Bringing virtual reality to medical doctors
RASimAs stands for Regional Anaesthesia Simulator and Assistant. The aim of this ambitious project is to gather European experts from very diverse fields, from computer sciences to anaesthesiology, to bring an innovative tool in the hands of the medical doctors to perform safer regional anaesthesia for the patient at reduced cost for the society. For that purpose, a virtual reality simulator and assistant will be developed, providing an innovative way for medical doctors to train extensively on virtual patients and to be assisted by additional patient-specific information during the procedure.
The project, led by the Department of Medical Informatics, Uniklinik RWTH Aachen (Germany), and started on 1st of November 2013 for three years, gathers experts from 10 European countries in a consortium of 14 academic, industrial and clinical partners. Medical doctors specialised in anaesthesia, scientists specialised in medical imaging, computer science or virtual reality and industrials specialised in medical devices have decided to join forces for this ambitious project. The resulting simulator and assistant tools are expected to benefit both to patients and society, with safer and lighter medical load at reduced costs.
Regional anaesthesia (RA) has been used increasingly during the past four decades. This is addressed to the perceived advantages of reduced postoperative pain, earlier mobility, shorter hospital stay, and significantly lower costs. The performance of regional anaesthesia necessitates blocking the peripheral nerves by local injection of anaesthetic. Clinically this is achieved by the insertion of the injection needle close to the peripheral nerve, which is visualized with ultrasound and the proximity of the needle to the nerve is assessed with an electric nerve stimulator.
However, it is a subtle technique and requires good theoretical, practical, and non-cognitive skills to allow trainees to achieve confidence in performing RA and to keep complications to a minimum. Current training methods for RA include cadavers, video teaching, ultrasound guidance, and simple virtual patient modelling. These techniques have limited capabilities and do not consider individual anatomy.
Aim of the Project
The goal of this project is to increase the application, the effectiveness and the success rates of RA and furthermore the diffusion of the method into a broader clinical use through the development of clinical tools to train new anaesthesiologists and assist them during the operation. The project should combine two independent but complementary systems: one system is for training and the other one is for operational guidance.
The training system will consist of one medical simulator recreating RA operation for the anaesthesiologist in a virtual reality environment. The trainee will be able to practise virtually the operation on various patient anatomies. The guidance system will consist on assisting anaesthesiologists during the practise of RA by providing enhanced feedback on image interpretation and patient-specific anatomy.
These two prototypes should be evaluated through a multi-centre clinical trial in Germany, Belgium and Ireland.
Progress towards the objectives
After one year of fruitful collaboration, significant progress have already been made towards the objectives. Relying on a decomposition of the work into several work packages, the first pieces of software and hardware of two prototypes have been developed. Cross-partners support tools such as data storage platform have also been developed to assist the developers in their tasks.
The specification for the simulator prototype has been released. The hardware architecture has been designed and first elements have been tested, such as a 3D printed ultrasound probe and a patient mannequin. In parallel, various software modules are currently in development and being integrated into the first prototype: ultrasound simulator, haptic simulator, courseware module. The software environment for the visualisation and biomechanical simulations will rely on H3D and SOFA software. Finally, a strong focus has been put on the building of the virtual patient, for which image processing tools are being developed to model several patient specificities, biomechanical behaviour of the tissues for RA are being models, as well as physiological behaviour in order to be able to simulate electrical stimulation.
In a similar approach, the hardware architecture and the first software elements have been designed and developed for the assistance prototype. An ultrasound system where the probed is tracked will be used in order to obtain in real-time an image registered on the virtual patient. In terms of software, image-based processing and registration tools are currently being developed in order to provide to the anaesthesiologist an enhanced pre-interpreted ultrasound image and a virtual view of the current patient.
In parallel to these developments, the first technical and ethical documents are being prepared for the approval of the clinical trials, as well as the protocol for the design of the study.
In many cases, general anaesthesia is still favoured over RA even when RA should theoretically be the method of choice, despite its documented benefits for patients: lower cardiovascular stress and other complications, reduced postoperative pain, earlier mobility, shorter hospital stay, and ultimately significantly lower costs. The slow adoption of RA is due to the lack of physician training.
Therefore, the key challenge is the training of physicians in order to increase the market adoption of RA procedures. RASimAs is expected to bring significant clinical, economic and scientific impacts. In particular the results of RASimAs will enable to stimulate the replacement of general anaesthesia by regional anaesthesia in many cases, leading to improved patient care, reduced complications and lower costs.
Controlled clinical trials to evaluate computer-based models and patient-specific approach will demonstrate the benefits of the technology in clinical environment. Advanced research in virtual reality medical simulation as well as real-time assistance based on patient-specific data will accelerate the scientific deployment of such technologies in clinical environment. Finally, by replacing general anaesthesia with RA and improving the success rate of RA procedures, significant reduction of costs are expected, estimated at 100,000 Euros by year and operating theatre.