Caregiver Preferences for Three-dimensional Printed or Augmented Reality Craniosynostosis Skull Models: A Cross-sectional Survey

BACKGROUND: Achieving caregiver understanding of craniosynostosis is a critical component of surgical care. Caregivers must navigate the emotional challenges of a congenital diagnosis, conceptualize skull anatomy, and make decisions on surgical treatment. Recent advances in three-dimensional (3D) printing and augmented reality (AR) have made medical model creation more accessible to providers. As a result, 3D-printed and AR anatomical models have been shown to improve communication between surgeons and caregivers for a variety of disease processes. Given these technological advancements, this study aims to compare the utility of 3D-printed versus AR models for craniosynostosis caregiver education. METHODS: Caregiver perspectives on three models were compared in this survey: 3D-printed, AR, and two-dimensional (2D) diagram. 2D diagrams were sourced from schematic diagrams found in the literature. 3D-printed and AR models were generated from preoperative cranial CT scans of patients with bicoronal, sagittal, and unicoronal craniosynostosis. A DICOM Viewer (Inobitec LLC) was used to export CT scans into virtual 3D meshes, which were smoothed and post-processed in MeshMixer (AutoDesk) to ensure 3D printability. 3D-printed models were printed using a Prusa MK3S (Prusa Research) printer in white PET-G plastic. To view the model in AR, the mesh was uploaded to Augment, a mobile AR platform. All models were incorporated into a Qualtrics survey distributed to caregivers through popular Facebook craniosynostosis support groups in February 2021. The survey presented the three models in random order. Caregivers were asked to rate how innovative and realistic each model felt on a five-point Likert scale. Caregivers also ranked the three models in terms of usefulness in learning about craniosynostosis, ability to ease caregiver anxiety, and ability to increase caregiver trust in surgeons. Caregiver ratings for the three models were compared using one-way ANOVA tests. RESULTS: A total of 73 self-identified craniosynostosis caregivers completed the survey [mean age 32 ± 5 years, majority White (94%) and women (71%)]. ANOVA testing demonstrated that caregivers ranked 3D-printed and AR models significantly higher than 2D models for learning about craniosynostosis anatomy (P < 0.05) and increasing their trust in surgeons (P < 0.05). In terms of easing caregiver anxiety, the AR model, but not the 3D-printed model, was found to be more effective than the 2D model. Both the unicoronal and bicoronal AR models were rated as more innovative (P < 0.05) and more realistic (P < 0.05) than their respective 2D models. 3D-printed models were seen as equally realistic and innovative compared with AR or 2D models. CONCLUSIONS: Our findings indicate that both 3D-printed and AR models can enhance caregiver understanding of craniosynostosis anatomy more so than 2D models. Based on this information, we recommend surgeons consider the unique advantages of these models as a powerful communication tool during patient consultations for improved caregiver understanding of craniosynostosis.