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Preamble Emerging Trends in Medical Preamble Emerging Trends in Medical Simulation: Simulation: Workshop CDs Workshop CDs Identifying the Needs of the Medical Community Identifying the Needs of the Medical Community

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Emerging Trends in Medical Emerging Trends in Medical Simulation: Simulation:

Identifying the Needs of the Medical Community Identifying the Needs of the Medical Community and Methods to Address Them and Methods to Address Them Alan Liu Alan Liu Dale Alverson Dale Alverson Mark Scerbo Mark Scerbo Mark Bowyer Mark Bowyer

http://simcen.usuhs.mil/mmvr2005 http://simcen.usuhs.mil/mmvr2005

MMVR 2005 – Session B

Preamble Preamble

  • Workshop CDs

Workshop CDs

  • Workshop website

Workshop website

http://simcen.usuhs.mil/mmvr2005 http://simcen.usuhs.mil/mmvr2005

  • Presentations and forum

Presentations and forum for discussion for discussion

"Hey you! Wake up when I'm talking."

MMVR 2005 – Session B

Schedule Schedule

  • Technology and Medical Simulation

Technology and Medical Simulation

  • A Clinical Perspective

A Clinical Perspective

  • Human Factors and Medical Simulation

Human Factors and Medical Simulation

  • Advanced Distributed Learning

Advanced Distributed Learning

  • Open discussion and conclusion

Open discussion and conclusion

MMVR 2005 – Session B

Speakers Speakers

  • Alan Liu

Alan Liu

– – Project Scientist (Medical Simulation), National Capital Area Project Scientist (Medical Simulation), National Capital Area Medical Simulation Center Medical Simulation Center

  • Mark Bowyer

Mark Bowyer

– – Surgical Director of the National Capital Area Medical Simulatio Surgical Director of the National Capital Area Medical Simulation n Center Center

  • Mark

Mark Scerbo Scerbo

– – Graduate Program Director, Human Factors Psychology doctoral Graduate Program Director, Human Factors Psychology doctoral program Old Dominion University program Old Dominion University

  • Dale

Dale Alverson Alverson

– – Medical Director, Center for Medical Director, Center for Telehealth Telehealth and and Cybermedicine Cybermedicine Research, Health Sciences Center, University of New Mexico Research, Health Sciences Center, University of New Mexico

Technology and Medical Simulation Technology and Medical Simulation

MMVR 2005 – Session B

Outline Outline

  • Motivation

Motivation

  • Trends

Trends

– – Survey of the State of the Art (past and present) Survey of the State of the Art (past and present)

  • What

What’ ’s ahead s ahead

  • What

What’ ’s missing s missing

– – And where we need to be And where we need to be

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MMVR 2005 – Session B

Why Simulation? Why Simulation?

  • More complex

More complex procedures procedures

  • Shorter patient

Shorter patient interaction time interaction time

  • Reduce medical errors

Reduce medical errors

Source: National Institute of Advanced Industrial Science and Technology, Japan

MMVR 2005 – Session B

Current Practice Current Practice

  • Animals

Animals – – Incorrect anatomy Incorrect anatomy

  • Cadavers

Cadavers – – Incorrect physiology Incorrect physiology

  • Patients

Patients – – Risk to patient safety Risk to patient safety

  • Each other

Each other – – Can be painful Can be painful

MMVR 2005 – Session B

Medical Simulators Medical Simulators

  • Computer

Computer-

  • based

based “ “Virtual Virtual” ” patient patient

  • Ability to mimic some

Ability to mimic some tissue properties tissue properties

  • Some physiological

Some physiological response response

  • Dexterous and

Dexterous and cognitive skills cognitive skills training training

MMVR 2005 – Session B

The Expectation Gap The Expectation Gap

  • Better visuals

Better visuals

  • Accurate tissue

Accurate tissue models models

  • Haptics

Haptics

  • Procedure specific

Procedure specific hardware hardware

  • Specific tasks

Specific tasks

  • Minimally invasive

Minimally invasive procedures procedures

  • Cost (pricey)

Cost (pricey)

  • Integration with

Integration with curriculum curriculum

  • More cases

More cases

  • More procedures

More procedures

  • Procedure independent

Procedure independent hardware hardware

  • Wider audience

Wider audience

– – Paramedic, first Paramedic, first responder responder

  • Cost (cheap)

Cost (cheap)

Gap

MMVR 2005 – Session B

The Expectation Gap The Expectation Gap

  • Better visuals

Better visuals

  • Accurate tissue

Accurate tissue models models

  • Haptics

Haptics

  • Procedure specific

Procedure specific hardware hardware

  • Specific tasks

Specific tasks

  • Minimally invasive

Minimally invasive procedures procedures

  • Cost (pricey)

Cost (pricey)

  • Integration with

Integration with curriculum curriculum

  • More cases

More cases

  • More procedures

More procedures

  • Procedure independent

Procedure independent hardware hardware

  • Wider audience

Wider audience

– – Paramedic, first Paramedic, first responder responder

  • Cost (cheap)

Cost (cheap)

Gap

MMVR 2005 – Session B

Why? Why?

  • Communications

Communications

– – How do you quantify How do you quantify “ “doesn doesn’ ’t feel right? t feel right?” ”

  • Different expectations

Different expectations

  • Human factors

Human factors

  • Team dynamics

Team dynamics

  • Understanding the

Understanding the learning process learning process

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MMVR 2005 – Session B MMVR 2005 – Session B

Trends in Technology Trends in Technology

  • Visual feedback

Visual feedback

  • Tissue models

Tissue models

  • Instrument simulation

Instrument simulation

– – Tactile and Haptic feedback Tactile and Haptic feedback

  • Hardware

Hardware

  • Procedure focus

Procedure focus

  • Team

Team-

  • based training

based training

MMVR 2005 – Session B

Visual Feedback Visual Feedback

Source: Morten BRO-NIELSEN, “VR Simulation of Abdominal Trauma Surgery”, MMVR ‘98 , MMVR 2005 – Session B

Simulating Surgical Instruments Simulating Surgical Instruments

MMVR 2005 – Session B

Surgical Effects Surgical Effects

  • Cutting

Cutting

  • Bleeding

Bleeding

  • Smoke

Smoke

Daniel Bielser, Computer Graphics Lab, ETH Zürich Source: Forschungszentrum Karlsruhe MMVR 2005 – Session B Xitact S.A. VRMagic GmbH Simbionix Image courtesy of Gerard Lacy, Haptica Procedicus VISTTM

, Mentice AB

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MMVR 2005 – Session B

Verefi Technologies Verefi Technologies

  • EndoTower

EndoTower

  • SmartTutor

SmartTutor

– – Adaptive difficulty Adaptive difficulty level level – – Listen to talk on Listen to talk on Saturday Saturday

Images courtesy of Randy Haluck, Verefi Technologies

MMVR 2005 – Session B

ProMIS (Haptica) ProMIS (Haptica)

  • Optically tracked

Optically tracked

  • Can use actual

Can use actual instruments instruments

  • Real and virtual

Real and virtual exercises exercises

  • Validated

Validated

Images courtesy of Gerard Lacy, Haptica Ltd.

MMVR 2005 – Session B

Lapsim (Surgical Science) Lapsim (Surgical Science)

  • Basic laparoscopic

Basic laparoscopic skills skills

– – Navigation, Cutting, Navigation, Cutting, Suturing Suturing

  • Intermediate skills

Intermediate skills

– – Dissection Dissection – – Lower intestine Lower intestine manipulation manipulation

MMVR 2005 – Session B

EYESI (VRMagic) EYESI (VRMagic)

  • Intraocular surgery

Intraocular surgery training training

  • Basic skills

Basic skills

– – Instrument and object Instrument and object manipulation manipulation

  • Tool operation

Tool operation

– – Microscope Microscope – – Vitrectomy unit Vitrectomy unit

MMVR 2005 – Session B

Continuous Curvilinear Continuous Curvilinear Capsulorhexis Simulator Capsulorhexis Simulator

Acknowledgements: Roger Webster1,3, Randy Haluck1,2, Aaron Benson1, Rod Shenk1,3 1 Verefi Technologies Inc., Hershey, PA USA 17033 2 Department of Surgery, Penn State University College of Medicine, Milton

  • S. Hershey Medical Center, Hershey, PA USA 17033

3 Department of Computer Science, Caputo Hall, Millersville University, Millersville, PA. USA 17551

MMVR 2005 – Session B

Epidural Injection Simulator Epidural Injection Simulator

(prototype for any needle procedure) (prototype for any needle procedure)

Slide Courtesy of M.A. Srinivasan, MIT

Haptic Interface inside the Mannequin provides touch feedback

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MMVR 2005 – Session B

Procedural Training Procedural Training Sequence Sequence Virtual IV Virtual IV Simulation Simulation Anatomic Viewer Anatomic Viewer Procedural Procedural Assessment Assessment

Simquest Virtual IV Trainer Simquest Virtual IV Trainer

Images courtesy of Bob Waddington, Simquest International

MMVR 2005 – Session B

Trends Trends

  • Focus on minimally

Focus on minimally invasive procedures invasive procedures

  • Specialized hardware

Specialized hardware

  • Better visual realism

Better visual realism

  • Haptic feedback

Haptic feedback

– – More of the same More of the same

  • Tactile feedback?

Tactile feedback?

  • Validation

Validation

vs

What What’ ’s Missing? s Missing?

MMVR 2005 – Session B

How much is enough? How much is enough?

  • How much realism is

How much realism is really necessary? really necessary?

– – And when does it And when does it become eye become eye-

  • candy?

candy?

  • Maybe its much less

Maybe its much less than you think than you think [BATTEAU04] [BATTEAU04]

  • What you need vs.

What you need vs. what you want. what you want.

MMVR 2005 – Session B

Open Surgery Open Surgery

Trauma is the major cause of death in the under-45 age group and the third leading cause of death in all populations

  • Yelle JD, Trask A. Trauma: an overview. In: Rippe JM, Irvin RS, Alpert JS, et al,
  • eds. Intensive Care Medicine. Boston: Little, Brown; 1996:1900-1904

MMVR 2005 – Session B

Open Surgery Simulators Open Surgery Simulators

  • Minimally Invasive

Minimally Invasive Surgery Surgery

– – Limited field of view (2D Limited field of view (2D mostly) mostly) – – Limited interaction Limited interaction – – Surgical manipulators Surgical manipulators

  • Open Surgery

Open Surgery

– – Wide open field of view Wide open field of view (any angle) (any angle) – – Interact with a wide variety Interact with a wide variety

  • f instruments and methods
  • f instruments and methods

– – HARD HARD

vs

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6

MMVR 2005 – Session B

Think Low Hanging Fruit Think Low Hanging Fruit

MMVR 2005 – Session B

A Common Framework A Common Framework

  • Software

Software

– – Open standards Open standards

» » See PANEL: INTEROPERABILITY STANDARDS FOR See PANEL: INTEROPERABILITY STANDARDS FOR MEDICAL MODELING AND SIMULATION: The Need, MEDICAL MODELING AND SIMULATION: The Need, Challenges and Opportunities Challenges and Opportunities

– – CAML (CIMIT) CAML (CIMIT) – – GiPSi GiPSi (Case Western) (Case Western)

  • Hardware

Hardware

– – Modular platform Modular platform – – VRDemo VRDemo

MMVR 2005 – Session B

Images courtesy of Randy Haluck, Verefi Technologies

MMVR 2005 – Session B

Team Training Team Training

  • One surgeon, one patient paradigm

One surgeon, one patient paradigm

– – What about the rest of the team? What about the rest of the team?

  • Medical treatment is a team effort

Medical treatment is a team effort

– – Trauma Trauma – – Mass Mass-

  • casualty management

casualty management

  • The need for a team trainer

The need for a team trainer

– – Distributed Distributed

MMVR 2005 – Session B

  • A winged cockroach

A winged cockroach jumped into the woman's jumped into the woman's mouth as she was cleaning mouth as she was cleaning her home her home

  • She tried to scoop the bug

She tried to scoop the bug

  • ut with a fork
  • ut with a fork
  • She swallowed the fork

She swallowed the fork

  • The surgeon removed the

The surgeon removed the fork with laparoscopic fork with laparoscopic surgery surgery

  • The cockroach was already

The cockroach was already digested. digested.

Source: www.joe-ks.com

MMVR 2005 – Session B

References References

  • [COSTA94] Costa KD, McCulloch AD.

[COSTA94] Costa KD, McCulloch AD. “ “Relationship between regional geometry and Relationship between regional geometry and mechanics in a three dimensional finite element mechanics in a three dimensional finite element model of the left ventricle. model of the left ventricle.” ” ASME Winter Annual ASME Winter Annual Meeting, Chicago, Nov. 6 Meeting, Chicago, Nov. 6-

  • 11, ASME Advances in

11, ASME Advances in Bioengineering, BED Bioengineering, BED-

  • vol. 28: 5
  • vol. 28: 5-
  • 6, 1994.

6, 1994.

  • [BATTEAU04] Batteau, A. Liu, J.B. A.

[BATTEAU04] Batteau, A. Liu, J.B. A. Maintz Maintz, ,

  • Y. Bhasin, M. Bowyer, "A Study on the
  • Y. Bhasin, M. Bowyer, "A Study on the

Perception of Haptics in Surgical Simulation", L. Perception of Haptics in Surgical Simulation", L. LNICS v. 3078, 2004. LNICS v. 3078, 2004.