Boston Children’s Hospital’s simulator program, SIMPeds, has formed a partnership with the special effects company Fractured FX to create ultra-realistic models of patients’ anatomy for surgical and medical training. The partnership was announced during Boston Children’s Hospital’s Global Pediatric Summit + Awards, where the first two models created through this partnership were on display.

“This is the nexus of medicine and art, surgery and cinema,” said SIMPeds Director Peter Weinstock, M.D., Ph.D.

The models, or “simulators” allow clinicians to practice and rehearse difficult or complex medical procedures without risk to patients. Boston Children’s hopes to begin offering them commercially to other medical centers over the coming year, with Fractured FX handling the manufacturing.

The models take medical realism to a new level—they not only look real but feel real. They incorporate artificial tissues that bleed and pulsate, manmade blood vessels that feel real when doctors insert a catheter and special gels that feel like brain tissue when an endoscope is guided through them.

“Getting the look and feel right is very important, particularly to surgeons and proceduralists,” said Weinstock. “To make simulations effective, you want to promote suspension of disbelief, to create an environment where everyone is believing that they’re working on a real child. Other simulators exist but their aesthetics and anatomy are fairly rudimentary, making it hard to keep people’s heads in the game. We’re excited to have these new simulators change that.”

Fractured FX won an Emmy earlier this fall for “American Horror Story: Freak Show,” but its work on “The Knick,” a Cinemax series about a New York City hospital in the early 1900s, with ultra-realistic surgical recreations—is what drew Weinstock’s attention. Boston Children’s and Fractured FX began discussions in 2014, and the company began prototyping trainers earlier this year together with SIMPeds’ SIMEngineering division.

“A lot of us had aspirations in medicine, and have collaborated with prosthesiologists to help improve prosthetics artistically,” said Fractured FX CEO Justin Raleigh. “We wanted to take our skills in special effects to try and help people. We’ve had to come up with new techniques to develop the elements you’d see in surgery, something we never had to do for film.”

One of the trainers on view at the Summit was designed to help surgeons put critically ill children on heart-lung bypass (also known as ECMO), which involves introducing tubes into the internal jugular vein and carotid artery. Members of Boston Children’s ECMO team worked with Fractured FX’s artists to create realistic models of the neck and upper chest, including the blood vessels and the vagus nerve (which surgeons need to avoid).

Unlike the existing trainers, with thick silicone skin that had to be cut through with a knife, the new trainers have realistic skin with subcutaneous fat that surgeons can dissect through and muscles surgeons can spread. Blood vessels, previously little more than tubes, are now thinner with a membrane over them; when surgeons insert a cannula, the blood feels like it has the right consistency.

The second trainer, developed in consultation with Boston Children’s neurosurgeons, is used to teach surgical residents how to perform a tricky procedure called endoscopic third ventriculostomy (ETV), used to treat hydrocephalus. ETV uses an endoscope to remove tumors and bypass other blockages that prevent fluid from draining from the brain. This requires working perilously close to the basilar artery—if that artery is torn, the patient could die. Operating on the models hones surgeons’ hand-eye coordination and takes away much of the risk.

More trainers, including models of cleft lip and palate, will soon be in the works, Weinstock promised.

The process of building a trainer begins with detailed drawings and a three-way knowledge exchange between Fractured FX, clinicians at Boston Children’s and SIMPeds experts in engineering, design and 3D printing. The Fractured FX team then starts experimenting with materials to simulate the look and feel of real body tissues—including brain tissue, muscles, bone, connective tissue, membranes around organs and even tumors, some of which are hard and rubbery, others very soft.

As the clinicians tinker with the trainers, they make comments that are recorded on video and shared with the Fractured FX team. “Then we iterate,” explained Melissa Burke, SIMPeds director of operations.

Once the team achieves the right look and feel, the next steps are assembly and the final product. The trainers include inserts of the relevant anatomy that can be replaced when another clinician needs to train. “In the end, you’d be hard pressed to tell which images are real, and which the model,” said Burke.

“It’s been a really nice back and forth working with actual surgeons and getting their input and knowledge,” said Raleigh. “We’ve been getting a crash course in surgery, and the SIMPeds engineers have come to our studio to learn about manufacturing techniques and how we process materials and make molds. It’s been very educational in both directions.”
Learn more about the hospital’s partnership with FracturedFX by watching the announcement below: