3D Systems Helps Walter Reed Army Medical Center Rebuild Lives Although Walter Reed Army Medical Center isn’t on the front lines, the hospital is not far removed from the action. The mission of Walter Reed is to provide advanced and sub-specialty health care and services to soldiers, their families, and a large community of military retirees. Through its 60 clinics, Walter Reed provides patient care, medical education and training, medical research, and combat medical readiness. An important function of the Medical Center is to treat Army and other military personnel following surgical, accidental, or combat trauma. To support effective treatment interventions, the Walter Reed 3D Medical Applications Center plays a vital role. The Center provides 3-D models for pre-surgical and post-surgical planning, as well as for patient and provider education. For that work, the Center uses the SLA® 7000 (stereolithography) system from 3D Systems (Valencia, California, USA). The SLA 7000 system is constantly in use, helping surgeons rebuild shattered bodies and lives. This support provided by the Center extends throughout the United States military. Because it is the only facility with a reasonable turnaround time today in building 3-D anatomical models, the Center supports all service branches. Track Record, Speed, and Consistency Some years ago, surgeons at Walter Reed began to look into rapid prototyping for pre-surgical planning. Thanks to computed tomography (CT) and magnetic resonance imaging (MRI), the Army surgeons had very accurate two-dimensional images of their patients. These imaging technologies revealed the location of bones and tissues through a series of single, isolated snapshots, instead of using an actual three-dimensional volume reconstruction. Whereas the CT and MRI images had to be examined one cross-section at a time for accurate patient diagnosis, the 3-D stereolithography technology allows these images to be converted to a 3-D model so that physicians can actually hold the information and examine all of the data at one time. To create these prototypes, Walter Reed surgeons needed a rapid prototyping tool. In 2001, the Medical Center chose a 3D Systems SLA 7000 system. This device has a low-vibration optical system, dual-spot laser technology, and high throughput. The build material used is translucent or transparent, making it possible for surgeons to see through a model. Also, 3D Systems is a company with a long track record in the stereolithography arena. Today the 3D Medical Applications Center produces many models that are used by both healthcare providers and patients. The models allow for more rapid and accurate diagnoses, more effective treatment planning, better informed patients, reduced time and costs related to the operating room and anesthesia, reduced need for follow-up surgeries, and better education and training of healthcare providers. The 3-D models are used for pre-operative planning and reconstruction, such as mock-ups of shoulders, pelvises, femurs, and facial bones. While originally intended primarily for other uses, the system has been pressed into service to help with the cranial and facial reconstruction that military personnel may require after combat. The machine runs between six and nine full models at a time. Shorter Surgeries to Reduce Risk and Cost In the Center’s rapid prototyping operations, data is transmitted in raw CT form, and then third-party software combines the 2-D images into an accurate 3-D rendering. Working with that image, Center personnel apply a filter to highlight desired features, such as bone. With the items of interest selected, the staff then submits the information to the SLA 7000 system. The machine creates a model, which can be multicolored to further highlight different regions. This patient-specific model is then used by the surgeon to plan an operation and for other activities, such as patient education. Prior to making an incision, the 3-D models provide the opportunity for the physician to see and feel the anatomy as it will be seen in the operating room, which facilitates more effective pre-operative planning. The system has only been in use at Walter Reed for a few months, and models have been employed in nearly 90 major cases. Although a complete study comparing the use and non-use of models has not been done, preliminary results are available. Surgeries done with a 3-D model have taken four-and-a-half hours less operating room time and cost $15,000 less than comparable surgeries done without a 3-D medical model. Shorter surgeries enable greater utilization of operating rooms and resources. Cutting time in surgery and the length of time a patient is under anesthesia should lead to better patient outcomes, faster healing times, and a lower morbidity rate. More Effective Patient Education Rapid prototyping with the SLA 7000 system enables patients to make decisions based on better information. In one case, a patient with cancer was considering surgery. A two-color model, however, clearly revealed that the surgery would require removing so much bone that the patient would find it difficult to walk. Using the model, the surgeon sat down with the patient and discussed the available options. Because of the 3-D model, the patient had a better understanding of the consequences of the surgery. That degree of truly informed consent means fewer surprises for the surgeon or the patient. The added information from the 3-D model is useful for more than just planning for surgery or deciding on surgery. In many combat trauma cases, surgeons are confronted with patients who are missing large pieces of their skulls. For patients and their families, dealing with the injury and surgery is highly stressful. Part of the problem is facing the unknown, and detailed 3-D models help with this aspect. Center staff, for example, will build a model of a cranial plate and take this to a patient education session. With model in hand, staff can put a replica of the proposed cranial plate against the damaged area of the patient’s skull and show the patient and family exactly how the implant will restore the original contours of the skull. That visual aide helps the situation greatly. Safer Vehicles While most of the work of the 3D Center has understandably been helping surgeons do their jobs, the Center and its 3D Systems-driven modeling have also contributed in other ways. For instance, work at the Center has saved soldiers on the battlefield. In one case, a soldier arrived at Walter Reed with blast damage to his face, which should have been protected by the shielding of the vehicle in which he was riding. Using a model of the injury, Army investigators were able to reconstruct the explosion and pinpoint why the shielding failed to protect the soldier. With that information, Army personnel went back to the manufacturer of the vehicle and showed how it needed to modify it to prevent injury to other soldiers. With help, the Walter Reed 3D Medical Applications Center will continue to combine the latest computer technology and 3-D modeling fabrication with traditional CT and MRI scans to greatly enhance medical efficiency and patient outcomes. Company Overview The Walter Reed Health Care System provides comprehensive health care for more than 150,000 soldiers and other military members, both active duty and retired. The System consists of 10 major treatment centers in three U.S. states, with a staff of more than 6,000. That total includes more than 600 Army physicians, many in training in graduate medical specialty programs. The Walter Reed Health Care System is the Army’s leading center of clinical research and innovation.