3D Printing: The Next Medical Miracle?

One of the rising stars of the show “Grey’s Anatomy” isn’t any of the Emmy-nominated actors or McDreamy, the doc with the flowing hair. Instead, it’s the 3D printing technology that has been used by the series’ surgical teams over the last few seasons for such procedures as creating an infant portal vein and building customized heart and liver surgical planning models.

Grey Sloane Memorial might be a fictional hospital setting, but its use of 3D printing is the real deal. Hospitals, private physicians, dental practitioners, and researchers across the globe are both experimenting and using 3D printing and other 3D technologies to solve tough medical problems, turning what was once considered sci-fi into routine procedures now featured on primetime television.

3D printing got its start in the medical field nearly a decade ago, initially tapped in the dental space for building crowns, bridges, and a range of orthodontic appliances. Over time and with improvements, the technology started taking hold in areas that require custom design and quicker turnaround than traditional methods, including the production of hearing aid shells and the clear teeth aligners used in place of metal braces.

With the cost of 3D print technology continuing to decline and thanks to a bonanza of activity on the materials front, the technology has taken off in a number of new directions. 3D printers are routinely being used to design and build generic and custom orthopedic implants; create anatomically correct, complex models for training and surgical planning; and develop custom and cost-effective surgical guides. More recently, there have been major breakthroughs using 3D printing to produce patient-specific prosthetics for extremities, exoskeletons, cranio-maxillofacial surgeries, and full facial reconstructions. On top of that, bioprinting is in the early research stage, with efforts underway to explore how to harness 3D printing capabilities to grow live tissue and eventually, human organs. (See “Bioprinting is the New Frontier.”)

Customization and Costs Savings

“There are inherent benefits to 3D printing technology when you are creating one-off or customized parts,” says Todd Pietila, business development manager for Materialise, a provider of 3D printing software and services. “That has obvious benefits when applied to the medical field because every patient has a slightly different anatomy and every procedure can benefit from a customized approach. The technology is so powerful in the health care industry because it allows for personalized treatment that is tailored to the patient in order to achieve the best outcomes.”

The continuing focus on rising health care costs is one reason why there is so much interest among the medical community in 3D printing technology. 3D printing offers a cost-effective way to produce personalized medical devices, especially in developing countries, where funding and resources for health care are scarce. While it’s still early for the more innovative 3D printing medical applications, experts see huge market potential as the technology becomes more accessible, prices come down and early pioneers share success stories that get the broader health care community on board.

“We’re starting to see 3D printing hit critical mass in the field as some of these experts apply the technology in exciting ways and get their peer groups to take notice,” says Scott Dunham, senior analyst at SmarTech Markets Publishing, a research company focused specifically on 3D printing. SmarTech Markets Publishing is projecting the total market for 3D printing in the medical field (including software, hardware and materials) to skyrocket from around $268 million last year to nearly $1.3 billion by 2024.

It’s not just 3D printing technology that’s fueling the growth, Dunham notes. The convergence of existing medical imaging, 3D design software and 3D printing is creating a new category of medical solutions where the sum is greater than any of its parts, Dunham says.

“Medical imaging technology, 3D design software and 3D printing technology have all been around for a long time, but now people are figuring out the best ways to use them all together, and that is amazingly powerful for medical applications,” Dunham says.

Creating A Digital Thread

Melding those core technologies is the key to 3D Systems’ strategy for the medical market, according to Cathy Lewis, executive vice president and chief marketing officer for the firm. In addition to its wide-ranging line of 3D printers, the company has assembled many core capabilities through acquisition: virtual surgical planning and tactile medical imaging technology from Medical Modeling; solutions for converting CT scans into full-color 3D models for export to 3D printers from Bespoke Modeling; optical imaging technology from VIDAR Systems Corp.; virtual reality surgical simulation and training from Simbionix; and direct metal 3D printing and manufacturing services from LayerWise.

“We’re providing a beginning-to-end digital thread that allows physicians to learn, plan and provide higher quality procedures,” Lewis says. “It’s all about having all of the tools in place to have better patient outcomes.”

3D Systems’ SLA (stereolithography apparatus) production printers are being tapped to create detailed medical models along with the inner ear hearing aids and invisible teeth aligners, while the SLS (selective laser sintering) printers are employed by health care providers and practitioners to create fixtures and surgical guides. The company’s LayerWise service and its line of ProX high-capacity direct metal 3D printers have also garnered a lot of traction in the medical market. They are used to create final implantable devices like knee replacements or dental appliances, Lewis says.

In one of the more recent and notable developments in this space, 3D Systems teamed up with Rita Leibinger Medical, a manufacturer of veterinary products, to design and 3D fabricate the patent-pending TTA RAPID, a titanium implant used in cruciate ligament repair in the hind legs of dogs. It promises faster recovery and less risk of infection and has been used on more than 10,000 dogs to date.

Stratasys’ 3D printers are also behind innovative efforts in medical 3D printing. The company’s line of Object Connex 3D printers has made significant inroads in this segment due to their ability to print in multi-materials and multiple colors at the same time, notes Scott Radar, general manager, Medical Solutions at Stratasys.

Radar says 3D printing technologies are having an impact on the medical field in three ways. For quite some time now, he says 3D printers have improved the design-to-manufacturing process, providing efficiencies and cost savings in how medical device companies make production-based jigs, castings and molds. There are also a lot of possibilities in leveraging 3D printing technology as a new production capability — whether that means printing products more locally or novel use cases like tissue printing, Radar explains. However, the area getting the most attention is using 3D printing to enhance the quality of patient care, which could include anything from realistic surgical planning models to the new generation of custom prosthetics.

The sheer variety of 3D printing technologies and new material choices are what is setting the stage for 3D medical printing to be a reality. For example, Stratasys currently offers over 1,000 different materials for 3D printers, including ULTEM 1010, an FDM (Fused Deposition Modeling) material with a certification for human contact, Radar says. As part of Materialise’s HeartPrint service, physicians can now print a combination of flexible and rigid materials in one model to create calcifications in anatomy such as vessels or valves.

“HeartPrint models are quite realistic in terms of what you would find with atrial or cardiac tissue, so a surgeon can cut into it and bend a vessel out of the way as they would in the operating room,” says Materialise’s Pietila. “By better understanding exactly what approach they’ll take, it saves time in the OR and it’s less stressful for both the surgeon and the patient.”

Real Life Medical Miracles

The anatomically correct, 3D printed surgical models are gaining traction across a range of surgical disciplines. At Miami Cardiac & Vascular Institute, doctors are using The PROcedure Rehearsal Studio from 3D Systems to create customized models to help them simulate, analyze and evaluate preoperative endovascular surgical treatment options for each patient. “We actually have patient-specific information and navigate or do a drive-through rehearsal doing a procedure before we actually do the procedure on the patient,” said Barry Katzen, M.D., founder and chief medical executive at the institute, in a video interview. “By doing this, everyone knows what to do and when they’re going to do it … which reduces the potential of error and improves the patient outcome.”

At the Kobe University Graduate School of Medicine, Stratasys multi-material 3D printers are being used to aid in medical training and surgical preparation. Instead of the traditional approach where surgeons plan operations based on CT and MRI images, the students are using full-sized, 3D-printed color models of patient organs, which can help uncover hidden tissues and blood vessels that might be blocked by larger organs in 2D scans, says Dr. Maki Sugimoto, associate professor, in a case study.

Beyond medical models, there has been a lot of progress in 3D-printed prosthetics, particularly lower-cost technologies that can help patients in developing countries. E-NABLE, for example, is a global network of volunteers that is leveraging 3D printing technologies to make hands and fingers for disabled children around the globe.

CBM Canada, a nonprofit disability and development organization, is working with the University of Toronto’s Critical Making Lab to develop a low-cost process for scanning, modeling, fabricating, and assembling lower-leg prosthetics for use in developing countries, says Mitchell Wilkie, director, International Programs for CBM Canada. The process, to be tested soon at the Comprehensive Rehabilitation Services for Uganda (CoRSU) hospital, pairs a MakerBot Z18 3D printer, scanning technology, and specialized software to allow practitioners in developing countries to inexpensively create the custom socket that is the critical part of a prosthetic in a matter of hours.

Still in the infancy stage is the work being done to apply 3D technologies, including 3D printing, to facial reconstruction and face transplants. Dr. Frank Rybicki, a radiologist and director of Brigham and Women’s Hospital’s Applied Imaging Science Lab, has a study underway exploring the use of CT and 3D printing technology to recreate life-size models of patient skulls to assist in face transplantation surgery.

While this team is exploring the merits of the technology for surgical preparation, a team of researchers at Texas A&M University Baylor College of Dentistry is employing software to design facial prosthetics for patients suffering massive trauma. The team, using 3D Systems’ Medical Modeling software, among other technologies, was able to create a life-like facial prosthetic for a patient who was not a candidate for transplant surgery. Using CT scans taken prior and post trauma, they pinpointed anchor spots for a prosthetic that was 3D printed and painted to approximate the patient’s pre-trauma face.

It’s this intersection of 3D printing and other digital 3D technologies that is paving the way for these medical miracles. “This is the flexibility that designers, engineers and clinicians at the intersection of 3D printing have been looking for,” says Stratasys’ Radar. “The rapidly expanding universe of true engineering-grade materials and the enhanced functionality of printers to make structural products is encouraging greater use and opening doors for greater creativity.”

More Info:

• 3D Systems
• Brigham and Women’s Hospital
• CBM Canada
• E-NABLE
• LayerWise
• Materialise
• Medical Modeling
• Organovo
• Rita Leibinger Medical
• Simbionix
• SmarTech Markets Publishing
• Stratasys
• Texas A&M
• VIDAR Systems Corp.