ACR Bulletin

Covering topics relevant to the practice of radiology

Seeing in 3D

The ACR is collecting anonymized 3D printing case information to advance radiologists’ value in specialty procedures.
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By comparing a local profile of clinical indications with those of the broader community, participants will gain insight into the range of indications used by their peers.

October 28, 2021

 Our primary purpose is the same as it is for all the registries that the ACR supports — to ensure the highest quality care for patients,” says Kenneth C. Wang, MD, PhD, staff radiologist at the Baltimore VA Medical Center and adjunct assistant professor at the University of Maryland. “The 3D Printing (3DP) Registry will allow users to compare local practices in 3DP with those of the broader community.”

The joint ACR and RSNA 3DP Registry was established for the coordinated tracking of clinical 3DP performed at the point of care. The registry collects anonymized 3DP case information with the goals of improving patient care and characterizing how resources are being used. The Bulletin recently spoke with Wang, who serves as co-chair of the registry, about how the 3DP Registry can track clinical outcomes, facilitate quality improvement, and give radiologists a seat at the table for 3DP reimbursement.

What can participants expect from the 3DP Registry?

The 3DP Registry is a relatively new part of the ACR’s National Radiology Data Registry® (NRDR) platform. We started accepting cases a little over a year ago. The registry houses data on 3DP performed at the point of care (that is, 3DP performed in hospitals, clinics, and practices, as opposed to 3DP performed by vendors and sold as a service to medical providers). This data will allow us to develop benchmarks for clinical indications, 3DP technologies, resource usage, and clinical outcomes. I would also note that a variety of resources are available to assist users with data collection and reporting.

How are cases collected for the 3DP Registry?

We had a goal about a year ago to collect 1,000 cases during an initial phase-in of the registry. We have already exceeded that mark and are looking to grow well beyond it. The more data we collect, the more meaningful it will be. We define a case as a specific clinical situation in which a 3DP object is created. Examples include models of the heart for surgical planning, models of the aorta for endovascular device selection and sizing, and surgical guides for craniomaxillofacial reconstruction. Data is then submitted to the registry using a case report form on the NRDR portal.

What do you hope to accomplish with the 3DP Registry?

The 3DP Registry will allow users to compare their own practices and workflows in clinical 3DP with the rest of the 3DP community. One fundamental aspect of the practice of 3DP relates to the clinical indications for using this technology. By comparing a local profile of clinical indications with those of the broader community, participants will gain insight into the range of indications used by their peers. This will allow institutions to consider ways to expand their own local practice of 3DP, and to do so in a quantitative way. That is, if registry data shows that urinary tract applications constitute an important class of clinical indications for 3DP, this will signal an opportunity for sites not currently engaged in making such models. Another important aspect of 3DP is the printing technologies and material types used, and the physical properties of the printed objects. Registry data will help to elucidate how facilities are choosing to create specific types of models in a range of clinical situations.

How does 3DP fit within radiology?

The creation of patient-specific 3DP models typically begins with imaging. Furthermore, the use of imaging to discern patients’ anatomy and disease is the fundamental expertise of radiologists. Consequently, radiology is a natural home for this type of work.

What does the future hold for 3DP, radiology, and reimbursement?

There are two things radiology practices need to know about the 3DP Registry: It will help them with quality improvement around 3DP and will support their argument for reimbursement. There are currently four Category III reimbursement codes for 3DP. Category III codes are temporary codes typically assigned for emerging technologies or procedures and are used for collecting data. Our goal is to collect enough data and literature to eventually support the creation of Category I codes that receive reimbursement from third-party payers, including CMS. The registry is a key component in collecting the necessary data for this effort. Our community is making progress — from having no CPT® codes, to establishing Category III codes, and working towards receiving formal reimbursement for 3DP services. The ACR is now working with the 3DP Registry Committee to do just that. We are also working with members of the ACR Commission on Economics and others who are familiar with the pathway to reimbursement.

What types of radiology groups may benefit from the 3DP Registry?

We wanted to make sure this registry is inclusive across the spectrum of all types of practice. Some of the institutions that are participating so far are academic institutions, but we are just as open and interested in private and rural practices — really anyone who is engaged in 3DP. Similarly, the benefits of registry participation, namely in the areas of quality improvement and reimbursement, will be equally relevant for practices of all types. The more I work on this project, the more I appreciate how much effort goes into the ACR’s registries and how valuable they are to our members. There is a  step-by-step start-up guide for anyone interested in joining the 3DP Registry. It is written to help potential users get underway with submitting data to the registry and learn how to get the most value out of registry participation.

Author Interview by Chad Hudnall,  Senior Writer, ACR Press