3D Printing for Prosthetics and Social Impact: Going In-Depth with Stratasys and the VA

With great power comes great responsibility; Peter Parker has internalized this concept in his crime-fighting ethos — and in the 3D printing industry, Stratasys is embracing this value of market leadership through its Corporate Social Responsibility (CSR) program. Led by Arita Mattsoff, Vice President of CSR at Stratasys, the initiative is focusing on giving back to the community at large. Rather than fighting supervillains, Stratasys’ take is much more grounded, working with innovative minds to give life to concepts that can improve human lives. One way that 3D printing is significantly impacting the quality of life for individuals is through the creation of customized prosthetics for those with missing limbs, notably including veterans.

Last spring, Stratasys and the US Department of Veterans Affairs (VA) launched a collaborative 3D printing hospital network, designed to accelerate doctor preparedness, advance quality healthcare, and build collaborative best practices. Stratasys worked with the VA Center of Innovation (VACI) to install 3D printers in five VA hospitals across the country, updating on progress early this year. Since the VA’s initial adoption, it has become a cornerstone for Stratasys CSR initiatives, with an increase in the use of 3D printing for VA hospitals.

The program offers a breadth of benefits to some of the population who can most benefit from personalized healthcare, and so to learn more I turned directly to the source for an in-depth look at the program, speaking recently with Mattsoff; Stratasys’ Director of Healthcare Solutions Michael Gaisford; and Gordon Bosker, M.Ed, Certified Prosthetist/Orthotist and Supervisor of the Orthotic/Prosthetic Department at Audile L Murphy VA Hospital in San Antonio, Texas.

Leading Social Change: Stratasys’ Perspective

I last spoke with Mattsoff and Gaisford at SOLIDWORKS World 2018, where Stratasys and Dassault Systèmes announced a collaboration with Unlimited Tomorrow. That conversation laid the groundwork for us to continue a discussion about Stratasys’ take on CSR as a growing focus.

“Stratasys has been building a professional foundation, which really started about three years ago. The company came to a point where there’s good foundations of the business, and the next steps are to expand activity for driving social change, social impact,” Mattsoff said, adding that a company like Stratasys with technology leadership in the 3D printing space is ideally positioned for driving social change and impact.

“Since the beginning of the year, CSR has become a strategic arm of Stratasys’ activities in general, of course supporting the business, it is part of the business model and culture. Part of the business model in that any activity we do in CSR is really fundamental to the business, is connected; 3D printing is part of the enabler of a project like the one we announced at SOLIDWORKS World, like the one we’re doing with the VA… Part of the culture is enabling employee engagement, we want employees to take part in social change activities.”

Stratasys address four primary pillars where 3D printing can act as a key driver of change for social impact, with initiatives in education, healthcare, areas of life-changing impact, and science.

• Education: Focusing on enhancing and advancing STEAM (science, technology, engineering, arts, mathematics) education for at-risk youth, girls, and other students who might not typically have access in their environments to newer technologies like 3D printing, as well as encouraging hands-on learning, active thinking, and engaging problem-solving approaches.
• Healthcare: Stratasys sees this area as a key driver of possible impact with 3D printed models for medical planning, prosthetics, and other medical applications.
• Life-Changing Projects: Visions for future projects include helping to clean water in parts of Africa lacking regular access to potable water supplies, building partnerships where 3D printing can help on the ground.
• Science: Working with universities for future-looking projects or programs, Stratasys seeks to support the use of advanced technology throughout the sciences.

Mattsoff underscored the importance in every initiative of an ecosystem approach and partner-driven advances. Through close work with the VA, Unlimited Tomorrow, and other organizations and businesses, she noted that Stratasys CSR “wants our partners and resellers to be involved in our projects.”

Stratasys and the VA

Staff at the San Antonio VA actively exploring opportunities for 3D printing to create new prostheses

Speaking directly of the VA initiative, Mattsoff noted that Stratasys’ healthcare unit brought the project to the table as a way for the company to apply its 3D printing capabilities to improve the quality of life for veterans.

“About a year ago, we donated 3D printers to five of their centers in the US, in different cities. This really fits the DNA of our CSR,” Mattsoff told me.

“Veterans have specific disabilities, specific needs, where we and the centers can help 3D print different devices. What’s important here is not only the physical capability that we enable, but also the psychological effect that they are able to do something they could not do yesterday. In many cases, they would not receive a device of this sort if it was not for 3D printing.”

Costs for traditional prosthetics are often prohibitively expensive. Because veterans’ healthcare is tied to their VA benefits, stipulations apply to the sorts of supported devices that they typically have access to, limiting options further. 3D printing allows for patient-specific creation of prosthetics at a significantly lower cost — though it has admittedly taken some time for the realizable benefits to be brought into the VA.

“Here we have a special case, with Gordon Bosker. For 20 years already he has been a fan of 3D printing. We all know that 20 years ago the technology wasn’t what it is today. When they got these 3D printers into the lab a year ago, he really wanted to take up where he was 20 years ago, learning and designing. He is a prosthetist specializing in his field, making artificial limbs for patients. For him I think it is a perfect match to use 3D printing,” she said.

“For us, it was very natural that we would team up with Veterans Affairs. It is a big organization that has the capabilities to not only get the 3D printers, but the people to get involved in using and learning it. It’s an organization that is built to last.”

From the Healthcare Solutions perspective, Gaisford noted he was intrigued by several aspects of this opportunity as he worked with radiologist Beth Ripley, MD, PhD, and leader of the VA initiative, to set up 3D printers not just in a single hospital, but across an entire healthcare system. The flexibility of digital manufacturing offers a way to share knowledge as well as direct designs throughout a full ecosystem, bringing new possibilities to medical professionals and those relying on them.

“This exemplifies 3D printing; there’s expertise across the system. You can have an expert in San Antonio design something, and print it in Boston or Albuquerque. Putting 3D printers in locations that are somewhat remote, not as heavily served, makes more possible. We didn’t do that in this case, sticking to mainly higher-volume centers for now, but the idea is to share skills across the network. Designers in one center can design a piece for someone across the country; how else can you have a prosthetist in one part of the country help someone across the US?” he said.

“The other part of this is the 3D printing knowledge center, coordinating not just across these centers, but across the entire VA that has interest in 3D printing. Hospitals far and wide have been investing in 3D printing — a number of VA centers have already done that. We can now take the knowledge being developed in these individual centers and multiply it by coordinating and sharing best practices and capabilities.”

Key to these capabilities was the choice for the specific hardware installation, as Stratasys’ desktop Mojo 3D printers are effectively turnkey. Gaisford noted that these are one of the easiest in the company’s portfolio to set up, install, and configure, creating an accessible tool for the VA centers — which had previously expressed “some skepticism about the ease and use of 3D printing and how it would be adapted.” The turnkey solution paved a smoother way to empower these centers to create in-house prosthetics manufacture, without the need for a technical expert to advise every step of every build. Across the five VA center installations, both Mojo and uPrint 3D printers are in use.

Military veteran getting fitted for his new 3D printed prosthetic

The use of 3D printing within the VA has the potential to truly change lives, and this very personalized impact is one that the CSR team feel very strongly.

“…In some cases it’s life-changing; that doesn’t only mean it’s life-threatening, but life-changing for enabling support through 3D printing, and what changes in some cases is their self-esteem or their feelings,” Mattsoff told me. “I think it’s inspiring and the very core of Stratasys CSR is to do social impact, social change in that way.”

In the San Antonio center, Bosker’s work is paving the way for enhanced adoption across the VA. As Mattsoff had noted, Bosker has been interested in 3D printing for two decades — and it’s only recently that he’s been able to leverage that interest into his work as a prosthetist/orthotist, as the VA’s collaboration with Stratasys has brought the technology to an accessible, viable level.

“In a nutshell, what Gordon is doing goes back to ease of use; because it was so accessible, he wanted to understand how 3D printing can be used in prosthetics and designing a socket. [The VA] didn’t want to invest in a large new technology platform for that and learn something specific. The Mojo, because of its versatility, was able to be quickly adapted to this purpose, and they could quickly develop an approach and iterate on that, really develop designs,” Gaisford explained.

“3D printing 20 years ago wasn’t as easy a process, not as easy to use, not as accessible, as it is today. Gordon found that the accessibility of the Mojo let him do more. He has a vision to use it more broadly in a variety of patients, with defined challenges. That’s really where the power came, and the collaboration across the network that he could do a knowledge-share with others within the VA.”

Mattsoff agreed, noting that that exchange of information is a key benefit of the technology today. As understanding of the latest capabilities broadens, and benefits of personalization can be accessed in real-world settings as a cost-effective solution, users like the VA will be able to better leverage additive manufacturing in their regular healthcare operations.

The partnership between Stratasys and the VA emerged began with a discussion about a year and a half ago, before Stratasys had a dedicated independent CSR function. Future projects will move more quickly, Mattsoff noted, with the strategic importance of CSR emerging for Stratasys’ core operations.

“The industry is of course maturing; the technology has been around for 30 years, each of us around for however long, and we see the industry and the technology maturing — Stratasys feels like we are a leader in the 3D printing space, and so it is our responsibility and a personal example that we need to lead also in the societal aspect of the industry,” Mattsoff told me.

“That’s why we have taken a strategic approach to CSR. We want to do it, we don’t do it because we feel like we must. It is a positive responsibility to be in a stage of the industry and the company to drive impact and change.”

The company sees itself as a role model in the industry, and looks to set a good example through its community-driven initiatives. As a city on a hill must serve as an example, as the age-old concept holds, so too must established market leaders provide a beacon for industry.

3D Printing in Healthcare: VA Perspective

Gordon Bosker

A few days after speaking with Mattsoff and Gaisford, I appreciated the opportunity to dig further into the full story by talking directly with Gordon Bosker for a full VA perspective on this initiative.

With decades of experience with prosthetics, Bosker worked with SLS 3D printing to create sockets for prosthetics in 2001 while working with the University of Texas Health Science Center in conjunction with the VA. At that time, working with the University of Texas at Austin’s SLS machine, the team there tested the sockets to ensure their safety, and several people were fitted with these.

“We made variable compliance sockets for below-the-knee prosthetics. We learned how to, by 3D printing, make an adjustable socket so if there was excessive pressure we could relieve it, and we did a lot of measuring with different devices,” Bosker explained of the work at the time.

“It was kind of unique, because when we presented this at a meeting we found that people weren’t really interested in 3D printing. They felt it was too expensive, and, ‘Are you trying to take our jobs away?’ It went by the wayside.”

Continuing with his work in prosthetics, it wasn’t until the last year that Bosker and the VA were positioned to “really start moving forward with [3D printing] again,” thanks to an Innovation Grant at the VA.

“Now, we are making BK and AK sockets,” he noted of current work with both below-the-knee (BK) and above-knee (AK) prosthetic sockets. “We had one go out and climb a mountain for us — we know it’s reliable.”

While 3D printing is certainly picking up in prosthetics applications across the world, the fact is that this is still both a nascent technology and a young use case. There remains a great deal of work to be done in furthering the adoption for widerspread, fully reliable use that will best serve the population.

“To me, you see a lot of things people are doing — but there’s so much more that can be done. Machinery is changing dramatically, and Stratasys is taking concepts bigger and better,” Bosker told me of his perception of technology in healthcare today.

“It’s exciting, because — again, it’s so new. There’s some software programs, I use Meshmixer and Autodesk 360, there are all sorts that can be utilized.”

Veteran testing a 3D printed socket

He noted that software represents another learning process, and an area that will be well served by a streamlined workflow. As Bosker put it, that learning process comes down to “what does everyone want to settle into to make everything work properly.”

3D scanning is also a critical part of this process, as a digital rendering of an individual’s exact anatomy is necessary to correctly design a custom socket. While Bosker is “the old school going into the new school,” he finds that “scanning is a very valuable process to understand what’s going on with that residual limb.” In addition to a full scan of the visible anatomy, he further makes the argument for the use of MRIs in the process, “to make sure we’re not missing anything internally, especially for our soldiers; an IED blast can cause all kinds of issues.” A complete understanding of every individual use case is necessary for a prosthetist to do a proper job of ensuring that each patient receives the best possible care for their unique circumstances.

In addition to the prosthetics, Bosker is appreciating the use of the Mojo for additional applications, including “a lot of finger splints.”

“Stratasys, I love the machines,” he enthused. “What we’re finding with it is once we get everything going, get the software the way we want it, the scanners the way we want, there’s nothing we can’t do with it. Within reason of course — I’d love to see them do a bigger machine! Right now what we’re doing is anything that fits into 5 x 5 x 5. I’m designing right now a cup for our wheelchairs. It may take a while to print, but the cost is so exponentially cheaper than it is to buy, when I can just hit a button and print it out, or modify something on the chair, or make a cover for an artificial hand.”

Bosker’s work, supported by the Innovation Grant, allows for the use of new technologies — and he notes that, “One thing we have to do here at the VA si to be more open to these.”

For his part, Bosker’s background is as not just a certified prosthetist, but an engineer, and this mindset informs his approach to each 3D printing project he undertakes.

“Whatever we design, especially for our amputees and for modifications — it better not fail. As an engineer, what I’ve always done is, if I can make it fail, then it’s not going to work. I work with it enough to make sure it doesn’t fail,” he told me.

“Some of the 3D printing, I’m talking BK socket, if they’re going to fracture, it will be where the connection is, to the foot, that’s the highest stress point. What we do, not scientifically, is we put it in cold weather, put it in the freezer, then try to break it — then we put some heat on it, see if it starts to deform.”

When working with the University of Texas at Austin years ago, those sockets were put into a device to test fatigue rate. Another step now to failure testing, he said, is “We give these sockets to a couple of young guys who we trust very well and say, ‘See what you can do to break it.’ We have yet to have one broken, we’re on the right path.”

Moving Forward with Medical 3D Printing

The next step for Bosker’s team is expanding on training and reach, working next with occupational therapists and physical therapists more closely.

“This is one of of these areas where there’s no limit to what we can do — the only limit is the type of machinery out there that can reproduce what we want, and the material we want to reproduce it. The goal is to see occupational therapists, physical therapists, and also our own clinical staff, to be more open to the concept. There are still people out there who say, ‘I can do this by hand’ — yeah, but we can do it a lot faster this way,” he said of 3D printing.

For Bosker, the important thing about the adoption of 3D printing is that it can open doors to almost limitless new potential in healthcare and personalized options. Remaining open-minded is critical for medical care providers to continue to enhance their patients’ treatment.

“The important thing, to me, is: don’t put blinders on, be open. That’s the biggest fall back we have. Things have been done a certain way for so long — there might be better ways. Don’t put blinders on. Keep going forward. I don’t want to use the word experimenting; it is, but it’s a controlled experiment. The issue being that we need to keep an open mind and keep working as we go forward — so much is possible. I can scan a BK leg and within six hours I can have a 3D printed socket the individual can wear,” he told me emphatically.

“The opportunities are just unbelievable, they’ve got to keep an open mind and go forward with this. There will be setbacks, but we’ve got to go forward with this. There are 3D printed devices for airplane wings, come on! If they feel safe enough to fly with them, they’re safe enough to walk with them.”

Two hand orthoses 3D printed at the Albuquerque VA

Moving forward with technology is the key for moving healthcare forward. The initiative at the VA can serve as a catalyst to see improved adoption of 3D printing across wider populations of amputees and all orthotic patients.

“The more we learn, the more we can bring that to the outside world. We want to bring that to the outside world, we’re on the front lines of that,” Bosker said.

“We were there years ago with 3D printing, and now’s really our opportunity to go forward with that. There are no limits; it’s in its infant stage. The printers coming on, with carbon elements, high strength — I could go on and on about the designs I see coming out. There’s got to be a controlled experiment: let’s try this, see if it it works. There’s a lot of involvement with universities, like at UT at Austin. I see a lot of changes in the attitude from this younger generation, they are willing to try it, to say, ‘Let’s go forward with it.’

“There’s no limitation. I’d love to try every machine out there, every Stratasys machine, every machine. We can come up with a feasible solution for everything we want to do. As an engineer, I am a tinkerer. I love to play with it.”

As Stratasys’ CSR initiative can serve as a beacon for industry, the work at the VA is set to light the way for broader adoption across healthcare.

Speaking with Mattsoff, Gaisford, and Bosker provided invaluable insight into the more human aspects of technology, and served as a humbling reminder of some of the truest benefits of additive manufacturing.

Discuss Stratasys, the VA, prosthetics, and other 3D printing topics at 3DPrintBoard.com or share your thoughts in the Facebook comments below.