With the use of 3D printing technology, the Singapore General Hospital (SGH) is able to make world-class medical treatments more precise, efficient and accessible. Dr Mark Tan, Clinical Lead of SGH’s 3D Printing Centre (3DPC), shares how.

In a condition called hypertrophic cardiomyopathy (HCM), the abnormal thickening of sections of the heart muscle makes it difficult for the heart to pump blood around the body, possibly resulting in long-term complications such as stroke, heart failure or even sudden cardiac arrest. Restoring normal heart function in this condition sometimes requires surgery, which can be highly complex.

However, things are changing with the use of 3D printing technology. "With 3D printed anatomical models, surgeons are able to better visualise the current state of a patient’s heart, rehearse the surgery on the model and clearly explain the procedure to patients,” explained Dr Mark Tan, Clinical Lead, SGH 3DPC and Consultant, Department of Diagnostic Radiology, SGH.

In 2022, the National Heart Centre Singapore (NHCS) worked closely with the SGH 3DPC in the use of 3D printed models for surgical planning and rehearsal of four patients with HCM. Anatomical models were 3D printed from the patient’s medical imaging out of material which mimicked cardiac muscle. The models allowed the surgical team a better appreciation of spatial anatomy for the surgical plan, a process which is sometimes difficult on a computer screen. The models also allowed the team to derive the amount of abnormal heart tissue to be removed and rehearse the procedure to do so in a low-stakes environment, prior to the actual surgery. This is the first time 3D printing was utilised in this manner in Singapore.

This is one of many ways clinical 3D printing can help SGH with the treatment of the complex array of cases it encounters as a national tertiary care centre. “Clinical 3D printing allows clinicians to use patient images to develop patient-specific medical models and devices that contribute to patient care in a personalised and individualised way,” he shared.

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Knowing what clinicians need

Dr Tan endeavours to create the platforms and systems for clinical 3D printing to continue to thrive, allowing medical treatment with this technology to be more precise, efficient and accessible for patients.

With expertise in clinical 3D design, additive manufacturing and medical imaging, a team of engineers, radiographers and radiologists form a core part of the SGH 3DPC team, and work closely with care teams to better support patient care. This is done by creating and supporting the development of patient-specific anatomical models for surgical rehearsal and implant sizing, intra-operative lesion targeting and reconstruction guides, prosthetics and orthotic devices, as well as patient-specific implants.

Take, for example, the deployment of surgical plates and screws in pelvic and facial fracture reconstructive surgery. The selection, sizing and shaping of these implants used to be done during surgery, which significantly added to the pressure surgeons faced, and lengthened the overall operative time. The clinical team is now able to work with the SGH 3DPC team to use the patient’s medical imaging to develop and print appropriate 3D physical anatomical models for clinicians to pre-size and pre-shape these implants before surgery in a safe, controlled environment, decreasing intra-operative surgical time.

In another example, a patient who presented with a tumour in his jaw required part of his jaw bone to be removed and reconstructed with an extracted portion of the fibula bone, found in the calf. Ordinarily, one’s quality of life is not significantly affected by the removal of this bone in the calf. However, as the patient was an athlete, his leg strength would be compromised with the removal of the fibula. To maintain his athletic ability, the clinicians worked with the SGH 3DPC team and two medical device companies to design, develop and deploy a 3D printed fibula bone replacement made of bioresorbable material to give the patient the best opportunity to continue his career.

Developing future capabilities

By bringing together the clinical and biomedical community in the care of its patients, the SGH 3DPC not only raises the standard of patient care, but also strengthens the institution’s education, research and development capabilities.

An example was during the height of the COVID-19 pandemic when cadavers were in short supply. In collaboration with Duke-NUS Medical School and the Singapore University of Technology and Design (SUTD), the SGH 3DPC led the effort to develop 3D printed temporal bones to augment existing cadavers, so as to facilitate the continued training of Ear, Nose and Throat (ENT) surgery residents in these specialised otological procedures. The knowledge and techniques developed from this would later allow the SGH 3DPC to work with the SGH and KK Women’s and Children’s Hospital (KKH) ENT units to develop temporal bone models to aid the care of five patients in 2022.

The centre hopes to continue developing capabilities to produce specialised and strategic medical devices in-house, increasing the hospital's resilience to potential similar supply chain disruptions. It also aims to allow the institution to keep pace with potential future areas of development in clinical 3D printing, such as the deployment of patient-specific implants at point of care, as well as the applied use of bioprinting for organ replacement.

"These are the directions the technology and science is moving in, and we want to be able to be in the position to adopt such advances when the time is right," Dr Tan explained.

Progress comes from questioning the status quo

Dr Tan invited clinicians to constantly ask themselves how they can employ various ways and means to provide better care for their patients.

"As an Academic Medical Centre in a regional health system that covers more than half of Singapore’s population, SingHealth has a mandate to stay on the cutting edge of innovative, yet accessible, medical care" he emphasised. "This is where we need to give patients the best treatment we can within this paradigm and the question is how we can lead the way in this. I think 3D printing is one of those ways," he concluded.

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