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 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 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 model, 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.

Best Practices

FDM vs SLS in Healthcare Settings

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.

Models/Scans as PHI

Consents needed? File labels? Cloud usage?

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.

• Models created at Ann and Robert H Lurie Children's Hospital of Chicago
• Models created at Riley Hospital for Children

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.

• Models created at Ann and Robert H Lurie Children's Hospital of Chicago
• Models created at Riley Hospital for Children

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.

Policies & Procedures

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Sanitizing

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Account Settings & Management

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Models of Printers

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Name (template)

Brand:

Current Programs Using:

Features:

Limitations:

Default Slicer:

Cost:

Flash Forge Adventurer 4

Adventurer 4

Brand: Flashforge

Current Programs Using: Ann & Robert H Lurie Children's Hospital of Chicago

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

Limitations: Proprietary nozzles, misleading bed leveling (uses average based on 9 points, not mesh), limit opportunities for user mods/adjustments

Default Slicer: FlashPrint

Cost: $700 (March 2023)

Creality Ender 3

Ender 3 Pro

Brand: Creality

Current Programs Using: Riley Hospital for Children

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.

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.

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.

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.

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).

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.

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

Ventilation: Likely, fumes aren't toxic but do smell (less then ABS)

Pros: strong heat/UV resistant prints, post processed with acetone,

Cons: prone to warping so may require an enclosure, stinky fumes, hygroscopic so requires a dry box for storage or drying before use

Compatible Accessories

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Adaptive & Inclusive options

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Additional Resources

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