Date Published: June 8, 2020
Publisher: Springer International Publishing
Author(s): David H. Ballard, Nicole Wake, Jan Witowski, Frank J. Rybicki, Adnan Sheikh.
Medical 3D printing has demonstrated value in anatomic models for abdominal, hepatobiliary, and gastrointestinal conditions. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness criteria for abdominal, hepatobiliary, and gastrointestinal 3D printing indications.
A literature search was conducted to identify all relevant articles using 3D printing technology associated with a number of abdominal pathologic processes. Each included study was graded according to published guidelines.
Evidence-based appropriateness guidelines are provided for the following areas: intra-hepatic masses, hilar cholangiocarcinoma, biliary stenosis, biliary stones, gallbladder pathology, pancreatic cancer, pancreatitis, splenic disease, gastric pathology, small bowel pathology, colorectal cancer, perianal fistula, visceral trauma, hernia, abdominal sarcoma, abdominal wall masses, and intra-abdominal fluid collections.
This document provides initial appropriate use criteria for medical 3D printing in abdominal, hepatobiliary, and gastrointestinal conditions.
In 2018, the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) published initial guidelines for medical 3D printing appropriateness . Those appropriateness guidelines included a number of organ or system-based appropriateness criteria; however, they did not include indications for abdominal, hepatobiliary, and gastrointestinal 3D printing. Medical 3D printing has been gaining popularity in new areas of clinical practice and is now performed for a variety of abdominal indications . However, there is no consensus on which abdominal, hepatobiliary, and gastrointestinal scenarios and indications can most benefit from 3D printing. The purpose of this work is to provide evidence-based appropriate use criteria for abdominal, hepatobiliary, and gastrointestinal indication for medical 3D printing.
The SIG initiated writing groups for appropriateness of performing 3D printing from medical imaging for various clinical conditions. This present work provides the literature search and strength of evidence to introduce the appropriateness of abdominal, hepatobiliary, and gastrointestinal 3D printing for clinical utilization, research, scientific, and informational purposes. Related work previously published and not covered in the present work includes genitourinary and abdominal vascular conditions, which were presented in the initial appropriateness guidelines . This work is loosely modeled after the American College of Radiology (ACR) Appropriateness Criteria® , in that the guidelines committee uses an evidence-based approach at scoring. Consensus among members is used when there is a paucity of evidence. Strength of evidence is determined by literature review.
Table 1 provides evidence-based guidelines, supplemented by expert opinion when there was a paucity of peer-review data, to define and support the use of 3D printing for patients with abdominal, hepatobiliary, and gastrointestinal conditions. The citations included in forming the appropriateness criteria and the strength of evidence assessment are presented in Appendices 1 and 2 respectively.
Table 1Appropriateness Ratings for Abdominal, Hepatobiliary, and Gastrointestinal Indications. The “Rating driven…” column denotes if the primary decision for the condition’s rating was decided primarily through results and discussion of the literature search or expert opinion (the latter was largely reserved for conditions with no or few supporting studies). The “Study quality” column reflects the graded strength of evidence assessment according to ACR Appropriateness Criteria Evidence Document50 (individual ratings available in Appendix 2). The highest/most robust level of evidence is ‘Category 1’ and the lowest is ‘Category 4.’ No studies qualified for Category 1, but multiple did qualify for Category 2
This document provides initial appropriate use criteria for 3D printing in abdominal, hepatobiliary, and gastrointestinal conditions. Adoption of common clinical standards regarding appropriate use, information and material management, and quality control are needed to ensure the greatest possible clinical benefit from 3D printing . With accruing evidence for value in 3D printing, recently implemented category III Current Procedural Terminology codes, and the upcoming ACR registry for 3D printing , it is anticipated that this consensus guideline document, created by the members of the RSNA 3D printing Special Interest Group, will provide a reference for clinical standards of 3D printing. The document will be periodically refined, based on expanding clinical applications and growing medical literature.