Although technically available since 2005, a still lesser-known standard feature of the PDF is the possibility to embed three-dimensional (3D) models, which enables the interactive visualization (eg, zooming, panning, rotating, and selection of components) of such objects with qualified reader software ( Figure 1 for an interactive version of this figure, see Multimedia Appendix 1).Ī PDF document with embedded 3D objects (3D PDF) has high potential in almost every scenario in which 3D objects should be visualized and exchanged between different platforms (eg, computers with different operating systems). However, the PDF offers more features than many people are aware of. This, in many cases, makes this format the best means for the exchange of electronic documents. Software that can read PDFs is installed on nearly every computer, and most internet browsers and email clients have a built-in PDF renderer. The best-known and most widely used data format for the exchange of electronic documents is probably the Portable Document Format (PDF), which was standardized by the International Organization for Standardization (ISO) as ISO 32000-2:2017. Furthermore, easy-to-use, standalone, and free-of-charge software tools for the creation of 3D PDFs should be developed. The potential of 3D PDF usage should be disseminated in the clinical and biomedical community. Only one software application presented an all-in-one solution with a graphical user interface.Ĭonclusions: The use of 3D PDF for visualization purposes in clinical communication and in biomedical publications is still not in common use, although both the necessary technique and suitable tools are available, and there are many arguments in favor of this technique. Most of these tools required advanced programming skills and/or the installation of further software packages. A method, protocol, software, library, or other tool for the creation of 3D PDFs or model files was described in 19 articles. In most cases, either animal or human anatomies were visualized. The disciplines that were covered beside medicine were many. Only one article described a clinical routine use case all others were pure research articles. Screening identified 200 in-scope publications, 13 covering the use of 3D PDF for medical purposes. Results: The search retrieved a total of 902 items. Finally, the latter category was analyzed in detail to provide an overview of the state of the art. The found literature was categorized into articles that (1) applied 3D PDF for visualization, (2) showed ways to use 3D PDF, and (3) provided tools or protocols for the creation of 3D PDFs or necessary models. Ineligible articles were removed after screening. Articles searched for were in English, peer-reviewed with biomedical reference, published since 2005 in a journal or presented at a conference or scientific meeting. Methods: A systematic literature review was performed using PubMed and Google Scholar. Objective: The objective of this review was to provide an overview of existing publications that apply 3D PDF technology and the protocols and tools for the creation of model files and 3D PDFs for scholarly purposes to demonstrate the possibilities and the ways to use this technology. Although PDF allows for the embedding of three-dimensional (3D) objects and although this technology has great potential for the communication of such data, it is not broadly used by the scientific community or by clinicians.
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