Last year, cardiologists at Boston Children’s Hospital reported developing a groundbreaking adhesive patch for sealing holes in the heart. The patch guides the heart’s own tissue to grow over it, forming an organic bridge. Once the hole is sealed, the biodegradable patch dissolves, leaving no foreign material in the body.
As revolutionary as this device was, it still had one major drawback: implanting the patch required highly invasive open-heart surgery. But that may be about to change.
3-D printing is rapidly becoming a part of surgical planning. Since July 2013, Boston Children’s Hospital’s 3-D printing service, part of the Simulator Program, has received about 200 requests from 16 departments around the hospital. It’s generated a total of about 300 prints, most of them replicating parts of the body to be operated on.
Most prints take between 4 and 28 hours to produce. The largest to date—an entire malformed rib cage—took 105 hours and 35 minutes to create and weighed 8.9 pounds. The smallest—a tiny tangle of blood vessels in the brain—took 4 hours and 21 minutes and weighed 1.34 ounces. Here is sampling of what’s been coming off the production line.
Ken Mandl, MD, MPH, director of the Boston Children’s Hospital Computational Health Informatics Program, is used to seeing the world through a different lens. In high school, he began clicking photographs with his camera and developing them in a darkroom in his basement. Now, he frames subjects through the lens of epidemiology and informatics—driving discovery and care transformation through big data, apps and large-scale federated research networks.
Four children with life-threatening malformations of blood vessels in the brain appear to be the first to benefit from 3D printing of their anatomy before undergoing high-risk corrective procedures.
The children, ranging from 2 months to 16 years old, all posed particular treatment challenges: cerebrovascular disease often entails complex tangles of vessels in sensitive brain areas.
“These children had unique anatomy with deep vessels that were very tricky to operate on,” says Boston Children’s neurosurgeon Edward Smith, MD, senior author of the paper and co-director of the hospital’s Cerebrovascular Surgery and Interventions Center. “The 3D-printed models allowed us to rehearse the cases beforehand and reduce operative risk as much as we could. You can physically hold the 3D models, view them from different angles, practice the operation with real instruments and get tactile feedback.”
“Progress in this field is limited only by the imagination of the investigators and, to some degree, by reality,” says Kohane, who also sees patients in Boston Children’s Department of Critical Care Medicine. “You can achieve really big things by thinking really small.”
Hypoplastic left heart syndrome (HLHS) is a rare but serious form of congenital heart disease that leaves the left pumping chamber (ventricle) of the heart severely underdeveloped. Children born with HLHS can’t pump enough oxygenated blood from their heart to the rest of their body and need surgery as soon as possible to survive. Treatment ultimately involves three corrective surgeries throughout the infant and toddler years.
The first surgery, known as the Norwood procedure, is the riskiest of the three. Ideally performed within the first week of life, the procedure re-routes the heart’s plumbing to ensure enough oxygenated blood is circulated while the child grows big enough for the second surgery. A device called a graft is used to connect the fully-functional right ventricle to the aorta, bypassing the stunted left ventricle, for proper blood flow. However, with each ventricular contraction, the graft gets squeezed, which can cause it to shift or lose its shape over time. Repeat interventions to adjust the graft are often needed.
Can a robotic talking bear have therapeutic value? “The Bear,” part of a New York Times video series called Robotica, offers a glimpse of Huggable’s potential when Beatrice Lipp, a child with a chronic medical condition, visits the hospital, nervous about what’s to come.
“We want to offer kids one more way of helping them to feel OK where they are in what’s otherwise a really stressful experience,” explains Dierdre Logan, PhD, director of Psychological Services for Pain Medicine at Boston Children’s Hospital.
Huggable, a creation of the MIT Media Lab’s Personal Robots Group and the Boston Children’s Simulator Program, comes into Beatrice’s room to chat, play games like “I Spy” and tell jokes. The session is recorded on video, and a bracelet called a Q Sensor collects Beatrice’s physiologic data–changes in skin conductance, temperature and motion that may indicate distress. Researchers at Northeastern University are analyzing these data to gauge the robot’s effect. Eventually, Huggable will be able to react to the data and respond accordingly—offering relaxation exercises and guided imagery, for example, if a child remains anxious.
Currently, Huggable is voiced by Child Life staff, but the ultimate goal is for it to work autonomously. Beatrice is part of a 90-child study comparing Huggable, an ordinary teddy bear and a tablet Huggable image.
I admit: My immediate thought on seeing Huggable was that kids would immediately see him (her?) as a fake, but the bear’s robotic nature doesn’t seem to faze them. As Logan says in the video:
I think there’s a way of connecting with kids that’s different than what grownups have to offer. They have incredible imaginations. And they can really suspend disbelief. There can be a true relationship that develops between Huggable and a patient.
Michael J. Docktor, MD, Boston Children’s Hospital’s clinical director of Innovation and director of Clinical Mobile Solutions, is also a practicing gastroenterologist, a proud father of two and a passionate mobile-and-digital health trailblazer. An original co-founder of Hacking Pediatrics, Docktor’s goal is to bridge the gap between entrepreneurship, consumer technology, design and clinical pain points.
Hover over the images and icons in the photo below to learn more about Docktor’s professional and personal life, favorite gadgets and more.
MIT’s implantable device could help docs determine best cancer medicine(Boston Business Journal)
Removing the trial and error associated with cancer drug treatments is high on oncologists’ wish lists. Heeding that call, MIT has developed an implantable device (about the size of a grain of rice) that can carry up to 30 different drug doses to a cancerous tumor, and then be removed to test responses.
Brain tumors, traumatic head injury and a number of brain and nervous system conditions can cause pressure to build up inside the skull. As intracranial pressure (ICP) rises, it can compress the brain and result in swelling of the optic nerves, damaging brain tissue and causing irreversible vision loss.
That’s what nearly happened to a 13-year-old boy who had three weeks of uncontrolled headaches and sudden double vision. His neuro-ophthalmologist at Boston Children’s Hospital, Gena Heidary, MD, PhD, found reduced vision in the right eye, along with poor peripheral vision, an enlarged blind spot and swelling of both optic nerves.
As Heidary suspected, he had idiopathic intracranial hypertension, a condition that can raise ICP both in children and adults. Heidary performed an operation around the optic nerve to relieve the pressure, and vision in the boy’s right eye gradually improved, though not completely. Heidary has had to monitor his ICP ever since to protect his visual system from further irreversible damage.
Unfortunately, such monitoring currently is pretty invasive.