Illinois Medicine

28 | S U M M E R 2 0 1 7 at Jump Simulation. "Most people don't have a virtual reality tool. The flexibility [vis-à-vis physically printing the 3-D heart] allows for an infinite number of perspectives in interacting with the content. The core element of what we're trying to do is improve understanding of complex pathologies that are related to imaging and modeling." "So, everything we do in this lab is focused around three-dimen- sional work flow," Bramlet adds. "What that means is, in order to see patient-relevant medical content, we must go through this transition from conventional MRI and CT images into a format that works in a three-dimensional environment." The AIM program has 3-D printed more than 65 cases, although the last half-dozen or so have been in virtual reality, and Bramlet an- ticipates this trend will continue. The AIM program was launched in 2013 when Bramlet partnered with Jump Simulation engineers to 3-D print the heart of a 9-month- old girl for presurgical planning. The work changed the course of the girl's surgery, leading to a new standard of care for the most complex surgical cases within OSF. That has since progressed, with a team of engineers now able to produce exact anatomical digital images that can be printed or inte- grated into a virtual environment. "There's an 'a-ha' moment of improved understanding," Bramlet says. "That procedure eliminates gaps in communication between doctors because the 3-D imaging eliminates differences in their ability to look at the heart spa- tially in conventional CT or MRI scans. This is the next evolution in 3-D modeling of the heart. After the success of the first half-dozen cases, the virtual real- ity environment will be applied to every complex pediatric heart case going forward, Bramlet says. He expects that virtual reality will be incorporated into the classroom by fall 2017. "We're pretty far down that road," he says. Students will be better able to learn the pathologies of the heart, he says, and apply that for more accurate diagnosis and treatment in the future. One surgeon who has used the virtual reality setup in actual cases is convinced it's a tool of the future. "What the virtual reality imaging allows you to do, which 3-D printing does not, is enlarge the image to any size you want and divide it and slice into it at any angle as you would wish so you can examine the anatomy. It's almost like being able to walk through the heart," says Mark Plunkett, MD, a congenital cardiac surgeon with OSF HealthCare Children's Hospital of Illinois and OSF Saint Francis Medical Center. "It allows you to define the anatomical relationships inside the heart. That's what this technology is proving to be valuable for," he says. "You can just 'walk around' the heart. I had one patient where I was trying to define the exact relationship of blood vessels at the back of the heart. And I just pulled up the virtual image and was able to define it very nicely." Plunkett says operating on these virtual images is not any more difficult than trying to learn a video game. "You have two handles in your hand that allow you to manipulate things," he says. "I started practicing over 20 years ago, and this would have been science fiction. I never would have dreamed of it when I first started." Technically, it's as if you're looking at the body as a stack of papers, one image and one millimeter at a time, with those images coming to- gether to create a 3-D picture. This process, called segmentation, is how Research Leaps Forward Through Jump ARCHES ANY COLLEGE OF MEDICINE AT PEORIA FACULTY are involved in research aimed at quick implementation through a program called Jump ARCHES, or Applied Research for Community Health through Engineering and Simulation, which is funded with a $62.5 million endowment. At Jump ARCHES, clinicians and engineers jointly work on projects that are meant to reach the public faster through a collaboration between the College of Medicine Peoria, OSF HealthCare and the University of Illinois College of Engineering. "Applied research is an important term because we're not doing basic research," says Paul Pribaz, vice president for simulation administration. "If an engineer has a sensor or algorithm, the money would be used to make it available for health care. Community means it's for our patients. We really want to focus on moving quickly toward patient impact." Matthew Bramlet, MD, for instance, is working on five projects through Jump ARCHES, including a virtual reality system of patient heart models. Through that project, researchers will develop an imaging protocol to help physicians get a better picture of the heart and the brain, leveraging CT/MRI imaging segmentation approaches to create new models for printing 3-D infant hearts (see p. 26). Bramlet is also working on developing an automatic 3-D segmentation method to make it easier to separate out images of particular organs, and a simulator to train surgeons in using extracorporeal membrane oxygenation in adult patients. This skill, which is difficult to perfect without practicing on real patients, helps save failing lungs and hearts during surgery. Other COM Peoria faculty working on Jump ARCHES projects include: • David Crawford, MD, associate professor of clinical surgery, who is performing research to improve the reliability and safety of minimally invasive robotic surgery. • Richard Pearl, MD, professor of surgery and pediatrics, who is putting together a framework that will help define the complexity of the total patient discharge system and enable hospitals to lessen the frequency of patients discharged from hospitals being readmitted soon after. • Charles Aprahamian, MD, clinical assistant professor of surgery, and his team, who are working to develop a new robotic platform that enables high- fidelity digital simulation that will facilitate easy surgical training for clinicians doing minimally invasive single-port laparoscopic surgery. • James Graumlich, MD, professor of internal medicine and pharmacology, who is collaborating with researchers in the development of a natural language processing tool that translates technical medication information into patient-centered language in electronic medical records. — Richard Asa Using a headset and hand controls, learners and clinicians alike can interact with precise, personalized detail of clinical cases. M P H O T O : L L O Y D D E G R A N E P H O T O : J U M P C E N T E R M E D I A S E R V I C E S

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