HITLab and the future of imaging

In 1997, while visiting the University of Washington, I dropped in on the Human Interface Technology Laboratory, known to the locals simply as HITLab. What drew me there was research into a surgical simulator. But what captured my imagination was a project exploring the concept of "virtual space" and an offshoot called "telesavance."

Back then, virtual reality was all the buzz, and a lot of the money for its development was coming from the military. HITLab, as it turned out, was getting a generous chunk from the U.S. Air Force. The money spent on virtual space and telesavance grew from HITLab's successful demonstration of its "Virtual Pilot," in which a pilot and copilot shared a virtual cockpit.

The goal was to bring together in virtual space several people involved in a single task: the pilot of a single-seat fighter, for example, with an AWACS operator, a forward air controller, and a ground controller. Even though the pilot was the only one in the fighter jet, he would be able to see--through telesavance--the facial expressions, behaviors, and gestures of the other three on his team, as though they were sitting with him in an expanded virtual cockpit.

Ultimately, it was thought, the fighter pilot wouldn't even have to board the plane. He would fly it remotely, while interacting with a team of specialists grouped in a virtual cockpit.

Such a scenario is hardly farfetched. (The military runs its Predator drone operation from a trailer outside Las Vegas, with virtual pilots scouring Iraq, Afghanistan, and, if media reports are correct, Iran.) Whether HITLab's research helped set up this program is impossible to say. The project with its virtual cockpit, according to the UW Web site, is no longer funded. But, at the very least, the research is worth a long, hard look by the vendors of imaging equipment.

Except for the wings, MR scanners and airplanes are amazingly alike. They both cost a lot of money; neither has much room; and each relies heavily on electronics. But the most important commonality is their dependence on skilled operators.

At the RSNA meeting two months ago, Siemens demonstrated software called Expert-i for operating MR scanners by remote control. A physician ran an MR scan at Northwestern University from his desktop PC at the University of California, Los Angeles. Siemens framed the technology as providing a "second opinion in seconds." But this may have been the understatement of the year.

Locked in this technology is the seed of an extraordinary new era in imaging. Imagine experts running cardiac MR scans from miles away, producing high-quality results while instructing onsite staff how to do such scans themselves. Dr. Paul Finn has. In fact, he's begun doing this from his PC in the UCLA Cardiovascular Research Laboratory. And even this barely hints at the true potential.

Centers of excellence might be set up where expert radiologists conduct and then interpret the results from challenging MR scans. Most intriguing is the potential for vendors to set up virtual training centers, where application specialists can instruct others at sites across the country and around the world efficiently and more cost-effectively than anyone could possibly do in person. But there's more. And that's where virtual space and telesavance come in.

Software called VCN (virtual computing network) can be downloaded by anyone with an Internet hookup, and, once installed, it can be used to control a distant computer. Siemens' Expert-i is a variation on this theme, which literally any vendor could create to suit its own equipment. But much of teaching and learning depends on the facial expressions, gestures, and behavior of teacher and student. Virtual space and telesavance might fill in this information.

It is widely accepted that the clinical impact of advanced medical techniques in this country is blunted because these advanced techniques are most effective only in the hands of experts. Virtual space and telesavance may be the tools by which this challenge can be overcome.

Vendors owe it to the imaging community, the patient population, and their shareholders to look carefully into what these technologies offer, develop them further, and apply them not only in MR but in any modality that might benefit. There is more to modern radiology than advanced scanners. And some of it may be waiting in virtual space.