Creation of Evidentiary Models from Radiological Imaging 3d Software and 3d Printing

Cynthia M Day MD

Biodynamic Research Corporation

5711 University Heights Blvd Suite 107 San Antonio TX 78249 (210) 691-0281 cdayBRConlinecom

Craig L Winterman

Herzfeld amp Rubin LLP

1925 Century Park East Suite 900 Los Angeles CA 90067 (310) 553-0451 cwintermanhrllp-lawcom

Dr Cynthia M Day MD has a degree in medicine is board certified in Diagnostic Radiology and is fellowship trained in Emergency Radiology After her fellowship Dr Day spent several years as faculty at Harvard Medical School while performing her duties as staff radiologist at Brigham and Womenrsquos Hospital in Boston Dr Day also has prior work experience in the oil and gas industry as a computer systems analyst and technical writer Her role at Biodynamic Research Corporation (BRC) includes independent consulting assignments for which evaluation of radiologic imaging studies is the primary focus as well as interpreting radiologic imaging studies in support of BRCrsquos injury causation and biomechanical analysis practice Her assessment of such studies includes but is not limited to interpreting radiology exams reporting pertinent findings and producing 3D images that aid in the visualization and understanding of complex injuries by non-medically trained personnelCraig L Winterman is a graduate of the University of Oregon and Southwestern University School of Law He joined Herzfeld amp Rubin LLP in 1977 and has been director of its Tort and Product Liability Practice Group since 1986 and its Business Litigation Group since 1999 The majority of his trials involved complex legal and factual issues ranging from jurisdiction to federal preemption He has successfully tried product liability cases involving catastrophic injuries including severe burns quadriplegia paraplegia brain injury and death to minors and adults Mr Winterman has also successfully defended hundreds of asbestos cases He also represents clients involved in major commercial litigation including breach of contract unfair business practices breach of warranty sexual harassment fraud director and officer liability antitrust violations class actions patent infringement and other business disputes He is a member of the American Board of Trial Advocates the Federation of Defense and Corporate Counsel DRI the Association of Southern California Defense Counsel and the Product Liability Advisory Council

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp3

Creation of Evidentiary Models from Radiological Imaging 3d Software and 3d Printing

I Introduction 5 II Advances in Radiology Medical Software and Printing 5 III Use of 3D Printed Models in Trial 6 IV Conclusion 7 V Appendix A 3-D Printing Facilities by State 7Endnotes 19

Table of Contents

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp5

Creation of Evidentiary Models from Radiological Imaging 3d Software and 3d Printing

I IntroductionCrsquoest le ton qui fait la chanson1

Trial attorneys and experts are always seeking clear concise and effective ways to illustrate testimony and opinions whether through the use of a drawing on a flip chart or chalk board the presentation of pictures or a model or a sophisticated computer animation or simulation the goal is the same to effectively commu-nicate an idea concept principal object or thing to the jury Advances in technology and software provide new tools through which to communicate Like any new tool it is imperative that new technologies be shown to be scientifically valid before judges will permit their use in the courtroom2

A good example of the development and validation of new computer technology can be gleaned from the field of automotive accident reconstruction In the mid-1960rsquos Raymond McHenry while working at Cornell Aeronautical Laboratory developed a mathematical model (based on the laws of physics) through which one could predict the movement of an automobile The program later became known as the Highway Vehicle Object Simulation Model (ldquoHVOSMrdquo) Mr McHenry validated the program though experimental test data In fact through the use of his model he designed the spiral jump scene that was used in the 1974 James Bond movie ldquoMan with the Golden Gunrdquo Today many accident simulation programs such as EDCRASH SMAC EDSMAC PC-Crash WinSMASH WinCRASH and HVE are effectively used to recreate or reconstruct accidents In the field of biomechanics and occupant kinematics computer programs such as MADYMO Articulated Total Body (ldquoATBrdquo) and Dynaman are used to illustrate the movement of occupants in automotive accidents

In personal injury matters it can be difficult to effectively communicate a musculo-skeletal or inter-nal organ injury to jurors Perhaps even more challenging is the task of effectively demonstrating a pre-exist-ing disease or underlying medical condition that may have played a role in either increasing the risk of or causing an individualrsquos injuries This article will address radiological procedures along with advances in com-puter software and printing technology that offer a new technique for attorneys and experts to use when pre-senting evidence pertaining to internal injuries After all it is not just what an attorney presents in terms of evidence that is important but as some have advocated it is perhaps the medium through which the evidence is presented that is even more important3

II Advances in Radiology Medical Software and PrintingNon-invasive radiological procedures have been an invaluable tool for physicians Todayrsquos physician

can view a fractured bone or diseased or damaged organ and can then assess what is the most appropriate medical care and treatment to provide to their patients Of course most of us take for granted the radiologi-cal advances that have taken place over the years especially with regards to CT scanning and MRI Advances in computer software have made these radiological procedures even more valuable tools for physicians Most patients (and jurors) however do not know that their doctors are using advanced computer software to assist them in interpreting and using radiological images Today through the use of software programs such as OsiriX MD TeraRecon and True 3D conventional 2D images can be converted into 3D images which then can be rotated and viewed in any direction This technology has many advantages not the least of which is its use by surgeons for pre-surgical planning 3D modeling allows the surgeon a better understanding of the anatomy and thus the ability to anticipate and plan for any abnormal or unusual conditions he or she may encounter during surgery

6emspemspProduct LiabilityemspemspFebruary 2017

Additive manufacturing is another very exciting technology that is being used in the medical field Traditional manufacturing methods involve materials being carved or shaped into a product Additive manu-facturing is the opposite Additive manufacturing is an appropriate name to describe technologies that build 3D objects by adding layer upon layer until the desired product is completed

In August 2012 President Obama launched the National Additive Manufacturing Innovation Institute a national effort bringing together industry universities and the federal government to provide innovation infra-structure to support new technologies and products created with additive manufacturing the formal term for 3D printing4 This technology has not only been approved but is being used by the FDA5 3D printing has become so prevalent that is it now being used in medical facilities throughout the US as well as in other countries6 3D printing allows physicians to create perfectly reconstructed anatomic models of a patientrsquos internal organs such as the liver lung prostate spine heart and even coronary arteries With 3D printed models surgeons are prepared well in advance of stepping into the operating theatre this permits surgeons to spend less time in surgery which greatly reduces the risk of complications speeds recovery and saves both time and money

III Use of 3D Printed Models in TrialIn a recent case an issue arose regarding a plaintiff who had a pre-existing condition known as Dif-

fuse Idiopathic Skeletal Hyperostosis or DISH DISH is the proliferation of bone at sites of ligamentous attach-ment to the spine involving at least four contiguous vertebral bodies Grossly DISH looks like candle wax dripping down the anterior aspect of the spine For jurors the candle wax effect is very difficult to envision on 2D CT images however once the CT images are reconstructed through the use of 3D software the ability to appreciate and understand the nature and extent of the disease is much easier to recognize The 3D images can then be modeled via a 3D printer creating a duplicate of the Plaintiff rsquos spine7 This model can then be introduced into evidence for the jurors not only to see but to actually hold in their hands enabling them to readily appreciate the ldquocandle wax drippingrdquo effect that the ligamentous ossification creates It further assists the juror in understanding why a person with DISH would be more susceptible to incurring a spinal fracture from very minor trauma and forces Below are examples of this process

A B C

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp7

Picture A Sagittal slice from a 2D CT scan Note the white bone proliferation along the anterior aspect of the lower thoracic spine indicative of DISH

Picture B Coronal 3D reconstructed image of the CT scan Note the candle wax effect along the right anterior (screen left) aspect of the spine

Picture C Photograph of the 3D model of the Plaintiff rsquos spine created using a 3D printer Note that the candle wax effect is readily apparent The model was of course life size

IV ConclusionThe use of radiological images in conjunction with 3D software and printing can be used to create

physical models that will assist attorneys and experts in explaining complex injuries and medical issues to the triers of fact Provided that the attorney lays a proper foundation for the evidence and in light of the fact that the 3D software and 3D printing technology are widely accepted and used by the medical community models create in this manner should be readily admissible

V Appendix A 3-D Printing Facilities by StateAlabama Swigro 1500 Pumphrey Avenue Auburn Alabama 36830 334-329-5353 httpwwwswigrocom

Prototyping Solutions 2076 Valleydale Terrace Birmingham AL 35244 888-220-6293 | Fax 205-987-7460 httpprototypingsolutionscom

Alaska Alaska Printerrsquos Supply 907 E Dowling Rd Suite 30 Anchorage AK 99518 907-563-7060 httpalaskaprinterssupplycomindexhtml

Arizona Stax3d Gilbert Business Center 1497 E Baseline Rd Ste 100-101 Gilbert AZ 85233 602-595-3155 httpstax3dcom

Stratasys 75 W Baseline Rd Ste 49 Gilbert AZ 85233

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp3

Creation of Evidentiary Models from Radiological Imaging 3d Software and 3d Printing

I Introduction 5 II Advances in Radiology Medical Software and Printing 5 III Use of 3D Printed Models in Trial 6 IV Conclusion 7 V Appendix A 3-D Printing Facilities by State 7Endnotes 19

Table of Contents

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp5

Creation of Evidentiary Models from Radiological Imaging 3d Software and 3d Printing

I IntroductionCrsquoest le ton qui fait la chanson1

Trial attorneys and experts are always seeking clear concise and effective ways to illustrate testimony and opinions whether through the use of a drawing on a flip chart or chalk board the presentation of pictures or a model or a sophisticated computer animation or simulation the goal is the same to effectively commu-nicate an idea concept principal object or thing to the jury Advances in technology and software provide new tools through which to communicate Like any new tool it is imperative that new technologies be shown to be scientifically valid before judges will permit their use in the courtroom2

A good example of the development and validation of new computer technology can be gleaned from the field of automotive accident reconstruction In the mid-1960rsquos Raymond McHenry while working at Cornell Aeronautical Laboratory developed a mathematical model (based on the laws of physics) through which one could predict the movement of an automobile The program later became known as the Highway Vehicle Object Simulation Model (ldquoHVOSMrdquo) Mr McHenry validated the program though experimental test data In fact through the use of his model he designed the spiral jump scene that was used in the 1974 James Bond movie ldquoMan with the Golden Gunrdquo Today many accident simulation programs such as EDCRASH SMAC EDSMAC PC-Crash WinSMASH WinCRASH and HVE are effectively used to recreate or reconstruct accidents In the field of biomechanics and occupant kinematics computer programs such as MADYMO Articulated Total Body (ldquoATBrdquo) and Dynaman are used to illustrate the movement of occupants in automotive accidents

In personal injury matters it can be difficult to effectively communicate a musculo-skeletal or inter-nal organ injury to jurors Perhaps even more challenging is the task of effectively demonstrating a pre-exist-ing disease or underlying medical condition that may have played a role in either increasing the risk of or causing an individualrsquos injuries This article will address radiological procedures along with advances in com-puter software and printing technology that offer a new technique for attorneys and experts to use when pre-senting evidence pertaining to internal injuries After all it is not just what an attorney presents in terms of evidence that is important but as some have advocated it is perhaps the medium through which the evidence is presented that is even more important3

II Advances in Radiology Medical Software and PrintingNon-invasive radiological procedures have been an invaluable tool for physicians Todayrsquos physician

can view a fractured bone or diseased or damaged organ and can then assess what is the most appropriate medical care and treatment to provide to their patients Of course most of us take for granted the radiologi-cal advances that have taken place over the years especially with regards to CT scanning and MRI Advances in computer software have made these radiological procedures even more valuable tools for physicians Most patients (and jurors) however do not know that their doctors are using advanced computer software to assist them in interpreting and using radiological images Today through the use of software programs such as OsiriX MD TeraRecon and True 3D conventional 2D images can be converted into 3D images which then can be rotated and viewed in any direction This technology has many advantages not the least of which is its use by surgeons for pre-surgical planning 3D modeling allows the surgeon a better understanding of the anatomy and thus the ability to anticipate and plan for any abnormal or unusual conditions he or she may encounter during surgery

6emspemspProduct LiabilityemspemspFebruary 2017

Additive manufacturing is another very exciting technology that is being used in the medical field Traditional manufacturing methods involve materials being carved or shaped into a product Additive manu-facturing is the opposite Additive manufacturing is an appropriate name to describe technologies that build 3D objects by adding layer upon layer until the desired product is completed

In August 2012 President Obama launched the National Additive Manufacturing Innovation Institute a national effort bringing together industry universities and the federal government to provide innovation infra-structure to support new technologies and products created with additive manufacturing the formal term for 3D printing4 This technology has not only been approved but is being used by the FDA5 3D printing has become so prevalent that is it now being used in medical facilities throughout the US as well as in other countries6 3D printing allows physicians to create perfectly reconstructed anatomic models of a patientrsquos internal organs such as the liver lung prostate spine heart and even coronary arteries With 3D printed models surgeons are prepared well in advance of stepping into the operating theatre this permits surgeons to spend less time in surgery which greatly reduces the risk of complications speeds recovery and saves both time and money

III Use of 3D Printed Models in TrialIn a recent case an issue arose regarding a plaintiff who had a pre-existing condition known as Dif-

fuse Idiopathic Skeletal Hyperostosis or DISH DISH is the proliferation of bone at sites of ligamentous attach-ment to the spine involving at least four contiguous vertebral bodies Grossly DISH looks like candle wax dripping down the anterior aspect of the spine For jurors the candle wax effect is very difficult to envision on 2D CT images however once the CT images are reconstructed through the use of 3D software the ability to appreciate and understand the nature and extent of the disease is much easier to recognize The 3D images can then be modeled via a 3D printer creating a duplicate of the Plaintiff rsquos spine7 This model can then be introduced into evidence for the jurors not only to see but to actually hold in their hands enabling them to readily appreciate the ldquocandle wax drippingrdquo effect that the ligamentous ossification creates It further assists the juror in understanding why a person with DISH would be more susceptible to incurring a spinal fracture from very minor trauma and forces Below are examples of this process

A B C

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp7

Picture A Sagittal slice from a 2D CT scan Note the white bone proliferation along the anterior aspect of the lower thoracic spine indicative of DISH

Picture B Coronal 3D reconstructed image of the CT scan Note the candle wax effect along the right anterior (screen left) aspect of the spine

Picture C Photograph of the 3D model of the Plaintiff rsquos spine created using a 3D printer Note that the candle wax effect is readily apparent The model was of course life size

IV ConclusionThe use of radiological images in conjunction with 3D software and printing can be used to create

physical models that will assist attorneys and experts in explaining complex injuries and medical issues to the triers of fact Provided that the attorney lays a proper foundation for the evidence and in light of the fact that the 3D software and 3D printing technology are widely accepted and used by the medical community models create in this manner should be readily admissible

V Appendix A 3-D Printing Facilities by StateAlabama Swigro 1500 Pumphrey Avenue Auburn Alabama 36830 334-329-5353 httpwwwswigrocom

Prototyping Solutions 2076 Valleydale Terrace Birmingham AL 35244 888-220-6293 | Fax 205-987-7460 httpprototypingsolutionscom

Alaska Alaska Printerrsquos Supply 907 E Dowling Rd Suite 30 Anchorage AK 99518 907-563-7060 httpalaskaprinterssupplycomindexhtml

Arizona Stax3d Gilbert Business Center 1497 E Baseline Rd Ste 100-101 Gilbert AZ 85233 602-595-3155 httpstax3dcom

Stratasys 75 W Baseline Rd Ste 49 Gilbert AZ 85233

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp5

Creation of Evidentiary Models from Radiological Imaging 3d Software and 3d Printing

I IntroductionCrsquoest le ton qui fait la chanson1

Trial attorneys and experts are always seeking clear concise and effective ways to illustrate testimony and opinions whether through the use of a drawing on a flip chart or chalk board the presentation of pictures or a model or a sophisticated computer animation or simulation the goal is the same to effectively commu-nicate an idea concept principal object or thing to the jury Advances in technology and software provide new tools through which to communicate Like any new tool it is imperative that new technologies be shown to be scientifically valid before judges will permit their use in the courtroom2

A good example of the development and validation of new computer technology can be gleaned from the field of automotive accident reconstruction In the mid-1960rsquos Raymond McHenry while working at Cornell Aeronautical Laboratory developed a mathematical model (based on the laws of physics) through which one could predict the movement of an automobile The program later became known as the Highway Vehicle Object Simulation Model (ldquoHVOSMrdquo) Mr McHenry validated the program though experimental test data In fact through the use of his model he designed the spiral jump scene that was used in the 1974 James Bond movie ldquoMan with the Golden Gunrdquo Today many accident simulation programs such as EDCRASH SMAC EDSMAC PC-Crash WinSMASH WinCRASH and HVE are effectively used to recreate or reconstruct accidents In the field of biomechanics and occupant kinematics computer programs such as MADYMO Articulated Total Body (ldquoATBrdquo) and Dynaman are used to illustrate the movement of occupants in automotive accidents

In personal injury matters it can be difficult to effectively communicate a musculo-skeletal or inter-nal organ injury to jurors Perhaps even more challenging is the task of effectively demonstrating a pre-exist-ing disease or underlying medical condition that may have played a role in either increasing the risk of or causing an individualrsquos injuries This article will address radiological procedures along with advances in com-puter software and printing technology that offer a new technique for attorneys and experts to use when pre-senting evidence pertaining to internal injuries After all it is not just what an attorney presents in terms of evidence that is important but as some have advocated it is perhaps the medium through which the evidence is presented that is even more important3

II Advances in Radiology Medical Software and PrintingNon-invasive radiological procedures have been an invaluable tool for physicians Todayrsquos physician

can view a fractured bone or diseased or damaged organ and can then assess what is the most appropriate medical care and treatment to provide to their patients Of course most of us take for granted the radiologi-cal advances that have taken place over the years especially with regards to CT scanning and MRI Advances in computer software have made these radiological procedures even more valuable tools for physicians Most patients (and jurors) however do not know that their doctors are using advanced computer software to assist them in interpreting and using radiological images Today through the use of software programs such as OsiriX MD TeraRecon and True 3D conventional 2D images can be converted into 3D images which then can be rotated and viewed in any direction This technology has many advantages not the least of which is its use by surgeons for pre-surgical planning 3D modeling allows the surgeon a better understanding of the anatomy and thus the ability to anticipate and plan for any abnormal or unusual conditions he or she may encounter during surgery

6emspemspProduct LiabilityemspemspFebruary 2017

Additive manufacturing is another very exciting technology that is being used in the medical field Traditional manufacturing methods involve materials being carved or shaped into a product Additive manu-facturing is the opposite Additive manufacturing is an appropriate name to describe technologies that build 3D objects by adding layer upon layer until the desired product is completed

In August 2012 President Obama launched the National Additive Manufacturing Innovation Institute a national effort bringing together industry universities and the federal government to provide innovation infra-structure to support new technologies and products created with additive manufacturing the formal term for 3D printing4 This technology has not only been approved but is being used by the FDA5 3D printing has become so prevalent that is it now being used in medical facilities throughout the US as well as in other countries6 3D printing allows physicians to create perfectly reconstructed anatomic models of a patientrsquos internal organs such as the liver lung prostate spine heart and even coronary arteries With 3D printed models surgeons are prepared well in advance of stepping into the operating theatre this permits surgeons to spend less time in surgery which greatly reduces the risk of complications speeds recovery and saves both time and money

III Use of 3D Printed Models in TrialIn a recent case an issue arose regarding a plaintiff who had a pre-existing condition known as Dif-

fuse Idiopathic Skeletal Hyperostosis or DISH DISH is the proliferation of bone at sites of ligamentous attach-ment to the spine involving at least four contiguous vertebral bodies Grossly DISH looks like candle wax dripping down the anterior aspect of the spine For jurors the candle wax effect is very difficult to envision on 2D CT images however once the CT images are reconstructed through the use of 3D software the ability to appreciate and understand the nature and extent of the disease is much easier to recognize The 3D images can then be modeled via a 3D printer creating a duplicate of the Plaintiff rsquos spine7 This model can then be introduced into evidence for the jurors not only to see but to actually hold in their hands enabling them to readily appreciate the ldquocandle wax drippingrdquo effect that the ligamentous ossification creates It further assists the juror in understanding why a person with DISH would be more susceptible to incurring a spinal fracture from very minor trauma and forces Below are examples of this process

A B C

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp7

Picture A Sagittal slice from a 2D CT scan Note the white bone proliferation along the anterior aspect of the lower thoracic spine indicative of DISH

Picture B Coronal 3D reconstructed image of the CT scan Note the candle wax effect along the right anterior (screen left) aspect of the spine

Picture C Photograph of the 3D model of the Plaintiff rsquos spine created using a 3D printer Note that the candle wax effect is readily apparent The model was of course life size

IV ConclusionThe use of radiological images in conjunction with 3D software and printing can be used to create

physical models that will assist attorneys and experts in explaining complex injuries and medical issues to the triers of fact Provided that the attorney lays a proper foundation for the evidence and in light of the fact that the 3D software and 3D printing technology are widely accepted and used by the medical community models create in this manner should be readily admissible

V Appendix A 3-D Printing Facilities by StateAlabama Swigro 1500 Pumphrey Avenue Auburn Alabama 36830 334-329-5353 httpwwwswigrocom

Prototyping Solutions 2076 Valleydale Terrace Birmingham AL 35244 888-220-6293 | Fax 205-987-7460 httpprototypingsolutionscom

Alaska Alaska Printerrsquos Supply 907 E Dowling Rd Suite 30 Anchorage AK 99518 907-563-7060 httpalaskaprinterssupplycomindexhtml

Arizona Stax3d Gilbert Business Center 1497 E Baseline Rd Ste 100-101 Gilbert AZ 85233 602-595-3155 httpstax3dcom

Stratasys 75 W Baseline Rd Ste 49 Gilbert AZ 85233

6emspemspProduct LiabilityemspemspFebruary 2017

Additive manufacturing is another very exciting technology that is being used in the medical field Traditional manufacturing methods involve materials being carved or shaped into a product Additive manu-facturing is the opposite Additive manufacturing is an appropriate name to describe technologies that build 3D objects by adding layer upon layer until the desired product is completed

In August 2012 President Obama launched the National Additive Manufacturing Innovation Institute a national effort bringing together industry universities and the federal government to provide innovation infra-structure to support new technologies and products created with additive manufacturing the formal term for 3D printing4 This technology has not only been approved but is being used by the FDA5 3D printing has become so prevalent that is it now being used in medical facilities throughout the US as well as in other countries6 3D printing allows physicians to create perfectly reconstructed anatomic models of a patientrsquos internal organs such as the liver lung prostate spine heart and even coronary arteries With 3D printed models surgeons are prepared well in advance of stepping into the operating theatre this permits surgeons to spend less time in surgery which greatly reduces the risk of complications speeds recovery and saves both time and money

III Use of 3D Printed Models in TrialIn a recent case an issue arose regarding a plaintiff who had a pre-existing condition known as Dif-

fuse Idiopathic Skeletal Hyperostosis or DISH DISH is the proliferation of bone at sites of ligamentous attach-ment to the spine involving at least four contiguous vertebral bodies Grossly DISH looks like candle wax dripping down the anterior aspect of the spine For jurors the candle wax effect is very difficult to envision on 2D CT images however once the CT images are reconstructed through the use of 3D software the ability to appreciate and understand the nature and extent of the disease is much easier to recognize The 3D images can then be modeled via a 3D printer creating a duplicate of the Plaintiff rsquos spine7 This model can then be introduced into evidence for the jurors not only to see but to actually hold in their hands enabling them to readily appreciate the ldquocandle wax drippingrdquo effect that the ligamentous ossification creates It further assists the juror in understanding why a person with DISH would be more susceptible to incurring a spinal fracture from very minor trauma and forces Below are examples of this process

A B C

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp7

Picture A Sagittal slice from a 2D CT scan Note the white bone proliferation along the anterior aspect of the lower thoracic spine indicative of DISH

Picture B Coronal 3D reconstructed image of the CT scan Note the candle wax effect along the right anterior (screen left) aspect of the spine

Picture C Photograph of the 3D model of the Plaintiff rsquos spine created using a 3D printer Note that the candle wax effect is readily apparent The model was of course life size

IV ConclusionThe use of radiological images in conjunction with 3D software and printing can be used to create

physical models that will assist attorneys and experts in explaining complex injuries and medical issues to the triers of fact Provided that the attorney lays a proper foundation for the evidence and in light of the fact that the 3D software and 3D printing technology are widely accepted and used by the medical community models create in this manner should be readily admissible

V Appendix A 3-D Printing Facilities by StateAlabama Swigro 1500 Pumphrey Avenue Auburn Alabama 36830 334-329-5353 httpwwwswigrocom

Prototyping Solutions 2076 Valleydale Terrace Birmingham AL 35244 888-220-6293 | Fax 205-987-7460 httpprototypingsolutionscom

Alaska Alaska Printerrsquos Supply 907 E Dowling Rd Suite 30 Anchorage AK 99518 907-563-7060 httpalaskaprinterssupplycomindexhtml

Arizona Stax3d Gilbert Business Center 1497 E Baseline Rd Ste 100-101 Gilbert AZ 85233 602-595-3155 httpstax3dcom

Stratasys 75 W Baseline Rd Ste 49 Gilbert AZ 85233

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp7

Picture A Sagittal slice from a 2D CT scan Note the white bone proliferation along the anterior aspect of the lower thoracic spine indicative of DISH

Picture B Coronal 3D reconstructed image of the CT scan Note the candle wax effect along the right anterior (screen left) aspect of the spine

Picture C Photograph of the 3D model of the Plaintiff rsquos spine created using a 3D printer Note that the candle wax effect is readily apparent The model was of course life size

IV ConclusionThe use of radiological images in conjunction with 3D software and printing can be used to create

physical models that will assist attorneys and experts in explaining complex injuries and medical issues to the triers of fact Provided that the attorney lays a proper foundation for the evidence and in light of the fact that the 3D software and 3D printing technology are widely accepted and used by the medical community models create in this manner should be readily admissible

V Appendix A 3-D Printing Facilities by StateAlabama Swigro 1500 Pumphrey Avenue Auburn Alabama 36830 334-329-5353 httpwwwswigrocom

Prototyping Solutions 2076 Valleydale Terrace Birmingham AL 35244 888-220-6293 | Fax 205-987-7460 httpprototypingsolutionscom

Alaska Alaska Printerrsquos Supply 907 E Dowling Rd Suite 30 Anchorage AK 99518 907-563-7060 httpalaskaprinterssupplycomindexhtml

Arizona Stax3d Gilbert Business Center 1497 E Baseline Rd Ste 100-101 Gilbert AZ 85233 602-595-3155 httpstax3dcom

Stratasys 75 W Baseline Rd Ste 49 Gilbert AZ 85233

8emspemspProduct LiabilityemspemspFebruary 2017

888-311-1017 480-656-4093 httpswwwstratasysdirectcom

Arkansas Arkandas Graphics Inc 800 South Gaines St Little Rock AR 72201 877-918-4847 Fax 501-376-7353 httpsarkansasgraphicscom

California Hollywood 3D Printing 1071 N Fairfax Ave Los Angeles CA 90046 (323) 645-7640 httpwwwhollywood3dprintingcomthings-made-here-1-1

DeezMaker (657) 333-6253 infodeezmakercom

Morpheus Prototypes LLC 1061 Segovia Circle Placentia CA 92870 (310)781-8208 Fax (714)204-0419 httpwwwmorpheusrpcom

TechShop Inc 300 South 2nd Street San Jose CA 95113 (800) 640-1975 infotechshopcom

Colorado 3d Printing Colorado 6901 West 117th Avenue unit 4 amp unit 8 Broomfield Colorado 80020 (303) 536-5186 (888) 814-6171 http3dprintingcoloradocom

Connecticut Interpro 630 Industrial Park Road Deep River CT 06417 1-888-392-0957 httpsinterpromodelscom

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp9

Oxford Performance Materials 30 South Satellite Road South Windsor CT 06074 860-698-9300 httpwwwoxfordpmcom

Delaware Printed Solid 2850 Ogletown Rd Newark DE 19713 302-439-0098 httpsprintedsolidcom

University of Delaware Information Technologies Newark DE 19716 (302) 831-6000 httpwww1udeledudeptformsit3DPrinting

Florida Forge 3D Printing Studio 1010 East Adams Street Ste 226 Downtown Jacksonville FL 32202 (904) 274-1714

3D Chimera 5246 SW 8th St Ste 204-A Coral Gables Florida 33134 786-701-0700 http3dchimeracom

Georgia Zyci 2030 Will Ross Court Atlanta Georgia 30341 404-334-7064 httpzycicom

3DCAD PRINTER INC 3D PRINTER TECHNOLOGY 3DCAD PRINTER INC 400 Galleria Parkway Suite 1500 Atlanta GA 30339 OFFICE (404) 795-2119 CELL 404-556-8828 httpwww3dcadprintercom

Hawaii 3D Innovations 2800 Woodlawn Dr Suite 101 Honolulu HI 96822

10emspemspProduct LiabilityemspemspFebruary 2017

808-722-8667 https3d-innovationscom

Sam O Hirota Inc 864 South Beretania Street Honolulu Hawaii 96813 808-537-9971 Fax 808-524-6313 infosamhirotacom

Idaho Intermoutain 3D 9225 Chinden Blvd Suite F Boise ID 83714 208-391-5570 httpwwwintermountain3dcom

3 Solutions Design 3653 Rickenbacker St Boise ID 83705 (208) 789-1944 http3solutionsdesigncom

Illinois CIdeas 125 Erick Street Suite A115 Crystal Lake IL 60014 8476391000 FAX 8476391983 httpwwwbuildpartscom

Indiana 3rd Dimension Industrial 3D Printing 7168 Zionsville Road Indianapolis IN 46268 888-266-1837 httpwwwprint3d4ucom

3D Parts Manufacturing LLC 1011 East Saint Clair Street Suite 200 Indianapolis IN 46202 317-860-6941 httpwww3dpartsmfgcom

Iowa Cedar Rapids Reproductions Inc Corporate Offices Rapids Reproductions Inc 6015 Huntington Ct NE Cedar Rapids IA 52402 319-364-2473

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp11

Fax 319-364-2645 httprapidsreprocom

Invent-A-Part Inc 1278 N 750 W 300 Springville UT 84663 800-479-4330 Fax 801-692-9142 httpwwwinventapartcom

Kansas Rapid Processing Solutions Inc 1367 S Anna St Wichita KS 67209 (316) 265-2001 Fax (316) 265-2002 | httpwwwrapidpsicom

Kentucky Art Lab 250 Simpson Avenue 110 Lexington Kentucky 40503 859-903-5857 artlabkygmailcom

3Space 1800 Cobalt Drive Louisville KY 40299 (502) 855-7222 http3spaceus

Louisiana Innovative Digital Manufacturing of Louisiana 720 Williams Blvd Kenner Louisiana 70062 (504)464-5577 infoidmoflacom

LA 3D 847 Galvez St Ste 101-C Mandeville LA 70448 (985) 778-0760 infola-3dcom

Maine L amp K Manufacturing First 3D-Printing Service Bureau in Maine 20 Godfrey Dr Orono ME 04473

12emspemspProduct LiabilityemspemspFebruary 2017

(207) 286-5306 akatonlkmanufacturingcom

Central Maine Community College 1250 Turner Street Auburn Maine 04210 207-755-5282 httpswwwcmcceduccs3DPrintingServicesaspxWE7r3WczXcs

Maryland 3D Print Factory 11 South Street Hancock Maryland 21750 301-491-4002 httpwww3-dprintfactorycomindexphp

Massachusetts 3D Printsmith LLC 24 Denby Rd Suite 211 Allston MA 02134 617 987 8777 sean3dprintsmithcom

BarnStorm Studio LLC 644 Newton Street South Hadley MA 01075 infobarnstormstudiocom 413-210-1698

Michigan Advanced Prototyping Inc 2269 Star Court Rochester Hills MI 48309 248-853-8256 Fax 248-853-8263 httpwwwrpquotecomindexphp

Axis Lab 3D 4291 Lake Mi Drive NW Grand Rapids Michigan (616) 430-3950 axislab3dgmailcom

Minnesota 3D Printing Ally 9963 Valley View Rd Eden Prairie MN 55344 (612) 285-3221 info3DprintingAllycom

httpwww3dprintingallycomindexhtml

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp13

Wellstronics3D LLC 2043 68th Street East Inver Grove Heights MN 55077 763-458-1931 infowellstronics3dcom httpwwwwellstronics3dcomdefaultaspx

3D Printing Minnesota 108 6th Avenue S Princeton MN 55371 763-389-4060 httpwww3dprintingminnesotaus

Mississippi Polymer Institute 46 Shelby Thames Drive Hattiesburg MS 39402 601-266-4607 infothepolymerinstitutecom

Missouri EngagED Printing 636-856-3380 makeengag3dprintingcom httpwwwengag3dprintingcom

Think a Little Bigger 4041 Forest Park Ave Suite 139 St Louis MO 63109 USA mattroggenthinkalittlebiggercom

Montana 3D Printing Color 5069 Highway 35 Kalispell Montana 59901 (855) 860-4700 httpwww3dprintingcolorcom

Montana 3D Printing 126 South Main St Joliet MT 59041 406-591-7224 infoprint3dmtcom httpsprint3dmtcomindexphp

Nebraska Kul3d 11625 I Street Omaha NE 68137 402-333-1661

14emspemspProduct LiabilityemspemspFebruary 2017

3Dsympatecoinccom httpwwwkul3dcom

Lincoln Machine 6401 Cornhusker Hwy Lincoln NE 68507 402-434-9140 httpwwwlincolnmachinecomindexhtml

Nevada 3D Print Zone 1400 Greg St 301 Sparks NV 89431 775-355-3244 http3dprintzoneus

Conception 1095 Spice Islands Drive Suite 100 Sparks NV 89431 775-339-1665 httpconceptionprotocomindexhtml

New Hampshire Solidscape Inc 316 Daniel Webster Hwy Merrimack NH 03054 603-429-9700 httpwwwsolid-scapecom

Form 3D Solutions amp Manufacturing LLC 32 Crosby Road Unit 1 Dover NH 03820 603-534-2074 httpform3dscom

New Jersey Cimquest Headquarters 3434 Route 22 West Suite 130 Branchburg NJ 08876 866-277-8778 httpwwwcimquest-inccom

OneSource Imaging Solutions Inc 535 NJ-38 123 Cherry Hill NJ 08002 800-894-2674 httpswwwosisitcom

New Mexico Optomec 3911 Singer NE

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp15

Albuquerque NM 87109 (505) 761-8250 httpwwwoptomeccom

3D Proven Systems 2121 Claremont Ave Albuquerque NM 87107 800-376-6203 httpwww3dprovensystemscom

New York PrintAWorld 394 McGuinness Blvd Greenpoint NY 11222 929-213-9604 httpwwwprtwdcom

3D Brooklyn 385 Troutman Street Studio 303 Brooklyn New York 11237 347-688-5203 httpwww3dbrooklyncom

North Carolina Fusion3 Design LLC 2700 Liberty Road Greensboro NC 27406 877-452-0010 httpswwwfusion3designcom

TouchStone 3D 1773 NW Maynard Rd Cary NC 27513 919-535-9895 httptouchstone3dcom

North Dakota Fargo 3D Printing 3041 12 Main Avenue Fargo ND 58103 866-326-3363 httpwwwfargo3dprintingcom

Ohio The Technology House 30555 Solon Industrial Parkway Solon OH 44139 440-248-3025 httpwwwtthcom

16emspemspProduct LiabilityemspemspFebruary 2017

Bastech Inc 9233 North Dixie Dr Dayton OH 45414 937-890-9292 salesbastechcom httpwwwbastechcom

Tangible Solutions 2555 University Boulevard Suite 100 Fairborn OH 45324 937-912-4603 httptangiblesolutions3dcom

Oklahoma Professional Image 3D 12437 E 60th St Tulsa OK 74146 800-722-8550 Pro3drpcalvertcocom

Standley Systems 26 E Main St Oklahoma City OK 73104 405-224-0819 httpwwwstandleyscom

Oregon Rapidmade Inc 2828 SW Kelly Avenue Suite B Portland OR 97201 503-943-2781 httpwwwrapidmadecom

InHaus Fabrication 275 W 8th Ave Eugene Or 541-603-9046 httpinhausfabricationcomindexhtml

Pennsylvania 3D Printing amp Copy Center Inc 1296 Adams Road Suite 150 Bensalem PA 19020 215-968-7900 Fax 215-968-1770 httpwww3d-printingcom

Solid Technologies 650 Sentry Parkway Blue Bell PA 19422

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp17

888-762-8441 httpsldtechcom

Rhode Island R amp D Technologies 70 Romano Vineyard Way Suite 114 North Kingstown RI 855-280-6477 httpswwwrnd-techcom

South Carolina ZVerse 1601 Shop Rd Suite K Columbia South Carolina 29201 803-764-0353 httpzversecom

TPM 1003 Laurens Road Greenville SC 29607 800-922-1145 httpwwwtpmcom

South Dakota Elite Business Systems 700 East 41st Street Sioux Falls SD 57105 605-332-7248 httpwwwelitebusinesssystemscomindexhtml

Tennessee NovaCopy Chattanooga 1936 Central Ave Chattanooga TN 37408 423-305-7799 httpsnovacopy3dcom

Texas Novacentrix 400 Parker Dr Suite 1110 Austin TX 78728 5124919500 httpwwwnovacentrixcom

PartSnap 2474 Houston St Grand Prairie TX 75050 214-449-1455 httpwwwpartsnapcom

18emspemspProduct LiabilityemspemspFebruary 2017

Biodynamic Research Corporation 5711 University Heights Blvd Suite 107 San Antonio TX 78249 210-691-0281 Fax 210-691-8823 infoBRConlinecom

Utah White Clouds 3D Printing 766 South Depot Drive Suite 8 Ogden UT 84404 385-206-8700 httpswwwwhitecloudscom

Virginia 3D CentralVA 1308 West Main Street Richmond VA 23220 804-254-2933 httpwww3dcentralvacom

Old World Labs A Hampton Roads Virginia Based Company 800-282-0386 httpwwwoldworldlabscomcontact-old-world-labs

Washington 3D Composites 5917 195th St NE Arlington WA 98223 12021 127th Ave NE Lake Stevens WA 98258 360-657-3330 httppro3dcompositescom

Studio Fathom 4302 Stone Way North Seattle WA 98103 (206) 582-1062 httpstudiofathomcom

Wisconsin Rapid 3D 217 E Pacific St Appleton WI 54911 920-815-3583 httpwwwrapid3dnet

Midwest Prototyping 10949 Blackhawk Drive

Creation of Evidentiary Models from Radiological ImagingemspemspDay and Wintermanemspemsp19

Blue Mounds WI 53517 608-437-1400 httpswwwmidwestprotocom

Wyoming Advanced Prototyping Inc 2269 Star Court Rochester Hills MI 48309 888-764-8999 httpwwwrpquotecomindexphp

Endnotes1 French which translates into ldquoIt is not what you do itrsquos the way you do itrdquo 2 For an excellent discussion on the admissibility of computer generated exhibits see Campbell Karen L et al ldquoAvatar

in the Courtroom Is 3D Technology Ready for Primetimerdquo Vol 63 Number 4 FDCC Quarterly (2013) The authors dis-cuss the difference between computer generated animations and simulations used for demonstrative purposes verses substantive evidence The article also contains a survey of appellate decisions in each of the 50 states which held that computer generated evidence was admissible

3 Understanding Media The Extensions of Man by Marshall McLuhan where he famously coined the phrase ldquoThe Medium is the Messagerdquo meaning that the form of the medium embeds itself in any message it would transmit or convey creating a symbiotic relationship by which the medium influences how the message is perceived Psycholo-gist would argue that there is a subliminal psychologically positive effect on jurors when they are presented with evi-dence that involves sophisticated communication methods and techniques

4 US Food amp Drug Administration FDA Voice August 15 2013 httpblogsfdagovfdavoiceindexphp201308fda-goes-3-d

5 See for example FDA News Release dated Feb 11 2011 approving 3D mammography imaging system at httpwwwfdagovNewsEventsNewsroomPressAnnouncementsucm243072htm

6 A few examples of how quickly 3D printing has been implemented around the world include at various medical facili-ties include Mount Sinai Health System NY Stanford University 3D and Quantitative Imaging Laboratory UCSF Cedar Sinai Medical Center Los Angeles CA Texas Childrenrsquos Hospital OSF HealthCare - Chicago Ill Southampton General Hospital Great Britain Queen Alexandria Hospital Portsmouth England Miamirsquos Nicklaus Childrenrsquos Hospi-tal and Dubai Health Authority Hospitals

7 It can be difficult to find a 3D printer that can create a model the size of a human spine In the example shown we had to make two models one of the upper spine and one of the lower spine However smaller anatomical body parts should not be difficult to create

• Creation of Evidentiary Models from Radiological Imaging 3d Software and 3d Printing
• • Cynthia M Day MD and Craig L Winterman
  • Table of Contents
  • • IIntroduction
    • IIAdvances in Radiology Medical Software and Printing
    • IIIUse of 3D Printed Models in Trial
    • IVConclusion
    • VAppendix A 3-D Printing Facilities by State
    • Endnotes