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Virtual environments, simulations and serious games are increasingly being employed for research, training, education, evaluation, and various business endeavors. This session will describe and demonstrate some of the diverse uses for virtual environments (VEs) in an alternate demonstration format. The session will begin with demonstrators providing a brief description of their VE, and how they’ve used it to answer a critical research question or address a unique need, including a video demonstration of the VE in action. After these introductions, all demonstrations will be set up around the room, and session attendees can move around the room for more direct interaction with both the demonstrations and the demonstrators. The objective of the session is to provoke ideas among the attendees for how VEs, simulations and serious games can help address their research, training, education, evaluation or business needs.

This review paper discusses the role of haptics within virtual medical training applications, particularly, where it can be used to aid a practitioner to learn and practice a task. The review summarizes aspects to be considered in the deployment of haptics technologies in medical training. First, both force/torque and tactile feedback hardware solutions that are currently produced commercially and in academia are reviewed, followed by the available haptics-related software and then an in-depth analysis of medical training simulations that include haptic feedback. The review is summarized with scrutiny of emerging technologies and discusses future directions in the field.

A training transfer paradigm was used to evaluate a virtual reality (VR) simulator for performing the burr hole drilling portion of a craniotomy procedure. Participants used a VR simulator that had a physical drill handle interfaced with a haptic force/torque feedback system. They practiced until they met a priori performance criteria and then repeated the procedure with a genuine drill and foam model of a skull. The results showed some positive transfer related to hand steadiness, but not for drilling time. The drilling model incorporated in the simulator may require more effort to maintain the drill position and more revolutions of the drill bit to penetrate the model skull. Thus, practice on the VR simulator enabled the participants to maintain better drill position on the physical model. From a clinical perspective, the findings underscore the advantages of practicing a critical surgical procedure on a simulator prior to performing on a genuine patient.

The Simulation-Based Open Surgery Training System (SOSTS) is a virtual reality simulator designed to provide training on a simulated orthopedic bone pinning procedure. The present version of SOSTS offers five distinct combinations of multi-sensory feedback during training. The purpose of this study was to investigate the effects of visual and haptic feedback on participants' ability to place a pin through a fractured tibia on the simulator. Enhanced visual feedback resulted in a significant reduction of pin alignment error, although participants in these conditions took five times longer to achieve proficiency than those in the moderate visual feedback conditions. Any form of haptic feedback resulted in significantly greater pin placement error than no haptic feedback. The results provide partial support for the proximity compatibility principle for display design.

The reproducibility of quantitative gait analysis measurements is an important consideration when analyzing data of both normal subjects and patients. Waveform similarity statistics were used to assess the reproducibility of lower extremity kinematic and kinetic data collected on 5 normal adult subjects. For each subject, gait evaluations were done on 3 separate test days with 3 trials collected each day. Pelvis angles were fairly repeatable, however, with notably poor reproducibility in sagittal plane tilt. Re-application errors of the sacral wand coupled with a small range of motion are believed to be the principle contributors to variability in this pelvis angle. The sagittal plane angles for the hip, knee, and ankle demonstrated excellent repeatability within test days and between test days. Frontal and transverse plane angles were fairly repeatable within test days but between-day repeatability was considerably lower. The `downstream' errors accompanying Euler angle calculations coupled with the smaller ranges of motion in the non-sagittal plane angles are suggested to contribute to the ambient variability already in these data and, thus, affect the within-day repeatability. Errors in re-application of midthigh and midcalf wands further contribute to the variability of these data between test days. Net resultant joint forces and moments were repeatable overall with slightly lower between-day statistical values. The exception to this observation was the adduction moment of the ankle which was notably variable between test days. Several explanations for this variability are presented. Results of this study have led to modifications in some marker placement procedures and reinforced the need for others already being used.

Present surgical education relies on a combination of observation, peer review, and practice on cadavers, and animals. In contrast, simulation technology, known as virtual reality, offers the ability to practice, hands-on surgical procedures in computer models that exhibit physical and physiological characteristics of living humans.

Telehealth applications are increasingly important in many areas of health education and training. In addition, they will play a vital role in biomedical research and research training by facilitating remote collaborations and providing access to expensive/remote instrumentation. In order to fulfill their true potential to leverage education, training, and research activities, innovations in telehealth applications should be fostered across a range of technology fronts, including online, on-demand computational models for simulation; simplified interfaces for software and hardware; software frameworks for simulations; portable telepresence systems; artificial intelligence applications to be applied when simulated human patients are not options; and the development of more simulator applications. This article presents the results of discussion on potential areas of future development, barries to overcome, and suggestions to translate the promise of telehealth applications into a transformed environment of training, education, and research in the health sciences.

Learning complex skills through simulation is a goal for training physicians in specialties such as interventional cardiology, where traditional training puts patients at risk. Intuitively, interactive simulation of anatomy, pathology and therapeutic actions should lead to shortening of the learning curve for novice or inexperienced physicians. An accurate recreation of the interactions among anatomy, pathology and therapeutic actions is a necessary, but not sufficient, condition for the development of a simulation-based training system. In addition to real-time graphic interactivity coupled with haptic response, a successful training tool will require features of a 'learning system' such as: an embedded curriculum, functionality that allows rehearsal and practice, hypertext links to educational information, personal archiving, and instructor review and testing capabilities. We describe how such a system might look for the field of interventional cardiology, and suggest that designing a simulation with both technical and pedagogical fidelity is essential in developing simulation-based training systems in any field of medicine.

In this article, we present an Interventional Cardiology Training System developed by the Medical Application Group at Mitsubishi Electric in collaboration with the Center for Innovative Minimally Invasive Therapy. The core of the ICTS is a computer simulation of interventional cardiology catheterization. This simulation integrates clinical expertise, research in learning, and technical innovations to create a realistic simulated environment. The goal of this training system is to augment the training of new cardiology fellows as well as to introduce cardiologists to new devices and procedures. To achieve this goal, both the technical components and the educational content of the ICTS bring new and unique features: a simulated fluoroscope, a physics model of a catheter, a haptic interface, a fluid flow simulation combined with a hemodynamic model and a learning system integrated in a user interface. The simulator is currently able to generate--in real-time--high quality x-ray images from a 3D anatomical model of the thorax, including a beating heart and animated lungs. The heart and lung motion is controlled by the hemodynamic model, which also computes blood pressure and EKG. The blood flow is then calculated according to the blood pressure and blood vessel characteristics. Any vascular tool, such as a catheter, guide wire or angioplasty balloon can be represented and accurately deformed by the flexible tool physics model. The haptics device controls the tool and provides appropriate feedback when contact with a vessel wall is detected. When the catheter is in place, a contrast agent can be injected into the coronary arteries; blood and contrast mixing is computed and a visual representation of the angiogram is displayed by the x-ray renderer. By bringing key advances in the area of medical simulation--with the real-time x-ray renderer for instance--and by integrating in a single system both high quality simulation and learning tools, the ICTS opens new perspectives for computer based training systems.

Medical simulation offers the opportunity to revolutionize the training of medical personnel, from paramedics and corpsmen to physicians, allowing early learning to occur in a no-risk environment, without putting patients at risk during the professional's early learning curve. However, the complexity of the problems involved in the development of the medical training systems as well as the spectrum of scientific fields that need to be covered have been a major limiting factor to the achievement of realistic simulations. We think that success in this effort cannot occur through uncoordinated efforts among domain experts working within their own fields. Success will come through medical personnel working side by side with engineers, computer scientists and designers to develop a simulation system that is useful and relevant. As part of our overall program to develop medical simulation, we have identified a critical infrastructure technology that will enable collaboration among simulation developers. When implemented, this Common Anatomy Modeling Language (CAML) will provide a common architecture for integrating the individual components of a medical simulation system.© (2000) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Interventional cardiology training traditionally involves one-on-one experience following a master-apprentice model, much as other procedural disciplines. Development of a realistic computer-based training system that includes hand-eye coordination, catheter and guide wire choices, three-dimensional anatomic representations, and an integrated learning system is desirable, in order to permit learning to occur safely, without putting patients at risk. Here we present the first report of a PC-based simulator that incorporates synthetic fluoroscopy, real-time three-dimensional interactive anatomic display, and selective right- and left-sided coronary catheterization and angiography using actual catheters. Significant learning components also are integrated into the simulator.

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Computer-based simulation is a goal for training physicians in specialties where traditional training puts patients at risk. Intuitively, interactive simulation of anatomy, pathology, and therapeutic actions should lead to shortening of the learning curve for novice or inexperienced physicians. Effective transfer of knowledge acquired in simulators must be shown for such devices to be widely accepted in the medical community. We have developed an Interventional Cardiology Training Simulator which incorporates real-time graphic interactivity coupled with haptic response, and an embedded curriculum permitting rehearsal, hypertext links, personal archiving and instructor review and testing capabilities. This linking of purely technical simulation with educational content creates a more robust educational purpose for procedural simulators.

The purpose of this study was to analyze intersegmen tal forces at the tibiofemoral joint and muscle activity during three commonly prescribed closed kinetic chain exercises: the power squat, the front squat, and the lunge. Subjects with anterior cruciate ligament-intact knees performed repetitions of each of the three exer cises using a 223-N (50-pound) barbell. The results showed that the mean tibiofemoral shear force was posterior (tibial force on femur) throughout the cycle of all three exercises. The magnitude of the posterior shear forces increased with knee flexion during the descent phase of each exercise. Joint compression forces remained constant throughout the descent and ascent phases of the power squat and the front squat. A net offset in extension for the moment about the knee was present for all three exercises. Increased quadri ceps muscle activity and decreased hamstring muscle activity are required to perform the lunge as compared with the power squat and the front squat. A posterior tibiofemoral shear force throughout the entire cycle of all three exercises in these subjects with anterior cru ciate ligament-intact knees indicates that the potential loading on the injured or reconstructed anterior cruci ate ligament is not significant. The magnitude of the posterior tibiofemoral shear force is not likely to be detrimental to the injured or reconstructed posterior cruciate ligament. These conclusions assume that the resultant anteroposterior shear force corresponds to the anterior and posterior cruciate ligament forces.

In the past, surgical simulations have largely been created through the development of dedicated applications that require considerable programming and computer graphics skills. Advances in simulation-based surgical education have been limited by this dependence on computer graphics programming expertise. To lower barriers to the adoption of simulation-based training, we are developing tools based on Teleos, software technology that allows a wide variety of medical content developers to author surgical training simulations without programming.