This document discusses the use of 3D printing for personalized medicine. It begins with background on 3D printing technologies and medical imaging. Applications discussed include medical education, surgical planning, and developing medical devices. A case study is presented on using 3D printing for planning surgery to treat an aortic arch aneurysm. The document also covers using 3D printing to create patient-specific surgical guides and implants. It concludes by discussing future directions like fully customized joint replacements printed from individual patient imaging data.

1. 3D Printing for
Personalized Medicine
In the New Healthcare Era
Ryan Klatte, BSBME
Principal Research Engineer
Lerner Research Institute
Jeff Yanof, Ph.D.
Senior Principal Research Engineer
Lerner Research Institute

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Introduction

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Introduction
http://mds.clevelandclinic.org

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Introduction

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Background
Medical Imaging Additive Manufacturing Patient-Based
Anatomical Model

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Background 3D Printing Technologies
Mainstream Additive Manufacturing Technologies
Stereolithography Fused Deposition Modeling
(Fused Filament
Fabrication)
Binder Jetting Selective Laser
Sintering
Polyjet
(multi-material jetting)
Selective Laser Melting
(Electron Beam, Direct
Metal Laser Sintering)
Continuous Light
Interface Production
MultiJet Fusion

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Background  3D Printing Features
(nearly) Unlimited Geometry

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Background Medical Imaging
, Ultrasound, PET, SPECTCT, MRI,

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Background Medical Imaging
CT & MRI Visualization

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Medical
Education
Surgical
Planning
Medical
Device
Development
Background Medical Imaging
Applications

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Background Applications
Medical Education
Textbook Graphics
Video
Catalog Model
Cadaver Labs

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Background Applications
Medical Education

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Background Applications
Surgical Planning
Tumor
Resection Remnant

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Background Applications
Medical Devices
Endoscope
Catheter | Guidewire
Pancreatic Duct
Bile Duct

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Medical Applications  Patient Specific Models
CT/MR Imaging 3D Reconstruction Digital Preparation 3D Printing Post Processing

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3D Printed Model Post Processing
Medical Applications  Anatomical Models
Training & Education

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3D Printed Model Real Anatomy
Viewed through airway endoscope
Medical Applications  Anatomical Models
Training & Education

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3D Reconstruction Digital Preparation 3D Printed Model
Descending Aorta
Medical Applications  Anatomical Models
Intrasvascular Device Testing
Common Iliac
External Iliac

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Medical Applications  Anatomical Models
Device Testing
easy Tortuous
Calcifications
Diameter
changes

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Medical Applications  Surgical Planning Case Study
Aortic Arch Aneurysm
Case History:
• Previous open heart surgery
Aortic Arch Aneurysm graft
Aortic value replacement
Present:
Kink in existing Aortic Graft

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Medical Applications  Surgical Planning Case Study
Aortic Arch Aneurysm
Open Repair vs. Endovascular Approach ?

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Step 1 - Imaging
Medical Applications  Arch Aneurysm Surgical Planning

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Step 2 – Image Segmentation
Medical Applications  Arch Aneurysm Surgical Planning

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Step 2 – Segmentation Preview
Medical Applications  Arch Aneurysm Surgical Planning

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Step 2 – Mesh Preview
Medical Applications  Arch Aneurysm Surgical Planning

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Step 2 – Mesh Preview
Medical Applications  Arch Aneurysm Surgical Planning

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Step 2 – Segmentation Refinement
Medical Applications  Arch Aneurysm Surgical Planning
aortic
valve
graft
kink
aneurysm
Rt.
coronary
focal
calcifi’n

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Step 3 – Digital Preparation
Medical Applications  Arch Aneurysm Surgical Planning

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Step 4 – 3D Printing
Medical Applications  Arch Aneurysm Surgical Planning

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Step 5 – Post Processing (Cleaning)
Medical Applications  Arch Aneurysm Surgical Planning

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Clinical Review
Medical Applications  Arch Aneurysm Surgical Planning
Open Repair
vs.
Intravascular
(minimally invasive)
?

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Total Shoulder Arthroplasty
Medical Applications  Patient Specific Devices
Surgical Planning & Intraoperative Tools

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Joseph P Iannotti et al, “ Comparison of Patient-Specific Instruments with Standard Surgical Instruments
in Determining Glenoid Component Position”, 2012 Journal of Bone and Joint Surgery Vol 94-A
Digital Surgical Planning
Medical Applications  Patient Specific Devices
Surgical Planning & Intraoperative Tools

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Joseph P Iannotti et al, “ Comparison of Patient-Specific Instruments with Standard Surgical Instruments
in Determining Glenoid Component Position”, 2012 Journal of Bone and Joint Surgery Vol 94-A
Published Trial Results
Outcomes measured
Standard
Surgical
Group (n=16)
Glenoid
Positioning
System Group
(n=15)
P Value
Nonoptimal implant
type used during
surgery
10 (63%) 1 (7%) < 0.001
Malposition
occurrences (version
and/or inclination)
14 (44%) 4 (13%) <0.001
Malpositioned Implants 12 (75%) 4 (27%) < 0.01
Medical Applications  Patient Specific Devices
Surgical Planning & Intraoperative Tools

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Medical Applications  Surgical Planning
Live Donor Liver Transplant
Live Donor Liver Transplant
Sahani D et al. Radiographics 2004;24:957-967

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Medical Applications  LDLT Surgical Planning
Digital Preparation
Planned
Resection
Line
Left Lobe
Right Lobe
Vena Cava

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Medical Applications  LDLT Surgical Planning
Surgical Planning & Intraoperative Reference
3D Printed Donor Liver

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Dr. Ingeborg van Kroonenburgh et. al., "Doctor and
engineer creating the future for 3D printed custom
made implants", Digital Dental News, April 2012 pp.
60-65
Steinert AF1, Sefrin L, Hoberg M,
Arnholdt J, Rudert M. “Individualized
total knee arthroplasty”, 2015 Apr
Orthopade Vol 44(4)290-2, 294-301.
doi: 10.1007/s00132-015-3104-1
(published in German)
Medical Applications  Future
Patient Specific Implants
3D Printed Jaw Implant ConforMIS

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Conclusion
Questions?
Ryan Klatte
• klatter@ccf.org
• 216.445.0289
Jeff Yanof
• yanofj@ccf.org
• 216.445.1944