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Over the past decade, healthcare has begun to adopt and adapt additive manufacturing (aka 3D printing) and mixed reality (XR) as it transitions into an era of precision medicine and valuebased reimbursement. Recently, there has been an inflection where the application and scale deployment of these technologies is rapidly increasing by healthcare delivery systems throughout the world. Despite this impressive acceleration, the intersection of healthcare, 3DP, and XR faces several challenges to continued and sustainable growth.
The Ochsner medical 3d (m3d) Lab is one of the few but growing numbers of labs utilizing XR and 3DP that is embedded in an integrated healthcare delivery system. As founder and medical director of the Ochsner medical 3d (m3d) lab, I lead the efforts to use 3DP and XR to facilitate patient education, enhance medical training, and improve clinical care delivery. The genesis of the lab dates to 2013 when I was a newly graduated neurologist serving as a Brain Injury Medicine Fellow at the Rehabilitation Institute of Chicago (now the Shirley Ability Institute). I was caring for a patient with a complex vascular malformation overlying their language center. While viewing and trying to explain the traditional 2D neuro-imaging to residents, nurses, therapists, family, and the patient, I began to appreciate the non-intuitive nature of medical imaging fully. This, combined with the patient’s language deficits, represented a significant information asymmetry and created barriers to education, clinical care, and patient engagement. This occurred around the time when 3DP was being introduced to the masses, and I thought it would be interesting and helpful to try to 3D print this patient’s medical imaging, not fully appreciating the odyssey that I was beginning. In the journey to accomplish this goal, I learned that the processing of medical imaging into a 3DP file overlapped significantly with the image processing used in video games. This led to collaborations with several individuals in the video game industry and the expansion into XR.
The continued growth of this work in 3DP and XR led to the foundation of the Ochsner m3d Lab in 2017. In addition to myself, The Ochsner m3d lab consists of an operations/lab manager, bioengineers, XR application developer, an information systems consultant, and a clinical integration specialist. Additionally, this work is vitally supported by a variety of undergraduates, medical students, residents and fellows, and non-physician clinicians. As a practicing neurologist, the lab has applied 3DP and XR initially and most frequently in the neurosciences. We are utilizing our advanced modeling capabilities in the treatment of aneurysms, epilepsy, and neurological tumors. Our most mature application is in collaboration with our complex spine surgeons, where 3DP and XR models are helping develop and optimize surgical approaches for individuals with complex abnormalities like scoliosis and cervical deformities.
"From a more balanced perspective, early adopters of XR in healthcare have to be mindful of not only showing research results but also to create concrete value to multiple stakeholders pertinent to healthcare delivery, ie regulators, administrators, payers, clinicians, and patients"
I attribute the high velocity and acceleration of adoption in the complex spine to:
1. Significant buy-in from the end-user clinicians, i.e., complex spine surgeons
2. High-fidelity imaging protocols that allow for a streamlined and effective segmentation process.
3. The highly 3D nature of these pathologies and the value in procedural planning of having a patient-specific 3D model
This case of a young lady with Down syndrome and Atlanto-Axial Instability is a great example of how 3DP and XR can empower patients and enhance clinical care delivery: Jalenea story
Although the neuroscience remains our most expansive adopter, this work has expanded dramatically to impact a variety of different specialties within the Ochsner Health System. To date, we have segmented over 200 anatomical models in over a dozen medical specialties, including liver and kidney transplant, cardiology, orthopedics, and pediatrics. We are merging our XR and 3DP capabilities in our anatomical modeling program by utilizing the former to inform the design and quality control of the latter. In addition to anatomical modeling, we are using AR for medical education and VR for distraction therapy in children.
It takes a diverse and diligent few to apply 3DP and XR successfully in healthcare. First, it is important to have a visionary who sees the long term value as well as the resources to support the work. Second, it takes clinicians willing to adopt these technologies into their practice as well as to adapt their workflows. Finally, it takes a specialized team to be able to create and deliver XR healthcare applications consistently and dynamically. All or necessary, but none by themselves are sufficient to ensure success.
I encourage my colleagues who are interested in deploying XR to reach out to our growing community as well as sensitizing their surroundings to the unique nature and requirements of medical XR. Most departments or medical systems are not accustomed to integrating biomedical engineers, XR application developers, and other novel technologists into workflows, nor do they fully appreciate the impact these assets can have on healthcare. The end product of a tangible XR anatomical model or distraction therapy application often resonates with clinicians and patients, which makes starting the dialogue easier but not easy. Thus the sooner and broader the conversation, the easier it will be to integrate XR into your healthcare institution.
Several challenges remain to have mainstream adoption of XR in healthcare settings, including regulatory, human, technical, and capital resources. The biggest current barrier, however, is the ability to capture the value 3DP and XR brings to the patient and clinical experience. We have preliminary data supporting a variety of hypotheses, e.g., improved surgical approach, decreased operative times, enhanced procedural training, optimized instrumentation usage, and surgical approach. We have also collected pilot data demonstrating decreased anxiety and improved biometrics like heart rate in children using XR during procedures like phlebotomy, port access, and cast removal. These results are preliminary and require larger, more robust validation studies with a focus on clinical outcomes and value capture. In capital-lean times, irrefutable data supporting 3DP and XR’s clinical utility is required to justify further investment and to scale by healthcare systems.
I am biased and think 3DP and XR will soon be as integral to healthcare as MRIs, EMRs, or IVs. From a more balanced perspective, early adopters of XR in healthcare have to be mindful of not only showing research results but also to create concrete value to multiple stakeholders pertinent to healthcare delivery, i.e., regulators, administrators, payers, clinicians, and patients. Despite these challenges, I am confident XR will be an important tool in the overarching strategy of value-based reimbursement, precision medicine, and personalized care. The sooner we can show 3DP and XR’s value not only to clinicians and patients but also to those in the C suite, the sooner we can achieve this goal. In conclusion, the timing in healthcare for XR is ideal. The space is undergoing a renaissance and adopting whole new categories of technologies and therapies, e.g., biologics, immunotherapies, electroceuticals, and 3DP. Healthcare is ripe and open to disruption as the necessity of a more sustainable clinical care delivery enterprise is driving innovation. Consistent with this theme, XR is a 21st-century technology that will allow clinicians to deliver 21st-century care.