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3D modeling is making a difference in complicated surgeries, but regulatory process hasn't caught up

 Kevin Asbury and his wife, Melissa, pose with the 3D-printed model of Kevin's liver which the couple credit with saving his life.
Kevin Asbury and his wife, Melissa, pose with the 3D-printed model of Kevin's liver which the couple credit with saving his life.

Kevin Asbury went to see his doctor last September for some bowel issues. At first, it was chalked up to getting more fiber in his diet.

But when the 40-year-old Yates City man's blood work showed he was severely anemic, more testing was ordered. A November colonoscopy confirmed the worst.

"They had found a mass. And so I was like a tumor, like cancer? And he's (my doctor) like, yeah," said Asbury.

It was stage 4 colon cancer. And worse, the cancer had spread to Kevin's liver.

"So I figured that was the end right there. I mean, you can't do surgery on a liver. I didn't think so," he said. "I know Melissa (Kevin's wife) took it a little harder. And I'm just kind of the cool, calm and collected type. So I was just like, 'Okay, we've got a problem. How are we going to fix it?', you know?"

Melissa Asbury had reason to be worried. She is a certified surgical technologist.

"You don't just go cut into the liver because it's so vascular and it bleeds like crazy," she said.

Kevin's doctors ordered six rounds of chemotherapy, followed by surgery to remove four tumors, one of which was situated near a major blood vessel. Surgeon Dr. Sonia Orcutt told him about 70 percent of his liver would be removed. That came with a 5 to 10 percent chance of liver failure.

But a couple weeks before Kevin was scheduled to go to the OR, he got an interesting phone call, asking for his permission to share some medical info with Caterpillar. He agreed.

"I guess Caterpillar took my CT and MRI images and they made a model," he said.

OSF HealthCare didn't possess the 3D printer needed to create the intricate model, so they borrowed some of Caterpillar's industrial tech.

"The blue and the pink things in this are the vessels coming in and out of the liver. You can also see them kind of spider webbing through the liver," Melissa described. "And then there's purple spots in this translucent gel. And those purple spots are his tumors."

Dr. Matthew Bramlet is a pediatric cardiologist at the University of Illinois College of Medicine Peoria and the Children's Hospital of Illinois. He's also the leader of the Advanced Imaging Modeling Lab at the Jump Trading Simulation and Education Center, which specializes in creating medical applications for 3D modeling tech.

"The printers that Cat has here in town afford us that unique opportunity where we can then not just hold it in our hand, but actually the surgeon can practice...can, you know, run a scalpel through the model," Bramlet said.

The scale model of Kevin's liver, about the size of the average apple, cost $11,000 to manufacture. As an "experimental" procedure, insurance companies won't cover the costs. That means the organizational foundations eat those expenses, making its application limited to all but the most complex cases, like Kevin's.

Bramlet says the Centers for Medicare and Medicaid Services just began conversations around approving 3D printing reimbursements last year.

But he says his laboratory is already moving beyond 3D printing towards using virtual reality modeling, a process he says is both cheaper and easier to use in most circumstances.

"We're gonna have to influence these regulators in D.C. to come and actually reimburse us for the technology we are using, because we've already bypassed the one that they're still experimenting with, really," said Bramlet.

Bramlet says a 3D visualization helps surgeons put together a mental representation of the procedure.

"Most people go through this process where if you've got a 3D puzzle, right, you're kind of thinking through how to do it in your mind's eye," he said. "If you're going to be taking apart an engine and putting it back together, mechanics got me thinking about what they're going to be doing. That's what we're achieving."

Melissa Asbury says having that mental representation helped Dr. Orcutt, her husband's surgeon achieve a better outcome. Kevin Asbury lost around 30 percent of his liver in the six-hour tumor removal surgery, rather than the 70 percent initially expected.

"Being able to print this image pretty much saved his life, because right now we can say that he is cancer free. He went from having stage four colon cancer to as far as his blood work and his scans. He has no cancer in his body at all right now," Melissa said. "And 5, 10 years ago, I don't think anybody could really say that, that if you had Stage 4 any cancer, that you're going to be able to survive, years down the road."

Dr. Bramlet says 3D virtual reality modeling is already a standard of care for complex surgeries at the Children's Hospital of Illinois, and they're sharing the technology with other institutions around the country in hopes of generating the outcomes needed for wider-scale adoption that would be covered by insurance companies.

"Anything that is a complex 3D problem with anatomy, this technology can have a dramatic impact," he said.

Kevin Asbury urges anyone suffering from digestive issues to get a colonoscopy, and he wants people battling cancer to know there's always hope.

"You just got to keep your faith and every day is a blessing. That's how I feel, you know, every holiday is more special now. Everything happens for a reason," Kevin said. Cancer kind of brought me closer to God. So you know, you just draw close to Him and you know everything's gonna be fine."

Copyright 2021 WCBU. To see more, visit WCBU.

Tim Shelley is the Assignment Editor and Digital Director at WCBU Peoria Public Radio.
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