3D technologies in hospital context

From the external "service" to the internal 3D laboratory As with all technological innovations, also in the biomedical sector 3D has had a strong impact on clinical processes in routine activities, hand in hand with the progress of 3D imaging technologies (CT, MRI, etc…).

The optimization of resolution obtained from the imaging has favored the development of software for three-dimensional reconstruction of medical images, and the ability to print the anatomical compartments to facilitate the visualization and study of an optimal preoperative planning. These new opportunities have attracted, in an increasingly concrete way, the attention of health professionals, who have discovered the benefits: greater safety, time savings and less inconvenience to operators.

In the last 10 years, many hospital centers have begun to acquire these tools, which have become part of the routine of care and diagnosis of patients. The ways in which healthcare facilities exploit these technologies are mainly two:

• Commission to third-party companies for the design, 3D printing and finishing of anatomical models, usually carried out by small businesses and start-ups, equipped with machines and skills.
• Creation of specialized 3D hubs and laboratories within the clinical facilities made up of 3D technologies and related tools, even if to date these are only a few state-of-the-art hospital centers.

Usually, it’s the best solution begin with the first solution, using the services of external companies and, once the request from professionals becomes more frequent, then it’s possible start to create special spaces within the hospital wards that make use, very often associated with innovative research fields. The first striking examples in Italy are: the Bambino Gesù Hospital in Rome which since 2015 has adopted 3D technology in the treatment processes of complex pathologies, ascertaining that the use of 3D printing models for maxillofacial surgery allows savings approximately 40% of the operative time.

Similarly, other complex hospitals have introduced 3D into routine clinical activities such as, for example, the Policlinico San MatteoMatteo in Pavia (Fig. 1) or the Pisan University Hospital. Consequently, other realities are taking action to incorporate this technological innovation and are currently in the planning and design phase of 3D Lab Ospedalieri, while others prefer to maintain the external service.

Fig.1: 3D4MED - Laboratorio interno Policlinico San Matteo di Pavia

Getting to this point is not so immediate. For this reason, it is still in doubt which is the most suitable way to guarantee the full service and use of innovation. Both possibilities offer different advantages and disadvantages, and this also depends on the type of hospital involved. Specific factors are to be considered:

1. Timing and quantity of urgent cases to be treated
2. Costs and logistics
3. Skills and specialized figures

So why choose one or the other mode?

For those who are approaching the use of these 3D technologies for the first time, resorting to the service of third-party companies in the practice of anatomical 3D printing can initially be advantageous in organizational and economic terms, delegating all the onerous part of reconstruction to the expert company. machine design and management with the consequent post-production phases. This way can be useful at the beginning but, once the requests for the use of these technologies become more frequent, it becomes difficult to manage the timing of communication of the clinical case and reception of the 3D anatomical model, especially when it comes to urgent cases to be treated.

So, it can be highlighted:

Fig.2: 3D printed preoperative visual model

The establishment of a hospital 3D laboratory must be thought of as an additional service contribution for the professional and for the patient himself, a place open to the clinicians of the facility where anyone can enter and interact with the engineering and technical figures present within it. To help healthcare facilities to orient themselves in the phase of setting up these laboratories, the Italian Association of Clinical Engineers (AIIC) has drawn up a guide in which they recommend introducing a logistic system for planning the prints, a sort of queue management flow, in a routine regime, attributing a priority score based on the patient's condition at the time of the request and the benefit that can be derived from the realization of the device, in accordance with the daily planning of interventions and visits to patients, in relation to cases of urgency. A scale that reflects the risk matrix is proposed (Fig. 3).

Fig.3: Urgency level matrix
(AIIC Guideline, Additive Manufacturing technologies in healthcare)

Integration of this internal service in the hospital or clinic can have various results:

Technological progress, we are witnessing, represents an unprecedented added value within the healthcare context, generating benefits not only for the patient but for all healthcare personnel, streamlining obsolete procedures and working methods, and with which sooner or later we will go to confront us. The return on investment in the adoption of the same cannot be placed in an immediate perspective but will be found once the entire digital transition mechanism is set in motion.

Preparation for the introduction of these technologies requires particular attention to the regulatory aspects and the choice of machines, consistent with the service to be provided, followed by careful identification of new trained and competent technical figures in starting the technology. To facilitate all this, there are funds and loans dedicated to public bodies and hospitals to refer to, with the aim of increasing the level of care and therapies for the patient and the innovative technological contribution within health facilities.

We thank Dr. Luca Borro for sharing the experience of the Bambino Gesù Hospital in Rome.