Boston Children’s has a long history of inventing new treatments or adapting new technologies, and that work continues today. Clinicians are using virtual reality, 3-D printing, robotics, and other technologies to reinvent pediatric care. Ahead, read about three cutting-edge techniques that are helping doctors better care for patients.
1. MODEL BEHAVIOR
Stephen Wilson sees evidence of patients in need of help at Boston Children’s Hospital every day — tumors nestled problematically close to jawbones, spines warped by scoliosis, hearts threatened by congenital defects. But Wilson, a soft-spoken engineer, doesn’t treat patients. He sees their digital files — their MRIs and CT scans — and uses those to build tools that help the hospital’s doctors prepare for the unexpected.
Wilson is the senior engineering manager in Boston Children’s pediatric simulator program, also known as SIMPeds. He and his colleagues create lifelike models — or simulations, in medical parlance — to help doctors and surgical teams plan for and rehearse procedures before the patient arrives. And it’s upending the centuries-old tradition of training doctors on flesh and blood.
“Medicine may be the last high-stakes industry that doesn’t practice before game time,” says Dr. Peter Weinstock, SIMPeds’ founder and executive director. Boston Children’s began building models in 2005, and the program took off when the hospital bought its first 3-D printer in 2012.
Weinstock calls the hospital’s SIMPeds unit a “Willy Wonka shop.” It produces roughly 100 detailed anatomical models a year. Some are creations that help plot out a specific surgical approach, while others are used by doctors to practice a surgery ahead of the real thing. Children’s surgeons refer to this as “operate twice, cut once.”
A surgeon facing a rare operation or one with a patient who has unusual anatomy will send the patient’s imaging files to the SIMPeds lab. There, the MRI or CT scan data is used to build a digital model of the relevant anatomy. The digital model can then be 3-D printed, layer by layer, in anywhere from four to 16 hours, depending on its complexity.
“An orthopedic surgeon can study a printed bone right at their desk, and determine the metal plates and screws they will need ahead of time, rather than in the OR,” Wilson says. Shortening the length of an operation lowers the cost and means the patient will spend less time under anesthesia. Perhaps most importantly, the pre-op model reduces surprises — surprises in the OR are seldom good. Sometimes examining a model will persuade a surgeon not to operate because the patient is too small or the proposed intervention is too dangerous.
SIMPeds mostly creates models for surgeons facing unusually complicated or rare operations. But over the years it has built a library of hundreds of digital files of all types of anatomy across all ages of children. That library has helped the hospital bring pediatric training models to at least eight different countries.
2. DECODING THE DIAGNOSIS
Kate Donovan was in high school when she was diagnosed with Crohn’s disease, an inflammation in the gastrointestinal tract. She’d been complaining about bellyaches and diarrhea for years, so the diagnosis was a relief — and yet overwhelming, too. What was an ulceration? How could she explain to friends why she couldn’t go out for pizza?
Donovan grew up to become clinical director of immersive technologies at the hospital’s Innovation and Digital Health Accelerator. In this role, she has found a way to help today’s kids better understand the answers to such questions. She and Michael Docktor, the clinical director of innovation, have created Health Voyager, an app that uses virtual reality to create a personalized Magic School Bus-like experience for patients feeling confused by a diagnosis of Crohn’s or colitis.
Studies find that 40 to 60 percent of all patients, adults included, forget as much as half of what doctors have told them within 10 minutes of a meeting. Health Voyager, which can be used on iPhones and iPads, aims to solve that problem. Using the app’s drag-and-drop interface, Docktor can transfer the important clinical results of a patient’s endoscopy or colonoscopy to an anatomical template and then generate a personalized cartoon-like version of the patient’s GI tract. It takes less than a minute to create and gives each patient an immersive tour of his or her body.
“The hope and expectation is that the kids are more engaged,” Docktor says. “That they are more likely to understand their disease better, [and] are more likely to be adherent to therapy.”
3. THE FUTURE OF SPINAL SURGERY
From his office on the second floor of the Fegan Building, Dr. Daniel Hedequist directs Boston Children’s Spine Division, the largest and busiest pediatric spine center in the country, which treats thousands of patients every year. Some patients suffer from spinal trauma, but most from a congenital spine condition like scoliosis.
In 1972, Boston Children’s clinicians invented the Boston Brace, which remains the most widely used nonsurgical treatment for scoliosis. The brace is always the first intervention for scoliosis because surgery requires cutting open a child’s back and inserting screws into the vertebrae, he says. An error of even a millimeter in placing a screw could damage the spinal cord. Yet sometimes surgery is unavoidable.
This year, the hospital’s spine division began using a new robotic system. Previously, surgeons would insert screws into the spine freehand based on experience and, as Hedequist puts it, “anatomical landmarks.” In the OR he would choose a screw from an array of dozens and decide the best angle to implant it. The new robotic system allows him to make most of those decisions ahead of time, which improves patient outcomes, among other advantages.
Once in the OR, the robotic arm moves into place with the appropriate screw in its drill. The planned angle of entry is based on the patient’s CT scans. But the robot also scans the patient on the operating table in real time, while the surgeon watches the drill entering the spine on a monitor.
For Hedequist, who already has a steady hand and two decades of experience, the new robotic system offers a sort of X-ray vision. It is, he suggests, “the future of spine surgery.”