How to Start and Scale up a Point-of-Care 3D Printing Lab

This quick response from a 3D printing service within the hospital saves valuable time during a pandemic. But an in-house lab has many more benefits than a rapid turnaround. Having a dedicated facility in-house can cut days off the 3D planning and/or printing process, support innovation initiatives, lower overall costs incurred by the hospital.

During our recent 3D Printing in Medicine: 2020 Digital Course, we gathered medical professionals to hear how they successfully started and scaled up their 3D printing labs and how to bring the most value to their institutions. 

Here’s a taste of some of the learnings from the event. 

Dr. Juling Ong, Craniofacial and Plastic Surgeon at Great Ormond Street Hospital (GOSH), said, “When I was considering setting up the 3D service, I felt it was important to speak to everyone who might benefit from the service. In fact, I found that a 3D technology was interesting to almost everyone I spoke with.” He continued that once he did his initial survey amongst hospital personnel, “a case for an in-house service is really, really convincing. Clinical quality, clinical safety, and service, all gained from 3D technology.” 

Many of the other speakers had similar stories. While each hospital has its own unique specifications, what they had in common is that once they started to explore the benefits of bringing 3D planning and printing directly into the hospital, they saw that it goes across disciplines and the benefits are numerous. 

Dr. Ong pointed out numerous specific benefits that he saw, including: 

• Clinical quality 
• Patient experience 
• Clinical safety 
• Financial 
• Clinical service improvement 
• Research 
• Innovation 

Within each of those, there are even more specific benefits. For example, under clinical safety, Dr. Ong pointed out that additional sub-benefits include improved understanding of anatomy, reduced complication rate¹, infinite testing of surgical options, reduced re-operation rate, and saving time in the OR.  

“This service is all about helping people transform their innovative ideas, using their imagination to convert into their reality using a safe, measurable, and reliable way,” says Dr. Ong. 

“This is the most important aspect,” according to Dr. Florien Thieringer from University Hospital Basel. “You need to have the right team. This means we do not focus only on radiologists or engineers or maxillofacial surgeons.”   

Each speaker during the event spoke on the importance of having many hospital disciplines come together for an in-house 3D service. The radiologists and radiographers are, of course, central as they are the ones taking the medical imaging data and, in many hospitals, even set up their service out of the radiology department.  

The speakers emphasized that the team cannot only be made up of radiologists exclusively. A fruitful 3D service includes other profiles, such as surgeons, biomedical engineers, clinical scientists, programmers, researchers, and managers, according to the speakers.  

With such interdisciplinary teams, communication is key for the success of your 3D lab. Mimics Viewer offers the perfect platform for communication of cases that allows interactive views and feedback on 3D patient models, planning, and device designs with stakeholders in and outside the institution. 

When it comes to the core skills and training for the staff, Dr. Peter Metherall, from Sheffield Teaching Hospital, noted that specific areas for skill development across the team include cross-sectional anatomy, IT skills, 3D image post-processing software, surgical and interventional procedures, quality assurance in 3D post-processing, 3D printing technologies, just to name a few.  

While many core skills can be learned on the job, Materialise has plenty of resources and courses to help learn this unique skill set. Our Materialise Academy portal includes tutorials, webinars, documentation, FAQs, and more. In addition, Materialise offers training events and workshops, including on-site options tailored for specific institutions, to develop 3D planning and printing skills. Plus, Materialise has a team of engineers on stand-by to support medical staff and answer their questions. 

For the scope of the work done by the team, many speakers also noted that their 3D services are truly multi-disciplinary, with Dr. Thieringer saying that specialists in cranio-maxilliofacial, spine, heart, lung and many more disciplines across the entire hospital use their in-house service. This collaboration is fruitful not only for their cases, but also within the wider medical field: within the last two years alone, findings from his team have made it into 20 publications. 

“Finding new accommodation in an existing hospital is always a challenge,” said Dr. Metherall. Many presenters spoke on the significance of having the service centrally located, so that it is easy for clinicians to drop by, which will further their use of the lab. And many also located the service within radiology, as mentioned above. 

“If your service is not located within radiology, it will be important to establish strong links as this will help you with the introduction of specific imaging protocols for 3D work,” said Dr. Metherall. “For example, we slightly modified the cardiac CT protocol for heart segmentations as we wanted more contrast in the right side of the heart. Of course, being embedded within radiology makes the process a lot easier.” 

Dr. Metherall pointed out that there are many cases where the expected outcome is not a 3D model, but rather a measurement or 3D visualization, such as a surface-rendered model or volume rendering. 3D models are useful to “get a sense of scale and better plan your procedures,” says Dr. Metherall. 

The printer technology and software are vital as this can help efficiency down the line. Dr. Metherall says that while segmentation can be time-consuming, it is more cost-effective than being in the OR. Plus, with methods to semi or fully automate this work and once the team has more experience, the time to do this task reduces.  

For IT infrastructure, Peter Metherall notes the importance of having good connectivity with the PACS system, and if based in radiology, to connect with the radiology information system. Having separate storage is important also as often the files are too large to store on the PACS system. He suggests working with the IT department to avoid having to figure out the back-ups with resilient storage. The latest edition of Mimics further integrates into the clinical workflow through a module that easily connects with hospitals’ PACS systems. Moreover, this update allows better management of 3D printing objects and relate image data using the new DICOM Encapsulated STL standard. 

“One of the most important sources of funding for us are still grants, both through funding bodies like local foundations, Swiss funding agencies or the EU but also through the hospital itself with innovation transfer grants,” said Dr. Thieringer.  

The presenters also spoke about funding not only to set up the service, but to continue later on. Since most medical insurance does not yet cover 3D prints, many speakers highlighted the importance of looking for sources for reimbursements once the lab is up and running.  For example, some use a system within the hospital to internally bill the different departments for using the 3D lab. 

Plus, many hospitals justify the scheme by analyzing the costs they’ve reduced by doing more planning before the surgery using 3D planning and printing. Preoperative planning  saves time in the OR when the cost per minute is high. By illustrating to hospital management the ways that costs can be cut, many departments are willing to use the service. Resources, such as this Materialise whitepaper, can further help hospitals analyze the value captured by setting up an in-house service. 

“We started with anatomical models for patient education, informed consent, planning surgical procedures, pre-selection, and bending implants and osteosynthesis plates. But later on with our collaboration partners, we could also produce patient-specific implants, which means you have to be aware of medical device regulations,” notes Dr. Thieringer. 

Materialise Mimics complies with the medical device regulations of different markets such as EU and US, to accurately 3D print anatomical models for diagnostic use in combination with printers from different manufacturers. Moreover, Mimics allows for users to easily label parts, with the latest version allowing for even faster labelling. This is essential in the clinical workflow to assure patient security by making it easy to identify 3D models once they come off the printer.  

“Do good and talk about it. Marketing is also very important. It may not be the first thing you think about when you start your 3D lab but it’s very important if you would like to grow,” said Dr. Thieringer. 

As 3D printing is seen as a cutting-edge technology, some of the discussions during the event were around leveraging the in-house service to increase their hospitals’ reputations. Promoting their 3D services is a concrete illustration of a hospital taking the lead in being an innovator to provide better healthcare to its patients through personalization. 

Dr. Thieringer also noted, “if you want to get more funding it’s important that others know what you’re doing. Scientific publications are important, but so are regional and national television, conferences, and events. 3D printing needs to be promoted. It’s an interesting topic and the people involved are engaged and want to know more about its use in medicine. It’s important to get the results from your work and let other people know.”  

Not only is connecting internally important, but discussing in-house 3D services with others outside your hospital are significant learning opportunities.  

Dr. Thieringer notes: “I would really recommend building up a network, a regional, a national, and an international network because in this area of 3D printing you can learn a lot from others and grow quickly with the help of strong networks.” 

One way to do that is through events such as the 3D Printing in Medicine: 2020 Digital Course. Materialise will host more events like this in the future. Check on our events page to see when the next event is and join to hear how others are effectively using 3D printing to be more efficient, improve patient care, increase cross-team collaboration, and more.  

Connecting with 3D printing specialists such as Materialise’s medical team helps hospitals define how they can increase the value of their specific offering by using 3D printing through tailored advice.