Picture the operating room of the future: Before a single incision is made, the surgeon uses a customized computer-generated model of the patient to help diagnose the condition needing treatment, to evaluate treatment options and to rehearse a personalized surgical plan.
When the real operation begins, a computer combines this information with three-dimensional medical images and displays the surgical plan, overlaid on the patient. Robotic devices augment the surgeon's own hand-eye coordination to help carry out the procedure exactly as planned.
With this electronic help, the surgery could be safer and more precise, yet less costly. And the patient would recover more quickly.
To help realize this goal, the National Science Foundation this month began a $12.9-million five-year cooperative agreement with Hopkins to establish the Engineering Research Center in Computer-Integrated Surgical Systems and Technology.
Russell H. Taylor, a professor of computer science, will serve as director of the nation's first research center set up to create computer-linked surgical systems and medical robots. Taylor said he believes that by combining highly advanced information technology with surgical expertise the center will usher in dramatic changes in medical care.
"Computer-integrated surgical systems and technology will have the same effect on health care in the next 20 years that computer-integrated manufacturing has had on industrial production over the past 20 years and for many of the same reasons," Taylor said. "By integrating information with action, these systems will lead to critical advances both in the quality of surgical treatment and in its cost-effectiveness."
Taylor's vision is shared by other prominent researchers at Hopkins and its partner institutions. The Hopkins participants will include researchers from the Whiting School of Engineering, the School of Medicine and the Applied Physics Laboratory. Partners are MIT and Brigham and Women's Hospital in Massachusetts and Carnegie Mellon University and Shadyside Hospital in Pennsylvania.
The universities and hospitals involved will contribute another $8.1 million over the first five years. Additionally, industry donors have pledged $1.75 million in funds for the first year alone. During the program's first five years, almost $9 million in industry funding is anticipated.
NSF funding for this research center is renewable for an additional five years. The program is expected to be financially self-sustaining after 10 years.
NSF's Engineering Research Centers focus interdisciplinary teams of faculty and students on research to produce next-generation technology and education. Through close collaboration with industry and other practitioners, they speed technology transfer and develop a new generation of engineers and scientists who are more effective in industry and practice. This ERC joins a group of 20 others that involve more than 500 firms in a wide range of fields, including bioengineering, multimedia technology and manufacturing.
James H. Anderson, a professor of radiology at the Johns Hopkins School of Medicine, will serve as deputy director of the new research center. Takeo Kanade of Carnegie Mellon University and Eric L. Grimson of MIT will be associate directors.
In Baltimore, the research center will be set up in new and renovated space at the Homewood and JHMI campuses. It will draw upon experts in computer science and in electrical, mechanical and biomedical engineering, as well as upon physicians specializing in fields such as radiology, neurosurgery, urology, orthopedics, ophthalmology and many other medical disciplines.
The Carnegie Mellon team--led by Kanade, director of that university's robotics institute--will focus on the development and applications of computer vision, sensors and robotic devices for computer-assisted surgery. The researchers will collaborate with Shadyside Hospital.
MIT will contribute computer models to plan and guide the surgery. "We take medical scans of a patient and use them to create a graphical reconstruction of the patient's internal anatomy," said Grimson, MIT's principal investigator for the center and a professor in the Department of Electrical Engineering and Computer Science. A prototype of this system has been in almost daily use at Brigham and Women's Hospital, MIT's collaborator, since 1997.
Hopkins president William R. Brody said, "This Engineering Research Center is a prime example of how collaborative, multidisciplinary teamwork and cutting-edge technology--directed at real, practical problems--will help shape the direction of both research and education within the university system of the 21st century. This technology promises to change the way health care is delivered throughout the world, benefiting both physicians and their patients."
Ilene Busch-Vishniac, dean of the Whiting School of Engineering, said, "This Engineering Research Center will build on a number of very strong imaging and robotics programs at Hopkins. Coupled with our strong collaboration with MIT, Carnegie Mellon and our schools' affiliated hospitals, this center is well-positioned to make major contributions to computer-assisted surgery."
Lynn Preston, ERC program leader at the NSF, added, "This ERC is an excellent example of how a team of researchers, medical practitioners and their industrial partners need a center to achieve their ambitious goals. Their vision of combining capability in robotics, computer modeling and imaging, and human-computer interfaces with surgery is nearly impossible in the traditional, disciplinary construct of a university. The center format enables collaboration across these disciplinary perspectives and sets ambitious technological goals in partnership with both industry and surgeons. Our review panels found this ERC to be very exciting and were optimistic about its potential to have a positive impact on health care."
Taylor, the center's director, is an internationally recognized expert in medical robotics and computer-assisted surgery, who moved to Hopkins from IBM Research in 1995.
He emphasized that these new tools will not replace highly trained surgeons but will augment their skills.
Human surgeons, he pointed out, far surpass machines in adaptability and, most important, judgment. But human hands need a large opening in which to work. They sometimes experience tremors and fatigue and may have difficulty manipulating very small objects. Also, humans can be harmed by the radiation used in some medical treatments.
A mechanical "hand," skillfully directed by a surgeon, could overcome these drawbacks. "You could transcend human limitations in the execution of surgical tasks," Taylor said.
Before a scalpel even touches the patient, he said, a surgeon could use advanced imaging and modeling equipment to plan the operation on a computer screen. "Then, in the operating room," Taylor said, "by using real-time imaging and real-time sensors, we will be able to match the virtual reality of this plan with the actual reality of the surgery.
"These systems will let you do things you could never do any other way," he added. "Also, they promote much greater consistency in surgical execution, fewer errors and fewer complications. Finally, the systems potentially allow you to record more data about what you intend to do, and what you actually did, in surgery, so that you can learn from your work and improve it."
Private industry will play a key role, providing research funds and helping to test and incorporate the new systems into modern operating rooms.
Finally, the center will have a strong educational component, training a new generation of engineers and physicians who will develop and use the new high-tech medical tools.
Taylor cautioned that many basic science and engineering problems must be solved before such medical computers and surgical robots can be used on patients. These include improvements in imaging and anatomical modeling techniques; sensors; and human-computer interfaces. These advances must be combined into systems and undergo rigorous testing in realistic settings, Taylor said. He added that industry engineers, surgeons, university researchers and students must work closely to speed progress.
"You need a venue to make these things happen," Taylor said. "That's what NSF engineering research centers are all about."