A tale of three countries: Three-dimensional printing for procedural simulation in the digital era

Abstract

The current severe acute respiratory virus coronavirus 2 (COVID-19) pandemic has highlighted the largely untapped versatility of three-dimensional (3D) printing in medicine. As the technology has entered the mainstream, 3D printers have become as accessible as conventional desktop printers and can retail now for as little as a few hundred US dollars. Recently, 3D printing has been leveraged to create and modify personal protective and other equipment in the context of global disruptions to traditional manufacturing supply chains. Three-dimensional printing also facilitates the cheap and accessible production of anatomical models for medical education. These models can be produced for as little as a few dollars compared to the substantial investment required to purchase commercial simulation trainers. Through recent improvements in available software, clinicians can now 3D print anatomical models from anonymised patient imaging, allowing educators to simulate procedures in both normal anatomy and more complex pathologies. Developing a model for 3D printing previously required advanced computer modelling and engineering skills to design a 3D virtual computer-aided design (CAD) file and export it for 3D printing. However, with improved software, after some basic training, developing 3D virtual images and models are now within the realm of hobbyist and amateur users of 3D printers. Once a useable 3D file has been created, it can in theory be successfully replicated on any 3D printer utilising the same settings anywhere in the world, similar to how an email attachment can be downloaded and printed on any paper printer worldwide. In lowand middle-income countries (LMIC), wired or wi-fi internet is not necessarily commonplace, but mobile data (3G/4G/5G) are still readily available. We aimed to ascertain if a healthcare team uninitiated in 3D printing could download, print and re-create a 3D phantom that had been developed by an expert team on the other side of the world with access to only simple instructions, mobile data, email and internet-based mobile messaging. We recently conducted a feasibility study to see if it was possible to reproduce a 3D printed teaching phantom accurately and reliably in separate countries using only an electronic virtual 3D image file of the phantom, along with previously published instructions and the use only of mobile internet access. A tally of the total internet usage was also logged. The virtual 3D image chosen for print was of a lumbar spine teaching model developed by Austin Hospital’s 3D Medical Printing Laboratory (3DMedLab.org.au). This was sent electronically to clinicians in Melbourne, Israel and New Zealand, with entry-level knowledge on the use of hobbyist 3D printing, along with the instructions outlined in Young et al.’s publication. The 3D file was subsequently downloaded and opened using CAD software specific to the 3D printers available (Materialise 3-Matic, Leuven, Belgium; and Simplify3D, Cincinnati, OH, USA). Once the file was opened, the model was saved onto a secure digital (SD) card (SanDisk, Milpitas, CA, USA) and printed on different models of Fused Deposition Modelling 3D printers, as shown in Table 1. To enable ultrasound imaging, the phantom was set in gel with similar sound propagation properties as human soft tissue. Ingredients were selected to be