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Barriers in adoption of additive Barriers in

adoption of
manufacturing in medical sector additive
manufacturing
supply chain
Neha Choudhary, Anish Kumar, Varun Sharma and Pradeep Kumar
Department of Mechanical and Industrial Engineering,
Indian Institute of Technology Roorkee, Roorkee, India Received 17 December 2020
Revised 11 January 2021
Accepted 18 January 2021
Abstract
Purpose – Additive manufacturing (AM) is expected to significantly transform the operations in manufacturing
sector. It is also proposed to have optimistic applications in the medical supply chains (SC). However, its adoption
in medical sector is faced with a range of barriers. Motivated by the need to establish an AM-based medical SC in a
developing economy, the present paper analyses the potential barriers that would hinder the adoption of AM in
medical SC.
Design/methodology/approach – Based on an extensive literature review and expert discussions, 12
significant barriers have been identified, which are analysed using an integrated interpretive structural
modelling–analytical network process (ISM–ANP) methodology. An interrelationship between these
barriers using ISM has been analysed to determine the driving-dependence power of these barriers using
MICMAC (Matrice d’ Impacts Croises-Multiplication Applique’ e a’ Classement) analysis. The barriers are
then ranked using the ANP approach.
Findings – It has been focussed that the non-availability of a variety of materials, lack of education and
training to designers and workers and production technology limitation are the most critical barriers. The
results suggest that the managers should give greater significance to the technological and organizational
barriers.
Originality/value – An approach to overcome these barriers can help the managers and organizations to
develop successful AM-based SCs. The study is the first to identify and analyse the barriers for successful
adoption of AM in medical SC context.
Keywords Additive manufacturing, Barriers, Supply chain, ISM, ANP
Paper type Research paper

1. Introduction
Additive Manufacturing (AM) is a process that models 3D structures by the addition of
material in a layer-by-layer manner. It is also popular by the name of rapid prototyping, 3D
printing, rapid tooling, direct digital manufacturing. This has come to light in the late 1980s for
making 3D models. AM is among the key technological developments in the fourth industrial
revolution (Schwab, 2016). Besides this, it has resulted in a strong impact and disruptions in the
operations of the supply chain (SC) (Mohr and Khan, 2015). AM has transfigured from making
prototypes and models to functional objects in a fast and cost-effective manner. It has found
wide applications in aerospace, automotive, medical, healthcare, clothing, fashion, food and
many other industries (Yao et al., 2020).
The production technologies of any industry significantly affect its supply chain
performance (Accenture, 2014; Kieviet and Alexander, 2017). AM brings with it the cost
benefits, lesser warehouse space, faster delivery, lowers assembly efforts, near net shape

The authors gratefully acknowledge the financial support provided by UCOST, Dehradun and DST,
India.
Journal of Advances in
Funding: The authors are grateful for the financial support provided by UCOST, Dehradun, and Management Research
DST, India. © Emerald Publishing Limited
0972-7981
Conflict of interest: The authors declare that they have no conflict of interest. DOI 10.1108/JAMR-12-2020-0341
JAMR manufacturing and customized products, etc. (Dwivedi et al., 2017; Niaki and Nonino, 2017).
Besides this, it allows bringing manufacturing units closer to demand points, thus minimizing
lead time and on-demand customized products (Narula et al., 2020; Sasson and Johnson, 2016).
AM produces the parts in one go, therefore minimizes the sub-component inventory and safety
stock, reduces the wastage of costly material. The technology also enables the production from
centralized to decentralized level (Walter et al., 2004), which would reduce the transportation
and inventory cost, thus simplifying the SC. Thus, AM offers disruptive improvements in SC,
enhancing the scope of new opportunities and business models (Piller et al., 2015).
AM already showed its potential in the modification of complex SC of aerospace and
automotive industries (Delic and Eyers, 2020; Khajavi et al., 2018). Many significant
applications in healthcare have also been proposed, such as 3D-printed medicine, implant
manufacturing, etc. It also provides patient-specific orthopaedic prosthetic devices and
implants, dental braces and crowns, soft and hard tissue constructs, drug delivery, fixation
devices, surgical planning and surgical instruments (Huang and Schmid, 2018). In the clinical
field, AM utilizes MRI/CT scans of the patient’s anatomy to fabricate customized implants in
a short time. The surgeons’ requirement for any customized surgical tool can be easily
fabricated using AM in the shortest possible time. It can also produce complex geometries,
porous structures with an optimized topology, which are hard to produce by non-additive
technologies.

1.1 Research motivation

Although AM is not new, it is still at its nascent stage for application in the clinical fields. The
possibility of a digitized SC, distributed and remote production, lower inventory and
distribution cost, low cycle time, on-demand production are all highly beneficial in medical
supply chains. AM ensures the fulfilment of any sudden demand in any remote location to
safeguard people’s health. However, despite the need as well as the benefits, there is still little
on-ground AM application, except for a few test cases. The reason for this could be the
challenges in the process, design assessment and optimization, finished part characterization,
material selection, policies and regulation categories (Food and Drug Administration, 2016;
Huang and Schmid, 2018).
The benefits of AM have huge potential to cater to the requirement of developing
countries. India’s medical supply chains are going through profound changes (Jamwal et al.,
2017). The healthcare equipment industry is expanding at a growth rate of 15.8% annually in
2017 compared to 4.1% global growth (Ministry of Commerce and Industry, 2017). Thus,
there is a vast potential for growth in demand for healthcare products that AM-based SCs can
fulfil in the near future. India mostly imports sophisticated medical equipment from other
countries to meet the population demand. Taking cognizance of this, the government of India,
under the scheme of “Make in India,” has approved to set up the medical device
manufacturing facilities, with medical device parks planned in several states (Make in India,
2018). However, in order to make this feasible, the identification of crucial challenges for the
adoption of AM in medical SC needs to be looked into. Wider adoption of this requires the
identification and analysis of many challenges to be met. Knowledge support for managers
and government is critical for the mitigation of these barriers in the medical SC. Thus, in the
present research, identification of the key barriers to the adoption of AM in medical SCs has
been analysed.

1.2 Research gaps and objectives

It is evident that AM is developing fast in different sectors, and technological innovation has
the capability to reshape the existing supply chains. However, only a few publications have
focussed on the application perspective of AM in the industry (Thomas-Seale et al., 2018). The
literature is mostly focused on the conceptual evaluation of the problems occurring in the AM Barriers in
supply chain (Chaudhuri et al., 2019). Only a few studies have been done to analyse the adoption of
challenges in AM implementation in different SCs (Dwivedi et al., 2017; Martinsuo and
Luomaranta, 2018). Besides this, there is no study that critically analyses the barriers to AM
additive
adoption in medical SC. Thus, there is a need for research on the application, industry manufacturing
adoption and decision support related to AM adoption in SC. The study of such problems
whose underlying mechanisms of different factors affecting it are not clear needs to be
addressed. The study of interactions between barriers and ranking of barriers could provide
significant decision support and managerial implications. Further, there is a gap in the
literature of AM considering SCs in developing countries. Developing economies of the world
have significant demand potential for AM. However, they lag in the uptake, technological
maturity and scalability of AM application.
Thus, considering these gaps in the literature, the present work analyses the critical
barriers for the adoption of AM in the medical SC with an aim to meet the following research
objectives-
(1) To identify the critical barriers to the adoption of AM in medical SC.
(2) To analyse the interrelationship among the barriers and propose rankings among
them.
In this regard, an extensive literature has been carried out in the following section to identify
the challenges in the adoption of AM and the various research approaches followed by the
researchers in the recent past. Further, the methodological approach adopted in this study is
presented in Section 3, followed by its application and results in Section 4. In Section 5,
analysis outcomes have been discussed. Section 6 provides some constructive conclusions
with an aim to address AM SC.

2. Literature review
In contrast to traditional manufacturing, AM provides flexibility to the supply chain in
producing products of a wide variety and low volume (Delic and Eyers, 2020; Varsha Shree
et al., 2020; Verboeket and Krikke, 2019). Multiple studies have focussed on the existing
scenarios to determine how, where and when to apply the AM to enhance SC performance and
decrease the complexity. The previous research attempts have addressed the use of AM in
automotive, aerospace and spare part SC (Khajavi et al., 2018; Holmstr€om et al., 2010; Li et al.,
2017). (Chekurov et al., 2018; Kretzschmar et al., 2018) studied the issues and readiness of AM
adoption in the digital spare part SC. The cost analysis of automotive and aerospace industries’
spare part SC has also been presented in recent years (Bonnın Roca et al., 2019; Li et al., 2017;
Strong et al., 2018). In this regard, Chowdhury et al. (2019) and Emelogu et al. (2016) analysed the
€
associated cost in the SC of the bio-implant manufacturing sector. Ozceylan et al. (2017) showed
the transformation in the traditional supply chain of orthopaedic insoles when replaced by the
AM supply chain through a case study. Previous studies have involved the challenges that
impact the supply chain of small and large industries to adopt AM (Chaudhuri et al., 2019;
Martinsuo and Luomaranta, 2018). However, none of the research attempts has critically
analysed these challenges in the field of medical sector supply chain for adopting AM.

2.1 Barriers of adoption of AM for sustainability medical SC

Large-scale acquisition of AM has a high potential/high barrier combination. Increasing
competition, demand for customizations and globalization id promoting firms to adopt
technology (Sharma et al., 2020). On one side, AM has high acceptance with awareness, but on
the other hand, it has technical barriers too (Lipodio et al., 2018). In the clinical field, AM is not
JAMR used for mass production but is used for mass customization. The adoption of AM in the
healthcare domain is not based on forecasting; it has an unpredictable future market.
It increases the supply chain complexity due to the handling of such a variance of demands
(Bogers et al., 2016). It requires high accuracy machines, which include high cost and time for
the fabrication of customized implants and pharmaceutical preparations (Zhang et al., 2020).
Stakeholders across the SC are thus, to some extent, reluctant to adopt AM.
Various AM techniques are available in the market. However, an appropriate machine–
material combination has to be selected based on customer requirements (Bogers et al., 2016;
Chekurov et al., 2018; Rogers et al., 2016). While the cost of these machines is a major barrier,
not every hardware and software combination is suitable for printing medical devices. Some
AM techniques take up to a day or more to fabricate anatomical models due to long data
interpretation time. Thus, the limitation of production speed is a significant barrier for AM
adoption (Gibson et al., 2010). There are also other productivity-related barriers such as
limitations of size, speed, low automation, print process instability and unreliability (Durach
et al., 2017; Dwivedi et al., 2017). Extrusion-based techniques (inkjet and 3D bio-printer) have a
small aperture of the nozzle and limited resolution (>50micron) due to which cells get
damaged during its passage from the nozzle. The Fused Deposition Modeling (FDM) process
generally uses high melting point materials that cause shrinkage, warpage due to
temperature gradient, needs a good cooling process (Yang et al., 2019). The scaffolds
prepared by Electron Beam Melting (EBM) have inaccuracies and rough surfaces, and
reduced pore size (Algardh et al., 2016; Eldesouky et al., 2017).
Further, the design of customized implants and scaffolds are tough to model into
designing software. For designing the intricate shape of scaffolds resembling actual bone, its
topology optimization to create a support structure for the model is also very critical
(Calignano, 2014). Besides this, different topology algorithms for scaffold fabrication like
solid isotropic material with penalization (SIMP) and evolutionary structural optimization
(ESO) (Guest and Prevost, 2007; Osanov and Guest, 2016) are cumbersome for their easy
adoption and requires highly skilled and trained operators. The fabrication of anatomically
fitted implants requires high-quality advanced MRI/CT scan systems, which require high
storage and qualified software developers and users (Yang et al., 2019). Due to these factors,
the unavailability of skilled labour and lack of education are critical barriers. The growth of
AM adoption in the healthcare field is hampered by insufficient skills of professionals, lack of
knowledge of varying input parameters and process steps affecting the part quality (Lipodio
et al., 2018).
The development of biodegradable and biocompatible material is a challenge for using
AM medical SC. AM has less availability of variety of materials because of the high cost
involved in the development of new materials, lack of standardization and poor material
characteristics (Kretzschmar et al., 2018). Different machines require different forms of raw
material for the fabrication of medical equipment. Some AM processes (powder bed fusion,
stereolithography) allow reuse of the leftover materials. Such leftover materials get exposed
to heat, moisture, etc., and loses its original properties; due to this, it is generally not
recommended in medical application to use leftover materials. (Grasso et al., 2018) showed
instability and poor part quality of Zn powder used in their research. The printing process
relied on different post processing techniques, with process imprecision (Bogers et al., 2016).
Biomedical implants have critical shapes, and however, hard to reach spaces, micro pores
remain unprocessed (Food and Drug Administration, 2016; Lowther et al., 2019). Hot isotropic
pressing (HIP) is used to increase the fatigue life of part, but it also decreases the yield
strength of the material (Food and Drug Administration, 2016). Ultrasonic cleaning has been
used in the recent past but proved insufficient to remove all remnants properly (Lowther et al.,
2019). Due to this, remnant bacterial infection may also occur. The process and software
validation is necessary to ensure the quality of medical devices (Food and Drug
Administration, 2016). These technical challenges also hamper the adoption of AM among Barriers in
medical practitioners. adoption of
Besides this, AM has the risk of leakage of knowledge during the transfer between
production sites, quality management and secure inventories. In order to confirm the safety of
additive
the patients’ health, producers feel the burden to meet the current regulations for medical manufacturing
devices and implants. There are also several regulatory challenges to meet the standards for
orthopaedic implants at every step, from the purchase of material to the sterilization of the
product (Lipodio et al., 2018; Lowther et al., 2019; Verboeket and Krikke, 2019). Besides this,
placing the AM facility is also anticipated to hinder the SC totally in the context of cost
(Emelogu et al., 2016). The home fabrication at a distributed level for the healthcare devices
will be challenging (Lipodio et al., 2018; Rayna and Striukova, 2016) due to the difficulty of
standardization (Bogers et al., 2016). Thus, in the present paper, a range of issues have been
analysed as 12 critical barriers. Table 1 shows the barriers to the adoption of AM in the
supply chain.

2.2 Research method

The decision-making methodologies have been used to analyse the underlying mechanisms
of different elements that influence the adoption of AM in the medical sector SC. Many
qualitative and quantitative approaches have been used in different areas in AM or medical
SC related –literature, some of which are listed in Table 2.
Various researchers have used the ISM-MICMAC methodology to find the
interrelationship between the critical factors and calculate the driving and dependency
powers (Bola~ nos et al., 2005; Govindan et al., 2012; Singh et al., 2007). It also helps to develop a
structured understanding of the research problem. The pairwise comparisons–based
methodologies, such as AHP and ANP, have been widely used for ranking purposes (Antil
et al., 2013). ANP uses a multidirectional decision approach between elements. It is a generic
form of the AHP and allows the interaction between different factors (Farsijani et al., 2014).
However, the ANP requires too many pairwise comparisons, which becomes cumbersome for
the experts. The integrated approach of ISM–ANP uses the results from the ISM model as an
input to the ANP model to reduce the number of pairwise comparisons required (Kumar et al.,
2020). Further, the ISM technique uses binary representation for factors’ relationships
without having any weights. So, in order to remove the limitation of ISM, it has been
integrated with the ANP model (Meena and Thakkar, 2014).

3. Proposed methodology
3.1 Data collection
The present research focuses on the investigation of barriers in the adoption of AM in the
medical sector. Based on the previous studies, a set of barriers was classified (refer Table 2).
The significance of these barriers was discussed with experts from industry, academia, as
well as the medical profession, having good knowledge in the area of additive manufacturing.
The experts’ profiles are presented in Table 3.
The experts were contacted through emails and phone calls and sought their inputs for the
ISM model through emails. The set of experts represented multiple stakeholders related to
medical SCs. One expert working in the company of additive manufacturing represented the
supplier side of AM technology. One expert who represented the demand side was a medical
practitioner in this domain. Further, one expert was from the government; four experts were
from academia with expertise in AM. After the ISM analysis, the ISM model’s interrelationships
were used to formulate the ANP model. Based on the ANP model, a questionnaire was again
prepared to collect the data for pairwise comparisons of the ANP model. Finally, the results of
JAMR S
no Barriers Description Sources

1 Production technology Various AM technologies have different Attaran (2017), Kretzschmar et al.
limitation limitations like slow speed, bad quality, (2018), Martinsuo and Luomaranta
strength of the part, limited build (2018), Ruffo and Hague (2007),
volume, etc. Every machine is not Schniederjans and Yalcin (2018),
suitable for all kinds of part production. Weller et al. (2015)
Fabrication of orthopaedic implants
with micron porosity and with high
dimensional accuracy is difficult
2 Non availability of Based on different types of AM Berman (2012), Kretzschmar et al.
variety of material processes there is limited number of (2018), Lowther et al. (2019)
useable materials because the
development of material according to the
medical application is difficult with
difficulties in creating complex
geometries
3 High cost of machine and The cost of superior quality of machine Attaran (2017), Baumers et al. (2016),
material and material being used in the medical Berman (2012), Schniederjans and
field is high. The development of new Yalcin (2018)
material requires high-cost specialized
instruments and maintenance of
machines is also high of new AM
technology
4 Resistance in adoption of Workers are familiar with old Dwivedi et al. (2017), Mellor et al.
new technology in technology and their nature of work. AM (2014)
workers is an automated process that requires
fewer number of workers, so workers
have a fear of losing their jobs and resist
to work with new technology
5 Unavailability of skilled Software-based techniques require Dwivedi et al. (2017), Martinsuo and
workers skilled workers to operate machines to Luomaranta (2018), Snyder et al.
get builds with desired properties and (2014), Weller et al. (2015)
specifications. In the AM process, skill is
needed for the selection of part
orientation, layer thickness, support
generation, using maximum build
volume, etc. A suitable candidate is
required to operate different AM
technologies (metal, polymer based)
6 Lack of education and In any organization, there is a need for Chaudhuri et al. (2019), Martinsuo and
training to designers and training to get the total benefit of new Luomaranta (2018), Snyder et al.
workers technology. Designers should be trained (2014), Weller et al. (2015)
to use topology optimization of
implantable devices, decoding data from
CT scans of patients, making generative
designs, etc. Suppliers of machine and
software sometimes do not provide
proper training at the time of
implementation like how to rectify
incomplete or defected parts, parameters
optimization for a specific product,
elimination of breakdown of a machine
Table 1. etc.
Barriers to the
adoption of AM (continued )
S
Barriers in
no Barriers Description Sources adoption of
7 Lack of post processing There is a lack of techniques used in Chaudhuri et al. (2019), Kretzschmar
additive
service surface finishing and coating of AM et al. (2018), Lowther et al. (2019), manufacturing
produced parts. Medical parts have Matias and Rao (2015)
complex geometry, so conventional
surface processing techniques face
problems as during post processing if
any remnant grit will be there, it will
create bacterial infections
8 Lack of buyer and The supplier of machines and materials Chaudhuri et al. (2019), Rahman and
supplier collaboration may affect the implementation of AM at Bennett (2009)
an early stage with good negotiation.
Collaboration with suppliers will help
out in making the right selection of
technology for avoiding
misspecifications in making critical
implantable devices. Lack of buyer
(hospital) and supplier collaboration will
also affect the after sale services like
spare part service, security issuesetc.
9 Difficulty in There are various standards based on Attaran (2017), Lowther et al. (2019),
standardization terminology, material, hardware, Thompson et al. (2016)
software, test parameters, quality
parameters, etc. in the medical field for
patients’ safety. There is a need to meet
standards or high specifications for
implantable devices at every step of the
manufacturing process
10 IPR threat of design Digitization has piracy threats of Chan et al. (2018), Chekurov et al.
inventory designs of medical implants during the (2018), Dwivedi et al. (2017), Weller
sharing of digital data. Instead of buying et al. (2015), Widmer and Rajan (2016)
the actual files, one may copy them by
applying reverse engineering or
scanning the part and producing several
copies
11 Lack of government Government support is essential in Dwivedi et al. (2017), Rogers et al.
support transferring from old technique to new (2016), Widmer and Rajan (2016)
technique, in providing subsidy, in
estimating any unmapped safety and
health hazard in additive manufacturing
implementation
12 Lack of customer Additive manufacturing is a new Muir and Haddud (2018)
acceptance technique, so customers (doctors) feel
hesitant is accepting the product
(implants or scaffolds), and customized
products will be costly too, so patients
will also have a lack of acceptance Table 1.

ISM and ANP were analysed together by generating a combined score of ISM levels and ANP
weights. The steps of the ISM and ANP methods have been presented in the following sections.

3.2 Interpretive structural modelling

ISM is an interactive technique proposed by Warfield in 1974 to find the interrelationship
between various elements of any issue. It is a well-established methodology and provides a
JAMR Research
Author Focus area method

Agrawal and Vinodh Factors influencing sustainable AM TISM -MICMAC

(2019)
Qin et al. (2019) Analysis of build orientation for additive manufacturing Fuzzy MADM
Ortız et al. (2015) Six sigma selection in the health care industry DEMETAL-
ANP
Dwivedi et al. (2017) Investigation of barriers while using AM in the automotive Fuzzy ISM
industries
Rane and Kirkire (2016) Analysis of Challenges in medical device development ISM-MICMAC
Knofius et al. (2016) Selection of spares for AM in after sale service AHP
Zaman et al. (2018) Analysis of interaction between product–process data of AM MCDM-AHP
Wang et al. (2018) Barriers in the selection of the AM process AHP-TOPSIS
Note(s): Abbreviations: TISM-MICMAC, total interpretive structural modelling- cross impact matrix
multiplication applied to classification; fuzzy MADM, fuzzy multiple attribute decision-making; AHP, analytic
hierarchy process; DEMETAL-ANP, decision making trial and evaluation- analytic network process; fuzzy-
Table 2. ISM, fuzzy interpretive structural modelling; ISM-MICMAC, interpretive structural modelling-cross impact
Literature of research matrix multiplication applied to classification; MCDM-AHP, multi-criteria decision-making analytic hierarchy
methods used in the process; AHP-TOPSIS, analytic hierarchy process-technique for order of preference by similarity to ideal
AM/medical field solution

Expert No Academia/industry Designation Experience (in years)

1 Industry CEO of an additive manufacturing company 10

2 Academia Professor 32
3 Government official Scientist-F, Indian Government 23
4 Academia Associate professor 18
5 Academia Assistant professor 4
Table 3. 6 Academia Assistant professor 3
Experts description 7 Doctor Doctor 6

hierarchical structure to represent the levels of elements (Tazaki and Amagasa, 1979). The
steps for ISM modelling are as follows (Kumar et al., 2020):
(1) The search for elements of problems or issues from the literature review.
(2) Development of a structural self-interaction matrix (SSIM) of elements.
(3) Formation of initial reachability matrix (IRM) from the SSIM according to binary
rules.
(4) Checking the IRM matrix for transitivity and further modify it to meet the rule of
transitivity for the formation of final reachable matrix (FRM). Transitivity refers to
“If issue A causes B and B causes C, then issue A will also cause issue C.”
(5) Levels are partitioned from FRM obtained in the previous step.
(6) Formation of the directed graph (digraph) based on different levels and eliminating
each link of transitivity.
(7) Formation of driving-dependence power diagram for cross-impact matrix
multiplication applied to classification (MICMAC) from FRM obtained.
3.3 Analytic network process Barriers in
ANP is a technique used for multi-criteria decision-making (MCDM) analysis. ANP is the adoption of
general form of AHP, which uses a network structure in place of hierarchy. ANP finds the
feedback and dependencies of elements at different levels and also among the same level
additive
elements. It is a well-established methodology and has the following steps: manufacturing
(1) Define the goals, criteria, sub-criteria, interdependencies and relationships among the
barriers using the ISM model to construct the ANP model.
(2) Conduct pairwise comparisons for the importance of one element over another.
(3) Form supermatrix with local priority weights obtained from the pairwise comparison
in the previous step.
(4) Normalize the supermatrix and formation of limiting supermatrix. The weighted
supermatrix is then raised to significant power to form the limiting supermatrix.

4. Application and results

4.1 ISM application
This section presents the application of the ISM to develop the interrelationship among the
previously identified barriers.
Step 1: Development of SSIM
Data collected from experts’ survey is used to develop SSIM to present the relationship
between listed barriers (Table 4). Following are the notations used to describe the
interrelationship among barriers.
V-Variable ðiÞ causes/affects variable ðjÞ
A-Variable ðjÞ causes/affects variable ðiÞ
X-Variable ðiÞ and ðjÞ causes/affect each other
O-Variables have no relation.
Step 2: Development of IRM and FRM

S.No Barriers 1 2 3 4 5 6 7 8 9 10 11 12

1. Production technology limitation ðB1Þ V X X X X O V V O X X

2. Non-availability of variety of material X A V O O O X O X X
ðB2Þ
3. High cost of machine and material ðB3Þ A X X O V V O X X
4. Resistance in adoption of new technology X X V O O O V V
in workers ðB4Þ
5. Unavailability of skilled workers ðB5Þ X V V O O X V
6. Lack of education and training to A O O O O V
designers and workers ðB6Þ
7. Lack of post-processing service ðB7Þ O O O O O
8. Lack of buyer and supplier collaboration O O O V
ðB8Þ
9. Difficulty in standardization ðB9Þ V O V
10. IPR threat of design inventory ðB10Þ A O Table 4.
11. Lack of government support ðB11Þ X Structural self-
12. Lack of customer acceptance ðB12Þ interaction matrix
JAMR Barriers 1 2 3 4 5 6 7 8 9 10 11 12

B1 1 1 1 1 1 1 0 1 1 0 1 1
B2 0 1 1 0 1 0 0 0 1 0 1 1
B3 1 1 1 0 1 1 0 1 1 0 1 1
B4 1 1 1 1 1 1 1 0 0 0 1 1
B5 1 0 1 1 1 1 1 1 0 0 1 1
B6 1 0 1 1 1 1 0 0 0 0 0 1
B7 0 0 0 0 0 1 1 0 0 0 0 0
B8 0 0 0 0 0 0 0 1 0 0 0 0
B9 0 1 0 0 0 0 0 0 1 1 0 1
Table 5. B10 0 0 0 0 0 0 0 0 0 1 0 0
Initial reachability B11 1 1 1 0 1 0 0 0 0 1 1 1
matrix B12 1 1 1 0 0 0 0 0 0 0 1 1

IRM, a binary matrix is transformed from SSIM (Table 5). The binary values for symbols
showing the relationship are as follows (Li and Wang, 2019):
V ði; jÞ has a binary value of 1 and V ðj; iÞ has a binary value of 0
A ði; jÞ has a binary value of 0 and Aðj; iÞ has a binary value of 1
X ði; jÞ and Xðj; iÞ both have a binary value of 1
O ði; jÞ and V ðj; iÞ both have a binary value of 0
IRM is then checked for transitivity rule to develop the final reachability matrix (FRM)
(Table 6).
Step 3: Division of levels and digraph formation
From the FRM antecedent set, the reachability set and intersection set for each barrier are
found, as shown in Table 7. The partition of barriers into levels is done by checking
reachability and intersection sets’ values. If the values of both sets are found the same for a

Driving
Barriers 1 2 3 4 5 6 7 8 9 10 11 12 power

B1 1 1 1 1 1 1 1T 1 1 1T 1 1 12
B2 1T 1 1 1T 1 1T 1T 1T 1 1T 1 1 12
B3 1 1 1 1T 1 1 1T 1 1 1T 1 1 12
B4 1 1 1 1 1 1 1 1T 1T 1T 1 1 12
B5 1 1T 1 1 1 1 1 1 1T 1T 1 1 12
B6 1 1T 1 1 1 1 1T 1T 1T 0 1T 1 11
B7 1T 0 1T 1T 1T 1 1 0 0 0 0 1T 7
B8 0 0 0 0 0 0 0 1 0 0 0 1T 2
B9 1T 1 1T 0 1T 0 0 0 1 1 1T 1 8
B10 0 0 0 0 0 0 0 0 0 1 0 0 1
B11 1 1 1 1T 1 1T 1T 1T 1T 1 1 1 12
Table 6. B12 1 1 1 1T 1T 1T 0 1T 1T 1T 1 1 11
Final reachability Dependence 10 9 10 9 10 9 8 9 9 9 9 11
matrix power
Barrier Reachability set Antecedent set Intersection set Levels
Barriers in
adoption of
B1 1,2,3,4,5,6,7,8,9,10,11,12 1,2,3,4,5,6,7,9,11,12 1,2,3,4,5,6,7,9,11,12 II additive
B2 1,2,3,4,5,6,7,8,9,10,11,12 1,2,3,4,5,6,9,11,12 1,2,3,4,5,6,9,11,12 IV
B3 1,2,3,4,5,6,7,8,9,10,11,12 1,2,3,4,5,6,7,9,11,12 1,2,3,4,5,6,7,9,11,12 II manufacturing
B4 1,2,3,4,5,6,7,8,9,10,11,12 1,2,3,4,5,6,7,11,12 1,2,3,4,5,6,7,11,12 III
B5 1,2,3,4,5,6,7,8,9,10,11,12 1,2,3,4,5,6,7,9,11,12 1,2,3,4,5,6,7,9,11,12 II
B6 1,2,3,4,5,6,7,8,9,11,12 1,2,3,4,5,6,7,11,12 1,2,3,4,5,6,7,11,12 V
B7 1,3,4,5,6,7,12 1,2,3,4,5,6,7,11 1,3,4,5,6,7 III
B8 8,12 1,2,3,4,5,6,8,11,12 8,12 I
B9 1,2,3,5,9,10,11,12 1,2,3,4,5,6,9,11,12 1,2,3,5,9,11 II
B10 10 1,2,3,4,5,9,10,11,12 10 I
B11 1,2,3,4,5,6,7,8,9,10,11,12 1,2,3,4,5,6,9,11,12 1,2,3,4,5,6,9,11,12 1V Table 7.
B12 1,2,3,4,5,6,8,9,10,11,12 1,2,3,4,5,6,7,8,9,11,12 1,2,3,4,5,6,8,9,11,12 II Level partition for ISM

Lack of buyer and supplier collaboration (B8) IPR threat of design inventory (B10 ) I

Production High cost of Unavailability of Difficulty in Lack of customer

II
Technology machine and skilled workers (B5) Standardization acceptance (B12)
Limitation (B1) material (B3) (B9)

Resistance in adoption of new technology in workers (B4) Lack of post processing service (B7) III

Non availability of variety of materials (B2) Lack of government support (B11) IV

Figure 1.
ISM model of barriers
Lack of education and training to designers and workers (B6) V

barrier, then it is set at level 1. Level 1 barriers are removed for further consideration for other
levels. This process is repeated until levels for each barrier is identified to form a digraph of
barriers as shown in Figure 1.

4.2 MICMAC application

MICMAC is used to analyse the barriers based on the driving power and dependence power of
each barrier obtained from FRM (Table 6). They are divided into four regions after drawing
the lines from half of the maximum value of driving power and dependence power (Figure 2).
Following are the four regions that can be inferred:
4.2.1 Independent region. This region has a strong driving with weak dependency power.
The barriers falling into this region are those who strongly drive other barriers, thus
significantly impact the overall model.
4.2.2 Linkage region. Barriers falling in this region have strong driving and dependence
power. They strongly drive other barriers as well as have feedback on themselves.
Production technology limitation ðB1Þ, non-availability of variety of material ðB2Þ, high cost
of machine and material ðB3Þ, resistance in adoption of new technology in workers ðB4Þ,
unavailability of skilled workersðB5Þ, lack of education and training to designers and
JAMR B2,4,11
B1,3,5
12
B6 B12

10

Driving power
8 B9

B7
i. Independent Region ii. Linkage Region
6

2 B8

B10
Figure 2. iv. Autonomous region iii. Dependent Region
0
MICMAC analysis of
0 2 4 6 8 10 12
barriers to AM
Dependence power

workersðB6Þ, lack of post-processing serviceðB7Þ, lack of customer acceptance ðB12Þ, lack of

government supportðB11Þ and difficulty in standardization ðB9Þ are in this region. They
easily impact the implementation of AM in the medical sector.
4.2.3 Autonomous region. This region has weak driving and dependency. Barriers falling
in this region have less impact and do not play many roles in the ISM model. Since no barrier
falls into this region, all of the barriers have considerable effect on the ISM model and are
important from the perspective of adoption of AM in the medical sector supply chain.
4.2.4 Dependent region. Barriers falling in this region have weak driving power with
strong dependence power. These occupy the topmost level in the ISM digraph and may reflect
the criticality of other barriers as well. Lack of buyer and supplier collaboration ðB8Þ and IPR
threat of design inventory ðB10Þ are in this region

Barriers

Technical factors Organizational factors Exogenous factors

B1 B2 B7 B9 B4 B5 B6 B3 B8 B10 B11 B12

Figure 3.
Analytic network
process model
4.3 ANP application Barriers in
The ANP network model (refer to Figure 3) is formed from the contextual relationship adoption of
obtained from the ISM matrix to show the importance of all barriers, which is difficult to
present in the ISM method.
additive
manufacturing
Step 1: Formation of the ANP model
The barriers are classified into three clusters namely, technical, organizational and exogenous
factors, as shown in Table 8. Technical factor consists of barriers related to machine and
material limitations, lack of post-processing and standardization, whereas organizational factor
consists of barriers related to workers and designers of organizations. Exogenous factor has
externally affected barriers. Based on the interconnections shown in Figure 3, a questionnaire
for the pairwise comparisons and the experts’ panel (Table 3), previously consulted for ISM
modelling, completed the questionnaire.
Step 2: Formation of super matrix and limit matrix

According to the experts’ responses, cluster matrix and supermatrix are developed. The
cluster weight matrix is shown in Table 9. The unweighted supermatrix is developed by
pairwise comparison between the barriers (nodes) shown in Table 10. It has all the local
priority information. Unweighted supermatrix is normalized by multiplying its elements by
corresponding weights of clusters to generate weighted supermatrix shown in Table 11. The
limiting matrix is obtained then by raising weighted supermatrix to powers by multiplying
itself until the numbers in the column reached the same for every column.
The final weights obtained from the limit matrix of the ANP model are shown in Table 12.
The ANP weights are multiplied by the ISM hierarchy level for each barrier. This study
utilizes the hierarchy level from the ISM and the ANP weights generated from pairwise
comparisons to understand the combined effect in the analysis of the barriers’ adoption
in AM.
The outcomes of the above analysis are discussed in the next part of the paper to identify
the significance of the results at each step.

Technical factor Organizational factor Exogenous factor

Production technology Resistance in adoption of new High cost of machine and

limitation ðB1Þ technology in workers ðB4Þ material ðB3Þ
Non-availability of variety of Unavailability of skilled workersðB5Þ Lack of buyer and supplier
materials ðB2Þ collaboration ðB8Þ
Lack of post-processing service Lack of education and training to IPR threat of design inventory
ðB7Þ designers and workersðB6Þ ðB10Þ
Difficulty in standardization Lack of customer acceptance
ðB9Þ ðB12Þ Table 8.
Lack of government Classification of
supportðB11Þ barriers into clusters

Technical factor Organizational factor Exogenous factor

Technical factor 0.3837 0.3837 0.3837 Table 9.

Organizational factor 0.3501 0.3501 0.3501 Cluster weight matrix
Exogenous factor 0.2663 0.2663 0.2663 for ANP
 JAMR

Table 10.

ANP model
Unweighted
supermatrix of
Clusters Technical factor Organizational factor Exogenous factor
B1 B2 B7 B9 B4 B5 B6 B3 B8 B10 B11 B12

Technical factor B1 0 0 0 0 0.4581 0.7434 1 0.3706 0 0 0.7908 0.7949

B2 0.5985 0 0 1 0.3305 0 0 0.397 0 0 0.2092 0.2051
B7 0 0 0 0 0.2114 0.2566 0 0 0 0 0 0
B9 0.4015 1 0 0 0 0 0 0.2324 0 1 0 0
Organizational factor B4 0.2385 0 0 0 0 0.3369 0.3534 0 0 0 0 0
B5 0.4311 1 0 0 0.4636 0 0.6466 0.5000 0 0 1 0
B6 0.3304 0 1 0 0.5364 0.6631 0 0.5000 0 0 0 0
Exogenous factor B3 0.5119 0.6071 0 0 0.4241 0.4196 0.5691 0 0 0 0.5011 0.5984
B8 0.16 0 0 0 0 0.1774 0 0.467 0 0 0 0
B10 0 0 0 0.5691 0 0 0 0 0 0 0.1403 0
B11 0.1217 0.1729 0 0 0.2574 0.2208 0 0.2973 0 0 0 0.4016
B12 0.2064 0.22 0 0.4309 0.3185 0.1822 0.4309 0.2355 1 0 0.3586 0
Clusters Technical factor Organizational factor Exogenous factor
B1 B2 B7 B9 B4 B5 B6 B3 B8 B10 B11 B12

Technical factor B1 0 0 0 0 0.1757 0.2852 0.3837 0.1422 0 0 0.3034 0.4692

B2 0.2296 0 0 0.5903 0.1268 0 0 0.1523 0 0 0.0803 0.1211
B7 0 0 0 0 0.0811 0.0984 0 0 0 0 0 0
B9 0.1541 0.3837 0 0 0 0 0 0.0892 0 1 0 0
Organizational factor B4 0.0835 0 0 0 0 0.1179 0.1237 0 0 0 0 0
B5 0.1509 0.3501 0 0 0.1623 0 0.2263 0.175 0 0 0.35 0
B6 0.1157 0 1 0 0.1878 0.2321 0 0.175 0 0 0 0
Exogenous factor B3 0.1363 0.1617 0 0 0.1129 0.1117 0.1515 0 0 0 0.1334 0.2452
B8 0.0426 0 0 0 0 0.0472 0 0.1244 0 0 0 0
B10 0 0 0 0.2331 0 0 0 0 0 0 0.0374 0
B11 0.0324 0.046 0 0 0.0685 0.0588 0 0.0792 0 0 0 0.1645
B12 0.055 0.0586 0 0.1766 0.0848 0.0485 0.1148 0.0627 1 0 0.0955 0
manufacturing
additive
adoption of
Barriers in

of ANP model
Weighted supermatrix
Table 11.
JAMR ISM ANP Level 3 Normalized (level 3
Clusters Bindex level weights weights weight) Rank

Technical factor B1 2 0.1549 0.3098 0.1213 3

B2 4 0.1409 0.5636 0.2206 1
B7 3 0.0166 0.0342 0.0195 10
B9 2 0.1163 0.0492 0.0910 5
Organizational B4 3 0.0403 0.1209 0.0473 8
factor B5 2 0.1351 0.2702 0.1058 4
B6 5 0.0921 0.4605 0.1802 2
Exogenous factor B3 2 0.107 0.214 0.0838 6
B8 1 0.0263 0.0263 0.0103 12
B10 1 0.0289 0.0289 0.0113 11
Table 12. B11 4 0.0464 0.1856 0.0726 7
Ranking of the barriers B12 2 0.0464 0.0928 0.0363 9

5. Discussion
ISM method and MICMAC analysis have shown the interrelationship between the selected
barriers. Figure 1 shows the five different levels of barriers. MICMAC study illustrates that
there are no barriers in autonomous and independent regions. Hence, no barrier is isolated
and independent, but all are interconnected in adopting AM in the 0medical sector supply
chain.̒ Lack of education and training of workers and designers ðB6Þ is the most influential
barrier. It has high driving power and is placed at the base of the structure (level V). It also
helps to drive the barriers of the four top levels. The model shows that barrier B6 helps in
achieving non-availability of a variety of materials ðB2Þ and lack of government support
ðB11Þ which are at level IV. The driving power of these barriers confirm their importance and
their combined effect leads to barriers, resistance in adoption of new technology in workers
ðB4Þ; and lack of post-processing services ðB7Þ, placed at level III. Barrier B4 and B7
collectively drive the barriers at level II, production technology limitation ðB1Þ, high cost of
machine and material ðB3Þ, unavailability of skilled workersðB5Þ, difficulty in
standardization ðB9Þ, lack of customer acceptance ðB12). ISM-MICMAC analysis shows
that all these barriers, as mentioned above, are in the linkage to drive each other. Notably, the
barriers of level II of ISM model are the driving barriers of lack of buyer and supplier
collaboration ðB8Þ and IPR threat of design inventory ðB10Þ. MICMAC analysis shows that
these two barriers are the most dependent barriers, influenced by all other barriers, as all
other barriers act as drivers of these two.
ANP model is used to identify the ranking of the listed barriers. The barriers are
classified into three clusters, i.e., technical factors, organizational factors and exogenous
factors. The ANP model with ISM inputs shows the ranking of barriers of order
B1 > B2 > B5 > B9 > B3 > B6 > B11 > B12 > B4 > B10 > B8 > B7 according to the
weights (refer Table 12). ANP result shows that production technology limitation ðB1Þ,
non-availability of variety of materials ðB2Þ, unavailability of skilled workersðB5Þ,
difficulty in standardization ðB9Þ;and high cost of machine and material ðB3Þ are among
the top five with priority barriers. These results of ANP are in contradiction with the ISM
result. ISM reveals the hierarchy of the barriers based on results obtained from FRM. It
gives greater significance to factors which drive others, while in ANP greater number of
comparisons are there for factors as which are more dependent upon others; thus, they get
greater weightage. Similar contradictions are also observed in the previous literature,
where ISM shows that the barriers at the higher level are the most influential, while ANP
shows that the dependent factors, which are at a lower level, are the most significant
(Bhadani et al., 2016). However, the ISM can only provide a qualitative assessment of the
factors, and with its assistance, ANP can provide better reasonable identification of critical Barriers in
barriers (Chang et al., 2013). adoption of
In order to overcome the dilemma, a combined scale of ISM level and ANP weight has been
used to prioritize the barriers. Table 12 shows the combined effect of the ISM–ANP model
additive
result; non-availability of variety of materials (B2; 0.2206) is at the highest priority, and lack of manufacturing
buyer and supplier collaboration (B8; 0.0103) is at the lowest priority. The average of the
ranking is 0.0833, so the barriers having the score greater than the average value is of
greater importance. The ranking order obtained from the integrated result is
B2 − B6 − B1 − B5 − B9 − B3 − B11 − B4 − B12 − B7 − B10 − B8: It can be seen that
combined result gives support to the ISM model, clarifies that non-availability of
variety of materials ðB2Þ, lack of education and training of designers and workers ðB6Þ
emerged as highly critical barriers in addition to production technology limitation
ðB1Þand lack of buyer and supplier collaboration ðB8Þ and IPR threat of design inventory
ðB10Þ as the least prioritized or dependent barriers.
Besides this, non-availability of variety of materials ðB2Þ is the most prioritized barrier in
the adoption of AM in medical sector supply chain. This can be accounted for the fact that
there are very restricted metals and polymers allowed to take into the operation theatres and
the human body. The development of new materials is quite expensive and time-consuming
also. This result concurs with previous literature related to AM application in clinical domain
(Lowther et al., 2019). AM technique allows the fabrication of complex shapes but on the same
page, materials to form that shape are limited, leading to non-adoption of AM in the medical
sector. Another significant barrier, namely, lack of education and training of designers and
workers ðB6Þ leads to non-understanding of machine and processes. The fabrication of
medical devices and human anatomy requires high skill designers (surgeons) along with
trained workers to operate the AM machines which is highly valuable for customers (Snyder
et al., 2014). This result is also in agreement with (Rane and Kirkire, 2016), which identifies
lack of technical expert and lack of academia interaction among the most influential barriers
for medical devices development in a developing economy. Significance of these factors in
previous literature is also reflected in our work with ðB6Þ and ðB5Þ having high ranks. The
service providers and organization itself should provide the training to overcome the
challenges faced by manufacturers and designers at adoption and maturity level (Chaudhuri
et al., 2019). The third-most prioritized barrier is the production technology limitation ðB1Þ.
This barrier is also identified as a critical barrier in previous literature (Dwivedi et al., 2017). It
is critical in AM adoption in medical SC due to its inconsistency in the fabrication, limited
build volume and poor strength compared to traditional processes, etc. On the other hand,
lack of buyer and supplier collaboration ðB8Þ and IPR threat of design inventory ðB10Þ are the
two most least-prioritized and most-dependent barriers. These factors fall into the exogenous
factors with least driving potential. While other barriers may have different priority weight
but they still have significant interrelations to drive other barriers as shown in ISM model.
The weights generated are relative, and it is essential to ensure that all barriers are given due
attention for successful adoption of AM in the medical SC. The managerial implications of all
the barriers have been discussed in the next section.

6. Managerial implications
This research offers insights for managers to understand barriers for the successful adoption
of AM in medical SC. The selected barriers can serve as a checklist that identifies key barriers
associated with AM adoption in the medical sector supply chain and also helps to examine
every barrier and its influence. The concept of identification of key barriers is crucial for
establishing a new AM-based SC and help to frame the desired policy environment for it.
Policymakers should focus on the availability of the required variety of materials and
JAMR training and education for workers and designers as the two major factors for providing such
an environment. Apart from the material, high cost of machines is also a major barrier. Both
these challenges can be mitigated by choosing the correct equipment–process combination in
line with the right available material (Rahman and Bennett, 2009). For medical devices,
machine–material combination incurs a high cost due to the development of new materials,
maintenance of machines, its high IT security, the cost of implementation, etc. The
government should facilitate developing a collaborative network of suppliers by providing
encouraging taxation policy, import duty relaxations, cost sharing for customers. Keeping in
view the scope of market for AM, organizations should negotiate better cost, provide after-
sale services, training etc. At the middle stage of adoption, lack of knowledge in designers and
workers and skilled workers’ unavailability cause a challenge. Organizations’ relations with
service providers will help in the workforce’s training and education at the time of purchase
and at the later stages to optimize the process (Chaudhuri et al., 2019). Universities and
educational institutes should be developed as disseminators of required technical skills. A
collaboration between academia and industry can help bridge the existing knowledge gap in
the workforce. The easy availability of a skilled workforce will certainly increase the
acceptance of AM among the customers (doctors). Organizations may face resistance in
workers to adopt new technology due to the anticipation of losing their jobs because AM is an
automated process. So, organizations should give proper training of new technology or
ensure them to involve in any other deserving jobs. Lack of standardization and IPR threats
could be mitigated by enabling transparency in the AM-based business models and medical
SC. A significant administrative and government support is needed to promote local
manufacturing by providing subsidies, tax relaxations and by spreading awareness for IPR
laws and research and developments in AM. Enforcement of strict-ruled IPR laws will
increase management’s confidence in the use of digital inventory.
While new barriers may come forward as the industry embraces AM in developing
nations, the topic requires more research. Other industries can also have similar studies on
AM application. The findings of this study can be generalized to similar industries like
pharmaceuticals, etc., where the AM can have innovative applications. This research serves
as an initial guide for managers to rethink their existing supply chain to update it with the
new AM-adopted supply chain.

7. Conclusions
The present study is aimed at understanding the barriers and their interrelationships for the
adoption of AM in medical SC. The knowledge support has been taken from the expert’s
panel, heterogeneously working in the additive manufacturing sector. The questionnaires
filled by the experts were used for the integrated ISM–ANP methodology to understand the
contextual relationship and prioritize the selected barriers. The integrated ISM–ANP
methodology presents a broad range of analysis with interrelationship as well as importance-
based criteria for decision-making. The study shows that the top three driving barriers are
non-availability of a variety of materials, lack of education and training to designers and
workers and production technology limitations. While these barriers are suggested to be
given greater priority, other barriers should also be given due attention by the managers.
With development and growth in industry, the selected barriers related to AM adoption may
vary in significance.
The study contributes both to the theory as well as practice; however, there is still limitation
of this research, which paves the way for further studies in this direction. First, the study is
based upon the subjective evaluation of the experts, which may vary from expert to expert.
More conclusive results with greater reliability could be observed using a broader sample data
collection and empirical evolution. There may be other factors that are not considered in this
study, which could be included in future studies. AM can be integrated with machine learning, Barriers in
artificial intelligence and other new technologies. Such an integration can be explored for adoption of
design, fabrication and manufacturing workflow management in AM-based supply chains.
Integration of AM with other disruptive technologies can also possibly mitigate the barriers for
additive
adoption of AM. From methodological perspective, future investigations could also consider manufacturing
other methodologies with DEMATEL, best–worst method, etc., to compare the results and
improve the comprehension of decision-making. This work may be forwarded with case-based
analysis of AM-based SCs to study its impact on the organization and customers in the Indian
context.

References
Accenture (2014), 3D Printing’s Disruptive Potential, Accenture Technology, Silicon Valley, CA,
available at: https://www.accenture.com/t20150523T041952__w__/us-en/_acnmedia/Accenture/
Conversion-Assets/DotCom/Documents/Global/PDF/Industries_14/Accenture-Disruptive-
Potential-3D-Printing.pdf.
Agrawal, R. and Vinodh, S. (2019), “Application of total interpretive structural modelling (TISM) for
analysis of factors influencing sustainable additive manufacturing: a case study”, Rapid
Prototyping Journal, Vol. 25 No. 7, pp. 1198-1223, doi: 10.1108/RPJ-06-2018-0152.
Algardh, J.K., Horn, T., West, H., Aman, R., Snis, A., Engqvist, H., Lausmaa, J. and Harrysson, O.
(2016), “Thickness dependency of mechanical properties for thin-walled titanium parts
manufactured by Electron Beam Melting (EBM) ®”, Additive Manufacturing, Vol. 12, pp. 45-50,
doi: 10.1016/j.addma.2016.06.009.
Antil, P., Singh, M. and Kumar, A. (2013), “Selection of merchant for Manufacturing industries
through application of analytic hierarchy process”, International Journal of Research In Applied
Science And Engineering Technology, Vol. 1 No. III, pp. 16-21, available at: https://www.ijraset.
com/fileserve.php?FID574.
Attaran, M. (2017), “The rise of 3-D printing: the advantages of additive manufacturing over
traditional manufacturing”, Business Horizons, Vol. 60 No5, pp. 677-688, doi: 10.1016/j.bushor.
2017.05.011.
Baumers, M., Dickens, P., Tuck, C. and Hague, R. (2016), “The cost of additive manufacturing: machine
productivity, economies of scale and technology-push”, Technological Forecasting and Social
Change, Elsevier, Vol. 102, pp. 193-201, doi: 10.1016/j.techfore.2015.02.015.
Berman, B. (2012), “3-D printing: the new industrial revolution”, Business Horizons, business horizons,
Vol. 55 No. 2, pp. 155-162, doi: 10.1016/j.bushor.2011.11.003.
Bhadani, A.K., Shankar, R. and Rao, D.V. (2016), “Modeling the barriers of service adoption in rural
Indian telecom using integrated ISM-ANP”, Journal of Modelling in Management, Vol. 11 No. 1,
pp. 2-25, doi: 10.1108/JM2-09-2013-0041.
Bogers, M., Hadar, R. and Bilberg, A. (2016), “Additive manufacturing for consumer-centric business
models: implications for supply chains in consumer goods manufacturing”, Technological
Forecasting and Social Change, Vol. 102, pp. 225-239, doi: 10.1016/j.techfore.2015.07.024.
nos, R., Fontela, E., Nenclares, A. and Pastor, P. (2005), “Using interpretive structural modelling in
Bola~
strategic decision-making groups”, Management Decision, Vol. 43 No. 6, pp. 877-895, doi: 10.1016/j.
techfore.2015.07.024.
Bonnın Roca, J., Vaishnav, P., Laureijs, R.E., Mendonça, J. and Fuchs, E.R.H. (2019), “Technology cost
drivers for a potential transition to decentralized manufacturing”, Additive Manufacturing,
Vol. 28, pp. 136-151, doi: 10.1016/j.addma.2019.04.010, Elsevier.
Calignano, F. (2014), “Design optimization of supports for overhanging structures in aluminum and
titanium alloys by selective laser melting”, Materials and Design, Vol. 64, pp. 203-213, doi: 10.1016/
j.matdes.2014.07.043.
JAMR Chan, H.K., Griffin, J., Lim, J.J., Zeng, F. and Chiu, A.S.F. (2018), “The impact of 3D Printing
Technology on the supply chain: manufacturing and legal perspectives”, International Journal
of Production Economics, Vol. 205, pp. 156-162, doi: 10.1016/j.ijpe.2018.09.009.
Chang, A.Y., Hu, K.J. and Hong, Y.L. (2013), “An ISM-ANP approach to identifying key agile factors in
launching a new product into mass production”, International Journal of Production Research,
Vol. 51 No. 2, pp. 582-597, doi: 10.1080/00207543.2012.657804.
Chaudhuri, A., Rogers, H., Soberg, P. and Pawar, K.S. (2019), “The role of service providers in 3D
printing adoption”, Industrial Management and Data Systems, Vol. 119 No. 6, pp. 1189-1205,
doi: 10.1108/IMDS-08-2018-0339.
Chekurov, S., Mets€a-Kortelainen, S., Salmi, M., Roda, I. and Jussila, A. (2018), “The perceived value of
additively manufactured digital spare parts in industry: an empirical investigation”,
International Journal of Production Economics, Vol. 205, pp. 87-97, doi: 10.1016/j.ijpe.2018.
09.008.
Chowdhury, S., Francis, J., Marufuzzaman, M. and Bian, L. (2019), “Supply chain cost analysis for
additively manufactured biomedical implants”, International Journal of Systems Science:
Operations and Logistics, Vol. 7 No. 3, pp. 275-290, doi: 10.1080/23302674.2019.1574365.
Delic, M. and Eyers, D.R. (2020), “The effect of additive manufacturing adoption on supply chain
flexibility and performance: an empirical analysis from the automotive industry”, International
Journal of Production Economics, Vol. 228, 107689, pp. 1-15, doi: 10.1016/j.ijpe.2020.107689.
Durach, C.F., Kurpjuweit, S. and Wagner, S.M. (2017), “The impact of additive manufacturing on
supply chains”, International Journal of Physical Distribution and Logistics Management, Vol. 47
No. 10, pp. 954-971, doi: 10.1108/IJPDLM-11-2016-0332.
Dwivedi, G., Srivastava, S.K. and Srivastava, R.K. (2017), “Analysis of barriers to implement additive
manufacturing technology in the Indian automotive sector”, International Journal of Physical
Distribution and Logistics Management, Vol. 47 No. 10, pp. 972-991, doi: 10.1108/IJPDLM-07-
2017-0222.
Eldesouky, I., Harrysson, O., West, H. and Elhofy, H. (2017), “Electron beam melted scaffolds for
orthopedic applications”, Additive Manufacturing, Vol. 17, pp. 169-175, doi: 10.1016/j.addma.
2017.08.005.
Emelogu, A., Marufuzzaman, M., Thompson, S.M., Shamsaei, N. and Bian, L. (2016), “Additive
manufacturing of biomedical implants: a feasibility assessment via supply-chain cost analysis”,
Additive Manufacturing, Elsevier B.V., Vol. 11, pp. 97-113, doi: 10.1016/j.addma.2016.04.006.
Farsijani, H., Nikabadi, M.S. and Amirtaheri, O. (2014), “Evaluation of advanced manufacturing
technologies for world-class using analytical network process method”, World Review of
Science, Technology and Sustainable Development, Vol. 11 No. 2, pp. 127-147, doi: 10.1504/
WRSTSD.2014.065674.
Food and Drug Administration (2016), “Technical considerations for additive manufactured medical
devices:guidance for industry and food and drug administration staff document”, in
Intergovernmental Panel on Climate ChangeCenter For Devices and Radiological Health,
Cambridge University Press, Cambridge, doi: 10.1017/CBO9781107415324.004.
Gibson, I., Rosen, D.W. and Stucker, B. (2010), Additive Manufacturing Technologies, Additive
Manufacturing Technologies: Rapid Prototyping to Direct Digital Manufacturing, Springer US,
Boston, MA, doi: 10.1007/978-1-4419-1120-9.
Govindan, K., Palaniappan, M., Zhu, Q. and Kannan, D. (2012), “Analysis of third party reverse
logistics provider using interpretive structural modeling”, International Journal of Production
Economics, Vol. 140 No. 1, pp. 204-211, doi: 10.1016/j.ijpe.2012.01.043.
Grasso, M., Demir, A.G., Previtali, B. and Colosimo, B.M. (2018), “In situ monitoring of selective laser
melting of zinc powder via infrared imaging of the process plume”, Robotics and Computer-
Integrated Manufacturing, Vol. 49, pp. 229-239, doi: 10.1016/j.rcim.2017.07.001.
Guest, J.K. and Prevost, J.H. (2007), “Design of maximum permeability material structures”, Computer Barriers in
Methods in Applied Mechanics and Engineering, Vol. 196 Nos 4–6, pp. 1006-1017, doi: 110.1016/j.
cma.2006.08.006. adoption of
Holmstr€om, J., Partanen, J., Tuomi, J. and Walter, M. (2010), “Rapid manufacturing in the spare parts
additive
supply chain: alternative approaches to capacity deployment”, Journal of Manufacturing manufacturing
Technology Management, Vol. 21 No. 6, pp. 687-697, doi: 10.1108/17410381011063996.
Huang, Y. and Schmid, S.R. (2018), “Additive manufacturing for health: state of the art, gaps and
needs, and recommendations”, Journal of Manufacturing Science and Engineering, Vol. 140
No. 9, pp. 094001–11, doi: 10.1115/1.4040430.
Jamwal, U., Panchal, D. and Kumar, A. (2017), “Change management in the Indian pharmaceutical
industry: a case study”, International Journal of Logistics Systems and Management, Vol. 27
No. 3, pp. 380-394, doi: 10.1504/IJLSM.2017.10005114.
Khajavi, S.H., Holmstr€om, J. and Partanen, J. (2018), “Additive manufacturing in the spare parts
supply chain: hub configuration and technology maturity”, Rapid Prototyping Journal, Vol. 24
No. 7, pp. 1178-1192, doi: 10.1108/RPJ-03-2017-0052.
Kieviet, A. and Alexander, S.M. (2017), “Is your supply chain ready for additive manufacturing?”,
Supply Chain Management Review, pp. 34-39, September-October, available at: https://www.
scmr.com/article/is_your_supply_chain_ready_for_additive_manufacturing.
Knofius, N., Van Der Heijden, M.C. and Zijm, W.H.M. (2016), “Selecting parts for additive
manufacturing in service logistics”, Journal of Manufacturing Technology Management,
Vol. 27 No. 7, pp. 915-931, doi: 10.1108/JMTM-02-2016-0025.
Kretzschmar, N., Chekurov, S., Salmi, M. and Tuomi, J. (2018), “Evaluating the readiness level of
additively manufactured digital spare parts: an industrial perspective”, Applied Sciences, Vol. 8
No. 10, p. 1837, doi: 10.3390/app8101837.
Kumar, A., Mangla, S.K., Kumar, P. and Karamperidis, S. (2020), “Challenges in perishable food supply
chains for sustainability management: a developing economy perspective”, Business Strategy
and the Environment, Vol. 29 No. 5, pp. 1809-1831, doi: 10.1002/bse.2470.
Li, Y. and Wang, X. (2019), “Using fuzzy analytic network process and ism methods for risk
assessment of public-private partnership: a China perspective”, Journal of Civil Engineering and
Management, Vol. 25 No. 2, pp. 168-183, doi: 10.3846/jcem.2019.8655.
Li, Y., Jia, G., Cheng, Y. and Hu, Y. (2017), “Additive manufacturing technology in spare parts supply
chain: a comparative study”, International Journal of Production Research, Vol. 55 No. 5,
pp. 1498-1515, doi: 10.1080/00207543.2016.1231433.
Lipodio, D., Colombi, V., D’Alessandro, G. and Verdiana, C. (2018), The Future of Health Care.
Potential, Impact and Models of 3D Printing in the Health Care Sector, Deloitte, available at:
https://www2.deloitte.com/content/dam/Deloitte/be/Documents/life-sciences-health-care/
ThefutureofHealthCare_ENG.pdf.
Lowther, M., Louth, S., Davey, A., Hussain, A., Ginestra, P., Carter, L., Eisenstein, N., et al. (2019),
“Clinical, industrial, and research perspectives on powder bed fusion additively manufactured
metal implants”, Additive Manufacturing, Vol. 28, pp. 565-584, doi: 10.1002/bse.2470.
Make in India (2018), “Sector survey: medical devices”, available at: https://www.makeinindia.com/
article/-/v/sector-survey-medical-devices#:∼:text5ThereareafewMedical,TamilNadu%
2CMaharashtraandGujarat (accessed 10 August 2020).
Martinsuo, M. and Luomaranta, T. (2018), “Adopting additive manufacturing in SMEs: exploring the
challenges and solutions”, Journal of Manufacturing Technology Management, Vol. 29 No. 6,
pp. 937-957, doi: 10.1108/JMTM-02-2018-0030.
Matias, E. and Rao, B. (2015), “3D printing: on its historical evolution and the implications for
business”, Portland International Conference on Management of Engineering and Technology,
pp. 551-558, doi: 10.1109/PICMET.2015.7273052.
JAMR Meena, K. and Thakkar, J. (2014), “Development of balanced scorecard for healthcare using
interpretive structural modeling and analytic network process”, Journal of Advances in
Management Research, Vol. 11 No. 3, pp. 232-256, doi: 10.1108/JAMR-12-2012-0051.
Mellor, S., Hao, L. and Zhang, D. (2014), “Additive manufacturing: a framework for implementation”,
International Journal of Production Economics, Vol. 149, pp. 194-201, doi: 10.1016/j.ijpe.2013.
07.008.
Ministry of Commerce and Industry, G. of I (2017), “Medical devices- sector overview”, available at:
https://www.makeinindia.com/article/-/v/sector-survey-medical-devices.
Mohr, S. and Khan, O. (2015), “3D printing and its disruptive impacts on supply chains of the future”,
Technology Innovation Management Review, Vol. 5 No. 11, pp. 20-25.
Muir, M. and Haddud, A. (2018), “Additive manufacturing in the mechanical engineering and medical
industries spare parts supply chain”, Journal of Manufacturing Technology Management,
Vol. 29 No. 2, pp. 372-397, doi: 10.1108/JMTM-01-2017-0004.
Narula, S., Prakash, S., Dwivedy, M., Talwar, V. and Tiwari, S.P. (2020), “Industry 4.0 adoption key
factors: an empirical study on manufacturing industry”, Journal of Advances in Management
Research, Vol. 17 No. 5, pp. 697-725, doi: 10.1108/JAMR-03-2020-0039.
Niaki, M.K. and Nonino, F. (2017), “Impact of additive manufacturing on business competitiveness: a
multiple case study”, Journal of Manufacturing Technology Management, Vol. 28 No. 1,
pp. 56-74, doi: 10.1108/JMTM-01-2016-0001.
Ortız, M.A., Felizzola, H.A. and Isaza, S.N. (2015), “A contrast between DEMATEL-ANP and ANP
methods for six sigma project selection: a case study in healthcare industry”, BMC Medical
Informatics and Decision Making, Vol. 15, Suppl 3, pp. 1-12, doi: 10.1186/1472-6947-15-S3-S3.
Osanov, M. and Guest, J.K. (2016), “Topology optimization for architected materials design”, Annual
Review of Materials Research, Vol. 46 No. 1, pp. 211-233, doi: 10.1146/annurev-matsci-070115-
031826.
€
Ozceylan, glu, O. (2017), “Impacts of additive manufacturing
E., Çetinkaya, C., Demirel, N. and Sabırlıo
on supply chain flow: a simulation approach in healthcare industry”, Logistics, Vol. 2 No. 1,
pp. 1-20, doi: 10.3390/logistics2010001.
Piller, F.T., Weller, C. and Kleer, R. (2015), “Business models with additive manufacturing—
opportunities and challenges from the perspective of economics and management”, in Brecher, C.
(Ed.), Advances in Production Technology, Springer International Publishing, Cham, pp. 39-48.
Qin, Y., Qi, Q., Scott, P.J. and Jiang, X. (2019), “Determination of optimal build orientation for additive
manufacturing using Muirhead mean and prioritised average operators”, Journal of Intelligent
Manufacturing, Springer, Vol. 30 No. 8, pp. 3015-3034, doi: 10.1007/s10845-019-01497-6.
Rahman, A.A. and Bennett, D. (2009), “Advanced manufacturing technology adoption in developing
countriesThe role of buyer-supplier relationships”, Journal of Manufacturing Technology
Management, Vol. 20 No. 8, pp. 1099-1118, doi: 10.1108/17410380910997236.
Rane, S.B. and Kirkire, M.S. (2016), “Analysis of barriers to medical device development in India: an
interpretive structural modelling approach”, International Journal of Systems Assurance
Engineering and Management, Vol. 7 No. 3, pp. 356-369, doi: 10.1007/s13198-016-0497-0.
Rayna, T. and Striukova, L. (2016), “From rapid prototyping to home fabrication: how 3D printing is
changing business model innovation”, Technological Forecasting and Social Change, Vol. 102,
pp. 214-224, doi: 10.1016/j.techfore.2015.07.023.
Rogers, H., Baricz, N. and Pawar, K.S. (2016), “3D printing services: classification, supply chain
implications and research agenda”, International Journal of Physical Distribution and Logistics
Management, Vol. 46 No. 10, pp. 886-907, doi: 10.1108/IJPDLM-07-2016-0210.
Ruffo, M. and Hague, R. (2007), “Cost estimation for rapid manufacturing - simultaneous production of
mixed components using laser sintering”, Proceedings of the Institution of Mechanical Engineers
- Part B: Journal of Engineering Manufacture, Vol. 221 No. 11, pp. 1585-1591, doi: 10.1243/
09544054JEM894.
Sasson, A. and Johnson, J.C. (2016), “The 3D printing order: variability, supercenters and supply chain Barriers in
reconfigurations”, International Journal of Physical Distribution and Logistics Management,
Vol. 46 No. 1, pp. 82-94, doi: 10.1108/IJPDLM-10-2015-0257. adoption of
Schniederjans, D.G. and Yalcin, M.G. (2018), “Perception of 3D-printing: analysis of manufacturing use
additive
and adoption”, Rapid Prototyping Journal, Vol. 24 No. 3, pp. 510-520, doi: 10.1108/RPJ-04- manufacturing
2017-0056.
Schwab, K. (2016), The Fourth Industrial Revolution: What it Means and How to Respond, World
Economic Forum, pp. 1-9, available at: https://www.weforum.org/agenda/2016/01/the-fourth-
industrial-revolution-what-it-means-and-how-to-respond/.
Sharma, J., Tyagi, M. and Bhardwaj, A. (2020), “Parametric review of food supply chain performance
implications under different aspects”, Journal of Advances in Management Research, Vol. 17
No. 3, pp. 421-453, doi: 10.1108/JAMR-10-2019-0193.
Singh, R.K., Garg, S.K., Deshmukh, S.G. and Kumar, M. (2007), “Modelling of critical success factors
for implementation of AMTs”, Journal of Modelling in Management, Vol. 2 No. 3, pp. 232-250,
doi: 10.1108/17465660710834444.
Snyder, G.H., Cotteleer, M.J. and Kotek, B. (2014), 3D Opportunity in Medical Technology, Deloitte
University Press, available at: https://www2.deloitte.com/content/dam/insights/us/articles/
additive-manufacturing-3d-opportunity-in-medtech/DUP_709-3D-Opportunity-MedTech_
MASTER.pdf.
Strong, D., Kay, M., Conner, B., Wakefield, T. and Manogharan, G. (2018), “Hybrid manufacturing –
integrating traditional manufacturers with additive manufacturing (AM) supply chain”,
Additive Manufacturing, Vol. 21, pp. 159-173, doi: 10.1016/j.addma.2018.03.010.
Tazaki, E. and Amagasa, M. (1979), “Structural modeling in a class of systems using fuzzy sets
theory”, Fuzzy Sets and Systems, Vol. 2 No. 1, pp. 87-103, doi: 10.1016/0165-0114(79)90018-6.
Thomas-Seale, L.E.J., Kirkman-Brown, J.C., Attallah, M.M., Espino, D.M. and Shepherd, D.E.T. (2018),
“The barriers to the progression of additive manufacture: perspectives from UK industry”,
International Journal of Production Economics, Vol. 198, pp. 104-118, doi: 10.1016/j.ijpe.2018.02.
003, Elsevier.
Thompson, M.K., Moroni, G., Vaneker, T., Fadel, G., Campbell, R.I., Gibson, I., Bernard, A., et al. (2016),
“Design for additive manufacturing: trends, opportunities, considerations, and constraints”,
CIRP Annals - Manufacturing Technology, Vol. 65, pp. 737-760, doi: 10.1016/j.cirp.2016.05.004.
Varsha Shree, M., Dhinakaran, V., Rajkumar, V., Bupathi Ram, P.M., Vijayakumar, M.D. and Sathish,
T. (2020), “Effect of 3D printing on supply chain management”, Materials Today: Proceedings,
Vol. 21, pp. 958-963, doi: 10.1016/j.matpr.2019.09.060.
Verboeket, V. and Krikke, H. (2019), “Additive manufacturing: a game changer in supply chain
design”, Logistics, Vol. 3 No. 2, p. 13, doi: 10.3390/logistics3020013.
Walter, M., Holmstr€om, J. and Yrj€ol€a, H. (2004), “Rapid manufacturing and its impact on supply
chain management”, Proceedings of the Logistics Research Network Annual Conference,
pp. 9-12, doi: 10.3390/logistics3020013.
Wang, Y., Zhong, R.Y. and Xu, X. (2018), “A decision support system for additive manufacturing
process selection using a hybrid multiple criteria decision-making method”, Rapid Prototyping
Journal, Vol. 24 No. 9, pp. 1544-1553, doi: 10.1108/RPJ-01-2018-0002.
Weller, C., Kleer, R. and Piller, F.T. (2015), “Economic implications of 3D printing: market structure
models in light of additive manufacturing revisited”, International Journal of Production
Economics, Vol. 164, pp. 43-56, doi: 10.1016/j.ijpe.2015.02.020.
Widmer, M. and Rajan, V. (2016), “3D opportunity for intellectual property risk”, A Deloitte series on
additive manufacturing, pp. 1-17, available at: https://www2.deloitte.com/insights/us/en/focus/
3d-opportunity/3d-printing-intellectual-property-risks.html.
Yang, Y., Wang, G., Liang, H., Gao, C., Peng, S., Shen, L. and Shuai, C. (2019), “Additive manufacturing of
bone scaffolds”, International Journal of Bioprinting, Vol. 5 No. 1, pp. 1-25, doi: 10.18063/IJB.v5i1.148.
JAMR Yao, T., Ye, J., Deng, Z., Zhang, K., Ma, Y. and Ouyang, H. (2020), “Tensile failure strength and
separation angle of FDM 3D printing PLA material: experimental and theoretical analyses”,
Composites Part B: Engineering, Vol. 188, p. 107894, doi: 10.1016/j.compositesb.2020.107894.
Zaman, U.K., uz, Rivette, M., Siadat, A. and Mousavi, S.M. (2018), “Integrated product-process
design: material and manufacturing process selection for additive manufacturing using multi-
criteria decision making”, Robotics and Computer-Integrated Manufacturing, Vol. 51,
pp. 169-180, doi: 10.1016/j.rcim.2017.12.005.
Zhang, J., Hu, Q., Wang, S., Tao, J. and Gou, M. (2020), “Digital light processing based three-
dimensional printing for medical applications”, International Journal of Bioprinting, Vol. 6 No. 1,
pp. 12-27, doi: 10.18063/ijb.v6i1.242.

Further reading
Ryan, M.J., Eyers, D.R., Potter, A.T., Purvis, L. and Gosling, J. (2017), “3D printing the future: scenarios
for supply chains reviewed”, International Journal of Physical Distribution and Logistics
Management, Vol. 47 No. 10, pp. 992-1014, doi: 10.1108/IJPDLM-12-2016-0359.

Corresponding author
Varun Sharma can be contacted at: [email protected]

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