Sometimes, Dr. Rose Ganim, chief of thoracic surgery at Baystate Medical Center in Springfield, lies awake at night contemplating the best approach for a complex operation.
When it comes to surgery, Ganim says, good planning can be the difference between life and death. And that makes getting an accurate picture of what’s going on beforehand imperative.
But even the most technologically advanced MRI and Cat scan machines produce only flat-layered images of what she’ll see in the operating room, and Ganim’s knowledge of human anatomy is all she has to turn over in her mind.
Replica organ models, however, like those printed by biomedical engineer Greg Gagnon in an office in Baystate’s intensive care unit, can get her as close to reality as possible without actually cutting a patient open. Single handedly — with support from the hospital’s administration — Gagnon, who is entirely self taught, is changing the way Baystate surgeons plan for their work.
“This kind of modeling helps me to sleep better, because I can imagine it much more easily,” Ganim says. She is sitting at a table in her Springfield office, and picks up a plastic replica of a large tumor on a patient’s rib cage compressing the right lung.
“On the CAT scan, it wasn’t really clear what was going on,” Ganim says. She sent the scans to Gagnon, who used software to convert the layered images into a 3-dimensional model, isolate the tumor, rib cage, and lungs, and print a replica, to scale, using three types of plastic to distinguish the different elements.
“It was a great illustration, and I was surprised how much more clear things were for me,” Ganim says.
During the surgery, the doctor was able to remove the whole tumor, solidifying 3-D printing as a routine way for her to plan for complex surgeries and educate her patients.
Over the last decade or so, 3-D technology has become widely used in the medical field, where it’s particularly useful to build patient-specific products, according to Dave Follette, director of advanced digital design and fabrication at the University of Massachusetts Amherst’s Institute for Applied Life Sciences. As an example, he pointed out Invisalign, a company that prints customized clear teeth aligners from dental scans.
At UMass, Follette says, the Institute for Applied Life Sciences, which translates research into products, and has seven commercial-grade 3-D printers, and has made orthopedic equipment, such as sockets matched to amputated limbs. Unlike traditional manufacturing, which can quickly mass produce square or circular patterns, Follette says 3-D printers aren’t limited to any specific shape.
“The manufacturing world is rectangles and circles. But plants and animals tend to be more curvy and rounded. The printer doesn’t care,” Follette notes, which makes it easier to prodice hearing aids, braces — “anything that interfaces with you,” he says.
At Baystate, and for doctors like Ganim, printing replica organs to illustrate medical problems has become widely used since Gagnon started applying it there about four years ago.
“It’s another tool that your doctor or surgeon has to use.” Gagnon, says in an interview in the biomedical office at Baystate, where he fixes broken respiratory equipment, which is his main job. “It’s going to, and has already, improved the patient experience.”
Gagnon, 34, has an associates degree in biomedical engineering from Gateway Community College in New Haven, Connecticut. There, he learned how to fix broken medical equipment, which landed him the job at Baystate. His expertise in 3-D technology came by happenstance: He fell into it while looking to replace an expensive clamp that holds ventilator hoses.
“It was a little clamp, and we couldn’t purchase it,” he says. “I tried getting it overseas, and couldn’t find anything. They said, ‘nope, you have to buy this $500 arm, the whole assembly,’ ” Gagnon recalls.
Instead, Gagnon convinced his boss to purchase an inexpensive 3-D printer for a few hundred dollars so he could make the piece himself.
“I started producing these little parts for our department, and Dr. Andy Doben walked by and said ‘I didn’t know we had a 3-D printer.’ And, within a week, he asked if I could print out a set of ribs,” Gagnon says. “I went online and Google-ed ‘how to take a CT scan and make a 3-D printable model.’ I found free software, downloaded the software, and within two days I had four ribs that were connected to a block of plastic.”
Since then, Gagnon’s 3-D prints, now made on a $3,000 machine that can print with a few different kinds of plastic, have reached nearly every corner of the hospital.
These days, Gagnon says he spends as much time as possible converting scans and working with doctors to make models for them.
For the most part, “if one of the docs asks ‘can you make me a model,’ I say ‘yes,’ and push everything else back,” Gagnon says. On average, prints take between 12 and 30 hours, from start to finish. The printing process itself is automated, and can run overnight.
Gagnon’s efforts have cut down on the amount of time surgeons need to spend in the operating room. He points to a printout of a patient’s jaw that’s resting next to a computer.
“This mandible was broken here, and here,” Gagnon says, pointing to two hairline breaks on the intact model.
“In the CT scan, they were separated,” he says, pulling the file up on the computer. The scan clearly shows the broken part which had become misaligned. Using the software, Gagnon realigned the broken bone and printed the reconstructed jaw.
Then, Dr. Michael Spink, an oral and maxillofacial surgeon, fitted metal plates used to hold the patient’s jaw together onto Gagnon’s model, allowing him to avoid doing that time-consuming adjustment on the actual jaw while the patient is in surgery.
“Now, he puts the patient under, cuts him open, puts (the plates) on, drills it in, and he’s done.”
Shorter operations mean safer surgeries, and less money spent by patients, says Dr. Kevin Moriarty, chief of pediatric surgery at Baystate Children’s Hospital. Depending on complications, surgery can cost more than $20 for every minute in the operating room, he says. Thus, saving even just a few minutes is important.
Longer operations also mean more time for problems to develop. Moriarty says.
In his practice, Moriarty uses video cameras and tiny surgical instruments attached to bendable ‘scopes’ during operations, which are threaded through 3 to 5 millimeter incisions.
Because he can’t physically touch anything while he’s doing surgery, and uses a video screen to guide the tools, Moriarty says Gagnon’s 3-D prints are key a key part of his work, both before and during surgeries.
“Sometimes, there are unexpected things that happen, and you have to change your approach,” he says. In that event, having a physical model in the operating room is invaluable.
Outside the operating room, Dr. Michael Yunes, chief of radiation oncology, uses the models to plan radiation treatments and help patients understand what’s going on.
He cites one brain tumor that he successfully treated as an example.
“The key thing here is that these tumors are in a very tight location. The brain stem sits right here, so to try to explain to someone where this tumor is by showing them pictures, that’s very different than handing them this,” he says, holding a 3-D printout of a human skull with a few small tumors inside depicted in red.
The 3-D printouts “give them, number one, confidence that we know what we’re talking about and that we know what we’re doing. It also gives them confidence that they’re choosing the right treatment,” he says.
Looking ahead, Yunes say he can think of a number of other ways to use 3-D printing, such as making custom shields to direct radiation treatment, or creating replica models with a material comparable to the human body on which to test radiation beforehand to test its effects.
Throughout the medical field, the possible applications for 3-D printing are broad. On a table in Gagnon’s office are a dozen or so large plastic screws that he designed and printed to help patients recovering from facial surgery wrench open their muscle-locked jaws. And next to those is a prototype hose clamp that Gagnon designed and printed for a Baystate nurse, who invented the piece over six years of field work. She recently obtained a patent for it.
On the computer, Gagnon clicks opens a model he’s working on that will give surgeons the ability to bend metal braces and plates, similar to those used in facial reconstruction, around 3-D models of a patient’s chest before entering the operating room. He notes another project he’s working on is helping surgeons refine their approach to hernia surgeries by measuring the injuries on 3-D models.
Eventually, Gagnon predicts that 3D printers will be able to make replica bones and other medical-grade items that can be put inside of a patient. Already, at Mass. General Hospital’s Laboratory for Therapeutic 3-D Bioprinting researchers are pursuing technology that could one day print organic human tissue, according to the lab’s website.
The implications for 3-D printing technology in the medical field seem limited only by the imagination.
“When they can print out a heart, then we’ll be in business,” Gagnon says.
Andy Castillo can be reached at acastillo@gazettenet.com.