Episode #78 | Bones, Paws, and Pixels: The 3D Revolution in Vet Medicine (Virtual Event Recording) - The Lattice (Official 3DHEALS Podcast)

Episode Transcript
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Speaker 1 (00:03):
Fantastic.
Good morning.
Rise and shine everybody.
Okay, we have some audienceslowly trickling in now.
Okay, my name is Jenny Chen.
I'm just going to use the firstcouple of minutes, when people
are slowly getting into thewebinar, to introduce myself and
3D Heels.
My name is Jenny Chen.

(00:23):
I started 3D Heels aboutactually apparently 10 years ago
.
I can't believe it.
I'm a steel practicingradiologist and I got into 3D
printing because you knowanatomical mottos to get started
with and actually the firstsoftware I encountered probably
is Materialize.

(00:44):
Who's also the sponsor for thisevent today?
And our goal we have three.
One is to educate everyoneabout 3D printing.
I think it's extremelyimportant because people, if you
meet anybody in the street andask them what do you think 3D
printing can do for healthcare,I bet what they think is enable
3D hand and that's all they canthink about, even though the

(01:07):
applications are so wide anddeeply penetrating in all
verticals in healthcare.
So I think it's important forus to educate everyone about the
potential and existing practiceusing 3D printing in healthcare
.
Now, and number two isnetworking.
So, even though everyone on thewebinar today is from all over
the world and typically we have30, 40 countries, in terms of

(01:29):
audience mix.
The majority is from NorthAmerica, a lot from Canada and
India, so it's a veryinternational crowd.
So we're hoping people can meetone another and maybe start
interesting conversations andeven companies.
And number three is we have aprogram called Pitch3D where we

(01:50):
discover early stage, from seedto series, a early stage startup
in the space of 3D technologies.
So it's not just 3D printingbut any related technologies
like AR, vr, which I'm prettysure a lot of people here also
use on occasions.
So those are the threefunctionalities 3D Heels perform

(02:11):
at the moment, and this topicis super interesting to both me
personally, because I actuallyown a dog the dog behind me is
not my real dog but very similarto my dog and I become a pet
owner three years ago andlearned so much about

(02:32):
veterinarian medicine than Iever, and I realized that
veterinarian medicine is notjust human medicine transforming
to animals.
It's a completely different,really different species, and so
this topic is very interestingto me personally.
But I also realize the vastpotential that 3D printing can

(02:53):
play in this space and I'm sureour amazing panel today will
share with us where things areand how it can transform the
industry.
So, without further ado, I'dlike to introduce our first

(03:13):
speaker, bradley Thomas, who isbasically leading the effort of
animal care in Materialize.
Materialize is also our sponsor, so I really appreciate the
support.
Brad, why don't you take over?

Speaker 2 (03:23):
Thank you, Jenny.

Speaker 3 (03:28):
All righty.

Speaker 2 (03:39):
All righty.
So, first off, I'm Brad Tumasaccount manager of academics.
I also get the pleasure ofworking with vet hospitals at
university as well as privateinstitutions.
So this is Mimics Impact inVeterinary Medicine.
So first off, I wanted to startoff by just info sharing.

(04:01):
So we attended VOS this lastmonth in Colorado and here are
some key learnings.
So many surgeons are interestedin virtual surgical planning and
3D printing, if they're notalready doing it.
Many residents are actuallyconducting research around
patient specific virtualsurgical planning and 3D
printing.
Orthopedic surgical guides arethe primary clinical use case

(04:24):
for surgeons.
Guide, our guide design tool,updates and mimics uh latest
release, have greatly reducedcreation time.
Uh, the orthopedic community isis awesome.
They're very collaborative.
I always enjoy going to the, tothe shows, to the acvs, vos,
all these different things, andjust seeing the dynamics of
everyone working together andknowing each other and really

(04:44):
working really well together.
There's no um, there's no, youknow, high competitiveness.
It's.
It's really just reallycollaborative.
There is a high demand umcurrently for surgeons, whether
it be in mobile surgery or innew institutional locations, and
I had never even heard ofmobile surgery.
I thought that was veryinteresting, just uh interesting
, just going from practice topractice.

(05:08):
So what are the use cases of 3Dvisualization?
A lot of times, education andtraining, surgical rehearsal,
surgical planning, 3d printedimplants and parts, plate
pre-contouring, 3d printedrecovery sleeves, and then
external prosthetics andorthotics are another use case.
So where do we fit in?

(05:28):
What is Mimix?
So Mimix is image processingand anatomical design software.
So what we do is we are able totake the DICOM imaging, ct, mri
, ultrasound and bring it toyour PC and create a 3D model.
Rendering from that so mixedplatform is something that we

(05:50):
want to see.
An end-to-end use case whereyou're going from end-to-end.
You have everything almostcovered within our software.
We have affordable packagesolutions for every size
institution.
We're looking to give you areturn on your investment for a
seamless end-to-end solution,starting from image acquisition.

(06:11):
That's starting off with yoursegmentation, what I showed in
the previous slide, creatingyour initial mask and making a
model, and then there's allsorts of outputs, whether that's
just being 3D model, measuring,planning, designing, and if
your end goal is to 3D print andfinally get personalized
treatment.
That's typically the end goalwe see in hospital as well as in

(06:35):
veterinary medicine.
So what are some of ourapplications?
Orthopedic surgery, as Imentioned mentioned, there's um,
as listed here, severaldifferent um surgeries that are
orthopedic, uh type surgeriesthat are used uh within mimics,
uh or use mimics is used to toplan these surgeries, uh, these

(06:58):
models.
Here are some reduction guidesand um placement guides for uh
ingo the deformity.
This is a case that we workedon several years ago for another
conference with Dr JasonBleedhorn and Dr Carlin, and
then this is just a quickrendering of the STLs just to
show you in 3D, and so these arepatient-specific guides based

(07:25):
on the anatomy.
And, moving to this, this isjust a quick video.
So what we're doing here isthis angular limb deformity,
initial segmentation, creating amask and cropping and splitting
the anatomy interest from thesurrounding that we're not so

(07:47):
interested in, and so this isjust simple cleanup for some of
those hounsfield units that areare kind of overlapping, and
just cleaning up the model tomake sure it's a nice smooth
model.
So here we're going ahead andwe're wrapping the model and

(08:12):
making it a nice smooth model,while still keeping the
anatomical accuracy, and thenmarking the model in order to
then create sorry, then create acylinder down the center of the
shaft, of the femoral shaft,and then creating another
anatomical landmark with thehead and using our design tools

(08:38):
here to do so.
And so this is creating anotherplane based on the anatomy in

(09:00):
order to create the cut rightangle of the reduction guide, to
create the correct cuttingservice, in order to create the
right angle of the reductionguide, to create the correct
cutting service, in order toproperly make the cutting guide
and have those planes in thecorrect anatomical area in order
to make the correction.
And so here now we have the cutfemur and we're now placing it

(09:35):
into position to then create thereposition guide for after the
osteotomy is done.
And so here again you'll see uscreate the area where we want

(10:20):
the guide base to be created,and then we're going to use some
of our quick design tools, socreating a guide base to be
created.
And then we're gonna use someof our quick design tools so
creating a guide base.
I know it's sped up, but it canvery quickly be done.
We have a guiding tube, a cutslot, a flange and a guide
bridge that can just quickly beadded.
And then that was just a quickcheck to make sure that the 3D

(10:43):
model was good for 3D printing.
And so, based on on thoseangles that we created, uh, with

(11:10):
the um, based on those angleswe created.
We now create a flange to lineup with those that angle and now
creating the the cylinders forthe guide tubes and for pin
placement.
So here now we have our guidetubes and we've took out the

(11:34):
inner cylinder and we now haveour guide tube created.
This is a simple cleanup of thetriangles just to make sure
that it's okay for 3D printing,and now cleaning up the guide

(11:56):
base in order to have it fitsnugly on the femur in surgery.
And this is another one ofthose quick tools that I
mentioned, the guide base tool,where we're quickly creating
those connections.
And so that's our final outcome.

(12:17):
And okay, just give me onesecond.
There we go.
So, moving on, another examplecase in ortho.
So this is pre-operativeplanning for hip acetabular cup
placement.
There's 3D measurements takenof the ALO version and angle of

(12:38):
inclination to lead to bettercup orientation.
There are four differentpatients with different types of
variations.
So there's luxoid acetabulum,chronic dysplasia, trauma,
acetabular deformation.
Patient-specific guides werecreated to have pin placement
secured to the ileal body.
This prevented post-op luxationjust by getting the correct cup

(13:03):
placement.
So here is the final model.
So this is a very complex modeland a very interesting use case
, but I wanted to share adifferent.
So other applications includedental and CMF surgeries,
oncology and tumor resection.
This is a model from MichiganState.
A 16-year-old female spayeddomestic short hair cat.

(13:23):
Michigan State.
A 16-year-old female spayeddomestic short hair cat.
10-month history of behaviorchanges led to a visit to the
hospital and MRI.
Surgical trainees utilized themodel to plan the surgical
approach.
The craniotomy sterilized andbrought into surgery to help
visualize interop and post-opimaging.
Confirmed complete excision ofthe tumor.

(13:45):
And another simple case here isthe canine root surface area.
This can be used either fordiagnosis or for just verifying
canine phenotype.
This was done by Dr AshleyCapon-Kerns at Animal Dental
Center.
Moving on to more of a complexcase, this was Dr Jason Suka, dr

(14:11):
Elias Wolfs and Dr Thatcher atUniversity of Wisconsin-Madison.
So this is a orbitalreconstruction and a titanium
mesh implant excision of theorbitozyygomatic maxillary tumor
.
There were three differentpatients.
We're looking here at theMaltese patient.
So what was first done was a CTscan of the patient, mirroring

(14:33):
of the healthy orbit to theaffected site, 3d printing of
the skull with the mirrored OZMCseed, adaption of customized
titanium mesh, surgical excisionof the lesion and direct or
staged insert insertion of theimplant.
So figure A is your post cystremoval and tooth removal.

(14:56):
Figure B is the progression ofthe lesion after.
Figure C is post op titaniummesh implanted and lesion
extracted.
And then figure d is eightmonths post-op with no, no sign
of that lesion, uh reoccurrence.
So one quote I have from thisgroup these techniques provide

(15:18):
the surgeon with improvedvisualization and thus better
understanding of the 3d printinganatomy.
Its virtual surgical planningis feasible in a clinical
setting and may decreasesurgical time and increase
surgical accuracy.
This allows improved fidelityof the surgically repaired side
and although it might have tookan hour or two to plan this, it

(15:41):
saved time intraoperatively andincreased the anatomic fidelity.
One more application here.
So neurology and spinal surgery.
You know vertebral pediclescrews, spinal fractures,
prosthetics and limbreconstruction.
Then congenital heart defect isone that we've seen.

(16:02):
That's new and we're excitedthat we were able to use it
within MIMICS.
So this case here is a dog waspresented with obstructive shock
, high heart rate, weak femoralarterial pulses.
It had an atrial septal defectand typically this isn't
diagnosed until about two yearsinto adulthood, and this is

(16:24):
about two years into the, theinto adulthood, and this is
about two years into a dog andactually in the human side it's
about 20 to four years old.
Until you see this defect, ctimaging and three modeling was
used to decide the appropriatetreatment of the dog in this
case, and no procedure was donein this dog, but the congenital
heart disease was managed formore than two years without

(16:44):
reoccurrence of heart failure.
So they were able to assess andfigure out if there was it was
worth it to do this surgery.
Any questions?
And here's all my contactinformation and also a QR code
for my LinkedIn If you want toconnect and be happy to talk to
y'all.

Speaker 1 (17:04):
Thank you, brad, for a very comprehensive
presentation.
Looks like you're going intoevery single medical field, you
know.
My question as a practitioneris you know, even though you
said that making these designsare fairly straightforward to a
person who's outside ofengineering, who have limited
skills, I wonder if you have anyways to automate this process

(17:28):
or script or something that makeit easier for people like me?

Speaker 2 (17:33):
Yeah, so we do have comprehensive trainings as well.
We have a full support team toassist with any developments and
workflows.
But we also have scriptingwithin our software and we're
currently working on a scriptfor the angular limb design
design workflow, because that'sa very common one, we see, and
we had many requests at VOS likehey, if you guys made a script
of that, it'd be something we'dbe interested.

(17:54):
So we're we're looking todevelop more scripts.
We do have a, a scriptingpackage that has some additional
scripts that can be used for,you know, different various
anatomical sites, but right nowthere's nothing for VET.
But we're actually developingit right now.

Speaker 1 (18:11):
Okay, and also I remember last year I think I
forgot the name of the presenterbut also from Materialize,
talking about they usepopulation data to generate AI,
ML algorithms to make the designprocess even easier.
I don't know if that's evenpossible for veterinarian
practices.
I mean, do you guys have anykind of AI or ML kind of

(18:35):
functionality?

Speaker 2 (18:36):
Yeah, so we have AI segmentation and actually we're
testing and it seems to beworking with a lot of the
veterinary bones is we have AIsegmentation that's built into
our software and you candirectly request it and it goes
into the cloud and it's donetypically less than 15 minutes

(18:56):
and it works with animal anatomyas well.
So the human anatomy AIsegmentations are actually
working for animal anatomy aswell.

Speaker 1 (19:05):
Human anatomy.
Ai segmentations are actuallyworking for animal anatomy as
well.
And what's?

Speaker 2 (19:17):
the typical learning curve, time-wise, for a
veterinarian doctor to learn andreally pick up and incorporate
into their practices?
Yeah, that's a good question.
So it depends on really themotivation of said surgeon and
the time they have.
I have a couple of cases wherepeople have picked it up in late
November and in a month theywere creating their own guides.
Yes, it might have taken alittle bit of time because they
haven't completely figured outtheir workflow, but I just

(19:40):
touched base with him before VOSand he's like I brought my
workflow down to less than anhour.
So from you know, initiallyfour hours trying to figure out
his workflow to now less than anhour, and we can even work with
him to improve that, I think.
I think there's definitely a.
I would say our software isuser friendly but there's also a
slight learning curve.

(20:00):
I would say our software isuser friendly but there's also a
slight learning curve.
And I'll say for that angularlimb deformity case that I
showed that was our applicationengineer's first time going
through the workflow and I gavehim instructions on how to do it
.
It was his first time doing itand he did that whole workflow

(20:20):
in 30 minutes.
Obviously it was sped up to fitthis form, fit this, uh, this
forum.
But, um, it took them maybefour to six hours to really get
a good feel and really get get aunderstanding of that workflow,
great.

Speaker 1 (20:33):
Well, thank you very much for the presentation.
Again, we'll come back for thepanelists discussion.
Um, I'm actually going to mixthings up a little bit, because
I just realized we have quite afew clinicians uh on on this
webinar and I want to kind oflike mix it up a little bit.
So I'm going to actually moveBill, dr Bill Oxley, up to the
next presenter.
I met Bill many years ago andhe is not only a practitioner

(20:58):
but also founded a couplecompanies, including one called
Vet3D, and so, bill, I'll letyou take over, including one
called VET3D.

Speaker 6 (21:07):
And so, bill, I'll let you take over, thank you.
Thank you, jenny, and thanks,brad, for that presentation.
Let me see if I can share myscreen here.

(21:56):
Are you guys seeing that?
Okay, yeah, perfect, fantastic,okay.
So, um, I guess, I guess it'sgood to follow on from that,
actually, because I guess I cangive the other view of this.
As an orthopod, as a clinician,my take on how we use the whole
technology that Brad hasdescribed is, I guess, coming at
it from the, the otherperspective, I suppose.
So, of a briefly um, todescribe who I am um, I'm a vet,

(22:16):
obviously.
Um, I graduated in 1997 and Iworked in general practice for
some years before taking a sortof specialist route really very
much focused on orthopaedics,and this was something that I
guess I'd always been passionateabout.
But, following on from doing aresidency at Willows, I then

(22:39):
became an RCVS specialist andbasically did full-time referral
orthopedics for maybe 10 years,and during that time, I kind of
became aware of the potentialof 3D printing initially, and
then surgical guide systems, andthis was really the motivation
for me starting Vet3D in 2014,when I just started doing cases

(23:03):
for myself.
Maybe, maybe, I guess fiveyears later I was doing so many
cases that I didn't have time todo both.
So since then, I've beenrunning VET3D full time and I
guess I'm going to take you on avery quick journey.
This was, I suppose, where Ivery first started back in 2014.

(23:26):
This was the first case I everused 3D printing, for this was a
little pug called Pixie who hada pretty nasty fracture of her
humerus, and I just got my firstFDM printer, which produced
beautiful green bones, as youcan see, and I thought it would
be kind of neat to print theopposite humus, to draw on the

(23:48):
the fracture lines and then topre-contour the plates.
So, um, I was able to use themodel to pre-contour the plates
that I thought I might want touse to fix the surgery, to fix
the fracture, and this was apixie the next day.
It was pretty cool and I guessthat was the very first time I
ever used 3D printing.
Obviously, as Brad showed, Imean on a very, very simplistic

(24:15):
level, in order to take your 3Dmodels from your CT to the
printer, you have to take thempretty much through some kind of
CAD, uh software, and when Iwas doing this, I realized the
potential for creating guides,and this was the very first uh
system that we ever made.
I mean, the, the thing that'slabeled C, that is actually a

(24:37):
surgical guide.
I mean, you wouldn't believehow things have changed since
then, but that was the firstclinical guide that we ever used
, and I'm pretty sure that wasthe first time that clinical
guides had ever been used inveterinary medicine or
neurosurgery, and this was thepaper that we published with my
colleague, seb Bayer, who stillworks with me at Vet3D, and this

(24:57):
was certainly the firstveterinary publication of a
clinically used 3d printed guide, and we use this for, obviously
, a pedicle screw placement in aneurosurgical setting.
Um, and this was the nextevolution um, this was an
arthrodesis guide.
That um I basically createdmyself back in 2017, and this

(25:21):
was again the first descriptionof a, an osteotomy and reduction
guide system, and this stillforms the basis of what we do
now, although things haveobviously moved on a long way.
Um, over time, we were able topublish more and more, and we've
published a lot of papers nowdescribing all sorts of facets
of surgical guide creation,deformity assessment, surgical

(25:48):
planning guide, design guide,application guide, accuracy and
this was the first paper wepublished that really showed
pretty good accuracy.
These are reasonably primitiveguides.
I mean.
You can see in the image, theseare guides that I designed,
really nothing like what my CADengineers design these days.
These were very, very primitive.
But even with these reallypretty, pretty primitive guides,

(26:10):
this is what six, six years agonow, seven years ago, we were
able to demonstrate accuracy ofcorrections within two degrees
in multiple planes, which ispretty pretty good really, and I
think I think, as techniqueshave just moved on
stratospherically since then, Ithink there's no question the

(26:30):
literature demonstrates that wecan correct deformities, we can
plan pedicle screws withdramatic accuracy these days and
, as I say, really, theosteostomy reduction guide
system, the basic system, haspretty much stayed the same from
those really very early days.
Um, what's changed, I suppose,is how we apply it, and brad

(26:53):
demonstrated talk very nicelyabout how you know the, the
processes of what is involved,but I think the, the thing that
is really different with how weapproach cases now is it's not
so much designing the guides,building the guides you know
these things are evolving soquickly it's really how we
assess the case.
How do we decide where to cut,how do we decide what to cut,

(27:17):
what is the, the process ofactually utilizing the, the raw
ct data, to do 3d deformityassessments, so we know how to
get the best outcomes from ourpatients.
And in many ways, that's thehard part.
I mean, that's the nextfrontier and creating the guys
themselves.
I wouldn't say it's the easypart, but it's uh, the, the, the

(27:38):
, the initial planning, that is,we're just discovering,
frontier after frontier, abouthow we actually should be
assessing these deformities andplanning these surgeries in 3D.
Um, oh, I'm just going to showyou that video there.
Um, so this is, um, effectivelythe way that the guide systems

(28:00):
have.
Um, I suppose I'd call this abasic guide system.
Now, this, this is a DFO system.
This is the one that Bradshowed you in 3MATIC, I think,
and this is effectively the samesystem.
This is how we do them thesedays.
These are the guides that weuse, and the osteotomy and
reduction principle is the basisfor, I think, all of the guide

(28:23):
systems that we do, really,although things get a lot more
complex than this.
But this video just gives youan illustration about how we can
utilise guides to create theplanned correction that we've
worked out beforehand.
And, of course, we've mentionedneurosurgical applications,
pedicle screw planning.

(28:44):
This is where we started thiswas our first ever system,
really but the ability to plansafe pedicle screw trajectories
in really small pedicles and wedo these down to French Bulldog
and Pug sizes, so these are 1.5mil screws and the ability to
safely plan these trajectoriesusing the ability to see

(29:06):
everything in cross-section, seeeverything in 3D, plan optimal
entry points, safe exit points,safe corridors, and then to
create guides that we can thenutilize to place those.
This has been the mainstay ofoh, probably I don't know if
we've done a thousand of these,but it must be something like
that.
We've done so many of thesecases.
Now we know these systems workextremely well, um, and the

(29:30):
neurosurgical stuff isfantastically exciting.
And these are these are screwsthat are unbelievably difficult
to place without the use ofguides, but also the CAD
planning.
I can't emphasize how importantthat is.
So, moving on to some maybe somemore complicated stuff because

(29:50):
I guess this is what kind offires people up this was a dog
called Rolo.
This is an example of a casewhere we were able to use CAD
planning and guides and a customimplant to do a combined
correction.
So not only had this poorlittle fella injured his carpus,
you can see he's kind of had aninjury and managed to disrupt

(30:13):
the small carpal bones in hispaw, but before that he's also
got quite a nasty limb deformityand he'd kind of been coping
okay with this limb deformity.
But the carpal injury requireda fusion of the joint, and
fusing a joint at the bottom ofa bendy leg is not so great for
the patient.
So we really needed to fix bothproblems at once and prior to

(30:36):
the the ability to apply thistechnology.
It would be immenselychallenging to correct, uh,
firstly to plan this, but thenthen to not only plan it get a
nice straight leg but then workout how we're going to cut the
bones, how we're going to do thefusion, how we're going to fix
all these three bits together atthe same time.
But using CAD planning we'reable to put all of those things

(30:58):
together in the plan.
We can create guides.
Sorry about the gory pictures.
I should have warned you, but Iguess you guys are expecting a
bit of surgery and this is ananimation of how we actually
utilize the guide system.
So the concept differs a littlebit from the DFO video I showed
you before.
When we're using custom platesthese days, because the plates

(31:20):
are 3D printed.
We're able to use the plate asa reduction guide.
So we don't have to use thosepins and the reduction guide
that you saw in the previousvideos.
We can actually use the plateto do that.
But that requires us to knowexactly where those screws are
going to go.
So the screw trajectories areCAD planned.
That integrates with the customplate that we design and so we

(31:45):
can plan the system around that.
So we know that if we pre-drillthe pilot holes for the screws,
we make the cuts in the rightplace.
We take those three segmentsthat we've created and we put
all of those back together inthe CAD to achieve the plan that
we were looking for.
We can make the whole processvery quick and very seamless for

(32:09):
the surgeon.
And you can see the images onthe left these are a colleague
of mine called Christoph Stork Idon't imagine he's watching,
but he's a great surgeon basedin the UK and this is how the
custom plate goes on.
And because we've alreadydrilled those holes, we know
exactly where those holes aregoing to be.
They're going to match up withthe plate that fits exactly onto

(32:32):
the bone, and it's a verystraightforward thing then for
the surgeon to apply the screws,the bone segments are pulled up
onto the plate and we achievethe pre-planned alignment that
we're looking for.
And this is Rolo afterwards.
You can see the pre-plannedalignment that we're looking for
.
Um, and this is rolloafterwards um, you can see the,
the post-optic radiographsreally beautifully aligned.
Uh, and he had a nice straightleg and there's a.

(32:53):
These heal really quickly andgetting these, these fusions, to
heal traditionally was verydifficult because they used to
have the joints bird, it wasvery difficult to get the bone
to heal.
But because we're using guidesand ostectomized arthrodesis
tends to heal extremely well, soit's a great application for
this surgery, for this technique.
Another case this is a greatdane, seven-year-old great dane

(33:18):
nasty bone tumor.
So this is a tumor calledosteosarcoma and these are are
really very aggressive.
These tumours, as you can seein the radiographs, they're very
destructive, they're verypainful and these dogs are
really quite sore and theseprogress quickly and if you
don't catch these, these limbswill fracture and that's an
extremely difficult situation tosort out.

(33:39):
So the way that we tend toaddress these these days again a
custom plate I mean these arenot the cases we do all the time
they're kind of cool, so hencewhy I'm presenting them here.
But this is the kind of customimplant that we can design, and
the principles of this implantare similar to the previous case
that I showed you.
We work out which bit of bonewe need to reset.

(34:02):
We design the plate using thesame principle.
We know where the screws aregoing to be, we know where the
plate's going to be, we knowwhat shape we want the leg to be
, we know which section of bonewe want to take out.
So we design the plateaccordingly and we use guides to
do the osteotomies and to drillthe pilot holes for the screws.

(34:22):
This is the plate.
My engineers are absolutelyamazing at creating these and
these are not easy to make ordesign.
So there's quite a lot thattechnical that goes into this,
which I'll briefly touch on atthe end.
But this is the implant that wedesigned for this case.
As you can see, there are lotsof screw holes.

(34:47):
These have to survive a longtime, and the video you'll see
in a minute shows why we put somany screws into these and the
cage in the middle is filledwith graft.
So that's the tumour, so a bitof a gory one, but you can see
how horrible these tumours are.
They're really, reallyaggressive and nasty.
The graft cage is filled withwith bone graft and that's then

(35:11):
implanted.
This is the post-op radiographsand this is the dog at 13 weeks
.
And this is probably one of myfavorite ever cases, one of my
favorite ever videos, becausethis kind of outcome is pretty
much unthinkable withtraditional limb spare
techniques and the beauty of thesystem that I've described to

(35:31):
you.
It's it's hard to see and wedon't really need to get into
this today, but there is boneingrowth.
So this, this implant is is isingrown um, and that will give
it the longevity it needs tokind of survive being in a very
boisterous great dame in thelong term.
But I'd mention that fat maxmaxillofacial um.
This is an example of a?

(35:52):
Uh, kerry terrier that had aunfortunate episode with another
dog in the park.
Uh, he basically had his um,his front of his nose grabbed by
a big dog, um, and you can seeit's kind of pretty much
disconnected here.
Um, this was a failed attemptto repair that.

(36:14):
So this poor dog not only hasan unstable front of his face,
front of his maxilla, but he'salso lost his soft palate and
you can see well, the mouse iskind of pointing there.
There's a huge hole in the boneof his maxilla.
But he's also lost his softpalate and you can see where the
mouse is kind of pointing there.
There's a huge hole in the thebone of his soft palate, so his
mouth is communicating with hisnose.
So it's a pretty desperatesituation for this dog and

(36:34):
traditionally again, this wouldbe a phenomenally difficult
scenario to sort out.
Um, so this is materializedsoftware, but you recognize it,
and what we're doing here isusing the software to plan safe
trajectories for screws so againmissing those teeth providing

(36:55):
appropriate anchor points for acustom implant that we can
utilize to firstly close the bigdefect in the hard palate, but
also, at the same time, wecreated a further implant to
stabilize the original failedstabilization on the top of the

(37:16):
maxilla.
So these are the implants thatwe designed.
Again, getting appropriatefixation points in a in a place
like this is is a very difficultsorry, excuse me, it's a very
difficult thing to do.
So.
Uh, a nice plan and very niceimplants and this was the.

(37:37):
This has only just been done soI can't show you any follow-up,
but these are literally just.
I think it was done last week.
Jenny mentioned, asked me pre-op, if we pre presentation, if we
do anything with AR and we douse sorry, we do use augmented

(37:59):
reality to a limited extent.
This isn't something that isroutine by any means, but I'll
show you one example of a casewhere we did use that.
This was a little dog withbilateral antebrachial
deformities.
As you can see, one side isworse than the other.
It's quite a cute little fella.

(38:20):
On one side we were able toplan a correction with a single
level, a single level osteotomy.
On the other side, he needed adouble level osteotomy.
And again, this is, I guess, thenext, the previous dimension to
everything that brad showed inthe, in the, in the materialized
package.
It's, it's great to be able todo your segment, a segmentation

(38:42):
to, to design your guides, tomake your own guides, but the
difficulty it's not so much that, it's the planning.
I mean, how do you know how to,how to plan that in 3d, how to
assess that deformity in 3d,where to make the osteotomies?
And this is the bit that thisis.
What I do full time now is isbasically plan these corrections
and uh, it, it, it's, it'sdifficult and it's um, it's a

(39:07):
complex thing and, uh, somethingthat contributes enormously to
the outcome in these cases.
So, when we use the ar, we uhpartner with a company called
amadisk in the uk.
These, these are this wasdeveloped this technology by a
human surgeon called Ad Ghanda.
He's a phenomenal surgeon superguy and he helps us create the

(39:33):
integration between our 3Dmodeling and the AR systems that
you need to actually translatethese techniques into surgery.
So, again, the first step is tocreate an animation very much
like what I showed you for theprevious cases, but what Amadisc
will then do is take that intothe AR software and systems.

(39:57):
They use a HoloLens and I'llshow you how it looks for the
surgeon.
Effectively, you can see sothere's a kind of a console and
what the surgeon here is doing.
They can use their handgestures to move between stages
of the surgery.
They can see instructions forthose stages listed and also the

(40:26):
animation, the 3d animation, uhkind of projected, so that they
can see what they kind of needto do next.
So, um, that was a it's brief,but you get the get the picture
and I think, for for the moreroutine things that we do,
arguably not essential, but formore, uh, complex applications
like the double levelcorrections, the custom plate
stuff, some of the neurosurgicalapplications.
This is a wonderful tool and Ithink it will become a lot more

(40:50):
uh, a lot more popular and a lotmore used.
And that's woody's outcome.
He did really well.
So just in summary, um, I thinkthe few key things I'd like to
say we've come such a long wayand basically from sort of FDM
printing in my back room tomaking these amazing custom

(41:11):
implants in not really very longat all, and it's super exciting
where we're going to go withthis.
As Brad said, there's been ahuge uptake um in clinical
application and I think that'sonly going to continue.
We've supplied over 3 000clinical guide systems now and
we're doing huge numbers um bothof just the more basic guide

(41:33):
systems but the more advancedcustom implant systems, that
that I've showed you, and thesego everywhere, um, now they go
all over the world and for usit's always been critical to to
combine this with clinicalresearch and we've we've
published a lot of informationon this that I think those two
things have to go hand in hand.

(41:54):
But these things come theydon't come easy and as we do
more complex things the amountof planning, 3d deformity
assessment, the clinicalintegration of the planning and
the assessment and the guidesystems and what we can do and
the implants becomes harder andharder and harder.
And I'm incredibly lucky tohave there are five of us now

(42:18):
boarded specialists working andwe mostly do consultancy.
We don't five of us now boardof specialists working and we
mostly do consultancy.
We don't the.
The guide systems are designed,uh and made by my team of cat
engineers and techs and it's the.
The bit that surgeons do is thebit before, it's the surgical
planning, it's the assessment,the integration with what the
surgeon wants for the case andwhat, what seems to be most
appropriate, and that's the bitthat's really hard, um, but yeah

(42:43):
, it's unbelievably rewarding,but it's also really quite a
challenging environment to workin and we rely, we use
Materialise, we use Formlabs, werely on a lot of engineering,
software and expert support tobe able to produce these systems
and, as I guess I've touched on, there will be more and more
use of custom plates.

(43:03):
This is an enormously growingarea.
There will be area integration.
In-house printing is somethingthat will come along and reduced
cost will come too, and that'sthe end.
Thank you for listening.

Speaker 1 (43:19):
Thank you so much, bill.
I agree, looks like there hasbeen a lot of progress, um, and
the cases are amazing.
What do you think in terms yousaid that the uh, some of the
surgical guide were the simplerversion now is more complex?
What are some of the majoradvancements in terms of the
design concept for the surgicalguides?

Speaker 6 (43:43):
I think it comes back to the.
That's a great questionactually.
It comes back to the complexityof the planning which I kind of
mentioned a couple of times.
I think the concept where wekind of started off nearly 10
years ago with a single levelcut, an osteotomy guide that
goes on, then you make your cutsand then a reduction guide goes
on, that's a nice simple,straightforward system and

(44:05):
that's still the basis of whatwe do.
But from there to now we'verealised just the vast greater
potential of what we can achievewith these systems and I think
the understanding of some of thecases I've shown you the double
level corrections, theintegration of the custom
implants these have been drivenby clinical need but they've

(44:27):
also required a significantevolution in how we design the
guides themselves.
The guides have had to get morecomplex and the integration
with the custom plates has hadto get more complex to service
that clinical need.
So I think that's where it'sbeen driven from has had to get
more complex to service thatclinical need.
So I think that's where it'sbeen driven from.
But we've certainly used moreand more advanced softwares to

(44:47):
be able to achieve that forsurgeons and we use a whole
range, including Materialise inorder to produce that sort of
range of things that are neededfor these clinical situations.

Speaker 1 (45:01):
Sounds like the veterinarian clinicians are also
evolving with the technology.

Speaker 6 (45:06):
Enormously, and these are new techniques and a lot of
what?
Well, a lot much of what we dois saying to surgeons look, you
know, here's a conceptcompletely foreign to anything
you've seen before.
You know, the use of thesecustom plates as reduction
devices.
This isn't.
Nobody gets taught this at vetschool.
You know a lot of people don'tget taught this in residency.

(45:27):
So you know, it is a very mucha collaborative process of um
really educating surgeons how touse these systems, um, as well
as actually creating them.
So, yeah, it's exciting, butit's kind of hard work to be
able to do that as well.

Speaker 1 (45:47):
Great.
We have two questions from theaudience that I'll address
really quickly.
One is from Ernest Kostinko.
He wants to do an internship atyour clinic.
So, ernest, you should justemail Bill directly to see if
there's a fit.
We will.
I think we share all thecontacts already.
So, ernest, you should justemail Bill directly to see if
there's a fit.
We will.
I think we share all thecontacts already.
And then the other question isvery technical.

(46:08):
It says are the implant holesDCP or no need from Sebastian?
I guess DCP is a dynamiccompression plate.
I actually look it up.

Speaker 6 (46:23):
No idea what that does, but other than the, you
know the words, words.
So there's a couple of aspects,I think, to that question and
sebastian correct me if I'mwrong the, the first, the, the,
the likely, the use of a dcphole allows for compression of
an osteotomy um, and I thinkthat's maybe where the question
is focused.
Another aspect to that islocking holes, and again this is

(46:46):
another whole lecture really,but whether we should be using
locking screw technology inthese custom plates and the
questions are linked.
I think the answer is we candesign these to create
compression, but the truth is wedon't really need to and, um,
it's probably, it's not it, thisis really technical and there's

(47:08):
a big.
I could talk about this forages and it's boring, uh.
But yeah, the answer to thequestion is we can design those,
but we basically we don'treally need to and I'm very
happy to expand on that, butit's probably not the the time
or place to do that.

Speaker 1 (47:24):
Yes, we are pressed on time yes, well, thank you,
bill.
I mean I'm sure you can talk, uh, outside of this event, um, so
we're going to move on to ournext because we, like bill said,
we're pressed on time.
We need to move on.
Um, thank you so much for afantastic presentation, but I
learned so much every time youpresent and we'll come back to

(47:45):
you later.
And next we're going tointroduce.
Our next speaker is MattPollack, who is the co-founder
for KaBiomet.
It's a Polish implantmanufacturer and design company,
is a polish implantmanufacturer and design company,
and we actually had aconversation quite a few years

(48:06):
ago in a podcast interviewfashion, and but I am pretty
sure a lot has changed since.
So, matt, why don't you startsharing your screen?

Speaker 3 (48:16):
yes, can you see it, because I have started sharing.

Speaker 1 (48:20):
No, because let's see , oh okay, let me just stop
Bill's screen.
Okay, there you go, there yougo.
I see it now.

Speaker 3 (48:30):
Yeah, so, yes, initially, we had the
opportunity to discuss a coupleof years ago and a lot has
changed.
The size of the company haschanged.
As the first factor.
I'm pretty honored and veryhonored to be the speaker at
this event, especially that BillOxley is the speaker as well.

(48:50):
So we are a kind of competitor,but not really.
He's the leader and the top ofthe top in our world.
So I'm just trying to followwith some successes.
But being a competitor, we, as acambiometer, focus a bit on

(49:11):
different things in these, inthese days.
So what has changed?
I'm a medical engineer humanmedical engineer as a background
.
I'm not a veterinary surgeon,I'm not a veterinarian.
So in our approach, we aretrying more to utilize medical

(49:32):
engineering approach and themedical engineering standards to
the product, mainly focusing onimplants, not the surgical
guides.
But since 2020, when the firstimplant and the guides for
veterinary market were designed,we already collected more than
800 cases, so not 3,000, but weare directing to 3,000, I hope,

(49:59):
in coming years.
So pre-surgical models,training bonds, surgical guides,
custom implants, but also someoff-shelf products, milestones
and clients.
Actually, we ship all over theworld our products, from Mexico
through Europe up to Singapore.

(50:20):
So first custom implant inpoland was five years ago.
Now we are providing ourproducts worldwide, so a couple
of clients also in uk, but theuk market is very difficult
because of vet 3d, but still acouple of clients there,

(50:42):
especially Polish surgeonsworking in UK communicating with
Polish company just as a kindof um supporting a national
company this way.
But um, one of our aspects whichhas changed during the years

(51:09):
since our last conversation ismanufacturing of workshop models
.
At Kabiomeda we manufacturemodels for the orthopedic
training and since last threeyears we have changed our
quantities from around 100models per year in 2022 up to
1000 models monthly.
When it comes to manufacturing,we provide models for

(51:31):
orthopaedic training,manufacturing our own materials
for 3D printing.
So our models are behaving as anatural bone.
They are not melting duringdrilling, they are not brittle.
They are used worldwide, frommexico through greece to
singapore, japan, tokyo, etc.
So in this year we haveachieved a capacity of

(51:55):
manufacturing 1000 bonds permonth when it comes to
orthopedic models only.
But building the brandcredibility, since a couple of
years we are constantlypublishing at orthopedic
congresses, so scientificposters, but also publications
in veterinary surgery journalsor biomedical engineering

(52:16):
journals, and so last year wehad the posters at three main
congresses, not only in Europebut across the world, and at
least a couple of publicationsto build this credibility behind
the products and behind thecompany.

(52:37):
But what do we do exactly?
I would say the same as BillOxley, but not exactly the same.
There are a couple of companieslike us, like Vet3D, like
Cabiomeda, across Europe.
So the market is pretty big andthere is space for at least a
couple of companies.
So surgical guides work smarter, not harder.

(53:01):
A kind of IKEA forveterinarians.
Here you have that set of toys,here you have the manual do the
job.
But we are approaching thissubject as engineers, so we are
not proposing ready-to-usesolutions.
It's rather a kind ofcooperation between engineer and
the surgeon.

(53:21):
As an engineer, we proposed twoor three solutions, how the
surgeon can approach the, theproblem.
But the surgeon is the, theperson responsible for the uh
for the patient.
So it's more like cooperationthan providing the, the
solutions.
So anti-brachial deformities, alot of deformities.

(53:42):
But also training models for avery, very vast amount of
orthopaedic trainings, from longbones up to school surgeries,
dentistry, surgeries.
As for now, we have more than400 models for the training in

(54:05):
our database and growing.
So if some company would liketo manage the training of
antebrachium deformity inDachshund, we can provide 20 of
them in a quality providing thesame feeling as drilling and
cutting in the bone.
So tons of the bones and thefacility focusing mainly on

(54:31):
bones, manufacturing like thewolf dentistry, as it was one of
the models manufactured for theexotic hospital, as it was one
of the models manufactured forthe exotic hospital, focusing on
the dentistry of the wolves.

(54:54):
So material of the, the school,transparent teeth as natural
tissue, but implants, mainly wefocus on implants.
I would say 60 of ourcustom-made products, or even 80
of our custom-made products areimplants manufactured according
to human medicine standards.
So spine surgeries, orthodisease, quite similar cases to

(55:18):
those presented by by buildingbefore, similar cases to those
presented by Bill before, with abit different approach as
besides 3D printing we have alsofull possibility of CNC
post-processing, polishing, cncpost-processing, cnc machining.
The 3D printing is just thestep in the whole machining

(55:43):
process.
My favorite part of the businessare partial joint prostheses
manufactured according to humanmedicine standards and finished
according to standards of kneeimplants in human medicine.

(56:04):
But the size of patient is abit different from 1.5 mini
Yorkshire Terrier up to 60 kiloCane Corso or 80 kilo Giant
Breed dogs.
So the smallest implant isaround a chicken size implant I

(56:24):
don't know if you can see in thecamera.
That's one of my smallestpatients, whereas bigger ones
are a bit bigger Still the sizeis a bit different than in human
medicine, but here you canprobably see yourself as it's a
deep mirror finished surface.

(56:45):
So a broad range of implants.
But there is a problem inveterinary market.
Despite the products areperfect, the, despite the

(57:09):
products are perfect, thesoftware is perfect,
materialized, which I'm alsousing, but not exactly mimics.
There is a big problem, same ashuman medicine implant.
Then there's a bit of problembecause in human medicine you
have to follow all of thestandards ISO certification, fda

(57:33):
certification.
In US MDR, tons of paperwork,tons of standards, tons of
paperwork, tons of standards,which is not present in
In veterinary medicine, in mostof the law systems, implants
are not considered as medicalproducts Because in the European

(57:55):
Union the same in the UnitedStates, from what I remember
medical product is intended tobe used in human being.
Veterinary is not a medicalscience, it's agriculture in
most of the countries.
So if it comes to the standards, if it comes to the surface,
finish, etc.

(58:16):
It's like Wild West.
Like wild west there are a lotof companies who are not
following any standard, justmanufacturing the implant and
telling that it's a perfectimplant for the animal, just use
it.
Responsibility of the companyis like nothing, because if we

(58:38):
don't have to follow thestandard, no one can do us
anything.
So the Caviomeda approach is abit different, as we are
following the standards andfocusing mainly on the human
medicine standards.
So in human medicine you haveto follow material

(58:59):
biocompatibility testing, phatictesting, precision
manufacturing all of thestandards which provide you
safety product, safe productwith proper safety cleanliness
that you can rely on.
In veterinary medicine it's amatter of trust between the

(59:22):
surgeon and the company.
But if the company is a seriousplayer and has a lot of money
to invest in the process, it'sokay.
But if it's a completely newcompany from nowhere, telling
that okay, our products areperfect, just use them, it's a
bit risky to rely only on thekind of trust as there are no

(59:51):
standards.
So theoretically, implantsdon't have to pass biomechanical
testing.
They can be done out ofanything because there is no
specific standard for thematerial quality.
Traceability, which is likebasics in human medicine,

(01:00:12):
doesn't exist.
So if we have a batch ofproducts in human medicine and
one screw is improper by meansof standards, manufacturer knows
everything about the batch andcan do the market callback etc.
In veterinary it's complicatedPoor material choice, corrosion

(01:00:33):
and rejection.
Lack of precision, implantmisfit, biomechanical failure,
no standardized testing,breakage.
And who is responsible forimplant failure?
The surgeon who doesn't knowhow to make the surgery?
The manufacturer, the providerof material?
The matter is very, verycomplicated so it has strict

(01:00:58):
impact on the veterinarians andpet owners.
If something will fail, who isresponsible?
If implant fail, it's alwaysthe responsibility of the
surgeon because he is the user.
But how he or she is checkingif the implant, if the product

(01:01:20):
is reliable, checking if theimplant, if the product is
reliable, it's completelydifferent situation than in
human medicine.
So at least in our approach, wefollow the quality standards of
human medicine products.
As from our responsibility, ifsomething will be wrong, the

(01:01:42):
company is responsible for it.
The dimensions from ct.
So if the software is validated, we can provide the precision

(01:02:10):
certified medical gradematerials in controlled medical
processes, even if we don't haveto follow it.
We use it just because of thisresponsibility and credibility.
Biomechanical strength, testing,traceability.
Every product has its numberhas full storage traceability in
the system.
So, for example, pgrs, custommade patelary groove prostheses

(01:02:36):
from raw material throughmechanical polishing, through
electrochemical polishing,through final product form.
It's a very complex processwhich at the end allows us to
have the quality exceeding humanmedicine standard by means of
surface quality.

(01:02:57):
We are exceeding human medicinestandards three times.
We are exceeding human medicinestandards three times.
So how market will respond tothe problem of growing and
growing number of companieswhich are offering the medical
veterinary products but theydon't have to follow any

(01:03:19):
standard because it's for animal?
The thing is changing and fromwhat we know from orthopedics
associations, surgeons aretrying to approach this problem
and trying to incorporate somestandards.
Probably the long journey is infront of us.

(01:03:41):
Standards.
Probably the long journey is infront of us, but it's not so
easy as just to take thesoftware, do the guide and do
the product how it looks inhuman medicine.
Is it just the surgeon is buyingthe software and doing the
guides?
Most of the time they are usingmedical engineers in hospitals.

(01:04:05):
They have departments ofmedical engineering in the
hospital, people who areresponsible for the process.
Who knows those technical parts?
And if we would like to use theapproach that veterinary
surgeon now will become theengineer responsible for the
product.
It's, at least in our opinion,not not so good solution.

(01:04:27):
Engineer is responsible forengineering, surgeon is
responsible for the surgery.
They should cooperate, not like.
Engineer is not going to do thesurgeries because he will learn
the surgery within one monthafter buying the software.
The same for the surgeon.
Is it good to buy the softwareand do the job after two weeks?

(01:04:50):
Not so easy and not so good.
How long did it take to beprecise and confident in
designing the guides For Bill?
After two weeks, two years,2,000 cases in veterinary market

(01:05:14):
.
Every single patient isdifferent.
It's not like we have patientsfrom 40 up to 80 kilos and
everyone is the same.
Every single product is a kindof prototyping and a kind of
doing something for the firsttime.
Amount of deformation, amount ofproblems in animals is 10,000

(01:05:36):
times more complicated than inhuman medicine, is 10,000 times
more complicated than in humanmedicine, especially when it
comes to the deformitycorrection of a femur of the dog
which is the size of a chicken.
We are speaking about surgerieson newborn babies.

(01:05:56):
Most of our patients are 4kilos, 3 kilos, 4 kilos, so it's
the size of a newborn baby.
And then the level ofcomplexity here is very, very,
very high.
One of my most complicatedcases was the deformity
correction with parallelprosthesis of this size of

(01:06:19):
patient.
Prosthesis of this size ofpatient, so it's 70 millimeters
femoral bone with a deformitycorrection and with replacement
of part of the joint.
The cut school is this size ifyou need to put the plate on it

(01:06:39):
and to have a full mirror finishof the plate for reconstruction
of the skull.
It's a completely differentlevel of complexity than
compared to human medicine.
Of course it's a bit differentlevel of responsibility in human
beings or in cats.

(01:07:02):
But if we treat it just as aliving organism and living being
, the cat will have the sameinfection as human.
If it will be not sterile, theywill have the same irritation.
If it will be not manufacturedfrom proper material, the

(01:07:24):
corrosion will be the same oreven worse in animal organism
because of the metabolism etc.
So the biggest problem in aveterinary market, not only by
means of 3D printing but overall, is the standards.
Human medicine standards shouldbe incorporated in veterinary
market.

(01:07:44):
And then we have human medicinestandards for 3D printing,
metallic 3D printing, polymeric3D printing.
So they should be used also inveterinary market.
So what makes us different?
Cambiomenda and big companies ormaybe not big because

(01:08:06):
Cambiomenda is still quite small.
We have like 12 people now withfive engineers and almost 400
square meters of manufacturingfloor floor but still that what

(01:08:30):
makes serious company differentis following the standards and
really focusing on thisengineering and medical
engineering part, not just.
I have bought the printer andI'm now doing the implants In
human medicine.
It will not work at all.
You just can't buy the printerand print implants or print the
surgical guides for orthopedicsurgeon doing the elbow

(01:08:52):
reconstruction in human medicine.
It's if it's not working inhuman medicine, it should not
work also in veterinary market.
And I hope it will be a fullstandardization and full quality
standards um demand andrequirement in this in this
market, as it's very, very, verycomplicated and complex part of

(01:09:16):
the of the market medicalmarket overall.
Of the market medical marketoverall.
Yeah, so with this positiveoutcome, that's all that I have
for today.

Speaker 1 (01:09:33):
Thank you, matt.
Thank you so much for thatpresentation and good discussion
about bringing veterinarymedicine implant production
quality to human grade.
I absolutely 100% agree.
And I do agree thatself-regulation, as opposed to
creating additional bureaucracyto regulate a space, is probably
the best initiative right now,because I think it's always a

(01:09:56):
balance between additionalregulation in a space with
bureaucracies versus.
You know, we are going toself-motivate and do a good job.
We have a question in theaudience but we're running out
of time, so we're going to moveon to the next speaker to so
that we can get to our paneldiscussion.
But, matt, you can take a lookat that question from Sebastian

(01:10:19):
in the question Q&A box.
But, matt, you can take a lookat that question from Sebastian
in the question Q&A box.
Our next speaker I'm going toinvite Dr Sinan from Vimex and
also he's a co-founder.
He's an orthopedic surgeonfirst of all and two.
He co-founded several differentcompanies focusing on
veterinarian implants.

(01:10:40):
He's located in Turkey, sothank you very much.

Speaker 5 (01:10:51):
Dr Sinan, thank you, jenny, and thank you for all
speakers.
There is a lot of good cases.
Thank you, bill, also for thesegood surgeries.
It's really very fantastic towatch them.
Thank you for all and it'sreally exciting for me to
collaborate with you here in thepresentation.
Thank you for all and it'sreally exciting for me to
collaborate with you here in thepresentation.
Sorry, I will just check.
Yes, I'm an orthopedic surgeontoo and I was just teaching in
the university.

(01:11:11):
First of all, 10 years ago Ifound the TraumaVet company,
which is just serving forveterinary orthopedic places and
secretives, and I was justproducing in subtractive
manufacturing.
And now we just built, twoyears ago, the V-Mix company

(01:11:32):
which is doing the additivemanufacturing.
I will also talk more aboutthis.
But what we do?
We have a lot of cases, justyou showed, and I'm really very
happy.
But we have some problems.
But we have some problemsSometimes.
We all have some problems, somecomplications.
I don't care if the surgeon'smistake or if it is an implant
failure, but we all haveproblems and sometimes we cannot

(01:11:52):
do anything without imaging anew system or a new solution.
Look, there is a really bigbone loss.
It's a necrotic tissue just inthe middle of the femur.
One third of the femur ismissing and this poor guy had a
lot of surgeries and in the endhe had a big loss of bone.

(01:12:13):
And what to do?
What's next?
And then implant failure andthen what to do?
We just didn't have so muchopportunities before.
Additive manufacturing justtouched our lives and touched
our quality of surgeries and thealso.
The owner is also problembecause she is also in pain.
The dog is also in pain.

(01:12:34):
We have a lot of texts, a lotof callings, but we have.
We need some time and duringthe last five years we have now
good imaging systems and imagingcenters.
The CT is much more availableright now in our countries and
doing the CT I'm just goingquite fast for the surgeries

(01:12:54):
because we really had a lot offantastic surgeries.
We have watched them and I'mjust showing.
There's also another imagingsystem center here in Istanbul.
This is our company.
Also.
We have an imaging centerbecause we need good images to
make good implants for themanufacturing.
We are quite a big companyserving veterinary doctors in a

(01:13:17):
lot of fields and parts, a lotof fields and parts and you all
know the softwares and see thebone and to deal as all other
doctors and engineers has donebefore.
We also do the same, quitesimilar prosthetic and cajun
place together and alsointegration bone in growth.
This is I'm really very excitedabout this because it's very

(01:13:41):
fantastic.
You you cannot even especiallycases like with bone loss if you
just put a cage, then I don'ttrust, only the secretes.
Bone-osteo integration is thekey and this is very fantastic,
that our engineers have a lot ofeffort on this.
They spent a lot of time andthey just do a lot of

(01:14:03):
improvements in those surfaces.
I will just talk in the nextslide.
And designing is really veryexciting with engineers because
doctors, especially orthopedicdoctors with the engineers, are
really great teams and I'mreally happy to work with very
talented engineers from BITECcompany I will just talk about.

(01:14:26):
We are just coming fromHumansight and BITEC company and
Kuntay is one of my friends andthe head engineer in those
companies has a huge experiencein metal additive manufacturing
and additive manufacturing andI'm very lucky to work with them
.
So we design, we decide andthen in a few hours or in a few

(01:14:47):
days we just have the implant.
This is very exciting as anorthopedic doctor.
And then the case when you getin the surgery.
It's super easy, it's super funto just put and it's really
very fast and you enjoy thesurgery because before the
surgery you just see thetrajectory of the secretion and
how you will send it, how youwill read it and the drill guys

(01:15:10):
is really making surgery veryfast and very easy.
This is what we really happywith.
Additive manufacturing and inveterinary medicine is growing
so fast.
The acceleration rate is muchmore bigger than human medicine
and I really love thesesurgeries.
Look, uh, the owner was textingme in pain but in after a few

(01:15:34):
months she's just texting mewith really good videos.
That makes me very happy.
I know you feel the same.
And uh, the orthopedic doctorsin the last maybe five years
they have problem withtoyberries.
We have a lot of toyberries inalso our country and we have a
lot of problem with these radialfractures.
Even we do the place andsickles or external fixation

(01:15:56):
that this little poor guy had alot of surgeries and the last
section was done with externalskeletal fixation.
And if the standard implants areno more helpful, so what's next
?
What can we do?
We were only talking aboutamputation just a few years ago,
but now we have some solutionsbecause we have now good

(01:16:17):
teammates.
We have friends, engineerfriends, and we are just working
together.
These are very talentedengineers from b-tech company,
trap tech company and in vmix.
We are just working together totreat our patients and for this
little guy also.
We have a lot of examplesbefore, so I'm just going quite
fast to catch the time.
We just see the bone and justcheck the healthy bone and then

(01:16:41):
make the guides to cut thenecrotic bone and after perfect
cutting the surfaces we just puta cage with a plate with
osteointegration where we wantand screeds also and to see the
stress level.
Before the surgeries, to test,as Mateusz has talked about to

(01:17:02):
test.
They are really very fantastic.
And also, neurosurgery is oneof the greatest parts of
additive manufacturing and 3Dprinting, because 3D printed
guys are crazy good and doingsurgeries, especially if you're
using the pedicle secretives,the polyaxial secretives.
Sending the secretives is quitehard and before the surgery we

(01:17:25):
just print it, see thetrajectories and try our guides
and then get in the surgery anddo our surgeries.
This is a case from Julian.
He is also a close friend ofmine and we are just
collaborating so much.
Also, 3d printing helps us somuch in trainings.
Really, if you just are intraining, even if you give the

(01:17:45):
lecture, the attenders when theytouch the bone or see the bone
or before the surgery.
Learning before the surgery.
If you want to plan the surgery, it helps you so much in
pre-planning.
Another thing is okay in vetalso, we are just doing just
straight plates and scripts.
This is good.

(01:18:05):
We can just contour the place.
There are some rules forapplication of plates and
scripts.
But anatomic plates are gettingmore popular.
So how to produce them, toproduce an anatomic plate, is
quite challenging when you justuse the CNC machine.
It's quite challenging when youjust use the CNC machine.
But if you're just printingthem, then it has much more
advantage.
And another case from ourstudies is when you just bend

(01:18:29):
the regular plates it loses alot of strength.
But if you're justmanufacturing, additive
manufacturing, and when you takethe additive manufacturing part
to CNC machining for a perfectlocking scripts, then it makes
really good difference.
This is what we do.
We also combine thetechnologies of additive
manufacturing and CNC machinestogether, subtractive

(01:18:51):
manufacturing together, and thismakes very good implants and
very, very good surgeries.
This is also another examplefrom pedicle scripts.
This is also another examplefrom pedicle scliffs.
And just see that there is areally tiny room to send the
scliffs.
So perfect, implantation of thepedicle scliffs needs really

(01:19:12):
guys and we are very happy tomake those guys.
This is another case fromIstanbul.
My friend Efe he's just adentist from Istanbul and we
just made a prosthesismandibular prosthesis for this

(01:19:34):
huge tumor.
This is another tumor from thesame clinic.
Let me just show you how toplan it.
We just make the perfect cutsand then replace the implant.

(01:20:16):
This is how we plan and test itand then produce it and then to
the surgery.
We really had a lot of greatsurgery, so I'm going fast.
This is another rostralmandibular tumor case with the
implant and this is another casefor reconstructive surgery.

(01:20:38):
And additive manufacturing justlets me to use a lot of
materials, not only stainlesssteel or titanium.
I can just use peak and otherpolymers.

(01:20:59):
We also develop some resins,bioresins, and then we use them,
check them.
This is also super flexible fora surgeon.
This is another case with secondlumbar section tumor.
We just plan and make acorpectomy and then design the

(01:21:24):
implants, send the guides forthe surgeon for a perfect and
easy surgery.
This is also the implant.
This is another female case, acage with a plate, because if we
don't have them, then we havereally big problem.

(01:21:45):
Amputation is not a solutionfor us.
And we just do the vertebralspacers for Wobbler syndromes.
We do a lot of spacers.
We just do the ITAP prosthesis,which I will show a small video
of a dog.
Really, guys, and this is thefirst case I think, of the world
this is from the BBC and NBCnews.

(01:22:07):
It was a sea turtle was injuredfrom maxilla and mandibula and
B-Tech company has made thefirst implant titanium 3D
printed implant for it and afterjust five years we just built a
new company which is calledVMIX, and our partners are
Hossvet, btech, traumavet andTraptech.

(01:22:27):
These are mother companies andthis is just a sister company
for Traumavet.
We are just doing the CNCmachining and additive
manufacturing together.
But what we do is not onlyhaving the software and just a
printer and then the print.
We have a really big experiencebecause our team has 35

(01:22:47):
engineers working inside thecompany and they have a huge
experience from Huma's side, andit's not only a software and a
production.
We are deep in developing newtechnologies, new processes and
new values and new applicationsfor veterinary use, new
processes and new alloys and newapplications for veterinary use
, especially testing anddeveloping new alloys which we

(01:23:08):
can easily clean, which we caneasily print and cost-effective.
We also do optimizing aboutthese new alloys, because
innovative alloys in veterinaryapplications will change quite a
bit.
Again.
We are testing strategy newalloys for veterinary
application using additivemanufacturing.

(01:23:28):
Unlike the medical sector, theveterinary market offers faster
opportunities, allowinginnovative materials to be
adapted more quickly, as Matoshas told.
But I'm just talking about thefirst period because we are just
conducting extensive researchon materials of medical
applications.
However, strict regulationsmean that even a proven material

(01:23:51):
can take years to reach to themarket.
But, in contrast, theveterinary sector presents a
more flexible landscape,creating a significant
opportunity for additivemanufacturing and innovation and
also integration which I reallylove it and optimizing the bone
engraft.
We just check the density, theporosity and the microstructures

(01:24:12):
for the perfectosteointegration for the
implants.
This is how our engineers spendtheir time.
We also check all the powders.
Our engineers spent their time.
We also check all the powdersthe titanium powders we use
under electron microscopy tohave the better medical products

(01:24:33):
.
We test all the materials andwe just use the same regulation
as human medicine uses and wejust use a lot of effort and
money to produce the bestimplants and we just have some
certifications fromnon-stotoxicity and others.
This is what we just creatednew powders, as I told you

(01:24:53):
before.
We have a lot of designs andcases.
We have some experience inveterinary field, but we are
always open to collaborate withother companies.
We are so open to collaborateand just develop new
technologies together.
This is pedicle surgery guides,as I told you before, and
another part is to guideassistance of the surgery,

(01:25:16):
because we just send thedocument to the surgeon, which
makes the understanding of thesurgeon the implant is in a
better way.
This is a photo from an ITAPcase from a cat.
This is a small movie inTurkish but there are subtitles.
I just want to show it to youbecause this little poor guy is

(01:25:36):
living on the streets.
He's a stray dog and had aterrible accident.
He had a lumbar fracture, hehad a surgery with pedicle
secretes and in the left side hehad an arthrodesis and in the
right side he had an amputation.
But we just made the ITAPprosthesis.
This is a case which we reallyspent a lot of time.

(01:25:58):
Let me show you this is what wereally love and why we do it.

(01:26:52):
And, as a doctor, what do I loveabout 3D printing?
The osteointegration makes iteasier.
Really, I love it.
And dreaming and creatingsomething is super, extremely
good for me, because I also knowsome surgeons.
They love to design, they loveto use the mimics and other
applications and they do theirown segmentation.

(01:27:15):
This is what is fun for them.
And to plan a surgery is alsovery fantastic.
And with 3D printing you arequite limitless.
You can imagine other solutionsand you can use a lot of
materials.
There is a lot of variations ofmaterials and preoperative
planning is very easy with 3Dprinting.

(01:27:37):
Perfect secretive implantationis very important in
neurosurgery and what I loveabout 3D printing as a producer
is much more time effective forprototyping.
Just on my desk I'm just tryingto make a new implant and I
have 3d printed bones and 3dprinted designs and I just

(01:27:58):
always try.
I always work with them, soit's quite good for me time
effective prototyping becausewhen you dream and just throw
the plate, then setting the cncmachine and producing it and
testing it, it takes quite muchmore time and creating a new
implant with additivemanufacturing is super easy and

(01:28:21):
you just don't have a lot ofloss of raw materials Shapes
doesn't matter anymore More thanatomic solutions for veterinary
orthopedists and you just don'tspend a lot of money for stocks
and combining technology andmaterials like locking screws.
We just do the locking screwsin our traditional CNC machines.

(01:28:41):
We just take it from theadditive manufacturing to CNC
machines.
They make it a perfect implantand sometimes we do the place
and screws and cages together,especially in TTA surgery.
We have the CNC machine, tta and3D printed CTA and
osteointegration is super crazy.

(01:29:02):
In 3D printed TTA.
You can just combine them, wejust put them in ourselves and
there is no more stock cost.
This is what I love in 3Dprinting as a producer.
This is what I love in 3Dprinting as a producer, and I
think that in the next featurewe will have biomedical and
medical engineers in thehospitals and some 3D printers
and we will just assist them.

(01:29:22):
The feature will change.
We will just carry ourfactories into the hospitals.
Thank you very much.

Speaker 1 (01:29:37):
This is what I will just talk about 3D printing in
Fantastic presentation and lovehow you work with Kunte, who I
will consider a friend of mineas well.
It really demonstrates thevalue of collaboration.
We're running out of time so wehave to leave all the questions
at the end, which should besoon.
So if you have any questions,please put them in the Q&A box

(01:29:58):
so Dr Sunen can address later.
We're going to move on to ournext speaker, luca Manassaro,
also Dr Manassaro, from Italy.
He is also doing his PhD rightnow, focusing on the 3D
technologies in veterinarymedicine.
So, luca, I'll let you takeover, but please keep in mind

(01:30:18):
that we do want to leave 15minutes at least for a panel
discussion at the end.

Speaker 4 (01:30:23):
So, yes, I will be really quick with my
presentation.
That's also a little bitdifferent compared to the one
already performed.
Just a sec, okay, I hope youcan see the presentation.

(01:30:50):
Yes, perfect.
We don't always have the lastmachinery compared to human

(01:31:15):
medicine, and so following sometips could be very helpful,
especially considering that weare not always performing the CT
ourselves.
A lot of people are justsharing the cases with us, and

(01:31:37):
so maybe giving some guidelinescould be helpful.
So I work in radiology at theveterinary hospital in the
University of Turin in Italy andof course, I'm a big fan of 3D
printing.
I think that the first anatomicmodels for students and also to

(01:32:00):
visualize to help to visualizesurgeons some complex cases were
done close to 10 years ago,years ago, and from a couple of

(01:32:21):
years we are also performingsome guide system for the
correction of limb deformities.
Doing the imaging for 3Dprinting.
We can use a variety of methods.
We can use a variety of methods.
Of course, the most popular oneand we will see why is computed
tomography, but we have also toconsider other imaging

(01:32:43):
modalities like COM-beamcomputed tomography, also MRI,
ultrasound and some opticalscanning method MRI, ultrasound
and some optical scanning method.
The right imaging modalitydepends on the anatomic area and

(01:33:04):
also the clinical needs.
So why CT is the preferred CT,the preferred modality for 3D
printing?
Because CT is very superiorwith resolution compared to all
the other methodologies and isalso very fast to acquire the

(01:33:29):
images and also, I can add,everybody can do the job.
Compared to CombinCT, combincthas a very good resolution on
bones and also a big advantagethat it's not involving too much

(01:33:52):
That is low dose radiationcompared to computed tomography.
But for example, even humanmedicine are using also this
modality.
Ultrasound generally lacks ofvolumetric data, so that's why
we prefer CT and opticalscanning for sure can only scan

(01:34:13):
external surfaces and cannotscan organs or bones.
So the big advantages of CT for3D printing are the high
spatial resolution.
That generally is thatgenerally is below one

(01:34:34):
millimeters.
It's very fast and versatilecompared to the other modalities
.
But we will see also that MRIcan play a big advantages in
evaluating soft tissues etcetera, but is less automatic
than CT, is less automatic thanCT Comprehensive bone tissue.

(01:34:58):
So the CT can scan in a verygood quality both bone and soft
tissue.
And also we have to considerthat CT is widely available in
veterinary clinics, especiallynowadays In the last few years.
A lot of clinics have their ownCT, so this is for sure a big

(01:35:23):
advantage.
There are some keyconsiderations for CT scanning
in veterinary medicine.
The first one is the need foranesthesia or sedation, because
animals cannot remain still likehuman patients, and also the

(01:35:44):
need of anesthesia is helpful toreduce motion artifacts.
We have also to consider thepositioning, so using special
support, etc.
And we have to consider someacquisition parameters because,
yes, as previously mentioned, inveterinary we don't have the

(01:36:08):
last machinery compared to humanmedicine.
So taking into considerationsome parameters can help a lot
in having a good image topost-process than for 3D
printing.
These are some parameters thatwe have to at least know to get

(01:36:33):
the best signal to noise ratio.
We have an example on the rightthere is a dorsal view of a
city and we have a lot of, let'ssay, mistake in this
acquisition.
So so on the top you can seesome lines that are actually

(01:36:56):
some breathing artifacts and arenot so welcome in a
segmentation process.
And also on the bottom we havea lot of noise.
This noise is given byradiation that is not going
through all the structures, sothere is a lot of noise, and

(01:37:17):
here we can for sure get abetter image.
So getting a better image, wehave to consider milliampere
seconds, so the quantity of theX-ray, the more.
The more we have milliamperesecond, the higher signal to
ratio we get.
Also, the kilovolt play asignificant role in it.

(01:37:43):
But we have also to considerthat the more we increase these
parameters, the more our CT ishitting, and so it's not
possible to acquire a total bodyscan with very high milliampere
seconds and very high kilovolt.
For example, slight thicknessplay also a role in reducing the

(01:38:06):
signal to a noise ratio.
So the thicker the slice reducethe spatial resolution, the
patient size, the the image ofthis on the right is pretty big
patient and so the bigger thepatient is, the harder to the

(01:38:27):
x-rays is to get all thestructure et cetera.
Another one is the pitch.
The pitch is the rotation ofthe tube along, the movement of
the bed in the CT and therotation time of the tube.

(01:38:50):
So there are some parametersthat we can optimize.
I think that there is not thebest recipe for anything, but
this could be taken intoconsideration and maybe given as

(01:39:11):
guidelines for who's taking theimaging of our region of
interest.
So nowadays not a problem tomaintain one millimeter for the
total body scan because most ofthe scanner are multi-detector

(01:39:34):
ones and we don't have so manyproblems.
But of course with somescanners we can get some heating
problems in having the wholebody scan in just one acquire.

(01:39:55):
We have also to consider thefove.
A lot of time I receive imagesthat are done for the whole body
and maybe just a bone of the, Idon't know, the forelimb is the
region of interest, maybe thecarpus, and we get some pretty

(01:40:23):
annoying artifact, let's say,because on the left you can see
the previsuous image, just zoomin and we have a lot of just
steps around the cortex of thebones and these are not helpful
for the segmentations, while onthe right side we have a

(01:40:45):
reconstructed image of the samescan, just with the proper
reconstruction FOV, and this iscrucial to have a very good
image to post-process, takinginto consideration the

(01:41:08):
positioning.
For example, in here we areseeing a scan for limbs and over
a pretty small patient and inhere we use normally for limbs
dorsal recumbency, the use ofcautions to support and align

(01:41:28):
the anatomy and also the limbshave to be moderately extended
to the gantry and also to be alittle bit distanced between the
two and directly the bone ofinterest should be placed at 90

(01:41:56):
degree angle compared to the CTgantry.
Okay, this is a funny image.
So we are vets and we scan alot of different animals and we
have to consider that we can runinto some funny situation.

(01:42:17):
So normally we work only withdog and cats.
But some patient, like forexample the duck, don't need any
anesthesia, it's just best tolay down with some towel around
her and no problem with the CTscan.

(01:42:38):
Also we have some very smallpatients and this is pretty
challenging to get a properresolution resolution and also

(01:42:59):
some long, very long patientlike the white snake on the
center and yeah, with just onescan is not possible to take all
these animals in one scan.
And then also, for example, onthe top left the eagle is with
some very peculiar anatomy.
So the bones, for example, arefull of air.

(01:43:20):
So in the slicing thesegmentation is not so easy at
all.
Here we have a common mistakefor a motion artifact on the
radius.
So you see the radius as asmall step and this is just a

(01:43:44):
breathing artifact.
A CT like that to reconstructand maybe do a limb, angular
limb correction would be not soideal to make guides system on

(01:44:06):
these artifacts.
So the proper scan is on theright and this is without the
motion artifact.
This looks like just a fracture.
We have also metal artifacts andthey are very hard to deal with

(01:44:29):
and we have some algorithms andthey depends on the CT scanner
mainly, and also other artifacts.
There are a lot of artifacts todeal with, like the beam
hardening artifacts or thevolume averaging where can go

(01:44:53):
with a very poor quality anatomyreconstructed.
So in general, I think that thebetter the acquisition, the
fastest the segmentation and thebetter the 3D model will be.
So we have to keep in mind whatwe have said, because there is

(01:45:15):
no just do the model, and here'sthe CT.
We have to think about a littlebit, just a little bit to the
CT, because the CT nowadays isvery simple acquisition compared
to some years ago, especiallyin veterinary.
Nowadays we have good scannertoo and so with just a few

(01:45:38):
little points we can get a goodmodel for our engineers and of
course also for radiologists,because I'm a radiologist and I
think that I can be put in themiddle between the surgeon and
the engineer to try to make thecollaboration better.
So I think that thesegmentation of the anatomical

(01:46:00):
structures is our job, and so weshould interface more between
the engineer and the surgeon,trying to speak the same
language, or both, I think.
And with that I'm done, thanks.

Speaker 1 (01:46:19):
Perfect timing, Luca.
I was just going to tell you.
Our time is up.
Thank you so much for thispresentation.
I'm also a radiologist, so thisis very interesting to me In
the back of my head.
Actually, in our privateconversations I'm talking to
matt about taking a look at adolphin ct, if he can allow me.
So I think now is a good timefor panel discussions.

(01:46:42):
So if our panelists are stillonline, uh, please join us.
I'm going to stop sharing inthe screen of luca here.
Luca, you can share your emailin the chat box.
Um, so if you want people toget in touch with you in the
chat box, so if you want peopleto get in touch with you, that
will be great.
So we have a couple of minutes.
Actually, I think this paneldiscussion is quite important

(01:47:03):
because I think right now for 3Dprinting industry as a whole, I
think the industry isexperiencing a bit of a downturn
lots of pessimism, companiesbeing acquired or merged.
It's a bit of a nadir of theindustry.
So, and another interestingconversation I had recently was

(01:47:24):
with a orthopedic 3D printingimplant veteran, and so my
question is what do you thinkthe longevity of this technology
is in this industry?
I mean.
Could it be that one daysurgical guides, for example,
will not be necessary andinstead we're just going to use

(01:47:44):
robotics and software to guidesurgery?
That's one, and number two isdo you think 3D printing will be
definitely a growing sector inmanufacturing implants?
And this question is definitelymore relevant to people the
speakers who focus on implants.
So I should just have a senseof where the future lies for the

(01:48:07):
industry.
I will open up to our firstspeaker, Brad first, and then
Bill, Dr Sennan and then Mattand Luca.

Speaker 2 (01:48:21):
Yeah, and this is something that Materialize has
considered as 3D printing viablefor the long-term future.
That's why we've looked intoand we started working and
developing in the augmentedreality and virtual reality
space working and developing inthe augmented reality and
virtual reality space.
We do have one veterinarysurgeon that's used augmented

(01:48:41):
reality within the clinicalsetting, just as Bill showed,
and it's a viable way forward if3D printing is on the way out
at some point in the future.
But I mean in terms of that,versus traditional manufacturing
, 3D printing is much moreaccessible and can fit into a

(01:49:03):
much smaller space.
So I think there definitelywill be a use case moving
forward.
It's just how large or how muchit grows from there I really
don't know, but good question.

Speaker 1 (01:49:17):
Yeah, Bill.
Do you have any thought aboutthe future?

Speaker 6 (01:49:20):
um, I I think, um in terms of guides, I mean, I I've
no doubt one day, you know,robotics will or other forms of
navigation will supersede guides, but I don't think that will be
for quite a long time,especially in veterinary.
I think the the degree ofaccuracy that you you need um

(01:49:44):
will, I'm sure one day beachievable, but I don't think
that's going to be for quitequite a while.
Um, and I think the the cost ofguides, even even if you're
doing one every week, I thinkfor a long time that will be
sort of more cost effective thana high-level piece of guiding

(01:50:06):
equipment.
So I think guides will be aroundfor a while, quite a long time
actually, but yeah, sure it'llcome.
I mean it's going to be.
I mean, goodness knows wherewe'll be one day.
Yeah, it'll be incredible, um,incredibly different thank you
um dr sunan.

Speaker 1 (01:50:26):
What do you think?

Speaker 5 (01:50:27):
yeah, for me I think with machine learning, uh, just
creating guides would be easierand everyone will be doing it.
I think that most of thesurgeons, especially veterinary
surgeons, will have some 3Dprinters in their clinics the
surgeons, they will love guides.
But in the next feature andit's very close, I am agree with

(01:50:50):
Bill the navigation systems andAR VR technologies will take
the advantage and in the nextfeature the guys will not be so
much popular and formanufacturing of orthopedic
implants is challenging.
But I think that we will nothave only one factory which is

(01:51:10):
full of CNC machines and therewill be CNC machines and
additive manufacturing togetherfor a while, but then in the
next feature, I think there willbe additive manufacturing only
for producing of orthopedicimplants.

Speaker 1 (01:51:26):
Wow, that's a pretty bold statement, but I think a
lot of people on this webinarwould like to hear it, matt.
What do you think?
The future?

Speaker 3 (01:51:38):
It's complicated by means of just replacing the
guides with robotic arm or justspecific robotic solution to
provide more and more accuracy.
Probably then it will be thesituation that every single
clinic needs an engineer to setup the robot.
It's not the situation that therobotic arm will just know what

(01:52:02):
to do with AI driven something,etc.
So from my point of view it'snot a big change if it will be
going from designing the guideup to programming the CNC robot
or the robotic arm which will dothe surgery in the surgical

(01:52:25):
room.
But the costs the basic roboticarm with six degrees of freedom
is like 100 000 or somethinglike this.
So for medical purpose it willbe one million.
Because you need to have thiszero at the end for
certification and safety reasonsand probably by means of costs

(01:52:50):
and because of the costs it'snot the closest future.
The another risk regarding theguides is that all of those
fancy small toy breeds with youknow problems will be forbidden.
Like the only breed availableallowable on the on the market

(01:53:14):
will be a completely healthy dog, then we will have a problem.
I think that the problem ofreplacing guides with robots is
not the closed future.

Speaker 1 (01:53:27):
Yeah, probably not as much of a concern for the human
market, luca, what do you think?

Speaker 4 (01:53:32):
Yeah, I think that it's very fascinating that we
can also think about virtualreality or augmented reality in
the terms of a guide system.
So get rid of guide and justuse maybe some goggles for the
surgeon that apply to theanatomy of the bone and making

(01:53:54):
the cut.
I think that the 3D printingUh-oh sorry.
A lot of advantage compared toaugmented reality and virtual
reality.
I mean, just a piece of thewhole operation could be done

(01:54:15):
maybe with virtual reality, but3d printing would be for sure.
Uh, very useful for the laststep at least.

Speaker 1 (01:54:24):
Yeah, for the implants, for the alignment of
the anatomy, etc yeah, thereason I mentioned is because
last week we just did a webinarfocusing on human orthopedic
implant devices and all themajor public implant companies
now have a combination ofimplants plus robot, so they

(01:54:44):
actually generate a lot ofrevenue from selling these
robots, and these robotsspecifically work for their 3D
printed implants.
These robots specifically workfor their 3D printed implants.
So it's a very interestingpathway that the major players
in the human market is playing.
But, like you guys justmentioned, the vet is very
different.
The patients are a lot harderto predict and customize for.

(01:55:12):
So, luca, since you're stillgetting your PhD, I want to

(01:55:37):
start the next question with you.
Is the next generationeducation for you know?
And if not, how are the nextgeneration learning about this?

Speaker 4 (01:55:43):
Yeah, I hope that 3D printers are more applied in the
university, for example, and weare using it for some student,
but still just in the maybespace special areas.
I mean not for every student,because especially in italy we

(01:56:06):
have a lot of students, so it'snot thinkable of managing
hundreds and hundreds of bones,at least maybe for the happiness
of Mateus could be very happyto print a lot of bones, but in
terms of economical reason it'snot the best.
But still, we are using it forshowing the case and it's very

(01:56:30):
helpful for the education andit's very helpful for the
education, but at this pointstill a small batch of students
may be really interested in thetopic.
Not for every student.

Speaker 1 (01:56:44):
So you have to really .

Speaker 3 (01:56:45):
Okay, go ahead If I may.
Tomorrow I have a lecture forUniversity of Padova veterinary
students regarding applicationsof 3D printing, so it's more and
more present in the programs.
It's not like they will havefull 3D printing subject for the

(01:57:08):
whole semester or something Isee, but at least for the
University of Padova.
They asked me last week toprovide the lecture for
veterinary students.
What is the current state ofmarket by means of 3D printing
and by means of 3D printed bones?
Actually, we sent quite a lotof 3D printed bones to Italian

(01:57:28):
universities, italianuniversities, so more and more
students are aware of thetechnology and the better for us
as a company providing suchservices.
But, as I'm trying to always putsome focus on it, it's not the

(01:57:51):
situation that if you ask acompany like mine, or Bill or
someone who is providingsurgical guides, that with our
product, the surgery will beeasy.
It's not working like this atall.
Those products are for very,very difficult surgeries to be

(01:58:16):
less difficult.
So it's not for easy approachthat I'm just after the studies.
I have zero experience, but Iwill print everything and do the
surgeries.
It's for making extremelycomplex cases, just difficult
cases, and it should be alwaysuh, underlined that cases, and

(01:58:38):
it should be always underlinedthat it's not to make life easy,
it's to make life easier fromvery difficult to just difficult
.

Speaker 1 (01:58:44):
Dr Sunnen, do you have any thought on the
education for the younger vets?

Speaker 5 (01:58:51):
For younger vets.
I think that the VR and ARsystems will not be available
for that much people, but Ithink 3D printed bone models and
surgery trainings will bereally very good because just
basic principles of bone platingand sequels there was a
question about dynamiccompression holes or something

(01:59:13):
To understanding thosebiomechanics and those forces,
those torques, bone-likematerials really work very good.
And for orthopedic education, Ithink that 3D printing will be
very useful for the students andeducation.

Speaker 1 (01:59:28):
Good point, Bill.
What do you think?

Speaker 6 (01:59:32):
Yeah, I think everybody's covered it.
I mean, I think at studentlevel this will always just be
something that people kind ofneed to know is available.
I think, as matthias said,these are these are generally
sort of more complex surgeriesand it's kind of it's the kind

(01:59:52):
of thing that you're going tolearn in a residency and you
know potentially sort ofadvanced general practitioner
level.
But the really difficultsurgeries are really residency
learnt and it's very much like ahip replacement or something
you as a vet student you'regoing to know about hip
replacements, but you you're notgoing to know details and I
think probably at the certainlythe more advanced levels, um,

(02:00:14):
that's very much where I thinkthis will be in terms of the
surgeon's journey through theeducation process.
I think it will be at that sortof resident type level, um, or
at least a sort of advancedorthopedic course time.

Speaker 1 (02:00:28):
Yeah, yeah, I mean, I was actually very impressed
when you said that now yourservice really focused on the
design process, which I think isthe hardest part is being
creative.
The real cerebral part is notthe mechanical part, it's the
creative, innovative for everysingle case.
How do you do a best job?

Speaker 6 (02:00:49):
That is the hard part for anyone.
Absolutely, jenny, it's so true.
And I think the things thatwe've discovered through this
process, with the ability toanalyze deformities in 3D it's a
new field, I mean this justdidn't exist.
And the previous mechanisms bywhich we did this, which is
still taught, you know, even tospecialist surgeons they're not

(02:01:13):
wrong, but they're not really ascomprehensive as they need to
be.
And we have a huge problem interms of educating specialists
with these new techniques,because people just aren't
taught them.
So we're kind of teaching someof this stuff as we go along and
innovating it at the same time.

(02:01:34):
And the yeah, I think it'simportant to understand that.
You know, everybody said itit's not just making a guide.
It's understanding the, thedeformity that you're treating
or the problem that you'retreating, understanding how the,
the surgery that you'replanning will interact with the
biology and the mechanics, andunderstanding how the guides and

(02:01:54):
implants will interact withthat to achieve the clinical
results.
And that's where I think justchucking a thousand cases into
some deep learning and trying toget AI to produce a guide
system, that's where thechallenge is going to be,
because it is so much more thanjust working out some angles and
doing some algorithms.

(02:02:16):
It's a lot more complex.
But this is the challenge andit's exciting.
But I think the challenge isunderestimated sometimes.

Speaker 1 (02:02:24):
Yeah, absolutely, brad.
We're going to wrap up with you.
What do you think?
How is Materialise helping theschools and educators with
bringing this technology intomore common practice?

Speaker 2 (02:02:38):
I would say yeah, so we have a Mimic student edition.
It comes with a course bookthat's pre-prepared and comes
with the student licenses thatcan be used by the teacher and
the students to teach in acourse, and all the grading can
be done there in terms of andthis is for VET.

(02:02:59):
This program is for VET.
We're developing stuff for VET.
Obviously, material I wasinitially developed for, you
know, academia, university andhuman use case initially, so
we're working to develop that aswell.
We do have a mixed usercertificate program as well,
where you can earn a certificate.
It's done online and can begraded online and be done at

(02:03:21):
your own pace as well.

Speaker 1 (02:03:23):
Yeah, maybe you can consider collaborate with some
of the speakers here, becausethey obviously have a lot of
experience and they alreadytaught me a lot, so they're
great teachers, no doubt.
Okay, everyone, thank you somuch for sticking to the end.
We are a very small butpassionate group about 3D
technology and veterinarymedicine and appreciate your

(02:03:45):
time.
This recording will be onlinefor a couple weeks for free and
you can invite your colleague orstudents to watch, and we will
also share interesting segmentsonline as well.
Thank you very much and I'llsee you next time.

Speaker 2 (02:04:00):
Thanks everyone.

Speaker 1 (02:04:01):
Bye-bye.
Have a good night and good day,bye-bye.

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Episode #78 | Bones, Paws, and Pixels: The 3D Revolution in Vet Medicine (Virtual Event Recording)

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Episode #78 | Bones, Paws, and Pixels: The 3D Revolution in Vet Medicine (Virtual Event Recording)