Translation Medicine Day February 23, 2018

1. “Toward Personalized Surgery”
“Translational Medicine Day”
UC San Diego
February 23, 2018
Dr. Larry Smarr
Director, California Institute for Telecommunications and Information Technology
Harry E. Gruber Professor,
Dept. of Computer Science and Engineering
Jacobs School of Engineering, UCSD
http://lsmarr.calit2.net
1

2. Quantifying the Need for Surgery

3. I Have Been Tracking My Internal Biomarkers For A Decade
To Understand My Body’s Dynamics
My Quarterly
Blood Draw
Calit2 64 Megapixel VROOM
Calit2 64 Megapixel VROOM

4. I Discovered by Using Stool Tests
Oscillatory Behavior in an Immune Variable Which is Antibacterial
Normal Range
<7.3 µg/mL
124x Upper Limit for Healthy
Lactoferrin is a Protein Shed from Neutrophils -
An Antibacterial that Sequesters Iron
Typical
Lactoferrin Value for
Active Inflammatory
Bowel Disease
(IBD)

5. Descending Colon
Sigmoid Colon
Threading Iliac Arteries
Major Kink
Confirming the IBD (Colonic Crohn’s) Hypothesis:
Finding the “Smoking Gun” with MRI Imaging
I Obtained the MRI DICOM Slices
From UCSD Medical Services
and Converted to Interactive 3D
Working With Calit2 Staff
Transverse Colon
Liver
Small Intestine
Diseased Sigmoid Colon
Cross Section
MRI Jan 2012
Severe Colon
Wall Swelling

6. Volumetric Visualization Enables
3D Printing of Diseased Organ
3D Volumetric
Visualization
Created by
Calit2’s Jurgen
Schulze
from January
2012 MRI

7. Full Body CAT Scan at mm Resolution, Including Virtual Colonoscopy
June 2016 Convinced Me Time Had Come for Surgery
No Air
Source: June 2016
Dr. Harvey Eisenberg,
Body Scan Intl., Irvine, CA

8. 2016 MRI Slice Through Sigmoid Colon
Reveals Thick Walls and Very Narrow Lumen
4.2mm
13.3mm
16.4mm
Source: Smarr MRI Oct. 25, 2016
Reading by Cynthia Santillan,
MD Radiologist, UCSD
Normal opening (bright yellow) is 40mm,
so mine is 1/10 the diameter it should be.
Normal wall thickness (dark yellow)
is 3mm, so wall thickness is 4-5 times
as thick as it should be.

9. The Ability to See Inside Myself Led
to My Co-Planning My Own Surgery

10. Pre-Surgical Planning
Using 3D Graphics and Virtual Reality

11. QI’s Jurgen Schulze Converted Smarr Abdominal MRI Slices
to 3D Organ Segmentation for Surgical Pre-Planning
MRI Slice from Dr. Cynthia Santillan 3D Organ Segmentation Made from
Dr. Santillan’s 150-Slice MRI
Images of Patient Smarr’s Abdomen
Created by Jurgen Schulze, Calit2

12. Jurgen Used the 3D Slicer Software
to Hand Color Each Organ in Each Slice

23. Patient & Surgeon Doing Pre-Surgical Planning in QI Virtual Reality:
Using Virtual Reality As Input for Positioning The Two Resection Cuts
Colon visualization by Jurgen Schulze, Calit2;
Photo credit Tom DeFanti, Calit2
Surgeon Sonia Ramamoorthy, MD
in Calit2 Virtual Reality CAVE
Friday November 21, 2016

24. Virtual Reality Brought Into
the Operating Theatre

25. QI Collaboration with Radiology, GI, and Surgery
to Support Sigmoid Colon Resection
UC San Diego Health Communications Planning Press Release Early March

26. Using QI Organ Segmentation in Jacobs OR
on Tuesday November 29, 2016
Patient Smarr
With da Vinci Robot
Arms Inside Him
OR Team Using Large Screens
To Watch Dr. Schulze’s da Vinci Images
Dr. Ramamoorthy Operating
Da Vinci Xi Robot During Surgery
Dr. Schulze Rotating 3D Organs To Match Up
With da Vinci Arms and Internal Camera

27. Dr. Ramamoorthy Using Interactive 3D Anatomy
To Plan Resection of Sigmoid Colon Which is Resting on Top of Bladder

28. Sonia Ramamoorthy, MD Explains
How These Technology Injections Changed Her Surgical Practice
http://ucsdnews.ucsd.edu/feature/visualizing_the_future_of_surgery

29. Dr. Kurisu Using Oculus Rift Virtual Reality
to Observe 360 Degree Time Lapse of Dr. Smarr’s Surgery
Jurgen Schulze Showing Mike Kurisu
How to Use
an Oculus Rift Virtual Reality Headset
Jurgen Schulze Used 360 Degree Camera
To Record Time Lapse Movie of Surgery

30. Using Virtual Reality
in Spinal Therapy

31. Images courtesy of Christine Chung MD, UCSD MSK Imaging Research Lab (www.MSKMRI.com)
T2 with fat suppression: makes fat dark and fluid bright
(emphasizes disc and fluid around spinal cord/roots)
T1 has contrast with fat bright
(shows bone and alignment well)
Advanced MRI:
Adjusting T1/T2 to Bring Out Regions of Interest
Severe
Central Canal
Stenosis

32. Dr. Kurisu Validating His Osteopathic Findings
with 3D MRI Virtual Reality
Visualizations from MRI by Jurgen Schulze, Calit2, UCSD

33. From Digitally-Enabled Future Patient
to Digitally-Enabled Future Doctor