Virtual surgical planning and 3D printing in pediatric musculoskeletal oncological resections: a proof-of-concept description

Jayanthi Parthasarathy; Brandon Jonard; Mitchell Rees; Bhavani Selvaraj; Thomas Scharschmidt

doi:10.1007/s11548-022-02745-6

Virtual surgical planning and 3D printing in pediatric musculoskeletal oncological resections: a proof-of-concept description

Int J Comput Assist Radiol Surg. 2023 Jan;18(1):95-104. doi: 10.1007/s11548-022-02745-6. Epub 2022 Sep 24.

Authors

Jayanthi Parthasarathy¹, Brandon Jonard², Mitchell Rees³, Bhavani Selvaraj³, Thomas Scharschmidt^{4

5}

Affiliations

¹ Department of Radiology, 3D Printing and Innovation Lab, Nationwide Children's Hospital, 700, Children's Dr, Columbus, OH, 43205, USA. Jayanthi.Parthasarathy@nationwidechildrens.org.
² University Hospitals/Case Western Reserve University School of Medicine, Cleveland, OH, USA.
³ Department of Radiology, 3D Printing and Innovation Lab, Nationwide Children's Hospital, 700, Children's Dr, Columbus, OH, 43205, USA.
⁴ Department of Orthopaedics, Nationwide Children's Hospital, 700, Children's Dr, Columbus, OH, 43205, USA. Thomas.Scharschmidt@osumc.edu.
⁵ Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Columbus, OH, 43210, USA. Thomas.Scharschmidt@osumc.edu.

PMID: 36152167
DOI: 10.1007/s11548-022-02745-6

Abstract

Background and objectives: Patient-specific models may have a role in planning and executing complex surgical procedures. However, creating patient-specific models with virtual surgical planning (VSP) has many steps, from initial imaging to finally realizing the three-dimensional printed model (3DPM). This manuscript evaluated the feasibility and potential benefits of multimodal imaging and geometric VSP and 3DPM in pediatric orthopedic tumor resection and reconstruction.

Materials and methods: Twelve children with Ewing's sarcoma, osteosarcoma, or chondrosarcoma were studied. Computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) were acquired as the standard-of-care. Bony and soft tissue components of the tumor and the adjacent bone were segmented to create a computer-generated 3D model of the region. VSP used the computer-generated 3D model. The Objet350 Stratasys™ polyjet printer printed the final physical model used for pre-surgical planning, intraoperative reference, and patient education. Clinical impact, the utility of the model, and its geometric accuracy were assessed.

Results: Subjectively, using the patient-specific model assisted in preoperative planning and intra-operative execution of the surgical plan. The mean difference between the models and the surgical resection was -0.09 mm (range: -0.29-0.45 mm). Pearson's correlation coefficient (r) of the cross-sectional area was -0.9994, linear regression r² = 0.9989, and the Bland Altman plot at 95% confidence interval showed all data within boundaries.

Conclusion: We studied the geometric accuracy, utility and clinical impact of VSP and 3DPM produced from multi-modal imaging studies and concluded 3DPM accurately represented the patients' tumor and proved very useful to the surgeon in both the preoperative surgical planning, patient and family education and operative phases. Future studies will be planned to evaluate surgery procedure duration and other outcomes.

Keywords: 3D Printed orthopedic models; Ewings sarcoma; Osteosarcoma; Tumor resection planning; Virtual surgical planning.

MeSH terms

Child
Humans
Imaging, Three-Dimensional
Magnetic Resonance Imaging / methods
Neoplasms*
Printing, Three-Dimensional
Surgery, Computer-Assisted* / methods
Tomography, X-Ray Computed / methods