 Three-dimensional graphic software constitutes the foundation for every printed object created by the 3D Medical Application Center at Walter Reed National Military Medical Center. Whether the 3D printed part begins with radiological images, a computer-aided design, or from a concept in the provider's head, medical models and custom devices all need an origin. One of the most common methods for designing a medical three-dimensional print file starts with importing radiology scans, such as computed tomography or magnetic resonance images. Specialized computer programs convert the scans into 3D representations of the individual anatomy. This software allows an engineer to segment images based on the grayscale or intensity values of the scans. Segmentations can be performed manually or by using automated functions depending on the quality of the images. Technicians separate bone, soft tissues and contrast medium based on these values and routinely edit the segments to verify the primary area of interest is accurately represented before finalizing the print file. Another design process which provides the freedom to generate customized organically shaped devices and implants are virtual clay environment programs. These three-dimensional platforms enable engineers to sculpt organic designs and transform existing 3D data with shaping and detailing tools not found in traditional software. In addition, the program interfaces with a stylus that provides haptic feedback to the technician, allowing them to virtually interact with the object. This helps achieve smooth transitions from bone to implant borders, making it easier to build specialized cranial implants or design non-geometrically shaped orthotic devices. At the forefront of adaptive design technology is mobile 3D scanning. This process enables technicians the opportunity to use portable handheld structured light devices to triangulate surface data of virtually any object. The scanner collects information by projecting narrow bands of light which work in concert with internal cameras. All of the data collected is then used to create digital representations of body parts, replicas of casts, or to duplicate the geometry of a specific item which requires modification. In addition, 3D digital photogrammetry can also be utilized to capture the soft tissue data of a patient. The process begins by simultaneously taking pictures or video from multiple positions. Then the technology stitches and triangulates all data into a digital three-dimensional object. This process allows the technician to reconstruct or build highly accurate and detailed 3D medical models. Considered the standard in professional design applications, computer aided design, or CAD, is used on a regular basis to produce parametric parts for medical research, equipment, and prosthetic attachments or devices. This software is highly accurate in dimensional analysis and mathematical scalability due to vector graphics. As such, CAD systems create extremely precise components. In addition, by speeding up the design process CAD enables better visualization of sub-assemblies, individual parts, and the final product. Many times, in order to complete a medical project, multiple software programs along with a combination of scanning technologies are merged together to create the desired product. In addition, once constructed some 3D printers may require structural supports. These additional build files are created by the technicians and integrated into the original digital model. Once the object and supports are generated, the data is transferred to the 3D printer and the additive manufacturing process begins. Before any model, implant, or device is built on a three-dimensional printer, specialized software and applications are utilized by the 3D Medical Application Center staff to virtually design these printable objects. As such, this unique technology is the linchpin which ensures that each and every three-dimensional structure produced is customized to meet the specific medical requirements for providers, researchers, and patients alike.