3D is defined by Google as “a process for making a physical object from a three-dimensional digital model, typically by laying down many successive thin layers of a material.”[1] The three-dimensional digital model is usually created using a design software such as CAD (Computer aided design). To print an object the design as well as the material are sent to the printer. Then the printer builds up the material in thin layers, creating the desired object, this is why 3D printing is known as a ‘successive layer’ process.

What is 3D printing? How does it work? What is it currently being used for? FutureProblems

At the moment 3D printing is still a relatively new concept especially in the medical world, however the industry is growing rapidly and by 2020 is expected to be a 5.2 billion dollar industry, this is a 300% growth in just 8 years. Right now the use of 3D printing in medicine only accounts for 8.8% of all of the uses of the applications of 3D printing.[3]

The printer that is used is normally either a modified ink jet printer or Organovo's NovoGen MMX. The NovoGen MMX, which is the world first commercial bioprinter. To create the tissue the printer layers cells between the water-based hydrogel. In December 2010 the NovoGen MMX was used by Organovo to produce the worlds first bioprinted blood vessels.

In medicine, 3D printing works in a slightly different way to normal 3D printing of an object. It is the same process whereby you make an object from a digital model, by printing in layers, but for tissues you have to use living cells. Instead of using a computer design software, MRI and CT scans are used to create an accurate 3D computer model that is specific to the individual. In order to print a part of the human body that contains living cells you need 3 main components; cells, hydrogel and a printer. [4]

The ‘bio-ink’ that is used contains the cells that are needed to create tissues. These cells are sourced in several different ways, including stem cells. Then these cells are cultured and allowed to multiply and grow, when a large enough amount of cells have been produced they are loaded into a cartridge to create the Bio-ink.

The Hydrogel is a water-based synthetic matrix that possesses a large amount of water, and it is used as a scaffold for building layers of cells and does not actually play any part in the final product.

One of the problems is that we currently do not understand the function of organ tissues enough, meaning that we cannot print them so that they function in the right way or at all. Cornell Engineer Hod Lipson said, “You can put cells of a Heart tissue in the right place together, but where’s the start button? The magic happens after the printing has taken place”. This of course is a problem that needs to be investigated in more detail before we have the ability to recreate an organ. [10]

Secondly a further issue to be overcome is the fact that after the organ had been manufactured, medical researches do not know how to keep the tissue alive and functioning.

Also there are some ethical issues such as the fact that even to even consider the idea of simply pressing a button and printing an organ is, to many people, utterly absurd. Some people believe that there may be the issue of in a sense trying to ‘play God’. I collected the opinions of people on the ethical issues by conducting a survey. However 13.04% of people said yes to ‘Do you think that there is an ethical problem with 'printing' organs and simply 'putting' them in anybody?’, their reasoning being that it is ‘unnatural’ and ‘how do you decide who gets the organ?’.

The main goal for the use of 3D printing in medicine is to be able to use printed tissue to make organs, which can be used in transplantation. Other future applications include the use in drug development.

Other possibilities include the use of the technology in cosmetic surgery. Christopher Barnett suggested in his book ’25 Things You Need to Know About the Future’, that 3D printing could be the new form of cosmetic surgery he writes about several possibilities and then goes on to say that he expects it “to be on the cards… by 2040 or 2050”.

Tracy Criswell, Assistant Professor at the Wake Forest Institute for Regenerative Medicine stated that “Since a good proportion of this research is being funded by the Department of Defense (US), it will probably be available to our wounded warriors before it come to the civilian population”, her statement also suggests that it is in fact the soldiers who will benefit from this cutting-edge technology before the rest of society. Such a technology being used could help speed up and guarantee the full recovery of soldiers.

3D printing is also being used to create prosthetic limbs. One of the most notable examples is the prosthetic hand that was made for a young girl called Hayley Fraser. Hayley was born without fully formed fingers on her left hand. However the advances in 3D printing have meant that she now has a 3D printed left hand. [8]

Currently 3D printing in medicine is used in many different ways including the creation of a small Kidney that functioned for 4 months, blood vessels, bladders, a tythoid gland and even a windpipe.

Conclusions

Currently 3D printing is being used to create models to train medical students. In 2014, an article was released on the BBC news website, the article explained that a man called Richard Arm created a model of a heart made of silicone at Nottingham Trent University. The model replicates the texture and internal workings of a real heart.[6]

3D printed models have been used to make detailed models to help surgeons plan complex surgeries. At a Hospital in New York , 3D printing was used to save the life of a two-week-old baby who required heart surgery as the heart “had holes” as well as “heart chambers in an unusual formation” according to Dr Bacha who performed the surgery. By using an MRI scan and 3D printing , they created a 3D copy of the babies heart, giving the surgeons chance to properly study the heart and develop a strategy for the surgery and save the babies life.[9]

The use of 3D printing in medicine offers a great solution to an ever-growing problem that the number of donors has decreased worldwide whilst the number of people needing a transplant has doubled. At this very moment in the UK around 10,000 people are waiting for an organ transplant, and of these people 3 a day will die waiting. This technology could help save the lives of people who die waiting for an organ and Dr. John Geibel, who is the Vice Chair and Director of Surgical Research at the Yale School of Medicine, shares this opinion he said ‘This field may provide a unique and new opportunity where we can print 3D organs that can supplement or replace the shortage of organs out there worldwide’.

Finally, I feel that if it is possible to 3D print a complex organ such as the heart the world we live in today will be absolutely revolutionised, and it would be the most radical and revolutionary medical discovery since Alexander Flemings Discover of Penicillin in 1928 and the Germ theory of disease in 1854.

Charlotte A

Graph to show predicted industry growth [3]

Pie chart to show the percentage applications of 3D printing [2]

Picture of the NovoGen MMX printer [5]

Sources:[1] https://www.google.co.uk/webhp?hl=en#safe=strict&hl=en-GB&q=3d+printing+definition [2] https://natgeoeducationblog.files.wordpress.com [3] http://www.3ders.org/images/3D_Printing-infographic-03.jpg [4] http://www.3ders.org/images/bioprinting-the-human-body-infographic.jpg [5] http://www.deskeng.com [6] http://www.bbc.co.uk/news/uk-england-nottinghamshire-29047165 [7] http://i.dailymail.co.uk [8] http://www.bbc.co.uk/news/uk-scotland-highlands-islands-29441115 [9] http://www.g2hr.com/3d-printed-heart-saves-babys-life-as-medical-technology-leaps-ahead/ [10] http://www.engadget.com/2014/06/20/3d-printed-organ-explainer/ [11] http://i.dailymail.co.uk/i/pix/2013/02/05/article-2273786-175C6E10000005DC-696_634x488.jpg [12] http://www.didayin.com [13] http://www.explainingthefuture.com/visions/bioprinter_800x600.jpg [14] http://www.texilaconnect.comOther Sources:• Christopher Barnett, 4th May 2013, 3D Printing: The Next Industrial Revolution, ExplainingTheFuture.com ®• Hod Lipson and Melba Kurman, 8th February 2013, Fabricated: The New World of 3D Printing, John Wiley and Sons, Inc.http://www.webmd.com/news/breaking-news/20140723/3d-printing ; http://www.cnbc.com/id/49348354 ; http://www.electromaterials.edu.au/news/can-you-3d-print-organs/ ; http://www.popsci.com/science/article/2013-07/how-3-d-printing-body-parts-will-revolutionize-medicine; http://www.nature.com/news/2008/080320/full/news.2008.675.html ; http://www.electromaterials.edu.au/news/can-you-3d-print-organs/ ; http://edition.cnn.com/2014/04/03/tech/innovation/3-d-printing-human-organs/ ; http://www.sciencemuseum.org.uk/~/media/Documents/downloads/antenna/3D%20Printing%20the%20Future%20of%20Medicine.pdf

Hayley Fraser with her 3D printed prosthetic arm [7]

3D-printed lifelike heart model from Nottingham Trent University [6]

3D-printed heart model used to save a two-week-old baby [14]

Futuristic illustration of a 3D skin printer by Christopher Barnett [12]

Futuristic illustration of a bioprinter by Christopher Barnett [13]

Futuristic illustration of how the ability to 3D print organs will be purchased [11]

3D printing being used in the medicinal arena was first truly established by Thomas Boland in 2003, when he and his team managed to reconfigure a normal printer to print with E.Coli bacteria, thus introducing ‘bio printing’ which is what the use of 3D printing in medicine has become known as. However at this time Boland was not using three-dimensional tissues, in order to print in three dimensions the printers had to be modified.

This research was undertaken as part of a

Higher Project Qualification.

In 2011 Dr Anthony Atala, the director of the wake forest institute for regenerative medicine, did a TED talk about the work he and his team were doing. At the time it was described as the ‘most radical application of 3D printing so far conceived’ because Dr Atala brought out a kidney that he had ‘printed earlier’. However the kidney was not fully functional.

When considering complex organs researchers face a major challenge, which is to provide the structure with a big enough amount of oxygen so it can survive until it is integrated into the body. Dr. Ibrahim Ozbolat, hopes to overcome the issue by bioprinting ‘microfluidic channels’ which will have the ability to function in a way similar to a normal vascular network.

In addition, we also need to consider the possibility of ‘knock off organs’ that will not function correctly and could potentially harm people and how the creators of such a technology would plan to protect people from this terrible possibility.

Similarly we could also gain the ability to help find cures to incurable diseases because for example we could use the bioprinters to print off organs that have tumors in them so surgeons could practice the operation that is needed to remove them. Also medical researchers could try and find ways to help cure people, by practicing on bioprinted organs or tissues.