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Huang R, Xu Z, Guan H, Zhou J, Yang K, Peng S, Yu H, Fu M, He L, Zhu Y, Jiang Y, Zhang G, Zhou H, Chow C. Construction of a virtual reality platform for computer-aided navigation Lingnan bone setting technique. Bioengineered 2023; 14:165-178. [PMID: 37377392 DOI: 10.1080/21655979.2023.2184546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/12/2022] [Accepted: 09/14/2022] [Indexed: 06/29/2023] Open
Abstract
To establish a standard Traditional Chinese medicine (TCM) bone setting technique, standardize the operation and inherit the TCM bone setting technique. This project was based on the interactive tracking of bone setting techniques with a dedicated position tracker, the motion tracking of bone setting techniques based on RGBD (Red Green Blue Depth) cameras, the digital analysis of bone setting techniques, and the design of the virtual reality platform for bone setting techniques. These key technical researches were combined to construct an interactive bone setting technique. The virtual simulation system can reproduce the implementation process of the expert's bone setting technique. The user can observe the implementation of the manipulative technique from multiple angles; through human-computer interaction, the whole process of implementation of the bone setting technique can be simulated, and the movement and reduction of the affected bone can be observed at the same time. It can be used as a teaching and training system for assisting bone setting techniques. Students can use the system to carry out repeated self-training, and can instantly compare with the standard techniques of the expert database, breaking the traditional teaching mode of 'expected and unspeakable' and avoid directly using patients. Therefore, this research makes it possible to reduce teaching costs, reduce risks, improve teaching quality, and make up for the lack of teaching conditions. It is very positive for the inheritance of the traditional Chinese 'intangible culture' of bone setting techniques, and to promote the digitalization and standardization of bone setting techniques.
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Affiliation(s)
- Ruojing Huang
- Orthopedic center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Zhiqiang Xu
- Orthopedic center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Honggang Guan
- Orthopedic center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Jie Zhou
- Orthopedic center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Kuangyang Yang
- Orthopedic center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Shaowu Peng
- School of Software Engineering, South China University of Technology, Guangzhou, Guangdong Province, China
| | - Haibo Yu
- Orthopedic center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Mingyun Fu
- Orthopedic center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Lilei He
- Orthopedic center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Yongzhan Zhu
- Orthopedic center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Yong Jiang
- Orthopedic center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Gai Zhang
- Orthopedic center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Huolong Zhou
- Orthopedic center, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - ChiHo Chow
- Orthopedic center, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
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Gao R, Kurenov S, Black EW, Peters J. Adding Safety Rules to Surgeon-Authored Virtual Reality Training. Simul Healthc 2023; 18:400-407. [PMID: 37342919 PMCID: PMC10739635 DOI: 10.1097/sih.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
INTRODUCTION The Toolkit for Illustration of Procedures in Surgery (TIPS) is an open source virtual reality (VR) laparoscopic simulation-based training environment with force feedback. The TIPS-author is a content creation interface that allows a surgeon educator (SE) to assemble new laparoscopic training modules. New technology enables safety rules to be specified by the SE, automatically tracks specified safety errors, and summarizes and communicates achievements and errors to the surgical trainee. METHODS The TIPS-author combines and initializes building blocks of anatomy with their physical properties, as selected by the SE from a database. The SE can add any safety rule that can be tested in terms of location, proximity, separation, clip count, and force. Errors are then automatically monitored during simulation and recorded as visual snapshots for feedback to the trainee. The TIPS was field tested at 2 surgical conferences, one before and one after adding the error snapshot feature. RESULTS Sixty-four respondents at 2 surgical conferences assessed the utility of TIPS on a Likert scale. While other ratings remained unchanged for an overall score of 5.24 of 7 (7 = very useful), the rating of the statement "The TIPS interface helps learners understand the force necessary to explore the anatomy" improved from 5.04 to 5.35 of 7 after the snapshot mechanism was added. CONCLUSIONS The ratings indicate the viability of the TIPS open source SE-authored surgical training units with safety rules. Presenting SE-determined procedural missteps via the snapshot mechanism at the end of the training increases perceived utility.
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Affiliation(s)
- Ruiliang Gao
- University of Florida, Gainesville, FL32611, USA
| | - Sergei Kurenov
- Roswell Park Comprehensive Cancer Center, Buffalo, NY14263, USA
| | | | - Jörg Peters
- University of Florida, Gainesville, FL32611, USA
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Cate G, Barnes J, Cherney S, Stambough J, Bumpass D, Barnes CL, Dickinson KJ. Current status of virtual reality simulation education for orthopedic residents: the need for a change in focus. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2023; 2:46. [PMID: 38013875 PMCID: PMC10032253 DOI: 10.1007/s44186-023-00120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023]
Abstract
Introduction Advances in technology are changing surgical education. Simulation provides an important adjunct to operative experience. This pedagogy has arguably become more important in light of the COVID-19 pandemic, with resultant reduction in operative exposure for trainees. Virtual reality (VR) simulators may provide significant contribution to experiential learning; however, much of the investigative focus to date has, correctly, been on establishing validity evidence for these constructs. The aim of this work was to perform a scoping review to assess the current status of VR simulation education to determine curricular development efforts for orthopedic residents. Methods With a trained medical librarian, searches of PubMed, EMBASE, and Web of Science were conducted for all articles in the last 10 years (September 2011-September 2021). Controlled vocabulary Medical Subject Headings (MeSH) terms and natural language developed with subject matter experts describing virtual reality or VR simulation and orthopedic training were used. Two trained reviewers evaluated all abstracts for inclusion. Exclusion criteria were all articles that did not assess VR simulation education involving orthopedic residents. Data were extracted from the included full-text articles including: study design, type of participants, type of VR simulation, simulated orthopedic skill, type of educational event, learner assessment including Kirkpatrick's level, assessment of quality using the Medical Education Research Study Quality Instrument (MERSQI), and level of effectiveness (LoE). Results Initial search identified 1,394 articles, of which 61 were included in the final qualitative synthesis. The majority (54%) were published in 2019- 2021, 49% in Europe. The commonest VR simulator was ArthroS (23%) and the commonest simulated skill was knee arthroscopy (33%). The majority of studies (70%) focused on simulator validation. Twenty-three studies described an educational module or curriculum, and of the 21 (34%) educational modules, 43% were one-off events. Most modules (18/21, 86%) assessed learners at Kirkpatrick level 2. With regard to methodological quality, 44% of studies had MERSQI 11.5-15 and 89% of studies had LoE of 2. Two studies had LoE of 3. Conclusion Current literature pertaining to VR training for orthopedic residents is focused on establishing validity and rarely forms part of a curriculum. Where the focus is education, the majority are discrete educational modules and do not teach a comprehensive amalgam of orthopedic skills. This suggests focus is needed to embed VR simulation training within formal curricula efforts guided by the work of Kern, and assess the efficacy of these against patient outcomes.
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Affiliation(s)
- Graham Cate
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jack Barnes
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Steven Cherney
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jeffrey Stambough
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - David Bumpass
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - C. Lowry Barnes
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Karen J. Dickinson
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR USA
- Office of Interprofessional Education, University of Arkansas for Medical Sciences, Little Rock, USA
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Zhang J, Lu V, Khanduja V. The impact of extended reality on surgery: a scoping review. INTERNATIONAL ORTHOPAEDICS 2023; 47:611-621. [PMID: 36645474 PMCID: PMC9841146 DOI: 10.1007/s00264-022-05663-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/03/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Extended reality (XR) is defined as a spectrum of technologies that range from purely virtual environments to enhanced real-world environments. In the past two decades, XR-assisted surgery has seen an increase in its use and also in research and development. This scoping review aims to map out the historical trends in these technologies and their future prospects, with an emphasis on the reported outcomes and ethical considerations on the use of these technologies. METHODS A systematic search of PubMed, Scopus, and Embase for literature related to XR-assisted surgery and telesurgery was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Primary studies, peer-reviewed articles that described procedures performed by surgeons on human subjects and cadavers, as well as studies describing general surgical education, were included. Non-surgical procedures, bedside procedures, veterinary procedures, procedures performed by medical students, and review articles were excluded. Studies were classified into the following categories: impact on surgery (pre-operative planning and intra-operative navigation/guidance), impact on the patient (pain and anxiety), and impact on the surgeon (surgical training and surgeon confidence). RESULTS One hundred and sixty-eight studies were included for analysis. Thirty-one studies investigated the use of XR for pre-operative planning concluded that virtual reality (VR) enhanced the surgeon's spatial awareness of important anatomical landmarks. This leads to shorter operating sessions and decreases surgical insult. Forty-nine studies explored the use of XR for intra-operative planning. They noted that augmented reality (AR) headsets highlight key landmarks, as well as important structures to avoid, which lowers the chance of accidental surgical trauma. Eleven studies investigated patients' pain and noted that VR is able to generate a meditative state. This is beneficial for patients, as it reduces the need for analgesics. Ten studies commented on patient anxiety, suggesting that VR is unsuccessful at altering patients' physiological parameters such as mean arterial blood pressure or cortisol levels. Sixty studies investigated surgical training whilst seven studies suggested that the use of XR-assisted technology increased surgeon confidence. CONCLUSION The growth of XR-assisted surgery is driven by advances in hardware and software. Whilst augmented virtuality and mixed reality are underexplored, the use of VR is growing especially in the fields of surgical training and pre-operative planning. Real-time intra-operative guidance is key for surgical precision, which is being supplemented with AR technology. XR-assisted surgery is likely to undertake a greater role in the near future, given the effect of COVID-19 limiting physical presence and the increasing complexity of surgical procedures.
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Affiliation(s)
- James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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Su S, Wang R, Zhou R, Chen Z, Zhou F. The effectiveness of virtual reality, augmented reality, and mixed reality training in total hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:121. [PMID: 36803782 PMCID: PMC9940416 DOI: 10.1186/s13018-023-03604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/10/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Extended reality (XR), including virtual reality (VR), augmented reality (AR), and mixed reality (MR), has been used in the training of total hip arthroplasty (THA). This study aims to examine the effectiveness of XR training in THA. METHODS In this systematic review and meta-analysis, we searched PubMed (MEDLINE), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and clinicaltrials.gov from inception to September 2022 for eligible studies. The Review Manager 5.4 software was applied to compare accuracy of inclination and anteversion, and surgical duration between XR training and conventional methods. RESULTS We identified 213 articles, of which 4 randomized clinical trials and 1 prospective controlled study including 106 participants met inclusion criteria. The pooled data indicated the XR training had better accuracy of inclination and shorter surgical duration than conventional methods (MD = -2.07, 95% CI [- 4.02 to -0.11], P = 0.04; SMD = -1.30, 95% CI [- 2.01 to -0.60], P = 0.0003), but the accuracy of anteversion was similar in the two groups. CONCLUSIONS This systematic review and meta-analysis found XR training had better accuracy of inclination and shorter surgical duration than conventional methods in THA, but the accuracy of anteversion was similar. Based on the pooled results, we suggested that XR training can better improve trainees' surgical skills than conventional methods in THA.
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Affiliation(s)
- Shilong Su
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191 China
| | - Ruideng Wang
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191 China
| | - Rubing Zhou
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191 China
| | - Zhengyang Chen
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191 China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191, China.
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Personalized virtual reality simulation training system for percutaneous needle insertion and comparison of zSpace and vive. Comput Biol Med 2022; 146:105585. [DOI: 10.1016/j.compbiomed.2022.105585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 05/01/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022]
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Exploitation of Emerging Technologies and Advanced Networks for a Smart Healthcare System. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12125859] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Current medical methods still confront numerous limitations and barriers to detect and fight against illnesses and disorders. The introduction of emerging technologies in the healthcare industry is anticipated to enable novel medical techniques for an efficient and effective smart healthcare system. Internet of Things (IoT), Wireless Sensor Networks (WSN), Big Data Analytics (BDA), and Cloud Computing (CC) can play a vital role in the instant detection of illnesses, diseases, viruses, or disorders. Complicated techniques such as Artificial Intelligence (AI), Machine Learning (ML), and Deep Learning (DL) could provide acceleration in drug and antibiotics discovery. Moreover, the integration of visualization techniques such as Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR) with Tactile Internet (TI), can be applied from the medical staff to provide the most accurate diagnosis and treatment for the patients. A novel system architecture, which combines several future technologies, is proposed in this paper. The objective is to describe the integration of a mixture of emerging technologies in assistance with advanced networks to provide a smart healthcare system that may be established in hospitals or medical centers. Such a system will be able to deliver immediate and accurate data to the medical stuff in order to aim them in order to provide precise patient diagnosis and treatment.
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Callari TC, Mortimer M, Moody L, Seyedmahmoudian M, Lewis R, Horan B. Smooth and safe tram journeys: tram driver perspectives and opportunities using a haptic master controller in a virtual reality environment. ERGONOMICS 2022; 65:445-466. [PMID: 34487483 DOI: 10.1080/00140139.2021.1977844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
Tram drivers operate a master controller to control the acceleration and braking of the tram. Operation should ensure passenger comfort and safety through smooth tram motion and the avoidance of jerkiness that may cause passengers to fall in the carriage. This work investigates current driver practices and strategies for tram driving in normal operations through interviews and the capacity of a new haptic master controller to support drivers in achieving smooth and safe tram journeys. A haptic feedback algorithm based on viscosity was implemented on the master controller to provide drivers with feedback on the rate at which they were accelerating and braking the tram. This aspect was tested in a virtual tram within a simulated inner city virtual reality environment. Results indicate that the haptic master controller and coupled viscosity feedback algorithm did not increase smoothness of driving during the simulated experiences. Despite this, the drivers indicated a preference for the provision of further haptic information to support driving tasks and the overall journey safety and smoothness. Practitioner Summary: This research comprises two studies. The first investigates strategies currently used by drivers to operate a tram smoothly in order to elicit design requirements for a haptic tram master controller. The second study evaluates the impact of a novel haptic master controller on journey smoothness within a virtual environment.
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Affiliation(s)
- Tiziana C Callari
- Centre for Arts, Memory and Communities, Coventry University, Coventry, UK
| | | | - Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry, UK
| | - Mehdi Seyedmahmoudian
- School of Software and Electrical Engineering, Swinburne University, Hawthorn, Australia
| | - Ryan Lewis
- National Transport Design Centre, Coventry University, Coventry, UK
| | - Ben Horan
- School of Engineering, Deakin University, Geelong, Australia
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Motaharifar M, Norouzzadeh A, Abdi P, Iranfar A, Lotfi F, Moshiri B, Lashay A, Mohammadi SF, Taghirad HD. Applications of Haptic Technology, Virtual Reality, and Artificial Intelligence in Medical Training During the COVID-19 Pandemic. Front Robot AI 2021; 8:612949. [PMID: 34476241 PMCID: PMC8407078 DOI: 10.3389/frobt.2021.612949] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 07/29/2021] [Indexed: 12/15/2022] Open
Abstract
This paper examines how haptic technology, virtual reality, and artificial intelligence help to reduce the physical contact in medical training during the COVID-19 Pandemic. Notably, any mistake made by the trainees during the education process might lead to undesired complications for the patient. Therefore, training of the medical skills to the trainees have always been a challenging issue for the expert surgeons, and this is even more challenging in pandemics. The current method of surgery training needs the novice surgeons to attend some courses, watch some procedure, and conduct their initial operations under the direct supervision of an expert surgeon. Owing to the requirement of physical contact in this method of medical training, the involved people including the novice and expert surgeons confront a potential risk of infection to the virus. This survey paper reviews recent technological breakthroughs along with new areas in which assistive technologies might provide a viable solution to reduce the physical contact in the medical institutes during the COVID-19 pandemic and similar crises.
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Affiliation(s)
- Mohammad Motaharifar
- Advanced Robotics and Automated Systems (ARAS), Industrial Control Center of Excellence, Faculty of Electrical Engineering, K. N. Toosi University of Technology, Tehran, Iran
- Department of Electrical Engineering, University of Isfahan, Isfahan, Iran
| | - Alireza Norouzzadeh
- Advanced Robotics and Automated Systems (ARAS), Industrial Control Center of Excellence, Faculty of Electrical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - Parisa Abdi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Iranfar
- School of Electrical and Computer Engineering, University College of Engineering, University of Tehran, Tehran, Iran
| | - Faraz Lotfi
- Advanced Robotics and Automated Systems (ARAS), Industrial Control Center of Excellence, Faculty of Electrical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - Behzad Moshiri
- School of Electrical and Computer Engineering, University College of Engineering, University of Tehran, Tehran, Iran
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Alireza Lashay
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Farzad Mohammadi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid D. Taghirad
- Advanced Robotics and Automated Systems (ARAS), Industrial Control Center of Excellence, Faculty of Electrical Engineering, K. N. Toosi University of Technology, Tehran, Iran
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Negrillo-Cárdenas J, Jiménez-Pérez JR, Madeira J, Feito FR. A virtual reality simulator for training the surgical reduction of patient-specific supracondylar humerus fractures. Int J Comput Assist Radiol Surg 2021; 17:65-73. [PMID: 34365526 PMCID: PMC8738450 DOI: 10.1007/s11548-021-02470-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/29/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Virtual reality has been used as a training platform in medicine, allowing the repetition of a situation/scenario as many times as needed and making it patient-specific prior to an operation. Of special interest is the minimally invasive plate osteosynthesis (MIPO). It represents a novel technique for orthopedic trauma surgery, but requires intensive training to acquire the required skills. In this paper, we propose a virtual reality platform for training the surgical reduction of supracondylar fractures of the humerus using MIPO. The system presents a detailed surgical theater where the surgeon has to place the bone fragments properly. METHODS Seven experienced users were selected to perform a surgical reduction using our proposal. Two paired humeri were scanned from a dataset obtained from the Complejo Hospitalario de Jaén. A virtual fracture was performed in one side of the pair, using the other as contralateral part. Users have to simulate a reduction for each case and fill out a survey about usability, using a five-option Likert scale. RESULTS The subjects have obtained excellent scores in both simulations. The users have notably reduced the time employed in the second experiment, being 60% less in average. Subjects have valued the usability (5.0), the intuitiveness (4.6), comfort (4.5), and realism (4.9) in a 1-5 Likert scale. The mean score of the usability survey was 4.66. CONCLUSION The system has shown a high learning rate, and it is expected that the trainees will reach an expert level after additional runs. By focusing on the movement of bone fragments, specialists acquire motor skills to avoid the malrotation of MIPO-treated fractures. A future study can fulfill the requirements needed to include this training system into the protocol of real surgeries. Therefore, we expect the system to increase the confidence of the trainees as well as to improve their decision making.
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Affiliation(s)
- José Negrillo-Cárdenas
- Fundación I+D del Software Libre (FIDESOL), Granada, Spain. .,Department of Computer Science, Graphics and Geomatics Group of Jaén, University of Jaén, Jaén, Spain.
| | | | - Joaquim Madeira
- Department of Electronics, Telecommunications and Informatics, Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal
| | - Francisco R Feito
- Department of Computer Science, Graphics and Geomatics Group of Jaén, University of Jaén, Jaén, Spain
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Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
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Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
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12
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Gillis ME, Scott SA, Richardson CG, Oxner WM, Gauthier L, Wilson DA, Glennie RA. Developing and Assessing the Feasibility of Implementing a Surgical Objective Structured Clinical Skills Examination (S-OSCE). JOURNAL OF SURGICAL EDUCATION 2020; 77:939-946. [PMID: 32179030 DOI: 10.1016/j.jsurg.2020.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/04/2020] [Accepted: 02/17/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To1 describe the development and evaluate the feasibility of a surgical objective structured clinical examination (OSCE) for the purpose of competency assessment based on the Royal College of Canada's CanMEDS framework. DESIGN A unique surgical OSCE was developed to evaluate the clinical and surgical management of common orthopaedic problems using simulated patients and cadaveric specimens. Cases were graded by degree of difficulty (less complex, complex, more complex) Developing an assessment tool with significant resource utilization and good correlation with traditional methods is challenging. The feasibility of an OSCE that evaluates independent clinical and surgical decision making was evaluated. In addition, as part of establishing construct validity, correlation of OSCE scores with previously validated O-scores was performed. SETTING A tertiary level academic teaching hospital. PARTICIPANTS Thirty-four Postgraduate year 3-5 trainees of a 5-year Canadian orthopedic residency program creating 96 operative case performances available for final review. RESULTS The development of the OSCE cases involved a multistep process with attending surgeons, residents and a surgical education consultant. There were 4 different OSCE days, over a 3 year period (2016-2018) encompassing a variety of less complex and more complex procedures. Performance on the OSCE correlated strongly with the (O-SCORE, 0.89) and a linear regression analysis correlated moderately with year of training (r2 = 0.5737). The feasibility analysis demonstrated good financial practicality with solid programmatic integration. CONCLUSIONS The unique surgical OSCE scores correlate strongly with an established entrustability scale. Administering this OSCE to evaluate preoperative and intraoperative decision making to complement other forms of assessment is feasible. The financial burden to training programs is modest in comparison to the insight gained by both residents and faculty.
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Affiliation(s)
- Megan E Gillis
- Division of Orthopedics, Department of Surgery, Dalhousie University School of Medicine, Nova Scotia, Canada
| | - Stephanie A Scott
- Division of Orthopedics, Department of Surgery, Dalhousie University School of Medicine, Nova Scotia, Canada
| | - C Glen Richardson
- Division of Orthopedics, Department of Surgery, Dalhousie University School of Medicine, Nova Scotia, Canada
| | - William M Oxner
- Division of Orthopedics, Department of Surgery, Dalhousie University School of Medicine, Nova Scotia, Canada
| | - Luc Gauthier
- Division of Orthopedics, Department of Surgery, Dalhousie University School of Medicine, Nova Scotia, Canada
| | - David A Wilson
- Division of Orthopedics, Department of Surgery, Dalhousie University School of Medicine, Nova Scotia, Canada
| | - Raymond A Glennie
- Division of Orthopedics, Department of Surgery, Dalhousie University School of Medicine, Nova Scotia, Canada.
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Long SA, Thomas G, Karam MD, Anderson DD. Do Skills Acquired from Training with a Wire Navigation Simulator Transfer to a Mock Operating Room Environment? Clin Orthop Relat Res 2019; 477:2189-2198. [PMID: 31135546 PMCID: PMC6999951 DOI: 10.1097/corr.0000000000000799] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/10/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Skills training and simulation play an increasingly important role in orthopaedic surgical education. The intent of simulation is to improve performance in the operating room (OR), a trait known as transfer validity. No prior studies have explored how simulator-based wire navigation training can transfer to higher-level tasks. Additionally, there is a lack of knowledge on the format in which wire navigation training should be deployed. QUESTIONS/PURPOSES (1) Which training methods (didactic content, deliberate practice, or proficiency-based practice) lead to the greatest improvement in performing a wire navigation task? (2) Does a resident's performance using a wire navigation simulator correlate with his or her performance on a higher-level simulation task in a mock OR involving a C-arm, a radiopaque femur model, and a large soft tissue surrogate surrounding the femur? METHODS Fifty-five residents from four different medical centers participated in this study over the course of 2 years. The residents were divided into three groups: traditional training (included first-year residents from the University of Iowa, University of Minnesota, and the Mayo Clinic), deliberate practice (included first-year residents from the University of Nebraska and the University of Minnesota), and proficiency training (included first-year residents from the University of Minnesota and the Mayo Clinic). Residents in each group received a didactic introduction covering the task of placing a wire to treat an intertrochanteric fracture, and this was considered traditional training. Deliberate practice involved training on a radiation-free simulator that provided specific feedback throughout the practice sessions. Proficiency training used the same simulator to train on specific components of wire navigation, like finding the correct starting point, to proficiency before moving to assessment. The wire navigation simulator uses a camera system to track the wire and provide computer-generated fluoroscopy. After training, task performance was assessed in a mock OR. Residents from each group were assessed in the mock OR based on their use of fluoroscopy, total time, and tip-apex distance. Correlation analysis was performed to examine the relationship between resident performance on the simulator and in the mock OR. RESULTS Residents in the two simulation-based training groups had a lower tip-apex distance than those in the traditional training group (didactic training tip-apex distance: 24 ± 7 mm, 95% CI, 20-27; deliberate practice tip-apex distance: 16 ± 5 mm, 95% CI, 13-19, p = 0.001; proficiency training tip-apex distance: 15 ± 4 mm, 95% CI, 13-18, p < 0.001). Residents in the proficiency training group used more images than those in the other groups (didactic training: 22 ± 12 images, p = 0.041; deliberate practice: 19 ± 8 images; p = 0.012, proficiency training: 31 ± 14 images). In the two simulation-based training groups, resident performance on the simulator, that is, tip-apex distance, image use, and overall time, was correlated with performance in the mock OR (r-square = 0.15 [p = 0.030], 0.61 [p < 0.001], and 0.43 [p < 0.001], respectively). CONCLUSIONS As residency programs are designing their curriculum to train wire navigation skills, emphasis should be placed on providing an environment that allows for deliberate practice with immediate feedback about their performance. Simulators such as the one presented in this study offer a safe environment for residents to learn this key skill. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Steven A Long
- S. A. Long, G. Thomas, M. D. Karam, D. D. Anderson, Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, IA, USA S. A. Long, D. D. Anderson, Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA G. Thomas, D. D. Anderson, Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA
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Ng SC, Ong WM. Training the registrar or the fellow? Time to choose? ANZ J Surg 2019; 89:802-803. [PMID: 31379077 DOI: 10.1111/ans.15215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Suat Chin Ng
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, Boxhill Hospital, Melbourne, Victoria, Australia
| | - Wei Ming Ong
- Department of Colorectal Surgery, Boxhill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Giordano L, Oliviero A, Peretti GM, Maffulli N. The presence of residents during orthopedic operation exerts no negative influence on outcome. Br Med Bull 2019; 130:65-80. [PMID: 31049559 DOI: 10.1093/bmb/ldz009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/05/2019] [Accepted: 03/26/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Operative procedural training is a key component of orthopedic surgery residency. It is unclear how and whether residents participation in orthopedic surgical procedures impacts on post-operative outcomes. SOURCES OF DATA A systematic search was performed to identify articles in which the presence of a resident in the operating room was certified, and was compared with interventions without the presence of residents. AREAS OF AGREEMENT There is a likely beneficial role of residents in the operating room, and there is only a weak association between the presence of a resident and a worse outcome for orthopedic surgical patients. AREAS OF CONTROVERSY Most of the studies were undertaken in USA, and this represents a limit from the point of view of comparison with other academic and clinical realities. GROWING POINT The data provide support for continued and perhaps increased involvement of resident in orthopedic surgery. AREAS OF RESEARCH To clarify the role of residents on clinically relevant outcomes in orthopedic patients, appropriately powered randomized control trials should be planned.
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Affiliation(s)
- Lorenzo Giordano
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy
| | - Antonio Oliviero
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy
| | | | - Nicola Maffulli
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK
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Can an Augmented Reality Headset Improve Accuracy of Acetabular Cup Orientation in Simulated THA? A Randomized Trial. Clin Orthop Relat Res 2019; 477:1190-1199. [PMID: 30507832 PMCID: PMC6494316 DOI: 10.1097/corr.0000000000000542] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Accurate implant orientation reduces wear and increases stability in arthroplasty but is a technically demanding skill. Augmented reality (AR) headsets overlay digital information on top of the real world. We have developed an enhanced AR headset capable of tracking bony anatomy in relation to an implant, but it has not yet been assessed for its suitability as a training tool for implant orientation. QUESTIONS/PURPOSES (1) In the setting of simulated THA performed by novices, does an AR headset improve the accuracy of acetabular component positioning compared with hands-on training by an expert surgeon? (2) What are trainees' perceptions of the AR headset in terms of realism of the task, acceptability of the technology, and its potential role for surgical training? METHODS Twenty-four study participants (medical students in their final year of school, who were applying to surgery residency programs, and who had no prior arthroplasty experience) participated in a randomized simulation trial using an AR headset and a simulated THA. Participants were randomized to two groups completing four once-weekly sessions of baseline assessment, training, and reassessment. One group trained using AR (with live holographic orientation feedback) and the other received one-on-one training from a hip arthroplasty surgeon. Demographics and baseline performance in orienting an acetabular implant to six patient-specific values on the phantom pelvis were collected before training and were comparable. The orientation error in degrees between the planned and achieved orientations was measured and was not different between groups with the numbers available (surgeon group mean error ± SD 16° ± 7° versus AR 14° ± 7°; p = 0.22). Participants trained by AR also completed a validated posttraining questionnaire evaluating their experiences. RESULTS During the four training sessions, participants using AR-guidance had smaller mean (± SD) errors in orientation than those receiving guidance from the surgeon: 1° ± 1° versus AR 6° ± 4°, p < 0.001. In the fourth session's assessment, participants in both groups had improved (surgeon group mean improvement 6°, 95% CI, 4-8°; p < 0.001 versus AR group 9°, 95% CI 7-10°; p < 0.001). There was no difference between participants in the surgeon-trained and AR-trained group: mean difference 1.2°, 95% CI, -1.8 to 4.2°; p = 0.281. In posttraining evaluation, 11 of 12 participants would use the AR platform as a training tool for developing visuospatial skills and 10 of 12 for procedure-specific rehearsals. Most participants (11 of 12) stated that a combination of an expert trainer for learning and AR for unsupervised training would be preferred. CONCLUSIONS A novel head-mounted AR platform tracked an implant in relation to bony anatomy to a clinically relevant level of accuracy during simulated THA. Learners were equally accurate, whether trained by AR or a surgeon. The platform enabled the use of real instruments and gave live feedback; AR was thus considered a feasible and valuable training tool as an adjunct to expert guidance in the operating room. Although there were no differences in accuracy between the groups trained using AR and those trained by an expert surgeon, we believe the tool may be useful in education because it demonstrates that some motor skills for arthroplasty may be learned in an unsupervised setting. Future studies will evaluate AR-training for arthroplasty skills other than cup orientation and its transfer validity to real surgery. LEVEL OF EVIDENCE Level I, therapeutic study.
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A Multi-procedural Virtual Reality Simulator for Orthopaedic Training. VIRTUAL, AUGMENTED AND MIXED REALITY. APPLICATIONS AND CASE STUDIES 2019. [DOI: 10.1007/978-3-030-21565-1_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Garrett B, Taverner T, Gromala D, Tao G, Cordingley E, Sun C. Virtual Reality Clinical Research: Promises and Challenges. JMIR Serious Games 2018; 6:e10839. [PMID: 30333096 PMCID: PMC6231864 DOI: 10.2196/10839] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/31/2018] [Accepted: 08/07/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Virtual reality (VR) therapy has been explored as a novel therapeutic approach for numerous health applications, in which three-dimensional virtual environments can be explored in real time. Studies have found positive outcomes for patients using VR for clinical conditions such as anxiety disorders, addictions, phobias, posttraumatic stress disorder, eating disorders, stroke rehabilitation, and for pain management. OBJECTIVE This work aims to highlight key issues in the implementation of clinical research for VR technologies. METHODS A discussion paper was developed from a narrative review of recent clinical research in the field, and the researchers' own experiences in conducting VR clinical research with chronic pain patients. RESULTS Some of the key issues in implementing clinical VR research include theoretical immaturity, a lack of technical standards, the problems of separating effects of media versus medium, practical in vivo issues, and costs. CONCLUSIONS Over the last decade, some significant successes have been claimed for the use of VR. Nevertheless, the implementation of clinical VR research outside of the laboratory presents substantial clinical challenges. It is argued that careful attention to addressing these issues in research design and pilot studies are needed in order to make clinical VR research more rigorous and improve the clinical significance of findings.
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Affiliation(s)
- Bernie Garrett
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Tarnia Taverner
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Diane Gromala
- School of Interactive Arts and Technology, Simon Fraser University, Surrey, BC, Canada
| | - Gordon Tao
- Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Elliott Cordingley
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Crystal Sun
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Cecil J, Gupta A, Pirela-Cruz M, Ramanathan P. An IoMT based cyber training framework for orthopedic surgery using Next Generation Internet technologies. INFORMATICS IN MEDICINE UNLOCKED 2018. [DOI: 10.1016/j.imu.2018.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Intelligent HMI in Orthopedic Navigation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1093:207-224. [DOI: 10.1007/978-981-13-1396-7_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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