Diameter measurements in three-dimensional printed flow phantom model of the carotid artery in preterm infants

Authors

  • Sujith Pereira Homerton University Hospital NHS Foundation Trust and Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
  • Jonathan Reeves Clinical Physics, Royal London Hospital, Barts Health NHS Trust, London, UK and Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
  • Malcolm Birch Clinical Physics, Royal London Hospital, Barts Health NHS Trust, London, UK and Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
  • Ahmed Ali Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, UK 3 Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK 4 Assiut University, Assiut, Egypt
  • Ajay Sinha Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, UK and Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
  • Stephen Kempley Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK

DOI:

https://doi.org/10.14738/jbemi.86.11166

Keywords:

3-dimensional, 3D printed flow phantom, carotid artery, preterm infant

Abstract

Diameter form an integral part of blood flow measurement. This study aimed to explore different three-dimensional (3D) printed materials to develop flow phantom models of the carotid artery in preterm newborn infants and to investigate ideal diameter measurement points using ultrasound that reflected accurate lumen diameter measurement.

Cerebral blood flow measurements data using Doppler ultrasound of the right common carotid artery from 21 randomly selected preterm infants were used to produce a 3D printed Doppler flow phantom model with three different vessel diameters. Diameters were measured by multiple observers blinded to phantom vessel characteristics and each other’s measurements. 9 measurement points were studied. Agreement between observers, inter and intra observer reliability and coefficient of variation (CoV) was examined.

Of the 63 diameter measurements, 45 (71%) were performed on flow phantoms with vessel diameter of 0.196 cm. Bland-Altman plots revealed that measurement performed using leading edge to centre (mean bias 1.8% {95%LOA -4.1% to 7.7%}) and centre to trailing edge (mean bias 1.1% {95%LOA -5.4% to 7.8%}) resulted in the most accurate lumen diameter measurements. Inter and intra-observer reliability was excellent. The mean CoV for inter observer measurements was 1.7% and intra observer measurements was 1.6% and 1.8% for each observer.

We successfully produced a 3D printed flow phantom model of the carotid artery in preterm infants and identified two measurement methods that result in reliable and accurate lumen diameter measurement. Researchers and clinicians can use this information for further studies involving ultrasound diameter measurements in small calibre vessels.

References

S. Johnson, N. Marlow, Early and long-term outcome of infants born extremely preterm, Arch Dis Child, 102 (2017) 97-102.

BAPM, Perinatal Management of Extreme Preterm Birth Before 27 weeks of gestation - A BAPM Framework for Practice, in, 2019.

W.P. de Boode, Advanced Hemodynamic Monitoring in the Neonatal Intensive Care Unit, Clin Perinatol, 47 (2020) 423-434.

L.M. Dix, F. van Bel, P.M. Lemmers, Monitoring Cerebral Oxygenation in Neonates: An Update, Front Pediatr, 5 (2017) 46.

A.K. Sinha, C. Cane, S.T. Kempley, Blood flow in the common carotid artery in term and preterm infants: reproducibility and relation to cardiac output, Arch Dis Child Fetal Neonatal Ed, 91 (2006) F31-35.

S.S. Pereira, A.K. Sinha, D.K. Shah, S.T. Kempley, Common carotid artery blood flow volume in extremely preterm infants, Acta Paediatr, 110 (2021) 1157-1165.

S. Pereira, J. Reeves, M. Birch, S. Finton-James, K. Verma, R. Krug, A. Sinha, S. Kempley, A realistic flow phantom model of the carotid artery in preterm infants for training and research, Ultrasound, 28 (2020) 145-154.

S.S. Pereira, A.K. Sinha, J.K. Morris, D.F. Wertheim, D.K. Shah, S.T. Kempley, Blood pressure intervention levels in preterm infants: pilot randomised trial, Arch Dis Child Fetal Neonatal Ed, (2018).

S.K. Jaganathan, E. Supriyanto, S. Murugesan, A. Balaji, M.K. Asokan, Biomaterials in cardiovascular research: applications and clinical implications, Biomed Res Int, 2014 (2014) 459465.

B.C. Gross, J.L. Erkal, S.Y. Lockwood, C. Chen, D.M. Spence, Evaluation of 3D printing and its potential impact on biotechnology and the chemical sciences, Anal Chem, 86 (2014) 3240-3253.

V. Filippou, C. Tsoumpas, Recent advances on the development of phantoms using 3D printing for imaging with CT, MRI, PET, SPECT, and ultrasound, Med Phys, (2018).

F.J. Rybicki, 3D Printing in Medicine: an introductory message from the Editor-in-Chief, 3D Print Med, 1 (2015) 1.

R.G. Nagassa, P.G. McMenamin, J.W. Adams, M.R. Quayle, J.V. Rosenfeld, Advanced 3D printed model of middle cerebral artery aneurysms for neurosurgery simulation, 3D Print Med, 5 (2019) 11.

G. Biglino, C. Capelli, D. Koniordou, D. Robertshaw, L.K. Leaver, S. Schievano, A.M. Taylor, J. Wray, Use of 3D models of congenital heart disease as an education tool for cardiac nurses, Congenit Heart Dis, 12 (2017) 113-118.

I. Lau, Z. Sun, Three-dimensional printing in congenital heart disease: A systematic review, J Med Radiat Sci, 65 (2018) 226-236.

G. Biglino, C. Capelli, J. Wray, S. Schievano, L.K. Leaver, S. Khambadkone, A. Giardini, G. Derrick, A. Jones, A.M. Taylor, 3D-manufactured patient-specific models of congenital heart defects for communication in clinical practice: feasibility and acceptability, BMJ Open, 5 (2015) e007165.

T. Kiserud, T. Saito, T. Ozaki, S. Rasmussen, M.A. Hanson, Validation of diameter measurements by ultrasound: intraobserver and interobserver variations assessed in vitro and in fetal sheep, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 13 (1999) 52-57.

C.J. Teirlinck, R.A. Bezemer, C. Kollmann, J. Lubbers, P.R. Hoskins, K.V. Ramnarine, P. Fish, K.E. Fredeldt, U.G. Schaarschmidt, Development of an example flow test object and comparison of five of these test objects, constructed in various laboratories, Ultrasonics, 36 (1998) 653-660.

J.M. Bland, D.G. Altman, Statistical methods for assessing agreement between two methods of clinical measurement, Lancet, 1 (1986) 307-310.

R.N. Landers, Computing intraclass correlations (ICC) as estimates of interrater reliability in SPSS., The Winnower, (2015).

J.R.K. Landis, G.G., The Measurement of Observer Agreeement for Categorical Data, Biometrics, 33 (1977) 159-174.

P.E. Shrout, J.L. Fleiss, Intraclass correlations: uses in assessing rater reliability, Psychol Bull, 86 (1979) 420-428.

S.S. Harmsen, Acoustic impedance matching using 3D printed lenses, in: Robotics and Mechatronics, University of Twente, Netherlands, 2018.

B. Driscoll, H. Keller, C. Coolens, Development of a dynamic flow imaging phantom for dynamic contrast-enhanced CT, Med Phys, 38 (2011) 4866-4880.

V. Lopez-Lopez, R. Robles-Campos, D. Garcia-Calderon, H. Lang, E. Cugat, S. Jimenez-Galanes, J.M. Fernandez-Cebrian, V. Sanchez-Turrion, J.M. Fernandez-Fernandez, M.A. Barrera-Gomez, J. de la Cruz, A. Lopez-Conesa, R. Brusadin, B. Gomez-Perez, P. Parrilla-Paricio, Applicability of 3D-printed models in hepatobiliary surgey: results from "LIV3DPRINT" multicenter study, HPB (Oxford), (2020).

S. Li, W.N. McDicken, P.R. Hoskins, Blood vessel diameter measurement by ultrasound, Physiol Meas, 14 (1993) 291-297.

Downloads

Published

2021-11-26

How to Cite

Pereira, S., Reeves, J. ., Birch, M., Ali, A., Sinha, A., & Kempley, S. (2021). Diameter measurements in three-dimensional printed flow phantom model of the carotid artery in preterm infants . British Journal of Healthcare and Medical Research, 8(6), 8–21. https://doi.org/10.14738/jbemi.86.11166

Issue

Vol. 8 No. 6 (2021): Journal of Biomedical Engineering and Medical Imaging

Section

Original Articles

License

Copyright (c) 2021 Sujith Pereira, Jonathan Reeves, Malcolm Birch, Ahmed Ali, Ajay Sinha, Stephen Kempley

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.