3D Printing

Summary

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 only been in the past few years that this technology has been available to the consumer market. Becoming more affordable, accessible, and applicable to almost every industry (e.g., local libraries, schools, and even individuals owning a 3D printer for as little as a few hundred dollars). In the healthcare setting, these machines have near limitless use potential from simply being a fun "toy factory", unique end product for an art/design project, resource for adaptive and medical education equipment, a personalized keepsake from a bereavement experience or several other uses your team or adjacent departments can dream up.

The most common steps involved with 3D printing, from start to finish, is the creation of a 3D model, conversion into a sliceable code, printing, and post processing. For each step, there are a variety of options, and subsequent learning curve that makes picking a printer, software program, and 3D model an important decision. Which is why it is a tool that perfectly fits the role of Game Techs, as most other hospital programs may not have the flexibility or bandwidth to tackle the education needed to fully utilize a 3D printing initiative within the healthcare settings.

A 3D model is a digital representation of a three-dimensional object, surface, or scene created using specialized computer software. 3D models can be used for a variety for purposes, such as animation, gaming, prototyping, simulation, and visualization. Computer-aided design (CAD) is the primarily type of software application used to design, modify, analyze, and optimize designs in a virtual environment. 3D models are integral in 3D printing, it is the digital instructions that a 3D printer needs in order to create a physical object.

Best Practices

FDM vs SLA in Healthcare Settings

There are a wide variety of commercially available 3D printing processes, that utilize a variety of techniques and materials to create a physical object from a digital model. In the non-clinical pediatric healthcare settings, there are two suitable technologies that standout: fused deposition modeling (FDM) and stereolithography (SLA).

FDM is the most widely used and works by extruding thermoplastic filaments, through a heated nozzle to rapidly heat and cool plastic, building up the physical model layer by layer. FDM is the most popular process because offers the most simplicity, low cost, and versatility. Through FDM, a printer uses string-like plastic (known as filament) to print parts with layer height accuracy of 100-200 microns (0.1-0.2 mms) and minimal post-processing needs.

SLA uses a UV layer to selectively cure a liquid resin, creating a physical object layer by layer out of a pool of liquid plastic. SLA primary difference from FDM, is that it uses light and liquid technology to develop parts with layer height accuracy as small as 25 microns (0.025mm), offering more detailed and complex geometries with finer features and smoother surfaces. However, this requires a much more in-depth and timely post-processing procedure in order to safely handle the final product. Known as curing and washing, these steps use potentially harmful liquid solutions that require ventilation, gloves, and other protective equipment.

Overall FDM is likely the best initial fit for use in the non-clinical healthcare setting, as it has a simplified workflow process and does not require extensive safety accommodations. However, every program is different in needs and accommodations, so it is helpful to know if your hospital program has alternative locations/workshops/etc - potentially opening the door to the variety of 3D printing technologies available.

Models/Scans as PHI

(This section will be a general rule of thumb, please remember to always check with your specific hospital's guidelines and rules for topics on PHI/HIPAA). PHI concerns primarily come in the following form:

3D Scans
- The primary concern with scans regards the act of photographing and converting 2D images of the patient (whether it be partial body, full body, with/without family members, etc) into 3D renders. From facial scans to fingerprints, there are many identifiable features that may or may not fall under PHI/HIPAA concerns.

Printing Patient Data
- Many programs display the 3D printer and ongoing printing process to patients, families, and guests. When printing personalized data/models (e.g., patient scans, bereavement/legacy items, etc) please keep in my who may be able to see the end product.

Storage of Patient Data
- The largest concern lies in how data is stored, what is stored, and who has access to it. Metadata used to label the 3D model/file should always be anonymized (e.g., patient name, date of birth, etc). Other considerations, many 3D printing slicers, programs, and companies are moving to a cloud storage solution, which increases the security risk for data leaks and the need for the cloud service providers on behalf of healthcare providers to ensure confidentiality, integrity, and availability of PHI stored. 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 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.
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.

Medical Play/Education

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.

Adaptive Equipment

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.

Legacy/Bereavement Items

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.

Lithophanes

Policies & Procedures

Sanitizing

It is rare that direct interaction with a 3D printer would be necessary for a patient or patient's room, so ignoring day to day cleaning, sanitizing is not a concern. As for models, prints are typically inexpensive so models given to patients should often be treated as giveaways and will not be sanitized.

Models of Printers

There are several different brands and styles of 3D printers. Visit the link above to explore models used by other programs and explore positives and negatives of each.

Software

The steps of taking a model to a physical 3D printed items requires a few different types of software. Visit the link above to learn about what software is used and details on specific programs.

Filament

Fused deposition modeling (FDM) printers use rolls of filament as their material source and are 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. Click link above for more detail.

Additional Resources

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