3D printing objects as knowledge artifacts for a do-it-yourself approach in clinical practice. A questionnaire-based user study in the orthopaedics domain

Publication Date05 Feb 2018
AuthorFederico Cabitza,Angela Locoro,Aurelio Ravarini
SubjectLibrary & information science,Librarianship/library management,Library technology,Information behaviour & retrieval,Metadata,Information & knowledge management,Information & communications technology,Internet
3D printing objects as knowledge
artifacts for a do-it-yourself
approach in clinical practice
A questionnaire-based user study in the
orthopaedics domain
Federico Cabitza
Università degli Studi di Milano-Bicocca, Milano, Italy and
I.R.C.C.S. Istituto Ortopedico Galeazzi, Milano, Italy
Angela Locoro
Università degli Studi di Milano-Bicocca, Milano, Italy, and
Aurelio Ravarini
Università Carlo Cattaneo LIUC, Castellanza (VA), Italy
Purpose The purpose of this paper is to investigate the phenomenon of the digital do-it-yourself (DiDIY) in
the medical domain. In particular, the main contribution of the paper is the analysis and discussion of a
questionnaire-based user study focused on 3D printing (3DP) technology, which was conducted among
clinicians of one of the most important research hospital group in Lombardy, Italy.
Design/methodology/approach A general reflection on the notion of knowledge artifacts (KAs) and
on the use of 3DP in medicine is followed by the research questions and by a more detailed analysis of the
specialist literature on the usage of 3DP technology for diagnostic, training and surgical planning
activities for clinicians and patients. The questionnaire-based user study design is then emerging from
the conceptual framework for DiDIY in healthcare. To help focus on the main actors and assets
composing the 3DP innovation roles in healthcare, the authors model: the DiDIY-er as the main initiatorof
the practice innovation; the available technology allowing the envisioning of new practices; the specific
activities gaining benefits from the innovative techniques introduced; and the knowledge community
continuously supporting and evolving knowledge practices.
Findings The authors discussthe results of the user study in the lightof the four main components of our
DiDIY framework and on the notion of KA. There are differences between high expertise, or senior, medical
doctors (MDs) and relatively lower expertise MDs, or younger MDs, regarding the willing to acquire 3DP
competences;those who have seen othercolleagues using 3DP are significantlymore in favor of 3DP adoptionin
medical practices,and those who wish to acquire3DP competence and do-by-themselves are significantlymore
interestedin the making of custom-made patient-specific tools, suchas cutting guides and templates; thereare
many recurrentthemes regarding how 3DPusage and application may improvemedical practice. Ineach of the
free-textquestions, there were commentsregarding the impact of 3DPon medical knowledge practices,such as
surgical rehearsal,surgery, pathology comprehension,patient-physician communicationand teaching.
Originality/value The 3DP adoption in healthcare is seen favorably and advocated by most of the
respondents.In this domain, 3DP objects can be consideredKAs legitimately.They can support knowledgeable
practices,promote knowledgesharing and circulationin the healthcare community,as well as contribute to their
improvement by theintroduction of a new DiDIY mindsetin the everyday work of MDs.
Keywords Orthopedics, 3D printing (3DP) in healthcare, Diagnostic, training and surgical tools, DiDIY,
Knowledge artifacts in healthcare, Radiology
Paper type Research paper
Data Technologies and
Vol. 52 No. 1, 2018
pp. 163-186
© Emerald PublishingLimited
DOI 10.1108/DTA-03-2017-0019
Received 22 March 2017
Revised 11 May 2017
Accepted 26 May 2017
The current issue and full text archive of this journal is available on Emerald Insight at:
The authors are grateful to Professor Giuseppe Banfi, Scientific Director of the Orthopaedic Institute
Galeazzi,for promoting the participationof the doctors working in his institutein the survey undertaken
in this study.The authors are also gratefulto the anonymous participantsfor sharing their opinionswith
the authors.This paper was partly supportedunder the DiDIY projectfunded from the EuropeanUnions
Horizon 2020 research and innovation program,under Grant Agreement No. 644344.
3D printing
objects as
1. Introduction
A knowledge artifact (KA) has been defined (Cabitza and Locoro, 2014) as any artifact that is
purposely designed to support knowledge-related activities in any practice. Although this is
a (intentionally) broad definition, it exclusively includes all of the tools that are used in
the human activities to take decisions, access a body of notions that are useful to interpret or
understand a situation or solve a problem and complete a task relying on past experiences
and solutions. After a comprehensive user study of the varied literature available on this
matter (Cabitza and Locoro, 2014), the paper identified two main perspectives along which
to conceive this class of artifacts: objectivity and situativity. These are seen as two extremes
of a broad spectrum of application solutions, which often offer functionalities that cannot be
traced back to only one extreme but rather lie in between.
What do thesetwo terms refer to? At the formerextreme, there lies the ideathat knowledge
can be expressedin explicit and linguistic forms, interms of guidelines, procedures,rules and
notions. As such, knowledge is somehow quantifiable (e.g. in termsof how many statements,
rules, notionsconstitute it); it exists independently of any possibleconsumers, like a book on a
library shelf; and it can be transferred from one place to another, e.g. by e-mail or a courier.
Therefore, knowledge is seen as if it werean object for any practical purpose(hence the name
of the approach). At the situativist extreme, instead, knowledge is assimilated to a
knowledgeablebehavior that competentpeople exhibit during a specificsituation and withina
social practice (a knowing how). This latter is seen as a set of activities where more or less
explicit rules andconventions, shared within a social group, stipulate and formalize the right
way to have things done (and where an often totally ineffable know-how allows the
practitioners to accomplish their tasks). In the situativist case, KAs are those artifacts that
enable the sharing of ideas, the learning process and the mediation of collective activities of
problem framing, agreement reaching and decision making, without knowledge being
objectified in any form (neither as written facts nor written rules) as above. This objective-
situative spectrum regards the degree of specification (high in objective KAs and low in
situative KAs Cabitza et al., 2013) and the very way in which knowledge is conceived
(cf. objectivismvs constructivism Vrasidas, 2000).In this contribution, to this dimensionwe
add two further dimensions regarding interactivity and tangibility. We are suggesting these
two propertiesfor KAs for the first time, andborrow them from two more generickeywords in
the human-computerinteraction literature, i.e. interactive systemsand tangible interfaces.
KAs can be either passive or interactive. And they can be either tangible or intangible. The
latter dipole allowsto distinguish, quite sharply, betweensoftware applications and physical,
tangible objects. The former KAs are certainly physical(and often even material) in that
their userscan perceive them, but their way to showthemselves is through patternsof energy
and matter that could hardly be touched. In this light, a mouse is just a tangible controllerto
move a pointer on the screen, but the real application regards bit of energy in memory
modules or pixel grids. Tangible objects, which we all are very familiar with, are usually
passive, but this is not necessarily always the case: a washing machine, for instance, can be
touched,but through some controllersit can also respond to the userscommands and settings
and, through sensors, it can take decisionson how to proceed in carrying out its washing
programs. On the other hand, not all of the intangible (software) objects are interactive in the
same way, nor necessarily so their level of interaction matters. For instance, the Wikipedia,
although it is a very comprehensive and convenient source of knowledge (in an objectivist
viewpoint), responds to the users textual query and allows just to open new pages from the
links of another one, in a sort of basic interaction; but it is not proactive in its provision of
knowledge nuggets, facts, taxonomies and procedures, as an expert system would be;
rather it is reactive.To the other extreme, there are decision supportsystems, that is software
systems that, once been fed in with the available information about a case, suggest ways to
classify, treat or manage it (e.g. in the healthcare domain, in the legal one and in customer

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