Dr. Strange’s augmented reality surgical assistant

We’re actually done with all of the artifacts from Doctor Strange. But there’s one last kind-of interface that’s worth talking about, and that’s when Strange assists with surgery on his own body.

After being shot with a soul-arrow by the zealot, Strange is in bad shape. He needs medical attention. He recovers his sling ring and creates a portal to the emergency room where he once worked. Stumbling with the pain, he manages to find Dr. Palmer and tell her he has a cardiac tamponade. They head to the operating theater and get Strange on the table.

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When Strange passes out, his “spirit” is ejected from his body as an astral projection. Once he realizes what’s happened, he gathers his wits and turns to observe the procedure.

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When Dr. Palmer approaches his body with a pericardiocentesis needle, Strange manifests so she can sense him and recommends that she aim “just a little higher.” At first she is understandably scared, but once he explains what’s happening, she gets back to business, and he acts as a virtual coach.

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In this role he points at the place she should insert the needle, and illuminates the chest cavity from within so she can kind of see the organ she’s targeting and the surrounding tissue. She asks him, “What were you stabbed with?” and he must confess, “I don’t know.”

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Things go off the rails when the zealot who stabbed him shows up also as an astral projection and begins to fight Strange, but that’s where we can leave off the narrative and focus on everything up to this point as an interface.

Imagine with me, if you will, that this is not magic, but a kind of augmented reality available to the doctor. Strange is an unusual character in that he is both one of the world’s great surgeons and the patient in the scene, so let’s tease apart each.

An augmented reality coach

Realize that Dr. Palmer is getting assistance from one of the world’s greatest surgeons, rendered as a volumetric projection (“hologram” in vernacular). She can talk to him as if he was there to get his advice, and, I presume, even dismiss him if she believes he was wrong. Wouldn’t doctors working in new domains relish the opportunity to get advice from experts until they they have built their own mastery?

Two notes to extend this idea.

In the spirit of evidence-based medicine and big idea, we must admit that it would be better to have diagnoses and advice based on the entirety of the medical record and current, ethical best practices, not just one individual expert. But if an individual doctor prefers to have that information delivered through an avatar of a favored mentor, why not?

The second note to anyone thinking of this as a real world model for an AR assistant: I would expect a fully realized solution to include augmentations other than just a human, of course, such as ideal angles for incisions, depth meters, and life signs.

A (crude) body visualization

One of the challenges surgeons have when working with internal damage is that the body is largely opaque. They have to use visualization tools like radiographs and (very) educated guesses to diagnose and treat what’s going on inside these fleshy boxes of ours. How awesome that the AR coach can help illuminate (in both senses) the body to help Dr. Palmer perform the procedure correctly?

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Admittedly, what we see in Doctor Strange is a crude version. This same x-ray vision appeared with more clarity and higher resolution in two other films, as cited in the Medical chapter of Make It So. In Lost in Space, the medical table projects a real-time volumetric scan of the organs inside Judy’s body into the eyes of the observers.

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In Chrysalis, Dr. Bruger sees a volumetric display of the patient on which she is teleoperating.

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But despite its low-resolution, I wanted to draw it out as another awesome and somewhat subtle part of the way this AR assistant helps the doctor.

A queryable patient avatar

Lastly, consider that Dr. Palmer is able to ask her patient what happened to him. Of course in the real world passed out patients aren’t able to answer questions, but of course understanding the events that led to a crisis are important. I can imagine several sci-fi ways that this information might be retrievable from the world.

  • Trace evidence on the patient’s body: High-resolution sensors throughout the operating theater could have automatically run forensic analysis on the patient the moment they entered the room to determine type of wound and likely causes, such as  microscopic detection of soot in entrance wounds.
  • Environmental sensors: If the accident happened in a place with sensors that are queryable, then the assistant could look at video footage, or listen in to microphones in the environment to help piece together what happened. Of course the notion of a queryable technological panoptican has massive privacy issues which cannot be overlooked, but if the information is available to medical professionals, it would be tragic to ignore it in genuine crises.
  • Human witnesses can provide informative narratives. Witness and first responders may be on record already. But in looking at the environmental sensors, the assistant might be able to instantly reach out to those who have not. Imagine one of these witness, shaken by the event he saw, on a commute home. His phone buzzes and it is the assistant saying, “Hello, Mr. Mackinnon. Records indicate that you were witness to a violent crime today, and your account of the event is needed for the victim, who is currently in surgery. Can you take a moment to answer some questions?”
  • Patient preferences should be automatically exposed and incorporated via the assistant as well. If the patient was a Jehovah’s Witnesses, for instance, then their desire not to have a blood transfusion should be raised in whatever form the assistant takes.

An surgical assistant could automatically query all of these sources to make a hypothesis of what happened and advise the procedure. This could be available doctor for the asking, volunteered by the assistant at a lull in more critical action, or offered by the assistant as a preventative. I suspect it’s more likely the doctor would ask the assistant than the patient, e.g. “OK, ERbot, what happened to this guy?” but if the doctor prefers, she should be able ask in the second person, as Dr. Palmer does in the scene, and the system should reply appropriately.

Sure, in this context, it’s magic, but since we can imagine how it could be done with technology, this scene gives us a very dense set of inspirational ideas for the future of surgical assistants.

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