Wednesday, May 25, 2022

Replies part 2–3D Printing question

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Many years ago I recall when the key word was custommanufactured today it is custom fitted. Yes we are headed in that direction,and much of the damage done we have done to ourselves in not protecting our professionin other ways.Al Pike, CP(E)************************* I am a custom shoe maker and certified orthotist, I took a course in 3D printing the writing is on the wall,I am also part of a volunteer group that make 3D printed hands for kids through T.O.M with the ground work being done by ENABLE, although it is a challenge and still in baby steps as far as suitable materials and actual printing mishaps, 
It is a way of the future and I have absolutely no doubt that is the trend. just a matter of time and with the leaps and bounds of tech innovation it is on our doorstep, best get computer design savyso that the best of both worlds can be had.

further info at https://www.youtube.com/watch?v=I_BQzJD9gpo

who is T.O.M?http://tomglobal.org/

warm greetingsKeren DarIsrael**********************************You do not need an expert until things are not working! That is when we are valuable. These devices that are being printed are not medical grade devices, and are not made as cheaply as presented. They do not take a beating, and are typically fragile, but look cool. That 25 dollar device does not include the actual cost of production. Those printers are costly and slow.******************************I went to a seminar on 3d printing a two years ago held at the BMW plant here in SC, as I had the same concerns as you.  My take away from that seminar(sales pitch) was the following:  yes prosthetics and orthotics can be 3d printed.  No its is not economical as told in our all-so-truthful media in that segment seen.  Our profession would have to have the largest 3d printer available to produce AK sockets the size we are seeing.  Those machines were at the time $250k give or take(I am sure they are cheaper now).  The real hidden cost is that they need the material cartridges for each material(color or type of plastics etc) that you want to incorporate in each device.  Its like an inkjet printer – you need all the colors and types of materials we use($$$$$).  Printing time is not fast either – takes hours to produce products our size. 

Yes, that BE for that child was done with maybe $35 of materials in that system – but what are the hidden fees(overhead – machine, labor, etc.)?  Biggest question I had with that story(I saw the same thing) how long before that kid broke that prosthesis?  How long did it take to fabricate? How long does it take to replace/repair parts etc?

It could happen in the future, but hopefully our profession continues to push for legislation requiring credentialed individuals for payment of our devices. 

Michael Lavezzo, CPO, CTP
Director of Central Fabrication

Friddle’s Orthopedic Appliances***********************************
The problem with these 3D printed prosthesis stories in the news. Is they always assume that all labor and equipment and experienced expertise is Free. That $50 hand is the cost of Just the plastic used to print it.
If any prosthetic office donated everything but the cost of just the material in the prosthetic. Than that prosthetic would be pretty cheap too. 3D printing is just a fabrication technique. It’s not necessarily cheaper or better. To make that 3D prosthetic, someone had to buy a very expensive piece of equipment. They had to buy software. They had to spend many hours learning how to use the machine and software. They have to have a space to work in, electricity, etc. All that is donated in a $50 3d printed prosthetic. Then there are the fit issues . You’ll never see that in a news story.
It will be a long time before you don’t need a professional with experience and skills to make a well fitted, good functioning prosthetic.

Glen Nienstadt
Prosthetic Artworks
570-828-6177
[email protected]***********************
Kevin,

Fear not. I am posting another comment from Ed Lemaire, up in Canada, and my response to him.

It’s all about the socket.

Warren

…and the number one reason that 3D printing, ostensibly working from a scan of the residual limb, will always result in a less accurate fitting socket: Scanners do not have the ability to capture the underlying bony shape.

I have seen some clever prosthetists who recognize the above, and who take a cast of a residual limb in normal fashion, and then scan the inside of the cast. That makes a great deal of sense to me, but still requires a hand cast, and the skills to go with it. I still wouldn’t trust anyone other than who took the cast to “modify” the scanned model.

One of the best reasons that I can think of for using scanners today is for the storage of shapes that are in use by patients. Often, the plaster model is destroyed in the fabrication process. Scanning a plaster model prior to fabrication would allow easy storage of the shape, without the need for a room full of plaster models.

The idea that a scanned image of a raw patient shape is somehow more technically accurate than a hand cast cracks me up. Every time that a person comes in my door asking if we have computer scanning capabilities, it takes me about 2 minutes to explain why we don’t, and why those who advocate for this technology are toying with the consumer, suggesting that it is to their benefit that their socket be made from a scan. It takes very little effort to help patients see that the use of a scanner to take a cast is for the convenience of the prosthetist, not the patient.

I know I am sort of drifting from your original post, which was focused on 3D printing, but I believe that these two technologies go hand in hand. That 3D prosthesis has to fit onto the patient’s residual limb somehow. That implies a socket shape.

Warren R Mays, CPO

—–Original Message—–
From: Orthotics and Prosthetics List [mailto:[email protected]] On Behalf Of Lemaire, Ed
Sent: Wednesday, June 29, 2016 5:26 AM
To: [email protected]
Subject: [OANDP-L] 3D printing – response

3d-printing, or additive manufacturing, will continue to be in the news since it is cool technology that brings machining-manufacturing abilities to the masses. However, the road to direct competition with current manufacturing approaches in P&O may be longer than you think. Here are some items to consider:

1)      3D printers relate to the technical craft, not the clinical. If clinicians continue to evolve and maintain the ability to make appropriate decisions that optimize function and comfort, this technology will be an advantage

a.      The same comments were made in the early 1990’s when CAD/CAM first came into P&O. The time will come when machines can make the correct decisions, but by then surgeons will also be replaced by robots.

2)      Current consumer 3D-printers replace well-constructed devices with cheap plastic models. Even with higher end 3D-printers using new materials,  problems persist in end-product quality when subjected to a range of peak and cyclic loading scenarios … as compared with parts produced using other manufacturing methods that can accommodate these loads

3)      The time to 3D-print parts is still relatively long, but becoming reasonable for a few devices a day.

4)      The cost of materials is always relatively low, and this is the price that keeps being mentioned in the media. In engineering teaching and research circles, I make the comment that this works well if you believe that engineers should not be paid for their work. A volunteer revolution in rehab would affect all disciplines, not just P&O. I would like to see media people asking these questions, including the lack of regulatory approval, legal implications for device failure, etc.

5)      While one-off devices can be produced in developing countries, this may not be the most economically beneficial way to fit the 10’s of thousands of people requiring P&O care around the world. For example, an order of 5,000-10,000 well constructed prosthetic hands from China may cost about the same, or less, than the materials to make a cheap plastic hand. You have to ship the plastic anyway so shipping costs cancel out.

6)      Current 3D-printing projects and open-source initiatives are good since children can get fun-colorful devices to play with, and these can be made by a loving family member. It is also good to expose students from a variety of fields about prosthetics and orthotics, but the loop needs to be close as to where these devices fit into the P&O technology ecosystem.

7)      The big advance from additive manufacturing will come from the ability to create devices that cannot be produced using current manufacturing methods. But to take advantage of this, the prosthetist and orthotist must evolve their skills beyond cast modification and lamination/plastic draping. Also, personal customization that includes sizing but also cosmetic factors must be considered … as already appearing in the market.

8)      Other than upper extremity devices, I would expect spinal orthoses to be a possible area for 3D-printing to evolve. Loads are reasonably small (i.e., compared to lower limb gait) and potential exist to print devices with variable flexibility and airflow that would be difficult or time-inefficient to produce another way. Need a large printer …

That is all for now.

Ed

Edward Lemaire, PhD
The Ottawa Hospital Rehabilitation Centre, Centre for Rehabilitation Research and Development Professor, U. Ottawa, Faculty of Medicine Board member, ISPO
————————————————————–

I want to thank everyone who replied, well almost everyone, haha.  Thanks Paul!

Kevin C. Matthews, CO/LOAdvanced Orthopedic Designs12315 Judson Rd. #206San Antonio, Texas  78233(210) 657-8100(210) 657-8105  fax

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