3d printing of cardiac structures from medical images: an overview of methods and interactive tools

The percutaneous interventions in the treatment of structural heart diseases represent nowadays a viable option for patients at high risk for surgery. However, unlike during the traditional open heart surgery, the heart structures to be corrected are not directly visualized by the physician during the interventions. The interpretation of the available medical images is often a demanding task and needs specific skills i.e. clinical experience and complex radiological and echocardiographic analysis. The new trend for cardiovascular diagnosis, surgical planning and intervention is, today, mutually connected with most recent developments in the field of 3D acquisition, interactive modelling and rapid prototyping techniques. This is particularly true when dealing with complex heart diseases since 3D-based techniques can really help in providing an accurate planning of the intervention and to support surgical intervention. To help the research community in confronting with this new trend in medical science, the present work provides an overview on most recent approaches and methodologies for creating physical prototypes of patient-specific cardiac structures, with particular reference to most critical phases such as: 3D image acquisition, interactive image segmentation and restoration, interactive 3D model reconstruction, physical prototyping through additive manufacturing. To this purpose, first, recent techniques for image enhancement to highlight anatomical structures of interest are presented together with the current state of the art of interactive image segmentation. Finally, most suitable techniques for prototyping the retrieved 3D model are investigated so as to derive a number of criteria for manufacturing prototypes useful for planning the medical intervention.