CHICAGO, Dec. 2, 2015 /PRNewswire-USNewswire/ -- A
combination of detailed 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, Dr. 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," Dr. 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," Dr. Krishnamurthy said.
"The concordance was almost perfect."
Dr. 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," Dr. 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.
Note: Copies of RSNA 2015 news releases and electronic images
will be available online at RSNA.org/press15 beginning
Monday, Nov. 30.
RSNA is an association of more than 54,000 radiologists,
radiation oncologists, medical physicists and related scientists,
promoting excellence in patient care and health care delivery
through education, research and technologic innovation. The Society
is based in Oak Brook, Ill.
(RSNA.org)
For patient-friendly information on CT, visit
RadiologyInfo.org.
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SOURCE Radiological Society of North
America (RSNA)