Written on January 5, 2017 by Matthew Bramlet
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.
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.
Written on December 15, 2016 by John Vozenilek, MD, FACEP
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.
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
ultimate 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.
Written on August 25, 2016 by Brent Cross
It’s been another successful summer for our Engineering Internship Program at Jump. This is the 4th year we’ve invited engineering students from all over the country to apply for this prestigious, competitive program where participants receive the mentorship and experience necessary to design, prototype and ultimately bring to market ideas for healthcare simulators and other devices.
25 students were accepted into this year’s cohort, but not all of them were engineering-focused. Two medical and four industrial design students were also included into the mix. This expands on the work already taking place at Jump that encourages collaboration between different disciplines to solve healthcare problems.
A majority of interns worked in dedicated teams of 3 or 4, focusing on a specific project as directed by the full-time engineering staff. Another team was tasked with coming up with its own product ideas that could be continued and advanced through Jump Simulation.
We were impressed with what this year’s interns were able to achieve.
Full-time engineering staff at Jump identify inefficient areas of training, conduct a market analysis of existing solutions, and consult with subject matter experts from OSF HealthCare to develop ideas for simulators. Many of our interns spent the summer working to turn those ideas into functioning prototypes. One is focused on training orthopedic surgeons, emergency medical services and emergency department physicians to treat dislocations. Another simulator will give nurses the opportunity to practice vascular access procedures.
Our engineering interns also worked on prototypes for devices to improve healthcare delivery. The so-called “Remote Neurological Examination System” allows patients with Amyotrophic Lateral Sclerosis (ALS) to be examined by a specialist from the comfort of their home or a rural physician’s office. This is beneficial for patients who are further along in their disease and can’t easily leave their homes. The portable, easy to use, force-sensitive knee brace works in conjunction with a Microsoft Kinect-like room-sensing camera to ensure patients are correctly performing the movements required in the neurological exam. The device instructs patients how to perform the components of the exam correctly, independent of a physician. It then quantitatively describes their performance to a physician.
Another idea for a prototype was borne out of a new program launched through Jump Sim that encourages nurses to submit descriptions of ongoing issues they face along with potential solutions. Two nurses submitted a project idea to improve patient safety. Our engineering interns partnered with the nurses to create a sensor that triggers a small light source under hospital beds when patients get out of bed at night. The device is expected to prevent patient falls.
The quality of this year’s prototypes was higher than in any year past and multiple projects will be continued by the full-time engineering staff. Beyond that, there’s chance the work behind the Vascular Access Trainer will be showcased at a biomedical engineering symposium. The Remote Neurological Examination System group applied for a grant to continue advancing its device through the Prize4Life organization.
Clinical Immersion Internship
We launched the Clinical Immersion Internship program this year as a result of a pilot program we started last summer where three engineering students were integrated into the clinical environment. The idea was for the team to observe and interview physicians, nurses, technologists and specialists throughout OSF to glean ideas for healthcare simulators and devices. The interns involved came up with 12 potential projects.
This year, the program received the backing of the University of Illinois College of Medicine at Peoria, OSF HealthCare, Jump Simulation, the University of Illinois Urbana-Champaign College of Engineering, and SIMnext, a Peoria-based private medical simulation firm. The team was also expanded to include not just four engineering students, but two medical students from UICOMP as well.
The team of six spent 10 weeks immersed with professional clinical teams through OSF and proposed more than 20 ideas for medical simulators and devices. The team was also responsible for vetting their concepts, developing business cases in support of them and working with a “build team” to establish prototypes. Many of the proposed projects will be further developed by our full-time staff.
The interns in this new program received a lot of clinical, translational and technical experience as well as a strong understanding of taking something from the bench to bedside. We expect the Clinical Immersion Internship project to help foster a strong relationship between the engineering program and medical school, and to provide a conduit for healthcare professionals to get their ideas out.
A Unique Experience For Interns
The Engineering Internship Program at Jump gives students an opportunity to get extensive experience with product design. They are taught the importance of interviewing subject matter experts to identify key user requirements for a product and translate them into a functioning prototype. They are able to utilize prototyping facilities and equipment to generate iterations for rapid review. Our interns also receive insights into specific aspects of product and professional development from professionals with experience in this market.
Next year we expect to more fully integrate full-time engineering staff members into the student teams with the intention of producing more refined prototypes at the end of the summer. Full-time staff has previously served in more of an advisory role. Further, we intend to make our instructional lecture series more robust including adding more technical lectures related to the projects we take on next year. We also hope to explore more of the collaborative opportunities available to us through our cohabitation of the OSF Innovation space at Jump by communicating more frequently with members of HealthCare Analytics and Performance Improvement specifically.
This internship program continues to evolve and we look forward to improving processes to make it an even better experience for engineering students.has