lockup_cvm2Most people can tell you a story about what made them finally decide to acquire a 3D printer or to start learning about the technology. For Dr. Michael Deveau, Radiation Oncologist and Clinical Associate Professor at Texas A&M College of Veterinary Medicine and Biomedical Sciences, it was a small dog named Cootie that motivated him to acquire a Gigabot 3D printer from re:3D for the college.

Cootie is a Bichon Frise who was suffering from a case of Cutaneous Lymphoma, a rare type of skin cancer. Her owner had tried multiple treatments, but nothing had been able to cure the dog until she was brought to Dr. Deveau. If you follow 3D printing news at all, you’ve probably read multiple case studies of doctors and surgeons using 3D printed models to guide them through surgical procedures, but Dr. Deveau did something completely different to help Cootie. Watch the full story below:

The treatment that Dr. Deveau devised for Cootie is completely new in the veterinary field, and we were lucky enough to be able to talk to him as well as to re:3D Global Sales Manager Morgan Hamel, who documented Cootie’s story, about the case and how 3D printing can change veterinary medicine.

What made you start looking into 3D printing?

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Dr. Michael Deveau

Dr. Deveau: “Our interest in 3D printing developed from the need to address a specific clinical deficiency. Cutaneous epitheliotropic T-cell lymphoma (CTCL) in the dog is an uncommon neoplastic condition with a poor prognosis. Many treatment strategies have been reported, but in general, the prognosis is poor especially in those patients with advanced or diffuse cutaneous presentations. In humans, total skin electron beam radiation therapy (TSEBT) is considered the primary treatment modality for late stage or early stage therapy refractory mycosis fungoides. While various permutations of techniques exist, one of the most common being the Stanford 6-dual field technique, several challenges exist requiring expertise and an establish infrastructure to successfully and safely implement.

In veterinary medicine, a similar TSEBT 6-dual field technique was developed and delivered in a cadaver dog utilizing the assistance of a medical physicist with expertise in total skin electron beam therapy. Although determined mechanistically feasible, the time commitment for the patient and the technical staff was not realistically clinically implementable. It was reported that several hours were required to deliver prescription dose to each of the twelve treatment fields and this was ignoring real-time patient treatment factors such as anesthetic induction and monitoring.

Helical tomotherapy is a form of intensity-modulated radiation therapy (IMRT), in which all the functional parts of a 6-MV linear accelerator are installed on a ring-style gantry and rotated around the patient as the patient translates through the bore. In veterinary medicine, helical tomotherapy offers several potential advantages for total skin treatments over other conventional C-arm style linacs. With helical tomotherapy a highly conformal and homogeneous dose distribution can be achieved but the combination of air to skin transition, obliquity in treatment beamlets, and the motion impact of breathing make surface doses difficult to calculate and predict.

Three dimensional printing is revolutionizing the manufacturing industry by offering a potential solution via the ability to rapidly create medical imaging and computer-aided design models. In veterinary radiation oncology, the technique offers the ability to create spatially unique or patient-specific structures by utilizing deposition tools that can extrude a variety of near-tissue equivalent materials. Leveraging these technologies, as a proof of concept, we developed a treatment strategy for diffuse manifestations of CTCL (or any cutaneous condition responsive to radiation therapy). In short, we print the shell of a patient that we use to encase them in at the time of therapy. This results in taking a strategy that was deemed infeasible and making it feasible both in implementation and logistics.”

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Cootie

What made you choose Gigabot in particular? Why is it well-suited to a case like this?

Dr. Deveau: “Our molds are spatially accurate shells of our patients which means the volumes we print tend to be quite large. While smaller printers are more than capable of printing a shell for small sized dogs, a majority of the patients we treat with this condition are much larger. Gigabot provides us a platform with ample print resolution and robust build volume to meet all of our clinical needs. Additionally, and serendipitously, they are a loco-regional company which made our logistical interactions easier. We also found the company took an interest in our proposed project and worked closely with our relatively naive team (from a 3D printing technology perspective) to ensure our endpoints were achieved.”

Morgan Hamel: “What Dr. Deveau was looking to do — essentially print a full-size shell of a medium-sized dog — would have been a much more laborious process on a smaller-scale 3D printer. With desktop printer build volumes traditionally less than a foot cubed, he would have been spending a lot of time breaking up his models, printing them out in smaller chunks, and then gluing them together to form the full-body shell. This is what prompted Dr. Deveau to look for something larger which also fit within the veterinary school’s budget. His Gigabot’s two-foot cubed build volume allowed him to print the shell in much larger pieces, minimizing the post-printing work on his end. Similarly, he was able to let these long prints run throughout his work day and even overnight, rather than having to come back every few hours to remove a smaller print and load up a new one.”

How could other veterinary or medical facilities benefit from a printer like this one?

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Morgan Hamel

Morgan Hamel: “I feel like the common thinking is that the 3D printers used in the medical field need to be those of the highest quality and resolution. You often hear of ultra-complex models printed by hundred-thousand-dollar-plus machines. But oftentimes, organizations — especially universities and teaching institutions — are limited by tight budgets where pools of money are being competed for by different departments which all want different pieces of equipment. So these high-price-tag printers are off the table, and the doctors and professors who have a genuine use for the technology are unable to take advantage of it. But in many cases these ultra-high-quality printers aren’t actually needed — the intended applications can be readily and sufficiently done on 3D printers one tier down, in the ‘desktop printer’ class of print resolution. Suddenly you’ve opened the door to this incredible tool for doctors and professors teaching our future doctors. Gigabot is at a price point that makes this tool accessible to many of the hospitals and schools that otherwise might reach an impasse if they wanted the ability to 3D print larger-scale models.

I learned from Dr. Deveau that there are not many veterinary teaching hospitals in the US with the ability to treat using helical tomotherapy — that machinery is only at a couple vet schools around the country. However, what Dr. Deveau discovered after getting a Gigabot for this one specific use case is a phenomenon that we’ve seen happen over and over at different facilities: an organization gets a Gigabot in for a specific use or project, word gets out about the new 3D printer, and suddenly people from other departments are coming to request time on the bot for other projects that weren’t the original reason for getting a Gigabot in the first place.

So even after Dr. Deveau’s project printing the shells for Cootie’s treatment was complete, their Gigabot has been kept busy printing a variety of other parts for people in different departments of the hospital. He’s done surgical models for clinicians in orthopedics and neurology so they can practice on a patient’s specific case before they actually get in there during surgery; he’s printed ear models from flexible filament that were implanted into stuffed animals for vet students to practice giving notoriously tricky ear exams to dogs; and he’s done some really off the wall work for a researcher studying how to reduce the problem of urinary crystals in goats, printing out quick, cheap implants mimicking the design of a human IUD, which she discovered worked well but were too costly for her to purchase on her research budget. So I think the lesson that we can learn from Texas A&M’s experience so far is that you might not even know how many diverse applications may come out of the woodwork for a 3D printer until you actually get one on campus. From the obvious use cases of surgical models and teaching tools for the classroom to goat IUDs…it’s really a matter of getting the bot there and letting the creative genius of the resident doctors and professors take over. To reappropriate the movie quote, ‘If you buy it, they will come.'”

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Cootie in her 3D printed shell

How else do you think you may use 3D printing in the future, and how do you see it changing veterinary medicine? Do you have any ideas for experimental uses we may not have seen before?

Dr. Deveau: “We have several uses and potential uses for the technology. We use 3D printed models at all levels of veterinary education from representative models for student use during their formal didactic years to surgical planning models that our surgeon use on the clinic floor and at the time of surgery. Clinically it has been used to create patient-specific splints and various limb or joint immobilizers. In veterinary radiation oncology we have used it not only as described above but it has allowed us to fabricate patient and species-specific immobilizers as well as better solutions for bolus and tissue compensator use. From a research prospective we have created a temporary bladder implant which allows us to monitor the impact of diet on urine composition. And there is interest to investigate the use of the technology to address several advanced imaging (current implants are either not safe to image or reduce image quality) and surgical reconstructive limitations (being able to replace defects created by trauma or disease such as cancer) we have in veterinary medicine.”

gigabotMorgan Hamel: “Using TAMU as a benchmark, I think the access to this technology is going to open up doors in ways we might not even be able to imagine right now. The key word here is ‘access.’ 3D printing has been around for decades, but it’s been prohibitively expensive for the majority. There have always been clear uses and applications in the medical field for 3D printing, so now with accessibly-priced 3D printers, the doctors and professors out there will finally be able to make these applications a reality. And the more people who have access to the technology, the more ideas for new and exciting applications will spring up. In Dr. Deveau’s case, the treatment technique he developed for Cootie was completely unheard of — it was an idea he conceived of after diving deeper into the treatment of Cutaneous Lymphoma and what was holding veterinarians back from being able to implement a feasible treatment.”

What advice would you give to a veterinarian or other medical professional who wants to use 3D printing in their practice, but doesn’t know where to start?

Dr. Deveau: “The field is maturing and becoming more readily apparent but there is no simple plug and play solution to 3D printing. What we found especially challenging was that while the printer was fairly straight forward to use with limited experience (because of the efforts by re3D to ensure their products, documentation, and support are user friendly and evolving), creating the files to address clinical solutions being printed required most of the work. Many software packages utilized to create these models are either expensive and or incomplete meaning that typically it requires the user to can familiarity with many. This can be time consuming and potentially unrewarding. What helped us tremendously was the guidance by individuals more familiar with the technology at re3D and on campus here at Texas A&M University. We also found several videos on Youtube on the various topics or questions we had which played a major role in reducing our learning curve. And of course, we can’t ignore trial and error!”

Are there any other thoughts or insights you would like to share?

Dr. Deveau: “I am veterinarian and my first goal is to advance veterinary healthcare. Often our patient’s healthcare and advancement of our standard of care is limited by cost. 3D printing technology provides us a cost-effective strategy to address several of these cost and material limitations. I am also a researcher believing what we learn from our patients can benefit our human counterparts. Being able to take from concept to fabrication, especially in a cost-effective manner, broadens our collaborative and translational landscape in the research we perform. Strategies utilizing this technology can be designed and implemented in veterinary companion animals (as a more representative model for humans as compared to rats or mice) and ultimately the techniques can be migrated eventually to humans.”

You can learn more about 3D printing and veterinary medicine at TAMU below:

Discuss in the Vet 3D Printing forum at 3DPB.com.

 

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