Models for Success
Spring 2020 | By Robert Stephens
On a Sunday evening, Jack聽Stubbs 麻豆精品 S� phone rings. He聽thinks about letting it go to聽voicemail until he notices聽who is calling: a doctor from Nemours聽Children 麻豆精品 S檚 Hospital. A small child with聽badly impacted teeth needs surgery聽right away, but it 麻豆精品 S檚 complicated,聽possibly life-threatening. The medical聽team looks to Stubbs for help.
Stubbs is not a doctor. As the聽director of the Prototype Development聽and 3D Print Lab (PD3D) at UCF, he 麻豆精品 S檚聽basically a gadget guy. His demeanor聽is as casual as the jeans he wears to聽his office at Central Florida Research聽Park. Here, Stubbs shows what first聽appear to be toys. Behind him, the聽constant drone of printers creates a聽soothing backdrop of white noise.
麻豆精品 S淭his is the cool stuff, 麻豆精品 S� Stubbs says.聽What you see barely begins to convey聽what he means. Over here is a head聽small enough to be on an American聽Girl doll 麻豆精品 S� except it 麻豆精品 S檚 more humanlike.聽Hey, isn 麻豆精品 S檛 that a heart? It 麻豆精品 S檚 remarkably聽realistic. Oh, and there 麻豆精品 S檚 a rib cage with聽slime around a kidney.
麻豆精品 S淭hat 麻豆精品 S檚 a patient-specific replica of a聽child 麻豆精品 S檚 midsection, 麻豆精品 S� says Stubbs. 麻豆精品 S淭he聽green stuff [represents] the tumor. We聽don 麻豆精品 S檛 know the child 麻豆精品 S檚 name or where聽the family lives, but I 麻豆精品 S檓 guessing it 麻豆精品 S檚 a聽girl, about 5 years old. 麻豆精品 S�
In other words, we 麻豆精品 S檙e looking at the聽closest depiction possible of a body聽part of an actual child. We 麻豆精品 S檙e also聽looking at her cancer.
麻豆精品 S淎 tumor isn 麻豆精品 S檛 the nice, tidy lump聽you see in pictures. In real life it 麻豆精品 S檚聽messy, and it makes the job of a聽physician challenging. That 麻豆精品 S檚 why聽these models are so valuable. We 麻豆精品 S檙e聽helping doctors save lives, 麻豆精品 S� Stubb says.
To be able to look at a model of a tumor from all angles, without the restrictions of an image on a computer screen, is completely changing how we are planning complex surgery, 麻豆精品 S� says Physician Craig Johnson, who is enterprise director of interventional radiology at Nemours Children 麻豆精品 S檚 Health System and chair of the department of radiology at Nemours Children 麻豆精品 S檚 Hospital in Orlando. (Photo by Nick Leyva 麻豆精品 S�15)
麻豆精品 S淎 tumor isn 麻豆精品 S檛 the nice, tidy lump聽you see in pictures. In real life it 麻豆精品 S檚聽messy, and it makes the job of a聽physician challenging. That 麻豆精品 S檚 why聽these models are so valuable. We 麻豆精品 S檙e聽helping doctors save lives. 麻豆精品 S�Jack Stubbs
Physician Craig Johnson chairs聽the department of radiology聽at Nemours Children 麻豆精品 S檚 Health聽System. He sees the young lives聽that are at stake and talks with the families聽trying to cope. He also appreciates the聽importance of Stubbs 麻豆精品 S� contributions.
麻豆精品 S淭he key to advancing medicine and saving聽lives is to combine the minds of doctors,聽clinicians and engineers, 麻豆精品 S� says Johnson.聽 麻豆精品 S淭hat 麻豆精品 S檚 why Jack 麻豆精品 S檚 patient-specific models are聽game changers. You have to remind yourself聽that each model is an exact replica, down to 0.1聽millimeter of what is actually inside that child. 麻豆精品 S�
The phone call Stubbs received on Sunday聽helps illustrate the lifesaving process. A doctor聽tells him about the patient 麻豆精品 S檚 teeth being buried聽deep among neurological tissues. Highly聽developed MRIs and CT scans are helpful only聽to a certain point.
麻豆精品 S淐an you help us? 麻豆精品 S� the doctor asks.
This is what enticed Stubbs and Fluvio Lobo,聽principal research and development engineer聽at PD3D, to leave their lab at the University聽of Minnesota and take positions at UCF.聽Here, they have the opportunity to combine聽technology, healthcare and education to do聽something incredible 麻豆精品 S� one precious life聽at a time.
At UCF 麻豆精品 S檚 PD3D lab in Central Florida聽Research Park, Director Jack Stubbs, Principal聽Research and Development Engineer Fluvio聽Lobo, Director of Generative Design Jim聽Inziello and artist Robert Sims 麻豆精品 S�19 collaborate with Nemours to produce the final 3D-printed surgical planning models. (Photo by Nick Leyva 麻豆精品 S�15)
A few hours after the phone call, Stubbs 麻豆精品 S櫬爐eam receives images of the child 麻豆精品 S檚 skull.聽Then the magic happens. PD3D director of聽generative design Jim Inziello and researcher聽Robert Sims 麻豆精品 S�19 add color-textured surfaces聽and features that will allow the doctors to聽better visualize the focal points of the surgery.聽The information is fed into a Stratasys Polyjet聽J750 printer 麻豆精品 S� one of the most advanced 3D聽printers of its kind, and one of the first to use聽FDA-approved software to develop anatomical聽models. Soon, a replica of the child 麻豆精品 S檚 jaw will聽be in Stubbs 麻豆精品 S� hands. He will deliver it to the聽physician, who in turn will use it with a team聽of neurologists, reconstructive surgeons and聽nurses. They will see the jaw and the buried聽teeth and the brain, not in pictures, but in the聽closest thing to real life. Then they will practice聽the surgery before the surgery.
麻豆精品 S淚t takes out the guesswork, big-time, 麻豆精品 S� says聽Johnson. 麻豆精品 S淭he surgeons can see everything聽the way they 麻豆精品 S檒l see it when they open the聽actual body rather than on a two-dimensional聽flat-panel TV. Sometimes they 麻豆精品 S檒l change their聽approach, maybe change an angle to remove a聽tumor and also save a kidney rather than taking聽it all out. 麻豆精品 S�
It 麻豆精品 S檚 something Johnson could barely imagine聽when he and a colleague first saw a 3D printer聽at Best Buy in 2014 and thought, 麻豆精品 S淲hat聽if? 麻豆精品 S� The future seemed to arrive fast when聽Nemours partnered with the PD3D lab three聽years later. Their first case together provided聽the ultimate test.
麻豆精品 S淲e had a teenager whose family had been聽told there was no way to treat a tumor that had聽grown to the size of a small basketball, 麻豆精品 S� says聽Johnson. 麻豆精品 S淭he tumor was around too many聽of his organs, and it had blood vessels around聽it. Chemo wasn 麻豆精品 S檛 working. He had no more聽options.
The Nemours doctors weren 麻豆精品 S檛 sure how聽helpful a model from the PD3D lab would be.
But they practiced on the model prior to the聽surgery and strategized how to specifically and聽safely remove the tumor. The boy walked out聽of the hospital three days later.
麻豆精品 S淚t 麻豆精品 S檚 been two years, and he 麻豆精品 S檚 had no聽recurrence of the cancer, 麻豆精品 S� Johnson says.
Pushpak Patel, a radiology technologist, leads 3D printing services at Nemours and works with the hospital 麻豆精品 S檚 CT and MRI groups to make the right imaging for the models. (Photo by Nick Leyva 麻豆精品 S�15)
While Stubbs and Lobo don 麻豆精品 S檛 have direct聽contact with patients, they do hear the good聽news from the doctors. 麻豆精品 S淗earing that 麻豆精品 S� it聽means a lot, 麻豆精品 S� says Lobo.
Word has started to spread. The UCF聽team has provided patient-specific models聽for hospital teams as far away as Seattle and聽San Francisco. Lake Nona Medical City will聽present more opportunities as it grows. Stubbs聽does admit frustration about moving this聽technology out further and faster, even though聽the 3D-printed models are being used in 113聽hospitals in North America and more than 250聽worldwide.
麻豆精品 S淭hat isn 麻豆精品 S檛 enough. There are thousands of聽hospitals around the world, 麻豆精品 S� he says, holding聽a replica of a rib cage. 麻豆精品 S淭his only costs $1,200聽to print. We have an opportunity to change聽healthcare 麻豆精品 S� to make it more affordable聽and to save lives. 麻豆精品 S�
麻豆精品 S淭his only costs $1,200聽to print. We have an opportunity to change聽healthcare 麻豆精品 S� to make it more affordable聽and to save lives. 麻豆精品 S�Jack Stubbs
Hospitals, despite copious financial reserves,聽cannot realistically do what 麻豆精品 S檚 being done at聽UCF. It isn 麻豆精品 S檛 just a $400,000 3D printer. It 麻豆精品 S檚聽literally a village, where expertise in 肠辞尘辫耻迟别谤听蝉肠颈别苍肠别, mechanical engineering, 产颈辞尘别诲颈肠补濒听蝉肠颈别苍肠别蝉, psychology and architecture can make聽these tiny heads and hearts come to life.
麻豆精品 S�Art students are as important as anyone, 麻豆精品 S澛爏ays Lobo. 麻豆精品 S淭hey paint each model to look the聽way a doctor will see it in surgery. They don 麻豆精品 S檛聽make it pretty 麻豆精品 S� they make it realistic. 麻豆精品 S�
Stubbs hands over a model of two conjoined聽heads, so small they both can be held in one聽palm. With this model, two lives could be saved.
麻豆精品 S淚t 麻豆精品 S檚 hard to describe how motivating it is聽when we hear what we hear on the other side聽of this procedure, 麻豆精品 S� says Johnson, referring to聽a child in post-op. 麻豆精品 S淚t 麻豆精品 S檚 more than a black and聽white image or a piece of plastic. It 麻豆精品 S檚 a living聽child. 麻豆精品 S�
In the laid-back office at Research Park, a聽printer continues to hum. The model of the聽child 麻豆精品 S檚 impacted teeth should be ready later聽this afternoon. Stubbs will deliver it himself to聽the surgical team, who will be given the chance聽to see the nuances and angles they hadn 麻豆精品 S檛 seen聽previously. They will operate tomorrow.
麻豆精品 S淭his is as real as it gets, 麻豆精品 S� says Stubbs. 麻豆精品 S淗ow聽cool is that? 麻豆精品 S�
MODELS FOR SUCCESS
A clear plastic was used to create聽a model of 3-month-old conjoined twins聽to allow doctors to clearly see where their聽blood vessels are located. Craniopagus聽twins, those who share a skull but not a聽brain, is a rare phenomenon and separation聽surgery requires surgeons to navigate聽delicate networks of arteries and veins that聽can often be tangled.
This model of an 8-year-old patient’s聽severe scoliosis聽allowed doctors to show and聽explain to the patient and his parents exactly聽how the child 麻豆精品 S檚 spine was curving. It also聽allowed surgeons to determine a surgical plan聽that would be almost impossible to visualize聽and plan using CT images alone.
The yellow object depicts a tumor聽within the abdomen of a 3-year-old patient.聽Surgeons used the model to determine how聽to remove the mass, which was growing聽between his kidneys (shown in dark red)聽and his pancreas (teal), while being sure聽to not rupture any of his veins (blue) or his聽arteries (orangish-red).
To help a 15-year-old patient better understand how a heart聽functions聽and how his particular condition affects it, doctors at Nemours聽Children 麻豆精品 S檚 Hospital used this model, which combines colors and labels to聽illustrate the patient 麻豆精品 S檚 anatomy. For example, the dark blue region in the聽front is a pulmonary artery, magenta is the right ventricle and yellow is the聽left ventricle.