Influencer: An Interview with Dr. Daniel Valentino On the Early Days and the Future of 3D Printing in Healthcare

Jenny:                        

Hi, everyone. We have the pleasure to have Dr. Daniel Valentino who is currently the Vice President of Global Technology and Innovation at Landauer. I worked with Dr. Valentino many years ago; almost a decade ago on fluid dynamics in aneurysms and I still remember those fun days, Dan.  Thank you so much for coming.

Dr. Valentino:

Thank you.

Jenny:                        

Thank you so much for sharing with me some of your interesting stories with 3D printing in the early days. Would you like to share that with us?

Dr. Valentino:

Sure. Where would you like to start? You want to know about why I got into 3D printing in the first place?

Jenny:                        

Yeah, like the very first … The beginning.

Dr. Valentino:

Yeah, so when I was at UCLA, I was actually interested in doing brain mapping for my PhD dissertation, but at that time, there was no funding available for brain mapping. It was very early in the field of brain mapping as well. I got a part-time job at the then-new radiology image processing laboratory at UCLA, where I was introduced to Professor Nick Mankovitz and he was interested in using some of the new equipment that they had to generate 3D images from CT scans. He had the vision of being able to translate the images into manufactured models.

One of the first projects that he introduced me to was … Or one of the first people that he introduced me to was a maxillofacial surgeon by the name of Neil Soker and Dr. Soker specialized in patients with severe maxillofacial deformities and wanted to use computers to help plan those surgeries. Those surgeries, as you know, Jenny, they’re very complex, even today, so Neil’s vision was that he could use a computer to better plan those surgeries so that he could get them done more effectively for the patient.

One of the first things that I did was we … We have to remember that the technology then was very different than the technology that we have today. One of the first things that we focused on was to try to take the CT scans and render them in 3D and then display those onto one of the graphic computers that we have.

Then from that, we would generate a 3D mesh, then we’d generate an STL file and we’d send that to a company that specialized in 2D milling. Essentially, they’d send the individual slices to a 2D milling machine and they’d cut each slice out of a sheet of plexiglass. They’d do that for every slice in the data set and from that, we could manually stack the plexiglass slices on top of each other to create a 3D object.

Jenny:                        

Wow, I can’t even imagine how long that takes. How long did it take you just to make one model?

Dr. Valentino:

In those days, from the time that we got the data until the time that we were able to actually generate the model was often two to three weeks.

Jenny:                        

Wow.

Dr. Valentino:

Yeah, there was a lot of computational processing to do to prepare the data and visualize it, but then we’d have to send the STL file to an outside dedicated company where they would cut the 2D slices and then they’d send all the plexiglass slices back to us and we would glue them back together to form a 3D model, so that entire process took often up to two to three weeks.

Jenny:                        

Now were these models mostly for surgical planning or they’re actually becoming part of patients, like nowadays people actually use them as part of the implantable hardware?

Dr. Valentino:

Oh yeah, that’s a great question, so one of the first things we did was in software, we would … One of the first programs I wrote was in software to move the bone forward and backward so that the surgeon could essentially determine or estimate where they would have to break the bone and how far forward they’d have to move it and where they’d attach it.

Then from that, after they did a virtual model, from that we could estimate pieces of bone that would need to be manufactured out of plexiglass or made out of plexiglass and then those pieces became the implant that were used in the patient, so we did that on several cases. One of the cases was actually a gunshot wound where a large portion of the skull was unfortunately destroyed or blown away and it had to be replaced, so we first reconstructed a virtual model of their head, then we used the computer to fill in the implant piece.

We actually made a 3D model of their skull and the potential implant and then physically after printing them, from that they actually made molds that they used to cast an implant.

Jenny:                        

I see.

Dr. Valentino:

Now, I think the direction we’ve moved since then is, we can directly print the implant.

Jenny:                        

Dan, I know you live in Chicago and so you have visited RSNA (Radiological Society of North America) and sounds like there is a lot of enthusiasm in 3D printing in radiology society. Did you go and what was your experience with that conference?

Dr. Valentino:

It was a very exciting time at RSNA. Amongst many different examples of 3D printing that I saw at the show, one of the things I think is particularly useful for physicians trying to understand the anatomy for a particular patient is the combination of different materials that’s now possible. For example, it’s possible to print models of the lungs with the airways in one material, the blood vessels in another material and the shape of the lung itself could be made out of a clear material and the entire thing is printed together to create one integrated model that allows you to visualize the actual anatomy from a real patient in exquisite detail.

Jenny:                        

I’m not sure you have answered this question, but were these models actually made at a physician’s office or were these made in a factory somewhere; somewhere outside of hospital?

Dr. Valentino:

No, no. Well, the one I just referred to was made in a research laboratory, but using desktop printing equipment.

Jenny:                        

So in-house, basically.

Dr. Valentino:

Yes.

Jenny:                        

Comparing all these decades of development of 3D printing technology, what do you think the big difference between now and then?

Dr. Valentino:

Well, back then, all of the equipment was extremely specialized. When we got started, there was no software for doing 3D rendering. There were no desktop computers capable of doing 3D rendering and there were no 3D printers, so we literally had to write the software. We had to get access to very dedicated computer hardware. These were very specialized imaging computers that had lots of memory and that would enable us to display the images. By playing back individual images in sequence, we could essentially play back a loop, a semi-loop and stimulate the object rotating on the computer.

Then the first 3D printers were really 5 axis milling machines. I guess the simplest was a 2D milling machine printing out the plexiglass sheet. A slightly more sophisticated stab in the process was the move to 5 axis milling machines, which were capable of actually milling out 3D objects out of a single block of plexiglass.

Then really the breakthrough I think came with stereolithography. That enabled us to essentially use the exact same technology that we were using to cut out a 2D slice, except that instead of cutting out the 2D slice, we used a laser to cure each 2D slice and out of a resin, so you had the … I don’t know if you’ve seen stereolithography systems, but you have a vat of resin and you cure one layer at a time and by curing each layer, you build up a 3D object. Stereolithography represents the first real breakthrough toward having desktop printing.

Jenny:                        

Yeah, if I remember correctly, I’ve seen the company, the initial 3D printing company, and I think it was 3D systems that was built based on the technology and then there are many others following that. Yeah, so what do you think of the future of 3D printing is like, specifically in healthcare field?

Dr. Valentino:

Well, I think there’s a tremendous opportunity for 3D printing, particularly because of the ability to print in different material. Right now, we’ve been using 3D modeling, particularly desktop 3D modeling primarily as an educational tool. It would help the physician understand a particular patient’s anatomy, but going forward where we’re able to print potentially in implantable metal or implantable material, I know that there are some groups that are working on making titanium implants directly from 3D models using technology I think that’s going to become available on your desktop and that will really revolutionize the way that surgical treatments are planned because you can envision.

The patient could come in, have a CT scanning done. The physician, in software, could plan the type of implant they want to do. They can actually create an implant that’s highly customized to that individual patient and print it that same day. You could imagine sterilizing it overnight and the patient comes in the next morning and gets the surgical procedure performed.

Jenny:                        

Yeah, I can imagine the amount of creativity this technology allows for surgeons to take better care of our patients. I’m very, very excited to see this.

Now Christmas is coming. If you have some wishes for the 3D printing community, can you share with us?

Dr. Valentino:

Do I have any wishes for the 3D printing community? [Chuckles]

Jenny:                        

Yes.

Dr. Valentino:

Okay, I think that it’s an interesting question. We’ve talked about how … Well, before I answer that question, I want to make a comment on why 3D printing is popular today as compared to three decades ago because I think that will help put things in perspective.

Three decades ago, everything was extremely specialized, whereas now, the technology’s reached the point where a physician can do all the work. They can use CT scans that they get on most of their patients. They can use desktop software. They can run all that software on a relatively inexpensive computer and they can buy a relatively inexpensive 3D printer and they can print with materials that are relatively inexpensive.

We’ve all heard the term the maker community and we’ve seen the rise of makers. We’re really seeing the rise of the medical makers. There’s a specialization in medicine now where physicians can become makers and they can make these devices. I think that is really driving the field. Instead of having to turn to a specialist with very specialized and very expensive equipment, physicians actually now sit down themselves and without having any kind of specialized engineering training, they can learn how to use the software and they can generate a model and they can have it in their hands. The only slow part of that whole entire process is it currently takes several hours to print a 3D model in great detail, but they can do everything else themselves in real time.

The only barrier that they have … When you ask me what are my best wishes for them … The barrier that they have is that that software’s still difficult to use. In many cases, you have to find multiple pieces of software and you have to know the sequence in which to use them in order to go from CT scans all the way through to a 3D model, so I can envision that we’re not very far away from having software that is even easier to use than the software we have today and where we have enough of the pieces integrated, especially that the physician can generate that 3D model directly from the one piece of software that we’re using.

My wish on the software side would be that they get all of the software integrated and simplify it even further, but my wish on the hardware side would be that we could get desktop 3D printers that will allow you to print in more exotic materials. I think that will be a real breakthrough, particularly for medicine.

Jenny:                        

Yes, exactly. We’re on the same page and I think with those factors and plus the creativity from the medical community, we’re looking at compounding exponential growth of great ideas that can be implemented into taking care of patients.

Thank you so much, Dan. That was really, really awesome.

I’m so glad that you were willing to share with us those amazing experiences. Thank you very much.

Dr. Valentino:

It was great talking with you again.

 

 

hchen23

Neuroradiologist by trade, enthusiast for big data, digital marketing, 3D printing in healthcare

1 Response

  1. Daniel J Valentino, Ph.D. says:

    Correction: the correct spellings of the names mentioned in the interview are Nick Mankovich, Ph.D., and Neil Stoker, M.D.. The work was performed between 1985-1987 in the Image Processing Laboratory in the Department of Radiological Sciences at UCLA.

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