Closing in on Anatomic Replication

The purpose of medical imaging from the very beginning was to figure out ways to look inside the body and learn what’s going on structurally and physiologically. To that end, physicians used x-rays or performed exploratory surgeries for decades to identify disease or injury. Then came the ultrasound in the 1960s that gave clinicians real-time images of internal body structures using sound waves. Imaging techniques progressed even further in the 1970s with the advent of CT scans and MRI, which are both commonly used today.

Dr. Matthew Bramlet discusses importance of anatomic replication at AHA Heart Innovation Forum. It’s my belief that 3D modeling will be the next critical tool used by physicians to not only diagnose, but improve surgical planning, patient outcomes and the education of future clinicians. It has the power to essentially produce exact replications of soft tissue structures, improving understanding among doctors and patients alike. But first, it will take collaboration across the U.S. to make this a reality.

I recently spoke at the American Heart Association-Midwest Affiliate’s Heart Innovation Forum to advocate for imaging techniques that lead to anatomic replication. The Advanced Imaging and Modeling (AIM) team at Jump Simulation has come up with a semi-automated process to convert CT and MRI scans into 3D digital images that can be printed or integrated into virtual environments like augmented and virtual realities (AR and VR). What we’ve learned is that these nearly perfect 3D surrogates of anatomy can’t happen without working to create quality images from the start.

Garbage In, Garbage Out

The old adage “garbage in, garbage out” applies directly to 3D modeling. The standard across the nation for the last ten years has been to quickly produce images that might not have the best quality but lead to diagnosis in an efficient and productive manner. The ability to print or view these images in three-dimensions, though, requires a little more time and effort but leads to discoveries we’ve never seen before.

There is a quality standard that must be met each step along the continuum of 3D modeling translation. If the image is poor – fail. If the segmentation is poor – fail. If the print is poor – fail. If the VR translation is poor – fail. The focus of our cardiovascular imaging efforts at OSF HealthCare is to generate the highest quality images we can attain.

Most recently, we sent a quality focused 3D heart digital file to the incredible engineers at Caterpillar’s additive manufacturing lab. They have a printer that allows us to produce a heart in a soft enough material that can be cut with a scalpel, allowing surgeons to effectively practice on a patient’s heart before surgery. The result was incredible. Not only were we able to practice the surgery before the operation, but we were able to see anatomic detail like never before seen, prompting an entirely new set of possibilities where 3D printing could potentially improve patient care.

Making a Case for High-Quality Imaging Standards

There are many physicians around the U.S who understand the impact 3D modeling can have on surgical planning, patient outcomes and the education of future clinicians. In fact, a group of us are working with the National Institutes of Health and the American Heart Association to create accuracy and quality standards for the Jump Simulation-curated 3D Heart Library, an open-source digital repository of hearts with congenital defects on the NIH 3D Print Exchange. However, I recognize there are still some skeptics out there who don’t understand the value of this technology.

My experience with these models has been that they give surgeons a point of reference they haven’t had before, giving them the ability to make informed decisions before operating on patients. They make viewing anatomical images intuitive across all medical specialties. 3D models give patients and their families a better understanding of procedures they may have to undergo. They also allow educators to easily explain different types of congenital heart disease and what they look like to physicians looking to master the skill of diagnosis or surgery.

Physicians are busy and it’s difficult to put the time and effort into higher quality imaging. However, doing so leads to exact anatomic replications and, in my opinion, is the next big jump in medical imaging surrogacy. It’s going to take clinicians making medical decisions or planning surgery to be impacted by this for the advocacy to come through the clinical community.

Advancing Simulation Beyond Education

Simulation in health care has powerful potential. For years, it’s been utilized to educate and train those seeking a career in medicine. It’s also been leveraged as a way to provide insights into latent health system flaws such as communication issues among clinicians or whether a medical facility has all the essential tools it needs to provide the best care possible.

u-of-i-innovation-space OSF HealthCare, through Jump Simulation and the University of Illinois, is expanding its use of simulation even further by leveraging it to design novel solutions in health care. The idea is to simulate problems discovered throughout the health care system so that engineers and clinicians can observe and brainstorm ways to fix these issues.

Using simulation as a design tool is still fairly new to health care systems around the U.S. But Jump Simulation and U of I have been collaborating on this type of work since the opening of Jump Trading Simulation & Education Center, so much so that there are now dedicated labs for these collaborative efforts in the newly minted space within Jump called OSF Innovation.

Four Labs, One Purpose

All four labs are located on the fourth floor of the Jump facility. Two will be dedicated to the ongoing work Jump Sim has established with the University of Illinois’ Colleges of Medicine and Engineering through Jump Applied Research for Community Health through Engineering and Simulation (ARCHES). The other two rooms are committed to projects in Advanced Imaging and Modeling.

All four assignments pair clinicians and engineers to develop medical education technology that will advance the clinical agenda at OSF. This is part of a larger effort by the University of Illinois re-thinking how it innovates around curriculum.

Two of the projects utilizing innovation lab space were recently awarded a continuation of Jump ARCHES funding. One team of individuals from OSF HealthCare, U of I, Illinois Neurological Institute, and Bradley University is creating a device to teach young health care professionals to practice feeling and identifying abnormal muscle behaviors in patients with brain lesions. The goal is to expand training to more than just neurologists so that OSF can increase the number of patients served.

The second development is focused on producing an avatar-based system to communicate with patients at the time of discharge so they fully understand their medical instructions before going home. The system could also be used to train medical students to communicate with patients in a simulated environment. The
dikshant-pradhan-working-on-orthopedic-trainerultimate goal of the project led by clinicians and engineers from U of I and OSF is to reduce readmission rates at area hospitals.

The two labs devoted to work in Advanced Imaging and Modeling are leveraging virtual and augmented reality technologies like the Oculus Rift and HTC Vive to revolutionize how clinicians and radiologists view anatomy and advance how human anatomy is taught to medical students.

Nurture, Validate and Disseminate

The intention of committing space for collaborative work among clinicians and engineers is to support teams with great ideas and provide technical and clinical expertise to advance their projects. Each of the teams selected to use the lab space within Jump will get to do so for up to a year. From there, these ventures can be validated within the simulation space at Jump and throughout the OSF Healthcare System.

Completed projects could eventually find a home within the University of Illinois’ curriculum and disseminated to its various medical campuses. It’s this ongoing collaboration between OSF and U of I that makes Jump Simulation a one-of-a-kind facility.

User-Centered Design Utilized to Develop App for Oncology Patients

Ensuring patients take their medications as prescribed by their doctors is an ongoing issue across the world. That’s even the case for patients with life-threatening diseases like cancer. Patients cite a number of reasons for failing to take oral anticancer medications (OAM), including confusion around when and how to take their pills. This is something I’ve witnessed firsthand.

user-centered design utilized to design appAs part of a master’s research project at the University of Illinois at Chicago, I shadowed an oncology pharmacist and pharmacy student as they gave medication instructions to a patient who was diagnosed with cancer for the second time.

The patient had experience taking OAMs before, but that didn’t make it any easier for him to retain all the directions that come with these types of medications. For example, the chemotherapy drug prescribed to this particular patient comes in 150 mg and 500 mg pills. To get the correct dosage, he had to do some math to get the 1800 milligrams he needs per day. The meds must also be taken for two full weeks every 21 days. Discussion about side effects is also part of the consultation.

Even with a background in pharmaceutical sciences, I would not have remembered the verbal instructions had I not written and doodled them down in my sketchbook. For OAMs there is a greater responsibility for the patients to make sure that they follow their prescriptions precisely (in contrast to IV chemotherapy). For effective self-care, patients need to be engaged and well informed.

Developing a Solution to OAM Non-Adherence Using User-Centered Design

An interdisciplinary team at the University of Illinois at Chicago (UIC) has developed a personalized mobile app to address some of the reasons cancer patients fail to take their medications correctly.  The goal of this project was to design a customized mobile app to empower patients taking OAMs and serve as a visual aid in facilitating communication between patients and their health care team.

My role was to incorporate user-centered design to create the user interface (UI) of the app, distill medical instructions in a visual way to engage the patients, and interview clinicians to determine what problems or challenges they are having and how we can overcome those challenges and deliver an effective educational tool.

My research found that cancer patients have a difficult time processing all of the information communicated to them by physicians because there’s so much to retain and they are already in a vulnerable, emotional state. Time constraints during in-clinic visits also present problems for clinicians to effectively deliver intervention details to patients.

My team decided to incorporate pictures and animation into the mobile app to help patients more easily understand the complex medical instructions they must follow. Studies have shown that pictures help patients form a mental model of a situation and enhance comprehension of text. It’s also been determined that use of a mobile device, in conjunction with animation has been shown to significantly improve patient understanding and clinician-patient communication, oam-2especially in low health literacy populations.

The app my team created is designed so patients can utilize it in the oncology pharmacy waiting room or during counseling with clinicians. The functionalities of the mobile app include:

  1. Patient-centered educational tutorials that include pictures of the specific OAMs prescribed along with information on the specific dosage and schedule.
  2. Patient scenario modules that allow patients to role play what they are supposed to do in certain medical situations.
  3. Customized medication calendar.
  4. Tailored text messages for reinforcement of take-home instructions and follow-up appointments.
  5. Personalized data are taken from specific patient’s electronic health record to ensure the information is customized.

How Did Patients Respond?

We gave patients the opportunity to evaluate prototypes of the different user interfaces UI) as well as the animations. They gave us their opinions on the icons used, the colors, font type, font size, and the layout and graphic elements in each design as well as the style of the animations.

We found that the patient scenario modules allowed patients to identify with the fictional patients in the scenarios, and were effective in modifying behaviors. By involving patients early in the design and development process, we invited them to be an integral part of their own cancer treatment team.

Current State of the Project

The application is now coded and hosted on Health Insurance Portability and Accountability (HIPAA)-compliant servers allowing tablets to access patient electronic health records. The research team is conducting a feasibility study at the UIC Cancer Center to evaluate this mobile education tool and how it will contribute to patients’ adherence to their OAMs and our understanding of the function served by visual aids in facilitating communication between patients and their health care team. Jump Simulation could help test the application in a Phase II study, pending grant funding.