O-Lab interns bring facial prosthetics into the future

The team developed a method of scanning a patient’s unaffected ear, flipping it digitally, and creating a 3D print to form the basis of a hand-finished prosthesis. The innovation will save prosthetists “hours and hours” of labour, according to the RMH facial prosthetist Jeff Magallanes, and will produce more realistic results for patients.

It is a huge improvement on the current process, which involves adapting an existing wax model from the hospital’s stores and taking an impression of the patient’s unaffected ear to use as a reference, before sculpting it by hand.

Because the digital scanning intervention is contact-free, it makes the process non-invasive, as well as being more detailed than current methods.

“It allows us to get things like the sizing more accurate, and those little details. It’s using the patient’s own ear, so that’s increasing patient satisfaction just knowing that,” explained the RMH facial prosthetist Jessica Willason.

Manager of the RMH prosthetic department and project sponsor, Mark Graf, agreed.

“It’s impossible to overestimate the impact of this project on patient experience,” he said.

“Facial prostheses are very personal items and the ability to scan and flip a feature from patient’s unaffected side to replace a missing feature on the affected side means that they get their ‘own’ ear/eye/ nose back.”

To develop the innovation, the team – consisting of interns Aaron Khoo, Caitlin Dowling and Naeim Akbari Shahkhosravi – mapped the existing process to identify the most impactful intervention point.

“We thought ok, what part of this is the most demanding? What is taking up the most time and effort? And if we implemented a 3D technology here, would it help, without cutting into the artistry of the process?” Aaron said.

They found that the creation of a base prosthetic ear would expedite the existing workflow. Prosthetists could then create a mould from the printed ear and use that mould to cast the final ear. This allows them to control the material and surface finish of the final ear, and also to add additional features and colours.

It was important that the team respected the human element of prosthetic work, supporting the process through technology, rather than entirely replacing it.

“Based on our understanding, we found that some parts of the process could be innovated with technology, and some parts still needed the technician’s expertise.

So, we considered these two facts and considered where the technology could be used,” Naeim explained.

Jeff and Jessica believe the key to the project’s success is the integration of the hand-made and the digital.

“There’s always that need for human interaction and enhancement,” Jessica said.

“But what this technology is doing is assisting, enhancing and making our work easier.”

The team worked closely with Jeff to understand how the innovation could be implemented, developing an education package for technicians new to 3D technology.

“By focusing on what the prosthetists most wanted and needed, we designed an intervention that fit into their existing workflow and could therefore be easily taken on board in the future. We also prioritised the user experience in developing our training materials, reducing barriers to implementation,” Caitlin explained.

The RMH is the only public hospital in Victoria offering facial prosthetics. Many patients come from regional areas, as well as interstate. Because the new technology allows the prosthesis to be produced much more quickly, patients may be able to avoid multiple trips or over-night stays in Melbourne.

Mark believes the digital integration will be transformative.

“This project will bring about a substantial change in the way facial prostheses are provided at the RMH,” he said.

“Records of 3D models can be kept digitally and labour hours per prosthesis reduced, without compromise in the quality of service provided. Importantly, incorporation of digital technology makes the fabrication more teachable to new staff.”

As well as the benefits to the hospital, the sponsor valued their experience working with the team.

“It was so easy to work with the O-Lab team,” Mark said.

“They listened to our needs, worked with us to understand our processes and delivered exactly what we were wanting to achieve with the added value of an education package to support continuity. I will definitely be recommending the O-Lab team to colleagues.”

Find out more about O-Lab and the Ignite program within which it sits.