Courtesy of Intermountain Healthcare

Medical innovators use 3D modeling to remove brain tumor

By Cara MacDonald, | Posted - Jan 26th, 2019 @ 8:35am

SALT LAKE CITY — Intermountain Healthcare is utilizing 3D modeling technology to improve patient experiences and help surgeons prepare for difficult surgeries.

Still, in a testing phase, some Intermountain patients have been able to experience this new technology as they underwent treatment for significant medical conditions.

Cheryl Ledward, a local Utahn, awoke one summer morning and noticed that there were spots in her vision where she couldn’t see some things.

“I noticed when I was looking at my phone that there were certain spots where I couldn’t see very well,” she explained.

Ledward was a little concerned and visited her doctor, who suggested that she go and have some eye tests done. They did a regional scan, which confirmed that a tiny vein had a blockage and it had burst and bled which caused some of the visual field loss.

Courtesy of Intermountain Healthcare

The specialist said that while there wasn’t a huge loss to her visual field and that her brain would likely fill in the gaps on her vision loss, she ought to do her due diligence and get her glucose, cholesterol, and carotid artery checked just to be safe.

“It was in the process of doing those screening tests that they did a CT of my neck which came back with some increased velocity in my left carotid,” Ledward said. “Based on that [my doctor] ordered a CT of my head and neck, and that’s where they saw the brain tumor.”

Sandwiched neatly between a nest of nerves and blood vessels, just behind her left eye and next to her internal carotid artery, the tumor was in a very precarious position.

“I was not expecting that diagnosis at all, it was a real shock to me,” Ledward said. “I had experienced a few headaches but they weren’t intense, they were mild.” So mild, in fact, that she assumed they were just dehydration-related from the hot and dry summer.

The 3D model

Ledward’s doctor referred her to a neurosurgeon, Dr. Paul House, MD, shortly after her diagnosis, but as her tumor was benign (meaning that it was not cancerous and wouldn’t spread to other organs in her body), she faced a long wait as the surgeon dealt with more dire cases.

“It was tough waiting a month and a half to even get in to see a neurosurgeon who could give me more information,” she said, adding that every single day it felt like the tumor was growing more inside of her.

Ledward grew so worried that a friend from work suggested she get in touch with Rami Shorti, who built 3D models of people’s anatomy prior to their surgeries. Shorti, a mechanical engineering graduate with a Ph.D. in biomechanics, was more than happy to help.

MRIs and CTs are 3D scans, but doctors look at them on 2D screens. Further, no scan shows the whole picture, so understanding the bigger idea can get complex. 3D printed models merge all scans into one tangible, tactile product which can be viewed from all angles.

Shorti was able to get a model of the tumor to Ledward during her long waiting period to get in to see House. She was able to see the images better, as well as where the actual tumor was located. A big concern of Ledward had been whether she would lose her eyesight because the tumor had looked to be pressing on her optic nerve in the initial scan she was shown.

Courtesy of Intermountain Healthcare

“When Rami sent the images, it showed me that there was actually a little bit of space between where my tumor was and my optic nerve,” she said. “It gave me a lot of comfort knowing that there was a good chance that the surgeons would be able to remove it without it affecting my eyes.”

Shorti is part of an innovation lab where they look at innovation technologies and their potential uses in healthcare. He believes that 3D printing has massive potential in the medical industry.

“To a product or service, there are different layers of value,” he explained. “One of those is functional. If you were to look at the 3D model, the surgeon is able to look at all the images and interact with it all in one tangible object, the closest thing to interacting with the patient anatomy before surgery.”

It helps them see the full picture without getting bogged down under many scans. Shorti added that the next project is to see how these models can be adapted so that doctors can actually practice dissecting them, such as in a tumor case where a portion of the organ might need to be resected or cut away.

“We’ve explored soft materials that have the capability to be cut and mimic tissue material, so when the tissue is cut, it feels like real tissue being cut,” Shorti said. “Then the next phase would be to look at it as a tool.”

Then there’s the emotional value of the product.

“Typically, the patients will have a scheduled meeting with the surgeon or doctor and they’ll consult around their condition,” Shorti explained. “But most of the time, they are listening to terminology they aren’t familiar with or they’re looking at a screen showcasing images that typically a radiologist is trained to read.”

Patients don’t generally understand what these enigmatic medical details mean. Having a physical model helps them to feel involved in their care, as they can see the condition they are facing. “Patients feel at ease and they are able to trust that the surgeon is going to do a great job.”

The Surgery

“Dr. House let me have a scan a few days before my actual surgery was scheduled,” Ledward said. “Rami would have time to build a model and get it to [House] before he operated so he could see it before the surgery.”

The model helped House clarify and consume what direction he should take in entering to get to the tumor.

“Using the model, it helped me think about different approaches and anticipate what I was going to find,” House said. “It allowed me to take a less invasive approach than originally planned.”

Ledward was told that her surgery would take five hours and that she could expect to be in the hospital for about five days. Her surgery was complete within two and a half hours and she only spent two days in the hospital. Ledward then spent five weeks recovering at home before heading back to work after a full recovery and with non-visible minimal scarring.

“I’m even amazed at myself about how quickly I recovered,” Ledward exclaimed.

After the surgery, House went to visit her with a big smile and good news. He had gotten everything, even the tumor's blood supply.

“I can’t even tell you how wonderful it is to see the broadest smile on your surgeon’s face and for him to tell you that he managed to get everything when initially he didn’t think he would be able to,” Ledward said.

Courtesy of Intermountain Healthcare

3D modeling in medicine

“Currently, even though this technology is getting more and more adoption, it’s really not something that is done for every patient,” Shorti said. “It’s done in settings where we need to explore and test assumptions that we haven’t yet explored. Typically, we start with cases that are pretty complex, with the surgeons following the same standard of care, so we can explore the possibilities without interrupting patient care.”

Shorti hopes that in the future 3D modeling will become a standard in patient care. He added that medicine as a field is becoming more and more collaborative with many more fields within the hospital. His engineering background has fit in well in the medical field, and he appreciates that modeling provides a means of combining art, science, and medicine.

“Creating a 3D print leverages your engineering skills as well as your artistic skills to make useful models both visually and physically," he said.

Cara MacDonald

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