that, when placed in the hands of doctors and nurses,

想像這會怎樣──

improved outcomes for children and adults, patients of all ages;

把一種新科技

reduced pain and suffering,

交給醫生和護士使用，

reduced time in the operating rooms,

它能改善兒童、成人，

reduced anesthetic times,

所有年齡患者的治療效果；

had the ultimate dose-response curve

它能降低病人的痛苦，

that the more you did it,

縮短手術的時間，

the better it benefitted patients?

減少麻醉的次數，

Here's a kicker: it has no side effects,

獲得最佳的劑量反應曲線；

and it's available no matter where care is delivered.

這技術被用得越多，

I can tell you as an ICU doctor at Boston Children's Hospital,

患者的獲益就越大。

this would be a game changer for me.

意料之外的是：它不但沒有副作用，

That technology is lifelike rehearsal.

且可用於任何治療。

This lifelike rehearsal is being delivered through medical simulation.

身為波士頓兒童醫院 加護病房的醫生，

I thought I would start with a case,

我認為局面會全然改觀。

just to really describe the challenge ahead,

我說的科技是

and why this technology is not just going to improve health care

仿真的醫學模擬和練習，

but why it's critical to health care.

用逼真的醫學模擬來練習。

This is a child that's born, young girl.

我先舉個實例

"Day of life zero," we call it,

來確切說明醫學所面臨的挑戰，

the first day of life, just born into the world.

為何這技術不但會改善醫療，

And just as she's being born,

並且是不可或缺的。

we notice very quickly that she is deteriorating.

這是一個剛出生的小女孩。

Her heart rate is going up, her blood pressure is going down,

我們稱為「生命的首日」，

she's breathing very, very fast.

她降生到這世界的第一天。

And the reason for this is displayed in this chest X-ray.

她一出生，

That's called a babygram,

我們立刻發現她的健康狀況

a full X-ray of a child's body, a little infant's body.

正急遽惡化。

As you look on the top side of this,

她的心跳加速，

that's where the heart and lungs are supposed to be.

血壓下降，

As you look at the bottom end, that's where the abdomen is,

呼吸非常急促。

and that's where the intestines are supposed to be.

這張 X 光片顯示病因。

And you can see how there's sort of that translucent area

我們稱之為嬰兒圖像 (babygram)，

that made its way up into the right side of this child's chest.

是嬰兒全身的 X 光片。

And those are the intestines -- in the wrong place.

圖片的上半

As a result, they're pushing on the lungs

是心臟和肺臟應該在的位置；

and making it very difficult for this poor baby to breathe.

下半是腹部和小腸應該在的位置。

The fix for this problem

看這塊半透明的區域，

is to take this child immediately to the operating room,

一直延伸到右上方嬰兒的胸腔，

bring those intestines back into the abdomen,

那是錯位的小腸。

let the lungs expand

小腸推擠肺部，

and allow this child to breathe again.

使得這可憐的嬰兒難以呼吸。

But before she can go to the operating room,

解決之道是馬上為她動手術，

she must get whisked away to the ICU, where I work.

把小腸移回腹部，

I work with surgical teams.

讓她肺的空間擴大，

We gather around her,

能夠恢復呼吸。

and we place this child on heart-lung bypass.

但在手術之前，

We put her to sleep,

必須先火速送她進我的加護病房。

we make a tiny little incision in the neck,

我和手術團隊圍繞著她，

we place catheters into the major vessels of the neck --

為她接上體外心肺循環機 ，

and I can tell you that these vessels are about the size of a pen,

上麻醉藥，

the tip of a pen --

在脖子上切個小口，

and then we have blood drawn from the body,

把導管伸入脖子的主動脈內。

we bring it through a machine, it gets oxygenated,

這些血管的尺寸只有筆尖那麼細。

and it goes back into the body.

我們抽出她的血液，

We save her life,

導入一台機器，充氧，

and get her safely to the operating room.

再送回體內。

Here's the problem:

我們挽救她的性命，

these disorders --

把她安全送進開刀房。

what is known is congenital diaphragmatic hernia --

問題在此：

this hole in the diaphragm that has allowed these intestines to sneak up --

她罹患的病

these disorders are rare.

被稱為「先天性橫膈疝氣」，

Even in the best hands in the world,

隔膜上有個洞使腸子得以向上移位，

there is still a challenge to get the volume --

是種罕見的疾病。

the natural volume of these patients --

即使是世上最優秀的外科醫生

in order to get our expertise curve at 100 percent.

也難以累積足夠的經驗，

They just don't present that often.

因為患者的數目太少，

So how do you make the rare common?

醫師難以練到百分之百的技術曲線。

Here's the other problem:

很難遇到這種病例。

in the health care system that I trained for over 20 years,

那麼，怎樣變罕見為常見呢？

what currently exists,

另外還有一個問題：

the model of training is called the apprenticeship model.

我服務了二十多年的醫療系統，

It's been around for centuries.

現行的訓練模式稱為「學徒模式」，

It's based on this idea that you see a surgery maybe once,

已有數百年的歷史。

maybe several times,

學徒模式的基本概念

you then go do that surgery,

是先看別人做一次或數次的手術，

and then ultimately you teach that surgery to the next generation.

然後自己動手術；

And implicit in this model --

最終再把這技術傳承給下一代。

I don't need to tell you this --

其實說白了，

is that we practice on the very patients that we are delivering care to.

相信大家也能想得到，

That's a problem.

學徒模式是一面開刀、一面練習。

I think there's a better approach.

這是個大問題。

Medicine may very well be the last high-stakes industry

我認為有更好的方法。

that does not practice prior to game time.

醫療很可能是最後一門

I want to describe to you a better approach through medical simulation.

不先訓練就實作的高風險行業了。

Well, the first thing we did is we went to other high-stakes industries

讓我闡述醫療模擬這個好辦法。

that had been using this type of methodology for decades.

我們先參觀其他已經使用這方法

This is nuclear power.

數十年之久的高風險行業，

Nuclear power runs scenarios on a regular basis

核電廠。

in order to practice what they hope will never occur.

核電廠會定期演習，

And as we're all very familiar, the airline industry --

練習和防範不樂見的未然；

we all get on planes now, comforted by the idea

還有大家熟悉的航空業。

that pilots and crews have trained on simulators much like these,

現今大家搭機都很放心，

training on scenarios that we hope will never occur,

因爲機師和機組人員

but we know if they did,

已被飛行模擬器訓練過，

they would be prepared for the worst.

像這樣的模擬器，

In fact, the airline industry has gone as far as to create fuselages

他們知道要如何應對 但願永不發生的緊急狀況；

of simulation environments,

萬一不幸發生了，

because of the importance of the team coming together.

我們有信心他們能應變。

This is an evacuation drill simulator.

事實上，

So again, if that ever were to happen, these rare, rare events,

航空業甚至直接打造機艙模擬情境，

they're ready to act on the drop of a dime.

因為整體團隊的運作至關重要。

I guess the most compelling for me in some ways is the sports industry --

這是模擬的疏散演習。

arguably high stakes.

我重申，一旦發生罕見事故，

You think about a baseball team: baseball players practice.

他們能夠瞬間應變。

I think it's a beautiful example of progressive training.

我猜，最吸引我目光的

The first thing they do is go out to spring training.

還是高風險的體育行業。

They go to a spring training camp,

我認為棒球隊球員練習

perhaps a simulator in baseball.

是個漸進訓練的好例子。

They're not on the real field, but they're on a simulated field,

他們先進行春季訓練。

and they're playing in the pregame season.

春訓用的可能是棒球模擬器，

Then they make their way to the field during the season games,

不是實體球場，而是模擬的球場。

and what's the first thing they do before they start the game?

他們打季前賽，

They go into the batting cage and do batting practice for hours,

然後在正規賽季進入棒球比賽場。

having different types of pitches being thrown at them,

開賽前他們先做些什麼呢？

hitting ball after ball as they limber their muscles,

先在擊球練習區揮棒幾個小時；

getting ready for the game itself.

面對各式球路

And here's the most phenomenal part of this,

一次又一次揮棒暖身，

and for all of you who watch any sport event,

為真正的比賽做準備。

you will see this phenomenon happen.

最不凡的部分，

The batter gets into the batter's box,

所有看球賽的人

the pitcher gets ready to pitch.

都會看到這現象：

Right before the pitch is thrown,

打者進入打擊區，

what does that batter do?

投手準備投球，

The batter steps out of the box

就在球被投出之前，

and takes a practice swing.

打者做什麼動作？

He wouldn't do it any other way.

打者離開打擊區

I want to talk to you about how we're building practice swings like this

練習揮棒。

in medicine.

打者必定這樣做。

We are building batting cages for the patients that we care about

告訴你

at Boston Children's.

我們如何為醫療行業建立練習系統，

I want to use this case that we recently built.

建造打擊練習區，

It's the case of a four-year-old who had a progressively enlarging head,

為心繫的患者

and as a result,

建在波士頓兒童醫院裡。

had loss of developmental milestones, neurologic milestones,

我用最近建的案例說明：

and the reason for this problem is here --

這個四歲兒童的頭部逐漸漲大，

it's called hydrocephalus.

以致發育不如預期，

So, a quick study in neurosurgery.

錯失了腦神經發育的里程碑。

There's the brain,

問題出在這裡：

and you can see the cranium surrounding the brain.

「腦積水」。

What surrounds the brain, between the brain and cranium,

快速簡介腦神經外科手術的做法。

is something called cerebrospinal fluid or fluid,

這是大腦，

which acts as a shock absorber.

顱骨包圍著大腦，

In your heads right now,

在大腦和顱骨之間流動的

there is cerebrospinal fluid just bathing your brains

是「腦脊液」，

and making its way around.

它的作用是緩衝撞擊力。

It's produced in one area and flows through,

此刻你的大腦

and then is re-exchanged.

浸泡在頭骨裡的腦脊液裡，

And this beautiful flow pattern occurs for all of us.

腦脊液繞著大腦流動，

But unfortunately in some children,

在一個地方產生腦脊液，

there's a blockage of this flow pattern,

流動，然後再循環，

much like a traffic jam.

每個人的腦脊液都美妙地流動著。

As a result, the fluid accumulates,

但不幸有些孩子的腦脊液

and the brain is pushed aside.

塞住不流動，

It has difficulty growing.

就像交通壅塞那樣。

As a result, the child loses neurologic milestones.

結果腦脊液積聚，

This is a devastating disease in children.

腦被擠到一邊，

The cure for this is surgery.

難以生長，

The traditional surgery is to take a bit of the cranium off,

孩子因此腦神經發育遲緩，

a bit of the skull,

這是種毀滅性的兒童病。

drain this fluid out, stick a drain in place,

治療方式是動手術。

and then eventually bring this drain internal to the body.

傳統手術是取下一小塊顱骨，

Big operation.

一小塊頭骨，

But some great news is that advances in neurosurgical care

安裝一條引流管排出腦脊液，

have allowed us to develop minimally invasive approaches

引流到身體的內部。

to this surgery.

這是個大手術。

Through a small pinhole, a camera can be inserted,

好消息是神經外科醫療

led into the deep brain structure,

已經進步到

and cause a little hole in a membrane that allows all that fluid to drain,

能讓我們施行微創手術。

much like it would in a sink.

相機可通過小針孔

All of a sudden, the brain is no longer under pressure,

進入深層的腦結構，

can re-expand

在腦膜上開個小孔引流腦脊液，

and we cure the child through a single-hole incision.

就像讓水槽排水一樣。

But here's the problem:

轉眼間，腦部不再受壓，

hydrocephalus is relatively rare.

能夠伸展，

And there are no good training methods

開一個小切口就能治療這孩子。

to get really good at getting this scope to the right place.

但問題是：

But surgeons have been quite creative about this, even our own.

腦積水相當罕見，

And they've come up with training models.

沒有好的訓練方法能讓我們

Here's the current training model.

嫻熟地把鏡頭擺放在正確的位置。

(Laughter)

對此外科醫生相當有創造力，

I kid you not.

我們自己的醫生也是。

This is a red pepper, not made in Hollywood;

他們發明了訓練模型。

it's real red pepper.

這是目前的訓練模型。

And what surgeons do is they stick a scope into the pepper,

（笑聲）

and they do what is called a "seedectomy."

我可沒開玩笑。

(Laughter)

這是個紅椒，不是好萊塢做的，

They use this scope to remove seeds using a little tweezer.

而是真正的紅椒。

And that is a way to get under their belts

外科醫生把鏡頭伸入紅椒，

the rudimentary components of doing this surgery.

進行所謂「椒籽切除術」。

Then they head right into the apprenticeship model,

（笑聲）

seeing many of them as they present themselves,

他們用鏡頭和小鑷子摘除紅椒籽，

then doing it, and then teaching it --

那是學會基本手術操作的方式。

waiting for these patients to arrive.

接著他們直接進入學徒模式，

We can do a lot better.

觀摩多次臨場的手術，

We are manufacturing reproductions of children

然後親自動手，接著傳授，

in order for surgeons and surgical teams to rehearse

等待著新的患者。

in the most relevant possible ways.

我們有更好的方式。

Let me show you this.

如今我們複製病童，

Here's my team

讓外科醫生和手術團隊

in what's called the SIM Engineering Division of the Simulator Program.

以最接近實況的方式一再練習。

This is an amazing team of individuals.

讓我來展示。

They are mechanical engineers;

這是我的團隊，

you're seeing here, illustrators.

模擬計劃的模擬工程團隊。

They take primary data from CT scans and MRIs,

團隊的每個人都很了不起。

translate it into digital information,

有機械工程師，

animate it,

和這裡看到的繪圖師。

put it together into the components of the child itself,

他們把電腦斷層

surface-scan elements of the child that have been casted as needed,

和核磁共振掃描的原始數據

depending on the surgery itself,

轉成數字資訊，

and then take this digital data and be able to output it

做成動畫，

on state-of-the-art, three-dimensional printing devices

整合做成兒童自身的器官。

that allow us to print the components

根據手術本身的需求，

exactly to the micron detail of what the child's anatomy will look like.

事先已掃描兒童的器官，

You can see here,

連同數據輸出到

the skull of this child being printed

最先進的三維列印機，

in the hours before we performed this surgery.

把兒童的器官列印出來，

But we could not do this work

細節精確到微米的程度。

without our dear friends on the West Coast in Hollywood, California.

這裡看到的是

These are individuals that are incredibly talented

兒童的頭骨

at being able to recreate reality.

在手術前數小時被列印出來。

It was not a long leap for us.

如果沒有西岸加州好萊塢的夥伴們

The more we got into this field,

我們無法做到。

the more it became clear to us that we are doing cinematography.

這些是特別擅長重製現實的人。

We're doing filmmaking,

這不算是我們的大躍進。

it's just that the actors are not actors.

在這個領域了解得越多就越清楚，

They're real doctors and nurses.

我們是在拍片，

So these are some photos of our dear friends at Fractured FX

在製作電影。

in Hollywood California,

但不由演員演出，

an Emmy-Award-winning special effects firm.

而是如假包換的醫生和護士。

This is Justin Raleigh and his group --

這些照片來自

this is not one of our patients --

任職於加州好萊塢 Fractured FX 的好朋友們，

(Laughter)

那是個獲得艾美獎的特效公司。

but kind of the exquisite work that these individuals do.

這是賈斯汀·羅利和他的隊友，

We have now collaborated and fused our experience,