14 ms·

Man saves wife’s sight by 3D printing her brain tumor

697 points by zaaaaz 12y ago

Flott 12y ago
Wow. Amazing story. Moral of the story : If you can, ask for a second opinion!
- agumonkey 12y ago
  Beware, my mother, dissatisfied with the first answer[1] asked for a second one, the next doctor told her exactly what she wanted to hear[2] but underestimated the risks. Massive internal bleeding during the operation => emergency decision => remove the whole organ. Like precogs, we may need a 3rd opinion as arbiter. [1] situation is very complex, probably need to remove part of an organ [2] the he could fix the issue without ablation le: simplification
  - Flott 12y ago
    Thanks for the reply. You're making a very valid point! First : Sorry to ear what happened to your mother. Doctors telling what we want to ear is also a problem! Mostly, I believe, because when something like a brain tumor is threatening your life, you might not want (and know) what is best for yourself. Doctors can be influenced by their patients. As you stated, the second opinion can be wrong and it is very hard for the patient to know who to believe. I wish everybody could have a little help from a friend with some photoshop & 3d printing skills!
    - agumonkey 12y ago
      Luckily, if I may say so, it wasn't that crippling, the damages were more emotional. Waking up to this kind of news unprepared (and they completely dismissed their lack of judgement, ha the sacred doctor) is a pretty big blow.
makmanalp 12y ago
This is an amazing story - and pretty much my worst nightmare. Not necessarily cancer itself, but the feeling and anxiety that you're not being treated and taken care of properly and that someone might be missing something. That doctors are (rightfully) unable to pay proper attention to everyone and everything just due to the sheer number of patients they must see. I know I'm prone to hypochondria, and it doesn't help to read things like this. I can't wait for a world where we can constantly monitor the body easily, and abnormalities can be detected quickly and unequivocally, and even have software that can aid doctors in diagnosing. I've read articles where doctors approach such ideas with skepticism, saying that more data isn't necessarily better, which surprises me very much. How can you look at two data points on a curve and guess what the curve looks like? Anyone else feel similarly? ---- edit: I see false positives and the cost of dealing with them brought up often in the replies - I think this is an issue exactly /because/ we suck so much at diagnosis. The argument that what you see may be wrong, therefore you must close your eyes just blows my mind. So you'd rather base timely detection of true positives on random chance? Maybe if we saw these false positives much more often then we could observe the false positives properly and know how to identify them and improve diagnostics. Or maybe we'd be able to know better when intervening would be more harmful than not intervening. That an intervention would be harmful should not affect the choice to monitor. And then there is also the issue of the diagnosis itself being potentially harmful (full-body CTs etc) which is equally terrifying and even more conflicting. We can also improve there too. In any case, this was supposed to be more about the nondiagnosis anxiety, but I'm not unhappy with where this discussion went.
- carbocation 12y ago
  Historically I have fallen into the "don't do unnecessary tests" camp, but I would be willing to consider an alternative viewpoint. Perhaps what is needed is continuous monitoring of biochemical data from volunteers longitudinally to help us understand if any of that data is actionable in a way that reduces suffering or prolongs life. I think the right sensors have not yet been invented for this purpose, but they are probably getting close.
  - emcrazyone 12y ago
jepper 12y ago
Interesting article, glad the operation was successful. The most interesting part of the article is not the advance in technology (nothing new, we've been using 3d prints as models for complicated fractures / bone tumours or even custom prostheses for years (academic centre)) but the low use rate of this technology by most hospitals. The trick with overlaying follow-up scans is called image fusion and is easy and can be done by one-click applications (for example http://www.blackfordanalysis.com/ http://www.blackfordanalysis.com/) but outside of lung noduli i know of little clinical use. I've seen these types of mistake made before and trying to introduce it locally. Image fusion is also an awesome surgical procedure analysis tool (both for research and clinical applications), complimentary to the standard PA examination. The patient education part is enormously helpful in practice. Cost per patient is however still high quite high for large models. For example a cardiac tumor model was printed with transparent plastic for around 500e. Our bone models luckily are a lot cheaper (non-clear plastic). When the price comes down i hope acceptance will improve.
- emcrazyone 12y ago
  @jepper I agree with your comments and to add to what you said, what really stuck out for me was how receptive the doctors were to his analysis. I didn't pick up any kind of resistance by the medical professionals to this guy's analysis. Also, I have a chronic condition and this comment from the article is just so true. "Scott’s recent thyroid surgery had taught them that getting the best care requires being proactive and extremely well informed. "
  - djokkataja 12y ago
    The article did mention that he contacted a number of doctors around the country, and it didn't sound like he had a horde of them competing over who would have the opportunity to perform the operation, just the one guy at UPMC. Plus since he had done a lot of research and "shopping around" for the thyroid procedure previously, he probably had a good idea of how to navigate the medical system to do this sort of thing.
- jarvic 12y ago
  >The trick with overlaying follow-up scans is called image fusion and is easy and can be done by one-click applications Just wanted to point out that image fusion is far from easy. The brain is easier than most areas of the body because the skull provides a good basis for performing a registration, but even then the brain has some small room to shift and you can't get a perfect alignment with only rigid transformations, especially when you're dealing with tumors. For most other parts of the body you have complications like organs shifting around, gas passing through the digestive system, patients being in slightly different orientations, etc. In these cases you most definitely need to use some kind of deformable registration, which is far from a solved problem, especially when you have things like tumors changing shape/size or even appearing from nowhere from one scan to the next.
Gurkenmaster 12y ago
This makes me doubt the reliability of cancer diagnosis: >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. Yet at the end of the article they say >if she had waited six months, she would have had severe, and possibly permanent, degradation of her sight.
- emcrazyone 12y ago
  You should doubt everything when it comes to your life. Question everything and leave no stone un-turned. I know this first hand. Doctors, very smart, just don't know everything. You really have to bone up on whatever is ailing you and really shop the knowledge base that is out there.
- kitbrennan 12y ago
  It's important to remember that this article is probably simplifying the doctor's advice. I imagine the neurologist ended with: "However, please come back immediately if you feel worse or notice any other symptoms." Obviously that 'may' have been a critical delay, and therefore Scott and her husband were certainly right in hindsight to be proactive about Scott's health.
- alexholehouse 12y ago
  > explaining that such masses were common among women, and suggested Scott have it checked again in a year. I know this sounds insane, but menigiomas (which I'd guess is what the neurologist suspected it was) are almost always benign and shockingly common - many post-mortems find these guys just kind of hanging out in/around the brain. The corollary is that any kind of cranial surgery has enormous risks. Point being, if a doctor sees what appears to be a (surprisingly) common event on a chart, they're not going to necessarily recommend further action other than observation UNLESS there's a change to the patient (which, as kitbrennan pointed out, almost certainly accompanied the "get it checked again in a year").
gadders 12y ago
In a similar vein, the chap in this article 3d printed his kidney stone to help surgeons: http://www.bbc.co.uk/news/uk-england-hampshire-30801273 http://www.bbc.co.uk/news/uk-england-hampshire-30801273 Ironically, he passed out due to the pain from his kidney stone when presenting to surgeons on the benefits of 3d printing.
jpmattia 12y ago
> 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. Think about the some of the implications of that statement for a while. It really is no wonder that the softer sciences have a reproducibility problem.
- drdeadringer 12y ago
  > the radiologist had just measured from a different point on the image. I had a similar experience when I was having a spinal curvature corrected. After a particular xray, several people -- a couple doctors, the xray guy, a med student or two, a mix of a couple people like this -- had measured my spine's then-current curvature and had come up with a huge range; to one, I had gotten worse... to another, I had some improvement... to the third, marginally the same with a smudge of improvement. In the end I got the most improvement I was going to get given my specific situation and I'm happy for//with that. The point is, it was literally three measurements on the same xray from which three mutually exclusive conclusions//opinions were [literally?] drawn. I'm therefore not surprised that there is similar with tumours.
- VikingCoder 12y ago
  There are multiple problems. The biggest problem in my mind is that outcomes are not tracked well. That means that there's no medical feedback loop to measure the long-term effectiveness of... anything. And no good way to do retrospective studies to prove new measurement techniques. And also the laws for patient protection makes it incredibly difficult to get even anonymized data for researchers to use. The next biggest problem is that there's a gold standard of treatment, and it's hard to get enough research to move the gold standard. In this case, the gold standard is essentially a diameter measurement, based on picking the visibly largest slice of a data set which happens to have an axis determined by the patient's somewhat random orientation in the CT scanner. Axial, Coronal, Sagittal. Those are not perfect, anatomical orientations - they're rough. Most radiologists won't take the time to create Multi-Planar Reformats along oblique or double-oblique angles. And even if they did, they'd still be eye-balling the measurement. It's not very hard from a regulatory standpoint to create tools to allow a radiologist to click here, click there, and show a measurement of distance. Then the radiologist can look at a similar measurement from a different radiologist on the previous scan, and say whether it's bigger or smaller now. (But some PACS still don't handle anisotropic MPR correctly, which just blows my mind.) It's vastly harder from a regulatory standpoint to say in a medical product for commercial use, "Hey, we automatically measured the volume of this tumor by automatically finding the boundary of the tissue and automatically ignoring the connected blood vessels and neighboring bone, and then we automatically found the largest cross-sectional diameter, and then we automatically compared the same measurements against the automatically non-linearly-registered longitudinal previous scan... diagnosis: the tumor is not growing, just changing shape slightly." People think their CT scans are examined for hours by a team of doctors, like on "House." In reality, you're lucky if your CT scan gets 5 minutes of investigation, and that's by a radiologist who was trained in med school to read X-Rays, not CT. And your oncology head CT may be read by a radiologist who specializes in abdominal pediatric Ultrasound. And there's almost certainly no double-reading for Quality Assurance. And there's no rating on radiologists to tell you who has the most accurate diagnosis. And he's probably using 2D measuring tools on 3D data - because that's what they're familiar with, and that's what the reconstruction software manufacturers provide, and that's the medical gold standard. On a shared computer, where some other radiologist (or resident!) might have changed the display settings in a way he didn't notice. And he's probably been reading images for 14 hours straight.
franciscop 12y ago
Man saves wife's X. Man strong. Man good. [/sarcasm]
- eklavya 12y ago
  What is wrong with you? It's such an inspiring story!!
- pluma 12y ago
  "Person saves spouse's x" doesn't have quite the same ring to it, does it?
mcmancini 12y ago
I coauthored a paper a few years ago on the intra-observer variability of measurements of brain tumors when using the bidimensional product. An increase of 25% in the BP is taken as an indicator of brain tumor progression. We found that the intra-observer variability is so high, you can get that 25% increase purely by chance. The first recommendation of the medical team, to wait and see, is understandable.
- escape_goat 12y ago
  From your wording, it seems like your brain might have slipped gears when talking about probabilities, from 'science' mode to 'homo sapiens sapiens hardwired quantity estimator' mode. When you say that "you can get that 25% increase purely by chance" do you mean (a) in better circumstances this should be formally impossible, or (b) the intra-observer variability is so high that there is significant (by some definition) possibility ___ of falsely detecting a 25% increase?
- billiam 12y ago
  That is a shocking thing to say. If they had followed the wait and see approach there's a good chance she might be blind right now. This high-handedness is why I have such a hard time with the medical profession.
  - gwern 12y ago
    > If they had followed the wait and see approach there's a good chance she might be blind right now. Operating on a brain unnecessarily has its own risks.
    - kbenson 12y ago
      Indeed, as someone who's had a close family member require brain surgery in the past, I would caution people against thinking of it like any other surgery. The equivalent of "a lingering stiffness" or "Skin tightening because of scar tissue" becomes something else entirely when talking about the brain, and by extension the mind.
  - 12y ago
_almosnow 12y ago
What's alarming is that a guy in his spare time can come up with a better diagnose than a 'certified professional'...
- zeidrich 12y ago
  He had spare time, the doctor didn't.
  - codereflection 12y ago
    Not only spare time (if it can even be called that), but SERIOUS motivation considering his wife's life was in danger.
  - SilasX 12y ago
    The doctor had work time, and ostensibly an entire eduction specifically for this job. The doctor was still at an (extreme) advantage.
- ceejayoz 12y ago
  The doctor spends all day getting other cases right, which doesn't make for as interesting of an article. Expecting them to be infallible is unfair.
ck2 12y ago
I've been skeptical about 3d printing's real uses and how it might be toy but this sold me. Great solution and ending. Hope it helps others too.
cafebeen 12y ago
Great story--I think one thing to highlight is 3D Slicer (the publicly-funded open source medical imaging tool used for all this): http://www.slicer.org http://www.slicer.org More doctors should be using tools like this. Hopefully stories like this will help to overcome the inertia in adoption.
harisamin 12y ago
This is truly amazing. Someone needs to fund this guy :)
graeham 12y ago
This is a cool application, but 3D reconstruction of DICOM images isn't that new. For example, there is the Mimics commercial package that is on version 17, and similar things are actually quite commonly used by radiologists. (see http://en.wikipedia.org/wiki/Mimics http://en.wikipedia.org/wiki/Mimics) Patient-specific surgery, and computer analysis in diagnosis and treatment is going to be very big (I'm betting four years of my life in doing a PhD in the field). Its always interesting when there is patient or family led efforts in the field, but this kind of thing was cutting edge in research probably 10-15 years ago (I 3D printed aortic aneurysms as an undergrad in ~2009 for a surgery planning project, and it wasn't a new thing then - example http://link.springer.com/article/10.1007/s100160010054 http://link.springer.com/article/10.1007/s100160010054). Its curious then why 3D printing for surgery planning hasn't become the standard-of-care yet. My instinct is that we'll see more improvements to 3D rendering, planning, and simulation on the computer, but a physical model is not that additionally helpful to surgeons for most cases. Especially considering increased cost and time compared to a computer model.
stefantalpalaru 12y ago
Alternate title: Man encourages his wife to go through unnecessary surgery for a benign and symptomless meningioma after she had an unnecessarily complicated thyroid removal in order to avoid a 4cm scar on her neck. Oh, he also made a shitty 3D model of her skull in the process.
- madengr 12y ago
  Ha ha, no shit. My wife had her thyroid removed last year. You don't even notice the scar unless you look really close, and she was back to work 1 week after surgery. The part that takes the longest is getting the thyroid pills dialed into the proper dosage; the surgery is fast with a quick recovery. Robots are not needed for this. There was a recent article saying the biggest factor for successful surgery is the quantity the surgeon has performed. In this case he had done thousands, and did plastic surgery too (hence a minimal scar).
- Karunamon 12y ago
  Did we read the same article? 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. Because I'd really like to think you're being this insensitive out of ignorance, rather than malice.
  - stefantalpalaru 12y ago
    Yes, we read the same article but we probably did not graduate from the same medical school. I noticed that the tumor did not grow between MRIs done "a few months" apart so the imminent danger invoked by the surgeon that did the highly unusual intervention looks to me like ass covering and justification for whomever paid for the intervention. There's also the publication that printed the article - a magazine known for its superficial interest in new and shiny tech, not its scientific accuracy. There's nothing in the very low res plastic 3D model that was not already visible on the radiologist's computer monitor. I'm being this insensitive because I'm an adult and I let reason ruin a good story.
  - 12y ago
jeffbarr 12y ago
My recommendation: If you ever have a CT scan, ask the imaging facility for a copy of the data. Make an archival backup for posterity and then download some free tools and spend some time exploring and learning about your own body. The DICOM format is widespread and you can find plenty of tools with a quick search.
- wwweston 12y ago
  Wish this was not only widespread practice for imaging but any medical test data.
mililani 12y ago
I'm wondering. Does anyone know if the tumor was cancerous or benign? They say that a lot of women have this, so I'm thinking it's benign like an adenoma, but in which further growth can cause later complications.
paulrademacher 12y ago
Redundant/distributed/crowd-sourced diagnoses? Instead of a single radiologist, fan it out to many.
Shinkei 12y ago
Wow... I really hope I didn't get to this thread too late that this just gets buried. This is a classic example of hyperbolic reporting to try and show physicians as some kind of incompetent lot whereas this 'guy working in his basement with passion and talent' figured out how to hack the entire field of Medicine. The fact is, nearly all Meningiomas are treated this way because they are overwhelmingly benign and the surgery to remove them is not. If the woman had lost her sight getting this surgery, then our Monday morning quarterbacking would've been entirely different... or not even reported. Also, surgeons in general SHOULD NOT improvise new techniques unless it's specifically warranted because their skill is in their muscle memory and if you upset what would otherwise be a routine craniotomy and turn it into something experimental, you are risking the chance of running into an unexpected complication. Granted, Radiology can be imprecise at measuring progression of tumors but this is mostly because of inter-observer reliability, sampling errors, etc. that could easily be mitigated by a software-side solution. In fact, there's a lot of research into measuring lung tumors this way. However, issues related to the FDA needing to approve all the diagnostic technology involved are why these are not implemented more quickly--some nifty program to measure the volume of a tumor would probably be against the law to use in a diagnostic setting (IANAL though, I am a physician). Edit: Another case in point, there is a great technique of placing a new Aortic (heart) valve in place using a catheter from a small puncture in an artery in the leg. This technique (seemingly paradoxically) has a GREATER risk of morbidity to the patient than the open heart surgery approach. There are many hypothesized reasons for this, but it is also a fact that the surgeons are simply better trained in the older open technique and its complications.
- endtime 12y ago
  Whether or not physicians are incompetent doesn't seem to address the result of the very first thing they did: > 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. I've had great doctors and terrible doctors, and the notion that the guy who graduated bottom of his class in medical school can always do better than a smart guy with an internet connection just doesn't pass muster in my experience. Of course some folks take this too far in the other direction, and I have a couple (mainstream, establishment, non-alternative, affiliated-with-big-hospitals) doctors whom I trust very much...but your blanket dismissal of "guy working in his basement" sounds, well, motivated.
Gatsky 12y ago
I can't be sure from just a photo, but the I suggest that the procedure wasn't completely without side effects. Her left eye is not symmetrical with the right, and the left eyebrow is elevated. This could represent some degree of peri-orbital muscle dysfunction due to the procedure damaging the nerves that supply those muscles. This could improve with time, not sure how long after the surgery this photo was taken. Even if it doesn't, you could say it is a minor side effect compared to losing your vision, but as Shinkei and others have pointed out, it isn't clear whether the vision was really in danger. Takes some of the shine off I suppose...
swederik 12y ago
Seems like I should probably use this thread to plug my startup. We are building a web interface for simple 3D modeling from CT and MRI data (https://www.prevuemedical.com/ https://www.prevuemedical.com/). Medical modeling software (e.g. Mimics by Materialise, Slicer) is mainly built for biomedical engineers, rather than radiologists. Our goal is to be Tinkercad to their Autocad. 3D Systems also offers Bespoke Modelling (http://www.3dsystems.com/ja/solutions/services/bespoke-modeling http://www.3dsystems.com/ja/solutions/services/bespoke-model...) but their emphasis is on visually appealing color models rather than accurate tissue segmentation and anatomical reproduction. We're really at a turning point for physical reproductions of anatomy. One-off cases are turning up all over the world for various surgical planning/training cases but it's not quite clear whether or not they improve outcomes. Some labs and hospitals are doing good work but we need large patient trials to see if physical models actually help reduce operating room time or recovery time. With positive findings hopefully we will see dedicated insurance reimbursements for surgical planning models. Maxillofacial applications are way ahead in this sense. One thing that's interesting is that the FDA considers 3D printed anatomical models similar to hard copies of X-rays, and so they are not specifically regulated yet. I expect the regulations to become more onerous, though.
iwince 12y ago
It's reassuring of the human condition that these two stick with it through thick and thin. Charting a course to success even when the medical expert(s) said otherwise.
stcredzero 12y ago
> Scott’s recent thyroid surgery had taught them that getting the best care requires being proactive and extremely well informed. So, if you go to a manufacturer or a printer, and you can just leave your order and be assured you'll get excellent service, this has tremendous value. This is first rate service. It saves your mental energy and it might even save you money in the long term. Now, if you go to a manufacturer or a printer, and you know that you have to be informed and stay on top of them, you should know that you are getting crappy service. At the very least, you should be getting a discount of some kind for the hassle. Healthcare in the US often means paying a lot for crappy service. It's even worse than dealing with mediocre manufacturers or printers, because of market distortions and lack of transparency in the system. If anyone wants to help this doctor out with spreading the above message, this might be a way to show off your chops as a web designer or a marketer. He's local to the bay area and his website is here: http://www.truecostofhealthcare.org/ http://www.truecostofhealthcare.org/ (Disclosure: He's my former PCP) EDIT: On the other hand, it is a credit to the doctors involved, that they welcomed the husband's input and expertise.

697 points by zaaaaz 12y ago

Flott 12y ago

Wow. Amazing story. Moral of the story : If you can, ask for a second opinion!

agumonkey 12y ago
Beware, my mother, dissatisfied with the first answer[1] asked for a second one, the next doctor told her exactly what she wanted to hear[2] but underestimated the risks. Massive internal bleeding during the operation => emergency decision => remove the whole organ. Like precogs, we may need a 3rd opinion as arbiter. [1] situation is very complex, probably need to remove part of an organ [2] the he could fix the issue without ablation le: simplification
- Flott 12y ago
  Thanks for the reply. You're making a very valid point! First : Sorry to ear what happened to your mother. Doctors telling what we want to ear is also a problem! Mostly, I believe, because when something like a brain tumor is threatening your life, you might not want (and know) what is best for yourself. Doctors can be influenced by their patients. As you stated, the second opinion can be wrong and it is very hard for the patient to know who to believe. I wish everybody could have a little help from a friend with some photoshop & 3d printing skills!
  - agumonkey 12y ago
    Luckily, if I may say so, it wasn't that crippling, the damages were more emotional. Waking up to this kind of news unprepared (and they completely dismissed their lack of judgement, ha the sacred doctor) is a pretty big blow.

makmanalp 12y ago

This is an amazing story - and pretty much my worst nightmare. Not necessarily cancer itself, but the feeling and anxiety that you're not being treated and taken care of properly and that someone might be missing something. That doctors are (rightfully) unable to pay proper attention to everyone and everything just due to the sheer number of patients they must see. I know I'm prone to hypochondria, and it doesn't help to read things like this. I can't wait for a world where we can constantly monitor the body easily, and abnormalities can be detected quickly and unequivocally, and even have software that can aid doctors in diagnosing. I've read articles where doctors approach such ideas with skepticism, saying that more data isn't necessarily better, which surprises me very much. How can you look at two data points on a curve and guess what the curve looks like? Anyone else feel similarly? ---- edit: I see false positives and the cost of dealing with them brought up often in the replies - I think this is an issue exactly /because/ we suck so much at diagnosis. The argument that what you see may be wrong, therefore you must close your eyes just blows my mind. So you'd rather base timely detection of true positives on random chance? Maybe if we saw these false positives much more often then we could observe the false positives properly and know how to identify them and improve diagnostics. Or maybe we'd be able to know better when intervening would be more harmful than not intervening. That an intervention would be harmful should not affect the choice to monitor. And then there is also the issue of the diagnosis itself being potentially harmful (full-body CTs etc) which is equally terrifying and even more conflicting. We can also improve there too. In any case, this was supposed to be more about the nondiagnosis anxiety, but I'm not unhappy with where this discussion went.

carbocation 12y ago
Historically I have fallen into the "don't do unnecessary tests" camp, but I would be willing to consider an alternative viewpoint. Perhaps what is needed is continuous monitoring of biochemical data from volunteers longitudinally to help us understand if any of that data is actionable in a way that reduces suffering or prolongs life. I think the right sensors have not yet been invented for this purpose, but they are probably getting close.
- emcrazyone 12y ago

jepper 12y ago

Interesting article, glad the operation was successful. The most interesting part of the article is not the advance in technology (nothing new, we've been using 3d prints as models for complicated fractures / bone tumours or even custom prostheses for years (academic centre)) but the low use rate of this technology by most hospitals. The trick with overlaying follow-up scans is called image fusion and is easy and can be done by one-click applications (for example http://www.blackfordanalysis.com/ http://www.blackfordanalysis.com/) but outside of lung noduli i know of little clinical use. I've seen these types of mistake made before and trying to introduce it locally. Image fusion is also an awesome surgical procedure analysis tool (both for research and clinical applications), complimentary to the standard PA examination. The patient education part is enormously helpful in practice. Cost per patient is however still high quite high for large models. For example a cardiac tumor model was printed with transparent plastic for around 500e. Our bone models luckily are a lot cheaper (non-clear plastic). When the price comes down i hope acceptance will improve.

emcrazyone 12y ago
@jepper I agree with your comments and to add to what you said, what really stuck out for me was how receptive the doctors were to his analysis. I didn't pick up any kind of resistance by the medical professionals to this guy's analysis. Also, I have a chronic condition and this comment from the article is just so true. "Scott’s recent thyroid surgery had taught them that getting the best care requires being proactive and extremely well informed. "
- djokkataja 12y ago
  The article did mention that he contacted a number of doctors around the country, and it didn't sound like he had a horde of them competing over who would have the opportunity to perform the operation, just the one guy at UPMC. Plus since he had done a lot of research and "shopping around" for the thyroid procedure previously, he probably had a good idea of how to navigate the medical system to do this sort of thing.
jarvic 12y ago
>The trick with overlaying follow-up scans is called image fusion and is easy and can be done by one-click applications Just wanted to point out that image fusion is far from easy. The brain is easier than most areas of the body because the skull provides a good basis for performing a registration, but even then the brain has some small room to shift and you can't get a perfect alignment with only rigid transformations, especially when you're dealing with tumors. For most other parts of the body you have complications like organs shifting around, gas passing through the digestive system, patients being in slightly different orientations, etc. In these cases you most definitely need to use some kind of deformable registration, which is far from a solved problem, especially when you have things like tumors changing shape/size or even appearing from nowhere from one scan to the next.

Gurkenmaster 12y ago

This makes me doubt the reliability of cancer diagnosis: >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. Yet at the end of the article they say >if she had waited six months, she would have had severe, and possibly permanent, degradation of her sight.

emcrazyone 12y ago
You should doubt everything when it comes to your life. Question everything and leave no stone un-turned. I know this first hand. Doctors, very smart, just don't know everything. You really have to bone up on whatever is ailing you and really shop the knowledge base that is out there.
kitbrennan 12y ago
It's important to remember that this article is probably simplifying the doctor's advice. I imagine the neurologist ended with: "However, please come back immediately if you feel worse or notice any other symptoms." Obviously that 'may' have been a critical delay, and therefore Scott and her husband were certainly right in hindsight to be proactive about Scott's health.
alexholehouse 12y ago
> explaining that such masses were common among women, and suggested Scott have it checked again in a year. I know this sounds insane, but menigiomas (which I'd guess is what the neurologist suspected it was) are almost always benign and shockingly common - many post-mortems find these guys just kind of hanging out in/around the brain. The corollary is that any kind of cranial surgery has enormous risks. Point being, if a doctor sees what appears to be a (surprisingly) common event on a chart, they're not going to necessarily recommend further action other than observation UNLESS there's a change to the patient (which, as kitbrennan pointed out, almost certainly accompanied the "get it checked again in a year").

gadders 12y ago

In a similar vein, the chap in this article 3d printed his kidney stone to help surgeons: http://www.bbc.co.uk/news/uk-england-hampshire-30801273 http://www.bbc.co.uk/news/uk-england-hampshire-30801273 Ironically, he passed out due to the pain from his kidney stone when presenting to surgeons on the benefits of 3d printing.

jpmattia 12y ago

> 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. Think about the some of the implications of that statement for a while. It really is no wonder that the softer sciences have a reproducibility problem.

drdeadringer 12y ago
> the radiologist had just measured from a different point on the image. I had a similar experience when I was having a spinal curvature corrected. After a particular xray, several people -- a couple doctors, the xray guy, a med student or two, a mix of a couple people like this -- had measured my spine's then-current curvature and had come up with a huge range; to one, I had gotten worse... to another, I had some improvement... to the third, marginally the same with a smudge of improvement. In the end I got the most improvement I was going to get given my specific situation and I'm happy for//with that. The point is, it was literally three measurements on the same xray from which three mutually exclusive conclusions//opinions were [literally?] drawn. I'm therefore not surprised that there is similar with tumours.
VikingCoder 12y ago
There are multiple problems. The biggest problem in my mind is that outcomes are not tracked well. That means that there's no medical feedback loop to measure the long-term effectiveness of... anything. And no good way to do retrospective studies to prove new measurement techniques. And also the laws for patient protection makes it incredibly difficult to get even anonymized data for researchers to use. The next biggest problem is that there's a gold standard of treatment, and it's hard to get enough research to move the gold standard. In this case, the gold standard is essentially a diameter measurement, based on picking the visibly largest slice of a data set which happens to have an axis determined by the patient's somewhat random orientation in the CT scanner. Axial, Coronal, Sagittal. Those are not perfect, anatomical orientations - they're rough. Most radiologists won't take the time to create Multi-Planar Reformats along oblique or double-oblique angles. And even if they did, they'd still be eye-balling the measurement. It's not very hard from a regulatory standpoint to create tools to allow a radiologist to click here, click there, and show a measurement of distance. Then the radiologist can look at a similar measurement from a different radiologist on the previous scan, and say whether it's bigger or smaller now. (But some PACS still don't handle anisotropic MPR correctly, which just blows my mind.) It's vastly harder from a regulatory standpoint to say in a medical product for commercial use, "Hey, we automatically measured the volume of this tumor by automatically finding the boundary of the tissue and automatically ignoring the connected blood vessels and neighboring bone, and then we automatically found the largest cross-sectional diameter, and then we automatically compared the same measurements against the automatically non-linearly-registered longitudinal previous scan... diagnosis: the tumor is not growing, just changing shape slightly." People think their CT scans are examined for hours by a team of doctors, like on "House." In reality, you're lucky if your CT scan gets 5 minutes of investigation, and that's by a radiologist who was trained in med school to read X-Rays, not CT. And your oncology head CT may be read by a radiologist who specializes in abdominal pediatric Ultrasound. And there's almost certainly no double-reading for Quality Assurance. And there's no rating on radiologists to tell you who has the most accurate diagnosis. And he's probably using 2D measuring tools on 3D data - because that's what they're familiar with, and that's what the reconstruction software manufacturers provide, and that's the medical gold standard. On a shared computer, where some other radiologist (or resident!) might have changed the display settings in a way he didn't notice. And he's probably been reading images for 14 hours straight.

franciscop 12y ago

Man saves wife's X. Man strong. Man good. [/sarcasm]

eklavya 12y ago
What is wrong with you? It's such an inspiring story!!
pluma 12y ago
"Person saves spouse's x" doesn't have quite the same ring to it, does it?

mcmancini 12y ago

I coauthored a paper a few years ago on the intra-observer variability of measurements of brain tumors when using the bidimensional product. An increase of 25% in the BP is taken as an indicator of brain tumor progression. We found that the intra-observer variability is so high, you can get that 25% increase purely by chance. The first recommendation of the medical team, to wait and see, is understandable.

escape_goat 12y ago
From your wording, it seems like your brain might have slipped gears when talking about probabilities, from 'science' mode to 'homo sapiens sapiens hardwired quantity estimator' mode. When you say that "you can get that 25% increase purely by chance" do you mean (a) in better circumstances this should be formally impossible, or (b) the intra-observer variability is so high that there is significant (by some definition) possibility ___ of falsely detecting a 25% increase?
billiam 12y ago
That is a shocking thing to say. If they had followed the wait and see approach there's a good chance she might be blind right now. This high-handedness is why I have such a hard time with the medical profession.
- gwern 12y ago
  > If they had followed the wait and see approach there's a good chance she might be blind right now. Operating on a brain unnecessarily has its own risks.
  - kbenson 12y ago
    Indeed, as someone who's had a close family member require brain surgery in the past, I would caution people against thinking of it like any other surgery. The equivalent of "a lingering stiffness" or "Skin tightening because of scar tissue" becomes something else entirely when talking about the brain, and by extension the mind.
- 12y ago

_almosnow 12y ago

What's alarming is that a guy in his spare time can come up with a better diagnose than a 'certified professional'...

zeidrich 12y ago
He had spare time, the doctor didn't.
- codereflection 12y ago
  Not only spare time (if it can even be called that), but SERIOUS motivation considering his wife's life was in danger.
- SilasX 12y ago
  The doctor had work time, and ostensibly an entire eduction specifically for this job. The doctor was still at an (extreme) advantage.
ceejayoz 12y ago
The doctor spends all day getting other cases right, which doesn't make for as interesting of an article. Expecting them to be infallible is unfair.

ck2 12y ago

I've been skeptical about 3d printing's real uses and how it might be toy but this sold me. Great solution and ending. Hope it helps others too.

cafebeen 12y ago

Great story--I think one thing to highlight is 3D Slicer (the publicly-funded open source medical imaging tool used for all this): http://www.slicer.org http://www.slicer.org More doctors should be using tools like this. Hopefully stories like this will help to overcome the inertia in adoption.

harisamin 12y ago

This is truly amazing. Someone needs to fund this guy :)

graeham 12y ago

This is a cool application, but 3D reconstruction of DICOM images isn't that new. For example, there is the Mimics commercial package that is on version 17, and similar things are actually quite commonly used by radiologists. (see http://en.wikipedia.org/wiki/Mimics http://en.wikipedia.org/wiki/Mimics) Patient-specific surgery, and computer analysis in diagnosis and treatment is going to be very big (I'm betting four years of my life in doing a PhD in the field). Its always interesting when there is patient or family led efforts in the field, but this kind of thing was cutting edge in research probably 10-15 years ago (I 3D printed aortic aneurysms as an undergrad in ~2009 for a surgery planning project, and it wasn't a new thing then - example http://link.springer.com/article/10.1007/s100160010054 http://link.springer.com/article/10.1007/s100160010054). Its curious then why 3D printing for surgery planning hasn't become the standard-of-care yet. My instinct is that we'll see more improvements to 3D rendering, planning, and simulation on the computer, but a physical model is not that additionally helpful to surgeons for most cases. Especially considering increased cost and time compared to a computer model.

stefantalpalaru 12y ago

Alternate title: Man encourages his wife to go through unnecessary surgery for a benign and symptomless meningioma after she had an unnecessarily complicated thyroid removal in order to avoid a 4cm scar on her neck. Oh, he also made a shitty 3D model of her skull in the process.

madengr 12y ago
Ha ha, no shit. My wife had her thyroid removed last year. You don't even notice the scar unless you look really close, and she was back to work 1 week after surgery. The part that takes the longest is getting the thyroid pills dialed into the proper dosage; the surgery is fast with a quick recovery. Robots are not needed for this. There was a recent article saying the biggest factor for successful surgery is the quantity the surgeon has performed. In this case he had done thousands, and did plastic surgery too (hence a minimal scar).
Karunamon 12y ago
Did we read the same article? 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. Because I'd really like to think you're being this insensitive out of ignorance, rather than malice.
- stefantalpalaru 12y ago
  Yes, we read the same article but we probably did not graduate from the same medical school. I noticed that the tumor did not grow between MRIs done "a few months" apart so the imminent danger invoked by the surgeon that did the highly unusual intervention looks to me like ass covering and justification for whomever paid for the intervention. There's also the publication that printed the article - a magazine known for its superficial interest in new and shiny tech, not its scientific accuracy. There's nothing in the very low res plastic 3D model that was not already visible on the radiologist's computer monitor. I'm being this insensitive because I'm an adult and I let reason ruin a good story.
- 12y ago

jeffbarr 12y ago

My recommendation: If you ever have a CT scan, ask the imaging facility for a copy of the data. Make an archival backup for posterity and then download some free tools and spend some time exploring and learning about your own body. The DICOM format is widespread and you can find plenty of tools with a quick search.

wwweston 12y ago
Wish this was not only widespread practice for imaging but any medical test data.

mililani 12y ago

I'm wondering. Does anyone know if the tumor was cancerous or benign? They say that a lot of women have this, so I'm thinking it's benign like an adenoma, but in which further growth can cause later complications.

paulrademacher 12y ago

Redundant/distributed/crowd-sourced diagnoses? Instead of a single radiologist, fan it out to many.

Shinkei 12y ago

Wow... I really hope I didn't get to this thread too late that this just gets buried. This is a classic example of hyperbolic reporting to try and show physicians as some kind of incompetent lot whereas this 'guy working in his basement with passion and talent' figured out how to hack the entire field of Medicine. The fact is, nearly all Meningiomas are treated this way because they are overwhelmingly benign and the surgery to remove them is not. If the woman had lost her sight getting this surgery, then our Monday morning quarterbacking would've been entirely different... or not even reported. Also, surgeons in general SHOULD NOT improvise new techniques unless it's specifically warranted because their skill is in their muscle memory and if you upset what would otherwise be a routine craniotomy and turn it into something experimental, you are risking the chance of running into an unexpected complication. Granted, Radiology can be imprecise at measuring progression of tumors but this is mostly because of inter-observer reliability, sampling errors, etc. that could easily be mitigated by a software-side solution. In fact, there's a lot of research into measuring lung tumors this way. However, issues related to the FDA needing to approve all the diagnostic technology involved are why these are not implemented more quickly--some nifty program to measure the volume of a tumor would probably be against the law to use in a diagnostic setting (IANAL though, I am a physician). Edit: Another case in point, there is a great technique of placing a new Aortic (heart) valve in place using a catheter from a small puncture in an artery in the leg. This technique (seemingly paradoxically) has a GREATER risk of morbidity to the patient than the open heart surgery approach. There are many hypothesized reasons for this, but it is also a fact that the surgeons are simply better trained in the older open technique and its complications.

endtime 12y ago
Whether or not physicians are incompetent doesn't seem to address the result of the very first thing they did: > 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. I've had great doctors and terrible doctors, and the notion that the guy who graduated bottom of his class in medical school can always do better than a smart guy with an internet connection just doesn't pass muster in my experience. Of course some folks take this too far in the other direction, and I have a couple (mainstream, establishment, non-alternative, affiliated-with-big-hospitals) doctors whom I trust very much...but your blanket dismissal of "guy working in his basement" sounds, well, motivated.

Gatsky 12y ago

I can't be sure from just a photo, but the I suggest that the procedure wasn't completely without side effects. Her left eye is not symmetrical with the right, and the left eyebrow is elevated. This could represent some degree of peri-orbital muscle dysfunction due to the procedure damaging the nerves that supply those muscles. This could improve with time, not sure how long after the surgery this photo was taken. Even if it doesn't, you could say it is a minor side effect compared to losing your vision, but as Shinkei and others have pointed out, it isn't clear whether the vision was really in danger. Takes some of the shine off I suppose...

swederik 12y ago

Seems like I should probably use this thread to plug my startup. We are building a web interface for simple 3D modeling from CT and MRI data (https://www.prevuemedical.com/ https://www.prevuemedical.com/). Medical modeling software (e.g. Mimics by Materialise, Slicer) is mainly built for biomedical engineers, rather than radiologists. Our goal is to be Tinkercad to their Autocad. 3D Systems also offers Bespoke Modelling (http://www.3dsystems.com/ja/solutions/services/bespoke-modeling http://www.3dsystems.com/ja/solutions/services/bespoke-model...) but their emphasis is on visually appealing color models rather than accurate tissue segmentation and anatomical reproduction. We're really at a turning point for physical reproductions of anatomy. One-off cases are turning up all over the world for various surgical planning/training cases but it's not quite clear whether or not they improve outcomes. Some labs and hospitals are doing good work but we need large patient trials to see if physical models actually help reduce operating room time or recovery time. With positive findings hopefully we will see dedicated insurance reimbursements for surgical planning models. Maxillofacial applications are way ahead in this sense. One thing that's interesting is that the FDA considers 3D printed anatomical models similar to hard copies of X-rays, and so they are not specifically regulated yet. I expect the regulations to become more onerous, though.

iwince 12y ago

It's reassuring of the human condition that these two stick with it through thick and thin. Charting a course to success even when the medical expert(s) said otherwise.

stcredzero 12y ago

> Scott’s recent thyroid surgery had taught them that getting the best care requires being proactive and extremely well informed. So, if you go to a manufacturer or a printer, and you can just leave your order and be assured you'll get excellent service, this has tremendous value. This is first rate service. It saves your mental energy and it might even save you money in the long term. Now, if you go to a manufacturer or a printer, and you know that you have to be informed and stay on top of them, you should know that you are getting crappy service. At the very least, you should be getting a discount of some kind for the hassle. Healthcare in the US often means paying a lot for crappy service. It's even worse than dealing with mediocre manufacturers or printers, because of market distortions and lack of transparency in the system. If anyone wants to help this doctor out with spreading the above message, this might be a way to show off your chops as a web designer or a marketer. He's local to the bay area and his website is here: http://www.truecostofhealthcare.org/ http://www.truecostofhealthcare.org/ (Disclosure: He's my former PCP) EDIT: On the other hand, it is a credit to the doctors involved, that they welcomed the husband's input and expertise.