Subscribe
Share
Share
Embed
In this episode of “Lab Medicine Rounds,” Justin Kreuter, M.D., sits down with Joseph Maleszewski, M.D., professor of Laboratory Medicine and Pathology, and consultant in Anatomic Pathology here at Mayo Clinic, to discuss the trending topic of 3D imaging technology.
A Mayo Clinic podcast for laboratory professionals, physicians, and students, hosted by Justin Kreuter, M.D., assistant professor of laboratory medicine and pathology at Mayo Clinic, featuring educational topics and insightful takeaways to apply in your practice.
(upbeat music)
- This is "Lab Medicine Rounds",
a curated podcast for physicians,
laboratory professionals, and students.
I'm your host, Justin Kreuter,
the bow type bandit of blood,
a transfusion medicine
pathologist at Mayo Clinic,
and today is really cool.
We're rounding with Dr. Joe Maleszewski,
Professor of Laboratory
Medicine in Pathology
and Consultant in Anatomic
Pathology here at Mayo Clinic
to discuss the trending topic
of 3D imaging technology.
Thanks for joining us
today, Dr. Maleszewski.
- Thanks Dr. Kreuter.
- Hey so, you know, you've been featured
in some of the press that
we've been doing around here
at the clinic, and I
think outside as well.
Maybe you could kind of start us off
with that kind of, you
know, why is 3D imaging
and printing important for patient care?
Kind of like it's not
so much a nice to have.
It actually really contributes something.
- Yeah, it's a great question.
It's certainly one that's
commonly asked, I think.
First, just a few brief words
on what 3D imaging actually is,
and it really provides
for a realistic depth
and allows a viewer to see into spaces,
notice movement of lights and shadows
to gain a fuller understanding
of actually what's being shown to them.
It's particularly important in areas
of surgical and autopsy pathology
where the specimens that we're looking at
really often require an
understanding of complex anatomy
or anatomical relationships
that we may or may not,
when we're first acquiring the image,
fully understand is important
to the ultimate understanding
of the specimen itself.
So being able to capture and reproduce
a three dimensional rendering
via digitally or physically
provides a lot more
opportunity for analysis.
It's simply more of a
complete and robust dataset
that we're capturing on the front end.
So instead of looking at static 2D photos
that may or may not include precise areas
of clinical interest, we can
pull up dynamic 3D images,
move and rotate them, visualize
all areas of the sample,
and have more nuanced conversations
with our colleagues, even our patients.
- That's wonderful.
If I can key on one thing
you brought up there,
this idea of being able to be dynamic.
That's something that
I've seen in a lot of.
Probably a lot of our listeners
can relate to, you know.
Somebody ask, you given a presentation.
Somebody asks a question, and
you have a slide for that,
but not immediately available.
- Exactly, exactly.
- It sounds like this is enabling
you to kind of on the fly-
- Absolutely analogic.
- Address the thought.
- Yeah, totally analogous there.
So, you know, you can just envision
a situation where you're sitting
and you're talking about a
specimen with the surgeon,
you're talking about a particular margin,
and then he or she says to you,
"Well, what about the
area just beyond that,
you know, just on the
other side of this picture?
You know, right there?"
And you wanna just grab
the picture and turn it,
but you can't, right?
You only have what you
captured right at that moment.
3D technology changes
that paradigm entirely.
Now, you can grab it and rotate it.
Just move it around just like
you would the actual specimen,
and in fact, you can actually
take the digital file,
send it over to a 3D printer,
and then have a reproduced copy
of the three-dimensional
object in front of you.
You can pick it up and
manipulate it that way, too.
- So you've kind of
centered us on, you know,
really where is some
clinical importance here?
Can you help our audience
kind of understand?
Again, we have clinicians,
laboratory professionals, and students.
Kinda help us understand, you know,
When should we be using this?
- Yeah.
- When is it not so good?
Kinda that nuance.
- Yeah, well, first of all,
I think one of the questions
that's commonly asked is,
you know, is this something
that's available even now,
even for me to use, just
more generally than that?
And I think the answer to that one,
before I get in answering the
other question you asked, is
that it's here, and it's now.
Sometimes folks, when you
mention 3D technology,
they kind of conjure up in their mind
a kind of gimmicky stuff,
you know, the old 3D movies
or serial boxes when you were a kid
where you cut out the
cardboard blue red glasses,
and all of a sudden you're
looking at a blurry object
that suddenly now has some depth to it.
The technology we're talking
about is quite a bit different.
It's really far more advanced than that,
and it's here, it's now,
and it's really becoming
ubiquitous for us.
Devices such as personal
computers, laptops, tablets,
even our cell phones allow
us to place 3D objects
into our world and interact with them
by way of augmented reality.
The cameras on our cell
phones actually now have
the capability to
photogrammatically collect data.
So you can use your
camera and scan objects,
and it'll create 3D renderings of those,
and then we can also take those objects
and not only use them in an augmented way
in our existing reality,
but we can create entire virtual rooms
and using virtual
reality, recreate spaces,
generate immersive learning opportunities,
learning experiences, that
are far and away more richer
than just reading about them.
- Wow.
- We can put trainees
into all kinds of
different environments now.
We can let them practice in safe spaces,
learn to deal with
myriad, complex situations
before turning them
loose into the real world
that are, you know,
certainly more high risk
and even more high stress.
So I think education is a space
where we're really gonna
see 3D technology taking off
because there's just so many
opportunities for it to shine.
It's basically recreating
the apprentice model
of learning in a way
that's incredibly low risk,
and, of course, you know,
in our current society,
we tend to be very low risk with things.
It's one of the things that I
think a lot of us physicians
lament about learning medicine today is
we don't wanna let learners too much
off the leash on their own to
do things because, you know,
we fear an adverse consequence
potentially happening.
Well, 3D worlds really can
be a nice stop gap to that.
They can recreate all kinds of situations,
and we can let learners
pretty much run free there
and see what takes off.
So I think education
is a really great space
where we're already seeing a lot of that,
you know, start to take hold.
Being able to collect 3D data and print it
using a 3D printer is also really cool.
Even though manipulating
3D digital images is fun,
there's still something really special
about holding something in your hand.
We've actually seen how important this is
for our patients, too, and this leads me
into, really, the answer to your question.
There is, you know, for decades,
our transplant patient population here
has been incredibly invested
in their underlying diseases.
Not that all patients aren't, in some way,
invested in their diseases,
but the transplant population
is a very unique patient population.
They wait for, you know,
some months, often years,
for these transplanted organs,
living with a chronic
disease that's debilitating.
They're involved in these communities
where they're waiting for
organs and things like that,
and so they're deeply
invested and understand
great amounts about their diseases,
almost to a patient in
the transplant population,
and so for decades here at Mayo Clinic,
our transplant patients
have actually requested
to be able to see their organs
after they come outside of them
'cause they've been hearing
about their disease,
they've been learning
about that, studying it,
and now, their disease organ has come out,
and they have a new one put in,
and it's natural for them
to be a little bit curious
of, "Can I see it?
Can I hold it?"
And we used to have a thing where we would
put their organ in a
bag and show it to 'em,
and it was, as you can imagine,
not an optimal experience in any way,
looking at something in a
little bag that's all sealed up,
and there's liquid in there,
and you kind of see it,
you kind of don't.
Well, now, using 3D technology,
we can actually replicate
their organ for them.
We can show it to them
digitally on a tablet
and let them move it around
or we can print off copies of their organ,
of their dissected organ or
of their undissected organ.
So, you know, I've got a
little heart here, specimen
that we actually scanned after
it came out of the patient
and printed it, and we can
reproduce any number of these.
We can sit down next to the
patient, hold it with them,
share it with them.
We can show dissected type specimens
and point out things that are not normal.
It's one thing to tell a patient that
their heart was big and dilated.
It's quite another thing to say,
"Your heart should only be about this big.
Instead, it's this big,"
and allow them to hold that in their hand
and then actually take a copy of it.
We can give them a copy
of their printed organ
where they can then take it home
to their family and friends,
and basically serve as
medical ambassadors,
sharing the knowledge and the information
that we've given them to
their family, their friends,
telling them about, you know,
what they were doing at Mayo,
you know, why they were there for so long,
what the doctors told them.
It's just a great satisfier,
and we've actually been studying that
in our transplant population
'cause we meet with
every transplant patient
and go over their organs and give them
a printed out copy of their
organ, and we've been studying
that was something called
video-reflexive ethnography,
and the results of that
have just been astounding.
The satisfaction scores for these patients
are just through the roof.
They really love that opportunity
to talk to pathologists,
to interact with us, to
learn about their diseases,
to learn about the role
that we play in their care.
It's been great.
- I'm really thrilled to hear that,
and I'm glad you kind
of brought into this,
and I actually wasn't aware
that you were studying it,
but I was kind of curious
about how does that
conversation go now differently?
'Cause, right, you've
done it in the old model,
and now, you're doing it in the new model.
I don't know.
Can you pick a story that
that you've been involved with
and kind of this is what
the typical questions were,
and now, you know, somebody can hold this,
I don't have a cool 3D art
like you do, but, you know,
how has that transformed the questions
and the understanding
that the patient has?
- Yeah, I mean, certainly
in that old paradigm,
like I was describing before,
where you're looking through a bag
at kind of murky fluid and an organ,
and you're trying to explain to 'em,
"Well, you see this here,
see how small this is?
This is how big the valve should be,
and this is how small
it was in your heart,"
and they look at it, and
you can just tell, right?
You can tell by the look on their face
that they see it and they don't.
Anybody who's taught
students knows that look.
That look where they're giving you that.
"Yeah, I see it," but
you're not totally convinced
that they're seeing it, right?
They're humoring you.
Because it's hard unless
you're used to looking
at that kind of thing,
it's just not obvious.
Here, the situation is far more controlled
so we make that organ look perfect.
We make it really demonstrate
the thing that we want to show
really, really nicely,
and we can even have like
printed out comparators next to it,
and then we can reproduce those,
and then they're holding it.
They're not looking through a bag.
They're not looking through it,
and so anybody can clearly see
the minute that you tell anybody,
"Your heart should be this
big, and here it is this big."
I mean, there's no mistaking that.
Everybody gets it implicitly.
So I think it's been a
paradigm changer for you,
and I can tell you, just
from a personal standpoint,
the best days that I
have here are those days
that I get to meet with
those patients, it seems.
Every interaction I had
with them is fantastic.
In fact, I met with a patient
and their family this morning,
and the questions they asked
and just kind of the understanding
that they walked away
from that encounter of their disease,
I have no doubt that it was increased
even above and beyond what
they had already known
in this invested population.
You know, a lot of times,
the conversation that
patients have with
their bedside clinicians
tend to be focused on treatment,
next steps, what are we
gonna do, where do we go,
you know, all this stuff.
They're not so focused on
what was the underlying issue?
Why did it happen?
Why did it get there?
What's the risk?
All these other things,
risk to family members.
Oftentimes, the conversation
isn't focused in those ways.
And then honestly, that's our wheelhouse.
Our wheelhouse is
pathobiology, pathogenesis,
why a disease comes about.
we are really optimized
to be able to answer
those types of questions.
What are the genetic implications?
What does this mean for my family members?
We can answer all of
those, and this is a nice,
quiet environment where
we're sitting down,
and we're just talking about
the condition they had.
They can ask any questions
they have about it,
and we do our best to answer it.
- Wow, Jo, you almost
talked me into signing up
for another fellowship and
being your fellow next year.
That sounds like an awesome experience.
- Yeah, it's fantastic.
- And I wanna put a tack to that
and kind of shift the gear a little bit,
although I don't wanna
diminish the clinical impact,
really, from the patient perspective,
which I think has been
an awesome highlight
of this podcast so far, but, you know,
something I was reading,
I think it was an article
that you participated in writing,
talking about kind of
the scan of the organ,
and then also talking about
the printing of the organ,
and I certainly understand
maybe they're linked,
maybe they're not linked.
Can you help us get our arms around
what is the value in the scan?
What is the print value?
- Yeah.
- Kind of understand
that a little bit better.
- That's a great question, too.
Definitely, both the scan
and the print have value.
The scan allows us to
archive the data digitally.
It gives us global access to it,
allows us to share it
across time and space.
The print is really just a
way of connecting with people
in a more intimate and tactile way.
As I just mentioned a few minutes ago,
the 3D universe is really
cool, and it's great,
but there's still
something totally special
about holding something,
sharing it with others,
passing it between us, and that's really
what the printing allows for.
So it's really a tool that
leverages that digital asset.
That digital asset can be used
in all kinds of different ways.
You know, for studying things,
we can parse the data in different ways.
We can look at it in different ways,
but the 3D print is really
just a reflection of that.
That's a physical manifestation.
- And so I imagine technologies
for scanning are improving
and that's resulting in better
models for you to look at,
and then is printing is
the materials being used,
improving in such a way
that you can get the same
kind of textures?
- Yeah, so definitely,
the biggest advancements
that we've seen in the last few years
have been colorimetrically,
and so, you know, it used to be
we would reproduce objects that were,
you know, neon pink and things like that
because the polymers we used
were kind of crazy colors,
but now, we're actually
able to capture the textures
and reflect them in the prints as well
so that they actually look
like the color and they
have the consistency
and all those textures of
the actual specimen itself.
We still tend to print
them in a rigid plastic.
There's all kinds of-
There's really soft ones.
There's pliable.
There's lots of materials
you can print in.
The ones that we most
commonly do are rigid
just because we like to make
them, you know, somewhat tough
and you know, not squishy
and stuff like that,
but yeah, there's lots
of opportunity there.
- Ah, now, you mentioned
that this is here and now,
this ability to scan and print specimens.
I imagine that although it sounds like
it's pretty available in the world today,
imagine cost and time,
kind of can be some classic challenges
that you might be navigating.
You run and you lead the
center here at Mayo Clinic
that's involved with 3D printing.
I'm kind of curious how do you see
this field really developing?
- Well, that's another great question,
and I think, as with most
other technology-based areas,
Moore's law kind of applies here.
For those in the audience
who may not be familiar
with Moore's law, it's the principle that,
essentially, the numbers of
transistors in a processor
double every couple of years,
but the price of that is
basically cut in half,
and so there's kind of
an inverse relationship.
Basically, the cost curve
bends down over time
with technology, as we all know.
This computer that we
bought five years ago,
we would've paid twice
as much for, you know,
and it had half the technology, it seems,
and the same thing is true
with this scanning technology.
The cost of scanners, the
availability of those scanners
is all certainly bending down.
It's not being widely deployed
in the realm of pathology yet,
however, there are other areas of medicine
that are really pushing boundaries
and at the forefront of this.
You know, now, if your
kid breaks their arm,
it's not uncommon for them
to actually 3D print a cast
for them in the now.
They can do that type of thing.
There's all kinds of
ways that this technology
is evolving in medicine.
3D printing actual organs
and actually plating cells
on polymers and reproducing ears
that they can implant onto people,
that's all, you know, budding technology
that's stemming from this as well.
We're just going to see
this continue to evolve,
and again, cost is higher right now,
but in three years, we're
gonna look back at it,
and it's gonna be, you know, again,
just like cell phones and
every other technology
in the areas of our lives.
- I know, when I was
younger, I had no idea.
I'd be debating with my young kids
about what age they can get
their cellphone. (laughs)
- Yeah, so we're having that debate, too.
What did you decide on?
(both laugh)
- The debate continues in our home.
(both laugh)
- I'm trying to convince my
daughter that 32 is a good age.
- Good luck with that.
(laughing continues)
You know, as you're talking,
and you're talking
about how this is really
taking down the cost.
I imagine right now, like you're saying
a lot of surgical fields,
procedural fields,
and, you know, you've given the examples
on how pathologists are relating this
to patients for our listeners.
You know, I could see,
whereas the cost goes down,
it becomes something
that is easier to print.
You know, there's opportunities
for this to be used
in other aspects of laboratory medicine,
and hopefully in things
like preventative medicine.
It's not just related to
the kind of high cost,
high procedure kind of areas.
- Yeah, yeah.
- This has been really fascinating.
- Thanks, we think so, too.
We're really excited about this.
- (laughs) Well, thanks, Jo, so much
for talking with us today.
You really connected, I think,
with each of our audiences,
the laboratory professional,
the clinician, and the medical student
or the student of healthcare.
Really appreciate your time today.
- Anytime, always happy to join.
- All right, and thank
you to our listeners
for joining us today.
We invite you to share your thoughts
and suggestions by email.
Please direct any suggestions
to mcleducation@mayo.edu
and reference this podcast.
If you've enjoyed "Lab
Medicine Rounds" podcast,
please subscribe, and until
our next rounds together,
we encourage you to continue
to connect lab medicine
and the clinical practice
through insightful conversations
and maybe a couple 3D models.
(upbeat music)