In this tutorial we will learn how to use the free medical imaging conversion service on embodi3D.com to create detailed anatomic muscle and skin 3D printable models in STL file format from medical CT scans. Muscle models show the detailed musculature by subtracting away the skin and fat. Even when created from a scan of an obese person, the model looks like it comes from a bodybuilder, Figure 1A. Skin models show an exact replica of the skin surface. The finest details are captured, including wrinkles and veins underneath the skin. Hair however is not captured in a CT scan and thus the model does not have any hair, Figure 1B.
Figure 1A (left): A muscle 3D printable model. Figure 1B (right): A skin 3D printable model
These models can be used for a variety of purposes such as medical and scientific education and research. Additionally, the skin models can be used to re-create a person's likeness in 3D from a medical scan. If you have had a CT scan of the head, you can create a lifelike replica of your head. You can create replicas of your friends, family, or even pets if they have had a medical CT scan. Alternatively, if you have a loved one who passed away but had a CT scan prior to death, you can use the scan to re-create an exact replica of their face. Even scans that are years old can be used for this purpose. Some people may consider this to be a little creepy, so if you are considering doing this think carefully first.
Before proceeding please register for an embodi3D.com account if you haven't already. You will need an account to use the service.
It is highly recommended that you download the associated file pack for this tutorial so that you can follow along with the exact same files that are used in this tutorial.
>> DOWNLOAD THE FREE FILE PACK BY CLICKING HERE <<
If you are interested in learning how to use the free embodi3D.com service, see my prior tutorials on creating bone models, processing multiple models simultaneously, and sharing and selling your models on the embodi3D.com website.
If you are interested in converting your own CT scan or that of a friend or family member, you can go to the radiology department of the hospital or clinic that did the scan and ask for the scan to be put on a CD or DVD for you. Figure 2 shows the radiology department at my hospital, called Image Management, and the CDs that they give out. Most radiology departments will have you sign a written release and give you a CD or DVD for free or with a small processing fee. If you are a doctor or other healthcare provider and want to 3D print a model for a patient, the radiology department can also help you. There are multiple online repositories of anonymized CT scans for research that are also available. If you have downloaded the file pack for this tutorial, example CT scans are included
Figure 2A, the Image Management (radiology) department at my hospital, where you can pick up a DVD of your CT scan as shown in Figure 2B (right). My hospital does this for free, but some may charge a trivial fee.
PART 1: Creating a Muscle STL model from NRRD File
Before we begin please bear in mind that this process only works for CT scan images. It will not work for MRI images. Before proceeding please check that the scan you wish to convert is a CT (CAT) scan!
Step 1: Convert Your CT scan to an Anonymized NRRD File with 3D Slicer
Open 3D Slicer. If you don't have the software program you can download it for free from slicer.org. Once Slicer has opened, take the folder from the download pack that is called STS_004. This folder contains anonymized DICOM images from a CT scan of the legs of a 24-year-old woman who had a muscle tumor. Drag and drop the entire folder onto the Slicer window, as shown in Figure 3. Slicer will ask you if you want to load the images into the DICOM database. Click OK. Slicer will also ask you if it should copy the images into the database, click Copy. Slicer will take about one minute to load the scanned.
Figure 3: Drag-and-drop the STS_004 DICOM folder from the file pack onto the Slicer window
Next, load the scan into the active wor king area in slicer. If the DICOM browser is not open, click on the Show DICOM browser button, as shown in Figure 4. Click on the STS_004 patient and series, and click the Load button, as shown in Figure 4. The leg CT scan will now load into the active seen within Slicer, as shown in Figure 5.
Figure 4: Open the DICOM browser and load the study into the active seen
Figure 5: The leg CT scan is shown in the active seen
Step 2: Trim the Scan so that only the Right Thigh is included.
Click on the Volume Rendering module from the Modules drop-down menu as shown in Figure 6. Turn on volume rendering by clicking on the eyeball button, as shown in Figure 7. Then, center the model in the 3D pane by clicking on the crosshairs button, Figure 7. If you don't have the same window layout as shown in Figure 7, you can correct this by clicking on the Four-Up window layout from the window layout drop-down menu, as shown in Figure 8.
Figure 6: Turn on the volume rendering module
Figure 7: Center the rendered volume.
Figure 8: Make sure you are in the Four-Up window layout
Next we are going to crop the volume so that we exclude everything other than the right knee and thigh. From the modules menu, select All Modules, Crop Volume, as shown in Figure 9. Turn on ROI visibility by clicking on the eyeball button, as shown in Figure 10. Then, move the region of interest box so that it only encapsulates the right thigh, as shown in Figure 10. You can adjust the size of the box by grabbing on the colored circular handles and moving the sides of the box as needed.
Figure 9: The Crop Volume module.
Figure 10: Turning on and adjusting the crop volume ROI (Region Of Interest)
Once the crop volume ROI is adjusted to the area that you want, perform the crop by clicking on the Crop button, Figure 11.
Figure 11: the Crop button.
The new, smaller volume that encompasses the right fight and knee has been assigned a cryptic name. The entire scan had a name of "2: CT IMAGES – RESEARCH," and the new thigh volume has a name "2: CT IMAGES-RESEARCH-subvolume-scale_1." That's a mouthful and I want to rename it to something more descriptive. I'm going to select the Volumes module, and then select the "2: CT IMAGES-RESEARCH-subvolume-scale_1" from the Active Volume drop-down menu. Then, from the same drop-down menu I'm going to select "Rename Current Volume". Type in whatever name you want. In this case I'm choosing "right thigh."
Figure 12: Renaming the newly cropped volume.
Step 3: Save the right thigh volume as an anonymized NRRD file.
Click on the Save button in the upper left-hand corner. The save window is then shown. All the checkboxes on the left except for the one that corresponds to the right by. Make sure the file format for this line says NRRD (.nrrd). Make sure you specify the proper directory you want the file to be saved as. When you are satisfied click on save. This is demonstrated in Figure 13. In the specified directory you should see a called right thigh.nrrd.
Figure 13: The save file options.
Step 4: Upload the NRRD file to embodi3D.com
Make sure you are logged into your embodi3D.com account. Click on Imag3D from the nav bar, Launch App. Then drag-and-drop your NRRD file onto the upload pain, as shown in Figure 14.
Figure 14: Uploading the NRRD file to embodi3D.com.
Figure 15: File processing options.
Step 5: Download your new STL file after processing is completed.
In about 5 to 15 minutes you should receive an email that says your file has finished processing and is ready to download. Follow the link in the email or access the new file via your profile on the embodi3D.com website. Your newly created STL file should have several rendered thumbnails associated with it on its download page. If you want to download the file click on the Download button, as shown in Figure 16.
Figure 16: the download page for your new muscle STL file
I opened the file in AutoDesk MeshMixer to have another look at it, and it looks terrific, as shown in Figure 17. This file is ready to 3D print!
Figure 17: The final 3D printable muscle model.
PART 2: Creating a Skin Model STL File Ready for 3D Printing
Creating a skin model is essentially identical to creating the muscle model, except instead of choosing the CT NRRD to Muscle STL on the embodi3D.com service, we choose CT NRRD to Skin STL.
Step 1: Load DICOM image set into Slicer
Launch Slicer. From the tutorial file pack drag and drop the MANIX folder onto the Slicer window to load this head and neck CT scan data set. This is shown in Figure 18.
Figure 18: Loading the head and neck CT scan into Slicer. It may take a minute or two to load. From the DICOM browser, click on the ANGIO CT series as shown in Figure 19.
Figure 19: Loading the ANGIO CT series from the MANIX data set
Step 2: Skip the trimming and crop volume operations
In this case we don't need to trim and crop a volume as we did with the muscle file above. We can skip Step 2.
Step 3: Save the CT scan in NRRD format.
Just as with the muscle file above, save the volume in NRRD format. Click on the save button, make sure that the checkbox for the nrrd file is selected and all other checkboxes are deselected. Specify the correct directory you want the file to be saved in, and click Save.
Step 4: Upload your NRRD file of the head to the embodi3D website.
Just as with the muscle file process as shown above, upload the head NRRD file to the embodi3D.com website. Enter in the required fields. In this case, however, under Operation choose the CT NRRD to Skin STL operation, as shown in Figure 20.
Figure 20: Selecting the CT NRRD to Skin STL file operation
Step 5: Download your new Skin STL file
After about 5 to 15 minutes, you should receive an email that says your file processing has been completed. Follow the link in the email or look for your file in the list the files you own in your profile. You should see that your skin STL file has been completed, with several rendered images, as shown in Figure 21. Go ahead and download your file. You can then check the quality of your file in Meshmixer as shown in Figure 22. In this instance everything looks great and the file is error free and ready for 3D printing.
Figure 21: The download page for your newly created 3D printable skin STL file.
Figure 22: Opening the file in Meshmixer for quality control checks. The file is error free and incredibly lifelike. It is ready for 3D printing.
Thank you very much! I hope you enjoyed this tutorial. If you use this service to create 3D printable models, please consider sharing your models with the embodi3D community. Here is a detailed tutorial that I wrote on exactly how to do this. This community is built on medical 3D makers helping each other. Please share the models that you create!
Please note the democratiz3D service was previously named "Imag3D"
In this tutorial you will learn how to quickly and easily make 3D printable bone models from medical CT scans using the free online service democratiz3D®. The method described here requires no prior knowledge of medical imaging or 3D printing software. Creation of your first model can be completed in as little as 10 minutes.
You can download the files used in this tutorial by clicking on this link. You must have a free Embodi3D member account to do so. If you don't have an account, registration is free and takes a minute. It is worth the time to register so you can follow along with the tutorial and use the democratiz3D service.
>> DOWNLOAD TUTORIAL FILES AND FOLLOW ALONG <<
Both video and written tutorials are included in this page.
Before we start you'll need to have a copy of a CT scan. If you are interested in 3D printing your own CT scan, you can go to the radiology department of the hospital or clinic that did the scan and ask for the scan to be put on a CD or DVD for you. Figures 1 and 2 show the radiology department at my hospital, called Image Management, and the CDs that they give out. Most radiology departments will have you sign a written release and give you a CD or DVD for free or with a small processing fee. If you are a doctor or other healthcare provider and want to 3D print a model for a patient, the radiology department can also help you. There are multiple online repositories of anonymized CT scans for research that are also available.
Figure 1: The radiology department window at my hospital.
Figure 2: An example of what a DVD containing a CT scan looks like. This looks like a standard CD or DVD.
Step 1: Register for an Embodi3D account
If you haven't already done so, you'll need to register for an embodi3d account. Registration is free and only takes a minute. Once you are registered you'll receive a confirmatory email that verifies you are the owner of the registered email account. Click the link in the email to activate your account. The democratiz3D service will use this email account to send you notifications when your files are ready for download.
Step 2: Create an NRRD file with Slicer
If you haven't already done so, go to slicer.org and download Slicer for your operating system. Slicer is a free software program for medical imaging research. It also has the ability to save medical imaging scans in a variety of formats, which is what we will use it for in this tutorial.
Next, launch Slicer. Insert your CD or DVD containing the CT scan into your computer and open the CD with File Explorer or equivalent file browsing application for your operating system. You should find a folder that contains numerous DICOM files in it, as shown in Figure 3. Drag-and-drop the entire DICOM folder onto the Slicer welcome page, as shown in Figure 4. Click OK when asked to load the study into the DICOM database. Click Copy when asked if you want to copy the images into the local database directory.
Figure 3: A typical DICOM data set contains numerous individual DICOM files.
Figure 4: Dragging and dropping the DICOM folder onto the Slicer application. This will load the CT scan.
Once Slicer has finished loading the study, click the save icon in the upper left-hand corner as shown in Figure 5. One of the files in the list will be of type NRRD. make sure that this file is checked and all other files are unchecked. click on the directory button for the NRRD file and select an appropriate directory to save the file. then click Save, as shown in Figure 6.
Figure 5: The Save button
Figure 6: The Save File box
The NRRD file is much better for uploading then DICOM. Instead of having multiple files in a DICOM data set, the NRRD file encapsulates the entire study in a single file. Also, identifiable patient information is removed from the NRRD file. The file is thus anonymized. This is important when sending information over the Internet because we do not want identifiable patient information transmitted.
Step 3: Upload the NRRD file to Embodi3D
Now go to www.embodi3d.com, click on the democratiz3D navigation menu and select Launch App, as shown in Figure 7. Drag and drop your NRRD file where indicated. While NRRD file is uploading, fill in the "File Name" and "About This File" fields, as shown in Figure 8.
Figure 7: Launching the democratiz3D application
Figure 8: Uploading the NRRD file and entering basic information
Figure 9: Basic information fields about your uploaded NRRD file
Next, turn on democratiz3D Processing by selecting the slider under democratiz3D Processing. Make sure the operation CT NRRD to Bone STL is selected. Leave the default threshold of 150 in place. Choose an appropriate quality. Low quality produces small files quickly but the output resolution is low. Medium quality is good for most applications and produces a relatively good file that is not too large. High quality takes the longest to process and produces large output files. Bear in mind that if you upload a low quality NRRD file don't expect the high quality setting to produce a stellar bone model. Medium quality is good enough for most applications.
If you wish, you have the option to specify whether you want your output file to be Private or Shared. If you're not sure, click Private. You can always change the visibility of the file later. If you're happy with your settings, click Save & Submit Files. This is shown in Figure 10.
Figure 10: Entering the democratiz3D Processing parameters.
Step 4: Review Your Completed Bone Model
After about 10 to 20 minutes you should receive an email informing you that your file is ready for download. The actual processing time may vary depending on the size and complexity of the file and the load on the processing servers. Click on the link within the email. If you are already on the embodied site, you can access your file by going to your profile. Click your account in the upper right-hand corner and select Profile, as shown in Figure 11.
Figure 11: Finding your profile.
Your processed file will have the same name as the uploaded NRRD file, except it will end in "– processed". Renders of your new 3D model will be automatically generated within about 6 to 10 minutes. From your new model page you can click "Download this file" to download. If you wish to share your file with the community, you can toggle the privacy setting by clicking Privacy in the lower right-hand corner. You can edit your file or move it from one category to another under the File Actions button on the lower left. These are shown in Figure 12.
Figure 12: Downloading, sharing, and editing your new 3D printable model.
If you wish to sell your new file, you can change your selling settings under File Actions, Edit Details. Set the file type to be Paid, and specify a price. Please note that your file must be shared in order for other people to see it. This is shown in Figure 13. If you are going to sell your file, be sure you select General Paid File License from the License Type field, or specify your own customized license. For more information about selling files, click here.
Figure 13: Making your new file available for sale on the Embodi3D marketplace.
That's it! Now you can create your own 3D printable bone models in minutes for free and share or sell them with the click of a button.If you want to download the STL file created in this tutorial, you can download it here. Happy 3D printing!
Dear Community Members,
After many months of work, we are happy to announce the addition of a feature that will allow you to sell medical models you have designed on Embodi3D.com. While we always have encouraged our members to consider allowing their medical STL files to be downloaded for free, we understand that when a ton of time is invested in creating a valuable and high-quality model, it is reasonable to ask for something in return. Now Embodi3D members have two options: 1) You can share your medical models for free, or 2) you can charge for them. We hope these two options encourage more sharing and file uploads. The more models available, the more it helps the medical 3D printing community.
For more details on how to sell your medical masterpieces on Embodi3D, go to the selling page.
Thanks, and happy 3D printing!
The rugged, replaceable, customizable, lightweight, and low cost nature of 3D printing technology make it ideal to make prosthetics for children, who quickly outgrow and/or wear them out.
E-nable is an online community of volunteers, parents, makers, and medical professionals committed to providing 3D printed prosthetics to children who need them.
Dr. Gloria Gogola, a pediatric hand surgeon at Shriners Hospitals for Children-Houston collaborated with E-nable and volunteer bioengineering students and faculty from Rice University to help children and parents build their own prosthetics. She published a paper along with two other researchers last week summarizing their work in The Journal of Hand Surgery to explain the advantages of using 3D printing for children’s prosthetics to other surgeons.
At almost a hundredth of the cost of traditional prosthetics, for $50 as opposed to $4,000, they are comparable to the price of a pair of shoes.
A recent Upworthy story told the “origin story” of E-nable. Blogger cdmalcolm gave an overview of E-nable’s charity work in a post for Embodi3D about a year ago.
Since then, membership in the E-nable Google+ group has doubled, reaching over 8,000 members as of this publication. They have brought hands to 40 countries around the world, providing them for free to children in need.
The recent story of four-year-old Anthony from Chile posted on enablingthefuture.org’s blog illustrates the process each child follows to get a new hand.
Because Anthony does not have a wrist, the joint powering most of E-nable’s devices, he needed an elbow actuated device. Anthony’s mother took his measurements and decided with the volunteers’ help that the Team Unlimbited Arm was the best fit.
Parents and children can also choose to help design, customize, print, and build the hands themselves. According to Jon Schull, the founder of E-nable, they take about three hours to print, and two hours to build, for $5 worth of raw material. Two big repositories for free designs are available from the National Institutes of Health and Enablingthefuture.org.
Volunteers helped print the arm and gave it to Anthony for a trial period to test the fit. They realized a he needed a thermoplastic cast for a comfortable, snug fit on his small arm.
Volunteer Francisco Nilo and Anthony sharing an obligatory fistbump. Photo credit: ProHand3D and Enablingthefuture.org
Coordinating was challenging as Anthony lived in Valparaiso, on the Pacific coast, a two hour drive northwest of Santiago, where the volunteers and 3D printing company, ProHand3D, were located.
Finally, local Santiago tattoo artist and illustrator Cesar Castillo painted the device with Spider Man designs, Anthony’s favorite superhero.
Final Spider-Man arm. Photo credit: ProHand3D and Enablingthefuture.org
To continue with more fun themes, in January of this year E-nable began having design contests every month. This month’s theme is Steampunk and the winner will receive copperfill and bronzefill filament coils, social media fame, and have their device displayed at the Maker Faire in Nantes, France. Past themes included Star Wars and task-specific devices.
Each hand is as unique as its child owner. Chile volunteer Francisco Nilo said of Anthony, “His mom shared with us that since Anthony received his Spiderman arm, he uses it all the time, even for sleeping! We know no one uses these devices all day long, but perhaps the superhero design has influenced him just a bit!”
People interested in volunteering for E-nable or those interested in procuring a prosthetic hand for a child may visit http://enablingthefuture.org/ and contact email@example.com
Twenty-three-year-old Amos Dudley is a digital design student in New Jersey. He went viral last week after coming up with a unique way to save some cash — by 3D printing his own braces.
Clear orthodontic aligners made from a mold of your own teeth can run thousands of dollars, but Dudley managed to create his own for less than $60 USD using a 3D printer.
Dudley had braces when he was younger but didn’t keep up with them, leaving him with a slightly crooked smile in his twenties. As a young student, he couldn’t afford to go to the orthodontist and get another custom pair, so he decided to use with the tools he had on hand. As a design student — that meant using state-of-the-art digital fabrication tools like a 3D printer.
Despite the fact that Dudley has no professional orthodontic experience whatsoever, the braces appear to be working. This image shows the difference after 16 weeks of wearing the custom braces:
Dudley came up with the idea to create his own braces after researching aligners online. He saw in close up images that they had the signs of 3D-printed layer striations, similar to the ones he’d seen on his own creations at school.
Dudley wrote on his blog, "What is to stop someone, who has access to a 3D printer, from making their own orthodontic aligners? Turns out, not much!”
He then dug into researching the orthodontic process, and took a mould of his teeth with alginate powder. He then filed it with PermaStone to set. Once he scanned the cast, he was able to use software to model how his teeth could progress in becoming straighter.
The whole process was actually pretty complex— Dudley had to identify his teeth as separate objects in the model and create a route for them to travel that avoided potential intersections with each other.
"Then it was just a matter of animating them into their correct positions," he writes. "I measured the total distance of travel, and divided it by the maximum recommended distance a tooth can travel per aligner. Each frame of animation was baked into a new STL model.”
He used a Stratasys Dimension 1200es 3D printer to do the job, available to him at the New Jersey Institute of Technology. He printed out 12 models and created plastic aligners to go over top of them, made from special dental plastic he found on eBay.
He’s been wearing them for 16 weeks so far.
"As far as I know, I’m the first person to have tried DIY-ing plastic aligners. They’re much more comfortable than braces, and fit my teeth quite well. I was pleased to find, when I put the first one on, that it only seemed to put any noticeable pressure on the teeth that I planned to move - a success!" he writes. "Most importantly, I feel like I can freely smile again.”
Since going viral, Dudley has been approached by many asking him to help make their orthodontic care more affordable, but he’s erring on the side of caution. He commented on his blog post, “Just want to clarify, again, I won't be making retainers/aligners for people (even if you offer money). I've thought about the possibility, and decided it's not a good idea for a large number of reasons. Sorry!”
Researchers from the Department of Biology at the University of Oregon, Eugene, have come up with an innovative use of 3D printing to study the biology of flower mimicry.
One of their models was the “Dracula Orchid” (Dracula effleurii). Despite its vampiric name, the flower is not carnivorous. They attract flies as pollinators, not food. Dracula here means “little dragon,” referring to their appearance.
Bitty Roy, the principle investigator on the study, described the pollination process: "What the orchid wants the fly to do when it arrives is to crawl into the column, whereupon the orchid sticks a pollinium (mass of pollen) onto the fly so that the fly can't possibly get it off. The fly then goes to another orchid, which then pulls it off."
The researchers travelled to Ecuador, South America, to study the orchids and their fly pollinators in the wild.
Roy also put the study into a larger evolutionary and ecological context: "Mimicry is one of the best examples of natural selection that we have," she said. "How mimicry evolves is a big question in evolutionary biology. In this case, there are about 150 species of these orchids. How are they pollinated? What sorts of connections are there? It's a case where these orchids plug into an entire endangered system. This work was done in the last unlogged watershed in western Ecuador, where cloud forests are disappearing at an alarming rate."
Roy and her research team wanted to know whether the different visual parts of the flower, its scent, or a combination of both, were responsible for attracting the flies. They presented their results in a paper published last month in The New Phytologist.
"Dracula orchids look and smell like mushrooms. We wanted to understand what it is about the flowers that is attractive to these mushroom-visiting flies," said Tobias Policha, the lead author of the paper.
The researchers designed their study to separate out the different parts of the flower: the triangular outer part (the calyx) and the inner pouch-shaped part (the labellum).
From upper left, counter-clockwise: completely artificial flower, completely real flower; real calyx, artificial labellum; artificial calyx, real labellum. Photo credit: Aleah Davis
To manufacture the artificial flowers, the team collaborated with Melinda Barnadas, co-owner of Magpie Studios, an arts studio expert in creating scientific art and models for museums.
The process to make the artificial flowers had several steps: casting the real flowers in impression molds, making a positive plaster cast of the molds, digitally scanning the cast, then 3D printing the files using a Zcorp Spectrum 510 printer. Finally the 3D-printed molds served to cast the flowers from medical grade, scentless silicon. The color was done using dye encapsulated in silicon, so the flies couldn’t smell it.
Real flower, on left, and a series of artificial flowers, created from 3D printed molds, in decreasing order of fly attractiveness. Image from research paper.
As a result of this study the researchers found that the flies were most attracted to the scented labellum. They hope their idea will be used in other studies where genetically modifiable models are not available.
Quotes from researchers pulled from the press release at EurekaAlert!
In a UK-first, surgeons at Alder Hey Children’s Hospital successfully used a 3D printed model of a spine to help complete an operation.
The procedure was the first time NHS doctors have ever used a 3D printed model in the operating room.
The model was used by surgeons on the West Derby hospital’s orthopedic team in their efforts to correct the curved back of an eight-year-old patient. The young girl from Whales suffers from kyphoscoliosis, a complicated congenital spinal problem.
The plastic model was made with the help of the patient’s CT scans, which were converted into a 3D printable format. The life-size replica was printed in a plastic so it could be sterilized, and then used in the operating room as a guide for the surgeons performing the operation.
An NHS First
This case is also the first time that a 3D printed model has been taken into the operating room to be used as a reference tool by NHS doctors. Jai Trivedi, Neil Davidson and Colin Bruce were the surgeons who performed the operation.
Trivedi, who was lead surgeon, said on Alder Hey’s blog, “There is no doubt the model made this complex procedure operation much safer as it allowed for accurate pre-operative planning and implementation at surgery. Sterile models that can be held during an operation should prove helpful for other surgeons.”
The model was made by the 3D printing firm 3D LifePrints. Their representative Henry Pinchbeck said, “We are delighted to be working with the talented surgical teams at Alder Hey who are leading the way in terms of adoption of innovative practices, such as 3D printing.”
A Beneficial Collaboration
3D LifePrints has been working closely with a number of Alder Hey doctors in orthopedics, cardio, craniofacial surgery, radiology and other areas to develop 3D models. Both parties believe the models can assist doctors with complex operations, enable easier communication between doctors and patients, and facilitate learning.
The successful surgery comes after a new scientific research center was recently opened next to Alder Hey, one component of £260m invested in future development.
The center boasts an innovation hub where doctors and scientists can work on building new healthcare technology, as well as facilities for developing and testing new medicines. The innovation service has the goal of harnessing less widely used technologies in healthcare (including 3D printing and bio-sensors) to develop strategies that improve health outcomes for surgery and critical care treatment.
This eight-year-old’s successful surgery is just another one of the many examples of how 3D printing can make medical treatment safer and more effective.
Image Credits: Alderhey Liverpool Echo
Hello This is my first 3D print. I used a 3D model of a kidney, which I made myself from a renal angiography. I printed it with one of my engineer geek friends using a Prusa i3 self-made 3d printer, 0,2 mm nozzle, 0,2mm layer thickness and PLA as material. This was my entering demonstration, which gave me an assignment as a freelancer anatomy assistant professor.
My ambitions are to use 2D and 3D models, along with the traditional cadaver techniques in my work as an anatomy teacher and to teach my students how to do it with their own hands. I have 12 years of experience as an internal physician in ER, 4 years as a psychiatrist, 3 years as an acupuncturist and a lifetime as an IT GEEK, I don't have any teaching experience, my english language skills are a bit rusty and I don't know what will come from this, but I'm eager to find out. Wish me luck:)
Much of the press for medical 3D bioprinting has revolved around recreating parts of the human body for medical transplants, implants, and reconstructive surgery. We often find these stories easy to relate to, with visuals that help us understand the benefits of each bioprinting solution.
However, another important aspect of bioprinting that may not be as obvious is its potential contribution to early-stage disease research. This type of research occurs in the laboratory, and focuses on how our cells (the tiny building blocks that make up every part of our body) function and interact during diseases. 3D bioprinting could present a step forward in how researchers construct experiments that help them understand disease.
One of the crucial steps to understanding each type of cancer is figuring out how it communicates with other cells, and what it is saying. Cells in a tumor may talk to cells from within the same tumor, or surrounding healthy cells, and all of this communication could be important for cancerous cells to grow and spread. Thus understanding how cells interact is an important step towards blocking this communication using medical treatments.
To easily set up experiments in the lab, researchers use cancer cell lines - cells which have been taken from tumors and trained to grow in the lab. These cell lines are grown in a single layer, and although this makes it easier to keep them happy, it is quite different to the way cells are arranged in our bodies, i.e. in multiple layers in a 3D space.
3D Bioprinting Cancer
With so many important functions of cancer due to the communication with other cells, it is beneficial for scientists to perform experiments on cancers that are as similar as possible to a living patient. Last year, researchers at the University of Connecticut and Harvard Medical School addressed this, published a review of 3D bioprinting focusing on its potential advantages for cancer research in the lab.
Cancers are a prime candidate for 3D bioprinting - many cancers exist as clumps of cells that lack specific structures, and thus do not require the typical scaffolding that bioprinting organs like ears or bones requires. By layering cells in 3D instead of 2D, a 3D printed tumor is better at replicating the structure of a tumor in a typical human body, and communication between cells in all directions can be achieved.
3D bioprinting also offers the possibility of mixing multiple cell types. This is important because cancer cells communicate not only with each other, but also healthy cells - for example, melanomas interact with surrounding skin cells. In fact, even within a tumor there may me multiple "versions" of cancer cells, all having different things to say each other. Since bioprinting multiple cell types is relatively simple, it is possible to recreate not only tumors themselves more effectively, but also their surroundings.
Current research already feeds into this, as there are already many different types of cancer cells available, and established techniques for getting them into a liquid form for 3D printing.
Customizable, reproducible experiments
It is incredibly important that the results of any research be reproducible, not only within a research group but also between research groups across the globe. Since bioprinting is done using 3D computer models, these can be easily distributed to other researchers. And with the ability to customize the construction of a tumor completely using bioprinting, scientists can validate their results and move faster to obtaining medical solutions.
One of the greatest challenges could be integrating 3D printing medical laboratory techniques that have been established for decades (the first cancer cell line was created in the 1950's). Luckily, companies like Biobots are capitalizing on this gap in the market, building accessible 3D bioprinters with standardized components. And repositories like Build With Life will hopefully hold not only bioprinting designs, but also important protocols that merge current medical research standards with 3D printing technology.
The utilization of bioprinted cancers could be important to the development of new medical treatments. By understanding the interactions between cancer cells and healthy cells in all dimensions, researchers can gain insights into the successful treatment of these cells. And all of the techniques mentioned above could be extended to a range of other diseases. Organovo has already capitalized on this idea, 3D printing liver cells for scientific testing.
One could even predict that, in the same way as 3D-printed organs of specific patients are being used to plan for surgery, 3D printed recreations of patient's tumors or diseases may be able to help tailor the most effective treatment for that patient. The future for integrating bioprinting into the workflows of laboratories around the world seems bright, and could offer faster and more accurate methods for carrying out early-stage research in cancer and many other diseases.
National Cancer Institute
Every year, the number of world-first surgeries with 3D printed materials is on the rise.
And a doctor in Australia recently added another success story to the list after implanting a 3D-printed vertebrae into a man’s spine.
Last year, neurosurgeon Ralph Mobbs of the Prince of Wales Hospital in Sydney, met a patient suffering from chordoma, a difficult form of cancer.
The man was in his 60s, and the cancer had caused a tumor to grow in a very difficult area to access. Hobbs told Mashable Australia, "At the top of the neck, there are two highly-specialised vertebrae that are involved in the flexion and rotation of the head. This tumor had occupied those two vertebrae.”
The prospects weren’t looking good for the man. If left untreated, the tumor would eventually compress the spinal cord and brain stem, resulting in quadriplegia.
Very few surgeons had ever tried to remove this kind of tumor before, because its location made the surgery high risk. It is possible to reconstruct the vertebrae, but they have to use bone from another part of the body to do it. Getting the right fit is difficult, which is why Mobbs decided 3D-printing was the best option.
"I saw this as a great opportunity," Mobbs explained. "[With 3D printing], the patient could be supplied with a custom-printed body part to achieve the goals of the surgery much better than we previously have had in our bag of tricks.”
Mobbs teamed up with Anatomics, an Australian medical device company, to construct the titanium implant. Anatomics also provided Mobbs with several models of the patient’s exact anatomy, which he used to practice the surgery on before attempting it.
Even with the ability to practice, Mobbs admitted to ABC news that the surgery was still very high-risk. But it was the only option for the patient that could result in a continued high quality of living.
The surgery is the first of its kind with this particular vertebrae. "To be able to get the printed implant that you know will fit perfectly because you've already done the operation on a model ... It was just a pure delight," he said. "It was as if someone had switched on a light and said 'crikey, if this isn't the future, well then I don't know what is’."
After a successful 15-hour surgery, the patient is now in recovery. Hobbs said he is doing well, but is suffering some effects of having such an invasive surgery performed through the mouth. "It has caused him some problems with his capacity to swallow, which he is gradually recovering," he said.
Mobbs is confident that the use of 3D printing in medicine will continue to grow. "There's no doubt this is the next big wave of medicine," he said. "For me, the holy grail of medicine is the manufacturing of bones, joints and organs on-demand to restore function and save lives."
Image Credits: Engadget and Mashable
Recently, the University of Texas Medical Branch at Galveston (UTMB) in conjunction with MakerNurse, John Sealy Hospital, and the Robert Wood Johnson Foundation, unveiled the first MakerHealth facility. This space was created to inspire nurses to creatively solve problems they see every day caring for their patients, using a diverse range of crafting tools, from zip ties to 3D printers. The initiative recognizes that many nurses are already coming up with creative solutions to problems with patient care, and aims to facilitate the DIY attitude. For example, one of the nurses has used his expertise in the burn care unit to devise a special showering unit for burn patients.
One of the most exciting concepts is that by providing this space, the hospital and University are supporting internal innovation. Too often nurses come up with extremely innovative ideas that are not captured - the nurses can be incredibly humble, believing that what they have done is the same as what anybody would do in their circumstances. By recognizing staff-driven innovation, the MakerHealth facility validates what nurses have been doing for decades and centuries - finding better ways to care for their patients. And hopefully this initiative will serve to connect these ideas with medical device companies who may lack the intimate connections to source such applied ideas themselves.
The accessibility of 3D printing to solve basic healthcare needs is a theme that has been mirrored in the utilisation of 3D printing for simple testing devices that assess patient diseases. Just last week, researchers at Kansas State University announced that they are developing a 3D-printed device that will be able to detect anemia (a condition where there is not enough iron in the blood) when connected to a smartphone. This development is building upon an already-growing repertoire, including devices that can assess eye health, detect sickle cell disease and cervical cancer, and read ELISA assays. The best part is the accessibility of these devices - most require only simple components a 3D printer, and a smartphone. The ease of putting these devices together can reduce the costs of healthcare, supporting poorer socioeconomic classes, regions, and nations.
All of the solutions described above are both influenced by and influencing the 'maker' mentality. A mentality driven by DIY attitudes, it is stretching healthcare to consumers as well - mobile healthcare is already a booming industry, with 52% of smartphone users gathering health-related information on their phones. The connections between smartphone and 3D printing technology mentioned above may mean that in the future, consumers will perform many tests themselves, perhaps as easily as one might conduct a pregnancy test. And if 3D printers become a common household item in a similar way to current home printers, it may be possible to perform these tests without having to leave the comfort of your own home. Thus 3D printing, smartphones and the maker mentality may result in a healthier population at a lower cost, less visits to the doctor, and more time for doctors to focus on complex healthcare issues.
The global 3D printing healthcare market is expected to have a compound annual growth rate (CAGR) of 26.2% up through the year 2020, according to a new report, World 3D Printing Healthcare Market-Opportunities and Forecasts, just published by Allied Market Research.
The report found many different factors that are influencing market growth, including breakthrough technologies. Portable, solar-powered, multi-material, and full color 3D printers make the technology easy to use anywhere.
Patient need is a strong factor driving growth: a rising number of people face issues related to old age, such as osteoporosis, which 3D printed technologies can address.
The report says that rising numbers of amputees, patients with auditory loss and dental problems will also fuel the need of external wearable devices, while the increased availability of biocompatible materials will help meet the demand. Customized 3D printed external wearable devices are widely considered to be better treatment options with optimized fitting and comfort.
External Wearable Devices
The application of external wearable devices are expected to contribute $2.3 billion to the 3D printing healthcare market by 2020.
There are a wide range of external wearable devices available thanks to 3D printing, such as prosthetic limbs.
Medical and surgical centers are also responsible for a considerable amount of growth, controlling roughly three-fourths of the global market.
Another reason growth is expected to continue is that the use of 3D printing for medical practice will help reduce surgery times, anesthesia exposure and risks during operation, which ultimately reduces surgical costs.
3D printed organs are also offering affordable alternatives to animal testing in medicine and pharmaceutical research. Using the organs allows researchers to reduce the time of clinical trials and risks associated with drug testing.
At the same time, advanced 3D printers are often costly. Medical practices and pharmaceutical companies making use of 3D printers are also often impeded by a lack of regulatory frameworks and copyright issues related to 3D printing of patented products.
While North America accounts for 2/5 of the healthcare 3D printing market, new regions will emerge as influential by 2020. Asia-Pacific is expected to be the fastest growing market, with a CAGR of 29.7% for the forecast period.
The growth is mostly fueled by rising awareness and the development of start-up companies in the Asia-Pacific and LAMEA regions. The materials segment in particular will grow throughout North America, Europe, and other areas thanks to the availability of biocomaptible materials.
Other Key Findings
• The highest CAGR of the forecast period for 3D healthcare services is projected at 26.6%.
Polymers account for roughly half of the market revenue for materials. Ceramics are also projected as the fastest growing segment (a CAGR of 32.1%).
• The electron beam melting technology segment is expected to grow at 29.6% CAGR from 2015 to 2020, higher than any other segment.
• Medical and surgical centers (accounting for 2/3 of the market) will continue to dominate throughout the forecast period.
• The fastest growing segment is expected to be engineering application, with a CAGR of 31.7% from 2015 to 2020.
Allied Market Research
This week cdmalcolm posted a great article here at Embodi3d.com on how 3D-printed replicas of patient’s organs are helping surgeons plan for complicated operations. Today I'd like to supplement this topic by talking about the advances 3D printing can bring to medical education, specifically by recreating human models for students to study and dissect.
Currently, the golden standard for teaching medical students the anatomy (overall structure) of the human body involves dissecting and observing cadavers – recently deceased humans who have given their bodies to science. However, obtaining and storing these bodies can be difficult for a number of reasons. For example, many cultural and religious beliefs preclude people from donating their bodies, and even in countries with strong donation programs bodies with rare diseases (by their very definition) are hard to find. Even when sufficient cadavers are donated, the process of preserving them to prevent natural decomposition can be costly.
New technology comprising a mixed approach of 3D printing and traditional manufacturing can solve many of these problems by recreating accurate and numerous replicas of human anatomy with minimal expense. A recent publication in the January/Februrary edition of the journal “Anatomical Sciences Education” highlighted a prototype for this technology; the team from The University College Dublin in Ireland were able to recreate a portion of the hip, with 3D-printed bone and blood vessels surrounded by a flesh-like filler and covered in a synthetic skin. On top of this, they were able to connect a pump to the blood vessels to mimic the typical human circulatory system. The result wasn't fancy - the components were placed in a Tupperware container with holes for the tubing - but it had most of the necessary components for students to learn, and more importantly, obtain valuable practical experience.
The advantage of using 3D printing for these models is that they can be changed to reflect the anatomy of specific diseases. For example, atherosclerosis occurs when blood vessels narrow, and it is an important factor in heart disease. In the prototype above, the team were able to 3D-print replicas of blood vessels from a healthy patient, and one with atherosclerosis - the vessels with atherosclerosis were a lot thicker, and students were able to assess this using ultrasound. The students were also able to perform basic techniques to locate the vessels via syringe, similar to how they may be required to set up an IV drip. And since the models only need to mimic the qualities of human organs rather than making functional tissue (see my previous article on the challenges of this), the models can be made relatively simply, and from materials that do not degrade over time like human flesh does.
It might seem like a reconstruction of the human body would never be able to replicate the experience of learning from a true human body, however the results of the study above and previous work by The Centre for Human Anatomy Education in Australia showed that 3D printed models are just as good as cadavers for teaching students the principles of anatomy. And thus the future of manufactured lifelike bodies for teaching seems bright - indeed, one could imagine that many trending technologies could be integrated with these models to provide teaching experiences that surpass the current standard delivered by cadavers. Digital sensors are rapidly becoming cheaper and more ubiquitous in technology, and these could be incorporated into anatomical models to provide feedback to students during practical tasks. Virtual reality (VR) and augmented reality (AR) are also trending with many potential application for medicine. Perhaps in the future, manufactured human anatomical models will be integrated with AR, in a way that replicates the experience of operating on real-life patients.
And so, 3D printing technology seems poised to replace the long-standing use of cadavers for medical education, and soon many medical students will be able to sigh with relief at not having to prepare themselves to touch and dissect decomposing, smelly bodies. The inexpensive production of realistic bodies will give students better access to practical hands-on education, better preparing them for their eventual roles dealing with real patients.
The utility of modern three-dimensional printing techniques for bio-medical and clinical use has been demonstrated repeatedly in recent years, with applications ranging from surgical modelling to tissue engineering and beyond.
Despite the promise and potential of three-dimensional printing methods, impediments to their widespread clinical uptake still remain. Many of the printers used for medical applications are highly specialised pieces of equipment that require trained operators and controlled operational conditions as well as potentially costly and unique raw materials. These factors can result in high production costs, and the necessity of dedicated sites which can in turn lead to delays between fabrication and clinical application.
Recent work by engineers and researchers at Zhejiang University in China has shown that desktop 3D-printing techniques may represent a more practical alternative for certain clinical tasks.
Desktop 3D printers may cost as little as $500, much less than the $15,000–30,000 machines routinely used in academic institutions. As well as the lower costs, Desktop 3D printers are considered to be much easier to operate. An Liu and co-workers tested the potential of these machines to fabricate bio-absorbable interference screws, used to secure hamstring tendon grafts commonly utilised to repair damaged anterior cruciate ligaments (ACL).
A screw-like scaffold, made from the same polylactic acid filament commonly used for conventional bio-absorbable screws, was printed using fused deposition modelling techniques then coated with hydroxyapatite (HA) to improve its osteoconductivity. The construct was also coated with mesenchymal stem cells, as these cells are widely considered to be of therapeutic value for anterior cruciate ligament regeneration.
A 3D porous structure is considered to be valuable to bone ingrowth into the screw, as this supports the cellular migration and mineral deposition, as well as vascular development, all required as the screw is incorporated into a patient’s bone. Conventional methods have struggled to control to formation of these structures, but by using 3D-printing techniques they can be easily manipulated by surgeons and specialists alike.
Once fabricated the 3D-printed screws were tested upon anterior cruciate ligament repairs in rabbits for up to three months. Magnetic resonance imaging showed that all of the 3D-printed screws were correctly positioned in the bone tunnel without any breakage or major complications, and that over the course of twelve weeks they appeared to incorporate into the bone tissue.
The approximate cost of a 3D printed bio-absorbable screw was 50 cents using industrial grade polylactic acid, and it is estimated that this equates to less than 10 USD using medical grade materials
The successful manufacture of a functional surgical device using desktop 3D printing technology demonstrates the potential for in situ fabrication at the clinic and opens up a range of in-house manufacturing possibilities to clinical staff, circumventing the requirement for costly equipment and bespoke materials as well as trained specialist operators.
3D Printing Surgical Implants at the clinic: A Experimental Study on Anterior Cruciate Ligament Reconstruction. Sci Rep. 2016 Feb 15;6:21704. doi: 10.1038/srep21704
3D printing organs is a small part of a technology that contributes to a wide range of industries. But no one can deny that the impact is greatest for the medical community, and the patients and families they’re helping.
Biomedical 3D printing is often associated with innovative new prosthetics and affordable custom implants, but that’s only half of the story.
3D printing organs has completely changed surgical planning for many doctors, with impressive results.
Doctors Find Their Optimal Surgical Approach with Medical 3D Printing These days, doctors with the right 3D printer can take scans of an individual’s organs and print out customized, realistic models of their unique structure. The method brings forward a wealth of information that doctors can use to inform a optimal surgical approach based on each patient’s unique anatomy.
Here are a few of the many ways these organ models are helping with surgical planning: Heart Models for Individualized Diagnosis Researchers at MIT and Boston Children’s Hospital recently put together a system to create physical, 3D-printed models of a patient’s heart in just a few hours.
The models, based on MRI scans, can help surgeons prepare for the unique anatomy of each individual patient, allowing them to plan an ultra-personalized approach.
The new method really goes above and beyond standard surgical planning techniques. Creating printable models used to require researchers to manually indicate an organ’s boundaries on a series of cross-sections from the MRI data, which can take up to 10 hours to complete.
The new method, using algorithms and a 3D printer, gives doctors an accurate physical heart model in about an hour. Defeating a Complex Aneurysm For some, 3D printed organ models already mean the difference between an inoperable aneurysm and a successful life-saving surgery.
Last year, a 3D-printed model of a woman’s brain helped surgeons plan a life-saving surgery to correct an aneurysm.
Dr. Siddiqui, who was involved with the surgery, said, "There are some commonalities between all human beings, but at the end of the day our vascular tree is as different as our fingerprints.”
The model helped surgeons perfect a plan catered to the patient’s specific needs.
"While we were doing that mock procedure we realised that we had to change some of the tools we wanted to use, given her anatomy," said Dr Siddiqui. Avoiding Deadly Complications For many surgeries, a surgeon won’t know what approach to take until they open the person up and look at the organ in question.
But 3D printed organs are a unique new tool that doctors are using to select an approach before surgery begins.
In one such case, the cardiology team at Brigham and Women’s Hospital and Boston decided to create a full-sized heart model after digital imaging was ineffective at helping them plan a surgical approach.
Radiologist Mike Steigner had to only spend a few moments looking at the 3D-printed model to know that their original plan of performing a minimally invasive catheterization had to go out the window. The patient needed open heart surgery, and the team had avoided an unforeseeable complication thanks to the model. 3D Printing Organs for Procedural Practice Practice does make perfect -- but for surgeons, this is a bit of a problem. The best model they can use to practice complex surgical procedures (short of a living human person) is a cadaver, and luckily, these are usually in short supply.
This is one important way that 3D printing organs is changing healthcare -- the models serve as the first life-like alternative to human organs that surgeons can use to plan and perfect their procedures.
And the applications are wide-reaching: 3D Printing Organs: The Biotexture Wet Model A Japanese firm is producing a wide range of 3D printed organ models based on scans of real organs. The method, called the Biotexture Wet Model, has allowed researchers to create an ultra-realistic lung, complete with blood vessels and tumors.
"With the wet model, doctors can experience the softness of organs and see them bleed," said Tomohiro Kinoshita of Fasotec. "We aim to help doctors improve their skills with the models.”
of doctors practicing with the model.
"I suppose that not only young, inexperienced doctors but also experienced doctors can perform a better operation if they can have a rehearsal first," said Dr. Maki Sugimoto. Preparing to Treat a Life-Threatening Heart Condition For sensitive surgeries, practice can mean the difference between life and death for a patient. Last year, a 3D-printed model of a 5-year-old’s heart helped doctors practice a procedure to solve her life-threatening heart condition.
Mia Gonzalez was born with a rare heart malformation. Her vascular ring was wrapped around her trachea, making it difficult to breathe.
But doctors at Nicklaus Children’s Hospital in Miami 3D printed several models of her heart, so they could practice surgery with her unique heart structure. Their preparations led to a successful surgery, and managed to reduce operation time by about 2 hours. Perfecting Ear Reconstruction In another use case, University of Washington researchers have been 3D-printing lifelike cartilage to practice reconstructing realistic ears. Before this, practice using a realistic material wasn’t possible -- the procedure involves using rib cartilage to create the new ear, which is in limited supply.
Surgeons are now able to perfect their ear reconstructions using as much 3D-printed cartilage as they need, so they can approached the precious rib cartilage with a practiced hand. 3D Bioprinting Makes More Surgeries for Children Possible Perhaps none have benefitted more from biomedical 3D printing organs than children.
Because it’s so difficult to find ways to practice complex or novel procedures, doctors are hesitant to try them on young children. Operations like these can be incredibly risky, and it wouldn’t be worthwhile to endanger babies with their whole lives ahead of them, unless it was a life-or-death situation.
But 3D printing organs is changing all that, by giving doctors the models they need to confidently plan and practice these risky procedures.
Here are a few success stories: An Infant Gets a New Face A 2-year-old girl was born with a Tessier facial cleft -- her face could not fuse properly. The condition was not life threatening, but her parents sought help at Boston Children’s Hospital anyway. A 3D-printed models of her skull appeared as the solution. After viewing her skull at different angles that an MRI could never capture, and practicing different cuts and manipulations, doctors there were able to justify the risk of performing a facial reconstruction on such a young girl. 2-Year-Old Receives First Adult Kidney Transplant Just recently, a 2-year-old girl was the first child to receive an adult kidney transplant with the help of 3D printing organs.
Lucy suffered heart failure as a baby, which caused her kidneys to shut down. To avoid a lifetime on dialysis, surgeons performed a transplant using a kidney donated by her father, Chris.
Doctors at Guy’s and St Thomas’ NHS Foundation Trust were confident they could perform the surgery successfully after 3D printing models of Lucy’s abdomen and Chris’ kidney to help them plan and practice.
Pankaj Chandak, a transplant registrar, said, "The most important benefit is to patient safety. The 3D printed models allow informative, hands-on planning, ahead of the surgery with replicas that are the next best thing to the actual organs themselves.” Future Directions of 3D Printing Organs As success stories with the help of 3D printed organ models continue to surface, it’s clear that traditional MRI or CT scans don’t carry nearly the same diagnostic and practical value as a real model that doctors can see and touch.
Still, you might say 3D printing is an underutilized technology in the medical field. Only around 75 US hospitals have a 3D printer for the purpose of printing model organs, of about 200 around the world.
Despite how few doctors have access to this technology, the models continue to help surgeons plan, prepare, and practice a wide range of operations with impressive results.
In coming years, it’s only expected that 3D printing organs will continue to change healthcare at an increasing pace.
Researchers around the world are working on ways to further optimize 3D printing organs -- MIT researchers are developing methods to make it faster, and Japanese scientists just came up with a way to make it even cheaper.
It would seem that the only thing stopping 3D printing organs from completely reinventing how doctors learn and approach surgeries is a little bit of time and a lot more 3D printers.
Image Credits: MIT BBC Smithsonian Belfast Telegraph CNN
Following the current interest and significant recent advances in three-dimensional printing, the field of tissue engineering is increasingly seeking to adapt this technology for the fabrication of biological tissues, and potentially entire organs, for clinical transplantation.
Despite significant demand for vascular grafts for clinical procedures such as coronary bypass surgery, the manufacture of synthetic blood vessels has proved to be problematic. Due to a tendency to cause thrombosis and a lack of growth potential, failure is not uncommon for conduits produced from conventional materials, especially in smaller diameter vessels. As a result, there is great interest in the development of a tissue engineered alternative, and three-dimensional bio-printing may hold the solution.
Freeform droplet-based laser bio-printing is an orifice-free printing approach which has been used to generate straight and branched cellular tubes, the fundamental component of engineered blood vessels. As droplet-based laser printing does not require a nozzle, it is particularly well suited to handling the viscous bio-inks often required for tissue engineering purposes without the risk of clogging.
By utilising an alginate hydrogel bio-ink capable of carrying a population of living cells, researchers from the University of Florida and Tulane University have printed straight and bifurcated (Y-shaped) tubular structures, demonstrating the promise of 3D-printing technologies for vascular tissue engineering applications. The generation of branched structures is of particular value as these are a fundamental component of native vasculature.
Layer-by-layer deposition of droplets of either an 8% alginate solution or a 2% alginate-fibroblast cell suspension was printed following a predesigned pattern. A Z-platform was used to lower each deposited layer, step-wise, into a CaCl2 crosslinking solution to induce gelation of the printed alginate, with each step being the same depth as the height of the previous layer of un-gelled alginate.
Initially, acellular straight-line tubes were printed to similar dimensions as human blood vessels, 170 individual layers built over 30 minutes to a height of 5.1mm, to form a tube with an internal diameter of 5mm. Subsequently, 5mm long, 45° Y-shaped tubes were produced, utilising the buoyancy provided by the calcium chloride crosslinking solution to support the formation of overhanging and spanning structures, and taking around two hours to complete.
With the printing conditions thus optimised the team then introduced cellular bio-ink into the printing process and reproduced both straight and Y-shaped constructs with an incorporated live cell population.
Loading the alginate solutions with cells appeared to disrupt droplet formation to an extent, leading to an increase in the minimum thickness of the vessel walls that could be produced, but the cell viability was considered to be acceptable for a printed bio-ink, and cell numbers were shown to increase over a 24 hour incubation, suggesting that the cells were healthy and proliferative following the bio-printing process.
As well as successfully demonstrating the potential of droplet-based laser bio-printing for the tissue engineering of blood vessels and similar tubular structures, this work represents the first example of an overhang being incorporated into a cellular bio-printed construct. Although further development and eventual clinical testing will ultimately be required to determine the suitability of these three dimensional printed blood vessels for therapeutic use, this success brings us a step closer to the use of viable 3D-printed constructs in life-saving vascular graft surgery.
There’s no denying that 3D printing has had a major impact on the healthcare industry, but it’s not just people who are benefiting.
3D printing is already helping veterinarians make major improvements in the healthcare treatment of our furry friends.
3D Printing Is Improving Animal Diagnosis
3D printing began as an expensive technology that only the top industries could make use of, but it’s quickly evolved into an affordable tool for a wide variety of applications, and in some cases, a household commodity.
Veterinarians are among the many doctors making use of 3D printing for patient diagnosis. Evelyn Galban, a neurosurgeon of the University of Pennsylvania’s School of Veterinary Medicine, is using 3D printing to help a canine patient with a malformed skull.
“It’s difficult to fully understand the malformation until we have it in our hands. That usually doesn’t happen until we’re in surgery,” she told Engineering.com.
But by examining a 3D printed model of the dog’s skull before surgery, she was able to create an informed plan of surgical action.
This is just one example of how 3D printing can help veterinarians understand the abnormalities they want to correct. Frank Verstraete of UC Davis School of Veterinary Medicine said, “[T]o be able to hold a replica […] in your hand […] The advantages of that are tenfold compared to a screen image.”
Printing Bones for Dogs
3D printing is helping veterinarians improve pre-operative health procedures. Deirdre Quinn-Gotham of Tuskegee University’s School of Veterinary Medicine collaborated with the Department of Aerospace Science Engineering on a 3D printing project to create a surgical metal plate as well as an abnormal canine humerus.
They used an orthopedic surgical plate to create a small-scale model, which they printed using a biodegradable plastic filament.
The resulting 3D-printed models were highly accurate — appearing virtually identical to the original bone.
The method could be used to improve preoperative procedures and planning for veterinary surgery, as well as precision in certain procedures.
And since the models can be preserved for long periods of time, they could be used as educational tools or models for future surgeries.
A Closer Look at Bone Fractures
Quinn-Gotham’s study is only the latest of its kind. A researcher at Kansas State University has already converted CT scans of animal bone into 3D prints. These can also be used to develop treatments for animal bone fractures and deformities, as well as for educational purposes.
“The digital CT scan files are just a lot of small, chopped up pieces of the bone image,” Castinado said. “I use a 3-D modeling software to make all those pieces into a whole. I also have to take away all the extra fragments that are attached to the bone so that when it is 3-D printed, it will look like a bone.”
Compared to human medicine, veterinary scientists are only on the edge of unlocking the potential uses of 3D printing for their patients. But the possibilities already seem promising.
Scientists at the Wake Forest Institute for Regenerative Medicine in North Carolina, USA, have taken the next step towards printing living replacement parts for our bodies. In a study published in the February 15th edition of Nature Biotechnology, the scientists revealed the ITOP (Integrated Tissue-Organ Printer). This 3D printer, which has been in development for over 10 years, is able to form structured living tissue, including ears, bones and muscles, which look and function like the real thing.
One of the biggest hurdles currently for printing body parts involves giving them the right shape and structure, rather than just making a mass of biological goop. Unfortunately, human cells are extremely sensitive, and many of the components that a 3D printer could use to give structure are also toxic, preventing the replacements from living happily over the long-term. However, the team came up with a specific layering pattern incorporating two key pieces of technology.
The first breakthrough is the optimised layering of two scaffolding materials, with each material having a part to play in generating the final living structure. One of the materials is very strong but toxic, and gives the body part its overall structure during the printing process, before being washed away immediately afterwards. In the meantime, the second material has been held in place by the shell, and has had the time it needs to harden. This material gives long-term stability to the living tissue without toxicity. Eventually it will be replaced by the body part’s own secretions, making it just like those we can already find in our bodies.
The second key technology is the incorporation of empty tunnels within the layers. These allow the transfer of life-giving oxygen and nutrients throughout the living tissue. The team was able to 3D print an ear, small pieces of bone, and some muscle tissue. More importantly, all of these retained their structure, and carried out their basic functions. For example, the 3D-printed bone produced calcium, the ear produced cartilage, and the muscle rearranged itself into the proper structure for exerting force.
These beginning steps set the stage for the next phase in custom-printing replacement body parts. Many hurdles still stand between the ITOP and its use in healthcare, such as figuring out how well the body tolerates the 3D printed replacements. However the research of this team is a huge step toward printing living, functioning replacements for our bodies. And the advantage of 3D-printing compared to other techniques is the extreme level of control, both over the construction of the replacement, and the tailoring of each piece to suit the subject perfectly.
Engineers at the University of California, San Diego led a team in developing life-like liver tissue with the help of 3D printing.
The model closely approximates a real human liver’s structure and function, and could be applied to drug screening and disease modeling research.
The study was published in the February 8th edition of Proceedings of the National Academy of Sciences.
The researchers hope that the new liver will help save pharmaceutical companies time and resources, making the production of new drugs more affordable. Pharmaceutical companies will be able to run pilot studies for new treatments without waiting for results from human or animal trials.
"It typically takes about 12 years and $1.8 billion to produce one FDA-approved drug," said Shaochen Chen, NanoEngineering professor at the UC San Diego Jacobs School of Engineering. "That's because over 90 percent of drugs don't pass animal tests or human clinical trials. We've made a tool that pharmaceutical companies could use to do pilot studies on their new drugs, and they won't have to wait until animal or human trials to test a drug's safety and efficacy on patients. This would let them focus on the most promising drug candidates earlier on in the process.”
Shaochen Chen is co-author of the study with Shu Chien, a professor of medicine and Bioengineering, and director of the Institute of Engineering in Medicine at UC San Diego.
The model is able to reproduce the liver’s complex system of delivering blood supply, making it a unique specimen for scientists interested in understanding the combined effect of metabolic and circulation functions on health and disease.
"The liver is unique in that it receives a dual blood supply with different pressures and chemical constituents. Our model has the potential of reproducing this intricate blood supply system, thus providing unprecedented understanding of the complex coupling between circulation and metabolic functions of the liver in health and disease," said Chien.
The artificial liver tissue was created using a novel bioprinting method that Chen’s laboratory developed. The entire structure is only 200 micrometers thick, and can be created in seconds. Other methods take hours. After printing, the structure was cultured for 20 days in vitro.
After culturing, the researchers performed various tests to see how well the tissue performed liver functions, such as albumin secretion and urea production.
The 3D-printed tissue is not the first model of its kind, but it was able to maintain functionality longer than other options. It also had a large amount of an important enzyme that scientists think affects the metabolism of different drugs.
The scientists hope that the new liver model can be used to reproduce and better understand various diseases, including cancer, cirrhosis, hepatitis, and others.
Chen said in the paper, “I think that this will serve as a great drug screening tool for pharmaceutical companies and that our 3D bioprinting technology opens the door for patient-specific organ printing in the future.”
Image Credits: RDMag American Bazaar Online Tech Times
Many doctors these days are now including 3D printing as part of their many surgical procedures. Dr. Jamie Levine from NYU Langone noted that there is a paradigm shift when it comes to doing surgical procedure in terms of using and relying on 3D printing.
A lot of hospitals all over the United States have already embraced 3D printing to create tools, models or craft tissues used for surgery. One of the hospitals that are leading the paradigm shift is the Institute for Reconstructive Plastic Surgery at NYU Langone. The surgeons from NYU Langone use special printers to create tools and 3D models that can save doctors from performing long and expensive surgeries. In fact, the hospital is able to save $20,000 to $30,000 for every reconstruction that the do.
The use of 3D printing in medical technology is very promising. In fact, the Food and Drug Administration has already approved the creation of 3D printed pills and vertebrae. There are also many researchers all over the world working with 3D printed organs to be used in organ transplantation.
Although medical-grade 3D printers still remain expensive, they can make infinite types of objects like surgical tools, anatomical models and other devices. Fortunately, there are now many companies that are developing cost-effective printers thus the cost is targeted to go down in the future.
There is a wide potential for innovation when it comes to using the 3D printing technology. With this technology, it is no wonder if many hospitals all over the world will rely on 3D printing technology to treat different diseases.
Harvard researchers have used 3D printing to create a replica of the human brain.
Despite being arguably the most important organ in the human body, scientists still understand very little about the brain’s structure and how it works. Hypotheses abound, but there have been few opportunities to explore them until now.
The Harvard researchers 3D-printed a gel brain to watch it grow, helping them make new inferences about how it develops its signature folds.
The study could help solve the mystery behind the structure of gray matter and help explain psychological disorders caused by under or overfolding of the brain.
Not all brains found in nature have the same distinctive folds as the human brain does. Many smaller species, such as rats, have completely smooth brains.
In a commentary about the study, Ellen Kuhl of Stanford University said the researchers "demonstrated that physical forces — not just biochemical processes alone — play a critical role in neurodevelopment. Their findings could have far-reaching clinical consequences for diagnosing, treating and preventing a wide variety of neurological disorders.”
Humans don’t start developing the folds in the womb until roughly 23 weeks of gestation. The folds also continue to develop after they’re born. We do know that there are some benefits to having a folded structure. For example, the folds allow for greater connectivity across the gray matter (surface layer of the brain).
Kuhn said, “Each cortical neuron is connected to 7,000 other neurons, resulting in 0.15 quadrillion connections and more than 150,000 km of nerve fibres.”
It’s believed that the unique nature of human brain gyrification, the scientific term for the brain’s growth, is that it’s a response to the need to maximize the amount of cortical neurons in a small space. The Harvard researchers put this to the test with their 3D printed growing brain, and concluded that the folds are the result of physical growth processes instead of biological need.
The 3D printed model received no chemical directives to develop folds (like the hypothesis predicts)— instead, it developed folds naturally in response to mechanical compression forces during growth.
The benefit for the placement of the cortical neurons is only a response to the process of growth, not an evolutionary mechanism in and of itself.
The researchers ran their simulation by creating a 3D printed model based on MRI data, with several layers of soft gel material. The layers were designed to expand when placed in a solvent, simulating the growth of the brain’s gyro and sulci (folds). The results were published recently in Nature Physics.
The experiment is a first step in opening new lines of research that can benefit doctors and neuroscientists in their efforts to understand the brain and its disorders. And while the 3D-printed gel brain is a far cry from a true physical model, it can still tell us a lot. Understanding the intricacies of brain growth may help scientists identify physical marketers linked to certain diseases, such as autism, schizophrenia or Alzheimers.
Image source: 3Dprint.com
Surgery on the anterior crucial ligament (ACL) is difficult. The standard surgical procedure involves drilling a tunnel on the tibia to remove the ligament and reconstructing it by using transplanted graft. In most cases, the affected area that has been treated has a good chance of re-tearing after being repaired. However, this technique has many limitations such as entering the knee through the tibia can make it difficult to reattach the ligament to the original attachment point.
Having said this, Dr. Dana Piasecki and the other orthopedic surgeons from the OrthoCarolina Sports Medicine came up with a solution by creating their own 3D printed surgical tool which allows them to drill and follow the normal path of the ligament and attach to the femur. This new tool mimics the natural positioning of the ACL.
The doctors turned to 3D printing to create a complicated tool but save costs on the production. The tool was made from a strong biocompatible metal to accommodate different knee sizes of different patients. The tool was finally manufactured by Stratasys Direct Manufacturing. The final tool is a low-cost device that is finally registered by the FDA as a Class 1 medical device.
Currently, the new medical tool dubbed as Pathfinder has 95% success rate when it comes to anchoring grafts to the original ligament. This also made it easier for doctors to carry out ACL surgery. With this tool, many orthopedic patients in need of ACL surgery will have new hope that they will get the best possible treatment that medical science can provide.
Every 3D printing case is different, and must be tailored for the individual patient’s specific clinical condition, anatomy, and imaging techniques.
A 47 year old woman with a renal mass was being evaluated for surgical treatment planning. A urologist familiar with my current 3D printing work requested a 3D printed model of the kidney. The purpose was to help demonstrate the anatomy of the mass with respect to the renal hilum, to help determine if a partial nephrectomy was possible, or if a total nephrectomy was required.
The patient had a documented reaction to radiographic iodinated contrast, and therefore an MRI was performed instead of a CT scan. The scan was performed on a 1.5 T GE Signa Excite system. The data set from a coronal 3D gradient echo pulse sequence acquisition was chosen because it best visualized the tumor encroachment into the renal sinus.
The 3D model was created from segmentation of the kidney from the 3D gradient echo acquisition. The renal parenchyma was then made into the digital 3D model, leaving the mass as negative space. This was then printed to demonstrate the entire kidney. An additional 3D model was created showing a bisected view of the kidney along the coronal plane. This was done to see which model would be of more utility.
The patient’s DICOM image files from the MRI were processed using the Materialise Innovation Suite’s Mimics and 3-matic software.
Initially I used the Mimics software segmentation tool to segment the normal renal parenchymal tissue. This left a filling defect where the mass was. This negative space was useful for demonstrating the extent of the tumor.
Using the 3-matic application I then took the 3D digital representation and created a model cut in the coronal plane. This helped better define the extent of the tumor invasion into the renal hilum.
Both the full kidney and the coronal bisected models were printed for the surgeon and the patient to review. The STL (stereolithography or standard tesselation language) files generated for the 3D models were then imported into both the Cura and MakerBot slicing software applications to generate the gcode for the Ultimaker 2 and .x3g file for the MakerBot printers.
Fused filament printing of the full kidney using Acrylonitrile Butadiene Styrene (ABS) on the MakerBot Replicator 2X Experimental Printer and sectioned kidney in Polylactic Acid (PLA) on the Ultimaker 2 printer.
In general I prefer PLA to ABS. With PLA there is less shrinkage and warping of the material during the printing process. PLA is of plant based origin (here in the US it is derived from corn starch) and can print lower layer height and sharper printed corners. PLA, a biodegradable plastic is used in medical devices and surgical implants, as it possesses the ability to degrade into inoffensive lactic acid in the body.
ABS is a petroleum-based recyclable non-biodegradable plastic. Unfortunately emits a potentially hazardous vapor during printing. The Replicator 2X however is optimized for ABS. http://pubs.acs.org/doi/pdf/10.1021/acs.est.5b04983
For more information about PLA/ABS see http://3dprintingforbeginners.com/filamentprimer/#sthash.p07fHBmh.dpuf
The urologist showed the models to the patient, and it help to convince her of the necessity of a total nephrectomy, rather than a partial nephrectomy.
Although the printed models showed the extent of the tumor invasion adequately for both the urologist and the patient to visualize, the models did not differentiate the mass from the renal sinus.
To better demonstrate the tumor invasion, a new model with two different color filaments was created. Hand segmentation of the 3D model of the mass was performed due to the limited tissue contrast between the mass and the surrounding soft tissue structures. Creation of two separate segmentation files and 3D models was made in Mimics.
This was then exported into 3-matic for local smoothing. Two separate STL files of both the mass and kidney were generated. The combined model was then bisected in the coronal plane and the additional two STL files were again generated.
Once the combined STL files were imported into the MakerBot software, they were repositioned on the build plate in an orientation to optimize the printing process. The STL models were positioned on the bed, above a ring spacer file. This is necessary for the proper printing contact. The model was oriented to minimize the amount of printing support structures.
When using the two filament colors, “purge walls” are generated by the software to help eliminate the small threads of filament from one color being deposited when the next color is laid down.
The two filament model enables the surgeon and the patient to better visualize the extent of the tumor invasion, clearly demonstrating normal from abnormal tissues.
Creating multicellular structures is a delicate procedure. For instance, the human heart is comprised of more than 2 billions of muscle cells that should be aligned and interact with one another to work properly. While 3D Bioprinting is a promising technology that allows scientists to create biological tissues, the problem remains—there is no single method available that uses a high level of precision to create multicellular structures that are functional, viable, and has good integrity.
Researchers from the Carnegie Mellon, Penn State as well as MIT have developed the acoustic tweezers technology which is a technique that utilizes sound waves to trap as well as manipulate individual cells. This technology is also used to align, transport, separate, and pattern individual cells without causing any cellular damages.
The acoustic tweezers created by the researchers come with a microfluidic device that uses sound wave generators to create sound waves along the edge of the device. The design of the device allows the researchers to manipulate and capture single cells.
The device provides a precise level of control when manipulating cells in terms of their spacing and geometry thus allowing scientists to explore the creation of tissues with complex geometries and patterns.
The results of the study provide a novel way for scientists to manipulate live cells in 3D without any invasive contact or biochemical labeling. This leaves the biological state during the manipulation in its original and unadulterated state. This can lead to new possibilities in research applications in fields like neuroscience, regenerative medicine, biomanufacturing, tissue engineering and cancer treatment.
3D printing has made a major impact on the medical industry in a wide variety of ways — custom prosthetics, surgical implants, bioprinted tissue, and other areas.
3D printed pills are one of the newest advancements, already in development, which could help treat minor and major medical conditions, including epilepsy and chronic pain.
Of course, non-3D printed medications are already available for most major ailments. But what makes 3D printed pills such a great advancement is that they can be customized to individual patient needs, resulting in a medicine that is more effective and cheaper than its traditionally-manufactured counterparts.
Researchers have already managed to 3D print unique powder-based and liquid-based shapes for pills to make it easier for children to swallow them. Aprecia, a New Jersey-based pharmaceutical company, also became the first company get FDA approval for a drug made by 3D printing. The medication is made to treat seizures in epileptic patients, and is designed to be more porous and potent that traditionally manufactured versions of the drug. Aprecia’s method creates pills that can disintegrate in under 10 seconds, making it easier for the body to absorb the drug.
Recent research out of Wake Forest University is also making innovative strides to advance 3D printed pills. They created a computer algorithm that could calculate dosages based on a patient’s biological and clinical parameters and design a pill suited for their unique needs. By creating such personalized pills, the algorithm can help increase drug accuracy and effectiveness, while also reducing negative side effects.
Many factors can affect a drug’s effectiveness with individual patients, including their weight, ethnic background, and organ functionality. No traditionally-produced medications take these factors into account, an approach that can sometimes cause more harm than good for patients.
The research from Wake Forest focused on tapping into these issues to develop highly personalized medicines. Known as “pharmacogenetics,” the research method hopes to enable the development of personalized drugs based on DNA information and other factors.
Min Pu, a professor of internal medicine, led the research team. She gave a presentation about the research to the American Heart Association Scientific Sessions (AHASS) in November, saying, “Our study uses the volume-concentration method to generate 3D-printed pills. What's different from current pharmaceutical industrials is that we use a computer algorithm to design and calculate dosages according to patients' biological and clinical parameters instead of using pre-determined dosages. Therefore, we can instantly create personalized pills. These personalized pills are then converted to 3D printable files and the pills can then be accurately printed using a 3D printer.”
Future scientific research into personalizing pills with 3D printing is likely on the horizon. Meanwhile, Aprecia Pharmaceuticals just announced it has received $35 million in investment funding to commercialize their drug, which we can expect will only serve to accelerate the development of 3D-printed pills by other pharmaceutical companies in the years to come.
Image Credits: Epilepsy Society 3Ders.org
A kidney transplant is a very sensitive operation and patients need to be compatible so that the organ recipient will not reject the donor organ. 3D printing paved the way for surgeons to be able to transplant an adult kidney to a toddler recipient.
In Northern Ireland, a 3-year old toddler is the first child in the world to survive a kidney transplant using adult kidneys. The toddler suffered from heart failure which had dire consequences on her kidneys as they were robbed of oxygen. Instead of settling with regular kidney dialysis, her parents decided to have her undergo a kidney transplant.
As stated by Guy’s and St. Thomas’ NHS Foundation, the kidney transplant was the first of its kind as it uses 3D printing to aid the transplant. The doctors used 3D printing technology to create a model of the patient’s abdomen. They also created a model of the donor’s kidney –the patient’s father –to see how everything fits. This minimizes the risks involved in the transplant.
Transplant specialist Pankaj Chandak noted that the surgery is quite complex thus the use of 3D printing technology helped surgeons plan ahead of time to increase the success of the operation and minimize the risk to the patient and donor during the surgery.
The operation was a complete success and doctors are excited to use this technology to treat different conditions, as well as help doctors, plan their course of action before the actual surgery. 3D printing has definitely made its way to mainstream medicine.