As 3D printing makes its way into patient care, teams of medical professionals must become familiar and comfortable with the technology that can help to save their patients’ lives through personalized care. 3D printed anatomical models, virtual surgical simulations, patient-specific medical instruments, and more high-tech tools are making their way into hospitals at a rapid rate as the medical community recognizes the benefits that 3D technologies bring to patient care. The applications for these tools are among the most heartwarming (and heart-saving) in the entire expanse of 3D printing, and it is with great honor that we are allowed a look inside the goings-on in lifesaving uses, and talking with those who are at the forefront of such activities — including some truly impressive women, as we continue to highlight the achievements of women working with 3D technologies in our Spotlight on Women series.
Dr. Dee Dee Wang (Md, FACC, FASE, FSCCT) is an experienced physician who currently carries many titles, including: Director of Structural Heart Imaging at Henry Ford Hospital’s Center for Structural Heart Disease, Medical Director of 3D Printing at the Henry Ford Innovation Institute, Clinical Assistant Professor with Wayne State University’s School of Medicine and the Director of the Cardiac CT CoreLab at Henry Ford Hospital’s Center for Structural Heart Disease. I had the pleasure of meeting her last month at Materialise World Summit in Brussels, an event with a full agenda of high-level professional speakers; Dr. Wang spoke in a session entitled “Critical Role of 3D Technology in Transcatheter Mitral Valve Therapies.” As her biography for MWS stated:
“Dr. Wang is a Level 3 Cocats trained in Echocardiography (with 3D TEE), Nuclear, and Cardiac CTA; and a Level 2 Cocats trained in Cardiac MRI and Cardiac PET. She specializes in Interventional Imaging in Structural Heart Interventions including Transcatheter mitral valve replacement therapies, tricuspid interventions, mitral e-clip, complex TAVRs/adult-congenital cases, LAA interventions, and ASD/PFO closures. Dr. Wang’s research interests are focused on advancing patient safety and procedural outcomes utilizing 3D+4D imaging and 3D printing for high-risk Structural Heart Interventions.”
Dr. Wang and I sat down to discuss her team’s work at Henry Ford so far as 3D printing is concerned. The patients she treats are not candidates for open heart surgery, she explained; they’re too sick, too old, too frail for such an invasive procedure, and are deemed too high-risk by surgeons.
“We take care of the sickest of the sick patients,” she explained.
The value in her field for 3D technologies isn’t necessarily a 3D print itself — though these are increasingly used — but is in CAD modeling, which allows Dr. Wang and her team of cardiologists to customize a procedure. Understanding the exact anatomy of a patient’s heart is important in the best case scenario for the fittest patient, but for those coming to Dr. Wang’s team for care, this is an even more critical requirement, particularly as surgery isn’t an option. The team works with catheters that are inserted into patients’ bodies through, effectively, a straw. Unlike surgeons, she explained, her team cannot manipulate their surroundings and have limited tactile sensation during a procedure.
“Using Mimics allows us to take a patient’s heart and see everything we want to anticipate,” Dr. Wang said. “So each patient’s procedure is safer, and is customized for them.”
Materialise’s Mimics software allows for accurate, efficiently-made patient models that bring incredible benefit to customized care — especially when customization can be hard to come by. The devices Dr. Wang and her team use in their cardiac procedures are not personalized for each patient: “We have only four device sizes for the whole world’s population,” she told me, because this field in medicine is so new. She expanded on this:
3D printing does come into play as well at Henry Ford, as the Ford Motor Fund Grant and donations support the work of the 3D printing center and the institute. Thanks to the hospital’s support and those donations, Dr. Wang said, they’re able to provide this level of patient care at no charge. While more 3D printing is coming to hospitals, the insurance system is still catching up to the newest technologies, and so much of this is not currently reimbursable through insurance; the patients in question in these cases, though, are so high-risk that there is no option other than providing the best care.
“You can imagine the difficulties in fitting four heart valve sizes to the population, so everything we can do to customize patient-specific modeling improves procedure outcome, minimizes complications, customizes the device to the patient more than we could otherwise.”
“We need to have a level of accuracy and consistency that cannot afford a mistake,” Dr. Wang told me of their efforts with 3D printing. “We’ve done over 400 3D prints in adult structural dimensions. We started in 2013. We hit 300 models in September, then 400 this month [April]. We’re seeing exponential growth because once we had those tools available we could use them more and more. We can retrain and rewrite how we do procedures in medicine by having an idea of what to expect before we go into a procedure.”
A massive benefit of patient-specific anatomical models to both doctor and patient is a deeper understanding of procedures; while the physician is able to enhance expectations and preparations for procedures, a patient is able to better comprehend just what is happening to them. This allows them to grasp what is happening to their own bodies, as well as how their medical team is set to address it. And it doesn’t hurt that “3D printing” still has an appealing ring to it, either.
“3D printing is the hottest research right now. ‘3D print’ when you say it is very sexy,” she explained. “The value of a 3D print is that we can show you something on the computer screen, turn it upside down, left and right, but it doesn’t have a fear factor. The 3D print allows us to put a scale model to the patient’s body. When you feel it and you see it and the accuracy is to within 1mm of the CT scan, that fear goes. You can zoom in and zoom out on a computer screen, on a 3D print it’s fixed. In all of our work we’re doing with 3D modeling, our vision is to make a sustainable cure for patients.”
“I’m in Detroit, it’s the home of the Big Three,” she noted of the city’s history with automakers. “Everything is automotive technology, the latest and greatest car; even in the ’80s, a car has more options on a radio than we have heart valve options in 2017. Automotive tech in 2017 is already driverless cars… It’s complex. If you tell a patient that a car has more crash testing than a medical device for your body does, you get shock. To get that same level of accuracy as we do to driving a car — it’s kind of sad that a car has more options with a radio or colors than the whole world’s population has options for heart valve sizes. The question is, which has more value, the life or a car? At Henry Ford Hospital, our vision under the father of trans-catheter valve, and my position as director of the 3D lab, is to bring automotive technology into medicine to patients for trans-catheter heart valve therapies because they deserve better, they deserve more.”
At Materialise World Summit in particular, Dr. Wang noted that on-site were a car and 3D printed glasses — but no images of sick patients. Medical is a large and rising application for the latest in technology, but it can be easier to show off automotive and optical solutions that are more palatable in a conference exhibit hall. MWS did indeed make an effort to showcase medical applications, as healthcare was one of the two sessions of presentations, alongside additive manufacturing, but had a smaller showing in the exhibition/networking area. Dr. Wang is passionate about offering the best in technology to those who actually need it — people.
“The investment should be in patients. People don’t want to die. People come to Henry Ford Hospital for hope, to possibly look into the opportunity they can live. They’re choosing to fight to live. As physicians we take something called the Hippocratic Oath, to do no harm to patients. So any tool we have, 3D print, CAD, we’ll take it, we’ll use it, because it’s better than we have right now. There are great visionaries and people, but we need to show them what the reality is in medicine, because it’s kind of an ugly reality. Then they can go back to their nanotechnology and their virtual reality; and they should, it’s cool stuff. But as a physician, advocating for our patients — they need our help,” she said emphatically.
“It’s hard to tell a 75-year-old man turned down for open heart surgery that we can’t help him because his heart is too big and we don’t have a valve that size, and have to tell him that he has six months to live, and hear his wife say, ‘that’s not fair.’ We have all this technology and yet I can’t help a 75-year-old man. At Henry Ford, we’re a very tight-knit center of heart disease group, we share the same drive fighting for our patients, we have a bond with all our patients because they come to us seeking hope. Every life saved is a win for us. The power of this is our experience is driving what new valve design should be. If we don’t speak up, people don’t know what physicians’ needs are and what patients’ needs are. Instead of waiting for industry to come to us for ideas, we’re doing what we can real time to help patients.”
The work being done in the Henry Ford Health System is inspiring indeed; all doctors clearly care about their patients, but the drive for bringing them the best was more than a passing undertone in my conversation with Dr. Wang. Within the next few months, I will be visiting the facilities in Detroit for a first-hand look at what technology can bring to the patients who need it to live. Not all 3D printing applications have life-or-death stakes, but the technologies that the hospital system works with can be very literal life savers.
With physicians like Dr. Wang advocating for the use of technology, there is a call to action for those developing and commercializing (and making insurance-reimbursable) new techniques: help people.
“For R&D in industry, the way it’s designed is that looking at the business model, what’s the biggest need in medicine right now? Then they design for that need, do a market analysis. That doesn’t mean there aren’t other needs not met yet. If others see money being generated, they follow that same path. For patients in our care that have not been presented with a commercially available option yet, they don’t have that lifespan to wait for that R&D to come to them, hence we’re forced to innovate and find more ways to help them. We can’t wait for what industry is providing. We as physicians have to lead to tell industry what our patients need,” Dr. Wang said. “We need to put physicians back into the business side of medicine.”
The bottom line for business comes in the form of money, that’s no secret; for patients, the return on investment is dearer than that. Investment into simulation technologies, 3D printing for medical applications, and bringing these technologies into hospitals and into the hands of those who can use it for the good of patients is necessary. For specialized cardiologists to only have four standard valve sizes for the nonstandard shape of humanity as a whole is not acceptable in a longer-term view. Patient-specific care is the future of medicine.
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If you are interested in sharing your story, or know a woman we should get in touch with for this new series, please reach out any time. Send us an email or connect on Twitter. We’re looking forward to sharing more stories about women in 3D printing. Find all the features in this series here.