Telemedicine, Virtual Reality, and Other Technologies That Will Transform How Healthcare is Provided

1. Telemedicine, Virtual Reality, and Other Technologies That Will Transform How Healthcare is Provided Richard M. Satava, MD FACS Professor of Surgery University of Washington School of Medicine and Program Manager, Advanced Biomedical Technologies Defense Advanced Research Projects Agency (DARPA) and Special Assistant, Advance Medical Technologies US Army Medical Research and Materiel Command 2nd CREST Symposium Telecommunication, Tele-immersion, and Tele-existance University of Tokyo Tokyo, Japan December 10, 2004

2. Figure 4 Scott Fisher wearing one of the first head mounted displays at the NASA Ames Research Center virtual reality laboratory – ca 1985. (Courtesy of Dr. Scott Fisher, PhD, Telepresence Research, Inc., Palo Alto, CA)

5. “The Future is here … . . . it’s the Information Age” Current Visions

6. New technologies that are emerging from Information Age discoveries are changing our basic approach in all areas of medicine . . . EXAMPLES Fundamental Concept

7. Holomer Total body-scan for total diagnosis From visible human to Virtual Soldier Multi-modal total body scan on every trauma patient in 15 seconds Satava March, 2004

8. Why robotics, imaging and • modeling & simulation • Healthcare is the only industry without a • computer representation of its “product” • A robot is not a machine . . . • it is an information system with arms . . . • A CT scanner is not an imaging system • it is an information system with eyes . . . • thus • An operating room is an information system with . . .

9. Minimally Invasive Surgery Remote Surgery Pre-operative planning Simulation & Training Intra-operative navigation Total Integration of Surgical Care Joel Jensen, SRI International, Menlo Park, CA

10. Remote telesurgery “Operation Lindberg” First remote and trans-Atlantic Telesurgery procedure ROUTINE telesurgery from Hamilton to North Bay 300 mile distant Prof. Jacques Marescaux, IRCAD Dr. Mehran Anvari, MD McMaster Univ, Toronto CANADA

11. “TriCorder” Point-of-care noninvasive therapy HIFU High Intensity Focused Ultrasound for Non-invasive Acoustic hemostasis Courtesy Larry Crum, Univ Washinton Applied Physics Lab

12. Medical Education “The resident knows everything (knowledge), . . .” Point-of-care ubiquitous knowledge

13. Total Patient Awareness • Defibrillator • Ventilator • Suction • Monitoring • Blood Chemistry Analysis • 3-Channel Fluid/Drug Infusion • Data Storage and Transmission • On-board Battery • On-board Oxygen • Accepts Off-Board Power and Oxygen “ . . .is aware of everything (patient) . . .” The LSTAT Courtesy of Integreated Medical Systems, Signal Hill, CA

14. LSTAT Deployment to Kosovo - March 2000 212th MASH Deployed with LSTAT - Combat Support Hospital Courtesy of Integreated Medical Systems, Signal Hill, CA

15. Classic Education and Examination

16. Simulation and Objective Assessment Surgical Simulators Laparoscopic hysterectomy Courtesy Michael vanLent, ICT, Los Angeles, CA LapSim simulator tasks - abstract & texture mapped Courtesy Andres Hytland, Sugical Science, Gothenburg, Sweden, 2000 Laparoscopic Simulator with tactile feedback Courtesy Murielle Launay, Xitact, Lausanne Switzerland

17. Haptics Full System ENT Sinusoscopy SimulatorLockheed Martin 1999

18. “Blue Dragon” passive recording device Courtesy Blake Hannaford, University of Washington, Seattle

19. Objective Assessment Novice Intermediate Expert Hand motion tracking patternsAra Darzi, MD. Imperial College, London, 2000

20. “Penelope” – robotic scrub nurse Michael Treat MD, Columbia Univ, NYC. 2003

21. Integrating Surgical Systems for Autonomy The Operating Room (personnel) of the Future 100,000 Surgeon Assistant Scrub Nurse Circulating nurse Satava March, 2000

22. The Operating Room of the Future

24. Predator 2003 Fighter Pilots – until 2002 Fighter Pilots – Beyond 2003 SATAVA 7 July, 1999 DARPA

25. “The Future is not what it used to be” ….Yogi Berra Disruptive Visions

26. The Information Age is NOT the FutureThe Information Age is the Present ...There is something else out there . . . . . . SATAVA 7 July, 1999 DARPA

27. The Future of Science Information is critical but not sole-sufficient Science is moving toward interdisciplinary fields Science must encompass all dimensions (or domains) Must also include time and information ? BioIntelligence Age SATAVA 7 July, 1999 DARPA

28. Clayton M Christensen

29. 2000 BC 0 1500 1800 1900 2000 AD TIME (year) BIO INTELLIGENCE AGE AGRICULTURAL AGE INDUSTRIAL AGE CONSUMER ACCEPTANCE INFORMATION AGE TECHNOLOGY DEVELOPMENT BIOINTELLIGENCE AGE Satava 29 July 99

30. The BioIntelligence Age Biosensors Biomaterials Biomimetic PHYSICAL BIOLOGIC FUTURE Genomics Bioinformatics Biocomputation Robotics HPCC/WWW MEMS/Nano INFORMATION Satava 2 Feb 1999

31. Global Concepts ?? BioIntelligence Age (what are the implications) The entire world is becoming “smarter” - embedded intelligence RF-ID, “smart dust” Networking provides distributed intelligence (informatics, telecom) The next wave will be Bio…..X mimicking or incorporating biologic processes Understanding biologic processes is a cornerstone (4 1/2 Billion yrs) 7 SATAVA 7 July, 1999 DARPA

32. Antenna IC circuit Connector Chip substrate RF-ID Radio-Frequency Identification Courtesy David Brock, Auto-ID and MIT, Boston, Mass

33. Government Inter-disciplinary Initiatives DARPA Fundamental Research at the [Bio:Micro:Info] Interface NASA BioAstronautics/Astrobiology NSBRI Human Systems Integration NCI Unconventional Projects NSF National Nanotechnology Initiative DoE Virtual Human Project Stanford Bio…X

34. Federal Investment in NanoTechnology Table 1. Summary of Federal nanotechnology investment FY 2002 Budget Request (in million of dollars)* Department/Agency FY00 FY01 FY02 FY03 FY04 Department of Defense 70 110 133.0 Department of Energy 58 93 97.0 Department of Justice - - 1.4 Environ Protection Agency - - 5.0 NASA 5 20 46.0 NIH 32 39 45.0 NIST 8 10 17.5 National Science Found 97150174.0 . Total 270 422 518.9 738 847 *Source: National Nanotechnology Investment in the FY 02/03 Budget Request by the President

35. University of Montana, 1999

37. University of Wisconson, 1999

38. Biomimetic Micro-robot Courtesy Sandia National Labs

39. Capsule camera for gastrointestinal endoscopy Courtesy Paul Swain, London, England

40. “BrainGate” John Donohue, Brown University, 2001 Richard Andersen, CalTech, 2003 Greg Kovacs. Stanford University, 1990

41. Recorded activity for intended movement to a briefly flashed target. TARGET PLAN MOVEMENT Time Brain Machine Interface – Controlling motion with thoughts Courtesy Richard Andersen, Cal Tech, Pasadena, CA

42. Thoughts into Action Direct brain implant control of robot arm Miguel Nicholai, Duke University, 2002 Satava March, 2000

43. Spinal Instrumentation Antenna Electronics Module Strain Gauge Pressure Sensor Smart prostheses Neurosurgical MEMS for Monitoring of Spinal Fusion Courtesy: E.C. Benzel, L.A. Ferrara, A.J. Fleischman, S.Roy

44. Tissue Engineering Artificial Ear Liver Scaffolding Artificial Blood Vessel J. Vacanti, MD MGH March, 2000

45. Courtesy of J. Vacanti, MD MGH March, 2000

46. Orb spider - web Spinnerette of spider Spider silk protein as biomaterial -BioSteel Nexia Biotechnologies, Montreal Canada Cross section of synthetic fiber

47. Femtosecond Laser (1 x 10 –15 sec) Los Alamos National Labs, Los Alamos NM Time of Flight Spectroscopy Cellular opto-poration Cold Spring Harbor Laboratory, Long Island, NY

48. BioSurgery Satava September 2003

49. Research in hibernation suspended animation hypometabolic states resuscitation reperfusion Relative size of subjects Alaska Black Bear Artic Ground Squirrel

50. Institute of Arctic Biology’s Toolik Field Station, Alaska's North Slope Suspended Animation Brian M. Barnes, Institute of Arctic Biology , University of Alaska Fairbanks 11/02