Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
Safe Place: The Center for Child Protection and Health, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatr Radiol. 2019 Jun;49(7):965-970. doi: 10.1007/s00247-019-04368-7. Epub 2019 Mar 15.
Three-dimensional (3-D) printing is gaining terrain in medical education, presurgical evaluation and recently as forensic evidence in court. Physicians, including radiologists, often provide expert testimony in court cases involving children with rib fractures and other injuries concerning for child physical abuse. Effectively communicating the complexities of fractures and other skeletal findings to nonmedical personnel using standard radiology studies can be challenging, especially during medical courtroom testimony. For this reason, we printed two 3-D models of the rib cage from the chest computed tomography (CT) scans of two patients with suspected non-accidental injury. The patients also had available chest radiographs. The DICOM (Digital Imaging and Communications in Medicine) data were 3-D reconstructed and segmented using two attenuation thresholds. We removed unwanted structures and printed them on a commercially available scanner. A pediatric radiologist, blinded to clinical data, reviewed both 3-D models, identified all rib lesions and classified them according to their healing stage. We compared the 3-D models and the chest radiograph against the chest CT as the standard of care. We convened a meeting with the Child Protection Team at out institution to get their feedback and opinions about the models. From our observations of our experts, three spontaneous interactions were observed. Instinctively, the experts picked up and grasped the models, rotating them, feeling them and angling them to better visualize the fractures from multiple angles. The experts expressed a willingness to consider using the models in court.
三维（3-D）打印技术在医学教育、术前评估以及最近的法庭法医证据中得到了广泛应用。包括放射科医生在内的医生经常在涉及肋骨骨折和其他儿童身体虐待相关伤害的法庭案件中提供专家证言。使用标准放射学研究向非医学专业人员有效传达骨折和其他骨骼发现的复杂性具有挑战性，尤其是在医学法庭证词中。出于这个原因，我们从两名疑似非意外损伤患者的胸部计算机断层扫描（CT）扫描中打印了两个肋骨笼的 3-D 模型。这些患者还提供了胸部 X 光片。使用两个衰减阈值对 DICOM（医学数字成像和通信）数据进行了 3-D 重建和分割。我们去除了不需要的结构并在商业上可用的扫描仪上进行了打印。一位儿科放射科医生对临床数据进行了盲法审查，对两个 3-D 模型进行了检查，识别了所有肋骨病变，并根据其愈合阶段对其进行了分类。我们将 3-D 模型和胸部 X 光片与胸部 CT 作为标准护理进行了比较。我们召集了我们机构的儿童保护小组会议，听取他们对模型的反馈和意见。从我们的专家观察中，观察到了三个自发的互动。专家本能地拿起并抓住模型，旋转它们，感受它们，并调整它们以从多个角度更好地可视化骨折。专家们表示愿意考虑在法庭上使用这些模型。
