3D printing: shaping future healthcare?

It has been three years since the UK Government hailed ‘advanced materials’ (a term that includes three dimensional or 3D printing) as one of its ‘eight great technologies’, and barely a week goes by without new reports of the promise of3D printing for improving healthcare. But will it be coming to a clinic near you any time soon? Whilst many of the cutting edge developments in 3D printing – for example tissue and organ printing - are very much in their infancy, there are applications already infiltrating healthcare. These include the use of bespoke 3D printed models for surgical planning, customised titanium implants, biocompatible implants, and patient tailored dentistry and prostheses.

3D printing in action – how can it help?

Surgeons have long relied on 2D (MRI / CT) scans to plan surgery. Now, computer assisted design software can convert these scans into digital 3D print files to create bespoke and often complex anatomical structures, which would be time-consuming and convoluted to produce using traditional manufacturing processes.

These 3D printed models can - and are - being used by physicians to plan and simulate surgery in advance of the procedure, thus reducing time in surgery, risks, and recovery times and by extension, improving the effectiveness of the procedure.

Advocates of 3D printing in healthcare argue that personalised implants too could result in better patient outcomes, particularly in complicated cases such as reconstructive surgery, where standard size and shape implants don’t suit all patients.

Why is clinical 3D printing still a luxury item?

A transplant performed in the Netherlands in 2011 using a 3D printed titanium jaw is broadly accepted as the first operation of its kind. Three years later a widely publicised case in Cardiff is believed to be the first to use 3D printing at every stage of a patient’s reconstructive procedure. Charing Cross Hospital has reportedly used the technology for planning ‘several hundred’ hip and knee surgeries. A plethora of examples exist. But given the first purported use of 3D printing for surgical planning and implants was back in 2011, it’s somewhat puzzling why five years later we are still admiring its use in dramatic [maxillofacial] surgery, rather than asking why it isn’t in the easy reach of all surgeons and patients. Granted, the path from innovation to mainstream implementation is rarely smooth, or swift, but in the case of 3D printing this journey could be hastened.

Developing a forward-looking, coherent strategy for implementation

There is no clear strategy on how 3D printing should be adopted and used across the NHS. Currently, the technology is used by enterprising clinicians and researchers with access to printing facilities. As one consultancy firm noted, ‘[the use of 3D printing] is very sporadic and it tends to be beholden to individual surgeons or technicians’. A health-system wide strategy for procuring, implementing and evaluating the value of 3D printing technologies would help to ensure this resource does not become the preserve of those few hospitals with access to the relevant facilities and expertise.

One of the most exciting aspects of 3D printing is its potential as a multi-use te chnology promising benefits across different clinical specialities (e.g. surgery, orthopaedics). As such, a system-wide strategy for using 3D printing could point out opportunities for sharing expensive resources and expertise across disciplines and avoid over-investment in technologies that might rapidly become obsolete.

Nurturing cross-disciplinary collaboration

The design of patient specific devices is a highly-skilled, multi-disciplinary, and labour-intensive process. For example, designing a customised implant requires the operation of quite complex computer modelling software, as well as an understanding of the relevant human anatomy. These broad ranging skills are not typically held by the same individuals. Therefore, nurturing a healthcare environment that facilitates effective collaboration and communication between those with the technical manufacturing and design proficiency and those with the clinical expertise will be pivotal to advancing the use of 3D printing for health benefit.

Demonstrating value to payers

With a claimed price tag of £12,000, a bespoke 3D printed titanium hip joint is around 10 times more expensive than a usual hip replacement joint. In a cash-strapped health system evidence of value is everything. Although the benefits of 3D printing are being published in individual cases, commissioners will rightly demand more systematic and longitudinal evidence to demonstrate that its clinical impact is significant and worth paying for. Positive indicators would include: reductions in surgery time patient recovery time and readmissions. Other indicators of patient outcomes including safety and performance must also be captured and evaluated if a case for wider use in our health system is to be made.

Is the future 3D?

So what does the future hold for 3D printing in healthcare? Already, there are claims that the future is actually 4D - the added dimension (time) referring to the creation of dynamic 3D printed objects that reshape or reassemble themselves over time, allowing the production of devices that change with growing anatomy. The possibilities of 4D printing are a truly remarkable but distant prospect at the present time. Meanwhile there is a great opportunity to reap the benefits of 3D printing for NHS patients promptly by mapping out a national strategy, gathering the evidence to support implementation, and empowering the experts to develop and deliver its benefits to their patients.