Episode #88 | Shaping Veterinary Medicine in 3D with Dr. Bill Oxley

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.

Chapters

• 0:01 Introduction to Dr. Bill Oxley
• 2:13 Falling in Love with Veterinary Orthopedics
• 5:35 The Eureka Moment with 3D Technology
• 7:39 2D vs. 3D Surgical Planning
• 13:57 How 3D Printed Guides Work
• 18:49 Building Vet3D and Technical Challenges
• 41:17 The Economics of Advanced Veterinary Care
• 48:34 Global Trends and Insurance Impact
• 54:31 Future of Veterinary Orthopedics

Transcript

Speaker 1: 0:01

Hi there, Welcome to episode number 88. Just a quick reminder this podcast is for informational purposes only and does not constitute medical or investment advice. Always consult with qualified professionals before making healthcare or financial decisions. Enjoy, Hi everyone. Welcome to the show.

Speaker 1: 0:22

I'm your host, Jenny Chen, and today we have the pleasure of having Dr Bill Oxley to be with us.

Speaker 1: 0:29

Dr Oxley has been with us several times during our virtual events focusing on veterinary medicine and 3D printing, and I have been impressed by his works many years ago, since before the pandemic by his works many years ago, since before the pandemic, so we're really honored to have him today as a guest. And just a little bit about Dr Axley's work and I'm going to call you Bill, since this is somewhat informal and Bill. So you were trained in Cambridge University Veterinary School and you practiced as a general veterinarian doctor for a number of years before you decided to go into orthopedics and since then you also incorporate 3D printing and 3D technology in general into your practice. And there's so many accomplishments. You published more than 20 co-authored papers on virtual surgical planning and 3D printing and you have facilitated more than 4,000 cases now using virtual surgical planning and 3D technologies and 3D printing. So it's really impressive. And you also are the co-founder or founder of, and CEO of, Vet3D, which is a company that's been operating for a decade now. So, Bill, welcome to the show.

Speaker 2: 1:48

Well, thank you, Jenny. That's really kind of it's great to be here. I've, yeah, always been a big fan of 3D Hills and your mission to kind of bring this technology more to the forefront. So, yeah, it's wonderful to be here.

Speaker 1: 2:02

I am obviously a fan of yours and you know I am a radiologist. I wanted to serve humans earlier in my career. What made you become interested in veterinary medicine and decided to go to vet school and then eventually become a surgeon today.

Speaker 2: 2:22

Yeah, I think it's a bit of a cliche, but I guess I've just always loved animals and I knew at school science was the thing that I enjoyed and I loved doing. I was terrible, terrible at art, I was terrible at languages, but science was the thing I could do. And I suppose when it came to decide what to do sort of further on in my educational career, I guess I put those two things together. So, yeah, that was the story. My mum and dad got a dog when I never wanted a dog, but then my mum and dad got a dog when I was 12. And of course I fell in love with her and then that was the start of it all. So yeah, it's a story that many would share, I think. But yeah, it's the science and the animals at the same time is always the the combination for me yeah, no, growing up with animals is a really wonderful experience.

Speaker 1: 3:14

I actually was later in my life to get a dog and I totally now get it why they're so important in our lives. You've practiced as a general practitioner for a decade, I would say almost before you decided to become a orthopedic surgeon and maybe specializing in small animal. Is that correct to say?

Speaker 2: 3:34

Yes. So I think the career progression is a little different to maybe how a new graduate would maybe do things now. For me, but certainly the path in the UK. When I just qualified it was possible to go straight into a residency and a more advanced career path.

Speaker 2: 3:53

But many vets would spend some time in general practice and I guess I got a little bit stuck in general practice because it was a lot of fun and I was doing my life, but I'd always had this hankering to be. I loved surgery and I never I don't know why I loved orthopedics. There was just something about it that I loved and I'd always. I always knew I wanted to do this. But and I sort of messed about a little bit in general practice and you know I enjoyed fixing factors but I I kind of knew that I wasn't very good at it.

Speaker 2: 4:27

And yeah, I was very fortunate that I had the opportunity to work at a referral practice and the surgeon there kind of took me under his wing and a friend of mine, duncan midgley, and he really got me started with orthopaedics and then I was able 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 a wonderful grounding in you know understanding what clients want, how to communicate with clients, just the real hands-on general practice. 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.

Speaker 1: 5:14

Um, and then you progressed into even more, uh, technical hands-on and and incorporating virtual surgical planning and 3D printing and 3D technologies into your practice. I mean, that is the leap that not many veterinary doctors would go for. So what inspired that?

Speaker 2: 5:35

Yeah, and this really was that kind of eureka moment, I suppose, when at that point I completed my residency, I'd become a specialist. At that point I completed my residency, I'd become a specialist, an orthopaedic specialist. And I was kind of reached that point in my career where, of course, naively at the time, I kind of thought well, you know, I've got my board exams, this means I should be this, all this perfect surgeon, I should be able to do anything. And I was still struggling with deformity corrections, and I'd been on the courses, I'd read the books, and I was still struggling with deformity corrections.

Speaker 2: 6:03

And I'd been on the courses, I'd read the books, I'd done the exams and I'd plan these things and I'd go to theatre and nothing that I planned would work. And then I'd be there and I'd be slightly panicking and the bones in two pieces and my plan isn't working. And for a long time I kind of blamed myself. But then after a while I kind of thought, kind of thought well, actually, maybe it's not me, maybe it's the way that we're planning these, maybe it's the way that we're actually thinking about with the way that we've been, we've been taught for all these years and how to plan these things, and so I started looking at bones in 3d um, just working out how to take them from the ct scanner, take them into cad software and just print them out so that I could look at them and maybe well, maybe I could work out why I can't understand how to do this.

Speaker 2: 6:48

Um, and as part of that process you have to take the bones through the CAD software and yeah, there's all this stuff that you can do in the CAD and all these buttons and you can cut the bones in it. And then, kind of I just had this thought that well, wow, I could actually use that to do my correction on the computer and make all my mistakes there before I went to surgery. And from there I kind of worked out that I could make and make guides to actually do that for me, do my planning, and that was really the start for me and it was really putting together that know sort of slightly, I guess. Techie, you know I've always loved cad, I've loved I had a 3d printer, I loved all that stuff. And putting that together with the, that level where I was with my surgery, those two, that the intersection of those was really what made that first step yeah, um, you know, during our prep work you said the printing is really the last step of this whole process.

Speaker 1: 7:46

The thought and design process is really the bulk of the work, really, and since you mentioned the traditional way of planning these surgeries, I would assume that the old ways was two-dimensional. Can you walk us through how it used to work?

Speaker 2: 8:03

Absolutely, you're exactly right. The original, and it's still widely used, and the theory that I think we'll probably come on to a little bit later as well is Cora theory, which most people have heard of, if you're interested in this kind of thing. It's originally sort of drawn by Draupeli who's just a legend, still doing clinical practice um, but at the time where draw developed the core theory, it was cts existed but all of the planning was really done in 2d um and that whole wonderful core framework, which is still completely valid um, was all derived from radiographs, really from, from, from 2d imaging ultimately, and that the theory is still absolutely correct.

Speaker 2: 8:53

The difficulty is in complex deformities, the, the, the, the sort of what we call it covariance, that the, the influence of a deformity in one plane, affects the measured 2D measured deformity, the value you get in the other planes.

Speaker 2: 9:11

It's fine if you've got a nice simple deformity, but with a really complex 3D deformity, it's not that the theory's wrong, it's that the data we put into the theory, the 2D data that we put into the theory, doesn't really work anymore. We can't get the right data and this is where the 3d planning can have enormous benefits, along with other things as well, um, and that was the kind of one of the things coming back to my anti-braking problem, I was, yeah, didn't do it. That was that was kind of what was going on. It was it was the planning that was so difficult. And then translating the planning to the actual operation is the next challenge, which the guides do. But, yeah, the difference between 2d planning and 3d planning is absolutely key, um, and it's completely changed how we assess deformities, um, with yeah we'd draw lines, we'd measure angles, we'd do that in all the different planes.

Speaker 2: 10:01

these days, pretty much, we just align the top bit in 3d, we align the bottom bit inD, and then we work out what to do in the middle, and it's a very, very different way of doing things.

Speaker 1: 10:11

It's very different, I have to say, during our prep work thanks for sending over a couple of papers that you published it actually changed my perception on my daily work as well, because I live in the 3D world. I deal with MRIs and CTs every day, but I have never tried to measure anything in 3D. That is a complete change of practice and you know my daily practice. For humans, I don't really measure much three-dimensional stuff other than you know, a big, big tumor. You measure the biggest diameter, but I actually don't know how you train yourself your eyes or concepts. I mean, this could be the core theory 2.0 for you, bill. You could totally just put a name on it um, like, how do you train yourself to actually have a quantitative analysis of these three-dimensional deformity, because they're not really like standard you know femur or humerus but rather they're like not normal looking joints.

Speaker 2: 11:15

How do?

Speaker 1: 11:15

you do that.

Speaker 2: 11:16

Yeah, it's a great question and I think this is where I think the evolution to 3D planning still I wouldn't say meets.

Speaker 2: 11:23

I think it's quite mainstream now, certainly in veterinary, but still meets some resistance because quite naturally, surgeons like to put a number on something they like to say it's got 20 degrees of virus, it's got 15 degrees of torsion, and that's because, kind of because we've been trained that way, but kind of because that's it just gives you a handle on what you're going to do. And when you kind of say to surgeons, well, yeah, that's great, but actually those numbers could well be wrong in your case anyway, and how are you going to do that 20 degrees and 15 degrees, and then you've got another plane, and how are you going to get the cut in the right place? It's a very different mindset and I think that's where a lot of the difficulty that people have had with this, with the 3d planning, has come that we don't really we can put numbers on things, but to get numbers for a really complex deformity you really need to do a three-dimensional matrix calculation that only a computer can do, and when you get these numbers out they don't really help you much anyway. Um, and it's a very difficult mindset to get into and I think people do struggle with it. And, yeah, it's subjective.

Speaker 2: 12:28

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 judgments about where to put these. Yeah, and it's certainly true to say that there are elements of the sort of surgical process that we cannot do in 3D. We'll probably not be able to do them for a very, very long time. So when we talk about joint incongruities, joint laxities, these are things we can't model. Yeah, technology we have at the minute and they matter, and sometimes there are things that the surgeon needs to do interruptively that maybe deviate from the plan that we've created. But at the same time, I think the concept of visual alignment, 3d visual alignment is kind of what we all used to do anyway.

Speaker 2: 13:11

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 do you do and what do we still do? Well, we line it up. You know, we, we, we have a look at the limb and we hold it, we line up the joints and we fix it like that, so you ballpark it. Yeah, in many ways there's subjectivity there. So it's not as if the process always gave you a perfect answer. Every time there is subjectivity, there always will be subjectivity, especially with our patients, because they're all different. A straight leg for a Daxi might not be a straight leg for a Dane and all these things.

Speaker 1: 13:47

Exactly. You also have different breeds that we don't really deal with in the human category. So that is another variable that you add into your daily work, variable that you add into your daily work. Now, after you have done all these cat analysis or 3d analysis of a deformity or abnormality, how do you, how do you incorporate 3d printing into the picture here and how does it work? Does it really close the deal for you?

Speaker 2: 14:13

yeah. So the, as we've just been saying, we can derive this wonderful plan in 3D and we can see we can do a virtual correction. If we get it wrong we can try it again and we can see that we've got a nice straight-looking limb. But to actually create that osteotomy for the surgeon it's got to be in the right place, at the right angle. Then you've got to move the segments in three dimensions exactly the right amount. So to translate that plan to theatre, that's where the 3d printing comes in. And effectively we just design a guide that snaps onto the bone only in one place and it tells the surgeon where to cut, and it has pins there's all sorts of things these days to then assist the surgeon in the realignment to make sure that that's. That's exactly how we've planned it. And then either the surgeon can just pop on a normal plate that they've pre-contoured to fit from a 3D printed model, or sometimes we use patient-specific implants. So the 3D printing of the guides and the models is how we shift the plan to reality in surgery.

Speaker 1: 15:16

How many times these surgical guides that you created doesn't fit or won't create the outcome? I mean does that happen often or not at all.

Speaker 2: 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 a particular correction and we can just tell you what the guides need to fit is contour. They need cortical contour. So we need some curves, some bumps, whatever it might be, for the guides to latch onto. And sometimes we're fixing a bone and there just aren't any, you know, for whatever reason, or they're really poor, and sometimes we can modify design to you know, get around that problem. But sometimes you have to say to 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're putting this guide on, uh.

Speaker 2: 16:10

The other situation where it can happen is growing animals, um, so obviously an animal that's growing quickly, it's going to the bones could be getting bigger, they're going to be changing shape as well. So if you have too long a gap between your CT and the surgery, the bone can just have changed and so the guide won't just literally doesn't fit on anymore. So there are predictable times when it can happen that we can be on the lookout, for it really shouldn't happen otherwise, as long as the surgeon has used the guides correctly and has put them on correctly, because you know we do do various sort of checks to make sure that the guides fit on the bones and we know that the bones and the guides that we derive from the CT data have very high fidelity to the CT. So we know that that bit should be okay. So if something goes wrong it's usually a sequencing error in in surgery now?

Speaker 1: 17:03

um, I've never performed a surgery before. I mean I've scrubbed into some. When you're in the surgical field, it's quite bloody and hard to see things, and not to mention you have to move all the soft tissues away to expose the bone. How do you find a landmark to snap on your guide? This is a question that bugs me forever.

Speaker 2: 17:21

I just gotta ask you yeah, and a lot of this comes down to how we actually plan the guide system. So part of what I do actually this is kind of. When I started doing this, I did the guide design. They were terrible. I did design the guides. I, you know, I printed them myself. I'm really lucky now I have people to help me with those things much better at it than me.

Speaker 2: 17:42

So my job now is really kind of doing the surgical planning because, being a surgeon, I can think 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 is going to be looking at when they've exposed the bone. I know what bits of the bone are safe to use for guides. You know which bits can we clean the soft tissues away, or where are veins, where are nerves, where are places that we just can't get to? So we can integrate that knowledge into the overall sort of conceptualization of the guide system. So when the surgeon comes to do it, there's the right bumps and nobbles and curves that the surgeon can access that are available for the guides to fit onto, so it's an important part of how we design the systems.

Speaker 1: 18:36

Wow, that's a lot more elaborate game plan than I thought it was going to be for sure, it's totally all in your head, except the final point of print the guide like you said yeah, so what was? The. So you've done 4,000 cases Were. These cases were done all through your company, vet3d, or there's some before that as well?

Speaker 2: 18:58

No, I mean mean I started doing them for myself so, um, you know, I suppose maybe I'd probably done a hundred or so of these from me and my immediate colleagues before I thought, actually this is really something I probably need to do something with um. And so, yeah, there was definitely a period before I really got into, I really started vet 3d as an entity, um, and was there like a aha moment, where you'd be like I want to translate this technology more practices and more animals I don't think it just a sort of specific moment, but it's kind of and I mean I won't, it was great, it was.

Speaker 2: 19:42

It's sort of when you kind of show it to colleagues that you expect and they say, whoa, that's actually pretty cool and that's really nice.

Speaker 1: 19:53

Yeah it is, I bet I can feel it, even though I didn't experience it actually this.

Speaker 2: 19:59

This is really something that could make a real difference. You do feel a sort of role imperative, but you do kind of the whole point of. For me, the whole point of being a surgeon, of trying to get really, really good at being a surgeon, is so that we can do better for our patients. And of course, there's professional pride. Pride, you know you want to do things well, but really you want to do them well for your patient because you want everything to work out really well. And I think for me, when I kind of it dawned on me that this really could help with clinical outcomes and it really could allow us to do things that we couldn't do before, I think that was when I thought, oh, I need to run with this. You know, I need to try and make something happen so you know this is not a video based.

Speaker 1: 20:46

I mean we're we're not showing animal videos, which people love, but I'm sure you have several really satisfying cases that you remember of your entire decades of experiences here. You want to share a few cases with us that really made it for you.

Speaker 2: 21:03

Absolutely.

Speaker 2: 21:03

I mean, there's one that completely sticks in my mind which was a great day, and I won't say her name because the owner was didn't really want us to share the case specifically, but we can talk in generalities and this was a great dane who had an osteosarcoma of her distal radius and she was a big dog, 60 kilo dog right and we had to.

Speaker 2: 21:28

Well, I didn't do the surgery, I made guides and implants for a surgeon to do um and we had to reset probably 20 centimetres of this dog's radius. So it's a huge resection in a dog and we were able to use a patient-specific implant for that dog, guide systems that we designed, a plate that we designed, and we were sent a video of the dog running on the beach at 12 weeks stop, completely sound, completely happy dog, and it was just one of those sort of cases where you think, well, that is, that's quite amazing, because that is something that would have been unbelievably difficult to achieve without a very specific type of implant and a very specific set of guides and planning. And to see that dog do so well was wonderful and it's probably my highlight case.

Speaker 1: 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 two meters. Oh no, that's zero point. Wait how many meters? That's zero point. Two meters? No, that's zero point.

Speaker 2: 22:38

Wait how many meters, that's zero point meters, 20 centimeters, 20 centimeters so yeah it's kind of that's pretty big.

Speaker 1: 22:44

That's pretty big, yeah. It's kind of that's almost like half of the leg right yeah yeah, yeah, it was a.

Speaker 2: 22:49

It was a significant proportion of this dog's radius. And this dog stands what kind of up to your? Up to your sort of chest, I suppose.

Speaker 2: 22:58

Um right, it's a big dog I mean, the other option for this dog would be amputation of some sort yeah, so previous sort of limb spares called limb spare, previous limb spare techniques have been described but they had high rates of complications. Dogs, could you know they would be lame because of the surgery, the, the attempts that were made to reconstruct the leg would take a long time or had high infection rates or other complication rates. So yeah, that would either be tried and so the dog would kind of just be lame and unhappy.

Speaker 2: 23:27

All, all of this every time it wouldn't be a dog anymore yeah, and these dogs are life limited so these tumors do normally metastasize and min survival times, maybe a year. So if you're going to do a big operation you need the dog to be a happy dog for a year. You don't need it to take a year.

Speaker 1: 23:41

Quality of life yeah.

Speaker 2: 23:44

So, that's a big thing, but yeah, you're right, otherwise it would be amputation. So it's all about quality of life and it's being able to use these technologies to improve that quality of life outcome.

Speaker 1: 24:05

And that was the case. It was a perfect case, perfect example of being able to do that. Yes, and, but you don't just rely on these. You know individual cases. You actually published 20 papers evaluating various aspects of virtual surgical planning.

Speaker 2: 24:13

And how do you collect these evidences and what are some of the numbers that you can show people that this procedure really is a better approach, significantly yeah, that's a great question and it's it's data that's hard for us to to collect actually, in veterinary medicine, for various reasons, outcome assessments are always hard to assess because you just can't ask the patients how they're doing Right, it sounds silly.

Speaker 1: 24:39

Pediatric patients forever. Yeah, it's the same thing.

Speaker 2: 24:43

Infants. It's quite a problem. So that level of outcome assessment has always been quite hard. But, that having been said, there are instruments to do that, there are ways to do that, and I think something that, moving forward, we really need to do is to 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.

Speaker 2: 25:05

A lot of the stuff we've published 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 for osteotomy creation, angles, positions and time as well, you know, showing that these things are quicker. They save surgical time, which is directly related to complications. So a lot of the stuff that we've published has been accuracy based, speed based, but also we have clinical outcomes of individual cases, small case series, sort of dax and deformity corrections, um, certain neurosurgical syndromes. We know we followed those dogs out for for periods of time, but it would be wonderful to do big number outcome studies and that's something that we will manage to do at some point yeah, well, hopefully some of the listeners can also reach out and collaborate.

Speaker 1: 26:05

Um now for people who are just starting to be interested in using this approach is there any paper specifically, or review papers, that you can recommend people to go for?

Speaker 2: 26:16

yeah, it's. It's a difficult field because there's still there are books on the human side about um 3d printing in in human medicine, but there isn't really anything that there is a. There is a publication on the the the veterinary side, but it it tends to my particular field, orthopedics. There isn't really very much on it and I think really if I was going to recommend one thing, it's draw paley's book, which is still, you know, sort of the bible for deformity correction and we'll put the link in there somewhere in a podcast note yeah and um, I mean, as if you're an orthopod and you're interested in understanding how to assess and to plan deformities.

Speaker 2: 26:56

That's the. That's the wonderful place to start. Um, but yeah, the 3d printing thing it's still, and certainly when I started there, just isn't. If you can't go and buy a book that tells you how to do this stuff and um, that's still the case and it is um. You know, people do ask me and I can't help everybody that asks me. You know, how do you, yeah, how do you do the segmentation? How do you print it? How do you assess this formality? It's like it's a whole book. I can't tell you, I can't teach you.

Speaker 1: 27:25

It's probably a series of books that no one has the time to write. That's the problem.

Speaker 2: 27:30

Again. You know a good friend of mine has 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.

Speaker 1: 27:41

It's impossible.

Speaker 2: 27:42

Yeah, it's a monstrous project. Yeah, it's huge, but yeah speaking of monstrous projects.

Speaker 1: 27:45

I mean I think that 3d, in a way, it is a big project for you, uh, in your life, and you know it is a business that you're building, where there are some. Tell us some of the challenges that you have met earlier, both on the technical side and also the business side of building VAT3D.

Speaker 2: 28:03

Yeah, I mean I think the first one was literally what we just said. I mean, I kind of knew what I wanted to do, but I had no idea how to do it. I didn't know how to extract DICOMs from the CT workstation, let alone turn them into a 3D model, let alone how to print them workstation, let alone turn them into a 3d model, let alone how to print them. And because I was kind of, I wanted to do it, I spent ages googling it and trying to work out how to do it. How could I do it with my ct machine, with my printer, and this huge learning curve of understanding cad software which you know, as it turns out, my I was very amateurish at, and now my colleagues who do all the planning, uh, the design, uh, for me are so much better at it than me and use amazing software so that I don't even can even turn on. So I think there is a huge, there was a huge technical learning curve to kind of make what was in my head actually happen.

Speaker 2: 28:57

Um, and I think that's probably the biggest challenge for anybody that kind of wants to dabble in this themselves. It's just those first steps in getting going with it, I think from the business side it kind of happened organically. It was little mini steps for me, you know, I didn't come in with a huge backer and a million dollars and I just said, well, you know, let's set up your lab. It was, you know, I kind of got another printer and then, you know, I got a little office. That was a big step. And then I am, I got my first employee and in fact these are like, of course you did, it's obvious, but at the time they were kind of kind of scary steps. But uh yeah, for me it's happened very much incrementally, which has been lovely because I've been able to build things up gradually and I think it's made a very solid foundation. But certainly I'm a no businessman, so I made a lot of mistakes in building up my team and kind of getting the organizational structure for the business organized.

Speaker 2: 29:53

But yeah, I could have done with a business expert to help me with that, that's for sure.

Speaker 1: 29:58

Well, some people don't need to go to business school to learn business. And then you just did it by doing, and I actually got interested in 3D printing also around the same time. I think around 2012 or 13 is when everybody started to talk about 3D printing for healthcare. I think that at the time, the 3D printing stocks are at the peak of its hype.

Speaker 1: 30:21

It was in the hundreds of dollars and everyone was totally talking about how 3D printing can change the world and I think I got into that wave of interest and it is very interesting, I'm still interested until today. However, it is absolutely true that there's no resource. There was no resource for you. There are a couple of open source softwares you can try perhaps, but it needs a lot of doodling and tinkering and there was no official courses to teach people what these are. We have some rudimentary courses kind of expose people what applications 3d printing can do, but by no means can teach people actually how to do it. That gap is, I think, still persists still today I agree with you.

Speaker 2: 31:10

I agree, and some you know the big human health care um, certainly on the orthopedic side, sort of materialize. You know they've been way out ahead and have done wonderful development work and they do run courses. But unless you know one of my cad techs, she basically learnt in the human healthcare system in the UK and it was very, still almost an apprenticeship and organic. You know there was nothing materialised but it was still very much and organic. You know there was no materialized but it was still very much. Well, you know her colleagues had learned how to use haptic and and different softwares and so she learns and it was very much that, rather than heading off and doing a degree in it or going on a big long course. So they, they do exist but they they absolutely.

Speaker 1: 31:54

There's nothing you can do to kind of take you through the whole process and without devouring any preparatory information, um what software and printer system do you guys use nowadays?

Speaker 2: 32:06

yeah, no, it's um, we use, actually we use a combination which is almost a case in point of what we've been saying. There's still nothing out there that, in our opinion, like just does everything and it is perfect. So we use mimics. That's a materialized package for our segmentation. But, to be honest, we also sometimes use horus, which is which is free if you've got a mac which one sorry horus, so h-o-r-u-s, so it's it's okay, never heard of it yeah, no, it's a.

Speaker 2: 32:33

It's a, it's an image viewing software. Oh interesting, but actually really quite good at segmentation as well. If you know what, what, what sequence to use um for the, the planning, I use a software called um autodesk netfab um which is a.

Speaker 2: 32:50

It's a generic cab yeah actually we have to use workarounds, but it's actually very good um and it. I've used it for all of this time and it it works nicely. Um, I have, um, my colleagues use three matic with another materialized software a bit, but predominantly geomagics, which is a um, uh, really a 3D modeling software. So it's used almost like sculpting. It's almost more of a sort of uh, free artistic. You know that people use it for sculpting 3d models for film, yeah, things like that.

Speaker 2: 33:24

I mean it's yeah, when these are haptic arm to literally sculpt uh virtual clay and that allows us to to make very organically shaped patient specific implants which are wonderful to use um and would be extremely impossible to create on a more sort of engineering-based CAD, where everything tends to be straight lines and angles, which is how plates have traditionally been designed in other softwares. And the printers, we still use Form Lab printers, so we use form force. Now, um, and they're they're good. I won't say they're perfect, but every printer in the world has a failure rate and you know we do get print fails, but actually they allow us to do all of the things that we need to do, so to print it uh, biocompatible plastics, autoclave, right, and we know that they have very high accuracy, high fidelity to the original CT.

Speaker 2: 34:25

So, obviously that's a whole textbook in itself, but we know what those printers produce for us. We know that that's going to be accurate to within well, basically microns. Well, sub-millimeter is best to say, uh, but high, high accuracy. So yeah, we know that each step of the, the process has the ability to produce the accuracy both of the guides and models that we need for the, the, the systems, to work clinically.

Speaker 1: 34:56

Yeah, I think that's a good segue for a couple of topics. One is the steps when a new surgeon wants to use your service to produce their own surgical guide. How does it work for them? And the next question will be the QA process, which I certainly don't want to book, but maybe some general descriptions about it sure, yeah.

Speaker 2: 35:21

So I mean again the, the certainly a surgeon that wants to, you know has a deformity, you know is thinking about using guides, really the, the whole way that we've kind of set up.

Speaker 2: 35:33

Vet 3d and other providers do things slightly differently, or some do, some don't. There's lots of different sort of uh workflows on offer, I guess these days um, but the way that we do it is always to kind of make use of myself and my colleagues. Um, in the us, jason laid on by antropovsky, in the states even kamikov said I work with a number of boarded surgeons who will do assessments. So the idea is more that it's not that somebody sends a ct and you know they kind of have to then communicate with an engineer to say, well, this is where you know I'd like you to, this is what I want to do. We will say we would kind of analyze a deformity or a neurosurgical problem. We'll give them a clinical input if they'd like it, which is usually helpful in a certainly deformity corrections where, like we were talking about the 2d versus 3d thing, you know, we can offer that level of insight into what the deformity is, discuss with the surgeon how they want to address it, because there's rarely you're right where in the wrong way.

Speaker 2: 36:32

There's always shades of gray with these yeah and then once we have a plan finalized with the surgeon, then we can kind of pass it on to the engineers and they'll do the design and the print and we send out the final system. So it's the whole way that we do. Things is tailored around the clinical aspects of the case as well as just like producing the guides and selling.

Speaker 1: 36:56

Right, it almost sounds like a second opinion.

Speaker 2: 36:58

It is, I think it is a surgical consultancy.

Speaker 2: 37:02

I mean it's you know some surgeons want more, some surgeons want less, and that's great. You know some. So you know, for cases where you know the surgeon, we've done loads before and the surgeon knows exactly what they want and they know exactly how we'll do it. They'll just say, yeah, it's another one of them. Great, off, we go, you go. You know that's fine. But the way that we tend to set things up because we are dealing with vastly more complex deformities these days, much more challenging problems there's always a clinical dimension. It's very rare that it's just like sort of a slam dunk. This is what you need. There is almost always nuances, different ways to do it surgeon preference, client preference. How much money have we got available? All of these factors that you need to kind of all integrate together to come up with a surgical 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 that it's time consuming and it's difficult.

Speaker 2: 37:59

Yes, Outside of the surgery theatre, time consuming outside of the operating room, and that's the point when you take it surgery, it's quicker and it should be exactly what you think is going to happen. Happens, which is what you want at that point in the proceedings. Um, so yeah, I think that's that's how it works with a new surgeon and it's and you know it's. There are other providers out there who will do some of the thing to us or who will just offer that engineer-based service, and some surgeons prefer that. They don't want me, you know so that is my question as well.

Speaker 1: 38:32

You know, personally I like a second dentist to have an opinion on my teeth or my dog god forbid if she ever needs surgery. I would like to have a second opinion. I don't mind of extra cost, um, but the thing is you need the surgeon, the primary surgeon, to have the humility to actually acknowledge limitation of knowledge and skills and actually reach out to people like you. How do you work with that dynamic?

Speaker 2: 38:57

it can, can be quite difficult. And it's a great question because I think there is and I think certainly there are certainly surgeons out there who see it as a personal slight that guides could even possibly improve their surgical outcomes. And you know, there is a little bit of an ego thing there sometimes. For sure, not a lot of them is a little bit of an ego thing there sometimes, for sure, not a lot of. I think I'm in many ways lucky because I have been doing this a long time and I've been publishing a lot on this and I've been right, I suppose I do have a level of experience and reputation for understanding deformities at a very high level.

Speaker 2: 39:35

And I think it's like anything, I think our profession, just we're going somewhere as human medicine we're becoming becoming so much more subspecialized.

Speaker 2: 39:43

You know, I think back in the day you were an orthopod and that was it.

Speaker 2: 39:47

And these days almost everybody has an area that they're particularly interested, they're particularly good at that they do a lot of and get particularly good and get particularly good, and for me that's deformity corrections. And you know, I think that most, most surgeons out there realize that yeah, that's cool. You know, that isn't that's not saying, oh, you're a rubbish surgeon that's saying well, you know, these guys do this day in, day out. Why wouldn't I sort of leverage that experience, that knowledge? So I think we're kind of past the point with most people now that they feel I'm coming in and kind of, uh, patronizing them or telling them how to do it and it is very much a collaboration. I mean I have to try and control myself, think, well, you know, I'd maybe do it this way, but you know there's perfectly valid alternatives and I'll by all means help you with those alternatives if that's what you prefer, and make guides. So but yeah, sometimes there is a process of tactile communication that's needed yeah, for sure the soft skills.

Speaker 1: 40:46

But, bill, you're such a nice person I can just tell after you know 30 minutes in. You're so easy to talk to and friendly. Uh, it will make things easier, probably, for people yeah, now in terms of the economics behind these cases. I don't know if it makes sense for the other people to reach out for your consultation or, just overall, does it save money for the overall cost, not just the surgery but also aftercare and stuff like that? What are the economics behind each case?

Speaker 2: 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 cost because, right, it's so. The cost is so much greater on the human side and you know, 10 minutes in in the operating room is whatever it is a thousand dollars or something crazy. So if you can save that 10 minutes, then you can save an 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.

Speaker 2: 41:49

Certainly there's quite a lot of um human literature now that demonstrates, you know, actual dollar savings, um, due to the use of guides, just basically through time. You know, if you, if you can take 10 or 15 minutes off your surgery which you will, you know, or more, then you save x amount of um money. Um, and the other costs are less tangible. But things like, certainly on the veterinary side, you know, if there is a complication, sometimes clients are able to pay for those, or if the dog's insured, then that's covered, but often, you know, vets end up covering complication costs quite often and if we can reduce complication costs, then that saves the practice money and also planning costs.

Speaker 2: 42:33

So for these very complex deformities, you know I would spend half a day, usually on my time off, sort of trying to work out how to fix this. And if the surgeon can save that time, they're not staring at radiographs, they're not drawing lines, they're not trying to work out angles, draw, you know literally, do you know trigonometry and and signs and things? Um, then that is saving them a chunk of time and that's a chunk of time they could be doing something else. You know they can either be doing 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 computing for um complex orthopedic surgery that's the plan.

Speaker 2: 43:13

So, and yeah, it's time consuming 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 of accurate level, than somebody that does one of these every six months, um, and doesn't really like them. So, um, I think there's a lot of ways. There are sort of tangible cost savings and intangible cost savings that are harder to sort of really pin down. Yeah, put them together, there was a significant offset of the cost of the guides, um, but where that is, I couldn't say, but it's definitely there yeah, I think you know the intangibles where the animal got better and lively.

Speaker 1: 43:53

You know the great, the great ding story. I bet that owner will come back again if there was some other dog but for the fact.

Speaker 2: 44:01

In fact she has, you know, told her friends in the great dame world that you know this works and so, and other cases have happened as a result of that. So, um, these are, these sort of ripple effects have do good, you know, in a, in a way that you can't really put your finger on, but yeah for sure.

Speaker 1: 44:21

Yeah, I was just thinking in terms of the economics. You know, the time saved, the complications saved, revision saved and happiness added up. Subtract the time, uh, with the cost of you having to do the planning and creating the guide. If that turns pretty positive and demonstrable, you know that that will be a turning point for this entire industry to really bloom.

Speaker 2: 44:44

Yeah, and I think we do see it and I think you know I I don't know a number, but I think the significant majority of surgeons that start using these 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 keep coming back. So I think it kind of fun but it didn't really work. You know, I think they people keep coming back.

Speaker 1: 45:01

So I think it kind of demonstrates that you know there is surge in happiness as well as probably financial happiness as well yeah, um, it translates in health care in general if the patient does better, eventually you will make money as well, because just goes hand in hand. Um now, speaking of your, um, your clients, um, you've helped you. You're not just doing it in europe, you did it in all over the world, right?

Speaker 2: 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. It's cool the bulk is those three main continents, I suppose, but I suppose that's where healthcare, pet healthcare, industries tend to be focused. But, yeah, it's lovely, yeah.

Speaker 1: 46:05

And then, so do you see any trends in these different markets? You know, for example, are you in Europe and, as I remember, european pet market has the highest penetration of medical insurance for pets, as opposed to America actually has pretty low pet insurance penetration. So do you see any market trends these days in these different markets?

Speaker 2: 46:27

I mean, you've hit the nail on the head. It's all about insurance, and I think mainland Europe is maybe still lagging behind with that compared to the UK. I think there's a very, very high rate of insurance in the UK, um, not so much in mainland Europe, okay, I think. Uh, certainly, in the States it's. It's increasing, but it's still pretty low, amazingly low, yeah. Yeah, but higher in in Australia, um, which is again why I think we do probably quite a lot more cases for Australian surgeons. There are some cultural things. I mean, I think the concept of you know having a pet that you spend lots of money on is still not so prevalent in some mainland European countries as it is in the UK or maybe in the US. You know dogs, they're working animals, you know, and the concepts.

Speaker 2: 47:20

Yes, my working animal is sleeping in front of me right now. Yes, absolutely, you know pets, you know dogs they're working animals, you know.

Speaker 1: 47:22

And the concepts?

Speaker 2: 47:22

yes, my working animal is sleeping in front of me, right now absolutely working so hard so there are some cultural differences, but I mean, I think we are very much driven by insurance, especially in in this era that we're now in of corporatization of veterinary health care, where you know everything is so much more expensive than it was, um, just anyway, because of the way the corporate structure works. So you know the concept of spending another thousand dollars, fifteen hundred dollars on a guide system. You know that kind of that extra little slice of money is maybe not so available. So there is no question that things are so much more expensive than they were maybe 10 years ago and that does impact on clients ability to pay and the reliance on insurance is is even greater as a result and so typically the surgeons pays you guys right and not the patient directly occasionally we do it that way.

Speaker 2: 48:16

But you, yeah, it's the surgeon pays, pays us.

Speaker 1: 48:20

We and if, if, let's say, if I have a dog that has a deformity but I want you I'm in the us and you're in uk and my we have a different surgeon who is working on the case, how do I, as a dog parent, convince or trying to get to a surgeon that can use your service? How does that work?

Speaker 2: 48:42

Yeah.

Speaker 1: 48:43

Hypothetically obviously.

Speaker 2: 48:46

I guess you kind of put your foot down and say and do your own research, because you're quite right, these systems are by no means used by every specialist orthopedic surgeon or neurosurgeon in the world. I'd love to know that number, actually, but I think it would be still quite a surprisingly low number. And if you personally think, goodness me, I really would like this technology, then you need to seek out somebody that uses it. And yeah, I guess, be a real advocate for your pet technology. Then you need to seek out somebody, that, that, that uses it and um, or yeah, I guess be a real advocate.

Speaker 2: 49:25

Yeah, we can, but we don't. We don't, sadly, actually deal with with general clients very much, but we do occasionally get people that do ring us up and say yeah, we have seen your stuff and where can we go, and Well, that's a good question, you know.

Speaker 1: 49:40

perhaps you can create a list of surgeons who would work in my area, for example, and generate some kind of partnership.

Speaker 2: 49:49

Certainly possible, and we do do that informally, but it would be certainly an evolution. It would be a nice resource for people.

Speaker 1: 49:56

Yeah, I saw your website. By the way, guys, I highly recommend to check out Vest3D website. Very informative, lots of details, lots of instructions. I love it. It's more explanatory and it provided a lot of clarity of what is going through my surgeon's head and how to achieve the accuracy and quality that you wanted to achieve. So I really love that aspect. And also, you know, speaking of the cost, I know it's expensive now but, like a lot of technology, I do believe it's going to get cheaper over time with the progression. Just imagine the TV. A couple of decades ago, the flat screen TV was extremely expensive and now it's just getting cheaper and better.

Speaker 2: 50:39

Yeah, yeah, well, but it will be. I think it'll be a little bit slower for us. Um, because the main, certainly for us, the main cost is time. It's surgeon time, it's technician time, it's engineer time and there is, it's not really that we're particularly limited by the computer. You know the processing power. We're not limited by the printers and we're not limited by the. You know anything physical, it's real time. So the obvious answer to that is AI. Ai will absolutely change what we do. But the impetus for ai to you know where veterinary orthopedic deformity corrections is a kind of pretty niche thing for ai and nobody is going to come along with you know five million dollars to invest in a tailor-made ai system for us.

Speaker 1: 51:34

So it's going to be a slow it's going to cost more than five million dollars it's going to cost more like $5 million. It's going to cost more than $5 million, like my billing is more like it, you know.

Speaker 2: 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.

Speaker 1: 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 accurate than me for sure to tell to forecast anything, what do you think 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 progression you're seeing?

Speaker 2: 52:11

you're going to see yeah, I think a lot of it will be joint replacement. So joint replacement is is always challenging for a load of technical reasons. You know, all the joints that we replace have their own technical challenges that are very difficult in some cases. And I think the not not even so much the 3D stuff really, but just the way that the whole field is progressing is extremely quick, extremely exciting. People are getting so good at it, talking about self-specialisation, but there is a lot of 3D stuff that does feed into that. You know, joint replacement, planning, patient-specific implants so I think that's going to be a huge area. And, more generally, I think the greater use of patient-specific implants, orthopaedic plates, not just joint stuff, but other areas as well, I think will be huge.

Speaker 2: 52:59

Specific implants, orthopedic plates, not just joint stuff, but other areas as well, I think will be huge. And you know the great day and I talked about one great example you know that was something that 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, and certainly not so efficiently. And that is because that's a tailor-made implant and that applies to many, many, many situations and that is within our reach, and that's something that we're doing right now and that will become much greater. And I think the other thing is spinal stabilization. This is another area where technology is rapidly progressing and I think in the future you know, we have new systems coming through, fixation systems and that will become so much better over the next few years. So, yeah, there's a lot of stuff happening.

Speaker 1: 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 one because I did not get it, because I heard it has a lot of spine issues and every procedure is $5,000.

Speaker 2: 54:06

They are predisposed to slipping discs. So disc rupture, disc protrusion, they are unfortunately predisposed. But there are many good screening systems out there now predisposed. But there are many good screening systems out there now. So it's possible to find uh, uh sort of breed lines that are much less at risk of that. But, yeah, bless them, they're probably, yeah, they're fantastic dogs.

Speaker 1: 54:29

I love them to bits and I love them too, just not the bill uh stuff wrong with them yeah no, no, a little bit tangential um is is biologics. You know some kind of um bioprinted, biofabricated scaffold or stuff like that. Is on your horizon at all, you think the next 10 years or so?

Speaker 2: 54:50

yeah, it's, there's a lot of research, so a lot of the, the, the.

Speaker 2: 54:56

Yeah, it's, it's difficult because a lot of the, the, the knowledge exists, but it's on the human side and it's human research, so a lot of the human research models are done in animals.

Speaker 2: 55:07

So there is a lot, a huge amount of incredible knowledge about how to bring these things forward, but the problem is it's all proprietary because these, these are companies that have spent billions of dollars researching stem cells, researching scaffolds, researching cartilage resurfacing. They're not about to share that with me and they're not about to share it with anybody, frankly, so that knowledge exists, but we can't get our hands on it, um, and again, some of it will come down to cost, um. You know, these things, by definition, are expensive, um, and they will be for a long time. So you know, there are systems where you can certainly pay companies to extract stem cells, um, which you can use, but the evidence, in the kind of relatively rudimentary way that they're currently available to be 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 printing a bioscaffold that's impregnated with stem cells and slotting that into a critical defect, yeah, we're way off from that, and we do have alternatives.

Speaker 2: 56:14

so it's not as if it's something that I feel is a huge priority, but it is something that is being worked on not by us but by clever people, so it will come through but not for.

Speaker 1: 56:25

So yeah, we're kind of reaching the end of our interview. We have a couple of fun questions for you. If a young veterinary doctor wants to get into 3d technology, what are your advice for him or her? Don't have a personal life because you won't have time oh okay, advice or warning I mean either one, I guess. And okay, of all the animals you have worked with, which, which kind of animal is your favorite?

Speaker 2: 56:58

oh, I love. Well, we mostly treat dogs, so big dogs and little dogs, yeah, so Daxies and Wolfhands, they're my favorite, so I love treating them. And we treated a kangaroo a few months ago Kangaroo.

Speaker 1: 57:09

Yeah, nice, that should be reported in news. I hope, hope to see you soon.

Speaker 2: 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 3d printed was a, a beer holder that sat on the arm oh, I like the sound of that and it was a curved couch and it made a flat top and I could put my beer on it. So that was it's pretty pretty we're gonna have a photo someday of that.

Speaker 1: 57:35

And then are you a big consumer of podcasts, books, any media you would recommend to people as a resource? Um, well, personal development, it doesn't have to be professional no, you do not, not really.

Speaker 2: 57:50

No, I I'm a big, I love, uh, climbing and mountaineering, and I think that that changed me as a person and it made me kind of very self-sufficient, very, um, single-minded. So I think having something like that that really kind of gives you that sense of you know, drive and determination to actually be fantastic, that's something I think is, um, is great. But yeah, it depends what your your are, I suppose.

Speaker 1: 58:20

So you must have read Into Thin Air or something like that Absolutely yeah. So what was your last peak that you climbed?

Speaker 2: 58:27

Oh, I run around in the hills in the Lake District where I live, so I go up and down and up and down and it's a beautiful place. So when I stopped being a full-time surgeon I could come and live anywhere. I just needed internet and a postal service. So I came to a beautiful part of England that has hills and valleys and lakes and lots of sheep and it's beautiful. So I kind of run around in those and yeah, that's like my dream life.

Speaker 1: 59:00

Not there yet. Well, I think we reached the end of this interview. Thank so much, bill, for your time and insight today. Um, and if people want to get in touch with you, how can they reach out to you?

Speaker 2: 59:09

yeah, just drop me an email. It's just bill at vet3dcouk okay, that's really easy.

Speaker 1: 59:15

Thank you so much, bill. Thank you, jenny, it's been a pleasure. Thank you, yes.