Information Technology: Bits and Bytes in Doctors's Robes (Part 2)

by Wiebke Heiss / MEDICA.de15/01/2009

2. Teil: 3D Cinema with Horror Elements



Peter Schlag has only one answer to such futuristic dreams: „This is never going to happen.“ The professor is one of the forerunners in the area of telesurgery and participated in the development of the operating room of the future, the OP 2000, located at the Charité in Berlin. Even though the possibility exists to work devices very precisely from a distance with a delay of only milliseconds this is not Schlag's primary goal. „We really do not need to make surgical procedures that we already handle any more complicated as for example due to moving the scalpel from far away.“ The German surgeon rather concentrates on improving telenavigation in order to enable the physician to get to the desired location inside the body destroying as little as possible on its way there.

This is certainly not as easy as it sounds. A phenomenon called organ shift stands in the way of the surgeon's transparency. Since the patient is not stiff and static, organs shift after the abdomen has been opened, liver and lung can swell like a bruised knee when being cut and on top of it the patient does not stop breathing during surgery therefore being in constant motion. „Data being collected before surgery with the help of CT or sonography do not correspond anymore to the data of a sliced patient“, Schlag describes one of the largest problems of modern surgery. The solution would be a possibility to constantly readjust during surgery. Schlag and his team are currently working on different systems that would one day make this feasible. „3D sonography is especially promising - optoelectronically or electromagnetically“, the Charité professor says.

The future surgeon therefore must get used to devices that allow to work surgical instruments ever more precisely. „Putting things right just by using the hands, the scalpel, suture and acus is going to be a thing of the past soon“, Schlag predicts. The surgeon will soon see the things visually with his own eyes and as a digital model and the surgery making use of natural openings will soon take up more and more space in the surgeon's every day life – and such procedures require a long distance journey through the patient's body. „It is always a lot more difficult to manipulate something precisely with a long stick than if you did it on a short distance with short instruments“, Schlag explains and basically means that new instruments are needed in future. The scalpel will slowly be replaced by devices that will resemble the endoscopic instruments of today.

© University Essen-Duisburg

Also the orthopedist must get used to future changes. His practice could one day remind of a 3D cinema with horror elements thanks to IT technologies that have their peak in virtual reality. „We can take a look from all sides at the patient's skeleton that is standing in the middle of the room. In 3D“, Dominik Raab explains, a young computer scientists from the University Essen-Duisburg in Germany. The only thing you need is MRI data of the patient's bones and a special helmet that consists of two small monitors depicting reality in form of the room's interior as well as the MRI graphics. A doctor wearing the helmet can walk around the virtual skeleton standing in the room and take a look at it from different angles. „That way the orthopedist can make out spacial correlations“, the engineer explains.

Bone date seem to be one of Raab's specialties. He also works on developing a special software with a team surrounding professor …... The software is supposed to combine data obtained by an MRI examination with that of a gait analysis, that have been obtained with an infrared camera filming the walking patient. „We wanted to replace the standardized bone models that have so far been formed the basis of the walking skeleton after a gait analysis with the real bones of the patient“, Raab says. This procedure is supposed to improve the accurateness of the model due to the determination of individual data such as the geometry and angels of the bones. Additionally, doctors can now see whether the bone itself may exhibit a problem such as a knob or a defective position. However, Raab and his colleagues from the Department of Mechanics and Robotics want more, they want simulation. „What would happen if I shortened an upper leg muscle? How would this change the patient's mode of walking?“, Raab questions. The scientists are now beginning to examine these kinds of questions with standing humans and it will take many years until it will be possible to answer such questions also for a walking individual.

Raab and colleagues are also interested into something similar to virtual X-raying: „We want to make it possible for the doctor to use the special data helmet in order to project the MRI data of an upper leg bone onto the real leg. That way the orthopedist can take a look at the real leg revealing also the real bone inside it.“ Artificial reality – also in use with computer games – could that way one day make the doctor's visit to a gamble with reality and illusions – for the sake of the patient's health.

- Part 1: Bits and Bytes in Doctor's Robes
- Part 2: 3D Cinema with Horror Elements