#edGY: 3D printing for healthcare: Where technology and the human body meet

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THE possibility of producing models of human cells and organs through 3D printing has brought about a lot of excitement.

Science enthusiasts marvel at the prospect of 3D printers producing models of kidneys needed to save lives and reduce the burden on organ donors.

But Ayishwariya Menon, who is into 3D printing and biomedicine, prefers to take a more level-headed and measured approach.

From the get-go, she prefaces her opinions with a warning that there could be a risk of “unrealistic expectations”, given the ongoing hype about what 3D printing can do for healthcare and humanity.

“There are limitations — some things we can do now and some things we may only be able to do in 10 or 20 years’ time.

 Therefore, responsible reporting is 

necessary to avoid misrepresenting what 3D printing can achieve,” says Ayishwariya, clinical team manager at Materialise Asia-Pacific.

Materialise is a 3D printing service company founded in 1990 that prides itself on being an innovator. Its core business includes providing products and services to engineering and medical professionals and consumers.

Some of its most exciting work is in the field of healthcare, which includes biomedical engineering software and services, surgical solutions for orthopaedic surgeons and cranio-maxillofacial (CMF) surgical solutions.

Belgium-headquartered Materialise, which has an office in Kuala Lumpur, is working with local doctors to apply 3D technology in areas of biomedical engineering, CMF and orthopaedics.

Materialise Malaysia Sdn Bhd also provides software for additive manufacturing.

#edGY speaks to Ayishwariya about the progress of 3D printing technology in Malaysia and what is possible at this point.

Ayishwariya, with a biomedical engineering background, was awarded the Governor’s Prize and the Student Centenary Prize at Imperial College London.

She has worked for The Acrobot Co Ltd in the UK in orthopaedic surgical navigation and robotics.

Application of 3D printing in healthcare

In brief, 3D printing incorporates various processes of layering to make a three-dimensional object.

Dentistry was one of the first healthcare sectors to adopt 3D printing technology and its use has matured with experience.

The use of 3D printing in other healthcare sectors is also picking up pace.

This technology is useful in the healthcare industry for several reasons. One is that scans can now be presented in three dimensions instead of the static two that we are used to.

Also, 3D printing can bring more benefits. For example, full-scale anatomy models can be produced to help surgeons prepare for a procedure by performing practice surgery and in some cases, aid them in bending plates to fit the anatomy before they are used in the operating theatre.

This process not only saves time but also the number of times a surgeon would have to operate on a patient before figuring out the actual problem.

The more radical use, which is still another couple of decades away, is to produce models of organs or tissues to be grafted onto a patient. Other things that 3D printing could produce are models of bone replacements and surgical guides.

What is available in Malaysia?

Generally, some CMF surgeries in Malaysia are done with the help of 3D-printed models.

In orthopaedic surgery, 3D-printed patient-specific guides or instruments are available for various applications, ranging from knee replacement to the reconstruction of bony anatomy on most long bones (the forearm or the leg).

More recently, patient-specific implants have been made available where the missing bone is essentially replaced with 3D-printed titanium implants designed to mimic its properties and shape.

How much does it cost?

When talking about the cost of 3D printers, there many aspects to consider.

“The reality of the situation is that there are many 3D printing applications in healthcare — ranging from an object placed inside a patient’s body, such as a customised implant, to consultation tools, such as plastic anatomical models that are made to scale,” says Ayishwariya.

Many people think that to 3D print, one only needs a printer. 

But, according to Ayishwariya, for medical applications, one would need a medical ecosystem built into the machine.

While the printers are important, the engineering and software that make the print possible cannot be overlooked.

“Patient safety and quality are in the forefront of our minds. Beyond selecting the right kind of machine and technology for healthcare applications, strict quality systems are required, along with the right software and the correct choice of biocompatible materials,” Ayishwariya says.

The costs depend on the types of application — its use will define the type of material and technology to be used and the amount of engineering work required. The price can range from RM2,000 to RM60,000.

“Using the appropriate material means that one application may use selective laser melting while another may use selective laser sintering or stereolithography. As these technologies vary, so do the costs,” she explains.

Stereolithography is a 3D-printing technology used for producing models, prototypes, patterns and production parts. These are done one layer at a time by curing a photo-reactive resin with an ultraviolet laser or other similar power sources.

As for selective laser melting, it is an additive manufacturing process that uses 3D computer-aided design data and a high-power laser beam to create three-dimensional metal parts by fusing fine metallic powders together.

Why the slow pick-up in this region?

Menon is not sure of the reasons for the slow pick-up, but from information she gathered from speaking to people she has worked with, she is able to point out a couple of things.

One of them is that countries with easy access to new technologies also have good legislation on healthcare, including reimbursement of healthcare costs.

“Often, I hear in Malaysia that the process of reimbursing patients is cumbersome and lengthy,” Ayishwariya says.

“However, I have no personal experience in this, so this is solely based on what people have told me.”

According to her, in most European countries, surgeons drive the adoption of new technologies, whereas in Malaysia, it is dependent on hospitals.

Most hospital boards typically will wait to have clinical outcomes before deciding to adopt new technologies.

“At this moment, 3D technology does not have a 10-year outcome studies, so there is a preference to wait for large-scale adoptions elsewhere before hospitals in Malaysia commit to something,” says Ayishwariya.

What can Malaysians expect

According to Ayishwariya, there is a lot of room for growth. A handful of surgeons and hospitals in the country are showing interest and actually applying 3D printing technology.

Kuala Lumpur Sports Medicine Centre and Materialise are working closely to make this technology more easily available, she says.

“Dr Ranjit Singh Gill, the hand and upper limb consultant at the centre, was the first person to use Materialise’s technology in the operating theatre in Malaysia. We want to build on this relationship so that more patients can have access to such solutions,” she adds.

The future of 3D printing technology looks exciting but it will take some time for it to flourish. 

 

This article first appeared in #edGY, The Edge Malaysia Weekly, on February 16 - 22, 2015. Read more here