D2p software

The process started from acquisition of real computed tomography angiography (CTA) datasets of a patient lower leg, which represents the donor-site for osteomyocutaneous fibular flap harvesting procedure. CTA scans were acquired after administering nonionic contrast media intravenously (Xenetix 350 Guerbet) and with a slice thickness of 0.6 mm (Lightspeed VCT LS Advantage 64 slices; General Electric Medical System).
Anatomical areas of interest of the subject’s leg were segmented using D2P™ software (3D Systems Inc., Rock Hill, SC, USA): bones (tibia and fibula), arterial vessels (popliteal, fibular, tibial and perforating arteries) and leg skin (distinguishing the skin paddle profile for harvesting, according to the virtual planning for mandibular reconstruction).
Three-dimensional meshes were then generated from all the segmented masks, and saved in STL format.

CCTA was performed using retrospective gating utilizing a 256-slice scanner (Brilliance iCT; Philips Healthcare, Cleveland, OH, USA) with 70 ml of intravenous non-ionic contrast medium (Iomeron 350, Bracco, Milano, Italy) followed by 40 ml of saline flush (at an injection rate of 4–5 ml/s). The CCTA data were reconstructed using a dedicated platform (Comprehensive Cardiac Analysis, Extended Brilliance Workspace (version 4.5); Philips Healthcare). Volumetric analysis was conducted using the best available diastolic phase that represented 80%–90% of the R-R interval.
The VR simulated heart models were created retrospectively based on the same CCTA data collected for each patient. Images were uploaded as Digital Imaging and Communications in Medicine (DICOM) files into D2P® software (3D Systems Inc. Littleton CO, USA) for cardiac chamber segmentation. The mesh files were converted into stereolithography (STL) format files that describe 3D objects’ surface geometry. The operator was able to see the resulting segmentation in a stereoscopic view using a dedicated system (Vive System, HTC, San Francisco, CA, USA).