3D Printing and Medical Libraries

28 November 2013 by Shannon Bohle, posted in Guest Writers, Technology, Uncategorized

Guest article by Patricia Anderson
Emerging Technologies Librarian at the University of Michigan
(http://pfa@umich.edu)

I've been lobbying for a while for medical libraries to start exploring the uses and skillsets within 3D printing. I've been watching the technology develop and seeing trends that make me think we (medical librarians) need to be paying attention. Trends like patients making their own assistive technology at home, and healthcare professionals using 3D printers to make tissue scaffolds that save people's lives. But let me step back a moment and talk first about what 3D printing is and how it differs from regular, 2D printing.

What is 3D Printing?
2013-09-03 at 09.09.35 Lego City @ Senayan

You know how 2D printing works: you have a flat sheet of paper and the printer puts down a layer of ink. Printing in 2D is a lot like the image above of our hospital's logo built in Legos, in which a pattern was made by laying down a single layer of Lego blocks. But you know how Legos work: you can layer them in many, many layers to make more complicated 3D constructions. 3D printers work like tiny Lego blocks set into place layer upon layer by inkjet robots.

"This is 3D Printing" by Science Museum

Yes, the 3D printers for home use bear a strong resemblance to the inkjet printers many of us tossed out a couple years ago. Some folks have even taken old inkjet printers and rebuilt them to use as 3D printers!

Part of what makes 3D printing so relevant and fascinating for healthcare is the ability to print from different types of materials. The Roadmap for Additive Manufacturing (2009) is a great source of information about different types of materials being used in 3D printing, which industries are using them, and for what purpose. Figure 6.1 in the publication lists groups of polymers, ceramics, and metals, as well as natural materials such as paper, and even living tissues that can be 3D printed. Some of the newer printers allow printing with more than one type of material at a time (also known as hybrid printing) so that you can mix them up, printing with plastics to give a base structure, electronics to embed sensors, and cells to create tissues, making prosthetics like 'bionic' ears. Hypothetically, 3D printers can be used to personalize the new prosthetic ear try to match the appearance of the individual's other natural ear.

"Biology Builders Exhibit
at the Royal Society Summer Science Exhibition 2013"
by the Royal Society

The up and coming trend with 3D printing is actually being called 4D printing. How does that work? To over-simplify, the gist of the idea is that 3D printers can print modular elements that can be constructed into larger objects, and that they can even be made programmable and self-assembling.

"Skylar Tibbits: The Emergence of '4D Printing'" by TED Talks

Hype

Before we get too excited, though, how realistic is all this? I mean, are 3D printers actually being used extensively right now, or is it mostly hype?

Hype - for a future blog post

If you look at the Gartner Hype Cycle for 2013, you will find elements of 3D printing positioned along the entire length of the curve in different places. The 4D printing is so new that it does not even appear on the curve. 3D bioprinting and biofabrication is very early in the process, just coming into general awareness and climbing the hype curve. 3D scanners are approaching the peak of hyped expectations, meaning people know about them but they are not quite ready for common use. Consumer 3D printing, as in home 3D printers, is at the peak of the hype cycle ("inflated expectations"), which is probably why you are even reading this. But enterprise 3D printing is way off on the right side of the curve, in the "Slope of Enlightenment," where it has actually proven useful and is in common use. After all, 3D printers have been used for decades to print circuit boards for computers, so that this is really not all that new.

History

Ann Arbor Mini Maker Faire 2013

One of the earliest patents I found for 3D printing, Composite polypropylene filament (US 3509013 A), was filed in 1966. In the medical literature, the earliest mention I found of something that sounded like 3D printing dates back to 1985. It uses the term "biofabricated" as if it had been around for a while, so there might even be earlier work on this.

Where are We Now?
Additive Manufacturing / 3D Printing in Corporate Enterprises

These days, 3D printing seems to be present in some fashion in most industries and areas of work. The image above of a "tree" is from the previously mentioned Roadmap for Additive Manufacturing, and gives a brief overview. Of course, it's interesting that medicine and art are the two areas with the most growth in applications of additive manufacturing and 3D printing. For medicine, the visualization highlights the areas of tissue engineering, orthopedics, and implants. I was curious if this was still true, so designed a search strategy, limited it to the most recent 5 years, exported just the titles and MeSH terms, and did a couple visualizations to focus in and explore what language and ideas seem to be most used now in healthcare literature around 3D printing.

Here is the search strategy I used:

("3d printing"[TIAB] OR "3D printer"[TIAB] OR "3D print"[TIAB]) OR ("three-dimensional printing"[TIAB] OR "three-dimensional printer"[TIAB] OR "threedimensional print"[TIAB]) OR ("biofabrication"[TIAB] OR "biofabricated"[TIAB] OR biofab[TIAB]) OR ("bioprinting"[MeSH Terms] OR bioprinting[TIAB] OR bioprinter[TIAB] OR bioprint[TIAB]) OR ("additive manufacturing"[TIAB] OR "additive manufacture"[TIAB]) OR "hybrid printing"[TIAB] OR ("printing"[MeSH Terms] AND "tissue engineering"[MeSH Terms]) : http://bit.ly/3dprintingPubmed

Here is what I found:

DataViz of 3D Printing Search Results in Pubmed

The above network visualization is based on MeSH terms and their relationships. The top seven MeSH terms used for 3D printing are:

1. Tissue Scaffolds
2. Tissue Engineering
3. Biocompatible Materials
4. Models, Anatomic
5. Computer Aided Design (this comprised two bubbles)
6. Bone Substitutes
7. Biotechnology

These seven terms, despite being the most used, account for only 12% (67) of the total number of citations found (n=571). This is hinted at by the shape of the data network, which shows several small networks that are disconnected or poorly connected to the main group. There is also a high level of terminology diversity being used. I identified some additional terms by looking through the MeSH visualization network. However, it was very helpful to also dig through titles and abstracts and then create a text cloud of terms and phrases:

Wordle of 3D printing search results in Pubmed

Some of the words not used in the search strategy, but appear here, include: hydrogels, bioactive, porous, patterned, micropatterned, sintering, inkjet, constructs, nanoparticles, embryonic, liver, cartilage, cell-laden ... and many more. The text cloud provides very interesting visualization of the key concepts in the field at this time.

Below is a list citing just a few real-world examples of 3D printing clinical and research applications:

● Visualizing a Child’s Deformed Heart Pre-Surgery with Rapid Prototyping. January 15, 2005. http://um3d.dc.umich.edu/2005/01/visualizing-a-childs-deformed-heart-pre-surgery-with-rapid-protoyping/

● Jack Merrin, Stanislas Leibler, John S. Chuang. Printing Multistrain Bacterial Patterns with a Piezoelectric Inkjet Printer. PLoS One July 25, 2007. http://www.plosone.org/article/info:doi/10.1371/journal.pone.0000663

● Simon J. Leigh, Robert J. Bradley, Christopher P. Purssell, Duncan R. Billson, David A. Hutchins. A Simple, Low-Cost Conductive Composite Material for 3D Printing of Electronic Sensors. PLoS One November 21, 2012 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0049365

● Marissa Fessenden. 3-D printed windpipe gives infant breath of life. Nature News May 28, 2013. http://www.nature.com/news/3-d-printed-windpipe-gives-infant-breath-of-life-1.13085

3D Printing to Equalize Access

Researchers and health care providers are not the only ones making use of 3D printing for changing lives. I was in awe of this ACS Webinar by Joseph Fortunak the first time I saw it:

"Green Chemistry and Global Access to Medicines in Developing Countries" by the American Chemical Society (58 mins.)

One of the ideas he discusses is the use of 3D printers to make pharmaceuticals more accessible in developing countries, where shipping costs and corporate interests create barriers that are sometimes insurmountable. The idea is to have raw materials on hand for synthesizing and formulating medicines available and use 3D printers to manufacture pills where and when they are needed. This idea has been popularized by the media with the idea that someday we might receive prescriptions by email, with attached bits of code to instruct a printer how to make the specific medications we need, rather than going to a pharmacy. While this remains to take place in the future, the impressive uses in Africa that provide "global access to medicines in developing countries," described in the above video, are being tested now.

There are other ways in which 3D printing is being utilized for the benefit of the underserved and those with less than ideal access to various types of care. One of the largest areas, hinted at by the 2009 Roadmap emphasis on orthopedics and implants, is the creation of custom prosthetics for patients and developed by patients and patient advocates.

"Boy Gets Prosthetic Hand Made by 3-D Printer" by CBS Evening News

Similarly, the Open Hand Project has the slogan of "Dexterity without Prosperity," highlighting their intent, via a crowdsourcing campaign, to enable those without wealth to enjoy the empowerment of prosthetics:

"Leading prosthetics can cost up to $100,000. By using emerging technologies like 3D printing, we can cut that down to under $1000. That’s two orders of magnitude cheaper, and means that these devices can reach a far broader audience!"

Many examples of similar projects, including other patient efforts to create their own prosthetics, present powerful emotional stories about barriers to access for affordable prosthetics and the empowerment that 3D printing provides. I list below just a few:

The Open Prosthetics Project

The Open Hand Project Powered By 3D Printing Gives Another Liam a New Hand

Robohand

Print Me an Arm

17-Year Old Creator of 3D Printed Robotic Hand Gives a Great TED Talk

It is not simply about prosthetics, though. Folks are also designing, making, and sharing patterns for assistive technology solutions, such as these custom spoons designed by an educational team project collaboration with physical therapy students and engineering students:

Detroit Maker Faire 2013

Prosthetics may get the most media attention, but the universe of 3D printed assistive devices potentially will have a much broader impact and can touch many more lives. A long tradition exists of people finding "home-grown" solutions for their own adaptability needs:

Beyond "Access" to "Beauty"

The initiatives described above are just a fraction of what's going on in the open source prosthetics movement, which is just a fraction of the broader open source assistive technology and hardware spaces. Beyond that context, you can also pivot this around to look at the ways in which 3D printing is opening new commercial spaces and giving access to different types of prosthetics. One of the concerning aspects of living with a prosthetic has been that they are "ugly, uncomfortable and difficult to operate," in the words of Fred Downs, a U.S. veteran. Making prosthetics that are functional but also beautiful, inspirational, and personally meaningful is a new aspect of prosthetic lifestyle that is offered by 3D printing for those with the economic resources or creative vision and talent. The media has picked up on both the fashion side as well as the tech and healthcare aspects of 3D printed prosthetics.

A few of the leaders in this space are Sophie de Oliveira Barata of The Alternative Limb Project and Scott Summit of Bespoke Innovations, but with the move toward personalization and customization, I expect to see many more individuals and companies working to develop special features and functions for prosthetic limbs.

Screen shot: Google Image Search for Beautiful Prosthetics

Sharing & Finding Printable Patterns

Yeggi is the largest and most comprehensive of the search engines for 3D printing patterns. None of these have what I, as a librarian, would think of as great metadata, so the trick to searching for 3D patterns is being creative when thinking of terms someone might have used to describe an object or concept. Yeggi indexes several search engines and communities where folks share patterns. Most of those communities specialize in patterns that suit only a certain printer meaning, when you search Yeggi, many of the patterns may not work on the printer you have. This example points out some interoperability problems with existing 3D printer technologies.

Screen shot: Yeggi: Assistive Tech results

Thingiverse is an example of one of these specialty collections. Patterns in Thingiverse work only on Makerbot printers. Thingiverse is where the patterns for the Robohand project can be found, for example. If you are using another company's printers you may want to check to see if there is a searchable pattern collection for that company. Different search engines offer different searchable fields, so it is worth exploring to see which one gives you the type of control you prefer. ShapeKing, for example, allows you to search for printers that meet certain specifications, software for creating and manipulation models, 3D scanners, all in addition to keyword searching for models and patterns.

What Libraries Can Do

Some of what libraries and librarians can do has already been discussed above. Librarians can help provide context and awareness related to questions arising about the use of 3D printing – how it is done, who is involved, what policies exist, what are the risk factors, how many pros and cons exist, what are the trends, where can model evaluations as well as education and support be found. Librarians can help people discover patterns and resources, create way-finding tools, and build collections of recommended resources. We can do all of that without even having access to a 3D printer just by being aware of what is going on and following the topic.

Many public libraries now have Makerspaces with 3D printers. Their activities have been documented extensively in American Library Association publications as well as in the media. There is a wonderful Facebook group to support librarians working in this area, called Makerspaces and the Participatory Library. They offer an excellent file with resources to support Makerspace projects in libraries. If you are considering this, you might also want to know about the Open Education Database (OEDb) publication, "A Librarian’s Guide to Makerspaces: 16 Resources"

In medical libraries, 3D printing is still a very new idea. A year ago I couldn't easily find a medical library with a 3D printer, but now I know of several. Shortly after I first wrote about this, Matthew Hoy, in Wisconsin, published an article about using 3D printers in medical libraries. A month later (March 2013), Kimberly Barker was asking for information about medical libraries with 3D printers during a #medlibs Twitter chat. Within six months, she had purchased one, installed it, tested it, started presenting about it, and found to her delight that it created new partnerships and opportunities for her library. You can find out more about what she is doing through her slide presentation, below:

"Implementation of a 3D Printer"
by Kimberley Barker, Manager for Technology Education & Computing, Moore Health Sciences Library, University of Virginia

The future of 3D printers in libraries seems limitless!

[This article is based on an earlier presentation by Kimberly Barker and myself, "What is 3D Printing and Why Your Library May Be Interested? (TechTime Session)," on September 19, 2013. An archived recording is available.]


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