Silvina Zabala-Travers – MD and Radiologist Degree from Universidad de la República (UdelaR) in Uruguay – 3D training at Sant Joan de Déu Hospital 3D Lab (Expert3D and internship) in Barcelona, Spain Dr. Zabala-Travers introduced 3D technologies to the academic medical field in Uruguay in 2019 and has since pioneered its development with a particular interest in training radiologists to be part of the workflow to ensure process precision. She founded and leads the Surgical Virtual Planning and 3D Printing Area at the Radiology Department Pereira Rossell Hospital Center, a state and university laboratory for the application of 3D technologies in diagnostics, surgical virtual planning, clinical simulation, and education for pediatric and adult patients. She is recently teamed up with a custom-implant manufacturer to co-found UPGRADE Medicals, a healthcare 3D-technology start-up that provides anatomical bio models, virtual planning with surgical guide design, and custom implant in metal, PEEK, and bioabsorbable materials. She is an invited professor at the Expert3D course and has given many conferences sharing her experience implementing a hospital 3D lab in a low-resource facility, as well as hands-on training on segmentation, biomodeling and virtual planning for bioengineers and surgical specialists. She presides over the Latin American Society of Pediatric Radiology (SLARP) New Technologies Committee, a network for the implementation of 3D technologies in Latin American countries. She also works as a Radiology Section Editor for the Elsevier Journal Annals of 3D Printed Medicine, currently Guest Editor for the Special Issue “Virtual Planning and Personalized Medicine”. Dr. Zabala-Travers will be speaking at the upcoming 3DHEALS virtual event Point of Care 3D Printing.
When was the first encounter you had with 3D printing?
Silvina: During my first US FDA summer job at the Center for Devices and Radiological Health in 2014, Dr. Axel Krieger and Dr. Laura Olivieri gave a seminar on their work on 3D cardiac printing at Children’s National. I remember looking in awe – like everybody else in the room – at the tiny heart in the palm of Dr. Krieger’s hand. Back in my office, however, I remember thinking “OK, yes, 3D prints are cool but…as radiologists, we should be able to post-process imaging data in a way that shows surgeons what they need without the need to bring more plastic to this world”. I could not have imagined at that time that I would now be the one looking at awe-faces from Dr. Krieger’s side. My own mind-changing journey in 3D printing, from “how cool” to “how pivotal”, helps me every day when introducing benefits to an audience new to this technique.
What inspired you to start your journey in 3D printing?
Silvina: 3D biomodeling brings my two passions together: medical images and technology. I began with virtual 3D biomodels, excited to apply technology to translate complex radiological findings from CT or MRI into three-dimensional, color-coded images that could be navigated in 360. A much more familiar language, easily understandable even by people who are not trained in medicine. From then on, it has all been a roller coaster of new thrilling possibilities, each one inspiring me to jump into the next journey: from virtual planning to surgical guide design, to intraoperative navigation, to custom implants that actually replace human parts!
My visit to Sant Joan de Déu Hospital’s 3D printing lab played a big role in inspiring the creation of the first 3D printing lab at point-of-care in Uruguay, as part of the Radiology Department at the Hospital Pereira Rossell, which I currently direct. It’s been very fulfilling being able to develop the technology in this state-university hospital while helping its community of children and women from less favorable social conditions, which are not usually the first benefitting from state-of-the-art technologies. Inspiration for co-founding my own company comes as a means to give other Uruguayans the same opportunity.
Who inspired you the most along this journey in 3D printing?
Silvina: The patient was a toddler when doctors removed her two anterior ribs trying to cure her of cancer. She had lived most of her life with her left chest asymmetric, paradoxically collapsing instead of expanding with every inhalation, but real problems began in adolescence when she even stopped moving her left arm as if that half of the body was not hers. Developing without the anterior ribs, her chest bones had deformed to adapt and the defect could not be fixed with conventional reconstruction techniques. It was then that I learned about her case. A virtual 3D biomodel was obtained from her CT for virtual planning, followed by many rounds of discussion together with thoracic, vascular, and plastic surgeons. A virtual design of ribs accommodating the specific shape of her chest defect was designed. The National organ donor bank agreed to CT scan the available donor ribs so that we could match the size between the required and the available ribs to reproduce the planned virtual design in the operating room. Chest with defect virtually planned rib design and matching donor ribs were 3D printed to simulate the procedure first and test the concept, before finally fixing her chest. An inspiring army of brains from many disciplines focused on helping one human being. One week after the procedure, on the 24th of December, I got a text message from her surgeon, including this phrase: “Today she saw herself in the mirror and she is happy”. The best Christmas gift I could have ever wished for. This is just one of the many stories that inspire my everyday work.
What motivates you the most for your work?
Silvina: 3D biomodels and virtual planning promote teams’ discussion to make better and safer treatment decisions for patients. It helps surgeons feel more confident, faster, and more precise during surgery and helps patients and their families understand their disease, empowering them to make informed treatment decisions. I work every day helping the less favored patients at the point-of-care Pereira Rossell Hospital 3D lab while, at the same time, I can help patients from any other place in the world thanks to the lack of geographical barriers granted by this job. This, together with other actions we are taking to make this technology affordable, contributes to the democratization of the technology, which is my ultimate goal. I cannot think of a more motivating job than the one I have!
What is/are the biggest obstacle(s) in your line of work? If you have conquered them, what were your solutions?
Silvina: Financial issues are always a barrier for more patients to benefit from this technology. First, hospital managements are more likely to make decisions in terms of reducing upfront costs than to invest in something that could potentially save future expenses. It has been useful for us to work along with clinicians to help management understand how this initial “expense” is in fact saving money for the hospital while providing patients with a better treatment solution.
Another obstacle I have found is the popular belief (probably with foundations) that these are techniques that only rich countries/hospitals can afford. I take this matter personally, since, as I said before, my greatest wish is to democratize this technology. I had the good luck of meeting my current business associate, whose principles on this matter are aligned with mine, and thus one of the foundations of our company Upgrade Medicals is to make technology affordable. Unfortunately, I have by no means conquered this obstacle and we have yet to break this limiting belief among our colleagues but I am optimistic it will be just a matter of time until the word spreads.
What do you think is (are) the biggest challenge(s) in 3D Printing/bio-printing? What do you think the potential solution(s) is (are)?
Silvina: One big challenge I see is increasing radiologists’ participation in these patients’ workflow, a key step to ensure safe practices. First, the radiology community needs to claim its key role in 3D biomodeling and 3D printing patient workflow, starting by increasing awareness among radiologists on this technology. Radiologists are experts in medical images, the first paramount step in all 3D practices. We need high-quality images, for high-quality segmentation to obtain high-fidelity anatomical models to ensure precision in virtual planning. Even though well-trained and experienced engineers, together with software tool development, can successfully manage most patients, we should not place the burden of precision and quality control on their shoulders only. I have experienced myself, how radiologists’ expertise in image processing, anatomy, disease, and therapy requirements has a pivotal role in closing the gap between engineers and clinicians by speaking a common language, with a huge impact on patient results. Solutions are educational events and round table discussions like Point-Of-Care 3D Printing, multi-disciplinary events where every actor can see their role in action.
If you are granted three wishes by a higher being, what would they be?
1- Peace in the world.
2- No hunger in the world.
3- That there were no countries or borders and all people were citizens of the world, in a way that for example a Medical Doctor Degree would be global and there would be equal treatment opportunities for everybody.
What advice would you give to a smart driven college student in the “real world”? What bad advice you heard should they ignore?
Silvina: Pursue your dreams. Create your own opportunities. Contact those people whose work you admire asking for advice, you will be surprised to hear back from that “celebrity” in your field offering to help you.
There will always be internal or external voices saying “you won’t make it”, “you are in a country/city/town with no such opportunities”, “this is for other people”, or “in this university, things are done differently”. I come from a little town, 3 hours away from the capital city where universities are in Uruguay, a Spanish-speaking developing country in Latin America. I had no relatives or family friends in the medical field to help me, and no one here had ever heard of 3D printing applied to medical treatment before I started my career.
Trust yourself. You can make it.