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A team of modeling and simulation researchers from Old Dominion University and Eastern Virginia Medical School made a big impression with a simple concept at the 4th annual Advanced Initiatives in Medical Simulations (AIMS) Conference and Congressional Exhibition May 8-9 in Washington, D.C.

The new tool that the team exhibited is a stethoscope, but a very smart "virtual pathology stethoscope" the researchers call the VPS. It can simulate sounds of the circulatory and respiratory systems to help medical students recognize the telltale sounds of sickness.

"Our demonstration was definitely the hit of the various displays," said Rick McKenzie, associate professor of electrical and computer engineering and a researcher at ODU's Virginia Modeling, Analysis and Simulation Center (VMASC). McKenzie is heading up the "augmented reality" stethoscope project together with Dr. Thomas Hubbard of EVMS's Theresa A. Thomas Professional Skills Teaching and Assessment Center.

Rep. Patrick Kennedy of Rhode Island, the son of Massachusetts Sen. Edward Kennedy and a champion of health care issues in Congress, spent an extra measure of time at the VMASC-EVMS demonstration and had good words for the project when he addressed the full AIMS conference, according to McKenzie.

"There were several people who wanted to buy the technology immediately," added Mark Scerbo, professor of human factors psychology at ODU and a collaborator in medical modeling with researchers at VMASC.

Medical schools for decades have trained doctors-to-be by using what is known as a standardized patient (SP). This is an actor skilled at pretending to be sick. The SP is able to report symptoms of a particular ailment. In working with SPs, medical students improve their interviewing skills and gain the medical judgment they need to diagnose ailments.

"Trouble is, when you put the stethoscope to the standardized patient, you find that he is healthy," Scerbo said. "Our augmented stethoscope simply substitutes pathological sounds for healthy sounds."

In other words, the SP reports and portrays symptoms of a particular ailment and when the medical student puts the augmented stethoscope to the SP's body, the sounds that the student hears provide evidence that can support the diagnosis. The audio menu includes pathological sounds recorded from actual patients.

The ODU-EVMS team took an SP from Hampton Roads, Patrick Walker, with them to the AIMS conference and was able to demonstrate exactly how the process works. "We had the only exhibit that used a genuine SP and we had a very successful showing," Scerbo reported.

"Many displays at the conference were very graphic and visually focused, but ours was personable and interactive," MacKenzie said.

Both Kennedy and Virginia 4th District Rep. Randy Forbes took time to test the stethoscope on Walker. When they listened at his neck, they heard the cyclic whooshing sound of plaque-restricted blood flow through the carotid artery. When they listened to his chest, they heard crackling sounds in the lungs, a sign of pneumonia or congestive heart failure.

Forbes, the chair of the Congressional Modeling and Simulation Caucus, expressed interest in learning more about medical modeling and simulation work going on in his 4th District, which includes Suffolk, where VMASC is headquartered.

ODU and EVMS have joined forces to form the National Center for Collaboration in Medical Modeling and Simulation, which has attracted national funding and national media attention. An article late last year in Mechanical Engineering magazine focused on one of the products of the collaboration-a virtual operating room. This immensely complicated system, which can be used to train surgeons and other operating room personnel, utilizes ODU's Cave Automatic Virtual Environment (CAVE).

A primary mission of VMASC is to create modeling, simulation and visualization applications that are practical enough for commercial development, and this is where the virtual pathology stethoscope shines.

McKenzie said the team's original VPS is very high-tech, but too expensive for broad use. This first system is called "tracked VPS" because it includes a sensing component that tracks on the body where the stethoscope's head is placed so the appropriate sound recording can be cued. The team received a patent for the "tracked VPS," but then moved on to improve the system's practicality.

The economical version is "SP-triggered VPS," for which another patent has been obtained. This is the system that was demonstrated at the AIMS conference, and for it the SP uses hidden controls to track the stethoscope's head and tell the system what sounds should be played. The second system is more economical because it does not have the automatic tracking component.

Preliminary tests with students at EVMS have been promising, McKenzie said. One series of tests reported in a paper written by McKenzie, Hubbard and other colleagues showed that the augmented standardized patient system is "statistically significant in providing a valid assessment tool."

The project team also includes John Ullian and Gayle Gliva-McConvey of EVMS and Hector Garcia, visualization lab manager for VMASC.

AIMS is a coalition of individuals and organizations committed to promoting medical simulation as a way to improve patient safety, reduce medical errors and lower health care costs.

This article was posted on: May 14, 2007

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