New startup uses video game technology to improve simulators for minimally invasive surgical techniques.
Sam Glassenberg doesn't call the tumor a boss fight, but that's essentially what it is. Bulbous and menacing, it lurks malevolently deep in the back of a virtual patient's mouth as Glassenberg guides a virtual fiberoptic endoscope on his smartphone. The tumor looks impenetrable, like a cross between a metroid and a peach, and I wonder how the patient's even alive. But Glassenberg shows me the tiny bubbles seeping through the tumor's edges every time the patient exhales, and with three hard motions, he rams the camera through them and thus past the tumor and into the trachea. A notice pops up. Perfect score. 50,000 points.
When I tried the sequence myself, I failed partially because I wasn't aware I was allowed to be so forceful with the device. But this is Airway EX, Glassenberg's own app, and he's had plenty of practice. Now available as a free beta for iOS and Android, it's the first official app out of his startup Level EX, which aims to let doctors practice on minimally invasive surgical techniques with their smartphones and tablets.
The app currently comes with 18 cases, each pulled from real patient cases and recreated from the photos, videos, and other media acquired by the doctors. It works much like the real things and the bulky standalone simulators, with the touch controls configured to guide the cable with the left hand and the right being used to rotate the camera. Level EX even worked with the Global Education Group to get some of the 18 cases to award a small amount of the Continuing Medical Education (CME) credits physicians need to renew their licenses.
It's certainly less expensive than existing methods. Glassenberg shows me a set of slides showing current virtual endoscope training methods, which usually involve visiting a far-off facility and using large devices.
In the case of doctors in Glassenberg's native Chicago, for instance, that often means traveling 160 miles south to Peoria. Anyone without access to such experiences might have to do with the older ways of learning this stuff, whether by working on cadavers or on live patients. In those cases, he says, they're often working with "normal" cases.
"Here, doctors can try out these minimally invasive devices on the specific cases where the device offers the most benefit," Glassenberg says.
Glassenberg himself has a long history with gaming technology, having once lead Microsoft's DirectX team and worked on Star Wars games for LucasArts.
In 2012 he made a simulator for fiberoptic laryngoscopy for his father that quickly amassed 100,000 users, and places like Stanford's medical school started preinstalling it on students' iPads. And thus he rallied several game developers to his cause at Level EX in order to give the projects the attention they clearly deserved.
"There's this huge gap between what we're doing in video games and what doctors have to train with," he said.
The result is startling realism, right down to uvulas that jiggle when the camera hits them, saliva that oozes on the camera, and trachea walls that thump in tune with heartbeats. Glassenberg shows me photos of real operations with his creations beside them, and the resemblance is startling. His app even accounts for differences with cameras, as in the case of a $300 single-use Blake Field-Scope M-5P0k camera, which features such shoddy quality it looks like something my webcam might have captured back in 2001.
Glassenberg hopes to see a future where doctors can use his app to "try out" endoscopes before they're even released, thus providing a way to provide feedback to the device's makers. He also sees it as furthering medical knowledge, as uploading a rare case to his app would expand the circle of suggestions beyond a few colleagues who might see the video and photos in an obscure presentation.
"Now you can submit the case to us," he says, "and three weeks later, we can send it out to tens of thousands of colleagues worldwide who can all compete to get the best outcome and best score."
And you don't even have to be one of those colleagues to try it out. Right now, you can download for free and learn how to stick a $40,000 scope down someone's mouth for free for both iOS and Android.