Hollywood SFX take medical training to a new level of realism

When critical care physicians at Boston Children’s Hospital practice cannulating an infant going on cardiopulmonary support, they’ll no longer have to cut through hard plastic mannequins with tubes for blood vessels. Instead, they’ll puncture a soft layer of realistic baby skin, dissect through subcutaneous fat and spread muscles that look and feel like the real thing.

They’ll insert the cannula into an internal jugular vein and carotid artery that are thin and flexible, after dissecting through their covering sheath. As they advance the cannula, the blood will have the right viscosity.

These mannequins are not your father’s Resusci-Anne. They’re the creation of the special make-up effects company Fractured FX, whose current credits include Cinemax’s The Knick, and Boston Children’s simulator program, SIMPeds. The models, or “simulators,” allow medical personnel to practice and rehearse tricky or complex medical procedures without any risk to patients.

This "patient" is being prepped for ECMO cannula insertion.
This “patient” is being prepped for ECMO cannula insertion.

“This is the nexus of medicine and art, surgery and cinema,” says SIMPeds Director Peter Weinstock, MD, PhD.

From horror flicks to medical simulation

Los Angeles-based Fractured FX won an Emmy this fall for American Horror Story: Freak Show, but its work on The Knick about a New York hospital in the early 1900s, with high-fidelity surgical recreations — is what drew Weinstock’s attention. Boston Children’s and Fractured FX began discussions in 2014, and the studio began prototyping two simulators earlier this year together with SIMPeds’ SIMEngineering division.

ETV simulation FracturedFX
A brain endoscopy: Real or fake?

“A lot of us had aspirations in medicine, and have collaborated with prosthesiologists to help improve prosthetics artistically,” says Fractured FX CEO Justin Raleigh. “We wanted to take our skills in special effects to try and help people.”

One model, of the neck and upper chest, was developed in consultation with the hospital’s ECMO team, is designed to help surgeons put critically ill children on heart-lung bypass. The model includes tissues that bleed and pulsate, blood vessels and the vagus nerve, which surgeons need to avoid.

A second simulator, developed with the neurosurgical team, is helping 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. The simulators, made with special gels that feel like real brain tissue, help surgeons hone their hand-eye coordination.

ECMO simulation trainer FracturedFX
The ‘business end’ of the ECMO trainer is a replaceable modular unit.

“Getting the look and feel right is very important, particularly to surgeons and proceduralists,” says 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.”

This has required Fractured FX’s artists to take a deeper dive into their craft than usual. “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,” says Raleigh.

Behind the scenes

The process of building a simulator begins with detailed drawings and a three-way knowledge exchange between the artists at Fractured FX, hospital clinicians 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 bone, connective tissue, membranes around organs and even tumors, some of which are hard and rubbery, others very soft.

medical mannequin simulationAs the clinicians tinker with simulator prototypes, their live comments are recorded on video and shared with the Fractured FX team. “Then we iterate,” says 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 simulators 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,” says Burke.

“It’s been a really nice back and forth working with actual surgeons and getting their input and knowledge,” says 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.”

The ECMO and ETV simulators make their public debut today at Boston Children’s Global Pediatric Innovation Summit + Awards. Boston Children’s hopes to begin offering the simulators commercially to other medical centers over the coming year, with Fractured FX handling the manufacturing.

Watch video highlights of the 2015 Global Pediatric Innovation Summit + Awards.