New Technology for Young Hearts

As a young pediatric cardiologist who specializes in imaging, Kanwal M. Farooqi, MD, has the utmost respect for her mentors. A 2007 graduateof New York Medical College, Dr. Farooqi spent six years training in pediatrics and pediatric cardiology at The Albert Einstein College of Medicine, Children’s Hospital at Montefiore. Then she spent a year at Mount Sinai Medical Center completing a non-invasive imaging fellowship learning about imaging technologies including cardiac magnetic resonance (MRI) and the “mainstay of diagnostic imaging in pediatric cardiology,” 2 dimensional (2D) echocardiography. “I have had wonderful mentors, some of the greatest out there,” she insists.

Typically at most hospital centers with a congenital heart surgical program, a conference to discuss patients is held weekly. “The imaging specialist will try to communicate to the audience of cardiologists, surgeons and other imagers what the anatomical relationships are and what the issues during surgery may be,” Farooqi explains. “In pediatric cardiology, we utilize echocardiography and ‘sweeps’ of the heart, producing a series of 2D images to get a sense of the 3D anatomy. This can be tough in a complex patient.”

There is a gap that exists between the 2D images acquired and the 3 dimensional anatomic relationships that “we need to communicate to our audience, including the congenital heart surgeon.” Even the projection of 3D images on a 2D screen is limiting because individuals vary in their ability of “mental rotation.” Not everyone can “infer the spatial relationships.” Farooqi asks, “Can you truly consider this effectively communicating three dimensions? The answer is probably no.”

When she was at Mount Sinai, the congenital heart surgeon suggested that the ability to produce 3D printed models be brought inhouse, if possible. He didn’t want to wait until he was in the operating room to become more familiar with his patients’ anatomy. And previously, a heart model had been created by sending an image dataset to an outside company. So making 3 dimensional models of the heart is exactly what Farooqi set out to do. She relied on free trial versions of software to teach herself how to use cardiac MRI datasets to create virtual models for viewing on a computer. It took months. “We didn’t have a 3D printer so I went to a company who made my first one out of courtesy. It was crude compared to the ones I make now but I was very excited.”

After being awarded the Glorney-Raisbeck Fellowship in cardiovascular disease, a grant from the New York Academy of Medicine, Farooqi spent the following year fine-tuning her techniques. Working with a mentor at Mount Sinai, “We outlined the best technique to make a 3D model using a process called segmentation, basically taking the dataset and highlighting parts of it.” Then, with a grant from the Congenital Heart Disease Coalition in New Jersey, Farooqi was able to buy a refurbished desktop 3D printer, called the Mojo, for the hospital. Most printers are larger, many of them industrial sized. “I love the Mojo because we can recreate fine anatomical details using a desktop printer. Each model is unique…something new that I have created.” The scenario she envisions is “a patient with newly diagnosed congenital heart disease coming in one day and having the physical replica of his or her anatomy in hand in time for discussion at a surgical conference the next day.”

Since July 2015, Farooqi has been an assistant professor in the Department of Pediatrics at Rutgers New Jersey Medical School and she is currently window-shopping for a 3D printer for the medical school. “The potential application of this technology for teaching is great. I’d like to put together a library of congenital heart disease models.”

She once tested the theory that people may not process 2D images presented to them into accurate 3D reconstructions in their minds. Along with a mentor who is now at Stony Brook, Farooqi created clips of 2D cardiac MRI image datasets of patients with complex congenital heart disease and asked a group of physicians to choose the correlating 3D printed models. Could the hearts be correlated to their clips? Not with complete accuracy.

“What is so exciting now are the limitations we are crossing in medical imaging.” Winner of numerous awards and honors, Farooqi has published frequently in peer-reviewed journals and always brings her creativity and curiosity to her work in her mission to make it possible to “touch a heart.” She says, “My chief saw a rendering I made and said, ‘This is the future of imaging.’” ●