The reliability and efficiency of 3D printing technology in clinical practice has been questioned several times by Indian practitioners. Tanmay Shah, Head of Innovations, Imaginarium Life, clears the air and talks about its potential
Tell us about the potential impact of 3D printing technology in clinical practice?
3D Printing finds a number of applications in medicine; to produce patient-specific anatomical models, surgical guides, jigs and fixtures, customised implants and device testing prototypes.
To provide patient specific anatomical models, we at Imaginarium Life use DICOM data (MRI’s and CT scans) and convert them into exact replicas of a patient’s anatomy. This can then be utilised by doctors for diagnosis and pre-operative surgeries. It not only helps a doctor be better prepared, but also helps in avoiding any surprises during the surgery.
Another application extends to surgical guides and customised implants. We work with a variety of biocompatible material that can temporarily, or even permanently, come in contact with internal organs without any hazardous repercussions. A surgical guide is akin to a stencil for a surgery, where it aids the surgeon in making a cut or drilling the bone at very specific angles in a predetermined fashion, so as to make the most precise insertions. A patient-specific implant is exactly what the name suggests — an implant that does not follow the small, medium and large sizes but is customised to fit the shape and size of a patient’s anatomy. As of now, this can only be done for hard tissue i.e. the bones.
The coolest application of 3D printing in the medical segment is definitely orthotics and prosthetics. Because 3D printing helps in mass customisation, we can use it for application such as the hand cast, where instead of an itchy plaster, we can make a airy plaster which also looks fantastic.
Where does India stand in this context?
India is witnessing a gradual adoption of this technology when it comes to healthcare. Imaginarium Life has engaged with a number of doctors and medical institutions in this respect, and the response is mixed. We’ve carried out a number of successful projects for real time cases in medicine, and it’s the younger generation of doctors who we find to be more open and accepting this technology for its numerous benefits. With respect to the long-drawn myths associated for this technology, some doctors tend to follow the age old view of ‘if it ain’t broke, don’t fix it.’ And this leads to only a fraction of them trying their hand at these new techniques. Most laws from the FDA and from the standpoint of the government are made for a high-volume-low-variety approach. Whereas where we come from, it’s a world of medium to low volume and very high variety.
Case study I
Challenge: Congenital Heart Disease (CHD) is a birth defect that brings with it a further complication of Ventricular Septum Defect, where an abnormal opening in the ventricular septum allows purified and impure blood to mix. 2D DICOM images cannot convey the complexity of these cases where an exact picture of the location and size of the opening is needed to decide on the correct course of action. The doctors asked Imaginarium Life to create a model that could be dissected to show the family the exact nature of the problem and decide for them on how the surgery needed to proceed.
Our solution: Imaginarium Life created a digital model along with the virtual patch generation that helped in accurate analysis of the defect. The model outlined the exact shape, size and location of the defect and the 3D geometry made studying the turbulence/ linearity of blood flow with ease. This helped visualise the various outcomes of different surgical approaches and helped the family make an informed decision.
In which surgical areas 3D printing technology is currently applied in India?
There’s nothing more customised in the world than the human body and 3D Printing allows customisation to a hitherto impossible level of detail. From study, diagnosis and planning to patient specific anatomical models, surgical guides, patient-specific implants and 3D printed customised prosthetics, this technology plays an important role at every stage in healthcare. The benefits are numerous:
- Detailed pathology
- Analysis of different surgical approaches
- Reduction In OR Time
- Optimised device design and development by testing and validation
- Enhanced clinical education
- Effective communication tool
What are the future applications that we can expect?
Apart from a more penetrative adoption of the current solutions that 3D printing has to offer to healthcare, there is also a huge potential in the field of bioprinting. This technology allows us to print in real, living tissue. Infact, experts have reportedly been successful in printing a fully functional organ! If things go as planned, the time is, not far when every hospital starts housing 3D printers, capable of printing everything from implants to prosthetics to real organs for transplant, all of it on-demand.
Case study II
Challenge: A patient suffering from advanced renal cancer needed to undergo a complex and delicate surgical procedure. This required the removal of a tumour that was present in the upper cortex of the kidney and even a slight miscalculation could lead to complete renal failure. This could only be done with the help of an exact model of the kidney that segmented crucial veins and arteries. The doctors approached Imaginarium Life to collaborate with them to create the model.
Our solution: On receiving the DICOM data, a digital model of the kidney was made. Major veins and arteries were identified and segmented along with the location and size of the tumour. Once the CAD file was locked, it was sent for printing. The printed part was finished and in no time the doctors had a tangible 3D kidney to help plan their surgery.
It is said that 3D printing technology has the potential to save a a lot of cost to healthcare providers and patients. But there isn’t much data to proved that. What do you have to say?
3D printing as a process takes digital files and converts it into a physical part. Because of the process that the 3D printers follow, complexity comes without a premium. It enables mass customisation i.e. the ability to mould each and every single product according to the requirements of individual patients. This is easier than it sounds, because with 3D printing, all that needs to be done is tweaking the digital files and making it adhere to every use case. As a result, customised implants and prosthetics that would otherwise cost a fortune, can easily be 3D printed at a fraction of the cost.
There are also questions raised on the quality and durability of 3D technology printed devices.
Our medical projects wouldn’t have been such great success if 3D printing was still grappling with something as basic as unreliable material. The technology has been in existence for more than three decades now, and has seen considerable advancements in terms of printing technology and printable materials. The materials used for printing surgical guides are all biocompatible, and can stay in contact with the human body for prolonged durations without causing any complications whatsoever. For implants, we use titanium, the FDA approved standard for such procedures. With the added precaution of sterilising every single piece of equipment before it enters the operation theatre, 3D printed printed devices are just as reliable, if not more than the conventional ones.
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