July 17, 2025 • 59 mins
What happens when cutting-edge technology meets veterinary expertise? Precision, innovation, and better outcomes for our four-legged family members.
Dr. Bill Oxley, a prominent figure in veterinary orthopaedics, walks us through the evolving world of 3D-guided veterinary surgery. With years of surgical experience behind him, Dr. Oxley began to question the limits of traditional planning methods. Complex bone deformities that looked manageable on initially often became challenges in the operating room. The tools weren’t the problem. The planning was. His solution? Bringing veterinary orthopedics into the three-dimensional world through advanced imaging, computer-aided design, and 3D printing.
Dr. Oxley's approach helped 3D planning completely change how we asses deformities for the better. The shift from struggling with conventional 2D planning to creating precise surgical guides. These custom guides allow surgeons to make exactly the right cuts in exactly the right places, dramatically improving outcomes for patients with complex orthopedic conditions. The emotional highlight comes when he shares the story of a Great Dane with bone cancer who, thanks to this technology, went from facing amputation to running joyfully on the beach just weeks after reconstructive surgery.
Beyond the technical aspects, we explore the business challenges of building Vet3D, the global adoption of these techniques, and how pet insurance dramatically impacts which animals can access these life-changing procedures. For pet owners, this conversation offers invaluable insights into what's possible when your beloved companion faces orthopedic challenges.
Curious about the cutting edge of veterinary care? Want to understand how technology is expanding what's possible for our pets? This episode will leave you amazed at how far veterinary medicine has come and hopeful about where it's heading. Connect with Dr. Bill directly at bill@vet3d.co.uk to learn more about these groundbreaking approaches.
Show notes, photo gallery, resource links: Please see our show notes here.
Sound Engineer: Faith Fernandes
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jenny Chen (00:01):
Hi there, Welcome to episode number 88.
Just a quick reminder thispodcast is for informational
purposes only and does notconstitute medical or investment
advice.
Always consult with qualifiedprofessionals before making
healthcare or financialdecisions.
Enjoy, Hi everyone.
Welcome to the show.
(00:22):
I'm your host, Jenny Chen, andtoday we have the pleasure of
having Dr Bill Oxley to be withus.
Dr Oxley has been with usseveral times during our virtual
events focusing on veterinarymedicine and 3D printing, and I
have been impressed by his worksmany years ago, since before
(00:42):
the pandemic by his works manyyears ago, since before the
pandemic, so we're reallyhonored to have him today as a
guest.
And just a little bit about DrAxley's work and I'm going to
call you Bill, since this issomewhat informal and Bill.
So you were trained inCambridge University Veterinary
School and you practiced as ageneral veterinarian doctor for
(01:05):
a number of years before youdecided to go into orthopedics
and since then you alsoincorporate 3D printing and 3D
technology in general into yourpractice.
And there's so manyaccomplishments.
You published more than 20co-authored papers on virtual
surgical planning and 3Dprinting and you have
(01:27):
facilitated more than 4,000cases now using virtual surgical
planning and 3D technologiesand 3D printing.
So it's really impressive.
And you also are the co-founderor founder of, and CEO of,
Vet3D, which is a company that'sbeen operating for a decade now
.
So, Bill, welcome to the show.
Bill Oxley (01:48):
Well, thank you, Jenny.
That's really kind of it'sgreat to be here.
I've, yeah, always been a bigfan of 3D Hills and your mission
to kind of bring thistechnology more to the forefront
.
So, yeah, it's wonderful to behere.
Jenny Chen (02:02):
I am obviously a fan of yours and you know I am a
radiologist.
I wanted to serve humansearlier in my career.
What made you become interestedin veterinary medicine and
decided to go to vet school andthen eventually become a surgeon
today.
Bill Oxley (02:22):
Yeah, I think it's a bit of a cliche, but I guess
I've just always loved animalsand I knew at school science was
the thing that I enjoyed and Iloved doing.
I was terrible, terrible at art, I was terrible at languages,
but science was the thing Icould do.
And I suppose when it came todecide what to do sort of
(02:44):
further on in my educationalcareer, I guess I put those two
things together.
So, yeah, that was the story.
My mum and dad got a dog when Inever wanted a dog, but then my
mum and dad got a dog when Iwas 12.
And of course I fell in lovewith her and then that was the
start of it all.
So yeah, it's a story that manywould share, I think.
But yeah, it's the science andthe animals at the same time is
(03:07):
always the the combination forme yeah, no, growing up with
animals is a really wonderfulexperience.
Jenny Chen (03:14):
I actually was later in my life to get a dog and I
totally now get it why they'reso important in our lives.
You've practiced as a generalpractitioner for a decade, I
would say almost before youdecided to become a orthopedic
surgeon and maybe specializingin small animal.
Is that correct to say?
Bill Oxley (03:34):
Yes.
So I think the careerprogression is a little
different to maybe how a newgraduate would maybe do things
now.
For me, but certainly the pathin the UK.
When I just qualified it waspossible to go straight into a
residency and a more advancedcareer path.
But many vets would spend sometime in general practice and I
(03:59):
guess I got a little bit stuckin general practice because it
was a lot of fun and I was doingmy life, but I'd always had
this hankering to be.
I loved surgery and I never Idon't know why I loved
orthopedics.
There was just something aboutit that I loved and I'd always.
I always knew I wanted to dothis.
But and I sort of messed abouta little bit in general practice
(04:22):
and you know I enjoyed fixingfactors but I I kind of knew
that I wasn't very good at it.
And yeah, I was very fortunatethat I had the opportunity to
work at a referral practice andthe surgeon there kind of took
me under his wing and a friendof mine, duncan midgley, and he
really got me started withorthopaedics and then I was able
(04:45):
to further my career path.
So yeah, I think there's.
Sometimes I look back and think, oh, maybe those years if I'd
been doing orthopaedics.
But I think it gives you awonderful grounding in you know
understanding what clients want,how to communicate with clients
, just the real hands-on generalpractice.
(05:07):
You can't beat that experience.
So I don't.
I don't regret it, but yeah,it's a job to get started I
agree that's wonderful.
Jenny Chen (05:14):
Um, and then you progressed into even more, uh,
technical hands-on and andincorporating virtual surgical
planning and 3D printing and 3Dtechnologies into your practice.
I mean, that is the leap thatnot many veterinary doctors
would go for.
So what inspired that?
Bill Oxley (05:35):
Yeah, and this really was that kind of eureka
moment, I suppose, when at thatpoint I completed my residency,
I'd become a specialist.
At that point I completed myresidency, I'd become a
specialist, an orthopaedicspecialist.
And I was kind of reached thatpoint in my career where, of
course, naively at the time, Ikind of thought well, you know,
I've got my board exams, thismeans I should be this, all this
(05:57):
perfect surgeon, I should beable to do anything.
And I was still struggling withdeformity corrections, and I'd
been on the courses, I'd readthe books, and I was still
struggling with deformitycorrections.
And I'd been on the courses, I'dread the books, I'd done the
exams and I'd plan these thingsand I'd go to theatre and
nothing that I planned wouldwork.
And then I'd be there and I'dbe slightly panicking and the
bones in two pieces and my planisn't working.
(06:18):
And for a long time I kind ofblamed myself.
But then after a while I kindof thought, kind of thought well
, actually, maybe it's not me,maybe it's the way that we're
planning these, maybe it's theway that we're actually thinking
about with the way that we'vebeen, we've been taught for all
these years and how to planthese things, and so I started
looking at bones in 3d um, justworking out how to take them
(06:39):
from the ct scanner, take theminto cad software and just print
them out so that I could lookat them and maybe well, maybe I
could work out why I can'tunderstand how to do this.
Um, and as part of that processyou have to take the bones
through the CAD software andyeah, there's all this stuff
that you can do in the CAD andall these buttons and you can
cut the bones in it.
And then, kind of I just hadthis thought that well, wow, I
(07:02):
could actually use that to do mycorrection on the computer and
make all my mistakes therebefore I went to surgery.
And from there I kind of workedout that I could make and make
guides to actually do that forme, do my planning, and that was
really the start for me and itwas really putting together that
know sort of slightly, I guess.
(07:25):
Techie, you know I've alwaysloved cad, I've loved I had a 3d
printer, I loved all that stuff.
And putting that together withthe, that level where I was with
my surgery, those two, that theintersection of those was
really what made that first stepyeah, um, you know, during our
prep work you said the printingis really the last step of this
whole process.
Jenny Chen (07:46):
The thought and design process is really the
bulk of the work, really, andsince you mentioned the
traditional way of planningthese surgeries, I would assume
that the old ways wastwo-dimensional.
Can you walk us through how itused to work?
Bill Oxley (08:03):
Absolutely, you're exactly right.
The original, and it's stillwidely used, and the theory that
I think we'll probably come onto a little bit later as well is
Cora theory, which most peoplehave heard of, if you're
interested in this kind of thing.
It's originally sort of drawnby Draupeli who's just a legend,
(08:25):
still doing clinical practiceum, but at the time where draw
developed the core theory, itwas cts existed but all of the
planning was really done in 2dum and that whole wonderful core
framework, which is stillcompletely valid um, was all
derived from radiographs, reallyfrom, from, from 2d imaging
(08:48):
ultimately, and that the theoryis still absolutely correct.
The difficulty is in complexdeformities, the, the, the, the
sort of what we call itcovariance, that the, the
influence of a deformity in oneplane, affects the measured 2D
measured deformity, the valueyou get in the other planes.
(09:11):
It's fine if you've got a nicesimple deformity, but with a
really complex 3D deformity,it's not that the theory's wrong
, it's that the data we put intothe theory, the 2D data that we
put into the theory, doesn'treally work anymore.
We can't get the right data andthis is where the 3d planning
(09:32):
can have enormous benefits,along with other things as well,
um, and that was the kind ofone of the things coming back to
my anti-braking problem, I was,yeah, didn't do it.
That was that was kind of whatwas going on.
It was it was the planning thatwas so difficult.
And then translating theplanning to the actual operation
is the next challenge, whichthe guides do.
But, yeah, the differencebetween 2d planning and 3d
planning is absolutely key, um,and it's completely changed how
(09:53):
we assess deformities, um, withyeah we'd draw lines, we'd
measure angles, we'd do that inall the different planes.
these days, pretty much, we justalign the top bit in 3d, we
align the bottom bit inD, andthen we work out what to do in
the middle, and it's a very,very different way of doing
things.
Jenny Chen (10:11):
It's very different, I have to say, during our prep
work thanks for sending over acouple of papers that you
published it actually changed myperception on my daily work as
well, because I live in the 3Dworld.
I deal with MRIs and CTs everyday, but I have never tried to
measure anything in 3D.
That is a complete change ofpractice and you know my daily
(10:36):
practice.
For humans, I don't reallymeasure much three-dimensional
stuff other than you know, a big, big tumor.
You measure the biggestdiameter, but I actually don't
know how you train yourself youreyes or concepts.
I mean, this could be the coretheory 2.0 for you, bill.
You could totally just put aname on it um, like, how do you
(10:57):
train yourself to actually havea quantitative analysis of these
three-dimensional deformity,because they're not really like
standard you know femur orhumerus but rather they're like
not normal looking joints.
Bill Oxley (11:15):
How do?
Jenny Chen (11:15):
you do that.
Bill Oxley (11:16):
Yeah, it's a great question and I think this is
where I think the evolution to3D planning still I wouldn't say
meets.
I think it's quite mainstreamnow, certainly in veterinary,
but still meets some resistancebecause quite naturally,
surgeons like to put a number onsomething they like to say it's
got 20 degrees of virus, it'sgot 15 degrees of torsion, and
(11:37):
that's because, kind of becausewe've been trained that way, but
kind of because that's it justgives you a handle on what
you're going to do.
And when you kind of say tosurgeons, well, yeah, that's
great, but actually thosenumbers could well be wrong in
your case anyway, and how areyou going to do that 20 degrees
and 15 degrees, and then you'vegot another plane, and how are
you going to get the cut in theright place?
It's a very different mindsetand I think that's where a lot
(12:05):
of the difficulty that peoplehave had with this, with the 3d
planning, has come that we don'treally we can put numbers on
things, but to get numbers for areally complex deformity you
really need to do athree-dimensional matrix
calculation that only a computercan do, and when you get these
numbers out they don't reallyhelp you much anyway.
Um, and it's a very difficultmindset to get into and I think
people do struggle with it.
(12:26):
And, yeah, it's subjective.
You know, as you rightly say,sometimes we're looking at these
joints and they don't look,they don't look right anymore,
and we we have to make judgmentsabout where to put these.
Yeah, and it's certainly trueto say that there are elements
of the sort of surgical processthat we cannot do in 3D.
(12:46):
We'll probably not be able todo them for a very, very long
time.
So when we talk about jointincongruities, joint laxities,
these are things we can't model.
Yeah, technology we have at theminute and they matter, and
sometimes there are things thatthe surgeon needs to do
interruptively that maybedeviate from the plan that we've
created.
But at the same time, I thinkthe concept of visual alignment,
(13:08):
3d visual alignment is kind ofwhat we all used to do anyway.
You know when, when I was there,I just got on boards and I was
just having my mild panic.
You know, what do we, what doyou do and what do we still do?
Well, we line it up.
You know, we, we, we have alook at the limb and we hold it,
we line up the joints and wefix it like that, so you
ballpark it.
Yeah, in many ways there'ssubjectivity there.
(13:28):
So it's not as if the processalways gave you a perfect answer
.
Every time there issubjectivity, there always will
be subjectivity, especially withour patients, because they're
all different.
A straight leg for a Daxi mightnot be a straight leg for a
Dane and all these things.
Jenny Chen (13:47):
Exactly.
You also have different breedsthat we don't really deal with
in the human category.
So that is another variablethat you add into your daily
work, variable that you add intoyour daily work.
Now, after you have done allthese cat analysis or 3d
analysis of a deformity orabnormality, how do you, how do
(14:07):
you incorporate 3d printing intothe picture here and how does
it work?
Does it really close the dealfor you?
Bill Oxley (14:13):
yeah.
So the, as we've just beensaying, we can derive this
wonderful plan in 3D and we cansee we can do a virtual
correction.
If we get it wrong we can tryit again and we can see that
we've got a nicestraight-looking limb.
But to actually create thatosteotomy for the surgeon it's
got to be in the right place, atthe right angle.
Then you've got to move thesegments in three dimensions
(14:35):
exactly the right amount.
So to translate that plan totheatre, that's where the 3d
printing comes in.
And effectively we just designa guide that snaps onto the bone
only in one place and it tellsthe surgeon where to cut, and it
has pins there's all sorts ofthings these days to then assist
the surgeon in the realignmentto make sure that that's.
(14:56):
That's exactly how we'veplanned it.
And then either the surgeon canjust pop on a normal plate that
they've pre-contoured to fitfrom a 3D printed model, or
sometimes we usepatient-specific implants.
So the 3D printing of theguides and the models is how we
shift the plan to reality insurgery.
Jenny Chen (15:16):
How many times these surgical guides that you
created doesn't fit or won'tcreate the outcome?
I mean does that happen oftenor not at all.
Bill Oxley (15:27):
It's something that absolutely can happen, um, but
it's usually, or it should be in, in predictable situations.
So sometimes we're planning aparticular correction and we can
just tell you what the guidesneed to fit is contour.
They need cortical contour.
So we need some curves, somebumps, whatever it might be, for
(15:48):
the guides to latch onto.
And sometimes we're fixing abone and there just aren't any,
you know, for whatever reason,or they're really poor, and
sometimes we can modify designto you know, get around that
problem.
But sometimes you have to sayto the surgeon look, this just
isn't a great case, you know,I'm really sorry, but you, you
know, probably get it to fit,but you're gonna have to be
super careful when you'reputting this guide on, uh.
(16:10):
The other situation where it canhappen is growing animals, um,
so obviously an animal that'sgrowing quickly, it's going to
the bones could be gettingbigger, they're going to be
changing shape as well.
So if you have too long a gapbetween your CT and the surgery,
the bone can just have changedand so the guide won't just
literally doesn't fit on anymore.
So there are predictable timeswhen it can happen that we can
(16:33):
be on the lookout, for it reallyshouldn't happen otherwise, as
long as the surgeon has used theguides correctly and has put
them on correctly, because youknow we do do various sort of
checks to make sure that theguides fit on the bones and we
know that the bones and theguides that we derive from the
CT data have very high fidelityto the CT.
(16:53):
So we know that that bit shouldbe okay.
So if something goes wrong it'susually a sequencing error in
in surgery now?
Jenny Chen (17:03):
um, I've never performed a surgery before.
I mean I've scrubbed into some.
When you're in the surgicalfield, it's quite bloody and
hard to see things, and not tomention you have to move all the
soft tissues away to expose thebone.
How do you find a landmark tosnap on your guide?
This is a question that bugs meforever.
Bill Oxley (17:21):
I just gotta ask you yeah, and a lot of this comes
down to how we actually plan theguide system.
So part of what I do actuallythis is kind of.
When I started doing this, Idid the guide design.
They were terrible.
I did design the guides.
I, you know, I printed themmyself.
I'm really lucky now I havepeople to help me with those
things much better at it than me.
(17:42):
So my job now is really kind ofdoing the surgical planning
because, being a surgeon, I canthink through the planning, all
the deformity correction stuff,the technical bits but also I
can think through well, actually, where is the exposure?
Because I've done the exposures, I know where they are.
So I know what the surgeon isgoing to be looking at when
they've exposed the bone.
I know what bits of the boneare safe to use for guides.
(18:08):
You know which bits can weclean the soft tissues away, or
where are veins, where arenerves, where are places that we
just can't get to?
So we can integrate thatknowledge into the overall sort
of conceptualization of theguide system.
So when the surgeon comes to doit, there's the right bumps and
(18:28):
nobbles and curves that thesurgeon can access that are
available for the guides to fitonto, so it's an important part
of how we design the systems.
Jenny Chen (18:36):
Wow, that's a lot more elaborate game plan than I
thought it was going to be forsure, it's totally all in your
head, except the final point ofprint the guide like you said
yeah, so what was?
The.
So you've done 4,000 cases Were.
These cases were done allthrough your company, vet3d, or
(18:56):
there's some before that as well?
Bill Oxley (18:58):
No, I mean mean I started doing them for myself so
, um, you know, I suppose maybeI'd probably done a hundred or
so of these from me and myimmediate colleagues before I
thought, actually this is reallysomething I probably need to do
something with um.
And so, yeah, there wasdefinitely a period before I
(19:20):
really got into, I reallystarted vet 3d as an entity, um,
and was there like a aha moment, where you'd be like I want to
translate this technology morepractices and more animals I
don't think it just a sort ofspecific moment, but it's kind
of and I mean I won't, it wasgreat, it was.
(19:42):
It's sort of when you kind ofshow it to colleagues that you
expect and they say, whoa,that's actually pretty cool and
that's really nice.
Jenny Chen (19:53):
Yeah it is, I bet I can feel it, even though I
didn't experience it actuallythis.
Bill Oxley (19:59):
This is really something that could make a real
difference.
You do feel a sort of roleimperative, but you do kind of
the whole point of.
For me, the whole point ofbeing a surgeon, of trying to
get really, really good at beinga surgeon, is so that we can do
better for our patients.
And of course, there'sprofessional pride.
(20:21):
Pride, you know you want to dothings well, but really you want
to do them well for yourpatient because you want
everything to work out reallywell.
And I think for me, when I kindof it dawned on me that this
really could help with clinicaloutcomes and it really could
allow us to do things that wecouldn't do before, I think that
was when I thought, oh, I needto run with this.
You know, I need to try andmake something happen so you
(20:44):
know this is not a video based.
Jenny Chen (20:46):
I mean we're we're not showing animal videos, which
people love, but I'm sure youhave several really satisfying
cases that you remember of yourentire decades of experiences
here.
You want to share a few caseswith us that really made it for
you.
Bill Oxley (21:03):
Absolutely.
I mean, there's one thatcompletely sticks in my mind
which was a great day, and Iwon't say her name because the
owner was didn't really want usto share the case specifically,
but we can talk in generalitiesand this was a great dane who
had an osteosarcoma of herdistal radius and she was a big
(21:25):
dog, 60 kilo dog right and wehad to.
Well, I didn't do the surgery, Imade guides and implants for a
surgeon to do um and we had toreset probably 20 centimetres of
this dog's radius.
So it's a huge resection in adog and we were able to use a
(21:46):
patient-specific implant forthat dog, guide systems that we
designed, a plate that wedesigned, and we were sent a
video of the dog running on thebeach at 12 weeks stop,
completely sound, completelyhappy dog, and it was just one
of those sort of cases where youthink, well, that is, that's
(22:10):
quite amazing, because that issomething that would have been
unbelievably difficult toachieve without a very specific
type of implant and a veryspecific set of guides and
planning.
And to see that dog do so wellwas wonderful and it's probably
my highlight case.
Jenny Chen (22:28):
Yeah, I mean, I'm just trying to visualize this
dog, right, I know they're big,I've never had one.
20 centimeter, that's like twometers.
Oh no, that's zero point.
Wait how many meters?
That's zero point.
Two meters?
No, that's zero point.
Bill Oxley (22:38):
Wait how many meters , that's zero point meters, 20
centimeters, 20 centimeters soyeah it's kind of that's pretty
big.
Jenny Chen (22:44):
That's pretty big, yeah.
It's kind of that's almost likehalf of the leg right yeah yeah
, yeah, it was a.
Bill Oxley (22:49):
It was a significant proportion of this dog's radius
.
And this dog stands what kindof up to your?
Up to your sort of chest, Isuppose.
Um right, it's a big dog I mean,the other option for this dog
would be amputation of some sortyeah, so previous sort of limb
spares called limb spare,previous limb spare techniques
have been described but they hadhigh rates of complications.
(23:10):
Dogs, could you know they wouldbe lame because of the surgery,
the, the attempts that weremade to reconstruct the leg
would take a long time or hadhigh infection rates or other
complication rates.
So yeah, that would either betried and so the dog would kind
of just be lame and unhappy.
All, all of this every time itwouldn't be a dog anymore yeah,
(23:30):
and these dogs are life limitedso these tumors do normally
metastasize and min survivaltimes, maybe a year.
So if you're going to do a bigoperation you need the dog to be
a happy dog for a year.
You don't need it to take ayear.
Jenny Chen (23:41):
Quality of life yeah .
Bill Oxley (23:44):
So, that's a big thing, but yeah, you're right,
otherwise it would be amputation.
So it's all about quality oflife and it's being able to use
these technologies to improvethat quality of life outcome.
Jenny Chen (24:05):
And that was the case.
It was a perfect case, perfectexample of being able to do that
.
Yes, and, but you don't justrely on these.
You know individual cases.
You actually published 20papers evaluating various
aspects of virtual surgicalplanning.
Bill Oxley (24:13):
And how do you collect these evidences and what
are some of the numbers thatyou can show people that this
procedure really is a betterapproach, significantly yeah,
that's a great question and it'sit's data that's hard for us to
to collect actually, inveterinary medicine, for various
reasons, outcome assessmentsare always hard to assess
(24:34):
because you just can't ask thepatients how they're doing Right
, it sounds silly.
Jenny Chen (24:39):
Pediatric patients forever.
Yeah, it's the same thing.
Bill Oxley (24:43):
Infants.
It's quite a problem.
So that level of outcomeassessment has always been quite
hard.
But, that having been said,there are instruments to do that
, there are ways to do that, andI think something that, moving
forward, we really need to do isto set up a case registry and
to collect that data long term,and that's something that we
should have done years ago and,frankly, we never got around to.
(25:05):
A lot of the stuff we'vepublished have been literally
the case I just described.
They've been proof of cases,they've been accuracy studies
that guides are more accurate,both for sort of neurosurgical
screw placement and forosteotomy creation, angles,
positions and time as well, youknow, showing that these things
are quicker.
(25:26):
They save surgical time, whichis directly related to
complications.
So a lot of the stuff thatwe've published has been
accuracy based, speed based, butalso we have clinical outcomes
of individual cases, small caseseries, sort of dax and
deformity corrections, um,certain neurosurgical syndromes.
We know we followed those dogsout for for periods of time, but
(25:50):
it would be wonderful to do bignumber outcome studies and
that's something that we willmanage to do at some point yeah,
well, hopefully some of thelisteners can also reach out and
collaborate.
Jenny Chen (26:05):
Um now for people who are just starting to be
interested in using thisapproach is there any paper
specifically, or review papers,that you can recommend people to
go for?
Bill Oxley (26:16):
yeah, it's.
It's a difficult field becausethere's still there are books on
the human side about um 3dprinting in in human medicine,
but there isn't really anythingthat there is a.
There is a publication on thethe the veterinary side, but it
it tends to my particular field,orthopedics.
There isn't really very much onit and I think really if I was
(26:37):
going to recommend one thing,it's draw paley's book, which is
still, you know, sort of thebible for deformity correction
and we'll put the link in theresomewhere in a podcast note yeah
and um, I mean, as if you're anorthopod and you're interested
in understanding how to assessand to plan deformities.
That's the.
That's the wonderful place tostart.
(26:58):
Um, but yeah, the 3d printingthing it's still, and certainly
when I started there, just isn't.
If you can't go and buy a bookthat tells you how to do this
stuff and um, that's still thecase and it is um.
You know, people do ask me andI can't help everybody that asks
me.
You know, how do you, yeah, howdo you do the segmentation?
(27:19):
How do you print it?
How do you assess thisformality?
It's like it's a whole book.
I can't tell you, I can't teachyou.
Jenny Chen (27:25):
It's probably a series of books that no one has
the time to write.
That's the problem.
Bill Oxley (27:30):
Again.
You know a good friend of minehas you know we were meant to be
writing, doing a book on this,editing a book on this and it's
just, I just don't have time.
Jenny Chen (27:41):
It's impossible.
Bill Oxley (27:42):
Yeah, it's a monstrous project.
Yeah, it's huge, but yeahspeaking of monstrous projects.
Jenny Chen (27:45):
I mean I think that 3d, in a way, it is a big
project for you, uh, in yourlife, and you know it is a
business that you're building,where there are some.
Tell us some of the challengesthat you have met earlier, both
on the technical side and alsothe business side of building
VAT3D.
Bill Oxley (28:03):
Yeah, I mean I think the first one was literally
what we just said.
I mean, I kind of knew what Iwanted to do, but I had no idea
how to do it.
I didn't know how to extractDICOMs from the CT workstation,
let alone turn them into a 3Dmodel, let alone how to print
them workstation, let alone turnthem into a 3d model, let alone
how to print them.
And because I was kind of, Iwanted to do it, I spent ages
(28:24):
googling it and trying to workout how to do it.
How could I do it with my ctmachine, with my printer, and
this huge learning curve ofunderstanding cad software which
you know, as it turns out, my Iwas very amateurish at, and now
my colleagues who do all theplanning, uh, the design, uh,
for me are so much better at itthan me and use amazing software
(28:46):
so that I don't even can eventurn on.
So I think there is a huge,there was a huge technical
learning curve to kind of makewhat was in my head actually
happen.
Um, and I think that's probablythe biggest challenge for
anybody that kind of wants todabble in this themselves.
It's just those first steps ingetting going with it, I think
(29:07):
from the business side it kindof happened organically.
It was little mini steps for me, you know, I didn't come in
with a huge backer and a milliondollars and I just said, well,
you know, let's set up your lab.
It was, you know, I kind of gotanother printer and then, you
know, I got a little office.
That was a big step.
And then I am, I got my firstemployee and in fact these are
like, of course you did, it'sobvious, but at the time they
(29:29):
were kind of kind of scary steps.
But uh yeah, for me it'shappened very much incrementally
, which has been lovely becauseI've been able to build things
up gradually and I think it'smade a very solid foundation.
But certainly I'm a nobusinessman, so I made a lot of
mistakes in building up my teamand kind of getting the
(29:50):
organizational structure for thebusiness organized.
But yeah, I could have done witha business expert to help me
with that, that's for sure.
Jenny Chen (29:58):
Well, some people don't need to go to business
school to learn business.
And then you just did it bydoing, and I actually got
interested in 3D printing alsoaround the same time.
I think around 2012 or 13 iswhen everybody started to talk
about 3D printing for healthcare.
I think that at the time, the3D printing stocks are at the
(30:20):
peak of its hype.
It was in the hundreds ofdollars and everyone was totally
talking about how 3D printingcan change the world and I think
I got into that wave ofinterest and it is very
interesting, I'm stillinterested until today.
However, it is absolutely truethat there's no resource.
There was no resource for you.
(30:41):
There are a couple of opensource softwares you can try
perhaps, but it needs a lot ofdoodling and tinkering and there
was no official courses toteach people what these are.
We have some rudimentarycourses kind of expose people
what applications 3d printingcan do, but by no means can
(31:04):
teach people actually how to doit.
That gap is, I think, stillpersists still today I agree
with you.
Bill Oxley (31:10):
I agree, and some you know the big human health
care um, certainly on theorthopedic side, sort of
materialize.
You know they've been way outahead and have done wonderful
development work and they do runcourses.
But unless you know one of mycad techs, she basically learnt
in the human healthcare systemin the UK and it was very, still
(31:34):
almost an apprenticeship andorganic.
You know there was nothingmaterialised but it was still
very much and organic.
You know there was nomaterialized but it was still
very much.
Well, you know her colleagueshad learned how to use haptic
and and different softwares andso she learns and it was very
much that, rather than headingoff and doing a degree in it or
going on a big long course.
So they, they do exist but theythey absolutely.
Jenny Chen (31:54):
There's nothing you can do to kind of take you
through the whole process andwithout devouring any
preparatory information, um whatsoftware and printer system do
you guys use nowadays?
Bill Oxley (32:06):
yeah, no, it's um, we use, actually we use a
combination which is almost acase in point of what we've been
saying.
There's still nothing out therethat, in our opinion, like just
does everything and it isperfect.
So we use mimics.
That's a materialized packagefor our segmentation.
But, to be honest, we alsosometimes use horus, which is
which is free if you've got amac which one sorry horus, so
(32:29):
h-o-r-u-s, so it's it's okay,never heard of it yeah, no, it's
a.
It's a, it's an image viewingsoftware.
Oh interesting, but actuallyreally quite good at
segmentation as well.
If you know what, what, whatsequence to use um for the, the
planning, I use a softwarecalled um autodesk netfab um
which is a.
(32:50):
It's a generic cab yeah actuallywe have to use workarounds, but
it's actually very good um andit.
I've used it for all of thistime and it it works nicely.
Um, I have, um, my colleaguesuse three matic with another
materialized software a bit, butpredominantly geomagics, which
is a um, uh, really a 3Dmodeling software.
(33:13):
So it's used almost likesculpting.
It's almost more of a sort ofuh, free artistic.
You know that people use it forsculpting 3d models for film,
yeah, things like that.
I mean it's yeah, when these arehaptic arm to literally sculpt
uh virtual clay and that allowsus to to make very organically
shaped patient specific implantswhich are wonderful to use um
(33:38):
and would be extremelyimpossible to create on a more
sort of engineering-based CAD,where everything tends to be
straight lines and angles, whichis how plates have
traditionally been designed inother softwares.
And the printers, we still useForm Lab printers, so we use
form force.
(33:59):
Now, um, and they're they'regood.
I won't say they're perfect,but every printer in the world
has a failure rate and you knowwe do get print fails, but
actually they allow us to do allof the things that we need to
do, so to print it uh,biocompatible plastics,
autoclave, right, and we knowthat they have very high
(34:19):
accuracy, high fidelity to theoriginal CT.
So, obviously that's a wholetextbook in itself, but we know
what those printers produce forus.
We know that that's going to beaccurate to within well,
basically microns.
Well, sub-millimeter is best tosay, uh, but high, high
(34:42):
accuracy.
So yeah, we know that each stepof the, the process has the
ability to produce the accuracyboth of the guides and models
that we need for the, the, thesystems, to work clinically.
Jenny Chen (34:56):
Yeah, I think that's a good segue for a couple of
topics.
One is the steps when a newsurgeon wants to use your
service to produce their ownsurgical guide.
How does it work for them?
And the next question will bethe QA process, which I
certainly don't want to book,but maybe some general
(35:17):
descriptions about it sure, yeah.
Bill Oxley (35:21):
So I mean again the, the certainly a surgeon that
wants to, you know has adeformity, you know is thinking
about using guides, really the,the whole way that we've kind of
set up.
Vet 3d and other providers dothings slightly differently, or
some do, some don't.
There's lots of different sortof uh workflows on offer, I
(35:42):
guess these days um, but the waythat we do it is always to kind
of make use of myself and mycolleagues.
Um, in the us, jason laid on byantropovsky, in the states even
kamikov said I work with anumber of boarded surgeons who
will do assessments.
So the idea is more that it'snot that somebody sends a ct and
(36:02):
you know they kind of have tothen communicate with an
engineer to say, well, this iswhere you know I'd like you to,
this is what I want to do.
We will say we would kind ofanalyze a deformity or a
neurosurgical problem.
We'll give them a clinicalinput if they'd like it, which
is usually helpful in acertainly deformity corrections
where, like we were talkingabout the 2d versus 3d thing,
(36:24):
you know, we can offer thatlevel of insight into what the
deformity is, discuss with thesurgeon how they want to address
it, because there's rarelyyou're right where in the wrong
way.
There's always shades of graywith these yeah and then once we
have a plan finalized with thesurgeon, then we can kind of
pass it on to the engineers andthey'll do the design and the
print and we send out the finalsystem.
(36:45):
So it's the whole way that wedo.
Things is tailored around theclinical aspects of the case as
well as just like producing theguides and selling.
Jenny Chen (36:56):
Right, it almost sounds like a second opinion.
Bill Oxley (36:58):
It is, I think it is a surgical consultancy.
I mean it's you know somesurgeons want more, some
surgeons want less, and that'sgreat.
You know some.
So you know, for cases whereyou know the surgeon, we've done
loads before and the surgeonknows exactly what they want and
they know exactly how we'll doit.
They'll just say, yeah, it'sanother one of them.
Great, off, we go, you go.
You know that's fine.
But the way that we tend to setthings up because we are
(37:22):
dealing with vastly more complexdeformities these days, much
more challenging problemsthere's always a clinical
dimension.
It's very rare that it's justlike sort of a slam dunk.
This is what you need.
There is almost always nuances,different ways to do it surgeon
preference, client preference.
(37:42):
How much money have we gotavailable?
All of these factors that youneed to kind of all integrate
together to come up with asurgical plan that's going to be
optimal for everybody, you know, for the surgeon, the patient,
the dog's owner, the cat's owner.
And that's where I think thatit's time consuming and it's
difficult.
Yes, Outside of the surgerytheatre, time consuming outside
(38:04):
of the operating room, andthat's the point when you take
it surgery, it's quicker and itshould be exactly what you think
is going to happen.
Happens, which is what you wantat that point in the
proceedings.
Um, so yeah, I think that'sthat's how it works with a new
surgeon and it's and you knowit's.
There are other providers outthere who will do some of the
thing to us or who will justoffer that engineer-based
(38:27):
service, and some surgeonsprefer that.
They don't want me, you know sothat is my question as well.
Jenny Chen (38:32):
You know, personally I like a second dentist to have
an opinion on my teeth or mydog god forbid if she ever needs
surgery.
I would like to have a secondopinion.
I don't mind of extra cost, um,but the thing is you need the
surgeon, the primary surgeon, tohave the humility to actually
acknowledge limitation ofknowledge and skills and
(38:53):
actually reach out to peoplelike you.
How do you work with thatdynamic?
Bill Oxley (38:57):
it can, can be quite difficult.
And it's a great questionbecause I think there is and I
think certainly there arecertainly surgeons out there who
see it as a personal slightthat guides could even possibly
improve their surgical outcomes.
And you know, there is a littlebit of an ego thing there
sometimes.
(39:17):
For sure, not a lot of them isa little bit of an ego thing
there sometimes, for sure, not alot of.
I think I'm in many ways luckybecause I have been doing this a
long time and I've beenpublishing a lot on this and
I've been right, I suppose I dohave a level of experience and
reputation for understandingdeformities at a very high level
.
And I think it's like anything,I think our profession, just
(39:39):
we're going somewhere as humanmedicine we're becoming becoming
so much more subspecialized.
You know, I think back in theday you were an orthopod and
that was it.
And these days almost everybodyhas an area that they're
particularly interested, they'reparticularly good at that they
do a lot of and get particularlygood and get particularly good,
(40:00):
and for me that's deformitycorrections.
And you know, I think that most, most surgeons out there
realize that yeah, that's cool.
You know, that isn't that's notsaying, oh, you're a rubbish
surgeon that's saying well, youknow, these guys do this day in,
day out.
Why wouldn't I sort of leveragethat experience, that knowledge
?
So I think we're kind of pastthe point with most people now
that they feel I'm coming in andkind of, uh, patronizing them
(40:22):
or telling them how to do it andit is very much a collaboration
.
I mean I have to try andcontrol myself, think, well, you
know, I'd maybe do it this way,but you know there's perfectly
valid alternatives and I'll byall means help you with those
alternatives if that's what youprefer, and make guides.
So but yeah, sometimes there isa process of tactile
(40:42):
communication that's needed yeah, for sure the soft skills.
Jenny Chen (40:46):
But, bill, you're such a nice person I can just
tell after you know 30 minutesin.
You're so easy to talk to andfriendly.
Uh, it will make things easier,probably, for people yeah, now
in terms of the economics behindthese cases.
I don't know if it makes sensefor the other people to reach
(41:08):
out for your consultation or,just overall, does it save money
for the overall cost, not justthe surgery but also aftercare
and stuff like that?
What are the economics behindeach case?
Bill Oxley (41:19):
I would love to be able to investigate this and
maybe on the veterinary side,certainly in human medicine,
people have looked at the costbecause, right, it's so.
The cost is so much greater onthe human side and you know, 10
minutes in in the operating roomis whatever it is a thousand
dollars or something crazy.
So if you can save that 10minutes, then you can save an
(41:42):
awful lot of money.
Um, and it's the same for us,but on a, on a sort of a few
rack sort of notches down.
Certainly there's quite a lot ofum human literature now that
demonstrates, you know, actualdollar savings, um, due to the
use of guides, just basicallythrough time.
You know, if you, if you cantake 10 or 15 minutes off your
(42:04):
surgery which you will, you know, or more, then you save x
amount of um money.
Um, and the other costs areless tangible.
But things like, certainly onthe veterinary side, you know,
if there is a complication,sometimes clients are able to
pay for those, or if the dog'sinsured, then that's covered,
but often, you know, vets end upcovering complication costs
(42:24):
quite often and if we can reducecomplication costs, then that
saves the practice money andalso planning costs.
So for these very complexdeformities, you know I would
spend half a day, usually on mytime off, sort of trying to work
out how to fix this.
And if the surgeon can savethat time, they're not staring
at radiographs, they're notdrawing lines, they're not
(42:45):
trying to work out angles, draw,you know literally, do you know
trigonometry and and signs andthings?
Um, then that is saving them achunk of time and that's a chunk
of time they could be doingsomething else.
You know they can either bedoing another operation and
creating income, or they can be,I don't know, spending with
their families, you know well,you're basically a quantum
(43:07):
computing for um complexorthopedic surgery that's the
plan.
So, and yeah, it's timeconsuming because, again,
because, like anything in life,because we do it all the time,
you know, we can do it quicker,usually right and hopefully, you
know, at a more sort ofaccurate level, than somebody
that does one of these every sixmonths, um, and doesn't really
(43:29):
like them.
So, um, I think there's a lotof ways.
There are sort of tangible costsavings and intangible cost
savings that are harder to sortof really pin down.
Yeah, put them together, therewas a significant offset of the
cost of the guides, um, butwhere that is, I couldn't say,
but it's definitely there yeah,I think you know the intangibles
(43:50):
where the animal got better andlively.
Jenny Chen (43:53):
You know the great, the great ding story.
I bet that owner will come backagain if there was some other
dog but for the fact.
Bill Oxley (44:01):
In fact she has, you know, told her friends in the
great dame world that you knowthis works and so, and other
cases have happened as a resultof that.
So, um, these are, these sortof ripple effects have do good,
you know, in a, in a way thatyou can't really put your finger
on, but yeah for sure.
Jenny Chen (44:21):
Yeah, I was just thinking in terms of the
economics.
You know, the time saved, thecomplications saved, revision
saved and happiness added up.
Subtract the time, uh, with thecost of you having to do the
planning and creating the guide.
If that turns pretty positiveand demonstrable, you know that
that will be a turning point forthis entire industry to really
(44:43):
bloom.
Bill Oxley (44:44):
Yeah, and I think we do see it and I think you know
I I don't know a number, but Ithink the significant majority
of surgeons that start usingthese keep using them.
You know they, they, oh well,that was kind of fun but it
didn't really work.
You know, I think they keepcoming back.
So I think it kind of fun butit didn't really work.
You know, I think they peoplekeep coming back.
Jenny Chen (45:01):
So I think it kind of demonstrates that you know
there is surge in happiness aswell as probably financial
happiness as well yeah, um, ittranslates in health care in
general if the patient doesbetter, eventually you will make
money as well, because justgoes hand in hand.
Um now, speaking of your, um,your clients, um, you've helped
(45:23):
you.
You're not just doing it ineurope, you did it in all over
the world, right?
Bill Oxley (45:28):
yeah, yeah, yeah, it's really cool.
Um, so, yeah, I mean europe,the us, obviously, um,
throughout europe, australia, uh, new zealand and you know other
places we do.
We have surgeons in Japan,south Korea, yeah, lots of
Brazil, lots of places.
So, yeah, it's cool.
(45:50):
It's cool the bulk is thosethree main continents, I suppose
, but I suppose that's wherehealthcare, pet healthcare,
industries tend to be focused.
But, yeah, it's lovely, yeah.
Jenny Chen (46:05):
And then, so do you see any trends in these
different markets?
You know, for example, are youin Europe and, as I remember,
european pet market has thehighest penetration of medical
insurance for pets, as opposedto America actually has pretty
low pet insurance penetration.
So do you see any market trendsthese days in these different
markets?
Bill Oxley (46:27):
I mean, you've hit the nail on the head.
It's all about insurance, and Ithink mainland Europe is maybe
still lagging behind with thatcompared to the UK.
I think there's a very, veryhigh rate of insurance in the UK
, um, not so much in mainlandEurope, okay, I think.
Uh, certainly, in the Statesit's.
(46:48):
It's increasing, but it's stillpretty low, amazingly low, yeah
.
Yeah, but higher in inAustralia, um, which is again
why I think we do probably quitea lot more cases for Australian
surgeons.
There are some cultural things.
I mean, I think the concept ofyou know having a pet that you
spend lots of money on is stillnot so prevalent in some
(47:11):
mainland European countries asit is in the UK or maybe in the
US.
You know dogs, they're workinganimals, you know, and the
concepts.
Yes, my working animal issleeping in front of me right
now.
Yes, absolutely, you know pets,you know dogs they're working
animals, you know.
Jenny Chen (47:22):
And the concepts?
Bill Oxley (47:22):
yes, my working animal is sleeping in front of
me, right now absolutely workingso hard so there are some
cultural differences, but I mean, I think we are very much
driven by insurance, especiallyin in this era that we're now in
of corporatization ofveterinary health care, where
you know everything is so muchmore expensive than it was, um,
(47:43):
just anyway, because of the waythe corporate structure works.
So you know the concept ofspending another thousand
dollars, fifteen hundred dollarson a guide system.
You know that kind of thatextra little slice of money is
maybe not so available.
So there is no question thatthings are so much more
expensive than they were maybe10 years ago and that does
(48:04):
impact on clients ability to payand the reliance on insurance
is is even greater as a resultand so typically the surgeons
pays you guys right and not thepatient directly occasionally we
do it that way.
But you, yeah, it's the surgeonpays, pays us.
Jenny Chen (48:20):
We and if, if, let's say, if I have a dog that has a
deformity but I want you I'm inthe us and you're in uk and my
we have a different surgeon whois working on the case, how do I
, as a dog parent, convince ortrying to get to a surgeon that
can use your service?
(48:40):
How does that work?
Bill Oxley (48:42):
Yeah.
Jenny Chen (48:43):
Hypothetically obviously.
Bill Oxley (48:46):
I guess you kind of put your foot down and say and
do your own research, becauseyou're quite right, these
systems are by no means used byevery specialist orthopedic
surgeon or neurosurgeon in theworld.
I'd love to know that number,actually, but I think it would
(49:07):
be still quite a surprisinglylow number.
And if you personally think,goodness me, I really would like
this technology, then you needto seek out somebody that uses
it.
And yeah, I guess, be a realadvocate for your pet technology
.
Then you need to seek outsomebody, that, that, that uses
it and um, or yeah, I guess be areal advocate.
Yeah, we can, but we don't.
We don't, sadly, actually dealwith with general clients very
(49:30):
much, but we do occasionally getpeople that do ring us up and
say yeah, we have seen yourstuff and where can we go, and
Well, that's a good question,you know.
Jenny Chen (49:40):
perhaps you can create a list of surgeons who
would work in my area, forexample, and generate some kind
of partnership.
Bill Oxley (49:49):
Certainly possible, and we do do that informally,
but it would be certainly anevolution.
It would be a nice resource forpeople.
Jenny Chen (49:56):
Yeah, I saw your website.
By the way, guys, I highlyrecommend to check out Vest3D
website.
Very informative, lots ofdetails, lots of instructions.
I love it.
It's more explanatory and itprovided a lot of clarity of
what is going through mysurgeon's head and how to
achieve the accuracy and qualitythat you wanted to achieve.
(50:18):
So I really love that aspect.
And also, you know, speaking ofthe cost, I know it's expensive
now but, like a lot oftechnology, I do believe it's
going to get cheaper over timewith the progression.
Just imagine the TV.
A couple of decades ago, theflat screen TV was extremely
expensive and now it's justgetting cheaper and better.
Bill Oxley (50:39):
Yeah, yeah, well, but it will be.
I think it'll be a little bitslower for us.
Um, because the main, certainlyfor us, the main cost is time.
It's surgeon time, it'stechnician time, it's engineer
time and there is, it's notreally that we're particularly
limited by the computer.
(51:01):
You know the processing power.
We're not limited by theprinters and we're not limited
by the.
You know anything physical,it's real time.
So the obvious answer to thatis AI.
Ai will absolutely change whatwe do.
But the impetus for ai to youknow where veterinary orthopedic
(51:25):
deformity corrections is a kindof pretty niche thing for ai
and nobody is going to comealong with you know five million
dollars to invest in atailor-made ai system for us.
Jenny Chen (51:34):
So it's going to be a slow it's going to cost more
than five million dollars it'sgoing to cost more like $5
million.
It's going to cost more than $5million, like my billing is
more like it, you know.
Bill Oxley (51:42):
It's going to be a while before anybody gets around
to helping us out with that,but sure, I'm sure it'll happen.
You know it'll happen one day,but that's probably the route.
Jenny Chen (51:53):
So what is I mean?
You're in, you're in the game.
You know more accurate than me,for sure to tell, to forecast
anything.
What you know more accuratethan me for sure to tell to
forecast anything, what do youthink the field is going to do
is specifically orthopedic, um,in veterinary medicine.
What do you think in, let's say, five, seven, ten years, what
kind of trend and progressionyou're seeing?
Bill Oxley (52:11):
you're going to see yeah, I think a lot of it will
be joint replacement.
So joint replacement is isalways challenging for a load of
technical reasons.
You know, all the joints thatwe replace have their own
technical challenges that arevery difficult in some cases.
And I think the not not even somuch the 3D stuff really, but
(52:35):
just the way that the wholefield is progressing is
extremely quick, extremelyexciting.
People are getting so good atit, talking about
self-specialisation, but thereis a lot of 3D stuff that does
feed into that.
You know, joint replacement,planning, patient-specific
implants so I think that's goingto be a huge area.
And, more generally, I thinkthe greater use of
(52:55):
patient-specific implants,orthopaedic plates, not just
joint stuff, but other areas aswell, I think will be huge.
Specific implants, orthopedicplates, not just joint stuff,
but other areas as well, I thinkwill be huge.
And you know the great day andI talked about one great example
you know that was somethingthat we just couldn't do.
You can't.
There are ways to do it,somebody will tell me off, but
not so well, I would argue, andcertainly not so efficiently.
(53:17):
And that is because that's atailor-made implant and that
applies to many, many, manysituations and that is within
our reach, and that's somethingthat we're doing right now and
that will become much greater.
And I think the other thing isspinal stabilization.
This is another area wheretechnology is rapidly
(53:37):
progressing and I think in thefuture you know, we have new
systems coming through, fixationsystems and that will become so
much better over the next fewyears.
So, yeah, there's a lot ofstuff happening.
Jenny Chen (53:49):
You know I'm a big fan of this dog, the wiener dog,
the Dachshund.
How do you say that?
Yeah, but I didn't get onebecause I did not get it,
because I heard it has a lot ofspine issues and every procedure
is $5,000.
Bill Oxley (54:06):
They are predisposed to slipping discs.
So disc rupture, discprotrusion, they are
unfortunately predisposed.
But there are many goodscreening systems out there now
predisposed.
But there are many goodscreening systems out there now.
So it's possible to find uh, uhsort of breed lines that are
much less at risk of that.
But, yeah, bless them, they'reprobably, yeah, they're
(54:28):
fantastic dogs.
Jenny Chen (54:29):
I love them to bits and I love them too, just not
the bill uh stuff wrong withthem yeah no, no, a little bit
tangential um is is biologics.
You know some kind of umbioprinted, biofabricated
scaffold or stuff like that.
Is on your horizon at all, youthink the next 10 years or so?
Bill Oxley (54:50):
yeah, it's, there's a lot of research, so a lot of
the, the, the.
Yeah, it's, it's difficultbecause a lot of the, the, the
knowledge exists, but it's onthe human side and it's human
research, so a lot of the humanresearch models are done in
animals.
So there is a lot, a huge amountof incredible knowledge about
(55:12):
how to bring these thingsforward, but the problem is it's
all proprietary because these,these are companies that have
spent billions of dollarsresearching stem cells,
researching scaffolds,researching cartilage
resurfacing.
They're not about to share thatwith me and they're not about
to share it with anybody,frankly, so that knowledge
exists, but we can't get ourhands on it, um, and again, some
(55:34):
of it will come down to cost,um.
You know, these things, bydefinition, are expensive, um,
and they will be for a long time.
So you know, there are systemswhere you can certainly pay
companies to extract stem cells,um, which you can use, but the
evidence, in the kind ofrelatively rudimentary way that
(55:55):
they're currently available tobe used, is a bit sketchy, to be
honest, I think yeah, it's so,yeah, it's out there for sure so
, in terms of actually printinga bioscaffold that's impregnated
with stem cells and slottingthat into a critical defect,
yeah, we're way off from that,and we do have alternatives.
so it's not as if it's somethingthat I feel is a huge priority,
(56:17):
but it is something that isbeing worked on not by us but by
clever people, so it will comethrough but not for.
Jenny Chen (56:25):
So yeah, we're kind of reaching the end of our
interview.
We have a couple of funquestions for you.
If a young veterinary doctorwants to get into 3d technology,
what are your advice for him orher?
Don't have a personal lifebecause you won't have time oh
(56:47):
okay, advice or warning I meaneither one, I guess.
And okay, of all the animalsyou have worked with, which,
which kind of animal is yourfavorite?
Bill Oxley (56:58):
oh, I love.
Well, we mostly treat dogs, sobig dogs and little dogs, yeah,
so Daxies and Wolfhands, they'remy favorite, so I love treating
them.
And we treated a kangaroo a fewmonths ago Kangaroo.
Jenny Chen (57:09):
Yeah, nice, that should be reported in news.
I hope, hope to see you soon.
Bill Oxley (57:17):
And if you're going to print anything for yourself.
What are you going to print?
Uh, I don't know.
The best thing I've ever 3dprinted was a, a beer holder
that sat on the arm oh, I likethe sound of that and it was a
curved couch and it made a flattop and I could put my beer on
it.
So that was it's pretty prettywe're gonna have a photo someday
of that.
Jenny Chen (57:35):
And then are you a big consumer of podcasts, books,
any media you would recommendto people as a resource?
Um, well, personal development,it doesn't have to be
professional no, you do not, notreally.
Bill Oxley (57:50):
No, I I'm a big, I love, uh, climbing and
mountaineering, and I think thatthat changed me as a person and
it made me kind of veryself-sufficient, very, um,
single-minded.
So I think having somethinglike that that really kind of
gives you that sense of you know, drive and determination to
(58:12):
actually be fantastic, that'ssomething I think is, um, is
great.
But yeah, it depends what youryour are, I suppose.
Jenny Chen (58:20):
So you must have read Into Thin Air or something
like that Absolutely yeah.
So what was your last peak thatyou climbed?
Bill Oxley (58:27):
Oh, I run around in the hills in the Lake District
where I live, so I go up anddown and up and down and it's a
beautiful place.
So when I stopped being afull-time surgeon I could come
and live anywhere.
I just needed internet and apostal service.
So I came to a beautiful partof England that has hills and
(58:47):
valleys and lakes and lots ofsheep and it's beautiful.
So I kind of run around inthose and yeah, that's like my
dream life.
Jenny Chen (59:00):
Not there yet.
Well, I think we reached theend of this interview.
Thank so much, bill, for yourtime and insight today.
Um, and if people want to getin touch with you, how can they
reach out to you?
Bill Oxley (59:09):
yeah, just drop me an email.
It's just bill at vet3dcoukokay, that's really easy.
Jenny Chen (59:15):
Thank you so much, bill.
Thank you, jenny, it's been apleasure.
Thank you, yes.
Hi there, Welcome to episode number 88.
Just a quick reminder thispodcast is for informational
purposes only and does notconstitute medical or investment
advice.
Always consult with qualifiedprofessionals before making
healthcare or financialdecisions.
Enjoy, Hi everyone.
Welcome to the show.
(00:22):
I'm your host, Jenny Chen, andtoday we have the pleasure of
having Dr Bill Oxley to be withus.
Dr Oxley has been with usseveral times during our virtual
events focusing on veterinarymedicine and 3D printing, and I
have been impressed by his worksmany years ago, since before
(00:42):
the pandemic by his works manyyears ago, since before the
pandemic, so we're reallyhonored to have him today as a
guest.
And just a little bit about DrAxley's work and I'm going to
call you Bill, since this issomewhat informal and Bill.
So you were trained inCambridge University Veterinary
School and you practiced as ageneral veterinarian doctor for
(01:05):
a number of years before youdecided to go into orthopedics
and since then you alsoincorporate 3D printing and 3D
technology in general into yourpractice.
And there's so manyaccomplishments.
You published more than 20co-authored papers on virtual
surgical planning and 3Dprinting and you have
(01:27):
facilitated more than 4,000cases now using virtual surgical
planning and 3D technologiesand 3D printing.
So it's really impressive.
And you also are the co-founderor founder of, and CEO of,
Vet3D, which is a company that'sbeen operating for a decade now
.
So, Bill, welcome to the show.
Bill Oxley (01:48):
Well, thank you, Jenny.
That's really kind of it'sgreat to be here.
I've, yeah, always been a bigfan of 3D Hills and your mission
to kind of bring thistechnology more to the forefront
.
So, yeah, it's wonderful to behere.
Jenny Chen (02:02):
I am obviously a fan of yours and you know I am a
radiologist.
I wanted to serve humansearlier in my career.
What made you become interestedin veterinary medicine and
decided to go to vet school andthen eventually become a surgeon
today.
Bill Oxley (02:22):
Yeah, I think it's a bit of a cliche, but I guess
I've just always loved animalsand I knew at school science was
the thing that I enjoyed and Iloved doing.
I was terrible, terrible at art, I was terrible at languages,
but science was the thing Icould do.
And I suppose when it came todecide what to do sort of
(02:44):
further on in my educationalcareer, I guess I put those two
things together.
So, yeah, that was the story.
My mum and dad got a dog when Inever wanted a dog, but then my
mum and dad got a dog when Iwas 12.
And of course I fell in lovewith her and then that was the
start of it all.
So yeah, it's a story that manywould share, I think.
But yeah, it's the science andthe animals at the same time is
(03:07):
always the the combination forme yeah, no, growing up with
animals is a really wonderfulexperience.
Jenny Chen (03:14):
I actually was later in my life to get a dog and I
totally now get it why they'reso important in our lives.
You've practiced as a generalpractitioner for a decade, I
would say almost before youdecided to become a orthopedic
surgeon and maybe specializingin small animal.
Is that correct to say?
Bill Oxley (03:34):
Yes.
So I think the careerprogression is a little
different to maybe how a newgraduate would maybe do things
now.
For me, but certainly the pathin the UK.
When I just qualified it waspossible to go straight into a
residency and a more advancedcareer path.
But many vets would spend sometime in general practice and I
(03:59):
guess I got a little bit stuckin general practice because it
was a lot of fun and I was doingmy life, but I'd always had
this hankering to be.
I loved surgery and I never Idon't know why I loved
orthopedics.
There was just something aboutit that I loved and I'd always.
I always knew I wanted to dothis.
But and I sort of messed abouta little bit in general practice
(04:22):
and you know I enjoyed fixingfactors but I I kind of knew
that I wasn't very good at it.
And yeah, I was very fortunatethat I had the opportunity to
work at a referral practice andthe surgeon there kind of took
me under his wing and a friendof mine, duncan midgley, and he
really got me started withorthopaedics and then I was able
(04:45):
to further my career path.
So yeah, I think there's.
Sometimes I look back and think, oh, maybe those years if I'd
been doing orthopaedics.
But I think it gives you awonderful grounding in you know
understanding what clients want,how to communicate with clients
, just the real hands-on generalpractice.
(05:07):
You can't beat that experience.
So I don't.
I don't regret it, but yeah,it's a job to get started I
agree that's wonderful.
Jenny Chen (05:14):
Um, and then you progressed into even more, uh,
technical hands-on and andincorporating virtual surgical
planning and 3D printing and 3Dtechnologies into your practice.
I mean, that is the leap thatnot many veterinary doctors
would go for.
So what inspired that?
Bill Oxley (05:35):
Yeah, and this really was that kind of eureka
moment, I suppose, when at thatpoint I completed my residency,
I'd become a specialist.
At that point I completed myresidency, I'd become a
specialist, an orthopaedicspecialist.
And I was kind of reached thatpoint in my career where, of
course, naively at the time, Ikind of thought well, you know,
I've got my board exams, thismeans I should be this, all this
(05:57):
perfect surgeon, I should beable to do anything.
And I was still struggling withdeformity corrections, and I'd
been on the courses, I'd readthe books, and I was still
struggling with deformitycorrections.
And I'd been on the courses, I'dread the books, I'd done the
exams and I'd plan these thingsand I'd go to theatre and
nothing that I planned wouldwork.
And then I'd be there and I'dbe slightly panicking and the
bones in two pieces and my planisn't working.
(06:18):
And for a long time I kind ofblamed myself.
But then after a while I kindof thought, kind of thought well
, actually, maybe it's not me,maybe it's the way that we're
planning these, maybe it's theway that we're actually thinking
about with the way that we'vebeen, we've been taught for all
these years and how to planthese things, and so I started
looking at bones in 3d um, justworking out how to take them
(06:39):
from the ct scanner, take theminto cad software and just print
them out so that I could lookat them and maybe well, maybe I
could work out why I can'tunderstand how to do this.
Um, and as part of that processyou have to take the bones
through the CAD software andyeah, there's all this stuff
that you can do in the CAD andall these buttons and you can
cut the bones in it.
And then, kind of I just hadthis thought that well, wow, I
(07:02):
could actually use that to do mycorrection on the computer and
make all my mistakes therebefore I went to surgery.
And from there I kind of workedout that I could make and make
guides to actually do that forme, do my planning, and that was
really the start for me and itwas really putting together that
know sort of slightly, I guess.
(07:25):
Techie, you know I've alwaysloved cad, I've loved I had a 3d
printer, I loved all that stuff.
And putting that together withthe, that level where I was with
my surgery, those two, that theintersection of those was
really what made that first stepyeah, um, you know, during our
prep work you said the printingis really the last step of this
whole process.
Jenny Chen (07:46):
The thought and design process is really the
bulk of the work, really, andsince you mentioned the
traditional way of planningthese surgeries, I would assume
that the old ways wastwo-dimensional.
Can you walk us through how itused to work?
Bill Oxley (08:03):
Absolutely, you're exactly right.
The original, and it's stillwidely used, and the theory that
I think we'll probably come onto a little bit later as well is
Cora theory, which most peoplehave heard of, if you're
interested in this kind of thing.
It's originally sort of drawnby Draupeli who's just a legend,
(08:25):
still doing clinical practiceum, but at the time where draw
developed the core theory, itwas cts existed but all of the
planning was really done in 2dum and that whole wonderful core
framework, which is stillcompletely valid um, was all
derived from radiographs, reallyfrom, from, from 2d imaging
(08:48):
ultimately, and that the theoryis still absolutely correct.
The difficulty is in complexdeformities, the, the, the, the
sort of what we call itcovariance, that the, the
influence of a deformity in oneplane, affects the measured 2D
measured deformity, the valueyou get in the other planes.
(09:11):
It's fine if you've got a nicesimple deformity, but with a
really complex 3D deformity,it's not that the theory's wrong
, it's that the data we put intothe theory, the 2D data that we
put into the theory, doesn'treally work anymore.
We can't get the right data andthis is where the 3d planning
(09:32):
can have enormous benefits,along with other things as well,
um, and that was the kind ofone of the things coming back to
my anti-braking problem, I was,yeah, didn't do it.
That was that was kind of whatwas going on.
It was it was the planning thatwas so difficult.
And then translating theplanning to the actual operation
is the next challenge, whichthe guides do.
But, yeah, the differencebetween 2d planning and 3d
planning is absolutely key, um,and it's completely changed how
(09:53):
we assess deformities, um, withyeah we'd draw lines, we'd
measure angles, we'd do that inall the different planes.
these days, pretty much, we justalign the top bit in 3d, we
align the bottom bit inD, andthen we work out what to do in
the middle, and it's a very,very different way of doing
things.
Jenny Chen (10:11):
It's very different, I have to say, during our prep
work thanks for sending over acouple of papers that you
published it actually changed myperception on my daily work as
well, because I live in the 3Dworld.
I deal with MRIs and CTs everyday, but I have never tried to
measure anything in 3D.
That is a complete change ofpractice and you know my daily
(10:36):
practice.
For humans, I don't reallymeasure much three-dimensional
stuff other than you know, a big, big tumor.
You measure the biggestdiameter, but I actually don't
know how you train yourself youreyes or concepts.
I mean, this could be the coretheory 2.0 for you, bill.
You could totally just put aname on it um, like, how do you
(10:57):
train yourself to actually havea quantitative analysis of these
three-dimensional deformity,because they're not really like
standard you know femur orhumerus but rather they're like
not normal looking joints.
Bill Oxley (11:15):
How do?
Jenny Chen (11:15):
you do that.
Bill Oxley (11:16):
Yeah, it's a great question and I think this is
where I think the evolution to3D planning still I wouldn't say
meets.
I think it's quite mainstreamnow, certainly in veterinary,
but still meets some resistancebecause quite naturally,
surgeons like to put a number onsomething they like to say it's
got 20 degrees of virus, it'sgot 15 degrees of torsion, and
(11:37):
that's because, kind of becausewe've been trained that way, but
kind of because that's it justgives you a handle on what
you're going to do.
And when you kind of say tosurgeons, well, yeah, that's
great, but actually thosenumbers could well be wrong in
your case anyway, and how areyou going to do that 20 degrees
and 15 degrees, and then you'vegot another plane, and how are
you going to get the cut in theright place?
It's a very different mindsetand I think that's where a lot
(12:05):
of the difficulty that peoplehave had with this, with the 3d
planning, has come that we don'treally we can put numbers on
things, but to get numbers for areally complex deformity you
really need to do athree-dimensional matrix
calculation that only a computercan do, and when you get these
numbers out they don't reallyhelp you much anyway.
Um, and it's a very difficultmindset to get into and I think
people do struggle with it.
(12:26):
And, yeah, it's subjective.
You know, as you rightly say,sometimes we're looking at these
joints and they don't look,they don't look right anymore,
and we we have to make judgmentsabout where to put these.
Yeah, and it's certainly trueto say that there are elements
of the sort of surgical processthat we cannot do in 3D.
(12:46):
We'll probably not be able todo them for a very, very long
time.
So when we talk about jointincongruities, joint laxities,
these are things we can't model.
Yeah, technology we have at theminute and they matter, and
sometimes there are things thatthe surgeon needs to do
interruptively that maybedeviate from the plan that we've
created.
But at the same time, I thinkthe concept of visual alignment,
(13:08):
3d visual alignment is kind ofwhat we all used to do anyway.
You know when, when I was there,I just got on boards and I was
just having my mild panic.
You know, what do we, what doyou do and what do we still do?
Well, we line it up.
You know, we, we, we have alook at the limb and we hold it,
we line up the joints and wefix it like that, so you
ballpark it.
Yeah, in many ways there'ssubjectivity there.
(13:28):
So it's not as if the processalways gave you a perfect answer
.
Every time there issubjectivity, there always will
be subjectivity, especially withour patients, because they're
all different.
A straight leg for a Daxi mightnot be a straight leg for a
Dane and all these things.
Jenny Chen (13:47):
Exactly.
You also have different breedsthat we don't really deal with
in the human category.
So that is another variablethat you add into your daily
work, variable that you add intoyour daily work.
Now, after you have done allthese cat analysis or 3d
analysis of a deformity orabnormality, how do you, how do
(14:07):
you incorporate 3d printing intothe picture here and how does
it work?
Does it really close the dealfor you?
Bill Oxley (14:13):
yeah.
So the, as we've just beensaying, we can derive this
wonderful plan in 3D and we cansee we can do a virtual
correction.
If we get it wrong we can tryit again and we can see that
we've got a nicestraight-looking limb.
But to actually create thatosteotomy for the surgeon it's
got to be in the right place, atthe right angle.
Then you've got to move thesegments in three dimensions
(14:35):
exactly the right amount.
So to translate that plan totheatre, that's where the 3d
printing comes in.
And effectively we just designa guide that snaps onto the bone
only in one place and it tellsthe surgeon where to cut, and it
has pins there's all sorts ofthings these days to then assist
the surgeon in the realignmentto make sure that that's.
(14:56):
That's exactly how we'veplanned it.
And then either the surgeon canjust pop on a normal plate that
they've pre-contoured to fitfrom a 3D printed model, or
sometimes we usepatient-specific implants.
So the 3D printing of theguides and the models is how we
shift the plan to reality insurgery.
Jenny Chen (15:16):
How many times these surgical guides that you
created doesn't fit or won'tcreate the outcome?
I mean does that happen oftenor not at all.
Bill Oxley (15:27):
It's something that absolutely can happen, um, but
it's usually, or it should be in, in predictable situations.
So sometimes we're planning aparticular correction and we can
just tell you what the guidesneed to fit is contour.
They need cortical contour.
So we need some curves, somebumps, whatever it might be, for
(15:48):
the guides to latch onto.
And sometimes we're fixing abone and there just aren't any,
you know, for whatever reason,or they're really poor, and
sometimes we can modify designto you know, get around that
problem.
But sometimes you have to sayto the surgeon look, this just
isn't a great case, you know,I'm really sorry, but you, you
know, probably get it to fit,but you're gonna have to be
super careful when you'reputting this guide on, uh.
(16:10):
The other situation where it canhappen is growing animals, um,
so obviously an animal that'sgrowing quickly, it's going to
the bones could be gettingbigger, they're going to be
changing shape as well.
So if you have too long a gapbetween your CT and the surgery,
the bone can just have changedand so the guide won't just
literally doesn't fit on anymore.
So there are predictable timeswhen it can happen that we can
(16:33):
be on the lookout, for it reallyshouldn't happen otherwise, as
long as the surgeon has used theguides correctly and has put
them on correctly, because youknow we do do various sort of
checks to make sure that theguides fit on the bones and we
know that the bones and theguides that we derive from the
CT data have very high fidelityto the CT.
(16:53):
So we know that that bit shouldbe okay.
So if something goes wrong it'susually a sequencing error in
in surgery now?
Jenny Chen (17:03):
um, I've never performed a surgery before.
I mean I've scrubbed into some.
When you're in the surgicalfield, it's quite bloody and
hard to see things, and not tomention you have to move all the
soft tissues away to expose thebone.
How do you find a landmark tosnap on your guide?
This is a question that bugs meforever.
Bill Oxley (17:21):
I just gotta ask you yeah, and a lot of this comes
down to how we actually plan theguide system.
So part of what I do actuallythis is kind of.
When I started doing this, Idid the guide design.
They were terrible.
I did design the guides.
I, you know, I printed themmyself.
I'm really lucky now I havepeople to help me with those
things much better at it than me.
(17:42):
So my job now is really kind ofdoing the surgical planning
because, being a surgeon, I canthink through the planning, all
the deformity correction stuff,the technical bits but also I
can think through well, actually, where is the exposure?
Because I've done the exposures, I know where they are.
So I know what the surgeon isgoing to be looking at when
they've exposed the bone.
I know what bits of the boneare safe to use for guides.
(18:08):
You know which bits can weclean the soft tissues away, or
where are veins, where arenerves, where are places that we
just can't get to?
So we can integrate thatknowledge into the overall sort
of conceptualization of theguide system.
So when the surgeon comes to doit, there's the right bumps and
(18:28):
nobbles and curves that thesurgeon can access that are
available for the guides to fitonto, so it's an important part
of how we design the systems.
Jenny Chen (18:36):
Wow, that's a lot more elaborate game plan than I
thought it was going to be forsure, it's totally all in your
head, except the final point ofprint the guide like you said
yeah, so what was?
The.
So you've done 4,000 cases Were.
These cases were done allthrough your company, vet3d, or
(18:56):
there's some before that as well?
Bill Oxley (18:58):
No, I mean mean I started doing them for myself so
, um, you know, I suppose maybeI'd probably done a hundred or
so of these from me and myimmediate colleagues before I
thought, actually this is reallysomething I probably need to do
something with um.
And so, yeah, there wasdefinitely a period before I
(19:20):
really got into, I reallystarted vet 3d as an entity, um,
and was there like a aha moment, where you'd be like I want to
translate this technology morepractices and more animals I
don't think it just a sort ofspecific moment, but it's kind
of and I mean I won't, it wasgreat, it was.
(19:42):
It's sort of when you kind ofshow it to colleagues that you
expect and they say, whoa,that's actually pretty cool and
that's really nice.
Jenny Chen (19:53):
Yeah it is, I bet I can feel it, even though I
didn't experience it actuallythis.
Bill Oxley (19:59):
This is really something that could make a real
difference.
You do feel a sort of roleimperative, but you do kind of
the whole point of.
For me, the whole point ofbeing a surgeon, of trying to
get really, really good at beinga surgeon, is so that we can do
better for our patients.
And of course, there'sprofessional pride.
(20:21):
Pride, you know you want to dothings well, but really you want
to do them well for yourpatient because you want
everything to work out reallywell.
And I think for me, when I kindof it dawned on me that this
really could help with clinicaloutcomes and it really could
allow us to do things that wecouldn't do before, I think that
was when I thought, oh, I needto run with this.
You know, I need to try andmake something happen so you
(20:44):
know this is not a video based.
Jenny Chen (20:46):
I mean we're we're not showing animal videos, which
people love, but I'm sure youhave several really satisfying
cases that you remember of yourentire decades of experiences
here.
You want to share a few caseswith us that really made it for
you.
Bill Oxley (21:03):
Absolutely.
I mean, there's one thatcompletely sticks in my mind
which was a great day, and Iwon't say her name because the
owner was didn't really want usto share the case specifically,
but we can talk in generalitiesand this was a great dane who
had an osteosarcoma of herdistal radius and she was a big
(21:25):
dog, 60 kilo dog right and wehad to.
Well, I didn't do the surgery, Imade guides and implants for a
surgeon to do um and we had toreset probably 20 centimetres of
this dog's radius.
So it's a huge resection in adog and we were able to use a
(21:46):
patient-specific implant forthat dog, guide systems that we
designed, a plate that wedesigned, and we were sent a
video of the dog running on thebeach at 12 weeks stop,
completely sound, completelyhappy dog, and it was just one
of those sort of cases where youthink, well, that is, that's
(22:10):
quite amazing, because that issomething that would have been
unbelievably difficult toachieve without a very specific
type of implant and a veryspecific set of guides and
planning.
And to see that dog do so wellwas wonderful and it's probably
my highlight case.
Jenny Chen (22:28):
Yeah, I mean, I'm just trying to visualize this
dog, right, I know they're big,I've never had one.
20 centimeter, that's like twometers.
Oh no, that's zero point.
Wait how many meters?
That's zero point.
Two meters?
No, that's zero point.
Bill Oxley (22:38):
Wait how many meters , that's zero point meters, 20
centimeters, 20 centimeters soyeah it's kind of that's pretty
big.
Jenny Chen (22:44):
That's pretty big, yeah.
It's kind of that's almost likehalf of the leg right yeah yeah
, yeah, it was a.
Bill Oxley (22:49):
It was a significant proportion of this dog's radius
.
And this dog stands what kindof up to your?
Up to your sort of chest, Isuppose.
Um right, it's a big dog I mean,the other option for this dog
would be amputation of some sortyeah, so previous sort of limb
spares called limb spare,previous limb spare techniques
have been described but they hadhigh rates of complications.
(23:10):
Dogs, could you know they wouldbe lame because of the surgery,
the, the attempts that weremade to reconstruct the leg
would take a long time or hadhigh infection rates or other
complication rates.
So yeah, that would either betried and so the dog would kind
of just be lame and unhappy.
All, all of this every time itwouldn't be a dog anymore yeah,
(23:30):
and these dogs are life limitedso these tumors do normally
metastasize and min survivaltimes, maybe a year.
So if you're going to do a bigoperation you need the dog to be
a happy dog for a year.
You don't need it to take ayear.
Jenny Chen (23:41):
Quality of life yeah .
Bill Oxley (23:44):
So, that's a big thing, but yeah, you're right,
otherwise it would be amputation.
So it's all about quality oflife and it's being able to use
these technologies to improvethat quality of life outcome.
Jenny Chen (24:05):
And that was the case.
It was a perfect case, perfectexample of being able to do that
.
Yes, and, but you don't justrely on these.
You know individual cases.
You actually published 20papers evaluating various
aspects of virtual surgicalplanning.
Bill Oxley (24:13):
And how do you collect these evidences and what
are some of the numbers thatyou can show people that this
procedure really is a betterapproach, significantly yeah,
that's a great question and it'sit's data that's hard for us to
to collect actually, inveterinary medicine, for various
reasons, outcome assessmentsare always hard to assess
(24:34):
because you just can't ask thepatients how they're doing Right
, it sounds silly.
Jenny Chen (24:39):
Pediatric patients forever.
Yeah, it's the same thing.
Bill Oxley (24:43):
Infants.
It's quite a problem.
So that level of outcomeassessment has always been quite
hard.
But, that having been said,there are instruments to do that
, there are ways to do that, andI think something that, moving
forward, we really need to do isto set up a case registry and
to collect that data long term,and that's something that we
should have done years ago and,frankly, we never got around to.
(25:05):
A lot of the stuff we'vepublished have been literally
the case I just described.
They've been proof of cases,they've been accuracy studies
that guides are more accurate,both for sort of neurosurgical
screw placement and forosteotomy creation, angles,
positions and time as well, youknow, showing that these things
are quicker.
(25:26):
They save surgical time, whichis directly related to
complications.
So a lot of the stuff thatwe've published has been
accuracy based, speed based, butalso we have clinical outcomes
of individual cases, small caseseries, sort of dax and
deformity corrections, um,certain neurosurgical syndromes.
We know we followed those dogsout for for periods of time, but
(25:50):
it would be wonderful to do bignumber outcome studies and
that's something that we willmanage to do at some point yeah,
well, hopefully some of thelisteners can also reach out and
collaborate.
Jenny Chen (26:05):
Um now for people who are just starting to be
interested in using thisapproach is there any paper
specifically, or review papers,that you can recommend people to
go for?
Bill Oxley (26:16):
yeah, it's.
It's a difficult field becausethere's still there are books on
the human side about um 3dprinting in in human medicine,
but there isn't really anythingthat there is a.
There is a publication on thethe the veterinary side, but it
it tends to my particular field,orthopedics.
There isn't really very much onit and I think really if I was
(26:37):
going to recommend one thing,it's draw paley's book, which is
still, you know, sort of thebible for deformity correction
and we'll put the link in theresomewhere in a podcast note yeah
and um, I mean, as if you're anorthopod and you're interested
in understanding how to assessand to plan deformities.
That's the.
That's the wonderful place tostart.
(26:58):
Um, but yeah, the 3d printingthing it's still, and certainly
when I started there, just isn't.
If you can't go and buy a bookthat tells you how to do this
stuff and um, that's still thecase and it is um.
You know, people do ask me andI can't help everybody that asks
me.
You know, how do you, yeah, howdo you do the segmentation?
(27:19):
How do you print it?
How do you assess thisformality?
It's like it's a whole book.
I can't tell you, I can't teachyou.
Jenny Chen (27:25):
It's probably a series of books that no one has
the time to write.
That's the problem.
Bill Oxley (27:30):
Again.
You know a good friend of minehas you know we were meant to be
writing, doing a book on this,editing a book on this and it's
just, I just don't have time.
Jenny Chen (27:41):
It's impossible.
Bill Oxley (27:42):
Yeah, it's a monstrous project.
Yeah, it's huge, but yeahspeaking of monstrous projects.
Jenny Chen (27:45):
I mean I think that 3d, in a way, it is a big
project for you, uh, in yourlife, and you know it is a
business that you're building,where there are some.
Tell us some of the challengesthat you have met earlier, both
on the technical side and alsothe business side of building
VAT3D.
Bill Oxley (28:03):
Yeah, I mean I think the first one was literally
what we just said.
I mean, I kind of knew what Iwanted to do, but I had no idea
how to do it.
I didn't know how to extractDICOMs from the CT workstation,
let alone turn them into a 3Dmodel, let alone how to print
them workstation, let alone turnthem into a 3d model, let alone
how to print them.
And because I was kind of, Iwanted to do it, I spent ages
(28:24):
googling it and trying to workout how to do it.
How could I do it with my ctmachine, with my printer, and
this huge learning curve ofunderstanding cad software which
you know, as it turns out, my Iwas very amateurish at, and now
my colleagues who do all theplanning, uh, the design, uh,
for me are so much better at itthan me and use amazing software
(28:46):
so that I don't even can eventurn on.
So I think there is a huge,there was a huge technical
learning curve to kind of makewhat was in my head actually
happen.
Um, and I think that's probablythe biggest challenge for
anybody that kind of wants todabble in this themselves.
It's just those first steps ingetting going with it, I think
(29:07):
from the business side it kindof happened organically.
It was little mini steps for me, you know, I didn't come in
with a huge backer and a milliondollars and I just said, well,
you know, let's set up your lab.
It was, you know, I kind of gotanother printer and then, you
know, I got a little office.
That was a big step.
And then I am, I got my firstemployee and in fact these are
like, of course you did, it'sobvious, but at the time they
(29:29):
were kind of kind of scary steps.
But uh yeah, for me it'shappened very much incrementally
, which has been lovely becauseI've been able to build things
up gradually and I think it'smade a very solid foundation.
But certainly I'm a nobusinessman, so I made a lot of
mistakes in building up my teamand kind of getting the
(29:50):
organizational structure for thebusiness organized.
But yeah, I could have done witha business expert to help me
with that, that's for sure.
Jenny Chen (29:58):
Well, some people don't need to go to business
school to learn business.
And then you just did it bydoing, and I actually got
interested in 3D printing alsoaround the same time.
I think around 2012 or 13 iswhen everybody started to talk
about 3D printing for healthcare.
I think that at the time, the3D printing stocks are at the
(30:20):
peak of its hype.
It was in the hundreds ofdollars and everyone was totally
talking about how 3D printingcan change the world and I think
I got into that wave ofinterest and it is very
interesting, I'm stillinterested until today.
However, it is absolutely truethat there's no resource.
There was no resource for you.
(30:41):
There are a couple of opensource softwares you can try
perhaps, but it needs a lot ofdoodling and tinkering and there
was no official courses toteach people what these are.
We have some rudimentarycourses kind of expose people
what applications 3d printingcan do, but by no means can
(31:04):
teach people actually how to doit.
That gap is, I think, stillpersists still today I agree
with you.
Bill Oxley (31:10):
I agree, and some you know the big human health
care um, certainly on theorthopedic side, sort of
materialize.
You know they've been way outahead and have done wonderful
development work and they do runcourses.
But unless you know one of mycad techs, she basically learnt
in the human healthcare systemin the UK and it was very, still
(31:34):
almost an apprenticeship andorganic.
You know there was nothingmaterialised but it was still
very much and organic.
You know there was nomaterialized but it was still
very much.
Well, you know her colleagueshad learned how to use haptic
and and different softwares andso she learns and it was very
much that, rather than headingoff and doing a degree in it or
going on a big long course.
So they, they do exist but theythey absolutely.
Jenny Chen (31:54):
There's nothing you can do to kind of take you
through the whole process andwithout devouring any
preparatory information, um whatsoftware and printer system do
you guys use nowadays?
Bill Oxley (32:06):
yeah, no, it's um, we use, actually we use a
combination which is almost acase in point of what we've been
saying.
There's still nothing out therethat, in our opinion, like just
does everything and it isperfect.
So we use mimics.
That's a materialized packagefor our segmentation.
But, to be honest, we alsosometimes use horus, which is
which is free if you've got amac which one sorry horus, so
(32:29):
h-o-r-u-s, so it's it's okay,never heard of it yeah, no, it's
a.
It's a, it's an image viewingsoftware.
Oh interesting, but actuallyreally quite good at
segmentation as well.
If you know what, what, whatsequence to use um for the, the
planning, I use a softwarecalled um autodesk netfab um
which is a.
(32:50):
It's a generic cab yeah actuallywe have to use workarounds, but
it's actually very good um andit.
I've used it for all of thistime and it it works nicely.
Um, I have, um, my colleaguesuse three matic with another
materialized software a bit, butpredominantly geomagics, which
is a um, uh, really a 3Dmodeling software.
(33:13):
So it's used almost likesculpting.
It's almost more of a sort ofuh, free artistic.
You know that people use it forsculpting 3d models for film,
yeah, things like that.
I mean it's yeah, when these arehaptic arm to literally sculpt
uh virtual clay and that allowsus to to make very organically
shaped patient specific implantswhich are wonderful to use um
(33:38):
and would be extremelyimpossible to create on a more
sort of engineering-based CAD,where everything tends to be
straight lines and angles, whichis how plates have
traditionally been designed inother softwares.
And the printers, we still useForm Lab printers, so we use
form force.
(33:59):
Now, um, and they're they'regood.
I won't say they're perfect,but every printer in the world
has a failure rate and you knowwe do get print fails, but
actually they allow us to do allof the things that we need to
do, so to print it uh,biocompatible plastics,
autoclave, right, and we knowthat they have very high
(34:19):
accuracy, high fidelity to theoriginal CT.
So, obviously that's a wholetextbook in itself, but we know
what those printers produce forus.
We know that that's going to beaccurate to within well,
basically microns.
Well, sub-millimeter is best tosay, uh, but high, high
(34:42):
accuracy.
So yeah, we know that each stepof the, the process has the
ability to produce the accuracyboth of the guides and models
that we need for the, the, thesystems, to work clinically.
Jenny Chen (34:56):
Yeah, I think that's a good segue for a couple of
topics.
One is the steps when a newsurgeon wants to use your
service to produce their ownsurgical guide.
How does it work for them?
And the next question will bethe QA process, which I
certainly don't want to book,but maybe some general
(35:17):
descriptions about it sure, yeah.
Bill Oxley (35:21):
So I mean again the, the certainly a surgeon that
wants to, you know has adeformity, you know is thinking
about using guides, really the,the whole way that we've kind of
set up.
Vet 3d and other providers dothings slightly differently, or
some do, some don't.
There's lots of different sortof uh workflows on offer, I
(35:42):
guess these days um, but the waythat we do it is always to kind
of make use of myself and mycolleagues.
Um, in the us, jason laid on byantropovsky, in the states even
kamikov said I work with anumber of boarded surgeons who
will do assessments.
So the idea is more that it'snot that somebody sends a ct and
(36:02):
you know they kind of have tothen communicate with an
engineer to say, well, this iswhere you know I'd like you to,
this is what I want to do.
We will say we would kind ofanalyze a deformity or a
neurosurgical problem.
We'll give them a clinicalinput if they'd like it, which
is usually helpful in acertainly deformity corrections
where, like we were talkingabout the 2d versus 3d thing,
(36:24):
you know, we can offer thatlevel of insight into what the
deformity is, discuss with thesurgeon how they want to address
it, because there's rarelyyou're right where in the wrong
way.
There's always shades of graywith these yeah and then once we
have a plan finalized with thesurgeon, then we can kind of
pass it on to the engineers andthey'll do the design and the
print and we send out the finalsystem.
(36:45):
So it's the whole way that wedo.
Things is tailored around theclinical aspects of the case as
well as just like producing theguides and selling.
Jenny Chen (36:56):
Right, it almost sounds like a second opinion.
Bill Oxley (36:58):
It is, I think it is a surgical consultancy.
I mean it's you know somesurgeons want more, some
surgeons want less, and that'sgreat.
You know some.
So you know, for cases whereyou know the surgeon, we've done
loads before and the surgeonknows exactly what they want and
they know exactly how we'll doit.
They'll just say, yeah, it'sanother one of them.
Great, off, we go, you go.
You know that's fine.
But the way that we tend to setthings up because we are
(37:22):
dealing with vastly more complexdeformities these days, much
more challenging problemsthere's always a clinical
dimension.
It's very rare that it's justlike sort of a slam dunk.
This is what you need.
There is almost always nuances,different ways to do it surgeon
preference, client preference.
(37:42):
How much money have we gotavailable?
All of these factors that youneed to kind of all integrate
together to come up with asurgical plan that's going to be
optimal for everybody, you know, for the surgeon, the patient,
the dog's owner, the cat's owner.
And that's where I think thatit's time consuming and it's
difficult.
Yes, Outside of the surgerytheatre, time consuming outside
(38:04):
of the operating room, andthat's the point when you take
it surgery, it's quicker and itshould be exactly what you think
is going to happen.
Happens, which is what you wantat that point in the
proceedings.
Um, so yeah, I think that'sthat's how it works with a new
surgeon and it's and you knowit's.
There are other providers outthere who will do some of the
thing to us or who will justoffer that engineer-based
(38:27):
service, and some surgeonsprefer that.
They don't want me, you know sothat is my question as well.
Jenny Chen (38:32):
You know, personally I like a second dentist to have
an opinion on my teeth or mydog god forbid if she ever needs
surgery.
I would like to have a secondopinion.
I don't mind of extra cost, um,but the thing is you need the
surgeon, the primary surgeon, tohave the humility to actually
acknowledge limitation ofknowledge and skills and
(38:53):
actually reach out to peoplelike you.
How do you work with thatdynamic?
Bill Oxley (38:57):
it can, can be quite difficult.
And it's a great questionbecause I think there is and I
think certainly there arecertainly surgeons out there who
see it as a personal slightthat guides could even possibly
improve their surgical outcomes.
And you know, there is a littlebit of an ego thing there
sometimes.
(39:17):
For sure, not a lot of them isa little bit of an ego thing
there sometimes, for sure, not alot of.
I think I'm in many ways luckybecause I have been doing this a
long time and I've beenpublishing a lot on this and
I've been right, I suppose I dohave a level of experience and
reputation for understandingdeformities at a very high level
.
And I think it's like anything,I think our profession, just
(39:39):
we're going somewhere as humanmedicine we're becoming becoming
so much more subspecialized.
You know, I think back in theday you were an orthopod and
that was it.
And these days almost everybodyhas an area that they're
particularly interested, they'reparticularly good at that they
do a lot of and get particularlygood and get particularly good,
(40:00):
and for me that's deformitycorrections.
And you know, I think that most, most surgeons out there
realize that yeah, that's cool.
You know, that isn't that's notsaying, oh, you're a rubbish
surgeon that's saying well, youknow, these guys do this day in,
day out.
Why wouldn't I sort of leveragethat experience, that knowledge
?
So I think we're kind of pastthe point with most people now
that they feel I'm coming in andkind of, uh, patronizing them
(40:22):
or telling them how to do it andit is very much a collaboration
.
I mean I have to try andcontrol myself, think, well, you
know, I'd maybe do it this way,but you know there's perfectly
valid alternatives and I'll byall means help you with those
alternatives if that's what youprefer, and make guides.
So but yeah, sometimes there isa process of tactile
(40:42):
communication that's needed yeah, for sure the soft skills.
Jenny Chen (40:46):
But, bill, you're such a nice person I can just
tell after you know 30 minutesin.
You're so easy to talk to andfriendly.
Uh, it will make things easier,probably, for people yeah, now
in terms of the economics behindthese cases.
I don't know if it makes sensefor the other people to reach
(41:08):
out for your consultation or,just overall, does it save money
for the overall cost, not justthe surgery but also aftercare
and stuff like that?
What are the economics behindeach case?
Bill Oxley (41:19):
I would love to be able to investigate this and
maybe on the veterinary side,certainly in human medicine,
people have looked at the costbecause, right, it's so.
The cost is so much greater onthe human side and you know, 10
minutes in in the operating roomis whatever it is a thousand
dollars or something crazy.
So if you can save that 10minutes, then you can save an
(41:42):
awful lot of money.
Um, and it's the same for us,but on a, on a sort of a few
rack sort of notches down.
Certainly there's quite a lot ofum human literature now that
demonstrates, you know, actualdollar savings, um, due to the
use of guides, just basicallythrough time.
You know, if you, if you cantake 10 or 15 minutes off your
(42:04):
surgery which you will, you know, or more, then you save x
amount of um money.
Um, and the other costs areless tangible.
But things like, certainly onthe veterinary side, you know,
if there is a complication,sometimes clients are able to
pay for those, or if the dog'sinsured, then that's covered,
but often, you know, vets end upcovering complication costs
(42:24):
quite often and if we can reducecomplication costs, then that
saves the practice money andalso planning costs.
So for these very complexdeformities, you know I would
spend half a day, usually on mytime off, sort of trying to work
out how to fix this.
And if the surgeon can savethat time, they're not staring
at radiographs, they're notdrawing lines, they're not
(42:45):
trying to work out angles, draw,you know literally, do you know
trigonometry and and signs andthings?
Um, then that is saving them achunk of time and that's a chunk
of time they could be doingsomething else.
You know they can either bedoing another operation and
creating income, or they can be,I don't know, spending with
their families, you know well,you're basically a quantum
(43:07):
computing for um complexorthopedic surgery that's the
plan.
So, and yeah, it's timeconsuming because, again,
because, like anything in life,because we do it all the time,
you know, we can do it quicker,usually right and hopefully, you
know, at a more sort ofaccurate level, than somebody
that does one of these every sixmonths, um, and doesn't really
(43:29):
like them.
So, um, I think there's a lotof ways.
There are sort of tangible costsavings and intangible cost
savings that are harder to sortof really pin down.
Yeah, put them together, therewas a significant offset of the
cost of the guides, um, butwhere that is, I couldn't say,
but it's definitely there yeah,I think you know the intangibles
(43:50):
where the animal got better andlively.
Jenny Chen (43:53):
You know the great, the great ding story.
I bet that owner will come backagain if there was some other
dog but for the fact.
Bill Oxley (44:01):
In fact she has, you know, told her friends in the
great dame world that you knowthis works and so, and other
cases have happened as a resultof that.
So, um, these are, these sortof ripple effects have do good,
you know, in a, in a way thatyou can't really put your finger
on, but yeah for sure.
Jenny Chen (44:21):
Yeah, I was just thinking in terms of the
economics.
You know, the time saved, thecomplications saved, revision
saved and happiness added up.
Subtract the time, uh, with thecost of you having to do the
planning and creating the guide.
If that turns pretty positiveand demonstrable, you know that
that will be a turning point forthis entire industry to really
(44:43):
bloom.
Bill Oxley (44:44):
Yeah, and I think we do see it and I think you know
I I don't know a number, but Ithink the significant majority
of surgeons that start usingthese keep using them.
You know they, they, oh well,that was kind of fun but it
didn't really work.
You know, I think they keepcoming back.
So I think it kind of fun butit didn't really work.
You know, I think they peoplekeep coming back.
Jenny Chen (45:01):
So I think it kind of demonstrates that you know
there is surge in happiness aswell as probably financial
happiness as well yeah, um, ittranslates in health care in
general if the patient doesbetter, eventually you will make
money as well, because justgoes hand in hand.
Um now, speaking of your, um,your clients, um, you've helped
(45:23):
you.
You're not just doing it ineurope, you did it in all over
the world, right?
Bill Oxley (45:28):
yeah, yeah, yeah, it's really cool.
Um, so, yeah, I mean europe,the us, obviously, um,
throughout europe, australia, uh, new zealand and you know other
places we do.
We have surgeons in Japan,south Korea, yeah, lots of
Brazil, lots of places.
So, yeah, it's cool.
(45:50):
It's cool the bulk is thosethree main continents, I suppose
, but I suppose that's wherehealthcare, pet healthcare,
industries tend to be focused.
But, yeah, it's lovely, yeah.
Jenny Chen (46:05):
And then, so do you see any trends in these
different markets?
You know, for example, are youin Europe and, as I remember,
european pet market has thehighest penetration of medical
insurance for pets, as opposedto America actually has pretty
low pet insurance penetration.
So do you see any market trendsthese days in these different
markets?
Bill Oxley (46:27):
I mean, you've hit the nail on the head.
It's all about insurance, and Ithink mainland Europe is maybe
still lagging behind with thatcompared to the UK.
I think there's a very, veryhigh rate of insurance in the UK
, um, not so much in mainlandEurope, okay, I think.
Uh, certainly, in the Statesit's.
(46:48):
It's increasing, but it's stillpretty low, amazingly low, yeah
.
Yeah, but higher in inAustralia, um, which is again
why I think we do probably quitea lot more cases for Australian
surgeons.
There are some cultural things.
I mean, I think the concept ofyou know having a pet that you
spend lots of money on is stillnot so prevalent in some
(47:11):
mainland European countries asit is in the UK or maybe in the
US.
You know dogs, they're workinganimals, you know, and the
concepts.
Yes, my working animal issleeping in front of me right
now.
Yes, absolutely, you know pets,you know dogs they're working
animals, you know.
Jenny Chen (47:22):
And the concepts?
Bill Oxley (47:22):
yes, my working animal is sleeping in front of
me, right now absolutely workingso hard so there are some
cultural differences, but I mean, I think we are very much
driven by insurance, especiallyin in this era that we're now in
of corporatization ofveterinary health care, where
you know everything is so muchmore expensive than it was, um,
(47:43):
just anyway, because of the waythe corporate structure works.
So you know the concept ofspending another thousand
dollars, fifteen hundred dollarson a guide system.
You know that kind of thatextra little slice of money is
maybe not so available.
So there is no question thatthings are so much more
expensive than they were maybe10 years ago and that does
(48:04):
impact on clients ability to payand the reliance on insurance
is is even greater as a resultand so typically the surgeons
pays you guys right and not thepatient directly occasionally we
do it that way.
But you, yeah, it's the surgeonpays, pays us.
Jenny Chen (48:20):
We and if, if, let's say, if I have a dog that has a
deformity but I want you I'm inthe us and you're in uk and my
we have a different surgeon whois working on the case, how do I
, as a dog parent, convince ortrying to get to a surgeon that
can use your service?
(48:40):
How does that work?
Bill Oxley (48:42):
Yeah.
Jenny Chen (48:43):
Hypothetically obviously.
Bill Oxley (48:46):
I guess you kind of put your foot down and say and
do your own research, becauseyou're quite right, these
systems are by no means used byevery specialist orthopedic
surgeon or neurosurgeon in theworld.
I'd love to know that number,actually, but I think it would
(49:07):
be still quite a surprisinglylow number.
And if you personally think,goodness me, I really would like
this technology, then you needto seek out somebody that uses
it.
And yeah, I guess, be a realadvocate for your pet technology
.
Then you need to seek outsomebody, that, that, that uses
it and um, or yeah, I guess be areal advocate.
Yeah, we can, but we don't.
We don't, sadly, actually dealwith with general clients very
(49:30):
much, but we do occasionally getpeople that do ring us up and
say yeah, we have seen yourstuff and where can we go, and
Well, that's a good question,you know.
Jenny Chen (49:40):
perhaps you can create a list of surgeons who
would work in my area, forexample, and generate some kind
of partnership.
Bill Oxley (49:49):
Certainly possible, and we do do that informally,
but it would be certainly anevolution.
It would be a nice resource forpeople.
Jenny Chen (49:56):
Yeah, I saw your website.
By the way, guys, I highlyrecommend to check out Vest3D
website.
Very informative, lots ofdetails, lots of instructions.
I love it.
It's more explanatory and itprovided a lot of clarity of
what is going through mysurgeon's head and how to
achieve the accuracy and qualitythat you wanted to achieve.
(50:18):
So I really love that aspect.
And also, you know, speaking ofthe cost, I know it's expensive
now but, like a lot oftechnology, I do believe it's
going to get cheaper over timewith the progression.
Just imagine the TV.
A couple of decades ago, theflat screen TV was extremely
expensive and now it's justgetting cheaper and better.
Bill Oxley (50:39):
Yeah, yeah, well, but it will be.
I think it'll be a little bitslower for us.
Um, because the main, certainlyfor us, the main cost is time.
It's surgeon time, it'stechnician time, it's engineer
time and there is, it's notreally that we're particularly
limited by the computer.
(51:01):
You know the processing power.
We're not limited by theprinters and we're not limited
by the.
You know anything physical,it's real time.
So the obvious answer to thatis AI.
Ai will absolutely change whatwe do.
But the impetus for ai to youknow where veterinary orthopedic
(51:25):
deformity corrections is a kindof pretty niche thing for ai
and nobody is going to comealong with you know five million
dollars to invest in atailor-made ai system for us.
Jenny Chen (51:34):
So it's going to be a slow it's going to cost more
than five million dollars it'sgoing to cost more like $5
million.
It's going to cost more than $5million, like my billing is
more like it, you know.
Bill Oxley (51:42):
It's going to be a while before anybody gets around
to helping us out with that,but sure, I'm sure it'll happen.
You know it'll happen one day,but that's probably the route.
Jenny Chen (51:53):
So what is I mean?
You're in, you're in the game.
You know more accurate than me,for sure to tell, to forecast
anything.
What you know more accuratethan me for sure to tell to
forecast anything, what do youthink the field is going to do
is specifically orthopedic, um,in veterinary medicine.
What do you think in, let's say, five, seven, ten years, what
kind of trend and progressionyou're seeing?
Bill Oxley (52:11):
you're going to see yeah, I think a lot of it will
be joint replacement.
So joint replacement is isalways challenging for a load of
technical reasons.
You know, all the joints thatwe replace have their own
technical challenges that arevery difficult in some cases.
And I think the not not even somuch the 3D stuff really, but
(52:35):
just the way that the wholefield is progressing is
extremely quick, extremelyexciting.
People are getting so good atit, talking about
self-specialisation, but thereis a lot of 3D stuff that does
feed into that.
You know, joint replacement,planning, patient-specific
implants so I think that's goingto be a huge area.
And, more generally, I thinkthe greater use of
(52:55):
patient-specific implants,orthopaedic plates, not just
joint stuff, but other areas aswell, I think will be huge.
Specific implants, orthopedicplates, not just joint stuff,
but other areas as well, I thinkwill be huge.
And you know the great day andI talked about one great example
you know that was somethingthat we just couldn't do.
You can't.
There are ways to do it,somebody will tell me off, but
not so well, I would argue, andcertainly not so efficiently.
(53:17):
And that is because that's atailor-made implant and that
applies to many, many, manysituations and that is within
our reach, and that's somethingthat we're doing right now and
that will become much greater.
And I think the other thing isspinal stabilization.
This is another area wheretechnology is rapidly
(53:37):
progressing and I think in thefuture you know, we have new
systems coming through, fixationsystems and that will become so
much better over the next fewyears.
So, yeah, there's a lot ofstuff happening.
Jenny Chen (53:49):
You know I'm a big fan of this dog, the wiener dog,
the Dachshund.
How do you say that?
Yeah, but I didn't get onebecause I did not get it,
because I heard it has a lot ofspine issues and every procedure
is $5,000.
Bill Oxley (54:06):
They are predisposed to slipping discs.
So disc rupture, discprotrusion, they are
unfortunately predisposed.
But there are many goodscreening systems out there now
predisposed.
But there are many goodscreening systems out there now.
So it's possible to find uh, uhsort of breed lines that are
much less at risk of that.
But, yeah, bless them, they'reprobably, yeah, they're
(54:28):
fantastic dogs.
Jenny Chen (54:29):
I love them to bits and I love them too, just not
the bill uh stuff wrong withthem yeah no, no, a little bit
tangential um is is biologics.
You know some kind of umbioprinted, biofabricated
scaffold or stuff like that.
Is on your horizon at all, youthink the next 10 years or so?
Bill Oxley (54:50):
yeah, it's, there's a lot of research, so a lot of
the, the, the.
Yeah, it's, it's difficultbecause a lot of the, the, the
knowledge exists, but it's onthe human side and it's human
research, so a lot of the humanresearch models are done in
animals.
So there is a lot, a huge amountof incredible knowledge about
(55:12):
how to bring these thingsforward, but the problem is it's
all proprietary because these,these are companies that have
spent billions of dollarsresearching stem cells,
researching scaffolds,researching cartilage
resurfacing.
They're not about to share thatwith me and they're not about
to share it with anybody,frankly, so that knowledge
exists, but we can't get ourhands on it, um, and again, some
(55:34):
of it will come down to cost,um.
You know, these things, bydefinition, are expensive, um,
and they will be for a long time.
So you know, there are systemswhere you can certainly pay
companies to extract stem cells,um, which you can use, but the
evidence, in the kind ofrelatively rudimentary way that
(55:55):
they're currently available tobe used, is a bit sketchy, to be
honest, I think yeah, it's so,yeah, it's out there for sure so
, in terms of actually printinga bioscaffold that's impregnated
with stem cells and slottingthat into a critical defect,
yeah, we're way off from that,and we do have alternatives.
so it's not as if it's somethingthat I feel is a huge priority,
(56:17):
but it is something that isbeing worked on not by us but by
clever people, so it will comethrough but not for.
Jenny Chen (56:25):
So yeah, we're kind of reaching the end of our
interview.
We have a couple of funquestions for you.
If a young veterinary doctorwants to get into 3d technology,
what are your advice for him orher?
Don't have a personal lifebecause you won't have time oh
(56:47):
okay, advice or warning I meaneither one, I guess.
And okay, of all the animalsyou have worked with, which,
which kind of animal is yourfavorite?
Bill Oxley (56:58):
oh, I love.
Well, we mostly treat dogs, sobig dogs and little dogs, yeah,
so Daxies and Wolfhands, they'remy favorite, so I love treating
them.
And we treated a kangaroo a fewmonths ago Kangaroo.
Jenny Chen (57:09):
Yeah, nice, that should be reported in news.
I hope, hope to see you soon.
Bill Oxley (57:17):
And if you're going to print anything for yourself.
What are you going to print?
Uh, I don't know.
The best thing I've ever 3dprinted was a, a beer holder
that sat on the arm oh, I likethe sound of that and it was a
curved couch and it made a flattop and I could put my beer on
it.
So that was it's pretty prettywe're gonna have a photo someday
of that.
Jenny Chen (57:35):
And then are you a big consumer of podcasts, books,
any media you would recommendto people as a resource?
Um, well, personal development,it doesn't have to be
professional no, you do not, notreally.
Bill Oxley (57:50):
No, I I'm a big, I love, uh, climbing and
mountaineering, and I think thatthat changed me as a person and
it made me kind of veryself-sufficient, very, um,
single-minded.
So I think having somethinglike that that really kind of
gives you that sense of you know, drive and determination to
(58:12):
actually be fantastic, that'ssomething I think is, um, is
great.
But yeah, it depends what youryour are, I suppose.
Jenny Chen (58:20):
So you must have read Into Thin Air or something
like that Absolutely yeah.
So what was your last peak thatyou climbed?
Bill Oxley (58:27):
Oh, I run around in the hills in the Lake District
where I live, so I go up anddown and up and down and it's a
beautiful place.
So when I stopped being afull-time surgeon I could come
and live anywhere.
I just needed internet and apostal service.
So I came to a beautiful partof England that has hills and
(58:47):
valleys and lakes and lots ofsheep and it's beautiful.
So I kind of run around inthose and yeah, that's like my
dream life.
Jenny Chen (59:00):
Not there yet.
Well, I think we reached theend of this interview.
Thank so much, bill, for yourtime and insight today.
Um, and if people want to getin touch with you, how can they
reach out to you?
Bill Oxley (59:09):
yeah, just drop me an email.
It's just bill at vet3dcoukokay, that's really easy.
Jenny Chen (59:15):
Thank you so much, bill.
Thank you, jenny, it's been apleasure.
Thank you, yes.
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