Point-of-care additive manufacturing: state of the art and adoption in Spanish hospitals during pre to post COVID-19 era

Arnau Valls-Esteve; Rubén I García; Anna Bellmunt; Harkaitz Eguiraun; Ines Jauregui; Cristina Del Amo; Nuria Adell-Gomez; Lucas Krauel; Josep Munuera

doi:10.1186/s41205-024-00244-9

Point-of-care additive manufacturing: state of the art and adoption in Spanish hospitals during pre to post COVID-19 era

3D Print Med. 2024 Dec 27;10(1):43. doi: 10.1186/s41205-024-00244-9.

Authors

Arnau Valls-Esteve^{1

2

3}, Rubén I García^{4

5

6}, Anna Bellmunt⁷, Harkaitz Eguiraun^{5

8}, Ines Jauregui⁴, Cristina Del Amo⁴, Nuria Adell-Gomez^{9

10}, Lucas Krauel^{10

11

12}, Josep Munuera^{13

14}

Affiliations

¹ Innovation Department, Hospital Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain. [email protected].
² 3D Unit (3D4H), Hospital Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain. [email protected].
³ Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Carrer de Casanova, 143, 08036, Barcelona, Spain. [email protected].
⁴ 3D Printing and Bioprinting Laboratory, Biobizkaia Health Research Institute, Plaza Crucess/N, 48903, Barakaldo, Spain.
⁵ Department of Graphic Design and Engineering Projects, Faculty of Engineering in Bilbao, University of the Basque Country UPV/EHU, Plaza Ingeniero Torres Quevedo 1, 48013, Bilbao, Spain.
⁶ Innovation and Quality Department, Cruces U. Hospital, Plaza Cruces S/N, 48903, Barakaldo, Spain.
⁷ Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Carrer Rosselló 149-153, 08036, Barcelona, Spain.
⁸ Research Centre for Experimental Marine Biology & Biotechnology, University of the Basque Country PiE-UPV/EHU, Areatza Pasealekua 47, 48620, Plentzia, Spain.
⁹ Innovation Department, Hospital Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.
¹⁰ 3D Unit (3D4H), Hospital Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.
¹¹ Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Carrer de Casanova, 143, 08036, Barcelona, Spain.
¹² Department of Pediatric Surgical Oncology, Pediatric Surgery Department, SJD Barcelona Children's Hospital, Universitat de Barcelona, Passeig Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Spain.
¹³ Diagnostic Imaging Department, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain.
¹⁴ Advanced Medical Imaging, Artificial Intelligence, and Imaging-Guided Therapy, Institut de Recerca Sant Pau (IR SANTPAU), Sant Quintí 77-79, 08041, Barcelona, Spain.

Abstract

Background: 3D technologies [Virtual and Augmented 3D planning, 3D printing (3DP), Additive Manufacturing (AM)] are rapidly being adopted in the healthcare sector, demonstrating their relevance in personalized medicine and the rapid development of medical devices. The study's purpose was to understand the state and evolution of 3DP/AM technologies at the Point-of-Care (PoC), its adoption, organization and process in Spanish hospitals and to understand and compare the evolution of the models, clinical applications, and challenges in utilizing the technology during the COVID-19 pandemic and beyond.

Methods: This was a questionnaire-based qualitative and longitudinal study. Data on 3DP and AM activities in Spain were collected from 73 hospitals/institutions falling under the ITEMAS (Platform for Innovation in Medical and Health Technologies) and the Plataforma ISCIII Biomodelos y Biobancos from January 2019 to May 2020 for the first study, and at the end of 2022 and 2023 for the second study.

Results: A total of 23 (31.5%) hospitals during the first study, while 30 (41.09%) during the second study reported having at least one 3DP/AM initiative. Post-covid, the majority of hospitals had onsite 3DP/AM services with a well-defined, structured, and centralized system. Traumatology and maxillofacial surgery services were found to be the most involved in 3DP projects for the production of custom-made surgical guides, prostheses and orthoses. Bioprinting initiatives were also noted to be expanding. Human resources, cost, and regulatory compliance were the key hurdles in introducing 3D/AM in hospitals.

Conclusions: In-house 3DP/AM units, with Mixed-Model is the most common model in Spain; The COVID-19 pandemic influenced the 3D planning activity and adoption. Further research and clinical trials, and improvements in resources, reimbursement and regulatory compliance are critical for the Point-of-care hospital growth of this breakthrough technology.

Keywords: 3D printing; Additive manufacturing; Anatomical models; Bioprinting; Point-of-Care manufacturing; Surgical education; Surgical planning.