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

697 点作者 zaaaaz超过 10 年前

21 条评论

jpmattia超过 10 年前
&gt; <i>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.</i><p>Think about the some of the implications of that statement for a while.<p>It really is no wonder that the softer sciences have a reproducibility problem.
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mcmancini超过 10 年前
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.
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Shinkei超过 10 年前
Wow... I really hope I didn&#x27;t get to this thread too late that this just gets buried.<p>This is a classic example of hyperbolic reporting to try and show physicians as some kind of incompetent lot whereas this &#x27;guy working in his basement with passion and talent&#x27; figured out how to hack the entire field of Medicine.<p>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&#x27;ve been entirely different... or not even reported. Also, surgeons in general SHOULD NOT improvise new techniques unless it&#x27;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.<p>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&#x27;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).<p>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.
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makmanalp超过 10 年前
This is an amazing story - and pretty much my worst nightmare. Not necessarily cancer itself, but the feeling and anxiety that you&#x27;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&#x27;m prone to hypochondria, and it doesn&#x27;t help to read things like this.<p>I can&#x27;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.<p>I&#x27;ve read articles where doctors approach such ideas with skepticism, saying that more data isn&#x27;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?<p>Anyone else feel similarly?<p>----<p>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 &#x2F;because&#x2F; we suck so much at diagnosis.<p>The argument that what you see may be wrong, therefore you must close your eyes just blows my mind. So you&#x27;d rather base timely detection of true positives on random chance?<p>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&#x27;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.<p>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.<p>In any case, this was supposed to be more about the nondiagnosis anxiety, but I&#x27;m not unhappy with where this discussion went.
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jepper超过 10 年前
Interesting article, glad the operation was successful.<p>The most interesting part of the article is not the advance in technology (nothing new, we&#x27;ve been using 3d prints as models for complicated fractures &#x2F; bone tumours or even custom prostheses for years (academic centre)) but the low use rate of this technology by most hospitals.<p>The trick with overlaying follow-up scans is called image fusion and is easy and can be done by one-click applications (for example <a href="http://www.blackfordanalysis.com/" rel="nofollow">http:&#x2F;&#x2F;www.blackfordanalysis.com&#x2F;</a>) but outside of lung noduli i know of little clinical use. I&#x27;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.<p>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.
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cafebeen超过 10 年前
Great story--I think one thing to highlight is 3D Slicer (the publicly-funded open source medical imaging tool used for all this):<p><a href="http://www.slicer.org" rel="nofollow">http:&#x2F;&#x2F;www.slicer.org</a><p>More doctors should be using tools like this. Hopefully stories like this will help to overcome the inertia in adoption.
swederik超过 10 年前
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 (<a href="https://www.prevuemedical.com/" rel="nofollow">https:&#x2F;&#x2F;www.prevuemedical.com&#x2F;</a>).<p>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 (<a href="http://www.3dsystems.com/ja/solutions/services/bespoke-modeling" rel="nofollow">http:&#x2F;&#x2F;www.3dsystems.com&#x2F;ja&#x2F;solutions&#x2F;services&#x2F;bespoke-model...</a>) but their emphasis is on visually appealing color models rather than accurate tissue segmentation and anatomical reproduction.<p>We&#x27;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&#x2F;training cases but it&#x27;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.<p>One thing that&#x27;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.
Gurkenmaster超过 10 年前
This makes me doubt the reliability of cancer diagnosis:<p>&gt;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.<p>Yet at the end of the article they say<p>&gt;if she had waited six months, she would have had severe, and possibly permanent, degradation of her sight.
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Gatsky超过 10 年前
I can&#x27;t be sure from just a photo, but the I suggest that the procedure wasn&#x27;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&#x27;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&#x27;t clear whether the vision was really in danger. Takes some of the shine off I suppose...
graeham超过 10 年前
This is a cool application, but 3D reconstruction of DICOM images isn&#x27;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 <a href="http://en.wikipedia.org/wiki/Mimics" rel="nofollow">http:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Mimics</a>)<p>Patient-specific surgery, and computer analysis in diagnosis and treatment is going to be very big (I&#x27;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&#x27;t a new thing then - example <a href="http://link.springer.com/article/10.1007/s100160010054" rel="nofollow">http:&#x2F;&#x2F;link.springer.com&#x2F;article&#x2F;10.1007&#x2F;s100160010054</a>).<p>Its curious then why 3D printing for surgery planning hasn&#x27;t become the standard-of-care yet. My instinct is that we&#x27;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.
stcredzero超过 10 年前
<i>&gt; Scott’s recent thyroid surgery had taught them that getting the best care requires being proactive and extremely well informed.</i><p>So, if you go to a manufacturer or a printer, and you can just leave your order and be assured you&#x27;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.<p>Healthcare in the US often means paying a lot for crappy service. It&#x27;s even worse than dealing with mediocre manufacturers or printers, because of market distortions and lack of transparency in the system.<p>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&#x27;s local to the bay area and his website is here: <a href="http://www.truecostofhealthcare.org/" rel="nofollow">http:&#x2F;&#x2F;www.truecostofhealthcare.org&#x2F;</a><p>(Disclosure: He&#x27;s my former PCP)<p>EDIT: On the other hand, it is a credit to the doctors involved, that they welcomed the husband&#x27;s input and expertise.
gadders超过 10 年前
In a similar vein, the chap in this article 3d printed his kidney stone to help surgeons:<p><a href="http://www.bbc.co.uk/news/uk-england-hampshire-30801273" rel="nofollow">http:&#x2F;&#x2F;www.bbc.co.uk&#x2F;news&#x2F;uk-england-hampshire-30801273</a><p>Ironically, he passed out due to the pain from his kidney stone when presenting to surgeons on the benefits of 3d printing.
jeffbarr超过 10 年前
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.<p>The DICOM format is widespread and you can find plenty of tools with a quick search.
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mililani超过 10 年前
I&#x27;m wondering. Does anyone know if the tumor was cancerous or benign? They say that a lot of women have this, so I&#x27;m thinking it&#x27;s benign like an adenoma, but in which further growth can cause later complications.
Flott超过 10 年前
Wow. Amazing story. Moral of the story : If you can, ask for a second opinion!
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ck2超过 10 年前
I&#x27;ve been skeptical about 3d printing&#x27;s real uses and how it might be toy but this sold me.<p>Great solution and ending. Hope it helps others too.
iwince超过 10 年前
It&#x27;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.
paulrademacher超过 10 年前
Redundant&#x2F;distributed&#x2F;crowd-sourced diagnoses? Instead of a single radiologist, fan it out to many.
harisamin超过 10 年前
This is truly amazing. Someone needs to fund this guy :)
_almosnow超过 10 年前
What&#x27;s alarming is that a guy in his spare time can come up with a better diagnose than a &#x27;certified professional&#x27;...
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stefantalpalaru超过 10 年前
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.
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