Beth Ripley, MD, PhD, and a 3D kidney model. Fron Oct. 8, 2020, VAntage Point blog.
SEATTLE — The use of 3D printing has grown by leaps and bounds over the last few years, finding its way into schools, libraries and even private homes. Nowhere is use of the technology advancing more swiftly than at VA. Much of that growth is due to the efforts of Beth Ripley, MD, PhD, a VA radiologist and the creator of VHA’s 3D printing network, which links VA hospitals across the country and allows them to pool resources to find innovative solutions to pressing medical problems.
Ripley discovered 3D printing during medical school when the technology was in its relative infancy.
“It was very new at the time. It was kind of out there,” she said. “One of the biggest challenges with how to do 3D printing was if it was going to be recognized as reimbursable. Is CMS going to pay for it? It’s very frustrating to think about money when you’re thinking about how to care for patients.”
Luckily, like many medical students, Ripley did part of her training at the VA. In 2016, she was hired as a radiologist by the VA Puget Sound Health Care System.
“3D printing and VA were a perfect match from the beginning,” Ripley declared. “It was a place where I could go and work toward a new technology that could have an impact on the health of patients and not have to justify it in terms of reimbursement.”
Once at VA, Ripley joined the VHA Innovators Network. Her first project was to grow the concept of a 3D printing network. At the time, only two VA hospitals had 3D printers, but they had been using them since 2010, well before most hospitals had even considered the technology.
“Those two were already so far along and had some really great expertise,” Ripley explained. “The question became how do we tap into that and share that expertise and grow it.”
Thanks to a donation from a manufacturer, VA acquired five additional 3D printers, which the nascent 3D printing network distributed evenly across the country.
“What we wanted to do was focus our resources and work together across those hospitals so we could impact veterans there and at all the hospitals in between that didn’t have 3D printing,” Ripley said.
Today, over 40 hospitals in VA’s system have 3D printing technology, all of them working together through the network to drive innovation.
“We took all those hospitals and put them in contact with each other and said, ‘Let’s share ideas,’” Ripley explained. “We encourage people to talk early and often about what they’re doing, what problems they’re facing and what early wins they’ve had. If somebody needs a 3D printed object, we don’t quibble about it. We just make it.”
One of the most common uses of the technology is in the treatment of kidney tumors. If not enough kidney tissue is removed, surgeons run the risk of leaving some of the cancer behind. However, the loss of too much kidney function will lead to a patient requiring dialysis, which drastically impacts a veterans’ quality of life.
Today, VA routinely uses 3D printers to print out model kidneys complete with tumors for patients and their surgeons to examine prior to their surgery. That way they can determine whether they can save part of the kidney.
VA also has been able to use the technology to assist cardiovascular surgeons performing minimally invasive heart valve replacements. In the invasive version of the surgery, a patient’s chest is cracked open, and surgeons can get a clear view of where the new valve will go. In the minimally invasive version, a catheter is run through an artery and the valve removed without the surgeon ever laying eyes on the heart.
“We print the heart for the surgeon so they can cut it open beforehand,” Ripley said. “They can look and measure and determine the exact valve size.”
While most of Ripley’s tales about her adventures in 3D printing are success stories, some of her biggest “aha moments” have come from medical problems that 3D printing helped prove were surgically untreatable.
During her fellowship year at the University of Washington, she and her colleagues were contacted through NIH by a Canadian family whose 1½-year-old daughter had a tumor on her spine. It was benign, but it was growing and impacting the child’s motor function.
“I figured, if I could make this model and help the surgeon see where the tumor is, they might be convinced to operate,” Ripley said.
But the more and more time Ripley spent on the case, the more she realized there would be no way to safely remove the tumor, which included a lot of nerve involvement around the spinal cord.
“It would be a disaster,” she declared. “It would be like trying to unravel a huge ball of yarn.”
With Ripley’s model in hand, the parents were able to better come to terms with why surgeons were unable to operate. In the end, the child grew, but the tumor remained the same size. Today the girl is 7 years old.
Ripley came across a similar case at VA. A veteran in Alaska had a complicated hip injury case. He’d already had a hip replacement, but, because he also had a prosthetic and so favored the other side, he was wearing his hip replacement out. He wanted it replaced.
“Normally he’d have to fly to central Alaska then on down to Seattle, consult with a surgeon, fly back, etcetera,” Ripley explained. To save the veteran the trip, VA printed two hips—one to examine in Seattle and one to send to the patient.
“The surgeon looked and said this could have a very poor outcome, and it’s unlikely to improve your symptoms,” Ripley said. “Once again, they were able to explain this to the patient, show them the model, save him the surgery. More importantly, he felt like he could really understand why the surgery didn’t make sense.”
When the pandemic hit and VA hospitals found themselves short of supplies nationwide, the 3D printing network was able to quickly step up.
“We had 60 different people collaborating on making the first 3D-printed face mask, and we did it in just 10 days,” Ripley said. “We came up with a functional prototype, and then we were able to ramp that up across the network.”
Currently the network is working on other small-scale items made scarce by the pandemic, such as nasal swabs.
Even in the midst of the pandemic, Ripley is looking toward the future and how VA can push the envelope with 3D printing technology.
“We need to understand how to make custom implants that go beyond surgical planning. Designing bespoke implants,” she said. “There’s also bioprinting—the printing of living tissue, which can be anything from bone to skin to someday in the future solid organs. Something like that is definitely on our road map. I’d like to see it come out of VA first.”