Friday, January 27, 2017

Radiologists continue to lead the charge to 3D printing

Dr. Adnan Sheikh is Associate
Professor at the University of
Ottawa, where he is Medical
Director for 3D printing
PARCA eNews – Jan. 30, 2017 – Many surgeons and other specialists have recognized the incredible potential of 3D printing. Using 3D printers, patient data is essentially turned into actionable, physical objects. The applications are numerous ranging from individualized prosthetics, to surgical models for preoperative planning, to anatomical replacement implants. At last year’s American College of Radiology annual meeting, a team of radiologists presented a paper showing how 3D printing could become a new service of the radiology department. At this year’s Radiology Society of North America (RSNA) annual meeting, 3D printing was one of the hottest topics with several presentations and workshops, culminating in the establishment of the RSNA 3D Special Interest Group. One of the organizers of the 3D printing area at RSNA was Dr. Adnan Sheikh, Medical Director for 3D Printing at the University of Ottawa, one of a handful of institutions that have already established 3D printing services.

PARCA eNews talked with Dr. Sheikh about this coming technology. He is a radiologist specializing in musculoskeletal radiology, with subspecialty training in emergency musculoskeletal radiology at the University of Ottawa Hospital. He credits the addition of Dr. Frank Rybicki as chair of the university’s radiology department for establishing the 3D printing service there and inspiring his interest in 3D printing.

Q. How is 3D printing being used at the University of Ottawa?
Currently the uses for 3D printing is both educational and research. Because cadavers are getting more and more difficult to obtain. So they are creating these models for teaching medical students as well as residents. The other important educational use is in a tertiary care center where you might see, for example, cardiac anomalies that occur at 1 in 100,000, that kind of rarity, we have these 3D printed rare cases, you can print those models and have your surgery residents practice on them.  So if it comes up sometime during their lifetimes, they can use these models to practice on them before practicing on the real patient.

The other thing that is coming up is anatomic modeling prior to surgery. By printing these 3D models, the surgeon gets a 3D visualization of the anatomy and a better understanding of the anatomy. The models aid in planning their surgery and preplanning the procedure prior to getting into the operating room, which reduces the surgery time as well as complications.

Q. Are you printing replacement parts?
Yes, you can make prosthesis or implants. You can do that, especially for cancer patients where the cancer has eroded the bone you can replicate it and mirror it in normal size and then place the implant, which is usually made of titanium, and place it into the human body. The other thing that is still in research is organ printing. That is something huge and the US is already expending a lot of research effort and dollars in developing the ability to print organs, which would allow you to be independent of donors. So you can print the organ and implant it. Skin for burn patients is an early use, you can regenerate or print skin and graft it onto the human body. It is already being done in some institutions, but not done widely yet. Once that can be done it will change treatment for these patients in the future.

Q. What are reasons for placing 3D printing in the radiology department?
3D printing can be done just about anywhere, I don't think it needs to be restricted to radiology, but I do think radiologists are the best people to do it. The reason I say that is that radiologists are equipped to do it. To 3D print a bone or liver you need to have a CT or MRI of the patient. Radiologists know how to acquire the images properly and how to interpret them. That makes radiologists more suited for 3D printing because when you take these DICOM images that come from a CT scan or MRI and then transform those images using software to SDL standard Destination file, that is taken up by the printer and gets printed in the printer.  

Q. How will 3D printing affect the PACS?
The biggest challenge we have for 3D printing is acquiring the images correctly. You need to get thin slices, and if you don't acquire them in the right way there can be discrepancies in what gets printed and what actually is implanted. Even if there is just a few centimeters difference here and there especially when doing implants, that can make a mismatch, and you are not printing the right thing. For the PACS administrator it won't change that much because you are acquiring images anyway. However, because these parts get printed you need someplace to store them. To be frank there is no common form of registration right now for how to do that. 

Q. How will 3D printing affect healthcare?
I think it will revolutionize the way we practice medicine. I think this is an upcoming technology and will change medicine in the future. I think more residents will use it, how much I'm not sure. It can definitely help in surgical planning. The other important thing is that using it for complex cases, operating room time comes down and that is a huge thing. That is definitely a big time savings for healthcare. As far as routine cases, it won't have much impact because that's what you do everyday, but for complex cases, once you do these things, you can print a hard model and practice on that model and you can go in and do the same thing on the patients because you've done the steps beforehand. Dr. Sanjay Gupta and Wayne Dash on CNN did a piece on 3D printing used as part of preoperative planning for separating conjoined twins. I highly recommend that you look at that if you are interested in 3D printing.

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