Advanced Technologies

Bioinformatics May
Forever Change Medicine

VIRTUAL REALITY—A COMPUTER-CREATED environment that simulates real-life situations—is expected to forever change medical practice and the teaching of science and medicine, revolutionizing the way surgery is done. Computer technology to improve the practice of medicine is a major goal of the Center for Bioinformatics at NASA's Ames Research Center, which is part of a larger national Biocomputation Center established by NASA and Stanford University in Palo Alto, California.

The Biocomputation Center is a national resource to further the use of virtual reality in medicine and will seek partnerships with other academic institutions, federal agencies and industry to accelerate the commonplace use of three-dimensional (3-D) and virtual environment technologies in science and medicine, as well as in space. The four areas on which the center concentrates for advanced computer technology applications in the study of biological systems are:

• Three-dimensional, serial section reconstruction (image processing)
• Advanced visualization (graphics/virtual environments)
• Modeling/simulation (finite element/neuronal networks/electrophysiology)
• Neurotechnology (from biological neuronal circuits and systems to chips, processors and computer architectures)

A virtual hospital, planned for the future, will link the best medical minds from around the country and the world to treat patients, simultaneously benefiting long-term human space presence by assisting in the emergency medical treatment of future space travelers. New medical technologies developed at the center will improve the ability of patients and surgeons to see outcomes before surgery is done. The center will also create a digital library of computerized "virtual patients" to be used to teach medical students and help physicians share information on uncommon surgeries.

Surgeons can use the big-screen workbench, special gloves, computer tracking wands and other devices to manipulate 3-D computer images of patients. "The physician can go in the night before surgery and use the computer in a virtual enviro nment to actually walk through the operation," said Dr. Muriel Ross, director of the Center for Bioinformatics at Ames.

Virtual Surgery Cutting Tool Software

Virtual reality computer tools to aid in complex facial reconstructive surgery has already been developed by the NASA-Stanford biocomputational team. Using a pair of 3-D glasses to see a patient's head from all angles on a monitor or virtual reality workbench, the surgeon uses a software scalpel and clear, accurate 3-D images to practice performing and visualizing outcomes of the surgery.

"The surgeon can work on the virtual reality image and replace the soft tissues to see what the patient may look like after facial reconstruction. If the doctor doesn't like what he or she sees, it's easy enough to start all over again," Ross explained.

Reconstruction of Serial Sections (ROSS) Software

Developed by researchers at the Ames Center for Bioinformatics, this software is combined with a series of computed-aided tomography (CAT) scans to make a 3-D image of any part of the body, as part of the virtual scalpel technique. Eventually, software systems could be used in other medical specialties or surgical procedures. The Ames bioinformatics team is working on a variety of virtual reality computer tools to aid in complex reconstructive surgery and other procedures, including breast reconstruction.

Breast Tumor Enhancement Software

The development of breast tumor enhancement software at the Ames Center for Bioinformatics may make it easier, clearer and more accurate for physicians to find breast tumors. A series of magnetic resonance imaging (MRI) breast scans are also combined with the ROSS software to form a high-fidelity, 3-D computerized picture, or "reconstruction," of a breast and tumor.

"These reconstructions are highly accurate 3-D visual models of affected breasts with tumors. Once this technique is fully developed, we think physicians will be able to visualize the borders of tumors more clearly," Ross said. The method eliminates "noise," or interference, seen in the more common renderings of breast tissues done in many clinics.

"Eventually, a special version of the software will be developed for MRI. In the meantime, we have demonstrated that high-fidelity, 3-D reconstructions can be made from typical MRI breast scans," explained Ross. "Later, we intend to work with sonograms," she said, which uses sound to visualize objects inside bodies. "We want to reduce noise that comes from multiple, echo-like reflections of sound coming from tissues. Borders of objects can be difficult to define because echoes bounce and can interfere with one another."

Ames Partners to Implement a Virtual Hospital

In an agreement with Salinas Valley Memorial Healthcare System that may revolutionize modern health care and develop a entirely new way of looking at the doctor-patient interface, cybersurgeons will be making house calls to patients miles and continents away. Work on the virtual hospital—a health care facility without walls but with technology to electronically transmit and manipulate 3D high-fidelity resolute images in real time—began in 1999 with hospital physicians providing feedback to NASA regarding image quality and network efficiency.

The virtual hospital project will give physicians at geographically dispersed locations the capability to share true-fidelity patient data (such as x-rays, MRIs and other 3-D images and data sets) on-line. Doctors will be able to collaborate with their colleagues around the corner or around the world, in the areas of consultation and diagnosis and in the performance of actual, although "virtual," surgeries.

Under the terms of this Space Act Agreement, Ames Research Center uses its expertise in bioinformatics and high-speed, high-bandwidth networks in establishing a workstation at Salinas Valley capable of transmitting data and receiving 3-D images of the human body over NASA's Next Generation Research and Education Network (NG/NREN). The hospital is comparable to UCLA, Stanford and other leading national medical facilities in terms of the number of heart catheterizations, angioplasties and bypass surgeries conducted on an annual basis, according to Salinas Valley officials.

Virtual Collaborative Clinic

This cooperative demonstration project, among five distant U.S. sites connected over a high- performance computer wide area network, was conducted in May 1999 to demonstrate how to use NASA telemedicine to diagnose patients, practice operations and train over a computer network. The demonstration was conducted to support remote collaborations, to plan surgeries and to make diagnoses—and eventually to operate from a remote site.

The sites linked were the Cleveland Clinic from NASA's Glenn Research Center in Ohio, the Northern Navajo Medical Service Center in New Mexico, Stanford University in California, Salinas Valley Memorial Healthcare System from the University of California at Santa Cruz and NASA's Ames Research Center, a major contributor to research on the Next Generation Internet. Physicians and technical staff at the five remote sites interacted with 3-D visualizations of patient specific data using the next- generation high-bandwidth networks, CalRen2 and Abilene, and Engineering Animation's World2World software.

The medical visualizations were a stereo reconstruction of a heart with a graft reconstructed from a CAT scan, stereo dynamic reconstructions (heart shown beating) of echocardiograms with Doppler effects and a 3-D virtual jaw surgery demonstration using the CyberScalpel, developed by the Amesâ Center for Bioinformatics, for irregular-shaped or round bones and organs. The interactions were carried out in real time. Computer screens at the five sites allowed each physician to view every procedure in stereo 3-D as the images of the virtual patient were manipulated. The specialists used high-fidelity, NASA-developed 3-D imaging software to analyze and discuss patients.

"We're looking at methods to bring the clinic to the patient, rather than the patient to the clinic," said Ross, who head's NASA's effort at Ames to develop patient care from a distance. "We're supporting remote collaborations of doctors at different locations on Earth. This will prepare us to use the technology for spacecraft crews traveling to the International Space Station, Mars or other planets, where specialists may not be available."

Specialists could guide a general practitioner or a robot operator on a spacecraft from a great distance, Ross explained. Specialists collaborating from different places on Earth could plan a medical procedure, then send it to an astronaut physician to perform. An operation could be performed in virtual reality a number of times, storing the procedure in computer memory, and then the approach that is best could be used during the actual operation. There have also been discussions of projecting a computer image onto a patient. The projected images could then guide doctors during operations.

The event demonstrated the potential for improving health care at the far corners of Earth through high-performance computing by linking remote sites with the best medical minds and facilities. The Virtual Collaborative Clinic is part of future plans that call for Ames and the Salinas hospital to work with Stanford University Medical Center and the Cleveland Clinic to explore implementing the virtual hospital technology to remote areas around the world. The three hospitals and all major cardiac centers will use high-speed Internet links to exchange images and information.

For more information, contact the Center for Bioinformatics at Ames Research Center.
Call: 650/604-4804, E-mail: http://biocomp.arc.nasa.gov Please mention you read about it in Innovation.