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The Jacobs Institute (JI), a non-profit medical innovation ‏centre in Buffalo, New York, is using 3D printing to ‏further its mission of creating the next generation of ‏medical technology to treat vascular disease, such as heart ‏attack and stroke. One of the ways it achieves this is by partnering ‏with researchers at State University of New York at ‏Buffalo (UB) and surgeons at the Gates Vascular Institute ‏(GVI) to plan for complex vascular surgeries.

A few years back, UB biomedical engineers, in consultation ‏with neurosurgeon and JI chief medical officer Adnan ‏Siddiqui, PhD, MD, FACS, FAHA , developed a way to 3D-print ‏brain arteries to better understand brain aneurysms and ‏stroke. As technology and the team’s creativity evolved, so ‏did the realism, complexity, and specificity of the 3D-printed ‏models. It began in a university lab as an experiment, where ‏the biomedical engineers painted layers of silicone over a ‏Play-Doh model of a brain aneurysm. Once the Play-Doh ‏was dissolved away inside the silicone, it created a single, ‏hollowed-out blood vessel. This was a tedious process. It ‏was improved rapidly by a technology called additive manufacturing, ‏also known as 3D printing. The UB lab purchased ‏a Stratasys Eden 260V 3D printer, which took brain artery ‏modeling to the next level.

Making Progress

In the last two years, UB and JI engineers collaborated to ‏create 3D-printed models of arteries to be used in various ‏ways, including physician training, device testing, and surgical ‏planning. These arterial models, known as “vascular phantoms”, ‏can be used for:

  • Medical device industry’s physicians and engineers to ‏learn more about successfully deploying devices inside ‏the arteries, whether in the heart, brain, or peripheral ‏vasculature;

  • Entrepreneurs to bring their endovascular device prototypes ‏and deploy them inside the models, to see how ‏the device performs in a life-like environment;

  • Gates Vascular Institute surgeons requesting a 3D replica ‏of a specific patient’s anatomy to practice surgery— ‏whether to make an appropriate device selection or to ‏practice the surgical approach in a particularly complex ‏anatomy—before touching the patient in an actual catheterisation ‏lab. These models are only created for select ‏patients with complex anatomies, not every patient.

Showcasing the collaborative accomplishments with the ‏university, the hospital, and building a relationship with Stratasys ‏allowed the JI to advance 3D printing further. It was designated ‏as a Stratasys “3D Printing Center of Excellence in ‏Healthcare” in April 2016. The JI acquired a new 3D printer ‏because of the Stratasys partnership and a grant from the ‏James H. Cummings Foundation.

Thus, the JI is poised to transform patient scans into operable ‏models for surgical planning. Its 3D printers, engineers, ‏and surgeons are uniquely and strategically located in one ‏facility. Its Stratasys Objet 500 Connex 3 multi-color, multimaterial, ‏3D printer produces top-quality vascular phantoms.

Patient in Mind

In order to create the patient-specific vascular phantom, there ‏are steps that the team of biomedical engineers must follow. ‏It is a process largely reliant on various computer programmes ‏to render a final file that can be loaded into the 3D printer.

Biomedical engineers take a patient’s MRI or CT scan and, ‏using specialised computer software (Toshiba Vital Images), ‏they identify the patient’s individual brain arteries in a process ‏called “segmentation”. Next, another computer programme ‏(Autodesk Meshmixer) is used to hollow-out the vessels and ‏add support and connectors, which attach the printed model ‏to a cardiac pump to simulate blood flow. Afterward, the ‏fully-refined and translated computer model is loaded into a ‏program called Objet Studio, which is what the Stratasys Objet ‏500 Connex 3 multi-material printer reads to create the 3D model. Once printed, the biomedical engineers then clean and ‏physically hollow out the model using a clean station, which ‏removes support material and transforms it into a useable ‏model. The model then accurately replicates the structure, ‏texture, and fragility of human vasculature. The physicians ‏have a model of human vasculature on which they can train ‏other surgeons, test endovascular device prototypes, or even ‏plan and practice for a complex surgery.

Surgical Application

In the case of surgical planning, the surgeon assembles the ‏surgical team in the Jacobs Institute Training Centre to perform ‏the procedure on the model under fluoroscopy. The surgeon’s ‏team is joined by JI engineers, who can converse about the ‏model’s properties or structure. The JI also documents the ‏procedure, capturing surgeon feedback on the models and ‏the surgical approach. The JI take photographs and videos, ‏to further catalogue the experience. The surgeon and the ‏surgical team use the models to crystallise the plan in several ‏ways during a practice surgery.

First, the surgeon must determine the optimal path to deploy ‏the device. Using the model can help the surgeon recognise ‏if using a certain vessel pathway is helpful or problematic. It ‏can also assist the surgeon in recognising which vessels are ‏twisted, or tortuous, and exactly how to handle the catheters ‏and wires to navigate the bends and turns.

Then, once the surgeon reaches the affected area of the ‏blood vessel, they can try using a particular device to treat ‏it—whether it is a device that will retrieve a clot in the case ‏of a stroke, or a stent and coil duo to treat an aneurysm. After ‏deploying the device, a surgeon may find deployment is too ‏difficult or that a different device might be better suited for ‏treatment of that particular case. Finally, the surgeon would ‏use the original or try an alternate device during the actual ‏surgery, with greater confidence that the original device would ‏have been unsuccessful.

There are numerous advantages to patients, surgeons, and ‏hospitals in using a 3D-printed model to devise an optimal ‏surgical plan. It: ‏

  • Allows surgeons to try a particular approach or device in a risk-free environment;

  • Provides the surgeon with practice time before performing the actual surgery, much like medical simulation;

  • Minimises the time a patient is on the table, being exposed to harmful radiation, as a surgeon tries to figure out the best approach;

  • Reduces surgical cost associated with longer surgery;

  • Reduces cost associated with incorrect device selection (catheters, wires, or devices types and sizes);

  • Determines which are the best tools for the specific patient’s case;

  • Helps the surgeon choose the appropriately-sized device;

  • Identifies complications so they can anticipate them in surgery.

The Future

The use of 3D printing in healthcare remains a novel practice ‏with room for increasingly sophisticated applications.

The Jacobs Institute judiciously applies this technology ‏to advance physician training, improve device testing, and ‏strengthen surgical planning. Surgical planning is still done on ‏a case-by-case basis for highly complex surgeries to reduce ‏complications and, hopefully, to improve patient outcomes. ‏Patients, physicians, and hospitals will reap the benefits, as ‏3D printing and the JI’s experience and processes evolve. ‏The future is bright for 3D printing and health care. Customising ‏surgical planning for complex cases bolsters hope for better ‏outcomes with patients suffering from vascular diseases. ‏The JI is uniquely positioned to push the envelope in developing ‏this technology. By leveraging its relationships with ‏surgeons, researchers, the medical device industry, and other ‏companies such as Stratasys, the JI can impact the future ‏of vascular medicine in Buffalo and beyond.

The JI’s was designated a Stratasys 3D Printing Centre of ‏Excellence in Healthcare in April 2016

Key Points
  • The JI uses 3D printing in a variety of ways, including physician training, device testing and surgical planning.

  • Biomedical engineers can transform patient scans into realistic, anatomically-specific 3D printed models of patient vasculature, using sophisticated computer software.

  • 3D printers, engineers, researchers, and surgeons located in one facility, facilitates a collaborative planning approach to impact patient outcomes for complex vascular surgeries.

  • Surgical planning for complex vascular surgeries benefits patients, physicians, and hospitals.

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