Government of Canada and McGill University investment revolutionizes surgical training, allows life-saving dry runs
September 15, 2010 — Montréal, Quebec
Surgeons across Canada will soon have a new tool that will lead to better outcomes for patients undergoing brain surgery. The Hon. Gary Goodyear, Minister of State for Science and Technology, was at the Montréal Neurological Institute and Hospital (The Neuro) of McGill University to open one of seven new virtual reality neurosurgery training centres that will be set up across the country.
"Our government is investing in science and technology to create jobs, improve Canadians' quality of life, and strengthen the economy," said Minister Goodyear. "This new centre will help doctors refine surgical techniques. It will reinforce Montréal's status as a world-leading centre for medical research and provide opportunities to export made-in-Canada technology to hospitals worldwide."
The new Neurosurgical Simulation Centre will accelerate medical training, and allow surgeons to hone their skills and improve patient care by practicing procedures on a virtual brain. The Centre features world-leading technology developed by the National Research Council that was developed in collaboration with surgeons at The Neuro.
Building on last year's world-first brain surgery simulation at the Queen Elizabeth II Health Sciences Centre in Halifax, this virtual reality technology is a significant leap forward in patient care and safety. High-definition haptic hardware allows neurosurgeons to touch and move parts of a simulation of a patient's brain.
"The Neuro is the first neurosurgical centre in the world to have a bimanual simulator. We pride ourselves in providing the most innovative initiatives for advancing medical training and improving patient care," said Dr. David Colman, Director of The Neuro. "Establishing the new centre reinforces The Neuro's commitment to adopting and developing novel technologies and systems to advance neuroscience and provide our patients with the best care possible."
"Neurosurgical oncology is evolving towards less invasive yet more complex procedures that require elaborate rehearsal," said Dr. Rolando Del Maestro, Director of the Brain Tumour Research Centre at The Neuro. "The expertise and technologies developed at The Neurosurgical Simulation Centre will be invaluable, providing neurosurgeons and residents a solid foundation for rehearsing surgical procedures."
“This new centre at The Neuro fits beautifully into our blueprint for 21st-century medicine,” added the Hon. Arthur T. Porter, Director General and CEO of the MUHC. “The clinical adoption of virtual-reality simulation will not only revolutionize how the next generation of neurosurgeons is trained but will also accelerate the adoption of innovative surgical techniques and reduce brain surgery risks, thus improving the quality and safety of the care we provide.”
The new facility at The Neuro is now fully operational and is currently used by resident neurosurgeons from across Montréal. The other Canadian sites for this technology are Halifax, Ottawa, Toronto, London, Winnipeg and Calgary.
As training is increasingly moved outside of operating theatres, virtual training will also streamline the use of valuable operating room time. The new training centres will provide researchers from the National Research Council with feedback from teaching hospitals and neurosurgeons to further improve the effectiveness of the simulator.
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About the Montreal Neurological Institute and Hospital
The Montreal Neurological Institute and Hospital - The Neuro, is a unique academic medical centre dedicated to neuroscience. The Neuro is a research and teaching institute of McGill University and forms the basis for the Neuroscience Mission of the McGill University Health Centre. Founded in 1934 by the renowned Dr. Wilder Penfield, The Neuro is recognized internationally for integrating research, compassionate patient care and advanced training, all key to advances in science and medicine. Neuro researchers are world leaders in cellular and molecular neuroscience, brain imaging, cognitive neuroscience and the study and treatment of epilepsy, multiple sclerosis and neuromuscular disorders. The Montreal Neurological Institute was named as one of the Seven Centres of Excellence in Budget 2007, which provided the MNI with $15 million in funding to support its research and commercialization activities related to neurological disease and neuroscience. For more information, please visit www.mni.mcgill.ca.
Backgrounder
Virtual Brain Surgery
Patient-specific virtual reality systems for surgical oncology
Rapidly evolving surgical techniques, patient safety concerns and the current inefficiency of operating room (OR) training are quickly driving the need for innovative simulation technologies in medicine. The potential for surgical error and the need for training are highest during the surgeon's learning curve. Simulation technologies allow surgeons to learn and practice complex medical procedures in a safe environment outside of the OR. The approach is similar to pilots that train with flight simulators before their first takeoff.
Virtual reality (VR) simulation, when combined with advanced imaging technologies such as magnetic resonance imaging (MRI), enables realistic rehearsal of an individual patient's surgical procedures prior to actual surgery. The potential of VR-simulators is far-reaching; not only does this technology have the capacity to improve and accelerate training procedures for surgeons, it also has the potential to yield better patient outcome as well as a more efficient healthcare system.
The surgical management of cancer, the most frequently used brain cancer therapy, is evolving towards less invasive yet more complex procedures that require elaborate rehearsal. Tumour removal is high-risk because of (i) potential damage to surrounding tissues such as functional areas, nerves and blood vessels and (ii) risk of cancer recurrence from incomplete tumour removal.
The NRC Patient-Specific Virtual Reality Systems for Surgical Oncology program aims to develop a VR-based simulation system for training, planning and rehearsing brain tumour surgeries. The system integrates medical image processing, material models, finite element modelling, graphics and haptics technologies to create patient-specific simulations. Picture a surgical rehearsal system that takes a scan of a specific patient's tumour and uses sophisticated software to convert that tumour image into a virtual environment. Add the system's ability to display touch and visual feedback to give the surgeon access to a highly-realistic and patient-specific surgical training tool. While this program is currently focused on neurosurgical oncology, this research will also provide a solid foundation for rehearsing a variety of other critical tumour resections such as colorectal, prostate and breast cancer.
The program involves the collaborative efforts of experts from NRC research institutes located across Canada. Furthermore, the program is strongly reinforced by a cross-Canada (from Halifax to Vancouver) network of hospitals, represented by key surgeons.
Overview of the system
We are developing a system for:
- surgical training,
- patient-specific surgical planning, and
- patient-specific surgery rehearsal
The system consists of the following main subsystems:
- The surgical planner
- The surgical VR trainer
The surgical planner permits the definition of the craniotomy and surgical corridor, by providing the surgeon with tools for the analysis of 3D medical images of various modalities. Medical imagery includes both standard-of-care and research images (e.g. diffusion-tensor imaging, functional MRI). Also, the surgical planner allows the spatial delineation of structures of interest (e.g. vascular structure, tumour mass, activation zones in fMRI, craniotomy extension) based on the fusion of available medical imagery.
Once the surgical corridor is defined, and objects of interest in the image have been identified, the surgical planning module will produce mathematical representations, or models, of the objects of interest. The models include the graphical representation of the selected objects and the virtual mechanical tissue model that will allow the rendering of haptic feedback during the surgical training/rehearsal stage. Greater detail is encoded in the models in relation to spatial regions that are enclosed by the surgical corridor, as compared to more distant regions: such variability in the level of detail in the representation is required in order to achieve a satisfactory real-time simulation of tissue mechanics during surgical training.
Patient-specific surgical rehearsal is achieved when the models generated from the planner are directly used in the simulator, as illustrated in Figure 1.
Figure 1: Block diagram for the surgical planning module. “Surgical Planning” involves craniotomy and surgical corridor definition, and extraction of objects of interest. “Model Generation” denotes the construction of mathematical models of the brain, in a manner appropriate for use in the surgical VR trainer (“Simulator”).
The surgical trainer allows a surgeon to interact with surgical tools in a 3D virtual space. The trainer has been designed for the development of skills ranging from basic motor skills to decision making. The simulator will include basic neurosurgical and patient case scenarios on which to train, with the same look and feel as in an actual surgery. For basic skills training, we took inspiration from the Fundamentals of Laparoscopic Surgery (FLS) program to develop a set of 5 basic neurosurgical tasks, the Fundamentals of Neurosurgery (FNS). A database of prepared brain tumour cases will also be available for procedural skills training. Metrics have been implemented in the simulator for automated assessment and instant feedback of user performance. Figure 2 describes the surgical trainer.
Realistic surgical simulation is obtained using finite-element (FE) software, which accurately predicts forces and deformations resulting from interactions between biological tissues and surgical tools, along with high-resolution visual and haptics rendering. The FE software is entirely developed in-house. Non-linear constitutive tissue models have been implemented into FE software to predict large tissue deformations and contact mechanics. Also, multi-mesh deformable models, including separate meshes for the surface and the underlying volume, are used to permit fast computation. Topology changes associated with tissue dissection are supported in the trainer.
Figure 2: Block diagram for the surgical trainer.
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