Just when I thought it was impossible to put more on my plate, something as simple as a 15 minute conversation with an engineer has led me into an awesome, game-changer of a detour. We visited the Graham Clinical Performance Center this past week and got to see some of the sophisticated methods they use in order to prep doctors-in-training for the real world. The clinic specializes in creating realistic atmospheres and situations to train doctors in patient care, medical assessments, surgery, etc. They hire actors and give them a “script” (a list of conditions and symptoms) and have rookie doctors come in and work with them in order to correctly identify what ails them. In another part of the clinic, they have staged operating rooms with extremely sophisticated dummies that are hooked up to life monitors and controlled remotely in another room, a la The Wizard of Oz. The dummies are given a variety of different traumas that require immediate action…or they will die! IVs must be administered with proper dosages, airways need to be cleared, and hemorrhaging must be controlled. All of this takes place in a confined operating room with time constraints and active monitoring in order to accurately create an operating room environment.
One project they are currently developing is straight science fiction: haptics and virtual reality. Christian Luciano has developed a technology called “ImmersiveTouch” which uses augmented reality to recreate a virtual surgical training environment. It would be impressive enough if it were just a three-dimensional VR module that allowed you to see your hands in the frame as you work on a patient. Yes, that would be awesome. But ImmersiveTouch lets the user FEEL WHAT YOU ARE TOUCHING. The “haptic” function of the simulator is a small, pen-like device that is attached to a mechanical arm and motor. When you look into the virtual world, you see your hand in a 3D landscape, holding whatever surgical tool the program specifies (scalpel, needle, drill). So say you want to practice a lumbar puncture, because who doesn’t?. You put on your 3d glasses, grab the haptic device and what you see is a fully rendered 3D patient with skin, muscles, arteries, nerves and bones laying in front of you. You steady your hand, which is holding the needle in place of the actual pen, you move it into position, and you press it against the patient’s skin. When you do so, the skin dimples around the end of the needle, then the motor-driven device responds and PUSHES BACK against the tool in your hand! You push the needle and it will puncture the skin, then you have to apply more pressure to go through muscle, intervertebral disc, etc., each layer set to have a different density and, thus, requiring a different pressure with the tool. When you touch bone, you can’t push it any further... My brain almost exploded.
When I say 3D patient, I don’t mean a crappy, smooth, simply-rendered polygonal dummy body. They use a combination of CT scans and MRIs to completely map out an actual human body with realistic skin and tissue textures, and you can go through each and every structure one by one. The simulator lets the user remove the skin layer, the muscle layer, make cross-sections through any part of the body - whatever someone would need to do in order to get the best view of approach for whichever surgical procedure they need to do. The 3D glasses allow the user to shift their head from side to side, which changes their position relative to the patient. The pen device can be switched out with simple tools such as scalpels and scissors, which plug directly into the machine for a more accurate feel. Sweet Jesus! The future is now!
With the advent of this technology, surgeons will have the ability to meet with a patient well in advance of their scheduled surgery, take a full scan of their body and go into the simulator and practice the exact surgery that will be required for their patient. They can foresee possible complications, see how structures in their body are associated to the surgical area, and *actually practice* the procedure as many times as necessary to become comfortable with the operation. This is next-level surgical planning and will cut down on the risks of surgery and time under the knife. A surgeon could, in real-time, perform a simulation of the surgery in front of the patient in order to show them what it will require. Barring any hilarious, accidental virtual reality scalpel slips, this could do a lot to alleviate patient anxiety associated with surgery.
“Haptics and Virtual Reality” just so happens to be one of the courses available in the spring, and is taught by the man who created ImmersiveTouch himself! Needless to say, I had to rearrange my class load in order to jump on the haptics bandwagon – I’d be a fool not to. The possible applications of this technology are extremely exciting and the advent of haptics and virtual reality integration in medicine is going to be HUGE.
Oh, the possibilities!