“I have made this letter longer than usual

because I lacked the time to make it short.”

- Blaise Pascal

INVESTIGATING THE

CLINICAL UTILITY OF 3-D

PRINTED MODELS OF

VACULAR PATHOLOGY

ANDREW SCHULICK, MD, FACS

DEVIKA SINGH, BSC

• Objects made by fusing and depositing material

• Variety of processes – some similar to inkjet

• Variety of materials Plastic

Metals

Ceramics

Powders

Liquids

Living cells

3-D Printing: Additive Manufacturing

• Manufacturing

• Entertainment

• Food

• Crime

3-D Printing: Utilized in Many Fields

• Structural Organ Printing Meniscus

Heart valve

Spinal disk

Bone

Limbs

• Vascularized Organ Recent progress

• Customized implants Hearing aids

Braces

Hip socket implants

Skull plates

Mandible

3-D Printing: Medical Applications

• Anatomic Modelling

• Surgical Preparation Neurosurgery

Spine surgery

3-D Printing: Medical Applications

• Nascent

• 3-D models of actual patient pathology for use in: Patient education

Resident training

Procedure planning, strategy

Testing innovation

• Endpoints (future goals) Increased compliance

Enhanced training

Decreased procedural costs

Enhanced patient safety

Innovation and R and D

3-D Printing: Medical Teaching

• DiCom image from CT segmented along region of interest

• 3-D model rendered using proprietary software

• Model manipulated to prepare mesh for printing

• Converted to STL file for printer

• STL uploaded and registered to a 3-D printer

3D Modeling: Method

Edviks000

• Carotid artery stenosis

post processed STL file

Vessel wall

Calcifications

• Subclavian artery

stenosis

Other Examples

• Traditionally via literature or video

• Health literacy is a barrier

• Dutch studies using 3-D models of patients’ tumors Enhanced comprehension

Increased compliance

• Use similar approach with vascular disease PVD

CVD

CAD

3-DP: Patient Education

• Expected to be as “completely” trained as prior generations despite: More information to learn

New techniques

Decreased resident hours

Decreased time in OR

Increased disease and case complexity

Specialization

• Vascular surgery Simulators are expensive

Vary in realism

Lack haptic feedback

3-DP: Resident/Fellow Training

• Print clear and hollow 3-D models of vascular pathology (Aortic Aneurysm)

• Utilize model to test wire and catheter navigation and realism

Proof of Concept

• Other materials More clear

More compliant

Tactile feedback

• Expand the model

• Flow pump

• Modular Inserts

Reuseable

• Case libraries

Next Steps

• Understand anatomy Haptic

Intuitive

• Visualize procedure

• Simulate procedure with actual anatomy Time savings

Cost savings/Less waste

Better outcomes

Advantages of Learning in 3-D

• As noted – practice “cuts” and “catheterizations”

• Endpoints Time savings

Cost savings

Increased safety

• Practical example: 3-D model of AAA with highly angulated neck

3-DP: Procedure Planning

• Difficult aortic arch Carotid stent

Pre-select catheters

• Branched aortic endografts Planning

Catheter selection

Save time, contrast, radiation

• Contrast-free procedures

3-DP: Procedure Planning

3-DP: Innovating and Testing

X

X

X

3-DP: Innovating and Testing: Ex

• Branch endografts Custom ordered

Expensive

Long lead time

• 3-D modelling Back bench production

Custom made

Immediate

Future

• Printing complex organs or their components

• In situ, in vivo 3-D printing

“Any sufficiently advanced technology

is indistinguishable from magic.”

-Albert Einstein