Unlocking the value of 3D printing medical devices in hospitals and universities

“I began my career in 3D printing working on a large US DoD program for full face transplantation where it was pioneered in the United States — at Brigham and Women’s Hospital in Boston, MA,” says Frank Rybicki, chair of the Department of Radiology at the University of Arizona. “These experiences led me to very quickly realize that 3D printing had many additional applications, and that bringing the service line into the hospital offers many advantages. While 3D printing is very ably performed by multiple providers, I am biased in thinking that it has its best ‘home’ in radiology!”

You’re also lead for the Banner University Medical Group – Phoenix. What are some of your responsibilities with that organization?
I am responsible for the delivery of premiere clinical radiology services from my colleagues at Banner. This is the largest academic radiology service in Phoenix, and the desert Southwest. As Chair, I am also responsible for the research and educational programs related to medical imaging. From the research angle, this includes projects in radiology as well as those that are supported by medical imaging. For education, this includes our residency program and other educational programs at the College of Medicine and within Banner Health.

In the abstract for your talk, you write “medical imaging data is often used inefficiently… most often for patients with abnormal imaging who require a complex procedure.” Why do you think this is so?
That’s the best question! Radiologists only use a fraction of the information when they render a report. They do extract essential information, but for sure not all of it. For most patients, this inefficiency has no consequence. For example, if a patient has a CT scan of the abdomen and pelvis for clinically suspected appendicitis and the scan shows a normal appendix, the key information has been extracted from the data — it is overall only fractional, but the question is answered, the patient is not going to the operating room (at least not for appendicitis), and any unused information is generally non-consequential. However, let’s take a completely different clinical scenario — an infant born with a complex congenital abnormality for whom corrective surgery is required. This patient will undergo cardiac MR for surgical planning. There is more information in those MR images than is in the report, and in many cases much more information. That information can be extracted electronically from artificial intelligence, and it can be extracted physically from Computer Aided Design (CAD) and 3D printing.

This presentation is not about AI, so let’s deal with that quickly — this patient’s data can and should be used in learning algorithms so as to improve diagnosis, discover biomarkers that can can’t be “seen with the naked eye,” and to enable integrated solutions that use composite data that includes medical images. With the AI parked for another day, let’s move to CAD and 3D printing. The MR images themselves are DICOM, but they undergo segmentation of a Volume of Interest (VOI) and then conversion of this data to a surface mesh file. A standard surface mesh file format is .STL. The conversion of this data to a surface mesh file enables the data to be used much more efficiently and completely.  The “final” surface mesh file is the final anatomic representation.  3D printing is one of the “Patient-Specific Realizations” of that surface mesh file. With this in hand, the patient can undergo corrective procedures.  3D printed anatomic models are now a prerequisite for complex congenital heart repair.

What role does 3D printing play in the field of radiology?
Every year, tens of thousands of patients undergo care that is based on 3D printing — and for every single case the modeling is based on radiology images.  Most radiologists do not even recognize this fact, since the usual workflow is that the DICOM images are sent to industry for free, after which the medical device is created and then sold back the hospital.  However, radiologist and radiology departments are now creating 3D printing in Health Care Facilities (HCFs), bringing care close to the patient and devices closer to the surgeon.

What do you see as the most important aspect of your work at this time?
The most important part of my work now is that I am drafting the updated billing codes for medical 3D printing in the United States.  These will be finalized and submitted by the American College of Radiology in Q2 2024.

What are some of the challenges of integrating 3D printing into clinical practice? How are these challenges being met?
The greatest challenge is pecuniary. When a hospital buys a 3D printed medical device from a company, the charges are accommodated by the current infrastructure, typically in large OR fees. I submit that 3D printing in HCFs saves money — however, funding the infrastructure is different than individual one-time payments.

What do you see as the future of 3D printing in radiology/medicine? What would you like to see?
If you step back, Computer Aided Design (CAD) or the generation of surface mesh files from CT and MR images is now front and center in medicine. The use of robotics hinges on CAD. All Augmented Reality (AR) and Virtual Reality (VR) cases hinge on CAD.  3D printing is one of the “Final Anatomic Representations” from a CAD file. The difference is this:  CAD can be done in the hospital, or HCF – and it IS being done in the hospital. Providers just need to be more organized and judicious in how it is done. These are the reasons that I founded and launched the 3D printing Special Interest Group within the Radiological Society of North America (RSNA), and this is the reason that I launched and serve as Editor-in-Chief of the journal 3D Printing in Medicine (2022, IF = 3.7).

What would you like attendees to learn from your talk at SPIE Medical Imaging?
I am hopeful that attendees will appreciate how CAD and 3D printing can be and is being performed in HCFs. I am very humbled by the success of the first edition of my 3D printing book, 3D Printing at Hospitals and Medical Centers: A Practical Guide for Medical Professionals, over multiple language markets. After several years and COVID, the 2^nd Edition of the book will be released soon.

My SPIE talk will be a walk through the first chapter of the 2^nd Edition, following the steps for 3D printing that unlock value. I will also go through nuances that are not in the book and are typically not in print — for example 3D printing billing codes. For example, I will review the specific questions that need to be answered, and our current best answers for those questions.

Lastly, CAD and 3D printing in hospitals and medical centers are among the most academically fruitful and “hot topics” — it may be the case that some people don’t realize this. Being front and center at the biggest imaging science meeting can’t hurt the cause for making this clear.