Three-dimensional printing of liver tumors using CT data: proof of concept morphological study

Hepatocellular carcinoma (HCC) currently represents a major health concern, mainly for its shifting pre-existing conditions that in turn lead to late diagnosis, thus increasing the mortality rate. An improved training of medical personnel involved in diagnosis, staging and the management of treatment is required.

We thus aimed to transition tumor view from two-dimensional, on-screen, methods to real, palpatory three-dimensional (3D) representations that can be printed using generally available tools, thus approachable in virtually any medical setting worldwide.

After obtaining ethical clearance, we included imaging contrast-enhanced data from 10 confirmed cases of HCC that we translated into a 3D computer render of the tumor with as much morphological data as possible. In addition, we simulated the inner structure of each tumor, simulating different stiffness levels across their respective surfaces, in order to better gauge possible necrosis or vascular particularities. This translated into 3D printed models that were obtained by using commercially available materials, experimenting with different filling methods in order to better simulate the stiffness of the lesion.

We administered a structured questionnaire to 43 students and 12 resident doctors (gastroenterologists and surgeons) that manage HCC cases. We assessed tumor morphology and the usefulness of the proposed model in everyday practice and evaluated their use in an academic environment.

The proposed method provides a cheap alternative to costly medical simulators, providing both curricular advantages as well as integrating well into normal HCC medical management.