Support : eNewsletters : Eye on Innovation : Issue 5, June 2010

Video games in medicine: Entertainment or Innovation?

"Creativity is thinking up new things. Innovation is doing new things." — Theodore Levitt

The nurses have been told there's a crisis. But they're hardly prepared for the chaos that awaits. Dozens of patients, stricken with a debilitating flu, crowd the emergency room. Some slump mutely in chairs. Others wander, moaning or calling out for blankets. Just as the nurses begin triage, part of the hospital goes dark: a blackout. This chaotic scene isn't real—it's part of an online simulation designed to help nurses make quick, sure decisions in emergencies. Imperial College London created a 3-D clinical environment and video with virtual patients that trainee doctors can diagnose and treat.

The multi-billion dollar video game industry has come a long way since its earliest electronic game, a cathode ray tube (CRT) missile simulator created in 1947 and the release of PONG in the 1970s. Video games have been accused of leading to childhood obesity, social isolation, stunted creativity and excessive exposure to violence. And, today, video games have even been miniaturized to hand-held devices enabling gamers never to be far from their "mindless" entertainment. For all the negatives, gaming has many beneficial effects such as improving hand-eye coordination, increasing fine motor and spatial skills, solving problems and improving reading and math skills.

In this issue of Eye on Innovation
Are video games a waste of time, mere mindless entertainment, or can they foster skills that lead to highly trained medical personnel and help patients as well? In this issue of Eye on Innovation, we'll:

• explore innovative uses of video games and virtual reality in medicine,
• identify top inventor locations for surgical simulator apparatus and
• check market and industry information to identify top companies in the field.

And, not to forget about cleantech discussed in Issue 4, we'll see if the cleantech industry is continuing to expand and where.

Video games—innovation or just plain fun?

In the health care industry, video games and virtual reality (VR) have long been recognized as a potential training tool for medical personnel. In a search in the Dialog OneSearch® category MEDICINE, articles relating video games and laparoscopy date from as early as 1993. For example, an article from the New York Times by John Holusha: "Carving out real-life uses for virtual reality; before cutting soft tissue, future surgeons may practice with 3-D software," focuses on utilizing virtual reality technology as a cost-effective method to train surgeons. In the early 1990s, the only way for surgeons to learn their specialized techniques was by practicing on animals or cadavers. Cadavers are expensive and do not provide the type of feedback such as cutting depth or nearness to other organs that VR software can provide. In 1993, Cine-Med, a French medical training company, announced it would introduce its first commercial laparoscopic VR training system in 1995. At the same time, the National Institutes of Health (NIH) began work on digitized cadavers that would work with VR software!

3-D isn't limited to wearing glasses in darkened theaters anymore
Virtual reality promises more than entertainment experiences. It could enhance learning, assist in surgical training or help reduce pain. Think of VR as an immersive type of 3-D video game. Users don a VR helmet while watching a video. Special software and a joystick let them look all around and take in the whole environment, including special-effect sounds and sometimes even smells. For example, computer-generated surgical simulators allow residents to practice and refine their techniques in a safe and cost-effective manner. Using VR gives the surgeon the feel for the technique and provides performance feedback. This is called haptic or force-feedback systems. Simply put, haptic VR surgical simulator systems give the surgeon the feel of "real" surgery and use all the motions required to perform the procedure. Virtual reality is truly the next step in the booming medical training industry.

If you're no good at computer games, don't operate!
An article written by David H. Banta in the British Medical Journal in 1993 on minimally invasive surgery (MIS) stresses the need for proper training for surgeons. The author states, "Traditional surgeons value manual dexterity. They open a body with a hand-held knife and sew the body shut by hand. They feel affected organs and judge whether tissue is normal. With minimally invasive surgery, surgeons must be able to judge three dimensions by looking through a scope and must be able to manipulate instruments guided by this judgment. It has been suggested that the skills required in playing video games are more relevant than the traditional skills of the surgeon."

Are video game skills really relevant to MIS surgeons? Several studies emphasize the point:

• Study 1. In a study cited in the Archives of Surgery, 2007, 33 residents and attending physicians were part of a 2002 study to measure whether any correlation exists between past video game experience and laparoscopic surgical skills. The study consisted of three different video games and surveys that took into consideration the surgeon's level of training, number of laparoscopic surgeries, video game playing (past and present) and length of time in surgical practice. The study showed that surgeons who played video games performed minimally invasive surgery (MIS) such as laparoscopy more efficiently and with fewer mistakes. In fact, surgeons who played video games at least three hours per week (during their formative years) correlated to 37% fewer surgical errors.
• Study 2. Another article, published in Gynaecological Endoscopy, followed 46 surgeons as they performed a commercial video game, as well as timed laparoscopic skill tests. The authors state, "There was a highly statistically significant correlation between skills tests and game time."

And, several subsequent studies show prior gaming experience leads to fewer surgical errors—practice does make perfect!

Can children's fascination with video games be healthy?
Many researchers are focusing on games aimed at the patient, rather than at the doctor. Studies focused on video game and virtual reality use in medicine with adolescents show promising results.

• Video games have been used to alleviate pre-operative anxiety in children and as an educational tool for pediatric oncology patients. In a study published in 2006, 112 children, aged 4-12 undergoing surgery, were randomly sorted into three groups; parent present (PP), PP and hand-held video game, PP and pre-operative sedatives. The PP and video game group versus PP alone or PP and sedative exhibited significant reduction in anxiety. Children became both mentally and physically absorbed in a familiar game thereby reducing anxiety and the need for pre-operative medication.
• What about VR as a means to control pain? Several studies since 2000 have shown the beneficial effects of VR on pain control. A 2000 study with two adolescent burn patients compared pain perception coupled with immersive VR or video games. In both cases, the patients reported less pain while playing virtual reality games versus video games, while undergoing wound dressing, an extremely painful procedure.

What is it about VR that makes it so attractive for pain modulation? The difference between VR and ordinary video games is that VR changes based on your actions and involves artificial intelligence. According to Dr. Scharar, pediatric anesthesiologist at Harborview Medical Center, "Your brain tends to allocate a lot of attention to pain. The idea behind using virtual reality is to flood the brain with other pleasant, attention-grabbing sensory inputs that can work to reduce pain perception and anxiety."

Getting serious about the Serious Games Market
By checking Dialog's collection of business and industry databases, we find digital games are becoming an important tool in helping patients improve their health and physicians and surgeons hone their skills. Games for Health, the leading professional community in the field of health games in the United States, brings together the best minds in game development and health care to advance game technologies that improve health and the delivery of health care. Orlando, Florida, is becoming the home to growing medical simulation technology.

Haptic (touch) technology and surgical/medical simulators are a global business. Several companies, formerly involved in building simulators for the military, aviation and space agencies, lead the way in this large, rapidly growing market:

• Located in San Jose, California, Immersion Corporation uses its TouchSense® technology to transform a 2-D experience into virtual reality for use in laparoscopic, endoscopic and arthroscopic (to name a few) simulators.
• SensAble Technologies, founded in 1993, evolved from work done at the Massachusetts Institute of Technology in the early 1990s. SensAble Technologies has more than 41 granted patents and over 7,000 systems installed worldwide. SensAble Technologies markets haptic devices and toolkits to manufacturers, as well as companies who create medical and dental simulators such as GMV or Medic Vision.
• GMV, a privately owned Spanish engineering company founded in 1984, has branched out into healthcare. Using SensAble Technology®, GMV has developed insight ArthroVR®, a simulator providing adapted surgical tools and configurable arthroscopic instruments to make the simulation as "real" as possible.
• Medic Vision Ltd., founded in Australia in 2001, currently has offices in Australia, the United Kingdom and Asia. Using SensAble Technology®, Medic Vision has created two simulators: a surgical drilling simulator and the world's first full procedure epidural simulator (Mediseus® Epidural). The Mediseus® Temporal Bone Simulator enables the surgeon to practice intricate surgery and receive feedback via the haptic technology and interactive anatomy.

Check patents to find the innovators
Review of the Dialog patent collection and analysis in Innography identifies the top five inventor locations for surgical simulator apparatus based on number of patents: the United States, China, the United Kingdom, Germany and Japan. In the use of game-like technology for training and simulation, Canada is also a serious competitor. Having acquired part of Immersion Corp.'s medical simulation business unit, CAE Healthcare will form its own surgical simulation division. Moreover, Tellyes Scientific Company, Ltd., one of China's leading suppliers of advanced medical education products now in high demand for physician training and continuing education, has announced a distribution agreement for Immersion Medical surgical simulators in China. "Healthcare is now a top priority in China, and we are experiencing a dramatic increase in the demand for training simulators, including virtual reality surgical simulators for medical education. The market for healthcare equipment and supplies is estimated at well over US $12 billion."

Conclusions and next steps
With some universities like George Mason now offering degrees in gaming, who knows what the future holds. A possibility now could be a reality in years to come. Emerging trends include:

• Surgeons performing procedures from remote sites, bringing specialized care to small communities and rural hospitals
• "Wiihabilitation": rehab therapy for patients recovering from strokes, broken bones, surgery and even combat injuries
• "Exergaming" to ensure maximum health benefits
• Rise of games for first responders and medical professionals; for example, simulators to train medics in the military to insert chest tubes
• The medical community's increasing interest in the potential of games
• Surgical training applications compatible with other mobile platforms

Dozens of games have been developed in recent years to train physicians, educate patients, improve fitness and help treat the addicted, the mentally ill and patients experiencing pain. Whether you are learning to suture, demonstrating procedures such as central line placement or a diagnostic ultrasound exam, teaching life saving surgical procedures like chest tube insertion or improving laparoscopic surgical skills, new technologies, in particular virtual reality simulators and medical video games, will have a major impact on health care in the next decade. I for one would want my surgeon to have plenty of simulated practice before drilling into my temporal bone! Wouldn't you?

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