Being part of a state of the art diagnostic medical imaging chain, we diagnose complex medical and surgical conditions everyday, where additive manufacturing techniques would have assisted the patient care and management. When universities in North America and Europe are taking quick strides in setting up integrated 3D printing departments, Indian medical universities are yet to be sensitized about the additive manufacturing. I am aware that some specialists and faculty doctors are using the additive manufacturing facilities from private vendors and 3D print service providers in their personal capacities. But such working models have inherent flaws that will make the whole process unsustainable, non beneficial and in extreme cases hazardous.
Broadly there are three areas in which healthcare can benefit from AM as of this day
1. Anatomic pre- surgical modeling/Rapid prototyping for surgical planning
2. Customised implants and prostheses
3. Educational and training models
And we are not talking about bio printing and customized drug delivery systems yet.
Anatomic pre- surgical modeling
Anatomical Modeling is a good area to start with. In simple terms, it is modeling an anatomy and associated pathological process from the virtual space to a real physical world. The individual variances of the human anatomy and physiology make the use of 3D-printed models ideal for surgical preparation. Having a tangible model of a patient’s anatomy available for a physician to study or use to simulate surgery is preferable to relying solely on MRI or CT scans. For example, every radiologist and orthopedic surgeon would know the complexity of acetabular fractures. The amount time spent by a radiologist to understand such fractures translates in to an equally complex report and the referring orthopedic needs to divest the same amount time to decipher the report. This process of communicating the pathology can be supplemented by 3D model real size or scaled down. There will be immense improvement in understanding the fracture patterns and planning the surgical approach. If good quality control is in place, there will be no surprises for the surgeon on the operating table. In vascular pathologies, the models can be used for training the interventionists like say in deploying a stent or inflating a balloon.
Solving the one size fits all problem
The other important issue that 3D printing can address is the customized implants and prosthesis. Despite the availability of wide range of sizes of the implants, there will always be cases where the surgeon needs to make a compromise call just because there is no perfect fit. 3d printing technologies can be used to make patient specific implants based on the data from CT and MRI scans. The customization of the 3D printed implants represents true macro and micro-structural personalization . These implants apart from incorporating the specific size and shape costumed to the patient’s, they also incorporate the specific microstructure of the cortical and trabecular components of the bone specific to the patient, thereby enabling bone-ingrowth at the bone-implant interface and hence improved prospects of implant success.
Educational and training models
3d printed models can serve as effective teaching tools for medical students. Such students usually work with two-dimensional X-ray images or two-dimensional images obtained from computed tomography (CT) or magnetic resonance (MR) scans to gain insight into pathologies. The recent emergence of three-dimensional renderings of CT, MR and sonographic imagery has improved visualization of complex pathologies but lacks tactile qualities. 3D-printed objects can be used to study complex pathologies and to practice procedures. One example would be complex congenital heart diseases. The spectrum of combination of cardiac anomalies can be overbearing for medical undergraduate or even post graduate students to visualize. But a set of life size 3d printed models representing the permutations and spectrum of such anomalies will be a valuable asset to any medical library. The hands on workshop cum teaching sessions using 3 D printed cardiac models conducted during the annual Radiology Society of North America (RSNA) conferences are very popular among residents and are immensely appreciated. Pre- and post-comprehension survey results have shown that students are better able to conceptualize complex anomalies when such 3D models are used.
Current scenario of 3D printing in India
As of this day, almost all of the 3D printing anatomic modeling needs of Indian hospitals are outsourced to 3D printing labs, companies and few start-ups. Dr. Bhavin Jankharia, a pioneer in Radiology in India was one of the first to set up a 3D printing facility in his “Picture This” (more popularly known as Jankharia Imaging) unit in Mumbai. Just recently, Amrita Institute invested in an in-house 3 D printing lab, probably the first of this nature in an Indian hospital. The hospitals in North India especially Delhi are outsourcing their needs. During on of my conversations with a friend, who is also the medical superintendent of a leading tertiary Hospital in west delhi, I was told the barrier in entry is not just the cost but the lack of knowledge and trained personel. Also A 3d printing facility has all potentials to be a hot bed of turf wars. The big questions is who will run the department?
In the next part, I will write about the technical and administrative aspects of running a 3 D printing lab.
Dr. Vasanthakumar Venugopal is a medical doctor who is a specialist radiologist. After his MBBS and MD in Radiology, he worked as an assistant professor at Maulana Azad medical college. Currently he is a consultant radiologist with Mahajan Imaging, New Delhi. He is one of the founding members of the 3D printing special interest group of Radiological society of North America. He is actively involved in framing the appropriateness criteria for 3D printing in medical sub specialities. He has professional software and hardware training on Additive manufacturing.
