Simulation Technology Challenges Traditional Radiology Education
Someday soon, adding an intracranial coiling training module to an in-house learning system will be considered as routine as buying a new subscription to a journal for the department library, a medical simulation guru predicts.
 Steven L. Dawson, M.D. Massachusetts General Hospital |
"Simulation is still in its infancy," said Steven L. Dawson, M.D., whose lecture at the RSNA 2008 Opening Session explored the possibilities and challenges of simulation as a learning tool for training programs. "But it's a tool that allows us to re-examine the way we think of education, how we can train in the future and how we adjust our educational traditions to these powerful new methods that hold great promise."
Dr. Dawson, an interventional radiologist and program lead in medical simulation at Massachusetts General Hospital and an associate professor at Harvard Medical School, emphasized that simulation programs—and the funding required to support them—require a concerted effort to reach their full potential.
Interactive Anatomy Program Mimics Video Game
Elsewhere at RSNA 2008, Ramin Javan, M.D., and Bryan S. Jeun, M.D., demonstrated their interactive computer game designed to familiarize students with anatomical structures. Drs. Javan and Jeun, former classmates at the University of Virginia, presented the education exhibit "Interactive 3D Simulation of Head and Neck and Vascular Anatomy with Radiologic Correlates: A First-Person Shooter 'Serious Gaming' Project."
"As part of the generation that grew up playing video games, we learned that when you explore 3D rooms and hallways, you quickly learn the layout and pinpoint exactly where the enemies are," said Dr. Javan, a resident at Baptist Memorial Hospital in Memphis, Tenn.
 A generation that grew up playing video games learns quickly from a game incorporating 3D structures, said Ramin Javan, M.D. (left), who demonstrated his interactive anatomy program at RSNA 2008. Image courtesy of Wake Forest University. |
The object of the game—shooting assorted viruses and bacteria that intelligently follow or flee from the player—is secondary to the exploration of the landscape, an anatomical model consisting of various "rooms" constructed from a conglomerate of virtually created structures as well as actual radiographic images. "The use of real volumetric datasets to create 3D models presents a unique opportunity and challenge," said Dr. Javan. "These models can be imported into the game environment, which will allow a user to view a 'real' patient's anatomy."
"In medical school, Ramin was an artist. He made this complex drawing of all the bony structures in the head," said Dr. Jeun, the game's programmer, now a resident at the West Virginia University Hospitals in Morgantown. "This became the basis for the game layout."
The most complete areas of the game landscape are the head and neck, and Drs. Javan and Jeun said their focus was especially on small and complex structures that are difficult to visualize in the imagination. Right-clicking on any of the structures displays its name. A compass accompanies the player, displaying anterior, posterior, medial and lateral directions. The intent, said the presenters, is to help players envision the structures in their proper spatial orientation.
One of the more elaborate "rooms" is in the inner ear, where players encounter vasculature, bones and nerves in their relative positions. "The room is transparent, and you can see the great vessels," explained Dr. Jeun. "That is relevant anatomy—you have to know they are below the floor." Players can take routes through a number of hallways, doors and windows throughout the head and neck—for example, going through the optic nerve to enter the eye by a route constructed from actual fundoscopic images.
"We have demonstrated our software to medical students and residents and it has been received with high praise," said Dr. Jeun. "For example, users were able to navigate through the pterygopalatine fossa—one of the most spatially difficult structures in the head and neck—in a short time period and were able to successfully describe all of its intricate connections."
Future plans include incorporating the Nintendo® Wii™ controller in the game, designing further anatomic structures and details, adding more Flash tutorials and quizzes, providing "challenges" or "missions" within the game and simulating basic interventional procedures in order to give users the ability to better manipulate the game's 3D world and target objects. The game is currently available on CD and can be installed on a personal computer with no additional software.
"We are in the process of developing the vascular anatomy of the head and neck," said Dr. Javan. "Our goal is to simulate interventional procedures such
 In this image of the game provided by Dr. Javan, bacteria shooting at the player cause damage represented by a reduction in "hit points." The blue transparent boxes represent entry to the skull. |
Organized Medicine Must Take Lead with Simulation
Simulation prototypes have shown success, said Dr. Dawson. "The sleeping giant is the actual specialty that uses simulation. That means that organized medicine must slip into the driver's seat and take control of the direction we're going."
Recent combined efforts of RSNA, the American College of Radiology, Society of Interventional Radiology and, to some extent, Cardiovascular and Interventional Radiological Society of Europe, are beginning to address this responsibility, said Dr. Dawson. Manufacturers will also drive developments as they create new devices for which pre-marketing training would be useful to ensure a smooth introduction, he predicted.
While Dr. Dawson focused on procedural simulation in his opening session lecture, he also noted the usefulness of "team training" simulation, which teaches individuals to communicate and function effectively as part of a group. In addition to training medical students, simulation is useful for introducing experienced radiologists to new procedures and helping them brush up on slipping performance, Dr. Dawson said.
"Our images have become digital and now our education must as well," said Dr. Dawson. "We will enlist radiologists, educational psychologists, engineers, computer scientists, mathematicians, designers and trainees to invent educational systems built around the capabilities of computer-based education, not text-based learning. We will move from lightbox learning to display screen learning. And the students we train will be completely comfortable in this medium, which shares characteristics with video gaming, social networking and immediate response that they use in their everyday lives."
