title: Use of 3-Dimensional Printing to Create Patient-Specific Thoracic Spine Models as Task Trainers.
abstract: OBJECTIVE
  Thoracic epidural anesthesia is a technically challenging procedure with a high failure rate of 24% to 32% nationwide. Residents in anesthesiology have limited opportunities to practice this technique adequately, and there are no training tools available for this purpose. Our objective was to build a low-cost patient-specific thoracic epidural training model.
  
  
  METHODS
  We obtained thoracic computed tomography scan data from patients with normal and kyphotic spine. The thoracic spine was segmented from the scan, and a 3-dimensional model of the spine was generated and printed. It was then placed in a customized wooden box and filled with different types of silicone to mimic human tissues. Attending physicians in our institution then tested the final model. They were asked to fill out a brief questionnaire after the identification of the landmarks and epidural space using ultrasound and real-time performance for a thoracic epidural on the model (Supplemental Digital Content 1, http://links.lww.com/AAP/A197). Likert scoring system was used for scoring.
  
  
  RESULTS
  The time to develop this simulator model took less than 4 days, and the materials cost approximately $400. Fourteen physicians tested the model for determining the realistic sensation while palpating the spinous process, needle entry through the silicone, the "pop" sensation and ultrasound fidelity of the model. Whereas the tactile fidelity scores were "neutral" (3.08, 3.06, and 3.0, respectively), the ultrasound guidance and overall suitability for residents were highly rated as being the most realistic (4.85 and 4.0, respectively).
  
  
  CONCLUSIONS
  It is possible to develop homemade, low-cost, patient-specific, and high-fidelity ultrasound guidance simulators for resident training in thoracic epidurals using 3-dimensional printing technology.
authors.affiliation: From the *Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; †Department of Radiology, Division of Vascular & Interventional Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and ‡Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Jelliffe
authors.initials: J
authors.lastname: Jeganathan
authors.forename: Yanick
authors.initials: Y
authors.lastname: Baribeau
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bortman
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
authors.forename: Marc
authors.initials: M
authors.lastname: Shnider
authors.forename: Muneeb
authors.initials: M
authors.lastname: Ahmed
authors.forename: Azad
authors.initials: A
authors.lastname: Mashari
authors.forename: Rabia
authors.initials: R
authors.lastname: Amir
authors.forename: Yannis
authors.initials: Y
authors.lastname: Amador
authors.forename: Robina
authors.initials: R
authors.lastname: Matyal
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D006801:Humans; D008953:Models, Anatomic; D066330:Printing, Three-Dimensional / Q000592:standards* / Q000706:statistics & numerical data*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods