Dima Elissa is a serial techpreneur currently CEO and founder of VisMed-3D, a biomedical design and consulting firm that uses Al to design and visualize 3D printed body parts. Dima was selected by Chicago magazine as one of the top Women in Tech, Chicago lnno’s 50 on Fire, MakeItBetter’s Top Chicago Women in Science and by Chicago Tribune’s BlueSky Vault as one of the Top 100 entrepreneurs in Chicago. Her recent designations include the American Medical Woman’s Association (AMWA) Tech and Innovation Lead to the Diversity, Inclusion & Innovation (DI&I) sector and an LGBT White House delegate on Technology and Innovation. Dima also serves as a member of the board of trustee of Hanover College, a board member for mHUB Chicago, iGIANT, is Chicago Chapter President for Women in Bio, and Chair of the STEM steering committee for the Aparecio Foundation. Dima holds a B.A. in Chemistry from Hanover College and has earned her MBA from Texas A&M’s May’s School of Business. @dimaelissa @vismed3d
Dima will be a speaker at our Chicago event during RSNA this year. 
Jenny: What inspired you to use 3D printing for your work?

DE: I’ve always been a technology forward individual… seeking the latest and greatest that innovation has to offer.  My career path is circuitous, beginning with a STEM degree in Chemistry to work for a Fortune 500 company in International Marketing. While there, I joined a new ventures division to identify, assess, evaluate and stage new business products, services and ideas supporting a single-product company with a ticking patent clock. During a nearly 10-year stint, I invested in a technology start-up that I later ran. Over the next few decades, I became a STEM MBA and continued launching businesses and evaluating niche technology ideas until I jettisoned the last one and began teaching entrepreneurship, coaching and mentoring women in the tech field who had new ideas or projects. During this phase, I stumbled upon 3D printing. A 30-year-old technology — yet new to me — heavily promoted innovation with new methods and applications, largely due to patent expiration and the open source community mindset. I explored what 3D printing could actually do today and its promise for the future. I was truly mesmerized. I could envision the power of novel design, disruptive design thinking, reimagining the impossible to be possible in nearly every facet of the industry to make objects, system components, improving and automating manufacturing, to accelerating machinery and vehicles production. Above all, I saw the value in healthcare to produce body parts as pre-surgical guides and educational tools to reduce errors, deliver more efficient medical procedures and lower costs while improving patient outcomes through more personalized, precision medicine with 3D imaging, AR/VR and automation of workflows leveraging AI.

Jenny: What is the biggest motivation for your work?

DE: I see the end-to-end benefit of using 3D workflows to create and support standards in healthcare across a series of modalities. Taking the imprecise and making it precise, the impersonal to becoming personal within the treatment of patients, from knee implants to anomalous tumor detection in organs and the entire body.

Jenny: What is the biggest challenge in your work?

DE: Today, I work with ANSI on the AMSC Standardization Roadmap for additive manufacturing to ensure the creation and cooperation across various imaging standards in healthcare and other manufacturing to allow for the creation of repeatable scalable applications within 3D workflows. Add that to the lack of reimbursement for these activities, and the prospects for this 3D business appear daunting.

Jenny: How do you approach working with people of differing backgrounds?

DE: I say that if necessity is the mother of invention, then diversity is the mother of success. As the tech and innovation lead for the American Medical Association, the Board secretary for iGIANT.org and other board designations, I serve to promote diversity across all my communities, endeavors and experiences I touch.  It’s been proven that a heterogeneous mix of backgrounds, for example in corporate boardrooms, yields greater returns within companies. I believe that is largely the case in most other scenarios, especially for innovation.

Jenny: How will you overcome this challenge?

DE: Each of us must learn to embrace the notion that we are responsible to bring about diverse thinking within our communities. It doesn’t happen alone, it doesn’t happen by accident; rather, actions must be deliberate and intentional to create a safe, welcoming place for all walks of life and ethnicities. We must invite and unite; we are all responsible for changing the lens of discrimination and exclusion based on race, color, ethnicity, orientation and new ways of thinking.

Jenny: What is your vision on the potential impact of your current work to the future of medicine?

DE: Creating a standard that allows for repeatable, sharable, consistent imaging data will change the ability to collaborate and extend patient information across medical homes and institutions of care, removing the limitations and inaccuracies of imaging data.

Jenny: What is the biggest change/improvement you’ve seen since last year?

DE: There are a greater awareness and a large effort being put forth by ANSI and other groups to ensure standards are being addressed for additive manufacturing. Getting everyone on the same page is critical.

Jenny: What are you passionate about?

DE: Bringing 3D imaging innovation to healthcare and industry. Doing well by doing good.

Jenny: What is the biggest risk you took in your career?

DE: Building a new company, VisMed3D when the challenges exceeded the immediate ROI because the healthcare reimbursement gateways are not yet matured to support the work and procedures fully realized within 3D technology.

Jenny: What do you like to do in your spare time?

DE: I have very little spare time, but I make sure I work out, play tennis and read. Serving on many academic, non-profit and community boards, I thrive to drive change to improve education, jobs and economic opportunity for all of our populations. I embrace every opportunity to speak and present on 3D printing, diversity, and inclusion, the Impact of Gender and Sex on Novel Technologies and innovation (iGIANT.org) I enjoy mentoring and advancing the youth mindset, especially younger women taking career paths that mirror their passions and aspirations, with an eye towards STEM, STEAM, STREAM or STEMm (medicine).

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(Cont’d) Considerations for Implementing a 3D Printing Core Service in Your Hospital: A Technical Analysis – Part 1

Verification and Labeling

After completing your segmentation and modeling work, you may be in a hurry to get your part on the 3D printer. However, there is an opportunity to unintentionally introduce errors in the above steps. Prior to printing, the accuracy of your final file should be verified against the original DICOM imaging. Did you take liberties and over-smooth or remove a key feature from the model? Did you cut away a structure that would be an important landmark for the surgeon? I would highly recommend a software solution that allows the user to overlay the STL surfaces back on the Dicom data. This will allow you to verify accuracy (and establish credibility with your surgical colleagues) as well as make subtle adjustments or refinements to the model.

Figure 4- Contour verification of prepared heart model demonstrated in Mimics Innovation Suite

Ensuring traceability of your 3D prints will also reduce the opportunity for making errors with your 3D printing program. As you scale your operation and build greater volumes of models, it is critical to understand what models are coming off the printer and what case they each belong to. To reduce the chance of mixing models or providing the wrong model to a surgeon, each anatomical model should be pre-labeled with software prior to printing. Use a requisition number that will trace back to the medical records to ensure traceability of your 3D models. You will also want to use labels if you create mirror images or want to clearly indicate what side of the patient the model was derived from. This will reduce the chance for operator confusion and eliminate the chance they may operate on the wrong side of the body.

Figure 5- Applying a text label to a heart model using Mimics Innovation Suite

Communication

Close collaboration between personnel is key in this process. It is necessary to define the scope and use of the model with the surgeon or interventionist prior to starting the process in addition to verification near the end. This can be facilitated through web meetings or face-to-face discussion. It can also help to have a software solution capable of exporting a file format which can be interrogated by the surgeon. It is highly unlikely that your surgeon will be able to open an STL file! Exports such as 3D PDFs can be an excellent tool for this purpose allowing efficient transfer and sharing of data within an environment of a simple PDF reader.

Figure 6- 3D PDF communication tool exported from Mimics Innovation Suite

3D File-Fixing

The STL file format is the universal digital 3D modeling format for 3D printing. This is the file that will be fed to the 3D printer to slice and build the part. Not all STL files are created equal. The number and quality of the triangle facets will determine the eventual quality of your printed part. You may also find very thin walls in the model that fall under the minimum resolution of your printer or that will be very brittle and tear-sensitive. It is imperative to have a robust STL diagnostic and fixing tool to ensure a successful and quality build. Nothing is more frustrating that build failures attributed to errors in the digital file. This is an area where significant time and money can be lost.

Figure 7- File fixing in preparation for 3D printing in Mimics Innovation Suite

3D Printing: How to Choose?

Insource or outsource? This is the first question you should ask. Outsourcing will allow you to minimize your upfront capital investment but is typically associated with longer lead times. Outsourcing can also be advantageous in the rapidly evolving market of 3D printers. What equipment you buy today could soon be obsolete with better and lower-cost technology being brought to market. From a purely economic standpoint, outsourcing is often the best strategy to get started.

If you decide to invest in a printer, where should you start? 3D printers come in many different technologies which all have their advantages. FDM, PolyJet, laser sintering, stereolithography, and binder jetting all have unique advantages for certain applications. Resolution, speed, materials, color and of course cost, are key factors you should consider. Leverage experts in the industry to understand what technology makes the most sense given your use case and budget.

In addition to understanding the best 3D printer for your program, you’ll also need to understand the space required to house it. Certain printing technologies take up a very small footprint while others may require dedicated facilities. Some machines require additional equipment to clean the models after printing or will have greater maintenance associated. Fully understand all of these considerations before making your choice.

Figure 8- Example of flexible 3D printed heart model (Image courtesy Materialise)

Personnel and Training

You will need specific skill sets to run an effective 3D printing service. Knowledge in imaging and anatomy/pathology is required for accurate segmentation. A level of engineering skill is needed to prepare your 3D models in the best way for printing. Additional resources may be needed to clean models and maintain machines. The scale of your operation will determine the resources needed. Start small and lay out a plan for organic growth. By starting at a small scale, it will help to build momentum with clinicians and administrators to support the activity. If you build it, they will come! Make sure to learn from and be trained by experts in the field. Master the process from image acquisition through 3D printing. This will ensure that you avoid common pitfalls and are operating in the most efficient way possible.

Figure 9- Example of multi-material 3D printed model of heart and airway anomaly (Image courtesy Materialise)

Final thought

Although 3D printing as a core service in a hospital is still in its infancy, many innovative institutions have been blazing a path. Leverage the experts both in industry and among your peers who have developed similar programs. This might mean working collaboratively on a few cases as a service or visiting other established medical 3D printing facilities. Establishing a new technology such as 3D printing can seem like an overwhelming endeavor. However, by taking into account the many considerations and requirements from the beginning, it will help you to develop a plan to start and grow a successful service for your institution.

Todd Pietila

Sr. Business Development Manager – Materialise

Todd.Pietila@materialise.com

References

Di Prima, M., Coburn, J., Hwang, D. et al. 3D Print Med (2015) 2: 1. doi:10.1186/s41205-016-0005-9

About the Author

Todd is a Senior Business Development Manager at Materialise where he specializes in delivering 3D software and 3D printing consultancy to the healthcare field. With a background in Biomedical Engineering, he has spent more than 6 years at Materialise in various engineering roles focused on applications of 3D printing in medicine.

His current position involves working directly with healthcare providers to develop and implement 3D printing solutions in clinical practice.

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The 3D printing market and more specifically, the medical 3D printing market, is still very much in a development stage as opposed to a mature state. Given this, a valuable exercise for existing and potential industry players is to examine the market along Porter’s Five Forces. This classic b-school framework shows where competitive power lies within an industry and thus how the industry is shaped going forward.

Figure 1: Porter’s Five Forces

Threat of New Entrants

This force is high. While there are barriers such as high R&D costs and IP protection, other key criteria for successfully entering into a new market look to be advantageous for new entrants in this area. This includes lack of a traditional manufacturing distribution channel needed as solutions can be printed and offered through e-commerce channels, lack of significant initial capital needed including labor costs, and the significant market growth forecast.

Buyer Power

This force is high. The buyers here are medical and surgical centers, pharmaceutical and biotech companies, and academic institutions. Because 3D printing in the medical space is still considered a novel concept rather than a mature solution, there is little information on what price or quality buyers require before moving forward with a purchase. This gives them significant bargaining power over the minds of 3D printing companies. Moreover, much of the buyer base in concentrated in a small number of powerful institutions.

Supplier Power

This force is low. The materials used for 3D printed solutions use commodity substances, though the printers require highly specialized components supplied by a small set of vendors. On a broader perspective, the 3D printing supply chain brings many of the components in traditional manufacturing in-house or near-house. This includes local printing and distributing solutions versus pushed-out-through distributed warehouse networks; low versus high transport costs; and customized production via “pull” demand from customers versus mass factory productions.

Threat of Substitutes

This force is low. The 3D printing technology in the medical industry is very much a brand new technology and it would take several years for another technology to prove it would be a viable alternative. Continuous advances in 3D printing itself are occurring, making any likely threat of substitutes from outside the industry unlikely. More likely, substitutes would occur from within the industry (e.g. quality of solutions in terms of material, durability, lifespan, etc.).

Competitor Rivalry

This force is medium. While companies such as Stratasys, 3D Systems, and Materialise have developed brand names for themselves within this industry, brand notoriety outside of this industry is less strong. Moreover, there are currently few major differentiators between solutions provided by each of the existing companies. One major differentiator is the time required to print a solution, however other key factors such as material selection, resolution, color variety, ease of use have not yet been established as unique selling points from any player.

Predicting the future of any developing industry is a challenging task. However, understanding the driving forces within the industry is valuable for determining areas of opportunity as well as areas of caution for firms who are in the industry and firms considering entering the industry.

About the Author

Jessica Lan – MBA Technology Management and Strategy; BS Computer Science, Summa Cum Laude.

Established management consultant focused on advancing healthcare through technology. Proven success in transforming large and small healthcare organizations through strategy development and operational change. Award winning recognition for business plan development and enterprise software solutions.

 

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