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Lee JW, Andersen SAW, Hittle B, Powell KA, Al-Fartoussi H, Banks L, Brannen Z, Lahchich M, Wiet GJ. Variability in Manual Segmentation of Temporal Bone Structures in Cone Beam CT Images. Otol Neurotol 2024; 45:e137-e141. [PMID: 38361290 DOI: 10.1097/mao.0000000000004119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE Manual segmentation of anatomical structures is the accepted "gold standard" for labeling structures in clinical images. However, the variability in manual segmentation of temporal bone structures in CBCT images of the temporal bone has not been systematically evaluated using multiple reviewers. Therefore, we evaluated the intravariability and intervariability of manual segmentation of inner ear structures in CBCT images of the temporal bone. METHODS Preoperative CBCTs scans of the inner ear were obtained from 10 patients who had undergone cochlear implant surgery. The cochlea, facial nerve, chorda tympani, mid-modiolar (MM) axis, and round window (RW) were manually segmented by five reviewers in two separate sessions that were at least 1 month apart. Interreviewer and intrareviewer variabilities were assessed using the Dice coefficient (DICE), volume similarity, mean Hausdorff Distance metrics, and visual review. RESULTS Manual segmentation of the cochlea was the most consistent within and across reviewers with a mean DICE of 0.91 (SD = 0.02) and 0.89 (SD = 0.01) respectively, followed by the facial nerve with a mean DICE of 0.83 (SD = 0.02) and 0.80 (SD = 0.03), respectively. The chorda tympani had the greatest amount of reviewer variability due to its thin size, and the location of the centroid of the RW and the MM axis were also quite variable between and within reviewers. CONCLUSIONS We observed significant variability in manual segmentation of some of the temporal bone structures across reviewers. This variability needs to be considered when interpreting the results in studies using one manual reviewer.
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Affiliation(s)
- Julian W Lee
- Ohio State University College of Medicine, Columbus, Ohio
| | - Steven Arild Wuyts Andersen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Bradley Hittle
- Department of Biomedical Informatics, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kimerly A Powell
- Department of Biomedical Informatics, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Hagar Al-Fartoussi
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Laura Banks
- Ohio State University College of Medicine, Columbus, Ohio
| | | | - Mariam Lahchich
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
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Andersen SAW, Hittle B, Värendh M, Lee J, Varadarajan V, Powell KA, Wiet GJ. Further Validity Evidence for Patient-Specific Virtual Reality Temporal Bone Surgical Simulation. Laryngoscope 2024; 134:1403-1409. [PMID: 37650640 DOI: 10.1002/lary.31016] [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] [Received: 04/17/2023] [Revised: 07/21/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Patient-specific virtual reality (VR) simulation of cochlear implant (CI) surgery potentially enables preoperative rehearsal and planning. We aim to gather supporting validity evidence for patient-specific simulation through the analysis of virtual performance and comparison with postoperative imaging. METHODS Prospective, multi-institutional study. Pre- and postoperative cone-beam CT scans of CI surgical patients were obtained and processed for patient-specific VR simulation. The virtual performances of five trainees and four attendings were recorded and (1) compared with volumes removed during actual surgery as determined in postoperative imaging, and (2) assessed using the Copenhagen Cochlear Implant Surgery Assessment Tool (CISAT) by two blinded raters. The volumes compared were cortical mastoidectomy, facial recess, and round window (RW) cochleostomy as well as violation of the facial nerve and chorda. RESULTS Trainees drilled more volume in the cortical mastoidectomy and facial recess, whereas attendings drilled more volume for the RW cochleostomy and made more violations. Except for the cochleostomy, attendings removed volumes closer to that determined in postoperative imaging. Trainees achieved a higher CISAT performance score compared with attendings (22.0 vs. 18.4 points) most likely due to lack of certain visual cues. CONCLUSION We found that there were differences in performance of trainees and attendings in patient-specific VR simulation of CI surgery as assessed by raters and in comparison with actual drilled volumes. The presented approach of volume comparison is novel and might be used for further validation of patient-specific VR simulation before clinical implementation for preoperative rehearsal in temporal bone surgery. LEVEL OF EVIDENCE n/a Laryngoscope, 134:1403-1409, 2024.
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Affiliation(s)
- Steven Arild Wuyts Andersen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology, Rigshospitalet, Copenhagen, Denmark
| | - Brad Hittle
- Department of Biomedical Informatics, Ohio State University, Columbus, Ohio, U.S.A
| | - Maria Värendh
- Department of Otorhinolaryngology, Örebro University Hospital, Örebro University, Örebro, Sweden
- Department of Otorhinolaryngology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Julian Lee
- Department of Otorhinolaryngology, The Ohio State University, Columbus, Ohio, U.S.A
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | | | - Kimerly A Powell
- Department of Biomedical Informatics, Ohio State University, Columbus, Ohio, U.S.A
| | - Gregory J Wiet
- Department of Otorhinolaryngology, The Ohio State University, Columbus, Ohio, U.S.A
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
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Feinmesser G, Yogev D, Goldberg T, Parmet Y, Illouz S, Vazgovsky O, Eshet Y, Tejman-Yarden S, Alon E. Virtual reality-based training and pre-operative planning for head and neck sentinel lymph node biopsy. Am J Otolaryngol 2023; 44:103976. [PMID: 37480684 DOI: 10.1016/j.amjoto.2023.103976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/04/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE Sentinel lymph node biopsy (SLNB) is crucial for managing head and neck skin cancer. However, variable lymphatic drainage can complicate SLN detection when using Single-Photon Emission Computed Tomography (SPECT) or lymphoscintigraphy. Virtual Reality (VR) can contribute to pre-operative planning by simulating a realistic 3D model, which improves orientation. VR can also facilitate real-patient training outside the operating room. This study explored using a VR platform for pre-operative planning in head and neck skin cancer patients undergoing SLNBs and assessed its value for residential training. MATERIALS AND METHODS In this prospective technology pilot study, attending surgeons and residents who performed 21 SLNB operations on patients with head and neck skin cancers (81% males, mean age 69.2 ± 11.3) used a VR simulation model based on each patient's pre-operative SPECT scan to examine patient-specific anatomy. After surgery, they completed a questionnaire on the efficiency of the VR simulation as a pre-operative planning tool and training device for residents. RESULTS The attending surgeons rated the VR model's accuracy at 8.3 ± 1.6 out of 10. Three-quarters (76%) of residents reported increased confidence after using VR. The physicians rated the platform's contribution to residents' training at 7.4 ± 2.1 to 8.9 ± 1.3 out of 10. CONCLUSION A VR SLNB simulation can accurately portray marked sentinel lymph nodes. It was rated high as a surgical planning and teaching tool among attending surgeons and residents alike and may play a role in pre-operative planning and resident training. Further studies are needed to explore its applications in practice.
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Affiliation(s)
- Gilad Feinmesser
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - David Yogev
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Arrow Project, Sheba Medical Center, Ramat Gan, Israel; Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel; The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel.
| | - Tomer Goldberg
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben Gurion University, Beer Sheva, Israel
| | - Shay Illouz
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Oliana Vazgovsky
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Eshet
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Shai Tejman-Yarden
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Eran Alon
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Arrow Project, Sheba Medical Center, Ramat Gan, Israel; Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
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Pipeline for Automated Processing of Clinical Cone-Beam Computed Tomography for Patient-Specific Temporal Bone Simulation: Validation and Clinical Feasibility. Otol Neurotol 2023; 44:e88-e94. [PMID: 36624596 DOI: 10.1097/mao.0000000000003771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Patient-specific simulation allows the surgeon to plan and rehearse the surgical approach ahead of time. Preoperative clinical imaging for this purpose requires time-consuming manual processing and segmentation of landmarks such as the facial nerve. We aimed to evaluate an automated pipeline with minimal manual interaction for processing clinical cone-beam computed tomography (CBCT) temporal bone imaging for patient-specific virtual reality (VR) simulation. STUDY DESIGN Prospective image processing of retrospective imaging series. SETTING Academic hospital. METHODS Eleven CBCTs were selected based on quality and used for validation of the processing pipeline. A larger naturalistic sample of 36 CBCTs were obtained to explore parameters for successful processing and feasibility for patient-specific VR simulation.Visual inspection and quantitative metrics were used to validate the accuracy of automated segmentation compared with manual segmentation. Range of acceptable rotational offsets and translation point selection variability were determined. Finally, feasibility in relation to image acquisition quality, processing time, and suitability for VR simulation was evaluated. RESULTS The performance of automated segmentation was acceptable compared with manual segmentation as reflected in the quantitative metrics. Total time for processing for new data sets was on average 8.3 minutes per data set; of this, it was less than 30 seconds for manual steps. Two of the 36 data sets failed because of extreme rotational offset, but overall the registration routine was robust to rotation and manual selection of a translational reference point. Another seven data sets had successful automated segmentation but insufficient suitability for VR simulation. CONCLUSION Automated processing of CBCT imaging has potential for preoperative VR simulation but requires further refinement.
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Timonen T, Dietz A, Linder P, Lehtimäki A, Löppönen H, Elomaa AP, Iso-Mustajärvi M. The effect of virtual reality on temporal bone anatomy evaluation and performance. Eur Arch Otorhinolaryngol 2022; 279:4303-4312. [PMID: 34837519 PMCID: PMC9363303 DOI: 10.1007/s00405-021-07183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE There is only limited data on the application of virtual reality (VR) for the evaluation of temporal bone anatomy. The aim of the present study was to compare the VR environment to traditional cross-sectional viewing of computed tomography images in a simulated preoperative planning setting in novice and expert surgeons. METHODS A novice (n = 5) and an expert group (n = 5), based on their otosurgery experience, were created. The participants were asked to identify 24 anatomical landmarks, perform 11 distance measurements between surgically relevant anatomical structures and 10 fiducial markers on five cadaver temporal bones in both VR environment and cross-sectional viewings in PACS interface. The data on performance time and user-experience (i.e., subjective validation) were collected. RESULTS The novice group made significantly more errors (p < 0.001) and with significantly longer performance time (p = 0.001) in cross-sectional viewing than the expert group. In the VR environment, there was no significant differences (errors and time) between the groups. The performance of novices improved faster in the VR. The novices showed significantly faster task performance (p = 0.003) and a trend towards fewer errors (p = 0.054) in VR compared to cross-sectional viewing. No such difference between the methods were observed in the expert group. The mean overall scores of user-experience were significantly higher for VR than cross-sectional viewing in both groups (p < 0.001). CONCLUSION In the VR environment, novices performed the anatomical evaluation of temporal bone faster and with fewer errors than in the traditional cross-sectional viewing, which supports its efficiency for the evaluation of complex anatomy.
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Affiliation(s)
- Tomi Timonen
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland.
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pia Linder
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland
| | - Antti Lehtimäki
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Löppönen
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Microsurgery Centre of Eastern Finland, Kuopio, Finland
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Matti Iso-Mustajärvi
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland
- Microsurgery Centre of Eastern Finland, Kuopio, Finland
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Frithioff A, Frendø M, Weiss K, Foghsgaard S, Pedersen DB, Sørensen MS, Wuyts Andersen SA. Effect of 3D-Printed Models on Cadaveric Dissection in Temporal Bone Training. OTO Open 2021; 5:2473974X211065012. [PMID: 34926973 PMCID: PMC8671684 DOI: 10.1177/2473974x211065012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Mastoidectomy is a cornerstone in the surgical management of middle and inner ear diseases. Unfortunately, training is challenged by insufficient access to human cadavers. Three-dimensional (3D) printing of temporal bones could alleviate this problem, but evidence on their educational effectiveness is lacking. It is largely unknown whether training on 3D-printed temporal bones improves mastoidectomy performance, including on cadavers, and how this training compares with virtual reality (VR) simulation. To address this knowledge gap, this study investigated whether training on 3D-printed temporal bones improves cadaveric dissection performance, and it compared this training with the already-established VR simulation. Study Design Prospective cohort study of an educational intervention. Setting Tertiary university hospital, cadaver dissection laboratory, and simulation center in Copenhagen, Denmark. Methods Eighteen otorhinolaryngology residents (intervention) attending the national temporal bone dissection course received 3 hours of mastoidectomy training on 3D-printed temporal bones. Posttraining cadaver mastoidectomy performances were rated by 3 experts using a validated assessment tool and compared with those of 66 previous course participants (control) who had received time-equivalent VR training prior to dissection. Results The intervention cohort outperformed the controls during cadaver dissection by 29% (P < .001); their performances were largely similar across training modalities but remained at a modest level (~50% of the maximum score). Conclusion Mastoidectomy skills improved from training on 3D-printed temporal bone and seemingly more so than on time-equivalent VR simulation. Importantly, these skills transferred to cadaveric dissection. Training on 3D-printed temporal bones can effectively supplement cadaver training when learning mastoidectomy.
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Affiliation(s)
- Andreas Frithioff
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark
| | - Martin Frendø
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark.,Department of Plastic and Reconstructive Surgery, Herlev Hospital, Copenhagen, Denmark
| | - Kenneth Weiss
- Department of Mechanical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Søren Foghsgaard
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Mads Sølvsten Sørensen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark
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Ribeiro DS, Jotz GP, Sousa NCD, Setogutti ET, Isolan GR, Stefani MA, Bento RF, Lavinsky J. Image-guided Temporal Bone Dissection Course. Int Arch Otorhinolaryngol 2021; 25:e594-e601. [PMID: 34737833 PMCID: PMC8558953 DOI: 10.1055/s-0040-1716573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 06/05/2020] [Indexed: 11/01/2022] Open
Abstract
Introduction Temporal bone anatomy is complex and demands a profound anatomical knowledge. Association between surgery and imaging helps in the process of learning three-dimensional (3D) anatomy and surgical techniques. High definition temporal bone imaging can play an important role in dissection training. Objective To describe a computed tomography (CT) image-guided temporal bone dissection course for surgical training in otolaryngology and to verify the satisfaction level of the students with the course. Methods Descriptive research. The course took place at a research laboratory, with three experienced temporal bone surgeons. The participants were 12 otolaryngology residents. The laboratory has 7 modern workstations with microscope and monitors linked with a computerized video system. Cadaveric temporal bones were donated to the university. Imaging acquisition of the cadaveric temporal bones used in the course was performed in a multislice CT scanner. The CT images of cadaveric temporal bones were available with real-time access on the laboratory monitor's screens during dissections. Results A total of 13 temporal bones were included for dissection. Students had the opportunity to view on the same screen, simultaneously, both the dissection video and the respective CT images of their temporal bone anatomical specimens. This allowed correlating surgical and imaging aspects of temporal bone anatomy. At the end of the course, participants answered a satisfaction survey. Conclusion Considering imaging methods are routinely used during most otologic surgeries, detailed knowledge of CT imaging should be explored in conjunction with the temporal bone anatomical dissection.
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Affiliation(s)
| | - Geraldo Pereira Jotz
- Department of Morphological Sciences, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Natália Cândido de Sousa
- Department of Otolaryngology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Gustavo Rassier Isolan
- Department of Neurosurgery, Centro Avançado de Neurologia e Neurocirurgia (CEANNE), Porto Alegre, RS, Brazil
| | - Marco Antonio Stefani
- Department of Morphological Sciences, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Postgraduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ricardo Ferreira Bento
- Department of Otolaryngology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Joel Lavinsky
- Department of Morphological Sciences, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Postgraduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Otolaryngology, Clínica Lavinsky, Porto Alegre, RS, Brazil
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Kadowaki Y, Hirano T, Suzuki M. A novel view of computed tomography images similar to the visual field of otologic surgeons. Laryngoscope Investig Otolaryngol 2021; 6:1128-1132. [PMID: 34667857 PMCID: PMC8513444 DOI: 10.1002/lio2.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/08/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES In preparation for endoscopic sinus surgery (ESS), the most important computed tomography (CT) image for otolaryngologists is the coronal plane image because it has a viewpoint similar to that of the surgical visual field. Contrastingly, otologic surgeons refer to axial and coronal plane images before ear surgery and must imagine the anatomical structure of the temporal bone by reconstructing three-dimensional (3D) images in their minds. We propose a "surgical position view (SPV) image," a novel viewpoint of CT images that enables otologic surgeons to see a perspective similar to the surgical visual field. METHOD Sagittal plane CT images of the temporal bone were created from axial plane images with multi-planar reconstruction (MPR). Then, the SPV image was obtained by rotating it 90° to the supine position. The entire process can be performed anywhere in the hospital within 1 minute using the electronic medical record computer's image viewer. RESULTS SPV images show anatomical structures of the temporal bone, external ear canal, mastoid cavity, sigmoid vein, facial nerve, ossicles, and cochlea, in a similar view to the actual ear surgery. Soft tissue such as cholesteatoma is depicted in the same concentration as the normal CT image. CONCLUSION The SPV image enables an otologic surgeon to see the temporal bone CT image from the actual ear surgery viewpoint simply and quickly. It helps to visualize the 3D anatomical structure of the temporal bone and can be useful for ear surgery planning. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Yoshinori Kadowaki
- Department of Otolaryngology and Head & Neck SurgeryOita University Faculty of MedicineYufu CityOitaJapan
| | - Takashi Hirano
- Department of Otolaryngology and Head & Neck SurgeryOita University Faculty of MedicineYufu CityOitaJapan
| | - Masashi Suzuki
- Department of Otolaryngology and Head & Neck SurgeryOita University Faculty of MedicineYufu CityOitaJapan
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Sieber DM, Andersen SAW, Sørensen MS, Mikkelsen PT. OpenEar Image Data Enables Case Variation in High Fidelity Virtual Reality Ear Surgery. Otol Neurotol 2021; 42:1245-1252. [PMID: 33883519 DOI: 10.1097/mao.0000000000003175] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Virtual reality (VR) simulation is an established option for temporal bone surgical training. Most VR simulators are based on computed tomography imaging, whereas the Visible Ear Simulator (VES) is based on high-fidelity cryosections of a single temporal bone specimen. Recently published OpenEar datasets combine cone-beam computed tomography (CBCT) and micro-slicing to achieve similar model quality. This study explores integration of OpenEar datasets into VES to enable case variation in simulation with implications for patient-specific modeling based on CBCT. METHODS The OpenEar dataset consists of segmented, coregistered, multimodal imaging sets of human temporal bones. We derived drillable bone segments from the dataset as well as triangulated surface models of critical structures such as facial nerve or dura. Realistic visualization was achieved using coloring from micro-slicing, custom tinting, and texture maps. Resulting models were validated by clinical experts. RESULTS Six of the eight OpenEar datasets could be integrated in VES complete with instructional guides for various temporal bone surgical procedures. Resulting models were of high quality because of postprocessing steps taken to increase realism including colorization and imaging artifact removal. Bone artifacts were common in CBCT, resulting in dehiscences that most often could not be found in the ground truth micro-slicing data. CONCLUSION New anatomy models are included in VES version 3.5 freeware and provide case variation for training which could help trainees to learn more quickly and transferably under variable practice conditions. The use of CBCT for VR simulation models without postprocessing results in bone artifacts, which should be considered when using clinical imaging for patient-specific simulation, surgical rehearsal, and planning.
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Istrate M, Hasbei-Popa M, Iliescu DA, Ghita AC, Ghita AM. Effects of cigarette smoking on sensorineural hearing impairment and age related macular degeneration. Tob Prev Cessat 2021; 7:55. [PMID: 34395952 PMCID: PMC8328227 DOI: 10.18332/tpc/138952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/13/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cigarette smoking has been causally associated with various diseases, and among the numerous harmful effects of smoking is included its impact on the senses of vision and hearing. The purpose of this study is to evaluate the impact of cigarette smoking on the visual and auditory functions. METHODS In this analytic study, hearing and smoking status of 40 patients with agerelated macular degeneration (AMD) were analyzed with 40 age-matched control subjects without AMD. In all subjects (n=80), retinal status was investigated by optical coherence tomography (OCT), with analyses of thickness central subfield (TCS) and thickness average cube (TAC) of the macula. All participants were examined with pure tone audiometry. Audiometric trials comprised pure tone bone and air conduction. The smoking history of all the subjects was recorded in detail. RESULTS A significant correlation was found between smoking status and visual (p<0.001) and hearing impairment (p<0.05). Cigarette smoking was found to be highly correlated with sensorineural hearing impairment and exudative macular degeneration. CONCLUSIONS Cigarette smoking damage anti-oxidative systems and tissue metabolism. We have underlined a clear correlation between the risk of sensorineural hearing impairment, exudative macular degeneration and cigarette smoking. Our findings may result in future screening of smokers to identify any hearing and vision impairment and for improving smoking cessation interventions.
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Affiliation(s)
- Marina Istrate
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Mihai Hasbei-Popa
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela A Iliescu
- Ocularcare Eye Clinic, Bucharest, Romania.,Department of Physiology, Faculty of Medicine and Pharmacy, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Aurelian M Ghita
- Ocularcare Eye Clinic, Bucharest, Romania.,Department of Physiology, Faculty of Medicine and Pharmacy, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Hattab G, Hatzipanayioti A, Klimova A, Pfeiffer M, Klausing P, Breucha M, Bechtolsheim FV, Helmert JR, Weitz J, Pannasch S, Speidel S. Investigating the utility of VR for spatial understanding in surgical planning: evaluation of head-mounted to desktop display. Sci Rep 2021; 11:13440. [PMID: 34188080 PMCID: PMC8241863 DOI: 10.1038/s41598-021-92536-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/11/2021] [Indexed: 02/06/2023] Open
Abstract
Recent technological advances have made Virtual Reality (VR) attractive in both research and real world applications such as training, rehabilitation, and gaming. Although these other fields benefited from VR technology, it remains unclear whether VR contributes to better spatial understanding and training in the context of surgical planning. In this study, we evaluated the use of VR by comparing the recall of spatial information in two learning conditions: a head-mounted display (HMD) and a desktop screen (DT). Specifically, we explored (a) a scene understanding and then (b) a direction estimation task using two 3D models (i.e., a liver and a pyramid). In the scene understanding task, participants had to navigate the rendered the 3D models by means of rotation, zoom and transparency in order to substantially identify the spatial relationships among its internal objects. In the subsequent direction estimation task, participants had to point at a previously identified target object, i.e., internal sphere, on a materialized 3D-printed version of the model using a tracked pointing tool. Results showed that the learning condition (HMD or DT) did not influence participants' memory and confidence ratings of the models. In contrast, the model type, that is, whether the model to be recalled was a liver or a pyramid significantly affected participants' memory about the internal structure of the model. Furthermore, localizing the internal position of the target sphere was also unaffected by participants' previous experience of the model via HMD or DT. Overall, results provide novel insights on the use of VR in a surgical planning scenario and have paramount implications in medical learning by shedding light on the mental model we make to recall spatial structures.
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Affiliation(s)
- Georges Hattab
- grid.461742.2Division of Translational Surgical Oncology (TSO), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
| | - Adamantini Hatzipanayioti
- grid.4488.00000 0001 2111 7257Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, 01062 Dresden, Germany ,grid.4488.00000 0001 2111 7257Unit of Lifespan Developmental Neuroscience, Faculty of Psychology, TU Dresden, 01062 Dresden, Germany
| | - Anna Klimova
- grid.4488.00000 0001 2111 7257Institute for Medical Informatics and Biometry (IMB), Faculty of Medicine, TU Dresden, 01307 Dresden, Germany ,grid.461742.2Core Unit for Data Management and Analytics, National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
| | - Micha Pfeiffer
- grid.461742.2Division of Translational Surgical Oncology (TSO), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
| | - Peter Klausing
- grid.461742.2Division of Translational Surgical Oncology (TSO), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany
| | - Michael Breucha
- grid.461742.2Division of Translational Surgical Oncology (TSO), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany ,grid.412282.f0000 0001 1091 2917Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Felix von Bechtolsheim
- grid.4488.00000 0001 2111 7257Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, 01062 Dresden, Germany ,grid.412282.f0000 0001 1091 2917Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jens R. Helmert
- grid.4488.00000 0001 2111 7257Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, 01062 Dresden, Germany ,grid.4488.00000 0001 2111 7257Engineering Psychology and Applied Cognitive Research, Faculty of Psychology, TU Dresden, 01062 Dresden, Germany
| | - Jürgen Weitz
- grid.4488.00000 0001 2111 7257Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, 01062 Dresden, Germany ,grid.412282.f0000 0001 1091 2917Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Sebastian Pannasch
- grid.4488.00000 0001 2111 7257Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, 01062 Dresden, Germany ,grid.4488.00000 0001 2111 7257Engineering Psychology and Applied Cognitive Research, Faculty of Psychology, TU Dresden, 01062 Dresden, Germany
| | - Stefanie Speidel
- grid.461742.2Division of Translational Surgical Oncology (TSO), National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany ,grid.4488.00000 0001 2111 7257Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, 01062 Dresden, Germany
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Andersen SAW, Varadarajan VV, Moberly AC, Hittle B, Powell KA, Wiet GJ. Patient-specific Virtual Temporal Bone Simulation Based on Clinical Cone-beam Computed Tomography. Laryngoscope 2021; 131:1855-1862. [PMID: 33780005 DOI: 10.1002/lary.29542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Patient-specific surgical simulation allows presurgical planning through three-dimensional (3D) visualization and virtual rehearsal. Virtual reality simulation for otologic surgery can be based on high-resolution cone-beam computed tomography (CBCT). This study aimed to evaluate clinicians' experience with patient-specific simulation of mastoid surgery. METHODS Prospective, multi-institutional study. Preoperative temporal bone CBCT scans of patients undergoing cochlear implantation (CI) were retrospectively obtained. Automated processing and segmentation routines were used. Otologic surgeons performed a complete mastoidectomy with facial recess approach on the patient-specific virtual cases in the institution's temporal bone simulator. Participants completed surveys regarding the perceived accuracy and utility of the simulation. RESULTS Twenty-two clinical CBCTs were obtained. Four attending otologic surgeons and 5 otolaryngology trainees enrolled in the study. The mean number of simulations completed by each participant was 16.5 (range 3-22). "Overall experience" and "usefulness for presurgical planning" were rated as "good," "very good," or "excellent" in 84.6% and 71.6% of the simulations, respectively. In 10.7% of simulations, the surgeon reported to have gained a significantly greater understanding of the patient's anatomy compared to standard imaging. Participants were able to better appreciate subtle anatomic findings after using the simulator for 60.4% of cases. Variable CBCT acquisition quality was the most reported limitation. CONCLUSION Patient-specific simulation using preoperative CBCT is feasible and may provide valuable insights prior to otologic surgery. Establishing a CBCT acquisition protocol that allows for consistent segmentation will be essential for reliable surgical simulation. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1855-1862, 2021.
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Affiliation(s)
- Steven Arild Wuyts Andersen
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A.,Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Varun V Varadarajan
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Bradley Hittle
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, U.S.A
| | - Kimerly A Powell
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, U.S.A
| | - Gregory J Wiet
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
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Andersen SAW, Bergman M, Keith JP, Powell KA, Hittle B, Malhotra P, Wiet GJ. Segmentation of Temporal Bone Anatomy for Patient-Specific Virtual Reality Simulation. Ann Otol Rhinol Laryngol 2020; 130:724-730. [DOI: 10.1177/0003489420970217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Virtual reality (VR) simulation for patient-specific pre-surgical planning and rehearsal requires accurate segmentation of key surgical landmark structures such as the facial nerve, ossicles, and cochlea. The aim of this study was to explore different approaches to segmentation of temporal bone surgical anatomy for patient-specific VR simulation. Methods: De-identified, clinical computed tomography imaging of 9 pediatric patients aged 3 months to 12 years were obtained retrospectively. The patients represented normal anatomy and key structures were manually segmented using open source software. The OTOPLAN (CAScination AG, Bern, Switzerland) otological planning software was used for guided segmentation. An atlas-based algorithm was used for computerized, automated segmentation. Experience with the different approaches as well as time and resulting models were compared. Results: Manual segmentation was time consuming but also the most flexible. The OTOPLAN software is not designed specifically for our purpose and therefore the number of structures that can be segmented is limited, there was some user-to-user variation as well as volume differences compared with manual segmentation. The atlas-based automated segmentation potentially allows a full range of structures to be segmented and produces segmentations comparable to those of manual segmentation with a processing time that is acceptable because of the minimal user interaction. Conclusion: Segmentation is fundamental for patient-specific VR simulation for pre-surgical planning and rehearsal in temporal bone surgery. The automated segmentation algorithm currently offers the most flexible and feasible approach and should be implemented. Further research is needed in relation to cases of abnormal anatomy. Level of evidence: 4
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Affiliation(s)
- Steven Arild Wuyts Andersen
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Otolaryngology—Head and Neck Surgery, Ohio State University, Columbus, OH, USA
- Department of Otorhinolaryngology—Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Maxwell Bergman
- Department of Otolaryngology—Head and Neck Surgery, Ohio State University, Columbus, OH, USA
| | - Jason P. Keith
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA
| | - Kimerly A. Powell
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA
| | - Brad Hittle
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA
| | - Prashant Malhotra
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Otolaryngology—Head and Neck Surgery, Ohio State University, Columbus, OH, USA
| | - Gregory J. Wiet
- Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Otolaryngology—Head and Neck Surgery, Ohio State University, Columbus, OH, USA
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Liu T, Tai Y, Zhao C, Wei L, Zhang J, Pan J, Shi J. Augmented reality in neurosurgical navigation: a survey. Int J Med Robot 2020; 16:e2160. [PMID: 32890440 DOI: 10.1002/rcs.2160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/19/2020] [Accepted: 08/29/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Neurosurgery has exceptionally high requirements for minimally invasive and safety. This survey attempts to analyze the practical application of AR in neurosurgical navigation. Also, this survey describes future trends in augmented reality neurosurgical navigation systems. METHODS In this survey, we searched related keywords "augmented reality", "virtual reality", "neurosurgery", "surgical simulation", "brain tumor surgery", "neurovascular surgery", "temporal bone surgery", and "spinal surgery" through Google Scholar, World Neurosurgery, PubMed and Science Direct. We collected 85 articles published over the past five years in areas related to this survey. RESULTS Detailed study has been conducted on the application of AR in neurosurgery and found that AR is constantly improving the overall efficiency of doctor training and treatment, which can help neurosurgeons learn and practice surgical procedures with zero risks. CONCLUSIONS Neurosurgical navigation is essential in neurosurgery. Despite certain technical limitations, it is still a necessary tool for the pursuit of maximum security and minimal intrusiveness. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tao Liu
- Yunnan Key Lab of Opto-electronic Information Technology, Yunnan Normal University, Kunming, China
| | - Yonghang Tai
- Yunnan Key Lab of Opto-electronic Information Technology, Yunnan Normal University, Kunming, China
| | - Chengming Zhao
- Yunnan Key Lab of Opto-electronic Information Technology, Yunnan Normal University, Kunming, China
| | - Lei Wei
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, VIC, Australia
| | - Jun Zhang
- Yunnan Key Lab of Opto-electronic Information Technology, Yunnan Normal University, Kunming, China
| | - Junjun Pan
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Junsheng Shi
- Yunnan Key Lab of Opto-electronic Information Technology, Yunnan Normal University, Kunming, China
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Kashikar TS, Kerwin TF, Moberly AC, Wiet GJ. A review of simulation applications in temporal bone surgery. Laryngoscope Investig Otolaryngol 2019; 4:420-424. [PMID: 31453352 PMCID: PMC6703115 DOI: 10.1002/lio2.277] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/07/2019] [Accepted: 03/17/2019] [Indexed: 01/04/2023] Open
Abstract
Background Temporal bone surgery is a technically challenging and high-risk procedure in an anatomically complex area. Safe temporal bone surgery emphasizes a consummate anatomic understanding and technique development that requires the guidance of an experienced otologic surgeon and years of practice. Temporal bone simulation can augment otologic surgical training and enable rehearsal of surgical procedures. Objectives The purpose of this article is to provide an updated review of temporal bone simulation platforms and their uses. Data Sources PubMed literature search. Search terms included temporal bone, temporal bone simulation, virtual reality (VR), and presurgical planning and rehearsal. Discussion Various simulation platforms such as cadaveric bone, three-dimensional (3D) printed models, and VR simulation have been used for temporal bone surgery training. However, each simulation method has its drawbacks. There is a need to improve upon current simulation platforms to enhance surgical training and skills assessment, as well as a need to explore other clinically significant applications of simulation, such as preoperative planning and rehearsal, in otologic surgery. Conclusions There is no replacement for actual surgical experience, but high-fidelity temporal bone models such as those produced with 3D printing and computer simulation have emerged as promising tools in otolaryngologic surgery. Improvements in the fidelity of both 3D printed and VR simulators as well as integration of a standardized assessment format would allow for an expansion in the use of these simulation platforms in training and assessment. Level of Evidence 5.
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Affiliation(s)
- Tanisha S Kashikar
- Ohio University Heritage College of Osteopathic Medicine Athens Ohio U.S.A
| | - Thomas F Kerwin
- Office of Research The Ohio State University Columbus Ohio U.S.A
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Columbus Ohio U.S.A
| | - Gregory J Wiet
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Columbus Ohio U.S.A.,Department of Pediatric Otolaryngology Nationwide Children's Hospital Columbus Ohio U.S.A
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Abstract
This article presents a summary of the current simulation training for otologic skills. There is a wide variety of educational approaches, assessment tools, and simulators in use, including simple low-cost task trainers to complex computer-based virtual reality systems. A systematic approach to otologic skills training using adult learning theory concepts, such as repeated and distributed practice, self-directed learning, and mastery learning, is necessary for these educational interventions to be effective. Future directions include development of measures of performance to assess efficacy of simulation training interventions and, for complex procedures, improvement in fidelity based on educational goals.
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Affiliation(s)
- Gregory J Wiet
- Department of Otolaryngology, Nationwide Children's Hospital and The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Biomedical Informatics, The Ohio State University, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43210, USA.
| | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, Copenhagen DK-2100, Denmark
| | - Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, Copenhagen DK-2100, Denmark; Copenhagen Academy for Medical Education and Simulation, The Simulation Centre, Rigshospitalet, Blegdamsvej 9, Copenhagen DK-2100, Denmark
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Locketz GD, Lui JT, Chan S, Salisbury K, Dort JC, Youngblood P, Blevins NH. Anatomy-Specific Virtual Reality Simulation in Temporal Bone Dissection: Perceived Utility and Impact on Surgeon Confidence. Otolaryngol Head Neck Surg 2017; 156:1142-1149. [DOI: 10.1177/0194599817691474] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the effect of anatomy-specific virtual reality (VR) surgical rehearsal on surgeon confidence and temporal bone dissection performance. Study Design Prospective pre- and poststudy of a novel virtual surgical rehearsal platform. Setting Academic otolaryngology–head and neck surgery residency training programs. Subjects and Methods Sixteen otolaryngology–head and neck surgery residents from 2 North American training institutions were recruited. Surveys were administered to assess subjects' baseline confidence in performing 12 subtasks of cortical mastoidectomy with facial recess. A cadaver temporal bone was randomly assigned to each subject. Cadaver specimens were scanned with a clinical computed tomography protocol, allowing the creation of anatomy-specific models for use in a VR surgical rehearsal platform. Subjects then rehearsed a virtual mastoidectomy on data sets derived from their specimens. Surgical confidence surveys were administered again. Subjects then dissected assigned cadaver specimens, which were blindly graded with a modified Welling scale. A final survey assessed the perceived utility of rehearsal on dissection performance. Results Of 16 subjects, 14 (87.5%) reported a significant increase in overall confidence after conducting an anatomy-specific VR rehearsal. A significant correlation existed between perceived utility of rehearsal and confidence improvement. The effect of rehearsal on confidence was dependent on trainee experience and the inherent difficulty of the surgical subtask. Postrehearsal confidence correlated strongly with graded dissection performance. Subjects rated anatomy-specific rehearsal as having a moderate to high contribution to their dissection performance. Conclusion Anatomy-specific virtual rehearsal improves surgeon confidence in performing mastoid dissection, dependent on surgeon experience and task difficulty. The subjective confidence gained through rehearsal correlates positively with subsequent objective dissection performance.
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Affiliation(s)
- Garrett D. Locketz
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Justin T. Lui
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Sonny Chan
- Department of Computer Science, University of Calgary, Calgary, Canada
| | - Kenneth Salisbury
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Joseph C. Dort
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Patricia Youngblood
- Division of Clinical Anatomy, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Nikolas H. Blevins
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California, USA
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