3D Printing & Imaging Health & Biohacking Science
Man Saves Wife’s Sight by 3D Printing Her Tumor
Pamela Shavaun Scott, with a 3D printed copy of her own skull. Her right index finger is indicating the location of the meningioma she had removed.
Pamela Shavaun Scott, with a 3D printed copy of her own skull. Her right index finger is indicating the location of the meningioma she had removed.

The summer of 2013 found Michael Balzer in good health. A few years earlier, he’d struggled with a long illness that had cost him his job. As he recovered, he built an independent career creating 3D graphics and helping his wife, a psychotherapist named Pamela Shavaun Scott, develop treatments for video game addiction. Balzer’s passion is technology, not medicine, but themes of malady and recovery have often surfaced during his digital pursuits. But Balzer didn’t feel the full impact of that connection until that summer, shortly after he launched his own business in 3D design, scanning, and printing. In August 2013, just as the new venture was getting off the ground, Scott started getting headaches.

It might have been nothing, but Scott had gotten her thyroid removed a few months earlier, so the pair had been keeping an especially close eye on anything that might have indicated a complication. Balzer pestered his wife to get an MRI, and when she finally agreed, the scan revealed a mass inside her skull, a three-centimeter tumor lodged behind her left eye. They were understandably terrified, but neurologists who read the radiology report seemed unconcerned, explaining that such masses were common among women, and suggested Scott have it checked again in a year.

That didn’t sit well with Balzer. Scott’s recent thyroid surgery had taught them that getting the best care requires being proactive and extremely well informed. A typical thyroid removal is performed via a large incision across the throat that requires a long, uncomfortable recovery and leaves a big scar, but when he and Scott began looking for alternatives, they discovered that she could avoid all that if they traveled from their home in California to the Center for Robotic Head and Neck Surgery at the University of Pittsburgh Medical Center. There, surgeons perform delicate procedures with a robotic arm that scales down their movements, making them smaller and more precise than what the human hand is capable of alone. The experience familiarized Balzer and Scott with both the cutting edge of medical technology and the importance of doing their own research. So although the first doctors told them to wait, Balzer and Scott sent the MRI results to a handful of neurologists around the country. Nearly all of them agreed that Scott needed surgery.

Lodged just behind Scott's left eye was a three-centimeter tumor
Lodged just behind Scott’s left eye was a three-centimeter tumor

At this point, Balzer requested Scott’s DICOM files (the standard digital format for medical imaging data) so he could work with them at home. It was a crucial step. A few months later, Scott had another MRI, and the radiologist came back with a horrifying report: The tumor had grown substantially, which indicated a far more grave condition than was initially diagnosed. But back at home, Balzer used Photoshop to layer the new DICOM files on top of the old images, and realized that the tumor hadn’t grown at all — the radiologist had just measured from a different point on the image. Once his relief subsided, Balzer was furious and more determined than ever to stay in control of Scott’s treatment. “I thought, ‘why don’t we take it to the next level?’” Balzer says. “Let’s see what kind of tools are available so that I can take the DICOMs, which are 2D slices, and convert them into a 3D model.” That decision changed everything.

Balzer, a former Air Force technical instructor and software engineer as well as 3D-imaging aficionado, is probably better prepared than most to take medical diagnostic technology into his own hands, but it’s not necessary to have his level of expertise to use 3D imaging to better understand a diagnosis and possible treatments, and it’s only getting easier. Groundbreaking advances in medical care are being made using basic maker tools and software, which means that state-of-the-art health care is becoming cheaper, faster, and more widely accessible, but also — and perhaps more importantly — it means that we can use these same tools to make sure our own health care is up to par.

When Balzer compiled images of Scott's skull into this 3D render, the form and shape of the tumor became visibile.
When Balzer compiled images of Scott’s skull into this 3D render, the form and shape of the tumor became visibile.

3D printing has already brought some astonishing changes to non-DIY medical care, and the field is still in its infancy. In China and Australia, where 3D-printed implants have been approved, doctors have replaced cancerous and malformed bones with bespoke titanium pelvises, shoulders, and ankles that are produced with speed, precision, and strength that were heretofore unimaginable. A team of British and Malaysian researchers used a multi-material 3D printer to create model heads with realistically textured skin, skull bones, brain matter, and tumors so that students could safely practice high-risk surgeries. In the U.S., a pair of doctors at the University of Michigan printed customized tracheal splints for two young children with a condition called tracheobronchomalacia, or softening of the trachea and bronchi, which causes the airways to collapse. The splints will allow the tracheal muscles to develop, and as they do, the supports will be safely absorbed into the children’s bodies. But one of the most widely useful applications is one of the simplest: Using patients’ CT scans to 3D print precise models of organs so that doctors can plan and prepare for surgical procedures. The software and equipment necessary are easily accessible to anyone — one University of Iowa surgeon tracked down a local jewelry maker with a 3D printer and convinced him to fabricate custom model hearts for the university in his spare time.

Balzer wanted a tangible model of Scott’s cranium so that he could get perspective on the location and size of the tumor and think about what kind of treatment to pursue. The standard removal process for a tumor like Scott’s, known as a meningioma, is a craniotomy, in which the skull is sawed open. Her tumor was located under her brain, so to remove it, doctors would have to physically lift her brain out of the way. This is as risky as it sounds. Nerves can be dislodged, and patients can lose their sense of smell, taste, or even sight. Thinking about her thyroid surgery, she and Balzer wondered if a similarly noninvasive procedure might be possible.

Anterior Skull Section with tumor removed.
by slo 3D creators
on Sketchfab

Balzer downloaded a free software program called InVesalius, developed by a research center in Brazil to convert MRI and CT scan data to 3D images. He used it to create a 3D volume rendering from Scott’s DICOM images, which allowed him to look at the tumor from any angle. Then he uploaded the files to Sketchfab and shared them with neurosurgeons around the country in the hope of finding one who was willing to try a new type of procedure. Perhaps unsurprisingly, he found the doctor he was looking for at UPMC, where Scott had her thyroid removed. A neurosurgeon there agreed to consider a minimally invasive operation in which he would access the tumor through Scott’s left eyelid and remove it using a micro drill. Balzer had adapted the volume renderings for 3D printing and produced a few full-size models of the front section of Scott’s skull on his MakerBot. To help the surgeon vet his micro drilling idea and plan the procedure, Balzer packed up one of the models and shipped it off to Pittsburgh.

This 3D print helped doctors plan a new, minimally-invasive surgery to remove Scott's meningioma.
This 3D print helped doctors plan a new, minimally-invasive surgery to remove Scott’s meningioma.

Balzer had unknowingly pioneered what researchers at the new Medical Innovation Lab in Austin, Texas, predict will soon be the standard of care. Using 3D printing to help plan procedures and to explain diagnoses to patients “is going to become the new normal,” says Dr. Michael Patton, CEO of the Lab, which launched in October 2014 with the goal of bringing new ideas for medical devices and technologies to market. Patton says its doors are open to creative thinkers like Balzer, and points out that 3D printing can accelerate the process of product, tool, and device development in medicine. “What you can now do through 3D printing is like what you’re able to do in the software world: Rapid iteration, fail fast, get something to market quickly,” Patton says. “You can print the prototypes, and then you can print out model organs on which to test the products. You can potentially obviate the need for some animal studies, and you can do this proof of concept before extensive patient trials are conducted.”

Trials, tests, and studies are a key point: One of the important roles of Medical Innovation Labs is to help guide inventions through the regulatory process. “It’s extensive and it’s burdensome,” Patton says, and it’s a reason many great ideas never make it off the back of cocktail napkins. But Patton doesn’t anticipate any regulatory issues with using 3D printed models for surgical planning, and he predicts that other advances involving simple scanning and printing will be brought to market with relative ease. “That is part of the new frontier with scanning and 3D printing, and we don’t see the regulatory hurdles that you would see with implants,” Patton says. He looks forward to being able to scan a broken bone at home and print out a breathable cast.

Closer at hand, but no less fantastic, is a handheld medical imaging device that will use ultrasound scanners to generate 3D images — no MRI necessary — and send them to a cloud service, where they can be accessed by doctors around the world. A startup called Butterfly Network recently received $100 million in funding to build the device and the cloud tool, which will recognize and automatically diagnose certain irregularities, such as a cleft palate in an unborn fetus, and learn over time. As more scans are uploaded, it will be able to automate more diagnoses.

Copy of RecentSkull copyPatton says he’s even more excited to work with inventors and makers than experts within the medical field. “So many people are trained to keep their head down and focus on practicing medicine,” he says, “and sometimes they don’t think about why they do things a certain way, or how they could do them differently.” Balzer is a prime example. 3D scanning and printing made high-tech health care accessible to him, but it also allowed him to influence progress in the medical establishment. This, as Patton says, is a radical new model for medical innovation.

Balzer has, in fact, been developing a product for medical use that’s similar to the Butterfly Network device, combining portable 3D scanning with a platform for doctors and patients to share images via a secure (HIPAA-compliant) cloud server. He’s also become more focused on education, and hosts a podcast called All Things 3D, on which he often invites doctors to speak. Recently, he organized a free seminar on 3D in medicine. “My big message now is that this stuff is out there, and a lot of it is free,” he says. “The first thing is getting the word out that your hands aren’t tied. Your buddy’s got a 3D printer? Use it.”

Scott had the tumor removed at UPMC in May 2014 through a small opening above her left eye. The neurosurgeon discovered that the tumor was starting to entangle her optic nerves, and told her that if she had waited six months, she would have had severe, and possibly permanent, degradation of her sight. The procedure took eight hours and 95% of the tumor was removed. She was back at work in three weeks. Her scars, Balzer says, are visible only to her.


Print Your Own

Want to print your medical image? Ask your doctor for your DICOM files and download 3D Slicer. Then use the Region Growing tool to segment the image. Extract a 3D mesh of the surface, save as an STL, and use ParaView to simplify it to a manageable number of triangles. To see more details, check out How to 3D Print Your Medical Scan right here on Make:.


163 thoughts on “Man Saves Wife’s Sight by 3D Printing Her Tumor

  1. This whole thing sounds great. I am wondering now that 9 months or so have passed has the tumor continued to grow? Will she need follow up care?

    1. Hi! This is Pamela. No further growth of the tumor, and my surgeon says the odds are 95% that there will be no further growth. I will have MRIs annually to monitor the area.

  2. Well done Mr Balzer. But this is a development I see everywhere. It started in biomedical research where animal surgeries were planned with 3D printed skulls and brains, and now I see my colleagues in neurosurgery use this for planning of deep brain stimulation implant surgeries. Nevertheless, congrats on this achievement and on fighting the inertia. All the best to Ms Scott.

    1. I was a bit shocked that Ms. Breselor chose to use the phrase “unknowingly pioneered” as well. I’m glad Mr. Balzer possessed the drive, skills and ability to find a creative DIY solution…but this isn’t a new approach to surgical planning. I only wish it were in more widespread use by now, but as Mr. Balzer has undoubtedly learned, it’s a highly regulated industry and innovation makes its way into the field at a snail’s pace.

      However, I’m thrilled to read that his wife is well and that he’s reinvented himself with it — the things that matter most.

      1. I totally agree with you, do not claim that I was the first, in fact in my interview I mentioned motivations was based on an article of Malaysian & Chinese surgery teams using a similar technique to create the skull, along with a different print material to create the brain and dura.

        I have also talked about the different uses, along with interviews with many leaders in the biomedical and medical field on their use of 3D technology. In fact the reason Sara contacted me is in reading the blog article done by 3D Printing Industry on me; which at the time was the back-story for the promotion of a free Google Hangouts On Air “3D in Medicine” seminar with Dr. Klioze, Dr. Copp, Dr. Vicente, and my co-host Chris Kopack who talked about how 3D technology is changing dentistry, radiology, general research in medicine and bio-medicine. The two hour seminar is out in our YouTube channel ‘All Things 3D’ along with several other interviews, roundtable discussions and weekly 3D news episodes. https://www.youtube.com/user/allthings3d

        I am sorry that this article gave the impression that I have discovered a new technique. I have not. I just used a number of open source tools and low cost 3D printers and cloud services to give those who were interested in taking her case, more information to work with and help Pamela and I understand what we are dealing with. My only motivation now is to tell the story about the diligent research, perseverance and using the tools available.

        One last thought. In all this, what was lost is the talented and gifted surgeons Dr. Gardner and Dr. Stefko at UPMC. They were receptive to my work and spent a great deal of time going over the procedure and more importantly spending EIGHT hours to remove the tumor with a micro drill. As Dr. Gardner said, “I suffer so the patient does not have to.” That still chokes me up.

        1. Mr. Balzer, thank you for taking the time to respond, but it’s not on you….this is entirely the author’s mistake. I’ve run into the same situation many times in my own field…misquoted, misinterpreted and inappropriately embellished by journalists.

          I’m just glad you’ve continued to push the envelope and help educate others about the possibilities. Many thanks for making a difference.

          1. This is not Sara’s fault.

            I think she did an excellent job of getting it right and following up with the chronological order. But I do feel it was to show how someone like myself can apply a “maker” attitude to our own healthcare. I just want to make sure that the reader does not think I invented anything other applying off-the-shelf low cost technology to something that has in the past taken from 10s of thousands or millions of dollars to accomplish and large research or learning centers. With that being said, I am not enept and have developed technology in the past (ironically a product that also had medical applications in the late 80s) and working on an iOS app with a medical purpose.

            You are welcome, it hs been my goal over the past six months on my own podcast/YouTube channel as well as funding out of my own pocket how 3D technology is changing the medical field.

  3. Thank you Sara for comprehensive article, but I want to stress Pamela did all the research on the medical end, she is the person to have at your side when things go south. Think of me as her IT department. I took care of all the communications and transfer of DICOM disks and files. This is an area I hope to improve upon. Many of these things are still sent on CDs or DVDs, when cloud services could expedite this. Something many doctors seem to agree on that patient data should not be isolated with different protocols and data systems. In our case, I set up a data repository to manage Pamela’s health data on my 256 bit encrypted server and sent links to the doctors. As you can imagine many didn’t know what I was sending them or their firewalls prevented access..

    Tune in this Friday at 9:30 am on All Things 3D via Google Hangout On Air (GHOA) https://plus.google.com/events/cmh5iluaj22lgma0q65hka2lg38 when we talk with Dr. Klioze, a radiologist with an engineering background to talk about GEs groundbreaking CT scanner ( hint, not so groundbreaking)

    1. Glad you posted. From the otherwise well written article I got the sense that either you were something of a control freak taking over your wife’s autonomy or that she was unable to be in control possibly due to the tumor.

      1. Ha ha, if you knew Pamela you would clearly know this not to be true. For the most part Pamela has allowed me to tell the story, key word “allowed.” Pamela strength is clearly medical jargon being in the industry for three decades. She is posting in this comment area as well.

    2. Michael, Is there a URL for the upcoming podcast? I found only your “All Things 3D” podcast page, at which the latest talk mentioned was October 22, 2014, and there’s no sign of Dr Klioze or a talk on Jan 16. Thanks.

          1. If you click on the event it should tell you when it will occur in your timezone. However, just to make sure, it will be on Friday the 16th, at 9:30 a.m. PST. The episode covers that week’s news in 3D tech, our latest projects and product usage and as we call them “Guest Crashers” who will be Dr. Scott Klioze. Look up his name on YouTube and you will find that he not only is superb radiologist, but a cardiologist and has an engineering background. It is this combination that in my opinion allowed him to created such concise videos on how MRIs & CT scanners work. We are also working together to create a tangible model from a diffusion tensor image. Without going into a lot of detail, has revolutionized brain imaging, but if you look at the image attached, you can see why creating tangible model is a little more difficult. I am planning to use SLA to print the model.

    3. This is amazing!!! I’m married to a 3D software designer & he showed me this. Mr. Balzer you should think about doing a start up for this!!! Great stuff!

      1. I have been asked to provide this service, but feel awkward charging for it. We (Pamela and I) are trying to determine a pricing structure that is fair and reasonable. However, my main goal is to empower the reader and listeners into using all this technology in their own advocacy.

        1. Hey. Here in canada, we have proper non-insane healthcare, and I wish it was the same for you. I think you are probably a very good person, my reason for believing this is because you know how hard it is to be in this position, and you feel wrong about doing it in the only way society knows how, capitalism. Health should be universal. I just wanted to say that you rock. Have a good life :3.

          1. I can call and get an MRI in 48 hours, with about $100 out of pocket.

            I know Canada loves not paying for insurance or co-pays, but the last I heard, having an MRI scheduled in 48 hours is pretty much unheard of up there.

          2. Canadian here. The time it takes to schedule and perform a medical test varies, depending on lots of factors, like how many other people need tests, severity of your symptoms, etc. I went to the emergency room with terrible abdominal pain and was in the CT scanner within a few hours.

            Also, while medicare does pay for most things 100% we get supplementary insurance for dental work and to help pay for drugs.

          3. Here in the USA, I went to the ER with terrible abdominal pain about 2 months ago and was in the CT scanner in less than one hour. Just saying…

          4. Heh heh, “just saying” are you? You seem to be implying that the slightly faster time-to-test you enjoyed means that your mostly commercialized medical system is better than our mostly socialized one. All I can say about that is no-one I know has ever had illness-related financial worries. No one I know has had to make a choice between a less effective treatment that their insurance covers and a more effective one that would bankrupt them. No one I know has ever had to tearfully beg an insurance rep only concerned with their loss ratio to please save their mother’s life. That peace of mind is more than worth having to wait a couple of hours more for my turn to see a doctor.

          5. This whole article is about the ability of an individual to make a difference using the healthcare system. I use the US healthcare system heavily and have not experienced your contentions. I’ve had friends with terrible diseases and no health insurance that didn’t experience your caricature.

          6. I’ve been to the emergency room at my American hospital 3 times this year. They don’t even ask about insurance or payment until the very end. Liar. Please don’t cite the your fellow liars at HuffPo. There is much more to Mr. Aprile’s story than they let on and that is why we don’t design healthcare based upon anecdote. He supposedly lost his healthcare by losing his job at the very institution that provided both his health insurance and his treatment. He rejected the approved treatment, and for that he would not have been treated in Canada or by the US government healthcare called Medicare. Medicare, by the way has a higher rejection rate than private health insurance. One can tell from your statements that you are simply a Communist and your Euro style healthcare is going belly-up anyway and covering it up with rejected treatments and long waiting times, VA style, hoping that you die first.

          7. Spend some time in any chronic illness support group, and you will find plenty of people who are receiving no medical care in the US. I was making $10K a month before I became disabled, and still only received about 20% of the treatments that I needed, after I spent my $50,000 in savings, including my entire 401K. US “health care” and the disability system are both inhumane.

          8. I don’t know if I believe you. You know and I know they would not have withheld treatment if you did not pay them. I have had friends with and without insurance receive treatment for cancer and no doctor ever asked if they could pay. This was at large hospitals and, in fact could have chosen between 2 or 3 hospitals for their treatment. That being said, policy should not be made based upon your anecdotes or mine.

          9. Most red states only extend medicaid to pregnant women and children. I am a cancer survivor and I would have been dead in half the US, We’re the only civilized country besides South Africa without Universal Healthcare. It’s backwards and pathetic.

          10. Now that, I know is not true, personally. Most all of the elderly in assisted living are on Medicaid in many so-called “red” states. I have known nursing homes to tell vets not to claim their VA benefits as it would make them ineligible for Medicaid when combined with Social Security. If you have breast cancer, you are more likely to die in Europe, than here. South Africa could not even come close to funding “universal” healthcare. That is becoming an issue in Europe, and the USA is trying to figure out how to meet it’s Medicare and Medicaid obligations in the near future.

          11. No one I know here in the US has done that either. But when I lived in Canada, plenty had to come up with their own workaround to defeat the system’s glacial pace.

            One was a retired RN, so had the knowledge to self-diagnose and self-treat (an anemia issue), such that by the time she could find another GP to get into the system after her original one had inconveniently retired – which took about six months – she’d recovered on her own.

            Another had a daughter who needed a test that had a critical time component, but the system was still jammed, enough such that the delay was medically relevant. What do? She was an active RN and so pulled strings to get her daughter moved up. You can judge her for that, but I don’t – that’s how it works when everything’s “in common” and there’s a short supply: eat or be eaten.

            You can imagine what happens to them if they’d lacked the knowledge or the connections.

            Canadians like to go on about the $ involved in the US system, and say things like “don’t get sick you’ll lose your house” etc. but you still pay in Canada; the currency’s just different. In Canada you pay in *time*. Good luck trying to
            make more of *that*.

          12. The difference is someone poor can afford to wait. Why do you think you should always be first? News flash, you are not more important than your neighbor. Also, your horror stories don’t jive with my experience. My mother had bowel cancer last year, radiation, surgery, some meds later, she’s cancer free (of course we cross our fingers for five years) and guess what – it didn’t cost my family a dime and she received excellent care. You brush off losing your house like it’s something that just happens to ‘other people’… yeah, it does. Those other people are real.

            Let’s break it down – the difference between my health care system and yours, is in yours, you can lose your house. In mine, you can’t. I’m sure we can both find examples of unreasonable delays and negligence in each other’s medical systems, but it’s only in yours where people get ruined financially.

          13. Thank you, you wouldn’t believe how many people have to declare bankruptcy due to medical bills in the US.

          14. I would implore you to take a look at the time it takes to get in to see a doctor in America. The differences between Canada, the UK and the USA are not as stark as you think.

          15. No one I know has had to beg an insurance company rep to save their life either. Nor do I know anyone who has been forced to make a poor treatment choice due to cost. I’m sure there are cases out there, just as there are cases where Canadians were denied expensive treatment or forced to wait an extraordinary amount of time to see a specialist, etc. No system is perfect.

          16. Here in the USA, my doctor told me to go to the ER to get some IV fluid because I had the flu really bad. I was in the CT scanner within 4 hours. $4,000 of testing later, I still didn’t have the IV fluids. I finally threatened to sue the hospital and, after 6 hours, they hung the fluids my doctor had ordered in the first place. Just saying…

          17. I didn’t make my point very well. In my case, there was clear over-use of resources and my insurance company (meaning all of us) got soaked for unnecessary services.

            What I really needed was more like what Japan offers. In Japan, they have these neighborhood clinics where there is a doctor on staff with a couple of beds for short term treatment. Think CVS Minute Clinic on steroids. You start out at one of those and, if your condition is more severe, they transfer you to a bigger hospital. I would bet you that if I had presented myself there, the doc would have hung a bag, topped me off, and let me go home.

            Parenthetically, something I don’t understand about the medical debate is that it seems to be based around just three systems: Ours, Canada’s and England’s. There are many other systems out there and they work in all kinds of ways.

          18. Hmm…he paid $0 and you or your insurance company paid $5000 or more. Regardless of how much time he waited, and considering he is here to tell the tale, the wait did not harm him physically…I think he wins.

            Just saying…he might have went to a busier hospital, on a day that was busy, or when a relevant technician was doing something else. One comparison does not a sample make, and it frankly doesn’t matter when the testing is done as long as waiting doesn’t harm the patient. In urgent cases, you both would have been scanned nearly immediately.

          19. No. He did not pay $0. Doctors, nurses, and lab techs in Canada do not work for free. Health care is expensive in both Canada and the USA. In Canada, you may pay for your health care differently (through much higher taxes), but you still pay for it.

          20. He did not pay $0. Let’s clear up that fallacy right now. He just paid in a different way than I did (i.e. taxes vs. premiums).

          21. It’s not a fallacy. You can say it is a misstatement if you disagree, but it certainly is not a fallacy. He paid $0 for the medical care. He may have paid taxes that cover the cost of the program, but paying taxes is not the same as paying for commercial, for-profit services.

            Taxes + healthcare premiums in the USA (middle class) > Taxes in Canada, by the way.

          22. It is a fallacy. He paid for his healthcare via taxes. I’m not debating who pays more, but Canadians do not pay $0 for heathcare.

          23. The fallacy is that Canadians do not pay $0 for their healthcare. They just pay in a different way. I won’t be responding beyond this because it’s a very simple thing to understand. Canadan citizens pay taxes to the government, which then spends some of that tax revenue on healthcare for the citizens. In Canada, the hospitals and clinics and labs and doctors and nurses and lab techs, etc. ,etc. are all paid money when providing healthcare to patients. They’re paid by the Canadian or Province governments, using taxpayer money, paid by citizens who pay taxes.

            Anyway, best wishes.

          24. A fallacy is a specific issue with the logic of an argument. There are dozens of types of fallacy, and I merely asked which one you felt my post qualified as. I wouldn’t attempt to talk down to people for “not understanding your point” when you can’t even be bothered to know the meanings of words you are using.

            They do pay $0 for their health care; it is just that the government and people of Canada have decided that one of the things they provide with tax money is health care, on this we totally agree. There can be no argument. But when you pay taxes that fund something, you are NOT paying for it. Go ahead and ask a police officer who pays their salary…it is certainly done with your tax money, but the city/county/state does the paying.

            What I am saying is that “he” would be paying the same, regardless of if he is ill or needs the services; this removes it from the realm of paying for services and makes it a completely different animal. He paid nothing beyond what he would be paying- hence, he paid $0. Canada’s health care is progressively funded by taxes based on income, so it is not only figuratively true that he paid $0, but could be quite literally true as well.

            Cheers.

          25. Here in the USA, thousands of people with terrible acute pain are sitting at home right now because they can’t afford to go to the ER. They won’t be in a CT scanner tonight, this week, or this month. JUST SAYING. And no, you can’t count on free care if you can’t pay, especially for something like abdominal pain. I have personally been turned away when I had a brain injury. Try to look at the bigger picture sometime.

          26. Nope. That’s what the right wing wants you to think. If you need an mri, you CAN get one. If you go in the free system, they judge if you REALLY need it, but there are non-socalized MRIs.

          27. You don’t need to cross over to the US to get MRI on demand. As long as a doctor requires it, MRI labs are plenty in Ontario.

          28. Leave politics behind. Politicians and their fellow travelers are about power and control which nets them money thru the backdoor. Get the gov out of your life. DIY as Balzer did or hire somebody to do it for you. No different that removing snow. DIY or hire somebody. Nothing is free. Everything of value requires creativity, and plenty of work (thinking is work too – ask any writer, artist, engineer, scientist, etc, etc).

          29. America is now run by corporations. Life in Canada looks so nice from down here.

            Don’t get sick in America. Even with insurance, you will probably go bankrupt if you are not already a multi-millionaire.

          30. Don’t let him kid you. Social medicine in Canada comes at a high price. It’s not free! Approx 35% of the Canadian tax base is spent on health care. I make 100k a year in Canada and pay about 43K in taxes. 35% of this pays for “free” Canadian Health Care. Not to mention that in Ontario. Those that make over 60k. Have to pay between a $600 – $900 health care subsidy. To cover those folks who do not pay taxes. We pay for it trust me .

          31. Good grief, please get over the Canada v. US medical arguments. Prob. some good in both but, if you have Parkinson’s, Canada is NOT the place to be – how many movement disorder specialists do they have??

          32. BS. I had a friend without health insurance discover he had lung cancer. Three hospitals with three different approaches toward treatment offered to treat him. They never even mentioned money. He wouldn’t get that kind of choice anywhere else in the world.

          33. Here in New York, we have the healthcare that Canadians cross the border to obtain. So, as insane as it is, it must be better than Canada.

          34. No that does NOT mean your healthcare in NY is better because of some few crossing from Canada for it. The reason is wait times – Canada’s healthcare is so good that there is virtually no one who cannot avail themselves of it, and therefore the wait times are sometimes excessive for some procedures. Those who can afford the ridiculous US med fees can avail themselves of getting their procedure done in less time.

          35. If doesn’t have to be one or the other. Some countries have socialized medicine and private hospitals. This one or the other debate is getting old! If you want to pay for an MRI, you do so and you can even get private insurance. I prefer the mixture of both to the Canadian system.

          36. Don’t be stupid. There are more MRIs in Pittsburgh than in all of Canada. That is what makes this innovation possible and also makes the US healthcare system the most innovative in the world, by far.

          37. Innovation doesn’t mean anything if only the rich can afford these supposed innovations. The article is about how an individual, not a paid doctor, innovated himself out of a bad situation when the medical community did not have the smarts, creativity, or resources to help him, which could just as easily have happened in my country.

            By the way your ‘system’ of care is capitalist, meaning there is incentive to repress treatments that work in favour of treatments that are less effective, to keep ill people paying for longer. Insurance companies are motivated to provide people with the cheapest care instead of the best care. That is unless you’re rich. Human health and the profit motive are incompatible. If you disagree, you’re probably affluent enough to not have to worry about health expenses, and you probably, like many Americans brought up to think that your way is the best way, don’t have any empathy for people who aren’t as lucky as you. All I can say about that attitude is, in literally every other developed country they have realized that handing over their health to business people isn’t in anyone’s best interest but businesspeople’s. Did you learn nothing from the 2008 financial collapse? Capitalism is not your friend!

            More MRIs in Pittsburgh huh… if you’d like to provide a source for that outrageous claim that might be an interesting statistic. If your source is, as I suspect, located between your butt cheeks, then you’re just grasping at straws. All the medical equipment in the world makes no difference if you don’t make it available to people affordably.

          38. Bogus, you’ve been willingly duped. That article neither makes, nor links, to any data on the number of MRI machines, anywhere. The Forbes article it cites (but doesn’t link to) doesn’t back it up with any data.

        2. If capitalism is done correctly you will be paid what you earn. It is when greed is involved and government forces issues that it becomes out of control. When something works all benefit. If something fails…..let it. Let people fill needs and create solutions. Keep the government out of it. All humanity will prosper if people like you are allowed to invent. As for poor people not getting equal care, it is only in a society where there is excess wealth that the poor and elderly are cared for so we need to stop redistributing wealth.

          1. Your post makes no sense, and in light of the upvotes, I feel I must offer counterpoints. You say that capitalism works as intended, except when greed or government intervention spoils it. I concede that half of this is true: the problem with any capitalist system is that greed can override the morality of people. It is at those precise moments that government does, can and should intervene. Almost every federal law, every federal agency, each regulation is in place to protect the citizenry from unscrupulous and unethical individuals and companies, who are usually motivated by…you guessed it: greed. Secondly, “wealth redistribution” has existed since nations and money came to exist. Those who govern understand that taxes must be levied to provide services for the common good. Instead of arguing against what you call “wealth redistribution”, argue what you think the level of commonality should be. You can not feasibly believe that we should not have roads, air traffic control, a military, police, firemen/women…and we all pay for these mostly based on a progressive system of taxes. I am curious as to why you think we should have all of the things I just mentioned, but not health care, which is even more essential to human life than any of the essential things I mentioned. EVERY OTHER ADVANCED NATION ON EARTH has universal health care. You say you want government out of it…well, government has a vested interest and specified purpose to protect the citizens from whom their power derives, whereas the companies you rely upon now are motivated by profit (read: greed) and answer only to their shareholders. Which one is more trustworthy?

          2. Did I say we should not have health care? No one was going without health care before Obama care. Again, it takes health care out of the hands of individuals and into the hands of government. It is worse today than it was before OC. Again, when there is choice businesses are forced to give more service for what they charge or they go out of business. I trust people that make choices of how to spend their hard earned dollars far more than I do someone in Washington to spend my tax dollars. BTW….roads are not federal government’s concern. I think what we both wish for is honest compassionate citizens. But this is not a rational hope. It is the nature of man to have some that will do anything for power and those that don’t earn their keep, and I am not talking about elderly, disabled or youth. That said the only way to keep them all in check is to have an open and free market society. The smallest government possible. People will vote with their dollars much more fairly and honestly than any poll booth. When government stays out of it the businesses that are most honest and have the best product will succeed. The ones we don’t support will fail. When people are free to choose the best will succeed. Government is the worst choice to decide what is right or wrong. What we have today in the US is that and it is not working. The way I like to describe this is if you go into the national forest you will see signs that say don’t feed the animals. Now why do you think they say that? Because when you take away someone or some animals ability to take care of itself you destroy the balance and cause hardship on all. The animals become dependent and if the food goes away they can’t take care of themselves and they die. In all the free feeding they reproduce like rabbits so when the famine comes more die. That is what wealth distribution is doing to our country today. People that can’t even take care of themselves are reproducing at an alarming rate and those that do support themselves are NOT reproducing. There is nothing wrong with capitalism. There is nothing wrong with people being rich. But we should not be supporting people that do not support themselves to reproduce when those that work can’t afford to have families themselves, and we should not be printing money to keep banks and the stock market from failing. Last the wealthy greedy people in this country are those that are being made wealthier by the Fed pumping funny money into the stock market to keep the appearance of “all is well”. But the bigger they are the harder they will fall because it is all going to crash soon.

          3. When you start talking about “people not earning their keep” while conveniently entirely ignoring the systemic issues that prevent those people from succeeding, your argument loses all credibility. You make references to the effect of education on reproduction, but make backward assumptions about cause and effect. You need a sociology course or two or three…you are not qualified to make the kind of judgments that you are making, and your unsupportable conclusions are tremendous proof. You’re great at echoing conservative talking points loosely based on economic theories that have been shown to be less than accurate, though. Read Piketty, if that’s the only thing you do.

          4. And, BTW, yes the federal government does indeed pay for many of the roads you drive on daily. And, yes, people suffered and still suffer with no health care. But, you missed the trees for the forest.

          5. You are so fulla shit. The roads ARE the federal governments concern! And ooooh yes, People certainly DID go without healthcare before the ACA,what crap you are spewing…

          6. The roads are the responsibility of state and local governments….or they used to be. That is who should take care of them. No one that needed health care went without, they could get care if they went to any hospital…it was the law. Many went without insurance because they felt they didn’t need it and that is different. For most of them the cost of paying cash for what little care they needed was far cheaper than premiums.

          7. PROFIT IS NOT GREED! That is a progressive idea and false! There is nothing stopping you from investing in something you believe in and allowing your money to work for you. That too is not greed.

          8. you are an idiot. When profit determines your politics, you are a silly twit…God help us all…cause you suck….

          9. Your ideal society would put us back where care such as this woman got would not be possible. If we were to go back to what you feel is fair there would be blood letting and leaches for the common cold again. But I can agree with one thing….God help us all.

          10. So if you plant a garden and it produces a great deal of good nutritious food you are greedy? I am very sorry you think the world is so unfair. I am sorry for you that everything must feel good to you or it is cast off as bad. I think you would be much happier living in a country like North Korea or Cuba. Then you would not have to worry about anyone having more than you do.

        3. Amazing work. What an inspiration to makers looking at working on projects with impact and responsible innovation. With regards to making it a company and charging people, you should set up a foundation or not for profit, and get grants from bigger foundations to promote this procedure and future research. I’m sure there are several foundations willing to allocate huge sums for such a cause.
          Truly inspired,
          Pavan

          1. I have in some cases. Will do in the future on a case by case basis. Working as a foundation does not mean you work for free. You draw salary, sufficient salary, but your vision will be driven by impact and not profits, is what I meant.

        4. Thanks so much. Sorry for my fellow commenters getting mired in the US vs Canada debate instead of focusing on your awesome work. This kind of innovation is needed whether there is socialized or commercialized medicine!

      1. We just made this one of our news items this morning and (embarrassingly) used my DICOM data of my torso with Dr. Klioze to highlight the power of this system. I sure wish I had something like this in 2013.

    4. What type of machines (model) generated this image, is there a specific feature i need to ask for with my imaging clinic?

      I could use this for my hip and L4-L% + S1-S2

      Thanks for your work. I will tune in!!

      1. This was a newer GE CT scan with < 1 mm resolution (I will provide the model number later). Here is an image done with an older CT scanner with 3mm resolution. As you can see it is coarser. Dr. Klioze talked about this before on our show previously, but I will indeed ask him again. From what I understood, the actual resolution is intentionally reduced to minimize dosage, but newer scanner as we will see on Friday not only provide higher resolution, but lower radiation. Kind of like having your cake and eating it with ice cream :). This where super computers on chip are coming into play allowing for faster (close to real-time) image computation — key to using lower radiation dosing.

    5. Reading this remarkable article I am wondering if this kind of surgery can save the life of my niece who has a brain tumour. She has two young children.
      As there has not been much in the way of treating this cancer I wondered what hope there would be if she was able to have this treatment.

      1. I can’t give you an medical advice, but I am sure that the UPMC neurosurgical department can be contacted to see if their procedures can help your niece. We are in no way experts on brain tumors and there many types and our only advice is do as much research as you can, get multiple opinions and if you can travel, look outside your local area.

        1. Many thanks for replying to my query. I do not know who the UMPC are or how to contact them. Please can you help me.

    6. I only have the words “Thanks” for letting the world know that there are things that are in our reach (even if they may seem like they are outside of our field) and we can make them happen if you have the will.
      Hope everything goes well from here on.

    7. Hello Michael,

      I have an MRI of my head from some years ago on CD/DVD. How much time would you think I would need to model the structures as a 3D-Model?
      I don’t know much about how to do this stuff… also, I can’t install the program, as it’s not available for mac.
      However, I got a very gifted fried who could likely do it, if the data on the CD is usable. What is a dicom image?

      1. Here is Wikipedia link on what a DICOM is, which stands for Digital Imaging and Communications in Medicine – http://en.wikipedia.org/wiki/DICOM .

        To model your head without any experience, would probably take a few days to understand the process, but there are some great tutorials for the two that I used in PDF and video. If you are new to this, try out InVesalius first – http://svn.softwarepublico.gov.br/trac/invesalius . They literally walk you through the process in a top down menu system. As mentioned elsewhere, the editing tools are lacking, but for doing bone, the standard threshold tool works nicely. There seems to be a Mac version but it is only available in a 32 bit version, which should run on newer Mac OS versions, but I have not verified this. I will try this later on today.

        So if your gifted girlfriend is familiar with 3D and has created 3D objects for 3D printing, maybe a few hours.

        By the way, there is great tutorial right here on Make on using 3D Slicer as well.

    8. HIPAA regulations would likely be the largest roadblock you’d face in attempting to grant all patients access to their files over a cloud-based system. The hospital would likely have to build its own server infrastructure, as storing data off-site (say, in Amazon’s cloud servers) would be massively difficult to justify to their auditors.

      If I were to design a web-based way for patients to access their records, I’d suggest providing a separate section of hospital intranet for patients, which they could connect to via VPN for the sole purpose of accessing their own patient files. Patient user accounts could be created with extremely limited access permissions to limit the damage a malicious entity could cause with a patient’s credentials. RSA tokens/smartphone apps could be used to further enhance security.

      It’s been a few years since I’ve worked with HIPAA, but I believe it would be possible to accomodate this access, but the cost and effort involved may be prohibitive for many smaller hospitals.

      1. Many of these things are occurring, UPMC and many other hospitals do have such a system where one can retrieve your records, and many are offering upload of limited file formats. It is DICOM and larger files structures that were not done in this manner, in our case and we had to rely on FEDEX, and USPS. There is a post in this thread of a new service that I hope catches on that allows you to upload you DICOM disks into the cloud.

        Google did have a service at one time where you could upload all of your medical records into their cloud, but for reasons that I am not sure of, they stopped supporting this service. However, Microsoft has a similar service that I use.

        In medical panel done by local tech industry chapter (It was also a GHOA that is up on the YouTube channel ‘All Things 3D’, the two physicians on the panel felt that access to all of a patient’s health data is extremely important to diagnosing and sorely lacking for a number of reasons. Here is hope this changes as well.

        1. I did see that link after I had posted my comment, and think that 3rd party cloud storage companies will likely be the way this is handled in the future. If patients upload their own files and data, then there would be no regulatory hurdles to overcome.

          Instant and easy access to information as a patient is definitely (and obviously, considering your experience) an issue, and I’m glad to see progress being made toward making easier access a reality.

          1. I am also on the other end of this as an iOS developer and the services that offered HIPAA compliant databases is limited and sadly Apple has not released Healthkit for use in an iPad app.

    9. I’m sorry I’m new to this platform and can’t future out how to contact you without replying to something even though I’m following you now. I was just dismissed with thyroid cancer from a FNA with u/s biopsy. I was told this Tuesday, 3 days ago? I was told me best hope is to remove my entire thyroid. I am a Cushing’s disease patient, so it’s been ongoing disability and illness for about 10 years now. I haven’t been fully informed on the surgery process here in Denver yet because I haven’t got that far yet. I am already suffering chronic pain and on heavy medications daily for pain alone. A long painful recovery is not going to be good for me or my four young children! I especially don’t want to look like I survived am attack of having my throat slit with a nasty scar! I have had enough brain surgeries and other surgeries and scars. I’m a living medical anomaly as it is. Even my rare Cushing’s is made more rare by having macroadenomas whilst they’re usually sure to microadenomas. Repeatedly I’ve been told I should be dead by now. I have so many medical ironies many get pushed back because of more pressing issues. It’s a never ending fight to avoid what going to kill me fastest first. Do you know of any places with the robot thyroid surgery since your wife had hers in Pittsburgh? We live in Denver CO. My husband supports us all on his income alone because I’ve been too sick work. I compensate my worthlessness by homeschooling our children so I can make a big impact and spend precious time with them in case something does nab the life out of me. We’re a right family of six and he has another daughter from his first wife he pays child support for too. We’re not wealthy or even well off. We just barely don’t qualify for SSI disability for me. They didn’t approve me until time had passed that I lost all my work credits. By that time his income was slightly better and I don’t qualify for income supplementation or medical assistance. I’d love to fundraise it whatever it takes to get the best treatment for my thyroid cancer, but we also have four kids at home and we’re both adult orphans so we have no grandparents to babysit, no family nearby. We just moved to Colorado for this pay increase last year and it turned out the cost of living cancelled out the pay raise here near Denver. Although the experience and career advancement still makes it slightly worth it. The problem is the few friends we had are in Nevada and it’s complicated to make new friends with for kids at home, no money for sitters, not familiar with anyone, 35 years old, and can’t even make friends at work because he’s the boss and that isn’t appropriate. If you could tell me if you know of any places who might have this technology now that might be closer to CO, I’d appreciate anything you out your wife found out. You’re obviously very resourceful! If not, in going to have to stay an online fundraiser to see if I can get myself to Pittsburgh. My husband will have to work. My kids will need care and schooling while I’m away! Please advise what you would do in my situation? I’m asking you because you’re good at coming up with the best plan of action! Thank you for reading my long, although highly summarized, story and questions!! Please if you can figure out how to tag me back to see your reply? Or find me on Facebook: SpitefulLadies is my Facebook URL you’ll need to friend request me or I’ll never see the message. You or your darling wife. The way you care for what care she gets remind me of my husband with me. I felt like you guys seem a lot like us.

      1. Do you butt heads like us? All kidding aside, I am sorry to hear this and even though I can’t imagine what you are enduring, I have some idea. On that note, let me refer this Shavaun and see what she thinks. We kind have delineated the lines of what each of us will respond to, and I am the techie. I will copy your note to her, and she can respond to your response.

    10. A good use for 3D is always welcome. As someone who had three brain surgeries before he was ten, it’s great to hear that your wife did so well – she is fortunate that you didn’t settle for the standard methods.

      1. Hi Winston,

        Actually it is reversed, I am lucky she didn’t settle for anything else. As I mentioned elsewhere I encouraged, then nagged for to get the initial MRI, and was pretty assertive with the initial neurologist (who we only went back to after the second MRI as a courtesy) to have it done. However the research and hours devoted finding the best doctors is all Pamela. I was her facilitator, her IT support group. I made sure the surgeons and medical centers received their emails, faxes and overnight packages. I also printed out images and eventually small models she could take with her in a portfolio that grew to over two inches over the course of this journey.

    11. Anytime you are in Bangalore, India, just let me know, would like to host you and Pam at our Makerspace (www.workbenchprojects.com) for a discussion and a workshop on this.

    12. Your work was excellent. I read your concern about charging for a service. First, turning your passion into your life’s work could not be a more satisfying thing. Second, the heartache and damage that your solution could avert for people (not to mention the expense) is dramatic and has an innumerable value to the people who ask for it. Third and last, the technology will continue to advance and your funding cutting edge (pun, couldn’t help myself) solutions will ultimately reduce the overall cost of healthcare as you stay ahead of current trends.

      I am someone who is actively working on ubiquitous and secure exchange of data that can be directed by the patient for medical record release for applications like this and so many more.

  4. I used three other printers besides the Makerbot Replicator 2. The Ultimaker 2 (one of the first off the assembly line), MakerGear M2 (the skull in the lead image) and a Kossel Clear (the smaller skull in front if the red background). Each have their strengths and weaknesses. Many of these buying decisions were based on Make’s 3D printer shootouts. Thanks Make!

    1. yes they do indeed. as do all humans, even professional humans. focus on what you _can_ affect: your own knowledge and understanding— and the consistently error-free application of same.

  5. What a fascinating read! So glad to hear this worked out and very excited to see where this takes medicine in the future

  6. This was a great article to read. Even myself, I all too often trust what my doctors say and am not NEARLY pro-active enough. This is an inspiration to not be afraid of taking some control in how you are treated.

  7. Seriously a great and facinating article! Currently how long does it take to get from DICOM files to a printed 3D model? How many different neurologists’ opinions where you able to get and was Sketchfab your best access? Lastly, like most people I’m sure talking to brain surgeons can be intimidating and overwhelming, especially when they only stay for 2-4mins before rushing out, do you have any tips on how to handle discussions with brain surgeons in a way so that they take your opinions and concerns seriously?

    1. I’ll leave Mike to respond to the technical details regarding printing. Regarding discussion with brain surgeons, I think most are very interested in discussing their work. I always take a list of my concerns or questions in writing to all medical visits, and do a lot of reading online about various treatment options beforehand.

    2. Hi Larry,
      The process for bone is relatively easy, with tools for segmenting the slices in to surface model fairly quickly. It is distinguishing soft tissue and organs that can be more difficult and require more time. In both cases you highlight (paint) the areas on each slice to indicate what you want to be turned into a model. It is where 3D Slicer shines because they provide an assortment of editing tools for doing this process. In my case, the skull took about an hour from importing the DICOM directory, creating a volume rendering, creating the mesh mask, and then converting it to an STL. From there I use NettFab to clean the STL mesh and make it 3D print worthy. If you are not familiar with NetFabb, I highly recommend it. They have a free version, personal version ($200) and PRO version (>$2000) http://www.netfabb.com/ I also recommend the latest MeshMixer http://www.meshmixer.com/, which now contain many tools for creating a valid STL file as well.

  8. Beautiful story, I am glad everything worked out so well for you as well as everyone who will benefit from this innovation, also there is at least one husband in the world who has a GREAT excuse for his wife as to why he needs to buy more toys for his 3d printer.

  9. I think there’s a huge emerging market for DIY healthcare, this is one example of it. Another is a friend of mine who left the US to pursue an AIDS treatment for himself and is now close to being considered virus free several years after learning microbiology through hard work and generous mentoring. Congratulations to both of you for this fabulous work!

    I suspect one key here is no maladies manifest themselves the same way in each patient, and much of the cost of successful treatment is custom designing the therapy to be maximally proportionate to the threat. In contrast to mainstream health establishment that is constantly at odds with insurance carriers for best diagnosis, Mr. Balzer and Ms. Scott deftly illustrated that people with existential self-interest will go to whatever ends are necessary to solve problems that the insurance industry cannot or will not pay for. Clearly, without their own investment, Ms. Scott would have fared terribly. (Note this is not an indictment of the insurance industry, excesses on both the side of the patient and the insurance carriers are well-documented.)

    It would be very interesting to get the EFF involved with this kind of thing early, before the medical establishment has a chance to introduce bottlenecks to self-care. It’s not clear whether they would do such a thing, but whenever monopolies are threatened, protective legislation written and purchased by K Street are not far behind. This is too important a matter to be left to chance.

    1. Thank you so much for your kind thoughts. One gets very motivated in circumstances such as this, and I really owe it all to Dr. Gardner and Dr. Steffco at UPMC. Fortunately, the only financial investment I had to make was the plane ticket across the country. Anthem Blue Cross covered everything, as well as the multiple pre and post surgery diagnostic tests and imaging. I feel very grateful. Most of my research was done on a Chromebook ;-)

  10. It’s an amazing case. There is some cloud options for sharing, view and analyze DICOM files. On medimsight.com you can upload your data and get quantification analysis, get structures segmentation or 3D reconstructions of these structures. Easy to download and print STL in 3D.

    1. My group, Riverside Radiology associates, serves roughly 17 hospitals. We maintain what is essentially a cloud, in that studies from all of these hospitals are on our own network. Subspecialty trained radiologists pull exams from their particular special area (orthopedics, neuro, etc) from all the hospitals to read. Thus, patients from very small hospitals have access to deep expertise as a result of the cloud system we operate.

  11. I don’t want to take anything away from the couple for their intense work, but what about the doctors in this story? They misdiagnosed the seriousness of the tumor and misinterpreted radiology results.

    I understand it’s important to take control of your own care, but what about those who don’t have the resources to do so? Aren’t some of these mistakes below an acceptable level of competence?

    1. As I said, the interpretation that the tumor had enlarged APPEARS to have been in error. How could that possibly occur??? Well, take a non-spherical object – for example, lets take a cone. Imagine a plane sectioning the cone at an oblique angle, and you get an oval. Now, change the angle by 10 degrees or so (and this amount of positioning change between studies done months apart is highly likely) and you get an oval with a very different major and minor axis measurements. That said, we are alert for such a change, and hopefully include such positioning changes in the estimate of size. And of course, near the edges of the tumor there is partial volume averaging, another source of imprecision when measuring masses, though, given its size, it is likely not an important source of error here.
      And it would be disingenuous to claim that every interpretation was 100% correct. Fallible humans interpret these. I am sure that at some point I have made this error, despite double checking myself. It’s just unavoidable. If the reader did this three times a day, then we would have to start asking some questions.

      1. Phil let me ask you a question. As a radiologist, do you work in a radiology clinic? If so, what is your procedure for reviewing scans? Do you review just the current scan, or do you review the entire history? Or is it the policy in your clinic that only radiologist follow an individual. My concern is, most people never see any images, and many physicians don’t know how to read them as well. They only thing the physician goes on is the written report, which in our case was never shown to us and reprocessed by the neurologist. If we had not taken upon ourselves to view and study the report and request another MRI with contrast, we would not have known the actual size, type and pervasive nature of the tumor. As said I cannot speak on the extent of how we are handling the neurologist, but I do not feel it is appropriate for medical professionals to use their license to push their own personal agenda.

        1. I work in a large hospital primarily, and occasionally in smaller hospitals, and also in an outpatient center (breast center) immediately adjacent to the main hospital, so it is. for all intents and purposes, the hospital.
          You ALWAYS look at the most recent pertinent exam and the report of that exam, and usually one or two more. Some types of exams require more stuff to be reviewed than others. PET scans, usually done for staging cancers, require rereading 2 or 3 other exams, each of which could have 200 images or so, along with pathology reports, and office notes. These are now available to us fairly quickly online. 10 years ago they weren’t, so we are better armed with information now than before. Mammography – we have current exam as well as all prior digitized exams (0 to 8 or so). These are on a workstation optimized for reading mammo (Hologic), so you have the current one on the left, and you can scroll through the old images on the right screen very quickly, making changes more evident (these are HUGE images, and the number of images that are held in RAM are such that the amount of RAM required to rapidly scroll through is massive.
          When you say the ENTIRE history… No -not as a rule. I don’t look at wrist X-rays when reading mammograms. I don’t look at the pap smear result when reading PET for lung cancer. You have to be intelligently selective.
          I think you were asking if one radiologist is assigned to each patient. No. Totally impractical. Scheduling would be impossible, and we are not always in the same place. Besides, the fact that different radiologists are looking over each case means that, during review of the older case, the patient is essentially getting a second opinion.
          Yes most people never see the images. And of course, if they did they wouldn’t know what they meant. Sort of encrypted, in a sense. So I don’t get real worked up about patients not seeing their own images (and as I pointed out before, you certainly can get these, every radiology department will give you a copy on request.) It’s just that for 99.9% of patients, the may as well be written in Chinese.

          And yes, the written report is what is gone on most of the time. You have now identified what I consider to be a real opportunity for improvement (ahem.). Our reports, aside from being laser printed, look no different than they did in the 1940’s. We should be including images with arrows to point to what we are talking about, occasional tables to follow lesion sizes over time, etc. All of this is really possible, but isn’t done. Because the systems do not play well together. Because (cynically) each company is not interested in sharing information with other companies. (The dictation system is Nuance, the imaging system is Fuji, the hospital information system is GE).

          1. Thank you Phil for detailed response. You are welcome to join us tomorrow as well if have time on “3D in Review”. It was never my goal to minimize the role of experts and professional like yoursel. My goal is to help and explore. I have always thought of what if the mistake I just made was in a medical situation. I do not envy anyone in a medical descipline. With that being said, I do feel we need to do more. As mentioned in the beginning of the article, I have had my own battles that until recently that went undiagnosed. It was the talents of local internalist who ordered the proper tests.

          2. Hi Phil,

            I apologize for not getting back to you and seeing your response until late last night. I hope you found the link elsewhere to view it. With that being said and if you watch the GHOA event, I hope you got different perspective of what I am trying to accomplish. From your other posts, you seem like a very experienced radiologist who see a great deal of scans on a daily basis and understand the logistics of data management.

            If you are working in anything groundbreaking that you think our 3D technology audience would like to find out about, please email me at info@allthings3d.net and we can do a 30 minute interview with you. Again it is not my intention to slight or minimize the role medicine plays in our society, but for me, being very technical in nature, the technological and scientific breakthroughs are not coming fast enough, but for some, it is way too fast, and sadly some ignore or even discourage these changes.

          3. not a problem. Later I found that the information was higher in the thread. I do have an interest in these things, so I may try to maintain contact.

          4. Yeah but you’re way off the point Phil, and you look cartoonish for it, even with all of your fancy read up-edness. Don’t worry, it’s just life. For example, there is rapidly growing evidence that expectations greatly influence test cases, but you and the medical community might not cite it as fact for another 20 or 30 years. Luckily human life span is short, so we have hospitals around that people can come check into and leave. The problem here, in my unprofessional opinion, seems like STS, or compassion fatigue if you aren’t near a computer/phone/book. Nobody wants a doctor with EVIDENT compassion fatigue. On a happier note, you probably make lots of money as a doctor, and you can go buy yourself some nice…. ummm…. wait, you’re almost. But don’t worry, new (cynical) quantum trials show there’s an exception to every rule!

            –Thanks to Sara Breselor for the article, and more to everyone in the hilarious comment section, time to get back to work. Have a great day!

    2. It appears Phil has responded to this and he is right. However, Phil does not know the whole story and does not know the area we live in. We are small community and sometime you have to go out your local area to find qualified help. In any case, I agree that the surgeons should receive all of the credit for applying a new procedure (< 5 years) and ensuring such a positive outcome. I cannot say enough about UPMC, their staff and their quality physicians. We have been tempted to move to Pittsburgh, but then we were told about the winters. Plus, here is hoping we don't have to come back anytime soon.

    1. Hmm, my comment was swallowed by Disqus. I hope you don’t feel that way after you hear Dr. Klioze tomorrow on “3D in Review” and a previous interview we did with him. He is an exceptional radiologist and cardiologist, who feels the patient is part of the treatment and something that I have not heard actually talks with the patient and their physician on the radiology report that was written.

      Again I want to stress that a majority of doctors and surgeons are very talented, skilled and competent. However, they are human with all the weaknesses you and I have, in fact the reality check is they are just like you and me. Maybe we should stop elevating them to an unreachable level.

  12. Radiologist here.

    A few reality-testing points.

    First – “A typical thyroid removal is performed via a large incision across the throat that requires a long, uncomfortable recovery and leaves a big scar,” Big scar – I’ll go along with that – typically 8-10m cm. But “long, uncomfortable recovery” I call bs on that one unless you consider a day or two long. Uncomfortable – not so much. AND the surgeons I know who use robotic surgery say you get something (smaller incision) and lose something (the ability to touch the organ to feel where potential tumors are.) The press typically present these techniques as earth shaking, as they have here, and it is almost never the case.

    Second – the article is titled as though the ability to 3D print saved her sight. BS again. I’ve been able for about 15 years to generate software 3D models on my Macbook Pro (Osirix – free software). Been able to do it on very expensive workstations at work also. For vascular studies – very useful. For other things, not. An experienced radiologist gets little or nothing out of 3D models. (except for vascular). Clinicians (neurologists, etc) very experienced in imaging -similar story. For this tumor, without seeing it, I can still make an accurate guess that the important information (lack of change) was on the images, and mis-interpreted. (Of course it was on the images, when they got the 3D model, created from these images, it was obviously not changed, so it was only how the images were presented (2D) that resulted in a mis-interpretation.) This could have been determined simply by going to the radiologist and asking him to go over them images with the patient, her husband, and the neurologist. Everyone is entitled to do this, by the way. You paid for it. I believe that the error made would have been discovered by careful inspection of the 2D images or by 3D software modeling. At any rate, there is another anomaly here. The final result – no change – would be a reason NOT to do surgery, yet it was done.

    Printing the 3D model, as opposed to manipulating it in software, is generally not additive. It might be in some cases, but we have never had a need to do a physical model .The surgeons have access to the software 3D model and can do all manner of measurements that they may want.

    There was a company about 15 years ago that would manufacture hip prostheses from the CT data given them. These were then CAD produced hips specific for each patient. Great Idea. It died. Company gone. Not really useful.

    And there are multiple large companies already in intense competition to deliver these 3D data. The software is VERY expensive, in part because they have to go through an FDA certification process. So, startups seem like a dead end here.

    1. Hi Phil,

      This was brief article and many of the discussion we had over a period of six months. I appreciate your opinion, but unless you have had a thyroidectomy, please don’t speak for those who have. The standard procedure can lead to painful and protracted healing. The daVinci robotics system should only be used by highly skilled and trained surgeons who understand all the nuances of the system, but with that being said Dr. Stang at UPMC is one such surgeon. As in the case of her brain tumor resection we talked with many ENT surgeons locally, nationally, and internationally (Korea).

      I also agree that there are a great deal of excellent medical professionals, including radiologists. That is why Dr. Klioze is joining us tomorrow. I respect his professional opinion and why I did an hour+ interview with him on All Things 3D.

      Finally the Dr. Gardner & Dr. Stefko the surgeons who performed the eight hour long surgery, are amazing and the true heroes of this story. My goal is inform this audience that there are tools out there to help you the patient, along with a wealth of information on the internet to help you digest and understand the data.

      As someone else said, medically professionals are human as well with all the faults and attributes of being human being. My goal with this interview was to help my wife find the best surgeons and provide all the information I could with my technical background that could help those performing the procedure. I have no false pretenses that it was me who saved her life or eye. But the truth is Pamela’s mother died at a very early age of a brain tumor 30 years ago, and I did not want the same thing to happen to my wife.

    2. @Phil I appreciate your candor, and I found your point of view to be… balancing. It’s good to know that we are not being offensive to ask to review images with the radiologist and the neurologist again, and that we can expect it as our right. I don’t have a 3D printer and I couldn’t imagine the work it took to figure all of this out as a a kind of DIY medical masterpiece. I almost felt pressured in the middle of the article to make sure that if this happened to me or my loved ones, I would remember to buy my own 3D printer and get started, LOL! Not all of us are capable of this and require other tools to get the best treatment. Thanks for reminding the rest of us that we pay for the experts with years of medical training to be….the experts.

      1. I totally agree LR. Even though I can do 3D stuff, I am not a radiologist, and as Dr. Klioze identifies in his own YouTube videos, the is weighty technology. This also holds true for the surgeons who performed critical life saving procedures. It was never my intention to make someone feel like if they did not understand 3D technology or any technology that they are doomed. I hope the more important point is to ask questions, research and find the best people in their particular field. As I have said elsewhere the real heroes are Dr. Gardner and Dr. Stefko, as well as my wife Pamela. I hope I never have to endure anything like this, and she had to go through critical surgical procedures in back-to-back years. She is my hero.

  13. It is very scary that we can’t trust our own doctors anymore, but gives us an amazing lesson on being proactive and no take an “it is ok” if you don’t feel that is ok.

  14. A tiny sliver of an expert’s attention doesn’t always outperform the total focus of someone with everything to lose.

  15. I want say that UPMC and excellent surgical staff, notably Dr. Gardner and Dr. Stefko, these were the lead surgeons in a multidisciplinary team of surgeons. I want to stress that they are the real (and our) heroes. Not only are they talented, they have a great sense of humor like Dr. Stefko’s team (the optomologist surgeon) referring themselves with titles from Star Trek the Next Generation. But the most important thing is their dedication. They were in surgery meticulously micro drilling out the bone and tumor for EIGHT hours. I can’t go more than 15 minutes with my Dremel tool in one stretch. As Dr. Gardner said, they suffer so their patients don’t have to.

  16. By the way. As another point of information. I always ask for my images on disk after each scan that I or one of my family has. I file them at home. You can view them on Osirix as mentioned elsewhere, and usually the disks have a viewing program embedded that runs on windows. People don’t understand sometimes how critically important it is to see old studies to evaluate something seen today. Was that nodule in the lung seen today there five years ago and simply not reported? As it happens, one of my studies that I had done about 6 years ago that I didn’t get a disk of was inexplicably lost, and we needed it. No one has a clue about how this could have been lost, given our sophisticated image archival, but it was. Reinforced the need to have a copy of all studies at home for extra security.

  17. Sara Breselor: The internet and access to it are so profound. Imagine being without that tool.
    A recent illegal move by President Obama may impact that ability. Think Obamacare for the internet. Call your congressman and ask them to stop federal takeover of the internet.

  18. If you happen to be on a Mac and are interested in viewing DICOM imagery, I recommend Osirix http://www.osirix-viewer.com. The free 32 bit version renders slower but otherwise (as far as I know) has feature parity with the FDA approved 64 bit version.

  19. “develop treatments for video game addiction”

    Uh, is she still developing “treatments” for diseases that don’t exist?

  20. This article is so informative and comprehensive, i have been keeping my 3D printing skillset on the shelves its time to find something great to contribute to

  21. I just had a Colloid brain cyst removed at UPMC in Nov. My surgeon was amazing and sho was all my care. This would have been so cool tho have done a see it in 3D before I had it removed.

  22. The argument about US vs Canada is unreal, none is better than the other one.

    If you draw a true matrix of cases, you will not be arguing like my kids saying that mine is better than yours. Congrats to the 3D man, and Pamela that went through it.

    Sometimes you need to do it by yourself in US, or you will end up dead… I would assume the Canada system is not perfect, but at least it leaves the patient perhaps with less worry about the mechanics , to focus on the recovery.

    This is my experience here in the US:
    I have auto work injury, still suffering with my injury being back to 2011.
    Our workers comp system by default plainly sucks in my case. Thankfully, I found an expert compassionate doctor almost one year after my injury, that listen top my chief complain and did what he could. It still hurts, but the workers comp insurer approach of trying to save a buck, messed me up big time….

    The workers compensation here in the US is not to compensate the worker, is to save money to the insurance companies, and so the worker does not sue the employer.

    One needs to be careful with attorneys too, some have no ethics and they play with our health like if it was a trivial matter like reading a newspaper. Attorneys in general do not understand much about medicine. doctors work is to treat the patient, and so the patient is left bouncing between both systems more often than not.

    In my case I asked several times for a functional MRI and Nerve Conductivity test, just because attorneys in litigation often tell me than the jury likes graphical items in the trial.

    I am sure in Canada there are challenges too, but a bigger issue for me, is when we have the supposedly well advertised best country in the world, with so much hatred within.

    did any of the USrs :) that are claiming that US is better than Canada ever had a workers comp injury?
    http://www.abajournal.com/magazine/article/insult_to_injury_texas_workers_comp_system_denies_delays_medical_help

    http://www.nytimes.com/2009/03/31/nyregion/31comp.html?pagewanted=all&_r=0

    http://centerjd.org/content/fact-sheet-workers-compensation-systems-delays-incompetence-and-bias

    There is a lot more…I found out that the Adjusters are brain washed to deny anything and everything….Why?

    Because they have financial incentive to do it..

    So in the case of healthcare, I am not totally certain, but one thing I want to say:

    I take my hat to Balzer, I am about to go in the same problem solving situation and buy a kit , because my workers insurer denies everything, and hired actually several “experts” to save money, one “expert” never saw me, saying that I had achieved expected improvement.

    Thank God I followed my instinct, because with so much headaches the world seemed pretty small about to end. when my face started to swell and a muscle spasm showed up, I decided to do the work myself, because no one was listen to my complains, and i didn’t want to die yet.

    I have since found a few good doctors, one of which saved my life, and spoke to just a few good attorneys with ethics. the vast majority of people I have seen, do not understand or pretend they don’t know what i am talking about.

    In summary, capitalism has its problems too…I would not be so fast in reacting to your angry self, just because you like your country, it does not mean its perfect, plus, as we all know, people act erratically when they are angry, reacting to fear and anxiety…

    http://www.nationmaster.com/country-info/compare/Canada/United-States/Crime

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Sara Breselor is a journalist and editor based in San Francisco. She writes about technology, art, culture, and weird news for the Harper's Weekly Review, Wired, and Communication Arts.

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