Medical 3D Players: Behind the Doors of a Double Hand and Face Transplant

Pieter Slagmolen  00:06 

Welcome to The Medical 3D Players Podcast. We're coming to you live from Materialise headquarters in Belgium to talk about mass personalization. We’re your hosts, Pieter Slagmolen and Sebastian DeBoodt, and we'll be delving into key developments in medical 3D technology by examining new and surprising dimensions with experts across the industry. If you're ready to change the world with us, please stay tuned and subscribe to our channel.  

Face transplants sound like they only benefit one person–being the person who gets the treatment–but today we’ll speak to our guest Alyssa Glennon, Clinical Engineer at Materialise, and we'll learn about the key insights and discoveries that benefit many areas of personalized care. 

Pieter Slagmolen 00:50 

Hi, Alyssa. So, you're a clinical engineer at our U.S. office. You've been with Materialise for eight years and in that in your role of plan hundreds of complex or to pedigree construction cases in both upper and lower extremities, you've been involved in for face transplants, which is basically as many as the most experienced surgical team in the world. And you're involved in pretty much all the cool stuff that we're doing it Materialise from our US office, including also the personalization things at the point-of-care we are working on. So yeah, welcome. And thanks for being part of this podcast. 

Alyssa Glennon  01:25 

Thanks for having me. Happy to be here. 

Sebastian De Boodt 01:27 

And so, we're definitely very interested in to hear your thoughts about mass personalization. But we can't dive straight into that without having talked about the double hand and face transplant case, which you have been recently involved in (and) which got a lot of exposure. So, let's start there. And maybe just take us to the beginning, like how did you actually get involved in that particular case?

Alyssa Glennon  01:53 

The lead surgeon at NYU had worked with us previously on face transplants. He's a cranial maxillofacial physician. And when he had this patient come to him with this unique need, he said, “You know what, you know, let's give Materialise a call.” And when he first reached out, we actually thought it was just a double hand transplant. And that's when I got involved because I had some experience doing hand transplants. And then we come to find out a few weeks later that he meant both. So, so, we had had some experience with patient-specific planning, both for more routine cases, and also, for the complex face transplants. It was a nice, nice fit, I think, from the beginning. 

Sebastian De Boodt 02:31 

So, so I'm assuming that, you know, when it comes to this case, it is more complex. Is it actually more complex than anything you've done before? What makes it more complex, particularly the procedure as a whole? 

Alyssa Glennon  02:47 

Transplants are, of course, more complex than a more routine procedure. This one wasn't necessarily any more complex than a different hand transplant that I might have worked on. But what's, what makes it more complicated are all the moving parts. So, you know, there's a team of physicians, basically, at every kind of surgical station for the case. There's one at each hand; there's one at the face. And then—there's the same on the donor, as well. So, we have six surgical team. There's a lot of physicians in the room at any one time. And those are just the acting surgeons, right? There's anesthesia, support personnel, and our staff. So, it's, it's a full house. And making sure that everyone's kind of on the same page with the procedure, understanding everyone's objectives, their preferences, trying to incorporate all that into our designs, into our process. That I think, is the most complicated factor... even just meeting with everyone, right? And explaining what the process is going to be and taking questions is difficult to get everyone in the same room at the same time. I think the logistics of a case like this are what makes it so complicated. 

Pieter Slagmolen 03:57 

And I guess it also takes quite a lot of time, you know, ahead of surgery. Well, assuming here that, you know, it's still you rely on a donor being available at some point in time, and then things need to happen. Assuming, that's not the moment when you start planning, right? Like how much time in advance do you actually start and what are some of the things that you do actually, upfront versus, you know, when, when the donor is available?  

Alyssa Glennon  04:21 

Yeah, certainly. It's a lengthy process. We were first made aware of the case in spring of 2019. Spring, early summer, and we had planned to kind of start rehearsing, basically, early summer of 2019. So, June timeframe, we started with cadaver labs. The surgical team plan to do a cadaver lab once every five or six weeks or so. And we were going to play as if that was the actual case. So, we did that for several months, I think five or six times before they actually even said, “Okay, now we're ready enough,” so that if a donor becomes available, we can do this surgery. And they listed the patient on the transplant list after about five or six months—he was a very rare transplant patient and there were very few percentages of donors that could work for him, given his blood protein profiles. But they wanted to kind of get him on the list as early as possible, knowing that there would likely be a wait period, I think surgery was almost a full year after he was listed on the transplant list. So, we had six, seven more rehearsals afterwards, just to continue to refine these skills, make sure the designs were all, you know, crisp. Make sure the surgical team knew where to be at any given time. It was like an orchestra in the OR trying to make sure that even how people moved through the the operating room was important given how crowded they were. So it was, every practice was definitely worth it. But it was probably a year and a half long. 

Sebastian De Boodt 06:01 

That's impressive. I mean, so that's like, I don't know, like 12–13 times in it, you got together, and went out, and is it done with this entire team? Or how does that work? 

Alyssa Glennon  06:13 

Yeah, so the first few were done in a cadaver lab-type settings. There were... it was it was a lab at NYU. It wasn't an official operating room or anything like that. And it was really just to kind of work out the nuts and bolts of what needed to happen. After probably three or four like that, they move to the operating room. That was specifically to practice that movement between the O.Rs. You know, with it being so crowded (and with there being so many moving parts), they wanted to make sure that all the instrumentation was placed in an efficient way that everyone could get to the things that they needed to get to, at any given time...(and) that the surgeons knew what their rotation was going to be throughout the procedure. It was a 20-hour surgery.  

Sebastian De Boodt 07:01 

And during that process, were there times where, you know, you and people in the team discovered, like things that you thought were gonna work, and it was like, “It's not working at all”—and need to go back to the drawing board? I don't know (if) you have some of those examples, maybe just from things that you thought was going to work. 

Alyssa Glennon  07:23 

With previous hand transplants, when you're just doing a hand, you're looking for a donor that has hands that are of a similar size to the patient that is going to receive them. You can do a lot of upfront analysis on what the sort of envelope of the size of those hands is going to be. When you're doing a hand and face transplants, especially on a patient who likely wasn't going to have a lot of options for matches from a donor, you don't have as much luxury to kind of pick and choose. So one of the things that we realized pretty early on was that if the blood profiles worked, we were going to move forward with this patient regardless of size difference between the donor and the recipient. So, for us making patient specific instrumentation that added this extra level of challenges, we were used to almost one-to-one matching. And when we had this potential for large size differences, we found out pretty quickly through cadavers–who had very different size differences–that that wasn't gonna work. And so we had to basically do a small, medium and large design for our hand guides, so that at the time of surgery, whichever size of donor became available, we could still accommodate, so we use the first half of the labs or so to specifically find very differently-sized cadavers who were representing the donor and the recipients to practice what that might look like, and to try to kind of pinpoint what our size range was going to be and what those differences might actually look like. There's not a lot of data on, you know, distance between arm bones on the greater population, for example. So, it was a challenge to build that data through the labs and then find the size ranges, and then incorporate that into all of our subsequent designs so that we were prepared for any opportunity.  

Pieter Slagmolen 09:20 

Wow, it sounds like it's not just really planning for it. It's really developing the procedure, you know, in the year before it actually happens. Yep, definitely part of it. So, it is probably the most complex thing that you've ever been involved in, then I'm assuming you're (doing with) each guide. 

Alyssa Glennon  09:35 

You know, that's, that's a procedure that we're very comfortable with. And I've done many, many times before, but adding that level of unknown and needing to have all these different options available. For each case, each cadaver lab, each false alarm kind of case was important. So certainly, all the extra parts, definitely added to the complexity. 

Pieter Slagmolen 09:58 

Give us an idea on how many parts, like 3D printed patient specific parts, that actually you needed or that you had available.

Alyssa Glennon  10:08 

For the hands, we had three sizes of guides for the donor and three for the recipient. We had that or each arm, so double that. And then we had some accessory pieces that we had 3D printed as well, that worked for the physician team. We had some identification tags that they use to label various pieces of the anatomy during surgery, so that they would remember what could quickly reattach them once the transplant occurred. There were, I think, six sort of “trees” that contained many of these little tags on them. And then we also had some splints, basically soft tissue splints a way to position the wrist in a certain degree of flexion, a certain degree of extension, so that they could make sure that the muscles were at the right tension to accomplish the full range of motion afterwards... probably close to 20 printed pieces, maybe just for the hands alone, that's excluding the face. I think over the course of the 13 or so labs that we supported, I think we 3D printed probably 400 parts, combined hand and face, to work out these designs to have parts available for the rehearsal, and all the different revisions and duplicates that we had to do as well. 

Pieter Slagmolen 11:35 

So one thing that's puzzling me, Alyssa Glennon, is that we talk about a face transplant, which to me feels like it's like a soft tissue procedure, we're changing the face of the person, they talk a lot about guides, which I associate that with a bony tissue procedure. How do those to do match? How did the guides come into a soft tissue procedure? 

Alyssa Glennon  11:56 

Primarily, our focus was on the bony part of the procedure. That was bread and butter for us. From the face side, you're right, there is quite a bit of soft tissue that's transplanted; that's really the main objective. And what we did with the guides is: the bone underneath the soft tissue is used as anchor points. We very strategically located these anchor points that the physician selected for the soft tissue to be transplanted. So there's, for example, points on the temple where you might have the soft tissue kind of connect. We helped them locate these very thin slices of bone that they could use to help actually transplant that tissue and then have it ready. So you need something to kind of get the skin to reattach to the bony anatomy. And we do that by keeping this anchor of bone with the skin as it's transplanted.

Sebastian De Boodt 12:52 

Oh, so the guides basically serve as a way to identify where the Velcro is going to be, that will allow you to attach it.

Alyssa Glennon  13:02 

Exactly, yeah. 

Sebastian De Boodt 13:05 

Nice. I'm assuming the way that you're explaining it, it seems like you're not just, you know, executing instructions from a surgeon in preparation. It's, you know, from your experience, also giving a lot of input and guidance to the surgical team then, yeah? How to use specific 3D printing technology. 

Alyssa Glennon  13:27 

The benefit of us having done previous hand and face transplants is, you know, we've have lessons learned from all of those. It was nice, my experience for hand transplants had come from a different institution. So it was helpful for me to bring some of that information to the NYU team and let them know what we had done previously. We also learned a lot with this NYU team, the identification tags I mentioned, that's the first time we've ever done that for a case. So, it was it was helpful to have some of that experience and to use that to kind of reassure the physicians and give them a little bit of confidence that these guides had been used in this type of case, before they'd been used successfully several times. You know: we can help you. But we also need to continue to work with you to make sure that we accomplish what your goals are for this specific patient. And so, of course, modifications are made every time.

Sebastian De Boodt 14:22 

I think confidence here is probably a good word, especially when you're doing some something like that for the first time. It's such a big team. In those rehearsal sessions was there any moment, any session where, you know, the team was like, “Ah, it's just too complicated. It's never gonna work”? Or was it always like, “Okay, we still need to hash out some things, but we'll get there”? 

Alyssa Glennon  14:46 

One of the things that the NYU team was great about was maintaining this kind of optimism, this sense of confidence. I don't think they ever wavered in their confidence for doing the case for the complexity of the case. I think they frequently questioned decisions, process, steps. They wanted to make sure that they were doing it right, step-by-step from the beginning to the end of the procedure. And, you know, the guides came into question, everything came into question at one point or another. The physicians ultimately evaluated each step and made sure that they selected the best method for them moving forward. I think I mentioned all the different surgeons and all the different preferences involved. I think some of them may have took some winning over others, depending on the specific item they were debating. But in the end, they were very good about really unifying around decisions and moving forward with them. 

Pieter Slagmolen 15:48 

One thing that I was wondering is if you mean, you're prepared in the planning of this, and obviously, it's a face transplant, as well. So, there's an aesthetic aspect to it, I would assume. What are kind of the risks that we can relate to as an engineer, that can help manage somehow through planning for the patient? 

Alyssa Glennon  16:08 

So on our cranial maxillofacial side, we can do a little bit of soft tissue simulation. The benefit there, as you mentioned, some aesthetics for the face. You can sort of estimate, and I say sort of because of course, you know, everything is changes in the OR. But you can give yourself kind of an idea of how things will look, you can see when you transplant the chin, do we make it too big? Is it too small? You can make fine adjustments like that. When we do the hands, we can control things like length, we can make sure that the final limb length is reasonable for this patient's size, we can look at things like range of motion, try to make sure that we're getting as functional as possible without results. So there's certainly some simulation and estimation that that we can do to help give the surgeons an idea of where they're going. In the end, it's not probably exact as to what happens intraoperatively. But again, just gives a little bit more information to go off of so that they know where their target is in the O.R. 

Sebastian De Boodt 17:16 

Pretty, pretty impressive. Maybe Alyssa Glennon, if you could take us through the day itself, like, you know, D-day like, you know, how, like I imagined it. You're working in your garden or something and then the phone rings. And it's like, “Alyssa, we need you at the office.” Like, what were you doing? When you know, is it like that? Like, do you get the call? And is it something that you've been waiting for? What were you doing at that moment? 

Alyssa Glennon  17:42 

We got an email in the evening on Monday evening, spread around 6pm. So just after kind of the workday had finished, and the email was a one liner from the head surgeon at NYU. It just said “It's go time.” All of a sudden, we’re on call and prepared for this case to happen. The interesting thing about the surgery is from the hands perspective, we had already designed product that was intended to fit any size donor. I mentioned the small, medium, large sizes before. So that product was already in New York waiting. But for the CMF side, for the face part, that was intended to be donor-specific. Once we knew that the case was live, we the CMF team was on overdrive, basically to receive images from NYU quickly that night, but I think we received them in the middle of the night. After we got that email, we processed them between then and dawn, basically the next day. Our CMF clinical engineer met with the NYU team early that next morning. We had guides designed by lunchtime that next day. And that evening, they were printed, they came off the machines, and then CMF clinical engineering, myself, grabbed them off the machines, drove as quickly as we could to the Detroit airport, and flew them to New York in time for surgery the following morning. So it was it was kind of a crazy time crunch situation. But we were well prepared. We had global teams ready to run the clock. Everyone had a set schedule, so that if in fact the images did come in the middle of the night—which of course they did—we were prepared and we were able to process them and get everything moving in time so that we could hand carry the rest of the products to New York just in time. 

Pieter Slagmolen 19:35 

Yeah, what a logistical machine. This is exactly what puzzles me. I mean you have you have 10s of people involved on the engineering side. You have you have a lot of a huge team on the surgical side involved. How do you how do you make sure that what you deliver, and what you bring to the table in the end, this is ready and that the quality is high? Do you have systems to do that? How do you make sure that what you in the end—taking a box with you on the airplane—is going to be exactly what's needed at that point in time? How do you manage that? 

Alyssa Glennon  20:10 

Well, the good news is we had had quite a bit of practice. We had done this 1,213 times before. Obviously, with a little less pressure those times knowing that it was a cadaver lab, but the process was identical. We were comfortable with moving through what we would need to do to accomplish this. We do have pretty robust quality systems to make sure that the product we deliver is ultimately exactly what we intend it to be. We have checks throughout the entire process, including the final parts that come off the machines. And while it was a little tight there, between everything getting off the machine and us making our flights to New York, you know, we didn't skip steps, we didn't cut corners, we made sure that every product that came off that machine had been inspected, had been cleaned, had been packaged appropriately. Then we were very careful in carrying them to New York to make sure that everything stayed intact, and everything was kept together so that they had everything that they would need. It was very easily labeled, clearly defined, and ready to be used right away. 

Sebastian De Boodt 21:17 

And so, you also jumped on the plane together with the parts? And ultimately you also helped in the O.R. or how does that work? 

Alyssa Glennon  21:25 

Yes. So, for the face, the face parts came with us on the plane. We brought them to New York, and they were sterilized right away and used in the actual surgery. The hand parts we had delivered a few weeks prior. So those had been already on the shelf. We actually had a hardware rep who was on the ground in New York, who was very familiar with our products, as well. He was not a Materialise rep but we had been working together for so long, he had been keeping tabs on all of the hand parts that had been arriving, sorting through them, and making sure that you knew what was positioned appropriately in the O.R. Once Emily, the other engineer and I got there, we helped, again, to sort through all the products, make sure things were lined up, in terms of when they would need to use, for each part throughout the case. Then we're ready to answer questions, and make sure everything that they needed was there and available. 

Sebastian De Boodt 22:25 

How do you get personally through such a day? I'm assuming it's like a huge adrenaline rush? Throughout? Like, what's the moment when, when you're like, ”Okay, it's gonna be fine.” Like, you know, like, “Job's done here. It’s out of our hands and we did a good job...” Is that when you enter the bar? Is that after the procedure? Or, you know... 

Alyssa Glennon  22:45 

Actually, all the tension I realized hadn't really been released until the press release that NYU gave with the patient actually there, showing off his face and his hands. There’s definitely a sigh of relief right after the surgery when we left the O.R. saying, “Yeah, everything worked.” You know, we were going really fast, making great time. It was perfect. But it was not until we actually saw the patient months later, did I really feel like, “Okay, we did it”!  You know... that everything worked out like it was supposed to. It's definitely an adrenaline rush at the time. Not a lot of sleep for a couple of days there, even if you wanted to! It wasn't until we saw the patient just a few months ago that I really felt like, “Okay, we know it worked.” 

Sebastian De Boodt 23:35 

Yeah. And that's probably because we're engineers. You're all on the call that we didn't even talk about. The patient that I assume, indeed, it's impressive to see the technical part, but I can totally imagine that it's when you see the actual patient, that that's really the moment of like, “Oh, yeah”! You know, yeah, this is, you know, the accomplishment, like they do. Do you have any reaction from the patients like, I mean, have you ever met him? Or is that like, you know... 

Alyssa Glennon  24:03 

I've seen him a couple of times, I've not met him, you know, shaking his hand or anything like that. But typically, that's not something that that we would do as engineers. Kind of more background personnel, I suppose, technical support for the case. We do hear updates from the physician team, how things are going, and they were pretty tight-lipped about this case, of course, because of the kind of unique nature of it. But we do get periodic updates: that he had been doing well in rehab, that his physical therapy was going very well, that he was, you know, being released from the hospital earlier than anticipated for extended physical therapy at home. You know, some seeds, I suppose being dropped for us so that we weren't sort of left in the lurch there, wondering. But I think I think the biggest thing seeing him, I think the biggest impact for me is even if you know the surgery went well, there's always extra factors afterwards that you worry about. Did, did the organs end up getting rejected? Did the immunosuppressant drugs work as they were supposed to? Is the too much skin in the limb length? There's all these other factors that you wonder about...it's not until you actually see the patients. And I saw one of my favorite photos of him was, he was playing pool, and that kind of fine motor skill that you need in your hands to be able to play a game like pool. It's just so rewarding for me to see that not only does he have hands, but he can use them so well, so quickly. Just a great, great photo to see. 

Sebastian De Boodt 25:42 

It's something that I don't even master. I think it's just amazing. I think, you know, it's, it's fantastic to hear I mean, both from external media, but also within Materialise, in this case, got quite some exposure and quite some interest. It’s highly motivational. And even now, I mean, you constantly mentioned things that still blow me away! I think it's really nice for you to share that.

Pieter Slagmolen 26:10 

Yeah, I agree. I think I think one of the things that that we do want to talk about after looking at the complexity, the immense logistical operation behind such a complex case is how does this how does this relate more to the topic of this podcast, basically, which is, which is more mass personalization, right, the scalability of it? Because I mean, my first impressions about after hearing your story is that being involved in the surgery, being there with a team of engineers, doing several cadaver labs, I would assume that's not common, right? That's not how you would typically handle a case, right? 

Alyssa Glennon  26:50 

That's true. Sometimes. For first-time users, we will have a clinical engineer available, especially if the case is more complicated. But certainly, we don't really do cadaver rehearsals, or things like that for more standard cases. 

Pieter Slagmolen 27:06 

But I mean, there are always skeptical people around this, right? Some might say that, I mean, we're putting in a lot of money, a lot of time, a lot of effort very, very highly skilled people to help one patient. Basically...What would that mean that if we use those resources...you can easily help hundreds of other patients somehow that are maybe less spectacular, but are also in need? Or in pain? Or have something that I could like help with? How do you reflect maybe if you look at what you're doing for this case, on what this case means? How do you reflect on what it means for the broader society as a whole? 

Alyssa Glennon  27:50 

I will, I will preface it by saying we don't do this case to the exclusion of others. Certainly, we have whole teams of engineers available who are supporting the cases that come into Materialise. So, while I agree that there are a lot of resources put towards this case, we certainly didn't exclude any other surgeries just to be able to accomplish this one. But really, to answer your question more directly, you know, I had a similar thought when the case was first presented to us. At first, I was a bit apprehensive, you know. Why? Why do we need to do this case—that's so complicated? Why can't we just do hands, and then later do a face, or vice versa? Why do we need to spend all this extra effort? And I think what ultimately won me over was this idea that (we need) medicine that’s always progressing. We're always looking for ways to be better, right? And that's true, you know, across society. And so, this case was probably going to happen sometime. I feel strongly that the technology that we provide adds value to these types of cases. Bringing this technology, allowing it to help this one patient, even though it was a highly-focused expertise from many, many people to do it. I think it trickles down. Right? So, so we're helping expand the awareness of the technology. The press that this particular patient got and NYU received. Right, that helps. That just helps more people understand that this type of technology is available. And it's available for complicated cases. And it's available for more straightforward cases. We, I don't think that this technology adds value only for cases like double hand and face transplants. I think it helps for every patient. We've shown that if it saves time in the O.R., you can reduce anesthesia, you can reduce revision rates. You know, there's lots of benefits applying this type of technology to various cases. And I think expanding that awareness is a really big benefit of doing these high profile cases. With that is all the lessons that we learned from it right, you know, we, we did those identification tags, we added some 3D printed splints, you know, we're changing designs, offering different sizes for guides, we're making modifications to better meets our surgeons’ needs, our patients’ needs. And those also trickle down, right? That technology gets expanded and broadens. And everything we learn from a case, we can apply to every other case down the road. So I think it's, you know, it's kind of multifaceted benefit. But there's, there's never, I don't think anything wrong with progress? Even if it's looks like it's going in one specific direction, there's always this trickle-down effect that benefits all these other patients, as well. 

Sebastian De Boodt 30:54 

Your job has also changed over the past ten years that as we started doing these cases ten years ago, that on a day-to-day basis, we found ways to do those more efficiently, or differently, entirely differently than we do today. What are according to you some of the more, I would say radical improvements, that you've seen in how you can handle such a case, over the past years? 

Alyssa Glennon  31:22 

When I started, almost ten years ago, now, the cases that I learned from when I started, they were I want to say, fairly standard. They were not very complex, they seemed to be quite straightforward. And the case reports that we would send with them kind of detailing the nitty gritty of each case–and all the decision-making that went through it– they were small and trim and had a few photos, or a few screenshots. That's about it. I think today, the vast majority of cases that we process are very complicated. They are patients who have have had problems, maybe since birth, and so their form anatomy was never normal. Whereas, before it was kind of, you know, someone had a normal form broke it, it didn't feel quite right. And now we're just trying to restore it to how it was. But now we're doing cases where there was no normal, there was just all these extra confounding factors that make the cases so complicated. Our case reports today, you know, from being previously, maybe five or six pages, could be upwards of 2,530 pages detailing all these little steps! And we've been able to—while increasing the complexity of these cases—also get faster at processing them. We're doing a higher volume, significantly higher volume of cases than we were doing when I started. And they're significantly more complex, as well. Our learning curve, I think, is quite steep. And we've really taken advantage of that and applied that to all of our cases moving forward. 

Sebastian De Boodt 33:07 

You’re also very much involved. You know, this entire shift that's now been happening on things moving to the Point-of-care , and, you know, where today more and more hospitals are doing 3D printing in house, It's never easy, but simpler cases in the hospital. Do you know, what's your explanation for this shift? Like it used to be a bit the ownership of companies to do those kinds of things. And that's like, rapidly shifting to things happening in hospitals. What causes that? 

Alyssa Glennon  33:47 

The more obvious one is probably time savings, right? When you have a printer on site, if it's the floor below you, or down the street, or down the hall, you have this advantage of being able to print, take it off the machine, clean it up and use it right away. There's no shipping, there's no packaging—there's none of that. So, you're taking out some of the steps of when you order it from a manufacturer like us. The other benefit is, you're less limited by what you can do. This case that we talked about the hand and face transplant, right, there were some features that were unique for this case. And we had to work extensively with the surgeons, back and forth. It took months. We had many, many meetings, discussing it, and including all of the rehearsals that we did, when you can do all that live, on the spot, and can prototype, and iterate, I think there are advantages. You're not limited, by say, what the Materialise processes are. So, if you wanted to do a case type that maybe Materialise doesn't support, you would have those tools available for you at the point-of-care that you could use, that you have no constraints—not in the same way anyway that Materialise might have. I think the time savings is a big one. The accessibility and the advantage of fewer restrictions in some ways.

Pieter Slagmolen 35:10 

Maybe say, that and the fact that it's, you know, in within the walls of the hospital. Do you see this, that this caused an acceleration in the adoption of technology itself? Because the end user and the engineer are basically just an office away from each other? Is that what's happening at all? 

Alyssa Glennon  35:29 

Yeah, I think we have seen an acceleration. And I think part of that also goes back to what we talked about before is this awareness. You know, when you're a surgeon, and you walk down the hall, and you can see a shelf of these pretty 3D-printed parts of all these various anatomies you might say, “Hey, that looks interesting,” and pop in and, and ask about it and say, “Oh, I might try this.” And when it's seems so easy to try, because the person right down the hall has the printer and can do it for you. There's much less barrier to entry, right? Otherwise, they'd have to maybe search online to find Materialise, give us a call, you know...there's more steps involved. For busy physicians, that could be a hurdle as well. But when it's right there, in front of you, I think, sure, you know, trying out new technology is always fun, right? This gives them an opportunity to try it and see if it works for them and adds value. And ultimately, I think it does. And so yeah, we see this acceleration, this expansion.  

Sebastian De Boodt 36:24 

In a way point-of-care is also contributing to the availability of personalized solutions just because of it's there. It's top of mind (and) basically brings people into these labs, where there is a collaboration aspect. I think it's a great element that it can realize (or) see where we're heading for the coming years. Like one of the things that we have talked about in a previous session was the fact that personalized care is expensive, or at least costly compared to the standard implants. And some of those costs can be brought back to clinical engineering work. I think it just to, you know, put it out there. Like, and obviously, what you did, I think that’s the story. If we started on the face transplant to show how invaluable the work is that you are, at the same time ever, you know, tried to automate as much as possible, like, is, is the job of a clinical engineer at risk? Is there you know, clinical engineer today in 10 years, you know, will he really have to retire? How do you look at that? 

Alyssa Glennon  37:34 

I think there's always going to be a need for high levels of expertise for these types of cases. And maybe it comes to a point where it's only for double hand and face transplant type of cases. A lot of the rest can be automated. I think there's always going to be a need for unique engineering perspective. On certain cases, there is a chance that the clinical engineer will move more to the point-of-care, and there'll be fewer options available from a service or manufacturing standard standpoint. But I don't think every hospital in the world is going to have 3D printing labs—I don't think that's really sustainable. I think you'll have major institutions that have them, sort of these regional centers, right, where a lot of patients who have complicated cases will be referred. And then you'll have smaller institutions that are capable of doing just that case; they just need the support from the technology. And they'll be able to outsource to services like Materialise offers. I don't think clinical engineering is going away. I think, if anything, it will grow, at least at first. And as automation comes out, and a sort of streamlines some of these processes, I think maybe some of the labor involved in some of the more upfront steps to these processes could move from the clinical engineer—but that just opens engineers up for other opportunities later on in the process. So, looking at things like patient-matched implants or patient-specific implants, finding ways to streamline the surgery, adding, maybe not patient-specific guides or implants, but maybe there are other tools that you know, like the identification tags that are not specific to this one individual patient, but is (still) a huge advantage to the surgical team. There are lots of other optimizations that I'm sure can be made in the medical space where an engineer can be invaluable. Maybe there are some shifts over time, but I don't see that going away. 

Pieter Slagmolen 39:36 

Totally agree. I mean, if you look at where technology enthusiasts, like me and Sebastian here where we're typically we get what's next. And there as well. Yeah, you talked about automation as something that will add, it will somehow change the role probably of a clinical engineer. If you look at some of the upcoming technologies that have been talked about a lot in this space, AI, things like AR, and so on and so forth. What do you think will be most impactful in the coming years? What do you think will have the biggest, or will drive, the biggest change in the end for the healthcare systems for if you have like, if you want that? 

Alyssa Glennon  40:16 

I think today, the way it looks, it's going to be AI that makes the biggest difference. I think there the efficiency gains that are made possible by, by using AI algorithms are far and away. The low hanging fruit, I think, there are technologies like AR VR, that are interesting, and might prove to be very useful for more specific use cases. But from a broad standpoint, I see increasing efficiency through AI as (having) the biggest benefits.

Pieter Slagmolen 40:51 

Yeah, totally agree, I think there's a lot of a lot to be gained. There are still things that can be automated through AI, and also made smarter.

Alyssa Glennon  41:00 

You know, the other thing that that AI enables is the accessibility, right? So right now, there aren't a ton of people who—a ton of engineers, maybe—who are intimately familiar with imaging. For example, I was just on a call, actually, earlier this week, where an institution was talking about the challenges they have with hiring personnel at the point-of-care , because a lot of the engineers who come are very tech savvy, but maybe have never looked at a medical image before. So training them to read images is complicated. And I think, you know, having this AI right now, a lot of the focus is on the first steps of segmentation and kind of translating these medical images into—something that an engineer is maybe more familiar with—into a CAD part, for example, right? Having AI take part of that step, I think is going to also help increase accessibility for this for these Point-of-care institutions. It all, you know, it all kind of flows together. But our ultimate goal is to make this as available to as many people in cases as possible. And I think the AI is really going to be a big focus for that.  

So it was an absolute pleasure having you here today, talking to us about face transplants. Your experience (and) expertise as a clinical engineer is really insightful, hopefully also to our audience, on mass personalization. So, thanks a lot for being here. 

Alyssa Glennon  43:48 

My pleasure. Definitely. 

43:50 

Thanks a lot. And that concludes our episode of today. 

43:53 

Yeah, sure. Make sure to subscribe to our channel. Follow the next episodes of the podcast and happy to continue to conversations, guys. 

44:01 

All right. Stay tuned.