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Hospital 3d Printing Program

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Video: Dicom to STL

This a video demonstrating the use of Mimics software to convert patient dicom images into 3D printable files. Mimics software has many great features to improve and ease workflow. Like other software programs most segmentation and exporting can be accomplished in 15 minutes.  

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From Dicom to .STL

There are several options for clinicians to use when converting a patients .dicom data into a 3D printed model. For our 3D Printing Program I use the Mimics Innovation Suite made by Materialise. The software is available for computers running Windows. The software receives regular updates to improve functionality and increase the efficiency and quality of the .dicom to 3D print workflow. It is capable of converting CT, MRI, and 3D ultrasound images into 3D models that are ready for the 3D printer. There are many things that I enjoy when using this software, including:​ Ease of use for beginner users Fast processing time, <30 minutes for many projects Many different features available

To give a demonstration on how the software is easy to use, I will use a CT scan of my own head. After the files are loaded, the software detects the appropriate scan studies that are present. You are able to load multiple scans into a single project. Apply thresholding: Mimics has built in presets for CT bone, soft-tissue, etc. I selected the preset for CT bone. After the thresholding is applied a new Mask is created. The mask shows only bone in the scan. Edit mask in 3D: Before i create a new 3D mask, i can edit my current mask to make changes such as removing unwanted pieces and cropping the unwanted areas before moving forward. Region Growing: In order to remove floating voxels and detach unwanted bony anatomy, the Region Growing tool is applied. It will preserve only the bone that is desired in the mask. Calculate 3D from Mask: Once the mask is edited the way you need, you will Calculate 3D object from the Mask. The 3D object can further exported into 3Matic for additional changes or exported as an .stl file for 3D printing. Export to 3Matic: I would demonstrate the tools for cleaning and preparing the part for printing Wrap to fill small holes Smoothing to smooth the surfaces Quick label to apply a label to the part Fix wizard to make sure the part is watertight for printing Export 3D PDF as a communication tool
[*]Copy-Paste the completed file from 3-matic back to Mimics. Show the contours of the 3D model on the original images. Point out the importance of verifying the accuracy of the part prior to exporting STL.

Conclusion:  
When evaluating software for printing 3D models from patient scans, look at features, cost, compatibility, and ease of use. Ask for a demonstration and trial before purchasing. There are different options for software, it is important to look for one that works with your workflow.   Want to learn more? Contact Me David@3dAdvantage.org
Visit my site 3DAdvantage

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Why your Simulation Center needs a 3D Printer

Why do we need this? This is usually the first response you will get when asking to buy a 3D Printer. What are the benefits? Return on Investment? To show the benefits of having this capability in your center here is a look at one of the many cases I have our used our 3D Printers to create custom piece's and improve realism in our simulation scenarios. As users of High-Fidelity Manikin's we all know these manikins are capable of replicating human patients with high realism. Unfortunately there are some limitations when using this equipment. Some limitations can cause a simulation scenario to go down a different route from what was intended. Problem: Some simulation's require the scenario to be Can't Intubate, Can Ventilate, the goal being the physician using a specific algorithm for treatment. However I was finding that even with the difficult airways features turned on (laryngospasm, pharyngeal swelling, and tongue swelling) the physicians were able to pass the ET tube into the trachea with little resistance (video 1) *Disclaimer* There is resistance when attempting to pass the tube through the vocal cords, passing the tube with resistance would not take place in a clinical setting, however it does happen in simulation. Video 1 Solution 1: I attempted to find solutions to implement in addition to using the manikin features that could improve the realism and prevent intubation. The first solution involved making changes to the ET Tube. I cut the cuff (preventing a seal from being obtained). This solution did not work as it required opening the packaging of the supplies, and trying to prevent the staff from testing the cuff prior to intubation. Even with the modifications the physician was still able to pass the tube through into the trachea. Solution 2: I decided to create a custom 3D printed piece that would prevent the tube from being passed. The manikin has a removable surgical airway that once removed exposes an opening behind the vocal cords (Figure 1). Figure 1 The opening would allow a 3D printed piece to fit perfectly without interfering with any of the manikin features. Using digital calipers i measured the diameter of the opening as well length to the vocal cords. Design: There were multiple programs i could use to design the prototype, TinkerCAD, 123D, or Fusion360. I started creating a rough design in TinkerCAD, as it is web-based and simple to use. Using TinkerCAD did have some limitations and my first print failed due to the walls being too thin. Design in TinkerCAD My next attempt was using Fusion360. As with any prototype you will go through several designs before reaching the final one. Using Fusion360 provided me with greater control and more options for creating the prototype. Using the dimensions from TinkerCAD, I was able to easily create the prototype (see Video 2). The prototype has four holes that allow air to pass. Also included is a solid tube extending out to allow from the piece to be removed with forceps. Video 2 Printing: For the 3D print I decided to use the Formlabs 1+ SLA printer. My reasons for choosing this printer over the other 3D printers was for several reasons. First I wanted the prototype to be clear, second i wanted a flexible material that could be compressed to insure an airtight seal. And last using the Formlabs software allowed me to only have to select the material I wanted to use, all settings are changed automatically. If I used one of the other printers I would need to change multiple values manually to use a flexible filament. I have great results using the Formlabs printer, and I knew the prototype would be good quality. The print settings were: Material: Flexible Resin v1 Layer Thickness: 0.1mm Volume: 5.99mL Print Time: 59 minutes Total Cost: $1.80/per print Blockage Prototype-Printed on Formlabs 1+ (Left) TinkerCAD Design, (Right) Fusion360 Design Testing the Prototype: To test the prototype. I inserted the piece into the surgical airway opening with the flat base facing the vocal cords. I attempted to intubate the manikin (video 3). The ET tube was not able to pass the vocal cords regardless of the amount of force applied. The prototype fit snuggly in the surgical airway opening (figure 2) providing normal manikin function without any restrictions. Video 3 Figure 2 Conclusion: The 3D Printed prototype functioned well during testing and during the simulation scenario's. The simple, low-cost design is achievable by using a 3D printer. The piece can be further modified to be used in a simulation that requires Can't Intubate, Can't Ventilate. Since there are 6 high-fidelity manikins in our center, all the manikins can be fitted with the piece for $10.80. There are countless ways to use a 3D printer in your center, this was just one example of the benefits the 3D printer can bring. Written by David Escobar Need Training? Contact me at david@3DAdvantage.org Please check out my site for more information 3DAdvantage.org

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3D Printer Software Overview

On my last post I gave an overview of the 3D printers I am currently using in our hospital program. Now I will be explaining the different software I have used from one time to another to go from 3D model to 3D print. The software I cover here is available as a free download or for under $500. 1. TinkerCAD: The first software I used was TinkerCAD. It is a web-based CAD design tool, Simply create a free account and start designing. The layout and menu's are simple and basic enough for beginners to naviagate. It offers many pre-made tools to use from adding letters to adding shapes. For creating designs in TinkerCAD it uses a combination of adding and subtracting shapes or using pre-made designs. The main tools I use are Align, Group, Ruler, and Cylinder. When finished you can download your designs for exporting to a 3D printer or use a 3rd party to print your design for you. For being a entry-level software I still use it to add connections between bones, and for simple movement between parts. Importing .stl files is an important function to use when creating files in other software and wanting to edit in TinkerCAD. Use in Healthcare Applications: Adding custom connections between parts, creating simple frames and supports. Pros: Simple design, easy to use, no software to download, free, always available online from any computer. Cons: Pre-loaded shapes can be limiting for complex parts. Amazing results can be achieved with practice and time. 2. 123D Design: This software is part of the Autodesk family. This a free download, geared more towards users with some knowledge of CAD software. Where TinkerCAD requires the user to use shapes to make designs, in 123D you can create from scratch. This software is ideal for designing prototypes and those wanting to becoming more familiar with CAD software. I use 123D when I need more control than what is offered in TinkerCAD. Use in Healthcare Applications: The software provides more customization than TinkerCAD. It allows for custom-made parts used in Rapid Prototyping Design. Pros: Simple to use, free, great for learning CAD software. Cons: Other software is capable of the same functions. 3. Autodesk Fusion360: I recently started using this software. As our 3D printing program grew I started to receive request to design prototypes based on drawings. Fusion360 has been my software of choice when creating prototypes. The software offers many tools from Sculpting, Combining, Importing Mesh, and Press & Pull, to name a few. I can spend countless post just discussing all the features available in Fusion360, best advice is to go use it. The online support is outstanding. Autodesk really has stood behind this product and helping the community, all my questions were answered within hours (during business hours) and customer support always provided screenshots or videos as well as the written steps. Fusion360 also has a new feature that will export directly to the printing software included or a 3rd party software, such as Preform, Simplify3d, Meshmixer, etc. Use in Healthcare Applications: Designing prototypes, creating designs based off of patient scan data, creating a wide range of models from simple to complex, allows for online collaboration with your team. Pros: Many features available, great online/community support, constant updates to software. Cons: Cost associated with purchasing software (minimal) 4. Meshmixer: Another software from the Autodesk family that I use. This is a very powerful & valuable piece of free software to have when 3D printing. Meshmixer gives you control over many different aspects of your model, including Transform, Plane Cut, Sculpt, Analysis, and adding Supports. The Analysis function provides Slicing of your model, it will correct errors and prepare the model for 3D Printing. Meshmixer allows direct exporting to certain printers (*listed in Meshmixer). Using the Support feature allows you to define how supports will be generated. This software also allows you to add or remove supports that are generated by the software, a very useful feature when printing a patient specific model that is dependent on accuracy. Use in Healthcare Applications: This software is a must-have. I use it to double-check for any slicing errors prior to printing. You can also sculpt organic models from scratch (see uterus) Pros: Free. Many editing options available. Will help ensure more successful prints. Cons: Although there are training guides and a community forum. The software can be overwhelming to a first time user. The best recommendation is to search forums and spend time using the software to become familiar with the available features. Conclusion There are many options available when choosing software to use. It is important to evaluate cost, ease of use, available functions, and capability with the 3D printers you will be using. Evaluate the goals of your 3D Printing Program to choose what combination of software you will need and use. Remember as most of the software featured here is free, spend time working with each one. Links to software websites found Here An added extra. Download a 3D Skull ready for Print Click Here Written by David Escobar Check out my site for more information 3DAdvantage.org Twitter: @descobar3d

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A look at 3D Printers for a Hospital Program

In order to help with choosing a 3D Printer for use in a Hospital 3d Printing Program i will be discussing the printers i currently use and how i use each one. All of the printers cost less then $5,000, which makes them affordable and avoids becoming a capital purchase. Makerbot Replicator 2 Skull on Makerbot Replicator 2 This printer was our first purchase when starting a 3D program. Overall the Replicator 2 is a very reliable and low cost option for beginning users. The printer only prints PLA out of the box, but can be modified to use other materials such as flexible filament. PLA comes in many different colors. The PLA is very affordable, which makes this printer for printing prototypes and supports are simple to remove. The printer does require user maintenance periodically. The printer also requires manual calibration and build plate leveling. Our primary use for this printer has been for rapid prototyping and presentations. For pre-surgical planning our Physicians requested clear printed models. The Replicator 2 can print in a Natural filament, however it did not meet the needs of the physicians. My only issues using this printer has been filament spool jams and occasional leveling. Makerbot desktop provides many customization options for infill, speed, temp, resolution, to name a few. Build Volume: 11.2 L x 6.0 W x 6.1 H in
Materials: PLA, *other materials available with modification to the printer
Best Uses: Rapid Prototyping, Color Models, Bones (Infill % can be customized)
Makerbot Replicator 2x Makerbot Replicator 2X The 2x was the second printer we added. I wanted a duel nozzle printer with the added benefits of new materials. With the addition of this printer we added ABS, Flexible, and Dissolvable filaments. This printer was my first experience with using a heated build plate and the new materials. Adding a printer with dual nozzles can add some challenges to overcome such as leveling the nozzles. Since this printer has been around for several years, there are many great tips & tricks available to someone just starting. I also increase successful prints by adding glue to the build plate. We use this printer for the same purposes as the Replicator 2, but with greater flexibility in materials and multiple colors. Just like the Replicator 2, the same maintenance and setup applies. We have added Simplify3d software to our library which has added greater function and customization to our Makerbot printers. Build Volume: 9.7 L x 6.0 W x 6.1 H in
Materials: ABS, PLA, Flexible, Dissolvable
Best Uses: Rapid Prototyping, Color Models, Bones (Infill % can be customized)
Formlabs 1+ Formlabs The Formlabs 1+ by far has been the strongest & most reliable printer we have purchased. It has help our program grow substantially, by allowing the prints to be clear, flexible and extremely durable, which has helped our research program use our models. This is the only SLA printer we have. The printer is simple to use and requires almost no setup, as no calibration is needed. I was printing within 15 minutes of turning the printer on for the first time. I use this printer for about 90% of the anatomical prints from patient CT/MRI data. The Preform software is easy to use and offers customization options, such as turning internal supports on or off. This is an important feature when printing accurate models of vessels or internal structures of the heart. I have had a 99% success rate when using this printer. The main difference for use is using resin instead of spools of filament. The resin can be a bit messy but cleans with little effort. Build Volume: 4.9 L x 4.9 W x 6.5 H in
Materials: Resin-White, Black, Grey, Clear, Flexible, Castable
Best Uses: Soft tissue and vessels, Heart values, Bones, Solid models, Clear models
CubePro Duo Unboxing the CubePro Duo Our newest addition to the center. We required a printer with a big build volume and offered multiple materials to be used. The printer can use PLA, ABS, and soon Nylon. The printer has a big build volume for the price range. The filament come in cartridges purchased from 3dSystems, so using 3rd party vendors for materials in not an option. The closed system does limit customization for pre-printing setup. It currently does not work directly with Simplify3d. This printer has required more user maintenance and setup compared to the other printers i use. The Z-Gap calibration can be very confusing as well as the lack of a direct connection to the printer ( print files are transferred via USB or Wifi) The supports generated are very weak and tend to fail very often resulting in failed prints. Although the printer has some obstacles to overcome it is capable of producing great prints. Build Volume: 11.2 L x 10.6 W x 9.06 H in
Materials: PLA, ABS, Nylon* (*coming soon)
Best Uses: Production quality prints. Multiple color & materials prints, Sterilizable prototypes
Written by David Escobar Want to learn more, please visit my site 3dAdvantage.org Follow me on twitter @descobar3d

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