Digital Images in Academic Plastic Surgery: A Novel and Secure Methodology for Use in Clinical Practice and Research.

BACKGROUND: Digital photographs have become an integral part in plastic and reconstructive surgery. They are significant in clinical research and outcome evaluation. There is a need for effective and secure methods to store, search, and retrieve those photographs. We developed a Health Insurance Portability and Accountability Act compliant searchable database to archive and index clinical information for clinical and research purposes. METHODS: At our craniofacial clinic, digital media (2-D, 3-D, and 4-D photographs) are obtained on a regular basis to evaluate and document treatment outcomes. In addition, patients are asked to enroll in our institutional review board (IRB)-approved imaging database. Daily, we link all digital photographs to the patient encounter through EPIC's Media Manager. This allows us to automatically identify and extract new digital media, patient demographics, diagnosis codes, relevant providers, and the text of the clinic notes to our digital database. To search our extensive database, we employed the VIEW search engine. RESULTS: To date, our database contains more than 277 000 images of 11 000 patients where more than 1900 patients are enrolled in the IRB study. This search engine allows full-text search with query response time between 2 and 5 seconds. The search engine displays the returned through a web page interface, which includes image thumbnails and the relevant part of the clinic note. In addition, a patient-specific chart allows the user to examine all patient notes and photographs. CONCLUSION: Our solution allows providers and researchers to retrieve all digital media securely and efficiently.

Three-Dimensional Printing for Craniofacial Surgery: A Single Institution's 5-Year Experience.

BACKGROUND: As 3-dimensional (3D) printers and models become more widely available and increasingly affordable, surgeons may consider investing in a printer for their own cleft or craniofacial center. To inform surgeons considering adoption of this evolving technology, this study describes one multi-surgeon center's 5-year experience using a 3D printer. METHODS: This study included 3D models printed between October 2012 and October 2017. A 3D Systems ZPrinter 650 was used to create all models. Models were subclassified by type (craniofacial vs noncraniofacial) and diagnosis, and the cost of consumable materials was recorded. A survey was distributed to craniofacial team members who used the printed models. Likert scales and free texts were used for responses about lessons learned and the usefulness of the printer for different craniofacial indications. RESULTS: A total of 106 models were printed at this institution during the 5-year time period. Printing times were 7.4 ± 1.9 hours for complete skulls and 6.0 ± 1.7 hours for maxillofacial prints. The average cost for a complete skull was about US$60 in material cost alone. The 3D printer was most frequently used for complex craniosynostosis, hemifacial microsomia syndrome, and fibrous dysplasia cases. The surgeons found the printer to be most useful for planning complex facial orthognathic cases and least useful for routine single-suture synostosis. CONCLUSION: Three-dimensional printing was found to be helpful for all 4 craniofacial surgeons, who would all invest again in a 3D printer. For lower volume centers, commercially printed models may be a more cost-effective alternative.