Purpose or Case Report: Fluoroscopy of the upper GI tract (UGI) can be difficult to master given the time-sensitive nature of the examination, the necessary hand-eye coordination, the complex button layout and broad featureset of the fluoroscopic equipment, the desire for minimizing radiation dose, and the required understanding of normal anatomy. Additionally, encountering abnormal findings for the first time, particularly before one is familiar with normal findings, can lead to confusion and increased difficulty in performing the examination. The use of 3D printed models of normal anatomy in pediatric fluoroscopic UGI training simulation has previously been demonstrated as a viable alternative to learning on live patients; however, such a technique has not previously been used with known pathological anatomic configurations.
Methods & Materials: A freely-available computer generated 3D model of the normal anatomy of the esophagus, stomach, and duodenum was downloaded and modified using Blender™ and Autodesk Fusion 360™. The model was edited to create 4 alternative models corresponding to the 4 classic patterns of abnormal UGI configuration: Malposition of the duodenal-jejunal junction (DJJ), corkscrew duodenum, complete duodenal obstruction, and partial duodenal obstruction with normally positioned DJJ. Additionally, known normal variants of anatomy (such as duodenum inversum) were modeled as well.

Inexpensive reusable simulator models were printed using a waterproof photo-reactive resin to allow residents to practice UGI fluoroscopy on both normal and abnormal patients. Residents were tested on their performance and interpretation of UGI fluoroscopy on these models to enhance their comfort with performing the examination and to increase their familiarity with these important variants/abnormalities.
Results: Though the models were entirely reliant on gravity-dependent flow of contrast, they behaved similar to real neonates when filled with contrast and placed in different positions.
Conclusions: 3D printed models of the UGI tract can serve as adequate training tools for both general examination performance as well as education of normal anatomic and pathological variants.