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

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

#31

Post by graeham »

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)

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).

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.

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

#32

Post by stefantalpalaru »

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.

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

#33

Post by billiam »

mcmancini wrote: post #19

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.

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.

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

#34

Post by tjradcliffe »

jarvic wrote: post #23
jepper wrote: post #20

Earlier quoted context omitted.

Yes it was a bit of a generalization, but i mean the practical use of the tool. The technology behind it is wonderful! For my specialty its relatively easy (bone being a rigid body). But this type of software already works quite well for lung, liver etc. With careful manual alignment it can work for soft tissue sarcoma (muscle) and other types of more movable tissue, providing a quick overview. Volume measurement is…

Yeah, I wasn't trying to be disagreeable, just pointing out that this is a very active area of research still, and there is always room for improvement. I work mostly with segmentation and shape analysis instead of registration, but I am involved with a project on multi-modal image fusion, which is even harder (and more interesting).

I've done a lot of work on multi-modal registration and would be interested in talking to you about this. It's an amazingly hard problem and I see a lot of wheels being reinvented whenever I look at what other people are doing.

My own work has been mostly commercial and so under NDA or otherwise unpublishable, but is primarily based on applications of the pseudo-correlation algorithm (Radcliffe, Rajapakshe, Shalev, Medical Physics, vol. 21, No. 6, pp. 761 769, June 1994.) I can be reached at tradcliffe at predictivepatterns.com if you're interested.

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

#35

Post by nhstanley »

jpmattia wrote: post #15

> 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.

> It really is no wonder that the softer sciences have a reproducibility problem.

Even Further, I think it's also indicative of medicine being full of people that have a fatalistic, passive attitude towards their patients and medical care. Medicine and health is really hard, and so many health professionals essentially believe that the only thing they can do is wait until something horrible happens before doing anything. And as the case with this woman, when something bad does happen, they bin it in their per-organized mental filing cabinet and you're fucked if they're wrong. Much like police officers, I think many get so jaded by the job that they can't be bothered to give a shit when they really should. And I really hope technology will save us from this.

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

#36

Post by romaniv »

jpmattia wrote: post #15

> 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.

Think about the some of the implications of that statement for a while.

Hm, people with 6-digit salaries and doctoral degrees whose main job is to figure out diseases perform worse than some random dude? That's the first thing that comes to my mind.

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

#37

Post by tjradcliffe »

mcmancini wrote: post #19

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.

I'm kind of fascinated that this sort of thing is still considered a publishable result. It's been known for at least twenty years that intra-observer variability is a significant factor in such things.

I'm not knocking the work you've done, but pointing out that when I was working in radiotherapy in the early 90's this kind of stuff (not on bidimensional product specifically, but whatever tumor volume measures were being used at the time) was being done. I wasn't involved in any of it directly, but recall colleagues who were, more-or-less ranting on about the degree to which chance predominated.

One issue I was more involved in was that every modality (CT, MR, fluoro...) gave significantly different tumour volumes and no one knew how to reconcile them in a clinically useful way.

Given that every measure we've ever devised seems subject to similar issues, there's an argument to be made that the very concept of "tumour size" is problematic. It seems to make sense, but the edges are too fuzzy to be very diagnostically useful in a depressingly large number of cases.

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

#38

Post by gwern »

billiam wrote: post #33
mcmancini wrote: post #19

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.

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.

> 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.

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

#39

Post by tjradcliffe »

nhstanley wrote: post #35
jpmattia wrote: post #15

> 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.

> It really is no wonder that the softer sciences have a reproducibility problem. Even Further, I think it's also indicative of medicine being full of people that have a fatalistic, passive attitude towards their patients and medical care. Medicine and health is really hard, and so many health professionals essentially believe that the only thing they can do is wait until something horrible happens before doing anyth…

It's somewhat less depressing than that, from a personal point of view, at least. Most interventions carry with them pretty significant risk. Therefore the choice is not between "do nothing and see what happens, or do something with zero risk and see if it helps", but rather "do nothing and see what happens, or do something really high risk and see if it does more harm than good."

Iatrogenic disease (harm caused by interventions) is by some measures the leading cause of death in the US, outstripping heart disease and standing at more than ten times the rate of death by automobile.

Under those circumstances, not doing anything until something horrible happens is not a bad policy, and the people engaged in it are not expressing cynical indifference so much as a due awareness of the real risks involved in almost any intervention.

Which is, admittedly, kind of depressing, but for quite different reasons. Either way, technology and patient empowerment are likely to help.

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

#40

Post by jkokenge »

nhstanley wrote: post #35
jpmattia wrote: post #15

> 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.

> It really is no wonder that the softer sciences have a reproducibility problem. Even Further, I think it's also indicative of medicine being full of people that have a fatalistic, passive attitude towards their patients and medical care. Medicine and health is really hard, and so many health professionals essentially believe that the only thing they can do is wait until something horrible happens before doing anyth…

It seems that health care professionals don't have a nuanced problem solving attitude. They make a diagnosis, see how this diagnosis fits into a preconceived treatment bin, then just solve from that position without understanding what's different, what's unique to each case. And, in their defense, they probably just don't have the time for that extra work. That's where I see technology as most useful....how to automate and make more efficient the redundant parts so professionals can concentrate on the important, unique parts to each patient's diagnosis.
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