Surgery sometimes can yield surprises for physicians as they operate on the human body. Now, three-dimensional modeling can take away some of that guesswork.
In fact, for many physicians, there’s little that can replace the ability to hold and manipulate an accurate model of the exact area of a patient’s body that will be operated upon.
At Mount Sinai Health System in New York, that capability can be offered to its physicians, through a specialized department called the Medical Modeling Core, a collaboration led by the Department of Neurosurgery.
The new effort serves Mount Sinai physicians who can get fast turnarounds of as little as 24 hours to receive accurate models of body structures. The Medical Modeling Core can fast-track model delivery, using radiological image data and specialized segmentation tools and computer code to expedite the process.
“Our simulation, prototyping, and 3D printing resources developed here at Mount Sinai are rare for a medical institution,” says Joshua Bederson, MD, professor and system chair for the Department of Neurosurgery at Mount Sinai Health System and Clinical Director of the Neurosurgery Simulation Core. “These models are used in the planning stages for minimally invasive approaches and can be a trial run for the surgery. In conjunction with simulation, they also play an important role in the patient consultation process.”
The service supports Mount Sinai physicians who can consult with engineers in the modeling department, which will provide virtual reality, simulation and three dimensional printing services on a low-cost, fee-for-service basis.
In-house design and production of the 3D models also leads to significant cost savings for Mount Sinai physicians. For example, a print that would cost $500 to model at the hospital could cost ten times that through a vendor.
The rapid prototyping center uses four 3-D printers as well as a laser cutter to produce patient specific anatomical features for pre-operative planning, says Anthony Costa, assistant professor for the Department of Neurosurgery and scientific director of the neurosurgery simulation core.
The service started about a year ago with a focus on creating models in advance of neurosurgeries, Costa says. “Over the last year, we’ve recognized a lot of scope beyond neurosurgery,” he adds. “Now, we’ve launched system wide, and physicians can come to us and consult with us on strategy for 3D modeling.”
While new applications come up all the time, the modeling unit does most of its work in doing models of tumors or with orthopedic procedures. “Tumors can be surrounded by a number of critical structures, such as cranial nerves, and surgeons have to really understand the relationships between the tumors and those structures before getting into surgery,” Costa says. “And we’ve done a lot of work with spine, orthopedics and pediatric cardiology. With these all, a 3D model can help you understand the surgery by holding the focus of the procedure in your hand.”
The Mount Sinai effort works because it draws together engineers who can create the models with information technology and the physicians who bring clinical expertise. In working together, they help each other in understanding what is critical to represent from a clinical side and how to overcome limitations in the technology in creating a model.
While the technology is advancing rapidly, “the process for generating 3D models has not made as much progress,” Costa says. “We specialize in image analysis from MRI, and we bridge the gap from what we can see in the image and what we can generate,” he adds. “It’s still very hard for current techniques to generate models from images—they are not very well automated.”
Mount Sinai’s department also is aiming to reduce turnaround times, able to create models in as little as 24 hours. “As a general rule, we guarantee a 72-hour turnaround,” Costa notes. “We’ve been able to do this because Mount Sinai has invested in the prototyping and engineering skills required to do this.”
The use of 3D modeling by other healthcare organizations may be limited because of the investment needed in both equipment and expertise. “It’s one thing to create one spectacular model by working on it for a very long time using expensive printers, but it’s not sustainable at the speed and scale we want to achieve.”
In only the short time the modeling service has been in existence, its models have made a difference in procedures. In one orthopedic hip procedure, a model made of the head of the femur was able to assure the surgeon doing the procedure that enough healthy bone remained there to reduce the complexity of the reconstruction and reduce the time and effort needed in the procedure.
In another, a young girl with scoliosis, or curvature of the spine, was afflicted with nearly a 90-degree bend, and the surgical goal was to implant hardware to straighten the spine. “We printed a model and the surgeon was able to orient it to the patient and to understand exactly where he was cutting,” Costa says. “It wasn’t a case where he knew in advance what he was going to do, so it really made a difference in the success of the procedure.”
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