Three-dimensional printing technology has been around for decades, but has seen a rapid expansion into commercial, manufacturing and industrial use over the past few years. As it makes its way into health care, what benefits could this relatively new technology offer?
Three-dimensional printing technology has been around for decades, but has seen a rapid expansion into commercial, manufacturing and industrial use over the past few years. As it makes its way into health care, what benefits could this relatively new technology offer?
Dr. Kevin Chen, Chief of Pediatric Surgery at Cardinal Glennon and Surgical Director of the 3D Lab at SSM Health, joins the show to discuss the use of 3D printing in his everyday work. Dr. Chen discusses how it can be used as an educational tool, how it affects the patient-caregiver relationship and where the technology can go in the future.
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Brian Reardon (00:07):
Welcome to Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host Brian Reardon. And with me as always during this season is Josh Matejka and our guest for this episode, we're going to be talking about the promise of 3D printing in healthcare. And with us in studio is Dr. Kevin Chen. He's chief of Pediatric plastic Surgery at Cardinal Glennon. He's also the surgical director of the 3D Lab for SSM Health. And we're going to bring Kevin in just a moment. But Josh, I want to start with you again. This season we're talking about technology and humanity. We've got a clinician with us, which is great. Can you maybe give a little context of how we came up with the topic of 3D printing for this episode?
Josh Matejka (00:52):
Sure. Well, I do want to give some credit to our team over at Catholic Health World and our colleagues there. They're the ones who kind of uncovered this story. And I remember when I was first reading about Dr. Chen and the work that he was doing at SSM Health, one of the things that really struck me is it's really easy to get trapped in when we're talking about technology, to get trapped in the world of artificial intelligence and algorithms and these kind of heady ideas that we're still learning a lot about how they integrate. But 3D printing has been around for a while and we were just talking about this off mic before the show. I've only ever seen it utilized in hobbies and maybe in manufacturing capabilities. So the idea of it being utilized in healthcare was really fascinating. But I think what really drew me to the story of Dr. Chen and his work was how he was using it to connect with his patients and how to better care for them. How these models that SSM utilizes really can calm people's nerves and make them feel like they understand the process a little better. And also the way that Dr. Chen talked about how this is almost a limitless technology that we can only limit through our own creativity and our imagination, which as a storyteller, I think really piqued my interest. So I'm really glad Dr. Chen was able to join us and I'm excited to hear what he has to say about the future and the present of this technology.
Brian Reardon (02:15):
Well, let's bring Dr. Chen into the conversation again. Dr. Kevin Chen is the chief of pediatric plastic surgery at Cardinal Glennon here in St. Louis. He's also the surgical director of the 3D Lab for SSM Health. Kevin, great to have you with us.
Dr. Kevin Chen (02:27):
Thanks for having me, Brian. It's great to be here.
Brian Reardon (02:29):
Yeah, and Josh mentioned this 3D printing. I wouldn't say it's a new technology, but boy, when this started emerging, boy, maybe a decade ago, I remember there was a lot of media hype similar to what we're seeing now with ai, and I think a lot of folks thought that this would really transform the economy and I'm sure it has had a lot of impact in productivity and maybe streamlining particularly in the manufacturing sector. But from your perspective, just broadly speaking, when did you first start to intrigued by 3D printing and the work you're doing in pediatric surgery?
Dr. Kevin Chen (03:03):
So like you said, 3D printing's been around for a while and broadly speaking, 3D printing's part of a larger umbrella called computer assisted manufacturing. And part of computer assisted manufacturing is also computer assisted design. So CAD or computer assisted design has been around almost as long as I have been in medicine. So as I was coming up as a trainee, we were using computer assisted design in complex reconstructive surgery. Already the manufacturing part lagged behind, but the design was already there. So you can imagine if a patient had a large cancer that got resected in their face, it's really helpful to have a pre-planned template that mirrored the other part of the face. And that was the computer assisted design part with 3D printing. Now in medicine, it allows us to produce models and it allows us to produce cutting guides that assist with the surgery itself, aside from just the planning.
Brian Reardon (04:04):
And I think the example that was brought up in the Catholic Health World article that Josh mentioned was orthodontics. This has been something that's used pretty regularly, I suppose for many, many years in the orthodontics field.
Dr. Kevin Chen (04:17):
Yeah, I mean, I hate to say it, but I will say that medicine lags far behind dentistry in the realm of 3D printing and computer assisted design in some ways because dentistry is almost tailor made for the fine movements and the fine details of a tooth really lend itself to design and manufacturing. So things like Invisalign are getting printed by 3D printers now, and things like prosthodontics are somewhat getting 3D designed as well.
Brian Reardon (04:49):
And I would imagine with any technology really it's a cost from the medical field was I would imagine having sort of specialized 3D printing for the work that you're doing. Again, in pediatric plastic surgery, you could design it on a computer, but then I would imagine back in the day you'd have to send that off to some major manufacturing medical equipment company that would then design it and there could be a lag time. And I'm guessing the infrastructure and just the capital costs alone were probably pretty prohibitive to doing a lot of customization. Is that a fair statement?
Dr. Kevin Chen (05:26):
I would say that there is a cost to the customization in many aspects. It's offset by the ease, at least for me in the surgery. So surgery time, as you might expect, is actually quite expensive. So if I can save 30 minutes to an hour, that offsets the cost of actually producing the implant or the model that I might use. And you're correct in that now and certainly 10 years ago, a lot of this was being done by industry due to restrictions in small 3D printers or even just economies of scale. But now when we have our own 3D print lab, it allows us the flexibility to do a lot more things in house, which like you mentioned, decreases lag time and for certain time sensitive things is really a lifesaver.
Brian Reardon (06:17):
Yeah. So how did the lab come about? Because again, I think that must have been quite a leap for us as M to say, yeah, we're going to buy this equipment, we're going to make that capital investment to do a lab. Was there I guess some persuading you needed to do? Was there sort of a cost benefit analysis that needed to be done before that capital investment was made?
Dr. Kevin Chen (06:35):
So I really can't take a lot of the credit for starting the lab. It was started by someone whose job I took over when I got here. But in discussion with our lovely foundation at Cardinal Glennon, a lot of it was spearheaded by the surgical director before me and the medical director in conjunction with the foundation. So the foundation very graciously funded a lot of the lab at the beginning in conjunction with some grant seed funding.
Brian Reardon (07:03):
No, and that's helpful because I think when people might hear about 3D printing, they might think about, well you mentioned some of these machines take up the size of a room. And again, as this technology advances like everything, it gets smaller and smaller. So let's move now to the benefit. Can you walk through some of the different applications that this printing lab can actually provide to help you as a surgeon?
Dr. Kevin Chen (07:25):
So one of the first things that the lab did and continues to do is the models as you mentioned. And that in particular helps with very, very difficult challenging anatomy and pathology. So a patient on the adult side that has coronary artery disease, their heart generally looks like any other heart. It just has plaque in the coronary arteries. However, for some of these congenital heart conditions, their ventricles, their atri are totally misshapen. They connect to places they shouldn't connect. And so without a model, the surgery can become very challenging. And for me, skull abnormalities are extremely difficult to see because I'm not peeling off the entire soft tissue, I'm accessing the skull from smaller incisions. So being able to visualize it in the model is also really helpful. I know Josh mentioned that he was drawn by the story of being able to connect with patients.
(08:20):
And certainly for them it can be even more challenging to visualize, I'm a medical professional and sometimes I have difficulties visualizing what is exactly going on with this patient. For them it's this totally abstract idea, oh, I have a congenital heart disease, I have a problem with my heart, but I really have no idea what that means sometimes. And having the model not only assist with surgery, but sometimes this helps us as humans connect with the patient because they can understand what's going on. And with that understanding comes a better surgeon, patient trust and understanding, which obviously leads to better outcomes.
Brian Reardon (08:57):
So as a surgeon, and I think you talked about this in the Catholic Health World article, typically you might be on a computer screen and something might be three day and rotating on the screen. And that might give you a sense as I go into the surgery, here's how I'm going to approach that. But you have a benefit when you can actually print out a model. Talk a little bit about how that helps you, gives you an edge, I guess, as a surgeon to actually physically hold something as opposed to just looking at something rotating on a screen.
Dr. Kevin Chen (09:23):
So I grew up playing a lot of sports and I think of surgery as a pretty similar to performing in sports. And one coach that I had was always telling me to visualize success. And I don't think I'm alone as a surgeon in saying that before difficult or complicated surgeries, I am visualizing or trying to visualize every step of the surgery and the better mental visualization I can create, then the better surgical outcome I feel that I can deliver. And having the tactile model just adds that extra element of reality to my mental visualization. And so the model, having it in hand really helps that aspect
Brian Reardon (10:07):
And for patients provides a teaching tool for them as well.
Dr. Kevin Chen (10:11):
Absolutely. Like I said, some of these pathologies and some of these diseases are very abstract. It's easy for us to say these complex long words and hand the diagnosis to them, but it's hard for them to understand sometimes without being able to see this is what my tumor looks like, this is what my heart condition looks like.
Brian Reardon (10:31):
And for your pediatric patients, what's that printing out a model for maybe some surgery you're going to do? Does that give them a sense of comfort, a sense of awe? Can you talk a little bit about the experience in interacting with pediatric patients and their families and using these models?
Dr. Kevin Chen (10:45):
I think it's both. For a lot of kids, the hospital is a big scary place and a lot of the models we print are very colorful. They show the bones in different colors like this is your normal bone, this is where the disease process starts. And I think it gives them a sense of concreteness that helps 'em through the process for sure.
Brian Reardon (11:07):
And that's the sort of training education piece. Obviously we talked about this earlier in these medical equipment companies that can use this technology is S SM actually producing, I know in joint surgery obviously that would be an obvious place where you could manufacture something that could then be used for a joint replacement or some similar type of orthopedic procedure. Can you talk a little bit about what are some of the practical applications from surgical or medical equipment?
Dr. Kevin Chen (11:36):
So that is a tricky part of having an in-hospital surgical printer or a 3D printer as you might imagine. And rightfully so. Any device that gets put into a patient has to undergo rigorous testing and 3D printed products fall into this gray area where they really haven't been tested. Sometimes the process has been tested, but the actual final product. And so we're very, very careful not to put anything that hasn't been tested into a patient. So a medical device like a replacement hip or replacement knee has been cleared by the FDA through various regulatory bodies, but something that we print or you print at a 3D printer never has.
Brian Reardon (12:27):
Yeah, and that makes sense. So enough fellow surgeon's like, Hey, here, you got this lab and I need this piece of equipment. Yeah, that's just not part of what this is designed to do. And you need to go through obviously the larger manufacturers who've gotten the FDA clearance to produce in mass quantity or larger quantities anyway, a particular surgical device.
Dr. Kevin Chen (12:47):
Sure, yeah. And certainly when we feel that it is safe, we go through our St. Louis University institutional review board and we qualify it as a research product and with the guidance of our research team, then we can have products that have more patient contact. But again, we're very, very careful to maintain all semblance of safety.
Brian Reardon (13:11):
So looking to the future, is there the opportunity, and I go back to surgical the Da Vinci system, those robotic surgery systems, which were actually designed I think for combat so that surgeons could remotely, that hasn't happened. I mean the technology is potentially there, but you just said they're being very careful in how that type of technology is rolled out. But you look at what the potential is just in other technology like self-driving cars. We've been hearing about that, that of course they're being very cautious and how that takes off. So what do you see the horizon for a 3D printing system? You have the lab you have at SSM being someday able to take maybe download a program and be able to design something that the FDA's approved and do it in a way that's going to be much more quicker than sending an order off to a company that has to then wait on the turnaround. So how do you see the, I guess, future of this technology unfolding at a local level of what you have at SSM?
Dr. Kevin Chen (14:10):
Yeah, I think that is a definite possibility and I could see it going that direction that you have individual stations where 3D printers are more locally available to you and then industry helps you design it, sends off the planning to the 3D printer locally to you, it prints it and then it's already readily available to you rather than having to get made far away and then shipped.
Brian Reardon (14:35):
But we're not there. We're probably, that's years away.
Dr. Kevin Chen (14:37):
I think we're years away from that basically because of infrastructure and because industry continues to make money off of having control over the production. So I think we're years away from locally medical devices that are going to go into a patient.
Brian Reardon (14:55):
Makes sense. And from just a broader perspective then, what are some of the, and maybe not locally, but just in general with the 3D technology for medical applications that maybe haven't been fully deployed yet or fully used?
Dr. Kevin Chen (15:08):
Yeah, I know Josh mentioned the attractiveness of ai and I think where AI is going to come into play is actually very much on the design side. So I think AI is going to help us design what the optimal implant may look like, maybe what the optimal joint based on what the femur and what the tibia look like or for me, what the optimal skull implant is going to look like. So I think from a software perspective, there's a lot of leaps to be made from the design perspective. And then manufacturing, they continue to get better at kind of design and manufacturing, integrity, speed, and then different levels of materials. We talked a little bit about the production of titanium 3D printing and then there are soon to probably have large scale silicone medical grade silicone 3D printers, which is going to be revolutionary also.
Brian Reardon (16:06):
So really I think the potential is there, but just with any technology, it's going to take time to get it to where it needs to be, be practical and readily available. Because I think you've mentioned the titanium is not something being done at SSM, you're going to need sort of a much larger facility and again, a scale of economy there in order to do that. But down the road, particularly with plastics and other things, the idea of personalized medicine and these implants could be a reality that you could say, okay, we're going to do a scan of somebody and they need this specific size and it's all coordinated. And then hopefully you've got that ability to print something pretty quickly and be able to do the surgeon not wait for weeks and weeks until something's produced.
Dr. Kevin Chen (16:51):
Absolutely. Yeah. Like I said, those capabilities are already there. There's just a lag time. But I think as the technology advances that will decrease and hopefully one day we'll be able to make all of those things.
Brian Reardon (17:04):
Well, we talk about re-imagining health in our strategic plan for CHA think this is an example of that, of thinking what is on the horizon. And Josh, I don't know, you've been listening to this conversation, your thoughts or questions as we kind of wrap up the conversation about this technology and how it pertains to the desire of Catholic healthcare really to make sure technology is a means to providing high level, high quality care that's compassionate and really helps elevate human flourishing.
Josh Matejka (17:31):
Yeah, thanks Brian. And thank you Dr. Chen for all of your thoughts in this article for Catholic Health World. And I mentioned this quote right up top. One of the things that really drew me in is you said the only limit really to this technology is our own creativity and how we can think about care and how working with patients, what would be your advice to other clinicians who are looking maybe not even at just 3D printing, but maybe that, what would be your advice to them in terms of how to think creatively about how to adapt these new technologies? I know it can be kind of daunting to do that kind of stuff to make that first leap, but how do people in your position think creatively in terms of how to adapt the next technology, the next thing that will enable you to take better care of your patients, to take that leap into a higher echelon of care?
Dr. Kevin Chen (18:24):
I would say it's probably like any other industry in that necessity breeds ingenuity. So every clinician is going to have a difficult disease diagnosis or a difficult patient that they're not exactly sure what the best answer is going to be, and especially in surgery, maybe what the best surgical technique is going to be. And that's when I think you can be especially creative and think outside the box to seek other answers that are going to best serve the patient.
Josh Matejka (18:56):
Yeah. Thanks Dr. Chen, that's really good insight.
Brian Reardon (18:58):
I think this has been really an interesting conversation and makes you, again, think about the promise of all the technology, but I think what you did, Kevin, was provide some pretty practical thinking about, yeah, this holds so much promise, but we have to be very cautious, judicious in how it's rolled out. And I love what you're doing at SSM in taking the technology and really using it to enhance a patient experience by education and really helping you as a clinician. You use a sports analogy, and I think having that sort of the practice of working with a model is going to help you. So that probably is reassuring to patients knowing that, hey, my surgeon has sort of a tactile sense of what's going on before you actually go into that surgery suite and start making an incision. So I think from that perspective, it's really fascinating. And then again, the potential of what is on the horizon I think is also really interesting and hopeful.
Dr. Kevin Chen (19:52):
Absolutely.
Brian Reardon (19:53):
Again, that was Dr. Kevin Chen. He's Chief of Pediatric Plastic Surgery at Cardinal Glennon. He's also the surgical director of the 3D Lab for SSM Health. Kevin, thanks for being with us and sharing your insights.
Dr. Kevin Chen (20:04):
Thank you so much for having us.
Brian Reardon (20:06):
This has been another episode of Health Calls, the podcast of the Catholic Health Association of the United States. I've been your host, Brian Reardon. Our show's executive producer is Josh Matejka, and we've had additional support from Yvonne Stroder. This episode was engineered by Brian Hartmann at Clayton Studios here in St. Louis. You can find Health Calls on all of your favorite podcast apps and services, as well as on our website www.chausa.org/podcast. If you enjoyed the show, go ahead and give us a five-star rating. We'd love to hear from you. And as always, thanks for listening.