Radiology

Michael Slag, surgery patient: The black area is the tumor. The white area are the ribs surrounding the tumor.

Narrator: Michael Slag is in awe of a tumor. Well, a 3D printed model of the tumor that was growing at the top of his right lung. A Mayo Clinic surgeon removed it in a minimally invasive operation. And just three days later, he's going home.

Mr. Slag: Well, it's unbelievable. In fact, I was walking the first night after surgery.

Narrator: Unbelievable because of how this 3D model spared him from what surely would have been a much more invasive operation, with a far longer and more painful recovery.

Mr. Slag: But I'm sure if my chest would have been split open, I probably would have been in an ICU and probably a whole lot different experience.

Jane Matsumoto, M.D., Radiologist, Mayo Clinic: This tumor, it's sitting right by the brachial plexus.

Narrator: The growth was a type of lung cancer called a Pancoast tumor, so rare that Mayo Clinic has only seen 60 cases in the past 20 years.

Shanda Blackmon, M.D., Thoracic Surgeon, Mayo Clinic: We frequently may have a plastic surgeon, an orthopedic surgeon, a vascular surgeon, and myself all involved in a Pancoast tumor resection. And when that's the case, there's nothing better than having a model for the whole team to meet around and plan the case.

Narrator: Thoracic surgeon Shanda Blackmon says the 3D model helped eliminate surprises by showing the team exactly how Michael's large tumor was wrapped around several critical nerves and blood vessels.

Dr. Blackmon: Clearly, everyone's tumor is different, and it's always in a different location.

Narrator: It took about 70 hours for a high tech 3D printer to create the model...

Dr. Matsumoto: ... of the brachial plexus.

Narrator: But radiologists put in many hours before that, incorporating MRI images, CT scans, and sophisticated computer software to first create a virtual model of Michael's anatomy.

Dr. Matsumoto: Those are the nerve roots coming out of the cervical spine...

Narrator: ...color coded for each specific tissue type.

Dr. Matsumoto: There you can see the veins, the aorta, pulmonary artery, and then the brachial plexus and the tumor up there.

Narrator: Radiologist Jane Matsumoto is co-director of Mayo Clinic's 3D anatomic modeling lab.

Dr. Matsumoto: The radiology department is made up of like 170 people who all have some specialty areas of expertise in bone, in lung, in nerves. You know, we're able to draw all those people in one area to work together to create this.

Narrator: It's a technology surgeons are using for complex cases in orthopedics, heart and vascular repair, pediatrics, and other specialties. Besides a quicker recovery, the less invasive approach, requiring less cutting, reassured Michael for another reason. You see, he is also Dr. Slag, an endocrinologist who performs some delicate medical procedures of his own.

Mr. Slag: This lighter gray area is the brachial plexus, a complex set of nerves that run the arm. Knowing that I was more likely to come out with a hand that worked compared to an arm that wasn't going to do very much was just a big load off my mind.

Jonathan M. Morris, M.D., Radiology, Mayo Clinic: There's really no hospital system that has built as much infrastructure around 3D printing as Mayo has. We've done a lot of studies in the field of head and neck cancer and 3D printing and how they're complementary. Some of those complementary studies just show better understanding of the patient's specific anatomy before entering the operating room. With patient-specific virtual surgical planning and cutting guides, you can save up to 2 hours in the operating room, which means less time for a patient under anesthesia. And we get a better outcome because of all the design ahead of time.

We've developed a specialty called point-of-care manufacturing. All the manufacturing as the physicians inside the hospital, so there's no translation needed. We go from CT scan to three-dimensional model of complex cancer in every area of the body, but particularly in head and neck, quite seamlessly. We're combining surgery, biomedical engineering and radiology all in one place to create not just the 3D printed models, but also the virtual surgical planning.

We take the imaging with the patient's anatomy and tumor and vascularity, and then we print those out in a life-size three-dimensional way and give them to the surgeon as kind of a roadmap.

Daniel L. Price, M.D., Otorhinolaryngology, Mayo Clinic: We're all used to looking at two-dimensional images of patients and CT scans and MRIs. And 3D modeling takes that 2D image and turns it into something that you can hold in your hands and really understand what's the patient's anatomy. Having guides that are custom fit to their jaw, to their bone that we're taking from another part of their body to reconstruct them so that we can get perfect bone-to-bone contact and make them look as much like they did prior to ever having a cancer diagnosis.

But you really have to get it perfect the first time. We have the opportunity to practice, plan and make it perfect on a computer before we ever get to the operating room. We found that patients had less complications long term when we use 3D modeling. They were less likely to have a plate break, and they were less likely to have that bone fracture or nonunion when we use 3D modeling.

Dr. Morris: Another advantage is patient consent. When you let the patient hold their own skull or their own mandible or their own tumor in their hands, then you can start using the model as a communication vehicle. Mayo Clinic is an integrated multidisciplinary team. So instead of just surgeon and neuroradiologists meeting to discuss cases, now we have surgeon, neuroradiologist, biomedical engineers, and 3D printing capabilities all in the same care team.

Dr. Price: We excel at complex patient care. And I think that's where our efficiency and the expertise of all of our colleagues to take care of those complex patients really comes into play.

Sarah Garcia, Isaac's wife: Isaac is the kind of person who is so energetic, and he loves doing things with his children. And he loves being outdoors. And, just, he's very adventurous and exciting. And I think that's part of why I fell in love with him to begin with.

Isaac Garcia, cancer survivor/Mayo Clinic patient: My name is Isaac Garcia. I'm 38 years old and I live in Rio Rancho, New Mexico. I'm married to Sarah Garcia, and we've been married for 15 years. In late 2014, I started having a dull pain in my groin. And I was referred to a urologist by my local primary care doctor, which led to a misdiagnosis and an unneeded surgery. And it ended up delaying me finding out the real problem. So then I was referred to an orthopedic specialist here in Albuquerque. And the orthopedic specialist thought, since I rode dirt bikes a lot, that I probably damaged something in a crash and it was nothing big, it was tendonitis. Let's get an MRI and we'll see what's in there, and it's not going to be a big deal.

Sarah Garcia: So we went to see the doctor and he came in and said, "I have bad news for you. You look like what's going on is a malignant tumor in your bone. You need to see an orthopedic oncologist. My secretary will give you information." And he left the room.

Isaac Garcia: My wife and I were just floored. We cried a lot. It was not good news, you know. It was horrifying news, actually.

Sarah Garcia: I was very afraid that a diagnosis of a bone cancer meant he wouldn't be here. We drove all around that day trying to get in to see an orthopedic oncologist. The wait times were over six weeks or more to even speak to a doctor. So I called my boss because I wasn't in any position to go to work the next day. And he told me don't give up, there's other places. Go wherever you have to go. So I Googled "best bone cancer doctor" and Mayo hospital came up.

Isaac Garcia: So my wife contacted the Mayo Clinic in Phoenix, and they told us to fax my MRI report and some of my information to them and and they would get back to us. And that was on a Monday. And they called back the next day on that Tuesday and said be here Friday.

Christopher Beauchamp, M.D., Consultant, Orthopedic Surgery, Mayo Clinic in Arizona: After we completed all of the tests and investigations and performed a biopsy, the diagnosis was a chondrosarcoma. It's a malignant bone tumor involving a very challenging, difficult location, and that was his hip socket. A chondrosarcoma is a purely surgical problem. There's no medical or any other treatment options available for it. And the surgical treatment for this, for him, was to remove his entire hip joint, the ball and socket joint. Fortunately, we didn't have to remove any of the important muscles around his hip, but that presents a difficult problem to reconstruct for him.

Isaac Garcia: And there was basically three options, and one of them was just removal and you don't put anything back in. So they remove your hip socket and the top of your femur and they don't put anything back in. It's called a flail hip. And then the other one was to use the pelvic bone from a cadaver. And they, you know, make it fit and hope that it takes. Dr. Beauchamp really didn't like that idea either. He said that the best thing is a 3D printed titanium implant.

Dr. Beauchamp: The subsequent treatment of removing the hip joint has become almost the holy grail of orthopedic oncology. We can do it better than we've been doing before. To be able to do the resection, to print the model, to design an implant, and the technology is there.

Sarah Garcia: Yeah, Dr. Beauchamp came out to tell us "it was a home run," is the words he used to describe the surgery. He said, "I got all of it. It's clean margins. I got it all. The cancer is gone."

Isaac Garcia: Because of the Mayo Clinic, I'm back, you know, back to living a normal, good life. I just have a whole new appreciation for how the little things that you usually take for granted, they all mean a lot now. I have a whole new appreciation for life.

Sarah Garcia: I would like to tell Dr. Beauchamp, thank you so much. To make such a huge impact on my husband's life. And because of that, my life and my kids. By using this incredible technology that isn't everywhere else, he offered such a good outcome. He did such a good job. I would tell him thank you.