 Physical things that we can talk about here is what's coming out of a 3D printer and some of the use cases where this really makes sense is for patient care and that's what we're going to hear about in this next session. Medical 3D printing innovating patient care through customized implants and the speaker is Samuel Albert Truusse and you are from all of this university, give him a hand. So what you need about medical 3D printing is of course that you can do devices customized to the individual patient. This is something that's been known for quite a long time in the standard industry. We don't all have the same shoe size so we can get whatever shoe we like, but only in predefined categories. So we have a size 10 or a size 9, that's okay but let's say you have a size 9.5 you are out of luck. The same goes for of course Ross, always a point of contention during Christmas time where poor guys have to buy something for their wives and get this right, but again you have predefined sizes, t-shirts, large, medium, small and all that. But of course in the clothing industry we do have customized clothing. We have tailors, we have some guys who can do a suit for a given person and only that person. The same is actually, well individualization is also occurring in this sector, so we have these booths where you can actually get a 3D body scan and get a customized suit made. So that's coming in the clothing area. If we switch to the medical industry we have sort of the same problem. So in this case we've got catheters going into the bladder, so MCHR, these are measured on a French scale historically, so it's just different diameters. But again we have these preset diameters for any given patient. Same holds for customized, well not customized, sorry for hip implants, we've got a range of ball sizes, we've got a range of stem lengths, we've got a range of angles and all that, but we choose from pre-existing models, which works beautifully if you have a sort of standard body. But sometimes you do have patients like this where we actually have a whole section of bone missing, so no standard solution would fit this patient. So in this case we'd like to be able to just print a device for this given patient and nobody else in the whole world. That's where 3D penning comes in, so what does it take? Well you need some sort of scan of the patient, you need to segment it to get a virtual model and then you need to create the physical model using 3D printing. I'll go through that rapidly and then I'll cover as many clinical cases as I actually can, but at the time I allocated we'll see how many we go through. So basically first of all you get the patient into a scanner, we get some sort of data, in this case it's a computer tomography or CT scanner. So these slices of patient information are loaded into a computer program, in this case a software called Mimics, where an operator chooses a given grayscale value and extracts a given organ, in this case the heart. This data can be transmitted over to a 3D printer like this and print it and then you get a physical model like this. I'm not saying that you can 3D print a heart, that's not the basic output of this, but I do present the case in just a moment where we actually use 3D heart models for planning purposes. So just to go into the 3D printing process a little bit more deeply, this is a powder printer or SLS printer where we have plastic powder, we extract the small layer, we have a laser melting the very top layer, it's preheated to almost the smelting point of the plastic and then the laser inputs the rest. Then we do another powder later and we melt the next layer and we melt the next layer and so forth, so builds and builds and builds until we get a final model. Then we remove it from the powder stack and blow off any unburnt powder and get the final model out. This is plastic but we can also do it in metal like this. So again we just heat until it's almost melting and then do a laser and melt the final steps. Then we've done a layer, we let it cool down a little bit, get a new layer on top in just a second and then the whole process repeats layer by layer by layer throughout the model. So that's what it takes but where can we use it? So as I said before we don't print hearts but we do actually print heart models. Some would like to print hearts, that's quite far off, but just to build a 3D model of a heart can actually be a great service in especially congenital heart defects. You guys up there probably have pretty standard hearts. I mean heart surgery is not that complicated once you know what's inside. But there are a number of small babies born who have severe malformations of the heart. For instance this one, the tetralogy of phallus where all the standard vessels are basically not where they're supposed to be, there's all kind of connections that shouldn't be there, they really don't know what they're going into. So standard model of doing this would be to create the CT scan and then just have a computer and try to look through it and say well guess what, how could I go in here, how could I do this? But it takes a certain kind of brain to translate these 2D images into a 3D world but if we create this 3D model of the heart you can actually try and test it out and print it in the catheter and see whether or not we can access whatever the geometry matches whatever heart valve we're trying to insert and all that. So we're actually using that for surgical planning in hospitals around the world. So that's purely model-based, purely planning. What about these implants? Well the best case is this guy called Kyber. He has a disease called tracheomalacia which basically means that his airways are defective. His cartilage is not strong enough to keep it open. When you breathe the lungs expand, we have negative pressure so we draw an air into the lungs. That means that our trachea and particularly male guys know this, you have the Adam's apple. So we've got a catheter skeleton holding open the airways in negative pressure but this guy had some defects in that respect. So the normal bronchus feeding air into the lungs tended to collapse and he was scheduled for a respirator and basically nobody expected him to survive. So they did some images of his airways and you can easily visualize the problem. His airways are completely blocked. So what to do? Well an engineer came up with a solution in which we scanned and extracted his airways and then created this little step going in and around his airways holding it open. The operation was a complete success and he was able to breathe normally just a month later and it's been replicated a number of times. The problem is that these airways are the standard airways so we can't use the same model across every single patient. We have to scan each baby and say well what's the specific geometry of the individual baby? The smart thing about this one is this one is printed in a mature called Po-Ri-Lacro Holocaprolactone which is biodegradable. In a year or two his airways are actually strong enough to stay open so it's only a time sensitive issue. So in this case this actually gets degraded inside the body and gets removed all by itself. He doesn't have to have surgery once his defect has been corrected. So again individual treatment for this given patient. Another excellent case involving actually the cloud. So the cloud gets mentioned again here. And it's this titanium cartilage block. So if you've got a breakdown of your cartilage inside the knee or hip you have severe pains because the cartilage is actually supposed to create a frictionless movement so you can move around. But in some patients this gets degraded and severe pain. So a Swedish company has actually come up with a solution where you scan the knee or hip or whatever remotely, ship them their MRI data. They do the down assessment of the data. They print a given implant in titanium for this defect. They also, which is very nice, print a surgical guide to allow the surgeon to just drill precisely where he has to drill in order to fit this titanium plug. And then they sterilize the kit, send it to the surgeon remotely, ready for surgery. Why do we need customized titanium plugs? Why not just do a given standard one? Well the geometry of the knee really, really changes from patient to patient. So you can't do a given standard plug because the surface is always changing. And depending on where the damage is situated, you need different plugs. So we do need customized devices in this respect. As I said, the surgery itself gets much easier because we actually print this device which gets put over the defect and lets the surgeon just drill with the standard two inside this place. And then you have a perfect match for the plug. So it's very much simpler and faster to operate using this procedure. So that was knees and that was frecumglacia, the airways. If we go to these artificial hips I showed you earlier, then we have a device like this one used for patients with abnormal hips. So again, going back to my initial slides, if you have a patient, a standard, patient with a standard hip, you can use these different standard methodologies where we've got these given ball type and given angles, given stem lengths and all that and it'll fit perfectly. But if you show up with a patient like this, nothing will fit because the geometry is so abnormal that we can't do anything about that in the normal manner. So in this case it's a 16-year-old Swedish girl who again was scanned and created a three-model of bones. And you can see here that there's quite a lot missing. So first of all, reconstruct the bones and then find out, well, where do we want the ball socket to be? Where do we want to put the screw holes? The screw holes can actually be put according to bone quality. We also know the bone quality from the scan. So we can situate each of these perfectly. Then we need to put in a number of screws and given lengths. They are not all the same length because the bone, of course, is varying in depth, which also can be utilized later on. So we can also actually do this from a company in Alborg who does biomechanics simulation, sorry. So we can get a sort of dynamic stress distribution of the implant and try to re-evaluate whether or not it should be recycled that way or another. So now I've got the geometry, send it to a printer, get it out, and of course sterilize and all that. And then we put it in the patient. Again, the procedure is vastly more simple than the standard way of doing it because we can put this device in. It fits perfectly. But then we can also put in a guide, a drilling guide. If you look closely, you can perhaps visualize that the sort of stops here are different lengths. So basically the surgeon all it has to do is to put it all the way through. It gets to the correct depth. The screws were different depths before. So again, he doesn't have to think. He just has to drill right down, put in all the screws, and you have a functioning hip for this given patient. Again, nobody else but her. Then we, of course, have to line it with some material and all that. But basically the basic contents are we can do a device for her and her only. That's basically all I had time for during a 15-minute presentation. But I could have talked about a lot of different other things. There's bioprinting with different stem cells. There's a lot of other fancy uses where we do skull caps and all that in free prints. We can print bone materials, which dissolve inside the body and allows us to print bones. This is a company from Fulton, actually. And there's quite a lot of work going on during printing of cartilage, for instance, ears, which gets ripped off. Then we can construct an ear from the other ear and get cartilage to grow on these scaffolds and put them in. But again, during a 15-minute timeframe, that's out of scope. If you really want to know more about this, I can go to this conference in Lubbock in September. There should be a lot more information during the two-day timeframe. So yeah, that's it. Thank you. Thank you.