Written by Aaron Minard
A 3-D printing revolution has seamlessly altered manufacturing, prototyping, and design processes for countless industries from space exploration to the operating room. Part of this transformation has resulted in the potential for improved surgical outcomes.
This potential was realized by a Houston mother whose daughter was diagnosed with transposition of the great vessels that required an emergency operation. With a business background in the 3-D printing industry and the support and enthusiasm of pediatric cardiothoracic surgeons, Anne Garcia founded the non-profit “OpHeart”. The mission of OpHeart is to place 3-D printed technology in the hands of pediatric cardiac surgeons to improve surgical outcomes in the lives of children.
Dr. Redmond Burke, Director of Cardiovascular Surgery at Nicklaus Children’s Hospital, aptly suggested that “You can’t give someone a piece of paper with a picture of a rubrics cube on it and say “How do you solve this?” You have to hold that three dimensional object in your hands and then come up with a solution.” Burke goes on to explain that 3D printing technology “..helped take someone from being inoperable to operable. And we saved their life.” 3-D printing technology affords surgeons the ability to hold, examine, plan, and practice their procedure on a patient specific model prior to entering the OR.
3-D printed models are also being utilized by Memorial Hermann Oral and Maxillofacial Surgeons in the Texas Medical Center for facial reconstructive surgery. Raw CT data is sent to Materialise, a company that created software known as “Mimics” which converts the CT data to a format understood by the 3-D printer. A patient specific model is then printed and an accurate model of the facial deformity, tumor, or injury is provided to the surgeon.
After the surgeons receive the 3-D printed models, they are used as a guide to contour titanium implants to reconstruct the framework of a face. This allows surgeons to perform and perfect their intended surgery outside of the OR on a model prior to engaging in complex facial reconstruction. Dr. Jonathon Jundt, an Assistant Professor and Oral and Maxillofacial Surgeon at Memorial Hermann in the Texas Medical Center stated that, “The ability to pre-bend plates prior to surgery can save hours of time in the OR. Before 3-D models were available, complex three-dimensional bending of titanium implants were done by hand in the OR while the patient remained under general anesthesia. Now, most titanium implant contouring is done before the patient sets foot in the OR.” Both hospitals and patients benefit from shorter and more accurate procedures in the OR. In some cases, additional corrective surgeries may be avoided by precisely realigning facial bones during the initial reconstruction.
While the current process of outsourcing the conversion of CT data to a 3-D printable format and the creation of a 3-D printed model is a useful resource, the timeframe for submitting the data and receiving the models can be lengthy. In order to reduce time and streamline model generation, some surgeons have elected to incorporate 3-D printing technology within their hospitals. One such hospital, the Salisbury District Hospital, acquired a Stratasys Objet 3-D printer and has utilized this technology extensively in their Oral and Maxillofacial Surgery division.
See a video highlighting their story here:
Given the positive affirmation by surgeons in multiple specialties on the advantages of utilizing 3-D printing for patient care, it seems likely we’ll continue to hear even more stories about 3-D printing for medical applications in 2016.
I am always on the lookout for 3D printing in unusual situations and in conjunction with National Maker’s Week this past week; I was looking at the Smithsonian’s 3D printing site. I have to say there are definitely some things that I want to print out from the site including fossils, statues and more. But what most intrigued me was a 3D rendering of Abraham Lincoln.
The Smithsonian has two life masks of Lincoln that were donated by the families of Clark Mills, a sculptor form the 1800s. The family donated a casting of the “life mask” of Lincoln to the Smithsonian in 1811, and this particular mask was done shortly before Lincoln’s 56th birthday in 1865. Life masks were a common practice done in the mid 1800s to showcase the face of a living person.
Lincoln always strived to be visible to the public during his time in office, and this is shown in the worry lines and gaunt features in the mask.
What was interesting to me was how my reactions to this type of portrait of this incredible leader were very intense. I am used to seeing pictures and paintings of the great leader who had such an important role in American history, but I had not seen the 3D scan of the President before. The 3D scan made him very human, very tired and very real to me.
Looking at the picture of the scan, I thought of my own grandpa. He shared Lincoln’s bony features and somewhat tired demeanor and I thought about how the Civil War must have changed Lincoln in so many ways. Compare the look on this 1865 mask to one that was done earlier in Lincoln’s life.
Volk was a sculptor who was doing a statue of Douglas and wanted a “matcher” for Lincoln after the famous debates. Lincoln sat for Volk in 1860 when his political star was rising but prior to his run for President. For a week, he went to Volk’s studio and sat for a plastic casting to be made of his face, in between court dates where he was the attorney working. This was before he rose up to be a national politician and had not been nominated for a presidential candidacy.
In five years, Lincoln aged so much. The above image is a 1917 copy from a bronze casting given to the Smithsonian in 1888.
I encourage you to explore the site at http://3d.si.edu/browser and find out a bit about the models and technology. There are STL files to download and information to be shared. Check on the last view in the series below – so life like.
I’m been a bit nostalgic for my days of relative leisure as a child with building blocks, Lincoln Logs and Tinker Toys and what came to me was that I’ve always been a maker in my heart. My all-time favorite toy growing up was Tinker Toys and spent hours upon hours with the stocks and couplers making everything from full size pedal cars to fantastical wings and buildings. I didn’t’ have rules on what I could build and what it was supposed to look like, but all in all, the structures went up, the cars were created and the “stuff” fueled my imagination and house with all sorts of objects.
I grew, and in a few years graduated to my first industrial arts course in junior high and the joy of drafting. Mr. Murray was a great teacher as we $learned about the details of drafting, how to show hidden features, putting down to paper an isometric view in addition to standard front, side and top and if needed back view. He explained us the need for careful notations on scale and units, as well as how to add details and views on features that needed an “exploded” inset drawing or even an additional drawing. I loved that class with all the things that we did ranging from drafting to fabricating plastics parts (I still have the acrylic candle holders and console bowl I made) as well as leatherwork, simple soldering and more.
From industrial arts we moved up to vo-tech classes in high school which at that time were a required series of courses that all students in the high school took. Ranging from welding to typing and culinary arts, those courses help many of us have part time jobs in college and after school as well as kept our education grounded into the workforce. I thank heavens every day for a well-rounded education in my small town and the dedicated teachers I met. I actually used my set of Tinker Toys to make a model for a public speaking class once. But, when my parents were cleaning out the misc. items before they moved to what would be their last home, the Tinker Toys finally were given away to another family with children. I didn’t think much about it then, but I missed those worn sticks and wooden round couplers years later when I was trying to explain a design with an interior feature to a co-worker. By then, CAD was mainstream to manufacturing and everyone had abandoned drafting and the drawing for electronic files and 3D views.
But then the reality of always using an electronic drawing came home to mass production – mistakes happen. Hidden problems were not as apparent in an electronic drawing or even a 2D hard copy drawing without having a physical model in hand. Hence the 1st article requirement was born. The 1st article was required on many projects where a physical part had to be produced first before high volume mass production could start. Hugely expensive, since the production part had to be tooled up, the 1st article became the dreaded stop to development and commercialization in many new parts because of the delays and the resulting “engineering changes” after the review. I remember the anxious days of review and holding my breath as a committee looked over, measured, evaluated and then signed off. As an engineer and application specialist, I used to hope that marketing didn’t review because they ALWAYS wanted more bells and whistles. The additional features from marketing meant an engineering change, more time, retooling and drove the tool costs to the sky.
Then prototypes using SLA, SLS, FDM, urethane castings, and more came about. Design reviews were so much easier and collaborative manufacturing became the normal mode for new projects. Reviews of what the part would look like, how to tool for features that could be a problem, agreeing on designs, compromises on details – all of these areas of communicating and review prior to high volume production were now enabled and normal. We took sturdy prototype parts beyond design reviews to functional testing for wind, handles them in focus groups for marketing, used them in trade show mock-ups, traveled with them for sales samples, and took 3D Printing with hybrid manufacturing/machining into new territory where legacy tech and new tech made money.
Enter the Maker Movement – where people wanted the power to make pieces and to indulge their imagination by making a physical part using 3D printing. A whole new group of participants got to use tech and creativity to do one off designs, creating new ways to satisfy needs and manufacturing low volume product without expensive tooling. Those opportunities have continued to grow and printers for the hobbyist continue expand. You only have to look at Kickstarter, attend a Makerfaire to see so many low cost Maker Printers. In the meantime, The President includes 3D printing as an emerging technology and the industrial arena sees prototyping and design verification via 3D printing is now being required by many industries and markets.
But to me, it all really started with that cylinder box of Tinker Toys. We created, we built, we tore it up and rebuilt and then we did all over again with Tinker Toys. That low tech that we never saw as a path forger would evolve to a 3D printer used today. Overall, the basic purpose still remains the same between the Tinker Toys box and the 3D printer – to express what we can imagine with a physical part.
And you know what – I never really did outgrow Tinker Toys. Occasionally I’ll see some at a garage sale and you can’t help but start messing with the pieces. And just like 3D printing, you can’t help but think about what you want to do with the technology.
Engatech hosted a plant tour and presentation at the Coleman Associates/HTC site on the 10th in Houston Texas. The event was full with standing room only. That led me to think about other times we have done “outside” events and reflect on trade group meetings where we have done plant tours. Overwhelmingly, plant tours are the most popular event that local interest groups hold. Having gone to my fair share of them, I wanted to get some background on why we all frock to going thru a plant with a group when we wouldn’t be caught in the same room with many of the attendees at these events on a normal day. So let’s go over some of the science behind this.
Per the Harvard Business Review, in general there are three reasons people like to take plant tours.
“There are three primary reasons for taking a tour: to learn, to assess, and to teach. Although those objectives overlap to some degree, they lead to very different types of tours. Learning tours are undertaken by people who believe that an operation has a feature or an ability that is valuable; they want to find out precisely what that ability is and how it works. Most often, the goal of a learning tour is to bring back the knowledge acquired on the tour to replicate the capability. Assessment tours are undertaken to determine how well a plant is doing either along an important dimension of performance or in terms of its ability to fulfill its role in the company’s operations strategy. Teaching tours are undertaken to pass knowledge from the visitor to the plant being toured. The three types of tours demand different questions and focus on different parts of the site.” (Upton, Harvard Business Review.)
The most plant tours are the one where I go to a plant to learn about a capability and to interface with knowledgeable experts at that site. This allows me to determine whether the technology is something that I want to consider without identifying myself as a prime target for a pitch. It is a relatively risk free way to doing a “look see” without having to interface with a company’s sales department or give away too much information when I am evaluating. The same reason that I take plant tours applies to why I go to the Texas State Fair and look at cars (for out of state readers – trust me on this one. If you go to the State Fair of Texas, which is the largest state fair in the USA, you want to see the car displays.) By going to a “display” I can see the tech, access the information in a risk free environment where I am a part of the crowd, and get to find out more info and even ask questions without being singled out.
So why does being part of a group seem popular in assessing tech? Because you can ask tough questions and the answers are perceived by the recipient as being less biased and more truthful in a group setting away from the “sales call.” I can ask by-standers and other attendees their opinion, perhaps even get some insight that I can’t get from the literature or a website. Often I can gather tribal knowledge about tips and techniques on hardware or in use processes on the plant floor from tours plus get to observe the comfort of the operators when they are using the tech or software. Plus I can do this without as much of an influence from the vendor on what answers I am being given or what I observe.
This shift goes along with the shift in sales development seen during the past 10 years as internet searches become the preferred means of gathering information versus face to face meetings and trade group conferences. Going to a plant tour offers a chance to go behind the scenes a bit to find out how the tech works in real life and get reviews from users all at once. The current thinking about the sales process is that prospects have gotten over 80% of the information used in making a buy prior to the final transaction and the trade show, showcase, plant tour and internet search are all part of the prior research. Prospects now are better informed, have a better idea of the features and benefits prior to a sales call, and want specifics on performance, pricing and solutions before they interface on a one to one basis with a sales professional.
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