What I've been pondering these few weeks is how realistic a surgical animation can be. To reconstruct the entire ALND procedure might require a lot of effort in rendering realistic textures, as well as non-mechanical movements of muscle and fat.
Right now what I could gather from different sources are animations that are more systematic; they are realistically rendered, but somehow I feel that they're not as realistic as what I'm aiming for.
Perhaps I should venture out to other animation such as gaming...(zombies with dangling flesh anyone?)
From reviewing my blog, I realize that I'm making an impression that my MRP is focusing on the Sentinel Lymph Node Biopsy (SLNB) procedure. In reality, the focus of my MRP has changed slightly after our 1st Committee meeting.
The focus would not be on the SLNB procedure, but the Axillary Lymph Node Dissection (ALND) procedure. There is currently insufficient viewing opportunities of this procedure for surgical residents, and therefore we propose to create a 3D computer animation of the procedure, to provide surgical residents with a learning tool.
For more details, please download my MRP proposal.
Date: Tuesday, May 12th Location: Department of Surgical Oncology Conference Room Time: 3-4:00pm
Attendance: Dr. Tulin Cil (Medical Content advisor) Gordon Tait (Non-voting member) Jodie Jenkinson (Supervisor) Michael Corrin (Non-voting member) Albert Fung
General overview of project - While the Sentinel Node Biopsy (SNB) procedure is becoming more common, the Axillary Lymph Node Dissection (ALND) procedure is becoming more obsolete; however there are certain cases where ALND is performed, especially in breast cancer patients that are in an advanced stage.
- Residents/fellows are expected to perform the ALND procedure if necessary, but due to minimal exposure to the actual procedure (as there less ALND procedures done these days), it is difficult for residents/fellows to gain the necessary training
- An online interactive training module would be beneficial to residents/fellows, to learn both the anatomy of the axilla/breast, as well as the surgical procedure
EIT Summer project - We propose that the online framework of the training module could be done as part of the EIT Summer initiative. This could provide me with a headstart to the project.
- A part of the EIT summer project would also involve 'reviving' the existing SNB training module Jodie, Nick, Linda and Meaghan have constructed in 2001. Tasks would include update the references to Pubmed abstracts instead of full-text articles, as well as bringing the website out to the public webspace instead of being confined in the Continuing Professional Education framework, which is password-protected.
Visual Problems - There would two main features in the training module:
A short 3D animation that explains the spatial anatomy of the axilla/breast and the underlying lymphatics,
Surgical video clips that are accompanied with 3D animation clips, with an interactive component (click-on-the-answer type quizzes etc)
- It would seem too ambitious to complete both features for an MRP; thus there is a choice between doing the 3D anatomy animation, or the surgical procedure videos interwined with 3D animation clips
- Following that logic, I would have to choose to either go into the 3D Visualization stream (to make the anatomy animation), or the Media Design stream (which I would focus more on presenting the surgical procedure and the interactive component)
- In addition, I would also have the choice of employing Maya 2009, or Cinema4D. Both are powerful 3D programs that could create excellent visuals, but both choices come with pros and cons.
- For example: Maya 2009 has a steep learning curve, but both Marc and Eddie would be dedicated instructors if I have any problems. Cinema4D is relatively easier to navigate, but I will have to search for help on my own.
Funding and Miscellaneous - Dr. Cil is willing to pitch in $10,000 for funding - The EIT initiative would be funding $4,000 for the summer
- For the surgical videos, we may have to contact Dr. David Adams at the Mount Sinai Hospital in New York for his specialized camera equipment
- In addition, if I were interested in observing the surgery myself, I only have until mid-June to go into the OR and observe Dr. Cil; she will be focusing mainly on research work after that date
Next Steps - I will have to make a choice between doing an animation or constructing the surgical videos module - Dr. Cil mentioned that I may be able to proceed into the Women's College Hospital OR to observe the procedure; I will have to do this before mid-June
- As the EIT paperwork is processed, I will follow up for a list of tasks to be completed this summer
- A final research proposal will be drafted by the end of June; we will meet again at that time
In 2001, Jodie, Nick, Linda and Meaghan Brierley collaborated and produced a professional, interactive online module that aimed to provide extensive information regarding the Sentinel Node Biopsy procedure. The module was also extensively reviewed and evaluated by surgeons, and their feedback were used to further improve the project. Needless to say, this is the most awesome existing visual out there. Source: IVIS Group, Biomedical Communications, University of Toronto (BMC rocks.) Purpose: To educate professionals in the Continuing Education Program of the theories, technical details and ongoing research in the Sentinel Node Biopsy procedure. This online multimedia tool includes documented information on the SNB procedure, interactive Quicktime movies that serve to illustrate the axillary lymphatic system, as well as animations that showcase the SNB procedure. Target audience: Professionals in related fields
Strengths: - Well-documented and extensive information on the theory, technology, anatomical field, actual technique and ongoing research on SNB - Self-test quizzes set after every section to ensure understanding of the presented material - Non-linear navigation allowing user to go back or jump to sections of interest - Clean, categorized layout allows minimal confusion - VRQuicktime interface allows user to comprehend the three-dimensionality of the axilla and its landmarks - Quicktime movie clips visualizes the entire SNB procedures; key steps are highlighted in the animations- Print version available for further review
Weaknesses: - Advanced course with extensive information; suitable for professionals but might be a bit too much for undergraduate medical students - There are still certain aspects in the SNB procedure that requires actual surgical training (e.g. palpation, navigating the gamma probe etc); the course cannot replace these essential sessions - Unsure why the bottom half of the interface is left blank...perhaps can free up more space for text?
Sentinel Node Biopsy education module, provided by CancerQuest at Emory University. The module consists of an education video, information on the procedure in text, a self-quiz as well as external links to related resources.
Source: CancerQuest, an online resource that provides documented information about cancer for the public Purpose: To provide a comprehensive overview of the SNB procedure in a multimedia format. Components include 3D animations, interview footage with doctors, detailed text on commonly asked questions, a self-test quiz and external links to related sites Target audience: Patient/family
Strengths: - Gives a complete picture of the SNB procedure; from the theory to practice and even post-procedural effects - Gives the patient a sense of engagement by including interactivity - Interview footage is useful to 'put a human face' on rationales and practices of the procedure - 3D animation shows clearly the site of sentinel lymph nodes, and demonstrates how dye/radioactive material enters the lymphatics
Weaknesses: - Self-test quiz is malfunctioning - Not an 'introductory' module; patients may have difficulties understanding everything the first time - Narrative/interviews still lack a sense of personal contact; both speak of 'the patient', not 'you'/'your' - The analogy used in the video for the lymphatic vessels and lymph nodes ('small streams joining to form a river') seems misleading; lymph nodes are not merely a collection of lymph - It would help to emphasize how cancerous cells migrate to other parts of the body via the lymphatic system
Sentinel Node Biopsy training video, provided by the University College London. From what I understand, this seems to be a training tool used for surgeons that are interested in practicing the procedure.
Source: University College London Senior Lecturer/Consultant Surgeon Purpose: To provide a narrated video of the SNB procedure to residents/students for training purposes Target audience: Surgical residents/students
Strengths: - A strong narration that guides the view through the process step by step
- Fine technical details are discussed in the video, such as using surgical wrap to hold the breast away from the surgical field, and the proper disinfection methods used for the radioactive probe
- Procedure is seen in its entirety, without omitting finer details of the procedure (e.g. The exploration of the axilla for multiple sentinel nodes, which was not shown in other visuals)
- Realistic footage would help residents/students relate to the actual procedure
Weaknesses: - There are two narrative voices that appear in the middle of the video; one of the narrator and one of the operating surgeon. Both contain valuable information about the procedure, but they are of different sound quality, and at certain times the narrations overlap, making it difficult to hear either one
- Occasional text that flashes on screen have a short duration, and disappears before the view can fully comprehend them
- Not sure how the procedure ends (simple suturing of the surgical field?)
This series was created by Ms. Terese Winslow, a medical artist based in Washington DC. It's a pity I couldn't find the original text/document these images were published for; it seems that the images are freely distributed among the web to all sorts of content.
Source: Medical Illustrator Portfolio Purpose: To provide an abridged overview for the SNB procedure Target audience: Patient/family
Strengths: - Clear and concise, provides the essential details for the SNB procedure - All key steps are accurately depicted (e.g. Injection site, location of sentinel lymph nodes etc) - Minimalistic, anything that is unrelated to the procedure is omitted, thus focusing attention solely on the breast, axilla and underlying lymph nodes - Non-traumatic, will not bring about anxiety to patient or their families by introducing surgical fields
Weaknesses: - Patients/families who are interested in learning more may not obtain more information based on this illustration series; accompanying text can only fill in details to a certain extent - Seems to elicit the idea that the procedure's only goal is to identify and eliminate cancerous tissue (tumor and affected lymph nodes); in reality, SNB is also used for staging and prognosis of breast cancer
This series of illustrations were done by a former BMC graduate, Ms. Myra Rudakewich. Unfortunately I couldn't locate the text that accompany these illustrations...
Source: Medical Illustrator Portfolio Purpose: To provide a general overview and highlight key steps in the SNB procedure Target audience: Undergraduate students
Strengths: - Provides a complete overview of the SNB procedure - Sequential images gives a linear flow of information, guiding the viewer step by step - Insets are useful to fill in details (e.g. Histological section of injection, basic concepts of lymph circulation, radioactive readings) - Layout is clear and concise, allowing the story to flow without obstruction or confusion
Weaknesses: - Limited text; cannot communicate further concepts simply with illustrations - The injection site should be at the tumor site; the illustration does not seem to clarify this - Does not explain the injection of two materials: The radioactive tin colloid and the methyl blue dye, as well as their respective roles in the SNB procedure - The series seem to stop once a single sentinel lymph node is found and dissected, while in reality, the axilla is explored to detect neighboring lymph nodes - The procedure that determines the presence of metastatic cells in the sentinel lymph node seem to be over-simplified
Jodie, Michael and me have been trying to arrange a meeting with Gordon Tait, as well as Dr. Cil. The story goes that Dr. Cil initially contacted Gordon (who is Michael's boss), with an interest to start the Sentinel Node Biopsy project.
However, we still haven't been able to reach Dr. Cil at the moment; the soonest we could meet would be next week, as Jodie wouldn't be available this week except tomorrow morning.
The impact on my preliminary proposal is that I'm not quite sure what scope to use in the broad field of Sentinel Node Biopsy. Should it be patient-oriented, or tailored more to health-care professionals (as Jodie has done a few years ago)? Is it going to be a web-based tool, focusing primarily on interactivity? Or is it going to be showcase a series of 3D animatics demonstrating the theory behind Sentinel Node Biopsy?
I guess the best I could do right now is to pick a field to start with, and merge it with my supervisors' ideas later on when we do have the meeting.
I am currently a Master's student in the Biomedical Communications Program at the University of Toronto.
This blog is set up to document and record the process of creating my Master's Research Project, which is a requirement to complete my M.ScBMC degree.
Through regular blog entries, I hope to capture the thought processes and inspirations I come across, as well as keep my committee members informed on the development of my project.
