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3-D Images Help Plastic Surgeons Repair Injuries

August 16, 1992|SANDRA BRETTING | SPECIAL TO THE TIMES

LAKEWOOD — Model Christina Mrotzek had posed for hundreds of photographs by the time she was 19. Raven-haired and lithe, the Lakewood teen-ager modeled everything from sportswear to high fashion.

But on July 15, Mrotzek's face appeared on perhaps the most important photograph of her life: a three-dimensional computer image that allowed a plastic surgeon to see underneath her skin and soft tissue to the crushed bones below.

Five days earlier Mrotzek was driving home from a party when she turned a corner and slammed into a parked flat-bed truck at about 50 m.p.h. Her car slid beneath the truck, and the edge of the bed smashed through the windshield, crushing the right side of her face. Her right cheekbone and eye socket were shattered, and her nose and left cheekbone were fractured.

In an instant, the young woman who had wanted to model since the age of 6 lay unconscious, her face bloated and bleeding.

"Christina was so sure she was going to be a famous model," said her mother, Arlene Mrotzek. "She used to practice in front of the mirror, even when she was a little girl. She always knew she was going to make it."

To reconstruct Christina Mrotzek's face, Long Beach plastic surgeon Gary Solomon relied on a technology first used in movie production.

In 1979, filmmaker George Lucas recruited staff from the New York Institute of Technology to develop realistic computer graphics for his films.

The result was Pixar, a form of three-dimensional imaging that appeared in a number of movies, including "Return of the Jedi." The holographic image of the Death Star that Harrison Ford and other Rebel pilots gaze into is produced by Pixar. In "Star Trek II: The Wrath of Khan," William Shatner views a 3-D Pixar image of a planet supposedly hit by the Genesis bomb.

Today, 3-D imaging is used not only in movies and medicine, but also in science and art. The technology takes information from diagnostic scans--such as satellite maps or medical CT (computer tomography) scans--then stacks the information, giving it three-dimensional thickness and depth.

The information from Mrotzek's CT scan was fed into a 3-D computer that allowed physicians to see the underlying structures.

"When we have a complex injury, I think we get more information from looking at a three-dimensional image as opposed to a two-dimensional one," Solomon said.

"I've been trained to read two-dimensional CT scans, but it requires me to make an intellectual change in my mind to take a two-dimensional image to three dimensions. With this, you can look at the image and say, 'Well, this is obviously the problem.' "

The problem for Solomon was that Mrotzek's facial bones were fragmented. The 3-D images gave him a clearer view before going into surgery.

"Basically, it allows me to plan out my approach before operating," Solomon said. "When you're doing a surgery, you can't always see everything. Sometimes I'll have a question during surgery, and I'll look back at the (3-D) X-rays."

Three-dimensional imaging is not new to medicine--it came into widespread use by surgeons in about 1988; what is new is the ability to bring flat sheets of the 3-D images into the operating room. Instead of looking at dozens of CT scans, now surgeons can view three or four sheets of 3-D film.

Three-dimensional imaging also allows physicians to remove unwanted images, say the top of the skull, to expose an overhead view of the facial bones underneath. The computer image can be rotated in any direction, allowing doctors to see a full model of the patient's head or other anatomy, almost as if it could be held in the palm of a hand.

Dr. Bernie H.K. Huang, vice chairman of the Department of Radiological Sciences at UCLA, participated in a nationwide research project in 1987 to see just how many uses physicians could find for 3-D imaging.

"When we started, we really had no goal, other than to see how far we could go," Huang said. "Now, that research is done. I think one of the most valuable ways we can use 3-D is to identify how tumors look, their relative position. Radiation therapists can locate a tumor and pinpoint where to deliver the X-ray dosage to the right place. I think they will be the ones to use it more and more."

Added Solomon, "Like any form of new technology, at first there was a tremendous enthusiasm for it. It was a panacea, and then, after a while, it sort of settled into its own. I think for the stuff that we're doing now--for craniofacial surgery, . . . for brain tumor localization--it will be the state of the art." The procedure, which is generally covered by insurance, costs $500 to $3,000 depending on how many images are needed.

Though today's physicians are almost blase about 3-D imaging, Mrotzek's mother, Arlene, is awed by its capabilities.

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