Radiology Needs to Own 3D Printing

The signs could not be more clear at this year’s annual meeting of the Radiological Society of North America (RSNA), every hands-on training course on 3D printing was sold out months in advance. The information sessions had more audience than there were seats in the rooms, and the attendees were pulling out their smartphones to snap a picture of virtually every slide being presented. On the showfloor, the presence of 3D models, printers, and software was ubiquitous.

The Opportunity for Radiology: Wide and Transformative

Already applied and matured in several industries, additive manufacturing (the technical term for 3D printing), is no stranger to health care. It has a strong clinical track record in dental applications, and its business case in the dental field has been solid for well over a decade. Now is the time when the field of radiology starts to grow interest and multiply initiatives in 3D printing, continuing on an exponential growth trend that started less than three years ago.

The incentive for radiology is quite obvious: Today, the main “product” radiologists provide to their customers, physicians, is the radiology report. For some years now, they have been asked to step up the value of this product by layering more “service” onto it – something they have been trying to do by delivering their product in a much more consultative, collaborative, and even patient-facing way.

So, what if radiology’s current product and service could both be augmented in a big way through 3D printing? What if radiology’s service line could expand to provide not just image interpretations, insights, and recommendations based on images, but also customized surgical guides and positioners, patient-specific prostheses, biocompatible implants for regenerative medicine, or deformable models for surgical training? The opportunities for radiology seem endless and are actually coming of age.[[{"type":"media","view_mode":"media_crop","fid":"44846","attributes":{"alt":"Nadim Michel Daher, Industry Principal, Medical Imaging and Imaging Informatics, Frost & Sullivan","class":"media-image media-image-right","id":"media_crop_1853661759153","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5052","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 213px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Nadim Michel Daher, Industry Principal, Medical Imaging and Imaging Informatics, Frost & Sullivan","typeof":"foaf:Image"}}]]

Rapid Clinical Expansion Strengthens the Case for Centralized 3D Printing Labs
Bone applications today constitute the number one use case, by far, for 3D printing based on radiology images. This puts orthopedic departments and orthopedic surgeons in a strong competitive position, at least on par with radiology, for capturing the growing opportunity of 3D printing services.

However, clinical use cases and applications of 3D printing continue to expand very rapidly beyond orthopedics, boosted by ongoing research and innovation. Notably, in areas such as cardiovascular (interventional cardiology, congenital heart disease, implantable heart valves, vascular surgery), otorhinolaryngology (ear, nose), abdominal (renal, liver), oncology, and orthopedics (skull, spine, mandible), but also in clinical research and quality control (phantoms), more case studies are being generated and capturing a lot of attention.

As clinical use cases diversify, the business case for an integrated approach to 3D printing in health care enterprises is becoming much stronger. Similar to the centralized 3D labs that many large institutions have formed around the advanced visualization and image postprocessing functions, centralized 3D printing labs would be best able to serve the variety of needs of different clinical stakeholders in an enterprise.

As such, who better than radiology, a central clinical function in its very essence, to take ownership of this new enterprise service line?

Industry Developing Health Care Specificity
In the U.S. health care market, like in several other developed markets, the demand for medical 3D printing solutions has been growing rapidly. Almost every health system now has at least one internal ‘champion’ experimenting with or growing interest in 3D printing.

A few dozens of U.S. hospitals have moved ahead to purchase their own 3D printer, with some even starting to grow a mixed fleet of different types of printers. Many facilities have also started relying on remote printing services from specialized vendors, who can receive image and expedite a printed model in less than a day.

In line with this rapid growth, the field of 3D printing is becoming less industry-agnostic to health care, forming a strong health care-specific value proposition. Different vendors are addressing any combination of these four main market opportunities:

1. 3D printing hardware, with different printer technologies and brands using various types of materials, from several large or small companies including Stratasys, 3D Systems, Hewlett Packard, RepRapPro, ExOne, and MakerBot.

2. Segmentation software, typically from any advanced visualization solution that provides advanced tools for 3D images from CT, MRI, cone-beam CT, or even TEE ultrasound images. Examples include Amira, 3D-Doctor, Slicer, Bespoke Modeling, and Materialise, whose Mimics Innovation Suite has dedicated segmentation functionality for the expressed purpose of 3D printing.

3. Computer-aided design (CAD) software, including a variety of licensed and open-source options, notably Meshlab, Rhino, Blender, and Materialise's Mimics Innovation Suite which also includes CAD tools integrated with segmentation functionality.

4. Professional services, a cornerstone for 3D printing’s value proposition, which may include consulting, training, implementation, as well as remote 3D printing services.

More Tightly Integrated 3D Printing Medical Imaging Offerings
Two examples of companies who have moved forward to develop an integrated solution for 3D printing in medical imaging – each through a very different approach:

• Materialise: the Belgium-based 3D printing company has built very deep specialization in health care. To build on the momentum in both its remote 3D printing services (which provided over 100,000 3D printed models last year), and its integrated suite of professional-grade software and services, the company has recently up-scaled the capacity of its U.S. operations.

• EOS imaging: the France-based company, maker of the stero-radiographic 3D imaging system EOS, is building on its 2013 acquisition of OneFit Medical to further extend the scope of its value proposition. EOS Imaging now offers a complete platform that brings 3D data, surgical planning solutions, models, and patient-specific instruments to their customers. The company offers an online service that prepares the DICOM data from an EOS exam for 3D printing on any technology. These anatomical models provide additional input for surgeons all along the patient care pathway: diagnosis, preoperative, postoperative, and follow-up.

Inching Closer to Mainstream Adoption While Embarking On the Road to Reimbursement
With the technology, the use cases and the appropriateness of 3D printing getting recognized in more case studies, some see this as a very good beginning for 3D printing on the road to reimbursement. In the wake of ever-declining reimbursement rates for medical imaging procedures, coupled with ever-increasing risk of commoditization of imaging services, the new value-add opportunity that 3D printing represents for radiology comes as a promising new growth opportunity.

Not only will 3D printing allow radiology departments to expand their service line into a whole new range of professional services, it will also increase the ‘personalization’ of radiology services to individual patients in line with the health care-wide push toward personalized medicine. If one judges by the interest on the part of radiologists, hospitals, software vendors, and hardware manufacturers, radiology seems in a fairly good position to capitalize on this up-and-coming opportunity.