Episode#113| How 3D Printing Explains the Unexplainable in Congenital Heart Disease with Dr. Tristan Ramcharan

This is one of two episodes we have recorded during our trip to Leuven Belgium for the Materialise 2026 Conference, focusing on 3D planning and 3D printing in hospitals. We talked with Dr. Tristan Remcharan about how pediatric cardiology imaging can become something you can literally hold, using 3D segmentation and 3D printing to make congenital heart disease easier to plan, teach, and explain. We also dig into the 2D versus 3D generational divide and the real-world funding hurdles that decide whether point-of-care 3D becomes routine care. 

Show notes: https://3dheals.com/episode-113-how-3d-printing-explains-the-unexplainable-with-dr-tristan-ramcharan/

YouTube Video: https://youtu.be/eNUQWwJq5HM?si=3QhxXxvvUaEhO1MD

The 3D cardiac printing program at Birmingham Children's Hospital is funded by charitable donations. 

To support Tristan's works directly: Birmingham Children's Hospital Charity — https://www.bch.org.uk/appeal/donate

Donate to the 3D cardiac printing program

Transcript

Welcome And Conference Context

Meet A Pediatric Cardiology Imager

SPEAKER_00 0:00

Hello everyone, welcome to episode 113. These next two episodes were recorded during the recent materialized 2026 conference in Leuven, Belgium, focusing on 3D planning and printing in hospitals. In this episode, I had the opportunity to interview Dr. Tristan Remcharin, a consultant pediatric and sports cardiologist at Birmingham Children's Hospital. We discussed how he and his colleagues leveraged 3D printing for surgical planning, education, and patient communication for children with congenital heart disease. We also discussed related systemic challenges and the 2D versus 3D generational divide. Enjoy. Please listen to the disclaimer at the end of this podcast. Hi there, Tristan.

SPEAKER_01 0:51

How are you doing?

SPEAKER_00 0:52

Good, nice to meet you at this conference.

SPEAKER_01 0:54

Thank you. It's been really lovely to be here, actually. Thank you.

SPEAKER_00 0:57

And I appreciate this opportunity to allow me to interview you. Um why don't you tell us about you, who you are, what you do on a daily basis?

SPEAKER_01 1:05

Yeah, sure. So my name is Dr. Tristan Ramtron. I'm a consultant pediatric and sport cardiologist in Birmingham Children's Hospital in England. Who kind of my day-to-day job is mostly obviously pediatric cardiology. I look after young children from birth, right up until 18. Most of that's conditional heart disease, some of it's acquired and inherited. I also do sport cardiology, so I look after uh quite a lot of young athletes from around the UK, patients who've had operations before, or children who've been picked up who are athletes in themselves, who've been picked up through screening to have heart conditions. I look after those. And of course, my uh my my my my bigger role or my uh kind of bread and butter is imaging. So I do uh cardiac CT. And of course, uh through that we do a lot of 3D reconstruction, 3D printing and segmentation.

SPEAKER_00 1:52

And yesterday I I had a glimpse of your work uh involving imaging and 3D technologies. Um, why don't you expand a little bit of what you use currently for your practice?

Teaching With Reproducible Heart Models

SPEAKER_01 2:05

So we've been using 3D for probably about three years or so. We've got quite a nice uh program set up at Michelin Hospital with a collaboration with Aston University. And we work through our students, our radiologists, our cardiologists, and our surgeons. We've basically been using 3D printing for three main reasons, really. The first is we use it for surgical treat um planning and surgical training. So, for example, uh a child who's having an operation with quite complex conditional heart disease, and so the opera the actual heart is quite difficult to understand, quite difficult to get your head around sometimes. And so we use the models to work out exactly, for example, where the hole might be, what the relationship between structures might be, so that when we actually have to go into theater, we have an understanding beforehand of exactly what we need to do. For example, if we have to print a patch or a baffle, that can help us to also plan the operation. And we've been doing that for more or less three years or so. Uh over the past 12 months or so, we've been using uh 3D segmentation more for teaching and for uh helping our trainees, our students understand congenital heart disease in a lot more detail. We use it, for example, one of the challenges that we have with congenital health disease because it's so difficult to get your head around sometimes in a three-dimensional aspect. We obviously have uh post-mortem specimens or morphology specimens, which are a very finite resource. And there's not many centers in the UK or it will, for that matter, that have access to that uh that that laboratory and have access to those specimens. And so, although we can demonstrate on them, we don't really let our students or trainees touch them because obviously they will degrade over time. And so it is a very finite resource. And so what we do instead now is if if we've got a three-dimensional uh segmentation done, we can print that and we can print it over and over again. So, if for example, the model breaks or gets degraded over time, we can just print another one. Of course, there's a cost behind that, sure. Yeah. But in terms of a specimen that's been there for 30 or 40 years, there's obviously a much better way of doing something in a uh reusable fashion and in a in a in a way that's actually um cost-effective as well. Yeah. And probably most recently, and for me, I think probably the biggest difference that this program can make is in terms of explaining conditions to families. So family education. Um we've had a most recent example where we've been working with a BBC to speak to a family and go through a case study. And I think for me, there's two ways to look at that. You have we have um c conditions sometimes where with the best will in the world, no matter how much we would like to make a difference or to do something, the heart's too complicated, too much of the heart's missing or or malformed, and we really can't do an operation. And these kids sometimes can look very well, but in reality they are struggling. And that palliative care approach where we really can't do anything, and the child, unfortunately, we there's no operation we can do to help the child. I think having a three-dimensional model can help in that situation because you can really explain to the family what the problem is, and they can see for themselves why it's so difficult for us to do something and why no matter what we wish we could, we really can't help here. And so I think that's really important. And on the converse, we have patients who, uh, for example, in the article I shared, where they look so well. And as a parent, it's so hard for you to understand or get your head around, well, my child looks completely fine. How is it that you can have, or he or she can have such a serious heart condition? And actually by printing that model or even with virtual reality, we can then show them exactly what the problem is, where the goal is, what the communication to their structures are, and why without an operation, but in the long term, this will be a problem. And for me, I think that's the most beneficial way because that really helps our families to understand in a lot more detail exactly what we're doing and exactly what the condition looks like.

Helping Families See The Problem

SPEAKER_00 5:53

Yeah, you know, I went to medical school way before you, 20 years ago. I don't even have that access to 3D images. I we did not have any virtual surgical planning that's widely accessible. We use cadaver, which is extremely expensive to both purchase and also maintain. So that is uh an evolution, I would say, for the field. Now, you mentioned that you were an imager. What do you think the role imaging played in this whole evolution of three technology?

SPEAKER_01 6:23

Yeah, it's it's it's a it's a fascinating question. You know, imaging started off for us with echartography. And echartography initially was what we call M mode, where basically you had a black and white image and it was just basically That's a two-dimensional. Exactly, yeah, two-dimensional black and white image where it was just a moving structure, and that's all you understood. And to be fair to my predecessors, they were able to use that to make you know complete sense of things, which I look at it now and think, I wouldn't know where to start. And I think that's a generational aspect as well. And actually now we have we you know we have echocardiography, which is two-dimensional and three-dimensional. We have uh cross-sectional imaging, which is either cardiac CT or cardiac MRI, and of course cardiac categorization and geography as well. And we can use all these modalities and put them together. But at the end of the day, they're mostly all two-dimensional aspects. And so being able to bring the three-dimensional aspect from the same uh um data set of uh the imaging data set, we can then pull that in and we can show exactly what it looks like in a three-dimensional way. So actually, it's really transformed how imaging is because now you can just see for yourself with a fairly minimal amount of work how much better and how much easier it is to understand. And that relationship is just transformative, I would say.

Imaging’s Shift From 2D To 3D

SPEAKER_00 7:34

Yeah, and you know, I'm still thinking about this whole 2D to 3D translation, even now, as we have already had a conversation about it, is you know, yesterday during the conversation, people were mostly want to transfer the 2D images to 3D. But then there's some slides showing that they also show orthogonal 2Ds to translate 3D back to 2D. What do you think of which trend are we eventually gonna get to?

SPEAKER_01 8:00

Yeah, I I think we'll probably be somewhere in between, is the honest answer. I think for those of us who've been doing this specialty for a long time, we still like our 2D datasets because that's what we are so accustomed to seeing. Our newer trainees, they are exposed to both in probably equal distribution, I would say. And so they would probably be comfortable with both. Whereas I think for someone who for a different generation, I think you still need that base data because that's what you've been growing growing up on or been training on for 20 or 30 years.

SPEAKER_00 8:31

Just x-rays. And just x-rays.

SPEAKER_01 8:33

Well, exactly, right? And so I think that's still so important. And even for myself who's kind of gone from 2D and 3D over the past 20 years, I still really need to see that two-dimensional data set because I can build that three-dimensional data set in my head, but I still like that two-dimensional picture. And also explain it to somebody else. I can, it's some ways it's much easier to explain a two-dimensional picture rather than a three-dimensional picture because it just takes a bit more effort and thinking sometimes to explain the three-dimensional side of things.

The Generational Divide In Visualization

SPEAKER_00 9:01

Yeah, we're different generations of physicians. I mean, I'm not that old. I don't feel old, uh, but uh, we're definitely trained in a different um technological environment. Do you feel um the fact that there is a huge generational change matters in terms of how you communicate to patients with these tools?

SPEAKER_01 9:23

Yeah, I mean, I I take the example of one of our medical students now who's been doing a lot of work with us. And, you know, he he builds models himself. He has his own printer, and he he just creates things out of nowhere. And I just I I look at him and I think, you're not even that much younger than me, and you can just do all these things. You know, I think about my kids and what they can do, and I think where will they be in 10 years' time? And actually what they will need to to to train and and and to teach on. And actually, yeah, I think it's it's so different, isn't it?

SPEAKER_00 9:50

Do you do you did you grow up playing video games?

SPEAKER_01 9:53

Yeah, I mean, uh so I wasn't I wasn't I was never good at console-based games. I was very good at PC games, actually. But I was never very good at getting consoles good working. And so I never I still do even now I don't have that, but PC games were for me phenomenal, actually. But the kids they could just do everything, right?

SPEAKER_00 10:08

Right. I mean they're a digital native.

SPEAKER_01 10:10

Yes, exactly. Well, is it you know almost a Netflix generation, they they struggle with ads. You know, we grew up watching a a program and there would be you know five or ten minutes of ads between every session, and you just accepted that. Now my kids wanted a way to escape ad button is when we watch terrestrial TV. And I'm like, well, no, you have to watch the ad, there's no choice. They can't understand why.

Point Of Care 3D Technology Beyond Cardiology

SPEAKER_00 10:30

The trade-offs in line. Exactly. Well, exactly. So we're both in a materialized conference, and the focus is um 3D planning, 3D printing at the point of care. What's your biggest takeaway so far and anything that's pleasantly surprised to you or something just surprising for you that you feel like we should talk about?

SPEAKER_01 10:47

I think for me, obviously we are very television, and so we see what we do on a daily basis, and we all forget sometimes that uh there are other specialties out there, there are other um aspects to three-dimensional or segmentation. Actually, it's been quite nice to see the other uh uses of three segmentation, even um biomedical and non-biomedical. And I think it's nice for us to think about because I've always wondered, oh, always hoping next, where can we go next from here? Obviously, we're very good at congenital heart disease, but you know, within our own hospital, who else can we involve? We've involved urology to an extent a little bit, but you know, what about neurosurgery, what about max facts? And actually, it's been quite nice to see what others are doing to be able to think, oh, actually, I can bring that into my my my my field actually now.

SPEAKER_00 11:31

And at your hospital, um you know you're in cardiology. Does the other specialties also use 3D technologies as well?

SPEAKER_01 11:38

So at the moment not really. And I think that's something we can work on now. I think we're you know everyone's very busy and it's something that's obviously been a transformative effect to us. But in terms of other paediatric specialties, it's not really been that much, even around the UK. And so actually, I think actually if you can bring it in now and say, I can demonstrate and said, well, actually, in in Barcelona, they're using it for this and that and this other specialty. Actually, what about you? What do you think? Can you guys help work with this and can it help you? And I think that's something where we can move on in the next 12 months or so. I think that would make a big difference to our hospital as a whole.

Funding Reality And NHS Reimbursement

SPEAKER_00 12:10

Well, at this conference, I heard this word reimbursement multiple times, and I think it is a very important key factor to think about that resources are scarce, especially given uh the recent NHS uh, I would say, dramas that's going on, probably ongoing and the underfunding. How do you deal with this?

SPEAKER_01 12:30

Yeah, it is a challenge. Um funding is is not easy, of course. And when it's a centralized funding model, and obviously everyone has to get a piece of that pie, it's very difficult to then come up with something new and transformative, which of course costs money and there's a financial aspect to it, and often it's not very cheap. And so we were very lucky to have charity funding. So we our Birmingham Children's Hospital charity were fantastic, and they gave us a grant of£150,000 for three years, and that really helped us to set the program up, to get the software in, to get the hardware in, and also to be able to pay for the models that we print. And I think that's why we were very, very grateful to them. And of course, we are hoping that they will continue to support us because I think at the moment there isn't enough acceptance of this technology in the NHS just yet to say that actually this is a standard of care and it should be centrally funded. So I think for now we will have to keep uh uh asking for charity funding. And it's been really helpful, actually, to be fair to them, that they've really been very supportive to us.

SPEAKER_00 13:28

So I saw a picture of you as the queen on LinkedIn. Obviously, the royal family is involved, I hope. Uh, but beyond the royal charity uh source, do you have uh are you looking anywhere else to look for this funding?

SPEAKER_01 13:42

So I th I think we're staying that it's locally to for now, because I think eventually, hopefully, as as a uh as a health system, as a country, we can come together and and you know work together across different centers. But I think for now, where people are still doing slightly different things themselves, I think we'll probably stay essential and sorry, stay local to our charity and and and and rely on their support for now.

Advice For Future Doctors And Closing

SPEAKER_00 14:05

Well, nonetheless, I'm gonna post a link of your donation if you have one on our website. So if people want to donate, they can do that. Um finally, do you have anything to say for the next generation of doctors, probably in their kindergarten at the moment? Uh what do you what do you have to say for them?

SPEAKER_01 14:23

I mean, I think medicine is one of those fields where once you're in it, you understand how rewarding it is. You can see the difference it makes on on a daily basis. And I think for me, particularly working with children every day and parents, so I see both sides. I see the difference it makes to a newborn baby, teenager, an athlete for that matter. But I also see as parents the emotional struggle that they go through and coming from one side to the other, you know, going through the operation, the just anxiety on their faces to come out just to share relief and reassurance and just gratitude that they have. And so I think that's something that that I'm sure you get in other fields, but I think it's unlike anything else in medicine. And so I think it for me it's it's an amazing field to be in medicine. I think there is no doubt, there's no doubt that it it has challenges, but as a rewarding career, I think there's nothing like it.

SPEAKER_00 15:21

Yeah, some of the conversations you have to have are really difficult that I, as a radiologist, do not have to go through. And so I thank you for having those conversations and also provide excellent care for the patients. So thank you so much, Tristan, for joining me today. Hope to see you another time.

SPEAKER_01 15:37

Absolutely. Thank you so much for having us.

SPEAKER_00 15:42

This podcast is for educational and informational purposes only. The views expressed do not constitute medical or financial advice. The technologies and procedures discussed may not be commercially available or suitable for every case. Always consult with a licensed professional.