Case TAVR080: Aortic Valve Step-by-Step Guide

Transcription

1 Case TAVR080: Aortic Valve Step-by-Step Guide 3D printing the aortic valve The 3D printed anatomical model is not for diagnostic use. M-06235C 208 Vital Images, Inc.

2 Case Airways - Learning objectives At the end of the session, the student will be able to:. Use and refine automatic segmentation. Aorta/TAVR using the generic Vitrea tools such as Sculpt, Visible Pick with HU thresholding (using WL). 2. Generate, verify and improve a region shell as aortic root wall and aortic valve (partial) model. 3. Generate a.stl mesh model of the aorta wall, preview the model in 3D and MPR viewers, and save the model on disk. 4. Reuse the.stl aortic wall model in an external software (Meshmixer). 5. Visualize the.stl model and improve the model using Sculpting tools. 6. Apply a cut plane on the model, analyze the model, its dimensions, strength, orientation, modify the orientation and location for printing. 7. Export the modified.stl file, prepare for 3D printing, select printer. Perform the segmentation of the calcium in the aortic wall and export it as.stl file. 8. Perform the segmentation of the calcium in the aortic wall and export it as.stl file. *All third party marks are property of their respective owners. 208 Vital Images, Inc. 2

3 Select Case TAVR 080 first series (). Applications Choose: TAVR Planning (2). Ser#, Select 3 (3). Open case (4) Vital Images, Inc. 3

4 Check automatic segmentation (). Tint/MPR vessel region (2). Let s restrict the future 3D model to the aortic root Vital Images, Inc. 4

5 Improve auto segmentation: select Sculpt tool (). Contour the aortic root (2). AddTo the selection as a new region renamed as aortic root (3) Vital Images, Inc. 5

6 Tint/MPR the aortic root region (). The leaflets are included in the lumen (2). Let s apply a new window level in 3D for thresholding: example type W and 380 L for /400HU WL (3) Vital Images, Inc. 6

7 Select the Visible Pick tool (under Organ Pick) (). Click in 3D aortic root (2). Check in MPR that the light blue selection excludes the leaflet and soft tissue but keeps the lumen (3). Otherwise choose a new WL - thresholding. AddTo to a new region (Aortic Root 2) (4) Vital Images, Inc. 7

8 You can select Show Volume region menu () to see the segmented root in solid colors. Let s now create a shell region representing the aortic wall. 208 Vital Images, Inc. 8

9 Select AorticRoot2 (). Select Create Shell (2) Vital Images, Inc. 9

10 Type a shell thickness larger than the slice thickness (). Here:.4 mm. OK (2) Vital Images, Inc. 0

11 Apply Show Volume for visualization (). The region shell has been created (2). We need to open the top and bottom ends of the aorta wall region (3) Vital Images, Inc.

12 Select Sculpt tool (). Draw in 3D a contour to exclude the top and bottom of the aorta (2). Click Remove (or equivalently AddTo Base = non segmented) (3) Vital Images, Inc. 2

13 We can now export the aortic root shell as a mesh model (.stl) (). 208 Vital Images, Inc. 3

14 Choose export quality 3 () and click Preview (2) Vital Images, Inc. 4

15 Select directory to save the.stl file (). Save As (2) Vital Images, Inc. 5

16 The STL files have been saved. OK (). 208 Vital Images, Inc. 6

17 Editing the 3D model Use of Meshmixer software is for demonstration purposes only 208 Vital Images, Inc. 7

18 Open Meshmixer and import the mesh model. 208 Vital Images, Inc. 8

19 Import the 3D model (.stl) using Meshmixer. 3D rotation: mouse wheel button Zoom = alt + right mouse button Pan: alt + mouse wheel 208 Vital Images, Inc. 9

20 Let s repair the model with the Sculpt tool. Choose Shrink smooth brush or Flatten brush (). Choose best brush size and strength (2). Flatten bumps in the 3D model (3) D rotation: right mouse button Zoom = alt + right mouse button Pan: alt + mouse wheel 208 Vital Images, Inc. 20

21 Apply cut plane: Select Edit menu Plane cut. 208 Vital Images, Inc. 2

22 Smooth edge cut plane: Use Sculpting tools. Choose Shrink smooth brush or Flatten brush (). Choose best brush size and strength(2). Make smoother edges in the 3D model (3) Vital Images, Inc. 22

23 Analyze the model check mesh defects. Here the model is ok. 208 Vital Images, Inc. 23

24 Analyze the model orient model for printing, adjust settings, update or accept. 208 Vital Images, Inc. 24

25 Analyze the model after model positioning on the printer tray 208 Vital Images, Inc. 25

26 Typical 3D printing result: with flexible material. 3D printed with Stratsys Objet Connex series Aortic wall: Rubber-like translucent (TangoPlus FLX930) Shore? Calcium: Rigid Opaque white material (VeroWhitePlus) 208 Vital Images, Inc. 26

27 Adding the calcified wall lesions 208 Vital Images, Inc. 27

28 Our case contains a single calcium spot adjacent to the segmented wall (shell). 208 Vital Images, Inc. 28

29 Select only the aortic lumen region containing the calcium spot (). Click Show Segmentation (2) Vital Images, Inc. 29

30 Select Visible pick tool (). Click on the calcium spot Vital Images, Inc. 30

31 Dilate 2X. AddTo Calcium region (). Rename it (2) Vital Images, Inc. 3

32 A new Calcium region has been created (). 208 Vital Images, Inc. 32

33 Save the calcium region () as.stl (2) Vital Images, Inc. 33

34 208 Vital Images, Inc. M-06235C 34