News Roundup

Will 3D printing be added to radiology services?

PARCA eNews – May 20, 2016 – At the American College of Radiology ACR 2016 annual meeting held May 15-19 in Washington, D.C., radiologists from New York and Pennsylvania provided a guide for radiologists interested in adding 3D printing to their practices. They presented a step-by-step workflow from acquisition of CT image data to consultation with referring clinicians using a 3D printed bone model. 

Why would radiologists want to add 3D printing to their imaging services? Many

surgeons and imaging specialists have recognized the incredible potential of 3D printing. Using 3D printers, patient data is essentially turned into actionable, physical objects. The applications are numerous ranging from custom sized prosthetics, to surgical models, to sizing implants. 

The authors said in their poster presentation, “Clinical and imaging expertise provide radiologists an ideal skill set for clinical 3D printing. As interest in clinical 3D printing continues to grow, the ability to provide this service to an existing referral network represents an unprecedented opportunity for interested radiology practices. For a nominal fixed and per-case cost, interested radiology practices can establish an in-house service to provide 3D printed bone models to interested clinician referrers and patients alike.”

In their workflow model, the presenters said they started with CT images of the head for a routine clinical indication. Images were segmented in 3D Slicer using a one-sided global threshold floor. This was processed into a surface mesh, exported as an STL file, and subsequently repaired using Meshmixer. The model was split to reveal relevant landmarks (sella, orbits, skull base foramina, craniocervical junction) as discussed with the clinician at the outset.

The final STL file was imported into Slic3r, and prepared into g-code instructions readable by a consumer 3D printer. Printing parameters were selected as appropriate for the case and chosen print material. Upon completion, support material was removed and the model was reviewed with the referring clinician.

The completed model was in two pieces on a 1:1 scale and included the craniocervical junction. Printing time from image to finished clinical model was approximately 50 hours, at an estimated material cost of $11.00.  All requested surface landmarks were visualized to the satisfaction of the referring clinician. While the surface finish was not as uniform as institution grade 3D printers, the presenters offered their model as a proof of concept.

How all this might affect PAC systems, was not discussed, but if the utility of 3D printing becomes widely adopted by clinicians, an obvious impact on PACS might be image storage capacity for an exponential increase in requests for 3D imaging.

Beyond that, critics suggest radiologists proceed with caution. In an opinion piece in Diagnostic Imaging, Ronald Schilling, PhD specifically pointed to the PACS experience for lessons learned. Noting that the initial failure to address workflow and training issues set back the PACS industry years as institutions grappled with finding workable implementations.

“I worry that the same could happen with 3D printing,” Schilling wrote. “If you could print a model directly in the office, in a matter of minutes that would be a tremendous asset. But 3D printing is notoriously slow. Creating a model makes sense for exceptional cases like the heart surgery at Nicklaus (Children’s Hospital, Miami) - but perhaps not for everyday operations. There’s often too much effort for the output.

“This begs the question: if hospitals spend millions on 3D printers, will doctors actually use them? Are there other ways to deliver some of the benefits of 3D printing, at faster speeds and without spending so much money on a piece of equipment that could soon be outdated?”