Feature | Advanced Visualization | December 02, 2015

CT and 3-D Printing Aid Surgical Separation of Conjoined Twins

For the first time, CT imaging and 3-D printing technology have been combined to help plan the surgical separation of conjoined twins

3-D printing, CT dataset, conjoined twins, surgical separation, physical model

3-D color segmentation of CT data with 3-D model used to help separate the conjoined twins.

3-D print, conjoined twins, RSNA 2015

3-D printed model of the conjoined twins created from CT datasets that were used to surgically separate them.

RSNA 2015, 3-D printing, Stratasys Connex 500, conjoined twins, surgical separation

The Stratasys Connex 500 3-D printer used to create the anatomical models from CT scans.

December 2, 2015 — A combination of detailed computed tomography (CT) imaging and 3-D printing technology has been used for the first time in the surgical planning for separation of conjoined twins, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

Conjoined twins, or twins whose bodies are connected, account for approximately one of every 200,000 live births. Survival rates are low and separating them through surgery is extremely difficult because they often share organs and blood vessels.

Specialists at Texas Children's Hospital in Houston brought a new approach to these challenges when they set out to surgically separate Knatalye Hope and Adeline Faith Mata, conjoined twins from Lubbock, Texas. Knatalye and Adeline were born on April 11, 2014, connected from the chest all the way down to the pelvis.

"This case was unique in the extent of fusion," said the study's lead author, Rajesh Krishnamurthy, M.D., chief of radiology research and cardiac imaging at Texas Children's Hospital. "It was one of the most complex separations ever for conjoined twins."

To prepare for the separation surgery, Krishnamurthy and colleagues performed volumetric CT imaging with a 320-detector scanner, administering intravenous contrast separately to both twins to enhance views of vital structures and help plan how to separate them to ensure survival of both children. They used a technique known as target mode prospective EKG gating to freeze the motion of the hearts on the images and get a more detailed view of the cardiovascular anatomy, while keeping the radiation exposure low.

"The CT scans showed that the babies' hearts were in the same cavity but were not fused," Krishnamurthy said. "Also, we detected a plane of separation of the liver that the surgeons would be able to use."

The team translated the CT imaging results into a color-coded physical 3-D model with skeletal structures and supports made in hard plastic resin, and organs built from a rubber-like material. The livers were printed as separate pieces of the transparent resin, with major blood vessels depicted in white for better visibility. The models were designed so that they could be assembled together or separated during the surgical planning process. The surgical team used the models during the exhaustive preparation process leading up to the surgery.

On February 17, a little more than 10 months after they were born, the Mata twins underwent surgical separation by a team of more than 26 clinicians, including 12 surgeons, six anesthesiologists and eight surgical nurses. The official separation took place approximately 18 hours into the 26-hour surgery.

The 3-D models proved to be an excellent source of information, as there were no major discrepancies between the models and the twins' actual anatomy.

"The surgeons found the landmarks for the liver, hearts and pelvic organs just as we had described," Krishnamurthy said. "The concordance was almost perfect."

Krishnamurthy expects the combination of volumetric CT, 3-D modeling and 3-D printing to become a standard part of preparation for surgical separation of conjoined twins, although barriers remain to its adoption.

"The 3-D printing technology has advanced quite a bit, and the costs are declining. What's limiting it is a lack of reimbursement for these services," he said. "The procedure is not currently recognized by insurance companies, so right now hospitals are supporting the costs."

Besides assisting clinicians prepare for surgery, the 3-D model also served another important function: helping the twins' parents, Elysse and John Eric Mata, understand the process.

"When I showed the mother the model and explained the procedure, she held my hand and thanked me," Krishnamurthy recalled. "They said, 'For the first time, we understand what is going to happen with our babies.'"

Knatalye Hope returned home in May 2015 and her sister Adeline Faith came home a month later. They are both doing well and have a Facebook page, "Helping Faith & Hope Mata," with updates on their progress.

Co-authors on the study are Nicholas Dodd, B.S.; Darrell Cass, M.D.; Amrita Murali; and Jayanthi Parthasarathy, B.D.S., M.S., Ph.D.

For more information: www.radiologyinfo.org

Related Content

#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 New studies use SIRD model to forecast COVID-19 spread; examine patient CT scans to correlate clinical features with mortality

Fig 1. A sample scoring on CT images of a 63-year-old woman from mortality group demonstrated a total score of 63. It was calculated as: for upper zone (A), 3 (consolidation) × 3 (50–75% distribution) × 2 (both right and left lungs) + 2 (ground glass opacity) ×1 (< 25% distribution) × 2 (both right and left lungs); for middle zone (B), 3 (consolidation) × 2 (25–50% distribution) × 2 (both right and left lungs) + 2 (ground glass opacity) × 2 (25–50% distribution) × 2 (both right and left lungs); for lower zone (C), 3 (consolidation) × (2 (25–50% distribution of the right lung) + 3 (50–75% distribution of the left lung)) + 2 (ground glass opacity) × (2 (25–50% distribution of the right lung) + 1 (< 25% distribution of the left lung)) Yuan et al, 2020 (CC BY 4.0)

News | Coronavirus (COVID-19) | April 01, 2020
April 1, 2020 — A new study, ...
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 Company emphasizes faster, more advanced CTs, making imaging easier for COVID-19 patients
News | Computed Tomography (CT) | April 01, 2020
April 1, 2020 — United Imaging, a global leader in advanc
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 A brief article from Henry Ford Health System in Detroit, published today in Radiology, reports on the first presumptive case of COVID-19–associated acute necrotizing hemorrhagic encephalopathy.

A, Image from noncontrast head CT demonstrates symmetric hypoattenuation within the bilateral medial thalami (arrows). B, Axial CT venogram demonstrates patency of the cerebral venous vasculature, including the internal cerebral veins (arrows). C, Coronal reformat of aCT angiogram demonstrates normal appearance of the basilar artery and proximal posterior cerebral arteries. Image courtesy of the Radiological Society of North America (RSNA)

News | Coronavirus (COVID-19) | March 31, 2020
March 31, 2020 — A brief article fr
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 The Chinese start-up company Infervision launches its AI-based solution InferRead CT Lung Covid-19 also in Europe
News | Artificial Intelligence | March 31, 2020
March 31, 2020 — Lung infections generated by the coronavirus can be detected in...
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 Doctor in our hospital is using this intelligent system for accurate diagnosis

Doctor in our hospital is using this intelligent system for accurate diagnosis. (Photo: Business Wire)

News | Artificial Intelligence | March 31, 2020
March 31, 2020 — The Intelligent Evalua...
RSNA's open data repository will compile images and correlative data to create a comprehensive source for COVID-19 research and education efforts #COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2
News | Coronavirus (COVID-19) | March 30, 2020
March 30, 2020 — The medical imaging community around the world is uniting to help address the...
In the light of the coronavirus outbreak, MILabs has enhanced its line of high-performance CT scanners to even better detect the disease #COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2
News | Computed Tomography (CT) | March 27, 2020
March 27, 2020 — Based on recent scientific research, diagnostic X-ray...
AI vendor Infervision's InferRead CT Pneumonia software uses artificial intelligence-assisted diagnosis to improve the overall efficiency of the radiology department. It is being developed in China as a high sensitivity detection aid for novel coronavirus pneumonia (COVID-19). #COVID19 #coronavirus #SARScov2

AI vendor Infervision's InferRead CT Pneumonia software uses artificial intelligence-assisted diagnosis to improve the overall efficiency of the radiology department. It is being developed in China as a high sensitivity detection aid for novel coronavirus pneumonia (COVID-19).

Feature | Coronavirus (COVID-19) | March 27, 2020 | Jilian Liu, M.D., HIMSS Greater China
An older couple walked into the Hubei Provincial Hospital of Integrated Chinese and Western Medicine near their neigh