Tangible Industries
Nicholas Jacobson is no stranger to his current surroundings. Though he’s spent the last few years working as a researcher at the University of Colorado Denver, the clinic room is almost a home away from home.
He’s been in meetings with many a surgeon, and is in the calendar of dozens more, trying to get them to see the light. Today, he’s there for personal reasons, and finally finds a doctor on the same wavelength.
“The doctor is going, ‘You 3D print? I’ve been wanting to talk to one of you guys.’ And he then gives me the spiel that I was giving the people who didn’t want to talk to me,” Jacobson retells the story. “So, it flipped. And now, I’ve got 35 surgeons on speed dial, I know their kid, I know their dog’s name, and they call me up: ‘I’ve got this idea, I’ve got that idea.’ It’s almost overwhelming at this point because they’ve got more ideas than I have time to handle.”
He speaks at RAPID + TCT no longer as a researcher, but now the co-founder of Tangible Industries – a company looking to turn those ideas into reality. Tangible Industries is hoping to pioneer advancements in 3D printed anatomical models, surgical planning tools and patient-specific implants – though the solutions roadmap doesn’t end there – and intends to help make these applications the standard of care.
As previously reported by TCT, Jacobson’s methods use 3D printing technology to print medical images at a level of spatial fidelity and spatial contrast resolution as the source images. He uses ‘a text file and PNGs’ to create slices and natively print voxels rather than using the internal slicer of a 3D printer. Essentially, he speaks to the printer, not the operating system inside the printer.
The end result is the creation of gradients in three dimensions, allowing Jacobson to vary colours and properties point by point in space. It is being manifested, so far, through the additive manufacture of surgical planning tools, such as a model of a heart that can accurately represent blood flow and be segmented in just 15 minutes.
“We’re able to replicate data that can’t be replicated otherwise. You can never do that with the traditional process,” Jacobson explains of the heart model, “because resolution would be too low and the file size would be too big. What we do, I think, is the best use of PolyJet printing. We’re able to make these machines sing. And I don’t want to wax too philosophical but the stuff that we do, from my perspective, is one of the first real advancements in manufacturing since the Industrial Revolution.”
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For regular readers of TCT Magazine – or attendees of the AMUG Conference – Jacobson might be familiar to you. Along with LAIKA Studios’ Robert Ducey, he delivered a keynote presentation in 2023 that provided a glimpse of what his computational design and bitmap printing methods can enable. He isn’t alone today either.
Sat next to him is co-founder Jordan Lewis, an entrepreneur who is a veterinarian by training and has spent the last decade and a half working in a range of businesses in medical and life sciences. He, like the surgeons that Jacobson eventually got on side, was impressed by the work Jacobson carried out while at the University of Colorado Anschutz Medical Campus.
Tangible Industries
That work was proceeded by the offer from Connex of a 3D printing system while Jacobson was at Harvard’s Wyss Institute for Biologically Inspired Engineering. Connex came to Jacobson with an ability to voxel print and a willingness to open up the machine. Jacobson and his colleagues then wrote some software around it, and began to do some structural analysis, with a surgeon noting that the black and white images being used to realise structures looked like an MRI. After a successful collaboration, Jacobson identified an opportunity to leverage the tech he had to develop complex medical structures alongside the architectural job he landed upon graduating.
It quickly became apparent that there was more fulfilment in the medical modelling work – the letters from families, the awards and the grants underlined that – and the University of Colorado Denver had soon given Jacobson a lab to run. For the last seven years, that’s what he’s been doing.
“Over that time, I’ve worked with dozens and dozens of surgeons and well over 50 students that have come through and worked on projects,” Jacobson says. “It’s been really good, but if I stay in academia, these things will die. I think this technology is way too powerful to let go.”
The power of what Jacobson has developed was communicated as part of the RAPID + TCT Conference, where the Tangible Industries co-founder presented the findings of a clinical trial for deep lab reconstructions. Thanks to Tangible’s methods, there was an operating time reduction of over an hour, resulting in a 6,000+ USD cost saving because each minute in the operating room equates to 100 USD. Not only did the hospital save money, but the surgeon also gained an hour to carry out other work. Jacobson also suggested reductions in follow-ups and time under anaesthesia, and improvements in downstream processes.
And that’s not to forget the most important consideration: the care given to the patient. Through Tangible’s methods, it is enabling the 3D printing of medical models in millions of colours. In turn, this will potentially facilitate printed devices that help surgeons tackle the most complex cases.
One example Jacobson gives is a scenario where a patient has clear cell carcinoma on the edge of their kidney – half inside, half outside. A surgeon approaching this procedure is aiming to get all of the tumour out, without bringing too much of the kidney away with it. In fact, they’ll be rated on that margin. With a Tangible Industries enabled anatomical model, Jacobson says, surgeons will be able to reduce those margin rates, while also gaining a better understanding of which vessels are feeding the tumour and where they are located.
He also identifies tractography as another area where Tangible Industries can facilitate improvements.
“This level of detail you could never do with STL because the file size is just too enormous. The resolution is too fine.” Jacobson says. “Once we get tractography, now we enter this whole realm of being able to take out tumours in the language parts of the brain, which are the scariest thing a neurosurgeon has to do. If you damage someone’s ability to speak, it’s shown to be more debilitating, a lower quality of life score, than if somebody’s quadriplegic. When they take out these tumours, they need to understand exactly where that is, where these lines are, where the FMRI information is, so they can avoid that. They’ve got methods for doing that, but they make mistakes all the time. These are better planning tools for more precise and more complicated surgeries. That’s where it starts to become really critical.”
The potential applications of Tangible Industries’ approach doesn’t end there. Jacboson suggests that while 3D printing for medicine has mostly been limited to ‘bony structures and gross anatomical features, and big skulls and dentures,’ volumetric printing will ‘allow us to print the rest of the body.’ He lists the brain, the kidneys, physiological data and tractography as focus areas, while he has already completed work on paediatric epilepsy and gender confirmation surgeries. Going back to the kidney tumour example from earlier, with so much detail in the models, surgeons will be able to clamp off the specific vessels that feed the tumours rather than clamping off the entire kidney.
This is where Tangible Industries expects to make its impact in the near term.
“The technology speaks for itself,” Lewis says. “There’s not a big gap between seeing and believing. So, I think that gives us an advantage and our challenge is really to get this out there and get this into the hands of surgeons, clinicians and researchers.”
That, however, is all a precursor to a much bigger ambition.
“This is also the basis of bioprinting,” Jacobson reveals. “Some of the work we’re doing is being able to replicate the human body well at multiple scales. We’re doing work with microstructures now, looking at cellular growth and understanding how cells want to inhabit microstructures. Like, can you create architectures, condominiums for cells to grow into rather than replicating, bioprinting, so we can make the body better than anyone else? There’s a market to get started there.”
Tangible Industries
What Tangible Industries is doing, per Lewis, is establishing a platform technology that can be utilised across various fields. As they stand that up, they’re ‘chipping away at smaller projects to deliver immediate impact. But in the background, Tangible is trying to create an ecosystem where they can bring others into the fold to continue development on some bigger challenges.
In line with its bioprinting ambitions, Tangible Industries has a ‘wonderful relationship’ with the Gates Center for Regenerative Medicine in Denver, who have awarded Jacobson a grant to look at the use of 3D printing in regenerative medicine. His proposal suggested ‘we can start to have a bridge between where we are now and full bioprinting in, perhaps, the next ten years, which means 3D printed parts that operate with the body, that are not a foreign object but actually create something for the body to grow into.
“Biomimetic applications, that’s available to us today,” Lewis says. “There’s a natural progression in creating things that mimic biological systems to things that assist biological systems to regenerate or function as they should into eventually – which is the holy grail – being able to replicate human tissue and organs.”
There is, they both concede, a tremendous amount of work to be done to make inroads into the replicating of human tissue and organs – and ‘there’s about five industries to develop along the way’ – but Tangible, to understate it, is hoping to participate in that process.
“I think long term,” Lewis finishes, “we're the operating system for the future of bioprinting. We do realise that there's a little bit of time and space between where we are today and realising that objective, but we do believe that this is the foundational technology that's going to allow that to become a reality.”
