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    Healing in 3D

    Modern medicine leans on Xbox & Avatar: Step inside Plato's Cave, aHouston-developed breakthrough

    Heather Staible
    Jul 20, 2011 | 3:03 pm
    • Plato's Cave at Methodist
    • Ear, nose and throat surgeons use Plato's cave technology frequently.
      Methodist Hospital
    • Doctors use Xbox controllers while looking inside a patient's body.
    • It also involves some of the same technology used in movies like "Avatar."
    • Plato's Cave layers real images onto each other, reconstructing the human body.
      Methodist Hospital
    • A Plato's Cave view of a lung.
      Methodist Hospital

    An Xbox game controller isn’t the typical tool of choice for surgeons, but behind the walls of a nondescript building in the shadow of the Texas Medical Center, it’s an invaluable instrument. So are a computer mouse, a touch screen table monitor and projectors.

    This is the future of medicine and can only be found only at Methodist Hospital’s Plato’s Cave.

    Unlike many medical centers or hospitals, there is no sterile feel or scent in Plato’s Cave. The walls are painted a warm reddish hue — and soft lighting and the gentle whir of computers create a womb-like feel, which makes sense considering the medical advancements born there. Dr. E. Brian Butler, chairman of radiation oncology at Methodist, created Plato’s Cave to cut through the shades of gray found on traditional X-rays.

    The result is an up close and detailed look at a patient and his or her illness, without ever having to make an incision.

    “We are breaking through old ways of thought,” Butler says. “This allows us to look at things the way we never have before.”

    Through technology developed by gamers, video game engineers, Paul Sovelius, Jr., (a scientific computing and visualization specialist at Methodist) and Dr. Butler, slices of images from CT, MRI and PET Scans are stacked on top of one another, reconstructing a 3D image through computer data, which is then projected on a screen. The complex layers of the human body come alive in the most infinite detail, allowing doctors to map out and visualize a personalized treatment plan for each patient.

    Doctors use the gaming controls to fly through a blood vessel three millimeters in size or zoom through the colon, watching out for polyps.

    As with all technology, advances are ongoing. When the program was first introduced in 2009, doctors used specialized glasses to view the 3D images, but that’s no longer necessary. In fact, the technology has made major leaps in just the last two years and in August doctors will be able to use 40 different hand gestures while in surgery to communicate with the technology, showing how the same science behind Microsoft’s Kinect is just as useful in the operating room as the living room.

    Doctors use the gaming controls to fly through a blood vessel three millimeters in size or zoom through the colon, watching out for polyps.

    Soon, a post-operative patient will immediately be scanned from the operating table, the images sent back to Plato’s Cave for analysis and then transmitted back to the operating room 10 seconds later.

    The benefits of Plato’s Cave are immeasurable and Butler feels this is the direction of modern medicine.

    “The amount of time to do operations will decrease, the length of hospital stay and complication rates will decrease, so this will save money,” he says. “We will have a picture book of each person’s medical history and better understanding of diseases. We are moving into evidence-based medicine and this really levels the playing field for surgery.”

    By doing virtual surgery, doctors can gauge things like depth perception. Butler explains the technology through film clips from movies like Lost in Space and Avatar, which superimpose a patient’s virtual body on top of his actual one. Plato’s Cave takes the concept even further with 4D printers, which take a 3D image with an actual recreation of a body part.

    Next to the heat-activated touch screen monitor, a life-sized hand and forearm sits on the table. It belongs to Nancy Huynh who works in Plato’s Cave as the anatomical 3D visualization delineator in the Department of Radiation Oncology. Surgeons can practice on a body part before an operation and even create a specific tool to meet the needs of a particular patient.

    Plato’s Cave technology is also a boon to bedside manner since patients get a straightforward look at their own bodies and the illness within.

    “A patient is diagnosed with cancer and they are scared to death," Butler says. "We can go and show patients with an iPad and educate their patient so they can understand the disease better."

    St. Judes Children’s Research Hospital, the military and even Hollywood are interested in the technology. A writer for the X-Files found Plato’s Cave intriguing.

    Technically CAVE stands for Computer Augmented Virtual Environment, but its roots lie in the literary. Greek philosopher Plato’s "The Allegory of the Cave" centers around a group of people chained to a wall in a cave facing a blank wall. The people see shadows on a wall and assume certain things about the shadow’s shapes, but it’s only when they are able to see what’s creating the shadow shapes do they begin to get a real understanding of what they are seeing.

    Butler likens Methodist Hospital’s version of Plato’s Cave to the allegory because doctors can see the real strata, connected tissues and even movement and sound of the human body in real time and color. Ear, nose and throat specialists are among the doctors who are finding Plato’s Cave especially helpful in surgeries.

    “We aren’t prisoners of previous thought processes,” Butler says and others agree.

    St. Judes Children’s Research Hospital, the military and even Hollywood are interested in the technology. A writer for the X-Files found Plato’s Cave intriguing and modern medical tools clearly deserve top-billing in an episode of Grey’s Anatomy. Plato’s Cave was created in Houston and soon, Washington D.C. will be home to Socrates Cave, with more CAVEs expected to be constructed over time.

    Something to think about the next time you sit down with Xbox controller in hand, ready to play Grand Theft Auto.

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    A crucial big 4-0

    Your heart in pictures: Methodist images provide a stark reminder of how quicklyheart disease strikes

    Heather Staible
    Jul 30, 2011 | 10:47 pm
    • Doctors use an imager to see where blood flow is weak. This image of an abnormalheart shows weakness in blue or black.
    • This is what a normal, healthy heart looks like.
    • The heart is enlarged in this image, showing a bypass graft, indicated by thesquiggly line.
    • This is what a heart with normal blood flow looks like.
    • This aorta shows evidence of a an aneurysm, a widening of the blood vessel. Thewhite line points to the aneurysm.
    • These images compare a normal abdominal aorta to an abdominal aortic aneurysm.

    It's easy to dismiss heart disease as a health problem only affecting older people, or those with a family history of the deadly disease. The reality is, coronary heart disease is the number one cause of death in America for men and women of any ethnic background.

    As the average age of people diagnosed with heart disease creeps lower, lifestyle changes are crucial to hitting the big 4-0 without having a cardiologist’s number saved in your iPhone.

    The Methodist DeBakey Heart & Vascular Center shared images with CultureMap, giving us an up close and personal look at how that cheeseburger, lack of sleep and stressed-to-the-max life can increase your risk of heart disease. The American Heart Association (AHA) encourages people to quit smoking, lose excess weight, eat a healthful diet, control blood pressure and keep cholesterol levels in check to maintain a healthy heart.

    Pictures of an abnormal heart show blood flow is weak across certain areas of the heart (blue or black). Information about blood flow helps doctors diagnose what ails a heart, and also help them decide how to approach surgery.

    Two in three men and one in every two women are at risk for cardiovascular heart disease at the age of 40. If it’s hard to imagine what that looks like, consider a series of images of the same heart, as the imager moves in three dimensions. Each pair of rows is a different dimension. Red shows where blood is flowing the most.

    Pictures of an abnormal heart show blood flow is weak across certain areas of the heart (blue or black). Information about blood flow helps doctors diagnose what ails a heart, and also help them decide how to approach surgery.

    The aorta is the largest and most important artery in the body taking blood from the heart, extending down to the bottom of the abdomen. The appearance of an aneurysm, a widening of the blood vessel, is usually the result of a weakening in the blood vessel wall. If left untreated, aneurysms can rupture, leading to internal bleeding and possibly death.

    Cardiologists treat coronary artery disease with a bypass graft. The grafted blood vessel is taken out of a patient's leg, then surgically attaching it to the heart and the aorta. A bypass gives blood a clearer path, allowing it to flow more easily from the heart.

    Other courses of treatment include mechanical heart valves commonly used by surgeons at the Methodist DeBakey Heart & Vascular Center. Surgeons insert a replacement heart valve by moving the device up the aorta, from the leg to the heart, avoiding open-heart surgery.

    The same everyday choices that endanger the heart can also help it. The AHA suggests positive self-talk, deep breathing, counting to 10, smiling, doing things you enjoy and relaxation exercises as ways to tame the stress in life.

    Even if you only smoke in social situations, cut it out. That is especially poignant for people between 25 and 44 — the age range with the highest percentage of people who smoke. Cigarette smokers generally have higher blood pressure which stretches arteries, causing scarring. Bad cholesterol, called LDL, often gets lodged in the scar tissue and combines with white blood cells to form clots. Good cholesterol, called HDL, helps keep the LDL from sticking and building up.

    Consistent exercise is another heart-healthy choice and a mere 30 minutes a day can do wonders for the heart. Eating at least four and a half cups of fruits and vegetables plus a minimum of two three and a half ounce servings of oily fish, like salmon, tuna, mackerel, herring and trout, weekly are also encouraged by the AHA.

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