May 15, 2009
NASA Celebrates 10th Anniversary of the Virtual Collaborative Clinic
 What do a Navajo grandmother and a NASA astronaut have in common? Both live in desolate, remote places, either in the New Mexico desert or aboard the International Space Station, and both will have difficulty getting medical treatment or transportation to a hospital if needed.
NASA
early on realized that there may be times when astronauts get into
trouble and require emergency medical assistance, whether they are
traveling in space, or living on the International Space Station. To solve this problem, NASA's
Ames Research Center developed a "virtual clinic" 10 years ago that has
been helping underserved populations in some of the most remote places
on Earth.
Celebrating its tenth anniversary this month, this "virtual clinic," called the Virtual Collaborative Clinic (VCC),
has been providing advanced medical breakthroughs since its inception.
When Ames developed this highly sophisticated "telemedicine," it was a
giant leap forward for health care.
"At a time when virtual
presence was only a dream, innovative thinkers at Ames demonstrated
that people from various site locations could work together in real
time, share expertise, information and skills to improve health care
delivery for communities in some of the most remote areas in the
world," said Steve Zornetzer, Associate Center Director and the former
Director of Information Technology at Ames.
The Virtual Collaborative Clinic
Conceived and developed at the Center of Bioinformatics at
Ames, a design team lead by Muriel Ross, developed three software tools
to help diagnose and plan medical treatment in the most hostile
environments. These tools combine advanced medical imaging with
high-performance, high-speed networking to give doctors
three-dimensional, high resolution, color images from a desktop station
in real time.
The first software application, "mesher,"
generates high fidelity, stereoscopic visualizations of
patient-specific data. Using information obtained from electron
microscopy, CT (computerized tomography) or MRI (magnetic resonance
imaging) scans, software engineers develop visualizations of the
patient's bone, tissue or organs.
Once these images are made, a second software tool, called "CyberScalpel,"
allows physicians, administrators and technicians at different
locations to view and evaluate the patient's problem or injury and
discuss the best medical procedure for treatment. By rotating and
manipulating the image, physicians can practice surgical procedures in
a virtual environment, reducing the time needed for surgery and
potentially improving surgical outcomes.
Physicians can cut into
virtual images and even remove tissue or bone. Sessions are
collaborative; any participant, whether local or distant, can rotate
the image to view it from different perspectives, while other
participants watch the same display and offer differing opinions for a
truly interactive atmosphere.
The Network
The
third tool is a multicasting application that enables simultaneous
sharing of information at various sites. The software regulates
information received and sent from routers, by minimizing transmission
delays to deliver data in near-real time, synchronizing large, 3D image
displays at end sites, and accommodating satellite/ terrestrial
networks on disparate platforms. To solve these problems, Cisco Systems
contributed the design of the multicast internet software.
In
addition, for the interactions among sites to be successful, the
network system needed bandwidth, scalability, reliability, and
multicasting capabilities. NASA needed an end-to-end IP-based network
solution. These networks --- the NASA Research and Education Network (NREN), the National Science Foundation's Very High Performance Backbone Network Service (vBNS),
Abilene, and the California Research and Education Network (CalREN2) –
connected the participating sites with the application server at Ames.
For
the satellite component, NASA used a very large bandwidth application
that provided high-speed access to the internet. This network solution
enabled NASA to connect five major facilities –Salinas Valley Memorial
Hospital from the University of California at Santa Cruz, Stanford
University Medical Center in California, the Northern Navajo Medical
Center in New Mexico, the Cleveland Clinic at NASA Glenn Research
Center and NASA Ames Research Center --- with high-performance WAN
(wide area network) that stretched across the United States.
A Concept Becomes Reality
With
all systems ready, the VCC was launched on May 4, 1999. For the first
time in history, medical experts from five sites had the opportunity to
discuss actual cases while viewing specific complex visualizations for
surgery in real time. Using ground link and satellite transmissions
through the VCC, doctors discussed cases and, in one instance,
performed virtual surgery. On the day of the demonstration, UC Santa
Cruz also set up an auditorium on site for anyone to observe what was
happening in the Virtual Collaborative Clinic.
The Cleveland
Clinic team discussed a case where the patient suffered from an
enlarged heart. The Salinas site treated an infant's arrhythmic heart
and results of cardiac surgery were presented by the Navajo, Cleveland
and Salinas hospitals.
"Dr. Muriel Ross and her partners in the
private sector, the health industry and private clinics, conceived,
implemented and demonstrated the utility of the Virtual Collaborative
Clinic," said Zornetzer. "NASA is
known for its leading edge technical capabilities, and the VCC project
demonstrated, over a decade ago, what is only today becoming more of a
reality."
New Developments
 Today
VCC is used for tooth autotransplantation, and to correct cleft
palates, facial reconstructive surgery, and hip reconstruction. Michael
Stephanides, a research physician at Stanford University Medical
Center, recalls three projects that were spawned from the 1999 virtual
clinic. The projects included software for a surgery to rebuild a
woman's face (nose and cheek); a microsurgery training simulator which
resulted in a prototype; and a 3D measuring tool that created jaws out
of leg bones for cancer patients.
"Advances in computing over
the last ten years have rapidly improved imaging and simulation in
healthcare. At Stanford, we were able to develop a simulation system
for craniofacial surgical planning. This technology is a significant
advantage in surgical planning and education, both of which can improve
patient safety and outcomes," said Dr. Stephen A. Schendel, a former
researcher at the Stanford University Medical Center in California.
Doctors say simulated surgeries save time and improve surgeries, and the VCC allows them to perform simulated surgical procedures. NASA's long-term goal for the VCC is
to ensure the health of astronauts as they probe deeper into space. But
the clinic's advanced network technologies also will help make
"universal" health care a reality, by offering the same quality health
care to patients in outlying areas as those who are treated in large,
well-known institutions.
The medical professionals involved in
the Virtual Collaborative Clinic would like to acknowledge the
contributions made by Bruce Finke, MD and Mark Carroll, MD from the
Indian Health Service.
Posted at 05:00 am by sarahbaltic
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