Newsbytes

One pathologist’s foray into 3D printing

January 2022—The use of three-dimensional printing in the pathology lab may still be in its infancy, but pathologist Danielle Lameirinhas Vieira Maracaja, MD, and her anesthesiologist husband have been affirming its value to pathologists, and the medical community in general, for years.

Dr. Danielle Maracaja, a pathologist at Atrium Health Wake Forest Baptist, Winston-Salem, NC, and assistant professor of pathology at Wake Forest School of Medicine, has been working alongside her husband, Luiz Maracaja, MD, associate professor of anesthesiology at the same hospital and medical school, in designing and producing medical tools using 3D-printing technology for more than five years. They took on one of their largest projects in early 2020, when Dr. Danielle Maracaja was a pathology fellow at Yale University School of Medicine and COVID-19 cases were spiking.

With personal protective equipment in short supply during the early days of the pandemic, Dr. Luiz Maracaja designed a face shield using the computer-aided design, or CAD, software SolidWorks, from Dassault Systems. The couple printed the face shields on their personal Formlabs Form 2 SLA 3D printer and assembled them at home, Dr. Danielle Maracaja explained in a presentation at the 2021 AACC annual scientific meeting last fall. The Maracajas were able to create 18 to 20 face shields per batch. (Each batch took approximately 10 hours to complete, and they typically produced two batches within 24 hours.) “It was a very stressful time and we just wanted to help,” Dr. Danielle Maracaja told CAP TODAY.

The hospital never distributed the face shields because that would have required a lengthy testing and approval process, Dr. Danielle Maracaja says. But the couple gave them away to colleagues who asked for them. As demand grew, the project became so overwhelming that the Maracajas brought the printed face shield parts to the hospital so hospital staff could assemble them on a volunteer basis during their breaks.

At the same time, some medical supplies, such as nasopharyngeal swabs, were in such short supply that the chair of pathology inquired about the Maracajas’ 3D-printing capabilities. But because of the limited capacity of the couple’s personal 3D printer and ongoing partnerships, the pathology department pursued other avenues for producing the swabs, Dr. Danielle Maracaja says.

The whole experience demonstrated how quickly 3D printing can create medical products in a time of shortage, but it also illustrated the challenges and limitations that labs face in implementing 3D-printing technology, Dr. Danielle Maracaja says.

While cost typically is not a large drawback, with 3D printers ranging from about $300 to $5,000, training is likely to be an issue, she says. To use the technology to its fullest, a staff member must be sufficiently trained on the software to design products or parts that have complex shapes or require precise measurements, Dr. Danielle Maracaja explains. Pathology labs should be aware that there are many options for obtaining that software training, she adds, including classes and online tutorials.

A large open-source community for 3D printing also exists, and numerous websites offer free Standard Triangle Language files for download. (STL is the standard file type used for generating instructions on 3D printing.) Rather than writing 3D-printing instructions from scratch, it is often easier and faster to find a free STL file for something similar to what you want to create and then modify those files to fit your needs, Dr. Danielle Maracaja says. The Maracajas distributed the STL files for their face shields as open-source files so anyone could use them.

Yet the exact size of a finished 3D-printed product can be difficult to predict because some materials used in 3D printers may shrink as they are cured, and some 3D-printed products need to be sanded down after printing to smooth rough edges, Dr. Danielle Maracaja explains. Laboratories should also be aware that the 3D-printing process can be slow if used to manufacture in large scale, she adds. Therefore, depending on the type and quantity of items desired, it can be cheaper to use other methods of manufacturing, such as injection mold.

Many large hospitals may have a 3D printer somewhere in their health system that pathologists can use, especially hospitals associated with a university, Dr. Danielle Maracaja notes. “It was nice that when there was a shortage of PPE and consumables for the testing of COVID that several universities and 3D-printing companies worked together to increase their manufacturing capabilities,” she says. But if a 3D printer is not available, interested parties can use one of the many services that will accept 3D-printing instructions in STL format to produce a product. The Maracajas have used remote 3D-printing services in the past, particularly when items they were building required a smoother surface, a more refined look, or a resistant material such as metal, she says.

In pathology, 3D printing is being used to replicate diseased organs for teaching, Dr. Danielle Maracaja says. This allows students to see 3D representations of rare conditions and may eliminate the biohazard risk of storing specimens in formalin. Similarly, 3D printing has been used in forensic pathology to recreate broken bones or other injuries that are the subject of criminal investigations. “It helps the jury to understand the mechanism of death,” she notes.

“Pathologists are very visual,” Dr. Danielle Maracaja says. “We like to see things. Having a piece 3D printed makes it available for a long period of time and people can view it more frequently.”

In clinical laboratories, 3D printing can also be used to build tools or pieces of equipment, such as hard-to-find replacement parts for older machinery, she says. The Maracajas used 3D printing to design and build a device that mounts a mobile phone onto the Butterfly IQ handheld ultrasound. This type of tool could be useful for cytopathologists performing ultrasound-guided fine-needle aspiration procedures, Dr. Danielle Maracaja says. The Butterfly IQ is attached by wire to a phone or tablet, but it can be difficult to balance the phone and ultrasound wand, and the wire connecting them can get in the way. The mounting system makes it easier for cytopathologists to hold the ultrasound and phone together in one hand and keep the other hand free to perform the procedure, she explains.

The Maracajas are now using 3D printing to develop a device for treating acute respiratory distress syndrome. The device is intended to improve lung ventilation and deliver drugs and cell-based therapies for ARDS treatment. The final product is not 3D printed, but the Maracajas used 3D printing to build components of the prototype and create model lungs and bronchial passageways for testing device placement.

“Sometimes what you are developing with 3D printing is something that is going to be a prototype for something bigger, or sometimes it’s a small detail you’re using in a larger project,” she says. “The plastic piece may not be your final product, but it can help you attain your final goal.”
—Renee Caruthers

Oracle to purchase Cerner

Oracle is slated to acquire Cerner this year in a $28.3 billion transaction, according to an announcement from both companies.

As part of the deal, Cerner will become a dedicated business unit of Oracle and the company’s “anchor asset” for expanding into the health care marketplace, Cerner reported.

Because Oracle has a global footprint, Cerner will offer its digital information systems to hospitals in a greater number of countries worldwide. The acquisition also will provide Cerner clients with new opportunities in cloud computing, artificial intelligence, and machine learning, thereby supporting Oracle’s goal of reaching zero unplanned downtime in medical institutions.

“Oracle’s autonomous database, low-code development tools, and voice digital assistant user interface enable us to rapidly modernize Cerner’s systems and move them to our Gen2 Cloud,” said Mike Sicilia, Oracle’s executive vice president of vertical industries, in a press statement. “This can be done very quickly because Cerner’s largest business and most important clinical system already runs on the Oracle database. . . . We will make Cerner’s systems much easier to learn and use by making Oracle’s hands-free voice digital assistant the primary interface to Cerner’s clinical systems.”

CompuGroup Medical offering new version of LIS

CompuGroup Medical has released version 21.3 of its CGM LabDaq laboratory information system.

Enhancements to the system, which were based on suggestions from LabDaq users, include improvements to the Data Miner software option, more robust order-routing rules, and a faster importer.

The Data Miner software option in LabDaq version 21.3 provides streamlined methods for sharing memorized queries. Data Miner allows users to search their database for real-time information on billing, requisitions, insurance, patient results, and patient outcomes.

“Not only can a user access the information they are looking for, but now they can easily share the query parameters so that other users can access the same dynamic results with just the click of a mouse,” said Carl Smith, general manager of the lab division for CompuGroup Medical US, in a press release.

CompuGroup Medical, 800-359-0911

Dr. Aller practices clinical informatics in Southern California. He can be reached at raller@usc.edu. Dennis Winsten is founder of Dennis Winsten & Associates, Healthcare Systems Consultants. He can be reached at dwinsten.az@gmail.com.