The Skull Model

The RP-ML Comes to the Rescue of a Boy in Need


Copyright © 2000, Ennex Corporation. All rights reserved.

Background:

In January 1997, Lynda Hurley posted on the RP-ML about a colleague whose son needed reconstructive surgery. They wanted a surgical model of the boy’s skull to help the doctors in planning the operation. Many people pitched in to offer and provide the services needed to image the boy’s skull in solid plastic. Two and half weeks after Lynda’s post, the finished model was in the surgeons’s hands, who later said they were able to complete the operation in two to three hours less than if they had not had the model to guide them. The surgery was successful and at last report the boy has been growing up healthy and happy to be rid of his deformity.


Index of Messages


01: From Lynda Hurley Re SERVICE BUREAU'S


Date: Wed Jan 15 1997 22:18:00 EET
From: Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com <Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com>
Subject: SERVICE BUREAU'S

One of our Lockheed Martin employees in the Northeast is looking for a Stereolithography service bureau to produce a copy of a CT scan of his son's skull for medical purposes. Unfortunately we cannot take this on because of funding (the government doesn't like us doing freebees). Does anyone know of a service bureau in or around Nashua New Hampshire? Also, if anyone knows of a research lab that would be willing to take this on free of charge, please let me know.

Thanks in advance for your time.

Lynda Hurley
Rapid Prototyping Lab
Orlando, Florida
Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com
(407)356-4390


02: From Marshall Burns Re Insurance for medical models


Date: Wed Jan 15 1997 23:11:13 EET
From: M. Burns <marshall (at) Ennex (dot) com>
Subject: Insurance for medical models

On Wed, 15 Jan 1997 Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com wrote:
> for a Stereolithography service bureau to produce a copy of a CT
> scan of his son's skull for medical purposes. Unfortunately we

Lynda, has your friend looked into whether his insurance would cover it? I have wondered when the insurance companies are going to recognize the cost and mortality reductions available from doing presurgical models. Does anyone out there know anything about any decisions by insurance companies one way or the other on this?

Best regards,
Marshall Burns
marshall (at) Ennex (dot) com

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03: From Andy Christensen Re Re: SERVICE BUREAU'S


Date: Thu Jan 16 1997 00:16:20 EET
From: Andy Christensen <ChefAndy (at) ix.netcom (dot) com>
Subject: Re: SERVICE BUREAU'S

Dear Lynda,

Medical Modeling Corporation has been in the business of creating SLA models from patient CT scan data for about two years. During this time we have seen our models used for many different purposes which range from presurgical planning and patient consent to the fabrication of "customized" implants. Medical Modeling Corporation is focused solely on the medical market, thus providing the patient with the best service possible. Our staff of is comprised of biomedical and design engineers. We have seen good success in insurance companies willingness to pick up the charges for these kind of models, especially when working with an implant company.

Marshall Burns wrote:
> Lynda, has your friend looked into whether his insurance would cover

In the case of some implant manufacturers the insurance companies are definitely seeing the cost savings from producing a model pre-surgically. The insurance companies are seeing this like they should. The advantages: 1) a cost savings in terms of operating room time, 2) a reduction of the number of surgeries needed to bring a patient to their final outcome, 3) a great tool for patient understanding and consent, and 4) a very accurate way of pre-bending or manufacturing a "customized" implant. We're having almost 100% coverage for our models, it just takes some pre-planning and approval prior to manufacturing.

Studies are also in the works to bring a comprehensive data set to the insurance companies. This study would look at cost/benefit of providing models for patients in need.

Lynda, we would be happy to look into getting insurance approval for the young man's model to be fabricated. If there are any questions, don't hesitate to call.

----------------------------------------------------------------------
Andy Christensen
Sales & Marketing
Medical Modeling Corporation
17301 W. Colfax Ave., Ste. 300
Golden, CO 80401 USA
303/273-5344
303/277-9472 fax
ChefAndy (at) ix.netcom (dot) com
medmodcorp (at) aol (dot) com

"SLA Anatomical Models . . . The Ultimate Analyis Tool."
----------------------------------------------------------------------


04: From Robert Thompson Re Re: SERVICE BUREAU'S For Medical Model


Date: Thu Jan 16 1997 01:30:48 EET
From: Robert Thompson <anatomics@qmi.asn.au>
Subject: Re: SERVICE BUREAU'S For Medical Model

Dear Lynda,

Anatomics here at the Queensland Manufacturing Institute could make you a facial or skull model at our normal rate which I think you will find is reasonable. If the model is a face only, the cost is usually about $US 800, and a skull would cost up to $US 2000, but this could be significantly less if the skull is small.

We have done cases from the US before, where we have received the data via e-mail, and shipped the biomodel back promptly via express courier. Alternatively, you could send us the data on DAT once we determined the format. Anyway, have a look at our web site (www.qmi.asn.au/anatomics) and see what you think.

Regards
Robert Thompson

//////////////////////////////////////////////////////////////////////////////
Anatomics Tel. 61 7 3364 0776
Queensland Manufacturing Institute Fax. 61 7 3364 0786
P.O. Box 4012, Eight Mile Plains Em. anatomics@qmi.asn.au
Q 4113 Australia Web www.qmi.asn.au/anatomics

Anatomics : The Biomodelling Specialists Enhancing Patient Care.
\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\


05: From Elaine Persall Re Insurance for medical models


Date: Thu Jan 16 1997 14:55:26 EET
From: Elaine Persall <persall (at) ces.clemson (dot) edu>
Subject: Insurance for medical models

Marshall Burns wrote........
> Lynda, has your friend looked into whether his insurance would cover

To all....I am a big advocate of educating insurance companies, doctors, and lawyers about the use of medical models. Until the current way of thinking is changed by users insisting upon a medical model...this change is likely to be slow. The medical community is often more ignorant than we as patients like to believe. Of course they may fear a loss of income since litigation could become obsolete. Naw.........I must be still asleep and dreaming.

Elaine

*******************************************************************
Opinions, suggestions, and other controversial matter VOID where prohibited.
******************************************************************
Elaine (Persall) Hunt, Director
Clemson University Laboratory to Advance Industrial Prototyping
206 Fluor Daniel Bldg. Clemson, SC 29643-0925
864-656-0321 (voice) 864-656-4435 (fax)
persall (at) ces.clemson (dot) edu
http://design.eng.clemson.edu/rp/persall/elaine.html


06: From Allan Lightman Re Re: Medical models


Date: Thu Jan 16 1997 17:05:14 EET
From: Lightman, Allan J. <LIGHTMAJ (at) main.udri.udayton (dot) edu>
Subject: Re: Medical models

Marshall Burns wrote........
> Lynda, has your friend looked into whether his insurance would cover

The issue of how to convince insurance companies about the practicality of supporting medical models is a difficult subject. In Europe they have taken the approach of compiling the surgeon's estimate on the impact in reduced time for the surgery, reduced recovery time for the patient, fewer numbers of surgeries while iterating to an acceptable result (yes this happens!), reduced chance for litigation, etc. The goal is to present quantitative documentation on the cost-savings so that the insurance companies will recognize the economic benefit and agree to support these models.

One of the large European efforts is the PHIDIAS project led by Materialise (Belgium). Bart Swaelens of Materialise will be participating in the Seventh International Conference on Rapid Prototyping where he will conduct the Medical Applications workshop. In conjunction with the workshop, we will organize a U.S. effort, with the guidance of Materialise, to develop a database of the impact of medical models in U.S. surgical practice. The goal is to be able to approach our insurance companies - the local "Good Housekeeping Seal of Approval" is essential. The impetus to get this underway is driven, in part, by the medical applications task of the Ohio University Rapid Prototyping Process Development Consortium. Anyone interesting in participating, supporting, or just maintaining contact is invited to attend.

Information on the conference can be obtained at: http://www.udri.udayton.edu/conf/rapidpro/ or by contacting: ICRP (at) udri.udayton (dot) edu For information on the consortium contact: agarwala (at) udri.udayton (dot) edu

Allan Lightman
University of Dayton Research Institute

Lightman (at) udri.udayton (dot) edu


07: From Steve Deak Re Re: SERVICE BUREAU'S


Date: Fri Jan 17 1997 18:19:48 EET
From: Steve Deak <ht-grp (at) cinti (dot) net>
Subject: Re: SERVICE BUREAU'S

Lynda Hurley wrote:

> >One of our Lockheed Martin employees in the Northeast is looking
> >for a Stereolithography service bureau to produce a copy of a CT
> >scan of his son's skull for medical purposes. Unfortunately we

Dear RP world:

I have approached Hasbro's upper management concerning this particular issue. I will build the skull model FREE OF CHARGE if this will be of medical benefit.

I will need an STL file, so I challenge someone to convert the CT images to an STL file and send them to me.

Let's do it!!

-- 
Steve Deak E-mail: ht-grp (at) cinti (dot) net
Manager-RP Services Voice: (513) 579-3270
Hasbro Toy Group Fax: (513) 579-3250
615 Elsinore Place
Cincinnati, OH 45202 "Our Business is Fun!"
USA


08: From Andy Christensen Re Re: SERVICE BUREAU'S


Date: Fri Jan 17 1997 20:50:47 EET
From: Andy Christensen <ChefAndy (at) ix.netcom (dot) com>
Subject: Re: SERVICE BUREAU'S

Steve Deak wrote:
> I have approached Hasbro's upper management concerning this particular
> issue. I will build the skull model FREE OF CHARGE if this will be of
> medical benefit.
>
> I will need an STL file, so I challenge someone to convert the CT images
> to an STL file and send them to me.

Dear Steve,

Your efforts for Lynda Hurley's colleague are commendable. Having been in this business for two years, we feel it is our duty to add a little bit on input. There are a few points that I would like to make on this same matter.

1) Industrial parts (ie: toys, boats, airplanes) are not equal to anatomical parts, even though they can be produced on the same equipment. The trick here lies in the processing of data from a CT scan. The value added by a medical bureau in this situation is the "cleanup" of the CT scan. Often when a CT scan is done, the patient will have teeth fillings or other implants which have the effect of scattering the radiation from a scan. The biomedical engineer's job is to decide what portion of the scan is "scatter" and what portion is bone. The post-processing step is also very important for retaining small features of bony anatomy.

2) Although the STL format (even though there are conflicting original meanings on what this is :-)) is the industry standard for rapid prototyping, it is not what medical bureaus use. A format more suited toward 2 1/2 dimensional data (stacked 2D slices) is the .slc format. This format maintains the integrity of the data from start to finish. On occasion we will utilize the .sli format for modeling.

3) Just as industrial parts have a potential to make money, so do anatomical parts. If the boy's father (and ultimately the surgeon) wish to proceed with a model that will be used to evaluate the child's anatomical situation, I think that this should be handled start to finish by a respected medical bureau.

I would be glad to speak with the surgeon on this case and discuss the re-imbursement possibilities. Oh, and by the way, a full skull .stl file would be somewhere in the neighborhood of 35MB and would tie up an SLA-250 for better than 2 days. Not to come down hard here, but these models are being used for very serious purposes and there are specialists who do this kind of work every day of the week.

Regards,
Andy Christensen

------------------------------------------------------------------------
Andy Christensen
Sales & Marketing
Medical Modeling Corporation
17301 W. Colfax Ave., Ste. 300
Golden, CO 80401 USA
303/273-5344
303/277-9472 fax
ChefAndy (at) ix.netcom (dot) com
medmodcorp (at) aol (dot) com

"SLA Anatomical Models . . . The Ultimate Analysis Tool."
------------------------------------------------------------------------


09: From Steve Deak Re Re: SERVICE BUREAU'S


Date: Fri Jan 17 1997 22:00:41 EET
From: Steve Deak <ht-grp (at) cinti (dot) net>
Subject: Re: SERVICE BUREAU'S

Andy Christensen wrote:
> The value added by a medical bureau in this situation is the
> "cleanup" of the CT scan.

I agree totally. Here is the "brains" (no pun intended)of the effort, in the data creation/manipulation. Someone skilled in this area is necessary before I can be of assistance.

My skill is in accurate creation of SL models. I've been in the industry for a few years from Aerospace to toys, and have built many complex shapes including CT-originated data. However, typical input for Hasbro's RP lab is Pro/E, UG, AutoCAD and .stl. Other than that, my data manipulation tools are limited.

> 3) Just as industrial parts have a potential to make money, so do
> anatomical parts. If the boy's father (and ultimately the surgeon) wish
> to proceed with a model that will be used to evaluate the child's
> anatomical situation, I think that this should be handled start to
> finish by a respected medical bureau.

By all means, if someone willing and more qualified wants to help, please do. If it were me, I'd want the best person on the job. I can only build an SL model, not create data or discern bone geometry.

> I would be glad to speak with the surgeon on this case and discuss the
> re-imbursement possibilities. Oh, and by the way, a full skull .stl
> file would be somewhere in the neighborhood of 35MB and would tie up an
> SLA-250 for better than 2 days. Not to come down hard here, but these
> models are being used for very serious purposes and there are
> specialists who do this kind of work every day of the week.

I intend to build this on our SLA-500, which would probably equate to 30 hours or so. I'd probably build a Nerf Launcher, Tonka Truck Body or a Playskool Medical Case with it to fill the machine. We build files in the 100Mb range regularly, I love detail and fine facets.

Our intention is to help, not enter the Medical field. However, I believe the concern here is an SL model would be useful but not created due to Health Insurance issues. Hasbro has a heart and we're willing to help. We don't do freebies regularly, but this one tugs at your heart. I'm proud to be a part of the Hasbro.

-- 
Steve Deak E-mail: ht-grp (at) cinti (dot) net
Manager-RP Services Voice: (513) 579-3270
Hasbro Toy Group Fax: (513) 579-3250
615 Elsinore Place
Cincinnati, OH 45202 "Our Business is Fun!"
USA


10: From Reed Williams Re RE: SERVICE BUREAU'S


Date: Fri Jan 17 1997 23:19:38 EET
From: Reed Williams <jrw (at) cyberramp (dot) net>
Subject: RE: SERVICE BUREAU'S

Dear Lynda,

Cyberform International, Inc., located in the Dallas/Fort Worth area is the leading company in the nation in providing anatomical models for preoperative planning for surgery. Cyberform provides this service on a routine basis, and has done so for many years. Cyberform has been instrumental in developing software applications which assist in Preoperative Planning and Anatomical Modeling.

Anatomical Modeling is a difficult procedure - many technical aspects are involved in converting medical CT and MRI information into the proper format without erroneously modeling the wrong anatomy. Cyberform is capable of providing "custom" designed surgical implants for replacing knees, hips, mandibles, and many other anatomical areas based on the medical information provided in the scanned images. With full time in house physicians, radiology technicians and medical engineers, Cyberform is able to assist you.

We have worked directly with insurance companies and physicians to assist with reimbursement issues, and may be able to help you in this area as well.

Cyberform is also a commercial rapid prototyping service bureau.

Ask for Marc McAlister, or myself, Reed Williams, MD

Phone: (972) 690-7700
     Fax: (972) 690-7999
     Email: cfi (at) cyberf (dot) com

Cyberform International, Inc
     407 International Parkway, Suite 403
     Richardson, TX 75081


11: From Jim Rollins Re Re: SERVICE BUREAU'S


Date: Fri Jan 17 1997 23:23:38 EET
From: Jim Rollins <smsscan (at) smsxrayscan (dot) com>
Subject: Re: SERVICE BUREAU'S

Steve Deak wrote:
> Let's do it!!

I'm in for the scanning and the creation of the stl file.

Let's do it for the good in all of us.

Jim

-- 
Jim Rollins Mailto://smsscan (at) smsxrayscan (dot) com
Dir. Scanning Services
Scientific Measurement Systems (SMS)
2210 Denton Drive
Suite 106
Austin, Texas 78758
tel# 512-837-4712
fax# 512-837-9082


12: From Jim Williams Re Re[2]: SERVICE BUREAU'S


Date: Sat Jan 18 1997 01:04:41 EET
From: jim (at) paramountind (dot) com <jim (at) paramountind (dot) com>
Subject: Re[2]: SERVICE BUREAU'S

Steve,
My compliments to Hasbro and you for taking this on... If Imageware is out there I wonder if they can convert the CT image to STL?

P.S. If the LM employee needs a duplicate of his sons skull, for whatever reason, Paramount would be willing to produce an RTV and a urethane cast at no cost...Just a thought.

Best Regards,
Jim Williams, CEO
Paramount Industries, Inc.
1.888.RPTOOLS
1.215.757.9611
1.215.757.9784 fax


13: From Steve Deak Re Skull Model Update


Date: Sat Jan 18 1997 05:40:58 EET
From: Steve Deak <ht-grp (at) cinti (dot) net>
Subject: Skull Model Update

I believe the RP community is due an update as to what has transpired today with regards to the skull medical model.

I spoke with the boy's father by telephone and found the CT image data is on 8mm tape, taken from a Picker PQ2000. The data will be sent to Scientific Measurement Systems (SMS), Austin, Texas (USA) as Jim Rollins has expressed an interest in creating the STL file from the CT data. The boy's father gave permission for anyone to access the CT data should anyone want to assist in this effort.

Jim Rollins at SMS said he will use Materialise's latest software to create the STL file at no charge.

Hasbro Toy Group has offered to build the SL model at no charge from the STL data.

Surgery to reconstruct lower and upper jaw, cheek and eye socket area of the 14 year-old boy is scheduled for February 11, 1997. The patient was born with the condition to be corrected. The boy's father is quite touched with the outpouring of interest from all over the world (and is amazed how fast word travels).

Several of today's rp-ml messages (Especially the messages which deal with insurance-related issues) have been forwarded to the boy's father to give him other views expressed concerning how this procedure should be accomplished and other contact persons for further reference.

All this in a couple of days. Now the real work begins. Lets hope this is successful. We welcome any and all additional assistance in this effort.
------------------------------------------------------------------
Steve Deak E-mail: ht-grp (at) cinti (dot) net
Manager-RP Services Voice: (513) 579-3270
Hasbro Toy Group Fax: (513) 579-3250
615 Elsinore Place
Cincinnati, OH 45202 "Our Business is Fun!"
USA


14: From Scott Turner Re Skull Model


Date: Sat Jan 18 1997 21:44:59 EET
From: Scott Turner <scott (at) scicontech (dot) com>
Subject: Skull Model

I would like to commend those involved in helping this ONE child with your act of charity and compassion. However, I would also pose the question as to why this technology is not available to every child facing such challenging surgery. I have been building anatomical models for UCLA at a financial loss since 1989, and in this country I have seen little or no penetration of this technology into medical practice in the U.S.

I would challenge those in academia who monitor this list to explain why their colleges in medicine are not embracing and exploring RP technology. There are RP Systems in many engineering schools throughout the U.S, but few in medical schools. Why is it that little of the grant moneys acquired by medical education institutions is earmarked for RP research? The only answer I can think of is that they do not see it as having much potential benefit. It is obviously not a high priority.

Having seen first hand how much product development has changed since 1986 when this technology was first introduced, to today, I can only imagine how much medicine would change if this same technologies was available to EVERYONE.

I am proud that if needed I or someone I knew would have RP technology available to them. I am also ashamed that its not available to the many who need it everyday, and have never heard about, or don't know how to get it.

Lastly, for those of you in Europe please ignore this message. I believe RP technology is being incorporated into medical research much more than here in the U.S.

Scott Turner

SCICON Technologies Corp.
Email: scott (at) scicontech (dot) com
Phone: 805-295-8630
Fax: 805-295-8630


15: From Jim Rollins Re Re: SERVICE BUREAU'S


Date: Sat Jan 18 1997 21:44:59 EET
From: Jim Rollins <smsscan (at) smsxrayscan (dot) com>
Subject: Re: SERVICE BUREAU'S

Reed Williams wrote:
>
> Dear Lynda,
>
> Cyberform International, Inc., located in the Dallas/Fort Worth area is the leading company in the nation in providing anatomical models for

Is this a chance to advertise or help??? I'm confused.

-- 
Jim Rollins
Scientific Measurement Systems
2210 Denton Drive, Suite 106
Austin, Texas 78754
Tel# 512-837-4712 xt519
Fax# 512-837-9082
http://smsscan (at) smsxrayscan (dot) com

"WE SEE THE REAL INSIDE OF THINGS"


16: From Ulrich Kliegis Re Re: Skull Model


Date: Sun Jan 19 1997 12:29:07 EET
From: Ulrich G. Kliegis <Ulrich.Kliegis (at) kiel (dot) netsurf.de>
Subject: Re: Skull Model

> From: Scott Turner <scott (at) scicontech (dot) com>
> To: "'rp-ml@bart.lpt.fi'" <rp-ml@bart.lpt.fi>
> Subject: Skull Model
> Date: Sat, 18 Jan 1997 11:33:04 -0800

> I would like to commend those involved in helping this ONE child
> with your act of charity and compassion. However, I would also pose
> the question as to why this technology is not available to every
> child facing such challenging surgery. I have been building
> anatomical models for UCLA at a financial loss since 1989, and in
> this country I have seen little or no penetration of this technology
> into medical practice in the U.S.

Scott,
Here, I am absolutely congruent with your opinion. I have made several thousands of anatomical models in the past years, in varying environments. As in every related business, we also made a relatively high number of models for 'free', which means, somebody else had to pay for it. OK, we did this without questioning in any case where the patient came out of an environment where reimbursement is a totally unknown word, like the little girl from Ukraina, for whom I was happy to process the CT data without charge, using MATERIALISE's fine software, and if we talk about charity, it has to be mentioned here too, that KL TECHNIK in Munich built the model without charging for it. We do this in dozens of cases, and we will continue to do this. But on the other hand, the machinery, the software, the work has to be paid for from some source.

Here in Europe, it was a very hard way to get where we are, and none of the medical RP companies has become a real high flyer so far. Problems with the material, shrinkage, unresolved questions of toxicity and other hazardous properties of the used chemicals etc., and last not least the high cost, prevented a faster growth here.

> I would challenge those in academia who monitor this list to explain
> why their colleges in medicine are not embracing and exploring RP
> technology. There are RP Systems in many engineering schools
> throughout the U.S, but few in medical schools. Why is it that
> little of the grant moneys acquired by medical education
> institutions is earmarked for RP research? The only answer I can
> think of is that they do not see it as having much potential
> benefit. It is obviously not a high priority.

You have to figure in the power of attorneys here. The unfamous White patent, its varying owners some of whom paid vast amounts of money to own that document did everything to deterr people from producing models for the mass market. One California based company scared off everyone who tried to enter that arena. Ironically, the prior art that makes this patent factually invalid is very little known and came up only two or three years ago.

On the other hand, prefinancing a solid study where the surgical outcome improvement can be shown (americans must be very different from the rest of the world, the FDA does not accept studies not done in the US as valid material), have not been done. The reasons are the same as the ones described above. No manager who has his senses together and does not want to run the risk to be fired would have payed a single dollar for the advancement of a technique where he would run the risk to loose a plurality of kilobucks, so to speak, even if the company would win the trial.
Next point: I guess the officials in the insurance companies who have to decide on such extra expenses are even less aware of technological advancements than their european colleagues. And as long as there is no big player lobbying for a reimbursement code for models, I don't see any real progress coming. Maybe pretty pessimistic, but realistic.
I myself had the experience of having made a model for a little girl (a US citizen) (a skull case too.) We made it for free, since it was a study to persuade the doctor of the benefits of the technique in this case.

Now, hold your breath:

The making of the model was delayed for technical reasons. Since this case was absolutely uncritical timewise (a connatal growth disorder, no acute reasons to regard the case as an emergency) there was no medical problem coming from this delay.
I received the copy of a letter of the father of the girl that he wrote to the doctor. It came out that the father was an attorney, and words like sueing for damages etc. turned out to be his way of making pressure. Would YOU ever do a case again under such circumstances? As a doctor? As a manufacturer? I think more than twice now.
Such a letter from a german attorney would not moved anything, but then, we do not let them rule our country alone.

> Having seen first hand how much product development has changed
> since 1986 when this technology was first introduced, to today, I
> can only imagine how much medicine would change if this same
> technologies was available to EVERYONE.

Completely right. A hospital in Austria who purchased one of the systems I was responsible for some time ago produced models for more than 600 of their own cases in three years. That is more than one case per working day. They plan every surgery (craniofacial) on a model, even the seemingly simple ones. See my recent publications on models as an instrument of quality management in surgery. Most surgery is begun without having a documented (stress that!) plan of how to arrive at the end. Would you build a house without having a plan? Without an engineer having calculated the statics?

> I am proud that if needed I or someone I knew would have RP
> technology available to them. I am also ashamed that its not
> available to the many who need it everyday, and have never heard
> about, or don't know how to get it.

Again, right.
One manufacturer of RP machines told me that their prices are purely market driven. IOW, they could be made much cheaper. A friend of mine built his own stereolithography machine from scratch, complete for 60,000 US$. Now figure that.

> Lastly, for those of you in Europe please ignore this message. I
> believe RP technology is being incorporated into medical research
> much more than here in the U.S.

Nope, we do NOT ignore it. Materialise and my former company invested heavily not only in the development of the technique but also in the introduction of this technique into clinical medicine, and all without the assistance, sometimes even against the interests of large companies who competed for the budget (mostly successfully :(( ). And the US is the potentially most interesting market for this. It is very hard, however, for a small european company to get hold of a solid position in the US without the backing of a major partner. We have the technology, we have the clinical experience, and we have the data.

It can be shown immediately how a model, even if the price is high, will amortize itself within less than an hour of operation time. But ignorance and different interests stand against that.

Another unresolved question: Who in the clinical environment is the right partner? The surgeon? The radiologist? Both claim understandably that it is their domain - and potential source of income - or trouble, depending on the situation.

Is modelling just making three dimensional x-rays? If so, ok, then its the job of the radiologist. But then the surgeon deserves to earn on the surgery planning too, not to mention that surgery planning should be mandatory, and not doing so should be called malpractice. Stuff for a different thread in a different mail list.

I'll give a talk on this at the upcoming SPIE conference on Medical Imaging in Newport Beach.
See: http://www.spie.org/info/mi97_home.html

Anybody interested should feel free to contact me.

Best regards, and sorry for getting this a bit longer. I did not have the time to write a shorter letter (J.W.Goethe).

Ulli Kliegis

nordcom medical systems GmbH
Kiel

business email to nordcom@t-online.de
private (this message is both private and business to the set reply - to address)
phone: +49 431 331144
fax: +49 431 331146

------------------------------------------
Ulrich G. Kliegis
Phone (x49) 431 33 11 44
Fax (x49) 431 33 11 46
http://kiel.netsurf.de/homes/Ulrich.Kliegis/Welcome.html
Don't flame me, I'm only the keyboard player...


17: From Steve Deak Re Re: Skull Model


Date: Sun Jan 19 1997 17:04:48 EET
From: Steve Deak <ht-grp (at) cinti (dot) net>
Subject: Re: Skull Model

Ulrich:

We're doing this with the "right" intentions. We see the problems of the world and choose to solve them one at a time (more than that gets overwhelming and discouraging).

Health care (or who it is availed to) in the USA lags the rest of the industrialized world because of structure, not technology. If this one skull model lights a fire in the surgeon to the benefits of RP, then we are inching (or centimeter'ing in metric units:-))our way to the goal of greater utilization of RP in the medical field.

We am trying to make a difference in what we can affect, and hope others do the same given their circumstances.
Best regards.
Steve Deak
------------------------------------------------------------------
Steve Deak E-mail: ht-grp (at) cinti (dot) net
Manager-RP Services Voice: (513) 579-3270
Hasbro Toy Group Fax: (513) 579-3250
615 Elsinore Place
Cincinnati, OH 45202 "Our Business is Fun!"
USA


18: From Ed Grenda Re Re: Skull Model


Date: Sun Jan 19 1997 18:51:27 EET
From: EdGrenda (at) aol (dot) com <EdGrenda (at) aol (dot) com>
Subject: Re: Skull Model

In a message dated 97-01-19 06:11:06 EST, you write: > You have to figure in the power of attorneys here. The unfamous White
> patent, its varying owners some of whom paid vast amounts of money to own

Dear Mr. Klegis et al:

Could someone enlighten us on the "unfamous White patent"? It may actually
be infamous, but for me at least it's unfamous. Is it an EPO patent?

Thanks and regards,
Ed Grenda
AutoFab Systems
19 Pondview Road
Arlington, MA 02174 USA
617-646-6280 (voice or fax)
EdGrenda (at) aol (dot) com (email)


19: From Terry Wohlers Re Skull Model Update


Date: Sun Jan 19 1997 19:19:59 EET
From: Terry T. Wohlers <73417.1465 (at) compuserve (dot) com>
Subject: Skull Model Update

Steve Deak wrote:

> All this in a couple of days. Now the real work begins. Lets hope this
> is successful. We welcome any and all additional assistance in this
> effort.

Steve - What you, Jim Rollins, and others are doing is really neat. I'd like to offer my help. An idea is to initiate a story for publication in an industry trade publication. It would help educate insurance companies and others who could help streamline reconstructive surgeries for accident victoms and those with birth defects. If you or others feel that this is worth pursuing, I'll run it by a couple of editor friends. Let me know.

Terry Wohlers
Wohlers Associates, Inc.
twohlers (at) compuserve (dot) com


20: From Tim Gornet Re Re: Skull Model Update


Date: Mon Jan 20 1997 01:26:05 EET
From: Timothy J. Gornet <tjgorn01@starbase.spd.louisville.edu>
Subject: Re: Skull Model Update

Dr. Steve Schmitt at Lackland Air Force Base has given presentations on this subject more than several times. The last was at Georgia Tech's RP conference last year. He has numerous cases of utilizing RP in the dental prosthodontics as well as for pre-surgery planning. In particular an ideal case was one of conjoined "Siamese" twins where the two children shared a leg. A RP model was made so that the doctors could plan the surgery so that each child could have a protion of a femur remaining for future prostheses. He also has done work in the areas of trauma, accidents and war injuries, as well as birth defects.

I believe that he also has some quantitative numbers in the area of costs/ benefits with respect to operative time saved etc..

I do not know if he monitors this list or not, but I believe that he is by far the most advanced user of RP in the medical field. His email is schmitt@whmc-lafb.af.mil . Hoepfully he will chime in with some of his experiences.

We are also one of those schools that uses an SLS quite a bit in the engineering school, but can't seem to get the medical school folks involved. I recently gave a presentation to our Dept. of Surgery, with plenty of Dr. Schmitt's slides to show them real applications of the technology. We had been trying for a couple of years to get them jump started, but this seemed to do it for them. Many times it is just getting the interest of the right person with the right applications. There are still MANY businesses that have never heard of rapid prototyping. Hard to believe but true. Terry Wohlers might know the numbers offhand as far as the penetration of solid modelers into engineering, but it is still not as large as those of us that are around RP all the time would believe. I bet the RP equipment manufacturers wish it was higher as well.

Many of the medical device (medical packaging, implants, prostheses, etc..) use RP extensively, but it is still vary rare for the surgeons, ENTs, etc.. to know anything of RP or modeling. Only in the last several years have good softwares that can manipulate the MRI/CT scans into smooth data for RP from the more coarse MRI/CT scan thicknesses. Materialise has some good tools to inter- polate in between the layers. I think there are alot of possibilities in the medical arena and there is more work going on than we see on the rp-ml list.

You really have to gain an internal champion in the medical school to take hold of the RP and make it work. Medical schools also have a tendency to have a very NIH attitude for things as well.

Good luck to Steve and the others involved. Hopefully the possible publicity will kick start some others in the medical arena to champion the use of RP.

Tim

-- 
Tim Gornet Computer Aided Engineering Consultant
INTERNET: tjgorn01@starbase.spd.louisville.edu
SLUGNET: Vogt Bldg. Rm 101, University of Louisville, Louisville, KY 40292
PHONENET: (502)852-0714 FAXNET: (502)852-8890


21: From Karl Denton Re RE: Skull Model Update


Date: Mon Jan 20 1997 03:39:34 EET
From: Karl R. Denton <karl (at) dentonco (dot) com>
Subject: RE: Skull Model Update

Terry,

I think that the skull model story is one that would shed a great deal of light on the RP industry and the benefits to those it is used on. I would love to see more in print about this touching story and maybe a follow up on the results or out-come.

The story idea should obviously be run by the parents of the child, having the select few on the rp-ml know about this is one thing, having the story splashed in print may be another! The parents should be the final editors of what ever is deemed to be printed. I'd also like to submit that the authors of this should volunteer there efforts just as the folks building the model and doing the data translation have done. In other words those connected to this should NOT profit from this.

Karl Denton
Denton and Company, Inc.


22: From George Sachs Re Re: Medical Uses of RP


Date: Mon Jan 20 1997 08:11:19 EET
From: George Sachs <sachs (at) pipeline (dot) com>
Subject: Re: Medical Uses of RP

There are new technologies and tests being introduced almost daily which claim to offer great benefits (and even breakthroughs) in the practice of medicine. Though it is true that the medical community is conservative and at times even reticent when it comes to embracing cutting edge technologies (they are still catching up on the effective use of computers for medical data acquistion, monitoring, billing, etc.), it is also true that they face many other constraints, which engineers do not have to deal with. They no longer have blank checks and have to cost justify everything they do, they have to worry about lawsuits, about FDA regulations, about justifying every proceedure, every test, and in their minds it may be safer and easier if along with everything else, they don't propose the latest "cost saving technology of the month". In the area of surgical planning there are other technologies besides RP which are being looked at, including virtual reality headsets offering tactile feedback for doing "virtual surgery", holographic displays, stereographic displays, and I am sure many other technologies which can claim to be of benefit to surgeons, physicians in general and patients (maybe every patient should have an MRI once a year?), but insurance companies will only embrace those proceedures which will prove to not only be "neat", but to have medical efficacy, while at the same time REDUCING costs. I feel it is a little insulting to those in the medical community to state that because RP has not been widely embraced as the greatest thing since sliced bread, that they are totally ignorant of the technology or its possibilities. When studies clearly show that the outcome of surgery with RP will be greatly improved while not affecting cost, or even better that costs go down, then you will see insurance companies willing to provide RP as a valid adjunt to current practices. To those thinking about writing about this topic, I would strongly encourage them to talk to those with several years of experience in using RP for just such medical proceedures and also to get the feedback from physicians and insurance companies who may well have investigated RP in depth and who have various perspectives as to its future use. It sounds to me that this is not exactly "new territory" and that there are experts in the field. As far as a toy company providing this service "gratis" as perhaps a one time only gesture, I only hope it is not a publicity stunt used for advertizing purposes and that the same company will on a regular basis consider doing this type of charitable work for the many, many truly indigent patients around the world who could benefit from such philanthropic offerings (it also does not appear that the parties in question were truly indigent and could not have raised the money to pay for this service, maybe a few thousand dollars, by some means). I can only hope the "fun" of helping someone using this "neat" technology is really contagious and will be repeated many times, by many companies and that it will not be used for personal promotion (which then is not charity). My hat's off to all those participating in the experiment however!

George Sachs
Paradyme Systems

>You really have to gain an internal champion in the medical school to take
>hold of the RP and make it work. Medical schools also have a tendency to have
>a very NIH attitude for things as well.
>
>Good luck to Steve and the others involved. Hopefully the possible publicity
>will kick start some others in the medical arena to champion the use of RP.
>
>> Steve - What you, Jim Rollins, and others are doing is really neat. I'd
>> like to offer my help. An idea is to initiate a story for publication in
>> an industry trade publication. It would help educate insurance companies
>> and others who could help streamline reconstructive surgeries for accident
>> victoms and those with birth defects. If you or others feel that this is
>> worth pursuing, I'll run it by a couple of editor friends. Let me know.
>>
>> Terry Wohlers


23: From Ulrich Kliegis Re Re: Skull Model


Date: Mon Jan 20 1997 11:08:09 EET
From: Ulrich G. Kliegis <Ulrich.Kliegis (at) kiel (dot) netsurf.de>
Subject: Re: Skull Model

> Could someone enlighten us on the "unfamous White patent"? It may
> actually be infamous, but for me at least it's unfamous. Is it an
> EPO patent?
>
> Thanks and regards,
> Ed Grenda

See US Patent 4.436.684.

After you have studied that, read

Altschuler BR, Herman GT: Head and Neck 3-D Mapping from Computed Tomographic Serial Scans, Proc., sixth conference on computer applications in radiology & computer/aided analysis of radiological images, ACR and IEEE computer society, Newport Beach, California, June 18-21, proceedings, 81 - 85, 1979

Enjoy.

UK
------------------------------------------
Ulrich G. Kliegis
Phone (x49) 431 33 11 44
Fax (x49) 431 33 11 46
http://kiel.netsurf.de/homes/Ulrich.Kliegis/Welcome.html
Don't flame me, I'm only the keyboard player...


24: From Ulrich Kliegis Re Re: Medical Uses of RP


Date: Mon Jan 20 1997 16:42:26 EET
From: Ulrich G. Kliegis <Ulrich.Kliegis (at) kiel (dot) netsurf.de>
Subject: Re: Medical Uses of RP

> Date: Mon, 20 Jan 1997 01:12:04 -0500
> To: rp-ml@bart.lpt.fi
> From: George Sachs <sachs (at) pipeline (dot) com>
> Subject: Re: Medical Uses of RP

George,
I agree wholeheartedly with everything you wrote. Maybe my european background and way of thinking. Some remarks on some points you mentioned.

> They no
> longer have blank checks and have to cost justify everything they
> do, they have to worry about lawsuits, about FDA regulations, about
> justifying every proceedure, every test, and in their minds it may
> be safer and easier if along with everything else, they don't
> propose the latest "cost saving technology of the month".

Doctors are willing to improve their methods wherever it is possible. But it is a good habit in medicine that new methods are not primarily selected by media coverage, much less by marketing approaches of third parties. What I missed in this thread so far is the thought if the father of the chid would be willing to jump on the marketing waggon at this time. Even with the availability of a planning model, craniofacial surgery remains a potentially life threatening enterprise. The surgeon who gets this planning model should really know what he is doing, and I am sure he will be responsible enough to really consider what he is going to do. I take the liberty to talk about this after having made many models of skulls that most of the readers of this forum would probably not recognize as a part of human skeletons. I participated in a number of the subsequent surgeries and claim to know what I am talking about. Media coverage is the least thing that comes to mind when you see the concentrated, maximally careful work of the surgeons. What comes to mind is the necessity of validated, multi center studies, outcome measurement, long term observation of the results compared to other, not model related techniques, and so on, like modern medical progress has been working successfully for decades.

I participated in one study done with a well known institution in St. Louis. Interested parties can look up an abstract in the 96 proceedings of the RSNA, titled "Complex Orthopedic Consultation for Acetabular Defects in Revision Arthroplasty" Authors: Lopes, Robertson, Kliegis, Sutherland.

A basic medical principle is the question for the indication, iow, when is what measure necessary to do? Quite clearly, it can be assumed that there is a wide range of relative and absolute indications for performing the planning on a model. But then the question is if today's RP models are the optimal fit for these needs. Production times of several days and cost (if you take the real cost) of several thousand dollars are simply unacceptable for a medical mass product. Bring the cost of an individual model down to, say, 200 dollars, and you are in business. It can be done. The cost can be justified in any case today where the operation would not be possible (with the same result) without a model. OR cost range in the 5,000 to 10,000 dollars / hour area. All specialized surgeons who use models todays have long waiting lists. All good reason to promote models for surgery planning. Yes, there are other ways to do it too, but they are complementary to each other.

The only solid way to get this introduction started is to really run controlled studies, invest in these (yes, that means many, many upfront dollars!) and show the result. Notabene, result. Not success. The validation, if it can be called a success, must be open in a study. It can be expected, though.

> or its possibilities. When studies clearly show that the outcome of
> surgery with RP will be greatly improved while not affecting cost,
> or even better that costs go down, then you will see insurance
> companies willing to provide RP as a valid adjunt to current
> practices.

Exactly.

-- Words about altruistic help snipped off. --

> I can only hope the "fun" of helping someone using this "neat"
> technology is really contagious and will be repeated many times, by
> many companies and that it will not be used for personal promotion
> (which then is not charity). My hat's off to all those participating
> in the experiment however!

Please do not forget that there are companies who invested in providing a professional product for this market. What quality assurance measures will be taken to guarantee that the model will be precise (if an implant has to be fabricated, the geometrical precision of the model is an essential!)? Is the toy company (I appreciate their willingness to help, but they move into a segment where the rules of the game read different) a medical device manufacturer? Do they have FDA approval to provide this service (even if it is for free!)? In Germany, the insurance companies demand now that medical expertise is involved in all critical steps of the data processing and the quality assurance in modelling. Pure engineering labs don't have a chance any longer in this market. Interpreting a CT image and drawing the right conclusions on the anatomy is a bit different from tranlating a drawing into an IGES file. Just a few years of medical school.

I hope the case of this patient will evolve into an unlimited success for the patient, the parents, and their friends. Everything else is business, and should not be mixed up with the human right of health and help. Please respect the privacy of the patient.

Ulli Kliegis.
------------------------------------------
Ulrich G. Kliegis
Phone (x49) 431 33 11 44
Fax (x49) 431 33 11 46
http://kiel.netsurf.de/homes/Ulrich.Kliegis/Welcome.html
Don't flame me, I'm only the keyboard player...


25: From Lynda Hurley Re Skull Model Update


Date: Mon Jan 20 1997 18:22:52 EET
From: Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com <Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com>
Subject: Skull Model Update

Steve/RP-ML: I would like to personally thank all of you who responded to my message of last week to help out Ed Thoman and his son. The number of people/companies who have come forth with an offer to either build the model, or to help out in other ways, has been overwhelming. This has truly been an eyeopener for me, and I'm sure for Ed, as to the number of people who are willing and eager to help out a stranger in need. Thanks again, and I am looking forward for the opportunity to see and meet a number of you at the users conference here in Orlando in February.

Lynda Hurley
Lockheed Martin
Rapid Prototyping Lab

Orlando, Florida
Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com
(407)356-4390


26: From Lynda Hurley Re Re: SERVICE BUREAU'S


Date: Mon Jan 20 1997 18:22:51 EET
From: Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com <Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com>
Subject: Re: SERVICE BUREAU'S

FYI: I received a call from these people today. They have offered to the transfer of the CT scan to an .stl file for free

Lynda Hurley

************************

Reed Williams wrote:
>
> Cyberform International, Inc., located in the Dallas/Fort Worth area is the
> leading company in the nation in providing anatomical models for

Is this a chance to advertise or help??? I'm confused.


27: From Lynda Hurley Re Re[2]: Skull Model Update


Date: Mon Jan 20 1997 19:10:27 EET
From: Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com <Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com>
Subject: Re[2]: Skull Model Update

> I think that the skull model story is one that would shed a great deal of light
> on the RP industry and the benefits to those it is used on. I would love to
> see more in print about this touching story and maybe a follow up on the
> results or out-come.
>
> Karl Denton

Karl: Ed Thoman has promised to let me know the outcome of his sons condition/surgery. As soon as I hear from him, and I will tell him to e-mail me with the results, I promise to pass the information on to all of you in Ed's own words

Lynda Hurley
Lockheed Martin
Rapid Prototyping Lab
Orlando, Florida
Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com


28: From Geoff Smith-Moritz Re Medical uses of rapid prototying


Date: Mon Jan 20 1997 22:57:33 EET
From: RPREPORT (at) aol (dot) com <RPREPORT (at) aol (dot) com>
Subject: Medical uses of rapid prototying

Dear rpml list:

I am extremely interested in doing a story or series of stories about the medical uses of rapid prototyping. This is one of the most exciting applications of these technologies. It's a continuing mystery to me as to why more university research hospitals aren't embracing rapid prototyping. The biggest problem I've had so far has been getting permissions from doctors, families, etc.

Anyone who would like to work with me on such a story need only contact me to get the ball rolling.

Geoff Smith-Moritz
Editor
Rapid Prototyping Report

(619) 488-0533
FAX: (619) 488-6052
e-mail: RPREPORT (at) aol (dot) com


29: From Tom Loebig Re Re: Skull Model Update


Date: Tue Jan 21 1997 17:26:48 EET
From: Thomas G. Loebig <tom (at) biomechanics.asri (dot) edu>
Subject: Re: Skull Model Update

Terry and all,

There was a segment on the Discovery channel in the US about two years ago, about Paul d'Urso and QMI. There was a similar, more detailed story on a British TV show that was about the case published by 3D Systems in their Edge publication on medical apps. There is also a plethora of case reports in the medical literature, not to mention the outstanding web page of Ulrich Kliegis. Information abounds, approval does not. Blame it on inertia, priorities, egos, attorneys, NIH attitudes, etc., and you're all right.

How many of us have experienced the drafters/designers who you'd have to pry their pencils and sliderules out of their cold, dead fingers before they'd switch to calculaters and CAD systems? Many doctors are just the same. Some will change, some won't, and we're all skeptical to a degree.

There IS alot of activity in this area, its just not publicized, and its not all limited to rp-ml.

Sometimes I wonder if I'm the only person cross-listing.

Tom

Thomas G. Loebig, MSME Allegheny Singer Research Institute
412.359.6773 fax 412.359.3238 Biomechanics Research Lab
tom (at) biomechanics.asri (dot) edu Pittsburgh, Pennsylvania, USA 15212


30: From Terry Wohlers Re Skull Model Update


Date: Tue Jan 21 1997 17:57:29 EET
From: Terry T. Wohlers <73417.1465 (at) compuserve (dot) com>
Subject: Skull Model Update

Karl Denton wrote:

> would love to see more in print about this touching story and maybe a
> follow up on the results or out-come.

I'm glad you feel this way. I sensed that a couple of others had mixed feelings about it.

> In other words those connected to this should NOT profit from this.

That goes without saying. Profiting from this effort in any way goes against its very spirit. As President Clinton said in yesterday's inauguration speech, "Nothing big ever comes from being small."

Terry Wohlers


31: From Lynda Hurley Re Skull Model


Date: Fri Jan 24 1997 16:12:03 EET
From: Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com <Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com>
Subject: Skull Model

RP-World: I received the following message from Ed Thoman and his family:

Lynda Hurley

************

Date: Thu, 23 Jan 1997 13:52 -0500 (EST)
From: EDWARD_THOMAN%MAILHUB (at) ccmail.orl.mmc (dot) com
To: Lynda_J_Hurley%ORL-MPLANT3-CC-P (at) ccmail.orl.mmc (dot) com

Our family wants to thank everyone who responded in behalf of providing a skull model for our son Brian's surgery. The response has been tremendous and overwhelming. God has blessed us and everyone involved. What a God we serve!

One company is currently converting the catscan data into a useable format while two companies will be producing skull models. To those who were willing to help ,we sincerely thank you for your generous offers.

Again we would like to thank everyone involved and will keep you informed as to our progress.

Julie and Ed


32: From Jim Williams Re Re[2]: Medical Uses of RP


Date: Tue Jan 28 1997 01:27:03 EET
From: jim (at) paramountind (dot) com <jim (at) paramountind (dot) com>
Subject: Re[2]: Medical Uses of RP

Mr. Sachs wrote...in response to offers by several companies who do not need the type puplicity as was eluded to by Mr. Sachs, considering they are a $2+ Billion company and have a strong track record for helping children and families in need, e.g. RI hospital for children primarilly constructed by funds raised/donated by Hasenfeld's

He wrote... "As far as a toy company providing this service "gratis" as perhaps a one time only gesture, I only hope it is not a publicity stunt used for advertizing purposes and that the same company will on a regular basis consider doing this type of charitable work for the many, many truly indigent patients around the world who could benefit from such philanthropic offerings (it also does not appear that the parties in question were truly indigent and could not have raised the money to pay for this service, maybe a few thousand dollars, by some means)"

Mr. Sachs... we can use our assets to help ourselves and at the same time benefit others that may not be as fortunate as we.

How do you know the the parties are not truly indigent?


33: From Steve Deak Re Skull Model Update


Date: Thu Jan 30 1997 23:01:16 EET
From: Steve Deak <ht-grp (at) cinti (dot) net>
Subject: Skull Model Update

Just a brief note to bring interested parties up-to-date on the skull medical model.

CT images were delivered to Jim Rollins at Scientific Measurements Systems (Austin, TX, USA)last week. Due to data compatibility problems, Jim forwarded the data to Marc McAllister (a trained radiologist) at Cyberform (Richardson, TX, USA). Cyberform transformed the CT images to STL format.

Hasbro received the data by 4mm DAT tape this morning and started SL model build (about 90 minutes ago). The model will be cleaned-up this weekend and forwarded to the family for a Monday 2/3/97 consultation with the surgeon. As noted earlier, the reconstructive surgery is scheduled for 2/11/97.

Many thanks to to those who have assisted and offered encouragement for this project. We will forward addition information if/when it develops.

-- 
Steve Deak E-mail: ht-grp (at) cinti (dot) net
Manager-RP Services Voice: (513) 579-3270
Hasbro Toy Group Fax: (513) 579-3250
615 Elsinore Place
Cincinnati, OH 45202 "Our Business is Fun!"
USA


34: From Andre Dolenc Re Medical Applications in Finland


Date: Fri Jan 31 1997 09:10:24 EET
From: Andre Dolenc <ado@deskartes.fi>
Subject: Medical Applications in Finland

Hello medical afficionados!

This is a short note concerning the use of RPT in connection with surgery planning in Finland.

During the period 1994-1995 the Helsinki University of Technology cooperated with the Dep. of Maxillofacial Surgery of the Helsinki Hospital to investigate the benefits of RP models for complex surgery planning, eg. facial reconstructions.

The results were *very* positive. I am happy to learn recently that the technique is now used on a regular basis, ie. about once a month; fortunately, it is not needed more often!

Models are delivered 4-5 days from the moment the patient is scanned. The patient is scanned in Helsinki and the models are produced in Oulu, several hundreds of km's away. Therefore, they can even apply the technique for patients in transit.

I can give a name if anyome wants more information. Perhaps they have published some material (in English) on the subject.

(PS: We started knocking on their door late 1992. It took one year to get their attention and their commitment. But, believe me, it was worth the effort!)

Have a nice day!

Regards,
Dr. Andre' DOLENC (Director, Rapid Tools)
----------------------------------------------------------------------
DeskArtes Oy Phone:+358-9-644 335/FAX:+358-9-644 330
Kalevankatu 3A http://www.deskartes.fi
FIN-00100 Helsinki, Finland mailto:ado@deskartes.fi
----------------------------------------------------------------------


35: From Andre Dolenc Re Re: Medical Applications


Date: Fri Jan 31 1997 18:27:09 EET
From: Andre Dolenc <ado@deskartes.fi>
Subject: Re: Medical Applications

> I would like very much to get a hold of any data published as a result
> of this project. A few questions: 1) were you paid for the models
> produced?, 2) what were the types of cases you saw the models being used
> for?, 3) did you address accuracy in the preparation of producing
> anatomical models?>
> Andy Christensen
> Sales & Marketing
> Medical Modeling Corporation

1. The Institute in Oulu which operates the equipment (an SLA250) made the models and, yes, they were paid market prices. Finland operates in a different way from most other countries due to the social security system in vigor today.

The Helsinki University Hospital is not a private organization. The surgeon is free to charge the patient anything he wants: the state will pay the bill. Well, almost anything he wants. He cannot buy a product which is of general use to the Hospital, but only items that are particular to a patient.

Consequently, if a surgeon believes a physical model is essential to the well-being of a patient (eg., it can reduce risks and/or costs), a model is made.

2. As far as I know, those recuperating from cancer, accidents and birth defects.

3. The Hospital did some accuracy analysis and they are satisfied.

Regards,
Dr. Andre' DOLENC (Director, Rapid Tools)
----------------------------------------------------------------------
DeskArtes Oy Phone:+358-9-644 335/FAX:+358-9-644 330
Kalevankatu 3A http://www.deskartes.fi
FIN-00100 Helsinki, Finland mailto:ado@deskartes.fi
----------------------------------------------------------------------


36: From Steve Deak Re Skull Model Update 2/3/97


Date: Mon Feb 03 1997 16:14:57 EET
From: Steve Deak <ht-grp (at) cinti (dot) net>
Subject: Skull Model Update 2/3/97

A further update for those interested in the skull medical model:

Hasbro's SL build of the skull was complete Friday night 1/31. The model was post-processed (support removal, resin stripping, and post curing) Saturday 2/1/97. The model was shipped via commercial airline 2/2/97 direct to the family for a 2/3/97 (today) consultation with the surgeon.

STL file data was also sent over the weekend to Kevin Robertson at Arrk Creative Network (San Diego, CA, USA) for a second skull model. Kevin offered his company's services to provide validation to the first model. Arrk's skull model will be delivered to the surgeon by way of Marc McAllister at Cyberform (Dallas, TX, USA). Mark McAllister is a trained radiologist and will verify the model agrees with the original CT images. The first model would have been routed through Cyberform for validation, but timing would not allow.

Many thanks to Arrk for coordinating CT image translation between Scientific Measurements and Cyberform. The schedule could not have come off without Kevin's help. Thanks again to Jim Rollins (Scientific Measurements), Marc Mc Allister (Cyberform) and Lynda Hurley (Lockheed-Martin)for their work on this project. We made a difference in one person's life today!

-- 
Steve Deak E-mail: ht-grp (at) cinti (dot) net
Manager-RP Services Voice: (513) 579-3270
Hasbro Toy Group Fax: (513) 579-3250
615 Elsinore Place
Cincinnati, OH 45202 "Our Business is Fun!"
USA


37: From Steve Deak Re Re: Skull Model Update 2/5/97


Date: Thu Feb 06 1997 14:57:50 EET
From: Steve Deak <ht-grp (at) cinti (dot) net>
Subject: Re: Skull Model Update 2/5/97

Kevin Robertson wrote:
>
> Steve, just to let you know, the skull is currently running and should be
> off the vat and ready to ship on Thursday. Will we be hearing back soon if
> this process was of any benefit? I'm sure anxious to hear that everyones
> efforts were of benefit to the surgical process.
>
> Thanks,
> Kevin

The skull model was received by the surgeon on Monday 2/3 during a scheduled pre-op meeting and was to be reviewed with a second surgeon on 2/4. The patient's father reported the surgeon was very impressed with the model detail. I believe the model gave the surgeon greater understanding of the CT images for increased confidence in what to expect during the 12-hour facial reconstruction surgery.

Surgery is scheduled for 2/11/97 in Lowell, Massachusetts, USA. Your skull model will provide a validation of the first model, especially since your model will be reviewed by the radiologist at Cyberform before delivery to the surgical team.

I'll keep everyone informed about their progress.

-- 
Steve Deak E-mail: ht-grp (at) cinti (dot) net
Manager-RP Services Voice: (513) 579-3270
Hasbro Toy Group Fax: (513) 579-3250
615 Elsinore Place
Cincinnati, OH 45202 "Our Business is Fun!"
USA


38: From Lynda Hurley Re Re: Skull Model Update 2/12/97


Date: Wed Feb 12 1997 16:25:58 EET
From: Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com <Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com>
Subject: Re: Skull Model Update 2/12/97

I just received a call from Ed Thoman (Brian's father), the 15 1/2 hour operation yesterday was a complete success. Of course the family is elated and wishes to express their gratitude to the rp community for all of their concern and outpouring of help. A special thank you to Steve Deak (Hasbro Corp), Jim Rollins (SMS), Marc McAlistar & Reed Williams (Cyberform) and Kevin Robertson (AARK). You all really made a difference in someone's life yesterday, and I hope to have the pleasure of meeting you all at the conference next week.

Lynda Hurley
Lockheed Martin
Rapid Prototyping Lab
5600 Sand Lake Road
Orlando, Florida 32819
(407)356-4390
Lynda_J_Hurley (at) ccmail.orl.mmc (dot) com


39: From Yakov Horenstein Re Re: Skull Model Update 2/12/97


Date: Wed Feb 12 1997 21:12:58 EET
From: Yakov Horenstein <yakov@planet.it>
Subject: Re: Skull Model Update 2/12/97

Lynda,

That's it? Were the 2 RP models useful? Was anything gained by using them? I can't help feeling a sense of anticlimax...

Of course, I'm glad for Brian Thoman, and wish him good health.

Yakov Horenstein
Milano, Italy


40: From Steve Deak Re Skull Model Update-2/27


Date: Thu Feb 27 1997 20:17:47 EET
From: Steve Deak <ht-grp (at) cinti (dot) net>
Subject: Skull Model Update-2/27

Two weeks have passed since the corrective surgery for Brian Thoman, we have some additional news to pass on.

As earlier reported, the reconstructive surgery lasted 15.5 hours to correct jaw and facial bone structure. SL models of the Brian's skull, created from CT images, were used by surgeons to pre-plan Operating Room procedures. One surgeon is reported to have remarked (through Brian's father) "I wish we had this model 4 months ago."

To create complete closure to the rp-ml for this subject, we (Marc McAllister and myself) are planning to speak directly to the surgeon(s) to obtain their perspective of SL model benefits. We will pass this information along as we learn.

Brian's father called yesterday to report Brian is now eating semi-solid foods, pasta noodles, eggs (scrambled), yogurt, etc. His 2-week liquid diet is not necessary as post-op healing and jaw movements continue to improve. Brian is experiencing new freedom in jaw movements not previously possible due to bone misalignment (now corrected). Brian will resume his 9th-grade education next Monday, 3/3/97, after missing only 8 days of school.

As noted previously, closure to this story will come with the response from the surgeons. We will report these findings hopefully in the next week or so.

-- 
Steve Deak E-mail: ht-grp (at) cinti (dot) net
Manager-RP Services Voice: (513) 579-3270
Hasbro Toy Group Fax: (513) 579-3250
615 Elsinore Place
Cincinnati, OH 45202 "Our Business is Fun!"
USA


Hurley and Deak look back on the event

In August 1999, in preparing this file for posting on the Internet, Ennex Corporation contacted Lynda Hurley and Steve Deak for a final update. Here is how they described the events in retrospect.



From Lynda Hurley on Monday, August 9, 1999

Marshall: This was actually done in early 1997. Ed Thoman, who works for one of our divisions of Lockheed, needed a skull model of his son who needed reconsructive surgery. Naturally, because we work for the same company, Ed had heard about the work that I do in Orlando, so he contacted me. I could not at the time actually do the work, so I put out a message on the rp-ml and asked if anyone would do the model for FREE. You wouldn't have believed the number of volunteers I had to do this work. I suggested to Ed that he use Steve Deak of Hasbro (I'm sure you know him) because I had met Steve and I knew he was very enthusiastic and anxious to do this work, and I was confident that he would do a great job. He did. Kevin Robertson of AARK did the translation of the CAT Scan to the .stl file that Steve needed, and then Steve built the model. Ed and his family received the model from Fed Ex. on a Sunday afternoon, and stopped to pick it up at the Fed. Ex. office on their way to church so that they could show it to their congregation. He was so grateful to all of us, and kept telling us over and over again how thankful he was for what we did for his son. It really gave us all a wonderful feeling that we could use this technology in this way. I have pictures of the skull model, and the thank you card with Brian's picture with the skull model, and I show this everytime I do a tour in this lab, which is usually a couple of times a week. Everyone can relate to that story, and they are all just amazed that this can be used for medical purposes. Also, this application is quite a diversion from the models and pictures of missiles that I normally have in this lab. As it turned out, we made a great choice in picking Steve at Hasbro to do the model, because Steve made arrangements for a whole box of Hasbro toys to be sent to Brian for his recuperation period, and then visited Ed and Brian while on a business trip.



From Steve Deak on Tuesday, August 10, 1999

Marshall:

I guess I did not close the story as I was getting some very strong e-mail criticizing Hasbro's participation and intent. We were "not qualified" and "damaging the medical modeling industry" as well as "grandstanding for personal gain." I did not want anymore of that.

I guess it has been 2-1/2 years since the model was made for Brian Thoman. Before the surgery, we did plan to talk to the surgeons concerning the benefits of pre-surgery models. Afterward, the desire of the surgeons to talk with us waned substantially. Brian's father did discuss the benefits with the surgeons during some of the post-operative visits. Second-hand, they believe the models saved 2-3 hours of Operating Room time. Further, there were no surprises when the operation began because they fully understood the bone structure to be repaired. I'm sure the doctors would say the same thing if they only had CT images, as they are trained to understand 3D images from 2D slices.

I did personally met Brian and his family for dinner 6 weeks after the surgery. Brian had regained substantial movement in his jaw and was resuming a "normal" teenage lifestyle. He was not limited to what he could do, so he was eating hard pretzels, etc for exercise. Brian had little external scarring and looked as normal as the next person. There were no perceivable disfiguring, operative or otherwise. No other surgeries were planned.

I do keep in touch with the family over the years, exchanging Christmas cards, mainly. Brian is now in High School, playing in the Marching Band, driving cars, and otherwise being a kid.

So, I guess I did gain personally from this. My life has better perspective and I have the satisfaction knowing I was part of an effort to make someone else's life better.

Steve Deak