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Materials & Methods

Fall 2019

The ENT 3D project is at an exciting point.  The project began over 4 years ago and is a continuation of the  Nose Cards project that was so much fun to create.  Nose Cards is an 11 minute video that goes over sinus and anatomy and problems using relatively simple 3D models.  Chapters 1 and 2 of the ENT 3D project is ready for viewing and covers the topics  in a much more robust and detailed production.   Chapter 3 is in progress and will cover common sinus and nasal problems and their solutions.  After these preliminary chapters, I will begin on the more technical topics for otolaryngologists and anatomy students.
 
If you have some type of 3D viewer or red blue glasses, start at the Stereoscopic Page.

Nose Cards

ENT3D was inspired by a project that started 20 years ago.  I built a simple 3D model of sinus anatomy and created an educational package called Nose Cards. 

Nose Cards was published in 1999.   CT scan data and 3D Studio Max were used to creat relatively simple computer models of nasal and sinus anatomy.  The kit was provided to physicians and patients with to explain the basic structure and function of the nasal cavity and the sinuses.  The series was printed on cards that were inserted into a folding viewer that provided a 3D experience.  The series can be viewed as a slide show here. 

Hardware and Software

The original shapes were obtained by using high resolution CT scans and using ITK Snap, a research radiology program that helps "segment" individual structures in  CT scans and MRIs.    The spacially accurate initial models were brought into ZBrush, the industry standard organic modeling and sculpting program.  Here they wered formatted into modern models with multiple resolution layers, displacement maps, UV Maps, and textures.  The completed textured models were then brought into 3D Studio Max for animation and rendering using V Ray rendering engine.  My workstation is a fairly robust 10 core overcloced i7 workstation with multiple monitors and high end graphics card.  One of my monitors is the 55 inch 4K LG 3D TV, which is used to preview and tune the 3D effects. 

I have 2 of 32 core AMD Threadripper based computers that serve as a render farm to speed the production.  These "nodes" are working day and night drawing frames.  3D high resolution images take a great deal of computer power and time.

The resulting images are then composited in Adobe After Effects or Premier Pro.  Photoshop is used where needed.  Compositing the final renders allows various components of a scene to be rendered seperately and composited in ways that allows future flexibility, best final appearance, and most efficient rendering times.

The videos are managed in Premier Pro and the 3D effects are managed with a plugin from Vision III Imaging company.  This plugin is also helpful in editing the 3D video footage from my various cameras that are used to document physical findings, surgical procedures, and other live interesting medical recordings.  Some of the stereosopic camera footage is in a format the requires conversion using Power Director Studio®, a non linear editor with native 3D support.   This package is also used to write some of the final output onto 3D BluRay DVDs.

The CAD Model

There are several high quality collections of 3D computer anatomy.  None have the detail in the sinus and nasal region as ENT3D.  Another unique aspect of ENT3D is the degree of integration of the CT scans and MRI scans.  The sinuses, skull base, and ear structures are available in 0.3 mm interpolated resolution in the 3DS Max environment.  They can be manipulated as a "pseudo volumetric space" with full control of opacity and integration of other 3D models in the same space. Most 3D anatomy models have been optimized for real time interactive manipulation.  That is very cool for sure but it is a much different direction than this project.  While ENT3D project is built in a format that could be used in real-time game engines and interactive virtual reality environments, the plan is to create pre scripted demonstrations and present them with high resolution stereoscopic displays. 

 Specifically my model begins in ZBrush.  The base shape with multiple levels of detail, UV maps, displacement maps, and texture maps are all primarily created and edited in ZBrush for maximum future flexibility.  Animation and rendering are done in 3DS Max using VRay rendering 

I have explored the real time anatomy models that I am aware of.  I find that at first, you spend a great deal of time learning how to navigate the sytem and learning how to get the most out of the model and the available tools for visualization.

ENT3D is fundamentally different.  An expert in the anatomy, physiology, and pathology of this area creates pre scripted tours and explanations.  You have the professional who knows the content as the same person who created and manages the computer assets.  This combination can provide unique educational demonstrations that can be quickly viewed on the internet or shown to large audiences and classrooms.

Nasal Anatomy Detail

One of the most unique aspects of the ENT3D model is the detailed and flexible model of sinus and nasal anatomy.  I haven't seen any other 3D models that have the comprehensive and detailed sinus and nasal anatomy that ENT3D has.  Our initial topics will focus on this aspect of ENT but eventually eill include other ear and throat topics.

The nasal cavity and sinuses have complicated spacial relationships to other critical structures.  The anatomy is hard to understand and even harder to master, especially given the variations in anatomy and challanges encountered during surgical procedures. ENT3D hopes students of this topic gain new understanding this using this innovative visualization media.

In addition to the complicated 3D computer model, there is a cadaver dissection of sinus anatomy that is documented with 3D photography from 2 angles.  Using modern software, these images are more flexible than ever and can be explored in ways that were not possible when the dissection and photography session was undertaken years ago.

Camera Systems

Apparently the modern era of 3D is over.  "Prosumer" 3D camera systems ceased production a few years ago.  Fortunately there are still models available on EBay in good condition.  I have 3 Sony 3D TD Camcorders with 3D printed modification adapters that allow macro lenses.  These cameras are great for closeups.  I have mounted one on a headworn system that permits a surgeons eye view of examinations and procedures and mounts cantilevered from IV poles provide excellent surgical documentatoin.  For more distant shots the Panasonic Z10000 model is available and is thought to be the best 3D "Prosumer" Camcorder ever made.  Both types record full 1080 per eye onto memory chips.  

For custom camera rigs I have 2 modified YI 4K action cams with C-mount modifications.  They can be used with various lenses and special mounts creating a 4k macro custom camera, they can be attached to a Zeiss/Karl Storz Microscope adapter and allow 4K x 2 views from the operative microscope, and they mount on 3D endoscopes that I have modified.  I obtained stereoscopic laparascopes on EBay that are designed to work with surgical robot systems.  Surprisingly, these extremely expensive robot laparascopes can be obtained on EBay for about $100 each.  They require fabrication to be used outside of their original systems.  I can mount the 2x 4K cameras on them for examinations of the mouth and throat and skull base.  
I have been acquiring and editing interesting findings for some time and will include these 3D videos into the various presentations.

Display Systems

In 2016 almost every high end TV had 3D capability.  In 2018 there is only 1 TV available with this option.  The pinnacle of 3D TV sets was the 2016 LG passive OLED 4K TV sets.  They came in 55, 65 and 77 inch.  I have been acquiring these used on EBay and even a few unopened examples. I use the small one as my main 3D monitor output from my workstation.  These TVs often demand a premium for a used set and they won't be around for long.  To prepare for showing, 4 of the 65 inch and 2 of the 77 inch models have been mounted in custom road cases for rolling transport to venues.  There are integral stands for positioning at different viewing heigths.

In addition to these special TV sets, projector systems are an excellent way to view 3D footage.  There are still many 3D projectors available.  In order to display 3D footage to a large audience, however, it is typical to use a dual projector system and various filtering systems so that passive 3D glasses can be used.  This is the same technology used in theatres for 3D movies and they employ polarized glasses.  One problem with polarized glasses is that a special type of projector screen is needed.  ENT3D has available the Omega Optical system that uses band pass filters and special glasses so that 3D projection presentations can be shown on regular white projector screens that are often already installed in classrooms and venues.  Some venues are better served with multiple smaller monitors.  4 65" and 2 77" LG OLED displays are available when that is the case.  For the largest venues I have both a 120" and a 165" free standing silver screen system.  GeoBox de mutiplexers convert the 3180x1080 into dual stream HD output for the two projectors.  I have both the 700 series and a 601 series.

In addition to 3D TVs and Projectors, stereoscopic footage can be viewed with Virtual Reality Headsets.  The new Oculus Go is especially suitable as it costs only $200 and requires no other hardware.  The presentation can be accessed over the internet or uploaded to the headset.  The resolution is not as good as projectors or TVs, but it is still very clear.

A  gamut of very inexpensive devices can also be clipped onto a smart phone.  The most common of these is the Google Cardboard viewer.  It is a cardboard box with lenses that you put your phone into, and view the media with almost no investment.  This experience is similar to a VR headset.