Depending on the severity of the condition and associated risk, surgical intervention may not always be the first choice. This is true for treating chest wall deformities such as pectus excavatum and pectus carinatum. For both conditions, novel non-surgical treatments have been developed to gradually alleviate the malformation making use of the elastic nature of the costal cartilages at an early age of the patient. To quantify the performance of such treatments, this paper introduces and discusses the development of a software-based instrument that utilizes 3D chest optical images (surface scans) as input and uses registration techniques to produce an objective gauge of a patient's physical improvement after undergoing treatments. Further discussed is an experiment designed to investigate the construct validity of the developed instrument.
Virtual Reality for surgical training is mainly focused on technical surgical skills. We work on providing a novel approach to the use of Virtual Reality focusing on the procedural aspects. Our system relies on a specific work-flow generating a model of the procedure from real case surgery observation in the operating room. This article presents the different technologies created in the context of our project and their relations as other components of our workflow.
Sensor enabled simulators may help in training and assessing clinical skill. Their are imitations on the locations current sensors can be placed without interfering with the clinical examination. In this study novel fabric force sensors were developed and tested. These sensors are soft and flexible and undetectable when placed in different locations in the simulator. Five sensors were added to our current sensor enabled breast simulator. Eight participants performed the clinical breast examination on the simulator and documented their findings. There was a significant relationship for both clinical breast examination time (r(6) = 0.99, p < 0.001) and average force (r(6) = 0.92, p < 0.005) between our current sensors and the new fabric sensors. In addition the senors were not noticed by the participants. These new sensors provide new methods to measure and assess clinical skill and performance.
Neuroanatomy is a challenging subject, with novice medical students often experiencing difficulty grasping the intricate 3D spatial relationships. Most of the anatomical teaching in undergraduate medicine utilizes conventional 2D resources. E-learning technologies facilitate the development of learner-centered educational tools that can be tailored to meet each student's educational needs, and may foster improved learning in neuroanatomy, however this has yet to be examined fully in the literature. An interactive 3D e-learning module was developed to complement gross anatomy laboratory instruction. Incorporating such 3D modules may provide additional support for students in areas of anatomy that are spatially challenging, such as neuroanatomy. Specific anatomical structures and their relative spatial positions to other structures can be clearly defined in the 3D virtual environment from viewpoints that may not readily be available using cadaveric or 2D image modalities. Providing an interactive user interface for the 3D module in which the student controls many factors may enable the student to develop an improved understanding of the spatial relationships. This work outlines the process for the development of a 3D interactive module of the cerebral structures included in the anatomy curriculum for undergraduate medical students in their second year of study.
Natural orifice translumenal endoscopic surgery (NOTES) procedures are rapidly being developed in diverse surgical fields. We are developing a Virtual Translumenal Endoscopic Surgery Trainer (VTEST™) built on a modularized platform that facilitates rapid development of virtual reality (VR) NOTES simulators. Both the hardware interface and software components consist of independent reusable and customizable modules. The developed modules are integrated to build a VR-NOTES simulator for training in the hybrid transvaginal NOTES cholecystectomy. The simulator was demonstrated and evaluated by expert NOTES surgeons at the 2015 Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) summit.
This study investigated how the ergonomic factors, such as hand dominance and postural selection, influenced on surgical performance regarding the changes of muscle activity. Twenty novices performed two virtual laparoscopic surgical training tasks and five target muscle activities were measured. Compared with using dominant hand, surgical skills performance using non-dominant hand increased muscle activities. Muscle fatigue is more likely induced in standing position than sitting position during practice. This study suggests an emerging need to focus on hand dominance during laparoscopic surgical training to address the impact of hand discrepancy on bimanual coordination. It is also important to pay attention on postural selection during training to reduce muscle fatigue, which possibly leads to injuries.
Artificial tactile sensing is a capability important for many applications and, in particular, for endoscopic surgery. A recently developed Medical Tactile Endosurgical Complex (MTEC) that is a certified and commercially available product is an efficient tool that provides such a capability. Currently the analysis of intraoperative tactile images that are registered and visualized by MTEC is performed manually by a surgeon. We show that heterogeneity detection - a key constituent of intraoperative tactile images analysis - can be efficiently automated. Such automation essentially reduces the requirement of attention retaining during the MTEC-based palpation.
This study examined how hand dominance could influence postural sway during laparoscopic skills practice. Ten inexperienced medical trainees performed a peg transfer task using the Fundamentals of Laparoscopic Surgery (FLS) training box and the virtual reality (VR) trainer. Surface electromyographic recordings of upper and lower limb muscles were taken, while the postural sway was measured by a pressure mapping system. Skills performance using the non-dominant hand required more muscle effort and increased more postural sway. Compared with the FLS training box, training with VR decreased the use of muscle effort and could reduce the influence of hand dominance on the overall postural sway during laparoscopic surgical skills practice.
Adults with Intellectual Disability (ID) are at high risk of being in poor health as a result of exercising infrequently; recent evidence indicates this is often due to there being a lack of opportunities to exercise. This pilot study involved an investigation of the use of motion-sensor game technology to enable and encourage exercise for this population. Five adults (two female; 3 male, aged 34-74 [M = 55.20, SD = 16.71] with ID used motion-sensor games to conduct exercise at weekly sessions at a day-centre. Session attendees reported to have enjoyed using the games, and that they would like to use the games in future. Interviews were conducted with six (four female; two male, aged 27-51 [M = 40.20, SD = 11.28]) day-centre staff, which indicated ways in which the motion-sensor games could be improved for use by adults with ID, and barriers to consider in relation to their possible future implementation. Findings indicate motion-sensor games provide a useful, enjoyable and accessible way for adults with ID to exercise. Future research could investigate implementation of motion-sensor games as a method for exercise promotion for this population on a larger scale.
In this study, the effect of the geometrical configuration of retroreflective markers on the maximum tracking uncertainty of target points during a medical navigation is analyzed. Methods that help users select and set up an optimal configuration for minimizing the navigation uncertainty are proposed. The methods are evaluated by simulating surgical navigation environment using an optical tracking system. The result shows that the maximum uncertainty of tracking the target points lying outside the marker region is a function of the configuration of some of the associated markers and the precision of the optical tracking system used. We also show that the use of flexible rigid bodies minimizes target tracking uncertainty by enabling a customized reconfiguration of markers for optimal pose with respect to individual surgical target position during preoperative planning phase.
The Virtual Pediatric Airways Workbench (VPAW) is a patient-centered surgical planning software system targeted to pediatric patients with airway obstruction. VPAW provides an intuitive surgical planning interface for clinicians and supports quantitative analysis regarding prospective surgeries to aid clinicians deciding on potential surgical intervention. VPAW enables a full surgical planning pipeline, including importing DICOM images, segmenting the airway, interactive 3D editing of airway geometries to express potential surgical treatment planning options, and creating input files for offline geometric analysis and computational fluid dynamics simulations for evaluation of surgical outcomes. In this paper, we describe the VPAW system and its use in one case study with a clinician to successfully describe an intended surgery outcome.
Keratoconus is a progressive non-inflammatory disease of the cornea. Rigid gas permeable contact lenses (RGPs) are prescribed when the disease progresses. Contact lens fitting and assessment is very difficult in these patients and is a concern of ophthalmologists and optometrists. In this study, a hierarchical fuzzy system is used to capture the expertise of experienced ophthalmologists during the lens evaluation phase of prescription. The system is fine-tuned using genetic algorithms. Sensitivity, specificity and accuracy of the final system are 88.9%, 94.4% and 92.6% respectively.
Conventional surgical telementoring systems require the trainee to shift focus away from the operating field to a nearby monitor to receive mentor guidance. This paper presents the next generation of telementoring systems. Our system, STAR (System for Telementoring with Augmented Reality) avoids focus shifts by placing mentor annotations directly into the trainee's field of view using augmented reality transparent display technology. This prototype was tested with pre-medical and medical students. Experiments were conducted where participants were asked to identify precise operating field locations communicated to them using either STAR or a conventional telementoring system. STAR was shown to improve accuracy and to reduce focus shifts. The initial STAR prototype only provides an approximate transparent display effect, without visual continuity between the display and the surrounding area. The current version of our transparent display provides visual continuity by showing the geometry and color of the operating field from the trainee's viewpoint.
This study investigated the haptic 'dissection' of a digital model of the hand and wrist in anatomy education at both undergraduate (UG) and postgraduate (PG) levels. The study ran over five successive years and was split into three discreet phases. Phase one compared the results of PG students across control, non-haptic and haptic groups. Phase two compared the results of UG students between control and haptic groups. Phase three compared the results of UG students across control, non-haptic and haptic groups. Results for all phases indicate that use of the model, both through haptic and non-haptic interfaces produced some significantly improved test results. The non-haptic group performing the strongest overall indicating that the addition of haptic feedback may not be beneficial to student learning.
Creating a significant negative impact on both their quality of life and the quality of patient care with an evident economical burden for the healthcare system, there is a growing concern over physician burnout. The range of interventions and treatments that have been used to address this problem, however, appear quite fragmented and lack compelling efficacy. We describe the main factors known to contribute to the development of physician burnout as well as currently available treatments. Studies seem to indicate that both specialisation area as well as personality traits may contribute to the manifestation. The highest risk specialties appear to be critical care physicians, emergency physicians, oncologists and internal medicine physicians, while the highest risk personality attributes are high neuroticism, low agreeableness, introversion, and negative affectivity. In addition, being exceedingly enthusiastic about one's work and having high aspirations at work, with an idealistic approach, also serve as factors which contribute to increased risk of burnout, and in particular for those who are new to the occupation.
We present a functional and patient-specific lumbar phantom for the training of spinal durotomy and dura closure under microscopic view, consisting of a lumbar model, pressurized dural surrogate, together immersed in a tissue-mimicking layer simulating fat, muscle and skin. The lumbar model was derived from a patient computed tomography scan, preserving the natural shape and curvature of the lumbar column. The inclusion of the simulated soft-tissue layer was critical for preserving the surgical ergonomics and presented a realistic view under the surgical microscope. As the success of dura repair is indicated by the watertight closure of the thecal sac, the dura surrogate was connected to a pressurized and closed-loop water system to provide functional cerebrospinal fluid leakage during durotomy. This functional phantom is inexpensive to construct, provides a realistic tactile and visual environment for spinal durotomy repair, and can be easily extended to simulate other patient-specific spinal interventions.
Camera positioning is critical for all telerobotic surgical systems. Inadequate visualization of the remote site can lead to serious errors that can jeopardize the patient. An autonomous camera algorithm has been developed on a medical robot (da Vinci) simulator. It is found to be robust in key scenarios of operation. This system behaves with predictable and expected actions for the camera arm with respect to the tool positions. The implementation of this system is described herein. The simulation closely models the methodology needed to implement autonomous camera control in a real hardware system. The camera control algorithm follows three rules: (1) keep the view centered on the tools, (2) keep the zoom level optimized such that the tools never leave the field of view, and (3) avoid unnecessary movement of the camera that may distract/disorient the surgeon. Our future work will apply this algorithm to the real da Vinci hardware.
This paper presents a simulation of Virtual Airway Skill Trainer (VAST) tasks. The simulated tasks are a part of two main airway management techniques; Endotracheal Intubation (ETI) and Cricothyroidotomy (CCT). ETI is a simple nonsurgical airway management technique, while CCT is the extreme surgical alternative to secure the airway of a patient. We developed identification of Mallampati class, finding the optimal angle for positioning pharyngeal/mouth axes tasks for ETI and identification of anatomical landmarks and incision tasks for CCT. Both ETI and CCT simulators were used to get physicians' feedback at Society for Education in Anesthesiology and Association for Surgical Education spring meetings. In this preliminary validation study, total 38 participants for ETI and 48 for CCT performed each simulation task and completed pre and post questionnaires. In this work, we present the details of the simulation for the tasks and also the analysis of the collected data from the validation study.
Inducing interference patterns of shear wave is one of the proposed methods for reducing the frame rate in measuring wave speed during tissue elastography. Previously, the Nyquist rate must be met in order to provide an appropriate image for extracting the patterns with a reasonable accuracy. In this article we propose a technique based on image registration, and apply it to ultrasound images acquired before and after inducing the shear waves to estimate the amplitude of displacement. The displacement of the tissue is then used to form the interference pattern of shear waves. The method does not induce any restrictions on the time interval between images, so the tissue elasticity can be calculated independent of the imaging rate. The average error in measuring the elasticity of the simulated phantom is 13.7%.
As one of the most commonly performed neurosurgical procedures, ventriculostomy training simulators are becoming increasingly familiar features in research institutes and teaching facilities. Despite their widespread implementations and adoption, simulators to date have not fully explored the landscape of performance metrics that reflect surgical proficiency. They opt instead for measures that are qualitative or simple to compute and conceptualize. In this paper, we examine and compare the use of various metrics to characterize the performance of users on simulated part-task ventriculostomy scenarios derived from patient data. As an initial study, we examine how our metrics relate to expert classification of scenario difficulty as well as measures of anatomical variation.
