3D Printing Expanding in Medicine: Implications for Radiology

3D Printing or more accurately, Additive Manufacturing, is quickly finding more and more medical applications. Several of these applications are in radiology. Radiologists are taking note as was evidenced by the sold out session at RSNA 2014, “Fundamentals of 3D Printing” on Sunday morning.

At this session, the team from the 3D Medical Applications Center at Walter Reed National Military Medical Center reported 3 areas of applications for 3D Printing.
1) Medical Models for use in surgical planning, patient education and consent and a pre and post-op record.
2) Virtual Surgery to actually perform the technique on a model.
3) Device design to create custom implants and surgical tools.

Full size models for use in surgical planning and reference during the surgery have proved to be so successful that orthopedic surgeons at Walter Reed use the models for all surgeries.

Frank J. Rybicki, M.D., radiologist and director of Brigham and Women’s Applied Imaging Science Laboratory reported on their experience with 3D Printed models to plan and perform face transplantation procedures. It was so successful it is now a mandatory step in surgical planning for these procedures. (RSNA Press Release)

Cleveland Clinic has also used 3D printed models in face transplantation. In addition the clinic employs 3D planted models in other surgeries. 3D printed models are employed in complex liver surgeries. No two livers are exactly alike and the damaged areas of the liver need to be removed without damaging the inner blood vessels while keeping the healthy areas of the liver intact. Surgeons study the 3D models which include the inner vessels prior to surgery and have the models available in the operating room during the procedure. ( Cleveland Clinic Makes Surgery more Personal)

Over the last two years, the use of 3D printed models has spread rapidly at Children’s Hospitals. These include the Children’s Hospital of Illinois, Boston Children’s Hospital, New York-Presbyterian Morgan Stanley Children’s Hospital, C.S. Mott Children’s Hospital, Miami Children’s Hospital, Phoenix Children’s Hospital, Texas Children’s Hospital, Lurie Children’s Hospital of Chicago, Children’s National Medical Center, Children’s Hospital of Philadelphia, and Kosair Children’s Hospital in Louisville among others.

A common application at children’s hospitals is the use of 3D printed hearts in surgical planning. Dr. Matthew Bramlet, a pediatric cardiologist at Children’s Hospital of Illinois in Peoria is taking it a step further. He has started a “library” of 3D printed hearts as a teaching tool. ( “Library of Hearts”)

Traditionally, physicians have used pathologic libraries but the hearts in these libraries have started falling apart. Due to the cost and difficulty of acquiring replacements, the pathologic libraries are closing. Dr. Bramlet has put out a nationwide call for pre and post op MRI and CT scans of congenital heart diseases of all ages. The online library will be housed at the Jumptrading Simulation and Education Center which is partnering with the NIH Print Exchange.

Boston Children’s Hospital added 3D printed models to its simulation program in early 2014. It has been rapidly adopted for surgical planning in many different types of surgery, including cerebrovascular. In the first year, over 100 3D models have been printed. It is becoming the standard for every patient in the Cerebrovascular Surgery and Interventions Center based on such successes as successful intervention in a case of infantile spasms. (Doctor turns to 3D Printers)

Currently, 3D printing activity is centered in the academic centers and specialty institutions, especially children’s hospitals. Typically 3D printed models cost in the $100 – $1000 range. Sophisticated models can cost much more and there is the cost of the labor required to process the data prior to printing. The capital investment is usually not large compared to imaging equipment costs. However, with no reimbursement, 3D printed models is not expected to be a service for most radiologists in the near future.

One of the few radiology practices offering 3D printing as a service is Spectrum Medical Imaging in Sydney, Australia. Data is being gathered to bolster the antidotal claims of improved surgical outcomes and shortened OR times. Patient demand may also play a role as patient centered care takes hold and with popular press stories such as “Man saves wife’s eyesight by 3D printing her brain tumor”.

Many practitioners currently employing 3D printing believe that it will become commonplace in radiology practices. Rajesh Krishnamurthy, MD, director for research and the cardiovascular imaging program at Texas Children’s Hospital’s EB Singleton Department of Pediatric Radiology says that in addition to the other advantages, it makes a huge difference to patient and care team comprehension of the procedure. Frank J. Rybicki, M.D., radiologist and director of Brigham and Women’s Applied Imaging Science Laboratory says that there is no doubt that 3D printing will be part of radiology practices. (“Ready to Hit Print?”)

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