The Artist Within
For Dr. Frank Rybicki, designing and building medical parts goes far beyond manufacturing
We see them in magazines, the Internet, and the evening news—photos of people whose faces have been disfigured through accidents or acts of cruelty. It’s difficult to imagine the anguish they must feel, never mind the loss of everyday human functions such as speech, smell, sight, and even breathing itself. As the daughter of one such individual said, “Life without a face is not a life.”
Thanks to the efforts of restorative surgeons, such as Dr. Bohdan Pomahac, these patients are given a second chance at a normal life. In 2011, he and a team of 30 physicians and nurses from Brigham and Women’s Hospital in Boston worked for more than 15 hours to perform the first full face transplant in the US. It was to be the first of several such surgeries.
The patient’s name was Dallas Wiens, and radiologist Frank Rybicki was there for the procedure. Both men’s lives were changed because of that day.
“I managed the imaging for that procedure as well as other complex maxillofacial cases,” said Dr. Rybicki. “We had 3D visualization capabilities through MRI and CT scans, but I recognized that there was a need for better tools and more complex surgical planning.”
Dr. Rybicki then began a long-term relationship with Peter Liacouras, PhD from Walter Reed hospital in Maryland, and through funding secured by Dr. Pomahac’s team and the US Department of Defense, they sought to increase the role for 3D printing in complex surgical planning. “There was limited use of additive manufacturing in hospitals back then, and these precious opportunities allowed us to explore the technology’s clinical potential and understand how we could expand the science of medical modeling,” he said.
The funding, and the work, had profound consequences not only for face transplantation, but for medicine in general.
In 2014, Dr. Rybicki was recruited to become professor and chair of the Department of Radiology at the University of Ottawa. In this capacity he has championed the technology, as it has been increasingly accepted as a way to improve the quality of life for innumerable patients.
By recruiting “very bright people” from Boston and beyond, Dr. Rybicki has established a team that opened one of the world’s first comprehensive medical 3D printing labs. “We never looked back from there, and today, we have a whole host of applications, including virtual and augmented reality,” he said.
Dr. Rybicki created a medical physics division within his growing department, including the RealizeLab under the directorship of Justin Sutherland, PhD. “This massive cabinet of imaging tools supports more accurate 3D printing, and ultimately, better patient outcomes. I believe that our Virtual Reality medical program—now used clinically for several strategic applications—is the first of its kind.”
But this isn’t a case of scan it, model it, print it, and hand it to the surgeon. Dr. Rybicki says he has come to realize that 3D printing of human body parts and replicas requires a certain level of artistry, especially when modeling and building aesthetic features, such as the face or hands. “I’m not the only one who’s recognized this,” he said. “A lot of people have reached out to me to discuss how they’ve assumed a new role, that of the physician-artist. It’s become a very fascinating field of study.”
For those manufacturers familiar with repairing damaged molds or broken tools, Dr. Rybicki’s work might seem to be a simple process of mirroring the undamaged half of the patient onto the part that needs fixing. Not so fast, he said. Physician-artists must not only learn to play with skin tones and textures, but also decide which blood vessels, muscle tissues, bones, and other parts of the patient’s 3D scan to include based on the upcoming procedure.
“You can definitely affect the outcome of the surgery by changing the model,” warned Dr. Rybicki. “That's the ultimate definition of artistic licensing.”
Rybicki’s artistic license was put to the test early last year when he and his team designed a prosthetic hand for a man who’d had four of his fingers torn off in a motorcycle accident. They’ve also produced anatomically correct models of a child’s heart, knee replacements, human skulls, and much more.
“I’m even working on a toe right now,” he said. “I see great value in what we’re doing and there are definitely many rewarding cases, but it’s also gratifying to make even the bread and butter surgeries easier.”