(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)