Pulse Physiology Engine

Distributed under the Apache License, Version 2.0. See accompanying NOTICE file for details.

Pulse Version 2.2.0 is available from our GitLab repository.

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If you have any other questions or concerns, email: kitwa.nosp@m.re@k.nosp@m.itwar.nosp@m.e.co.nosp@m.m

What is the Pulse Physiology Engine?

The Pulse Physiology Engine is a C++ based, open source, multi-platform (Windows, Mac, and Linux), comprehensive human physiology simulator that will drive medical education, research, and training technologies. The engine enables accurate and consistent physiology simulation across the medical community. The engine can be used as a standalone application or integrated with simulators, sensor interfaces, and models of all fidelities. We are advancing the engine and exploring new avenues of research, such as pediatrics, patient-specific modeling and virtual surgery planning/rehearsal.

There are Publications on several systems and clinical scenarios.

What kind of data can I get from the physiology engine?

An instance of an engine models a single patient's physiology.

  • The patient is defined by parameters, such as height, weight, systolic and diastolic pressure.
  • You can initialize the patient with specific chronic and/or disease states via conditions.
  • You can modify the patients external environmental conditions (weather, submerge in water, etc.)
  • You can apply various actions (acute insults/injuries, interventions, conscious breathing, exercise, etc.) to be applied to the patient.
  • The patient can also interact with equipment models, such as an Anesthesia and/or an ECG Machine as well as an Inhaler via actions.
  • You can integrate the engine into your applications.

Available data is defined within the engine in three major ways:

  • System data, such as Cardiovascular, Respiratory, etc.
    • Analogous to system vitals
      • Examples: heart rate, oxygen consumption, mean arterial pressure, etc.
  • Compartment data
    • Flow, pressure, and volume related to specific region of the body or component of equipment
      • Examples: Cerebral Blood Flow, Right Lung Volume, Right Heart Pressure
    • Substance specific data related to a specific part of the body or component of equipment
      • Examples: The Extracellular concentration of succinylcholine in the brain tissue, anesthesia machine gas inlet oxygen volume fraction
  • Assessments
    • Formed at the level of a clinician's report, Intended to mimic test results
      • Example: Pulmonary Function Test

Want to learn more about Implementation and Integration?

Check out the FAQ for more about Pulse.


What are some possible physiology engine applications?

Virtual/Augmented Environments
Manikin-Based Simulations
Clinical Explorations

There is a wide range of potential applications, a few include:

  • Powering serious games for medical education and training
  • Producing responsive physiology in real time for manikin training
  • Integrating a single-system model into the engine to understand full-body physiologic response
  • Providing inputs and outputs for sensor systems
  • Teaching and education
  • Pairing with virtual surgery planning/rehearsal

Featured Applications Leveraging Pulse

Pulse Physiology Explorer

The Pulse Physiology Engine is a powerful tool in computing the physiological responses to acute injury and treatment. However, without a visualization tool the information is difficult to understand. As part of the Kitware physiology repository, we have developed a visualization tool built on Qt to provide a way to dynamically interact with the Pulse physiology engine.


For more information on getting and using this tool, visit our Wiki

Pulse Unity Asset

The Pulse Unity Asset is available for free download on the Unity Asset Store and the release page of the open-source project on Gitlab. The Pulse Unity Asset enables the integration of the Pulse Physiology Engine into Unity applications targeting Windows, Linux and MacOS platforms.

Our user manual offers in-depth details of all the Pulse asset functionality. It is included in the unity package and can be found on our release page.

Trauma Simulator

Description
Team
Links
An immersive virtual reality emergency medicine training simulator for military medical personnel. This simulator uses the Unity game engine and Pulse to provide dynamic physiological feedback on the patient's condition from a wide range of injuries and treatments.






Military Simulation & Training Magazine Article
Kitware Blog Post

Closed-Loop Physiology Management System

Description
Team
Links
A system for investigating closed-loop physiology management for critical care with in-silico patients. Closed-Loop Assistants (CLAs) are designed to leverage medical device interfaces to add computers/algorithms to the clinical care loop to aid indecision-making and to implement the automatic application of interventions.




Kitware Blog Post
CLASim Website
CLASim Repository
F. Gessa, P. Asare, A. Bray, R. Clipp, and M. Poler, "Towards A Test and Validation Framework for Closed-Loop Physiology Management Systems for Critical and Perioperative Care," in Medical Cyber Physical Systems Workshop, 2018.
Farooq Gessa, Philip Asare1, Dikendra Karki1, Aaron Bray, Rachel B. Clipp, Mark Poler, "Simulation-Based Test and Validation of Medical Cyber-Physical Systems for Critical and Perioperative Care," Workshop on Monitoring and Testing of Cyber-Physical Systems (MT-CPS).
Farooq Gessa, Aaron Bray, Rachel Clipp, Philip Asare, S. Mark Poler, "A Proof-of-Concept Framework for Testing and Validating Networked Medical Device Applications and Closed-Loop Physiology Management Systems for Critical and Perioperative Care," Society for Technology in Anesthesia (STA) Annual Meeting

Medical Simulation and Training Architecture (MSTA)

Description
Team
Links
The MSTA platform provides an open standard to connect manikins, part-tasks trainers, physiology engines, and other simulation technologies to support the creation of complex training systems necessary for future force readiness efforts. MSTA successfully demonstrated an integrated TCCC training scenario that took a wounded virtual patient from field care to role 2 care. The training system consisted of a manikin, a custom control panel, a part task trainer, the Pulse physiology engine and an after action review engine. This work was performed under Contract #W900KK-17-C-0041


Kitware Blog Post

Ventilation Management Trainer

Description
Team
Links
A training simulator designed to mimic respiratory distress during mechanical ventilation. A simulated torso was developed and integrated with an appropriately equipped Special Medical Emergency Evacuation Device affixed with medical equipment utilized during Critical Care Air Transport Team missions. The torso includes a lung model, upper airway, and head with reproducible computerized algorithms with the ability to simulate respiratory distress. The simulator is responsive to providers' interventions in treating conditions encountered during mechanical ventilation. Pulse is fully integrated to autonomously drive all patient responses.




Rodriquez Jr, Dario, Thomas Blakeman, Dina Gomaa, and Richard Branson. Advancing Mechanical Ventilation Management through Simulation. No. AFRL-SA-WP-SR-2019-0006. USAFSAM/FHE Wright-Patterson AFB United States, 2019.

Combat Casualty Care Augmented Reality Intelligent Training System (C3ARESYS)

Description
Team
Links
An augmented reality system to improve the realism of Combat Medics (68W) and Combat Lifesavers scenario-based training. C3ARESYS provides the opportunity to train on wounds and casualties that respond to treatments with feedback adapted to the trainee's skill level. C3ARESYS offloads work from the instructor, enabling focus on teaching rather than fixing shortcomings in casualty simulation. Pulse is used to provide dynamic interactions to the patient and provide physiological feedback from the patient.




Taylor, Glenn, Anthony Deschamps, Alyssa Tanaka, Denise Nicholson, Gerd Bruder, Gregory Welch, and Francisco Guido-Sanz, "Augmented Reality for Tactical Combat Casualty Care Training," International Conference on Augmented Cognition. Springer, Cham, 2018.

The BioMojo Virtual Patient Experience (VPE)

Description
Team
Links
An interactive, multiplayer 3D healthcare and medicine themed, STEM education product. BioMojo VPE is designed to inspire and educate youth towards careers in healthcare, clinical research and biomedical engineering through fun, challenging virtual role play, teamwork, and problem-solving. Themes include emergency medicine, preventable chronic diseases, physiology, anatomy, genomics, and pharmacotherapy. Players will perform (virtual) diagnostic procedures and other interactions with virtual patient avatars. Virtual patient physiology is provided by Pulse.


BioMojo

Extra Corporeal Membrane Oxygenation (ECMO) Training Simulator

Description
Team
Links
A full-fledged training simulator of various procedures and scenarios involved in ECMO and the associated complications. The simulator has three main parts: 1. A physical cardiovascular circuit that mimics the human circulation system, including an artificial human heart and a synthetic vasculature with cannulation pads. 2. A physical ECMO circuit to simulate oxygenation with a color changing blood simulant, an external pump to regulate flow, and sensors to monitor vitals. 3. A mathematical model of human physiology simulating respiratory failure and cardiac arrest based on Pulse Physiology Engine. Pulse helps to simulate clinical scenarios (i.e., hypovolemia, hypoxia, etc.) by controlling the cardiovascular and ECMO circuits, and provides real-time physiological feedback for experimental training.




ECMO Simulator Website

Virtual Pediatric Airway Workbench (VPAW)

Description
Team
Links
A surgical planning tool for subglottic stenosis that incorporates three major components. VPAW initiates with a CT scan of the patient and obtains a geometrical model through segmentation and surface reconstruction. It then employs a computational fluid dynamics (CFD) engine based on a Lattice-Boltzmann formulation to provide airflow parameters for Pulse. Pulse then provides the physiologic response due to the airflow. A real-time geometric authoring tool allows surgeons to edit the tracheal geometry using a haptic device as part of a surgical planning. VPAW calculates the physiologic results of each plan to be assessed by surgeons to identify the best course of action.




Kitware Blog Post
L. Potter, S. Arikatla, A. Bray, J. Webb, and A. Enquobahrie, "Physiology informed virtual surgical planning: a case study with a virtual airway surgical planner and BioGears," in SPIE Medical Imaging, 2017.

Ventriculoperitoneal Shunt Performance

Description
Team
Links
A high-fidelity computational surrogate head model focused on the ventricular system to optimize the performance of ventriculoperitoneal shunts. The cerebrospinal fluid model is being coupled with the cerebrovascular system using the Pulse physiology engine. In addition to globally quantifying the essential cerebrovascular parameters for the local high-fidelity analysis of shunt function, Pulse also provides an invaluable training capability to teach students about the effects of elevated ICP due to hydro-cephalus on the entire body.


Bray, Aaron, Jeffrey B. Webb, Andinet Enquobahrie, Jared Vicory, Jerry Heneghan, Robert Hubal, Stephanie TerMaath, Philip Asare, and Rachel B. Clipp, "Pulse Physiology Engine: an Open-Source Software Platform for Computational Modeling of Human Medical Simulation," SN Comprehensive Clinical Medicine (2019).

Modeling Valvular Diseases

Description
Team
Links
Simulating three valvular conditions: aortic stenosis, aortic regurgitation, and mitral stenosis. Pulse virtual physiology software has the potential to transform medical education by allowing medical students to learn in a consequence-free environment. Medically accurate physiology models are required to ensure that lessons learned virtually translate to the real world.




Paul Ruales Rosero, Pavithra Rajeswaran, Jeffrey Webb, Aaron Bray, Thenkurussi Kesavadas. "Modelling Valvular Diseases Using a Virtual Physiology Engine." 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. Honolulu, Hawaii. 2018.
Physiology Engine-Based Simulation Website

SOFA Integration

Description
Team
Links
Created an interface plugin within the SOFA multi-physics simulation framework to link with the Pulse physiology engine.


GitHub repository
Kitware Blog Post
Developer Blog Post

Modular Deployment

Description
Team
Links
Pulse is deployable on low size, weight, power, and cost (SWaP-C) systems, and has been shown to run faster than real-time on several single-board computers.
Kitware Blog Post

To feature your Pulse use case, please email us at kitwa.nosp@m.re@k.nosp@m.itwar.nosp@m.e.co.nosp@m.m!