3D Printers Bring Specialized Options to More Patients

Larry Hand

December 02, 2014

Three-dimensional (3D) printing is beginning to reshape medical practice, but its implications for healthcare may be complex, according to an opinion article published online December 2 in JAMA. Although questions remain about how best to use the technology, experts agree that 3D printing is already changing patient care.

"While not a panacea, 3D printing is increasingly finding its place in patient care, from its expanding use in surgical planning to the vision of printing whole new organs for transplantation," write Mark H. Michalski, MD, from the Investigative Medicine Program, and Joseph S. Ross, MD, from the Robert Wood Johnson Foundation Clinical Scholars Program, both at Yale University School of Medicine in New Haven, Connecticut.

"Indeed, 3D printing may serve as a means of distributing manufacturing in the same way that the Internet distributes information."

3D printing has been used in dentistry for more than 10 years, they note, because it provides the capability to produce molds for many dental implants.

Surgical Uses

Head and neck surgeons also have begun using 3D printing to make preoperative models for complex surgeries.

"For example, several facial reconstructive surgeries are performed by first harvesting the fibula, which is then fashioned in the operating room into new bony structures," they write. "These surgeries can now be augmented using computer planning programs to generate surgical plans that determine the ideal way to harvest and incise the fibula to create a reconstructive graft."

Researchers outside clinics and hospitals are using 3D printing to create medical devices for a broad range of conditions that are tailored to an individual patient's anatomy. The authors write that a biocompatible polymer splint has been use to prevent airway collapse in one case of neonatal bronchomalacia. It was designed to be naturally resorbed within 3 years.

3D printing also has been used to create prosthetics, with digital blueprints made freely available for download and reproduction, they write.

However, they note, few studies have evaluated how 3D printing has performed regarding safety and regulatory issues. "At this early phase, it is unclear what the ultimate value of 3D printing will be for health and how it will specifically affect outcomes."

Questions also remain as to how regulation may affect use of 3D printing, they add.

"As 3D printing continues to integrate into medical practice, physicians and patients face the challenge of understanding this complex technology, taking advantage of its potential, and weighing its potential risks," they conclude.

Already Working

"I think it's very prescient for [JAMA] to publish this," Leonard S. Marks, MD, a urologist at the University of California, Los Angeles, Medical Center, told Medscape Medical News. He is coauthor of a study published earlier this year on using 3D imaging to develop molds for prostate organs after their removal.

"There are lots of applications in medicine for 3D printing. Our interest in this began about 3 or 4 years ago. We are interested in the correlation between prostate cancer seen on [a magnetic resonance imaging] image and prostate cancer as it appears in the organ after it's removed," he explained.

"The question being: Is [magnetic resonance imaging] an accurate predictor of what's actually there?" he continued. "To make the correlation more perfect, we use 3D printing to make a custom mold for the prostate to go into after it is removed so that it can then be sliced in a systematic fashion."

His group has videos on YouTube, on the Target Prostate Biopsy channel.

3D printing "has been a big help to our work," he said, without costing a lot of money. "A cool thing about 3D printing is that it's cheap. We don't have the best printer out there. I think we paid about $2500 3 years ago for a 3D printer that does our work just fine. Our biomedical engineers thought that they had won the lottery when we got that printer."

It helps provide information that is used to determine treatment levels, he added.

"It's allowed us to predict what's actually in the prostate. We've never had that opportunity before," he said. "It allows us to find the serious cancers more quickly and to find the insignificant cancers, which are very common in the prostate, and put them in proper perspective more quickly and to save people the worry that they may have a serious disease when in actuality there's not.

"You know who's got a bad one and who doesn't."

Dr Michalski has reported serving as a consultant to Butterfly Network and Hyerfine Research; Dr Ross has reported receiving grant support from Medtronic and Johnson & Johnson and federal agencies and serving as an advisor for FAIR Health; Dr Marks has disclosed no relevant financial relationships.

JAMA. Published online December 2, 2014.


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