Stories about: SIMPeds

Moulage meets medicine: Making simulations feel real with special effects makeup

medical moulage - Maeve Geary at work
Photo: Katherine C. Cohen/Boston Children’s Hospital

Maeve Geary, BDes, to our knowledge, is the first PhD candidate to specialize in medical special effects simulation. A native of Belfast, Ireland, she completed a Bachelor of Design degree in Special Effects Development at the University of Bolton (Manchester, England). She has been with Boston Children’s Hospital’s Simulator Program, SIMPeds, since April 2016. At SIMPeds, she has contributed to a variety of custom “trainers” and is exploring whether increasing the realistic look and feel of mannequins impacts training and trainees’ ability to learn. Recently, she led the development of a trainer for urinary catheterization in infants — complete with visually and haptically accurate genitals, urethral opening and fat rolls.

It’s now apparent that treating medical mannequins with greater visual and haptic realism makes medical simulation training more effective for clinicians. Moulage, or special effects makeup, is an important part of making simulations feel real.

Here’s a quick tutorial in some very basic effects achieved with simple, readily available drugstore ingredients. Although much of my research is on complex fabrication techniques adapted from the film and television industry, these techniques are simple and accessible to all. (If you’re in Boston, attend our live demos this week!)

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Training neurosurgeons in a rare hydrocephalus procedure, with a little help from Hollywood

ETV trainer

A 4-year-old has a progressively enlarging head and loss of developmental milestones: a clear case of hydrocephalus. He undergoes a minimally invasive endoscopic third ventriculostomy (ETV) to drain off the trapped cerebrospinal fluid.

This requires puncturing the floor of the brain’s third ventricle (fluid-filled cavity) with an endoscope — while avoiding a lethal tear in the basilar artery, which lies perilously close.

There are no good neurosurgical training models for this rare and scary operation.

“We semi-blindly poke a hole through the ventricle floor,” says Benjamin Warf, MD, director of Neonatal and Congenital Anomaly Neurosurgery at Boston Children’s Hospital. “To make the technique safer and to be able to train more people, it would be very helpful to make that hole in a way that’s less anxiety-provoking.”

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GALLERY: Custom-built ‘trainers’ help clinicians master procedures

medical mannequins manikins trainers medical simulation
Andrew Hosmer (left) and Noah Schulz at the bench, building parts for medical trainers.

Walking into the SIMPeds Engineering Studio, a few blocks from Boston Children’s Hospital, the first thing you notice is body parts — high-fidelity replicas of human anatomy in various sizes. Some are in a glass display case, while others are laid out in various states of assembly, from a lone finger to the complete abdominal cavity of a newborn, packed with diminutive organs. Six newborn-sized, hollow duodenums, cast in rubber over a plastic mold, hang ready near a workbench.

These aren’t your usual medical mannequins.

In the adjoining InventorSpace, three 3D printers stand ready to fabricate additional custom parts. Some will be used by surgeons to rehearse an upcoming complex operation. Others are used for general training and preparedness purposes.

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Clinical simulation training goes to the dogs

clinical simulation

Boston Children’s Hospital’s fast-growing Simulator Program, SIMPeds, creates medical scenarios for clinical teams to practice challenging procedures and situations in a risk-free environment. Now serving 27 departments and divisions at the hospital, SIMPeds’ customized simulations prepare clinicians for everything from a Code Blue to complex surgery to breaking difficult news to parents.

At the Simulation Center this week, there was one special team member being trained: Rafa, a Miniature Australian Shepherd auditioning to be part of Pawprints, Boston Children’s dog visitation program. Not all dogs are behaviorally up to the job when confronted with a hospital environment. So the SIM team created a mock intensive-care-unit patient room, fully equipped and complete with an overly enthusiastic child (overwhelming for some dogs), played by SIM engineer Katie Fitzpatrick. As Rafa interacted with the “patient,” the SIM staff set off alarms, had “doctors” and “nurses” come in and out and staged other hospital things that might distract or make a dog skittish.

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Making rare operations common through special effects simulation

What if I told you that there was a new technology that improved outcomes for patients of all ages, reduced pain and suffering, reduced time in the operating room, reduced anesthetic times and, the more you did it, the better it benefited patients. And here’s the kicker — it has no side effects. And it’s available everywhere care is delivered.”

That’s what critical care physician Peter Weinstock, MD, PhD, described at his recent TEDx talk in the Boston suburb of Natick.

Weinstock is director of Boston Children’s Hospital’s Simulator Program, SIMPeds. The technology is ultra-high-fidelity medical simulation coupled with a simple concept: practicing before game time.

I mean really practicing.

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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.

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From napkin sketch to new product: Rapid prototyping service speeds medical device development

rapid 3D prototyping services at hospitals
These custom devices hold fiber optic probes used to measure blood oxygenation in newborns. (Courtesy Noah Schulz, SIMPeds)

Some people bring data and completed designs. Others just bring simple sketches. “We have this idea for this device,” they begin. “It may only help 15 kids a year, but it could really improve their quality of life.”

Other people bring only a clinical need: “We need something to keep babies lying still after their procedure, without having to medicate them.”

To make these ideas more tangible and help launch them down a formal development path, the Boston Children’s Hospital Simulator Program, SIMPeds, has begun making its 3D printing and engineering service available to help hospital staff rapidly prototype new devices.

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