Abstract:

Objective

Exploring the methodological elements of constructing a liver phantom for training transjugular intrahepatic portal systemic shunt （TIPS） in a real interventional procedure environment.

Methods

A retrospective analysis was conducted on the DSA image data of 36 patients treated with TIPS in our hospital.Three typical cases' enhanced CT thin-layer data were selected as the master version.Mimics software and 3D MAX software were used to extract， reconstruct， and smooth the models of hepatic vein，portal vein， inferior vena cava， and liver.The connection model between portal vein and hepatic vein and the mold model were established.The hardness of silicone blocks with different Shore hardness was tested by needle puncture.After 3D printing the above model， and the silicone for simulating hardened liver was injected for molding and demolding operations.The pipeline path was established according to the principle of blood circulation and connected to the liver silicone model and submersible pump.CT scanning and TIPS simulation training under digital subtraction angiography （DSA） were performed on the model to evaluate its reliability and realism.

Results

The key elements of this study included the three-dimensional modeling of small-diameter connecting pipes and mold molds for portal vein branches and hepatic vein branches， as well as the demolding operation of the molds.Silicone with a Shore hardness of 10° could simulate liver with heavier hardening， while silicone with a Shore hardness of 5° could simulate liver with lighter hardening.The CT images of the model could achieve path planning for portal vein puncture from the hepatic vein，and the internal and various interfaces of the model showed good anti-leakage characteristics.The hepatic vein and portal vein imaging were similar to real procedure， and the liver puncture process had realistic resistance feedback.

Conclusion

The construction of a liver phantom containing hepatic veins and portal veins is technically feasible， with high reliability and realism， and can be used for TIPS simulation training of interventional physicians.

Key words: Transjugular intrahepatic portosystemic shunt, Model, Three-dimensional reconstruction, Simulation