Mar. 6, 2000 The University of Illinois at Chicago College of Medicine will introduce biomedical tele-immersion into the curriculum of surgical residents beginning in July. The residents will participate in a unique research project to measure whether virtual reality technology, high-performance computing and high-speed networking can improve medical education.
With a new $1.04 million grant from the National Institutes of Health National Library of Medicine, UIC researchers are developing and refining virtual models of the liver, pelvic floor and temporal bone, and studying the models' impact on medical education and training. The project is a collaboration among researchers in the Virtual Reality in Medicine Laboratory in UIC's College of Health and Human Development Sciences, the UIC College of Engineering's Electronic Visualization Laboratory, the UIC College of Medicine's departments of surgery, head and neck surgery and medical education, as well as physicians in the colon and rectal surgery department at neighboring Cook County Hospital.
What do the liver, pelvic floor and temporal bone have in common? They all are highly complex, 3-D anatomical structures that can be difficult for physicians, surgeons and medical students to learn, said Mary Rasmussen, research assistant professor of biomedical visualization, founder of the Virtual Reality in Medicine Laboratory and co-principal investigator on the project.
Among the new medical education and training scenarios the researchers envision are:
* The world's leading medical educators and practitioners provide interactive instruction in real-time for increasingly specialized procedures to medical students and professionals in disparate locations throughout the world.
* Medical educators teach pelvic floor anatomy to all primary-care physicians, increasing the likelihood that these practitioners will be able to identify anorectal disorders, one of the most common reasons why people seek medical assistance, and precursors to colorectal cancer, the second most common form of cancer in both men and women.
* Surgeons in training perfect their skills by performing virtual surgical procedures.
* Experienced surgeons map out procedures by transmitting patient-specific data drawn from MRIs, CATs and other imaging technologies into virtual models.
"When we first show these technologies to medical professionals they usually say 'Wow, that's great, but I don't see how it will help me.' Then two days later, they call us with 20 ideas," Rasmussen said.
Dr. Jonathan Silverstein, principal investigator on the project, said managed care has put pressure on medical educators to find more efficient ways to train medical students. He explained, "Managed care emphasizes getting patients in and out of the operating room as quickly as possible, but teaching takes a lot of time. As a result, today's residents spend less time in the operating room."
Silverstein expects the incorporation of virtual reality models into the UIC College of Medicine curriculum to improve the efficiency and efficacy of medical training and produce residents who are better prepared for operating room experiences.
In the UIC Medical Center application of 3-D virtual reality, surgical residents will explore the models while standing before a 24-square-foot-screen called an Immersadesk. The UIC Virtual Reality in Medicine Laboratory is equipped with two such screens.
The residents wear special eyeglasses to view oversized, full-color, 3-D images of an anatomical structure and simulate their immersion into the environment of this structure. They use an electronic wand to, among other things, point to specific areas, change the orientation of the structure, bring it farther or nearer, add and subtract overlying and underlying structures, and take a virtual tour of the anatomical structure. The eyeglasses track the viewer's movements so that the system automatically orients the model in relation to the viewer.
Anatomy is the foundation of medical education, said Dr. Russell Pearl, UIC associate professor of surgery and biomedical visualization. Virtual reality models have many advantages over textbooks, synthetic models and even cadavers for teaching anatomy, Pearl said. Unlike synthetic models, virtual reality models may be viewed from an infinite number of perspectives and manipulated in an infinite number of ways. Though virtual reality models will not replace cadaver dissections, Pearl explained that they can surpass cadavers, for instance, in the depiction of anorectal muscle anatomy and muscle activity.
In tele-immersion, the viewer is totally immersed in the 3-D environment and is networked to participants at other locations with similar equipment via the Internet. The manipulations by electronic wand of one viewer are reflected in the view of the person at the other location.
The project is called "Biomedical Tele-immersion for the Next Generation Internet" because biomedical tele-immersion is best suited to the wider bandwidth, completely secure Internet that the government is developing. The next generation Internet will be available to users only by reservation.
The University of Illinois at Chicago is uniquely positioned to develop and apply biomedical tele-immersion, Silverstein said, for these reasons:
* Researchers in the UIC College of Engineering's Electronic Visualization Laboratory invented the virtual reality environment, the Immersadesk (and its predecessor, the CAVE) that provides the platform for the team's virtual reality models.
* Electronic Visualization Laboratory researchers are developing broadband networking, the new technology that makes it possible for students across the world to simultaneously view, interact with, and discuss the virtual reality models.
* UIC is home to the School of Biomedical Visualization and Health Information Sciences, which is evolving into the premiere institution for digital biomedical illustration and provides the team with the modeling, medical illustration and computer science expertise needed to design, develop and execute virtual reality models.
* UIC is home to the largest medical school in the country and a large medical center, providing the team with the resources and environment needed for development and deployment.
"Frequently you see technology of this kind and say, 'Gee whiz,' but then find out that it's not being and may never be applied," Silverstein said. "These resources and this infrastructure put us in position to integrate this technology into medical education and medical practice."
Journalists may arrange to explore the models on the Immersadesk by contacting Jody Oesterreicher, (312) 996-8277 or firstname.lastname@example.org
With 25,000 students, the University of Illinois at Chicago is the largest and most diverse university in the Chicago area. UIC is home to the largest medical school in the United States and is one of only 88 national Research I universities.
VIRTUAL REALITY ORGANS UNDER CONSTRUCTION AT UIC
The UIC researchers chose to develop the pelvic floor not only because it is a complex part of the body, but also because it is an area of the body that receives little attention from both the general public and health care professionals. "It isn't aesthetic. It's not socially acceptable to discuss this part of the body in public," said Dr. Russell Pearl, UIC associate professor of surgery and biomedical visualization. "This attitude carries over into medical education. Not a lot of time is spent on anorectal disease in medical school," added Pearl, an attending colon and rectal surgeon at Cook County Hospital. "Sadly, some people are suffering because they and their physicians are uninformed or misinformed."
Pearl is working closely with Mary Rasmussen, co-director of the Virtual Reality in Medicine Laboratory, and other experts in the lab to develop the virtual reality pelvic floor model. The virtual reality model is based on a synthetic model that Pearl and a UIC team developed 10 years ago. The researchers are inputting endoscopic images to recreate the textures of the rectum and anal canal. Viewers will be able to add and subtract superficial and underlying structures including bones, blood vessels and layers of muscle tissue. They also will be able to view the muscle contractions involved in defecation and view pathological conditions including hemorrhoids and fissures. Viewers will even be able to take a virtual tour of this part of the body.
Pearl envisions using the model not only to educate health care professionals, but also to educate patients. "Ideally patients will sit down and view the model with me. When patients understand more, they are more cooperative, more confident in their physicians and, in turn, less fearful of procedures," he said.
UIC otolaryngology-head and neck surgery resident Theodore Mason suggested that researchers in the Virtual Reality in Medicine Laboratory create a model of the temporal bone because of the difficulty of learning surgery on the head and neck. "The problem is that there are very delicate structures - nerves, hearing organs, structures for balance - all of them encased in bone as in a cue ball," Mason said. "To treat some disease processes we have to go in with a drill, without hitting anything. One false move and the patient could be deaf, or one side of his face could be paralyzed. Surgeons in training spend untold hours studying the anatomy of this region."
The researchers, led by Rasmussen, drew from a UIC collection of more than 300 glass slides mounted with cross-sectional cuts through a human temporal bone. Some of the bones in the ear are so tiny that they are hard to preserve, so members of the team sculpted models of these three small bones of the middle ear, called the ossicles. The experts integrated the slides and sculpted models of the ossicles into an electronic 3-D model of the temporal bone and ear. The result, they say, is a more complete and better representation of the complexity of the organ than any two-dimensional drawing or sculpted model. Viewers can take a virtual tour of the ear and even see a translucent pink eardrum vibrate and jostle the malleus bone in real-time response to the veiwer's voice.
Surgeons in training typically operate on 20 to 30 cadaver bones before touching a patient. Exploring the ear with the Immersadesk won't replace the experience of drilling into the temporal bone, but, Mason said, it does provide valuable complimentary training.
The complex and hidden vascular structure of the liver and the tremendous amount of variability among human livers motivated Dr. Jonathan Silverstein, assistant professor of surgery and co-director of UIC's Virtual Reality in Medicine Laboratory, to propose that UIC researchers create a virtual reality liver. The virtual reality liver that Silverstein, Rasmussen and their team is constructing will emphasize the relationship between the surface and underlying vascular structure of the liver.
CAT scans of human livers form the basis for the team's model. "We'll use scans that show interesting variations," Silverstein said. "The key with the liver model is to show variability. Variability in liver anatomy is one of the most important issues."
Residents may not encounter all or even most liver variations during their training and the variations they do encounter, they may encounter just once.
"It's hit or miss," Silverstein said. "By using the model we formalize the knowledge and ensure that residents have seen all of the variations." The model also will show pathological conditions and will be used to train students in surgical approaches to liver disease.
Silverstein said that he is particularly excited about the ability of the researchers to distribute this information internationally. "There are just a handful of people who understand and can teach complex liver anatomy. We are very fortunate that some of them are in the Division of General Surgery at UIC. Now we have an opportunity to share their knowledge."
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