3D printing is one of the emerging technologies in medicine. In advance of the ‘3rd Conference on 3D Printing in Medicine’ (May 4th and 5th in Mainz), MedicalView spoke with Andreas Giannopoulos, MD and PhD, a Deputy Attending Physician in the Department of Nuclear Medicine at the University Hospital Zurich about his presentation “Cardiovascular 3D Printing: Clinical Applications, Educational Opportunities, Future Perspectives“.

Interview: Sascha Keutel

Dr Giannopoulos, what is the status quo of cardiovascular 3D printing?

Similarly to medical 3D printing of other human body parts, cardiovascular 3D printing is currently undergoing a rapid transition from niche applications to more routine clinical utilization. This increased utilization is secondary to lower costs and greater awareness that 3D printing can enhance patient care. Europe follows slowly but steadily the fast-paced rhythms of USA in terms of utilization of this technology into the clinical routine.

What practical applications does it have so far?

While advanced visualization in cardiovascular imaging is instrumental for diagnoses and communication with referring physicians, there is an unmet need to render DICOM images as 3D models capable of providing tactile feedback und tangible depth information of both normal cardiovascular anatomy and pathologies. Cardiovascular 3D printing holds great promise towards patient-tailored medicine practice and has shown its feasibility, accuracy, reproducibility and the added value in almost every aspect of cardiovascular medicine.

3D bioprinting

3D Printed model of an adult patient with corrected congenital heart disease that required re-intervention. (c) Image courtesy of Dr. Dimitris Mitsouras, Brigham and Women’s Hospital, Boston.

What are the next steps in research and development of cardiovascular 3D printing?

Quite a few. There is a need to develop the proper materials for the particular cardiovascular anatomy, depending of course on the kind of printer that one uses. Future research should also invest in designing and printing patient-specific instruments and devices. An important step however would be the determination of the appropriate indications for cardiovascular 3D Printing. Not all pathologies need to be printed and not all kind of printouts are useful. Cardiovascular 3D Printing opens new horizons for research, from bench-top work with new materials, targeting the model that optimally represent the human anatomy to clinical applications, enabling patient- and disease-specific planning and simulation of interventions/operations.

How will those innovations transform the healthcare industry?

Medical 3D printing is a game changer. Those that are involved in the field should make every effort possible to advance the field with the look into the future, into the next generations. It goes without saying, that once we have established the appropriate indications for cardiovascular 3D printing and the technology becomes recognized as a necessary tool for those patients, worldwide healthcare systems will welcome and endorse this novel modality.

What, if any effects, will the use of bioprinted organs and/or tissue have on the patients?

Cardiovascular 3D bioprinting is a field of active research, although applications have so far not moved far from the wet­lab. If one considers medical 3D printing to be in its infancy, then cardiovascular 3D bioprinting is probably still a fetus. We will have to wait, I guess for a couple of years to see translation of these applications into the clinical world.

Rigid and flexible 3D printed models of the aortic route.
(c) Image courtesy of Dr. Dimitris Mitsouras, Brigham and Women’s Hospital, Boston

You were one of the first few dedicated Medical 3D Printing Research Fellows globally. What is it that fascinates you most in your work?

I have always been fascinated by imaging and art. Medical 3D printing, and in particular cardiovascular 3D printing allows me to combine these two elements, while at the same time rigorously translate the results of my work into models that advance patient care. Just looking at the faces of caregivers and patients when they see a model and grasp the anatomic relationships, the pathology and the suggested solution is enthralling.

What are your personal goals for the future?

My main focus in the forthcoming time period will be to establish a 3D printing service in my institution and/or advising departments on how to run such a service. One of my priorities is to work out whether an in-house 3D printing lab or a partnership with the industry is the ideal way of providing such a service for other physicians and for patients.

In the long-run, I will continue to promote the technology particularly in Switzerland but also in Europe as a whole. Especially the educational aspects of cardiovascular 3D printing is a field that I am keen on to contribute into the future.

What are those educational opportunities?

Cardiovascular 3D printing is poised to revolutionize the education of students and medical professionals. The steps that I consider necessary to develop 3D printing-geared cardiovascular education will require a medley of traditional and modern educational tools.

3D Printed model of a hypertrophic obstructive cardiomyopathy.
(c) Image courtesy of Dr. Ahmed Ouda, Cardiac Surgery Department, University Hospiral Zurich

Firstly, we need to publish more scientific books and articles dedicated to cardiovascular 3D printing journals. Secondly, we need to incorporate this new modality into the medical education systems and in residencies or fellowships core curriculum. A third step would be to further promote and present the educational opportunities in scientific meetings and to increase the interaction via online tutorials and hands-on courses.

As part of the contemporary educational opportunities that 3D printing provides, such hands-on educational courses and hands-on surgical training courses are taking place worldwide. In these sessions, surgeons and trainees can practice and improve their surgical skills on 3D printed models before performing the specific operation in patients. These courses have been highly successful and with high audience satisfaction.

Aside from students and physicians it is also important to mention that 3D printing can also be particularly helpful in the education of patients and their families, as well as the process of decision-making and consent.

What are the learning objectives of your presentation at the ‘3rd Conference on 3D Printing in Medicine’?

Firstly, the fact that cardiovascular 3D printed models are a natural progression from 3D visualization as they can convey information more efficiently compared to images, and sometimes they might convey additional information that are not appreciated from images. Secondly, cardiovascular 3D printed models allow for advanced visualization enhancing diagnosis, enable surgical planning, simulation and intra-operative navigation for complex procedures where software simulators do not exist/not correspond to every clinical scenario. The latter is particularly the case in structural heart diseases that demand commonly a fully 3D appreciation of anatomy.

In this regard, patient-specific 3D printed models can provide a useful adjunct in the care of patients with complex congenital heart diseases. Importantly, educational opportunities for cardiovascular 3D printing span from physician-patient communication to training of students-residents-surgeons, utilizing traditional and novel educational tools.

In summary, cardiovascular 3D printing is the “modality” of the current and future cardiovascular imager generation. We need to strictly define its boundaries and simplify what is complex. We need to improve feasibility, efficiency, quality and safety by succeeding in

  • costs reduction
  • identifying the appropriate modality for source images
  • establishing the appropriate classifications/guidelines
  • training the new generations of imagers.

What is the main message that your audience should take away from your presentation?

It is of prime importance for experts and enthusiasts, physicians and technicians, academia and industry as well as regulatory affairs to meet, discuss and shape the future of medical 3D printing. I cannot stress enough the need for all parties involved to work together for the promotion of this technology that will ultimately change the face of medicine.

 

PROFILE:

Andreas A. Giannopoulos, MD and PhD.

Andreas A. Giannopoulos received his MD and PhD degree from Aristotle University Medical School, Thessaloniki, Greece. He completed his training in Internal Medicine in Greece and in Germany, which was followed by a research fellowship on cardiovascular imaging in the Applied Imaging Science Lab, Brigham and Women’s Hospital, Harvard Medical School. He was one of the first few dedicated Medical 3D Printing Research Fellows globally and serves as Associate Editor of 3D Printing in Medicine. He is currently a Deputy Attending Physician at the Division of Cardiac Imaging, Department of Nuclear Medicine at the University Hospital of Zurich.