A Glimpse into the Future: 3D Modeling for Clinician Training & Bioprinting-The HSB Blog 1/19/23
Our Take:
The 3D modeling and bioprinting industry is emerging as a unique and multifaceted solution towards medical training, planning & executing complex surgeries, and creating biologically necessary, personalized tissues and organs for patients. Innovations in this industry are yielding encouraging results in making diagnoses more accurate, improving clinician knowledge, and giving patients better health outcomes because this technology gives care providers easier access to the resources they need to improve care, albeit at prices that are restrictive to most organizations.
Additionally, 3D bioprinting is far from the panacea it is purported to be as it is yet impossible to fully print complex, vascularized structures such as fully functioning human organs, limiting care providers to the creation of basic tissue and biomimetic structures that are designed to temporarily fix a patient’s issues while they wait for organ transplants or other treatment. Ethical concerns exist as well, as many people are uncomfortable with the idea of “playing God” so to speak and using pluripotent human stem cells to create any type of organic structure. Regardless, innovation is expected to continue along with market growth and given a few decades, 3D modeling and bioprinting will likely become more common in the healthcare industry.
Key Takeaways:
3D bioprinters can cost up to $65,000, with software costing up to $15,000 and high hourly fees to capture and obtain CT scans from a healthcare provider (Frontiers in Pediatrics)
3D modeling provides a number of advantages for training medical students and clinicians and allows for proficiency-based training in a variety of contexts
Information technology training of 3D models generated from medical imaging allows for the creation of easily shareable design blueprints, and machine learning has been used to create training databases and digital twins
These technologies give rise to ethical concerns around quality, safety, and human enhancement, as well as technical concerns about the lack of suitable biomaterials and the complexity of the biostructures being printed (Journal of Biomedical Imaging and Bioengineering)
The Problem:
Healthcare providers are always searching for novel solutions to solve problems that arise when coordinating and delivering care. Technological innovations drive new changes in the market and introduce new ways to diagnose and treat the issues that patients face, and in the context of medical imaging, there is ample room for improvement. Doctors across the globe currently rely on 2D scans derived from computed tomography (CT) and magnetic resonance imaging (MRI) scans, which essentially translate 3D data into 2D scans which leaves more uncertainty and room for interpretation as radiologists convey the information they gather to clinicians who lack their background and experience.
Applying these advancements in 3D modeling empowers advancements in fields such as tissue engineering and regenerative medicine. These technologies which aim to artificially create functional tissues constructs, aim to integrate these new methods and to analyze data, build and edit human tissues, and benefit even more from ongoing advancements in medical imaging, Using 3D modeling in conjunction with organ bioprinting technology that relies on these models have the potential to yield large returns for the healthcare industry and could result in significant changes.
The Backdrop:
3D bioprinting is the layer-by-layer printing process of functional 3D tissue constructs using a unique type of bio ink known as tissue spheroids. These spheroids lack biological scaffolds and can easily adapt to the correct geometric shape required to bond with other cells. This in turn causes greater cell-cell interaction, cell growth, cell differentiation, and resistance to environmental factors due to high cell density achieved through bioprinting efforts according to a study from the International Journal of Bioprinting.
These biological advancements are accompanied by advancements in 3D digital imaging as well, which allows the data collected to be transformed into the 3D images necessary to print tissue in the first place. Information technology transferring of 3D models generated from medical imaging allows for the creation of design blueprints that let other clinicians replicate similar results given they possess the appropriate technology. In addition, as noted by Procedia Engineering, computer-assisted design software including predictive simulations are utilized in both the printing and post-printing process to assist in optimizing the printability of bio inks and can reduce the number of experimental trials required to bioprint tissues. Computer-aided design (CAD) data is combined with computer numerical control, specialized mechanical technology and material science in order to print biomimetic and complex tissue structures using the traditional 3D printing technique of layered overlay, allowing clinicians to replicate anatomical structures with relative biomechanical accuracy considering the fledgling nature of this technology.
As noted in the Journal of Advanced Science, training programs deploy sensors and real-time feedback systems to provide more comprehensive feedback to guide instruction and help to better delineate the typical workflow. In tandem with the sensors and real-time feedback, machine learning is being leveraged to create training databases from large datasets and even digital twins which can be used to assist in the planning and execution phases of complicated surgeries according to the International Journal of Bioprinting.
At present, 3D bioprinting is primarily used by the pharmaceutical industry to design in vitro models to test new drugs on animals. This assists in making the experimentation process quicker while minimizing mistakes and maximizing cost savings given animal models are generally considered accurate and reliable tools to determine toxicity and model disease but can be expensive and have ethical issues. This technology can also provide patients with personalized organic tissue and organs designed and created from their own cellular material, significantly lowering the risk of organ rejection. As noted by AAPS PharmSciTech, the growth in demand for human treatment using 3D printed tissues are driven by the medical demands of aging Americans, rising demand for organ donors, ethical concerns around animal testing, clinical wound care, and joint repair and replacement procedures. This growth is significant with an expected compound annual growth rate of 15.8% from 2022 to 2030 per Grand View Research.
The applications of the 3D imaging and modeling technologies that enable bioprinting hold great promise in and of themselves. For example, 3D imaging can enable clinicians to perform a variety of complex treatments more easily than before. Using CT and MRI scans, radiologists can create 3D reference models that help surgeons better prepare for their job and visualize new solutions that may be harder to deduce from 2D scans.
During one procedure in 2016, Dr. Michael Eames used 3D imaging to recreate a digital twin of a child’s arm, who was suffering injuries from unhealed bones that prevented the rotation of his arm and caused intense pain. Once the orthopedic team created the digital twin of the arm, they could see that it was only necessary to reshape the child’s bones, which was an insight that ended up decreasing the procedure time from 4 hours to 30 minutes and returning 90% arm-range movement to the patient only 4 weeks after his surgery. Compared to similar surgeries not conducted using 3D modeling methods, self-reported postoperative pain and scarring were much lower, ultimately leading to lower costs for both hospital and patient, a shorter recovery time, and greater patient satisfaction according to a press release from Axial3D.
Training outcomes for medical students is another important application of this technology, allowing for proficiency-based training in a variety of surgical contexts as an increasing number of training curricula are beginning to adopt simulation as a part of their programs. Basic simulators which help new students hone their surgical skills are available as teaching tools, and some simulators meant for skilled surgeons to perfect their strategy before entering the operating room, are able to fully simulate entire procedures such as joint replacements and fixating fractures, according to an article published in the Journal of Future Medicine.
Using 3D simulators ultimately changes the nature of learning and gives students a more individual approach towards their coursework as their hands-on experience will no longer be limited to unwieldy manuals, predetermined lab times, and doctor shadowing. 3D models allow for interactive manipulation, a better understanding of spatial relationships, and the utilization of novel methods of visualization for learning anatomy that trainees have been reported to enjoy more. However, despite the plethora of benefits of this technology, price is a limiting factor if educational institutions wish to print these 3D models. For example, an article in the Journal of the American College of Radiology found that each 3D model cost approximately $3,000 per procedure with an operating cost of over$200,000 per year to run the 3D printing service. Skilled technicians and talented 3D designers are also needed to properly utilize specialized software that can interpret and reimagine 2-dimensional CT and MRI scans in great 3-dimensional detail according to an article published in the Annals of 3D Printed Medicine.
Implications:
As technological innovation rapidly advances, the 3D bioprinting industry will continue to leverage advanced imaging and modeling techniques in attempts to create exact replications of anatomical structures. The use of 3D modeling in viewing anatomical images makes the process of understanding medical imaging more intuitive, leading to more accurate diagnoses, better surgical planning, better patient and care provider education, and improved health outcomes according to an article from Jump Simulation. Innovations in this field are also leading to greater integration of organisms with technology, such as the creation of extremely complex microphysiological devices that integrate sensors within soft tissue structures, created by the Wyss Institute at Harvard University.
This technology can be further adapted to create other vascularized tissues that researchers can use to investigate the effects of certain regenerative medicine and drug testing, with biosensors able to yield more accurate and localized results than with previous technologies, according to the Wyss Institute. Additionally, 3D models created using these new methods of medical imagery can easily be shared with other medical practitioners with access to 3D bioprinting technology to benefit in a similar way. However, this raises questions about privacy and the legality of sharing detailed anatomical models of patients’ organs which will require explicit informed consent.
Despite these initial promising indications for 3D bioprinting technology, there are a number of challenges that the technology will need to overcome before broader adoption. Although it has a bright future in the healthcare industry, current technology is simply not enough yet to meet the demands of the modern patient and the price to use it is often unattainably high.
In addition, a variety of technical challenges exist, including the need to increase the resolution and speed of bioprinter technology, the inability to recreate the organic cellular density of certain tissues and organs, the lack of suitable biomaterials needed to replicate this technology on a much larger scale as pluripotent stem cells are difficult to come by, and of course the complexity of the biostructures being printed, particularly vascularized tissue that must be properly constructed to avoid necrosis as per an article published in the Journal of Biomedical Imaging and Bioengineering.
There are also ethical issues that raise a number of concerns such as equality, safety, and human enhancement as outlined by a study from the International Journal of Scientific & Technology Research. Will patients have equal opportunities to access 3D bioprinting technology regardless of socioeconomic status, and how do insurers plan on covering payment for such services, if at all? Is this new technology safe for humans in the long term, and will medical staff receive sufficient training to use it? Finally, will this technology be ultimately used to build better people and improve their bodies by replacing organs with brand new ones, not to mention the inevitable integration of man and machine that is already being assessed in a variety of clinical contexts? These issues must be addressed by care providers, federal regulators, and the patients that will benefit from 3D bioprinting to assuage concerns and give legitimacy to a promising new technology with the potential to revolutionize tissue engineering, regenerative medicine, and clinical training.
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