we've been tracking 3d printing here at nlm since, oh, 1998. some of our early forays into this technology included patient-specific surgical instrumentation and we did that around '99, 2000. this is an example in some ways ofthe kinds of printing that can be done
uses of 3d printing in medicine, for surgical instrumentation.this is actually a bone femur that was created—this is the original bone femur and this is the 3d model. this actually received 510(k) approval from the fda,
this process, so that you can actually dodiagnoses from this technology to diagnose orthopedic problems. and as you can see, the resolution is such thatyou can faithfully represent complex bony structures. one thing you can't do with your actual bone is look right up the marrow channel and see what's going on. this is some of the early work that we did.we were looking actually to make templates to drill holes in bones, specifically the pedicles of people's spines during spinal reconstruction.
we wanted to make sure that those holes were placed in the correct location at the correct depth.so we're making spine templates in order to allowpeople to do procedures, drilling. this particular process wasfor total hip arthroplasty. you wanted a very precise hole,placed at a particular angle in the head of the femur, and then basically using a series of cutting devices, like you would cut down a tooth for a crown, you would cut down the head of the femur, the ball head of the femur for a post,
and then replace it with a spherical prosthesis. so we were actually trying to get specific surgical instrumentation done. early on, in fact, back when i was working at the university of mississippi medical center,i was working on a project for interventional magnetic resonanceimaging—surgical mri. we were approached by a group that did rapid prototyping, the polymer institute at southern mississippi. they said, "we can make custom instrumentsfor your doctors, for your surgeons."
actually... doctors don't want custom instruments. if you brought them a squishy pencilor a pen, they'd throw it away and go back to the #2 yellow pencilbecause they prefer what they grew up with. the scalpels don't wanna be in any funny shape. and i'd told them so, but i realized i was mistaken when iarrived at nih. i was at a spine surgery workshop and i realized that doctors may only want one scalpel, one instrument,because doctors
want it to all come out the same, more or less—the procedures to come out the same. but it occurred to me later thatpatients all come in different shapes and sizes. and if you're going to do custominstrumentation, you want to do instrumentation that's customized for your patients. and that's how we first got involved in 3d printing. clinicians and patients can utilize it, can employ 3d printing in treatment and diagnosis inmany, many different ways, as i said. this process is similar to whatpeople call 3d printing today. it goes by the technical name"fused deposition modeling"
but we all know it as 3d printing. like i said, it received 510(k) approval from the fda, so you can actually do diagnosis. some of the early work that we were doing here at the national library of medicine includes tryingto make templates for surgery. there's a fellow by the name of frank bova at the university of florida in gainesville, who has several patents to do this, and they're actually talking about making craniotomies more specific. they would actually put templates down that allow people to
put craniotomies in particular places. other forms of uses for this sort of thing is as visualization. this is a visualization that we did for colleagues across the street at walter reed army medical center. they actually did the diagnosis, but their printer was down, and so as a collaboration, we simply printed it for them, and in time for the surgeon. this is a way to visualize the actual problem, but also the approach that the surgeon might need.
so for surgical planning, the surgeon maywanna actually approach it— —what you're seeing here is a large arteriovenous malformation. the black spikes are actually just support material to make sure it's architecturally correct. so you see a large arteriovenous malformation, and the doctor who actually did this original surgical plan put this window in so the surgeon could actually see the approach for how they might try to mitigate this particular condition.
this gives the doctor something to visualize,
but also gives the patient something to visualize as well. it gives them the opportunity to see, "oh, that's what's inside my head," for instance.
