1. National Library of Medicine
TATRC MEDICAL MODELING
&
SIMULATION
P O R T F O L I O
I N F O R M A T I O N B R I E F I N G T O
Open Source Software Framework for Organ Modeling and Simulation Conference
National Library of Medicine
June 24, 2001
Presenter: J. Harvey Magee
P R O J E C T T E A M
Dr. Gerald R. Moses, Projects Supervisor
301 – 619 – 4000 /
J. Harvey Magee, Project Officer
301 – 619 – 4002 /

2. Fort Detrick Frederick, Maryland
Headquarters U.S. Army Medical Research
and Materiel Command
Major General John S. Parker, Commanding General

3. Mission Telemedicine and Advanced Medical Technology Program
TATRC
Telemedicine & Advanced Technology Research Center
Cutting Edge Medical Technology
Telemedicine and Advanced Medical Technology Program
Mission
Apply physiological and medical knowledge, advanced diagnostics, simulations, and effector systems integrated with information and telecommunications to enhance operational and medical decision-making, improve medical training, and deliver medical treatment across all barriers.
The program scope is to identify, explore, and demonstrate key technologies and biomedical principles required to overcome technology barriers that are both medically and militarily unique.
Department of Defense,
Joint Warfighting Science and Technology Plan, Chapter IX, Joint Readiness and Logistics, 1999

4. Why do we Need Simulation?
Military medical personnel [note: 100,000 of them] must practice battlefield trauma care skills (GAO Report June 98).
Training should replicate combat specific wounds & battlefield environmental stressors. Civilian injuries are unlike war.
Traditional “see one, do one, teach one” method is changing.
There are increased restrictions on animal use for training.
Cost to conduct mass casualty exercises is prohibitive.
Health care payors are resistant to reimburse for training.
There are risks from treatment by care providers-in-training.

5. Kohn, Corrigan, Donaldson,
PLUS………..
“Every year at least 44,000 Americans die …of medical errors”
Medical errors are the 7th leading cause of U.S. death, greater than car accidents, breast cancer, or AIDS
Pharmacy errors are no longer the leading medical error. Surgical errors are.
“Recommendation 4.1: Congress should create a Center to…develop knowledge and understanding of errors…develop a research agenda…evaluate methods for identifying and preventing errors….”
Kohn, Corrigan, Donaldson,
Institute of Medicine, 1999

6. (Simulation Technologies for Trauma Care)
PORTFOLIO
Tissue
Modeling
STATCARE
(Simulation Technologies for Trauma Care)
MSTI
(Medical Simulation
Trainer Initiative)
CTPS
(Combat Trauma
Patient Simulator)
Simulation
Meta-
Analysis
(Complete)
ENTSurgical
Simulator
Ureteroscopic
Endoscopic
3-D Volumetric
Imaging, Haptics
TATRC Medical Modeling & Simulation Portfolio
CIMIT / Ben Taub
JHU / CCF
G U / J H U
COLLABORATIONS
C I M I T / S t a n f o r d
FUNDING EFFORTS
Congressionals
PRMRP
S B I R
OTHER
D U S & T
A M P
S T T R
N M T B
R T I / E s e m b l e
End Users
RAD II
STRICOM
NLM
O N R
O R N L
NCAMSC (USUHS)
RELATIONSHIPS
Strategic Plan,
Good Science, Sound
Business Processes

7. Strategic Plan, Good Science, Sound Business Processes
Workshop on Surgical Simulation [Algorithms] (Stanford)
June 01
Surgical Metrics (Yale)
July 01
Strategic Plan,
Good Science, Sound
Business Processes
Open Source Framework (NFAS)
July 01
Haptics Users Group
(Colorado)
Oct 01

8. MULTIPLE TECHNOLOGIES
T O M E E T M U L T I P L E T R A I N I N G N E E D S
PC-based Interactive VR/Multimedia
Digitally Enhanced
Mannequins
Virtual
Workbenches
Total Immersion Virtual Reality

9. Assessment of Medical Training Simulators
Evaluation methodology
Formulate overall objectives of the evaluation.
Develop general experimental design.
Select and develop appropriate treatment scenarios.
Develop dependent variables / performance metrics.
Performance Metrics
Develop measurable standards against which to assess performance.
Determine participants & pre-evaluation orientation requirements.

10. Research Challenges
Real-time in vivo tissue property measurement and mathematical modeling
Tissue-tool interactions
Graphics and visualization
Learning systems
Metrics development and learning transfer assessment
Open source architecture (Common Anatomical Modeling Language [CAML], CIMIT)

11. Original Strategy (Feb 00)
Assess the landscape – “Meta-Analysis”
Engage the experts – 70-person “Integrated Research Team”, Feb 00
Converge the worlds
Support the science
Designate the “lead agency” to integrate efforts – TATRC has been designated.
Develop & honor professional business practices at all stages of the process

12. Current Strategy
Expand our consortia to address the core problems facing simulation.
Constructively collaborate on various aspects of essential research.
Demonstrate that simulator-based learning actually transfers to patient care, through validation studies and development of training metrics based upon simulator use.
Identify sufficient funds to answer these needs within the next five years (well…not ALL these needs).

13. Informal Ways We’re Trying to Help
Broad Agency Announcement, US Army Medical Research Materiel Command
Broad Agency Announcement #99-1
Section F, Telemedicine and Advanced Technology Program
Ask to be added to our “Funding Opportunity List”
Contact me if questions: J. Harvey Magee