Mayo Clinic Creates Free 3D-Printed SpineSurgery Simulator for Medical Training
The ongoing COVID-19 pandemic has demandedan unprecedented response from healthcare systems around the world. And to overcome the visible impact caused by the disease, the medical field is heavilyrelying on 3D printing technologies, digital trends, telehealth, artificialintelligence, and robotics. If crises can accelerate innovation andcollaboration, then this pandemic has proven that innovators from a wide rangeof fields, working together to confront the outbreak, will play a critical rolein enabling the breakthroughs needed for humanity to advance.
As part of their continuing efforts toshare knowledge, a team of experts at the 3D printing lab at Mayo Clinic’sDepartment of Neurosurgery—the B.R.A.I.N. (Biotechnology Research andInnovation Neuroscience) Laboratory—have created the first open-access,3D-printed simulator for resident and medical student education in spinalanatomy and pedicle screw placement.
Also known as SpineBox, the simulatordesign can be 3D printed on any desktop device, has a total cost of under 10dollars, can be disseminated to neurosurgical and orthopedic residents trainingin spinal surgery to continue their practice during the current operativefurlough, and the STL file can be downloaded for free at the Autodesk Online Gallery,or by following the linkhere.
The creators of SpineBox and co-founders of B.R.A.I.N., William Clifton, a neurosurgery resident at the Mayo Clinic inFlorida, and Aaron Damon, a researcher and lab specialist at the SimulationCenter at the Mayo Clinic, recently published a paper in Cureus describing theprocess behind their development, as well as its uses in anatomical educationand training for pedicle screw placement in the lumbar region of the spine.
Moreover, as the world came to a halt amidthe coronavirus pandemic, medical students were sidelined from their trainingas schools ended contact with patients. In the United States, 90,000 medicalstudents have responded with grassroots efforts to secure masks, staff-patientcall centers, and even provide childcare for healthcare workers who need to beat the frontlines. Even if students go back to school sometime this year, thecurrent global situation has proven how important it is to have access tolearning tools that are mobile and independent of hospital-related conditions.
The recent outbreak has diminished manyneurosurgical learning opportunities throughout the world due to conferencecancellations, decreased operating room utility, and quarantine policies. Inthe study, Clifton and Damon revealed that a simulator design that is easilycreated and portable for dissemination to neurosurgical trainees does not exist. That was something they were eager to develop and share with the medicalcommunity.
The five co-authors of the paper, includingClifton and Damon, along with Mayo Clinic neurosurgeons Mark Pichelmann, EricNottmeier, and Fidel Valero-Moreno, decided to carry out this project toprovide institutions across the world with a cost-effective, easily available“in-house” model.
During the study, ten SpineBoxes weresuccessfully printed using acrylonitrile butadiene styrene (ABS) filament on a Raise3D Pro2 Plus fused deposition modeling (FDM) 3D printer. It took the team30 hours and $9.68 of material to print each SpineBox.
在研究过程中，团队在Raise3D Pro2 Plus 熔融沉积成型(FDM) 3D打印机上使用ABS耗材成功打印了10个SpineBox。每个SpineBox，团队花费30个小时和价值9.68美元的耗材。
The team first acquired an anonymized CTscan of the lumbar spine of an adult patient to produce lumbar vertebral modelsthat adequately replicated normal surface anatomy. The CT scan was then uploadedinto the open source 3D Slicer platform, where five lumbar vertebrates (L1-L5) were individually selected, and facet joints and intervertebral spaces weremanually separated to produce individually segmented models of the lumbarvertebrae. Each of the five lumbar vertebral models was then converted into an STL file and uploaded into the CAD software platform Meshmixer, which was alsoused to construct a virtual housing box for the vertebral models. The sliced SpineBox STL file was converted into a G-code to finally be 3D printed.
In order to enhance the educationalexperience, the team decided that they would also replicate the soft tissuestructure by creating a soft barrier so that medical trainees wouldn’t see thevertebral model directly, providing a surgical environment that enabled them tooperate in realistic conditions. In this case, they decided to cut flexibleupholstery polyurethane foam sheets to fit the dimensions of the simulatorhousing box (at 17.6 x 18.6 cm). After the assembly was complete, the veryrealistic simulator allowed trainees to cut through the foam with a scalpel anduse surgical retractors to simulate the separation of the soft tissue after theincision, allowing them to see into the operative cavity.
The use of polyurethane foam for soft tissue simulation as in a live operative scenario
为了增强教育体验，团队决定通过设计一个软屏障来复制人体皮肤软组织结构，这样医学生就不会直接看到脊椎模型，从而提供一个拟真的外科手术环境，使他们能够在更贴近现实的条件下操作。为了实现这个目标，他们需要切割柔性室内装饰聚氨酯泡沫片，以适应模拟器外壳盒的尺寸(17.6 x 18.6厘米)。组装完成后，受训者用手术刀切开泡沫片，并使用手术牵开器模拟切口后软组织的分离后，可以让学生们看到手术腔，非常逼真。
As described in the paper, Clifton and Damon have already begun using CAD design and 3D printing at the Mayo Clinic, in Jacksonville, to construct SpineBox simulators, which are also disposable and able to replicate the cortico-cancellous interface for pedicle screw placement.
The primary learning goal of the simulator was to instruct junior neurosurgical trainees in the anatomy and technique for pedicle screw placement in the lumbar spine. As stated in the study, they have already 3D-printed 10 SpineBox models for training, which were used to place a total of 100 pedicle screws in 50 lumbar levels.
The pedicle screws of the 3D-printed lumbar vertebrae can be seen within the model after being placed and graded based on location for both teaching and objective skill assessment
3D printing has already proven to be atechnology that can provide the means to recreate key points of anatomy foranatomical and procedural learning. This is especially true in the realm ofspinal surgery, as with Clifton and Damon’s original Biomimetic Human TissueSimulators, another training model they developed to help hundreds of medicalresidents improve their skills. Furthermore, as many institutions around theworld continue to acquire desktop 3Dprinters, they will need more open-access and cheap simulator designs that donot require purchase or extensive assembly.
The SpineBox simulator represents theresult of many years of research focused on innovation in healthcare education.In addition, it can change the way medical schools prepare physicians for thedemands of the future, especially as hospitals and procedures continue toundergo changes in the era of the pandemic.
Clearly committed to using 3D printing torevolutionize the way surgeons are taught, Clifton and Damon continue tosurprise us with their improved designs and free-access delivery of simulatorsto any institution around the world that needs them, surely, many will takeadvantage of this new development.