Feinberg Professor turns iPad into Virtual Larynx for Intubation Training

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Raymond Glassenberg, MD, associate professor in anesthesiology, uses the iLarynx app, which provides a virtual reality for learning to use a fiberoptic bronchoscope.

Raymond Glassenberg, MD, ’75, associate professor in anesthesiology, has taught the principles of airway intubation in hundreds of settings, but recently, he developed a tool for students to learn while riding the Red Line, sitting at home, or relaxing between classes.

Inventor of the iPad app iLarynx, Glassenberg removed a tablet computer from his briefcase to illustrate just how useful the teaching tool could be. Rather than tie up a $15,000 fiberoptic bronchoscope, or use a $30,000 virtual reality simulation mannequin, the doctor worked with his son, a software designer, to develop a three-dimensional representation of the human airway.

Giving students a view identical to the tiny scope used during fiberoptic intubation, iLarynx utilizes the iPad’s accelerometer, or sensitivity to movement, to simulate the feel of rotating the device for proper alignment. Touch screen buttons advance the scope into the trachea as users move through the larynx, around the uvula, and under the epiglottis to have a view of the vocal cords. The app provides no set pathways, and a misstep causes the “patient” to cough and the screen to become fogged over. Successful intubation ends each exercise.

“We needed a means of teaching the residents how to use a fiberoptic bronchoscope,” Glassenberg said. “This app provides a different educational tool. It’s skills learning rather than didactic teaching.”

Raymond Glassenberg, MD, associate professor in anesthesiology, worked with his son to invent an iPad app that simulates airway intubation.

Since being offered for free a few months ago, iLarynx has been downloaded more than 10,000 times and was recognized by the Society for Obstetric Anesthesia and Perinatology with a best in education award. It was also named one of the top 10 free iPad medical apps by iMedicalApps.com.

“The app provides a feel for what we do in the hospital,” Glassenberg said. “It very closely replicates the real world.”

After approaching his son Sam to bring the app to the iPad, Glassenberg determined three distinct scenarios that iLarynx should replicate: a normal patient with spontaneous breathing; a patient given muscle relaxers so that the vocal cords aren’t moving; and a patient with a tumor.

To test the iLarynx’s usefulness, he conducted a research project where half of a group of medical students had 20 minutes to work with the app, while the other half were exposed to pictures illustrating the anatomy of the larynx. When both groups were given the opportunity to use a real scope on an airway mannequin, the app-exposed students fared much better in developing the proper level of dexterity.

Having developed video games for the “Star Wars” film series, and having managed a game platform at Microsoft, Sam Glassenberg was well aware of the 3D technology that makes iLarynx so successful. Comparing use of the app to keeping a virtual race car on the track, Glassenberg is proud to have paired his son’s gaming knowledge with 34 years of experience at Northwestern University Feinberg School of Medicine.

“We are currently working on other scenarios to make the app an even better addition to the learning process,” Glassenberg said. “While books hold didactic information and the protocol for how to hold a scope, a $30,000 virtual reality mannequin cannot do what this thing does because the iPad has an accelerometer and can be easily turned 180 degrees offering a realistic feel for how the bronchoscope reacts. As for the success, I am completely amazed by it.”

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