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Army Medicine Leads the Industry in Use of 3D Technology for Surgery

Dr. Stephen Rouse, DDS, stands in the tiny space of the 3-D Medical Applications Center at Walter Reed Army Medical Center (WRAMC), surrounded by computer screens. Open spaces on desks and shelves are covered with models of bones and skulls; some wear ski caps, and one sits upside down, holding candy. The quirkiness of the lab belies the Center’s important role creating three-dimensional models and implants for Soldiers complex craniofacial and orthopedic reconstructive surgery.

Soldiers with head or pelvic injuries at WRAMC or other Army Medical Centers have thin-slice digital images (computed tomography or CT) of their injuries sent to Dr. Rouse’s center. There he converts the two-dimensional images into 3-D resin models which are an exact life-size replica of the patient’s skull or pelvis, showing the condition of the bone, including fragmentation. The models are used by surgeons to familiarize themselves with the patient’s condition, to plan the operation and also to explain the procedure and expected results to the patients and their families prior to surgery. In addition, this process is used to create implants made out of plastic or titanium mesh to replace damaged or missing sections of bone for reconstructive surgery. The titanium mesh is a newer material that allows tissue to grow through it, improving blood flow and reducing incidents of infection.

The models are built by a rapid prototyping machine that works similarly to an ink jet printer; it reads the CT scans and ‘prints’ across a vat of liquid resin, which is raised a tenth of a millimeter at a time until the completed three dimensional model emerges in about eight hours.

“We have data showing that in every case where models have been used, it has cut down the surgery time between one and six hours,” Rouse says. Reduced operating times have resulted in measurably improved patient outcomes. The Army far outdistances civilian medicine in the use of 3-D models, despite the advantages. There are several reasons for this including a lack of awareness among the civilian medical community and the expense involved. Dr. Rouse has lectured about the center he founded in 2004 at medical and dental conferences in the United States and internationally to call attention to the potential for this technology. 

The process of rapid prototyping was actually developed more than 20 years ago as a way to design parts for industrial machinery. Companies that make rapid prototypes occasionally work with hospitals, but the 3-D Medical Applications Center is unique in that it is currently the only in-hospital provider of these services in the United States. 

For reconstructive surgery, the Center’s team of computer experts uses the mirror image of the patient’s head and old photos to design implants that will allow the patient to look as much as possible the way he or she did prior to being injured.

Dr. Rouse explains that many Soldiers who see themselves after their injury do not recognize themselves,   but the implants allow the surgeons to rebuild their skull, jaw and cheekbones to look like they once did. Restoration of an injured patient’s physical appearance makes a tremendous impact on their psychological health and recovery. This process has enormous potential for use in reconstructive surgery in the civilian world for individuals who have been in automobile accidents as well.

Dr. Rouse, the founder of the center, started his career practicing general dentistry in the U.S. Army Dental Corps and eventually rose to be the Dental Corps’ Chief Information Officer. Now that he has retired, he is using the dental and technology skills he honed over his career once again for the benefit of Soldiers, but this time as a civilian operating on the leading edge of medical technology. To date, he and the Center have participated in almost 700 major cases, and have built approximately 1,600 models. In addition to craniofacial reconstruction, the center is called in for cases ranging from aneurysms to prosthetic sockets and design, and plastic surgery. 

Dr.  Rouse explains his passion for the center. “I’m doing this for our young men and women. Nothing is more important to me personally than to make whole the Soldiers, Sailors and Airmen who have sacrificed so much for our country.”