If technology is indeed the “great growling engine for change” — as futurist Alvin Toffler once described — then there’s a joyful noise resonating from the engineering labs at the University at Buffalo.
UB engineers and applied scientists, joining ranks with those on the frontlines of medicine and the life sciences, are providing game-changing solutions for many of health care’s most intractable challenges. Within their labs, ideas — both big and small — are incubated, shared, supported, tested and ultimately translated into real-world applications that benefit both patient and the biomedical community alike.
The retooling of 21st century medicine — with its tectonic shift to developing patient-tailored diagnostics and therapies, and its greater reliance on data sharing and interdisciplinary teamwork — is shaping the new health care landscape where the demand for simpler, better, smaller, less expensive, more convenient and more efficient technology is both unrelenting and urgent.
Ciprian “Chip” Ionita, director of the Endovascular Devices and Imaging Lab at the Toshiba Stroke and Vascular Research Center, and an assistant professor in the Department of Biomedical Engineering, is more than up to the challenge.
A pioneer in the testing and development of endovascular medical devices, Ionita has, in fact, created some of the world’s most sophisticated models of the brain’s highly complex vascular system using 3-D printing, a computer-assisted technology that has found limitless possibilities in the fields of engineering, biomedicine, art, architecture, and countless others over the last 15-20 years.
Ionita begins by taking radiographic images from a patient’s CT or MRI brain scans, and isolating the areas of interest in a process called segmentation. Using special software, the data is then converted to a stereolithographic (STL) file format — “the highest quality representation of a 3-D geometric image,” he says — and sent to a 3-D printer, which creates, layer by layer, a life-sized 3-D model made of a photopolymer material that mimics the texture of human tissue.
The end result is an elegant illustration of a precision medicine tool — one that is far superior to more conventional approaches to device testing and treatment planning. “Cadavers lack the appropriate mechanical properties because of their collapsed systems,” said Ionita, “and frankly, there is no way that a pig’s geometry resembles that of a human.” The 3-D models work because they not only offer the look and feel of human tissue, but they capture even the subtlest variances in the vascular architecture.
Ask Ionita how many models his lab has created over the years and he admits that he has “lost count,” but it’s likely a number “somewhere in the thousands.”
It’s not a stretch to say that surgeons and engineers share an affinity for problem solving, making any collaboration a natural fit.
Ionita, who holds appointments in bioengineering, radiology and neurosurgery, recalls his early work with Adnan Siddiqui, MD, PhD, vice chair of neurosurgery and the director of the Toshiba Stroke and Vascular Research Center.
“We started by building 3-D printed brain arteries to test treatment devices for certain endovascular conditions, such as blood clots and aneurysms,” said Ionita. But as the number of more challenging neurosurgeries grew, so did requests for more nuanced models. “Each time, Dr. Siddiqui motivated us to raise the bar — asking Can you add this? Can you do this? until we arrived at a point where we created a 3-D model of the brain’s entire vascular system.”
Up until then, it had never been done — no small feat either, considering its intricacies.
Such teamwork led to more patient-specific 3-D models that Siddiqui and other neurosurgeons use to steer treatment plans. “It’s a win-win situation for everyone,” said Ionita. “ For the surgeon, it better informs decision-making and validates with greater confidence the surgical plan. For us, it expands our knowledge base and what we as engineers have to offer.”
Treatment strategies are sometimes revised and devices reconsidered based on the critical information the 3-D models provide. Unknowns become givens, as neurosurgeons simulate the actual experience of a complex procedure before he/she even enters the OR.
What’s more, says Ionita, “the models are created on demand, allowing us to deliver just what the doctor ordered in a timely fashion.”
To put their stamp on the biotechnological advances of tomorrow, “our engineers, and especially our trainees, must be completely immersed in the daily clinical reality of health care today — and that’s the mindset we encourage in our graduate and undergraduate students,” said Ionita.
In December of 2016, in collaboration with the Jacobs Institute, Richard Izzo, one of Ionita’s biomedical engineering graduate students who also holds a UB bachelor’s degree in biomedical engineering and chemistry and is one of 25 Western New York Prosperity Scholars at UB, had a unique opportunity to test firsthand just how powerful 3-D printing technology — with the surgical muscle behind it — could be.
UB’s Chair of Surgery Stephen Schwaitzberg, MD, whose own research interests include device development, needed help on a particularly daunting case.
“One of his patients had come to the ER complaining of severe abdominal pain and the inability to keep food down,” said Izzo. A review of the patient’s medical history revealed that he had been in an accident 20 years earlier, but the full force of that trauma had only now come to light.
CT scans confirmed that his stomach had folded in on itself and that most of the organs in his abdominal cavity had shifted upwards into the lungs. “Anatomically, nothing was where it should’ve been,” said Izzo, “and Dr. Schwaitzberg was looking for us to create a 3-D model of this patient’s internal organ system.”
It took about a week to design, edit and print the model. “We wound up with a 3-D replica of the patient’s internal organ system from his pelvis to his neck bone,” said Izzo. Organs were labeled and colored, and the model, which had moveable parts, was used as a teaching tool for the delicate surgery to correctly reposition the patient’s organs.
And how is the patient today?
“I am told he’s doing just fine,” said Izzo, who presented this unique case — and garnered one of the top honors — at the 2017 Graduate Student Poster Competition, sponsored by UB’s School of Engineering and Applied Sciences.
“My lab is located just one floor above the operating room and the possibilities that this proximity brings to the real-life application of our research is nothing short of mind-blowing,” he said.
Hoping to complete his graduate training in 2020, Izzo is currently exploring the uses of 3-D printing in cardiac care — developing heart valves in collaboration with Vijay Iyer, MD, an interventional cardiologist in the Jacobs School.
“We’ve only just scratched the surface in this technology’s application in heart surgery,” says Ionita. “A new clinical trial is underway in which we are making customized models for all our cardiac patients to validate the software we use for coronary disease. We predict that this will lead to the development of implant devices so that we will no longer have to rely on one-size-fits-all models.”
Kwang W. Oh is director of UB’s Sensors and MicroActuators Learning Lab (SMALL), a place, he says, where big things stem from micro- and nanotechnology, the science of manipulating matter at micro, molecular and atomic scales. Focusing on micro- and nanotechnology-based biological micro-electro-mechanical-systems (BioMEMS), Oh provides life scientists and physicians with the right tools “to solve problems in their own fields.”
Oh came to UB in 2006 from Samsung, where he served as a member of its senior research and development team. “I was exposed to the very real problems facing the life sciences and subsequently developed a keen interest in applying engineering tools to the fields of biomedical research,” he said. At UB, he found other like-minded individuals who understood the important interplay of biology and technology.
Oh, who holds appointments in the Departments of Electrical Engineering and Biomedical Engineering, explains that the science behind BioMEMS has played a significant role in ushering in recent advances in genomics, proteomics, single cell analysis and point- of-care diagnostics. BioMEMS research encompasses lab-on-a-chip technology, in which one or more laboratory functions are integrated onto a single chip using trace amounts of fluids, such as blood. Microfluidics forms the basis for much of Oh’s research, including the building of phantom models to test wearable medical devices.
In 2015, he received funding from Qualcomm, a multinational semiconductor and telecommunications equipment company headquartered in San Diego, to develop a phantom arm to test a new blood pressure monitor. To be effective, the limb would need to mimic the physiological and acoustical properties of a human arm, he said.
Phil Schneider, one of six graduate students in SMALL and also a Western New York Prosperity Scholar and 2018 SUNY Chancellor's Award winner, worked on this project. “I had done an internship with Qualcomm where we worked on creating a new type of wearable sensor that can be worn on an arm to measure different types of vascular compliance features like heart rate and blood pressure. We took this research a step further by developing a creative way to test the sensor."
“We wound up developing a workable arm with artificial blood vessels, but it lacked certain subdermal properties,” said Schneider, who will complete his doctorate in electrical engineering in May. ”With additional funding from the National Science Foundation, “we designed and created a phantom finger that had all the dermotographic features necessary for device testing — digital arteries, bone, fat, muscle, fingerprints and a fully functioning 3-D blood capillary network.”
The technology used to create these phantom models has important health care applications, said Schneider. “Imagine a time in the not-too-distant future where individuals can pick up a wearable blood pressure or heart monitoring device at their local drugstore. It could be that simple and convenient.”
In Oh’s lab, the traditional notions of problem solving are routinely challenged, and sometimes solutions to stubborn problems really do require MacGyver-like resourcefulness. “You have to think out of the box and wear the hat of a scientist,” said Schneider, whose grandfather and father are both engineers. “Some people say that I’m not a real electrical engineer because I don’t do circuits, but the truth is that the electrical engineers of today are far more diverse in their talent and areas of interest.”
When Oh’s team was looking at ways to build capillaries for their phantom finger, “we discovered that all it took was $60 and an Amazon Prime membership,” jokes Schneider, who purchased a cotton candy machine online. “A human capillary is roughly the same size as a single cotton candy fiber so we used these strands to successfully build a small vascular network.”
And what do Easter eggs have to offer bioengineering research? “Quite a lot,” says Oh. Inspired by the traditional Ukrainian Easter egg painting technique called “pysanky,” in which elaborate miniature wax designs are printed on the surface of an egg, “we applied a paraffin wax-based approach to low cost, rapid prototyping of microfluidic devices.”
Oh is also investigating new ways to harness vacuum-driven energy to create more reliable microfluidic components, such as micropumps and microvalves, to facilitate lab-on-a-chip commercialization. “We have devised a manual, syringe-assisted, vacuum-driven micropump for plasma separation from a tiny drop of finger-prick blood and believe it has the potential to lead to practical biomedical lab-on-a-chip devices that can screen for glucose levels, cancer cells, viruses, DNA molecules and other applications.”
Because technology provides the tools and biology the problems, the two should enjoy a happy marriage.
Oh likes to share his favorite quote, which he came across in a journal article, with his colleagues and trainees. “It pretty much sums up the relationship our engineers have with clinicians and life scientists,” he says.
Ionita concurs, maintaining that this culture of collaboration has been UB’s modus operandi for as long as he can remember. “There’s always been a wealth of talent across disciplines here, and good ideas — whoever brings them to the table — make for meaningful teamwork and compelling results, ” he says.
It’s “the coolest place for a biomedical engineer to be right now,” says Izzo.