3D Printing

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== Summary ==
== 3D Printing in Healthcare Settings: Overview and Best Practices ==
3D printers are tools to help bring 3D models or scans into the real world. While the technology has been present for numerous years, it has become more affordable and accessible in the last few years, with many people able to interact with a printer at a local library or purchase their own machines for as little as a few hundred dollars. In the health care setting, these machines have almost unlimited uses from simply being a fun "toy factory", unique end product for an art/design project, resource for adaptive and medical education equipment, a unique keepsake from a bereavement experience or several other uses your team or adjacent departments can dream up. There is a learning curve for each printer, program, and navigating 3D models, which is a perfect fit for Game Techs, as most other programs may not have the flexibility or bandwidth to tackle the education needed to fully utilize a 3D printing program full capabilities.


==Best Practices==
== Introduction ==
3D printers are revolutionary tools that bring digital models or scans into the physical realm. While the technology has been available for several years, it has become more affordable, accessible, and applicable across various industries, including healthcare settings such as local libraries, schools, and individuals owning 3D printers for as little as a few hundred dollars. In the healthcare context, 3D printers have limitless potential, serving as not just a "toy factory" but also as a resource for adaptive and medical education equipment, personalized keepsakes from bereavement experiences, and much more.


=== FDM vs SLS in Healthcare Settings ===
== 3D Printing Process ==
There are currently two major commercial types of 3D printing fused deposition modeling (FDM) and stereolithography (SLA). FDM is the most widely used and works by extruding thermoplastic filaments, through a heated nozzle and applying the plastic layer by layer to build a models. SLA uses a laser to cure liquid resin into hardened plastic creating detailed and smooth finished results. While SLA printers can create smaller and more detailed prints, FDM is likely the best fit to use in the healthcare setting. The main reason for this is the the printing process and uses of resin, requires proper ventilation and often the use of a respirator when working with the materials. Most spaces in a hospital do not allow for open windows or ventilation options that would make this process safe, making SLA a poor choice for this setting. If your program is located offsite, or has access to a workshop space, you may be able to make safety accommodations.  
The typical steps involved in 3D printing, from start to finish, include the creation of a 3D model, conversion into sliceable code, the printing process, and post-processing. Each step presents various options and a learning curve, making decisions about the printer, software program, and 3D model crucial. This complexity makes 3D printing an ideal tool for Game Techs, offering flexibility and bandwidth that other hospital programs may lack to fully utilize this technology.


===Models/Scans as PHI===
=== 3D Model Creation ===
Consents needed? File labels? Cloud usage?
A 3D model is a digital representation of a three-dimensional object, surface, or scene created using specialized computer software, primarily computer-aided design (CAD). These models are essential in 3D printing, providing the digital instructions necessary for the printer to create a physical object.


==Recommended Uses==
== Best Practices ==
===Normalization/Play===
A 3D printer can simply be a fun way to engage and play with a patient while they are hospitalized. The "wow" factor is typically enough to ice break most interactions and there are numerous fun and free models available on the internet to print favorite characters, and fun fidgets. It is also can be a great expression tool where a patient can create a 3D model in [[tinkercad]] or in a VR sculpting program and then have the physical end product. This can be great for extended admissions or "frequent fliers" to have long term projects to work on while hospitalized. Patients and families will often come up with fun and unique ideas once they wrap their head around what a 3D printer can do, so ask away! Below are some examples shared by numerous programs


* A 3D scan of a siblings face was added to a generic game piece and used in numerous games the patient and sibling would play over video chat.
=== FDM vs SLA in Healthcare Settings ===
* A patient explored options for IV line management, as they were often frustrated as things would get tangled and independently found carabiner clip models to print.  
In non-clinical pediatric healthcare settings, two suitable 3D printing technologies stand out: Fused Deposition Modeling (FDM) and Stereolithography (SLA).


===Medical Play/Education===
* FDM: This widely used process involves extruding thermoplastic filaments through a heated nozzle, building up the physical model layer by layer. FDM is popular for its simplicity, low cost, and versatility. It is suitable for the non-clinical healthcare setting due to its simplified workflow and minimal post-processing needs.
Medical play and education is large aspect of how a Child Life Specialists can help a patient and their family cope with being in the healthcare environment. Utilization of real medical materials is particularly helpful as it gives a concrete experience for the child and allows them to explore what actually be used for their care, thus making it less surprising/scary. However medical items are typically expensive and unique items such as trachs or g-tubes are in limited supply for teaching and typically the patient is not able to keep said item after an education session. Using 3D printing, models of these items can be printed to real life specs and used in sessions with patients who in turn can keep them at bedside to continue medical play even after the CCLS has left the room. Models can also be scaled up to explore aspects in greater details or scaled down to fit teddy bears or medical dolls. While the exact textures and colors may be different then the real models, 3D printed models will still provide a positive impact. Meet with your child life team to explore what items would be most utilized and explore modeling the item yourself or use program curated collections list below.
* SLA: Utilizing a UV layer to cure a liquid resin layer by layer, SLA offers more detailed and complex geometries with finer features and smoother surfaces. However, it requires a more in-depth and time-consuming post-processing procedure, involving potentially harmful liquid solutions.


*[https://www.printables.com/@LurieChildren_642788/models Models created at Ann and Robert H Lurie Children's Hospital of Chicago]
While FDM is a good initial fit for non-clinical healthcare settings, program-specific needs and accommodations may influence the choice of 3D printing technology.
*[https://www.printables.com/@RileyCLZTechS_331130/models Models created at Riley Hospital for Children]


===Adaptive Equipment===
== Models/Scans as PHI ==
Adaptive equipment is often expensive and at time difficult to obtain in the health care setting. While some devices are complex and tailored to the individually, others can be fairly simplistic and universal. 3D printing allows a quick/cheap resource for patients and can help them participate in other distracting/normalizing activities while hospitalized. These devices may be only needed temporarily if a patient is simply weak from treatment/recovery or preeminent due to a diagnosis or injury. It will likely be beneficial to consult your child life, rehabilitation, or orthotics teams to explore current needs/deficits. That being said simple tools like grips can be helpful in art or music therapy sessions and there are numerous options that can be utilized with gaming and other tech that would be utilized gaming focused bedside sessions. Here are a few models or curated collections that may be helpful.
Considerations related to Protected Health Information (PHI) are crucial in 3D printing. General rules of thumb include:


*[https://www.printables.com/@LurieChildren_642788/models Models created at Ann and Robert H Lurie Children's Hospital of Chicago]
=== 3D Scans ===
*[https://www.printables.com/@RileyCLZTechS_331130/models Models created at Riley Hospital for Children]


===Legacy/Bereavement Items===
* Concerns arise from photographing and converting 2D images into 3D renders.
3D printing can provide unique and powerful keepsakes in memory making for a family. This is a difficult and nuanced experience which often has social workers, Chaplins, or child life specialists being the main emotional support during these experiences. Touching with these teams or your hospital palliative care department is a good first step to explore how 3D printing can help during the experiences. From there it is important to establish a referral system, realistic time lines, and print limits for this process to be sustainable. Often one may be tempted to be over accommodating due to weight of these interactions, but having clearly defined and upheld limits is important. We have listed some common model type/techniques that programs use in Legacy Building/Bereavement referrals.  
* Identifiable features, whether facial scans or fingerprints, may fall under PHI/HIPAA concerns.


==== Lithophanes====
=== Printing Patient Data ===


== Policies & Procedures==
* When printing personalized data/models (e.g., patient scans, bereavement/legacy items), consider who may see the end product, especially when displayed to patients, families, and guests.
Example Text


===Sanitizing===
=== Storage of Patient Data ===
Example Text


==Account Settings & Management==
* Ensure data storage adheres to hospital guidelines and rules, with metadata anonymized to protect patient information.
Example Text
* Be cautious if using cloud storage solutions, considering the risk of data leaks and the need for security measures.


==Models of Printers==
Consent forms are recommended to ensure compliance with hospital procedures and standards regarding PHI and HIPAA. For more information on [https://www.hhs.gov/hipaa/for-professionals/special-topics/cloud-computing/index.html HIPAA cloud-computing] and general [https://www.hhs.gov/hipaa/for-professionals/security/guidance/index.html HIPAA security guidance]
[[File:3D Printer Placeholder.png|left|thumb|150x150px|Placeholder Pic]]


===Name (template)===
While many hospitals have various operating procedures and standards, consent forms are always a safe step in ensuring and protecting staff and the hospital in a similar capacity as to when photography and videography is used.
Brand:


Current Programs Using:
==Recommended Uses==
===Normalization/Play===


Features:
* A 3D printer can serve as a fun way to engage and play with hospitalized patients.
* Printing fun models or fidgets can provide a positive impact, especially for long-term admissions or frequent fliers.
* Encourage patients and families to come up with unique ideas and preferences for 3D-printed items.


Limitations:
=== Medical Play/Education ===


Default Slicer:
* 3D printing allows the creation of models for medical play and education, offering concrete experiences for children to explore medical items.
* Models can be used to simulate medical tools and procedures, enhancing the educational experience for young patients.
* Collaborate with Child Life Specialists to identify items that would be most useful in medical play sessions.


Cost:
*[https://www.printables.com/@LurieChildren_642788/models Models created at Ann and Robert H Lurie Children's Hospital of Chicago]
*[https://www.printables.com/@RileyCLZTechS_331130/models Models created at Riley Hospital for Children]


[[File:Flash Forge Adventurer 4.png|left|thumb|152x152px|Flash Forge Adventurer 4]]
===Adaptive Equipment===


===Adventurer 4===
* 3D printing offers a cost-effective solution for creating adaptive equipment for patients with specific needs.
'''Brand''': Flashforge
* Consult with child life, rehabilitation, or orthotics teams to identify current needs and deficits.
* Simple tools like grips can be beneficial in art or music therapy sessions, enhancing the patient's ability to participate in various activities.


'''Current Programs Using''': Ann & Robert H Lurie Children's Hospital of Chicago
*[https://www.printables.com/@LurieChildren_642788/models Models created at Ann and Robert H Lurie Children's Hospital of Chicago]
*[https://www.printables.com/@RileyCLZTechS_331130/models Models created at Riley Hospital for Children]
*[https://www.printables.com/@CalebKraft/collections/104951 Models created by Caleb Kraft in partnership with AbleGamers Charity]


'''Features:'''  Enclosed, heated bed, quick swap nozzles, flexible/removable build plate, ready out of box, filament detection sensor, touch screen UI
===Legacy/Bereavement Items===


'''Limitations:''' Proprietary nozzles, misleading bed leveling (uses average based on 9 points, not mesh), limit opportunities for user mods/adjustments
* 3D printing can provide unique and powerful keepsakes for families in memory-making processes.
* Collaborate with social workers, chaplains, or child life specialists to explore how 3D printing can be integrated into legacy-building and bereavement experiences.
* Establish clear referral systems, realistic timelines, and print limits to ensure a sustainable and supportive process for families.


'''Default Slicer:''' FlashPrint
By following best practices and exploring recommended uses, 3D printing can become a valuable tool in healthcare settings, offering innovative solutions for patient care, education, and emotional support.


'''Cost:''' $700 (March 2023)
== Policies & Procedures==
 
[[File:Ender 3.png|left|thumb|181x181px|Creality Ender 3]]
 
===Ender 3===
'''Brand''': Creality
 
'''Current Programs Using''': Riley Children's Hospital
 
'''Features''': open frame,  heated & removable build plate, fast, customizable, open source, well documented, pretty big build area
 
'''Limitations''': some assembly required, manual bed leveling, exposed print area
 
'''Default Slicer:''' Prusa Slicer
 
'''Cost:''' <$200 (March 2023)
 
==Slicers==
Slicers are programs that take 3D models and "slice" them into horizontal layers for the 3D printer to print. This is also where you will be adjusting layer height (affects detail/time of print), supports (needed to print overhangs), print speed/temperature (slight adjustments needed depending on the [[filament]] being used), and other settings. Most printers have a default slicer but some are better supported and most can be used with any printer.
 
===[https://ultimaker.com/software/ultimaker-cura Cura]===
The default slicer for the UltiMaker devices, but the arguable favorite in the 3D printing community. Actively being developed with updates coming out several times a year, often with industry changing advancements. Can be a bit more complex in advance settings, but nothing that isn't learnable through watching a few YouTube videos. Also has an option for community add-ons which offer several quality of life improvements. 
 
=== [https://www.flashforge.com/product-detail/FlashPrint-slicer-for-flashforge-fdm-3d-printers FlashPrint]===
The default slicer for the Flashforge devices. Works well with these devices and can be used with other brands of printers, but nothing flashy or special that puts it above other slicers.
 
==Modeling Software==
To edit or clean up 3D models, there are several different programs one can use. Each has different levels of complexity and limitations.
 
===[https://www.tinkercad.com/ Tinkercad]===
A web based design program that allows the user to create 3D models using predefined shapes. Shape dimensions can be modified free hand or inputting precise measurements. Users combine normal and "ghost" shapes to delete portions of objects. While it will load already created STL files, it does have a set limit on file size/triangle account. This is a great introduction into 3D modeling and a good resource to introduce to a patient to create their own project.
 
===[https://www.blender.org/ Blender]===
A free program revolving around 3D modeling and animation. A bit more in depth then other software, requiring time spend watching tutorials or simply messing around to get a feel for the process. Users can modify models on the mesh level by adjust vectors and face or use the sculpting mode for a more artistic approach. Will load most complex STL files and is a great way to combine two models into one (e.g. a [[lithophane]] and a stand).
 
=== [https://www.autodesk.com/products/fusion-360/overview?term=1-YEAR&tab=subscription Fusion360]===
Fusion 360 is a cloud-based 3D CAD program that utilizes the cloud storage for easier use in collaboration on complex projects. Another advantage of the cloud platform is that Fusion stores the entire history of the model including the changes to it. Numerous design options are available, including freeform, solid, and mesh modeling. The software is free for personal and noncommercial use, but has limitations on the number of projects stored on the cloud.
 
===[https://meshmixer.com/ Meshmixer]===
While it is no longer being developed, Meshmixer provides straight forward and unique tools in editing mesh models including planner cuts, filling/hollowing models, and creating tubes. While likely not the first choice in creating models from scratch, these tools can be helpful in end stage processing.
 
==Filament==
Fused deposition modeling (FDM) printers use rolls of filament as their material source andare several different types that each have ideal usages, strengths, and limitations. Below are some of the most common types used, but advancements are made each year, so other unique products may be available/best fit for your needs.
 
===PLA===
PLA (Polylactic Acid) is the most common 3D printing material because it is easy to use and is made from renewable resources and thus, biodegradable. Some companies have PLA+ or Silk variants that mix additives into the base PLA to increase strength, smoothness, texture etc. This will often modify print temperature or other setting, so make note on what is listed on the package.
 
'''Typical Temp Range:''' 205±15 °C
 
'''Heated Bed:''' Not Required
 
'''Ventilation:''' Not Required
 
'''Pros''': most cost effective, easiest materiel to work with
 
'''Cons:''' not super strong, can warp in high heat, degrades with UV exposure over time
 
===ABS===
ABS (Acrylonitrile Butadiene Styrene) is another commonly used 3D printer material. Best used for making durable parts that need to withstand higher temperatures.
 
'''Typical Temp Range:''' 230±10 °C
 
'''Heated Bed:''' 90±10 °C
 
'''Ventilation:''' Likely, fumes aren't toxic but do smell
 
'''Pros''': strong heat/UV resistant prints, can be post process with acetone for a glossy finish
 
'''Cons:''' prone to warping so may require an enclosure, stinky fumes
 
===PET (PETG)===
PET (Polyethylene terephthalate) is almost a combination of the ease of use of PLA with the durability of ABS.
 
'''Typical Temp Range:''' 245±10 °C
 
'''Heated Bed:''' Not required
 
'''Ventilation:''' Not required
 
'''Pros''': stronger then PLA, barley warps, no odor, more transparent then other materials,
 
'''Cons:''' harder to clean during post-processing, can get stuck to print bed, very hygroscopic so requires a dry box for storage or drying before use
 
===TPU===
TPU (Thermoplastic Polyurethane) is an elastic, oil/grease resistant, and abrasion-resistant material with a shore hardness of 95A. This materials is great for grips, cases, and other item that require more flexibility
 
'''Typical Temp Range:''' 220±10 °C (can depend on brand)
 
'''Heated Bed:''' 40±10 °C
 
'''Ventilation:''' Not required
 
'''Pros''': elastic/soft material, low warp-age/shrinkage,
 
'''Cons:''' difficult to print, prone to clogging particularly with systems using a bowden extruder, difficult to post-process especially support removal, hygroscopic so requires a dry box for storage or drying before use
 
===ASA===
Acrylonitrile styrene acrylate (ASA) was developed as an alternative to ABS. With a number of additional features, like improved weather resistance and resistance to yellowing from UVs, making it an excellent choice for parts or prints meant for outdoor use.
 
'''Typical Temp Range:''' 250±10 °C


'''Heated Bed:''' 90±10 °C
== Sanitizing ==
Given the rare necessity for direct interaction with a 3D printer in a patient's room, day-to-day cleaning and sanitizing are not major concerns. Regarding models, prints are typically inexpensive, so those given to patients should be treated as giveaways and will not be sanitized.


'''Ventilation:''' Likely, fumes aren't toxic but do smell (less then ABS)
== Models of Printers ==
Various brands and styles of 3D printers are available. Explore the link above to review models used by other programs, understanding the positives and negatives associated with each.


'''Pros''': strong heat/UV resistant prints, post processed with acetone,
== Software ==
The process of transforming a digital model into a physical 3D printed item involves different types of software. Refer to the link above to learn about the software used and get details on specific programs.


'''Cons:''' prone to warping so may require an enclosure, stinky fumes, hygroscopic so requires a dry box for storage or drying before use
== Filament ==
Fused Deposition Modeling (FDM) printers utilize rolls of filament as their material source, and there are several types, each with ideal usages, strengths, and limitations. While the link above provides details on common types, keep in mind that advancements are made each year, and other unique products may be available to best suit your needs. Click the link above for more detailed information.


==Compatible Accessories==
== Adaptive Equipment (Continued) ==
Example Text


==Adaptive & Inclusive options==
* 3D printing serves as a cost-effective solution for crafting adaptive equipment tailored to the specific needs of patients.
Example Text
* Collaborate with child life, rehabilitation, or orthotics teams to identify current needs and deficits.
* Simple tools like grips can significantly benefit art or music therapy sessions, enhancing the patient's ability to participate in various activities.


==Additional Resources==
==Additional Resources==
Example Text
Example Text

Latest revision as of 18:26, 23 January 2024

3D Printing in Healthcare Settings: Overview and Best Practices

Introduction

3D printers are revolutionary tools that bring digital models or scans into the physical realm. While the technology has been available for several years, it has become more affordable, accessible, and applicable across various industries, including healthcare settings such as local libraries, schools, and individuals owning 3D printers for as little as a few hundred dollars. In the healthcare context, 3D printers have limitless potential, serving as not just a "toy factory" but also as a resource for adaptive and medical education equipment, personalized keepsakes from bereavement experiences, and much more.

3D Printing Process

The typical steps involved in 3D printing, from start to finish, include the creation of a 3D model, conversion into sliceable code, the printing process, and post-processing. Each step presents various options and a learning curve, making decisions about the printer, software program, and 3D model crucial. This complexity makes 3D printing an ideal tool for Game Techs, offering flexibility and bandwidth that other hospital programs may lack to fully utilize this technology.

3D Model Creation

A 3D model is a digital representation of a three-dimensional object, surface, or scene created using specialized computer software, primarily computer-aided design (CAD). These models are essential in 3D printing, providing the digital instructions necessary for the printer to create a physical object.

Best Practices

FDM vs SLA in Healthcare Settings

In non-clinical pediatric healthcare settings, two suitable 3D printing technologies stand out: Fused Deposition Modeling (FDM) and Stereolithography (SLA).

  • FDM: This widely used process involves extruding thermoplastic filaments through a heated nozzle, building up the physical model layer by layer. FDM is popular for its simplicity, low cost, and versatility. It is suitable for the non-clinical healthcare setting due to its simplified workflow and minimal post-processing needs.
  • SLA: Utilizing a UV layer to cure a liquid resin layer by layer, SLA offers more detailed and complex geometries with finer features and smoother surfaces. However, it requires a more in-depth and time-consuming post-processing procedure, involving potentially harmful liquid solutions.

While FDM is a good initial fit for non-clinical healthcare settings, program-specific needs and accommodations may influence the choice of 3D printing technology.

Models/Scans as PHI

Considerations related to Protected Health Information (PHI) are crucial in 3D printing. General rules of thumb include:

3D Scans

  • Concerns arise from photographing and converting 2D images into 3D renders.
  • Identifiable features, whether facial scans or fingerprints, may fall under PHI/HIPAA concerns.

Printing Patient Data

  • When printing personalized data/models (e.g., patient scans, bereavement/legacy items), consider who may see the end product, especially when displayed to patients, families, and guests.

Storage of Patient Data

  • Ensure data storage adheres to hospital guidelines and rules, with metadata anonymized to protect patient information.
  • Be cautious if using cloud storage solutions, considering the risk of data leaks and the need for security measures.

Consent forms are recommended to ensure compliance with hospital procedures and standards regarding PHI and HIPAA. For more information on HIPAA cloud-computing and general HIPAA security guidance

While many hospitals have various operating procedures and standards, consent forms are always a safe step in ensuring and protecting staff and the hospital in a similar capacity as to when photography and videography is used.

Recommended Uses

Normalization/Play

  • A 3D printer can serve as a fun way to engage and play with hospitalized patients.
  • Printing fun models or fidgets can provide a positive impact, especially for long-term admissions or frequent fliers.
  • Encourage patients and families to come up with unique ideas and preferences for 3D-printed items.

Medical Play/Education

  • 3D printing allows the creation of models for medical play and education, offering concrete experiences for children to explore medical items.
  • Models can be used to simulate medical tools and procedures, enhancing the educational experience for young patients.
  • Collaborate with Child Life Specialists to identify items that would be most useful in medical play sessions.

Adaptive Equipment

  • 3D printing offers a cost-effective solution for creating adaptive equipment for patients with specific needs.
  • Consult with child life, rehabilitation, or orthotics teams to identify current needs and deficits.
  • Simple tools like grips can be beneficial in art or music therapy sessions, enhancing the patient's ability to participate in various activities.

Legacy/Bereavement Items

  • 3D printing can provide unique and powerful keepsakes for families in memory-making processes.
  • Collaborate with social workers, chaplains, or child life specialists to explore how 3D printing can be integrated into legacy-building and bereavement experiences.
  • Establish clear referral systems, realistic timelines, and print limits to ensure a sustainable and supportive process for families.

By following best practices and exploring recommended uses, 3D printing can become a valuable tool in healthcare settings, offering innovative solutions for patient care, education, and emotional support.

Policies & Procedures

Sanitizing

Given the rare necessity for direct interaction with a 3D printer in a patient's room, day-to-day cleaning and sanitizing are not major concerns. Regarding models, prints are typically inexpensive, so those given to patients should be treated as giveaways and will not be sanitized.

Models of Printers

Various brands and styles of 3D printers are available. Explore the link above to review models used by other programs, understanding the positives and negatives associated with each.

Software

The process of transforming a digital model into a physical 3D printed item involves different types of software. Refer to the link above to learn about the software used and get details on specific programs.

Filament

Fused Deposition Modeling (FDM) printers utilize rolls of filament as their material source, and there are several types, each with ideal usages, strengths, and limitations. While the link above provides details on common types, keep in mind that advancements are made each year, and other unique products may be available to best suit your needs. Click the link above for more detailed information.

Adaptive Equipment (Continued)

  • 3D printing serves as a cost-effective solution for crafting adaptive equipment tailored to the specific needs of patients.
  • Collaborate with child life, rehabilitation, or orthotics teams to identify current needs and deficits.
  • Simple tools like grips can significantly benefit art or music therapy sessions, enhancing the patient's ability to participate in various activities.

Additional Resources

Example Text

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