3D printing of musculoskeletal tissues: impact on safety and health at work

Integrating Exposure Assessment and Process Hazard Analysis: The Nano-Enabled 3D Printing Filament Extrusion Case

Nanoparticles are being used in novel applications of the thermoplastics industry, including automotive parts, the sports industry and leisure and consumer goods, which can be produced nowadays through additive manufacturing. However, there is limited information on the health and safety aspects during the production of these new materials, mainly from recycled sources. This study covers the exposure assessment to nano- and micro-size particles emitted from the nanocomposites during the production of filaments for 3D printing through a compounding and extrusion pilot line using recycled (post-industrial) thermoplastic polyurethane (TPU) and recycled polyamide 12 (PA12), which have been also upcycled through reinforcement with iron oxide nanoparticles (Fe₃O₄ NPs), introducing matrix healing properties triggered by induction heating. The assessment protocol included near- and far-field measurements, considering the extruder as the primary emission source, and portable measuring devices for evaluating particulate emissions reaching the inhalable zone of the lab workers. A Failure Modes and Effects Analysis (FMEA) study for the extrusion process line was defined along with a Failure Tree Analysis (FTA) process in which the process deviations, their sources and the relations between them were documented. FTA allowed the identification of events that should take place in parallel (simultaneously) or in series for the failure modes to take place and the respective corrective actions to be proposed (additional to the existing control measures).

Identification of effective control technologies for additive manufacturing

Additive manufacturing (AM) refers to several types of processes that join materials to build objects, often layer-by-layer, from a computer-aided design file. Many AM processes release potentially hazardous particles and gases during printing and associated tasks. There is limited understanding of the efficacy of controls including elimination, substitution, administrative, and personal protective technologies to reduce or remove emissions, which is an impediment to implementation of risk mitigation strategies. The Medline, Embase, Environmental Science Collection, CINAHL, Scopus, and Web of Science databases and other resources were used to identify 42 articles that met the inclusion criteria for this review. Key findings were as follows: 1) engineering controls for material extrusion-type fused filament fabrication (FFF) 3-D printers and material jetting printers that included local exhaust ventilation generally exhibited higher efficacy to decrease particle and gas levels compared with isolation alone, and 2) engineering controls for particle emissions from FFF 3-D printers displayed higher efficacy for ultrafine particles compared with fine particles and in test chambers compared with real-world settings. Critical knowledge gaps identified included a need for data: 1) on efficacy of controls for all AM process types, 2) better understanding approaches to control particles over a range of sizes and gas-phase emissions, 3) obtained using a standardized collection approach to facilitate inter-comparison of study results, 4) approaches that go beyond the inhalation exposure pathway to include controls to minimize dermal exposures, and 5) to evaluate not just the engineering tier, but also the prevention-through-design and other tiers of the hierarchy of controls.

Organic compound and particle emissions of additive manufacturing with photopolymer resins and chemical outgassing of manufactured resin products

Photopolymer resins are applied at an increasing rate in additive manufacturing (AM) industry as vat photopolymerization (VP) and material jetting (MJ) methods gain more popularity. The aim of this study was to measure volatile organic compound (VOC), carbonyl compound, ultrafine particle (UFP), and particulate matter (PM₁₀) air concentrations emitted in 3D printer operations. Individual chemicals were identified when multiple photopolymer resin feedstocks were used in various VP and MJ printers. The size distributions of UFPs, and indoor air parameters were also monitored. Finally, the VOC outgassing of the cured resin materials was determined over 84 days. The data demonstrated that 3D printer operators were exposed to low concentrations of airborne exposure agents as follows: average concentrations of VOCs were between 41 and 87 µg/m³, UFP number levels ranged between 0.19 and 3.62 × 10³ number/cm³; however, no impact was detected on air parameters or PM₁₀ concentrations. A majority of the UFPs existed in the 10-45 nm size range. The identified compounds included hazardous species included sensitizing acrylates and carcinogenic formaldehyde. The outgassed products included similar compounds that were encountered during the AM processes, and post-processing solvents. Products heated to 37°C emitted 1.4‒2.9-fold more VOCs than at room temperature. Total emissions were reduced by 84‒96% after 28 days roughly from 3000-14000 to 100-1000 µg/m²/hr. In conclusion, resin printer operators are exposed to low concentrations of hazardous emissions, which might result in adverse health outcomes during prolonged exposure. Manufactured resin products are suggested to be stored for 4 weeks after their production to reduce potential consumer VOC hazards.

State of the art in additive manufacturing and its possible chemical and particle hazards-review

Additive manufacturing, enabling rapid prototyping and so-called on-demand production, has become a common method of creating parts or whole devices. On a 3D printer, real objects are produced layer by layer, thus creating extraordinary possibilities as to the number of applications for this type of devices. The opportunities offered by this technique seem to be pushing new boundaries when it comes to both the use of 3D printing in practice and new materials from which the 3D objects can be printed. However, the question arises whether, at the same time, this solution is safe enough to be used without limitations, wherever and by everyone. According to the scientific reports, three-dimensional printing can pose a threat to the user, not only in terms of physical or mechanical hazards, but also through the potential emissions of chemical substances and fine particles. Thus, the presented publication collects information on the additive manufacturing, different techniques, and ways of printing with application of diverse raw materials. It presents an overview of the last 5 years' publications focusing on 3D printing, especially regarding the potential chemical and particle emission resulting from the use of such printers in both the working environment and private spaces.

New and Emerging Hazards for Health and Safety within Digitalized Manufacturing Systems

The Fourth Industrial Revolution is radically reshaping the procedures and the manufacturing environments through the digitalization process. The digitalization process can change according to the context and to specific solutions, and it is able to modify manufacturing systems and production areas. All the employees are directly affected by the transformation of the working environment, manufacturing tools, and working conditions and by the increasing need for new competencies. In this context, it is crucial to identify new and emerging hazards concerning the health and safety of the employees to ensure a conscious and safe digital transformation for everyone involved. In this regard, the paper presents the state of the research and defines seven areas of interest for a safe and harmless digital transformation for the employees, drawing attention to the hazards in the different technological areas. The state of the research unveils the absence of detailed analysis to identify specific hazards of 4.0 technologies. Therefore, every specific 4.0 technologies is analyzed by an extensive review to provide a comprehensive matrix of new and emerging hazards for health and safety within digitalized manufacturing systems. The results can help manufacturing organizations to perform robust risk assessments for worker when introducing specific 4.0 technologies.

Toxicity risks of occupational exposure in 3D printing and bioprinting industries: A systematic review

3-Dimensional (3D) printing and bioprinting are the new technologies. In 3D printing, synthetic polymers such as acrylonitrile, butadiene, and styrene, polylactic acid, nylon, and some metals are used as feedstocks. During 3D printing, volatile organic compounds (VOCs) and nanoparticles can be released. In the bioprinting process, natural polymers are most commonly used. All of these materials have direct and indirect toxic effects in exposed people. Therefore, the aim of this study was to provide a comprehensive review of toxicity risks due to occupational exposure to pollutants in the 3D printing and bioprinting industries. The Cochrane review method was used as a guideline for systematic review. Articles were searched in the databases including PubMed, Scopus, Web of Science, and Google Scholar. This systematic review showed that VOCs and ultra-fine particles are often released in fused deposition modeling and selective laser sintering, respectively. Asthma, chronic obstructive pulmonary disease, allergic rhinitis, and DNA damage were observed in occupational exposure to synthetic polymers. Metal nanoparticles can induce adverse health effects on the respiratory and nervous systems. This study emphasized the need to further study the toxicity of 3D printing and bioprinting-induced air pollutants. Also, consideration of safety and health principles is necessary in 3D printing and bioprinting workplaces.

Establishing Quality and Safety in Hospital-based 3D Printing Programs: Patient-first Approach

The adoption of three-dimensional (3D) printing is rapidly spreading across hospitals, and the complexity of 3D-printed models and devices is growing. While exciting, the rapid growth and increasing complexity also put patients at increased risk for potential errors and decreased quality of the final product. More than ever, a strong quality management system (QMS) must be in place to identify potential errors, mitigate those errors, and continually enhance the quality of the product that is delivered to patients. The continuous repetition of the traditional processes of care, without insight into the positive or negative impact, is ultimately detrimental to the delivery of patient care. Repetitive tasks within a process can be measured, refined, and improved and translate into high levels of quality, and the same is true within the 3D printing process. The authors share their own experiences and growing pains in building a QMS into their 3D printing processes. They highlight errors encountered along the way, how they were addressed, and how they have strived to improve consistency, facilitate communication, and replicate successes. They also describe the vital intersection of health care providers, regulatory groups, and traditional manufacturers, who contribute essential elements to a common goal of providing quality and safety to patients. ©RSNA, 2021.

Cartilage Tissue Engineering by Extrusion Bioprinting: Process Analysis, Risk Evaluation, and Mitigation Strategies

Extrusion bioprinting is considered promising in cartilage tissue engineering since it allows the fabrication of complex, customized, and living constructs potentially suitable for clinical applications. However, clinical translation is often complicated by the variability and unknown/unsolved issues related to this technology. The aim of this study was to perform a risk analysis on a research process, consisting in the bioprinting of a stem cell-laden collagen bioink to fabricate constructs with cartilage-like properties. The method utilized was the Failure Mode and Effect Analysis/Failure Mode and Effect Criticality Analysis (FMEA/FMECA) which foresees a mapping of the process to proactively identify related risks and the mitigation actions. This proactive risk analysis allowed the identification of forty-seven possible failure modes, deriving from seventy-one potential causes. Twenty-four failure modes displayed a high-risk level according to the selected evaluation criteria and threshold (RPN > 100). The results highlighted that the main process risks are a relatively low fidelity of the fabricated structures, unsuitable parameters/material properties, the death of encapsulated cells due to the shear stress generated along the nozzle by mechanical extrusion, and possible biological contamination phenomena. The main mitigation actions involved personnel training and the implementation of dedicated procedures, system calibration, printing conditions check, and, most importantly, a thorough knowledge of selected biomaterial and cell properties that could be built either through the provided data/scientific literature or their preliminary assessment through dedicated experimental optimization phase. To conclude, highlighting issues in the early research phase and putting in place all the required actions to mitigate risks will make easier to develop a standardized process to be quickly translated to clinical use.

Additive Manufacturing for Occupational Hygiene: A Comprehensive Review of Processes, Emissions, & Exposures

This comprehensive review introduces occupational (industrial) hygienists and toxicologists to the seven basic additive manufacturing (AM) process categories. Forty-six articles were identified that reported real-world measurements for all AM processes, except sheet lamination. Particles released from powder bed fusion (PBF), material jetting (MJ), material extrusion (ME), and directed energy deposition (DED) processes exhibited nanoscale to submicron scale; real-time particle number (mobility sizers, condensation nuclei counters, miniDiSC, electrical diffusion batteries) and surface area monitors (diffusion chargers) were generally sufficient for these processes. Binder jetting (BJ) machines released particles up to 8.5 µm; optical particle sizers (number) and laser scattering photometers (mass) were sufficient for this process. PBF and DED processes (powdered metallic feedstocks) released particles that contained respiratory irritants (chromium, molybdenum), central nervous system toxicants (manganese), and carcinogens (nickel). All process categories, except those that use metallic feedstocks, released organic gases, including (but not limited to), respiratory irritants (toluene, xylenes), asthmagens (methyl methacrylate, styrene), and carcinogens (benzene, formaldehyde, acetaldehyde). Real-time photoionization detectors for total volatile organics provided useful information for processes that utilize polymer feedstock materials. More research is needed to understand 1) facility-, machine-, and feedstock-related factors that influence emissions and exposures, 2) dermal exposure and biological burden, and 3) task-based exposures. Harmonized emissions monitoring and exposure assessment approaches are needed to facilitate inter-comparison of study results. Improved understanding of AM process emissions and exposures is needed for hygienists to ensure appropriate health and safety conditions for workers and for toxicologists to design experimental protocols that accurately mimic real-world exposure conditions.ABBREVIATIONS ABS : acrylonitrile butadiene styrene; ACGIH® TLV® : American Conference of Governmental Industrial Hygienists Threshold Limit Value; ACH : air change per hour; AM : additive manufacturing; ASA : acrylonitrile styrene acrylate; AVP : acetone vapor polishing; BJ : binder jetting; CAM-LEM : computer-aided manufacturing of laminated engineering materials; CNF : carbon nanofiber; CNT : carbon nanotube; CP : co-polyester; CNC : condensation nuclei counter; CVP : chloroform vapor polishing; DED : directed energy deposition; DLP : digital light processing; EBM : electron beam melting; EELS : electron energy loss spectrometry; EDB : electrical diffusion batteries; EDX : energy dispersive x-ray analyzer; ER : emission rate; FDM™ : fused deposition modeling; FFF : fused filament fabrication; IAQ : indoor air quality; LSP : laser scattering photometer; LCD : liquid crystal display; LDSA : lung deposited particle surface area; LOD : limit of detection; LOM : laminated object manufacturing; LOQ : limit of quantitation; MCE : mixed cellulose ester filter; ME : material extrusion; MJ : material jetting; OEL : occupational exposure limit; OPS : optical particle sizer; PBF : powder bed fusion; PBZ : personal breathing zone; PC : polycarbonate; PEEK : poly ether ether ketone; PET : polyethylene terephthalate; PETG : Polyethylene terephthalate glycol; PID : photoionization detector; PLA : polylactic acid; PM1 : particulate matter with aerodynamic diameter less than 1 µm; PM2.5 : particulate matter with aerodynamic diameter less than 2.5 µm; PM10 : particulate matter with aerodynamic diameter less than 10 µm; PSL : plastic sheet lamination; PVA : polyvinyl alcohol; REL : recommended exposure limit; SDL : selective deposition lamination; SDS : safety data sheet; SEM : scanning electron microscopy; SL : sheet lamination; SLA : stereolithography; SLM : selective laser melting; SMPS : scanning mobility particle sizer; SVOC : semi-volatile organic compound; TEM : transmission electron microscopy; TGA : thermal gravimetric analysis; TPU : thermo polyurethane; UAM : ultrasonic additive manufacturing; UC : ultrasonic consolidation; TVOC : total volatile organic compounds; TWA : time-weighted average; VOC : volatile organic compound; VP : vat photopolymerization.

Prevention through design: insights from computational fluid dynamics modeling to predict exposure to ultrafine particles from 3D printing

Fused filament fabrication (FFF) 3D printers are increasingly used in industrial, academic, military, and residential sectors, yet their emissions and associated user exposure scenarios are not fully described. Characterization of potential user exposure and environmental releases requires robust investigation. During operation, common FFF 3D printers emit varying amounts of ultrafine particles (UFPs) depending upon feedstock material and operation procedures. Volatile organic compounds associated with these emissions exhibit distinct odors; however, the UFP portion is largely imperceptible by humans. This investigation presents straightforward computational modeling as well as experimental validation to provide actionable insights for the proactive design of lower exposure spaces where 3D printers may be used. Specifically, data suggest that forced clean airflows may create lower exposure spaces, and that computational modeling might be employed to predict these spaces with reasonable accuracy to assist with room design. The configuration and positioning of room air ventilation diffusers may be a key factor in identifying lower exposure spaces. A workflow of measuring emissions during a printing process in an ANSI/CAN/UL 2904 environmental chamber was used to provide data for computational fluid dynamics (CFD) modeling of a 6 m2 room. Measurements of the particle concentrations in a Class 1000 clean room of identical geometry were found to pass the Hanna test for agreement between model and experimental data, validating the findings.

Polymeric drug delivery systems by additive manufacturing

Additive manufacturing (AM) is gaining interests in drug delivery applications, offering innovative opportunities for the design and development of systems with complex geometry and programmed controlled release profile. In addition, polymer-based drug delivery systems can improve drug safety, efficacy, patient compliance, and are the key materials in AM. Therefore, combining AM and polymers can be beneficial to overcome the existing limitations in the development of controlled release drug delivery systems. Considering these advantages, here we are focusing on the recent developments in the field of polymeric drug delivery systems prepared by AM. This review provides a comprehensive overview on a holistic polymer-AM perspective for drug delivery systems with discussion on the materials, properties, design and fabrication techniques and the mechanisms used to achieve a controlled release system. The current challenges and future perspectives for personalized medicine and clinical use of these systems are also briefly discussed.

Digital readiness in 3D bioprinting: software, governance and hospitals' proto-clinical interfaces

Aim: To understand the process through which some hospitals have become ready to assimilate the digital technologies required for 3D bioprinting. By enhancing their digital readiness, hospitals will be able to develop the current proto-clinical potentialities of bioprinting. Materials & methods: We conducted interviews with bioprinting researchers, entrepreneurs and regulators in three countries (United Kingdom, Italy and Brazil). We analyzed bioprinting papers in which hospital-based researchers participated. We also analyzed the international bioprinting market. Result s: Digital readiness is more advanced in some hospitals and countries, which have noticed the strategic relevance of bioprinting. Furthermore, it is strengthened by the reformulation of the relations between hospitals and other institutions, a phenomenon that is here interpreted with the concept of interfaces.

Patient Counseling Through the Pelvicalyceal-shaped Labyrinth: In Search of an Easy Understanding of the Upcoming Stone Removal: A Pilot Study

OBJECTIVE

To investigate the impact of a mobile application (app) displaying a visualization of the internal anatomy of the pelvicalyceal systemPCS and of kidney stones on patient understanding of their affected kidney anatomy and their upcoming percutaneous nephrolithotripsy (PCNL).

MATERIALS AND METHODS

One-hundred patients who required PCNL were included in this study, and all patients were nonrandomly distributed into 2 groups: counseled using only 3D-reconstructed computed tomography (CT) images (group 1) or using only the "InsKid" app (group 2). Patient data were obtained from CT scans as Digital Imaging and Communications in Medicine format and converted into stereolithography (STL) format. All patients completed the questionnaire after counseling, and the results were compared between groups.

RESULTS

Patients from group 2 better understood the anatomy of their affected kidney by 53%; awareness regarding their stone location was better by 32%; the steps of planned surgery, as well as possible complications, were more transparent for patients using the app by 24% and 56%, respectively. The number of patients who were dissatisfied with the mobile counseling dropped by 70%. The average duration of consultation with the 3D reconstruction of CT images was 10.9 ± 0.6 min, while counseling using our program reliably led to a reduction in this duration (7.3 ± 0.5 min).

CONCLUSION

The InsKid app is a freely available, easy-to-use educational software that improves patient counseling without considerable financial expense or long waiting periods for use.

Emissions and health risks from the use of 3D printers in an occupational setting

The aim of this study was to determine concentrations of particulates and volatile organic compounds (VOCs) emitted from 3D printers using polylactic acid (PLA) filaments at a university workroom to assess exposure and health risks in an occupational setting. Under typical-case (one printer) and worst-case (three printers operating simultaneously) scenarios, particulate concentration (total and respirable), VOCs and formaldehyde were measured. Air samples were collected in the printing room and adjacent hallway. Size-resolved levels of nano-diameter particles were also collected in the printing room. Total particulate levels were higher in the worst-case scenario (0.7 mg/m³) vs. typical-case scenario (0.3 mg/m³). Respirable particulate and formaldehyde concentrations were similar between the two scenarios. Size-resolved measurements showed that most particles ranged from approximately 27 to 116 nm. Total VOC levels were approximately 6-fold higher during the worst-case scenario vs. typical situation with isopropyl alcohol being the predominant VOC. Airborne concentrations in the hallway were generally lower than inside the printing room. All measurements were below their respective occupational exposure limits. In summary, emissions of particulates and VOCs increased when multiple 3D printers were operating simultaneously. Airborne levels in the adjacent hallway were similar between the two scenarios. Overall, data suggest a low risk of significant and persistent adverse health effects. Nevertheless, the health effects attributed to 3D printing are not fully known and adherence to good hygiene principles is recommended during use of this technology.