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Found 37 results

  1. Medical Three-dimensional (3D) printing has a variety of uses and is becoming an integral part of dentistry, oral surgery and dental lab workflows. 3D printing in dentistry is the natural progression from computer-aided design (CAD) and computer-aided manufacturing (CAM) technology which has been used for years by dental labs to create crowns, veneers, bridges and implants. Now, 3D printing is taking its place with 3D printing solutions for dental, orthodontic, and maxillofacial applications. Several 3D printer manufacturers, including Stratasys and EnvisionTEC, offer specialized materials and printers as part of their dental 3D printing solutions. Anyone can create 3D printed dental models and embodi3D has created a dental 3D printing tutorial which guides readers through the process of 3D printing teeth and mandible. What is Dental 3D Printing? Three-dimensional printing begins with a special scanner. The mouth of the patient can be scanned using contact or non-contact scanning technology. The device works by creating a super accurate, patient specific digital image of a dental surface that is then saved as a computer file. Using specialized software, the scan is translated into a 3D digital representation. The resulting digital model may be a tooth, several teeth or the jaw. This digital imaging is not only replacing CAD/CAM technology, but it is also replacing some of the old plaster impressions traditionally used. Once the scan is complete and a 3D image has been created, the specialized software will prepare it for physical model creation. There are two popular methods for creating a physical model from the digital representation. The first method involves using a technique called slicing. With the help of specialized computer software, the original three-dimensional image is divided into thin horizontal layers. These layers are then transmitted to the 3D printer. The physical model is then printed layer by layer until the physical 3D model is complete. The second method is CNC milling. In this case, the complete digital image is transferred to a milling machine. Rather than print a model layer by layer, the milling machine starts with a solid piece of material. The machine then carves the new 3D physical model out of that block of material. As techniques become more advanced, 3D models become more accurate and the technology becomes more readily available, the first method is used more often in dental diagnosis, treatment planning and construction of dental appliances such as dental implants, orthodontics, denture bases and bite guards. Advantages of 3D Printing Teeth, Crowns, Dentures and Other Dental Anatomy 3D imaging has been used in dentistry for many years, however, the traditional method of model creation involves dental plaster models. While these models are accurate, so are 3D printed oral models. In fact, dental 3D printing is not only accurate, it is quick and a lot less messy. Patients who have undergone fitting for a crown or other dental appliance generally do not remember the process fondly. Plaster is messy and it has been necessary for patients to be fitted with a temporary appliance only to return for a second visit. This is both inconvenient and time-consuming. 3D imaging and printing can alleviate this problem. In dental offices with the capability, the process is fast and patients can often be fitted with their permanent appliance in a single visit without the plaster mess. This makes the entire process far more convenient for patients. Dentists also benefit from 3D printing and imaging. Imaging files are far easier to store than bulky plaster casts. By going digital, dentists and maxillofacial surgeons can store patient information indefinitely. This makes it easier to refer to files time and again for comparison, planning and treatment. As the 3D printer technology becomes more accessible, the cost of use is going down. Patients can have these procedures performed at prices comparable to traditional methods, and these costs will continue to decrease as 3D printer prices decrease. Advances in 3D printing technology are constantly improving. Whereas manual creation of implants, crowns and prosthetics required a high degree of specialization, 3D printing can quickly and easily create highly accurate models. This provides better fitting, more personalized appliances improving both comfort and efficacy of prosthetics. 3D Printing in Maxillofacial and Oral Surgery Maxillofacial and oral surgery is an area where 3D printing is currently being utilized for a variety of reasons including cancer, birth defects, injury or receding bone. Corrective surgery is often needed in cases like these. A prosthesis, implant, dental mesh, surgical stent and more can be created through the 3D scanning and printing process to aid patients. In addition to creating the actual prosthetics, three-dimensional printing is also helpful as part of the planning process. Three-dimensional printing can be used to create prototypes of the planned devices prior to surgery. Having the ability to simulate devices prior to implantation can help surgeons work out complex reconstructions and ensure that devices fit well. This allows the entire surgical process to be safer and easier. 3D Printed Dental Implants As with maxillofacial surgery, 3D scanning and 3D printing improve the fit, comfort and ease of dental implant surgery. 3D scans of the patient’s teeth, gums and jaw allow dentists to have a high degree of accuracy and as a result 3D printed dental anatomy is patient specific. There are many advantages to using 3D printing for dental implant surgery including: Determine depth and width of bone Accurate sizing for implants Determine the location of sinuses and nerves Three dimensional printing creates accurate models that ensure a good fit. It is used to address issues such as location, angle and depth of the implant prior to surgery. This same technology allows dentists to create templates and surgical drill guides for permanent implants. Many dentists use these guides to improve surgical safety as they guide the surgeon’s hand, ensure correct placement and restrict the depth of the drill. How 3D Printing is Used for Crowns With 3D scanning and printing, dentists and patients can forgo the plaster dental mold and the need to rely on a lab for crown creation. With 3D technology, dentists can use a scanning camera and specialized software to create an exact three-dimensional image of the tooth that needs to be crowned if the tooth has not broken below the gum line. This image is then transmitted to a 3D printer or milling machine that carves a porcelain crown to exact specifications. The entire process can be completed in about an hour allowing patients to leave the dental office with a permanent crown on the same day. Three-dimensional imaging is one more tool in the dentists’ and oral surgeons’ arsenal to provide better oral health care. With three-dimensional imaging and printing, dentists can gain more complete information for diagnosis and treatment, ensure safer procedures and provide a more comfortable fit for oral devices.
  2. If you are planning on using the democratiz3D service to automatically convert a medical scan to a 3D printable STL model, or you just happen to be working with medical scans for another reason, it is important to know if you are working with a CT (Computed Tomography or CAT) or MRI (Magnetic Resonance Imaging) scan. In this tutorial I'll show you how to quickly and easily tell the difference between a CT and MRI. I am a board-certified radiologist, and spent years mastering the subtleties of radiology physics for my board examinations and clinical practice. My goal here is not to bore you with unnecessary detail, although I am capable of that, but rather to give you a quick, easy, and practical way to understand the difference between CT and MRI if you are a non-medical person. A Brief Overview of How CT and MRI Works For both CT (left) and MRI (right) scans you will lie on a moving table and be put into a circular machine that looks like a big doughnut. The table will move your body into the doughnut hole. The scan will then be performed. You may or may not get IV contrast through an IV. The machines look very similar but the scan pictures are totally different! CT and CAT Scans are the Same A CT scan, from Computed Tomography, and a CAT scan from Computed Axial Tomography are the same thing. CT scans are based on x-rays. A CT scanner is basically a rotating x-ray machine that takes sequential x-ray pictures of your body as it spins around. A computer then takes the data from the individual images, combines that with the known angle and position of the image at the time of exposure, and re-creates a three-dimensional representation of the body. Because CT scans are based on x-rays, bones are white and air is black on a CT scan just as it is on an x-ray as shown in Figure 1 below. Modern CT scanners are very fast, and usually the scan is performed in less than five minutes. Figure 1: A standard chest x-ray. Note that bones are white and air is black. Miscle and fat are shades of gray. CT scans are based on x-ray so body structures have the same color as they don on an x-ray. How does MRI Work? MRI uses a totally different mechanism to generate an image. MRI images are made using hydrogen atoms in your body and magnets. Yes, super strong magnets. Hydrogen is present in water, fat, protein, and most of the "soft tissue" structures of the body. The doughnut of an MRI does not house a rotating x-ray machine as it does in a CT scanner. Rather, it houses a superconducting electromagnet, basically a super strong magnet. The hydrogen atoms in your body line up with the magnetic field. Don't worry, this is perfectly safe and you won't feel anything. A radio transmitter, yes just like an FM radio station transmitter, will send some radio waves into your body, which will knock some of the hydrogen atoms out of alignment. As the hydrogen nuclei return back to their baseline position they emit a signal that can be measured and used to generate an image. MRI Pulse Sequences Differ Among Manufacturers The frequency, intensity, and timing of the radio waves used to excite the hydrogen atoms, called a "pulse sequence," can be modified so that only certain hydrogen atoms are excited and emit a signal. For example, when using a Short Tau Inversion Recovery (STIR) pulse sequence hydrogen atoms attached to fat molecules are turned off. When using a Fluid Attenuation Inversion Recovery (FLAIR) pulse sequence, hydrogen atoms attached to water molecules are turned off. Because there are so many variables that can be tweaked there are literally hundreds if not thousands of ways that pulse sequences can be constructed, each generating a slightly different type of image. To further complicate the matter, medical scanner manufacturers develop their own custom flavors of pulse sequences and give them specific brand names. So a balanced gradient echo pulse sequence is called True FISP on a Siemens scanner, FIESTA on a GE scanner, Balanced FFE on Philips, BASG on Hitachi, and True SSFP on Toshiba machines. Here is a list of pulse sequence names from various MRI manufacturers. This Radiographics article gives more detail about MRI physics if you want to get into the nitty-gritty. Figure 2: Examples of MRI images from the same patient. From left to right, T1, T2, FLAIR, and T1 post-contrast images of the brain in a patient with a right frontal lobe brain tumor. Note that tissue types (fat, water, blood vessels) can appear differently depending on the pulse sequence and presence of IV contrast. How to Tell the Difference Between a CT Scan and an MRI Scan? A Step by Step Guide Step 1: Read the Radiologist's Report The easiest way to tell what kind of a scan you had is to read the radiologist's report. All reports began with a formal title that will say what kind of scan you had, what body part was imaged, and whether IV contrast was used, for example "MRI brain with and without IV contrast," or "CT abdomen and pelvis without contrast." Step 2: Remember Your Experience in the MRI or CT (CAT) Scanner Were you on the scanner table for less than 10 minutes? If so you probably had a CT scan as MRIs take much longer. Did you have to wear earmuffs to protect your hearing from loud banging during the scan? If so, that was an MRI as the shifting magnetic fields cause the internal components of the machine to make noise. Did you have to drink lots of nasty flavored liquid a few hours before the scan? If so, this is oral contrast and is almost always for a CT. How to tell the difference between CT and MRI by looking at the pictures If you don't have access to the radiology report and don't remember the experience in the scanner because the scan was A) not done on you, or you were to drunk/high/sedated to remember, then you may have to figure out what kind of scan you had by looking at the pictures. This can be complicated, but don't fear I'll show you how to figure it out in this section. First, you need to get a copy of your scan. You can usually get this from the radiology or imaging department at the hospital or clinic where you had the scan performed. Typically these come on a CD or DVD. The disc may already have a program that will allow you to view the scan. If it doesn't, you'll have to download a program capable of reading DICOM files, such as 3D Slicer. Open your scan according to the instructions of your specific program. You may notice that your scan is composed of several sets of images, called series. Each series contains a stack of images. For CT scans these are usually images in different planes (axial, coronal, and sagittal) or before and after administration of IV contrast. For MRI each series is usually a different pulse sequence, which may also be before or after IV contrast. Step 3: Does the medical imaging software program tell you what kind of scan you have? Most imaging software programs will tell you what kind of scan you have under a field called "modality." The picture below shows a screen capture from 3D Slicer. Looking at the Modality column makes it pretty obvious that this is a CT scan. Figure 3: A screen capture from the 3D Slicer program shows the kind of scan under the modality column. Step 4: Can you see the CAT scan or MRI table the patient is laying on? If you can see the table that the patient is laying on or a brace that their head or other body part is secured in, you probably have a CT scan. MRI tables and braces are designed of materials that don't give off a signal in the MRI machine, so they are invisible. CT scan tables absorb some of the x-ray photons used to make the picture, so they are visible on the scan. Figure 4: A CT scan (left) and MRI (right) that show the patient table visible on the CT but not the MRI. Step 5: Is fat or water white? MRI usually shows fat and water as white. In MRI scans the fat underneath the skin or reservoirs of water in the body can be either white or dark in appearance, depending on the pulse sequence. For CT however, fat and water are almost never white. Look for fat just underneath the skin in almost any part of the body. Structures that contained mostly water include the cerebrospinal fluid around the spinal cord in the spinal canal and around the brain, the vitreous humor inside the eyeballs, bile within the gallbladder and biliary tree of the liver, urine within the bladder and collecting systems of the kidneys, and in some abnormal states such as pleural fluid in the thorax and ascites in the abdomen. It should be noted that water-containing structures can be made to look white on CT scans by intentional mixing of contrast in the structures in highly specialized scans, such as in a CT urogram or CT myelogram. But in general if either fat or fluid in the body looks white, you are dealing with an MRI. Step 6: Is the bone black? CT never shows bones as black. If you can see bony structures on your scan and they are black or dark gray in coloration, you are dealing with an MRI. On CT scans the bone is always white because the calcium blocks (attenuates) the x-ray photons. The calcium does not emit a signal in MRI scans, and thus appears dark. Bone marrow can be made to also appear dark on certain MRI pulse sequences, such as STIR sequences. If your scan shows dark bones and bone marrow, you are dealing with an MRI. A question I am often asked is "If bones are white on CT scans, if I see white bones can I assume it is a CT?" Unfortunately not. The calcium in bones does not emit signal on MRI and thus appears black. However, many bones also contain bone marrow which has a great deal of fat. Certain MRI sequences like T1 and T2 depict fat as bright white, and thus bone marrow-containing bone will look white on the scans. An expert can look carefully at the bone and discriminate between the calcium containing cortical bone and fat containing medullary bone, but this is beyond what a layperson will notice without specialized training. Self Test: Examples of CT and MRI Scans Here are some examples for you to test your newfound knowledge. Example 1 Figure 5A: A mystery scan of the brain Look at the scan above. Can you see the table that the patient is laying on? No, so this is probably an MRI. Let's not be hasty in our judgment and find further evidence to confirm our suspicion. Is the cerebrospinal fluid surrounding the brain and in the ventricles of the brain white? No, on this scan the CSF appears black. Both CT scans and MRIs can have dark appearing CSF, so this doesn't help us. Is the skin and thin layer of subcutaneous fat on the scalp white? Yes it is. That means this is an MRI. Well, if this is an MRI than the bones of the skull, the calvarium, should be dark, right? Yes, and indeed the calvarium is as shown in Figure 5B. You can see the black egg shaped oval around the brain, which is the calcium containing skull. The only portion of the skull that is white is in the frontal area where fat containing bone marrow is present between two thin layers of calcium containing bony cortex. This is an MRI. Figure 5B: The mystery scan is a T1 spoiled gradient echo MRI image of the brain. Incidentally this person has a brain tumor involving the left frontal lobe. Example 2 Figure 6A: Another mystery scan of the brain Look at the scan above. Let's go through our process to determine if this is a CT or MRI. First of all, can you see the table the patient is lying on or brace? Yes you can, there is a U-shaped brace keeping the head in position for the scan. We can conclude that this is a CT scan. Let's investigate further to confirm our conclusion. Is fat or water white? If either is white, then this is an MRI. In this scan we can see both fat underneath the skin of the cheeks which appears dark gray to black. Additionally, the material in the eyeball is a dark gray, immediately behind the relatively white appearing lenses of the eye. Finally, the cerebrospinal fluid surrounding the brainstem appears gray. This is not clearly an MRI, which further confirms our suspicion that it is a CT. If indeed this is a CT, then the bones of the skull should be white, and indeed they are. You can see the bright white shaped skull surrounding the brain. You can even see part of the cheekbones, the zygomatic arch, extending forward just outside the eyes. This is a CT scan. Figure 6B: The mystery scan is a CT brain without IV contrast. Example 3 Figure 7A: A mystery scan of the abdomen In this example we see an image through the upper abdomen depicting multiple intra-abdominal organs. Let's use our methodology to try and figure out what kind of scan this is. First of all, can you see the table that the patient is laying on? Yes you can. That means we are dealing with the CT. Let's go ahead and look for some additional evidence to confirm our suspicion. Do the bones appear white? Yes they do. You can see the white colored thoracic vertebrae in the center of the image, and multiple ribs are present, also white. If this is indeed a CT scan than any water-containing structures should not be white, and indeed they are not. In this image there are three water-containing structures. The spinal canal contains cerebrospinal fluid (CSF). The pickle shaped gallbladder can be seen just underneath the liver. Also, this patient has a large (and benign) left kidney cyst. All of these structures appear a dark gray. Also, the fat underneath the skin is a dark gray color. This is not in MRI. It is a CT. Figure 7B: The mystery scan is a CT of the abdomen with IV contrast Example 4 Figure 8A: A mystery scan of the left thigh Identifying this scan is challenging. Let's first look for the presence of the table. We don't see one but the image may have been trimmed to exclude it, or the image area may just not be big enough to see the table. We can't be sure a table is in present but just outside the image. Is the fat under the skin or any fluid-filled structures white? If so, this would indicate it is an MRI. The large white colored structure in the middle of the picture is a tumor. The fat underneath the skin is not white, it is dark gray in color. Also, the picture is through the mid thigh and there are no normal water containing structures in this area, so we can't use this to help us. Well, if this is a CT scan than the bone should be white. Is it? The answer is no. We can see a dark donut-shaped structure just to the right of the large white tumor. This is the femur bone, the major bone of the thigh and it is black. This cannot be a CT. It must be an MRI. This example is tricky because a fat suppression pulse sequence was used to turn the normally white colored fat a dark gray. Additionally no normal water containing structures are present on this image. The large tumor in the mid thigh is lighting up like a lightbulb and can be confusing and distracting. But, the presence of black colored bone is a dead giveaway. Figure 8B: The mystery scan is a contrast-enhanced T2 fat-suppressed MRI Conclusion: Now You Can Determine is a Scan is CT or MRI This tutorial outlines a simple process that anybody can use to identify whether a scan is a CT or MRI. The democratiz3D service on this website can be used to convert any CT scan into a 3D printable bone model. Soon, a feature will be added that will allow you to convert a brain MRI into a 3D printable model. Additional features will be forthcoming. The service is free and easy to use, but you do need to tell it what kind of scan your uploading. Hopefully this tutorial will help you identify your scan. If you'd like to learn more about the democratiz3D service click here. Thank you very much and I hope you found this tutorial to be helpful. Nothing in this article should be considered medical advice. If you have a medical question, ask your doctor.
  3. The Embodi3D website offers a large and ever-growing library of 3D printable files that are available for free to anyone who signs up for a free account. Images include files from normal anatomy to those related to paleontology to complex musculoskeletal tumors. This site was founded by a practicing interventional radiologist with a passion for 3D printing and perfecting an easier method for converting files into those that may be downloaded and printed—a medical 3D printing application called democratiz3D. Commercial Medical 3D Printing Software Three-dimensional printing has become a popular research and industrial interest in the orthopaedic surgery world. International companies such as Stryker (www.stryker.com) and DePuy Synthes (www.depuysynthes.com) are now marketing designs in craniofacial reconstruction, arthroplasty, and spine deformity surgery that utilize 3D printing in order to individualize implants and surgical techniques. Specialized software for 3D printing in healthcare is sold by Materialise in an offering called Mimics. Vital Images, a medical imaging and informatics company, has partnered with Stratsys, a 3D printer manufacturer, to provide a segmentation and healthcare 3D printing solution. However, these technologies are costly, and may be cost-prohibitive for the average patient or surgeon. Three-Dimensional Printing for Patient Education and Surgical Planning Although most radiology departments currently have the capability to quickly convert a CT (computer tomography) scan to a three-dimensional image for better understanding of a patient’s anatomy, visualized anatomy cannot replace the ability to feel and manipulate a model. Three-dimensional printing can, however, bring these images to life. Printers have the capability to use differing materials, such as polymers, plastics, ceramics, metals, and biologics to create models. These models can be an excellent tool for patient and trainee education as well as surgical planning. In procedures such as complex tumors or difficult pelvic fractures, the surgeon could practice different techniques on an exact replica of the patient’s anatomy so that they have a better grasp of their approach to the patient. Furthermore, trainees currently learn and practice their surgical skills on cadaveric specimens, which can also be costly. Having access to a 3D printer that could create models could potentially decrease the utilization of cadavers. Free and Easy Medical Three-Dimensional Printing Creating files from CT scans that can be used in 3D printing is easy with the use of the Embodi3d website. Detailed instructions are available on the tutorial pages of the website, but a brief overview will be described here. CT scans may be obtained from the radiology department in DICOM format. Free software available online at www.slicer.org can be used to review the DICOM imaging, isolate the area of interest and convert to an .nrrd file. This .nrrd file may then be loaded onto the democratiz3D application and formatted in a number of ways based on threshold as shown in the images below. Files may be opened through the application or dragged and dropped into the file area (Figure 1, Figure 2). Details of the file, such as the title, description of the anatomy or pathology, and keywords are placed beneath the upload (Figure 3). Different thresholds are available to be automatically placed on the uploaded file, including bone, detailed bone, muscle, and skin (Figure 4). These files as well as the final, processed, files may be shared or remain private, free or at a fee to download by the community. Figure 1. The link to the democratiz3D application is located at the top menu bar of the main page at https://www.embodi3d.com. Figure 2. Once on the democratiz3D application, you may upload the .nrrd file or drag and drop the .nrrd file into the uploading area. Figure 3. While the .nrrd file is processing, you may edit the details of the file, such as the title, tags, and description. Figure 4. The application allows for thresholding of bone, detailed bone, muscle, and skin from the uploaded CT scan. Once the file has been processed, you receive a notification and may view the file as well as automatically created screen shots (Figure 5). This is now an STL file that may be downloaded by clicking “Download this file”. If this is a file that you have downloaded, you may also edit the details of the file, move it to another category or upload a new version of the STL file directly onto the page (Figure 6). Although the democratiz3D application is a powerful and quick tool to convert .nrrd files to STL files, it is limited by the quality of the CT scan. Therefore, users may wish to clean up the model using free software such as Meshmixer or Blender. Once the files have been edited, they are maintained as an STL file that may be directly uploaded onto the page as a new version (Figure 7). These may then be placed in a category that is most descriptive of the file (Figure 8). Figure 5. After about 5-20 minutes of processing (depending on the size of the file), you will get a notification and e-mail that the file has processed. The democrati3D application has converted the file into an STL file is now available for downloading and use in 3D printing. Figure 6. If you would like to change the details, or upload new files or screen shots, you may choose from the drop-down menu. Figure 7. In order to upload a new version of the file, such as after it is edited in the free software Meshmixer or Blender, you may choose from the drop-down menu and drag and drop a new STL file. Figure 8. Because Embodi3D has created a library divided into different categories, you may move your file into the appropriate category to allow for ease of sharing with the community. Alternatively, files that have been downloaded and edited may be uploaded as new files using the “Create” selection on the top menu (Figure 9). Once you have chosen the most accurate category (Figure 10), you can upload the new file by selecting the file or drag and drop into the proper area (Figure 11). This will then take you to similar section as outlined above in order to edit the details and sharing options for your file. Figure 9. Upload an STL file by selecting the “Create” menu at the top of the webpage. Figure 10. Select the category under which the file most accurately fits. Figure 11. Upload the STL file by dragging and dropping or selecting the file. As you can see, creating STL files from individual CT scans is an easy, 15-20 minute process that is reasonable for the busy orthopaedic surgeon to utilize in their practice. For educational purposes, however, not every trainee, surgeon, or radiologist has access to patients with such a wide array of pathologies. The Embodi3D community provides an ever-growing diverse library of normal anatomy and pathology that may be downloaded for free and used for 3D printing. The files are divided into categories including: Bones, Muscles, Cardiac and Vascular, Brain and nervous system, Organs of the Body, Veterinary, Paleontology, Anthropology, Research and Miscellaneous. In order to access these files, click “Download” from the top menu (Figure 12), which will take you to the main Downloads page (Figure 13). The categories available are listed on the right side of the page, and will bring you to each category page. There, the number of files available within each category is listed. Once the desired file is selected, the file may be downloaded as described above. Figure 12. In order to access the library of files, click “Download” from the top menu on the main page. Figure 13. The Downloads page has a listing of the available categories to browse and explore for the desired files. Creating and printing 3D models of CT scans will be useful in the future of medicine and the era of individualized medicine. The free library of medical 3D printing files available at embodi3D.com as well as the free conversion application democratiz3D will be an invaluable resource for education as well as for the private orthopaedic surgeon with limited resources. Furthermore, because healthcare costs are a main focus in the United States, having the ability to download and create models for a much lower price than through commercial 3D printing companies will be useful to decrease the cost of individualized care. For more information about 3D printing in orthopaedic surgery, please see the following references: Cai H. Application of 3D printing in orthopedics: status quo and opportunities in China. Ann Transl Med. 2015;3(Suppl 1):S12. Eltorai AEM, Nguyen E, Daniels AH. Three-Dimensional Printing in Orthopedic Surgery. Orthopedics. 2015;38(11):684-687. Mulford JS, Babazadeh S, Mackay N. Three-dimensional printing in orthopaedic surgery: review of current and future applications. ANZ J Surg. 2016;86(9):648-653. Tack P, Victor J, Gemmel P, Annemans L. 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online. 2016;15(1):115.
  4. Version 1.0.0

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    This model is the right foot and ankle muscle rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient unfortunately died 9.5 months after diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The primary motions of the ankle are dorsiflexion, plantarflexion, inversion and eversion. However with the addition of midfoot motion (adduction, and abduction), the foot may supinate (inversion and adduction) or pronate (eversion and abduction). In order to accomplish these motions, muscles outside of the foot (extrinsic) and muscles within the foot (intrinsic) attach throughout the foot, crossing one or more joints. Laterally, the peroneus brevis and tertius attach on the proximal fifth metatarsal to evert the foot. The peroneus longus courses under the cuboid to attach on the plantar surface of the first metatarsal, acting as the primary plantarflexor of the first ray and, secondarily, the foot. Together, these muscles also assist in stabilizing the ankle for patients with deficient lateral ankle ligaments from chronic sprains. Medially, the posterior tibialis inserts on the plantar aspect of the navicular cuneiforms and metatarsal bases, acting primarily to invert the foot and secondarily to plantarflex the foot. The flexor hallucis longus inserts on the base of the distal phalanx of the great toe to plantarflex the great toe, and the flexor digitorum inserts on the bases of the distal phalanges of the lesser four toes, acting to plantarflex the toes. The gastrocnemius inserts on the calcaneus as the Achilles tendon and plantarflexes the foot. Anteriorly, the tibialis anterior inserts on the dorsal medial cuneiform and plantar aspect of the first metatarsal base as the primary ankle dorsiflexor and secondary inverter. The Extensor hallucis longus and extensor digitorum longus insert on the dorsal aspect of the base of the distal phalanges to dorsiflex the great toe and lesser toes, respectively. This model was created from the file STS_023.

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  5. Version 1.0.0

    2 downloads

    This model is the left foot and ankle muscle rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient unfortunately died 9.5 months after diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The primary motions of the ankle are dorsiflexion, plantarflexion, inversion and eversion. However with the addition of midfoot motion (adduction, and abduction), the foot may supinate (inversion and adduction) or pronate (eversion and abduction). In order to accomplish these motions, muscles outside of the foot (extrinsic) and muscles within the foot (intrinsic) attach throughout the foot, crossing one or more joints. Laterally, the peroneus brevis and tertius attach on the proximal fifth metatarsal to evert the foot. The peroneus longus courses under the cuboid to attach on the plantar surface of the first metatarsal, acting as the primary plantarflexor of the first ray and, secondarily, the foot. Together, these muscles also assist in stabilizing the ankle for patients with deficient lateral ankle ligaments from chronic sprains. Medially, the posterior tibialis inserts on the plantar aspect of the navicular cuneiforms and metatarsal bases, acting primarily to invert the foot and secondarily to plantarflex the foot. The flexor hallucis longus inserts on the base of the distal phalanx of the great toe to plantarflex the great toe, and the flexor digitorum inserts on the bases of the distal phalanges of the lesser four toes, acting to plantarflex the toes. The gastrocnemius inserts on the calcaneus as the Achilles tendon and plantarflexes the foot. Anteriorly, the tibialis anterior inserts on the dorsal medial cuneiform and plantar aspect of the first metatarsal base as the primary ankle dorsiflexor and secondary inverter. The Extensor hallucis longus and extensor digitorum longus insert on the dorsal aspect of the base of the distal phalanges to dorsiflex the great toe and lesser toes, respectively. This model was created from the file STS_023.

    Free

  6. Version 1.0.0

    2 downloads

    This model is the left thigh muscle rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient unfortunately died 9.5 months after diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. Myxoid fibrosarcoma (or myxoid MFH) is the most common subtype of MFH, at about 10%-20% of cases. Clinically, the tumor presents as a deep, slow-growing, painless mass. It is located more commonly in the lower extremities and retroperitoneum. Imaging on MRI demonstrates a mass with low signal intensity on T1-weighting imaging, and high signal intensity on T2-weighted imaging. On histology, a myxoid background is present with a storiform (or cartwheel) pattern seen on low-power imaging, seen in fibrosarcomas. A “myxoid background” is composed of a clear, mucoid substance. Treatment includes radiation, wide surgical resection, and chemotherapy in selected cases. However, the 5-year survival is 50%-60% depending on size, grade, depth and presence of metastasis. The term “malignant fibrous histiocytoma” was coined in the 1960s by Margaret R. Murray when histology a sarcoma demonstrated an appearance like histiocytes, with characteristics of phagocytosis and a pleomorphic pattern. With further research, this entity was identified to have a wider range of appearances with a fibrous characteristic. Today, these sarcomas are known as “pleomorphic sarcomas.” Recently, a change in the understanding of soft tissue tumors has purported that MFH is not a specific type of cancer, but a common morphologic pattern shared by unrelated tumors. One school of thought states that this morphologic pattern is shared by tumors as a common final pathway in cancer progression whereas another school of thought believes that true pleomorphic sarcomas are the result of a transformation from mesenchymal stem cells. Future research into understanding the pathway of these sarcomas and progression will help to target specific therapies and, hopefully, eventual cures. This model was created from the file STS_023.

    Free

  7. Version 1.0.0

    4 downloads

    This model is the left foot and ankle bone rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient unfortunately died 9.5 months after diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The ankle is a hinge (or ginglymus) joint made of the distal tibia (tibial plafond, medial and posterior malleoli) superiorly and medially, the distal fibula (lateral malleolus) laterally and the talus inferiorly. Together, these structures form the ankle “mortise”, which refers to the bony arch. Stability is provided by the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) laterally, and the superficial and deep deltoid ligaments medially. The ankle is one of my most common sites of musculoskeletal injury, including ankle fractures and ankle sprains, due to the ability of the joint to invert and evert. The most common ligament involved in the ATFL. Radiographic analysis of an ankle after injury should include the so-called “mortise view”, upon which measurements can be made to determine congruity of the ankle joint. Normal measurements include >1 mm tibiofibular overlap, </= 4mm medial clear space, and <6 mm of tibiofibular clear space. The talocrural ankle is measured by the bisection of a line through the tibial anatomical axis and another line through the tips of the malleoli. Shortening of the lateral malleolus can lead to an increased talocrural angle. The foot is commonly divided into three segments: hindfoot, midfoot, and forefoot. These sections are divided by the transverse tarsal joint (between the talus and calcaneus proximally and navicular and cuboid distally), and the tarsometatarsal joint (between the cuboids and cuneiforms proximally and the metatarsals distally). The first tarsometatarsal joint (medially) is termed the “Lisfranc” joint, and is the site of the Lisfranc injury seen primarily in athletic injuries. This model was created from the file STS_023.

    Free

  8. Version 1.0.0

    3 downloads

    This model is the left lower extremity bone rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient is still living with the metastatic disease at 2.5 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing The lower extremity consists of the femur, tibia, fibula, and foot. The femur has an anterior bow of differing degrees, which is important to understand when fixing a femur fracture with an intramedullary nail to not penetrate the anterior cortex. Distally, the femur includes the medial and lateral femoral condyles, which articulate with the proximal tibia to form the knee joint, as well as the trochlea anteriorly, which articulates with the patella. The proximal tibia includes the medial plateau (which is concave) and the lateral plateau (which is convex). The Proximal tibia has a 7-10 degree posterior slope. On the anterior proximal tibia, the tibial tuberosity, where the patellar tendon attaches. On the anteromedial surface of the tibia is Gerdy's tubercle, where the sartorius, gracilis, and semitendinosus attach. The distal tibia creates the superior and medial (plafond and medial malleolus) of the ankle joint. The proximal fibula is the attachment for the posterolateral corner structures of the knee joint. The peroneal nerve wraps around the fibular neck. The distal fibula is the lateral malleolus and a common site for ankle fractures. This model was created from the file STS_022.

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  9. Version 1.0.0

    2 downloads

    This model is the right thigh skin rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient is still living with the metastatic disease at 2.5 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The thigh is divided into three compartments: the anterior, posterior, and adductor. After a femoral fracture or vascular injury in the thigh, increasing pressure within a compartment may threaten to compromise blood flow to muscles within the compartment, a syndrome known as “compartment syndrome.” Compartment syndrome is diagnosed clinically as “pain out of proportion to exam.” In patients that a clinical exam may not be obtained, such as those who are intubated or with a traumatic brain injury, a Stryker needle of each compartment may be performed. The diagnosis of compartment syndrome is defined as pressures within 30 mmHg of diastolic blood pressure. Compartment syndrome is an emergency and thigh fasciotomies must be performed immediately to prevent compromise of muscles within the compartment at risk. Thigh fasciotomies may be performed through a single incision for release of the anterior and posterior compartments, or a medial incision for decompression of the adductor compartment (less common). For the single incision technique, the incision is created laterally, and the fascia lata is incised. This exposes the anterior compartment, which is decompressed. The lateral intermuscular septum is then incised to decompress the posterior compartment. This model was created from the file STS_022.

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  10. Version 1.0.0

    3 downloads

    This model is the left leg bone rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient is still living with the metastatic disease at 2.5 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The leg includes the area between the knee and the ankle and houses the tibia and fibula. The proximal tibia includes the medial plateau (which is concave) and the lateral plateau (which is convex). The Proximal tibia has a 7-10 degree posterior slope. The tibial tuberosity is located on the anterior proximal tibia, which is where the patellar tendon attaches. On the anteromedial surface of the tibia is Gerdy's tubercle, where the sartorius, gracilis, and semitendinosus attach. The distal tibia creates the superior and medial (plafond and medial malleolus) of the ankle joint. The proximal fibula is the attachment for the posterolateral corner structures of the knee joint. The peroneal nerve wraps around the fibular neck. The distal fibula is the lateral malleolus and a common site for ankle fractures. The ankle is a hinge (or ginglymus) joint made of the distal tibia (tibial plafond, medial and posterior malleoli) superiorly and medially, the distal fibula (lateral malleolus) laterally and the talus inferiorly. Together, these structures form the ankle “mortise”, which refers to the bony arch. Normal range of motion is 20 degrees dorsiflexion and 50 degrees plantarflexion. Stability is provided by the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) laterally, and the superficial and deep deltoid ligaments medially. The ankle is one of my most common sites of musculoskeletal injury, including ankle fractures and ankle sprains, due to the ability of the joint to invert and evert. The most common ligament involved in the ATFL. The foot is commonly divided into three segments: hindfoot, midfoot, and forefoot. These sections are divided by the transverse tarsal joint (between the talus and calcaneus proximally and navicular and cuboid distally), and the tarsometatarsal joint (between the cuboids and cuneiforms proximally and the metatarsals distally). The first tarsometatarsal joint (medially) is termed the “Lisfranc” joint, and is the site of the Lisfranc injury seen primarily in athletic injuries. This model was created from the file STS_022.

    Free

  11. Version 1.0.0

    5 downloads

    This model is the right lower extremity bone rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient is still living with the metastatic disease at 2.5 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The leg includes the area between the knee and the ankle and houses the tibia and fibula. The proximal tibia includes the medial plateau (which is concave) and the lateral plateau (which is convex). The Proximal tibia has a 7-10 degree posterior slope. The tibial tuberosity is located on the anterior proximal tibia, which is where the patellar tendon attaches. On the anteromedial surface of the tibia is Gerdy's tubercle, where the sartorius, gracilis, and semitendinosus attach. The distal tibia creates the superior and medial (plafond and medial malleolus) of the ankle joint. The proximal fibula is the attachment for the posterolateral corner structures of the knee joint. The peroneal nerve wraps around the fibular neck. The distal fibula is the lateral malleolus and a common site for ankle fractures. The ankle is a hinge (or ginglymus) joint made of the distal tibia (tibial plafond, medial and posterior malleoli) superiorly and medially, the distal fibula (lateral malleolus) laterally and the talus inferiorly. Together, these structures form the ankle “mortise”, which refers to the bony arch. Normal range of motion is 20 degrees dorsiflexion and 50 degrees plantarflexion. Stability is provided by the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) laterally, and the superficial and deep deltoid ligaments medially. The ankle is one of my most common sites of musculoskeletal injury, including ankle fractures and ankle sprains, due to the ability of the joint to invert and evert. The most common ligament involved in the ATFL. The foot is commonly divided into three segments: hindfoot, midfoot, and forefoot. These sections are divided by the transverse tarsal joint (between the talus and calcaneus proximally and navicular and cuboid distally), and the tarsometatarsal joint (between the cuboids and cuneiforms proximally and the metatarsals distally). The first tarsometatarsal joint (medially) is termed the “Lisfranc” joint, and is the site of the Lisfranc injury seen primarily in athletic injuries. This model was created from the file STS_022.

    Free

  12. Version 1.0.0

    4 downloads

    This model is the right thigh muscle rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient is still living with the metastatic disease at 2.5 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The thigh is divided into three compartments: the anterior, posterior, and adductor. The anterior compartment contains the “quadriceps muscles”, made up of the vastus lateralis, vastus medialis vastus intermedius, and rectus femoris, and the sartorius. These muscles are innervated by the femoral nerve (L3-L4), and act to extend the leg. The Sartorius muscle originates at the ASIS and crosses anterior to the quadriceps muscle to insert on the medial tibia in the pes anserinus. The posterior compartment contains the “hamstrings”, made up of the semitendinosus, semimembranosus, and short and long heads of the biceps femoris. These muscles act to flex the leg. All of these muscles are innervated by the sciatic nerve (tibial division) except for the short head of the biceps femoris, which is innervated by the sciatic nerve (peroneal division). The adductor compartment contains the adductor longus, adductor brevis, adductor magnus, and gracilis, which act to adduct the thigh. These muscles are innervated by the obturator, and the adductor magnus has dual innervation with the sciatic nerve. In addition, the obturator externus (a thigh external rotator) and pectineus muscle (thigh flexor and adductor) are located within this compartment. This model was created from the file STS_022.

    Free

  13. Version 1.0.0

    1 download

    This model is the right leg skin rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient is still living with the metastatic disease at 2.5 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. Landmarks of the lower extremity consist of bony and muscular landmarks. Proximally, the extensor mechanism consists of the quadriceps tendon, patella, and the tibial tuberosity, which is located on the anterior proximal tibia, where the patellar tendon attaches. On the anteromedial surface of the tibia is Gerdy's tubercle, where the sartorius, gracilis, and semitendinosus attach. Laterally, the head of the fibula may be palpated, which is the attachment for the posterolateral corner structures of the knee joint. The peroneal nerve wraps around the fibular neck, and a tinel’s sign may be elicited due to its superficial position at this location. Distally, the anterior ankle joint may be palpated. Pain with palpation may be indicative of osteoarthritis if general or an osteochondral defect if localized. The medial and lateral malleoli are located on either side of the tibiotalar joint, respectively and are the site of common ankle fractures. Posteriorly, the Achilles tendon inserts on the calcaneus. A defect along this tendon may be a sign of a tendon rupture. The superficial peroneal nerve can possibly be isolated on the lateral aspect of the dorsal foot with full plantarflexion of the fourth ray. Topographical landmarks of the foot and ankle consist of muscular, tendinous, and bony structures. Proximally, the superficial muscles of the anterior (tibialis anterior), lateral (peroneals) and posterior (gastrocnemius) compartments may be palpated. Anteriorly, the tibialis anterior tendon crosses the ankle joint and is used as a landmark for ankle joint injections and aspirations, where the practitioner will place the needle just lateral to the tendon. Posteriorly, the gastrocnemius and soleus converge to form the Achilles tendon. Ruptures of the tendon as well as tendinous changes due to Achilles tendinopathy may be palpated. At the level of the ankle joint, the joint line, medial malleolus (distal tibia) and lateral malleolus (distal fibula) may be palpated. The extensor hallucis longus and extensor digitorum longus tendons are visible at the surface of the dorsal foot. The extensor digitorum brevis muscle belly is seen on the dorsum of the lateral foot. On the plantar foot, the plantar fascia may be palpated. Nodules associated with plantar fascial fibromatosis may be palpated here. Plantar fasciitis is also diagnosed when pain is associated with palpation of the insertion of the plantar fascia on the medial heel. Other common pathologies on the plantar foot are ulcerations associated with diabetic neuropathy and other neuropathic conditions. This model was created from the file STS_022.

    Free

  14. Version 1.0.0

    1 download

    This model is the bilateral thigh skin rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient is still living with the metastatic disease at 2.5 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. Myxoid fibrosarcoma (or myxoid MFH) is the most common subtype of MFH, at about 10%-20% of cases. Clinically, the tumor presents as a deep, slow-growing, painless mass. It is located more commonly in the lower extremities and retroperitoneum. Imaging on MRI demonstrates a mass with low signal intensity on T1-weighting imaging, and high signal intensity on T2-weighted imaging. On histology, a myxoid background is present with a storiform (or cartwheel) pattern seen on low-power imaging, seen in fibrosarcomas. A “myxoid background” is composed of a clear, mucoid substance. Treatment includes radiation, wide surgical resection, and chemotherapy in selected cases. However, the 5-year survival is 50%-60% depending on size, grade, depth and presence of metastasis. The term “malignant fibrous histiocytoma” was coined in the 1960s by Margaret R. Murray when histology a sarcoma demonstrated an appearance like histiocytes, with characteristics of phagocytosis and a pleomorphic pattern. With further research, this entity was identified to have a wider range of appearances with a fibrous characteristic. Today, these sarcomas are known as “pleomorphic sarcomas.” Recently, a change in the understanding of soft tissue tumors has purported that MFH is not a specific type of cancer, but a common morphologic pattern shared by unrelated tumors. One school of thought states that this morphologic pattern is shared by tumors as a common final pathway in cancer progression whereas another school of thought believes that true pleomorphic sarcomas are the result of a transformation from mesenchymal stem cells. Future research into understanding the pathway of these sarcomas and progression will help to target specific therapies and, hopefully, eventual cures. This model was created from the file STS_022.

    Free

  15. Version 1.0.0

    1 download

    This model is the left leg skin rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient is still living with the metastatic disease at 2.5 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. Landmarks of the lower extremity consist of bony and muscular landmarks. Proximally, the extensor mechanism consists of the quadriceps tendon, patella, and the tibial tuberosity, which is located on the anterior proximal tibia, where the patellar tendon attaches. On the anteromedial surface of the tibia is Gerdy's tubercle, where the sartorius, gracilis, and semitendinosus attach. Laterally, the head of the fibula may be palpated, which is the attachment for the posterolateral corner structures of the knee joint. The peroneal nerve wraps around the fibular neck, and a tinel’s sign may be elicited due to its superficial position at this location. Distally, the anterior ankle joint may be palpated. Pain with palpation may be indicative of osteoarthritis if general or an osteochondral defect if localized. The medial and lateral malleoli are located on either side of the tibiotalar joint, respectively and are the site of common ankle fractures. Posteriorly, the Achilles tendon inserts on the calcaneus. A defect along this tendon may be a sign of a tendon rupture. The superficial peroneal nerve can possibly be isolated on the lateral aspect of the dorsal foot with full plantarflexion of the fourth ray. Topographical landmarks of the foot and ankle consist of muscular, tendinous, and bony structures. Proximally, the superficial muscles of the anterior (tibialis anterior), lateral (peroneals) and posterior (gastrocnemius) compartments may be palpated. Anteriorly, the tibialis anterior tendon crosses the ankle joint and is used as a landmark for ankle joint injections and aspirations, where the practitioner will place the needle just lateral to the tendon. Posteriorly, the gastrocnemius and soleus converge to form the Achilles tendon. Ruptures of the tendon as well as tendinous changes due to Achilles tendinopathy may be palpated. At the level of the ankle joint, the joint line, medial malleolus (distal tibia) and lateral malleolus (distal fibula) may be palpated. The extensor hallucis longus and extensor digitorum longus tendons are visible at the surface of the dorsal foot. The extensor digitorum brevis muscle belly is seen on the dorsum of the lateral foot. On the plantar foot, the plantar fascia may be palpated. Nodules associated with plantar fascial fibromatosis may be palpated here. Plantar fasciitis is also diagnosed when pain is associated with palpation of the insertion of the plantar fascia on the medial heel. Other common pathologies on the plantar foot are ulcerations associated with diabetic neuropathy and other neuropathic conditions. This model was created from the file STS_022.

    Free

  16. Version 1.0.0

    4 downloads

    This model is the right knee muscle rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient is still living with the metastatic disease at 2.5 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The knee is a hinge joint that does not have true bony stabilization, so it requires soft tissue static and dynamic stabilizers to prevent excess motion through the joint. In addition, the knee goes through a “screw home” mechanism in which the tibia rotates externally and “locks” into extension during the last 15-20 degrees of extension. Multiple structures, therefore, are needed to work in concert to prevent excess strain through this joint during these daily motions. On the medial aspect of the knee, the static stabilizers consist of the superficial and deep medial collateral ligaments (MCL) and the posterior oblique ligament (POL). The dynamic stabilizers are the semimembranosus, vastus medialis, medial gastrocnemius, and pes tendons (semitendinosus, gracilis, and sartorius). The lateral stabilizers are best known as the posterolateral corner, and consist of the static stabilizers (lateral collateral ligament (LCL), iliotibial band (ITB), arcuate ligament), and dynamic stabilizers (popliteus, biceps femoris, lateral gastrocnemius). Inside the joint, the anterior cruciate ligament provides resistance to anterior tibial translation varus, and internal rotation, whereas the posterior cruciate ligament provides resistance to posterior tibial translation, varus, valgus, and external rotation. This model was created from the file STS_022.

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  17. Version 1.0.0

    1 download

    This model is the left lower extremity muscle rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient is still living with the metastatic disease at 2.5 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. Myxoid fibrosarcoma (or myxoid MFH) is the most common subtype of MFH, at about 10%-20% of cases. Clinically, the tumor presents as a deep, slow-growing, painless mass. It is located more commonly in the lower extremities and retroperitoneum. Imaging on MRI demonstrates a mass with low signal intensity on T1-weighting imaging, and high signal intensity on T2-weighted imaging. On histology, a myxoid background is present with a storiform (or cartwheel) pattern seen on low-power imaging, seen in fibrosarcomas. A “myxoid background” is composed of a clear, mucoid substance. Treatment includes radiation, wide surgical resection, and chemotherapy in selected cases. However, the 5-year survival is 50%-60% depending on size, grade, depth and presence of metastasis. The term “malignant fibrous histiocytoma” was coined in the 1960s by Margaret R. Murray when histology a sarcoma demonstrated an appearance like histiocytes, with characteristics of phagocytosis and a pleomorphic pattern. With further research, this entity was identified to have a wider range of appearances with a fibrous characteristic. Today, these sarcomas are known as “pleomorphic sarcomas.” Recently, a change in the understanding of soft tissue tumors has purported that MFH is not a specific type of cancer, but a common morphologic pattern shared by unrelated tumors. One school of thought states that this morphologic pattern is shared by tumors as a common final pathway in cancer progression whereas another school of thought believes that true pleomorphic sarcomas are the result of a transformation from mesenchymal stem cells. Future research into understanding the pathway of these sarcomas and progression will help to target specific therapies and, hopefully, eventual cures. This model was created from the file STS_022.

    Free

  18. Version 1.0.0

    9 downloads

    This model is the right knee bone rendering of a 65-year-old male with left thigh myxoid fibrosarcoma. At the time of diagnosis, the patient had metastases to his lungs. The patient therefore underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy and was found to have an intermediate grade lesion at the time of diagnosis. The patient is still living with the metastatic disease at 2.5 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The knee is composed of 3 separate joints: two hinge joints (medial and lateral femorotibial joints), and one sellar, or gliding, joint (the patellofemoral joint). These also compose the three compartments of the knee: medial, lateral, and patellofemoral. Although the knee is thought of as a hinge joint, it has 6 degrees of motion: extension/flexion, internal/external rotation, varus/valgus, anterior/posterior translation, medial/lateral translation, and compression/distraction. To provide stability to the joint, static and dynamic stabilizers surround the knee, including muscles and ligaments. The major ligaments that provide stability to the knee include the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), lateral (or fibular) collateral ligament (LCL), and medial collateral ligament (MCL). The ACL prevents anterior translation of the knee and the PCL prevents posterior translation of the knee. The LCL prevents varus stresses and the MCL prevents valgus stresses on the knee. Furthermore, the medial meniscus is a secondary stabilizer to anterior translation and is therefore commonly injured during an ACL tear or after an untreated ACL tear. This model was created from the file STS_022.

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  19. Version 1.0.0

    1 download

    This model is the bilateral thigh rendering of a 49-year-old male with a right medial thigh undifferentiated pleomorphic malignant fibrous histiocytoma (MFH). The patient underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy treatment and was found to have a high-grade lesion at the time of diagnosis. Metastases to his lungs were also found at diagnosis. The patient is still living with the disease at 2 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. Undifferentiated pleomorphic MFH has more recently been classified as Undifferentiated Pleomorphic Sarcoma. This is the most common soft tissue sarcoma in late adulthood, commonly occurring between 55 to 80 years old and most commonly in Caucasian males. Clinically, it presents as a slow growing mass in the extremities. Biopsy of the lesion demonstrates, as its name implies, an undifferentiated and pleomorphic appearance. Pleomorphism is the pathologic description of cells and nuclei with variability in size, shape and staining, which is characteristic of a malignant neoplasm. “Undifferentiated” means that the tissue does not appear like an identifiable tissue structure. Treatment consists of wide resection and radiation. Chemotherapy is added in cases of metastasis, most commonly to the lung. Five-year survival is between 35-60% depending on grade of tumor and metastases. This model was created from the file STS_021.

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  20. Version 1.0.0

    1 download

    This model is the right thigh skin rendering of a 49-year-old male with a right medial thigh undifferentiated pleomorphic malignant fibrous histiocytoma (MFH). The patient underwent neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy treatment and was found to have a high-grade lesion at the time of diagnosis. Metastases to his lungs were also found at diagnosis. The patient is still living with the disease at 2 years since diagnosis. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. Undifferentiated pleomorphic MFH has more recently been classified as Undifferentiated Pleomorphic Sarcoma. This is the most common soft tissue sarcoma in late adulthood, commonly occurring between 55 to 80 years old and most commonly in Caucasian males. Clinically, it presents as a slowly growing mass in the extremities. Biopsy of the lesion demonstrates, as its name implies, an undifferentiated and pleomorphic appearance. Pleomorphism is the pathologic description of cells and nuclei with variability in size, shape, and staining, which is characteristic of a malignant neoplasm. “Undifferentiated” means that the tissue does not appear like an identifiable tissue structure. Treatment consists of wide resection and radiation. Chemotherapy is added in cases of metastasis, most commonly to the lung. Five-year survival is between 35-60% depending on the grade of tumor and metastases. This model was created from the file STS_021.

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  21. Version 1.0.0

    3 downloads

    This is the normal right leg muscle model (including foot) of a 56 year old male with right anterior thigh pleomorphic leiomyosarcoma. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The lower leg is divided into four muscle compartments: the anterior, lateral, superficial posterior, and deep posterior compartments. The anterior compartment is made from the dorsiflexors, including the tibialis anterior, extensor hallucis longus (EHL), extensor digitorum longus (EDL) and peroneus tertius, which are innervated by the deep peroneal nerve. The lateral compartment includes the peroneus longus and peroneus brevis, which assist in foot eversion and are innervated by the superficial peroneal nerve. The superficial posterior compartment includes the gastrocnemius, soleus, and plantaris, which assist in plantarflexion and are innervated by the tibial nerve. The deep posterior compartment is made up of the popliteus, flexor hallucis longus (FHL), flexor digitorum longus (FDL), and tibialis posterior, which mostly assist in plantarflexion and are innervated similarly by the tibial nerve. This file was created from the file STS_014.

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  22. Version 1.0.0

    1 download

    This is the normal right foot and ankle bone model of a 56 year old male with right anterior thigh pleomorphic leiomyosarcoma. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The ankle is a hinge (or ginglymus) joint made of the distal tibia (tibial plafond, medial and posterior malleoli) superiorly and medially, the distal fibula (lateral malleolus) laterally and the talus inferiorly. Together, these structures form the ankle “mortise”, which refers to the bony arch. The normal range of motion is 20 degrees dorsiflexion and 50 degrees plantarflexion. Stability is provided by the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) laterally, and the superficial and deep deltoid ligaments medially. The ankle is one of my most common sites of musculoskeletal injury, including ankle fractures and ankle sprains, due to the ability of the joint to invert and evert. The most common ligament involved in the ATFL. The foot is commonly divided into three segments: hindfoot, midfoot, and forefoot. These sections are divided by the transverse tarsal joint (between the talus and calcaneus proximally and navicular and cuboid distally), and the tarsometatarsal joint (between the cuboids and cuneiforms proximally and the metatarsals distally). The first tarsometatarsal joint (medially) is termed the “Lisfranc” joint and is the site of the Lisfranc injury seen primarily in athletic injuries. This model was created from the file STS_014.

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  23. Version 1.0.0

    2 downloads

    This is the normal left knee muscle model of a 56 year old male with right anterior thigh pleomorphic leiomyosarcoma. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The knee is composed of 3 separate joints: two hinge joints (medial and lateral femorotibial joints), and one sellar, or gliding, joint (the patellofemoral joint). These also compose the three compartments of the knee: medial, lateral, and patellofemoral. Although the knee is thought of as a hinge joint, it actually has 6 degrees of motion: extension/flexion, internal/external rotation, varus/valgus, anterior/posterior translation, medial/lateral translation, and compression/distraction. In order to provide stability to this inherently unstable knee, static and dynamic stabilizers surround the knee, including muscles and ligaments. On the medial aspect of the knee, the static stabilizers consist of the superficial and deep medial collateral ligaments (MCL) and the posterior oblique ligament (POL). The dynamic stabilizers are the semimembranosus, vastus medialis, medial gastrocnemius, and pes tendons (semitendinosus, gracilis, and sartorius). The lateral stabilizers are best known as the posterolateral corner, and consist of the static stabilizers (lateral collateral ligament (LCL), iliotibial band (ITB), arcuate ligament), and dynamic stabilizers (popliteus, biceps femoris, lateral gastrocnemius). Inside the joint, the anterior cruciate ligament provides resistance to anterior tibial translation varus, and internal rotation, whereas the posterior cruciate ligament provides resistance to posterior tibial translation, varus, valgus, and external rotation. This model was created from the file STS_014.

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  24. Version 1.0.0

    7 downloads

    This is the normal right leg bone model (including foot) of an 82-year-old male. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The leg includes the area between the knee and the ankle and houses the tibia and fibula. The proximal tibia includes the medial plateau (which is concave) and the lateral plateau (which is convex). The Proximal tibia has a 7-10 degree posterior slope. On the anterior proximal tibia, the tibial tuberosity, where the patellar tendon attaches. On the anteromedial surface of the tibia is Gerdy's tubercle, where the sartorius, gracilis, and semitendinosus attach. The distal tibia creates the superior and medial (plafond and medial malleolus) of the ankle joint. The proximal fibula is the attachment for the posterolateral corner structures of the knee joint. The peroneal nerve wraps around the fibular neck. The distal fibula is the lateral malleolus and a common site for ankle fractures. This model was created from the file STS_013.

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  25. Version 1.0.0

    2 downloads

    This is the normal right hip model of an 82-year-old male. This is an STL file created from DICOM images of his CT scan which may be used for 3D printing. The hip joint is a ball and socket joint that has intrinsic stability from osseous, ligamentous, and muscular structures. The hip capsule is made of the iliofemoral, pubofemoral, and ischiofemoral ligaments which attach from the acetabulum to the femoral neck. The normal acetabulum is anteverted 15 degrees and abducted 45 degrees. The normal femoral anteversion is between 10-15 degrees. The proximal femur also includes the greater trochanter, to which the external rotators are attached, and the lesser trochanter, to which the iliopsoas is attached. This model was created from the file STS_013.

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