Cheryl Martin (Host): Welcome to Healing Heroes, PDX, the podcast series from the Specialists at Shriners Children's Portland. I'm Cheryl Martin. On this episode, we're highlighting advances in technology for making orthotic and prosthetic devices and the pros and cons of 3D Printing. Here to explain it all is Todd DeWees, he's the manager of pediatric orthotic and prosthetic services, commonly called POPS and the residency director at Shriners Children's Portland. Todd, delighted you're on this episode to tell us about some of the latest developments in technology for orthotic and prosthetic devices.

Todd DeWees, MHA, L/CPO: It is a pleasure to be here, Cheryl. Thank you for having me.

Host: So first, tell us more about yourself and your role here at Shriners Children's Portland.

Todd DeWees, MHA, L/CPO: So my role is both department management and patient care. We provide orthotic and prosthetic devices for patients that we see here at Shriners Hospital in Portland. For those of you that don't know, an orthotic device is a device that augments a body part that's not functioning correctly.

You might think of like a knee brace if you had blown your knee out skiing. That's an orthosis. A prosthetic device is a device that replaces a body part that is absent or in the case of a lot of our patients never developed in utero.

Host: So I understand there is some big news very recently regarding 3D printing of orthotics and prosthetics. I'd love for you to explain it to us.

Todd DeWees, MHA, L/CPO: Yeah, so, two organizations that are subcontractors to Medicare, Medicaid, and I won't get too deep into the weeds, but they're kind of the administrative arm of the Medicaid Medicare services for the country. They determine what devices are appropriate for provision in orthotics and prosthetics. What those definitions are and what they include. They finally came out with a determination. So it's basically a ruling on how laws are written that is accepting of additive manufacturing or 3D printing as a viable method for fabricating prosthetic devices. They had a similar finding about a year ago.

 But because the two are different as I explained earlier, we really wanted to wait until we had clarification on both categories.

Host: Tell us the impact of this on the POPS department at Shriners Children's, Portland.

Todd DeWees, MHA, L/CPO: Yeah, so this really allows us to move into utilizing additive manufacturing as a viable manufacturing schema. Traditionally manufactured devices are very, very labor intensive. They take very specialized skills, craft people to build them. And so we've been a little reluctant to move into additive manufacturing because there was a lot of ambiguity about whether or not they were considered legitimately produced devices for billing insurance companies.

 And we want to make sure that we're staying in check with the regulatory agencies. So this allows us to start to move in that direction in the patient care arena. We've been working with some other groups over the past couple years to lay the groundwork and make sure that we can prove that the devices that we make through additive manufacturing, are substantially similar to devices that we're making through traditional manufacturing.

Host: Talk about the biggest differences between 3D printing and traditional fabrication.

Todd DeWees, MHA, L/CPO: Yeah, so there's a whole litany of differences. I mean, I think in the Portland area, one of the biggest differences is how much material waste there is in a traditionally manufactured device.

About half of the materials that come into a P and O office. It's not unique to our office. Any office when you're traditionally manufacturing, end up going out in the garbage can which is not very environmentally responsible or friendly, but currently we don't really have options to mitigate that. Whereas with additive manufacturing, those devices about 5% of the material ends up waste, which is substantial savings just from the environmental standpoint as well.

 Another advantage is that it takes some of the redundant time consuming monotonous tasks away from these really skilled people that are doing the fabrication. It allows them to function at the top of their skillset and do the things that really make them specialized. So it makes them a bit more efficient and makes their job, I think, more enjoyable.

Host: That's great. You've already touched on this, but anything else in your opinion in terms of the pros and cons of 3D printing?

Todd DeWees, MHA, L/CPO: Yeah, so the pros I kind of talked about. There are drawbacks. The machines to print at a production level are very expensive pieces of equipment. They require specialized skill sets to operate them. They are really good at doing some things and not so good at doing other things, so there are some limitations.

And then the materials that you're able to use in those machines are limited. And so that's part of why we've been working with some groups at some local universities and some industry partners to try to make sure that when we produce something out of that 3D printer that it's what we're used to seeing and what we're used to working with or at least substantially similar to that, so that we know that what we're putting on our patients is going to be what they're used to seeing and what they're used to getting.

Host: So despite those drawbacks that you mentioned, do you still think 3D printing is the future of the orthotics and prosthetics industry? And if so, why or why not?

Todd DeWees, MHA, L/CPO: I think it's absolutely a tool that we will be using. It will probably, my guess is that at some point in the next five to 10 years, it will be responsible for probably half of what we produce. There are some things that I don't know how it ever replaces traditional manufacturing. There are places where it is going to be a very valuable tool.

I can push print on a machine and walk out the door at night and it works overnight. And then when I come back in the morning, I can clean it out and push print again so that it's ready to start another cycle, so it can work when I don't want to. Everybody likes to go home at the end of the day and have their weekends and these tools allow us to do that, but still service our patients in a timely and efficient manner.

Host: Any other concerns or skepticisms about 3D printing?

Todd DeWees, MHA, L/CPO: I think because it's a fairly new technology in our field, I mean, it's a technology that's been around for decades, quite honestly. But when the patents dropped off a number of years ago and everybody started getting into this space, manufacturing these printers, they became more ubiquitous.

The costs are starting to come down. But it's a new tool. And so I'm not sure that we're a hundred percent where the right case use is and where the wrong case use is. And I think there's going to be some growing pains and some learning. I think as an industry we're very good at learning those lessons quickly.

But there are going to be places where we think it's going to work really good, and we're going to find out not so much. And there are going to be places that we're thinking, ah, that's just, that's not the appropriate application and it turns out to be one of the best tools. So I think the lack of knowledge is probably one of the biggest cautions.

And we have to make sure that we're putting our patients first as we go forward, so that as we apply these new technologies that they're getting safe and effective treatment.

Host: Great. Todd, anything else you wanted to add on this topic?

Todd DeWees, MHA, L/CPO: The one thing that I'd like to add is that some of these technologies can be paired with other things that we're doing in the technology space. So, a device that's fabricated in a 3D printer, you can put that device in a computer simulation before you even build it and figure out through modeling where it might fail.

And in a traditionally manufactured device, that option just doesn't exist because there's just too many variables to account for. So I think in a lot of ways it has the opportunity to make patient care safer. But we're just building those models out now. The use of 3D printing has been dabbled in for maybe the last five years in our industry, but it's been mostly non-weight-bearing devices or people that are, are a little less risk averse than maybe I am with my patients. And so I think as we get moved through this initial growth phase, things are going to get much better and, we're going to see a lot of benefits. But like I said, it's a growth phase.

Host: Todd DeWees, thank you for enlightening us on the latest advances in 3D printing and how they can impact the making of orthotic and prosthetic devices. Very informative. Thanks again.

Todd DeWees, MHA, L/CPO: Thank you and thanks for having me today.

Host: That concludes this episode of Healing Heroes PDX, with Shriners Children's Portland. To learn more, head on over to our website, shrinersportland.org. If you found this podcast helpful, please share it on your social media and check out the entire podcast library for other topics of interest to you. Thanks for listening.