The Future of Healthcare? Virtual Reality.

In this episode, Brendan speaks with Dr. Daniel Ackil, Director of Simulation Education and Assistant Professor to the Department of Emergency Medicine at the University of Vermont Health Network Larner College of Medicine, and Dr. Randy D’Amico, a neurosurgeon at Lenox Hill Hospital at Northwell Health, about the impact virtual reality is having on healthcare today. 

Transcript

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Hello, everyone, and welcome to. That's understandable. I'm your host, Brendan McEvoy, US head of External Communications at AstraZeneca. If this podcast has been enjoyable, informative for you, take a moment to like and follow on your favorite streaming service. And if you know anyone else interested in today's topic, be sure to share, because our goal is to help everyone to better understand what science can do when we all work together. With that in mind, we are currently accepting nominations for guest for season two. Could you or someone you know offer a unique perspective on scientific innovation, sustainable health care, or health equity? If so, check out our show notes for how to contact us. Imagine this you're watching the latest sci fi blockbuster. The hero is wheeled into a futuristic operating room. Monitors and screens flash with 3D models of the hero's brain. There's something large just behind here. Heroes eye. A surgeon runs in wearing a headset that displays the hero's vitals and a feed from their endoscope. The music swells as the surgeon begins to operate, and then suddenly, the surgeon is transported inside the brain of our hero. Before the movie cuts to the recovery room several hours later, as the doctor enters to explain that everything is going to be okay, the lights come on and everyone claps and cheers. If you think this scene could only happen in the latest superhero movie or space adventure, think again. Virtual reality or VR as it's called, has been a real tool for medical professionals since the 90s, when doctor Barbara Rotherham, then executive director of Emory Healthcare Veterans Program, began using VR to treat psychological disorders like phobias. Today, VR is being used to facilitate advances in pain management, surgery and surgical training, medicine development and innovation. As well as supply chain management. And with great success to a Harvard Business Review study found that using a VR platform improves students overall surgical performance by 230% when compared to traditional training. While the National Library of Medicine reports there's anywhere between a 66 to 90% success rate when virtual reality is used to treat post-traumatic stress disorder or PTSD in conjunction with cognitive behavioral therapy. So virtual reality is a virtual miracle of modern medicine, right? It is driving some incredible feats of medicine. But we're here to have a real conversation about virtual reality with two health care professionals who use it. I'm happy to introduce our guest. First up is doctor Randy D'Amico. Doctor D'Amico is a neurosurgeon at Lenox Hill Hospital at Northwell Health in New York City, where he treats brain tumors, spinal fusion, neck pain, and spine problems, among other conditions. Additionally, doctor D'Amico is an assistant professor of neurosurgery at Hofstra University specializing in surgical neuro oncology, with a focus on skull base and endoscopic approaches. And joining doctor D'Amico is Doctor Daniel Ackil. Doctor Ackil is the director of simulation education and assistant professor at the Department of Emergency Medicine, University of Vermont Health Network, Lerner College of Medicine. And he has more than ten years of experience in the medical field as an emergency medicine physician and a professor of an emergency medicine. Welcome to. That's understandable. Doctors D'Amico and Ackil. And thank you for being here today. Thanks so much for having us. Yeah, it's a pleasure. Great. So we only have a short time together, so I'll jump right in with with some questions. So in my intro, I laid out what seems like a pretty outlandish scenario for the application of VR and healthcare. So in your opinion, is this just Hollywood fluff or are you seeing applications like the one described already in practice? Doctor D'Amico, I'll start with you and then go to you, Doctor Ackil. Thanks, Brandon. and yeah, I want to just say thanks again for having us on here. It's a it's a pleasure to talk about this. And it's something kind of near and dear to what I'm doing. My in my own practice. I actually, I think it's not that far fetched at all. I think that we've made incredible strides in this stuff, and it's really important to understand kind of the terminology. because VR can be a little bit misleading. Right? So there's virtual reality where you're in a virtual environment, and that's the stuff that you alluded to with the psychiatric treatments, things for PTSD and things like that, where you're immersed in something, there's augmented reality where it's, an image overlaid in what you see around you. And then there's extended reality or mixed reality, which is kind of the bigger picture of things. this is stuff that we're incorporating on a, on a daily basis in operative kind of planning and actually execution. As we get further and the tech gets better. And, and we're looking at it in a lot of the different disciplines that are involved in neurosurgery. Anyway, to make, you know, patient outcomes, patient experience better. Great. How about you, doctor? Ackil? Yeah. Thanks again. Just want to echo, very happy to be here. And this is very exciting conversation. a lot of my work around education involves, procedural training. so I'm an emergency physician. not a surgeon, but we do a lot of bedside procedures and, including, you know, central lines, lumbar punctures, things like that. And one of the things that's extremely exciting for us is seeing, like, Doctor D'Amico reference the technology really explode around educational tools. for these kinds of things, on many levels, one, in particular that's sort of near and dear to us up in Vermont is the sustainability aspect. when we train, you know, hundreds of residents every year on, on central lines, and new attendings, there's an extreme amount of waste involved with all that equipment. leftover, you know, needles can be recycled and so on. But, ultimately, we're producing a large amount of waste and, and any amount of, waste reduction that virtual reality and a lot of these, you know, augmented reality, ocular oculus, headset trainers that are out there in the software that's being developed, is a huge win for us. Great. That's interesting. I didn't think about the sustainability piece. So if I simplified, is it sort of the equivalent to we've all had sort of some sort of game on our, on our iPhones, right, of pretending to be a doctor or is that going through some sort of procedure that it's walking you through? Is this is a simulation essentially avoiding an actual trying something out or testing something or learning something on a cadaver, or if it's some sort of artificial, device or, you know, body part or something like that. Is that sort of is this eliminating the need for that and thus the point around the waste. Correct. Or certainly minimizing, the need for excess use of kits or, you know, these procedural CAS one, they cost a lot of money. a typical central line kit, for example, is about $150 in is about a pound or 2 pounds of trash after being utilized for a training session. and I think there is a need to get hands on real equipment and get that tactile feedback. But, certainly for introductions to procedures and initial, background steps and, and training, order of operation things, the virtual reality space is a huge win, not only for the waste aspect, but also for, you know, faculty hours and staff needed to do this training. Yeah. Brendan, I think I think you make a a great point, though. You know, this is, the waste part is a huge part. And this is definitely saying, I mean, not to mention a resident or a a tech, right? A medical technician can do the procedure a hundred times and generate nothing, right? Just keep going through it until they get rote memorization of the steps. And and they're actually physically seeing these things in front of them and, and placing them where they need to be. and as the technology and the imaging get better, this is becoming more and more kind of realistic. And so I think that's a huge component. And then, you know, you and Doctor Ackil both mentioned cadavers. I mean, from a surgical from neurosurgical training aspect. Cadavers are humans. We have to get humans that have died into a lab. and they're expensive. and you can only use them really once. and they're critical to training. So a lot of these, augmented reality systems now have these virtual anatomy setups where you can pull apart a human being, and the relationships are accurate, right. And sometimes they're a little cartoony, sometimes they're not. It depends on which one you're doing. But the relationships are what really matter. And so before you go in and you do that actual categoric dissection, you've maybe dissected this 50 times, right? Five times, ten times, whatever it is. and that there's a huge win to that in the education space, without a doubt. As well as the way space. And just one additional follow up question is how how realistic is the simulation? I would imagine you don't go from sort of a simulation to directly onto a patient. Right? I would think there is, is there like an in-between where you're going from the simulation into maybe a more realistic testing environment before you actually, are to interact directly with a patient on a procedure. So, you know, in the neurosurgery space right now, the systems that we use, the virtual reality one, that's the, offer simulation, there's different systems, and all of them offer different components. Right. So the ones that offer simulation, those simulations are still artificial looking. you know, I, I joke around a lot that I think the video game companies should get involved with the surgical, you know, companies because, you know, video games have gravity, right? They've established algorithms to, to represent gravity. And in the surgical world or in the medical world, we don't really have that yet. And so graphics wise, it's all evolving. It's all getting better. But there's definitely a difference in the neural surgical space. I use a lot of 3D representations of images. so like an MRI that'll I can rotate around in space and manipulate and that doesn't look like a brain, right? It looks like an MRI, but it's a 3D MRI that I can manipulate. And it's dynamic versus just a static image. It's interesting. Doctor Ackil, do you have anything else you wanted to add on that that topic? Yeah, I, I, this is yeah, really exciting to hear, Doctor D'Amico's take on things, and I agree. there's a lot of research behind medical education theory in general. And, gamification, is really something we should be embracing. you know, as parents were before the podcast talking about our children and we, oh, oh, screen times bad, screen times bad. And I think we have to sort of get past that, and focus on the content and screens or how we learn screens or where we read and, yeah, augmented reality, virtual reality is is the future. And any sort of gamification of delivering an educational platform is going to be well received by today's learners. and yeah, I think, just back to the cadaver piece that doctor D'Amico mentioned. it it is an extremely complex, complicated process. for an organ donor or a human who is decided when they pass on, they would like their body to go to science. There's unbelievable amount of hoops before that cadaver specimen is in an anatomy lab, and we have fairly limited access. up here in Vermont to be honest. And that any sort of, sharing or, you know, really utilizing the cadaver for, for physicians and surgeons that are going to be training is is highly desirable. for not just sustainability and and efficiency. another thing I'd like to add, you know, we think about virtual reality, as always, being in, a headset and, and completely engrossed in another environment. I think there's many layers to the technology boom that's happening. in particular for our training. We're very excited about the 3D printing models that exist, particularly for a lot of these high acuity, low occurrence procedures that emergency physicians may have to perform. we work in a fairly rural environment, where, you know, our level one trauma center, we have neurosurgery, but, you know, the next closest neurosurgeons may be 100 miles away. so often a lot of the sort of critical airway procedures, you know, emergency childbirth, these simulators that are being developed now and 3D printing as are extremely high fidelity. and that's what we're fairly highly invested in, continuing to stay on the cusp of that. I was really surprised by the sustainability benefits of medical training and prep with VR and AR. As both doctor spoke, I started to realize just how incredible this technology is and wanted to hear more, especially about what it was really like using VR and AR to assist with something like brain surgery, or in training a student to perform a procedure correctly. Doctor D'Amico, you earlier you were talking about, you know, how you're using, augmented reality I think is the more appropriate term as a neurosurgeon or and what your, the procedures you do. Can you help just to kind of bring it to life. Like what what does it actually look like. Like procedure. How would it be used. and just kind of considering our, our audience or myself, you know, like for those of us who haven't been in an operating room or you're very familiar with sort of the, you know, most common, I'll say nerve, neurosurgical procedures, how does it look? So I, I primarily do tumor surgery. I'm. I'm a neurosurgical oncologist. I do brain tumors and spine tumors, for the most part. And traditionally, the way I would look at a case that gets presented to me is on a two dimensional screen, right? There is something called an axial or coronal and a sagittal cut. And I basically make a 3D representation of the imaging one layer at a time, you know, millimeter by millimeter, until I've got a 3D representation in my head. And over the course of training, which is, you know, seven years plus fellowship plus practice, you start to be able to understand, what that 3D anatomy is going to look like. You could almost see the brain or the tumor itself in your, in your mind as you're, you know, looking at the scans. But it's, it's a cumbersome way to look at things and it's not really intuitive because that's not how the world is. Right. And so, the way I use augmented reality right now is it starts in the planning phase instead of you know, when I'm planning a surgical procedure, I upload the MRI and it gets a 3D representation that now is floating in front of me. So like, imagine you're looking at me right here and, you know, we can see each other. The audience at home can't. But there's a brain floating in front of me, and it's three dimensional, and I can zoom in or zoom out as much as I want, and I can rotate it in space, and I can all of a sudden start to see the complex anatomical relationships. so blood vessels that are very small coursing over the tumor that are going to be in my way on my approach. All right. I can better identify where my bone needs to be. And one of the important things about about these mixed reality systems is that there are layers. This is digital information, right. So any digital information that I can put on an MRI machine, I can put on this layer. And so I've started I do a lot of research on something called connectome, which looks at the functional connectivity of the brain. And I can now actually overlay maps of function brain function on this 3D representation and get an idea of the tumors. Relationships are really important, not just anatomic things like nerves and vessels, but function. Right. and so you, you know, the, the joke is kind of like, you know, baseball players, I guess. Not a joke at all. But the conversation is that baseball players, if you imagine the pitch coming at you and swinging, you get better at baseball. and there's, there's some sort of rehearsal, ability that we get from just seeing it over and over and over again before. So prior to a surgery, I spin this image around and usually alone in my office, just rotating my hands in the air wearing funny goggles. but I get a really good 3D representation of what I'm about to do, and these things are accurate. And like I said, they're layered. And that's a really important component. Then you do your surgery, you tend to see, you know, it looks like brain, it doesn't look like an MRI. And it's real. It's right in front of you. But you've seen it all. So you know where things are. You know where that critical artery is. You know where that function is. and then the other thing we started to incorporate is, you know, sharing that with the patient. Right? Because now the patient when when I show the patient a two dimensional image on a screen, it took me seven years to learn how to read. the patient has no idea what they're looking at. Right. And MRI eyes are reversed and you're upside down. And, you know, the patient doesn't understand how to put that in 3D space. So now all of a sudden, I get to show them their brain and I put it, you know, aligned with that however they want to and where their critical areas are. So it improves their understanding. and then in the post, upsetting things like rehabilitation. Right. There's people studying now, putting actual immersive goggles on and taking you out of the hospital, taking you into a different place. And, you know, to a doctor actually, before gamifying it a little bit, right? You're not just going up one step with physical therapy in the hospital. You're climbing Mount Everest, right? Or something, something a little more difficult. So it's, there's a lot of different use techniques for it. That's how I use it practically for surgical planning. and, you know, it's remarkable the the accuracy, the precision of it and that ability to see the surgery without opening anyone up is a really, really cool. And I think, fundamental component of this. And how do patients react? Are patients sort of surprised that this is being utilized or, you know, in, you know, in advance of their procedure or are they just surprised it's being utilized in general? What's sort of the. Yeah, I mean, I don't typically put the goggles on the patient. Okay. it would just it would take a long time. So what I do is actually, I will I will record the image. So there's an image on a screen and I'll record the rotation and I'll point things out with like pointers on the screen or whatever. So they see a 3D representation. I think that's most important. They don't need to be walking through their brain. Right. but I think that just seeing that, that 3D representation and accurate 3D representation is enough. And people have looked at this, I think that there's a huge opportunity for just, you know, increasing, you know, patient understanding and patient experience because you're really you're bringing them into their care more. Right. It's immersive. That's the whole point. Yeah. That's that's yeah. Very cool. Doctor Ackil, you know what is kind of in a similar vein. What is your your students reaction. You know, are they did they sort of come in knowing that that VR is going to be a component of their, their training, or is that sort of a surprise to them? And, you know, what's that what's that interaction and what's there? How do you sort of gauge their, sort of experience as they're, acclimating to it? Yeah, a lot of the, a lot of the training modules I've done in the past, and my fellowship, my background is in ultrasound training and a lot of the software, that was out there, we were using sort of took the role of, you know, a direct observation and observed, you know, clinical skill that was being performed in, in some of the software now can give you feedback in terms of your, your hand motion, efficiency, number of movements, the path that you're moving with, with some of the ultrasound training. So for some of our learners, when we were doing those things, it was eye opening to them. Wow. I'm really sure being inefficient with some of my hand movements, and some of our surgeons up here did a similar project, where they had their, the orthopedic group had their residents wearing GoPro cameras as they were doing procedures. And, and that's a great concept, to get feedback and learn from, but extremely time intensive. So I think, again, as the technology grows and a lot of these, monitoring devices have artificial intelligence that can give you that sort of feedback on, efficiency of procedures. it's exciting, but yeah, our learners, yeah, we're still working on how to incorporate things, more and more. And every day in my intro, I had cited the, Harvard Business Review study that was, you know, related to VR platform improving students overall surgical performance by 230% compared to traditional training. I'm curious, do you have reflections as you sort of I experienced both. I'm sure you know, we're all prior to VR being introduced into now seeing it with the students is do you, you know, anecdotally or and maybe even more data driven. Do you does that resonate with you that there's a more there's more accuracy in procedures post education with a VR versus without. Yeah, I would say, you know, the old adage was see one do one, teach one. And that was how learners would always just go through by, sort of experience. And there wasn't really a great way to to validate or perform a competency assessment along the way. so, you know, it's very exciting. I think for them in a lot of ways to, you know, go through a procedure in the simulation lab. And I think, like, everything, you know, whether you're, you know, doing brain surgery like doctor D'Amico or, you know, flight simulators, this is the this is the new training platform is high, high fidelity simulation. and certainly, you know, it's a great onramp, but, I think the, the sort of blending and incorporating it with practice on, certainly humans. But to get you to that initial point of initial competency to be safe, and safe to do this with live patients is is the key here? Yeah. We've looked at this in neurosurgery also. You know, a lot of the data comes from other surgical subspecialties, and medical subspecialties as a whole. But within neurosurgery itself, people have looked at it and, you know, are benefits to surgical outcomes, which is a really hard thing to actually count and argue, but improve performance of learning for the trainees. and there's enhanced cognitive and spatial awareness after doing this because again, you're seeing the way this looks, the difficulty with anything educational, from a medical standpoint, is you can imagine that, technology is not free. And investing in education provides really long term cost benefits, but nothing in the short term. So you're asking always for a really big investment in something that's not going to see maybe a measurable result for years. and so that's always kind of the controversial part of how do we get more, more partnership with these companies because, you know, they're they're sometimes selling you a very expensive piece of technology that's very advanced. And, and there's no immediate ROI on that. Right? Yeah, that's that's interesting point. You know, I guess a inaccurate assumption, right, is that most hospitals would just have this technology or be able to adopt it. And obviously that's a very naive thinking. Just given we know that health care in general is expensive right? From there to become, you know, become a physician to, you know, obviously operate a huge hospital health system, all of that. So it yeah, it's naive to think that this could just be, you know, easily deployed at every hospital or that every, you know, physician or hospital leadership team would adopt this technology. Yeah. I think we need people like Doctor Ackil providing evidence, right. Showing that people get better faster, that there's less waste. That's a cost. That's an immediate cost. That's a big cost savings. And that's a great argument. especially for the procedures that are done with these disposable packets, you know, on an everyday measure. and so that's a super important part. And then the other part is just collaboration with the industry partners or just having them kind of buy in. Also an understanding that, you know, their investment, the investment of other companies into them is going to be it's going to be a hard thing to measure. and that's been the big the biggest issue, I think, that we've had with it here. And number two, this is training. I mean, this opens up the possibility of training people all over the world. All right. This isn't like a local thing, only I'm not just training my residents, Doctor Eggleton. Training is as the technology gets better. All of a sudden you have a virtual simulation that someone in, you know, rural sub-Saharan Africa can learn how to do the procedure. And just on the internet. Right. the say the internet, does that make me sound old? The internet, what do we call it? What do they call it nowadays? The web, I think online, I think that I think that was better than then. If you had said World Wide Web. Yeah, I appreciate it. It, but no, but I think there's a really that's that's a even harder thing to measure. Right. How do you measure a reduction in, in medical, in disparities in medical training internationally? and that's why I think that and I said it in the beginning, this is here, this is happening. It's the future without a doubt. There's no going back from it. but it's a very hard thing to measure, and therefore it's a hard thing. You go to your administration and say, hey, I need $250,000 or whatever it is, 50,000 or 20,000 or whatever. It's like going to your mom and asking for an allowance, but you haven't made your bed, you know, and nothing to prove it. Well, there's one topic that that you just touched on, Doctor D'Amico, that I definitely want to, put in the parking lot cause I want to come back to it. And that was sort of around this, maybe increase in accessibility or, you know, potential broader social, social impacts. I want to come back to that. One of the questions I realized I failed to ask both of you is how long ago did you start to incorporate either augmented reality or VR into your work? So, Doctor D'Amico, I'll start with you. so actually the the company that I use, which I don't know if we want to say names around this company called, metaverse. The founder of metaverse is a neurosurgeon, and he and I are, we're the same kind of year. We kind of. We're colleagues, you know, through training and whatnot. But a difference in humans. And so, you know, he founded this and went initially into the neurosurgery space, where, you know, neurosurgical procedures are they tend to be, you know, a combination of microscopic, macroscopic, and there's a lot of delicate anatomy. And also and you can visualize this with really high fidelity. And then the, the part about layering different things on it becomes really important because we use a lot of weird, you know, functional parts and things like that, or sophisticated, not weird. I guess it's a better thing. but so I started using it probably around five years ago, but I wasn't able to get it installed officially because of the problems I was addressing until probably about a year ago. And now we're kind of accelerating, in terms of what our use is going to be like and how we incorporate it into the cases. And so now I really aside from like a spine tumor where I don't really need it, yet, although I think there is utility there, I use it on pretty much every brain case that I do. and so it's a daily occurrence. And just so I guess, and now you probably would have a hard time picturing a world without, without this technology then. Is that is that fair? Can you can you imagine a world without GPS? Can you go back to paper maps? Right. So paper maps were accurate. They were great. They did a great job. And then GPS came along. Right. And all of a sudden you had this layered, high fidelity, extremely accurate, updatable and connectable technology that there's no way to go back from that. Right. And so this stuff exists. It's not it's not there yet. Right. It's not, you know, Waze telling me that there's a tire on the side of the road as I'm driving past it. But, but it's going there and that's where it's going to get. And, and that's the power of both of technology. Right. And the advances in technology, which are going to, you know, the rapid introduction of AI over the past year or so is going to speed things along. and it's the, the, you know, the benefit of just, you know, people being innovative. Right? I think I forget who said I'm going to butcher the quote. I think it was like, Henry Ford who said, you know, if I didn't, if I didn't invent the car or if I ask people what they wanted, they would have asked for faster horses. Right. And so, you know, that that's that's ridiculous. And that's kind of the concept here, right? You can you can make my resolution of my screen better, but I'm still looking at a two dimensional image. This is outside of the box. And the people hopefully in the future are going to think even more outside of the box about how to use this stuff. And it's the next level. Yeah, it's a great analogy that it puts it into perspective. Doctor, how about you? How long ago did you start using this in your, education educational training. Yeah. So we've been using, I guess, what you could call virtual reality for quite a while in terms of our the high fidelity mannequins that we have, that can do also, you can control their airway spasm, their vocal cords, make their tongue swell. and, you know. Yeah. Like doctor D'Amico mentioned, it's just continuing to evolve, and it'll be exciting to see. I mean, so many of these innovations that we, we deal with and not only the, the medical world, but just education world in general comes about through, students asking the right questions and, and sort of pushing the envelope. And it'll be exciting to see where, you know, this next generation of physicians and medical professionals that really grew up, with, you know, computers and, and tech and have some software background, really take these things. but yeah, we, you know, we're trying to sort of constantly evolve and always looking for new ways. But again, yeah, to Doctor D'Amico's point it, it's hard to ask, you know, for tens of thousands of dollars for some of these systems where you can't prove an immediate impact. but what we try to do is incorporate into our already existing, simulation training programs. And we've seen a significant reduction in central line associated bloodstream infections just by having a really standardized training program. so I think as these virtual reality platforms getting corporatized, into more standardized simulation and more standardized planning, you know, it'll offload a lot of the sort of human work hours involved, the waste and the benefit, certainly will follow. It was clear that both doctor D'Amico and Doctor Ackil believe that these technologies revolutionized how they trained and cared for patients. The advantages provided over more traditional methods were night and day, as they described how much they rely on VR and AR, which made me ask, what do they see as the future for these technologies? You're kind of in many ways, kind of shifting my mind to the future. So how do you how do each of you think VR or augmented reality may be used in the future? Are there new applications in the medical profession that are maybe either in the infancy now that maybe five, ten years, you might see sort of drastic differences or, maybe there's not. Maybe they haven't been introduced, but you could see just in your experience how they might, over time, be leveraged in new or different ways. Doctor, to make a I'll start with you. I mean, this is this is all I dream about, right? This is I sit around and think about, you know, how are things going to change? and it's hard when you, when you're constrained by the reality that, you know, and I think this is the issue with adoption technology sometimes, I think the two things I mentioned are huge, right. Upgradability. And if we're in the digital age, everything's digital, right. And that means that we can upgrade it. So as new things come along, as AI gets more incorporated into things like interpretation, you know, specifically and then recommendation even, who knows? You know, we're going to be able to always be at the forefront and then that connectivity component of it, which is that, you know, if there's an upgrade here in New York City, there's no reason that Doctor Apple doesn't have it in Vermont immediately. Right. That's incredible. or again, you know, to go back to South America or or India or wherever, you know, it's global. So I think those are huge components that that are just broad statements about how tech I think moves forward in terms of the actual VR, AR mixed reality technology itself. you know, the idea here is that you can it's the layers. You can keep layering so you can get the computer now to identify those blood vessels. I don't need my eyes anymore. Right. It's going to color them red so I know exactly where they are or veins or be blue. It's even another layer. It'll tell me again where that functionality is. What's the what's the percentage risk of to damage it based on its reading of MRI, multiple MRI, things like that. I think those are those are just kind of easy, low hanging fruit. We can probably do it now if you have the right programmer just working on it. Right. and then you, you just have to go into robotics. You have to think about how are robots incorporate into this. Because once you have this incredible representation, there's no reason that something else can't do this. you know, it's a mechanical act and there's judgment involved. and so, you know, if I gets good enough to be able to have accurate judgment. Sure. But I think that, you know, those are kind of the futures that I see immediately. But again, I'm also not the guy to ask. I think the younger generation my doctor Ackil mentioned growing up with video games, growing up with screens, they're going to have a lot more insight into where to put these, these images and how to use them. that's someone like me. Well, and just say, yeah, yeah, who knows what this the young yeah. Young generation right now might come up with in, you know, over the next five, ten, 20 years. It's super exciting. Yeah. Doctor Ackil, how about, for you as you think about the future, you know, what are your hopes for? You know, yeah. Or, you know, what do you potentially see on the horizon? Yeah, I think, like doctor D'Amico mentioned, a lot of what we do is, real time interpretation, you know, EKGs, for example. There's a pretty amazing program out there using AI, called the Queen of hearts. And, I don't want to get too much into their specific product, but it it can help offload a lot of the cognitive burden for us. while you're on a busy ship trying to manage, you know, 20 patients at a time, the radiology imaging interpretation, I think there's going to be a huge boom in artificial intelligence interpreting, Cat scans, MRI's, X-rays. so that's going to be exciting in, in the sort of day to day clinical work that I do is to sort of see how that those types of, tech advances change things. then as far as education goes, yeah, I, I'm really excited to see the, the virtual reality environments change. I mean, you can what what we do a lot of is we create simulated clinical experiences and we write scripts and essentially try to throw curveballs at our learners and see how they react and see how they think, and, and there's no reason we can't, create a script and sort of, you know, it'll be a much more immersive experience for them and really, truly, choose your own, choose your own adventure, sort of clinical scenarios and see how they react. and I think that'll be exciting as the software becomes more available and hopefully some of these prices come down a little bit, we can incorporate more and more also, you know, just throw one other thing in there. It's everything we're doing is being digitized. Right. So patient lab values are being digitized. The notes are being digitized. My my camera. So you know, we use a microscope or something called an X script. That's a digital camera. That's digital video feed that could all go into this and all would be used to make this stuff better. so the simulations can be, you know, based on real surgery that the camera captured and then, you know, modified. So I really think that the future of this is pretty wide open. it's extremely early. As good as we've gotten over the past, you know, few years that this has been around and available. it is very, very rudimentary in terms of where it's going. Yeah. I mean, it's it's exciting to think about. So obviously we've talked about the impact of VR and AR, specifically in that health care setting in that the direct impact it would have, on a patient, also on physicians in training and then ultimately on a patient. You also, Doctor Ackil, you mentioned and then doctor D'Amico, you elaborated on the sustainability component too. So there's other benefits there. One of the things started to make a you started to talk about that made me start to think about broader social implications. Or, you know, we hear a lot about within health care, the issue of, inequity or lack of accessibility. Is there a world where we could have a technology in New York City that is somehow leveraged to a another country that maybe couldn't necessarily doesn't have the same level of accessibility, or is not able to afford it? Is there any benefits you see there that this is maybe helping to improve or overcome some of the the barriers to health equity? Yeah, 100%. I mean, it's a clear representation, or simulation, if you will, of what we do here. Right. And and it doesn't have to be me. I mean, you know, getting to every doctor I believe in can be, you know, the world's leading expert on something extremely rare, where all of a sudden, you know, somewhere else had access to that and access to the treatment, planning, the thought process. I think, you know, the it democratizes access, right? It just makes it more equitable, more a level playing field. now there's there's trouble with that, right? Because not everyone. You need me here at access, you need to be online, right? You need this tech that is still currently pretty expensive. And you need people to invest in education, and want to. But yeah, I without a doubt just you're you could be brought in to an operating room on Mars if you want it. Right. Just virtually and see how, you know whoever's up there is doing surgery. Yes. Anything to add, doctor Ackil? yeah. As far as the sort of health equity piece, you know, we we feel very strongly, you know, we're we're a network of, six hospitals. We have this sort of so-called mothership, the level one trauma center in Burlington, Vermont, and then several outlying community hospitals and some of these emergency rooms. It's, you know, eight beds and and one, one physician. so to bring the the sort of, you know, level one care out into the community is a huge mission of our network. And we feel that simulation in general is a means to that end. And it's already, you know, there. I can give you a dozen anecdotes of particular cases where, you know, a patient had a, you know, lifesaving procedure done in the community that ten years ago. Never in a million years would they have tried, without the simulation training programs that we're doing. And I think, yeah, certainly making these things digitized, deliverable, remotely and getting education. so they don't you don't have to train everybody at the mothership and then go back out, but train to bring education to the community, is a big mission of what we do, and not in virtual reality in the future is going to be a huge part of that fantastic. So our time is is coming to a close here. I know we've really only scratched the surface, and so I'm hopeful that maybe we can discuss this topic more in a in a future episode, or at least I'm sure I know I'm going to start probably down a Google path after this, as I'm sure our listeners. Well, but but I, I'm thinking about the to our listeners. Right. Who are potentially our hopefully future medical students or are could be people who are currently, you know, receive some sort of diagnosis, right. Or are potentially needing a surgery. From your perspective, doctor D'Amico, what advice if if you think there's any sort of hesitant outset, like I'm coming from a hesitancy standpoint, if there's any hesitancy to a patient who might be aware of sort of augmented reality or virtual reality in their procedure, what sort of advice or what would you give to them to maybe ease? Then he concerns that they have or, you know, or anything in that realm that may be a barrier to them pursuing the best care because of maybe new technological advances in a, you know, an adverse reaction to that. There's a hard question. I don't think, you know, from a, from a student, from an education standpoint, from a learner. I would just say embrace it. Right. You're busy. It's hard to try new things. It's hard to struggle with that learning curve. Trust me. Neurosurgeons don't want to be considered not an expert in something. But put on the goggles, see what it looks like. Okay. you know, we published on this, actually, from near where, people felt. Oh, it may offer a benefit. and we pulled all these residents across the country and then we polled people who had access and the numbers of who thought it was beneficial were, you know, statistically significantly higher because just putting it on and experiencing it for that one minute is automatically going to change your insight into it or your perspective on it from a patient standpoint, you know, you got to trust your doctor, right? if the doctor this isn't this isn't doing your surgery. And so it's, it's a tool and. Right, so it's it's belts and suspenders. It's another way to look at things, that are going to give you another way to measure things. And just like, you know, the, the old see, when do one teach one, there's a surgical adage which is measured twice, cut once. And so this gives you a better way to measure great. Doctor Ackil, anything to build on there. no, just I'll, I'll add I think, you know, for the future learners out there in the future medical students and future physicians, it's an exciting time, to be training and just the. We're very lucky in this country. We have open access to, sharing over the internet, and there's no real content filters. and just. Yeah, excited to see what's next. So awesome. So I, I know I said that was the last question, but I feel obligated as someone who is quite fascinated by medical dramas, and I'm sure you probably get this question a lot without naming as any single TV show out there. What how accurate are are some of these medical dramas on TV? Yeah, in terms of the, you know, how they're, you know, how they're, reacting and, and these situations that they're put in, in, you know, E.R. situations or other medical situations. I'm just I'm curious how from your from your standpoint, how accurate those medical dramas are. Doctor Ackil, you go you go first. This is your this is your world. Yeah. It's a, that the shows, can be somewhat accurate. I think in reality people are, probably more tired and, less good looking. I mean, you have to throw it in there. It's 100% accurate. No, that the hospital is not full of beautiful people. and I'll add, they have, you know, there's like, one surgeon who's operating on the brain. The heart. They'll let you know their, if if that was only possible. But, there's a whole team out there. It's it's not one person. It's not five people on there. Yeah. All right, I'll watch those shows of the grain of salt from now on. And I have to say, I don't want to make you both blush, but I think we could have done this. This, podcast is a video because you say all doctors aren't good looking, but, you know, I can hear I and I know I think you're you're not making a good case, Brendan. I don't know, man. Brendan. You're giving me a little Ryan Reynolds. you give me a little. Yeah. I will take. I will take any any and all compliments saved for the viewers, but, yeah. Well, I just want to thank you both so much for your time, for your insights. We covered a lot of ground here. And like I said, I think we only scratched the surface. So hopefully the listeners here, we'll we'll explore this further. So sometimes medical technology moves so quickly. It can feel like we're living in a sci fi story, but it's encouraging to see how these advances are making a real difference for patients. I'm thankful Doctor D'Amico, Doctor Ackil, and really, for all the other health care professionals like them who are adopting new tools and techniques to improve outcomes, I know the experiences they both shared have helped me clear up some of the questions I had and hopefully, listener, you've gotten a clearer perspective about the role of virtual reality and augmented reality and medicine. And as always, hopefully this made health care a little bit more understandable. So thanks again Doctor D'Amico, Doctor Ackil for joining us. Thank you guys so much. Yeah. Thanks so much for having us. This was fun. Absolutely. And then thanks again to all of our listeners for joining. That's understandable. For more information about today's episode, be sure to check the show notes. Until next time, be well. Be healthy. Be understanding.