Balseiro teachers and Garraham Hospital medical staff are behind this innovative initiative. Nuclear engineer Enzo Alberto Dari, physicist René Cejas Bolecek and Dr. Ignacio Berra share the details.
Physicists and doctors work in a system to plan complex surgeries. Photo: UNCUYO Press
The system for planning complex surgeries with 3D imageses result of the joint of two areas of human knowledge: medicine and physics. Thanks to a group of experts, work is currently being done on the possibility of introducing this technique. The same consists in simulating physiological characteristics and the blood flow behavior of the patients before heart surgery. The initiative is carried out through an interdisciplinary team, which includes Balseiro Institute professionals, the Bariloche Atomic Center and the Garraham Hospital.
It is a proposal -in constant development- used in pediatric hospitals of first level, as is the case of the Boston Children’s Hospital. Ignacio Berra, Garrahan cardiovascular surgeon, witnessed the application of this technique in that North American institution on the occasion of your stay in the United States, and brought the idea to Argentina with the intention to implement and improve it.
For this, he had the collaboration of two teachers from the Balseiro Institute: the nuclear engineer Enzo Alberto Dari and the physicist René Cejas Bolecek, from the Department of Computational Mechanics (MECOM) of the Bariloche Atomic Center (CAB). Three other members of the same group also participate in the project: Mauro Fermín, William Machaca and Mariano Cantero.
Professionals from different areas of human knowledge participate in the elaboration of the system. Image: freepik
“We started a collaboration with Dr. Berra’s group and the Department of Computational Mechanics a little less than two years ago, and it is already giving extremely encouraging results,” said Dari, who serves as Head of MECOM. Until now, the methodology developed has allowed us to assist in the pre-surgical planning of five patients whose surgeries were successfully performed.
The methodology
The Hospital Garrahan of Buenos Aires is a institution specialized in High Complexity Pediatrics where they assist children and adolescents according to their health needs. Some procedures they are very complex and require a multidisciplinary approach.
Within the institution, Ignacio Berra works in pediatric cardiovascular surgeries and heart, lung and kidney transplants and to treat patients with certain cardiovascular conditions, the doctor implemented the technique he observed at Boston Children’s Hospital that allows evaluating different surgical options before performing an operation. Previously, he gave a detail regarding the methodology, through a colloquium that he offered in the Balseiro
The step-by-step procedure
Firstif the makes to the patient a CT or MRIfrom which images are obtained in DICOM format (Digital Imaging and Communications in Medicine). Later one is made 3D reconstruction of your physiology and so you get a three-dimensional model of your anatomy.
“Here we began with the Balseiro and the people from the Hospital to think in a different way, and we began to reconstruct three-dimensional models to see exactly the geometry of the patient. This personalizes the treatment,” said Berra. The initial contact was made with the director of the Institute, Mariano Cantero, who immediately contacted his colleagues from MECOM and Balseiro himself. In addition, the surgeon stated that this technique makes it possible to approximate the physiological conditions of patients “long before the operation, having a mate or a coffee, and thus your head begins to assimilate that geometry.”
The full charla by Ignacio Berra in the Balseiro you can see in this link.
From Bariloche to Buenos Aires
The engineer Enzo Dari and the physicist René Cejas are graduates and professors from the Balseiro Institute and researchers in the Department of Computational Mechanics of the CAB. During the COVID-19 pandemic, collaborated through virtuality with the Berra team to develop the technique of planning complex surgeries from 3D models of the physiology of the patients.
In this regard, Enzo Dari commented that his group’s contribution to the project promoted by the Garrahan team consisted of the development of computational fluid dynamics calculations from the combination of physiological data from patients. “These calculations allow us to represent the hemodynamic behavior in the different surgical options that are being evaluated,” said the engineer and researcher at the National Atomic Energy Commission (CNEA) and the National Council for Scientific and Technical Research (CONICET).
From these simulation results percentage calculations are performed hepatic flow distribution and energy loss that are used as complementary information in pre-surgical planning”, explained René Cejas, Ph.D. in Physics and CNEA researcher at MECOM.
The system seeks to plan complex surgeries through 3D images. Photo: freepik
When asked regarding his experience in simulating the cardiovascular system, Dari stated that he had participated in procedures of this type. While Cejas affirmed that MECOM has been working for years in the area of medical image processing and 3D visualization software development, which allowed them to “integrate these developments with knowledge of computational simulations to apply them in the simulation of the cardiovascular system”.
difficulties and challenges
According to Dari and Cejas, when a project of these characteristics is tackled, numerous challenges such as the application to specific patientsthe interpretation of the images to translate into a physical-mathematical model and the validation of the results obtained, among others. And they clarified that, in addition, their collaboration consists of the numerical simulation of different alternatives to carry out an intervention.
Regarding the reliability of the simulations, the scientists affirmed that even if the numerical tool is not fully “calibrated” or validated, the results it produces can provide comparative information. “The calibration or validation of the computational modeling process in real cases is very difficult and is a current research topic”said Eyebrows.
Likewise, the physicist spoke regarding some difficulties that arise at this stage, which are linked to the complexity of the physiological behavior of the human body and the specificity of each patient and each surgery. And he explained that in the absence of precise data for a particular case, the information can be used comparatively to rule out certain surgical options.
The project has a series of challenges: the specific application to patients, interpretation of the images and validation of the results. Image: freepik
Balance and status of the project
“Lo value of the project is the collaboration of the scientific field with the public health sector tackling a real problem. In our case, the generosity of Dr. Berra and his team was essential in giving us the space to participate and try to understand some of the problems they face daily in the hospital. From this, each one contributes different knowledge and ways of approaching the problem from their specialty”, assured René Cejas, graduate in Physics from the National University of San Luis (2007) and Ph.D. in Physics from the Balseiro Institute (2015).
Regarding the current status of the project, Enzo Dari stated: “At this stage of the collaboration, expert participation is still necessary for the preparation, execution and analysis of the simulations. Once the chain of tools to be used is better adjusted, procedures can be standardized, automated and thinking regarding generating software that is transferable to the medical field, without requiring extensive training for its use”, concluded the nuclear engineer graduated from the careers of Nuclear Engineering (1989) and Doctorate in Nuclear Engineering (1994).
It is important to note that projects like this highlight the importance of joint work between different areas of knowledge and above all, between various sectors such as science and public health to make a concrete contribution to our society.
