Radiology and 3D printing?

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GLOO_Cannon

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Hello guys! Just an over-caffeinated MS3 here that recently got interested in radiology so take this with a grain of salt, but I recently stumbled upon this video and it made me think about the direction that Radiology, as a field, may take in the future:



**Edit - description of the vid for those who can't/ don't want to watch the vid: It's showing how 3D printing anatomically-fitting (perfect or near perfect fit) bioimplants for orthopedic reconstruction! With the surgeons actually implanting the 3Dprinted reconstruction which perfectly fits the patient's individual anatomy!

and upon some further digging, found out that many Radiologists have already begun research/training into image-guided medical 3D printing (Reconstructive Radiology perhaps? Yeah I just made that up... since 3D constructs are being reconstructed from radiologic images? lol idk :laugh: )

From: RSNA Publications Online

"A “3D printing laboratory” in radiology is now likely to emerge, with some parallels to and differences from early 3D laboratories. Although overall 3D printing costs continue to decrease, start-up expenses without near-term reimbursement will likely limit early adoption to radiologists currently proficient in advanced visualization. However, creating accurate 3D-printed models requires an additional fund of knowledge and mastery of new technical skills to generate unique printable file formats recognized by 3D printers. Early-adopter radiologists must invest in developing and honing these skills. Over time, these skills will be incorporated into training programs and implemented with use of software that is better integrated to radiology workflow, facilitating the pathway for most or all radiologists to use a 3D printer as a step to improved patient care."

From: Radiology in 3D - Radiology Today Magazine

"Due to their skillset, radiologists play a key role in medical 3D printing. The volumetric data sets from patients required for the models are acquired in radiology departments, and radiologists are the natural workforce to convert those images to STL files, according to Rybicki. He does caution, however, that as the technology continues to evolve and once reimbursement finally arrives, radiologists could possibly end up in a less influential position, if they do not remain active in the process and in crafting standard operating procedures."

From: 3D printing finds myriad roles in healthcare

"Without a single, central specialty taking the lead in implementing the technology, 3D printing's integration will be exposed to inefficiencies and potential disorganization as multiple specialties attempt to implement similar processes simultaneously.

As the universal hub for image acquisition and storage within hospitals and healthcare systems, radiology is appropriately positioned to administer and refine 3D printing processes..."

From: Radiology Needs to Own 3D Printing | Diagnostic Imaging

"...what if radiology’s current product and service could both be augmented in a big way through 3D printing? What if radiology’s service line could expand to provide not just image interpretations, insights, and recommendations based on images, but also customized surgical guides and positioners, patient-specific prostheses, biocompatible implants for regenerative medicine, or deformable models for surgical training? The opportunities for radiology seem endless and are actually coming of age."

And lastly this... (Skip to 10:30 for the synthetic oncolytic virus/possible nano drug delivery mechanism and 3D printing thing)



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As you can tell I'm very excited about this, considering this would add value to services Radiologists can provide in addition to diagnostic interpretation and procedures!

What do you guys think? Is this too science-fiction-y or is this the next logical step for Radiology? (image-guided 3D reconstruction)

Again I'm just an MS3 so take the above with a grain of salt, but If anyone has any additional references for those interested in this, it would be much appreciated! :)

**A couple of questions I have would be:

1. For the veterans and experienced radiologists that actually know the realities of the field, what are your thoughts on the matter? Would turf wars be anticipated or would radiologists be seen as a having a key role in this? (The time spent modelling on on a workstation vs Time spent consulting with patients/operating, etc)

2. How come most attention on this forum is being given to AI and machine learning (something that could potentially DECREASE the value of radiologists in the future) as opposed to pouring energy into the development of image-guided medical 3Dprinting and ensuring that Radiologists play a key role in it? (something that could potentially INCREASE the value of radiologists in the future)

**Update: For those interested in Translational Research, here: National Institutes of Health funds $6.25 million center for 3D bioprinting and tissue engineering

**Update2: I take back what I said about AI/Machine Learning! Lots of interesting emerging applications, especially with 3D genomics and interesting applications for molecular imaging, rendering, and bioprinting!

Edit: Included a description for the first vid. This isn't the run-of-the-mill surgery guidance usage of 3D printing guys, it's a step towards bioprinting! Printing out anatomically fitting bioimplants!

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At my institution radiologists head up 3D printing and it is something that is paid attention to, but your mileage will vary depending on where you are.

Part of the problem is that there isn't really any reimbursement for 3D printing and it's expensive. If that changes, I could see it being far more widespread.


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1. For the veterans and experienced radiologists that actually know the realities of the field, what are your thoughts on the matter? Would turf wars be anticipated or would radiologists be seen as a having a key role in this? (The time spent modelling on on a workstation vs Time spent consulting with patients/operating, etc)

2. How come most attention on this forum is being given to AI and machine learning (something that could potentially DECREASE the value of radiologists in the future) as opposed to pouring energy into the development of image-guided medical 3Dprinting and ensuring that Radiologists play a key role in it? (something that could potentially INCREASE the value of radiologists in the future)

Hi GLOO_Cannon, apologies I'm in my research lab and can't watch your videos right now. I can provide you a couple a facts about 3D printing in radiology. There's this excellent article circa December 2015 that summarized the current status of 3D printing in radiology. At my institution we have a 3D printing lab, for radiology...and it's not used. The lab exists when/if 3D printing becomes reimbursable. I think it's unlikely at this point for 3D printing to take off; especially considering many of the benefits can be achieved using VR + responsive feedback devices. For kicks, here's a video that I helped make of VR + MRI images:

https://drive.google.com/open?id=0B6Vt16NqHup2X2hUaFFyY01xOVk

The image used in the video is quite cool because it demonstrates the potential value of VR in radiology. I segmented the 3D volume of livers with hepatocellular carcinoma, and I segmented the individual tumors using standard radiology tooling on each slice. The magic of VR is that you can see where the tumors lie within the liver using a clipping plane. You could use the same method to segment vessels for IR procedures. There are already responsive feedback devices that use these reconstructions with tactile feedback for simulating procedures. For anyone interested, the Mac OS X software OsiriX can convert MRI images into STL for use with 3D printers and VR.

I like 3D printing and VR, but I question how much value they provide. Machine learning (ML) is a different story. Starting in 2012 we saw the success of a very new paradigm in ML called deep learning. These methods automatically identify the features needed to solve a classification task from the raw source data. It has shown success in computer vision on tasks that are similar to diagnostic radiology.
 
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Hi GLOO_Cannon, apologies I'm in my research lab and can't watch your videos right now. I can provide you a couple a facts about 3D printing in radiology. There's this excellent article circa December 2015 that summarized the current status of 3D printing in radiology. At my institution we have a 3D printing lab, for radiology...and it's not used. The lab exists when/if 3D printing becomes reimbursable. I think it's unlikely at this point for 3D printing to take off; especially considering many of the benefits can be achieved using VR + responsive feedback devices. For kicks, here's a video that I helped make of VR + MRI images:

https://drive.google.com/open?id=0B6Vt16NqHup2X2hUaFFyY01xOVk

The image used in the video is quite cool because it demonstrates the potential value of VR in radiology. I segmented the 3D volume of livers with hepatocellular carcinoma, and I segmented the individual tumors using standard radiology tooling on each slice. The magic of VR is that you can see where the tumors lie within the liver using a clipping plane. You could use the same method to segment vessels for IR procedures. There are already responsive feedback devices that use these reconstructions with tactile feedback for simulating procedures. For anyone interested, the Mac OS X software OsiriX can convert MRI images into STL for use with 3D printers and VR.

I like 3D printing and VR, but I question how much value they provide. Machine learning (ML) is a different story. Starting in 2012 we saw the success of a very new paradigm in ML called deep learning. These methods automatically identify the features needed to solve a classification task from the raw source data. It has shown success in computer vision on tasks that are similar to diagnostic radiology.

Ahh in terms of "value", I meant adding relevance in terms of additional modalities to (non-IR) radiology services. Something like, say, using volumetric data from something like 3DCT and applying it to Bioprinting wherein the radiologists would be the ones who head up this particular reconstruction service (And the videos + articles I linked would help clear things up with what I mean by "value"! haha sorry I wasn't clear on it).

Whereas advanced diagnostic AI [if/when it starts encroaching DR territory] would deprive diagnostic radiologists of experience in terms of getting used to "bread and butter" cases (since those would be automated) and would in effect decrease their overall relevance/value as well as decreasing their overall income (since the easy to read cases are automated). It's why diagnostic AI is meeting a lot of resistance, imho (again I'm just an MS3 so I don't have much firsthand experience with this so feel free to correct me anytime! :D )

Here in case anyone wants to know more about bioprinting :)

https://www.researchgate.net/profil...and_Organs/links/54ca3f450cf2c70ce521a333.pdf

http://www.nature.com/nbt/journal/v32/n8/full/nbt.2958.html

Edit: Oh! and this too, in case it wasn't emphasized in my OP haha (about the "value" of 3D printing in radiology)

From: http://www.diagnosticimaging.com/rsna-2015/radiology-needs-own-3d-printing

"...what if radiology’s current product and service could both be augmented in a big way through 3D printing? What if radiology’s service line could expand to provide not just image interpretations, insights, and recommendations based on images, but also customized surgical guides and positioners, patient-specific prostheses, biocompatible implants for regenerative medicine, or deformable models for surgical training? The opportunities for radiology seem endless and are actually coming of age."
 
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Long-time lurker, first time poster here. As someone whose original goal was Surgery->Transplant surg, but ultimately matched into DR (though hopefully going to IR), I was initially bummed because I thought my original research interests in transplant histocompatibility wouldn't be much use anymore and that I'd be stuck in a dark room reading images if my IR plans don't work out.

But then I came along this thread and it gave me something to be excited about amidst all the doom and gloom about job market and outsourcing woes. I do see a couple of areas for improvement, though:

1. Immuno/histocompatibility- I know that genetic engineering technology like CRISPR already exists and is being refined but how long before we get to a point where we could effectively use it to engineer bioprinting material that could be histocompatible to individual patients? Definitely something that needs to be addressed.

2. Logistics- Seeing as reimbursement is an issue, only the super well-funded academic centers and the wealthy would be able to partake in this in the earlier stages. Let's say there's rich guy x in hospital A but hospital A doesn't have bioprinting equipment/expertise. Would current methods of transporting organs be sufficient or would bioprinted organs be less robust when it comes to being lugged around in an ice box?

Bottomline: This could actually revolutionize not just radiology, or even medicine in general, but even healthcare and biomedical/pharmaceutical research. Since bioprinted organoids are apparently something being worked on, animal testing may not be totally necessary in the future. Some main hurdles that need to be looked into would be the above i mentioned + reimbursement before this can become widespread, though.
 
Long-time lurker, first time poster here. As someone whose original goal was Surgery->Transplant surg, but ultimately matched into DR (though hopefully going to IR), I was initially bummed because I thought my original research interests in transplant histocompatibility wouldn't be much use anymore and that I'd be stuck in a dark room reading images if my IR plans don't work out.

But then I came along this thread and it gave me something to be excited about amidst all the doom and gloom about job market and outsourcing woes. I do see a couple of areas for improvement, though:

1. Immuno/histocompatibility- I know that genetic engineering technology like CRISPR already exists and is being refined but how long before we get to a point where we could effectively use it to engineer bioprinting material that could be histocompatible to individual patients? Definitely something that needs to be addressed.

2. Logistics- Seeing as reimbursement is an issue, only the super well-funded academic centers and the wealthy would be able to partake in this in the earlier stages. Let's say there's rich guy x in hospital A but hospital A doesn't have bioprinting equipment/expertise. Would current methods of transporting organs be sufficient or would bioprinted organs be less robust when it comes to being lugged around in an ice box?

Bottomline: This could actually revolutionize not just radiology, or even medicine in general, but even healthcare and biomedical/pharmaceutical research. Since bioprinted organoids are apparently something being worked on, animal testing may not be totally necessary in the future. Some main hurdles that need to be looked into would be the above i mentioned + reimbursement before this can become widespread, though.

Very valid points! And yeah, I agree with both you and @surgonc2017 that reimbursement is definitely an obstacle atm, but I hope healthcare leadership is working with insurance companies/politicians/corporate overlords to change all that.

And yup, definitely more work needs to be done before bioprinting becomes more widespread, though atm there are a lot of other applications for medical 3Dprinting such as in the first article I linked in the OP :D (http://pubs.rsna.org/doi/full/10.1148/rg.2015140320)

Oh yeah and to clarify: I didn't mean that IR wouldn't be able to participate in this. All radiologists would be able to participate in this upcoming field since this requires imaging expertise and technical expertise!

For anyone interested, there's this upcoming event by 3DHeals (2017 Global conference) that's gonna be held on April 19-20, 2017 over in San Francisco!
(Details: 3DHEALS AND UCSF PRESENT 3DHEALS2017 )

Edit: Found an auntminnie article echoing my sentiments in this thread
3DHeals conference explores 3D printing and more

"For radiologists looking to keep their skills relevant in a highly automated future, 3D printing is a great place to start, Chen added.

"Everyone is responsible for their own future," she said.

Registration fees for the meeting have been intentionally minimized for medical students ($50) and residents ($150), and they are reasonable for physicians ($450) as well"


Edit2: Old link to event I posted was broken, this updated one works now
Edit3: Linked bioprinting translational research opportunities in OP updates
 
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man, this is badass tech. reminds me of the star trek replicator but for body psrts lol. rads didnt even cross my mind until i found out about interventional onc recently...

ended up here only cause the sdn specialty selector ranked rads diagnostic higher than heme, onc, and surgonc after retaking it for procrastination's sake :laugh:
 
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Hi, I am looking into this topic myself, I own a small 3D printing business and have come into the opportunity of partnering up with a pregnancy ultrasound business and have found the means to process the scan files into an .Stl file and then 3D printing the baby. But am having difficulty in actually exporting the correct files from the ultrasound machine. Everyone I export the scan files in .DCM format the files appear as a .DCM format but when opened in my slicer software they appear as images rather than actual volume data. Is there anybody that could maybe help me out with what I am doing wrong? Anything would be greatly appreciated.

Thanks!
Wes
 
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3D printing and radiology is very cool. Definitely keeping an eye on this as an MS3 and beyond.
 
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