Analyze Diet
PloS one2019; 14(8); e0220332; doi: 10.1371/journal.pone.0220332

Various 3D printed materials mimic bone ultrasonographically: 3D printed models of the equine cervical articular process joints as a simulator for ultrasound guided intra-articular injections.

Abstract: In the equine racehorse industry, reduced athletic performance due to joint injury and lameness has been extensively reviewed. Intra-articular injections of glucocorticoids are routinely used to relieve pain and inflammation associated with osteoarthritis. Intra-articular injections of pharmaceutical agents require practice for precise needle placement and to minimize complications. Training on simulators or models is a viable alternative for developing these technical skills. The purpose of this study was to compare the qualitative ultrasonographic characteristics of three-dimensional (3D) printed models of equine cervical articular process joints to that of a dissected equine cervical spine (gold standard). A randomized complete block design study was conducted in which a total of thirteen cervical articular process joint models were printed using several materials, printers, and printing technologies. Ultrasound video clips with the models immersed in water were recorded. Two board certified veterinary radiologists and three veterinary radiology residents reviewed the videos and responded to a survey assessing and comparing the ultrasonographic characteristics of the 3D printed models to those of the gold standard. Six 3D printed models had ultrasonographic characteristics similar to the gold standard. These six models were (material, printer, printing technology): nylon PA 12, EOS Formiga P100, selective laser sintering (P = 0.99); Onyx nylon with chopped carbon fiber, Markforged Onyx Two, fused deposition modeling (P = 0.48); polycarbonate, Ultimaker 3, fused deposition modeling (P = 0.28); gypsum, ProJet CJP 660 Pro, ColorJet Printing (P = 0.28); polylactic acid, Prusa I3, fused deposition modeling (P = 0.23); and high temperature V1 resin, Form 2, stereolithography (P = 0.22). When assessed in water, it is possible to replicate the qualitative ultrasonographic characteristics of bone using three dimensional printed models made by combining different materials, printing technologies, and printers. However, not all models share similar qualitative ultrasonographic characteristics with bone. We suggest that the aforementioned six models be used as proxy for simulating bones or joints for use with ultrasound. In order to replicate the resistance and acoustic window provided by soft tissues, further work testing the ability of these models to withstand embedding in material such as ballistic gelatin is required.
Publication Date: 2019-08-06 PubMed ID: 31386687PubMed Central: PMC6684155DOI: 10.1371/journal.pone.0220332Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
  • Journal Article
  • Research Support
  • Non-U.S. Gov't

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research article investigates how three-dimensional (3D) printed models can mimic the characteristics of horse joints when viewed under ultrasound, with the aim of providing a training tool for vets practicing precise needle placement for intra-articular injections.

Background and Purpose of the Study

  • This study is rooted in the equine racehorse industry where joint injuries and lameness regularly affect the performance of racehorses.
  • To alleviate the pain and inflammation caused by osteoarthritis, intra-articular injections of glucocorticoids are commonly used. However, administering these injections requires high precision in needle placement, and training on accurate models is essential to develop this skill.
  • The objective of this study was to compare the ultrasonographic characteristics of 3D printed models of horse joints to those of a dissected equine cervical spine (considered the gold standard).

Research Methodology and Results

  • The researchers conducted a randomized complete block design study, printing thirteen models of cervical articular process joint using a variety of materials, printers, and printing technologies.
  • These models were then submerged in water, and ultrasound video footage was taken.
  • A group of qualified veterinary radiologists and residents then analyzed the footage and responded to a survey comparing the ultrasonographic characteristics of the 3D printed models to those of the gold standard.
  • Out of the thirteen, six of the 3D printed models successfully replicated the ultrasonographic characteristics of the dissected equine spine. These six were created using different combinations of materials, printers, and technologies, illustrating a range of potential methods to create effective models.

Study Conclusion and Future Research

  • The successful models demonstrate that 3D printing technology can be employed to create realistic replicas of bone structures for training purposes in administering intra-articular injections.
  • However, the study also found some models did not effectively mimic the original joint, hence careful selection and combination of materials, printers, and technologies is necessary.
  • The researchers suggested that the chosen six models could serve as effective simulants for training.
  • They also indicated a need for further research to test the models’ ability to replicate the resistance and acoustic window provided by soft tissues, potentially by embedding them in ballistic gelatin or similar materials.

Cite This Article

APA
Beaulieu A, Linden AZ, Phillips J, Arroyo LG, Koenig J, Monteith G. (2019). Various 3D printed materials mimic bone ultrasonographically: 3D printed models of the equine cervical articular process joints as a simulator for ultrasound guided intra-articular injections. PLoS One, 14(8), e0220332. https://doi.org/10.1371/journal.pone.0220332

Publication

ISSN: 1932-6203
NlmUniqueID: 101285081
Country: United States
Language: English
Volume: 14
Issue: 8
Pages: e0220332
PII: e0220332

Researcher Affiliations

Beaulieu, Alexandra
  • Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.
Linden, Alex Zur
  • Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.
Phillips, John
  • Digital Haptics Laboratory, College of Arts, University of Guelph, Guelph, Ontario, Canada.
  • Center for Advanced Manufacturing and Design Technologies, Sheridan College, Brampton, Ontario, Canada.
Arroyo, Luis G
  • Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.
Koenig, Judith
  • Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.
Monteith, Gabrielle
  • Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.

MeSH Terms

  • Animals
  • Horses
  • Injections, Intra-Articular / methods
  • Joints / diagnostic imaging
  • Models, Biological
  • Neck / diagnostic imaging
  • Printing, Three-Dimensional
  • Ultrasonography / methods

Conflict of Interest Statement

The authors have declared that no competing interests exist.

References

This article includes 35 references
  1. de Souza MV. Osteoarthritis in horses–Part 1: relationship between clinical and radiographic examination for the diagnosis.. Braz. Arch. Biol. Technol. 2016; 59.
  2. Goodrich LR, Nixon AJ. Medical treatment of osteoarthritis in the horse - a review.. Vet J 2006 Jan;171(1):51-69.
    doi: 10.1016/j.tvjl.2004.07.008pubmed: 16427582google scholar: lookup
  3. McIlwraith CW, Frisbie DD, Kawcak CE. The horse as a model of naturally occurring osteoarthritis.. Bone Joint Res 2012 Nov;1(11):297-309.
  4. Jeffcott LB, Rossdale PD, Freestone J, Frank CJ, Towers-Clark PF. An assessment of wastage in thoroughbred racing from conception to 4 years of age.. Equine Vet J 1982 Jul;14(3):185-98.
  5. Kidd JA, Fuller C, Barr ARS. Osteoarthritis in the horse.. Equine Vet Educ. 2001;13(3):160–168.
  6. De Lasalle J, Alexander K, Olive J, Laverty S. COMPARISONS AMONG RADIOGRAPHY, ULTRASONOGRAPHY AND COMPUTED TOMOGRAPHY FOR EX VIVO CHARACTERIZATION OF STIFLE OSTEOARTHRITIS IN THE HORSE.. Vet Radiol Ultrasound 2016 Sep;57(5):489-501.
    doi: 10.1111/vru.12370pubmed: 27237699google scholar: lookup
  7. Brandt KD, Dieppe P, Radin E. Etiopathogenesis of osteoarthritis.. Med Clin North Am 2009 Jan;93(1):1-24, xv.
    doi: 10.1016/j.mcna.2008.08.009pubmed: 19059018google scholar: lookup
  8. Radin EL, Burr DB, Caterson B, Fyhrie D, Brown TD, Boyd RD. Mechanical determinants of osteoarthrosis.. Semin Arthritis Rheum 1991 Dec;21(3 Suppl 2):12-21.
    pubmed: 1796301doi: 10.1016/0049-0172(91)90036-ygoogle scholar: lookup
  9. Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis.. World J Orthop 2014 Jul 18;5(3):351-61.
    doi: 10.5312/wjo.v5.i3.351pmc: PMC4095029pubmed: 25035839google scholar: lookup
  10. Mattoon JS, Drost WT, Grguric MR, Auld DM, Reed SM. Technique for equine cervical articular process joint injection.. Vet Radiol Ultrasound 2004 May-Jun;45(3):238-40.
  11. Purefoy Johnson J, Stack JD, Rowan C, Handel I, O'Leary JM. Ultrasound-guided approach to the cervical articular process joints in horses: a validation of the technique in cadavers.. Vet Comp Orthop Traumatol 2017 May 22;30(3):165-171.
    doi: 10.3415/VCOT-16-09-0139pubmed: 28094412google scholar: lookup
  12. David F, Rougier M, Alexander K, Morisset S. Ultrasound-guided coxofemoral arthrocentesis in horses.. Equine Vet J 2007 Jan;39(1):79-83.
    pubmed: 17228601doi: 10.2746/042516407x153093google scholar: lookup
  13. Whitcomb MB, Vaughan B, Katzman S, Hersman J. ULTRASOUND-GUIDED INJECTIONS IN HORSES WITH CRANIOVENTRAL DISTENSION OF THE COXOFEMORAL JOINT CAPSULE: FEASIBILITY FOR A CRANIOVENTRAL APPROACH.. Vet Radiol Ultrasound 2016 Mar-Apr;57(2):199-206.
    doi: 10.1111/vru.12323pubmed: 26748616google scholar: lookup
  14. Kleider N. How to Inject the Medial Femorotibial Joint Recess Under Ultrasound Guidance.. AAEP proceedings 2013;59: 220–225.
  15. Herdrich MRA, Arrieta SE, Nelson BB, Frisbie DD, Moorman VJ. A technique of needle redirection at a single craniolateral site for injection of three compartments of the equine stifle joint.. Am J Vet Res 2017 Sep;78(9):1077-1084.
    doi: 10.2460/ajvr.78.9.1077pubmed: 28836846google scholar: lookup
  16. Nielsen JV, Berg LC, Thoefnert MB, Thomsen PD. Accuracy of ultrasound-guided intra-articular injection of cervical facet joints in horses: a cadaveric study.. Equine Vet J 2003 Nov;35(7):657-61.
    pubmed: 14649356doi: 10.2746/042516403775696366google scholar: lookup
  17. Fox V, Sinclair C, Bolt DM, Lowe J, Weller R. Design and validation of a simulator for equine joint injections.. J Vet Med Educ 2013 Summer;40(2):152-7.
    doi: 10.3138/jvme.0912-083R1pubmed: 23709111google scholar: lookup
  18. Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative.. Acad Med 2003 Aug;78(8):783-8.
  19. Sørensen JL, Østergaard D, LeBlanc V, Ottesen B, Konge L, Dieckmann P, Van der Vleuten C. Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation.. BMC Med Educ 2017 Jan 21;17(1):20.
    doi: 10.1186/s12909-016-0838-3pmc: PMC5251301pubmed: 28109296google scholar: lookup
  20. Motola I, Devine LA, Chung HS, Sullivan JE, Issenberg SB. Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82.. Med Teach 2013 Oct;35(10):e1511-30.
    doi: 10.3109/0142159X.2013.818632pubmed: 23941678google scholar: lookup
  21. Favier V, Zemiti N, Caravaca Mora O, Subsol G, Captier G, Lebrun R, Crampette L, Mondain M, Gilles B. Geometric and mechanical evaluation of 3D-printing materials for skull base anatomical education and endoscopic surgery simulation - A first step to create reliable customized simulators.. PLoS One 2017;12(12):e0189486.
  22. Al-Elq AH. Simulation-based medical teaching and learning.. J Family Community Med 2010 Jan;17(1):35-40.
    doi: 10.4103/1319-1683.68787pmc: PMC3195067pubmed: 22022669google scholar: lookup
  23. Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review.. Med Teach 2005 Jan;27(1):10-28.
    doi: 10.1080/01421590500046924pubmed: 16147767google scholar: lookup
  24. McMenamin PG, Quayle MR, McHenry CR, Adams JW. The production of anatomical teaching resources using three-dimensional (3D) printing technology.. Anat Sci Educ 2014 Nov-Dec;7(6):479-86.
    doi: 10.1002/ase.1475pubmed: 24976019google scholar: lookup
  25. Chae MP, Rozen WM, McMenamin PG, Findlay MW, Spychal RT, Hunter-Smith DJ. Emerging Applications of Bedside 3D Printing in Plastic Surgery.. Front Surg 2015;2:25.
    doi: 10.3389/fsurg.2015.00025pmc: PMC4468745pubmed: 26137465google scholar: lookup
  26. Mowry SE, Jammal H, Myer C 4th, Solares CA, Weinberger P. A Novel Temporal Bone Simulation Model Using 3D Printing Techniques.. Otol Neurotol 2015 Sep;36(9):1562-5.
    doi: 10.1097/MAO.0000000000000848pubmed: 26375979google scholar: lookup
  27. Takahashi K, Morita Y, Ohshima S, Izumi S, Kubota Y, Yamamoto Y, Takahashi S, Horii A. Creating an Optimal 3D Printed Model for Temporal Bone Dissection Training.. Ann Otol Rhinol Laryngol 2017 Jul;126(7):530-536.
    doi: 10.1177/0003489417705395pubmed: 28420248google scholar: lookup
  28. Culjat MO, Goldenberg D, Tewari P, Singh RS. A review of tissue substitutes for ultrasound imaging.. Ultrasound Med Biol 2010 Jun;36(6):861-73.
  29. Tatarinov A, Pontaga I, Vilks U. Modeling the influence of mineral content and porosity on ultrasound parameter in bone by using synthetic phantoms.. Mech Compos Mater 1999;35(2): 147–154.
  30. Barkmann R, Lüsse S, Stampa B, Sakata S, Heller M, Glüer CC. Assessment of the geometry of human finger phalanges using quantitative ultrasound in vivo.. Osteoporos Int 2000;11(9):745-55.
    doi: 10.1007/s001980070053pubmed: 11148802google scholar: lookup
  31. Clarke AJ, Evans JA, Truscott JG, Milner R, Smith MA. A phantom for quantitative ultrasound of trabecular bone.. Phys Med Biol 1994 Oct;39(10):1677-87.
    doi: 10.1088/0031-9155/39/10/011pubmed: 15551538google scholar: lookup
  32. Formlabs. How to 3D Print Anatomical Models for Preoperative Planning and Enhanced Patient Consent. Somerville; 2017 [cited 2019 April 28]. 14 p..
  33. Bushberg JT, Seibert JA, Leidholdt EM, Boone JM. The Essential Physics of Medical Imaging. 3rd ed Philadelphia: Kippincott Willians & Wilkins, 2012. Chapter 14: Ultrasound; p. 501–576.
  34. Kremkau FW. Sonography Principles and Instruments. 9th ed St. Louis: Elsevier, 2016. Chapter 6: Artifacts; p. 183–216.
  35. Mitsouras D, Liacouras P, Imanzadeh A, Giannopoulos AA, Cai T, Kumamaru KK, George E, Wake N, Caterson EJ, Pomahac B, Ho VB, Grant GT, Rybicki FJ. Medical 3D Printing for the Radiologist.. Radiographics 2015 Nov-Dec;35(7):1965-88.
    doi: 10.1148/rg.2015140320pmc: PMC4671424pubmed: 26562233google scholar: lookup

Citations

This article has been cited 6 times.
  1. Feng H, Ma Y, Wang SJ, Zhang S, Li Z. The Correlation of Regional Microstructure and Mechanics of the Cervical Articular Process in Adults. Materials (Basel) 2021 Oct 26;14(21).
    doi: 10.3390/ma14216409pubmed: 34771937google scholar: lookup
  2. Al Rashid A, Koҫ M. Creep and Recovery Behavior of Continuous Fiber-Reinforced 3DP Composites. Polymers (Basel) 2021 May 19;13(10).
    doi: 10.3390/polym13101644pubmed: 34069317google scholar: lookup
  3. Choi Y, Lee IJ, Park K, Park KR, Cho Y, Kim JW, Lee H. Patient-Specific Quality Assurance Using a 3D-Printed Chest Phantom for Intraoperative Radiotherapy in Breast Cancer. Front Oncol 2021;11:629927.
    doi: 10.3389/fonc.2021.629927pubmed: 33791216google scholar: lookup
  4. Xia D, Xing F, Zhang J, Lang J, Tan G, Cui X. Utilization of 3D printing modeling techniques in the simulation instruction of ultrasound-guided puncture procedures on scoliotic spines of spinal muscular atrophy. 3D Print Med 2025 Apr 27;11(1):19.
    doi: 10.1186/s41205-025-00266-xpubmed: 40287565google scholar: lookup
  5. Díaz-Regañón D, Mendaza-De Cal R, García-Sancho M, Rodríguez-Franco F, Sainz Á, Rodriguez-Quiros J, Rojo C. Canine Upper Digestive Tract 3D Model: Assessing Its Utility for Anatomy and Upper Endoscopy Learning. Animals (Basel) 2024 Mar 31;14(7).
    doi: 10.3390/ani14071070pubmed: 38612309google scholar: lookup
  6. Jagannathan A, Micallef J, Clarke T, Armstrong K, Dubrowski A. The Iterative Design and Development of an Affordable Ultrasound Simulator. Cureus 2024 Jan;16(1):e52300.
    doi: 10.7759/cureus.52300pubmed: 38357039google scholar: lookup