Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Trying to go live now. Yeah. Ok. So now. Ok, so we started now. So um ok. Ok. So hello everyone. So today we've got our first um talk for um our B on medicine uh series starting with Professor Ds Medical Technology and real. Uh Would you like to, to introduce you or would you like to start? I thank you. That all. Is this an inaugural presentation then if it's your first one for this series? Yeah, we've had other kind of series, but in terms of this kind of medicine, thank you very much for the invitation. In fact, I was a recent event like the British Trade Industry UK India visit and we went to in uh in India. It was, it was great and I've been to India a couple of times with this project actually. So, thank you for the invitation. I'm gonna give you a bit of a whirlwind kind of summary of er extended reality in medicine. My name's Jag, I'm a, I'm a consultant surgeon, um a head and neck reconstructive surgeon, um and a professor of surgery, but also a professor of extended reality in medicine and surgery. I have a research group in Xr. Um and I have, I think I found an effective way to bring efficiency to training and equity to learning using extended reality. And I'm going to give you a, a bit of a choice with the technology and its potential applications. So I'll share the screen and, and then I'll go into my presentation, so I hope you can see that. So a lot of the slides that I'll be showing you in fact will be based on my work in Africa over the last year. And you know, this is, this is about to come into the UK. Um We are about to, well, we on boarded last Sunday at Imperial with regional reps from all of the UK and have pretty much most of the medical schools covered in the UK. We're going to be bringing this concept of using extended reality to train surgeons of every grade, every specialty, every surgeon. And what this technology will do is that it will bring efficiency and trading and equity to learning and it will upskill the staff. So these are just some of the Insta posts over the last few weeks. 90% of all the UK universities have brims student representatives. We've surveyed more than 300 students but actually trained more than 750 medical students in workshops over the last three months. And you know, I'm going to try not to use my words, but actually use the words of those that are much more important. It's very empowering when somebody says I learned more in 10 minutes watching my work than actually scrubbing up in theaters. And 74% of those people that we've questioned uh in more than 300 students, I think said that what I'm about to show you is more effective in training surgeons than traditional teaching. And so of course, we're here for the conference with you and we're here to the British Tamil Medical Association because I think this is a really important part of the technology massively widens participation and it's accessible to all if you overcome the boundaries and the barriers of the technology. Actually, that's a relatively low cost in terms of the potential impact that it has. So this is a list of the events over the next few months, more than 60 events. Now in most of the medical schools in the UK, what I like about this technology is that it, it definitely widens participation. It definitely ticks a sustainability box because it's a more effective way to train people without travel. It ticks a med tech box. It ticks an innovation box. I want to show you examples of how it can tick the A I box. But my focus has been uh global surgery over the last year, having traveled to more than nine African countries as well as India. And so just this month alone, we ran a uh ophthalmology, uh course conference. Last week, aesthetic dentistry has applications in dentistry. This weekend we are er running an anesthetics event. Uh There's a taster event in cardiff ophthalmology event. Warwick has another event and then we have the SI M event at BT S and later on in the month K CL and Imperial and B ATS as well. So that's just an example of some of the events that are coming up of the, just this month alone. We're going to be um hosting more than 60 events over the next four months because I think people are genuinely quite interested. So this is the library. This is what I've created. It's an immersive training experience for every surgical specialty. So let's have a look at what that content is. It's anesthetics, breast surgery, craniomaxillofacial trauma. Imagine being able to put a VR headset on and seeing all these surgical procedures, damage control, front of neck access, a mantle calm who's a professor and ex navy chief of surgery, ran the damage control course a few weeks ago. Um emergency medicine, ent facial aesthetics, facial palsy free flap. Each one of these procedures is a VR experience, of course, general surgery, hand surgery, huge library in orthopedics, trauma, hand surgery, plastics, maxillofacial surgery. And more recently in the most recent course at Guilford, we had a transplant and cardiac surgery course. So I'm presenting to you the largest immersive surgical training resources in the world and this is what we're doing with combining headset and give an immersive training experience in which everybody sees that operative procedure is a shared immersive training experience. Malawi Cape Town, South America using these VR headsets. It's an all in one box and we're starting to scare out to trust to innovation hubs to universities and let's show you what that actually is. So imagine being able to put on a headset and have a different way to learn a new way to try it. It's using synchronized VR, we can combine that experience for that shared immersive learning experience. It's created by surgeons, it's created for surgeons. And the technical perspective is that there's lots of different approaches. This is called six degrees of freedom in a simulation for mandatory training. I've evaluated this scientifically, I'll show you some of the data for that. So that's basically life support. You put a headset on and you can see them through the simulation, mandatory training with basic life support, mandatory training with fire safety training through variety of simulations in which you put a headset on and you see the back graft and the fire, you can put out a fire with an extinguisher, you can put in the chest train with no hand controllers. This is a mandatory skill for every surgeon in the UK and in goes the chest, right? Understanding the endo topical perspective of that. VR anatomy is really important particularly for Africa because in Africa, there is no access to cadavers. Imagine being able to walk into the skull base, perform a neck dissection in VR overlay, critical anatomy. So go up with created is the world's largest immersive trade resource laparotomy. So a bowel anastomosis with multiple old ladies. This is called spatial computing. You can see how the anastomosis was before and gyne 20% of perioperative death in Africa is O and G. But our library extends into every single ent plastics, O fs, ophthalmology, ology, general surgery, breast surgery, neurosurgery, orthopedics. Those are plastics, vascular surgery, emergency medicine, anesthesia. So I can put a headset on and show you how to size a femoral head. But of course, the focus for me is global surgery because I'm convinced this technology will bring efficiency to learning and equity to train ac section in VR. Can you see it? So rupture the membranes and the in virtual reality with multiple camera overlays one. Bye. I good. Awesome. And the baby. So that's the C section in virtual reality closure, trauma, laparotomy by man. So damage control, multiple legs in the arm using goods overlay, tibial plateau fracture, orthopedic procedures and approaches multiple camera perspectives where you feel like you're there at present. Cadavers allow you to progress through surgery quickly. This is me raising a radio before I'm free flat and I can tell my trainings ready to look, look at this view as I preserve the radio con nerve break through the cephalic and dissection. It's going to every medical school in the UK. What it brings is efficiency to training and what it will bring to Africa as equity to learning. That's what extended reality will do. So I'm a practicing surgeon. I do complex facial reconstruction. This is a recent case that I did, I did a free flap four days ago, a fibula free flap with quite a complex scans hemimandible. In this particular case, I use 3D printing. I use virtual surgical planning to resect and you can see that. So I'm a consultant surgeon at East Grinstead. So that's a 3D printed plate for oral floor reconstruction. And then if you look at the next picture, that's a complex chimeric free flap with three perforators with an A LT. So that's vastus. So that's my day job. I use virtual surgical planning and I use 3D printing and I use uh uh principles of complex reconstruction to reconstruct the head and neck. That's the patient who was discharged at nine days post surgery and the margins are clear, but we still have radiotherapy. But I'm going to take you to this slide because I'm convinced this technology that I'm about to describe to, you will have a profound place in bringing balance to surgical opportunity in some of the poorest parts of the world in the global South. And we've managed to reach um a lot of places in the courses that I've run 100 countries, 6000 participants and this is the narrative that is that I use the Lancet Commission on why we need to train more surgeons. Over the past two decades, global health has focused on individual. So global health traditionally focuses on medical conditions like tuberculosis, 5 million people. Those hurdles manifest with a delay in seeking care, receiving care, reaching the hospital does not guarantee treatment. So I started my work with procedures, section fracture, understood how I could use in those approaches. These conditions are treatable. 20% of perioperative death is. So we created a big and as a result of receiving surgical care. So we need more, more, more 2.2 million more access to. By 2013, the total costs required to reach these targets are significant at approximately $350 billion by 2030. But there is a more effective the estimated 12 point to do that and prote economic growth making surgery an indispensable part of health care. So that's the technical aspects of some of the technology that that I can describe to you. Um you know, these are all immersive experiences. Six degrees of freedom is that virtual reality experience in a digitally created world. We can have 360 video with overlay that I've shown you some of the cadaveric stuff and some of the uh life surgery, we can make that interactive as well. And that's a compelling argument for using extended reality to train doctors and surgeons. It's four times faster. In terms of acquiring skills, you have 16 times more likelihood of improving retention of information using this technology, there's an increased engagement, it saves money and it enhances safety. And there's lots of clinical trials that have demonstrated that. So what does VR an extended reality do? It increases learning engagement by fostering a sense of presence improves retention enables hands on learning, promotes collaboration and can create a personalized learning experience. So I uniquely started with gabber dissection on the bottom, right? And the argument that I get, you know, I've had this argument when I went to um um the some of the training places in India, including Masi in Delhi and Ludhiana, the professors will say, well, there's no haptics jag. So how do you train a surgeon when there's no haptics? What percentage of the people in that theater environment are using their hands? Medical students don't use their hands. 2nd, 3rd, 4th assist resident in Malawi, they're not using their hands, they're watching, they're retracting. You don't need to necessarily use your hands. But of course, the way to learn surgery and the apprenticeship of surgery is to use your hands, but nobody stands still in theaters. So how do you get around the problem of not being able to move a single camera? You lose overlay? So this is an example of how we've evaluated this with um motion capture physiological sensors and headsets and eye tracking. This is a very basic um virtual reality experience we created for basic life support and we evaluated it using all of those mortalities. I'm gonna run through this slide. So this is the motion capture suite and we track the eyes. So it's not all rose. There are some problems with this technology. Certainly for high fidelity, like my kind of surgery, it's quite some way away. There's no haptics in that. And as I'll demonstrate to you from a gaze perspective and motion capture perspective, there are differences in the real world experience. So it's really important to be able to evaluate it and its potential. And that's what I've done over the last few years, I've evaluated it with biomechanics, with eye tracking uh to give a really kind of genuine, authentic a perspective on it. So for example, if you look at gays, when we look at basic life support in a real world experience versus virtual reality, it's much more physical in a real world experience. But there are differences in frustration, complexity, stress distraction, as well as perceptual strain in this thing called a stimulation task load index. And it takes longer to complete the simulation as well. The body posture can be very different in a very basic rudimentary skill of being able to compress the chest. So you can imagine when you're then performing high fidelity surgery like microvascular surgery, there will be real differences. But of course, we've also evaluated the global health perspectives and the unanimous perspective that this technology can have a very important place in Africa. So I want to show you some Gabba stuff, of course, no photos and nothing on social media. It's a video that we often show uh when we are running the Gabba workshops. It's by our Head of Anatomy on just having a respect for dignity and not to breach confidentiality and those screenshots. So this is what we do. We go to Africa, we've been to Africa. It's a new way to learn. This is in uh South America. What I like about this particular slide is that there's a senior, this chap here. He's a senior cardiothoracic surgeon. Why does he need to watch my, my work? Because what I'm about to show him is this, it's a clamshell thoracotomy with a multiple camera overlays ondas quick progression. How do you train someone to do something that you seldom perform? It's really difficult. But this technology gives us the opportunity to be able to train surgeons. You see these wonderful views of the anterior cardiac chest wall ligaments and that's what overlay can offer. This is now called spatial computing since uh Apple released its device. So you can change the narrative of these videos by adding something called interactive video. Interactive video is quite interesting because it allows you to be able to create assessment tools. And then the the immersive experience can be applicable for any grade of surgery from medical students all the way up to the chief of surgery. This is in cape town to attendees, interns or residents, fellows and senior consultants by adding interactive hotspots that immersive experience can be applicable to any greater surgeon. So this is an example I have done this to Shaka in er Mam Cer in New Delhi. She's demonstrating how to manage an atomic uterus. So I've added an interactive hotspot and that's an algorithm. So there's another example here of how I've done that with the radio 403 flat by adding interaction, I can change the narrative of the entire experience. This is an Fr CS level question, an Allen test that can assess flow through the artery and then I can direct the view to the different perspectives. This is the view for raising the forearm flap. This is the view for the surface anatomy. This is the view for preserving the cephalic, presumably ready cutaneous as I include the cephalic. And then this is an interaction for medical students. Much more basic level interaction. So adding interactions allows me to be able to change the narrative of that experience. And I've shown you the library already. It's pretty extensive. And this is what you see. Imagine this image wrapped around your head. You have multiple overlays, hunger, divers orthopedics, urology into the retroperitoneum ent overlay, endoscopic news, how to set up the patients ophthalmology, small volume perspectives and you simply turn your head. This is now spatial computing neurosurgery to consultant, describing how they've adapted the pterional approach in their clinical practice. Lots of upper limb trauma complex, lower limb injuries with multi MDT approaches, vascular orthopedics, plastics, cardiac surgery into the chest and into the valve, overlay, powerpoint presentations. I can overlay zoom meetings. And so what it allows you to do is to travel to some of the, the remote parts of the world and be able to simply run workshops with 10 headsets. VR headsets, I can run a workshop in O and D I can run a workshop in damage control. Once you put the headset on and synchronize that training experience, it enables you to be able to run workshops in every single surgical specialty from plastics to head and neck to FS as my parent's specialty to O and D. Give somebody a lecture in U try version, give them an Immers of experience in trying to exper uh in U version transplant surgery, cardiac surgery, we failed in the last course, breast surgery. The library's extensive neurosurgery, urology, aesthetics, vascular surgery, cardiac surgery. So it's a new way to try it. And by combining all those headsets together through this thing called Synchronized VR means that you can really give the pearls of knowledge and experience through the subtleties of complex surgical procedures for advanced trainees and that's called Synchronized VR. And that's what we're doing. This is the undergraduate program. So we on boarded these students and it's really quite important to demonstrate. I'm gonna show you there some of the their findings in the course that they ran. So we run a national training program for undergraduates using this technology and it's a student led division of RS and we run workshops and these are their words, not mine. It addresses the limitations of traditional surgical education. It expands access to underrepresented specialties, it augments and supplements their curriculum. So we ran now 40 workshops and we covered as many areas and regions of the UK and we had lectures on surgical procedures, immersive training experiences in VR and then VR anatomy. And again, their words, not mine, it gives detailed insights and perspectives that are often unavailable in that theater setting and the hierarchy of that theater setting. The medical students don't often see very much with significant p values in knowledge acquisition in confidence in surgical procedures. And then again, I impact on anatomical confidence. So that's the impact it will have on them as we scale out across the UK. So invited to integrate this into the new medical school at the University of Surrey and then I'll finish on its applications in global health. This is a cartogram showing the number of doctors in the global South compared to the global North. You can see the number of doctors in Africa per population and this is what we've been doing over the last year. We've been to nine African countries starting with Kenya running a workshop in br training surgeons of every surgical specialty using the resource that we've already created by creating a new resource. And then from Kenya, we went to Rwanda and then South Uganda in a combined program in anesthetics and surgery. And then from there with life surgery, we went to Cameroon, donated ultrasound instruments and run a workshop in extended reality. This is low cost frugal, just learning how to tie knots to high tech with VL Zambia, much more formal with the white coat coats. And then from Zambia, we went to South Africa different experience, Burundi, 70% absolute poverty in their population. Workshops in Burundi, burn surgeons are coming to the UK in a few months to create content in French and go back with full hardware capability. And this is in Cape Town and then from Cape Town to Malawi. So synchronized VL and Malawi and then from Malawi a few weeks ago to Tanzania regional anesthesia and ultrasound. And then we go to Sudan and Ethiopia in the coming weeks. So that's the global health perspectives of this technology. So that's in Cape Town, synchronized VR. This is in Malawi S VR and in Cameroon anesthesia and surgery and then Zambia. But there's also this idea of virtual humans. So real kind of difficult conversations you can chat to your PT uh in VR to develop communication skills in situations that you would normally never expose medical students. And that was in Tanzania a few weeks ago. So imagine being able to run a regional aesthetic workshop in which you can pick up a probe in VR see cross sectional views of ultrasound. There we go, that's an ultrasound probe. And I can literally place that anywhere over the body and be able to see cross sectional view in VR. So we use that to train in regional anesthesia. But what we also did in September of last year was to integrate this technology into a head net course, an upper limb course as well as create new content. So full integration and this is VR anatomy. So VR anatomy, I think has a huge role in Africa because access to cadavers is limited. And so imagine being able to walk into the skull base and be able to dissect in VR what we'll be doing over the next year is to create 10 training centers in 10 African countries in which we will donate the equipment and access to this resource. So you can imagine dissection, transfacial access and I can walk into the skull base and an appreciation of that anatomy from a three dimensional perspective, particularly for head and neck is much more powerful than just reading a book. So this is an example of how we can have an immersive experience with lots of people in that space. So this is an ent trainee in that VR space. I asked him to walk into the pharynx. So here he comes and he walks into the oropharynx and this is what he sees. So understanding their anatomy and appreciating it in an immersive experience is much more powerful than a conventional reading a book. So we've got some augmented reality projects. This is a skin cancer project in which we can overlay the facial subunits of the face to help surgeons make decisions on how to manage skin cancer. Attach a dermatome a a dermoscopes rather to the mobile phone. It can help with diagnostics using A I but also has break the face into subunits and then give various geometric approaches, the management of subunits. But it also helps with understanding where the relevant anatomy is the critical anatomy. So you see that in the next slide in here, I demonstrate the subunits of the face or demonstrate the surgical mappings that can help surgeons make decisions. And I demonstrate the nerves, the facial nerve, the danger zones, trigeminal nerve, parotid duct, facial nerve, and also Tangi line, which demonstrates the critical zone when the frontal branch of the facial nerve crosses the psychotic arch in its most superficial course. So here's a facial nerve. So this is augmented reality, helping surgeons make decisions, helping to define surgical options. And that's on the horizon, that's the critical zones. And then of course, Tan's line. So this is a fire safety simulation that we created mandatory training for 1.3 million NHS workers using a combination of those techniques 360 video, a digital twin of the ward uh on our hospital with multiple simulations. So you can walk through that spaces, open doors, select how you evacuate using 360 video an overlay. So I'm convinced this is how we will deliver the workforce plan in the next few years as we increase the number of medical students. But we don't increase the number of surgeons, physicians and GPS to train these medical students. Generative of A II think will allow surgeons and clinicians to be able to build six degrees of freedom and a fraction of the cost. And it's imminent, you can talk to a computer and it will create that simulation for you in that for your immersive experience. So we've got some patient safety work that we're creating with a dermatome simulation and this course is happening this year in June. So again, an immersive training experience in which I will combine virtual reality both in terms of anatomy and demonstration of surgical procedures with our library. But it, it's really important to emphasize that actually nothing will replace the habit of actually tissue manipulation. And the next closest thing we have to surgery is uh Cadaveric. And so we combine this with Cadaveric techniques. So that's me done. Um I'm gonna stop sharing and I can take any questions. Thanks Rohan. Yeah, if anyone has any questions, they can put it in the chart to you. It looks like I'm not getting new but I can start if um if that's OK. Uh I was actually go actually, it was a very interesting talker, very informative um and also extremely er cool to see. Um I was just wondering like you, you know how that with the releases, like, say uh I know Apple, did they kind of like spatial computing and vision pro and things like that? Is that something, do you see like similar, something similar or even like kind of like, do you see yourself like perhaps like leveraging with maybe bigger companies or something like that? So I think, I think the problem with the Apple, the Apple Vision Pro is a 4 to 5000 lb headset. It's come down now to 3000 lbs. It's prohibitively expensive, a brilliant device. But the Po Four Ultra offers mixed reality and a fraction of that costs 600 lbs. So we've got several projects now which we're overlaying, for example, suturing techniques and you have a complete clear pass through. I'm running a mixed reality event in which I'll be raising several surgical procedures of free flaps with a VR headset on II. Think the adoption of that technology in which surgeons wear something during an operation requires an evaluation and and a better understanding because these these devices are, are are licensed for education. Once you put something on your face, then it's a medical device. I can't think of anything worse than putting anything on my face. Unless it has a real value. So I wear loops because it brings me magnification and it gives me light. But actually, when I'm training my trainees, I need to have a complete awareness of my 360 environment rather than just focusing on, in, on the surgery. So I don't know the answer to that question uh as to what role mixed reality has and spatial computing has intraoperatively. But the point of the research group is to try to understand that and evaluate it using a much more systematic approach uh and really getting down to its, its value. Uh and it's uh and its its opportunity er during surgery. Great, that's very useful. Um Just waiting to see if anything else, any other questions. Uh in the meanwhile, I will send the uh feedback forms so people can fill it out. OK. Super. Thank you very much, Rohan. Lovely to present for the British Indian Medical Association. And uh hopefully we can meet again. Yeah, hopefully. Uh definitely we will be having more events soon. So if you like to come in the future, we will in comp. OK. Thank you. Thank you, bye-bye.