At UCLA, it's medicine 2.0
Tucked deep in the basement of UCLA’s Center for the Health Sciences is a room that looks more like an inventor’s fantasy workshop than the medical research facility it is. Tables are piled high with tools, electronics, prototype equipment parts and a few stray robotic arms. Posters on the wall describe pending projects in dense technical language with accompanying photos of futuristic devices.
This hidden space is where scientists are working at the very forefront of technological advances in medicine. Its assemblage of smarts, parts and computers is contributing to an emerging era of personalized, tech-enabled health care treatment and medical research that challenges our imaginations.
Cool inventions like replacement bones and inexpensive DIY plastic hands, fingers and other prosthetics are now being created on 3-D printers like the ones at UCLA for a fraction of the cost of traditional versions. And 3-D bio-printing is being used to regenerate skin, blood vessels, tracheal splints and heart tissue. Somewhere, a researcher is working to 3-D-print a heart, while another is trying to “print” functioning human kidneys.
At UCLA, the work toward turning these sci-fi explorations into reality is taking place in the Center for Advanced Surgical and Interventional Technology (CASIT). Through CASIT, surgeons interact with biomedical engineers to lay the foundations for new clinical interventions. CASIT facilities include the Gonda Robotic Center, a telecommunications center, a computer-simulation facility and an integrated operating room suite.
The overall goal of CASIT is to make health care more accessible by accelerating the process of turning basic scientific research into practical medical tools and then finding companies to manufacture them.
Heart surgeons at UCLA, for example, are exploring how 3-D printing can help them treat infants and children with congenital heart disease. In a first for the university, doctors in February prepared for the complicated surgery of a 7-month-old by studying a printed plastic replica of the baby’s heart. The model of the heart was created by a tech company in Belgium that used high-quality MRI images from UCLA and its own sophisticated software and 3-D printer.
“This first case was a way to learn the mechanism [of the 3-D-printing process] and to explore how to proceed,” says Dr. J. Paul Finn, professor of radiology and director of magnetic resonance research at UCLA Radiology.
The infant had two abnormalities in the structure of his heart — a rare and complex condition. Examining the 3-D-generated plastic heart helped physicians analyze how best to repair both abnormalities. While most 3-D printing uses hard plastic, this printed heart was made of a rubbery plastic “that resembles the consistency of a gummy bear,” says Dr. Brian Reemtsen, a pediatric cardiothoracic surgeon who is working with Finn. So the shape of the heart changes as it beats, making it more realistic.
This year, doctors expect to use printed hearts as part of surgery preparation for another five infants. The potential is enormous, Reemtsen says. “With a physically accurate model of a heart, we can establish if only one incision is needed instead of two, or we can see if it’s possible to not just correct the problem, but also to change a baby’s anatomy to normal, which will allow the child to live decades longer than he or she would otherwise. We can also practice a procedure beforehand with less time pressure. Cardiac surgery is a timed event.”
UCLA doctors at the Ahmanson/UCLA Adult Congenital Heart Disease Center are also using 3-D printing to create models of adult hearts to practice surgery beforehand for procedures such as a difficult heart-valve replacement.
UCLA medical researchers are moving the field forward in another area — working on wearable tools that give doctors hard information where they once had to rely only on patients’ imperfect memories. Among the most impressive efforts is the work being done with heart-surgery recovery and stroke therapy.
This year, for example, about a dozen UCLA heart-surgery patients have gone home with toolboxes that contain a pre-programmed computer tablet and wireless digital sensors that patients use to measure their weight, pulse and heart rate. These measurements are automatically transmitted to a nurse practitioner, who reviews the patient’s information and uses the tablet to hold video calls to discuss recovery progress and visually check on the patient.
“Everything is extremely easy for patients. They just turn on the computer tablet, and the screen asks them questions and tells them exactly what to do,” explains cardiothoracic surgeon Peyman Benharash, who oversees the heart-surgery-telehealth program. Data will alert the patient’s health care team about abnormal heart rhythm, lung problems, weight gain from fluid retention and other problems before a patient requires hospitalization.
About 20 percent of heart-surgery patients in the U.S. are readmitted to a hospital within 30 days of discharge, according to researchers at Duke University Medical Center. In contrast, the readmission rate has dipped to about 6 percent among heart-surgery patients who participate in this program and other in-home web-conferencing programs, according to a recent UCLA study, Dr. Benharash says.
Sensors can now record the vibrations of the digestive tract to help doctors advise patients when and how to eat.
Patients are also wearing ankle sensors that record accelerations and decelerations as they move so that a smartphone can send the data to computer programs that analyze the type, quantity and quality of the movements. A new device— a pair of disposable, one-inch sensors that people wear on their abdomens — senses and records the vibrations of their digestive tract. A computer at the patient’s bedside analyzes the information to tell doctors when and how the person should eat.
“That information tells us when the patient is ready to eat full meals and can be released from the hospital,” said gastroenterologist Dr. Brennan Spiegel.
As clinicians continue to set the goals that UCLA engineers then work to achieve, medical teams at UCLA will be fabricating custom devices and making models of body parts in-house, thanks to 3-D printing. And with big data, they will be able to help high-risk patients through telehealth, mobile health applications, wearable biosensors and even social media.
As Spiegel puts it: “That is the path forward.”