Manufacturing technology
Parts on demand
Additive manufacturing has yielded a great many benefits for medical device companies, hospitals and ultimately the patients they serve. But sometimes time is of the essence, and with cost pressures a part of outsourcing 3D-printed parts, some industry experts believe in-house facilities will become a norm for patient-specific device manufacturing. Isabel Ellis speaks to Elizabeth Silvestro, AM engineering manager at the Children’s Hospital of Philadelphia, and Andy Christensen, chair of the Radiological Society of North America (RSNA) 3D Printing Special Interest Group, to better understand the impact, and the future, of AM at the point of care.
he Children’s Hospital of Philadelphia (CHOP) bought its first 3D printer primarily to model hearts. It did not expect to find such a compelling use case in melting them – metaphorically, that is. The story starts in 2020, with the birth of Lilianna and Addison Altobelli, twin girls joined at the chest and abdomen. Since 1957, CHOP has separated more conjoined twins than any other hospital in the US. Practice makes perfect, but, with such a rare condition, it’s very difficult to be able to. Before the Altobellis, the hospital had still only performed 28 procedures in more than 60 years. Or that would be the number – unless you count all the rehearsals made possible by the hospital’s onsite 3D printing facility. In preparation for the operation, the Children’s Hospital Additive Manufacturing for Pediatrics (CHAMP) lab created full-size 3D models of the Altobelli twins’ shared anatomy – which spanned their chest wall, diaphragm and liver. Designed to be assembled and disassembled like Lego, these models helped the surgical team solve the unique challenges of safely separating Addison and Lilianna, and then enabled them to repeatedly walk through the procedure for doing so. The
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results speak for themselves. Ten months after they were born, in a ten-hour operation, Addison and Lilianna were successfully separated. “We’re starting a new book – it’s not even a new chapter, it’s a new book,” said the twins’ father, Dom, after bringing them home to Chicago in late 2021. “We started a brand-new book for the girls, and there’s an Addy book, and there’s a Lily book.” But the CHAMP lab’s involvement didn’t end there. Dom and his wife Maggie wanted a keepsake, something that their daughters could return to as they grew up. That meant there was one more model left to make. For that, CHOP medical illustrator Brittany Bennett took a full surface scan of the twins prior to their operation, refined it, and removed all the medical tubes, lines and trachs. Then the engineers printed it. “We were able to give the parents a little model of the two girls in their conjoined state,” explains Elizabeth Silvestro, the lab’s lead engineer. “And the mother was over the moon.” CHAMP had given her more than she thought was possible: her children, twice over. “She had never seen them without the tubes; the only time was in this model.”
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