An Opportunity to Improve Quality of Care: Sheng Qi on the Importance of Point of Care 3D Medical Printing for the East of England

Professor Sheng Qi, Professor of Pharmeceutical Material Science and Technology at the University of East Anglia, provided insight into Point of Care 3D Medical Printing and how this service is transforming patient care, and how this research is driving towards a localised 3D printing service for the East of England.

Your Research Group has led on two UEAHSCP funded projects; Adopting 3D Technology to Improve Breast Cancer (BEAT) and Regional NHS Point of Care 3D Printing Service (POC_3DP). Could you tell us about both of those projects?

We did a Regional Point of Care 3D Printing Service evaluation first (POC3DP) and we used the breast cancer project (BEAT) as a case study, so just to briefly explain what both are, the regional NHS Point of Care 3D Printing Service evaluation study is really trying to evaluate whether within our region – Norfolk and Suffolk – we would benefit from having a point of care medical 3D service for serving our local NHS hospitals, because this type of point of care 3D printing service are available in over 40 hospitals within England and they are mainly in major hospitals, and those hospitals serve their regional small hospitals as well.

So, we have, through the project, visited and talked to many hospitals who have their own point of care medical 3D printing services. At the same time during the project, we also sent out surveys to our regional consultant and surgeon community just to find out how much they know about 3D printing services, whether they have been using them, and whether they would like to introduce this new technology into their practice to improve the quality of care of the patient.

For the first project in terms of the outcome, we delivered a workshop targeting our regional consultants and surgeons. Through the survey we gathered the data and found out we definitely do have a need, from the clinical aspect, that a lot of surgeons from different disciplines are welcoming if we do have a point of care within the region and they would definitely adopt the technology.

The technology, in terms of using medical 3D printing to help either through patient education to active training of junior surgeons, as well as surgical planning and surgical aid, many of the hospitals went with it.

They clearly demonstrated the advantage and the cost savings they have generated for their own Trust. That’s why we think there is a very good argument being made in terms that we should, within our region, considering the numbers of Trusts we have and the size of the hospitals we have.

We followed up with the second project, which is the BEAT project, because during the first project what we learned from the experience of other Trusts is that you really need to build your business case in order to get the next phase funding to set up a service like that. We thought, in order to build the business case, we really need to find a few good case studies to demonstrate practically that this is definitely beneficial.

When we connected with the hospitals, we got an overwhelming welcome from the surgeons at NNUH (Norfolk and Norwich University Hospital) – particularly through the plastic surgeons who are operating on breast cancer patients, so this is the project co-created with the breast reconstruction surgeons at both NNUH and James Paget University Hospital, because two Trusts are performing two very different types of breast reconstruction and breast conserving operations for breast cancer patients.

We managed to create a brand-new type of workflow, including 3D technology, that is 3D scanning as well as 3D printing to facilitate the breast reconstruction operations in terms of speeding up the process, improving the accuracy of the operation and shortening the recovery of the patient.

In the past 15+ years since the NHS has been using 3D printed technology how has this technology advanced and where do you see it going in the future?

Early on, 3D printing was adopted in the 1990’s. Very few hospitals would have this technology in-house. They would be outsourced and contracted a lot of times to large multinational companies. NNUH are still doing that, they’ve been doing that for 15 years. They’re still outsourced to companies in Europe and the US.

In terms of advancement, it’s really the application of it. Each time a surgeon from different disciplines innovates within their discipline and 3D printing is very much of a customised technology. In most cases it’s not a technology that is used to mass produce one design of a device, but it’s really suited for individual cases, so the latest and most advanced use of 3D printing is in the surgical field.

At the end of last year (2023), the first ever PEAK printer was able to print a part of a patient’s skull and implant it into the patient. That patient actually had a life-long deformation of a part of his skull and he eventually, I think he’s possibly in his 50’s, be able to have a normal skull, which made him very happy, so that is the most advancement, which is a personalised 3D printed body part which has actually been implanted.

Most of the cases we are currently using within the hospital is 3D printed, but they are mainly surgical aids or models for planning the surgery or for helping through the surgery process, for example, personalised cutting guides or most for measuring stuff, so a personalised 3D printable implanted device is still quite rare but I think that is the future and with the advancements of medical materials we can see that there is a lot of personalised implantable devices which are biocompatible and made from biocompatible materials which would, in the years to come, be used in real clinical practice.

So where do you see the opportunities for the East of England in this field?

I really see this as an opportunity to improve the quality of the care and help to produce cost-saving for the East of England. It is a cascading effect when you can shorten the theatre time of the patient needed for the surgery and the improved accuracy of the surgery you will reduce the recovery time the patient needed, and that means the patient will be able to be discharged quickly, the bed will be released quickly, and you will be able to get through more patients in terms of surgery much more quickly, so it really is a chain effect.

I think the technology has really good potential to help the region in terms of productivity of the Trust and the quality of care that we can provide to the patient because personalised surgical guides are more accurate, and even 3D printed models to explain to the patient before surgery in terms of where and how the surgery will be performed, research has proved its significantly improved the satisfaction of the patient for their care, so I think there is loads we can do and it’s a really good technology if we introduce it can really improve the quality of care, saving cost as well improve the patient’s satisfaction for the care we provide in the region.

Our goal is really to support and work together with our regional Trusts and our surgeons to try to see how we can set up the service regionally for our patients and for our Trust to help them save money.

What’s been the most rewarding part of the project so far?

The most rewarding part of the project is really hearing the feedback from the surgeons. Knowing there’s a need, knowing this project is needed and we are doing something which will benefit in the future of the region. I think that is very rewarding.

We did the survey in the first project and took feedback from each workshop we produced. We did three workshops and all the feedback we got was very positive and we have more and more surgeons getting in touch, would like to know more and explore the use of 3D printing in their surgical practice, so I think that is very promising and keeps us pushing and moving forward.

In your project summary you provided examples of how the group would like to develop scaffolds to hold transplanted fat and release anti-cancer drugs to patients after post-mastectomy breast reconstruction. Could you provide details on how this may work?

Our vision is that we’ll be able to put 3D printed scaffold based on the amount of tissue – the breast tissue and tumour tissue being removed from each individual patient – and then print the scaffold exactly to replace that void of the cancer tissue that being taken out. At the same time that scaffold would be able to hold the fatty tissue taken from another part of the patient’s body so it’s not empty space.

That’s normally the procedure they do. They do the liposuction, and they replace the fat into the void space but more importantly we also want to incorporate anti-cancer drugs into the implant.

This means we can minimise the risk of recurrent cancer, just in case any cancer cell has not been removed completely and this has been done in the past for other types of cancer, for example, there are implantable products for some type of the brain cancers, but none of those are personalised which means when you put the drug into it, it is still left with quite a big void if the tumour is quite big.

So, we think that this type of personalised design and implant would definitely have a very unique benefit for the patient because it will still give the patient the same original shape of the breast and at the same time minimise the risk of recurrent cancer.

What is the normal process undergoing post-mastectomy breast reconstruction without the use of 3D printed technology?

The normal procedure is the patient would come in to do the removal. Some patients will be doing the reconstruction at the same time, but most patients won’t. All the patients have this complete removal operation and be offered with the breast reconstruction, but actually a small number of the patient’s take up. It’s because the reconstruction process is really quite risk bearing as well as a long recovering period.

So, when a patient comes in for the breast reconstruction, normally the surgeon will pre-plan where to take the fat tissues from the other part of their body to be moved into the breast. Normally it’s from their tummy or their legs, or their bottom, or sometimes in the back, and that means this patient would be having multiple sites of trauma within their body when they have this operation.

Normally it would last a very long period of time because the surgeon doing the surgery has to make sure not only the volumes match as well as the shape has to, they have to shape the breast, so most of the patients that undergo such operations, they normally would have more than one operation because they would have the major operation to remove the fat, then replace the fat, having the skin, shaping the breast, and once that’s done often the shape may not be perfect so they often have to come back after they’ve recovered for correction operations, and each time these are whole body anaesthesia, they will be out of work for a few weeks, if not months, so it is a very painful process for the patient.

And that’s why 3D printing can really help, because 3D printing can get the volume and the shape right the first time, so you can really minimise the risk of the patient having multiple operations.

It can also shorten the time of the surgery, which means that you would cost the hospital less, because the surgical theatre would cost thousands per hour, so the longer the patient stays in, the higher the price as well as less patients they can operate on within a day.

Is there anything you wanted to share on what the POC_3DP Research Group is working on at the moment?

We’re really trying very hard to build the business case at the moment, and we’re looking for other sources of funding to help with other types of surgeons.

Currently we have a request from thoracic robotic surgeons for not only printing implantable customised implants, but also be able to print artificial human tissues to train junior robotic surgeons.

In terms of training, robotic surgeons haven’t got much to use. A dead body doesn’t really come very cheap or very often and animal tissues are not really relevant to humans and the key point for robotic surgeons is the hand feeling the mechanical forces, the robotic surgeons are feeling when operating, are completely different from real surgical processes, so when they touch a blood vessel, on the handles of their robots it feels completely different from you cutting through a real blood vessel, so that is the element they really want to train.

We have a few projects in the pipeline, we’re looking for funding to be able to bring those as a whole portfolio of the case study that we can present eventually when we’ll be able to identify the right funding source for setting the service up.