Skip to main content
Log in

Setting up a biomodeling, virtual planning, and three-dimensional printing service in Uruguay

  • Review
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

A Correction to this article was published on 20 February 2024

This article has been updated

Abstract

Virtual surgical planning and three-dimensional (D) printing are rapidly becoming essential for challenging and complex surgeries around the world. An Ibero-American survey reported a lack of awareness of technology benefits and scarce financial resources as the two main barriers to widespread adoption of 3-D technologies. The Pereira Rossell Hospital Center is a publicly funded maternal and pediatric academic clinical center in Uruguay, a low-resource Latin American country, that successfully created and has been running a 3-D unit for 4 years. The present work is a step-by-step review of the 3-D technology implementation process in a hospital with minimal financial investment. References to training, software, hardware, and the management of human resources are included. Difficulties throughout the process and future challenges are also discussed.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

A video demonstration depicting the navigation of a 3-D biomodel for virtual surgical planning is available as Supplementary Material. Complementary clinical data on the anonymized patients are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

Change history

References

  1. (2023) Classification of digital health interventions v1.0. https://www.who.int/publications/i/item/WHO-RHR-18.06. Accessed 28

  2. Collins TE, Akselrod S, Altymysheva A et al (2023) The promise of digital health technologies for integrated care for maternal and child health and non-communicable diseases. BMJ 381:e071074. https://doi.org/10.1136/bmj-2022-071074

    Article  PubMed  Google Scholar 

  3. Global strategy on digital health 2020–2025. https://www.who.int/publications/i/item/9789240020924. Accessed 28 Nov 2023

  4. Murali S, Ding H, Adedeji F, et al (2023) Bringing MRI to low- and middle-income countries: directions, challenges and potential solutions. NMR Biomed e4992. https://doi.org/10.1002/nbm.4992

  5. (2019) WHO guideline recommendations on digital interventions for health system strengthening. World Health Organization, Geneva

  6. (2023) Digital implementation investment guide (DIIG): quick deployment guide. https://www.who.int/publications/i/item/9789240056572. Accessed 28

  7. Travers SZ (2021) Biomodeling and 3D printing: a novel radiology subspecialty. Annals of 3D Printed Medicine 4:100038. https://doi.org/10.1016/j.stlm.2021.100038

    Article  Google Scholar 

  8. Wong RMY, Wong PY, Liu C et al (2021) 3D printing in orthopaedic surgery: a scoping review of randomized controlled trials. Bone Joint Res 10:807–819. https://doi.org/10.1302/2046-3758.1012.BJR-2021-0288.R2

    Article  PubMed  PubMed Central  Google Scholar 

  9. Biglino G, Capelli C, Leaver L-K et al (2015) Involving patients, families and medical staff in the evaluation of 3D printing models of congenital heart disease. Commun Med 12:157–169. https://doi.org/10.1558/cam.28455

    Article  PubMed  Google Scholar 

  10. V S S, Panigrahy N, Rath SN, (2021) Recent approaches in clinical applications of 3D printing in neonates and pediatrics. Eur J Pediatr 180:323–332. https://doi.org/10.1007/s00431-020-03819-w

    Article  PubMed  Google Scholar 

  11. Irnstorfer N, Unger E, Hojreh A, Homolka P (2019) An anthropomorphic phantom representing a prematurely born neonate for digital x-ray imaging using 3D printing: proof of concept and comparison of image quality from different systems. Sci Rep 9:14357. https://doi.org/10.1038/s41598-019-50925-3

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  12. Anwar S, Singh GK, Varughese J et al (2017) 3D printing in complex congenital heart disease: across a spectrum of age, pathology, and imaging techniques. JACC Cardiovasc Imaging 10:953–956. https://doi.org/10.1016/j.jcmg.2016.03.013

    Article  PubMed  Google Scholar 

  13. Costello JP, Olivieri LJ, Su L et al (2015) Incorporating three-dimensional printing into a simulation-based congenital heart disease and critical care training curriculum for resident physicians. Congenit Heart Dis 10:185–190. https://doi.org/10.1111/chd.12238

    Article  PubMed  Google Scholar 

  14. Langdon C, Hinojosa-Bernal J, Munuera J et al (2023) 3D printing as surgical planning and training in pediatric endoscopic skull base surgery - systematic review and practical example. Int J Pediatr Otorhinolaryngol 168:111543. https://doi.org/10.1016/j.ijporl.2023.111543

    Article  PubMed  Google Scholar 

  15. Weinstock P, Rehder R, Prabhu SP et al (2017) Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects. J Neurosurg Pediatr 20:1–9. https://doi.org/10.3171/2017.1.PEDS16568

    Article  PubMed  Google Scholar 

  16. Pereira HR, Barzegar M, Hamadelseed O et al (2022) 3D surgical planning of pediatric tumors: a review. Int J Comput Assist Radiol Surg 17:805–816. https://doi.org/10.1007/s11548-022-02557-8

    Article  PubMed  Google Scholar 

  17. Sánchez-Sánchez Á, Girón-Vallejo Ó, Ruiz-Pruneda R et al (2018) Three-dimensional printed model and virtual reconstruction: an extra tool for pediatric solid tumors surgery. European J Pediatr Surg Rep 6:e70–e76. https://doi.org/10.1055/s-0038-1672165

    Article  PubMed  PubMed Central  Google Scholar 

  18. Valls-Esteve A, Adell-Gómez N, Pasten A et al (2023) Exploring the potential of three-dimensional imaging, printing, and modeling in pediatric surgical oncology: a new era of precision surgery. Children (Basel) 10:832. https://doi.org/10.3390/children10050832

    Article  PubMed  Google Scholar 

  19. Raza M, Murphy D, Gelfer Y (2021) The effect of three-dimensional (3D) printing on quantitative and qualitative outcomes in paediatric orthopaedic osteotomies: a systematic review. EFORT Open Reviews 6:130–138. https://doi.org/10.1302/2058-5241.6.200092

    Article  PubMed  PubMed Central  Google Scholar 

  20. Frizziero S, Liverani, et al (2019) Paediatric orthopaedic surgery with 3D printing: improvements and cost reduction. Symmetry 11:1317. https://doi.org/10.3390/sym11101317

    Article  ADS  Google Scholar 

  21. Parthasarathy J, Jonard B, Rees M et al (2023) Virtual surgical planning and 3D printing in pediatric musculoskeletal oncological resections: a proof-of-concept description. Int J Comput Assist Radiol Surg 18:95–104. https://doi.org/10.1007/s11548-022-02745-6

    Article  PubMed  Google Scholar 

  22. Gong T, Lu M, Min L et al (2023) Reconstruction of a 3D-printed endoprosthesis after joint-preserving surgery with intraoperative physeal distraction for childhood malignancies of the distal femur. J Orthop Surg Res 18:534. https://doi.org/10.1186/s13018-023-04037-4

    Article  PubMed  PubMed Central  Google Scholar 

  23. Park JW, Kang HG (2022) Application of 3-dimensional printing implants for bone tumors. Clin Exp Pediatr 65:476–482. https://doi.org/10.3345/cep.2021.01326

    Article  PubMed  Google Scholar 

  24. Fessenden M 3-D printed windpipe gives infant breath of life | Scientific American

  25. Les AS, Ohye RG, Filbrun AG et al (2019) 3D-printed, externally-implanted, bioresorbable airway splints for severe tracheobronchomalacia. Laryngoscope 129:1763–1771. https://doi.org/10.1002/lary.27863

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Morrison RJ, Hollister SJ, Niedner MF et al (2015) Mitigation of tracheobronchomalacia with 3D-printed personalized medical devices in pediatric patients. Sci Transl Med 7:285ra64. https://doi.org/10.1126/scitranslmed.3010825

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mannoor MS, Jiang Z, James T et al (2013) 3D printed bionic ears. Nano Lett 13:2634–2639. https://doi.org/10.1021/nl4007744

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  28. Bergmann C, Lindner M, Zhang W et al (2010) 3D printing of bone substitute implants using calcium phosphate and bioactive glasses. J Eur Ceram Soc 30:2563–2567. https://doi.org/10.1016/j.jeurceramsoc.2010.04.037

    Article  CAS  Google Scholar 

  29. Gatto M, Memoli G, Shaw A et al (2012) Three-dimensional printing (3DP) of neonatal head phantom for ultrasound: thermocouple embedding and simulation of bone. Med Eng Phys 34:929–937. https://doi.org/10.1016/j.medengphy.2011.10.012

    Article  PubMed  Google Scholar 

  30. Londoño MJ, Arango JF, Isaza JF (2023) Design and development of a low-cost pediatric videolaryngoscope. Proc Des Soc 3:1217–1226. https://doi.org/10.1017/pds.2023.122

    Article  Google Scholar 

  31. Rankin TM, Giovinco NA, Cucher DJ et al (2014) Three-dimensional printing surgical instruments: are we there yet? J Surg Res 189:193–197. https://doi.org/10.1016/j.jss.2014.02.020

    Article  PubMed  PubMed Central  Google Scholar 

  32. Irfan Ul Haq M, Khuroo S, Raina A et al (2022) 3D printing for development of medical equipment amidst coronavirus (COVID-19) pandemic—review and advancements. Res Biomed Eng 38:305–315. https://doi.org/10.1007/s42600-020-00098-0

    Article  Google Scholar 

  33. (1998) Draft guidance for industry on developing medical imaging drugs and biologics; availability--FDA. Availability of guidance. Fed Regist 63:55067–55069

  34. Mitsouras D, Liacouras P, Imanzadeh A et al (2015) Medical 3D printing for the radiologist. Radiographics 35:1965–1988. https://doi.org/10.1148/rg.2015140320

    Article  PubMed  Google Scholar 

  35. Ballard DH, Trace AP, Ali S et al (2018) Clinical applications of 3D printing: primer for radiologists. Acad Radiol 25:52–65. https://doi.org/10.1016/j.acra.2017.08.004

    Article  PubMed  Google Scholar 

  36. Mitsouras D, Liacouras PC, Wake N, Rybicki FJ (2020) Radiographics update: medical 3D printing for the radiologist. Radiographics 40:E21–E23. https://doi.org/10.1148/rg.2020190217

    Article  PubMed  Google Scholar 

  37. Siles Hinojosa A, Roldón Golet M, Zabala Travers S, Hernández del Arco S (2021) 3-D technology & pediatric surgery: Ibero-American survey. British Journal of surgery 108. https://doi.org/10.1093/bjs/znab160.021

  38. EPOSTM - C-16801. https://epos.myesr.org/poster/esr/ecr2022/C-16801. Accessed 28 Nov 2023

  39. Mazzola F, Smithers F, Cheng K et al (2020) Time and cost-analysis of virtual surgical planning for head and neck reconstruction: a matched pair analysis. Oral Oncol 100:104491. https://doi.org/10.1016/j.oraloncology.2019.104491

    Article  PubMed  Google Scholar 

  40. Ballard DH, Mills P, Duszak R et al (2020) Medical 3D printing cost-savings in orthopedic and maxillofacial surgery: cost analysis of operating room time saved with 3D printed anatomic models and surgical guides. Acad Radiol 27:1103–1113. https://doi.org/10.1016/j.acra.2019.08.011

    Article  PubMed  Google Scholar 

  41. Ravi P, Burch MB, Farahani S et al (2023) Utility and costs during the initial year of 3D printing in an academic hospital. J Am Coll Radiol 20:193–204. https://doi.org/10.1016/j.jacr.2022.07.001

    Article  PubMed  Google Scholar 

  42. Amorim P, Moraes T, Silva J, Pedrini H (2015) Invesalius: an interactive rendering framework for health care support. In: Bebis G, Boyle R, Parvin B, et al (eds) Advances in visual computing. Springer International Publishing, Cham, pp 45–54 https://doi.org/10.1007/978-3-319-27857-5_5

  43. Kikinis R, Pieper SD, Vosburgh KG (2014) 3D slicer: a platform for subject-specific image analysis, visualization, and clinical support. In: Jolesz FA (ed) Intraoperative imaging and image-guided therapy. Springer New York, New York, NY, pp 277–289 https://doi.org/10.1007/978-1-4614-7657-3_19

  44. Yushkevich PA, Piven J, Hazlett HC et al (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 31:1116–1128. https://doi.org/10.1016/j.neuroimage.2006.01.015

    Article  PubMed  Google Scholar 

  45. Frajhof L, Borges J, Hoffmann E et al (2018) Virtual reality, mixed reality and augmented reality in surgical planning for video or robotically assisted thoracoscopic anatomic resections for treatment of lung cancer. J Vis Surg 4:143–143. https://doi.org/10.21037/jovs.2018.06.02

    Article  Google Scholar 

  46. Virzì A, Muller CO, Marret J-B et al (2020) Comprehensive review of 3D segmentation software tools for MRI usable for pelvic surgery planning. J Digit Imaging 33:99–110. https://doi.org/10.1007/s10278-019-00239-7

    Article  PubMed  Google Scholar 

  47. Wegmüller L, Halbeisen F, Sharma N et al (2021) Consumer vs. high-end 3D printers for guided implant surgery-an in vitro accuracy assessment study of different 3D printing technologies. J Clin Med 10:4894. https://doi.org/10.3390/jcm10214894

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ramezani M, Mohd Ripin Z (2023) 4D printing in biomedical engineering: advancements, challenges, and future directions. J Funct Biomater 14:347. https://doi.org/10.3390/jfb14070347

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge radiologists Dr. Jose Perdomo, Dr. Juan Sattler, and industrial engineer Nicolas Rucks for their important role in the initiation of the 3-D Printing Unit at the Pereira Rossell Hospital Center. In addition, the creation of this Unit would not have been possible without the trust and support of Dr. Victoria Lafluf, Pereira Rossell Hospital General Director. We would also like to express our gratitude to Victoria Ramirez, Hansel Otero, and Mohammad Jalloul, for their invaluable contribution in the preparation of this manuscript.

Author information

Authors and Affiliations

Authors

Contributions

Both authors contributed to the preparation of this manuscript. The first draft of the manuscript was written by S.Z-T. and revised by A.G-B. Both authors read and approved the final version of this manuscript.

Corresponding author

Correspondence to Silvina Zabala-Travers.

Ethics declarations

Conflicts of interest

S.Z-T. is a co-founder of Upgrade Medicals a 3-D technologies company in Uruguay and has a collaboration with Inobitec DICOM Viewer PRO software developers. A.G-B. declares no conflicts of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: The original article contains an error in relation to the details of the company, Inobitec, which authors of the article gave as “Inobitec LLC, Voronezh, Russia, DICOM Viewer Pro ® FZ LLC, Extended Segmentation Module”. This should read as “Inobitec DICOM Viewer Pro, Inobitec Software FZ LLC, Dubai, United Arab Emirates

Supplementary information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 14096 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zabala-Travers, S., García-Bayce, A. Setting up a biomodeling, virtual planning, and three-dimensional printing service in Uruguay. Pediatr Radiol 54, 438–449 (2024). https://doi.org/10.1007/s00247-024-05864-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-024-05864-1

Keywords

Navigation