In this issue, we discuss the explosive growth of 3D printing in medicine and the ACR® 3D Printing (3DP) Registry with Kenneth C. Wang, MD, PhD, Co-Chair of the ACR/RSNA 3D Printing Registry Governance Committee, Staff Radiologist at the Baltimore VA Medical Center and Adjunct Assistant Professor at the University of Maryland School of Medicine.
3D printing is increasingly used in today's healthcare environments. Can you give us some examples of how imaged-based models are being used to enhance patient care?
One of my areas of interest is orthopedic applications. 3D printed models of bones can be useful to surgeons in planning for orthopedic procedures. For example, a 3D printed model of bones in the shoulder can help surgeons understand which type of shoulder replacement surgery will be most appropriate for a patient, how best to operationalize that procedure and how to optimize the chances of long-term success.
3DP is also commonly used in the setting of cardiac abnormalities. For example, in children with congenital heart defects, 3D printed models of the heart can help pediatric cardiac surgeons understand how best to surgically correct those defects. Or, in the case of patients with craniomaxillofacial tumors, 3D printed models and guides help surgeons perform resection and reconstruction. As another example, 3D printing of kidney tumors can assist urologists and interventional radiologists in treatment planning. There are many other examples, but broadly speaking, 3DP can be a valuable tool in planning, optimizing and performing surgery and other interventions.
Why do 3D printing at all?
There are many advanced techniques for doing visualizations of images on screen. And radiologists are well accustomed to working with these visualization technologies. So people ask: “Why would we need to make these 3D printed models?” My response is that 3D printing and on-screen image manipulation are highly complementary techniques. If you're trying to make a detailed measurement, sometimes the screen-based images are the best way to do that. However, when you want to gain intuition about the three-dimensional shape of a structure, or the relationship of structures in space, or the physical scale of an area of interest, having a printed model that you can hold in your hands often provides insights beyond on-screen visualization. 3DP is also useful in communicating with other providers about the information contained in the images, and it’s especially useful to surgeons in incorporating that information and translating it into an operative plan.
Why are radiologists at the center of 3D printing?
With much of 3DP, the benefit of printing comes from the patient-specific nature of what is depicted. And that almost always starts with imaging. That's why we, as radiologists, are so well positioned to be at the center of these workflows. We can use our deep understanding of imaging modalities, anatomy and disease to create models, to interpret findings and also to know the limitations of the images and to communicate with other providers.
What is the ACR 3DP Registry and why is it an indispensable part of quality and safety?
The ACR 3DP Registry is an ACR National Radiology Data Registry (NRDR®) and a joint initiative of the ACR and the Radiological Society of North America. The 3DP Registry collects anonymized information about 3D printing performed at the point of care — in hospitals, clinics and physicians’ offices — with the ultimate goals of improving patient care and characterizing resource utilization. Over the last 10 years or so, we have seen exponential growth in the amount of published research about clinical applications of 3D printing. So there's a lot of activity in this area, and the registry represents the first and largest effort to collect broad-based information about 3DP in a systematic way.
The registry’s nationwide database helps answer all types of questions about 3D printing, including clinical indications and intended uses for printed models; model construction techniques and effort; and clinical impact of the models. Participation in the 3DP Registry will allow a practice to no longer work in isolation. Benchmark reports for participants will be available in the future to be used as a driver for quality improvement. Participating facilities can then compare themselves with those benchmarks. This will allow practices to evaluate their own use of 3DP in the context of the broader community, which could reveal opportunities to expand into new clinical applications, or to optimize 3DP workflows, or to leverage new printing technologies.
How can practices can get started with the 3DP Registry?
It’s sometimes a little daunting for people who are beginning to participate. However, there are many resources available to help sites get started. A great strength of this registry is that it's part of the NRDR platform. That means it leverages all of the resources and mechanisms that NRDR has in place, including the support staff. What’s more, there are a number of specific resources we've put together for the 3DP Registry to help people get started. One is the 3D Printing Registry Startup Guide, which provides a step-by-step approach to participation — from assembling your team to reviewing your reports. And, you can watch the 3DP Registry: Getting Started Webinars. Of course, if you already participate in other NRDR registries, you can just add the 3DP Registry to your facility registration.
What are three steps radiologists can take to become more involved, learn and participate?
One step is to attend sessions at meetings like the ACR Annual Meeting and the RSNA Annual Meeting that talk about 3D printing. Those sessions will give people a sense of why this technology is useful and how radiology practices can engage with it. It’s also a great way to interact with other physicians and vendors in this space to get more information about technologies and trends. Second, there is a wealth of published literature around 3DP, including a journal called 3D Printing in Medicine, which is a great source of information, and the Imaging 3.0 case study about Creating 3D Models from Imaging at the University of Cincinnati College of Medicine. And, third, if you are already engaged in 3D printing, make sure you join the ACR 3DP Registry. Learn more
In the Spotlight
Kenneth C. Wang, MD, PhD, is the MRI Section Chief at the Baltimore VA Medical Center and Adjunct Assistant Professor in the Department of Diagnostic Radiology and Nuclear Medicine at the University of Maryland School of Medicine. He also serves as the Co-Chair of the ACR 3DP Registry Governance Committee. Dr. Wang earned his BS, MS and PhD degrees in electrical engineering from Stanford University, and his MD from the University of California, San Francisco. He completed his radiology residency and musculoskeletal radiology fellowship at Johns Hopkins and an imaging informatics fellowship at the University of Maryland. His research interests include shoulder and ankle imaging, AI, semantic computation, image segmentation, 3D printing and MR neurography.