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How virtual reality is changing the game in healthcare How virtual reality is changing the game in healthcare
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In a small operating theatre underneath University College London hospital, a team of cardiologists are in a race against time. They’re performing an angioplasty, a delicate and dextrous procedure where tiny wires are inserted into the heart to widen coronary arteries narrowed by plaque buildup. Things have gone badly wrong. In a small operating theatre underneath Hammersmith hospital, a team of cardiologists are in a race against time. They’re performing an angioplasty, a delicate and dextrous procedure where tiny wires are inserted into the heart to widen coronary arteries narrowed by plaque buildup. Things have gone badly wrong.
One of the wires has perforated the artery walls, causing a rapid leakage of blood. With fluid building up around the heart, the team must act quickly. A microscopic balloon has to be blown up inside the artery to stop further blood loss, before a drain is inserted through a tiny keyhole incision to remove the excess. This has to be done in less than five minutes to prevent the patient going into cardiac arrest.One of the wires has perforated the artery walls, causing a rapid leakage of blood. With fluid building up around the heart, the team must act quickly. A microscopic balloon has to be blown up inside the artery to stop further blood loss, before a drain is inserted through a tiny keyhole incision to remove the excess. This has to be done in less than five minutes to prevent the patient going into cardiac arrest.
While the mood is one of grim urgency, this time it isn’t quite life and death on the line. The patient is an actor and the damaged heart, a sophisticated robot. It’s all part of a highly immersive virtual simulation, the likes of which are rapidly changing the way surgeons, doctors and nurses are trained in the NHS.While the mood is one of grim urgency, this time it isn’t quite life and death on the line. The patient is an actor and the damaged heart, a sophisticated robot. It’s all part of a highly immersive virtual simulation, the likes of which are rapidly changing the way surgeons, doctors and nurses are trained in the NHS.
Emmanuel Ako, a senior cardiologist, is leading the team performing the operation. Like almost all his colleagues, he learnt his trade, the equipment, communication, and the fine motor skills required for the job, through real life operations, chaperoned at all times by a consultant. “Your first puncture or procedure would literally be on a live patient,” he says. Dr Emmanuel Ako, a senior cardiologist, is leading the team performing the operation. Like almost all his colleagues, he learnt his trade, the equipment, communication, and the fine motor skills required for the job, through real life operations, chaperoned at all times by a consultant. “Your first puncture or procedure would literally be on a live patient,” he says.
But the system is changing, and fast. Owing to greater patient awareness and involvement in healthcare, operations are increasingly being led and performed by senior consultants. Trainee surgeons can assist and observe but hands-on experience is harder to come by. “There’s more pressure from patients to have access to the best trained person available,” says Fernando Bello, a researcher in the department of surgery and cancer at Imperial College, London. “Of course this is positive in many ways but, along with reduction in working hours, it makes it harder for trainees to get the exposure they need.” But the system is changing, and fast. Owing to greater patient awareness and involvement in healthcare, operations are increasingly being led and performed by senior consultants. Trainee surgeons can assist and observe but hands-on experience is harder to come by. “There’s more pressure from patients to have access to the best trained person available,” says Dr Fernando Bello, a researcher in the department of surgery and cancer at Imperial College, London. “Of course this is positive in many ways but, along with reduction in working hours, it makes it harder for trainees to get the exposure they need.”
Over the past four years, hospitals across the UK have increasingly been turning to simulation and the virtual world for answers. Bello works at Imperial’s specialist centre for engagement and simulation science alongside Professor Roger Kneebone, who has pioneered the field over the past 15 years. Kneebone first began looking at ways to simulate various scenarios in clinical medicine for training purposes, based on his experiences first as a trauma surgeon and then as a GP.Over the past four years, hospitals across the UK have increasingly been turning to simulation and the virtual world for answers. Bello works at Imperial’s specialist centre for engagement and simulation science alongside Professor Roger Kneebone, who has pioneered the field over the past 15 years. Kneebone first began looking at ways to simulate various scenarios in clinical medicine for training purposes, based on his experiences first as a trauma surgeon and then as a GP.
For surgeons, he uses an array of theatrical techniques to recreate an operating theatre. The sights, sounds and lighting are exactly the same as the real thing, along with the staff. To increase the sense of immersion, trainee surgeons take part in the simulations along with anaesthetists, nurses and various technological and visual effects. For cardiologists performing angioplasty, the robot they’re operating on is draped with an actor sitting underneath it at the head end, to look like a patient lying down. The robot and operating tool are embedded with the latest haptic technology, so it feels exactly as if the tiny wires are being pushed through a real person.For surgeons, he uses an array of theatrical techniques to recreate an operating theatre. The sights, sounds and lighting are exactly the same as the real thing, along with the staff. To increase the sense of immersion, trainee surgeons take part in the simulations along with anaesthetists, nurses and various technological and visual effects. For cardiologists performing angioplasty, the robot they’re operating on is draped with an actor sitting underneath it at the head end, to look like a patient lying down. The robot and operating tool are embedded with the latest haptic technology, so it feels exactly as if the tiny wires are being pushed through a real person.
“When you push a wire into an artery it’s not smooth,” Ako says. “There’s some resistance. And that’s programmed into the system, as is the slight resistance you feel when you make the initial puncture. In front of you they have real life x-rays to navigate, as you would use on an actual person, so you’re getting not only a visual feel, but also the tactile and haptic feel of the equipment. It’s very realistic, very high definition.” “When you push a wire through a diseased artery it’s not smooth,” Ako says. “There’s some resistance. And that’s programmed into the system, as is the slight resistance you feel when you make the initial puncture. In front of you they have real life x-rays to navigate, as you would use on an actual person, so you’re getting not only a visual feel, but also the tactile and haptic feel of the equipment. It’s very realistic, very high definition.”
To test the ability to react in real time to challenges, trainees can face any of a range of pre-programmed scenarios. For trainee cardiologists there are 52, ranging from the wrong drug being accidentally injected, to an artery perforation, to the patient having an allergic reaction to various dyes used to look at their arteries. In the latter case, monitors around the operating table start showing that blood pressure and heart rate are going down, and those running the simulation will instruct the actor via headphones to display difficulties in breathing.To test the ability to react in real time to challenges, trainees can face any of a range of pre-programmed scenarios. For trainee cardiologists there are 52, ranging from the wrong drug being accidentally injected, to an artery perforation, to the patient having an allergic reaction to various dyes used to look at their arteries. In the latter case, monitors around the operating table start showing that blood pressure and heart rate are going down, and those running the simulation will instruct the actor via headphones to display difficulties in breathing.
In future there are plans to combine the existing robotics and haptic technology with Occulus Rift from the gaming world. Surgeons will conduct the simulated operation while wearing goggles, transporting them into a virtual environment containing larger, more complex equipment such as x-ray scanners.In future there are plans to combine the existing robotics and haptic technology with Occulus Rift from the gaming world. Surgeons will conduct the simulated operation while wearing goggles, transporting them into a virtual environment containing larger, more complex equipment such as x-ray scanners.
“There have been studies of surgeons during these immersive simulation and you see that they get a physical response,” Ako says. “So the heart rate’s racing, the adrenaline is up, it’s like an emergency is actually happening. And then in real life it just takes the stress away, you go into that mode and just do exactly what you’ve done in the simulation.”“There have been studies of surgeons during these immersive simulation and you see that they get a physical response,” Ako says. “So the heart rate’s racing, the adrenaline is up, it’s like an emergency is actually happening. And then in real life it just takes the stress away, you go into that mode and just do exactly what you’ve done in the simulation.”
The simulations also allow the often overlooked human side of surgery to be rehearsed and improved. With sometimes 10 or more people involved in an operation, Ako says that most of the time serious mistakes in theatre occur due to poor communication. With large operations increasingly being done on patients who are consciously awake and under local anaesthetic, surgeons are having to learn to communicate with those undergoing the operation.The simulations also allow the often overlooked human side of surgery to be rehearsed and improved. With sometimes 10 or more people involved in an operation, Ako says that most of the time serious mistakes in theatre occur due to poor communication. With large operations increasingly being done on patients who are consciously awake and under local anaesthetic, surgeons are having to learn to communicate with those undergoing the operation.
Kneebone is also looking to use simulations to allow prospective patients who are waiting to undergo a procedure to experience the operation environment beforehand as a way of reducing anxiety. At St Mary’s hospital in London, a new patient experience hub allows them to experience what the operating theatre will look like and even what certain procedures, such as angioplasty, would feel like.Kneebone is also looking to use simulations to allow prospective patients who are waiting to undergo a procedure to experience the operation environment beforehand as a way of reducing anxiety. At St Mary’s hospital in London, a new patient experience hub allows them to experience what the operating theatre will look like and even what certain procedures, such as angioplasty, would feel like.
“The idea is that patients can experience the procedure first through simulation, to demystify it and get used to it,” Kneebone says. “And it allows us to assess things from reducing delays to reassuring patients, and look at how we might do them a bit better.”“The idea is that patients can experience the procedure first through simulation, to demystify it and get used to it,” Kneebone says. “And it allows us to assess things from reducing delays to reassuring patients, and look at how we might do them a bit better.”
There are now more than 20 specialist simulation centres across the UK using these techniques to train those across the medical profession, from surgeons to GPs. Kneebone says this is only going to increase. “There’s going to be big pressures on the educational system with many thousand more doctors coming into the system in the next few years,” he says. “I think simulation offers huge potential to help with that … it’s completely changing the way cardiologists and cardiothoracic surgeons work.”There are now more than 20 specialist simulation centres across the UK using these techniques to train those across the medical profession, from surgeons to GPs. Kneebone says this is only going to increase. “There’s going to be big pressures on the educational system with many thousand more doctors coming into the system in the next few years,” he says. “I think simulation offers huge potential to help with that … it’s completely changing the way cardiologists and cardiothoracic surgeons work.”
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