilgore Typodent, Kilgore International, Coldwater, MI) was set in a 20 cm water phantom and scanned on a single-source CT scanner with gantry tilting capacity (SOMATOM Edge, Siemens Healthcare, Forchheim, Germany) under 5 scenerios: (1) Baseline acquisition at 120 kV with no gantry tilt, no jaw spacer, (2) acquisition at 140 kV, (3) acquisition with a gantry tilt at 15°, (4) acquisition with a non-radiopaque jaw spacer and (5) acquisition with a jaw spacer and a gantry tilt at 15°. All acquisitions were reconstructed both with and without a dedicated iterative metal artifact reduction algorithm (MAR).

Three-dimensional printed models in multidisciplinary planning of complex tracheal reconstruction.

Three-dimensional printed models are increasingly used in medicine and surgery, but applications of these models in the planning of operative procedures is not well described. In particular, their benefits have not been documented in complex, multiservice, high-risk operations. We describe five cases of complex pediatric tracheal reconstruction for which three-dimensional models had specific benefits in planning as well as in education of trainees, operating room staff, and patient families.

Melorheostosis: A Retrospective Clinical Analysis of 24 Patients at the Mayo Clinic.

Background: Current understanding of the clinical features of persons with melorheostosis is restricted primarily to individual case reports and small case series.

Objective: To assess the clinical features of patients with melorheostosis treated at our institution from 1972 through 2010.

Design: Chart review.

Technique for 3-Dimesional (3D) Modeling of Osteoarticular Medial Femoral Condyle Vascularized Grafting to Replace the Proximal Pole of Unsalvagable Scaphoid Nonunions.

This study describes a novel technique for the preoperative surgical planning for an osteoarticular medial femoral condyle (MFC) graft to replace the proximal pole of a scaphoid. In cases of proximal pole scaphoid nonunion or in Preiser disease, fragmentation of the articular surface can occur, leading to significant pain and disability. Osteoarticular MFC bone grafting can be used to treat these injuries by providing a vascularized osteoarticular surface.

The Utility of Magnetic Resonance Imaging in the Evaluation of Accessory Scrotum in the Newborn.

Accessory scrotum, a rare form of congenital scrotal anomaly that is often associated with other genitourinary and anorectal anomalies, is characterized by ectopic scrotal tissue in the presence of a normal, orthotopic scrotum. Here, we present a case of accessory scrotum in a newborn male. We describe our experience with the utilization of preoperative pelvic magnetic resonance imaging to characterize the complex relationship between the accessory scrotum and ano-sphincteric complex, as well as identify associated genitourinary abnormalities.

Use of Personalized Printed 3-Dimensional Kidney Models for Simulation before Nephron Sparing Surgery: Methodology and Examples from a Case Series.

Introduction: Nephron sparing surgery may be challenging in cases of complex or aberrant renal anatomy. 3-Dimensional printing technology has allowed the creation of 3-dimensional models that can aid in preoperative surgical planning and simulation. We describe the construction of personalized 3-dimensional kidney models, and present a series of patients with complex surgical anatomy to illustrate their use in surgical planning and performance of complex nephron sparing surgery.

Radiation Dose Reduction in Pediatric Body CT Using Iterative Reconstruction and a Novel Image-Based Denoising Method.

Objective: The objective of this study was to evaluate the radiation dose reduction potential of a novel image-based denoising technique in pediatric abdominopelvic and chest CT examinations and compare it with a commercial iterative reconstruction method.

Materials And Methods: Data were retrospectively collected from 50 (25 abdominopelvic and 25 chest) clinically indicated pediatric CT examinations. For each examination, a validated noise-insertion tool was used to simulate half-dose data, which were reconstructed using filtered back-projection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) methods.

Prevalence and risk factors for post thrombotic syndrome after deep vein thrombosis in children: a cohort study.

Background: While post thrombotic syndrome (PTS) is increasingly recognized as a frequent and potentially serious complication of deep vein thrombosis (DVT) in children, limited information is available regarding predictors of PTS.

Methods: Using the Mayo Clinic Master Diagnostic Index, all pediatric patients (age 0 to 18 years) with a potential DVT based on ICD-8 codes over the 15-year period, 1995 to 2009 were identified. A validated PTS survey instrument was mailed to eligible patients followed by a second mailing and three reminder phone calls for non-responders.

Health-related quality of life in children and young adults with post-thrombotic syndrome: results from a cross-sectional study.

Objective: While post-thrombotic syndrome (PTS) is increasingly recognized in children with a history of deep vein thrombosis (DVT), its impact on the health-related quality of life (HRQoL) is unknown. Our objective was to evaluate the association between the PTS and HRQoL by surveying a cohort of patients treated at our institution for DVT.

Materials/methods: All unique pediatric patients (0-18 years) treated for a DVT at the Mayo Clinic during the 15-year period, 1995-2009 were identified.

Tips and tricks for MR angiography of pediatric and adult congenital cardiovascular diseases.

Objective: The use of contrast-enhanced MR angiography (MRA) as an alternative to CT angiography or conventional angiography to assess pediatric and adult patients with cardiovascular diseases has the potential to significantly reduce patients' lifetime exposure to ionizing radiation. However, imaging this group of patients can be challenging because of a number of factors, including small size, difficulty timing the contrast bolus to the territory of interest, and the presence of metallic susceptibility artifact resulting from stents or clips.

Conclusion: We present some suggestions to overcome many of these obstacles to MRA in these patients, highlighted with illustrations from clinical cases.