Dr Peter Kohl of Oxford University has a dream. A dream of using virtual reality models of the body's organs that simulate both structurally and functionally to revolutionise both our understanding and treatment provision to patients.

He is one of the lead instigators on the Virtual Psychological Human or VPH project being funded by the European Union, which he hopes will see results within the next 5-10 years.

He feels that for decades biology has focussed on tearing the body down into isolated component pieces, and now its time to stop doing that, and build back up from those components into a holistic approach once again.

"We have developed better tools to look at smaller parts of the puzzle in terms of structure and function," he said. "We have drilled down into the detail. At the same time, our knowledge has become a fragmented construction site. We now need to understand how the pieces interact with each other and the environment."

However, Dr Kohl believes a complete model of the body will never be finished.

"A model cannot aim to capture every aspect of the original; otherwise it would be just as complex and unwieldy as the real thing," he said. "A model is a simplified representation of reality. Different models are built for different purposes. Models need to be constantly updated with testing, and new models will be needed for different specific reasons. Like tools in a tool-box, you need to select your model to fit the question."

"A computer model can be used as a tool to access plausibility and help a human researcher or clinician work more efficiently through scenarios. Computers can already calculate more steps ahead than a chess master - we need to make use of this to be able to cope in the real world."

Dr Kohl that these simulations need to be assessed thoroughly, rather than just taking whichever approach produces a model that seems to match the patient exactly, as only by comparing a thorough model with the differences experienced by the patient, will anything be learnt.

"If you compare your predication with real life and you get an exact match, this is great for clinicians. Within the given framework your model addresses reality. This increases your confidence - but there is no knowledge gained. However, if your model and reality are different - this drives insight. Either your data is incorrect, implementation is wrong or understanding inaccurate. You have more to learn."

Use In Care

Currently, if a patient has been admitted to hospital, before a major surgery, a diagnostic scan and blood workup will be done, to verify the current state of things inside the patient. At the best and most efficient facilities, this currently takes 45 minutes to come back to doctors. During these 45 minutes, there is a window, not currently utilised, whereby the DICOM/PACs digital scan data, which comes back immediately, could be compared to VPH visualisation data, to note the differences between the patient's organ of concern, and a fully functional organ both static and in real-time operation. This would highlight individual muscle filaments, nerve channels, and areas of concern not just in the immediate malfunction site, but around it, perhaps feeding into it as well. This kind of data would give surgeons a much greater understanding of the problem, in the run up to working on it.

By seeing the differences, and the interplay of the patient's heart muscles for example, they might decide the best place to attack is not where the symptoms are exhibiting after all, but rather a knot of tissue that is somewhat away from the problem site, but which their visualisation data shows is actually driving the problem.

The result of all this visualisation work should be a swifter, more accurate surgical procedure with less invasion into the body's systems, since the cause of a problem can be accurately targeted. On the flip side of course, fewer complications and shorter recovery time, putting patients back on their feet and avoiding unnecessary procedures.
Worries

Of course, the whole idea is a radical departure from traditional clinical work, which may worry ptients and practitioners alike.

Perhaps Dr Kohl's argument on this topic, makes the most sense:

"Why should a quantitative computer model be any less reliable than a doctor-based in-brain assessment of a patient? "

References

Operating on the virtual human

Bigger Than Life: Virtual Physiological Heart