The Phoenix Children’s Heart Center created a couple of years ago its own in-house Cardiac 3D Print Lab. Dr. Justin Ryan, lead research scientist at the lab, and Dr. Stephen Pophal, interventional cardiologist, explained to MedicalExpo how 3D printed models of babies’ hearts represent a tremendous aid in surgical planning, education and communication with families.
MedicalExpo e-magazine: How did you start the lab?
Dr. Justin Ryan: We started the research at Arizona State University six years ago and about three years ago we got a grant to get a 3D printer inside the hospital. Before that, we were outsourcing the printing, which was an expensive process and quite slow, as well. It would take about a week to get a heart model.
To have our own 3D printer inside the hospital really reduced our turnaround time. In an emergency situation, we are able to 3D print a heart within a 24-hour turnaround, or even in some cases the same day.
In our lab, we have a main 3D printer and two smaller printers that print plastic material. The material we use for our main 3D printer is very similar to resin-like material. The cost of a 3D printer can vary a lot. You can get a do-it-yourself printer from $2,000 to a high-end printer for $320,000. For our main printer, we got something kind of middle line, which is about $65,000.
ME e-magazine: How do you work with the surgeons?
Dr. Ryan: A surgeon or a cardiologist recognizes that they need a heart for a procedure because it is a very complex case and they need to better prepare themselves. So they contact me. That child will have a CT or MRI for the normal standard of care. I recreate a 3D model from that—it is like a reconstruction process that can take up to four hours for very complex hearts. Then from there, I start the 3D printer and it takes about three hours to print a pediatric heart.
ME e-magazine: What do you do with the models once the surgery is over?
Dr. Ryan: Once the surgery is over, we keep them all to build a library that we use for education, either at the local medical college or in the case that a family has a question about their child’s defect. Over the past two and a half years, we produced around 280 hearts.
ME e-magazine: How old are your patients?
Dr. Ryan: We are a pediatric center and we deal with very complex congenital diseases. Our patients are mainly under one year of age and quite a few of them are in the first couple of months of life. We also cooperate with other institutions, so we produce heart models for 85- or 90-year-old patients.
ME e-magazine: Dr. Pophal, what are the benefits of using 3D printed models?
Dr. Stephen Pophal: We use them for surgical planning, cardiac catheterization planning or education for the families. One of the most unique assets of the lab is its location. We have a very busy cardiac clinic and the lab is right in the middle.
Typically, every Monday and Thursday we meet as a committee to discuss difficult patients. Depending on the case, we say that it would improve care if we had a 3D model. So we walk down the hall to the lab, fill out a form and discuss the case with Dr. Ryan. Once the form is complete, there is a priority list to print the model. When Justin has it done, either he hands it directly to the surgeon or puts it on his/her desk so the next morning he/she can look at it, review it all day before the procedure.
Seeing the actual size of the heart and the actual abnormalities in a very simple form really allows you to have good vision of what you need to do during your procedure. And the families are overwhelmingly happy about the models.
ME e-magazine: Does it help you a lot in comparison to previous procedures?
Seeing the actual size of the heart and the actual abnormalities in a very simple form really allows you to have good vision of what you need to do during your procedure.
Dr. Pophal: Yes, I truly believe so. I’m a cardiac catheterization doctor. I pass a catheter up the vessel of a small baby; having a 3D model on my desk before surgery is very useful because I know exactly where I need to steer that catheter in order to put a stent in an artery, for example. I have a road map already in my hand, in my brain, and it makes the procedure go a lot smoother, with less risk to the babies.
The most striking thing about these 3D models, when you have them in your hands, is how small and complex a newborn baby’s heart can be compared to an adult’s normal heart. It’s impressive. The whole heart is the size of a lime.
ME e-magazine: Your main 3D printer also prints colors. What are they for?
Dr. Pophal: With the colors on the heart model, you have a pattern recognition of where things are. It’s like looking at a map in which the different European countries are color-coded. It’s very easy to identify where Germany is, where Poland is, etc.
But if it’s just all black and white with very limited boundaries, it’s sometimes difficult to identify where a country is, even for somebody who is an expert.
So when you just see the colored heart model you can tell the diagnosis probably within 10 seconds as opposed to try to analyze it for a minute or two.