TITLE: Concept and Design of a 3D Printed Support to Assist Hand Scanning for the Realization of Customized Orthosis
AUTHORS: Gabriele Baronio, Paola Volonghi, Alberto Signoroni
PUBLISHED ON: Applied Bionics and Biomechanics (link)
YEAR: 2017
ABSTRACT: In the rehabilitation field, the use of additive manufacturing techniques to realize customized orthoses is increasingly widespread. Obtaining a 3D model for the 3D printing phase can be done following different methodologies. We consider the creation of personalized upper limb orthoses, also including fingers, starting from the acquisition of the hand geometry through accurate 3D scanning. However, hand scanning procedure presents differences between healthy subjects and patients affected by pathologies that compromise upper limb functionality. In this work, we present the concept and design of a 3D printed support to assist hand scanning of such patients. The device, realized with FDM additive manufacturing techniques in ABS material, allows palmar acquisitions, and its design and test are motivated by the following needs: (1) immobilizing the hand of patients during the palmar scanning to reduce involuntary movements affecting the scanning quality and (2) keeping hands open and in a correct position, especially to contrast the high degree of hypertonicity of spastic subjects. The resulting device can be used indifferently for the right and the left hand; it is provided in four-dimensional sizes and may be also suitable as a palmar support for the acquisition of the dorsal side of the hand.

TITLE: Repliche anatomiche stampate in 3D: un nuovo strumento per la pianificazione chirurgica e il consenso informato
AUTHORS: N. Bizzotto, M.L. Rizzo, D. Romani, A. Zardini, C. Rossignoli, B. Magnan 
PUBLISHED ON: GIHTAD, 2017. 10:3 (link)
YEAR: 2017

TITLE: A Critical Analysis of a Hand Orthosis Reverse Engineering and 3D Printing Process
AUTHORS: Gabriele Baronio, Sami Harran, Alberto Signoroni 
PUBLISHED ON: Applied Bionics and Biomechanics (link)
YEAR: 2016
ABSTRACT: The possibility to realize highly customized orthoses is receiving boost thanks to the widespread diffusion of low-cost 3D printing technologies. However, rapid prototyping (RP) with 3D printers is only the final stage of patient personalized orthotics processes. A reverse engineering (RE) process is in fact essential before RP, to digitize the 3D anatomy of interest and to process the obtained surface with suitable modeling software, in order to produce the virtual solid model of the orthosis to be printed. In this paper, we focus on the specific and demanding case of the customized production of hand orthosis. We design and test the essential steps of the entire production process with particular emphasis on the accurate acquisition of the forearm geometry and on the subsequent production of a printable model of the orthosis. The choice of the various hardware and software tools (3D scanner, modeling software, and FDM printer) is aimed at the mitigation of the design and production costs while guaranteeing suitable levels of data accuracy, process efficiency, and design versatility. Eventually, the proposed method is critically analyzed so that the residual issues and critical aspects are highlighted in order to discuss possible alternative approaches and to derive insightful observations that could guide future research activities.

TITLE: Fabrication of Co–Cr–Mo endoprosthetic ankle devices by means of Selective Laser Melting (SLM)
AUTHORS: E. Liverani, A. Fortunato, A. Leardini, C. Belvedere, S. Siegler, L. Ceschini , A. Ascari 
PUBLISHED ON: Materials and Design
YEAR: 2016
ABSTRACT: A study of Cobalt–Chromium–Molybdenum endoprosthetic ankle implant fabrication by means of SLM is presented, including process characterization and kinematic considerations. Process optimization is first performed on samples with simple geometry to maximize density and mechanical strength using Co–Cr–Mo powders. Parameters such as laser scanning velocity, laser power and scanning strategy are varied, amongst others. Mechanical tests and microstructural analyses are performed to define process parameter windows for fabrication of near full density prostheses with negligible microstructural defects. Prosthetic ankles, based on medical imaging and biomechanical modeling, are then manufactured and kinematically tested to confirm their functional integrity and performance.

TITLE: Patient’s Specific Template for Spine Surgery
AUTHORS: Paolo D. Parchi, Gisberto Evangelisti, Valentina Cervi, Lorenzo Andreani, Marina Carbone, Sara Condino, Vincenzo Ferrari, Michele Lisanti
PUBLISHED ON: L.E. Ritacco et al. (eds.), Computer-Assisted Musculoskeletal Surgery: Thinking and Executing in 3D, DOI 10.1007/978-3-319-12943-3_15
YEAR: 2016
KEYWORDS: Freehand technique • Fluoroscopic guidance • Robotic platform • 3D printers • Preoperative planning
ABSTRACT: Currently, Pedicle screws are positioned using a freehand technique or under fl uoroscopic guidance. Although computer navigation has improved its accuracy over the last years, image guided navigation has still little use among physicians for orthopaedic surgeries. This is because computer assisted surgeries are very expensive, specially the required equipment, and also has diffi culties related to use. The drill must be perfectly orientated following the navigator screen, which is no easy task to perform. A new asset for pedicle screw placement is to use a robotic platform, which reduces misplacement. However, it is too expensive and its learning curve can take a long time to be completed. In some cases this kind of technology must not be useful and practical. A third solution for pedicle screw placement is to use Patient’s Specifi c Templates, which is less expensive and less complex to learn. This alternative is stable at a unique position, easy to use, easy to place (with high reproducibility), less invasive and more accurate. The time from design to production of one template is short, although it depends by the familiarization with the software used (time spent for the preoperative planning and the template design) and by the 3D printer used. Previously planned surgeries reduce costs and the time spent in the operating room during a procedure because surgeons can predict and perform the surgery before the real operation. Furthermore the use of patient’s specifi c templates can save surgeons from potential errors, and consequently additional costs for the health system due to additional treatments or legal reasons.

TITLE: Total Hip Replacement Simulatosr with Virtual Planning and Physical Replica for Surgical Training and Reharsal
AUTHORS: Paolo Parchi , Sara Condino , Marina Carbone , Marco Gesi , Vincenzo Ferrari , Mauro Ferrari , Michele Lisanti
PUBLISHED ON: Proceeding (832) Biomedical Engineering – DOI: 10.2316/P.2016.832-030 (link)
YEAR: 2016
KEYWORDS: Hip replacement surgery • surgical simulation • surgical planning • physical simulator • hip simulator
ABSTRACT: Live Surgery is today an integral component of surgical training programs and innovative surgical technique dissemination. However, the increasing pressure to maintain efficiency and reduce surgical risks has raised the need for structured training sessions through simulation technologies. Simulation has the potential to overcome several limitations of live surgery, allowing the trainee to gain procedural experience in a safe and controlled environment. In Total Hip Replacement intervention surgical simulation can help not only in training but also in planning the intervention. In this work the authors present the HipSim/PSP-HipSim physical patient specific simulators and 3D Hip Plugin virtual environment (e-SPres3D s.r.l), and their preliminary validation both for training purposes and for surgical rehearsal. 13 othopaedic surgeons participated in this study and answered a questionnaire. Results demonstrate the appropriateness of the HipSim/PSPHipSim simulators as training instrument and the effectiveness of the PSP-HipSim and 3D Hip Plugin for patient specific surgical planning.

TITLE: Three-Dimensional Printing of Bone Fractures: A New Tangible Realistic Way for Preoperative Planning and Education
AUTHORS: Bizzotto N., Sandri A., Regis D., Romani D., Tami I., Magnan B.
PUBLISHED ON: Surg Innov DOI: 10.1177/1553350614547773 (link)
YEAR: 2015

TITLE: Custom-fit total knee arthroplasty: our initial experience with 30 knees
AUTHORS: Enrico Bonicoli, Lorenzo Andreani, Paolo Parchi, Nicola Piolanti, Michele Lisanti
PUBLISHED ON: Eur J Orthop Surg Traumatol DOI 10.1007/s00590-013-1304-0
YEAR: 2013
KEYWORDS: Custom-fit technique • Total knee arthroplasty • Patient-specific cutting blocks • MRI
ABSTRACT: We report our initial experience of total knee arthroplasty (TKA) using customized cutting block technology in 30 TKAs from December 2010 to September 2012. Customized blocks were generated for each of the knees using preoperative magnetic resonance imaging of knee and long-leg weight-bearing radiographs. At 30 days, long-leg radiographs were obtained to evaluate the coronal alignment. Twenty-six of the 30 knees had a mechanical axis restored to within 3 of neutral. We conclude that this technology can be safely used in most of the cases of osteoarthritis.

TITLE: Computer Tomography Prototyping and Virtual Procedure Simulation in Difficult Cases of Hip Replacement Surgery
AUTHORS: Paolo D. Parchi, Vincenzo Ferrari, Sara Condino, Nicola Piolanti, Gisberto Evangelisti, Lorenzo Andreani, Michele Lisanti
YEAR: 2013
ABSTRACT: Each year approximately 1 million total hip replacements (THR) are performed worldwide. A percentage of failure due to surgical approach and imprecise implant placement still exists. These result in several serious complications. We propose an approach to plan, to simulate, and to assist prosthesis implantation for difficult cases of THR based on 3-D virtual models, generated by segmenting patients’ CT images, 3-D solid models, obtained by rapid prototyping (RP), and virtual procedure simulation. We carried out 8 THR with the aid of 3-D reconstruction and RP. After each procedure a questionnaire was submitted to the surgeon to assess the perceived added value of the technology. In all cases, the surgeon evaluated the 3-D model as useful in order to perform the planning. The clinical results showed a mean increase in the Harris Hip Score of about 42.5 points. The mean time of prototyping was 7.3 hours, (min 3.5 hours, max 9.3 hours). The mean surgery time was 65 minutes (min 50 minutes, max 88 minutes). Our study suggests that meticulous preoperative planning is necessary in front of a great aberration of the joint and in absence of normal anatomical landmarks, CT scan is mandatory, and 3-D reconstruction with solid model is useful.

TITLE: An optimal design for patient-specific templates for pedicle spine screws placement
AUTHORS: V. Ferrari, P. Parchi, S. Condino, M. Carbone, A. Baluganti, M. Ferrari, F. Mosca, M. Lisanti
PUBLISHED ON: Int J Med Robotics Comput Assist Surg DOI: 10.1002/rcs.1439
YEAR: 2012
ABSTRACT: Background. Currently, pedicle screws are positioned using a free-hand technique or under fluoroscopic guidance, with error in the range 10–40%, depending on the skill of the surgeon. Methods. After spine CT acquisition, each vertebra is segmented and the surgeon plans screw positioning in a virtual environment, then the template is designed around the chosen trajectories. This design is based on surgical and mechanical considerations to obtain an optimal solution to guarantee template stability, simple positioning and minimized intervention invasiveness. In vitro evaluation on synthetic spine models and ex vivo animal tests on porcine specimens were performed, with the insertion of 28 Kirschner wires. Results. During the in vitro tests, all the surgeons rendered positive evaluations regarding the device and considered template placement to be easy. Ex vivo tests were evaluated by CT examination, which showed that 96.5% of the Kirschner wires had been correctly inserted. Conclusions, The proposed solution is a promising, simple, highly precise, lowcost solution to safely performing posterior stabilization. Such a solution would be of interest even in hospitals in which a few spine interventions are performed per year, and for which it is not reasonable to purchase the equipment required for robotic or navigated approaches.


TITLE: Neuronavigazione. Il futuro è nei biomodelli
AUTHORS: Villiam Dallolio
PUBLISHED ON: Tecnica Ospedaliera (download)
YEAR: 2017
KEYWORDS: neurochirurgia • neuronavigazione • stampa 3D • biomodelli • neurosurgery • neuronavigation • 3D printing • biomodels
ABSTRACT: Messa a punto da Villiam Dallolio, neurochirurgo e pioniere della stampa 3D in neurochirurgia, la neuronavigazione integrata è un’efficace tecnica che rende ancora più sicura la chirurgia.


TITLE: 3D Printing of CT Dataset: Validation of an Open Source and Consumer-Available Workflow
AUTHORS: Bortolotto C., Eshja E., Peroni C., Orlandi M.A., Bizzotto N., Poggi P.
PUBLISHED ON: J Digit Imaging. DOI: 10.1007/s10278-015-9810-8. (link)
YEAR: 2016
KEYWORDS: Computer-aided design • Dimensional measurement accuracy • Imaging three-dimensional • Multidetector computed tomography • Printing
ABSTRACT: The broad availability of cheap three-dimensional (3D) printing equipment has raised the need for a thorough analysis on its effects on clinical accuracy. Our aim is to determine whether the accuracy of 3D printing process is affected by the use of a low-budget workflow based on open source software and consumer’s commercially available 3D printers. A group of test objects was scanned with a 64-slice computed tomography (CT) in order to build their 3D copies. CT datasets were elaborated using a software chain based on three free and open source software. Objects were printed out with a commercially available 3D printer. Both the 3D copies and the test objects were measured using a digital professional caliper. Overall, the objects’ mean absolute difference between test objects and 3D copies is 0.23 mm and the mean relative difference amounts to 0.55 %. Our results demonstrate that the accuracy of 3D printing process remains high despite the use of a low-budget workflow.

Medicina Legale

TITLE: 3D Printing Applications in Forensic Medicine
AUTHORS: Maria Livia Rizzo, Annamaria Govi, Giordano Fabbri Varliero, Silvia Pari, Caterina Cerri, Susi Pelotti
IALM Intersocietal Symposium, 2016 (download)


TITOLO: Modelli anatomici 3D cerebrali e spinali per ottimizzare la pianificazione e la strategia chirurgica. Realtà “reale” a complemento della realtà virtuale. 
AUTORI: Villiam Dallolio
EXPOSANITA’ 2016 (download)

Biodiritto e Aspetti Legali

TITOLO: Stampa 3D in Medicina: Aspetti Legali
AUTORI: Maria Livia Rizzo, Marco Giacomello
EXPOSANITA’ 2016 (download)

TITOLO: La sanità elettronica in una prospettiva rivoluzionaria: gli aspetti legali della stampa 3D in medicina
AUTORI: Maria Livia Rizzo, Marco Giacomello
PUBBLICATO IN: “Strumenti, diritti, regole e nuove relazioni di cura. Il paziente europeo protagonista nell’eHealth” a cura di Carla Faralli, Raffaella Brighi, Michele Martoni. Giappichelli
ANNO: 2015