3D Printing: Medical Applications | Michael Balzer and Pamela Scott | TEDxCibeles

Translator: Reiko Bovee
Reviewer: Maki Sugimoto Michael Balzer: Hola.
That’s about the extent of my Spanish, (Laughter) but I learned one new word yesterday,
and that’s cráneo, skull. I’m the guy who created my wife’s skull to save her life, her eye
and even her soul. No, not really. I was part of a team of Pamela,
two surgeons and technology, kind of, as I call it, the healer,
the magician and the warrior, and together we defeated the pain
and suffering that was in her. We’d like to invite you into our story. Pamela Scott: When I was 16 years old,
my mother died of a brain tumor. And of course, this impacted me
very deeply. But it also left me
with a tremendous interest and passion in understanding
health and medical research. Now we live on a very small community
in the Central Coast of California. It’s halfway between Los Angeles
and San Francisco. We have very limited
specialty medical services there, which is difficult for anyone
who has a serious illness. Major medical centers
are at least 4 hours away. Now, I’d like to talk to you
about my pain. Imagine having the worst headache
you’ve ever had. And imagine having that headache go on
24 hours a day, 7 days a week for months. In the summer of 2013,
this is what I was experiencing. I went to my primary care physician,
she had no idea what was wrong. I went to emergency rooms,
they had no idea what was wrong. So I was referred to a local neurologist who was very well thought of
and respected, and he diagnosed me with migraines, kind of classic
but severe migraine syndrome. So, he prescribed a very
complicated regimen of pills. I took so many pills.
I had trouble keeping track of them. I also had injections,
I had inhalant medication. But the headaches kept getting
worse and worse over the months, until finally I could not sleep at night. There were no imaging studies done,
nothing was ordered by the doctor. No MRI, no CT scans. And so we really never had
a very good idea what was going on inside my head. MB: So, she came to me and said, “Can you come with me
to see this neurologist? He’s not listening to me.
I’m still having a lot of pain.” So, I did and sure enough,
he was very adamant to keep the same treatment going. So, I had to tell him, “You know her mother died
at the age of 53 of a brain tumor. Humor me, let’s do an MRI.” He paused. I guess
he was somewhat surprised that I would say that. And he relented and ordered the MRI. PS: Now there are two types of MRIs. One is a standard MRI
which is fast and easy, but it doesn’t give very much information. The other one is a better MRI,
and it’s done with contrast dye. My doctor only ordered the first MRI
even though he said, with that, there was absolutely
no reason to do it, no clinical information
that he thought would be important. We did that MRI and I got a report
back from the radiologist that indicated there was something wrong
in this part of my skull. The radiologist recommended
that we have the second type of MRI in order to determine
more specifically what that was. My doctor, the neurologist,
refused to do this and said I should continue the medication,
all the pills that weren’t working, go home and come back
to see him in a year. This was entirely unacceptable to me. So, I went back to my primary care doctor,
and she looked at the report, and she ordered the better MRI
with contrast dye. And, to my surprise it did turn out
that in fact I had a brain tumor. MB: This is the report. It’s difficult to read but essentially
it identifies the size of her tumor. To put it in perspective,
this was the size of the tumor. About the size of a golfball. This was lodged
between her eye and her brain. There’s also some other
medical jargon here, but I’m somewhat of a visual guy. So I created this
to help me understand it. I took my own measurements;
I circled the area where the tumor is. Now this is an MRI, bone does not
show up in MRI, it’s dark. If you notice right above her left eye
is a very dark space that’s the tumor. But it also indicates the type
of tumor, a bony tumor. PS: I think we all are uncomfortable
when we think about our deaths, but there’s always been something
that has frightened me more than death. And that’s the thought
of having brain damage: no longer being myself because that’s what had happened
to my mother. The problem with the location
of this tumor was that it was under the frontal lobe
of the brain. Now, the frontal lobe
is where we have our intelligence, our reasoning, our memories,
it’s the seat of our personality, it’s what makes us unique. I went to two local neurosurgeons,
and both of them said that I really should consider
the tumor inoperable because in order to remove it, they would have to do
an ear-to-ear craniotomy, so cutting my skull open,
remove a piece of the skull, and then, because of the location
of the tumor, apply traction to try to lift it or move the brain aside
in order to reach the tumor. Now, by doing that, both doctors said
there was a very high possibility I would have brain damage from this. One doctor said
I may never be functional again, I may never be normal,
I may never leave the ICU. This was not acceptable to me. The other problem was
that if I did not remove the tumor, the tumor could continue to grow and would grow up
into the frontal lobe there. So I would have
the same outcome ultimately although we don’t know how soon. I needed to do something different. I was anxious, yes. So, I went to the Internet which of course
we have to be careful about. It comes with the caveat
because how much information, particularly medical information,
on the Internet is good information? I’m going to guess about 10%. 90% of it – Facebook, no; forums, no –
not good information. But I discovered that all major
medical centers have websites that you can go to
and find so much information you can read about the newest techniques
in treating so many different diseases, and they talk about the special
treatments that they have, along with providing links to videos
and other information that is reputable. So, this is what I did,
and I learned so much. I also learned that there was something
called a “distant patient program”. I had never heard of this before. And many of these
university medical centers will do an evaluation of your case
by looking at your records that you can send to them. So you don’t actually have to go there and their team of physicians
will go over your situation, discuss it together,
develop a provisional diagnosis or their best guess about what it is
and then determine the best treatment that they would have to offer
at their clinic or their hospital. And then they would call you on the phone,
and discuss that with you. So I thought this was
a wonderful thing to do, and that’s what I began doing. MB: Now, everybody handles
anxiety differently. Pamela handles it with research,
research and more research, and she would come to me
with this research. “Can we get this?”
“Can we get that?” I have a IT background,
so I accumulated a lot of information. In fact, we had a white binder
about 10 centimeters thick of documentation, reports, scans
that I created that she would take to all the local surgeons, physicians
throughout California. However, we also needed
to send this information throughout the rest of the country. So it was my responsibility
to use email, facsimiles even the web portals that somebody’s
medical systems put together in order to present this information. But I also do something else. I started a 3D print company. I also started a podcast. In one of my episodes, I had talked
about a Malaysian neurosurgeon who printed a 3D skull and brain,
and used that for practice surgery. Now [in] Malaysia, [they] can’t use
cadavers, it’s illegal, so I could understand
the reasoning for that. Coincidentally, ironically,
Pamela had a brain tumor, and I thought to myself, “Wouldn’t it be neat
if I could apply these skills that I have just learned
to be able to help her?” So, I went to work but immediately
I ran into roadblocks. This software is horrendously expensive,
and it’s also for the medical community. One, I’m not in the medical community. Two, I don’t have a lot of money. So, like Pamela I used the Internet
and did a lot of searching. And I came up with two open-source
research programs that allowed me to do what I needed to do. One of them was from Brazil,
part of their Technology Center. The other one was from a research company
on the East Coast. Through the two of these things, after a couple of weeks of training –
that I trained myself – I came up with this. This is a 3D volume render. On the right hand side
you see a bunch of slices. These are CT scans.
Bone shows up very well in these. There’s about 300 of them. All together they rendered
this skull here. Now, the skull by itself is great
for Halloween, but nothing more. So, there’re other powerful tools in here. They’re called ROI
or “regions of interest,” and they virtually allow me
to slice the skull in half. And I did it right over the left eye, and you can see not too clearly the tumor, and I’ll highlight it a little bit here. As you can see there is the tumor. Now the magic behind this kind of software
is that I can rotate it, so here’s an animation
where I cut it in half so that I can look inside this skull. A few years back
I would have had to kill Pamela in order for this to happen. No, I’m trying to save her. So because of technology, I now
have the ability to look inside there. And I’ll circle it here,
again, there’s the tumor, Now I said earlier that I 3D print, so I wanted to take this
to the next level. It’s great to be able to look
at this stuff on a computer, but wouldn’t it be great
if I could actually touch it? So I went to work, the same software
gave me the ability to create a model that I applied to a printer. So, here is a time-lapse image. Obviously if you’ve ever worked
with a 3D printer, they’re not this fast. It took about 8 to 12 hours
to create this skull. Now this is kind of creepy,
kind of reminds me of the Terminator. However, this is that 3D printer, and this, a year and half ago, is the time-lapse that I created,
and this is the skull. Don’t you think it kind of looks like her?
(Laughter) I like the cute little nose here. Now, the reality is we want to look
inside of it , so here is the tumor. We can actually touch this tumor. I was extremely excited about this,
so I ran to her and said, “Look, I’ve got your skull here!
Here’s your tumor.” She greeted me with a look of horror. I thought to myself, “Why?” but then it dawned on me,
for the first time she came away with what was inside her
causing her all that pain. But what does Pamela do?
Research. PS: I had found something miraculous and something that most doctors
were not familiar with, and had never heard of. There were 2 major medical centers on the East Coast,
so across the country from us, that have developed
a new surgical technique for the kind of tumor that I had. It was perfect. One was Johns Hopkins Medical Center, the other one was the University
of Pittsburgh Medical Center. In this procedure, groundbreaking, there would be a team of a neurosurgeon
working with an oculoplastic surgeon. They would make a tiny incision,
truly tiny in the crease of my eyelid, and then the neurosurgeon
would go over the eye and directly into the tumor
to remove it in very tiny bits, small increments,
over the course of several hours. Thus I would have no craniotomy,
no movement of my brain, and this would eliminate
the risk of brain damage. I was very excited about this,
and I really wanted it done. Now UPMC could get us in
within a few weeks, so I went ahead and scheduled
the surgery there as soon as I could. MB: So a few weeks later,
we got on a plane, and we went to Pittsburgh, Pennsylvania. The next day she had some labs done,
and we had an opportunity to talk to the surgeons, in particular
the neurosurgeon Dr. Gardner. So I asked him because I had sent him
one of these skulls, and said, “What do you think of it?” He kind of chuckled, he said, “We passed it around
in one of our meetings.” He said, “We thought it was extremely cool
how we can look at something, touch it,” because normally all they had
was some images and some text documents, so they were able to touch it,
now we had a fellow with him, he said, “The huge potential of using this
for education is enormous because now we can take data
from a patient immediately and apply it into a tangible model
and use that as the Malaysian neurosurgeons
use for practice.” PS: My surgery was very successful. This photograph was taken
10 days after the surgery. The surgeon had encouraged me,
to get up and walk every day, and so I was walking a little bit
and Mike’s idea on day 10 was that we would go a half mile
and walk to a museum and then walk around the museum. So this is what we did. MB: It was a great museum.
PS: It was. And you would never know that I had had brain surgery
10 days earlier unless you peeked
under those big dark glasses, and then you might think
that I had an affinity for purple eyeshadow on just one eye,
but no one had any idea. And 5 hours after this photo was taken I was back on a plane to California, and 10 days after that,
I was back at work in my office. Pain-free, no impairments whatsoever,
driving my car and absolutely fine. MB: This is an object that rotates.
So I did 2 things. I did 2D resolution images,
and I also did a 3D scan of her head and sent that to them,
so they can rotate it, zoom in on it, look at it
from different angles. This allowed us not to ever
have to go back to Pittsburgh because they and all the information
at their fingertips. I see huge potential in this:
long distance surgeries and long distance postoperative checkups. PS: Now, this is a close-up photograph
of both my eyes, 2 months after surgery. There’s no photoshop,
no make-up, completely natural. Can you tell which eye
had a brain tumor removed? MB: That one.
PS: You’re always wrong. (Laughter) Now, I am a psychotherapist by profession,
dealing with people who are going through difficulties
going through traumas and stress. They often ask me,
“How do you cope? What do I do?” I like to use a metaphor
of inner archetypes, the characters within us
that are through mythology and literature, and I always talk about
having an inner healer, having an inner warrior,
having an inner magician, and how do we bring
those resources up out of ourselves. And there are times perhaps
when we’re too depleted and we have to seek
those resources externally. And this is a wonderful thing to do. Now, Mike and I obviously dream big,
and I like to think of my life as a book, and I am the author of the story. It’s an adventure story,
and it’s not always fun, but it’s always a very interesting story. And I hope at the end of my life
that I can hold up this book and say, “I am very happy with the way
this turned out.” MB: I hope I’m a protagonist in your book
and not an antagonist. However, in my book
she is one of the heroes. She went through a lot
of pain and suffering. I was not going to cry so soon – (Applause) thank you – but she persevered
where other people have not. She is a warrior to me. But I also want a special note
to the two surgeons, notably Dr. Gardner and the technology
and the people behind it. CT scans just came out,
MRIs were still on the drawing board that’s when her mother fell into a coma. They determined that it was a brain tumor
from the CT scan, but it was too late. I wonder today
how that story would turn up. Thank you. (Applause)

13 comments

  1. Michael and Pamela are not only inspirational on an individual basis, as a powerful team they illustrate what love, passion, intelligence and tenacity can create in order to overcome a very difficult challenge. Wonderful job!

  2. Touching..thumbs up to the heroic courage.
    I design patient-specific implants and templates for PGIMER, Chandigarh (India).
    3D printing is a vital requirement for the medical industry in India and is growing very fast.
    Your video is an inspiration to the people suffering from similar problems, therefore, I will circulate and share it with doctors and colleagues. Thank you

  3. What a great story. Where can i find more information for the software used to transform CT scan data into 3D printed models? I'm aware of Slicer 3D and Osiris I believe.

  4. Inspirational and emotional TEd talk about 3d printing. How can I get in touch with Michael Balzer and/or Pamela Scott?

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