Precision Health Care Driven by 3D Systems’ Medical 3D Printing

In a world of exploding smartphones, fictional augmented reality (AR) glasses and government spying, one might wonder whether or not new technology really advances the human predicament or if it just allows a few executives to score some extra dough here and there. Occasionally, however, a new technology will come along and contribute dramatically to the quality of life for us humans.

ENGINEERING.com was given an exclusive tour of 3D Systems' Healthcare Technology Center in Littleton, Color. (Image courtesy of 3D Systems.)

This year, 3D Systems opened the doors to a brand new facility just outside of Denver, Colo. and, from a visit to the site, it became apparent that 3D printing, when used for medical purposes, really falls into that latter category. At the new Healthcare Technology Center, 3D Systems is actually doing whatever it can to improve life on Earth.

3D Printing in Medicine

According to Gartner, healthcare is the industry first primed to be disrupted by the current evolution of 3D printing technology. This is because, at the technology's current state, it's already able to advance medicine greatly. By transforming a patient’s CT scan into a 3D model, it's possible to diagnose an illness, rehearse a surgery, create surgical guides or even 3D print patient-specific implants.

These things are already happening and are already changing the lives of people worldwide. At the Healthcare Technology Center, the team has been performing these activities for over 15 years, resulting in a highly trained staff that works closely with doctors and surgeons to improve the lives of patients.

Prior to its acquisition in 2014, the Colorado group was known as Medical Modeling. Along with Simbionix and LayerWise, which were also bought by 3D Systems in 2014, it represents a key component of the 3D printing firm’s Healthcare Division. Now, the site performs engineering, consultation and additive manufacturing as it relates to patient-specific medicine.

From DICOM to Print

Creating a patient-specific print usually starts with Digital Imaging and Communication in Medicine (DICOM) data, a patient's CT scan as represented by some 200 individual grayscale slices. Experts at 3D Systems compile this data and filter out the information required to make a 3D model. Selecting the light areas on every layer, for instance, it's possible to isolate just the bone within a scan and create a 3D model of a patient’s skull. Once the model is cleaned up and refined, this can be exported as a standard, 3D printable STL file for further work.

Using patient CT scans, 3D Systems engineers are able to work with doctors to create custom implants and surgical devices. (Image courtesy of 3D Systems.)

3D Systems is aiming to partially automate and streamline this process with its own proprietary software, DICOM to Print. Though still in development, the tool will make it possible for medical professionals to create 3D printable models from CT data without relying as heavily on trained engineers, such as those at the Healthcare Technology Center.

A patient-specific, full-color model can be colorcoded to indicate patient anatomy, including treatment areas, such as the white calcification of the heart above. (Image courtesy of 3D Systems.)

As a 3D model alone, this can already be an invaluable tool for doctors. 3D printed in full color gypsum with 3D Systems' ColorJet Printing, the model can make for the perfect teaching aid to educate patients about a given health condition. 3D printed in translucent and pink plastic with stereolithography (SLA), the object can highlight that condition more clearly. Or, when printed in multiple materials with MultiJet Printing, it's possible to even simulate the actual tissue of an organ to rehearse a surgery.

This SLA print of a spine uses two colors, pink to represent where a medical device or guide may be placed and white to represent the bone itself.

However, with this 3D model, 3D Systems can also help surgeons worldwide to create medical devices and even plan procedures. For this, the file heads to the facility’s engineers, who actually work hand in hand with doctors to execute treatment plans—a service that 3D Systems has branded as Virtual Surgical Planning (VSP).

At the site, it was possible to overhear a biomedical engineer teleconference with a surgeon. In a demonstration case presented to us, one engineer explained that he could share his or her screen with the doctor in order to design and place the proper surgical guides for resectioning a skull to alleviate pressure caused by congenital cranial abnormalities. As the 3D Systems employee moved a guide on the screen, a doctor on the other end of the phone might ask for it to be rotated or moved. This process would continue until the device was complete.

3D-printed trabecular hip implant with porous structure for bone growth. (Image courtesy of 3D Systems.)

Through VSP, 3D Systems can aid in the creation of surgical guides, medical models, implants and instruments, all of which are patient specific, but the company also works with medical device manufacturers to mass produce products. Using 3D Systems' ProX DMP 320 3D printer, as well as some Arcam electron beam melting machines, the facility manufactures batches of implants that are not tailored to specific patients.

Instead, 3D printing is leveraged for its ability to fabricate implants with unique geometries that are strength-to-weight optimized and which rely on porous structures for their demonstrated osteoregenerative properties. Through the small holes throughout 3D-printed bone implants, such as a hip joint, new bone tissue is able to grow and incorporate these devices more adequately into the body.

All of these activities pair well with 3D Systems simulation products, which are made possible by the acquisition of Simbionix. With the largest suite of medical simulation tools, 3D Systems Healthcare Division is able to train medical professionals on various procedures, from endoscopies and ultrasounds to angiograms and laparoscopic surgeries. The simulation modules vary in terms of realism, but can incorporate tools such as haptic controllers and 3D displays to provide an unprecedented level of surgical uncanniness.

Accurate haptic controllers make it possible to actually feel the movement of a device within the body, enabling flight simulator-like training for medical professionals. (Image courtesy of 3D Systems.)

The new PROcedure suite even makes it possible to import a patient’s own DICOM data in order to rehearse actual operations. While only available for the angiogram module at present, this feature will be available with a growing number of the modules in the future.

Twins

Altogether, the engineers at the Healthcare Technology Center were acting as both medical technicians and designers, creating parts such as custom implants and surgical guides that could ultimately save a patient’s life. While the facility presented many such instances, from full facial reconstruction to infant heart surgery, one of the most recent and remarkable examples was that of the McDonald twins.

The McDonald twins, who were born conjoined at the head. (Image courtesy of Children’s Hospital at Montefiore.)

In October of this year, doctors at Children’s Hospital at Montefiore in Bronx, N.Y., performed the fourth in a previously unthinkable series of separation surgeries on a pair of 13-month-old twin boys who were joined at the skull. 3D Systems Vice President of Medical Devices Katie Weimer, who was present during the surgery, relayed the tale of how various types of imaging data were used to reconstruct detailed models of the infants’ heads. In addition to using the boys’ skulls, the team was able to model their vasculature and brain matter by 3D printing a variety of models from which they could more effectively plan the surgery.

A 3D-printed SLA model of the McDonald twins’ skulls, with pink representing the cluster of veins that almost proved too difficult to separate. (Image courtesy of 3D Systems.)

This provided Dr. James Goodrich, the surgeon leading the procedure, to anticipate any issues that might arise during the procedure, including a cluster of veins that the boys shared. After rehearsal and planning, the McDonald twins underwent the final separation surgery. Upon successful completion of the operation, the boys were placed in the critical care unit for recovery.

The Bigger Picture

Gartner predicts that, “[b]y 2019, 10 percent of people in the developed world will be living with 3D-printed items that are on or in their bodies” and that “3D printing will be a critical tool in over 35 percent of surgical procedures requiring prosthetic and implant devices (including synthetic organs) placed inside and around the body.”

It’s difficult to determine the accuracy of that prediction, but evidence from the Healthcare Technology Center demonstrates that we may already be on that path. According to Kevin McAlea, executive vice president and chief operating officer of healthcare for 3D Systems, the facility has already produced over 500,000 devices and participated in over 75,000 medical cases.

As it stands, some of the items being produced at the facility are new iterations of existing medical products, such as the mass produced hip implants mentioned above. McAlea explained, however, that this is just the beginning. In addition to seeing 3D printers actually installed in hospitals, McAlea anticipates that device manufacturers will begin redesigning devices for 3D printing, rather than just using the technology to produce standard devices. This means further weight reduction, new, complex geometries, even entirely new devices that have not yet been imagined.

For 3D Systems, the Healthcare Division will become part of the larger trend of “precision healthcare,” in which patients receive personally tailored care through new technologies. For the patients, it means that advanced technology is being put to good use.