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.
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.
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.
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.
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.
Patton 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:.