The Association of University Radiologists Radiology Research Alliance Task Force on three-dimensional (3D) printing presents a review of the logistic considerations for establishing a clinical service using this new technology, specifically focused on implications for radiology. Specific topics include printer selection for 3D printing, software selection, creating a 3D model for printing, providing a 3D printing service, research directions, and opportunities for radiologists to be involved in 3D printing. A thorough understanding of the technology and its capabilities is necessary as the field of 3D printing continues to grow. Radiologists are in the unique position to guide this emerging technology and its use in the clinical arena.
Introduction
Producing three-dimensional (3D) physical prototypes from digital models became popular in the late 1990s . Over the past decade, the heath-care sector has shown increased interest in this technology for clinical use. Radiology has a long-standing history of acquiring and maintaining volumetric anatomic data. This precedent leaves our specialty at an advantage to unlock the true potential of medical 3D printing for mainstream use.
The process of creating 3D models from digital data can be categorized into four major steps: image acquisition, image segmentation, creation of a 3D model, and transfer of model data to a 3D printer . Image acquisition is most commonly in the form of computed tomography (CT), due to rapid acquisition and relative ease of image post-processing for 3D printing . The volumetric data are analyzed to ensure that there are no gaps in anatomy during acquisition . Volumetric data from CT, magnetic resonance imaging (MRI), or ultrasound images are rendered in digital imaging and communication in medicine (DICOM) format. DICOM data cannot be 3D printed, and thus image data require conversion using specialized software into one of several output file types amenable for 3D printing. The most common of these is Standard Tessellation Language or STereoLithography (STL) format, which helps 3D printers to define objects by surfaces that enclose a region of space . These surfaces are defined as collections of triangles called facets.
Segmentation is the process of extracting region of interest (ROI)-specific data and refining the STL representation of the selected anatomy . This step requires specialized software to ensure model integrity, preferably with software programs that are approved by the Food and Drug Administration (FDA) . Parts of segmentation can be automated or manual, which can serve as a challenge for radiologists who may be unfamiliar with the application software.
After segmentation, acquired STL data are sent to another program for creation of a 3D model . Open-source and commercially available computer-aided design or computer-aided manufacturing software packages include many post-processing techniques, such as smoothing and wrapping, that must be used to ensure printability of a 3D model ( Table 1 ). Lastly, the completed STL file is transferred to a 3D printer for production. The various steps of creating a 3D model are illustrated in Figure 1 .
TABLE 1
Examples of Various Free Software Platforms Available for the Creation of 3D-printed Models
CURA Beginner Slicer software to prepare STL files for 3D printing Free PC, Mac, Linux CRAFTWARE Beginner Slicer software to prepare STL files for 3D printing Free PC, Mac OSIRIX Intermediate To create 3D model and prepare STL file Osirix lite (32 bit) is free. Mac only Osirix MD (64 bit) costs about $600 USD HOROS Intermediate To create 3D model and prepare STL file 64-bit Free, donation to user group requested Mac only NETFABB Intermediate Slicer to prepare STL files for 3D printing Basic free, professional edition paid PC, Mac, Linux REPETIER Intermediate-advanced Slicer software to prepare STL files for 3D printing Free PC, Mac, Linux 3-D TOOL Intermediate To view and check STL files Free PC MESHFIX Intermediate Check STL files Free PC SLIC3R Professional Slicer software to prepare STL files for 3D printing Free PC, Mac, Linux BLENDER Professional Edit STL files for 3D printing Free PC, Mac
PC, personal computer; STL, Standard Tessellation Language or STereoLithography; 3D, three-dimensional.
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Printer Selection for 3D Printing
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Material Extrusion
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Powder Bed Fusion
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Vat Photopolymerization
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Material Jetting
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Binder Jetting
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Sheet Lamination
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Directed Energy Deposition
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Software Selection for 3D Printing
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Creating a 3D Model for Printing
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Providing a 3D Printing Service
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Entry-level Use
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Educational Use
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Clinical Use
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Research Directions in 3D Printing
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General Directions
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Materials Research
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Other Research Opportunities
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Conclusion
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