A Review:

Additive fabrication
technologies applied to
medicine and health care
J. Giannatsis & V. Dedoussis
International Journal of Advanced
Manufacturing Technology (2009) Vol. 40pages 116127

Contents:
1. Introduction.
2. Fabrication of RP models based
on medical data.
3. RP biomodels for surgical
planning.
4. Tools for intra-operation
guidance and testing.
5. Patient-specific implants.
2

Contents:
6. Tissue and organism
manufacturing engineering.
7. Drug delivery and microscale
devices.
8. Discussion and concluding
remarks.

1. Introduction
Additive fabrication (AF) and rapid
prototyping (RP) technologies are
mostly associated with applications in
the product development and the
design process as well as with small
batch manufacturing.

1. Introduction
What makes RP particularly appealing
for all applications is the fact that
compared
to
alternative
manufacturing technologies, like CNC
machining, RP systems can fabricate
parts of almost any geometrical
complexity in relatively lower time
and with reduced cost and without
high technical expertise.

1. Introduction
RP technologies are even more
appealing for medical applications as
they utilize medical imaging data
(obtained
by
techniques
like
computed tomography - CT or
magnetic resonance imaging - MRI),
almost directly, for the production of
customized patient specific parts.

1. Introduction
Medical applications of RP
technologies:
Biomodelling, which is the fabrication
of physical models of parts of the
human anatomy for surgery planning
or testing.
Design and fabrication of customized
implants for prosthetic operations, and
plastic surgery.
Fabrication of porous implants
(scaffolds) and tissue engineering.

1. Introduction
RP technologies have not yet been
widely adopted in the medical and
health-care sectors because of:
High cost and time required for the
fabrication of corresponding models.
The accuracy of RP systems, which is not
sufficient for some applications, due
mainly to poor or inaccurate medical
imaging data.
Materials and their properties, i.e.,
flexibility, strength and biocompatibility.

2. Fabrication of RP models
based on medical data
First, obtain the data of the patients
area of interest with the use of (CT,
MRI, etc.), which provides a
representation of the patients
anatomy through a series of 2D
images.
The images are next manipulated
using special software, which
converts the 2D image information to
a 3D representation.

2. Fabrication of RP models
based on medical data
Choi et al. analyzed the possible
sources of error in biomodeling and
identified the main sources of error in
the translation of 2D data to a 3D
virtual model.
This has led to the development of
special software tools like Mimics
from Materialise Inc. and Biobuild
that have simplified and enhanced
the accuracy of the 2D- 3D data

3. RP biomodels for surgical

planning
Since every patient is unique, the
surgeon must fully understand the
anatomy of the patient before
operation.
In complex surgical operations, RP
biomodels facilitate diagnosis and
treatment planning, and decrease the
risk of the surgery.
Furthermore, the study of a biomodel
allows a detailed evaluation of the
operation, without the time pressure

3. RP biomodels for surgical

planning

Muller
et
al.
investigated
the
usefulness of RP models of the skull in
craniofacial and neurosurgical practice.
RP biomodels of 52 patients, whose
treatment
required
corrective/reconstructive cranioplasty
were fabricated.
They report that SL models help
increase operation accuracy, support
accurate
fabrication
of
implants,
facilitate pre-surgical simulation and

4. Tools for intra-operation

guidance and testing
DUrso
et
al.
investigated
the
possibility of using accurate SL
biomodels
of
the
patient
neurosurgical stereotactic surgery.
The method of stereotaxy is a
minimally invasive form of surgical
intervention which uses 3D coordinates
in order to locate specific targets and
perform on them an operation like
removal, implantation or injection.

4. Tools for intra-operation

guidance and testing
The location of the target is based on
MRI/CT data and is determined with
respect to a reference frame that is
attached to the patients body.
They report that biomodel-guided
stereotaxy is advantageous in terms of
speed,
simplicity,
accuracy,
and
versatility but with the extra cost and
time required for biomodel fabrication.

4. Tools for intra-operation

guidance and testing
Starly et al. used the SL model as a
medium for the transfer of the
anticipated skull geometry in a surgical
guidance system.
In this approach, the 3D virtual model
of the patients skull is constructed first
using CT data.
The virtual model is then split in two
parts, the undamaged half and the
defective half that contains the

4. Tools for intra-operation

guidance and testing
SLS have been employed for the
construction of protective patientspecific shielding masks that may
be used as protective shields during
cancer treatment.
The fabrication procedure proposed by
De Beer et al. comprises of three
phases:
First the face geometry for the mask is
captured by 3D photography.

5. Patient-specific implants
Truscott et al. used SLS models in the
design
process
of
customized
titanium elbow implants which
greatly improved the accuracy and
reduced the cost of the implant design
process.
Winder et al. present ten clinical cases
in which the required titanium implants
for the reconstruction of skull defects
were created using RP models as
masters for casting.

5. Patient-specific implants
Bens et al. developed a flexible (meth)
acrylate based resin for SL that could
be
useful
in
various biomedical
applications.
Hunt et al. employed SLS for the
fabrication of moulds for the production
of wax investment casting patterns.
According to their findings, the bone
growth in implants fabricated this way
is less than in porous implants
directly fabricated with SLS.

6. Tissue and organism

manufacturing engineering
RP technologies are also ideal for the
fabrication of implants with special
geometry,
like
scaffolds
for
the
restoration of tissues.
Scaffolds
are
porous
supporting
structures that are used as a vessel
for the transplantation of tissue
cells into the body of the patient.
They serve as the platform for the
guided growth of new tissue in

6. Tissue and organism

manufacturing engineering
Chen et al. presented a case where an
SL mould of the intended scaffold
geometry was used to cast an
artificial bone through injection of
calcium phosphate cement (CPC), which
is a non-toxic soluble material and bone
morphogenic protein.
Tests performed on animals showed that
the artificial bone scaffold accelerated
the growth of the actual bone.

6. Tissue and organism

manufacturing engineering
3D scaffold modeling is a tradeoff
design process (porosity versus
structural strength) that requires
considerable time and effort employing
standard mechanical design software.
Chua et al. suggested utilizing libraries
of
application-specific
polyhedral
shapes that are used as constructing
elements of the scaffolds.

6. Tissue and organism

manufacturing engineering
Yan et al. proposed a new process called
(low-temperature
deposition
manufacturing LDM) employs the
layer manufacturing principle and an
extrusion-type
system
for
the
construction of composite scaffolds.
Compared to established AF methods,
the LDM process is reported to preserve
bio-activities of scaffold materials
because of its non-heating liquefying
processing of materials.

7. Drug delivery and

microscale devices
RP technologies are expected to prove
very useful in the fabrication of
customized micro-systems and devices
for controlled drug delivery.
Such devices involve complex micronscale networks of fluidic and electronic
components capable of operating in an
integrated manner.

8. Discussion and concluding

remarks
The review of the international
specialized literature showed that
custom biomodels fabricated with RP
technologies are quite useful for
planning and the rehearsal of complex
surgical operations.
Among the RP technologies applied to
medicine, SL seems to have attracted
the attention of most researchers.

8. Discussion and concluding

remarks
SL is not only relatively more accurate
but also SL resins provide the
advantage of biomodel transparency
that can be quite useful in surgery
rehearsal.
However, they are not biocompatible
and require special handling; a fact that
makes adoption of SL systems in the
hospital environment difficult.
The accuracy and the low surface

8. Discussion and concluding

remarks
Fabrication of custom-made scaffolds is
another application in which RP can be
quite useful.
Two approaches have been identified:
Direct Methods they employ a RP
system for the fabrication of the actual
scaffold itself.
Indirect Methods they employ RP for
the fabrication of the tool (pattern or
mould) that will be used for the

8. Discussion and concluding

remarks
Micro- and nano- AF technologies are
expected
to
make
possible
the
fabrication of controllable drug-delivery
units or implants in the micron or the
submicron level.
Fabrication
of
artificial
organ
substitutes is a very interesting area of
research,
that
enables
controlled
assembly of living cells and supporting
material in order to construct the organ
substitute.