Breakthrough printer in use at University of Iowa – Dallas County News

The nearly $500,000 3D-printer can make a custom replica of body parts.

IOWA CITY Under the overhead lights, on a bed in the pediatric catheterization lab on the fifth floor of the University of Iowa Stead Family Children's Hospital, a half-dozen doctors stared at a clump of translucent silicone, about the size of a child's fist.

The doctors wanted to fix a 10-year-old girl's defective heart without using scalpels. But they weren't sure their technique would work, worried that a replacement valve would fall out of place and block other arteries.

So the doctors practiced on a 3D-printed custom replica of the girl's organ, a kind of dress rehearsal university officials hope will become more common in Iowa as the state invests in a new, $500,000 printer.

The girl had a leaky pulmonary valve. Every time her heart compressed, a little less than half of the blood slipped back into the pumping chamber. The chamber had doubled in size. Her heart was out of rhythm. She grew tired faster than her friends when they played volleyball.

A surgeon could have stepped in: hooked her up to a heart-lung machine, cracked her sternum, sliced open her chest, fed cold fluid into her heart until it stopped, cut an artery, inserted a new valve, sewed up the artery, warmed up and restarted the heart, and then closed her chest.

But Ravi Ashwath, director of non-invasive cardiology at Stead Family Department of Pediatrics, said the patient would recover faster with a procedure known as transcatheter pulmonary valve replacement. An interventional cardiologist would insert a catheter into a vein below the girl's stomach and feed the tube toward her heart. The doctor would guide the catheter into the pulmonary artery.

A replacement valve from a cow's vein would sit inside the catheter. If all went as planned, as the doctor pulled the tube out of the artery, the new valve would remain.

The technique takes about 90 minutes, compared to a six-hour, open-heart surgery, Ashwath said. A patient could leave the hospital after two days, compared to about 10.

But the doctors worried the technique wouldn't work, because of the architecture of the girl's heart. When they studied a 3D image, they thought the artery didn't have a place where the valve could sit. The valve might slip and block other arteries that run toward the lungs.

"You can't have a 100% notion that this is going to work," Ashwath said.

He brought a CT scan of her heart to Protostudios, a 3D printing lab at the University of Iowa. The staff used the scan to print a silicone replica of the heart's pumping chamber and surrounding arteries.

In the lab, a doctor placed the heart on the bed, exactly where the girl would lie. He ran the tube into the fake heart and pulled back, leaving the valve. It sat on the silicone artery, where it was needed.

Two months passed, and the doctor performed the technique on the girl. It went just as the model had indicated.

Ashwath said he is pushing for other doctors to take advantage of the printers on campus.

"This is the same heart they're going to see, right?" he said. "We want to make sure they understand the anatomy, just as they'll see it. No surprises."

Protostudios already has six 3D printers, including a metal printer, a carbon fiber printer and a photopolymer printer, which prints both hard and soft materials.

Now, the center is getting its seventh and most sophisticated device. The Iowa Economic Development Authority has approved spending $490,000 on a Stratasys J750 Digital Anatomy 3D Printer, which is capable of creating even more realistic replicas of body parts than the university's current printer. The university expects to receive the new device this summer.

First offered on the market in October, the printer uses resins created by the company's chemists in Israel. When cured with ultraviolet light, the formulations are supposed to replicate the texture, density and at times doughiness of muscle tissue, skin and bone.

In Iowa City, university officials believe the printer can help the hospitals recruit and retain doctors because they will be able to hone their techniques. Medical students will train more effectively. And, from an economic development point of view, doctors and nurses with an entrepreneurial bent can test new inventions on realistic hearts and spines.

"To print organ materials that literally have the density and the feel of an organ is something we couldn't do before," said Jon Darsee, the University of Iowa's chief innovation officer. "We could print an organ. But we couldn't print it with the same kind of texture feel that it actually has. Now we can do that. That's an enormous breakthrough."

A spokesman for Stratasys declined to say how many of the printers the company has sold to hospitals, universities and medical supply companies. All Scott Drikakis, the company's health care segment leader, would offer is that no other academic medical center in Iowa has one.

He said the university will use software that accompanies the printer. Users can insert a scan of the body part they want to print. Then, they can select characteristics of the patient, such as age. The printed product should give doctors a model with details down to the density of the bone or the squishiness of the heart.

"They were visual models," Drikakis said of products from the company's previous printer, one of which Protostudios owns. "They could see them. They could touch them. They could measure them. But there was no bio-mechanical similarity between what was in their hands, what they 3D printed, and what they would expect to see in surgery."

Protostudios opened in 2017 to support the state's entrepreneurs, printing prototypes for new tools. Located in the MERGE coworking space in downtown Iowa City, the staff mostly focuses on helping health care startups, said Darsee, an occasional contributor to the Des Moines Register. But the group has also printed furniture, sensors and musical instruments.

Darsee said he believes the field will grow more in the health care sector after the American Medical Association in July approved a proposal to create Current Procedural Terminology codes for 3D printing. That allows doctors to bill insurance companies for time spent printing models and using them to prep for procedures.

Darsee said the government also will eventually establish reimbursement rates for these techniques, allowing doctors to bill the Centers for Medicare and Medicaid Services for their work.

Unlike the past printers with Protostudios, the new device will reside inside University of Iowa Hospitals and Clinics. Darsee said that will encourage doctors to practice surgeries and experiment with new devices more.

Neil Quellhorst, the director of prototype engineering at the University of Iowa, said medical school professors also will use the printer to teach. Protostudios is already working with the university's dental school, which has historically relied on cadavers.

"The problem is, you never know what you're getting," he said of the old method. "It could be a perfect tooth. It could be bad."

Protostudios has tried to print teeth in as much detail as possible, recreating nerve, pulp, dentin and enamel. When students needed to practice filling cavities, professors told Quellhorst how deep of a divot to build into the fake tooth.

For the most part, Quellhorst said, they have been pleased with what they've created, but, "we've taken this as far as we can (with the current printer)."

"But when we get the new printer, we'll be able to take the replication of a real tooth even further. We certainly intend to do that. We will do that."

Tyler Jett covers jobs and the economy for the Register. Contact him at tjett@registermedia.com.

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Breakthrough printer in use at University of Iowa - Dallas County News