Nicholas Giovinco

[geō-VEEN-koh]

Providing a centralized feed for a number of different interests and discussions.  Please feel free to browse and participate.

DragonCON 2011 - Open Source Medicine in the Reprap Revolution

"Open Source Medicine in the
Reprap Revolution"


Panelist: Dr. Nicholas Giovinco

Open hardware, software and internet standards are permitting increased collaboration and a team approach to modern medicine, with amazing results.


This post is intended as a companion to the actual lecture given.  I intend to further edit and populate this page with follow-up information in addition to the references already provided.  To those of you who were able to make it out to the event, thank you!  Visit www.dragoncon.org for more information.

 

Freeside Atlanta Technology Space Freesidealtanta.org

A very special thanks to the guys and gals at Freeside Atlanta Technology Space.  Come out to the regular "Freeside Weekly" community open house events, for anyone interested.

The definition of medicine per Wikipedia.org http://en.wikipedia.org/wiki/Medicine

This is a nice and informative explanation of medicine itself.  A little history goes a long way...  Essentially, medicine is the science and the art of healing.

"Doctoring" is nothing new to Social Species

File:Grooming monkeys PLW edit.jpgFile:The Doctor Luke Fildes crop.jpg

Religion has continued to be an important role in health care delivery and health reception

There always seems to be a religious connection between healing and religion.  Also, the imagery of the stake with a serpant may possibly represent overcoming fear.

Spirituality and clinical care
Spiritual values and skills are increasingly recognised as necessary aspects of clinical care
Larry Culliford, consultant psychiatrist (larry.culliford{at}southdowns.nhs.uk)
South Downs Health NHS Trust, Brighton Community Mental Health Centre, Brighton BN1 3RJ

File:HippocraticOath.jpg

The man pictured on the left is Imhotep, the earliest known physician by name.  The man on the right is Hippocrates, the "Father of Medicine".

The "Open-ness" of Medicine

Medical practices, literature, tools, and techniques have continued to spread, since its inception.

File:Medicine aryballos Louvre CA1989-2183.jpgFile:The Canon of Medicine.jpg

Roman surgical instruments spread and have become relatively unchanged over the last 2,000 years.

File:Sommer, Giorgio (1834-1914) - n. 11141 - Museo di Napoli - Strumenti di chirurgia.jpgFile:Rimini219.jpg

Surgical Applications of today.  The science and the art of surgical technique.

surgical instruments ce markhttp://4.bp.blogspot.com/_bj7klv9gHfE/S-OJJYrJFJI/AAAAAAAACIY/aOKbzj1Iml0/s1600/Chief_of_the_Medical_Staff-p.jpg

Just a plug for Morbid Anatomy Blog

http://3.bp.blogspot.com/-LvaUT2Q_ee8/TmKomXXtRVI/AAAAAAAACnc/RwISrvlvtl4/s1600/1.jpg

Rather than sifting through several different examples, I wanted to illustrate my point from the perspectives of a single disease.  "Diabetes"

File:Suckale08 fig3 glucose insulin day.jpg

This graph represents the flucutating insulin levels in the body, throughout the day.

WolframAlpha Sheds some light on Diabetes

These are a rundown of associated diseases in conjunction with Diabetic appointments to a doctor's office.  Diabetes is a part a collective disease of bodily degeneration.


Persius Potato http://bentobjects.blogspot.com/2011/08/persius-potato.html

I love the bentopjects blog.  The coffee table book on sale is a worthwhile purchase or gift, indeed

Hunger and the potential to over-eat:

Hunger center in brain

McDonald's for a better tomorrow?

The Stairway to amputation

Diabetes > Neuropathy > Deformation (Charcot) > Ulceration > Amputation

Overview of the RANKL pathway in terms of explaining how Charcot may arise in patient's with Neuropathy.

Diabetes costs more than War on Terror and War on Drugs, combined!

Techology Challenges and Innovations:

This discussion and explanation of the overall "Health Challenge" of any disease.  We have an assumed standard of care which everyone is entitled to.  I agree with this notion, and I feel that we may soon be able to provide this before long, from the benefits of sophisticated and ubiquitous technology.  Moore's Law will continue to prove useful.  Technolog will dominate medical delivery in the future, until eventuall we become technology itself...

 File:PPTMooresLawai.jpg

Gradual evolutionary improvements and innovations have an additive (Red) benefit over time.  Technological improvements, when combined, have a synergistic behavior (Blue).  Synergy itself is accelerated from faster spread and fundamental empowerment to people such as Makers/Hackers/DIY enthusiasts, who are able to collaborate in proximity or over the internet (Green).

Portability, Durability, Automation, Intelligence, Affordability, and Ubiquity will be technologic neccessities as post-modern medicine progresses.  The benefits of lightweight materials which are small and powerful will merit the ability for personal health servers.  These advances will permit the ability for medical devices to become internal and external applications to the patient's body.

Science is sexy!

Q: What is the difference between science fiction and science fact?
A: Time

The revolution to come!

The original printing press brought revolution itself to the masses.  Religion itself became open source, once people could read and interprit the word of the bible.  Political revolutions became empowered with printed manuscripts, similar to social networking technologies of today.

File:Gutenberg press.jpg

3D printing will be no different.  The medical applications have already begun...

Press coverage and growing public knowledge of 3D printing has continued to explode month after month

"soon anyone will be able to make complex products quickly and cheaply, something that will democratise innovation and unleash human creativity."  New Scientist

Markus Kayser - Solar Sinter Project from Markus Kayser on Vimeo.

A rundown of amazing DIY printing services/sites.  These illustrate the creative explosion of 3D printing in progress:

"... from so simple a beginning endless forms most beautiful and most wonderful have been, and are being evolved."
— Charles Darwin
On the Origin of Species

http://endlessforms.com/ - Design Objects with Evolution!

i.materialise.com - 3D printing service for everybody with an eye for design and a head full of ideas.

http://www.ponoko.com/ - It’s where creators, digital fabricators, materials suppliers and buyers meet to make (almost) anything.

http://www.makerbot.com - Home of the Botcave

Http://www.Thingivere.com - Digital Designs for Physical Objects

http://open3dp.me.washington.edu/ Laboratory in the Mechanical Engineering Department on the University of Washington campus.

Modern day Fablab business to come, will most likely reflect:

A truely service economy in "self driven" socialism will replace modern day capitalism

Pertaining medical applications of "printing"


http://www.dailymail.co.uk/sciencetech/article-1283709/Doctors-able-print-new-organs-transplant-patients.html

The cells are layered in circles and sandwich a gel between them.

Out on a Limb Documentary

We could possible see some DIY applications of currently existing technology and Reprap, to create such prosthesis in the not too distant future.

One More Thing... (R)

This is the Recent developments in research to date.  I wanted to share a head's up:

We at SALSA have long embraced the benefits of inter-connectivity and Open Source solutions; surgical planning and collaboration are no exception. The concept of 3D surgical "printing" (templating and simulation) in lower extremity reconstruction is not entirely commonplace. This is likely for a number of reasons. With the continual maturation of free and Open Source software applications as well as the ever increasing capabilities of Reprap technology, these limitations are overcome. Charcot foot reconstruction is a challenging endeavor with significant intraoperative demands and uncertainties. Even experienced surgeons benefit from preoperative preparation in order to reduce operative time and potential complications. Classic 2D templating techniques may fall short when faced with the multiplane and complex nature of neuroarthropathic architecture. For this, a scenario to improve surgical delivery was Co-designed by members of Dekalb Medical Residency, Southern Arizona Limb Salvage Alliance researchers, and Freeside Atlanta and then performed by Dr. S. Patrick Dunn DPM.

Clinical and Radiograph films of patient's foot.
This process started with a high resolution Computed Tomography scan. These standard DICOM images were able to be processed with Axial data in (freeware) Osirix Image Viewer. These files were then used for 3D Surface Rendering. As has been described, this offers a physicians an improved sense of spatial pathology. This constructed model is then something which can be imported into an a 3D application of your choice. For our purposes, we were able to use a combination of Meshlab and Blender, for this study.
Computed Tomography demonstrating significant architectural destruction and luxation
We started by importing the Stereo Lithography data (STL) data into Blender and templating out a multiplane wedge/chevron across our anatomic reconstruction. This was then then "practiced" as a booleon resection in the objects geometry. This simulation technique afforded real-time viewing and assessment of osseous apposition. The process could be undone and reattempted for optimal outcome, as many times as desired. Once a satisfactory simulation was achieved, measurements and axis orientation was able to be measured to scale (Blender units must first be calibrated to match the CT scale).
Furthermore, this STL formatted data was then utilized for making three dimensional "prints" of the patient's anatomy. This physical prints may be manufactured on the technology and method of your choosing. For our purposes, we chose the selective deposition/binding methods offered by the Zcorp printing technology for printing sawbone replicas.
Simulated osteotomies matched up to realworld osteotomies. Booleon simulation may be performed in a variety of freeware or profession 3D applications.
These printing machines are often expensive at market value. Reprap enthusiast and non-institutional "Printistas" have adopted these devices and have made several modifications o the proprietary hardware as well as printing recipe's to serve a number of desired outcomes. Our models were printed on the Z400/402 machine technology, which was modified by nullset, with his published technique for DIY printer cartridge making.
Before these models could be printed, the geometry and surface information needed to be further optimized. Our member, Patch, performed this in Meshlab, in order to optimize the geometry prior to ZPrint importation. These printed models were to attempt "freehand" osteotomies, matching the measured landmarks from the simulated ones, which were used to size and fit an Ilizarov frame construct. This construct was subsequently sterilized and used for the procedure itself, to follow.
Telemedical preoperative planning was discussed amongst surgeons at two locations, (Tucson, AZ and Decatur, GA) via live video link, whereby alternative fixation options, instrumentation, additional hardware and closure techniques were exchanged.
The operative procedure was conducted by utilizing percutaneous K-wires to match the orientation of the multiplane wedge resection simulated. Once this was in place, the sequential resection performed and reduction was achieved. Additional internal fixation was implanted and the external Ilizarov construct was applied with minimal modification.
The techniques described are evolutionary advances to current surgical planning and preparation. The integration of open source software solutions with DIY hardware hacking and Reprap technology will continue to demonstrate feasible improvements to quality of care and reduction of cost in the post-modern medical era. More to come? The second phase are printing biocompatable "parts" just as recent advances in solid organ "printing" have shown. -Nicholas Giovinco and David G. Armstrong

I sincerely enjoyed the oppurtunity to speak this year.  I would love to be at next year's *Con.  Stay tuned...

 

Nicholas Giovinco
www.DrGlass.org