Models for Success
Spring 2020 | By Robert Stephens
On a Sunday evening, Jack聽Stubbs鈥� phone rings. He聽thinks about letting it go to聽voicemail until he notices聽who is calling: a doctor from Nemours聽Children鈥檚 Hospital. A small child with聽badly impacted teeth needs surgery聽right away, but it鈥檚 complicated,聽possibly life-threatening. The medical聽team looks to Stubbs for help.
Stubbs is not a doctor. As the聽director of the Prototype Development聽and 3D Print Lab (PD3D) at UCF, he鈥檚聽basically a gadget guy. His demeanor聽is as casual as the jeans he wears to聽his office at Central Florida Research聽Park. Here, Stubbs shows what first聽appear to be toys. Behind him, the聽constant drone of printers creates a聽soothing backdrop of white noise.
鈥淭his is the cool stuff,鈥� Stubbs says.聽What you see barely begins to convey聽what he means. Over here is a head聽small enough to be on an American聽Girl doll 鈥� except it鈥檚 more humanlike.聽Hey, isn鈥檛 that a heart? It鈥檚 remarkably聽realistic. Oh, and there鈥檚 a rib cage with聽slime around a kidney.
鈥淭hat鈥檚 a patient-specific replica of a聽child鈥檚 midsection,鈥� says Stubbs. 鈥淭he聽green stuff [represents] the tumor. We聽don鈥檛 know the child鈥檚 name or where聽the family lives, but I鈥檓 guessing it鈥檚 a聽girl, about 5 years old.鈥�
In other words, we鈥檙e looking at the聽closest depiction possible of a body聽part of an actual child. We鈥檙e also聽looking at her cancer.
鈥淎 tumor isn鈥檛 the nice, tidy lump聽you see in pictures. In real life it鈥檚聽messy, and it makes the job of a聽physician challenging. That鈥檚 why聽these models are so valuable. We鈥檙e聽helping doctors save lives,鈥� Stubb says.
To be able to look at a model of a tumor from all angles, without the restrictions of an image on a computer screen, is completely changing how we are planning complex surgery,鈥� says Physician Craig Johnson, who is enterprise director of interventional radiology at Nemours Children鈥檚 Health System and chair of the department of radiology at Nemours Children鈥檚 Hospital in Orlando. (Photo by Nick Leyva 鈥�15)
鈥淎 tumor isn鈥檛 the nice, tidy lump聽you see in pictures. In real life it鈥檚聽messy, and it makes the job of a聽physician challenging. That鈥檚 why聽these models are so valuable. We鈥檙e聽helping doctors save lives.鈥�Jack Stubbs
Physician Craig Johnson chairs聽the department of radiology聽at Nemours Children鈥檚 Health聽System. He sees the young lives聽that are at stake and talks with the families聽trying to cope. He also appreciates the聽importance of Stubbs鈥� contributions.
鈥淭he key to advancing medicine and saving聽lives is to combine the minds of doctors,聽clinicians and engineers,鈥� says Johnson.聽鈥淭hat鈥檚 why Jack鈥檚 patient-specific models are聽game changers. You have to remind yourself聽that each model is an exact replica, down to 0.1聽millimeter of what is actually inside that child.鈥�
The phone call Stubbs received on Sunday聽helps illustrate the lifesaving process. A doctor聽tells him about the patient鈥檚 teeth being buried聽deep among neurological tissues. Highly聽developed MRIs and CT scans are helpful only聽to a certain point.
鈥淐an you help us?鈥� the doctor asks.
This is what enticed Stubbs and Fluvio Lobo,聽principal research and development engineer聽at PD3D, to leave their lab at the University聽of Minnesota and take positions at UCF.聽Here, they have the opportunity to combine聽technology, healthcare and education to do聽something incredible 鈥� one precious life聽at a time.
At UCF鈥檚 PD3D lab in Central Florida聽Research Park, Director Jack Stubbs, Principal聽Research and Development Engineer Fluvio聽Lobo, Director of Generative Design Jim聽Inziello and artist Robert Sims 鈥�19 collaborate with Nemours to produce the final 3D-printed surgical planning models. (Photo by Nick Leyva 鈥�15)
A few hours after the phone call, Stubbs鈥櫬爐eam receives images of the child鈥檚 skull.聽Then the magic happens. PD3D director of聽generative design Jim Inziello and researcher聽Robert Sims 鈥�19 add color-textured surfaces聽and features that will allow the doctors to聽better visualize the focal points of the surgery.聽The information is fed into a Stratasys Polyjet聽J750 printer 鈥� one of the most advanced 3D聽printers of its kind, and one of the first to use聽FDA-approved software to develop anatomical聽models. Soon, a replica of the child鈥檚 jaw will聽be in Stubbs鈥� hands. He will deliver it to the聽physician, who in turn will use it with a team聽of neurologists, reconstructive surgeons and聽nurses. They will see the jaw and the buried聽teeth and the brain, not in pictures, but in the聽closest thing to real life. Then they will practice聽the surgery before the surgery.
鈥淚t takes out the guesswork, big-time,鈥� says聽Johnson. 鈥淭he surgeons can see everything聽the way they鈥檒l see it when they open the聽actual body rather than on a two-dimensional聽flat-panel TV. Sometimes they鈥檒l change their聽approach, maybe change an angle to remove a聽tumor and also save a kidney rather than taking聽it all out.鈥�
It鈥檚 something Johnson could barely imagine聽when he and a colleague first saw a 3D printer聽at Best Buy in 2014 and thought, 鈥淲hat聽if?鈥� The future seemed to arrive fast when聽Nemours partnered with the PD3D lab three聽years later. Their first case together provided聽the ultimate test.
鈥淲e had a teenager whose family had been聽told there was no way to treat a tumor that had聽grown to the size of a small basketball,鈥� says聽Johnson. 鈥淭he tumor was around too many聽of his organs, and it had blood vessels around聽it. Chemo wasn鈥檛 working. He had no more聽options.
The Nemours doctors weren鈥檛 sure how聽helpful a model from the PD3D lab would be.
But they practiced on the model prior to the聽surgery and strategized how to specifically and聽safely remove the tumor. The boy walked out聽of the hospital three days later.
鈥淚t鈥檚 been two years, and he鈥檚 had no聽recurrence of the cancer,鈥� Johnson says.
Pushpak Patel, a radiology technologist, leads 3D printing services at Nemours and works with the hospital鈥檚 CT and MRI groups to make the right imaging for the models. (Photo by Nick Leyva 鈥�15)
While Stubbs and Lobo don鈥檛 have direct聽contact with patients, they do hear the good聽news from the doctors. 鈥淗earing that 鈥� it聽means a lot,鈥� says Lobo.
Word has started to spread. The UCF聽team has provided patient-specific models聽for hospital teams as far away as Seattle and聽San Francisco. Lake Nona Medical City will聽present more opportunities as it grows. Stubbs聽does admit frustration about moving this聽technology out further and faster, even though聽the 3D-printed models are being used in 113聽hospitals in North America and more than 250聽worldwide.
鈥淭hat isn鈥檛 enough. There are thousands of聽hospitals around the world,鈥� he says, holding聽a replica of a rib cage. 鈥淭his only costs $1,200聽to print. We have an opportunity to change聽healthcare 鈥� to make it more affordable聽and to save lives.鈥�
鈥淭his only costs $1,200聽to print. We have an opportunity to change聽healthcare 鈥� to make it more affordable聽and to save lives.鈥�Jack Stubbs
Hospitals, despite copious financial reserves,聽cannot realistically do what鈥檚 being done at聽UCF. It isn鈥檛 just a $400,000 3D printer. It鈥檚聽literally a village, where expertise in 肠辞尘辫耻迟别谤听蝉肠颈别苍肠别, mechanical engineering, 产颈辞尘别诲颈肠补濒听蝉肠颈别苍肠别蝉, psychology and architecture can make聽these tiny heads and hearts come to life.
鈥�Art students are as important as anyone,鈥澛爏ays Lobo. 鈥淭hey paint each model to look the聽way a doctor will see it in surgery. They don鈥檛聽make it pretty 鈥� they make it realistic.鈥�
Stubbs hands over a model of two conjoined聽heads, so small they both can be held in one聽palm. With this model, two lives could be saved.
鈥淚t鈥檚 hard to describe how motivating it is聽when we hear what we hear on the other side聽of this procedure,鈥� says Johnson, referring to聽a child in post-op. 鈥淚t鈥檚 more than a black and聽white image or a piece of plastic. It鈥檚 a living聽child.鈥�
In the laid-back office at Research Park, a聽printer continues to hum. The model of the聽child鈥檚 impacted teeth should be ready later聽this afternoon. Stubbs will deliver it himself to聽the surgical team, who will be given the chance聽to see the nuances and angles they hadn鈥檛 seen聽previously. They will operate tomorrow.
鈥淭his is as real as it gets,鈥� says Stubbs. 鈥淗ow聽cool is that?鈥�
MODELS FOR SUCCESS
A clear plastic was used to create聽a model of 3-month-old conjoined twins聽to allow doctors to clearly see where their聽blood vessels are located. Craniopagus聽twins, those who share a skull but not a聽brain, is a rare phenomenon and separation聽surgery requires surgeons to navigate聽delicate networks of arteries and veins that聽can often be tangled.
This model of an 8-year-old patient’s聽severe scoliosis聽allowed doctors to show and聽explain to the patient and his parents exactly聽how the child鈥檚 spine was curving. It also聽allowed surgeons to determine a surgical plan聽that would be almost impossible to visualize聽and plan using CT images alone.
The yellow object depicts a tumor聽within the abdomen of a 3-year-old patient.聽Surgeons used the model to determine how聽to remove the mass, which was growing聽between his kidneys (shown in dark red)聽and his pancreas (teal), while being sure聽to not rupture any of his veins (blue) or his聽arteries (orangish-red).
To help a 15-year-old patient better understand how a heart聽functions聽and how his particular condition affects it, doctors at Nemours聽Children鈥檚 Hospital used this model, which combines colors and labels to聽illustrate the patient鈥檚 anatomy. For example, the dark blue region in the聽front is a pulmonary artery, magenta is the right ventricle and yellow is the聽left ventricle.