S p e c i a l A r t i c l e • P i c t o r i a l E s s ay

Esses et al.
Applications of 3D Models Derived From MDCT Data

Special Article
Pictorial Essay
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Clinical Applications of Physical 3D

Models Derived From MDCT Data
and Created by Rapid Prototyping
Steven J. Esses1,2 OBJECTIVE. In this article, we describe the production of physical models from CT
Phillip Berman1 data using rapid prototyping and present their clinical application. MDCT data acquisition of
Allan I. Bloom1 isotropic voxels and modern postprocessing techniques provide exquisite detail for clinicians
Jacob Sosna1,3 and radiologists.
CONCLUSION. In recent years, rapid prototyping technologies have provided new
Esses SJ, Berman P, Bloom AI, Sosna J possibilities to visualize complex anatomic structures through the generation of physical
models that can be used to assist with diagnosis, surgical planning, prosthesis design, and
patient communication.

Background ramic particles into a 3D object. In fused depo-

Keywords: 3D model, prosthesis design, rapid
prototyping, surgical planning
DOI:10.2214/AJR.10.5681
Received August 29, 2010; accepted after revision
September 30, 2010.
1
Department of Radiology, Hadassah Hebrew University
Medical Center, PO Box 12000, Jerusalem 91120, Israel.
Address correspondence to J. Sosna
(jacobs@hadassah.org.il).
2
Mount Sinai School of Medicine, New York, NY.
3
Department of Radiology, Beth Israel Deaconess
Medical Center, Harvard School of Medicine, Boston, MA.
WEB
This is a Web exclusive article.
AJR 2011; 196:W683–W688
0361–803X/11/1966–W683
© American Roentgen Ray Society
Rapid prototyping involves creating a
physical 3D model from a computer model.
The technology has been used by industry to
create forerunners of intended final products,
including automobiles, toys, and computers.
Models can be analyzed and modified before
production is planned [1].
In medicine, rapid prototyping has been used
by physicians to improve diagnostic accuracy,
plan complex interventions, and aid in medi-
cal student and resident understanding of dis-
ease. It has been particularly helpful with re-
gard to complex anatomic structures and disor-
ders that are not easily captured or understood
in two dimensions. Some CT workstations can
now quickly export DICOM-based CT data into
the standard triangular language (STL) format
used in rapid prototyping. This has greatly facil-
itated the printing of 3D models derived from ra-
diologic images (Fig. 1). In the printing process,
CT slices are created as 2D layers, and a meth-
od of assembling these layers into a solid mass
is applied. As CT slice thickness is reduced, 3D
model resolution will continue to improve [1].
Methods of Rapid Prototyping
There are five major types of rapid prototyp-
ing: STL, selective laser sintering, fused de-
position modeling, multijet modeling, and 3D
printing. In STL, a laser emitting ultraviolet
light causes local polymerization of a pool of
photosensitive resin in shapes corresponding to
each CT slice. In selective laser sintering, a la-
ser is used to fuse small plastic, metal, or ce-
sition modeling, a plastic is melted and extrud-
ed through a nozzle that can move horizontal-
ly and vertically to lay down plastic according
to CT slice information. In the multijet model
process, layers of powder are selectively bond-
ed by a water-based ink that is released in the
shape corresponding to the CT slice informa-
tion. In 3D printing, a photopolymer-based res-
in is jetted via high-resolution inkjet and cured
using ultraviolet light [2].
Clinical Applications
Maxillofacial Surgery and Otolaryngology
Three-dimensional models are particularly
useful for planning maxillofacial surgeries, be-
cause the anatomy and procedures in this re-
gion are especially complex (Figs. 2 and 3). An
early prospective trial assessed the efficacy of
3D biomodels in craniofacial and maxillofa-
cial surgeries. Three-dimensional models con-
tributed positively to diagnosis, operative plan-
ning, and informed consent. In addition, sur-
geons estimated that the use of models reduced
operating time by a mean of 17.63% [3].
Rapid prototyping plays an important role
in prosthesis engineering for craniofacial and
maxillofacial surgery and otolaryn­gologic re-
constructive surgery (Fig. 4). In one study, rap-
id prototyping technology was used to create
auricular prostheses according to CT scans of
patients’ contralateral ears. The most common
indications for reconstructive surgery were ear
loss due to tumor, congenital malformation,
and traumatic ear injury. A 3D image of the pa-

AJR:196, June 2011 W683

 Esses et al.

tient’s unaffected ear was created on the basis
of CT data and was inverted, creating a mirror
image. A cast of the inverted image was creat-
ed using rapid prototyping, and the final pros-
thesis was created from this cast [4, 5].
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diovascular disease. The technology can be
particularly helpful with respect to surgical
and catheter-based interventions. These pro-
cedures can be aided by a physician’s abili-
ty to physically manipulate rapid prototyped
models to determine the 3D spatial relation-
References
1. Webb P. A review of rapid prototyping (RP)
techniques in the medical and biomedical sector.
J Med Eng Technol 2000; 24:149–153
2. Kim MS, Hansgen AR, Wink O, Quaife RA,
Carroll JD. Rapid prototyping: a new tool in

Neurosurgery ships of cardiac structures. understanding and treating structural heart

Rapid prototyping has also been used for
neurosurgical procedures, including repair of
skull defects and intravascular interventions.
Several groups have created 3D models of cra-
nial defects from CT scans to personalize the
cranial implant used for repairs [6, 7] (Fig. 5).
Benefits derived from the plates included re-
duced hospital admissions, improved fit, and
improved cosmetic outcomes. Other groups
have used the models to plan constructive and
reconstructive cranioplasty and to plan surgi-
cal approaches to uncommonly complex skull-
based tumors. In most of these cases, operating
time and errors were reduced [8].
Orthopedics
Several groups have begun to use rapid
prototyping technology for orthopedic diag-
nosis and surgical planning. The technolo-
gy has been applied to treat disorders of the
spine, hip, pelvis, and shoulder (Fig. 6). One
group used 3D polystyrene models based on
CT scans in the treatment of complex and se-
vere spinal deformity. The models allowed the
surgeons to measure deformities directly, per-
form preoperative morphologic assessments,
and communicate more effectively with fami-
lies. The models also allowed the surgeons to
preoperatively determine the proper location
for placement of pedicle screws [9].
Cardiovascular
Three-dimensional models can play a ma-
jor role in the diagnosis and treatment of car-
Many reports in the literature describe the
use of models in the treatment of valve dis-
ease. Schievano et al. [10] determined pa-
tients’ suitability for percutaneous pulmonary
valve implantation by assessing 3D MRI-
based models of the right ventricular outflow
tract and pulmonary trunk. Cardiologists cor-
rectly determined whether valve implantation
would be successful in two of eight patients
using MRI alone and in five of eight patients
using the rapid prototyped models.
Rapid prototyping has also been used for
the surgical and catheter-based treatment of
pathologic abnormalities involving the aorta,
including cases of complex abdominal aor-
tic aneurysms (Fig. 7). The models can help
orient clinicians in catheter-based interven-
tions, such as coronary artery stent proce-
dures (Fig. 8).
Conclusion
Rapid prototyping can assist with diagno-
sis, surgical and catheter-based intervention
planning, patient communication, and pros-
thesis design in fields as diverse as maxillo-
facial surgery and cardiology. In the past 2
years, vendors have begun to equip worksta-
tions with the ability to convert DICOM files
from CT scans to STL files, thereby drasti-
cally reducing the complexity and time to
create physical models. Rapid prototyping
technology may become another tool for ra-
diologists to improve visualization of com-
plex anatomy.
disease. Circulation 2008; 117:2388–2394
3. D’Urso PS, Barker TM, Earwaker WJ, et al.
Stereolithographic biomodelling in cranio-
maxillofacial surgery: a prospective trial. J
Craniomaxillofac Surg 1999; 27:30–37
4. Karayazgan-Saracoglu B, Gunay Y, Atay A.
Fabrication of an auricular prosthesis using
computed tomography and rapid prototyping
technique. J Craniofac Surg 2009; 20:1169–1172
5. Turgut G, Sacak B, Kiran K, Bas L. Use of rapid
prototyping in prosthetic auricular restoration. J
Craniofac Surg 2009; 20:321–325
6. Maravelakis E, David K, Antoniadis A, Manios
A, Bilalis N, Papaharilaou Y. Reverse engineering
techniques for cranioplasty: a case study. J Med
Eng Technol 2008 32:115–121
7. Winder J, Cooke RS, Gray J, Fannin T, Fegan T.
Medical rapid prototyping and 3D CT in the
manufacture of custom made cranial titanium
plates. J Med Eng Technol 1999; 23:26–28
8. Müller A, Krishnan KG, Uhl E, Mast G. The
application of rapid prototyping techniques in
cranial reconstruction and preoperative
planning in neurosurgery. J Craniofac Surg
2003; 14:899–914
9. Mao K, Wang Y, Xiao S, et al. Clinical application
of computer-designed polystyrene models in
complex severe spinal deformities: a pilot study.
Eur Spine J 2010; 19:797–802
10. Schievano S, Migliavacca F, Coats L, et al.
Percutaneous pulmonary valve implantation
based on rapid prototyping of right ventricular
outflow tract and pulmonary trunk from MR data.
Radiology 2007; 242:490–497

Fig. 1—Photograph of rapid prototyping device.

Patient undergoes CT, and 3D rendering is derived
from DICOM-based CT data on 3D workstation.
Images are exported in standard triangular language
format, which can be read by the rapid prototyping
device, and a physical model is created. (Photograph
of 3D printer courtesy of Objet Geometries, Ltd.)

W684 AJR:196, June 2011

 Applications of 3D Models Derived From MDCT Data
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A B C

D E F
Fig. 2—29-year-old man with ameloblastoma of left mandible.
A, Image shows 3D rendering of mandible.
B and C, 3D rapid prototyped model allowed preoperative planning of bony incisions (B) and preoperative
contouring of titanium bone plate used in mandible reconstruction (C). Preoperative contouring allowed more-
precise plate to be constructed.
D, Photo shows plate in use during surgery. Operating time was substantially reduced.
E and F, Before subsequent operation, another 3D model (E) was constructed by rapid prototyping to aid
in planning dimensions of bone graft that would be harvested from patient’s hip during surgery. 3D model
illustrating bone graft placement (F). Bone graft was implanted in operating room, thereby completing jaw
reconstruction.
G, Image shows graft after implantation.

AJR:196, June 2011 W685

 Esses et al.

Fig. 3—16-year-old girl who presented with limited

ability to open her mouth because of overgrowth of
coronoid process of mandible.
A, CT-derived 3D reconstruction illustrates extent to
which patient was able to open her mouth.
B, 3D reconstruction illustrates coronoid process
overgrowth.
C and D, 3D rapid prototype models were used to
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determine optimal point for resection. Surgery

enabled patient to open her mouth more widely.

A B

C D

A B C
Fig. 4—18-year-old man whose right zygomatic bone was fractured in fight.
A and B, Axial CT image (A) and 3D reconstruction (B) illustrate fracture; 3D image was exported in standard triangle language format.
C, Physical model was created by rapid prototyping.
(Fig. 4 continues on next page)

W686 AJR:196, June 2011

 Applications of 3D Models Derived From MDCT Data

Fig. 4 (continued)—18-year-old man whose right

zygomatic bone was fractured in fight.
D and E, 3D model was used as template to create
implant.
F, Photograph shows patient before surgery. Note
that area of fracture underneath right eye has sunken
appearance.
G, Photograph shows patient after surgery.
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D E

F G

Fig. 5—3D model of a skull after

craniectomy.
A, To personalize cranial
implants in skull repairs, a 3D
model of the negative defect is
created.
B, Model of implant is shown
fitted to skull defect. Implant
is then produced from
biocompatible acrylic media.
(Photographs courtesy of Objet
Geometries, Ltd.)
A B

AJR:196, June 2011 W687

 Fig. 6—25-year-old man who presented with
Esses et al. fractured scapula secondary to trauma.
A and B, Radiograph (A) and CT scan (B) illustrate
fracture (arrows, A and B).
C, 3D model was used to plan scapula reconstruction
and to pinpoint optimal location for plate placement.
D, Postoperative radiograph.
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A B

C D

Fig. 7—79-year-old man with abdominal aortic

aneurysm.
A, Image shows 3D rendering of aneurysm derived
from DICOM-based CT data.
B, Photograph of rapid prototyped model.
C, Model was brought into operating room to help
orient surgeon performing stent procedure.
A B C

Fig. 8—71-year-old man with coronary artery disease who was

referred for coronary artery stent placement.
A, Femoral approach was precluded by tortuous thoracic aorta, as
seen in this 3D rendering.
B, Photograph shows posterior view of CT-derived rapid prototype
model of left subclavian artery. Left-subclavian approach was also
difficult because of artery’s route. Model was brought into catheter
laboratory to aid with orientation and facilitated catheterization.
A B

W688 AJR:196, June 2011

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