3D printing might save your life one day. It's transforming medicine and health care.

What can 3D printing do for medicine? The "sky is the limit," says Northwell Health researcher Dr. Todd Goldstein.

Northwell Health
  • Medical professionals are currently using 3D printers to create prosthetics and patient-specific organ models that doctors can use to prepare for surgery.
  • Eventually, scientists hope to print patient-specific organs that can be transplanted safely into the human body.
  • Northwell Health, New York State's largest health care provider, is pioneering 3D printing in medicine in three key ways.

Imagine that a health emergency strikes and you need an organ transplant – say, a heart. You get your name on a transplant list, but you find out there's a waiting period of six months. Tens of thousands of people find themselves in this dire situation every year. But 3D printing has the potential to change that forever.

The technology could usher in a future where transplantable organs can be printed not only cheaply, but also to the exact anatomical specifications of each individual patient.

What other innovations could 3D printing bring to medicine and health care? The sky is the limit, according to Dr. Todd Goldstein, a researcher with the corporate venturing arm of Northwell Health, New York State's largest health care provider and an industry leader in 3D-printing research and development.

"It comes down to what people can think up and dream up what they want to use 3D printing for," Goldstein says. "Ideally, you would hope that 50 years from now you'd have on-demand, 3D printing of organs."

While that's still on the horizon for researchers, 3D printing is already improving lives by revolutionizing medicine in three key areas.

​Printing realistic, customized organ models

3D printers can take images from MRI, PET, sonography or other technologies and convert them into life-size, three-dimensional models of patients' organs. These models serve as hands-on visualization tools that help surgeons plan the best approaches for complex procedures.

They also allow doctors to customize patient-specific models prior to surgery. For example, Northwell employs 3D printing in several clinical applications:

  • Tumor resection models clearly highlight the tumor and surrounding tissue
  • Orthopedic models are useful for pre-surgery measuring and medical device adjustments
  • Vascular models identify malformations in organs, tumors, sliced chambers, blood flow, valves, muscle tissue, and calcifications
  • Dentistry oral implants and appliances can be created in just one day, significantly reducing wait periods for Northwell dentists and their patients

Using realistic models not only delivers better health results but also shortens operating times. That gives patients less time under anesthesia, and hospitals potential savings of millions of dollars over just a few years.

Being able to visualize procedures before they occur also helps to comfort patients and their families. Take, for instance, the case of Barnaby Goberdhan, a man who discovered that his young son, Isaiah, had an aggressive tumor in his palate. Goberdhan met with Neha A. Patel, MD, a pediatric otolaryngologist at Cohen Children's Medical Center, a Northwell Health hospital, to discuss the procedure and learn about it with help from a 3D-printed model.

"Having a 3D printed depiction of my son was really helpful when talking with the doctor about his surgery," said Mr. Goberdhan. "The doctor was able to do more than talk me through what they were going to do – Dr. Patel showed me. There is almost nothing more frightening and stressful than having your child go through surgery. There were several options Dr. Patel walked us through for the best way to preserve Isaiah's teeth and prevent additional cuts within his mouth. I wanted all of my questions answered so I could be less fearful and more prepared to talk my son through what he was about to face. I wanted Isaiah to feel prepared. With the 3D model, we both felt more at ease."

For years, 3D printing surgical models was prohibitively expensive. Now, more affordable systems such as Formlabs' Form Cell give more hospitals across the country access to the technology in order to produce realistic, patient-specific models, usually within one day.

3D-printed prosthetics

Credit: Northwell Health

While 3D-printed organs are a long way in the future, today's technology is well suited for manufacturing prosthetics. 3D-printed prosthetics are often remarkably more affordable and personalized than their traditional counterparts. That's a big deal for many families, especially those with children who outgrow prosthetics and are forced to buy new ones.

One recent breakthrough in 3D-printed prosthetics came when Dan Lasko, a former Marine who lost the lower part of his left leg in Afghanistan, wanted the ability to swim with his prosthetic leg. Wearing prosthetics in water has been possible for years, but they typically slow swimmers down. No device had been able to go seamlessly from land to water or to help propel its wearer through the water.

To fix that, Northwell Health recently funded a project that developed The Fin – the world's first truly amphibious prosthetic. With The Fin, Lasko and his family can go straight into the pool from the locker room – or the diving board.

"I got back in the pool with my two young sons and for the first time was able to dive into the pool with them," Lasko said.

3D-printed prosthetics will help improve the daily lives of the nearly 2 million Americans who've lost a limb. That's promising because the increasing prevalence of Type 2 diabetes is expected to greatly increase the number of amputees in the U.S., according to a study published in the Archives of Physical Medicine and Rehabilitation.

​3D bioprinting

For years, 3D printers have manufactured various products: phone cases, toys, and even operational guns. To produce these objects, the machines heat a raw material, typically plastic, and build the object layer-by-layer according to a particular design.

3D bioprinting, a young field developed by researchers with Northwell Health, may someday perform the same process but instead with living cells in a raw material called bioink.

Daniel A. Grande, director at the Orthopedic Research Laboratory in the Feinstein Institute for Medical Research, an arm of Northwell Health, said he and his team first pursued 3D bioprinting by modifying 3D printers so they'd accept living cells.

"My initial concept of 3D printing was early studies that looked at modifying ink-jet printers, where we incorporate a bioink that includes cells within a delivery vehicle," Grande says. "That hydrogel can then be polymerized, or hardened, upon heat or UV-light stimulation, so that we can actually make a complex structure, three-dimensionally, that incorporates living cells. The hardened hydro-gel is then able to keep the cells alive and viable. It's also biocompatible, so it can be safely implanted in humans."

It's a promising enterprise, and it can radically change how we experience medical care.

"3D bioprinting's potential is almost limitless and has the potential to replace many different parts of the human body," says Michael Dowling, president and CEO at Northwell Health, and author of Health Care Reboot. "Researchers envision a future with 3D printers in every emergency room, where doctors are able to print emergency implants of organs and bones on demand and revolutionize the way medicine is practiced."

Dr. Todd Goldstein explains more about 3D bioprinting below:

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The shocking, forgotten history of cretinism

Now an insult, 'cretin' was the medical term for a debilitating disease endemic in the Alps until the early 20th century.

Image from p. 96 of the report on goiters and cretins by Dr Jules Baillarger (1873), public domain. Found here on the page Culture, Histoire et Patrimoine de Passy.
Strange Maps
  • Until about a century ago, 'cretinism' was endemic throughout large parts of the Alps.
  • Sufferers often had a visibly enlarged thyroid gland, and in the worst cases were severely retarded.
  • Although 'goiter belts' in North America and Europe have been eradicated, the disease remains common throughout the world.

Age-old blight

\u200bCretins with goiter, Styria (Austria), early 19th century.

Cretins with goiter, Styria (Austria), early 19th century.

Image: Oesterreichs Tibur (1819), public domain. Found here on Wikimedia Commons.

How do you make Captain Haddock swear like the drunken sailor he is, without R-rating the comic that stars his much milder-mannered friend Tintin?

Eventually Hergé, Tintin's spiritual father, found the answer. Whenever Haddock verbally exploded, his stream of invective was colorful rather than off-color. The captain merely shouted scientific and esoteric terms at the victims of his frequent displeasure.

So when Haddock let out "crétin des Alpes" ('Alpine cretin') in the original French-language version of The Seven Crystal Balls (serialised from 1943), the expression was sufficiently obscure to be inoffensive, its topographic specificity only adding to the humorous effect (1).

Yet the word 'cretin' has a very real, very shocking and at that time still very recent history, and indeed a link to the Alps. When Haddock used the term, the age-old blight of cretinism had been erased only a few decades earlier. But the relative isolation of the sufferers, and the pitiful nature of their suffering, had already wiped the disease from public memory.

Human geography

\u200bMap of the geographic distribution of 'cretinism and idiocy in France'.

Map of the geographic distribution of 'cretinism and idiocy in France'. White: less than 2 'cretins or idiots' per 1,000 inhabitants. Lightest grey: at least two. Middle shade: at least three. Darkest grey: at least five.

Image from p. 96 of the report on goiters and cretins by Dr Jules Baillarger (1873), public domain. Found here on the page Culture, Histoire et Patrimoine de Passy.

From the 18th century onwards, travellers exploring the then remote Alps for their natural beauty were often horrified by the region's human geography. Among the inhabitants of some secluded valleys, they found many who suffered from physical deformities and mental retardation.

In the Guide du Voyageur en Suisse (1788), Thomas Martyn observed: "These imbeciles, known as 'cretins', are plentiful (in the Valais region of Switzerland). Their body resembles that of a dwarf, they appear misshapen and sombre, their minds are devoid of all activity. Their smile only indicates that the cretin is merely a living animal."

The most prominent physical symptom was a so-called 'goiter' (2) – a greatly enlarged thyroid gland, bulging forward from the neck. Other physical symptoms included dwarfism (with adult sufferers as short as 1 meter (3 ft 3 in), loss of hair, thick skin, enlarged tongue and/or belly, and muscle impairment sometimes severe enough to prevent walking or even standing.

Additionally, cretinism could manifest as cognitive impairment, from slight to severe mental retardation. Some sufferers were so afflicted they couldn't speak or take basic care of themselves.

Iodine deficiency

'Joseph le cr\u00e9tin': photograph by Eugene Trutat (1840-1910).

'Joseph le crétin': photograph by Eugene Trutat (1840-1910).

Image preserved by the Muséum de Toulouse public domain. Found here at Wikimedia Commons.

Although not yet by that name, 'cretinism' was known to the ancients and was described by Roman writers. However, because its most severe manifestations were limited to isolated mountainous regions, it was long underreported – and misdiagnosed. Early medical hypotheses blamed stagnant valley air, bad water, 'geological toxicity,' or inbreeding for the congenital disorder.

The actual cause of cretinism is iodine deficiency, which is why the current preferred term is 'congenital iodine deficiency syndrome' or CIDS. Iodine is a mineral that is needed for the production of thyroid hormones, without which the human body's metabolism can't properly function.

Iodine is most abundantly present in the oceans and is transported to land by rain. However, it is not uniformly present in soil. It is most notably absent from mountainous and other inland regions, especially those subject to frequent flooding.

Plants grown in these regions will also be iodine-deficient, and will locals eating only locally-sourced foods. The soil in some Alpine regions is severely iodine deficient. In combination with dietary monoculture, this explains the abundance of cretinism in the region.

Goiter belts

\u200bGeographic distribution of goiters throughout Europe in 1883

Geographic distribution of goiters throughout Europe in 1883: not just in the Alps or Pyrenees, but also notably throughout western Germany, northern Italy, Austria and Britain.

Image: Bircher (1883), public domain. Found here on the page Culture, Histoire et Patrimoine de Passy.

From the 18th century, 'cretinism' became the common term for the disease in French medical texts. The word's origin is uncertain but may derive from the French 'chrétien' ('Christian'), a common greeting in the French Alps – or perhaps a term used as a reminder of the basic humanity of the sufferers. Other possible etymologies:

  • 'creta', Latin for 'chalk', because of the sufferers' pale appearance;
  • 'cretira', a local word for 'creature'; or
  • 'cretine', a French word for soil deposited by flowing water, based on the assumption that poor soil caused the disease.

Around 1850, the French state identified around 20,000 of its citizens as 'cretins' and around 100,000 as sufferers from the goiter, in 24 of its around 90 departments – especially in its mountainous regions, in both the Alps and Pyrenees.

In the 19th century, so-called 'goiter belts' were identified in Europe and North America: regions where the most visible symptom of cretinism was relatively common – even if the severity of the illness was usually much less than in the worst-afflicted parts of the Alps.

Originally a neutral term, 'cretin' fell out of use as an official medical term (in both English and French) in the early 20th century due to pejoration, i.e. the downgrading of a word's meaning (3), and its use is now shunned.

Problems remain

Map showing the relationship between iodine deficiencies (grey) and goiter occurrence (shaded) in the United States.

Map showing the relationship between iodine deficiencies (grey) and goiter occurrence (shaded) in the United States. Date unknown - probably early 20th century.

Image: Armed Forces Institute of Pathology, public domain. Found here at JC Durbant.

With the growth of trade in the 19th century, the dependence on locally grown produce throughout Europe diminished, greatly reducing the occurrence of the disease. Around that time, Swiss doctors were the first to propose iodine deficiency as the genuine cause of cretinism. However, it took three generations for this theory to be proven – if action had been taken immediately, about 50,000 sufferers would have been saved the disorder's debilitating effects.

From 1922, Switzerland began to distribute iodised cooking salt, as well as iodised lozenges for children. Almost immediately, new cases of cretinism ceased to occur. At present, more than 120 countries have mandatory programs for adding iodine to food staples (typically salt, but also flour, rice or oil).

In developed countries, cretinism has almost completely been wiped out, thanks to standard screening for thyroid function on newborn babies. Iodine deficiency is still a sufficiently serious problem to remain the most common preventable cause of brain damage in new-borns and young children today. If the condition is found, its symptoms can be suppressed by lifelong administration of thyroxine.


Strange Maps #1009

Got a strange map? Let me know at strangemaps@gmail.com.

(1) Haddock later recycles the insult in other geographic contexts: "crétin de l'Himalaya" (Tintin in Tibet) and "crétin des Balkans" (The Calculus Affair).

(2) Derived via Provençal and French from the Latin gutturus, 'throat'.

(3) A similar process occurred with 'lunatic' and 'spastic', no longer neutral descriptors, now adjectives with a decidedly negative connotation.

Is masturbation the new cold and flu medicine?

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Columbia Pictures
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