Creating optimal orthotics and prosthetics with Artec Eva and Spider

An orthotics and prosthetics specialist needed to find the best 3D scanning solution for making precision O&P products faster while reducing overall production costs.

The global orthotics and prosthetics (O&P) market was estimated at $8.15 billion in 2017. That number is rising worldwide every year due to an aging population, an increase in sports- and fitness-related injuries, as well as a growing volume of diabetes-related amputations and bone cancer. By the year 2050, the number of people age 60 and over is expected to double, soaring from 962 million in 2017 to 2.1 billion in 2050.

As demand for O&P products climbs, government medical plans and insurance companies have been scrutinizing claims more closely than ever before, not simply paying out as they once did. What this means for O&P specialists is tighter margins and focusing on delivering solutions that are both highly needed and not available over the counter.

One such O&P practice is Hagen Orthotics & Prosthetics of Willmar, Minnesota. The owner, Warren Hagen, a combat veteran and certified Orthotist and Pedorthist, has made it his focus and passion to deliver the very best O&P solutions to his patients. He believes that technology plays a crucial role in this, because what has worked for many years is not always what works best. On a day to day basis, with his close involvement during every facet of his practice, he’s always looking for ways to make their products and service better than they were the day before.

Which brings us to 3D scanning. What would only have been a sci-fi fan’s dream a few years ago has today become a reality. Patients sit down, relax, and have their legs or feet or arms or other body parts scanned with a handheld 3D scanner. This usually takes just 2 to 5 minutes. Then these scans are converted into 3D models destined for either a 3D printer or a specialized router that “carves” orthoses out of EVA foam and other materials. All this is done right there in the office. And the levels of precision, cost savings, and quality of the products have been remarkable.

“With each of the steps from scanner all the way to using the router, the time savings is at least 30%,” said Warren Hagen, “and in the long run, total savings in costs have been well beyond 30%.”

But it wasn’t always this way. They have used various 3D scanners over the years, such as Amfit, yet after careful research, they finally settled on Artec Eva and Spider, two professional color 3D scanners that are well-known for their use in the medical and scientific fields and other industries. Both scanners use 100%-safe structured light, making them perfect for the medical field, for technicians as well as patients. Eva was purchased from Gold Certified reseller Laser Design, and Spider from Certified reseller Rapidscan 3D.

“Each of our Artec scanners provides us with the level of ability to produce incredible models to work with,” said Hagen, “Eva is the best for working with larger body parts, and Space Spider is perfect for cast models and smaller, more detailed projects.”

When it came to designing O&P products in the past, prior to 3D scanning, what that meant was using plaster and fiberglass to make casts for patients. While these technologies are certainly still an option if needed, they are messy and time consuming, with plaster casting taking on average 200% to 500% of the time that it takes to do a precise digital 3D scan (2-5 minutes for a scan, versus 11 minutes for a cast). Cost savings are equally impressive, with an average cast costing more than $50 in materials, not to mention the labor costs associated with its creation. While the cost of a 3D scan is a mere handful of dollars in comparison.

“Many of our patients are elderly, and having to sit still for a cast is not something so comfortable for them,” said Hagen, “and that’s where Eva and Space Spider really shine…having to sit still for just a couple of minutes makes a big difference in their comfort level.”

And in recent years, the increase in patient satisfaction has climbed from “satisfied” to “devoted.” Hagen explained, “Our patients quickly see that this is simply not something they can buy over the counter…it’s a custom product designed exactly for them, created to perfectly match their anatomy and their lifestyle, and it’s going to last them a long time. Mobility is so important, especially when we get older. And we’re giving that back to them, with real comfort. They’re telling their friends and family about this.”

What the current work process looks like is as follows: the patient comes in and is evaluated, which involves a physical exam, verbal, patient history, and so on; then the patient’s arm or leg or other body part is scanned with either Eva or Space Spider, where the scans are done directly in Artec Studio, which is where the scans are stitched together and processed into a 3D model, and in the case of a foot scan, this model is sent as an STL file to Fitfoot360 (a custom orthotics design program), or to Meshmixer for other body parts (leg, arm, etc.), and following either one of those, the 3D model is sent on to Aspire software to prepare the 3D model for carving, then on to the Freedom router for carving.

The final 3D model can also be sent to Simplify, for 3D printing. In the case of an orthosis, after carving, the top cover is glued on, and the ready product is taken to the patient for fitting. In terms of 3D printing, the practice is also regularly designing and creating braces for legs, wrists, feet, and hands.

“The level of precision we’re talking about is unbeatable, and the fact that we can deliver it every time, without question, is something we just can’t ignore,” said Hagen, “And scanning with Eva and Space Spider is as easy as 1-2-3, where you see the scan right there on the screen in Artec Studio, so you know exactly that your scan is capturing all the data, because you see it happening in real time.”

They also have been using Eva and Space Spider for a process they have named, “Shell Offset.” What that entails is scanning the specific body part, such as an arm or leg, and then sending the 3D model over to a program such as Meshmixer. For example, if a patient has broken her right arm, then her left arm is scanned with Eva (Space Spider is used for smaller body parts), because the left arm is the straight limb. In the software, this limb is then “mirrored” to now look like the patient’s right arm. This creates the desired level of symmetry with both left and right arms.

From there, the 3D model of the new arm is modified to remove any defects or to add build up of the arm in boney areas or near joints. This is to add comfort spots to the brace after it is printed. From this point, the “shell” is created by making a digital copy of the arm and increasing the offset in size to whatever desired thickness is called for. The size of the 3D digital limb is enlarged in x, y, and z coordinates. Then both the modified limb and the Shell cover are selected in the software, to make the hollowed shell/brace cover by using the Boolean Difference edit command in Meshmixer.

“This is how we create a perfect shell, cover, casing, etc,” said Hagen, “We also do a few things like building up key areas of the brace to reinforce against breakage, and we also use the software to cut and trim areas around the brace so that the patient can more easily remove the brace. Then we send the brace over to our 3D printer.”

“Our braces are designed to last many months if not years, depending on patient use, design of the brace, and materials used.” Hagen Orthotics and Prosthetics uses the highest quality of such materials as EVA, MDF, as well as various plastics such as PETG, PLA, Copolymer, polypropylene, and PCTPE. “Obviously a grandmother and a 320-pound linebacker are going to need different kinds of braces, and we’re happy to say that we can give them, or anyone, exactly what they need, each and every time.”

3D-printed AFO (ankle-foot orthosis) by Warren Hagen and Artec Spider