3D printing in healthcare

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3D printing keeps popping up in the news, from home manufacture of guns and weapons in the United States to artwork. There's scope in engineering, manufacturing, architecture and design, and it could be used in healthcare. BBC Science Unit's Carl Smith learned more when he toured the Hairston Biofabrication Institute, which is a new addition to the Royal Brisbane and Women's Hospital.

3D printing is a technology that is not very well suited at making a lot of things that are exactly the same. But what it does very well is print and make one off. So what that is useful for is to make devices that will fit you and only you. And having the ability to manufacture that at the point of care means that we're able to deliver and to evaluate those personalized, patient match or custom made medical devices right here on site.

Yep, 3D printing in a hospital setting to make healthcare more personalized.

My name is Mathilde Sell. I'm the general manager of the Huston Bar Fabrication Institute.

What is a biofabrication institute?

Aims at translating 3D technologies to the practice of medicine. So I'm talking about technologies like 3D printing that we employ in health services and personalized medical devices for our patients.

It certainly makes for a good pitch, but I wanted to visit today to see a few tangible examples of this. So tag along to meet those working on better and more realistic models for.

Mm-hmm.

Devices designed specifically for patients to make for more effective and comfier treatments, and implantable scaffolds to assist with recovery and repair. Then finally, better artificial skin to help burns patients. While 3D printing might be the most attention-grabbing and perhaps zeitgeisty element of what they do here, the Institute also explores 3D scanning techniques. And virtual modeling. And Mathilde DeSell says each of these has the potential to help create more personalized care.

Sometimes a small, medium, and large system just does not work because the anatomy Just looks different because of a trauma, because of a birth defect, because of aging, because of cancer. And in those cases you need to access solutions that are very much matched to the patient's specific anatomy.

From the outside, it is just a fairly nondescript looking hospital building. Maybe just describe what we can see as we head into the left.

So we have display cabinets, anatomical model here of an aorta, and in the middle of the aorta the bulge that you can see is an aneurysm. And we can 3D print in materials that you see that are flexible. Those materials can replicate the mechanical properties of human tissue. Look what your auto feels like.

She tells me these kinds of bespoke models are already used by surgeons to help design the best care for patients, especially if they need a difficult procedure like inserting a custom stent into an aorta.

In some cases Quite complex, what hard to visualize on a screen with medical imaging. And also you can't interact with them very well. But what we can do is we can model it, we can 3D print it, so we know if the stent is gonna work. work or if the design needs adjusting, we know how difficult accessing the area is going to be as well. In doing this, you may be saving yourself six hours in a theatre.

Saving hours of operating time lost through trial and error mid-surgery could make a big difference for patients and for surgeons. Past these displays, we enter one of the institute's laboratories. On a long bench in front of us, there's an array of tiny cubes of 3D printed materials.

So the various materials that we are looking at serve obviously a variety of purposes.

Some of these are quite hard, like this joy.

This not very expensive to make. A few dollars for the kidney model that I'm holding right now.

But as we move further down the bench, some of the 3D printed materials have much more unusual textures and much finer details.

This kind of material comes off our digital anatomy printer. Each of these little cubes is actually printed in a material that will replicate a different part of the human anatomy. In terms of how it feels, and you're welcome to poke and prode. The one that you're poking now replicates what a vessel wall feels like. If you poke one of these, this is what a solid tumour feels like. If we poke one of these, this is what the human liver feels like.

Although my mind immediately jumps to how these might replicate or replace parts of the human body, she says the more immediate use for these kinds of materials is training surgery.

Because we want to make those experiences as lifelike as we possibly can. So not only does it have to look right, it has to feel right. How do you train someone to perform brain surgery? The way it's done typically is on a cadaver. But the caveat with this is that you're not getting a lot of variety in terms of pathologies. With 3D modeling and 3D printing, we can simulate any pathology. And that can be used to train junior surgeons, but also maybe to train surgeons who might not have access.

She says a lifelike, exact model of a patient's unique injury can also be used in planning personalized procedures.

Imagine you...

Amen.

And you fractured your joke. That's pretty bad. It's in a few pieces. So our maxillofacial surgeon will be First of all, sending you to get some medical imaging done so you can visualize what's happening. And we take those images and we're able to reconstruct that in three dimension. We create a virtual model of your fractured jaw. And then we're gonna 3D print Jojo right here on site. And they can plan exactly how they're going to reconstruct.

To hear more about this kind of work, the head of the hospital's Maxillofacial Unit, just on the other side of this building, meets me with a handful of 3D printed models.

Thank you.

So my name's Martin Batstone.

Maybe it's a bit of a baseline. What's the traditional way of working with the patient?

Yeah, sure. So I suppose this example that we're talking about is a reconstruction of someone's mandible or their lower jaw after either trauma or most commonly resection due to a malignant or benign tumour.

As he's speaking, he holds up a model, a more traditional lower jaw reconstruction. A straight piece of bone has been cut into smaller chunks and roughly slotted together into a curved jawbone shape.

And we're looking at people's mandibles who've all been reconstructed with the fibulate, which is a common donocide, it's part of your lower leg. We basically use carpentry to try and adjust the shape of them so they look as close as possible to to your mandible and that often involves cutting them into smaller pieces, removing small wedges

The pieces of leg bone are held in place by a metal frame, and he tells me they eventually fuse together as the body heals. doctor Batstone tells me this process would usually be done during the surgery.

in the operating theatre break the bone to make it the right shape and close up. So that worked, but you can imagine that it was time consuming and not necessarily accurate and all the planning was done intra operatively.

Probably means more time in an operating theatre for you and for patients, right?

That's correct. And these operations are quite long, ranging between sort of six and twelve hours. So I guess what's changed what's happened over the years we've used what we would call virtual surgical planning. modeling and patient specific implants. So virtual surgical planning means you import typically imaging data, so it's C T scan, and then you virtually perform the operation. So you Draw lines, virtually cut out the tumour, decide which

So he says already, just with the ability to 3D scan and model virtually, the experience will often be better for patients and for certain.

Accurate. Probably time saving is the biggest factor. And the other thing I think it does is overcome experience issues on behalf of the surgeon, you can get a very good result.

It's the first step we've got in front of us here, but I believe

technology and new approaches that we've got in front of us as well.

Yeah, so I suppose that's still a part of your body that gets transplanted to another part of your body and whenever you do that there's a spot We would call donocyte morbidity or

And he says 3D printing approaches being trialed here are helping to make this first step possible.

So we're using a bioabsorbable polyester. The technical term for it is polycaprolactone, but it can be 3D printed. It's dissolved by your own body over about two year period, and if it's charged or seeded with cells and bits of bone, it will grow bone into it and thus the shape becomes much more like the shape of your jaw and we can do that in a customized or patient specific fashion.

This would be a very neat trick. Instead of just sticking rough little chunks of cut up leg bone together, He says this process would involve building a bespoke printed scaffold around those chunks, or even just around the patient's cells, and this encourages the bone to grow and fill in the gaps in the scaffold.

That's exactly right. And we can even go so far as to plan within the scaffold where we're likely to put dental implants to allow them to get their teeth back as well.

Sounds like pretty science fiction stuff, but we've got the models in front of us, so is this being used very often in patients now? These...

ones that I'm showing you now are actually part of a proposed clinical trial and that's already obtained ethics approval, so that means the ethics review committee say it's safe to perform.

The breast reconstruction project he's talking about there was a world first. In 2022, the Hurston Biofabrication Institute and collaborators were able to use this technology to reconstruct a woman's breasts. That woman's silicon breast implants were reportedly causing side effects, so the team replaced them with a bioresorbable 3D printed scaffold, seeded with her own fat cells.

As a surgeon it's been incredibly exciting. I kind of felt like we were left behind for many years as IT power got better and better and you could see my colleagues in radiology or radiation and oncology all benefiting from that. Nothing was happening for us and Virtual surgical planning and 3D printing has really changed that and I'm a technophobe. So if I like something it definitely works. And what needs to happen really is the the cost of delivering it needs to come down.

As 3D printing technology improves, doctor Martin Batstone says it will open up even more pathways for surgeons. For example, some 3D printers are able to use metal instead of plastic. So he says one possibility could be three D printed metal implants that could be absorbed into the body after tissues have healed around them.

So one example is the metal plate that we put in to hold the segments of bone in the right position. Currently that's made out of titanium, which is a very strong biocompatible material, but it is not meant to be there. No one was born with metal in their body. And ultimately a reasonable proportion of them cause problems. So I would like those metals to go away. By that I mean be dissolved, be part of your body or excreted. So that's effectively a resorbable metal.

Dr. Martin Batstone heads back to work at the Maxillofacial Unit in the main wings of the hospital building. And then Mathilde DeSell shows me a few of the 3D printers they have scattered throughout the research institute.

So 3D printing in general works by constructing an object in a layer-by-layer fashion. There are different technologies I would like to show you today. So the first one is my little favorite. I'm gonna open it.

So what are we seeing in here?

So what we're looking at now is the guts of a Nylon 3D printer. We've got a bit of a rolling pin over here on the side. It's going to layer the powder on our print bed that sits right here in the middle. On top of the print bed we have a laser.

Tack så mycket.

out of here. That laser is going to hit the powder and sinter it, melt, solidify it. And our object is built like that, in a bottom-up, layer-by-layer fashion.

As we walk through and look at some of the other giant machines, she tells me this technology isn't only useful for printing things that will go inside our bodies.

A good example is what Tanja and her team are doing, which is 3D printing of radiation therapy aids. So these devices are directly used Be a bit more accurate as radiation therapy is delivered to their patients.

I'm Tanya Kairn. I'm the Director of Medical Physics for Cancer Care Services at the Royal Brisbane Women's Hospital.

What do you do?

I guess the the broader question is what is a physicist doing in a radiation oncology department? And at the Royal Brisbane and Women's Hospital we have quite a few physicists. Our role in this department and all radiation oncology departments in Australia is to make sure that when one unit of radiation is delivered to a patient, so one gray of radiation is delivered to a patient.

In radiation therapy, a high dose of radiation is blasted at a tumor with the goal of killing it. Dr. Kahn works to make this process as precise as possible.

Mm that's the most basic aspect. But in order to make sure that that one gray of radiation is delivered correctly inside a human being. That means that the patient needs to be imaged correctly. And then that those dose distributions, which can be very, very complicated these days, can be delivered accurately by our machines.

But to make sure the burst of radiation hits the right area sometimes means more than a well calibrated machine and accurate scans.

In a contemporary radiotherapy, external beam radiotherapy treatment, the machine is rotating around a patient, delivering that dose. while the patient is lying there as still as they can be, with immobilization equipment to help them stay still, some of which is fitted specifically for that patient, but some of it is like generic handholds and things.

Like the traditional implanted materials we heard about earlier, sometimes this kind of equipment just isn't fit for purpose, which means the dose of radiation might not hit its mark, potentially harming patients.

For example, to treat the lower leg, you need a treatment of the bone in your lower leg. The particular issue with the lower leg is if you can imagine for your CT imaging, your foot was pointed exactly up towards the ceiling and When you go for your treatment, your foot could be rotated out or rotated in, turned out, or turned in, and either of those positions

And Dr. Ken says 3D printing helps her and her team in other ways too. By creating better lifelike models of generic or specific patterns. using the array of anatomically accurate printed materials we saw earlier. These models can help make sure each burst of radiation is hitting the right area, and that the new machines or radiation techniques are working accurately.

In the past we might have used a comparatively simple patient model. This is all very, very exciting. A head that contains tissue equivalent, tissue, bone equivalent bone, brain equivalent brain and you know all of the air gaps and things. And it is also contributed a lot to make sure new technologies are doing the thing that they're supposed to be doing.

And finally, she says 3D printing has also helped with more targeted radiation therapies, especially for cancers like those on the skin. This is through what are called boluses, 3D printed chunks that sit on top of a patient's skin, helping to focus radiation on a more localized area.

The patient is being treated using a high energy X-ray beam. And when that beam comes out of the machine, goes through the air, gets to the patient's tissue, gets to their skin, it will take several millimetres, like a centimetre and a half. for that dose to build up in that patient's skin so that you will not get your maximum dose until after a centimeter or so. If you want to treat cancer of the skin, so BCCs and SCCs, uh ball is it's a method of

And Dr. Kan tells me they've already made hundreds of these small, simple devices to help treat about 200 patients over the past couple of years.

Tomorrow's engineers and surgeons' careers will likely look vastly different to what they were a decade ago. We train surgeons to use 3D printers. We send engineers to observe surgical procedures.

I'm very cautious of terms like future of health, but give me a glimpse of what's just around the corner. What do you see as the kind of next big priority areas for research at the Biofabrication Institute?

I think one of the very promising and interesting avenues it's actually in the tissue engineering space. tissue engineering approaches that are personalized to regenerate skin.

And when it comes to regrowing skin, the next member of the institute I meet tells me this is already being used on some patients today.

I'm Jason Brown. I'm the director of Queensland Adult Statewide Burn Service. We are in the research tissue lab. So look in this lab we look at different technologies to grow skin cells, mostly fibroblasts and keratinocytes, the keratinocytes being the waterproof layer on the outside of your skin, and they're often the first layer lost when you get burnt, and they're also the layer that keep you alive.

Dr. Brown tells me that in severe burns patients, those with more than 20 or 30 percent of the body's surface area burnt, treatment regimes have changed a lot over the past few decades. Nowadays, the first step is removing all the burnt tissue. He says this has been shown to help patients survive, but it also means huge parts of the body are suddenly open to the outside world and infections.

Part of that technology to enable that model to change has been been the ability to temporarily seal your wounds with different technologies and that's often synthetic artificial skins and other things. And also the ability to expand your donorcyte. So if you've only got if you've got a 90% burn, you've only got 10% of your body you can use to as a donor site to cover the burn. So we have to expand that out to cover the other 90%.

A big focus of his team's work is improving survival rates in these more extreme cases by experimenting with how skin tissue is grown and by using different types of artificial skins to temporarily seal up wounds.

The other thing we use now, which is an Australian technology, which is a synthetic skin, which is actually made of polyurethane. And that polyurethane you grow into and you break it down over 18 months. And that polyurethane can act as your skin for a couple of months if we need to. And when you're ready to graft, you peel off a little bit at a time and you put your skin on.

It's incredible.

So that buys us several weeks. Now what that allows us to do is start growing their skin.

And Dr. Brown's team is also looking at ways to improve wound healing, aiming for less scarring once the patient's regenerated skin tissue is ready. So they've been using 3D imaging to better understand aspects like burn depth, ultimately helping to guide surgical planning. And they've also made use of 3D printing technology for things like custom pressure devices to help healing and prosthetics.

In Australia, most of the larger burn centres have a capability to grow cells. Fiona Wood at Perth has been doing the spray on. kind of suspension of cells, the Alfred and Melbourne are doing sheets of cells similar to what we're doing. It's trying to get it to work well is difficult because it's not an exact science growing ne skin for people. Skin grafting is very common, we are very good at doing it.

But already these new processes they've developed are helping patients.

Survival's not a not a barrier now. We've had 90% burns survive and they survive well. A lot of these people are back at work. There was a Bodie from Anley Beach, Crispy Dave, I'm sure he's happy for me to mention his name. He's back running his own boat up at Witch Sundays, you know, it was his boat that blew up and caused his burn, but now he's back doing what he loves.

And echoing what the others told me, Dr. Jason Brown says in a field like his, having researchers embedded within the hospital setting and working directly with those applying research. Means new technology will quickly find its way to patient care, saving and improving more lives sooner.

having direct contact with those researchers and saying, actually, you know, this is a problem I have, this is an idea I have, what are you doing? And they'll go, oh actually we had forgotten about that. We've got this idea. Do you think that might work? I go, well, let's find out. So you suddenly get this focused research on a clinical problem. The result of that is the outputs can be directly transmitted.

Carlsmith produced that report on the future of healthcare and 3D printing.

On Radio National, you're with the Health Report.

This next story Norman is about Kylie and Gillian, two friends who've had strokes. many years apart. This episode explores Kylie's journey and you hear from her children and her husband, and I have to say that as a Health professional listening, I found it quite moving hearing Kylie relive the day of her stroke and and share her decision for having children. This is a very special story to listen to with some very unique insights.

And it's part of a series and this is episode one and we'll also have it online. But here's the story.

When we started the breakfast on Thursday morning, it was like we're gonna conquer the world.

Yes, we had there were power breakfast. And we sit there and solve the world's problems. And we saw the sky was the limit. Yeah. My husband was going to raise the kids if we had children. Yep. And

Remember that?

He was going to take the time off work and let me continue on my huge path to success.

We were about twenty eight then, so a few years before you had to stroke. Take me back to that morning.

Well, it started a day like any other day. I was at home getting ready to go to work. I was having breakfast and I r had this incredibly painful toothache and I had made an emergency appointment to see the dentist. It it all gets a bit hazy from here. I was preparing to go out, dress for work and everything, and all of a sudden everything just went black. I would wake up and try and call somebody, but I couldn't speak. It came to the time for my meeting and

I had a number of different scenarios going through in my head as to what had happened to you d that day, but things weren't normal. So I wasn't sure what to expect when I got home and found you unresponsive on the couch.

I had been there for literally hours.

Six hours or something.

Yeah.

Then I called the ambulance, um said I think my partner's had a stroke and we took you to the Royal Sydney Hospital.

The next thing I remember was Chris going with me in the ambulance. And I remember I just bought this brand new skirt and I was wearing it for the first day. And I remember the doctor getting up every I'm cutting my skirt off.

Yeah.

And I remember the time being horrified.

Thank you.

Do you

You have any recollection? then of what happened next?

You know, I I guess I was looking for certainty and none of the doctors could give any certainty apart from the fact that it was quite a severe stroke and you know, recovery from stroke is not um linear and it's not normal. they were also very honest and transparent in terms of, you know, likelihood of recovery. Look, it was a life changing moment, right? So I was grappling with loss and and shock.

So what were you thinking, Kylie? Did you have a sense of what had happened?

I kind of knew there was something fairly major wrong. I couldn't comprehend that I'd had a stroke. And I always look at this time as being really hard on everyone else. on my husband and my friends and my family because for them they thought I was dying. Mm. And then when I had gained consciousness again, I wasn't the same person. But my husband got our close group of friends and he told them all that I wasn't to eat hospital food because I didn't like hospital food.

what it the main thing I remember is just how much you had changed. And how it sounds so awful, but I was fascinated because you knew exactly what you were saying, but it w came out all gobbledygook for me and that was fascinating.

Because when you learn to talk again, what you're saying to yourself.

Yeah.

is a certain something But what you actually physically say is completely different. Yeah. And my parents like I love them to death. But my parents they would just brush over it and just say, Oh, isn't that nice? Whereas Chris and my best friend Amanda would all of a sudden stop me and say, Ha no, hang on.

Yeah.

What do you mean?

Wait a minute.

Makes sense.

Yeah, try again. So I was still at that stage just prior to the birth of my first child.

So this was twelve months after the stroke you decided to have kids. What were you thinking?

Well, it came down to we're going to have children one day. Why don't we have them now while I'm recovering from the stroke? Oh my god.

Yep, of course.

Because it made sense to us that we use the time I was off work anyway to begin the family.

Yeah.

Now, we hadn't thought through entirely what that meant. And it was that same look from my hospital because uh they knew I was stubborn and big headed. And when I told them they thought, Oh, well, if anyone can do it, you can. But let's just work out how you're going to do it.

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You could see people thinking, oh my god, what are they doing? What do you recall growing up? a mother who had a stroke, did you realize I was different or?

Because I'd grown up with my mum having the stroke, I didn't really think of it as abnormal or different. So

Yeah, I've got a similar experience of just It took me a while to even realise that there was something different or unique about my mother. Probably took when I first went over to another kid's house, met their family, um realised that my family was different than theirs.

It's so interesting because Corey and Barron didn't know you before you had the strokes. But obviously I didn't And I remember at that time and I'm so embarrassed to say it, but it w it it needs to be talked about because I thought the reality is you're not quite the same and so we kind of lost touch.

Yeah. I'd still class this as friends. Yeah.

Yeah, absolutely. Absolutely.

we often thought about each other and that but we didn't touch base. And I was so much based on recovery because I always took it as right, this is where I am today. this is what I've got to get over to make it to tomorrow. And if I can do that, then I can slowly build myself up and I can recover. Because I was determined to fully recover at that stage.

Yeah, absolutely. And I'm laughing, not at you, but actually with you. because when you had your stroke I couldn't really understand what you were going through. Not not really. But now I can.

Yeah, you ended up at the same rehabilitation center as me.

Yeah, when I had my stroke twenty years later.

I have to say, Norman, the part of Carly's story that really struck me was when she said the health professionals cut off her skirt. And she had a good dose of humour. It is. And it's the things that sometimes we as the you you forget that's a new skirt and she'd bought it for her work, but a very beautiful and insightful story.

Yeah.

Check out all four episodes of a stroke of luck on the ABC Listen Up or wherever you get department.

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