A view from the frontier: turning hospitals into factories

Developments in 3D printing and associated software will empower hospitals and communities to fabricate, rather than buy, many of their solutions. Brent Balinski spoke to neurosurgeon, inventor and founder of Anatomics Dr Paul D’Urso about making healthcare personalised, as well as faster, cheaper and better.

The next decade will see a revolution in healthcare, with everyone better off except for global manufacturers of “off the shelf” devices and implants.

That’s the opinion of Dr Paul D’Urso, a leading neurosurgeon, inventor and founder of Anatomics.

“Every aspect of medicine will be affected by this technology in a positive way,” he said, referring to the growing use of 3D printing in hospitals for patient-specific applications, something the Australian surgeon has led the world in. It will play an important role in the increasing personalisation of healthcare, alongside things such as connectivity, big data and wearable devices.

D’Urso, who spoke to Manufacturers’ Monthly recently between surgeries at the Epworth Richmond Hospital (he performs roughly 500 operations there a year) saw the future when he was exposed a stereolithographic 3D printer in 1991.

He saw that there was important work to be done in turning CT data input into additive manufacturing output. Stereolithographic biomodelling proved enormously useful in producing anatomical models for purposes such as communication and preparation for surgery, and in creating custom implants.

“I just stepped into a whole frontier of unexplored medicine,” he explained of the work, which became the subject of his PhD research.

“It was really kind of difficult when I first started in 1991 with 386 computers and very limited Internet and so forth,” he explained. “But now it’s easy – [you can] do it on your iPhone, virtually.”

This played a role in pioneering surgical work, including in operating on deformities and, more recently, several titanium implant world firsts.

“Everything I did was new, everything I touched was a world first, and so it was just like that.”

A wealth of untapped potential lies in using the technology for “community-based personalised medicine”, a topic on which D’Urso will present at the Inside 3D Printing conference in May.

Transport, logistics, inventory and other costs will be taken out of the picture, according to the model, involving creating implants and other structures at the point of use.

There have been many predictions made about the impact of additive manufacturing on supply chains since it became a popular topic. D’Urso’s thesis is that, as with other applications, bringing production closer to the point of consumption will reinvent the way many businesses run.

Completely custom prosthetic implants made in community hospitals would be horrid news for the big implant manufacturers, such as Du Puy Synthes, Medtronic and Stryker, which announced in January that it would invest heavily in a new metal 3D printing facility.

“So all of the logistics and inventory and waste that we can’t afford in healthcare now is gone – it disappears. But what does Stryker get now, out of this?” D’Urso asked.

“They get very little, because all they’ve got is a CAD design. That’s all they’ve got. Their whole manufacturing site and logistics and inventory and all that – that’s all gone. We don’t need those any longer.”

Metal additive manufacturing is predicted to have a huge impact in the biomedical world, with huge design flexibility and the biocompatibility of titanium making it an obvious application.

A very popular early application for titanium 3D printing has been acetabular hip cups.

In Australia, Anatomics (often with frequent collaborators the CSIRO and RMIT) and D’Urso have been involved in numerous metal implant world-firsts in the last two years.

These include a titanium heel bone that saved a bone cancer-sufferer’s leg, a titanium sternum-and-ribcage combo for a Spanish chest wall sarcoma patient, and an implant to replace a portion of a patient’s spine suffering from a chordoma.

What the surgeon gets most excited about now, though, is the new AnatomicsRx company, which is developing software architecture to spread the ability for “online engineering”, essential for the community healthcare vision.

“Now we can link everything up and hospitals and schools can integrate that 3D printing technology in their own facilities,” he said.

“We can use all of our knowledge base and experience and actually put it directly into the facilities and they can make things for themselves

“So now hospitals can make things and we can reduce the cost and we can actually give money to the hospitals to make it, we can employ people in Geelong or Wollongong to do that work, we can allow doctors to create things again.”

The vision of every hospital as a factory is an exciting one, though has some way to go. And with healthcare costs seldom far from the news, it’s bound to at least be of curiosity to policymakers.

Anatomics, the CSIRO, and a network of several Australian hospitals and universities are planning a three-year trial of the 3D printing-based community personalised healthcare model.

Realising the vision will require regulatory and reimbursement structure changes, D’Urso said, and urged the federal government to see the merit of hospitals that make things.

“[Prime minister Turnbull]  talks about the $1 billion innovation policy as he holds our 3D printed titanium ribs at CSIRO and launches his policy, okay, well now’s the time for the government to come back and support us,” said D’Urso

“They’re talking about it, that’s fine, and this is my mission, but really we need federal support at the federal leadership to move forward with this initiative. And then we want to take it to Singapore and the USA.”

Dr Paul D’Urso will give the keynote address, “Community Based Personalised Healthcare”, at the Inside 3D Printing event on May 12 at 9 am. Click here for more information.