Designing Hyperrealistic Body Parts, From Eyeballs To Placentas

FLORA LICHTMAN: Hey, I’m Flora Lichtman, and this is Science Friday.

[MUSIC PLAYING]

SciFri, I just got back from Columbia, Missouri, where we were doing a live stage show with radio station KBIA. So today in the pod, we are bringing you a conversation from Mizzou’s Jesse Auditorium about a guy with a Mary Poppins bag full of fake body parts. I kid you not.

DAMON COYLE: Some smells may arise too, so we have what we refer to as liquid butt.

[APPLAUSE]

FLORA LICHTMAN: If you, like the entire staff of Science Friday, have been binging The Pitt, you may have noticed that medical dramas are looking really real these days. You’re watching in your PJs on your couch. But those intubations and surgeries look so real, it’s like you’re in the emergency room.

But it’s not just TV doctors that are using realistic body parts to simulate medical Procedures real doctors and training physician assistants and nurses are using prosthetics to learn how to sew stitches and draw blood and practice other procedures, which means it is someone’s job to sculpt these realistic body parts, these silicone stand ins for arms and eyes and other appendages. And that is what my next guest does for a living.

Damon Coyle is a medical sculptor and innovation specialist at the University of Missouri here in Columbia. Welcome to Science Friday.

DAMON COYLE: Thank you.

[APPLAUSE]

FLORA LICHTMAN: Damon, I see you have props. Is this for me?

DAMON COYLE: It’s yours.

FLORA LICHTMAN: Damon just gave me an ear–

[LAUGHTER]

–that feels a lot like an ear. Can I take it home?

DAMON COYLE: It’s yours. It’s my business card.

[LAUGHTER]

FLORA LICHTMAN: This is amazing. This is the best gift I’ve ever gotten.

DAMON COYLE: It’s yours.

FLORA LICHTMAN: Truly. What else did you bring?

DAMON COYLE: Oh, geez. In my Mary Poppins grab bag here, quite a few appendages, various bits of human anatomy.

FLORA LICHTMAN: I see a placenta up there.

DAMON COYLE: Yes, that’s exactly what this is. So a lot of my job is research, reducing the reality gap in simulation to make the medical education that much more robust for our learners and abroad. I took plenty of photos of my wife’s placenta.

Or was it my daughter’s placenta? I’m not sure. Who does the placenta belong to, really? Chicken and egg.

[LAUGHTER]

For the placenta, got a magnet here to take out of the baby’s belly button. If you want to go and feel that–

FLORA LICHTMAN: I would love to.

DAMON COYLE: It looks wet, but it’s just shiny. It’s not actually wet.

FLORA LICHTMAN: It’s very real. As someone who’s also seen a placenta, it’s almost too real.

DAMON COYLE: Thank you. Thank you.

FLORA LICHTMAN: How long does it take to make one of these? Well, let’s take the baby you have up here.

DAMON COYLE: The baby? So that, with a sculpt, maybe about a week’s worth of sculpting and then making the molds.

FLORA LICHTMAN: You’re sculpting with what? What’s the first step?

DAMON COYLE: All right. So for instance, let’s use this neonatal IV access, so getting very small IV cannulas into a very small sick baby in the neonatal intensive care unit, very difficult procedure to perform. This starts– at least this particular project started with a ball of clay.

FLORA LICHTMAN: So this is a clay tiny baby leg.

DAMON COYLE: That’s correct. Yep, and I had the NICU nurses take photos with the parents’ permission, of course, of patients that were in the NICU in order for me to get an accurate size. And of course, all the small details, veins, and wrinkles and such need to be represented in order for the experience to be immersive.

FLORA LICHTMAN: So you start with clay. You sculpt the body part. And then what happens?

DAMON COYLE: You make a series of molds. So it’s one thing to make a one-off prop, and that’s normally what you see in the special effects or the movie industry in Hollywood. They’ll have a series of props that they’ll use for various shoots.

What I like to do, and what we spend a lot of time, is trying to solve the engineering problems of making molds so that we could make as many of these in the future as we want or, better yet, license this to industry such that we can share all the work that we’ve done here at the University of Missouri with the rest of the world because, if our clinicians, our nurses, our medical students, our nursing students, our dieticians, our OTs and PTs are getting use out of these products, it stands to reason that everybody else globally will get a really good use out of it as well.

FLORA LICHTMAN: How widespread is the use of prosthetic models like these for training medical professionals?

DAMON COYLE: Oh, it’s very, very common. Our role is to facilitate the replication of interactive clinical environments, practice as though we are playing, no different than athletics or practicing an instrument. You practice repetitively until that becomes muscle memory, such that when it is game day, when you have that scalpel in hand, you’ve done it 100 to 1,000 times.

FLORA LICHTMAN: Damon, how many people in the world have your job?

DAMON COYLE: I don’t know of any counterpart in the United States that has a role specific to mine that’s working at a state-funded land grant university at a clinical simulation center that is doing what I’m doing and, that is, refined prototypes of medical educational tools.

FLORA LICHTMAN: So this is one of a kind program here at Mizzou?

DAMON COYLE: Yes, and I’m very, very grateful and very, very fortunate.

[APPLAUSE]

FLORA LICHTMAN: That’s very cool. I think we should do a demonstration.

DAMON COYLE: OK, let’s do a demonstration.

FLORA LICHTMAN: Should we go to our table?

DAMON COYLE: Yeah, let’s do it.

FLORA LICHTMAN: You’ve got a Dexter table over here that we–

DAMON COYLE: [LAUGHS] OK, so let’s set the stage here.

FLORA LICHTMAN: So we have a full-size human arm.

DAMON COYLE: Yes, this is a full-size human arm that is–

FLORA LICHTMAN: Looks and feels a lot like a human arm–

DAMON COYLE: Yeah, so the materials that we use are–

FLORA LICHTMAN: In a very creepy way.

DAMON COYLE: It’s a platinum-cured silicone. It’s totally inert. It’s not going to cause any skin sensitivities, like latex would historically. And a little cool fact about this, normally, like I said, I’ll start with a clay sculpt, but for a composition this large, it would have taken me a long time to get all those small details and wrinkles and pitting and whatnot. So I actually use a life cast for this. So I had a model come in.

FLORA LICHTMAN: Who was the lucky model?

DAMON COYLE: Oh, she’s a beautiful, beautiful model. She was nine months pregnant, so she had about 20% extra blood volume.

FLORA LICHTMAN: And was really glad to be doing this, I’m sure.

DAMON COYLE: Her vessels were just nice and plump and popping.

[LAUGHTER]

And I said, honey– my wife–

[LAUGHTER]

Please come in. It’s going to take 45 minutes tops. She was like this, with 20 pounds on her arm, for four hours.

[AUDIENCE EXCLAIMS, LAUGHTER]

Sorry.

FLORA LICHTMAN: Can we give her round of applause?

[APPLAUSE]

How many times can you stick this? How many times can you reuse one of your arms?

DAMON COYLE: So that comes down to– those are design considerations when I’m– as an industrial designer, those are the key learning objectives that I need to attack in order to make it a good product, not necessarily a good training tool but a good product. So one, I’m trying to make these feel and look and behave realistically, but I also want them to be user friendly so they don’t deteriorate and become useless or they’re prohibitively expensive.

So the skin of this is actually bolstered. If you look really closely, there’s some fine, almost fishnet fabric in there, and that’s going to keep punctures. It’s going to keep that silicone from tearing if it’s ever stretched. Think of like a chain link fence or ripstop fabric.

When you have a fray in a sweater, it just keeps going and going. This is going to stop that. So thousands of sticks, to answer your question. The limiting factor on this is actually the vessels, which you can just quickly pop them out. So you can de-skin this vessel. Yeah.

FLORA LICHTMAN: Whoa. Right? So we’re looking underneath the flap of this– there’s a skin flap, and you can peel it back. And then there are these tubes that are going through the arm.

DAMON COYLE: And the big challenge with this particular project, it took about 18 months all in to finish this. The finish line was making sure that the vasculature was anatomically accurate. That’s paramount, and then secondly, making it a good product.

FLORA LICHTMAN: I mean, and the arm is jiggling like a real arm. It’s really remarkable. So we’ve got arms to do a blood draw, and we’ve got half a face here.

There’s two eyes. One is kind of bulging out. It’s alarmingly lifelike. You just repositioned it, which is quite scary. Now what happens next?

DAMON COYLE: All right, so this patient comes into the emergency room. Say they were in a bar fight or a motor vehicle collision. And they’ve got some serious contusions around the eye. They’re coming in with complaints of vision loss.

So a good emergency med doc is going to take a good history and identify that there’s probably what’s referred to as a retrobulbar hematoma. That just means blood behind the eye. And it’s pushing on the optic nerve, pushing on the blood supply. If not remedied, this patient is going to lose eyesight. So it is an emergency.

So what we’re going to do is we’re going to do a procedure referred to as a lateral canthotomy. We need to get that eyeball, believe it or not, to be pushed out because, if it stays where it is, it’s basically a gasket holding all that blood back there. And we need to let it forward. Otherwise this patient is going to lose eyesight.

So let’s go ahead and get going. First and foremost, I don’t have any simulated anesthetic, but let’s pretend this is. We’re going to anesthetize this area because it’s very sensitive.

FLORA LICHTMAN: That seems like a good idea.

DAMON COYLE: You’re welcome, patient. All right, so we would go ahead and say that this is an anesthetic, some lidocaine. We’re going to go right in here.

But I’m going to have some forceps. And what I’m going to do is I’m going to go in between the eye and the canthus, and I’m going to crush and hold that there for approximately one minute. And that’s going to provide what we call hemostasis, or stopping bleeding.

If we don’t do this, it’s going to bleed when we cut it. Then we’re going to take our pair of scissors, and we’re going to make a small incision. What I’m trying to do is I’m really feeling for a tissue density difference.

In real life scenario, and much like this scenario here, it’s going to be very messy. There’s going to be a lot of swelling inherently. So we really need to go by feel, which, again, it’s inherently a good model because it’s going to allow those emergency medical doctors to practice this procedure.

And then we’re going to come in here and simply cut this bottom cruz right there. And what that’s going to allow for is that eyeball to protrude forward. And believe it or not, that is the end of the procedure.

Very simple procedure. Notice I said simple, not easy. But there is no task trainer product on the market that teaches this procedure.

[APPLAUSE]

FLORA LICHTMAN: Wow, amazing. Watching this, watching you work with these, it occurs to me that the point is that it’s so realistic. That is what makes it an effective tool. The more I’m like, wah, as a layperson, the more useful, I’m sure, it is to doctors and medical professionals who are training on it.

DAMON COYLE: Yeah. In some instances, realism isn’t paramount. Sometimes it’s just rapid repetition for various procedures. But for most procedures, reducing the reality gap such that you make the tissues feel real, you make them bleed, can do nothing but help the transfer of knowledge. And that’s our goal at the Shelden Simulation Center is to transfer knowledge from the simulated environment, this replicated environment, to the real world in order to reduce negative patient outcomes.

[MUSIC PLAYING]

FLORA LICHTMAN: Stick around. We’ll be right back after this short break.

Do you have to think about other senses and preparing physicians for those realities too?

DAMON COYLE: Absolutely. Yeah, so we have feel. We got that down with the density of the tissues, trying to use various silicones in order to emulate the tissues that we’re trying to simulate. We have quality paint jobs, building up translucent layers with an airbrush to try to make those skin complexions be very convincing.

But there’s smell too. So we have a task trainer here. It’s an I&D trainer. It’s an incision and drainage is what that stands for. So you’d be able to lyse this with a– I don’t have a scalpel, or I would do it right now.

And out would come some nice loculations and pus. And Some smells may arise too. So we have what we refer to as liquid butt. That’s not what it says.

[LAUGHTER]

FLORA LICHTMAN: Liquid butt. You heard it here on Science Friday. It exists.

[LAUGHTER]

DAMON COYLE: And it’s an oil based– I don’t where it’s derived from or how it’s synthesized. But you can mix that in with petroleum jelly, which I have a recipe for making puss-y locations of a cyst. And I’ll add that to it, just to give our learners a little bit of a surprise because it’s all about reducing the reality gap and transferring the knowledge.

FLORA LICHTMAN: Have you taken on the CPR dummy?

DAMON COYLE: Have I done what?

FLORA LICHTMAN: Taken on the CPR dummy. I feel like everyone has trained on a CPR dummy. They’re like big and plastic. Do you have a version?

DAMON COYLE: Oh, no, no, no. I haven’t made an ultra realistic one. Again, that’s a really good example of where realism, making it look realistic, isn’t paramount. They just need to learn good technique and when to do their rescue breaths and when to do compressions.

Realism there is something that we can forgo in order to get more personnel through a training or something like that. But no, I never have. That’d be cool though.

FLORA LICHTMAN: Let’s go to the audience. Go ahead.

AUDIENCE: Hi, Damon. Could you talk a bit about your background?

DAMON COYLE: Oh, sure. Absolutely. I got my start in medicine through art. In an attempt to get better at the superficial muscle anatomy illustration, I took an anatomy course in high school, quickly fell in love with the taxonomy and of learning the medical terminology and all the Latin prefixes and suffixes.

And it was conducive to my sensibilities. So I was like, OK, well, let’s go down the path of medicine. I think that’s where I would fit in. Went to medical school here at the University of Missouri, dropped out of medical school here at the University of Missouri.

[LAUGHTER]

And a big reason for that was I simply wasn’t fulfilled. So much of what brings me fulfillment is creating and making tangible items that people can appreciate and that I can come back to and refine.

And it just so happens that our executive director, Dena Higbee, who’s been with the Sheldon Simulation Center for 15 to 20 years, she forecasted that there is just quite the drought of optimal medical educational tools. And she happened to figure out my skill set while I was out of medical school. And just when I thought I was out, I’m back on campus.

FLORA LICHTMAN: As they say.

DAMON COYLE: And yeah, and the rest is really history. And our catalog continues to grow as various departments at the University continue to find out about this resource.

FLORA LICHTMAN: Lots of questions from the audience. Let’s go over here.

AUDIENCE: Is this work being used in veterinary medicine?

DAMON COYLE: Oh, great question. Thank you. I had limited space up here, but I do have a canine rectal trainer right over there.

[LAUGHTER]

I mentioned there’s a drought of good, optimal training products for human medicine. It’s even more Wild West in the vet med arena. There’s only two or three heavy-hitting manufacturers, so I have so much work when it comes to vet medicine and one of them being the dog butt.

[LAUGHTER]

FLORA LICHTMAN: I can’t think of a better place to leave it.

[LAUGHTER]

[APPLAUSE]

Damon Coyle, medical sculptor and innovation specialist at the University of Missouri right here in Columbia, thank you for coming on the show.

DAMON COYLE: Thank you, Flora.

[APPLAUSE]

[MUSIC PLAYING]

FLORA LICHTMAN: And that is about all we have time for. Lots of folks helped make this show happen, including–

DEE PETERSCHMIDT: Dee Peterschmidt.

PRAISE AGOCHI: Praise Agochi.

KATHLEEN DAVIS: Kathleen Davis.

SANTIAGO FLOREZ: Santiago Flórez.

FLORA LICHTMAN: I’m Flora Lichtman. Thanks for listening.

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