Episode #99 | 3D Printing for Orthotics & Prosthetics (Virtual Event)

Orthotics and prosthetics are entering a new era. Instead of hand-built devices that take days to shape and adjust, clinicians can now scan a limb, tune the geometry in software, and print a device that fits with impressive consistency. This episode explores how that shift is happening in real clinics and fabrication labs by hearing from experts who are shaping the future of digital O and P.

We have Michael Schmitt of Prosthetic Plus , who has moved from traditional clinical practice into advanced additive manufacturing and now helps run a central fabrication site that blends MJF and FDM production. He explains how accurate scanning and thoughtful CAD design create devices that can be reprinted months later from the same file in a perfect new size. David Johnson of HP builds on this by showing how polymer Multi Jet Fusion has become a reliable platform for orthotics and prosthetics, offering durable materials, isotropic strength, and the throughput needed for large-scale production.

Once the prints come off the build plate, Emilie Simpson of DyeMansion
explains how they are transformed into smooth, hygienic, biocompatible devices through cleaning, surfacing, vapor smoothing, and deep-dye coloring. Her work shows why post-processing is essential for patient comfort and clinical durability. Finally, Tara Wright of Gillette Children’s Specialty Healthcare brings everything back to the patient. She shares a compelling case where her team scanned and printed a replacement UCBL that matched the feel of a worn original, cut fitting time dramatically, and performed well for more than fifteen months. Her experience demonstrates how digital production can raise consistency and reduce strain on clinicians.

Together, these voices map out a practical path for clinics that want to adopt scan-to-print workflows. Start with accessible FDM printers to learn digital modification. Move to production with MJF through central fabrication or service bureaus. Scale when your volume, staffing, and materials align, and explore decentralized scanning with centralized manufacturing to broaden access.

Whether you are a clinician, technician, engineer, or healthcare innovator, this conversation offers a clear look at how digital manufacturing is transforming O and P. Tune in to learn how these tools can deliver better fit, faster turnaround, and more equitable access for patients everywhere.

On-Demand Course Link

Youtube Highlights

Event Write-up

Chapters

• 0:00 Welcome & 3DHEALS Mission
• 2:39 Introduction
• 2:43 Michael’s Path From Handcraft To Digital
• 5:37 Garage Printers To Central Fabrication
• 12:05 Moving From FDM To HP Powder Bed
• 15:35 Lattices, Liners, And Patient Comfort
• 18:30 Partial Feet, TPU, And Hybrids
• 22:40 Custom Gauntlets And Printed Straps
• 27:10 Upper Limb Devices And DIP Fingers
• 31:20 Reprints, Repeatability, And Scaling
• 33:01 Q&A: Tools, Software, And Materials
• 39:43 HP Workflow: Scan To Print
• 44:20 Nesting, Materials, And Throughput
• 48:40 Process Control And Build Strategy
• 54:21 Post-Processing Deep Dive
• 58:40 Biocompatibility, Smoothing, And Dye
• 1:04:00 Durability, Hygiene, And Colorfastness
• 1:07:30 Introducing Gillette Children’s Use Case
• 1:11:10 Scanners, Carvers, And Partnerships
• 1:15:05 Research On 3D Printed AFOs
• 1:18:15 Case Study: Copying Legacy UCBLs
• 1:23:05 Service Bureaus And Hybrid Workflows
• 1:26:20 Regulatory Realities For Cranial Helmets
• 1:31:40 Scalability, Economics, And Adoption
• 1:38:05 Global Access And Decentralized Models
• 1:42:45 Wishes, Next Steps, And Closing

Transcript

SPEAKER_01: 0:01

Hello, hello, hello. Good morning and good afternoon and perhaps good evening. I know every every time there are some people signing in 4 a.m. and their time's off. So thank you very much. This is Jenny Chen, the founder of 3D Fields, and I just want to talk a little bit about 3D Guilds so that people can trickle in. We have three missions. One is to educate people about how 3D printing can really impact healthcare instead of just what you see on TikTok. So we actually dig deeper into topics that you can learn. Number two is networking. We have been doing mostly virtual events, but we are starting to do in-person events as well. In fact, we are working on something right before JP Morgan conference next year on January 11th. So stay tuned for announcement. That's going to be in San Francisco. And the the way we want to network is so people can collaborate, form companies together, research projects, anything, friends. So your virtual, you can put your social media link that you want to connect people with in the chat box and also tell us who you are, where you're from. And and this way is a is a good way, effective way of uh being visible in this virtual event. And number three is also extremely important for us, is our pitched 3D program. We help with early stage startup fundraising at no cost. And uh so if you're interested, if you're early stage, which means before series B, so series C or A, you are qualified. And uh in terms of the kind of companies, uh we focus on 3D technologies. So 3D printing, ARVR, and related uh companies like biomaterials and software-related companies are all welcome to apply. So uh I will share a link in the chat box later so that you can look at it. Now, today's topic is really, I would say, the essential topic in 3D printing. I mean, ever since the invention of 3D printing in and the application of 3D printing in healthcare, people have been talking about how to apply this technology in the OMP space. I think people have to remember, I mean, everybody remembers uh that the history of Enable, which is still a uh a pretty good organization uh nowadays, still is still uh working, and I'm sure the speakers know more than about that than me. Um, so it's it's really the core of the application verticals using additive manufacturing. So today we have a really great panel of speakers. We have two clinicians, which is really rare, but one for more general public and the other one is more specialized. So we're really in for a treat, and we have some great technologists who also work together with each other, but also with the clinicians. So this is a fully integrated panel. And uh so I think everyone here is in for a treat. So I would like to introduce our first speaker, uh Michael Schmidt. He is a clinician uh in uh Wisconsin, right? Located in Wisconsin. Um, and he has a lot of great information to share how to integrate this technology into his practice. Take it away, Michael.

SPEAKER_05: 3:22

All right, thanks, Jenny. Um so we're gonna get kind of right into it. I have a PowerPoint presentation. Uh like Jenny said, I'm Michael Schmidt. Um, I work for Prosthetic Plus here in Wisconsin. Um I here I'll just quick uh share my share my screen here and we'll we'll get right into it as far as uh my little presentation that we got going on here. Let's see here. All right, can can everyone see what uh see what I'm looking for?

SPEAKER_01: 4:00

Yep, yes.

SPEAKER_05: 4:01

All right, cool, excellent. Thanks. All right, so um yeah, so I work for Prosthetic Plus. We're a centralized uh C fab in Spencer, Wisconsin, which is kind of right in the center of the state, if you're looking at your hand. Um so we uh been a company for 20 years. Uh the owner of the company, Lonnie Damewood, basically started it in his garage, uh, doing a lot of interesting uh fabrication of uh custom prosthetics and uh do a lot of centralized fabrication for prosthetics in the United States. So, kind of the first question that everyone more or less asks when you say that you work in prosthetics or thoughts is like, all right, how how did you get into this? Because this is a very uh niche field that not many people kind of know about. So uh I did my uh post-baccalaureate certificate out at Cal State Dominguez Hills in Long Beach, California. And uh yeah, that's me. Uh bottom right corner there, as far as I still uh have made a made impact on the school, I guess you could say, where uh I'm still on a poster there. I at least I was five years ago. This is but um my good buddy Taylor's on on the uh the right of of the patient model there. So uh then after Cal State went to uh prosthetic laboratories in Rochester, Minnesota, who another one of our panelists also was there for her residency as well, which is pretty cool. Um, and then after that was a board certified process for 10 years. And in that time, I was 100% traditional fabrication where I would pull my own check sockets, I would do some of my own laminations. Um, basically, you know, if I could do it, I was going to do it. Uh, I was I was young, I was a bachelor, I didn't have much going on. So to stay late or to go in on weekends to to pull a check socket to do something uh in the lab with my hands, it was nothing. I could just go in there and get it done because I could. But um as with anything, life kind of progresses and life gets in the way. You you get married, you have some kids, and all of a sudden you really can't go in on the weekends to do that kind of thing. So I transitioned away from 100% traditionally fabrication uh for myself to doing uh 100% digital. Uh and it wasn't it wasn't pretty, it didn't happen overnight. There was a lot of uh trial and error to that, where you just have to bite the bullet and and get it done. Where doing um all my modifications, digital modifications, uh digitally and just working on getting through that process. So um, and then uh after that, I kind of got into the LinkedIn world and I saw some people doing some amazing things uh with um 3D printing. So uh that's that's kind of what I started to do, where I literally got a couple uh artilleries X X2 side liners in the clinic and then one in my garage at home, and I started printing my own check sockets because I didn't want to send out my uh fabrication to a carver to get something done. I wanted to have that in my own pocket to be able to do that. So uh big shout outs to Arthur Hobden, uh, Derek Schmidt, Arthur from OMP Digital Design Uh Designer, and then Derek Schmidt from uh Limin Lattice that helped me a lot during that process. So, you know, I was literally in my garage, uh, you know, messing around with slicing profiles to get things going, to uh, you know, make my own check sockets. I was making my own uh 3D, uh 3D covers and things like that. And so I was doing that for uh a good year. And then um I was sending a lot of my finished fabrication to Prosthetic Plus, where they were doing my laminations. And so that's what um had that uh channel to talk to Lonnie about what I was doing and what I could possibly do for them that wanted to get into the digital um workspace as well. So I started with Prosthetic Plus two years ago, where we were doing primarily filament uh depositive management uh uh as far as all FDM. So uh doing cosmetic covers, doing uh dotting tubes for for for companies, doing uh foot orthotics. Uh, shout out to Leo Poly that uh been working with Drew Meyer for a while now with um all of our foot orthotics. They do a great job with that. And then still, you know, 3D printing our our three uh check sockets, you know, using my profiles that I developed to be and and and worked with to get a nice clear uh check socket to to send out to clinicians. So, you know, just really what Lonnie wanted to, you know, his vision of what we wanted to go through is that you know skilled technicians are are hard to come by. And we have some amazing technicians that work at Prosthetic Plus. And but you know, it's it's still a lot of work to get them to that point, that where they're at, you know, you have to train them, they have to go, some of them go through schooling, some of them don't, but to be able to, you know, uh work towards some of the more uh automated digital printing uh was something that he really wanted to get into. So we were going through that process, doing all of our filament-based uh 3D printing. And but it was always kind of the goal to to get towards um powder-based. And we uh opened up communications with uh HP about a year and a half ago. It happened really fast, if you're gonna ask me honestly. And uh we started working with HP to move towards a um powder-based 3D printing, and it all kind of started with a problem, where we had, and kind of all solutions start with the problem, where we had a clinician that was with us for uh many, many years, and he had a patient that really could not take too much uh distal uh discomfort or distal contact at all. So we were working with different 3D printed soft liners, trying to work through that, different traditionally fabricated, but just nothing really seemed to work for this lady. Um, where I just kind of had, I was going through a couple different uh trainings with different latticing um and monkeying around with that. And I was like, hey, I think I might just like let's just try something. We'll just we'll just see. So we uh sent this basically what we have over here is this prototype that we were working on um for just the latticing and uh cushioning that we're working on for a total different projects to uh HP that did our prototype printing for it and sent that out to the patient and she loved it. So also got the gears turning. It's like, all right, let's let's see what we can't possibly do and and see what we can't uh help out our our clients and and their patients and in our central fabrication. So we uh we kind of jumped in with uh two you know two feet right into the into the deep end. You know, we got uh our HP 5200 system that uh David and and HB have been really great with helping us out and getting us going with that, uh, where we print both uh rigid PA12 and then flexible TPU BS uh BSSF TPU. Um where yeah, it was kind of a crazy thing where I, you know, kind of told Bonnie, I was like, hey man, if you were gonna tell me that we were gonna be going right into it maybe a year after I started, I I wouldn't have believed you. But it's been really great where we started a kind of a soft, um, soft opening where we worked on getting things going with uh with TPU um for a lot of liners. Um started out with a lot of uh BK um liners and and distal cushioning, um, kind of going with what we had developed for that one individual and seeing, hey, is this going to work for other people as well? And and you know, following the the footsteps of individuals like you know, Brent Wright and Advanced 3D and just seeing what we can do as a as a prosthetic fabrication site, um, where we do a lot, what what we primarily do for our prostheses right now is a what we call hybrid fabrication, where a lot of times the interflexible or some sort of part of prosthesis is going to be 3D printed. Um, whether that be out of filament, we still do plenty of filament uh liners for individuals that it's kind of funny, people that you know want to have the the easily replication of a product. Um that's one of the biggest things that we will see with with our uh with our clients that want to have something that's you know easily repeatable, um, but also just people that want to have some sort of uh non-packable, non-packable cushioning for for their process as well. So a lot of times we're doing an interflexible that's 3D printed with a laminated hard socket that go over goes over the top of that. Um, you know, we still have a lot of individuals that want to have some kind of cool lamination and and some sort of pattern. So we still will do that for for those individuals. Um, and you know, it's kind of funny. I feel like I add a a dummy or something new to my repertoire every single week, where we'll throw in different uh attachments for uh valves, um, distal endlocks, that type of thing um for those prostes. Um one of the big things that we've been doing as well is some of the partial feet applications that we've been doing with um TPU lately, um, where we started off doing a lot of filament-based uh TPU partial feet in the beginning, but we just with uh transitioning over to powder base, um, really have been taking off with some of the partial foot applications um with toe fillers, as you can see on the left and the right options for that, where we'll still uh line those with a nice interface like TriLam or some sort of foam base for the diabetic populations that we do see. Um where a lot of times with our fabrication, we'll do either a digital scan that comes in where we have a seven-axis carver that we can still carve those models and then scan those uh to, or you know, use those digital ones to be able to uh fabricate these devices. But have some really good success with some of these um higher up partial feet as well and a nice rollover through the forefoot is something that we've been doing. And of course a sandal toe for those individuals too. Um this was another really cool one that we did where we can still spray skin the um the TPU and then do a uh did a kind of a cool one with this one with a distal lamination that attaches right to a show part um foot. So that was a pretty pretty cool one that we did that was fairly unique, where um the the patient really did enjoy this, where still had the cosmetics that she was looking for that was very similar to what she had in the past, that was traditionally fabricated out of leather, but um as far as overall, much lighter, much uh more breathable as well. As far as you can't see from this this picture, but the backside is is open as well. Um, so it was a lot lighter for the patient. She really seemed to like it a lot. Um, one of our really big successes with that one. So that was a pretty cool one that we did. Um, yes, all the um TPU and and even Rigid PA 12, we've been able to uh spray your skin at any color that we want to for somebody that wants to have a little bit more cosmetic uh look for it. Um then Jenny, slow me down or or stop me if there's some great question. I I don't know if I got this going on here.

SPEAKER_01: 16:09

Well, we'll we'll gather all the questions at the end. Oh, cool, no worries.

SPEAKER_05: 16:13

Awesome. All right, all right. So um, and then for you know, also been doing another big thing that we do as is as a company we've been doing for the past 20 years is custom leather ankle gauntlets. It's something that we really pride ourselves on. We have some amazing orthotic clinician uh technicians that work for the company up in Spencer that do some beautiful uh uh leather ankle gauntlets and suede ankle gauntlets. And one of the easiest transitions that we've had is going into a custom uh TPU leather, uh not leather, uh ankle gauntlet, where um the individual and the clinicians are really liking them, where they're a lot lighter. Um they're more streamlined to the to the patient, more breathable as far as having the pass-throughs that we can make that are just not um possible in in traditional fabrication. So that's one of the things that we see a lot of is these uh custom ankle gauntlets that we can still do uh a lot of the same um closures that we've had in the past, whether it be uh laces, uh straps, some revo closures. Actually, uh this is an earlier photo. Um, we actually 3D print our own straps too, where they uh they that was one of the fun projects that I that we were messing around with where we uh 3D print our own straps and it's made on the same TPU and we uh uh sew some some Velgro onto it. Um so it's it's pretty cool for that. Um still it's kind of fighting a lot. You took a look at one of the one of these basically is like, man, it's really cool, but you know, we then we got just regular straps on there. What can we do? So maybe print our own. So we we did that every for for a few of our our leathering gullets too, which is kind of funny. Um again, we've been working with Leo Poly, been a really good uh partner with us to do um custom foot orthodox as well out of TPU, um with a lattice uh to interface as well uh with a skin. We do a lot of those for for some some clients that we have that that uh have been trying to decentralize their uh work fabric um central fabrication inside their own office, where I I have a lot of conversations with clinicians where they're like, hey, I'm trying not to have burnout with my tech. And I find out that they're filling uh and pouring you know, traditionally fabricated uh foot orthotics almost two or three times a day or a week, you know, the whole day is just filling squash boxes and thermophoreing foot orthotics. So it's like, hey, let's let's take some of that load off you guys and and and have your clinic your technicians focus on on things that they actually enjoy to do. Not saying that, you know, traditionally fabricating foot orthotics is a is a lackluster job, but it is it is very tedious and time consuming as someone that has done that in the past. Um and then some of the more unique things that we've been doing were you know trying to have a having a lattice stove pipe uh signs prostheses where it's all open on the inside with um the latticeing to allow for the bulbous distaline to get down uh and then also self-suspend on that lattice as well. This was a fun project we did uh Lily like a week ago. Whereas just kind of a, you know, with 3D printing, uh, you know, being a very prototype driven field and it's it's early goings, we we can still do that with with prosthetics, you know. It's like, hey, I got I got an idea. Let's let's let's see what we can do where we still have you know the custom distilled lattice and cushioning as well. Um so that was a really cool project that turned out pretty dang awesome as well. And then some things that we still, you know, people have been doing for uh you know a long period of time with with thermoforming were you know, AK brims to have a a nice, soft, inner flexible brim that, you know, is then integrated right into the uh laminated socket and keys in, just same the same way that we would normally do traditionally fabricated, but we're doing it um uh with 3D printing where you know you could have a little bit more flexibility in the uh groin in that area to be able to have um different thicknesses to just have uh more flexibility is one of the things that we do for a few different clinicians as well. And uh some of the things that really kind of get me going and a fun project that we've had for some pediatric prosthetics. Um, so this was a um we we will do a dual material um uh printing where we'll do a uh interflexible that's uh TPU, and then we'll integrate a PA12 um struts into that. And then with those PA12 struts, this is where Keno that beat the snot out of this. Where um top of the B12, and then that can be integrated right into the processes to give him uh even more strength to it, and then also for you know cosmetic purposes as well, where it's you know a fun thing that the kid wants to wear and and wants to proceed with it, where uh yeah, this this this kiddo uh basically came back and that thing was just shredded, you know, as far as overall the the use that that thing got. And it was kind of funny where the clinician said, Hey, can we uh can we make another one? I said, Yeah, of course. We reprinted it, made it just a little bit bigger in speed areas of a new scan that we got sent, and boom, whole new processes for the for the kiddo to wear and and to beat up again because that's what that's what kids do. I always told my my pediatric patients, hey, uh go break this and bring it back to me, because that's that's what's probably gonna happen, as Tara will probably say as well. So and then you know, integrating that also into our um gauntlets as well. You know, one of the things that we had talked to some clinicians about um was trying to still have uh increased rigidity with flexibility without extra bulk. So that's a pretty long laundry list of what they wanted to have. But with a tradition uh traditionally fabricated, this isn't possible, where we have the um PA-12 inlaid into the TPU, something that we're pretty proud of as far as being able to not have that extra bulk in that process where it's actually laid into um a uh relief that's inside built inside the TPU. So we'll do that with our uh custom ankle gauntlets as well and SMOs as this one is. So uh the other material that we primarily print at Prosthetic Plus is PA12 with our HP 5200. Um we do still do some wet laminations over that, as you've seen, with some um patients and clinicians that want to have some sort of cosmetic uh transfer that's over the top of it. Um and then some of the cooler things that we've been able to do as well is uh some upper extremity work, but this is a um five uh individuals been seeing five of their other digits on their on their uh on their hand, on their right hand, uh, where we have all printed in place uh digits that are powered by wrist-driven and uh uh elastic laces uh for the extension of the digits. Um it's worked out really well for that individual to be able to grasp onto items and work with their uh occupational therapist to to uh have some return to their ADLs. So that was a uh a pretty cool project where we're able to just say, hey, that we got this, this person, they're trying to do this, then the other thing. And we were able to uh 3D print this. And and one of the great things was as far as uh lack of um overall technician work. There's one thing that I really strive to do where it's like, I don't want a 3D project to bog down a technician. So that's just all 3D printed in place. They just have to run the wiring through it and then out the door it goes. Tries to we try to get that going for as many individuals as we can. Um, this is a passive partial hand that we did for an individual um where they were uh yeah, they didn't have great insurance that was going to cover something like this, where the clinician was like, hey, we just need to do something for this person. So we're able to uh 3D print this um for that individual uh that matched his his contralateral limb. But there's missing L for the digits. One other thing that we've been doing also for some uh clients and some of our uh our um clinicians is a DIP finger by measurement where I have a template set up with that they can give me uh three different measurements as far as of that affected limb uh or or finger, where uh we can then make a small DIP passive uh prosthys. And this was basically thought up of for people that just you know aren't that want to do a self-pay option where they already have like a uh um I'm very cosmetic um finger prosthesis, whether it be silicone, custom painted silicone, and they got the first one came about because they didn't want to uh to damage the other one. They wanted to have one basically for for for work and the other one was for uh for show. So we made this for that individual that was a self-pay item. So we do that um at some frequency for for the individuals that want to have a self-pay um TP uh somewhat cosmetic TPU finger. And then uh going with a uh fully 3D printed um AE processus where this person um was a long-range truck driver and uh he had was a um AE on his on his right side and he said to full basically processes on that side, a um articulating uh lock it lockable elbow, um, you know, quick disconnect wrist with a um you know a hook on that side as well. And so the only thing I do with that elbow is I lock it at about eight 95 degrees and I use it to uh change the knobs on my on my radio when I'm driving. So I it's just heavy. I don't really use this elbow very much. So clinician had a good idea of saying, well, let's just 3D prints it. If we're not gonna use it, it's gonna be really light for you. And that's exactly what we did with a uh a fully 3D printed uh PA12 um that locked in the the wrist that we epoxied into place, and that's what he used it for as far as whenever he's on the road, he can just go over and switch over his his uh program dials on his radio to to uh to change the station. That's all he really used his prosthesis for. And he still had his traditionally fabricated one when he was out and needed to have that that elbow um to be able to uh to use that. So pretty cool thing that we were able to do. And then doing some uh PA12 uh AK sockets, obviously, all depends on the size of the individual and the weight of the individual um to be able to do a fully 3D printed uh prosthesis with a um TPU interflexible with a PA12 um rigid frame. We've been doing that a lot with um Revo sockets from Click Medical. Um to be able to do those, um my technicians do like that a lot because as far as the overall fabrication for traditionally fabricated uh Revo click socket is time consuming. So to be able to do that with what we've been doing uh does take a lot of the um technicians' time away uh away from them when they're doing it traditionally fabricated. So they whenever they see a 3D printed revo, they get kind of excited because they know that, oh man, that's that's going over to Mike, he's just gonna knock that out pretty dang quick. And then they just have to do the the wiring because I am remote. I don't work at the site, I go up there every other week to to check on things and do a little bit of grunt work, but overall I'm I'm at home. And then another thing we've been doing for uh different individuals is a jointed BK socket, um, where we'll have uh uprights going up to the thigh for extra stability for individuals. Uh something that we've been doing uh with relative frequency, where we do uh have done some um neorthoses that will attach to a BK socket as well. Um we'll key into them. And then uh kind of some of the unique fabrication that we that we get to do were um this was an individual that was a hip disarticulation patient that um you know she would wear her hip processes from from time to time and she would go about her day with it. But then there were some times where she would go out on uh with her friends and she really didn't want to have her her heavyweight processes with her, and she would have her forearm crutches or and she would go get around with that. But so she wanted to have something that was there. So they tried to uh they they went with a um just a foam uh cover that was below her, and she didn't really like that because she was like, Oh, it's it's nice, but. You know, I kind of want some, she was she kind of wanted something that was a little bit flashy. So I talked with the clinician and I was like, I think we can probably do something that's that's pretty dang cool. So um it does, you know, it had uh attaches up to her uh a belt that's around her her waist, and as far as flexible joints that go down to where the cover cover starts, and then it has a articulated knee joint that's on there. So when she does go to sit down, it bends at the flexible joints that are up at the hip, bends at the uh the knee to allow her to sit and it fills out her her leggings. And most of the times I don't think she actually, you know, have her leggings go too far down, where she likes to kind of show it off a little bit, and uh it's fun for those kind of things. So that's just unique things that we're able to do uh in print and then uh as far as you know different processes that we wanted to do that are a little bit more, you know, uh I would say new age or or funky as well, without a PA 12 with a uh custom uh cover that's attached right to the socket as well. Am I still presenting? I feel like I'm frozen.

SPEAKER_01: 31:14

I I can hear you, Michael. Um you can try to advance your slides. Although I do want to mention that the the time is running short for now.

SPEAKER_05: 31:23

Okay, I'll get done. I'll get done real quick here. Okay so you know, uh hey, here we go. So quick going through. Sorry, I when I get kind of excited about a topic, I can talk forever. Um so getting forward to kind of why it matters um is is kind of wrapping things up here as far as repeatability. Um, and I didn't really get into what we've been doing lately. You know, we've been doing this for for a year now. So we've had patients and clinicians that are coming back that have had something 3D printed seven, eight months ago, and they're at 15 to 16 ply a stock. They've had a decrease in their overall volume, where we can then take that previous file and have that digital footprint of where they were previously to then refabricate their new prosthesis at that reduced volume. Um, so yeah, when you tell a clinician to say, hey, yeah, no, we can just reprint that 12 ply smaller if you want to with a new check socket, they get real excited that they, you know, don't have to, you know, uh they're they're busy individuals. They they want to have you know the best thing for their patient and for their their overall work life to get that you know back underneath the to your imagination as far as what we can possibly do uh for for our patients. Um but yeah, if you have any kind of other questions or are interested in what we do as a company, uh to go to prostheticplus.com uh if you want to order or get any more information as far as the office at prostheticplus.com.

SPEAKER_01: 33:01

Thank you so much, Michael. And yes, we do have a lot of questions. Um you can find in the chat later, uh, but I ask everybody to try to put their questions in QA box so that in case we've run out of time for any speakers, you can also type in your answers directly in the QA box. I think a general question that I'm gathering from the stream of questions is one is, you know, there are a lot of starters here, people who haven't gone into the space, and they just want to know how did you what kind of tools did you use? Like what kind of printer, exactly what kind of printer that you started with, and what kind of software you use is open source, or you have to pay for it. Yeah. If you can expand on that.

SPEAKER_05: 33:40

I I'm a little bit unique as far as what I do. I do like to have a couple different um options for myself. Um I I worked with uh, like I said, Derek Schmidt and Arthur Hobden when I first started getting into this, um, where they kind of preached and and your bottom line, you know, trying to keep things uh on on the uh up and up for for what you're overall um getting charged for, which I do suggest as well. So working with I worked with Mesh Mixer for the first goings, which is for a free software. Um then when I kind of get got a little bit more advanced from that, I started working with uh Fusion 360 and ZBrush. And then after I kind of got good at that, I switched over a little bit to um to Rhino and Grasshopper from uh what HP had told me to do with with David. Um so I that's kind of what I I transitioned through to start with something very, very simple that you know you can mess around with. And there's plenty of of YouTube videos that are out there of individuals working with mesh mixer to to make prosthes and to to get going with their digital modifications and things like that. And then when I was clinician, I I worked with um with Quorum. Uh no, it's like quorum, no, uh as far as well, they were tech tech med and they got a quant uh sorry, I'm I'm butchering it right now. But they were tech med at the time when I was working with them. And then you're gosh.

SPEAKER_01: 35:05

Wait, what is it again? Scanning repeat. Sorry. Okay, okay.

SPEAKER_05: 35:09

Quand Q W A N D R A. Thanks, Tara. Um, so I was working with with them when I was a digital clinician with with Hangar Clinic, um, which was a really good, I whenever someone asked me about as far as who they should go with, I I normally gravitate towards that one. And then obviously with um Leah Poly is as another one of our partners that we worked with to uh do our modifications for foot orthotics primarily is what we use those for. But um as far as you know getting things going, starting out basic as you can, mess mixer uh is the is a good part. Where I like I said, I had my uh I don't think they make them anymore as far as my uh artillery side wire X2 is what I had in my in my garage there, uh I started going. And then uh I do have uh a bamboo uh bamboo labs P1S in my in my garage down here. I I keep keep on working on my garage. Um so uh as far as you know for for some of my smaller prototyping that I that I'll still do for for prosthetics and orthotics.

SPEAKER_01: 36:06

Thank you. Um and one uh one other question I want to ask since we're running out of time is uh materials. A lot of people are really fascinated with the fact that you can use TPU to generate the straps. Is that correct?

SPEAKER_05: 36:18

Yeah, yeah, no. Um so yeah, that's that's that's something that I I kind of was messing around with where I started out with just you know a maybe a 12-inch uh you know strap that was one and a half inch wide by one point, I think one point one and a quarter millimeters thick. And so we started just printing those for a couple smaller projects, especially pediatrics. And then I kind of got this crazy idea. I was like, well, you know, we only have so much room inside of a of a what David's gonna do as well, uh HP 5200. So I was like, okay, well, what if we just did a coil, a long 3D printed TPU coil that was, you know, probably about eight inches uh in diameter, but it's probably about three feet long. So that's what we started to do with some of our 3D printed straps was to do that, and then um the guys kind of got crazy with it. I don't know if anybody saw that at uh at AOPA where they actually um imaged onto it and then uh clear-coated it with some uh with some clear TPU to uh to do some pretty cool stuff.

SPEAKER_00: 37:26

It was on uh David's model at Aiopa, but yeah, so yeah, no um interrupt that question real quick because I happen to have the straps we did.

SPEAKER_02: 37:35

Oh, cool.

SPEAKER_00: 37:35

So this is the example. So this was just done on a filament printer.

SPEAKER_05: 37:41

Um it one.

SPEAKER_00: 37:43

And they basically printed a square. It was really cool to see the design is actually also an HP product. It's our uh 2D latex printer. So it's like a printer kind of designed for like billboards and high durability uh graphic printing. So this was an idea that we did for a rythorthosis. Wow. When I visited Prostect Plus to put all together, there's like, hey, let's do this. So we cut a few and then um, you know, put some connection points on it and Velcro, and then we were ready to go.

SPEAKER_05: 38:16

That's amazing. We had some really, really great um engineering students that are with us over the summer that did some pretty cool um filament-based 3D printing with us, and then also we just transitioned a little bit to uh to the powder base as well. But the yeah, the uh TPU um straps you printed about uh um um it's like what if kind of thing. Well, well, let's let's just give it a go. And because uh yeah, we just we want it to look a certain way, you know, and and that's what Lonnie kind of wanted to have. So it was a fun little thing that we did.

SPEAKER_01: 38:46

So that's so awesome. Um look, one of these days I'm gonna invite you back for a dedicated 90 minutes just with you, Michael.

SPEAKER_05: 38:55

And then so that people can get their uh can get their special to be able to have something like that.

SPEAKER_01: 39:00

That's because I feel like we do have a lot of things to say. Um so but uh anyways, we have a lot of great questions. I I want to just post one question to all speakers on uh live right now is that there are a lot of questions about scalability and economics behind establishing this kind of practice, either in a small or large uh healthcare setting. Um, I want to address this question, but at the end of the discussion, so that you can have some time to think about that question. Um but we do have to move on to our next speaker. Thank you so much, Michael. You can put your contact in the chat box so people can also email you if you want to share your email there. Uh but I'm gonna move on to our next speaker, Dave Johnson, who is representing our sponsor of the event, HP. And obviously he already can't wait to get on the camera uh just now. And he's partnering crime. Emily Simpson from uh Dynason will also speak afterwards. Um so so Dave, why don't David, uh why don't you uh start your presentation?

SPEAKER_00: 40:03

Sounds good. Uh Emily, if you want to share that, and I can go through it. Uh I was keeping track of some of the questions that people were asking, so I'll I'll try to answer them as I go through it. Um and then Emily and I are gonna cover kind of the full spectrum of technology, so we'll do all of our QA together um at the end of both of our sections. All right. So my name's David Johnson. I'm an application engineer for HP. I've been with HP in this role for about four years and then an additive for about 10. Um, I was at a composite startup and then Stratasys Reseller prior. Uh where I'm kind of focused here is I started as our lead healthcare application engineer about three and a half years ago. And based on what I saw, OP is kind of where we need to really focus. We also do like medical instruments like surgical guides, medical equipment. But reality is I think the customization for O and P is where the strength of 3D printing really showcases. So I've been advocating and pushing for that in this role and kind of helping customers like Michael and uh conversations with Tara to like kind of help them adopt this process and how they can utilize it best. So you saw everything at the end of the cycle with uh what Michael is showing. I'm gonna kind of give you the workflow to get there from the very beginning, starting with the 3D scanning and patient data. Um we're now we're kind of shifting how this is done, where traditionally you'll get like a cast or plaster and then kind of traditionally go through that. So this is the digital workflow ending in the same type of product. So go to 3D modeling. Um, I'll kind of go into a little bit more detail the softwares that Michael shared, the 3D printing process. After that, Emily would take over with the part and post-processing. And then the assembly is kind of when Michael was showing where like it would go to one of their technicians to add the final stages, whether it be straps, laces, things like that, to make it a product that's ready to ship to the clinic and patient. So um Dr. Chen shared this, but you know, this is another reason why we're here. There's just a pretty big growth in OP. I am seeing this also in the last probably five years. We were talking a little bit before that we're starting to see a bigger adoption as some of the more higher risk category uh applications are hitting the market. We're seeing more companies have some type of product line or avenue towards 3D printing. So it's growing, it's exciting. Um, as a part of where Emily and I are here, we're trying to help with that transition. It's really difficult. Uh, even Mike uh and I struggled to go through a lot of it and I would consider him kind of an advanced user going into it. Um so this is why we're really hyper focused on OEP. We want to see, you know, better patient outcomes with the kind of data we have moving forward and you know, try to bridge some of those gaps. All right. So this is a Vorum scanner, which is now Quadra, which is now owned by Equal. So I really like it because it showcases a full spectrum of what these scanning devices do. Um, we'll start with a cranial scan, which is probably the more difficult one, um, as you can see, to try to keep an infant completely still is a challenge. This used to be kind of a plaster mold, and it was very uncomfortable. One of the benefits of scanning is you can take multiple shots and kind of piece all the scans together, as you're seeing here, where you can create some reference points. The uh process can take a few minutes, and you can see even the patient can be moving during it. So the scanning and software implementations are getting very intelligent where they can connect all his pieces. Um, even the user experience and kind of advanced user is becoming more minimal so that a clinician with you know minimal training can do it. Looking for a few different landmark scans, you can see the rectification marks on the actual patient themselves. Really important because those rectifications become critical when you go through the design process when you import them. So you can actually see those scan marks going into the scanning process. Um, as mentioned, you know, these can also be done in phones and tablets. Uh, structure, Snugfit are two other really popular ones we're seeing in this market. But once you go from here, this is now your patient data. You take it to the next step into a more scanning format. All right. So high level, as what Mike was talking about. This is where his focus is. Um, you can see the kind of top left picture, that's your scan that you received from the prior slide. And we are taking that through a multiple-step process to get to the final device. So um, this can be a manual process with certain softwares. This can be automated where you can do something like this from scan to final part in just a few minutes. The focus is basically you're going to be doing an offset off the patient data. You'll do the rough design, trim lines. Um, and then you would also go into uh what we call DFAM or design for additive manufacturing. This is the stuff that you saw in a lot of Mike's products uh when it comes to latticing. So this is adding that extra benefit that we can 3D print at no cost, whereas you can't really do traditionally, but there's a massive amount of performance, whether that comes from like mechanical performance or even the patient um comfort, because you know, better comfort for patient means better usage of the device. And that's the end goal with all of this. I had I saw one question that um I did want to go into because there's a few things Mike had, but when it came to textures, um the question was leather. So this is something we can do. Um, this is a TPU belt similar to the material that Mike is printing. Might be a little hard, but we do have uh leather texture on it. So that and latticing with elastomers and our TPU material is something I'm very excited about. It's a very underutilized area. Um and there's uh a software that hopefully would be released through Balliopoly that makes this a matter of minutes for the design. I'm very excited about that because if I was to do this myself on a decent CAD with decent CAD experience, it will probably take me an hour. So we're seeing a lot of softwares that are just minimizing this step. So a you know, more beginner user has a capability to do some pretty impressive output with design in just a few clicks of a button. So we're starting to see that more and more. Um so with this, this is where the Mesh Mixture Fusion 360, what Mike's using, the more automation side capabilities, a software like Rhino. And the important thing is like you can teach this all yourself. Um, when I met Mike, we were probably the same level of CAD experience. Maybe I had a little bit more just because I took it in college and have used it through my career. Mike surpassed me by a lot just with him self-teaching and doing things like that. So it is something you can do on your own with limited resources. I highly encourage it. Yes, you are, Mike. Um still very uh open area to learn on a do-it-yourself basis and addition for uh assistance as well. All right. So we have our parts design. Now we go to a platform for multi-jet fusion. So this is called a uh nesting. So you can see a handful of O and P devices being nested into basically our build platform. Because we're printing in powder, we don't require support material because unused powder basically serves that purpose. And um, this is basically how we prep our build. So we lay all the parts out that are current orders, hit nest, go grab a coffee, can take a few minutes, and then it gives us something like this. This is what we send to the printer. This is what Mike puts together. And there was a question on timing with his parts. So, regardless of how many parts we have there, a full build like this with our process takes about 12 hours to print. So there's a good question, but like how do we fit it? I'll let Mike answer that towards the end. But um, you know, our packing densities average is about 7%. O and P is a little harder because they take up a lot of space and not a lot of part volume. Um, so it's really kind of strategic of how you utilize this space effectively for someone on the clinic side or someone that's printing these. All right. Going into our materials. So probably our most utilized ones are PA12 and elastomers, so like TPU. Um, we've had the Ford AM used to DSF, now we're rebranding it in HP, all still the same material. Uh, it's gone through some transitions, but those are the two most common ones. We have uh rigid material and then elastomer that allows that for that latticeine. One of the uh few other ones are PA12 white. So especially for pediatrics, uh, vibrant colors like this and this are really important uh because it's something cool for the child to wear and they're gonna wear it more often. Uh, very big for cranial orthoses as well. And then polypropylene, we see a bit because that's just a common traditional material, so it's an easier transition for clinicians to do. And then the other one that we have coming up is P11. So one of the challenges we had with P11, it was a more costly material because of the recycle ratio. All these materials are typically 70% to 90% recycling material, which impacts the final part cost. P11 was more on the 70% side, so it's a harder material to justify due to its cost. But Emily, if you can go to the next slide, we do have a generation two material coming out for PA11 that will be 8020 now, which is the same as our TPU and PA12. Um, I'm very excited about this because, like from a material mechanics side, PA11 is, I think, a more benefit material because it allows a little more flexibility with the part and allows for a little more movement from the patient perspective. But we do see a massive reduction of part costs moving from this Gen 1 material to the Gen 2. So this will be available end of this year for our newer systems in the fleet. All right. So starting our process, we are mixing the recycled material and the fresh material. So what the system is doing, this is our build unit. This is basically that build platform you saw when we nested it together. So when it's being loaded, um our processing station, which you see here, is pulling the fresh material and the recycled material, mixing it together, and it's loading that up for the build. I think our video might have froze a little bit. There we go. Okay. So the recycled material is basically reclaimed material from prior builds. So I'll show you a step on that. It seems to keep stopping there. Emily, you can go to the next one. So once we have that build unit, we throw it in our printer. And this is the multi-jet fusion process. So it's an airp-based system. Regardless of what you have in X and Y, it'll take the same amount of time to print a single layer, which is about seven to nine seconds. So in that process, we are jetting out a fusing agent. That agent is absorbing heat from those lamps going across, and that's what's actually melting the parts together. Um it's a very thermal controlled process. It's basically a giant battle of thermodynamics. So as we print each layer, we have thermal cameras tracking if things are too hot, too cold, adjusting for on the fly with the final print. And uh as I mentioned, it's about 12 hours to do a full build of parts. After we are done with that, there's a cooling period. But the nice thing is we're our build units are on uh like a trolley. So the moment that print's done and goes into the cooling stage, you can pull it out of the printer. And then as it's cooling, you can start printing another build. Um, this allows our customers to really utilize the throughput of the system. And then once we are cooled, we take those parts back to our processing station, and then we're kind of excavating for diner cones. So there'll be a vacuum that sucks up and reclaims any unused powder that becomes recycled powder for future batches. And then we have uh a small layer of powder still in the parts that we have to then media blast. But I will let Emily take it over from here as we transition to kind of the post-processing side of this entire workflow.

SPEAKER_04: 54:16

All right, thanks, David. Starting with a quick introduction of myself, my name is Emily Simpson. I am an application engineer with Dimansion. I'll get into more of what Dimansion does as a company, but we are a post-processing company. I come with a background of biomedical engineering, with the bulk of that within ONP, including being an engineer at a OEM also big name that we all know. So David gave a good overview of what the 3D printing process is. Mike also gave an overview of what the applications might look like. I'm here to answer the question how can I customize my 3D printed O and P device? We saw in some of those videos that there is going to need to be some post-processing done with the parts coming out of the printer. The first problem that we have is the parts are going to be encased in powder. Even though we're vacuuming off that reusable powder from the outside of the part, there's still going to be a thin layer of powder on the outside that's gone through a semi-transitional phase that is not going to be reintroduced into the printer. We want to discard those pennies worth of powder. So we're going to need to implement a cleaning method. Another issue that we have is the parts coming out of a printer are usually one color. More commonly, they're going to be gray or they're going to be white. Well, we know with ONP, there are common colors such as black. There is blue and pink for pediatrics. There's also skin tones. So what post-processing is going to do, it's going to enable an end use application. It's going to take that raw 3D printed part and make it into a device that can be put onto a patient. In turn, we are adding customization, which is going to help with the adoption from the patient, also just the aesthetics of it. And ultimately, we are going to industrialize 3D printing. A little bit of overview about Dimansian. Dimansian is a post-processing company headquartered in Munich, Germany, but also has some offices in the US as well. We are going to specialize in three different categories. The first is going to be cleaning, the second is going to be surfacing, where there are two different types, and the last is going to be coloring. So just to set the stage and give an overview of the equipment on the screen, starting from left to right. The first one on the left is going to be the PowerShot C. C stands for cleaning. This is going to be our means of depowdering the parts using a bead blaster. An entire batch of parts coming from the HP printer will be put into that rotating basket and will be blasted with media. Generally, this is going to be a glass media. There's also other types of media as well. But overall, it's going to remove the excess powder from the outside of the part. If we take it one step further, we are going to introduce the PowerShot X. This is now going to have the advantage of cleaning andor surfacing, and surfacing in the means of mechanical shot painting. So this is going to be a quick, easy process, about 10 minutes. That's going to reduce the surface roughness of the part by about 37%. And it's ultimately going to be mechanical shot painting. The machine in the center is going to be a combination of those. It is going to allow for cleaning and surfacing in a single machine with a larger format. So this can now accommodate 1.5 HP builds. So it's a little bit larger as it accommodates larger part belt parts and batch sizes using that belt-driven operation versus the drum-driven before. Then the larger machine you see there is going to be our vapor smoothing. I'll get into more about what vapor smoothing means, but this is a way to completely seal the outside surface of the part. I do want to say don't let this machine size scare you. This is the largest machine that we offer, but we do have three sizes of smaller machines as well. And then the last system you see on the screen is going to be called our DM60. This is going to be our deep dye coloring system, which is going to add uh dye and color to the parts. Starting off with the biggest question, I also saw in the chat here. The most common question that we get is 3D printing and post-processing safe for medical devices, or is it biocompatible? The answer is yes. All of the materials that David showed, as well as all the machines and processes I previously spoke to, do have certifications for biocompatibility through ISO. So rest assured, all of these devices will be safe, including things like a class two medical device like a cranial helmet. Where the first one is going to be our power shot S, which this is going to be mechanical shot painting. This is going to use a larger diameter media that is going to hit the part surface, bounce off, therefore impacting the surface and reducing the surface roughness and increasing the scratch resistance of the part. This is a quick, easy process to increase aesthetics of your part. The issue that we have with a uh 3D printed part is by nature it's going to be porous. That means it's going to generally have a rough surface and it can introduce things like contamination, um, skin irritation, things like that. So if we can reduce the surface roughness of a part with a quick 10 to 15 minute process for all of the parts, since it's a batch based process, that is a quick, easy win. If we compare it though to the next level of smoothing, this is going to be called our vapor fuse surfacing via the PowerFuse S. As the industry, we love acronyms, so apologies. I will try to keep them to a minimum, but if you have any questions, please let me know. But this is going to use a vaporized solvent that is going to condensate on the surface of the part and it's going to micro-dissolve the surface to make it a completely sealed part surface. That means it's going to be sealed against contamination, air, and it will allow things like suction suspension, vacuum, things like that. All this being said, it does not affect the mechanical properties nor the dimensional accuracy of the part. This is going to be a longer process at about two and a half hours, but again, it's going to be a batch-based process. So you can run an entire batch of MJF parts at once. Speaking more to the sealed surfaces, so what I just mentioned, the Power Fuse S is going to create that sealed surface. It is going to use a green solvent that is fully enclosed within the system. So that means you have no need for external venting or PPE since it is a very safe solvent called benzyl alcohol. For example, this is used in a lot of consumer applications like perfumes or bengay, for example. So this is actually going to inhibit bacterial growth on the surface of the part, not only because we seal it, but also because of the solvent that we use. We can also do vapor smoothing on multiple different materials. The most common ones that we see are PA12, which is definitely the most popular in the industry, but we can also do things like TPU. So that means we can have a completely sealed, flexible inner socket as well as the rigid outer socket. The difference between the mechanical shot painting and the vapor smoothing comes down to the difference in surface roughness. So we're going to see a slight decrease in surface roughness with the mechanical shot painting, and we're going to see upwards of an 83% reduction of surface roughness when we're completely sealing the part. The biggest advantage though comes to sealing the part against contamination. So picture is worth a thousand words. So on the bottom left here, we have an image. The top image is a raw printed part from an HP printer out of PA12. If we put a contaminant on the part surface, it is going to quickly soak up that contamination due to its ferocity. That's going to be very difficult to clean. If we do that same exercise with a part that has been completely sealed, the bottom image, we can see that we can just quickly wipe off the contamination because it is sealed. So we can wash things with either soap and water or just simply wipe it off. The next question that we get is Is 3D printing durable enough for an OMP device? And the answer is yes. HP, as along with some of our partners, have proven that there is a QR code on the bottom right, which is going to be a case study with Quorum Prosthetics, where it's going to compare a traditionally fabbed carbon fiber socket to one that has been 3D printed. What we see, especially when we're doing vapor smooth surfacing, is that we are going to maintain or improve the material properties, which is meaning that it's going to be durable for everyday wear and cleaning. If you're a nerdy engineer like me, I have a table of material properties on the upper right. So we can see that when we are doing a vapor fuse surfacing, we are going to see a slight increase in the uh tensile modulus of the part, so therefore the strength of the part. So we want people to take pride in the device that we're wearing they're wearing. And I think Michael gave great examples of that. Let's make it unique, let's make it someone proud to be able to wear this. It's also important for things like brand identification or color coding in regards to other medical device applications. But when we consider coloring, we need to consider a couple of factors. It needs to be durable, it needs to be biocompatible, it needs to have a consistent color, and that color needs to be permanently bonded to the part so that it doesn't bleach onto the application or the uh where did we all start with coloring? I'll admit I did it. I bought an Instapot and writ dye and try to dye my own 3D printed parts. So when we talk about writ dye, this is commonly where people start. This is going to be boiling water and some off-the-shelf stain. This is going to be considered a surface stain. It's going to lack biocompatibility certifications, UV resistance, and ultimately it is not going to be permanently bonded onto the skin so or onto the part so it'll leach off onto it. If we compare that to what the dimension DM60 does, the DM60, in the most simplest of terms, is a pressure cooker mixed with a Keurig. So it'll be a pressurized water vessel that has a cartridge for a color. We're going to put that in. Again, it can accommodate an entire batch of MJF parts. But this, under that elevated temperature and pressure, is actually going to embed the dye about 250 microns into the part. That means even if you scratch off that top layer, you are still going to see dye underneath. We're also not adding material to it, so you're not affecting the dimensional accuracy accuracy of it. And then also with the common theme here, this process is also going to be biocompatible, and all of our dyes do have UV inhibitors built in. That is two different um comparisons I have on the screen. The first one is going to be due to the UV inhibitors. When we have a pot-dyed part, some of you might have seen it. You dye it black and you put it in the sun, it's going to turn blue or purple. So again, that is going to be a surface stain. But due to that chemical reaction in those UV inhibitors, we are going to see that the part that has been dyed with the DM60 is going to be permanently bonded to the surface. Another exercise that we like to do is taking a pot-dyed part versus one that's been done with dimangin and put them in hot water. Hot water is going to expedite any leaching that we might see. So you can see what happens on the screen. If we put a part that has been pot dyed into water, it is going to quickly leach out into the water. And we don't want that happening. We don't want that going onto a skin or an infant's head or anything like that. Versus our deep dye colored parts, they are going to be permanent bonus. They're not going to leach out into the skin. As far as your color options, there is a limitation. We can dye lighter than the starting material. So for gray, for example, we can return to white. But we do have about 250 dyes off the shelf. More specifically relating to HP, we have about 34 colors designed specifically for HP, whether that is a gray starting material or a white starting material. I hope you enjoyed that overview of the additive manufacturing process, whether that was through 3D printing or post-processing. Our goal is to make it easy. So let's make it easy on you and the patients. So in a few minutes, we'll open up the floor for questions, either for David and myself. But I did want to mention there seems to be some questions in the chat of how do I get involved, how do I get more visibility into this industry. Both HP and Dimansion are at a variety of trade shows, whether that is for ONP such as AOPA, but there are also some specific 3D printing trade shows such as Amug or Rapid, where we are going to see there is a lot of O and P applications there. So if you have a chance, please come check us out. And David, feel free to jump in.

SPEAKER_00: 1:07:51

Yeah, I want to add one important note for AMUG. So I'm on the healthcare track for that conference. And we, as of last year, and we'll repeat it this year, we became certified for ABC for CEUs. So if anyone's interested, there will be that opportunity. Also, if you'd like to present anything, uh, Michael and Tara, this also goes out to you. It will be next year in March in Reno. So if there's any interest, please feel free to reach out to me or go to the Amug website. The portal's currently open for uh presentations, abstracts.

SPEAKER_01: 1:08:29

Thank you guys. Um by the way, Emily, you can put your contact in chat uh if if you want them to uh people to email you. Um there are many good questions. We're kind of running short on time, but I'll just address one of them because they're really good. Uh one is to Dave, uh David, on the orientation of multiple parts to print. Have you seen any challenges related to mechanical property deformation due to heat distribution during the print?

SPEAKER_00: 1:08:55

Yeah, so orientation, our process is isotropic. So orientation mechanical properties won't differ the way they would in filament. Um, where orientation plays a key role is just surface finish. So we want to be 30 degrees away from horizontal or vertical. So you're gonna like orient it like that to help prevent that. Um, the bigger challenge with our process, as I mentioned, it's a giant thermodynamic battle, is going to be heat. So location of where your part is in the build. If you think about a box, corners are gonna cool the fastest, then sides and in the middle. Um, that sometimes can play a key role. And then also with like if you have a really thick part, you know, more part volume equals more heat. So we typically recommend to be under a certain millimeter wall thickness. If you go over, it just becomes very hot and more difficult for us to control. So those are typically the areas that help with that, and that kind of goes into optimizing your design for a process. And usually you can mitigate it in certain ways. Um, Michael and I have worked on a few things that were like, hey, why did this happen? And then we kind of walk through the part design, then even going into like the build design, that kind of goes into helping mitigate a lot of the thermal stress issues.

SPEAKER_01: 1:10:17

That does sound like a good question, though, nonetheless. It sounds like there's some tweaking that needs to be done. Okay, so another question from the same uh audience, uh, Harash, it's a question for Emily is Have you seen any variation in mechanical properties of excess powder collected after print? And how many cycles can we reuse the excess powder?

SPEAKER_04: 1:10:38

Yeah, so I think we do need to separate that question. So the powder that is reintroduced into the printer via that vacuum that David was showing in the video, that is going to be reused for quite a long time since new powder is introduced every time you print. There once you see that the powder has started to oxidize or turn yellow, generally that's time to replace the powder. But honestly, that doesn't happen very often. For that thin layer of powder on the outside of the part that you then introduce to the bead blaster, that is not going to be reused. That has gone through a semi-transitional phase where it's semi-crystallized. We're now going to put that back into the printer and then we'll go directly into the waste bin of the bead blasting machine.

SPEAKER_01: 1:11:19

Okay, cool. We have several really good questions, but we are actually running towards, you know, uh we're running on a timeline here. So I won't I want to come back to some of those questions and speakers who want to type in their answers, feel free to do so. Um, but I'm gonna introduce the last speaker, but not the least, who's working on uh a different species. I'm just kidding. Uh kids, kids are not smaller adults, they're different, they really are a different species. Um, so I think what Tara is working on, Tara is a clinician uh for Gilead uh Children's Hospital. Um, and what she's working on is very critical for the pediatric patients. So, Tara, I'll let you take it away.

SPEAKER_03: 1:12:01

Right, great. Thank you so much, everybody, for having me here today. Again, my name is Tara Wright. I'm a clinician at Gillette Children Specialty Healthcare in St. Paul, Minnesota. Um, it was great to see Mike's presentation where he kind of gave an overview of a lot of um applications, orthotics and prosthetics, and we got deep into how 3D printing and post-processing actually works. And I'm going to present more of an in-depth case study on uh one particular application that we are using at Gillette Children's. As Mike mentioned, we did do our residency at the same location down in Rochester, Minnesota. And since then, I've been working for about 10 years at Gillette Children's here in St. Paul, Minnesota. Um, so again, at Gillette Children's, we treat children, both children and adults who have brain, bone, and movement conditions that began during childhood. So we see a lot of people who are diagnosed with cerebral palsy, spina bifida, other neuromuscular conditions that generally are diagnosed during childhood. And approximately 40% of all patients that come through Gillette Children's require an orthotic or prosthetic device. Um, so we have been doing 3D printing here at Gillette for several years at this point. Um, back when I started at Gillette Children's, we had a, and we still do have, a Stratasys Fortis 450 fuse filament fabrication printer in our central fabrication. At that point, the materials were not such that we were printing end-use devices, but we're using it for prototyping. And at that point, we were um we were scanning uh for cranial remolding orthoses, but instead of fabricating the helmet out of 3D printing, we were carving the positive model and then doing traditional fabrication. And that was all intended so that when the materials caught up to what we needed them to do, um, we would already have the skills in hand to be able to kind of start off two steps ahead. Um, we also have a seven-axis carver in-house from Vorum, which is now part of Quadra. We have several different scanning technologies. So we use LIDAR scanners on iPads and phones. We do have structure sensors and those types, uh, LIDAR and structure sensors are great for larger models, so wheelchair seating, spinal orthoses. And then we also have um some different handheld scanners that we use for cranial remolding, prosthetics, and the rest of our smaller orthotic devices. So we have a spectra scanner, we have techmed body scanners, which have been discontinued, but we also are replacing those with iron scanners, um, all very similar in how they work. There's also peel scanners that are out on the market too. Um, so currently, our current state of 3D printing at Gillette Children's is we are delivering 3D printed cranial remolding orthoses. They're called tallies, and that is through our partner, Invent Medical. Invent Medical has a variety of other types of orthoses that they offer as well that we are starting to utilize. Um, our seating practitioners partner with a company called Ride Designs on custom seating systems, and they use, they currently are doing a custom 3D printed seat back in different types of cushions that go into the wheelchair. We print parts for orthotics. So we have a uh pectus carinatum orthosis, um, and some of the parts are 3D printed for that. Um, there's some assistive devices that are 3D printed. So for our wheelchairs, for the lap trays, we have 3D printed custom cup holders that can be inserted there. Um, fabrication tooling. So instead of using pipe or rebar in a lot of our um positive models, uh, our carved models or plaster models that we're still using, we actually 3D printed reusable mandrels that we can um that we can use over and over again instead of throwing out the pipe and the rebar after a few uses. We also have some research going on within our department as well. So we are currently in data collection on a study which is looking at workflows and patient satisfaction for 3D printed AFOs in pediatric cerebral palsy populations. Um, now in orthotics and prosthetics, we get really excited. Sometimes, even if we get 10 patients, you know, usually we're not looking at hundreds or thousands of participants in our study. So our goal right now is to recruit about 27 patients into the study. And we currently have nine patients who've been recruited, and we've got a um about six more months of recruitment to go for that population. And um, so far we have had pretty good luck with both our hybrid orthoses, which were molded traditionally traditionally and then print uh 3D printed, as well as our full digital AFOs, which are scanned uh and printed. And so far we've only had one AFO break, which is pretty good when we look at the rest of the literature that's available for 3D printed AFOs. There's a lot of mechanical failure happening in the literature. And then we have several other novel applications. We have uh a practitioner who worked with um someone who plays hockey in the wintertime and needed a different type of grip on his hockey stick. And so they were able to model and 3D print uh a unique grip for his hockey stick. Um, and I'm gonna talk about one of our other novel applications as well. Um, so let's see, there we go. All right, so we're gonna talk about one of my patients, not actually pediatric, but adult patient who has dipic cerebral palsy, so it affects their lower extremities more than their upper upper limbs. And this particular patient had used bilateral UCBL orthoses, it's a high-profile type of foot orthotic, used their current UCBLs for about 10 years. It's a picture on the screen here of that one of those UCBLs. You can see the plastic doesn't look like it's in great shape. There's been a lot of stress to it, and I was worried about them imminently failing. And so I saw this patient for new suit UCBLs just due to wear of the old orthoses. And so our traditional workflow, we capture the shape of the patient's limb, usually by a fiberglass mold or wrap. Then we fill that with the plaster slurry, take the fiberglass off, and we have a three-dimensional plaster model of the patient's limb. We'll modify that plaster model to add plaster to areas where uh we don't want there to be pressure and we might take away plaster in areas where we want increased corrective forces. Then we have to vacuum form a sheet of heated plastic over the uh the plaster model. And then the last step is to trim the AFO off the model and apply any accessories and finishing. So that's our traditional workflow. We did see the full digital workflow where we still shape capture, but generally it's through a scan. Um we modify, but that's all happening in software. We 3D print the model and then we go through post-processing. Um, so for this particular patient, we did new traditionally manufactured UCBLs. Um, they looked good, they fit well, they worked well. However, the patient rejected the orthoses because they didn't feel exactly the same as the old UCBLs. So we're running into this problem where a patient who has used orthoses for a long, long time wants to find that feel of the old orthoses that fit well, that worked well, that were just worn out. We couldn't do traditional manufacturing again because we weren't going to be able to get exactly the same carbon copy of her current orthoses. We couldn't also do full traditional or full digital manufacturing because, same thing. We would have a shape that we captured and we would be applying our own modifications. So, what we wanted to do was we wanted to copy the orthoses that she already had and um and fabricate those. So basically, she's going in from one shape into the next orthosis that's exactly the same shape. So pretty smooth transition is what we were trying to hit on. So instead, we went to a hybrid workflow. And so this was our novel use of the 3D printing technology. So instead of scanning the model, um, and we tried scanning the UCBL itself, but because of its reflective properties, it didn't scan very well. So what we did is we wrapped the current UCBL, we backfilled it with our plaster slurry, we took the UCBL off, and now we have a three-dimensional plaster model that exactly is the same shape of the old UCBL. We then used our scanner to take a digital scan of the plaster model. We modified it within the software. So we measured the different thicknesses of the plastic to make sure that the plastic was the exact same thickness as the old orthosis. Then we went through and printed the model. Um we did a prototype on our in-house printer. However, because it's fuse filament fabrication, it's highly susceptible to forces that are uh applied perpendicular to the way that it's fabricated. And so we prefer a powder bed fusion for any um any definitive devices. So we partnered with our local service bureau. DI Labs is the local service bureau that we're using. They do all of our MGF printing for us. Um, and we partner with the Service Bureau because we don't have a high enough volume at this point to justify purchasing uh another printer to have in-house. And it also allows us a little bit more ability to experiment. So let's say we wanted to try different materials or a different printer. We have the ability to use all those resources that are available to us through the Service Bureau versus having to invest in all of these different materials and printers in-house. And then of course, it still goes through the post-processing, smoothing, and surface finishes. So our our end um, well, here is our uh our prototype. So you can see that we had the plaster model and then our in-house printer, we did our prototype just to check dimensionality before definitive printing. You can see the trim lines are just a hair different, but the fit was really amazing. We were really impressed with the dimensionality. And then our definitive orthoses were fabricated out of PA12. We didn't do any post-processing on these, so we didn't dye them, we didn't vapor smooth them. We just really wanted kind of an economical experimental solution. Um, for this patient in particular, we are able to reduce our fitting time from the typical of one hour down to 15 minutes because it's the exact same shape of their old orthoses. Basically, the patient put them on, we put them in their shoes, they walked around and we're like, I'm out of here, see you later. Um, so the patient was able to confirm the comfort of these orthoses, matched the old orthoses. And now this patient has been wearing these orthoses every day for over the last 15 months. And I have checked them on occasion. We haven't had any issues with the materials fatiguing or showing signs of stress or breakdown. Um, and then just to wrap up my my portion here, you can see this is the old UCBL next to the new UCBL. There is, you know, on the old one, there was uh an area where the heat adjusted. We were able to build that relief right into the new orthosis. And it was the easiest fit of my life as a clinician. Um, and so future state for this particular patient, while the UCBLs are highly functional, they also have some gait deviations that affect them in the sagittal plane. And so when they walk, they land a little bit more on their forefoot or ball of the foot than the heel or kind of a flat foot gait. But they've been resistant to going into an AFO just due to their previous experience with AFOs or ankle foot orthoses. So what we're doing now, the patient is going to continue to use their daily UCBLs, but we've taken a digital scan of their limb. We have uh merged it with the model of the UCBLs and basically extended it up into an AFO. Those are in the process of being printed right now. And so we're going to put those on the patient in a week or two when we get them back from DI Labs and see if the patient is more accepting of using an AFO when we can match the level of comfort with something that they've used in the past. So that was my very, very quick presentation. Um, I know there were a couple of questions I can address before we jump into everything about um like regulatory and taking models for cranial remolding orthoses. So in orthotics and prosthetics, primarily the only thing that's FDA regulated that we do are cranial remolding orthoses. And so any cranial remolding orthosis, uh, any new model has to go through FDA approval before we can apply it to patients. And so that was one of the reasons why it took a little bit of time for the Invent Medical Tally to reach the American market. They were using it in Europe, but they had to go through the FDA approval process here in the United States. Um, Autobach has their own 3D printed helmet. Um there is uh trying to think of the company. There are two other ones that are on the market as well. And Ortho America.

SPEAKER_02: 1:24:58

Yeah. Ortho.

SPEAKER_03: 1:24:59

Yes. And then excellent. Thank you. Um, and the reason why we're not doing um direct patient models for cranial molding orthoses is because we would have to do it in plaster. We can't do it in fiberglass. We're not, you know, the way fiberglass lays down, we're not gonna get an intimate enough shape. And they used to do it in plaster before we had scanning technologies, but it's kind of traumatic for baby parents and the orthodist because it's messy. It takes a long time, and you literally have to lay wet plaster over a baby's head. You have to worry about their hair, you got to wait till it dries, you got to get it off. They might be crying and upset, and they might be moving around, which is gonna be hard to lay a plaster on a moving baby as well. So we find using some basic tools, toys. Um, we have a light spinner that we use, and then we bring in one of our other orthodists, usually as our professional distractor, and you distract the baby. All you need is about 15 seconds if you get locked in to get a good scan, and then you're done. So um, super quick and easy as long as long as you have a uh distraction tool available there.

SPEAKER_05: 1:26:05

Sarah, did you ever do a uh mold of an individual at Mayo for a craniotomy?

SPEAKER_03: 1:26:10

Yes. Yep. So my only experience was with Mayo Clinic at that time. On occasion, they would have someone brain swelling, have to remove a uh part of the skull. And um those were really tough too, even on an adult patient who can cooperate. They generally were on a ton of pain medications, usually at two nurses there holding the patient up, two clinicians working to mold the patient as quickly as possible. And so anytime I've come across anything like that since then, I say, yes, we can do it, but let's scan it. We don't have to take plaster models of people's heads. I would, that's like the last type of plaster model I would want taken on me is off of my head. So um, yeah, there's a lot of other, a lot of other tools we have in our toolbox. Um, I see a couple different questions on here. Yes. Um, what are the requirements for designing a cranium remolding orthosis in 3D software? Um, so primarily what you need to be able to do is get an accurate shape. So the scanner is really important. We find the handheld scanners have greater dimensionality, greater dimensional accuracy than LiDAR structure sensor or other iPad scanners. Those are better for bigger shapes. Um, so get it get an accurate uh shape first. And then in the software, really what they're doing is they're contouring the neck. Um, so just using some basic skills to lengthen and contour the neck because that's generally where the cap is suspending from. And then wherever the area of asymmetry is, whether it's in the middle of the back of the head, off to the side, they might have forehead asymmetry involved, is they're adding buildups or reliefs onto the scan. Um, so that when they're printing the helmet, what they have is a scan that's going to contact everywhere where we want to hold growth and it's going to have space in the helmet in the areas where you want to encourage growth. However, no helmet is fully 3D printed. There, there does need to be an interface. And right now we are not 3D printing the interfaces. Some companies will lay in different types of foam to give a little bit of protection. Um, and then some other companies use uh a soft uh fabric interface as well. So still some uh non-3D printed components in there.

SPEAKER_00: 1:28:18

I want to add one thing because I've been involved with all the 510Ks for cranials. There is a huge, huge uh demand around the scan to software geometry, especially if you're trying to automate it. Um, this is why I think right now it's probably easier to work with some of those companies because they've basically over-engineered that process to make it failure proof. And that was a huge component to their 510Ks. Like the material prints, it was like that was a very minimal point. It was like that workflow side. So to do it yourself, I think is a very big uh upheaval versus going through the customers that have kind of finalized, they've gotten approval for it. And timing, it takes probably a year or more to get approval for a device like that. So that's the other side of looking to try to do it yourself with software.

SPEAKER_01: 1:29:12

And do you have to provide um I'm sorry, Dave? Yeah, do you have to provide all the documentations for the FDA? I mean, every time, basically.

SPEAKER_03: 1:29:21

And you have to go through reapproval every so many years. And so Gillette actually was the second or third uh manufacturer to have their own cranial remolding orthosis, and this year um would be 20 years of the Gillette uh cranio cap design. Um, however, because we were looking at having to go through the FDA approval process again and we have these other um helmets on the market, we decided to partner with Invent Medical. And so we are actually no longer going to be at the end of this year um fabricating our cranio cap in-house just because that FDA approval process is so rigorous and time. Intensive, expensive, and you have to repeat it.

SPEAKER_05: 1:30:03

Yeah. And does amaz an amazing job. They really do.

SPEAKER_00: 1:30:07

Yeah. As a manufacturer of record, you have to take everything. So you have to do all the software information that's a requirement, all the design scanning aspects, all the biocompatibility of the 3D printed material. If you want to use dimantion consistently, you got to go through all that as well and confirm all the testing. It's not fun. So it's uh usually the stacks of paper for these submissions are like multiple feet high. So it's if you don't have consulting or regulation experience, you basically have to hire internally or use a consultant that is expertise in that. It's a very complex, long process to really figure out.

SPEAKER_01: 1:30:50

Gotta invite uh Invent Medical next time to this panel next year. Uh there's so many good things about them. Um, you know, one encouragement facts is like I I start, I live in the Bay Area, and uh I and yeah, I talk about 3D printing all the time, but I never really see them in my life. But now I'm just walking around the street, I see a couple kids wearing the helmet. And I was so excited, I almost want to go up to them like a weirdo and and just say, oh my God, is this 3D printed? And I'm pretty sure it is. So uh so yeah, there's light at the end of the tunnel. Um, so thank you so much for an amazing presentation and amazing presentations for everybody. Uh so we're at the point of doing some panel discussion. I think earlier we talked about scalability and economics because um money is important to sustain innovation and a new practice and to have the change of mindset and everything goes together. So what are your thoughts on the scalability of this technology in the OMP industry? Um, what it needs right now at this moment to continue the growth?

SPEAKER_03: 1:32:03

I I'll kind of summarize that uh clinician-wise. So you can, I mean, it's pretty obvious that the way Gillette and the way that um Mike Schmidt's company is going about it are very different ways. So Prosthetic Plus is investing in a lot of um technology in-house, which is a great way to do it. Um, and then Gillette is investing in partnering with other industry partners. So we use service bureaus, we're partnering with other manufacturers. And so those are two really good ways that you can scale up. So um obviously uh when you have the technology in-house, you've uh things can turn around a lot faster. You don't have to wait for things to come back and forth through the mail. Um, so you can do a lot more prototyping, you can do it a lot faster. But again, when you're working with service bureaus and other manufacturers, you're taking a lot of the um a lot of the monetary investment out of the picture and you can experiment with a lot of different technologies in a shorter period of time before you uh before you marry yourself to one type of technology. Um and so you know, we're never marrying.

SPEAKER_02: 1:33:09

We're never married to any because the new ones always come in.

SPEAKER_05: 1:33:13

Always come in.

SPEAKER_03: 1:33:14

Yeah, I think getting someone um, so they don't teach uh digital manufacturing in in school, whether you are in technical school or if you're in a master's program for clinical. Um so what you need to do is you need to get an engineer. You have to get an engineer. Our uh we have one full-time digital technician who is an engineer by trade. He does 3D printing. I understand 3D printing and I understand the clinical applications, but we have to work together and we work so closely together to really get anything done. Um, I would be a lot farther behind in this process if I had to learn all of the different pieces of software um as deeply as he does to be able to get any of this work done. And so partnering with people who have the knowledge that fill the gaps um that you don't have is is really important for scaling this up as well.

SPEAKER_01: 1:34:03

Yeah, that's really well said.

SPEAKER_04: 1:34:04

And jumping into some more process.

SPEAKER_05: 1:34:07

Oh, go for it, sorry.

SPEAKER_04: 1:34:09

Sorry, no problem. Just quickly jumping in about some more benefits of the 3D printing or additive manufacturing process. The goal is to make the life easier for clinicians and also for the patients. So you now no longer have to have skilled labor, which is oftentimes hard to find, and you can make batch-based processes. So you're not working one device at a time. You're gonna press go on the printer, and at 12 hours later, you're gonna come out with 16 cranial helmets. We also are gonna eliminate the need for physical models, so storage of the physical models. You no longer have plaster casts thrown about your office. And when a reprint is needed, as inevitable, when these patients abuse the devices, as Mike liked to show us, we can just press reprint. And the last thing is the accuracy. For traditional modification, we rely on the accuracy of the scaled labor or the human hand. But when talking about 3D printing, we're at plus or minus uh 0.2 millimeters, so a strand of your hair. So you are going to be very accurate when you're printing. Yeah, totally agree.

SPEAKER_05: 1:35:10

Having some new processing is scary.

SPEAKER_01: 1:35:15

Michael, I think your connection is a little bit spotty. We we can only hear just a little bit. Oh, would you suck? You may have to repeat. Yeah. Just repeat what you just said. Yeah, now it's better. Now it's better.

unknown: 1:35:26

Yeah.

SPEAKER_05: 1:35:26

As far as just having the clinician being open to uh newer things, you know, change is scary, change is is something that a lot of people aren't very comfortable with, but you know, relying on different companies to be able to do the jobs that that they cannot do, like Tara was saying, like, you know, partnering with another uh company or individual to to help you along that road is going to help you out to get get to where you need to be to have a better work life balance.

SPEAKER_01: 1:35:52

I was I went through the same thing where I I couldn't do all the things I think we we we lost you again, kind of.

SPEAKER_05: 1:36:21

Sorry, yeah.

SPEAKER_01: 1:36:27

I just lost you the last two minutes.

SPEAKER_05: 1:36:29

Yeah. Can you can you hear me now? Yeah, that'll be a TV commercial. Um just being open to change and trying to partner with with the right companies to to help you with that change uh to get into a digital uh workflow is gonna be important.

SPEAKER_00: 1:36:45

Yeah, I'll uh I'll try that on the HP side. So I would say like our equipment is not cheap. It's not one to start with. Um get there's incredible filament printers for like under a thousand or under two thousand. I think starting there, playing around with the softwares, um, you know, Prosthetic Plus and another larger O and P customer, they're probably, I think, in both in the top 10 of that TPE usage globally, their software challenge was more critical and a longer deciding factor than looking at a 3D printing ROI for their business. So if you can start that process earlier, which like lower costs, as Mike said, there's free softwares, very low-cost softwares that you can teach yourself with. Having a printer in-house just to do film and stuff to test concepts is really important. Um, ultimately, our printers are going to be for very specific cases, high, high printing, high throughput. So, as Tara said, you can use a service bureau that has these fleet of printers. You can use a central fab like Prosthetic Plus. Um, you know, it will take time doing that before you can say, hey, do we want to bring this in-house? And sometimes that'll never be the case. So there's always that factor there. Um, but I think the getting used to the process, the design process, and with Michael and every customer, we talked to them six months after having our printer. They're doing 5x the things that they thought they were because they're like, hey, let's try this and throw a part in. Um, so just having openness, having availability, the technology, I think helps that create a process go a lot faster.

SPEAKER_01: 1:38:30

Totally. I mean, I have my own personal input is if technology is easier enough, eventually it will scale. I mean, now everybody is using Chat GDP because it's so freaking easy. Uh, even Granny can do. So if that day comes for 3D printing, I bet everybody is gonna is gonna use it. Now, another question that's related, and I saw in the in the question uh stream is low resource and patient uh benefits. I I don't know how much these new technologies cost at the end for a patient. Um just wondering one is how how can low resource areas benefit from this? And and two is when is this gonna the the economic benefit can potentially be created and passed down to patients? Two questions.

SPEAKER_03: 1:39:19

Sorry, compound question. I I prepared for this question. Um and so I would recommend everybody go look at the Operation Namaste website that's Jeff Aaronstone, is a clinician. He has worked a lot in Nepal in figuring out how to get uh prosthetic services to people who live in rural mountainous areas. And so they have something called a limb kit, and it's basically a um a prosthetic and orthotic lab with a printer built into a trunk that you can travel with and work with patients. And even if you're um if you're doing diagnostic types of devices, you can do diagnostic types of devices on here and then take them back uh for fitting. Um anybody who works in 3D printing and orthotics and prosthetics also knows of Brent Wright. Brent Wright does a lot of outreach and he talks about centralization versus decentralization for both modifications and for manufacturing. And so he has done some work where if he couldn't take um, you know, his computer and his software with him when he was traveling, what he would do is he'd take the scanner, scan the patient, send the model back to his people in the United States. They'd modify it, he would print it off where he was at and he would deliver it. And so there's a lot of different ways that you can decentralize different parts of fabrication so that you can take advantage of resources from all over the world. Um, so there's a lot of different ways to do it, but I highly recommend checking out uh following Brent Wright and then checking out Operation Namaste.

SPEAKER_01: 1:40:51

Brent Wright also has a great podcast, so I'm gonna give him a shout out here too for that.

SPEAKER_03: 1:40:56

Yeah, and I believe you did a QA with him a couple of years ago that I'm gonna link in the chat. Yeah, maybe yeah.

SPEAKER_01: 1:41:02

I think I think I saw your name on his list of guests before. Um, so everyone else, any any um uh thought about how to pass down the economic benefits or if there is any economic benefit?

SPEAKER_00: 1:41:15

Tara beat me to it. Uh Brent Wright typically does some type of uh travel mission to that exact scenario. Um the decentralized for centralized is very good to think about. Can you like filament printers can still do a lot of value? You're never moving to MJF printer ever. So uh that concept isn't working. Um we did have a case this year. It was very tight timeline, and not every situation it might make sense, but uh through Limlab, and I'm trying to find the course of it or the website, but um they partnered with one of our service bureaus, AB Corp. And it was very similar where they like went in, they did traditional prosthesis for a few areas, I think in Africa, and a lot of patients came in for it. So like we didn't really have timeline for like, hey, stay here for two weeks. Um so they got scans, they did normal prosthetic manufacturing, and then like two days later, they fit everyone. So they actually had someone print smooth, die, and then sent someone on a plane to them to like be delivered. So it can move very fast. There was very little margin for error there. But I was very impressed with that. And that conversation started at AAOP this year in March. So like we can move quickly when we have everything set. Um, I think just finding people that are really wanting to focus on that can really find the right partners to do it with.

SPEAKER_01: 1:42:44

If you have that wrote up, uh written up in an article, that would be great. I'd love to share that.

SPEAKER_00: 1:42:49

We did uh we did a webinar for it and I will share it in the chat.

SPEAKER_05: 1:42:53

Um, it was a really cool story that kind of utilized that concept of a go back to what Brian Ken always kind of says as far as having you know boots on the ground, as far as individuals that are going to be there and having the training for those individuals to be able to troubleshoot some things with uh with a 3D printer, you know, because there's never going to be uh uh something that works all the time. There's gonna be things that need to be maintenance and and worked on and also just overall expertise in the field. So working with those communities to be able to get them up to speed and and being self-sufficient is also a really important thing as well, um, to lay that groundwork in order to continue to have that type of care over in a in an impoverished area as well.

SPEAKER_01: 1:43:37

Okay, fantastic. Um anyone else? Um Emily, have you chimed in for this?

SPEAKER_04: 1:43:45

The one thing I would mention is if it is cost um not possible cost-wise to bring technology into house, there are a variety of service providers. While they may specialize in OP, they see quite a bit of devices. So they will have a network of printers, whether they are PA12, TPU, or oftentimes Metal, they'll also have uh post-processing as well. So if you're looking for any recommendations, David, you can pass those along as well.

SPEAKER_01: 1:44:12

Awesome. Um, we are at the end of our webinar. Um, but I want to, uh since you guys are donating your time for free, I want to offer an opportunity for shout-outs of your wants and wishes at the moment that can help you. I mean, I we're approaching the end of 2025, but um if you have any wishes for 2026, that also counts. So anything that's like you really, really want right now, you can just shout out to the universe and we'll share this webinar with everybody. Um so hopefully the universe will respond. Uh so Emily, I'll start with you. What's do you have anything that's on on your plate that you really wish to happen within a year? That's a good question.

SPEAKER_04: 1:44:58

Put me first. Yeah, that's all world pieces for sure. Within the ONP market, though, I would like um people need to be so scared of adopting new technology. I think that is the biggest barrier that I've seen. We've definitely been crossing the chasm a lot in the last few years. But again, I said it before and I'll say it again. Our intention is to make everyone's life easier. So if we can all come together and adopt it uh and make things more in reach for everyone, I think that will get us across the chasm for sure.

SPEAKER_01: 1:45:25

Yeah, my mindset shift is really important. Um, Tara, any any wishes at the moment?

SPEAKER_03: 1:45:32

Yeah, so uh for 2026, we are looking forward to uh doing more prosthetics in 3D printing and added manufacturing. So I'm really looking forward to potentially partnering with Prosthetic Plus over the next year and uh uh gaining access to a lot of the work that they've been doing and apply that to some of our pediatric patients.

SPEAKER_01: 1:45:52

Awesome. Michael?

SPEAKER_05: 1:45:55

Well, no, I gotta say I look forward to working with TerraPods in 2026. Oh, that's so sweet. And to get into a digital uh workflow, I really do think it's gonna be not only beneficial for the clinician, but beneficial for their patients as well. To have that digital footprint of where people are going and to be able to help them down the road.

SPEAKER_01: 1:46:23

Yeah, totally. David.

SPEAKER_00: 1:46:26

Um anything that makes this process easier, whether it's scanning software, um, this webinar, I I love seeing interest and adoption and um, you know, customers like Michael grow and just absolutely crush it in what they're doing. So that always excites me about this job. One other one is uh we kind of restarted a consortium that we did earlier this year for coding and healthcare re insurance reimbursement. So I am very excited to see what we can do that. Uh we got an acceptance of coding for prosthetic, which I was expecting to take two to three years, and we got it done in under a year. So there's an openness there, there's some excitement, and just loving to see where that goes with uh kind of the current group we have.

SPEAKER_01: 1:47:17

That's really critical. I I think one thing I really love about this space, and it's done well demonstrated today by the panel, is that in this space in particular, people love to hand hold everybody else to get on the same uh same same page. Um there are a lot of altruism that's demonstrated, not just you know, within the community locally, but also globally. So I'm always it's really uh warms my heart to see those every time. So thank you very much for donating your time. Thanks for the audience. Hugely engaging audience. I hope we addressed most of the questions. If not, you've got the contact, you can reach out to the speaker. And this webinar will be on demand for a couple weeks, so you can just log on or share with your colleagues and they can watch it. There's no cost. Okay, well, thank you very much again, and hopefully uh you have a good Halloween or Thanksgiving or whatever holiday that's coming up. We're we're we're into the holiday season. So thank you very much again, and see you next time. Okay, bye bye. Bye everyone.