Three-dimensional printed flow phantom model of the carotid artery in preterm infants for training and research
Keywords:3-dimensional, 3D printed, flow volume measurements, flow phantom, carotid artery, preterm infant, ultrasound
The aim of this study was to perform flow volume measurements with Doppler ultrasound using novel 3D printed flow phantom models of carotid artery in preterm infants with varying characteristics.
Clinical data from cerebral blood flow measurements using Doppler ultrasound of the right common carotid artery from premature newborn infants were used to produce a 3D printed Doppler flow phantom model with three different vessel diameters; 0.158 cm, 0.196 cm and 0.244 cm. Leading edge to centre was used to measure vessel diameter. Two observers performed flow volume measurements using continuous and pulsatile flow. Agreement between observers was examined using Bland-Altman plots.
24 measurements were performed. 18 (75%) measurements were performed using continuous flow. Pulsatile flow measurements were performed on lumen diameter of 0.244 cm only using physiological rates. Bland-Altman analysis for continuous flow measurements for observer 1 and 2 were -0.007 (95%LOA -4.3 to 4.3) ml/min and 3.2 (95%LOA -2.7 to 9.1) ml/min. Bias for pulsatile flow measurements for observer 1 and 2 were 1.5 (95%LOA -0.8 to 3.8) ml/min and 4.6 (0.7 to 8.5) ml/min respectively. Inter and intra-observer reliability was excellent for majority of measurements. The mean coefficient of variation for inter observer diameter measurements was 1.2% and intra observer measurements were between 1.5% to 3.9% for both observers.
Flow volume measurements performed using 3D printed materials resulted in realistic echogenicities mimicking biological tissues. Validity and reliability studies, within and between, observers showed acceptable results. Researchers and clinicians can use this model for further training and simulation.
W.P. de Boode, Advanced Hemodynamic Monitoring in the Neonatal Intensive Care Unit, Clin Perinatol, 47 (2020) 423-434.
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.
M.B. Rominger, E.M. Muller-Stuler, M. Pinto, A.S. Becker, K. Martini, T. Frauenfelder, V. Klingmuller, Easy Pulsatile Phantom for Teaching and Validation of Flow Measurements in Ultrasound, Ultrasound Int Open, 2 (2016) E93-97.
J.C. Rippey, P. Blanco, P.J. Carr, An affordable and easily constructed model for training in ultrasound-guided vascular access, J Vasc Access, 16 (2015) 422-427.
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. Pereira, J. Reeves, M. Birch, A. Ali, A. Sinha, S. Kempley, Diameter measurements in three-dimensional printed flow phantom model of the carotid artery in preterm infants, Journal of Biomedical Engineering and Medical Imaging, 8 (2021) 8-21.
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).
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.
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).
L.A. Critchley, J.A. Critchley, A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques, Journal of clinical monitoring and computing, 15 (1999) 85-91.
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).
How to Cite
Copyright (c) 2021 Sujith Pereira, Jonathan Reeves, Malcolm Birch, Ahmed Ali, Ajay Sinha, Stephen Kempley
This work is licensed under a Creative Commons Attribution 4.0 International License.