Personalized heart models for surgical planning

System can convert MRI scans into 3D-printed, physical models in a few hours.

Scientia — Researchers at MIT and Boston Children’s Hospital have developed a system that can take MRI scans of a patient’s heart and, in a matter of hours, convert them into a tangible, physical model that surgeons can use to plan surgery.

New system from MIT and Boston Children’s Hospital researchers converts MRI scans into 3D-printed heart models (shown here).
Photo: Bryce Vickmark

The models could provide a more intuitive way for surgeons to assess and prepare for the anatomical idiosyncrasies of individual patients. “Our collaborators are convinced that this will make a difference,” says Polina Golland, a professor of electrical engineering and computer science at MIT, who led the project. “The phrase I heard is that ‘surgeons see with their hands,’ that the perception is in the touch.”

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This fall, seven cardiac surgeons at Boston Children’s Hospital will participate in a study intended to evaluate the models’ usefulness.

Golland and her colleagues will describe their new system at the International Conference on Medical Image Computing and Computer Assisted Intervention in October. Danielle Pace, an MIT graduate student in electrical engineering and computer science, is first author on the paper and spearheaded the development of the software that analyzes the MRI scans. Mehdi Moghari, a physicist at Boston Children’s Hospital, developed new procedures that increase the precision of MRI scans tenfold, and Andrew Powell, a cardiologist at the hospital, leads the project’s clinical work.

The work was funded by both Boston Children’s Hospital and by Harvard Catalyst, a consortium aimed at rapidly moving scientific innovation into the clinic.

MRI data consist of a series of cross sections of a three-dimensional object. Like a black-and-white photograph, each cross section has regions of dark and light, and the boundaries between those regions may indicate the edges of anatomical structures. Then again, they may not.

Determining the boundaries between distinct objects in an image is one of the central problems in computer vision, known as “image segmentation.” But general-purpose image-segmentation algorithms aren’t reliable enough to produce the very precise models that surgical planning requires.

New system from MIT and Boston Children’s Hospital researchers converts MRI scans into 3D-printed heart models (shown here).
Photo: Bryce Vickmark

Human factors

Typically, the way to make an image-segmentation algorithm more precise is to augment it with a generic model of the object to be segmented. Human hearts, for instance, have chambers and blood vessels that are usually in roughly the same places relative to each other. That anatomical consistency could give a segmentation algorithm a way to weed out improbable conclusions about object boundaries.

The problem with that approach is that many of the cardiac patients at Boston Children’s Hospital require surgery precisely because the anatomy of their hearts is irregular. Inferences from a generic model could obscure the very features that matter most to the surgeon.

In the past, researchers have produced printable models of the heart by manually indicating boundaries in MRI scans. But with the 200 or so cross sections in one of Moghari’s high-precision scans, that process can take eight to 10 hours.

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“They want to bring the kids in for scanning and spend probably a day or two doing planning of how exactly they’re going to operate,” Golland says. “If it takes another day just to process the images, it becomes unwieldy.”

Pace and Golland’s solution was to ask a human expert to identify boundaries in a few of the cross sections and allow algorithms to take over from there. Their strongest results came when they asked the expert to segment only a small patch —one-ninth of the total area — of each cross section.

New system from MIT and Boston Children’s Hospital researchers converts MRI scans into 3D-printed heart models (shown here).
Photo: Bryce Vickmark

In that case, segmenting just 14 patches and letting the algorithm infer the rest yielded 90 percent agreement with expert segmentation of the entire collection of 200 cross sections. Human segmentation of just three patches yielded 80 percent agreement.

“I think that if somebody told me that I could segment the whole heart from eight slices out of 200, I would not have believed them,” Golland says. “It was a surprise to us.”

Together, human segmentation of sample patches and the algorithmic generation of a digital, 3-D heart model takes about an hour. The 3-D-printing process takes a couple of hours more.

Prognosis

Currently, the algorithm examines patches of unsegmented cross sections and looks for similar features in the nearest segmented cross sections. But Golland believes that its performance might be improved if it also examined patches that ran obliquely across several cross sections. This and other variations on the algorithm are the subject of ongoing research.

The clinical study in the fall will involve MRIs from 10 patients who have already received treatment at Boston Children’s Hospital. Each of seven surgeons will be given data on all 10 patients — some, probably, more than once. That data will include the raw MRI scans and, on a randomized basis, either a physical model or a computerized 3-D model, based, again at random, on either human segmentations or algorithmic segmentations.

Using that data, the surgeons will draw up surgical plans, which will be compared with documentation of the interventions that were performed on each of the patients. The hope is that the study will shed light on whether 3-D-printed physical models can actually improve surgical outcomes.

“Absolutely, a 3-D model would indeed help,” says Sitaram Emani, a cardiac surgeon at Boston Children’s Hospital who is not a co-author on the new paper. “We have used this type of model in a few patients, and in fact performed ‘virtual surgery’ on the heart to simulate real conditions. Doing this really helped with the real surgery in terms of reducing the amount of time spent examining the heart and performing the repair.”

“I think having this will also reduce the incidence of residual lesions — imperfections in repair — by allowing us to simulate and plan the size and shape of patches to be used,” Emani adds. “Ultimately, 3D-printed patches based upon the model will allow us to tailor prosthesis to patient.”

“Finally, having this immensely simplifies discussions with families, who find the anatomy confusing,” Emani says. “This gives them a better visual, and many patients and families have commented on how this empowers them to understand their condition better.”

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– Credit and Resource –

Larry Hardesty | MIT News Office

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Personalized heart models for surgical planning

Printing transparent glass in 3-D

New system in 3-D printing is the first to create strong, solid glass structures from computerized designs.

The glass 3-D printing process.
Photo: Steven Keating

Scientia — The technology behind 3-D printing — which initially grew out of work at MIT — has exploded in recent years to encompass a wide variety of materials, including plastics and metals. Simultaneously, the cost of 3-D printers has fallen sufficiently to make them household consumer items.

Now a team of MIT researchers has opened up a new frontier in 3-D printing: the ability to print optically transparent glass objects.

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The new system, described in the Journal of 3D Printing and Additive Manufacturing, was developed by Neri Oxman, an associate professor at the MIT Media Lab; Peter Houk, director of the MIT Glass Lab; MIT researchers John Klein and Michael Stern; and six others.

Other groups have attempted to 3-D print glass objects, but a major obstacle has been the extremely high temperature needed to melt the material. Some have used tiny particles of glass, melded together at a lower temperature in a technique called sintering. But such objects are structurally weak and optically cloudy, eliminating two of glass’s most desirable attributes: strength and transparency.

The high-temperature system developed by the MIT team retains those properties, producing printed glass objects that are both strong and fully transparent to light. Like other 3-D printers now on the market, the device can print designs created in a computer-assisted design program, producing a finished product with little human intervention.

In the present version, molten glass is loaded into a hopper in the top of the device after being gathered from a conventional glassblowing kiln. When completed, the finished piece must be cut away from the moving platform on which it is assembled.

In operation, the device’s hopper, and a nozzle through which the glass is extruded to form an object, are maintained at temperatures of about 1,900 degrees Fahrenheit, far higher than the temperatures used for other 3-D printing. The stream of glowing molten glass from the nozzle resembles honey as it coils onto a platform, cooling and hardening as it goes.

One challenge the researchers faced was keeping the filament of glass hot enough so the next layer of the structure would adhere to it, but not so hot that the structure would collapse into a shapeless lump. They ended up producing three separate components that can independently be heated to the required temperatures: the upper reservoir for the stock of molten glass, the nozzle at the bottom of that chamber, and a lower chamber where the printed object is built up.

Scanning electron microscope image of a sample from a printed glass prism.
Image: James Weaver

The concept began as a project in a course on additive manufacturing, Klein says; he and others decided to refine the concept when initial work showed the idea had promise. But it was still a long and laborious process, with a lot of trial-and-error.

“Glass is inherently a very difficult material to work with,” Klein says: Its viscosity changes with temperature, requiring precise control of temperature at all stages of the process.

The new process could allow unprecedented control over the glass shapes that can be produced, Oxman says.

“We can design and print components with variable thicknesses and complex inner features — unlike glassblowing, where the inner features reflect the outer shape,” Oxman explains. For example, she adds, “We can control solar transmittance. … Unlike a pressed or blown-glass part, which necessarily has a smooth internal surface, a printed part can have complex surface features on the inside as well as the outside, and such features could act as optical lenses.”

Oxman adds that she foresees the process being adapted to create much larger structures.

Photo: Andy Ryan

“Could we surpass the modern architectural tradition of discrete formal and functional partitions, and generate an all-in-one building skin that is at once structural and transparent?” she asks. “Because glass is at once structural and transparent, it is relatively easy to consider the integration of structural and environmental building performance within a single integrated skin.”

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Houk cites several additional directions for pushing the research further. One is adding pressure to the system — either through a mechanical plunger or compressed gas — to produce a more uniform flow, and thus a more uniform width to the extruded filament of glass. Additional work will focus on the use of colors in the glass, which the team has already demonstrated in limited testing.

Klein says the printing system is an example of multidisciplinary work facilitated by MIT’s flexible departmental boundaries — in this case, involving team members from the Media Lab, the Department of Mechanical Engineering, and the MIT Glass Lab, which is part of the Department of Materials Science and Engineering.

Photo: Chikara Inamura

– Credit and Resource –

David L. Chandler | MIT News Office

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Printing transparent glass in 3-D