Michael Teixido, M.D., Christiana Care otolaryngologist and Patrick Coller in DBI's CAVE.

July 6, 2006
Reprinted from Focus, a publication of Christiana Care Health System

Virtual reality software creates a fantastic voyage

As the room darkens, pairs of black-rimmed plastic glasses turn toward the projection screen. Another 3-D classic at the Saturday matinee? Not exactly.

What appears at the front of the room, seemingly suspended in mid-air, is something many are seeing in three-dimensional, living color for the very first time. It is the entire infrastructure of the inner ear, presented in this latest production by Michael Teixido, M.D., Christiana Care otolaryngologist and neurotologist, whose 3-D "movies " are granting a whole new perspective on the many complex and obscure components of this delicate organ.

Designing the "virtual " ear
"The workings of the inner ear are supported by a network of nerves, bone and membranous structures encased in bone that do not lend themselves very well to demonstration by dissection, " Dr. Teixido explains. "Up until now, in order to study the anatomy of the inner ear, one had to slice it into thin sections the way a pathologist slices a piece of tissue for viewing under the microscope. " Looking at these individual slices doesn’t serve us very well, he says, when we are trying to visualize what the inner ear looks like in real life and how it functions.

Using technology similar to what aerospace companies use to design and test the next generation of passenger jets, scientists at Harvard University developed the first computerized models of the inner ear, constructed slice by slice from digital copies of pathology tissue slide collections. Dr. Teixido has taken this technology to its full potential using stereo presentation and movie making. The resultant 3-D, anatomically accurate models of the inner ear can be spun, tilted, constructed and deconstructed right before your very eyes. "This allows us not only to study the anatomy of the inner ear but also to look at the relationships of its many structures better than we are able to do with the naked eye, " he says.

And the possibilities for this amazing "virtual " ear appear endless. It can serve as a practice field for anatomical dissection or cyber surgery, a simulation model for better understanding inner ear pathology or a test site in the development of potential treatments and new implant devices to improve hearing. "Because this gives us a new way to look at things, we can now extend the basic work of anatomists and make correlations with disease states that we were never able to do before, " he explains.

Better than the real thing

Dr. Teixido is using the virtual ear models he has constructed to teach temporal bone and ear anatomy to otolaryngology residents at Christiana Care, Thomas Jefferson University and several others in the area. His practice partner, Neil Hockstein, M.D., is working on a 3-D stereo model for the study of sinus anatomy. "With these models we have the opportunity for a whole room full of people to see what the surgeon is seeing in 3-D all at the same time. In a teaching setting, " he says, "this is a great advantage, and very soon, everybody studying just about anything is going to be looking at information in this way. " Dr. Teixido is currently working on a text book chapter to help others design their own virtual human models. "My goal is to make the technology as broadly accessible as possible, " he adds.

Dizzying heights

Numerous presentations at scientific meetings have prompted offers of tissue slide collections from around the world. One group of slides created from the temporal bone of a young male donor at Johns Hopkins University has allowed Dr. Teixido to create a 3-D model of the labyrinth, the delicate membranous structure of the inner ear that controls balance. He is using this model to illustrate what happens to patients with benign paroxysmal positional vertigo, a condition responsible for 45 percent of all dizziness, and a source of countless falls and hip fractures in the elderly. "My hope is that with the simulation model, we can help primary care physicians develop the skills they need to diagnose this widespread condition that is difficult to accurately assess and treat, " he explains.

Statewide collaboration

Dr. Teixido is assisted in his work by University of Delaware (UD) senior, Patrick Coller, under the guidance of Karl V. Steiner, associate director of the Delaware Biotechnology Institute (DBI). "I am very excited about the connection we’ve established between our students and the physicians at Christiana Care, " says Dr. Steiner. "Our interdisciplinary collaboration has allowed us to reach into areas of discovery that we only could dream of just five years ago. " What is more, he adds, "Many students like Patrick, have blossomed in their field of study with the opportunity to work with real data on projects that have real-life medical applications. " In May of this year, Coller received the John K. Scoggin, Sr. Memorial Award from the UD Computer and Information Sciences Department in recognition of his undergraduate research work with Dr. Teixido.

With funding from the Delaware IDeA Network of Biomedical Research Excellence (INBRE), supported by the National Institutes of Health, several Christiana Care physicians are working closely with scientists around the state to develop virtual reality models for the life sciences. DBI has developed nationally recognized expertise in virtual 3-D imaging with its multi-million dollar investment in high speed computing and projection technology, resulting in their award-winning, virtual reality CAVE. According to Brian Little, M.D., Ph.D., CCHS Vice President of Academic Affairs and Research, "The ability of CCHS staff to use this facility and the plans to incorporate aspects of this technology into the Virtual Education and Simulation Technology Laboratory [VEST Lab] at Christiana Care will provide excellent educational opportunities for all CCHS staff and enhance the quality of healthcare in our region. "