How 3-D Printing Is Revolutionizing Medicine at Cleveland Clinic

Following a bilateral lung transplant, a patient at Cleveland Clinic’s Respiratory Institute developed an unusual bronchomalacia. He struggled with recurring pneumonia and had trouble clearing secretions.

An airway stent became necessary, but standard devices would not suffice. A stent of the proper length and diameter – designed with a tapered end, to match the patient’s anatomy – did not exist.

The best solution? Build one.

Today, patient-customized medical devices can be more readily accessible thanks to three-dimensional (3-D) printing.

Just as an inkjet printer reproduces a digital image with ink and paper, a 3-D printer reproduces a digital model – often derived from high-resolution CT or MRI scans – with resin, thermoplastics, photopolymers or other materials. By stacking the material layer by layer, 3-D printing builds physical objects, often within hours.

In the case of the respiratory patient, Cleveland Clinic surgeons used 3-D technology not to manufacture the actual stent but to customize a mold. Silicone was injected into the mold, around a mandrel, to create a stent sized and shaped for the patient.

Clinical uses for 3-D printing

The use of 3-D printing at Cleveland Clinic and other medical centers is still in its infancy, but the technology is already revolutionizing medicine. For example, Cleveland Clinic physicians have used 3-D printing to:

• Plan liver resection. Nizar Zein, MD, Chief of Hepatology at Cleveland Clinic, has built more than 20 liver models to date to improve surgical planning and training. Models are made from a flexible resin with internal lumen geometry generated from a reconstructed CT scan.

Comparing a 3-D printed model of a right hepatic lobe graft with its native counterpart.

• Test innovative heart and vascular devices. Cleveland Clinic’s 3-D printers have helped craft novel heart and vascular devices, such as endovascular grafts, replacement valves and a new artificial heart. As in other specialties, 3-D printing also helps Cleveland Clinic heart and vascular surgeons plan procedures and enhance knowledge of the heart and vascular system.

A polymer model of an aortic aneurysm, produced by a 3-D printer at Cleveland Clinic.

• Practice respiratory procedures ex vivo. “We have identified many respiratory patients with complex anatomical challenges,” says Thomas Gildea, MD, Head of the Section of Bronchology at Cleveland Clinic. “Printing a 3-D model of each patient’s airway anomaly can provide us an opportunity to try different techniques ex vivo to address the problem.”

CT scan data is used to create a digital model of a patient’s airway, which can be output as a 3-D printed model.

• Educate kidney residents and patients. “We have found that by using imaging-based 3-D kidney models as an educational and visualization aid, medical students and resident physicians are better able to characterize a particular patient’s renal tumor,” write Jihad H. Kaouk, MD, Director of Cleveland Clinic Glickman Urological & Kidney Institute’s Center for Robotic and Image Guided Surgery, and Peter Caputo, MD, a fellow in Cleveland Clinic’s Department of Urology. “This visualization benefit extends to patients, too. Patients with newly discovered renal masses can hold and examine a 3-D rendering of their kidney and tumor, helping us educate them about their condition and further engage them in their care.”

What will be next?

Innovative methods like these are helping Cleveland Clinic improve patient care as well as advance medical education and research. As the future of 3-D printing unfolds, we look forward to realizing its full potential, which may include:

• Customizing anatomy training for medical students, potentially eliminating the need for cadavers
• Further developing automated surgery by using 3-D models to help “train” robotic systems
• Producing replacement organs and body parts by 3-D bio-printing with living tissue

Using this new technology in smart, innovative ways will help us continue to provide the highest-quality, patient-specific care, which will translate to better outcomes.