By Sara Bondell - May 24, 2021
As a retired art teacher, Jean Lowe is no stranger to 3D printing. She once used the technique to make badges for an art conference.
But she never imagined she would be holding a 3D model of her liver in her hands.
Lowe was diagnosed with a small bowel neuroendocrine tumor in 2018. Her cancer spread to her liver, and surgeons are preparing to remove four tumors from the organ this month. Like most undergoing major surgery, she was nervous.
But when Dr. Daniel Anaya, surgical oncologist and section head of the Hepatobiliary Program at Moffitt Cancer Center, walked into the exam room for a pre-operative appointment, everything changed. He was holding an exact replica of Lowe’s liver. Using the model, he was able to not only show Lowe where her tumors were located, but also demonstrate how he will be removing them.
“Now I understand exactly what he is doing, so it’s perfect,” said Lowe. “This is tremendously helpful.”
In the past, surgeons have shown patients scans and drawn on a 2D liver template. But scans can be difficult for a lay person to understand and the drawings don’t account for all of a patient’s unique characteristics.
Lowe is the first patient at Moffitt to see a 3D liver model, but she won’t be the last, thanks to a collaboration between the cancer center and University of South Florida’s Department of Radiology.
Printing in 3D
A few years ago, 3D printing started to increase in popularity in the radiology field as radiologists recognized the potential models could have in patient care.
“3D models have been used to educate patients about their disease, for trainee education and for pre-operative planning so the surgeon has a much better idea of what to expect before operating on a patient,” said Moffitt radiologist Dr. Rikesh Makanji.
"3D models have been used to educate patients about their disease, for trainee education and for pre-operative planning so the surgeon has a much better idea of what to expect before operating on a patient."- radiologist Dr. Rikesh Makanji
Makanji applied for an internal grant to obtain a small printer and turned to Dr. Summer Decker, Director for 3D Clinical Applications at USF Health’s Department of Radiology, whose team pioneered a robust 3D printing program that makes models for other hospitals around the area and other parts of the country. Decker and her team began to train the Moffitt radiologists and her lab agreed to partner with the cancer center to collaborate on cases and print models. Together, they realized they could enhance cancer care.
“As radiologists, we are primarily looking at 2D images and making measurements on a single plane. And to us, that makes sense,” said Moffitt radiologist Dr. Daniel Jeong. “But I think when we expand this to patients, they get a much better feel by looking at the 3D model and seeing the spatial orientation of the structures.”
“As clinical partners, USF Health and Moffitt are uniquely positioned to use cutting edge technologies, like 3D printing, to benefit patients with increased understanding of their case and ultimately better clinical outcomes through this exciting collaboration,” said Decker.
When the COVID-19 pandemic hit, the team found a new opportunity to use 3D printing. With a national shortage of nasal swabs for COVID-19 testing, the USF Health 3D lab and its colleagues in USF Health Infectious Disease designed a nasal swab, a critical component of the COVID-19 testing kit, that could be 3D printed. As an affiliate partner, Moffitt was able to use its small printer to help, printing several thousand swabs to test patients.
After the height of the pandemic, Anaya approached the USF Health 3D Lab about working on models for one of the body’s most complex organs: the liver.
“We wanted to continue to advance the field of complex liver surgery by bringing in novel technologies for our patients and trainees and to help improve surgery even beyond our current practices and outstanding outcomes,” said Anaya.
The liver has many different types of vasculature, including veins, arteries and bile ducts, making it unlike any other organ in the body. Because of this, it’s a challenging organ to operate on, especially when it comes to removing cancer.
A 3D model can ease some of those challenges. “It’s the patient’s exact liver, with their exact tumor and the cancer’s relation to vessels and bile ducts,” said Anaya.
To create the liver model, Moffitt sends a patient’s scan to USF’s 3D team. After conferring with the physician to better understand what the goal of the model is, the data is put into a computer that generates the 3D model. Once the physician approves the model, it’s ready to print. To fully customize the model, it can also be hand painted, varnished and shaped after printing. Models can also have magnetic pieces to demonstrate removal of parts, and the lab can even create a cutting guide for surgeons to use in the operating room.
Before showing a patient the model, it can be used for surgical planning. The extent of the surgery largely depends on how close a tumor is to a vessel, and surgeons can use the model to make measurements and essentially practice the surgery ahead of time.
“Sometimes the case is more complex and we have to figure out, how will we be able to cut the tumor out?” said Anaya. “By looking at the model we can determine the best way to remove tumors and work around the vessels.”
The models can also be used for training. USF has established a 3D printing rotation for residents, and trainees can take some of a hospital’s most complex cases and print a model to practice on.
Because of the models’ many uses, radiologists hope they help draw back the curtain on their field.
“I don’t think patients really understand what radiologists do and how much training really goes into reading scans,” said Makanji. “So, in very broad strokes, I think these models can provide some insight into the kind of work we do. And even working with the surgeons and developing relationships with them is equally as important.”
Now that the team has figured out the best way to print the liver models, it hopes the collaboration can continue to help patients with other cancer types in the future.
“It is great to create a product that is tangible that a patient can hold instead of just taking home a disk where they may not understand what is on the disk or the big words in the radiology report,” said Moffitt radiologist Dr. Trevor Rose. “This helps them understand the process a little bit easier and that’s a great connection to make with the patients and the ordering physicians.”
Doing the right thing
Before coming to Moffitt, no one mentioned to Lowe that she would be candidate for surgery. She was shocked when the cancer center told her she had another option, and when surgery became the next course of action, she worried, is this the right choice?
But Anaya used the 3D model to explain how he is going to remove three of Lowe’s tumor and burn the fourth. He showed Lowe which vessels he would have to cut, which part of the liver he will remove.
“This is not a routine tool used by other centers, and I would say you are among the few to have a real liver model developed to plan and explain surgical treatment,” Anaya tells her.
Lowe breathed a sigh of relief. The surgery made so much more sense now.
“I was very nervous before and wondering if I made the right decision,” said Lowe. “This clarifies it and shows that I am in the right place and doing the right thing.”