Pioneering 3D Printing in Medical Practice: The Omaha Experience

From MRI technologist to cardiac imaging coordinator, Gabe Linke is a pioneer in healthcare’s 3D printing revolution. Anchored at Omaha’s Children’s Hospital & Medical Center, this burgeoning initiative has grown from its roots in cardiac imaging to impact multiple medical subspecialties. Fueled by philanthropic support from the Goldwin Foundation and key partnerships, Linke and his team exemplify what happens when innovative thinking converges with urgent clinical demand.

Gabe Linke

Linke transitioned to Children’s from a Veterans Health (VA) hospital in 2015 to advance his work in congenital heart imaging. However, during his job interview, Linke was handed a 3D printed heart model that the hospital had purchased through a vendor, which unexpectedly shifted his focus. When asked, “Do you think you could figure out how to make these?” Linke saw a new career opportunity to explore. With the help of generous donations that covered the cost of a high-end Stratasys Eden 260VS printer and Materialise’s Mimics software, he started a 3D printing program at the hospital. What began as a focus on cardiac care soon expanded to include multiple medical specialties.

Printing anatomical models at the 3D Advanced Visualization Lab

Evolutionary leap

Initially a side project for Linke, the 3D printing program soon became a hospital necessity. Especially when it became clear that the program could be helpful in more than just heart care. The program expanded into general surgery and cranial maxillofacial treatment and eventually became part of the hospital’s larger radiology department. The program’s growth into new areas was carefully planned and supported by a reliable funding source.

One of the most critical milestones for the program was establishing a sustainable funding and workflow model. By linking the lab’s specialized 3D printing services to the already reimbursed 3D post-processing medical billing codes, known as current procedural terminology (CPT) codes, the program was able to secure a consistent funding source. This financial stability allowed what started as Linke working alone to grow into a three-person team and upgraded from a small back room to a fully equipped lab.

“When I started at Children’s seven years ago, I had no idea how pioneering our work was until I went to a RAPID +TCT conference and sat with other hospitals starting with 3D printing anatomical models. At first, I felt like I wasn’t supposed to be there. But when asked, ‘What have you printed?’ and I mentioned probably half a dozen hearts, another attendee replied, ‘That’s more than most have.’ Right then, I knew we were really on the cutting edge of what this technology could become,” explained Linke.

The OR at Omaha Children’s Hospital & Medical Center

Ripple effects

The 3D printing initiative had transformative effects on medical professionals and hospital patients. Not only has it aided in surgical preparations, but it has also made medical procedures more understandable to families and young patients. The program’s outreach also includes creating training tools and phantoms, objects that mimic human tissues for calibration and training purposes. The initiative has thrived on teamwork, with partnerships like Jorge Zuniga’s Biomechanics lab at the University of Nebraska and its Makers Club, all contributing to a booming 3D printing ecosystem.

By 2020, the lab finally became what it is today, the 3D Advanced Visualization Lab. Designed to give surgeons a tactile and interactive experience with their patient’s anatomy, the lab relies on complex 3D models. Using 3D printing, the lab rendered medical images into tangible, accurate, and complex models. These models greatly assisted surgeons in their pre-operative planning, leading to quicker surgeries and better patient outcomes.

Anatomical models at the 3D Advanced Visualization Lab

Over the years, the technology has advanced from single-material to high-end, multi-color Stratasys printers. Surgeons praise this leap, and it’s vital for helping families better understand surgeries, adding immense value to patient care.

“As part of a holistic approach to patient care, we rely on Formlabs printers for our bereavement program to make 3D printed hands and feet of patients who have passed away. We’re also starting an action figure program for our hematology patients where we’ll scan their faces and put them on action figures. The foundation is always clinical. However, working with child life and pastoral care has greatly impacted our patients.”

Tech for med

According to Linke, the lab serves as a multifaceted resource for physicians, offering a range of 3D technologies to enhance patient care. Initially focused on 3D printing, the lab has expanded to include virtual reality (VR) and 3D screens. Each technology meets the different needs of surgeons and physicians, whether VR for immersive interaction or 3D printing for tactile models. Over the past year, the lab has seen VR catch up in terms of its practical applications. Linke emphasizes the importance of user-friendly access to these tools, allowing medical professionals to manipulate visualizations for more precise and effective treatments easily. This layered approach to 3D technology, Linke believes, is revolutionizing multiple aspects of healthcare.

Overall, the lab will produce around 60 3D prints this year. However, that figure only captures part of the full scope of the work, as it also engages in virtual planning thanks to VR and 3D screen technology. Linke indicates that the lab processes 10 to 12 weekly cases, primarily CT angiograms and cardiac MRIs. Post-processing is a key revenue source for the lab, making the total project count much higher than just 3D prints.

“We’ve recently upgraded our printer to a J850 with digital anatomy capabilities, and it’s a game-changer for creating more lifelike simulation models. These new models can mimic real tissue, giving surgeons a far more authentic experience during simulation. Over time, we’ve experimented with various materials to find the right texture and flexibility. Our latest addition, tissue matrix, is promising. This technology is not just for research; it has practical applications for training and education. We’re thrilled that our simulation team is on board, and we have numerous projects ready to take advantage of these advances. Unlike the early days when I had to experiment in my garage, we now have a fully-equipped lab, allowing us to explore even further with techniques like silicon molding,” adds Linke

The 3D Advanced Visualization Lab

Collaboration and innovation are the cornerstones of the lab. He is excited about a new Innovation Center opening at the hospital aimed at collaborating with industry to create child-specific healthcare technologies, therapies, and solutions tailored to their unique medical needs. The lab has also formed key educational partnerships, notably with the UNMC. More specifically, the iEXCEL Program within the Global Davis Center. Bill Glass and his team have been involved in multiple collaborative projects on virtual 3D health education.

Children’s 3D lab has also been a key contributor to Clarkson College, working with their staff to form the first certificate program for 3D printing in healthcare in 2020. These collaborations have turned Omaha into a significant hub for 3D printing in healthcare. Linke also noted that the lab has built strong networks beyond Omaha, including connections with professionals in Minneapolis and at the USF Radiology Division for 3D clinical applications. This collaborative approach is helping to accelerate the adoption and development of 3D technology in healthcare.

Beyond medical models

Despite the meteoric rise of 3D printing in healthcare, not all is smooth sailing. One of the major hurdles is insurance coverage. While some cases see reimbursement, the need for a uniform reimbursement standard often leaves the program to absorb the costs. Nonetheless, Linke stresses that the primary focus is enhancing patient care rather than getting caught up in the complexities of medical billing.

“Insurance coverage for our 3D lab is a mixed bag right now. We mainly rely on CPT codes for post-processing as our main funding source. While some cases get reimbursed, not all do. We’re cautious about not burdening patients with out-of-pocket costs. Unlike some places that pre-authorize printing based on insurance approval, our institution is willing to bear the cost to provide better patient care. It’s a complex and evolving landscape, but we’re pushing for insurance to recognize the value of this technology in improving healthcare outcomes. Right now, the industry is in its infancy regarding reimbursement, but we’re advocating for change,” states Linke.

3D printed hands of patients

While a 3D lab may not be essential for every hospital, it can be particularly beneficial for pediatric settings. According to the experience at the hospital, the need for such a facility can depend on various factors, including the patient population and the scope of medical work, says Linke. Although regulatory hurdles like 510(k) compliance exist for Children’s to print for other institutions, many hospitals could still benefit from partnerships with existing labs for research, education, or specialized clinical projects, such as tumor work in adult patients.

Looking ahead, the future of 3D printing in healthcare is brimming with possibilities. Linke sees potential in bioprinting, particularly with multi-material capabilities. Although the lab focuses on visualization, he never turns down an opportunity to collaborate with the University of Nebraska’s Dr. Bin Duan and his Biomaterials, Biofabrication, and Biointerface lab. He foresees a network of specialists who can advance the field collectively, requiring skills ranging from mechanical engineering to medical imaging. “It’s an exciting time,” he says, “and I’m excited to see where it all goes.”

All images courtesy of Omaha Children’s Hospital & Medical Center 3D Advanced Visualization Lab