Robotic simulators for tissue examination training with multimodal sensory feedback

Tissue examination by hand remains an essential technique in clinical practice. The effective application depends on skills in sensorimotor coordination, mainly involving haptic, visual, and auditory feedback. The skills clinicians have to learn can be as subtle as regulating finger pressure with breathing, choosing palpation action, monitoring involuntary facial and vocal expressions in response to palpation, and using pain expressions both as a source of information and as a constraint on physical examination. Patient simulators can provide a safe learning platform to novice physicians before trying real patients. This paper reviews state-of-the-art medical simulators for the training for the first time with a consideration of providing multimodal feedback to learn as many manual examination techniques as possible. The study summarizes current advances in tissue examination training devices simulating different medical conditions and providing different types of feedback modalities. Opportunities with the development of pain expression, tissue modeling, actuation, and sensing are also analyzed to support the future design of effective tissue examination simulators

Granular jamming based controllable organ design for abdominal palpation

Medical manikins play an essential role in the training process of physicians. Currently, most available simulators for abdominal palpation training do not contain controllable organs for dynamic simulations. In this paper, we present a soft robotics controllable liver that can simulate various liver diseases and symptoms for effective and realistic palpation training. The tumors in the liver model are designed based on granular jamming with positive pressure, which converts the fluid-like impalpable particles to a solid-like tumor state by applying low positive pressure on the membrane. Through inflation, the tumor size, liver stiffness, and liver size can be controlled from normal liver state to various abnormalities including enlarged liver, cirrhotic liver, and multiple cancerous and malignant tumors. Mechanical tests have been conducted in the study to evaluate the liver design and the role of positive pressure granular jamming in tumor simulations

Desenvolvimento e avaliação de simuladores como recursos didáticos para o treinamento de habilidades clínico veterinárias

Orientadora : Profª Drª Simone Tostes de Oliveira StedileCo-orientadora : Profª Drª Carla Forte Maiolino MolentoDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências Agrárias, Programa de Pós-Graduação em Ciências Veterinárias. Defesa: Curitiba, 24/03/2015Inclui referênciasÁrea de concentração : Ciências veterináriasResumo: O uso de métodos alternativos para o treinamento de procedimentos clínicos na Medicina Veterinária constitui uma possibilidade de superar dois grandes problemas atuais: um de ordem ética, que é a utilização de animais vivos como recursos didáticos, e outro de ordem técnica, que é a oportunidade limitada de os estudantes desenvolverem e exercitarem suas capacidades clínicas. Simultaneamente, o desenvolvimento de métodos alternativos possibilita a implementação do princípio ético dos 3Rs, substituição, redução e refinamento do uso de animais no ensino. Considerando-se as vantagens do uso de métodos alternativos, desenvolveu-se um simulador de paciente canino que permitiu aos estudantes o treinamento da técnica de palpação prostática. O uso de métodos alternativos para o treinamento clínico ainda é um assunto negligenciado em muitos cursos de Medicina Veterinária, o que motivou a segunda parte deste trabalho, a elaboração de um guia para a realização de uma oficina sobre métodos alternativos com o intuito de expandir o conhecimento ético e técnico dos participantes. A oficina resultou em um notável envolvimento dos participantes com o tema e na criação de quatro modelos alternativos para o treino de procedimentos clínicos. Palavras-chave: educação humanitária, substituição, aprendizado prático, métodos alternativos, ética.Abstract: The use of alternative methods for clinical training in veterinary medicine is an opportunity to overcome two major issues in contemporary practice: an ethical one, which is the use of live animals as teaching resources, and a technical one, which is the limited opportunity for students to develop and exercise their clinical skills. Simultaneously, the development of alternative methods enables the implementation of the ethical principle of the 3Rs, replacement, reduction and refinement of animal use in teaching. Considering the advantages of using alternative methods, we developed a canine patient simulator that allowed students to train the prostate palpation technique. The use of alternative methods for the clinical training is still a neglected subject in many veterinary medicine courses, which led us to the second part of this work, the development of a guide for conducting a workshop on alternative methods in order to expand ethical and technical knowledge of the participants. The workshop resulted in a notable participant involvement with the topic and the creation of four alternative models for training of clinical procedures. Keywords: humane education, replacement, practical learning, alternative methods, ethics

An Abdominal Phantom with Tunable Stiffness Nodules and Force Sensing Capability for Palpation Training

Robotic phantoms enable advanced physical examination training before using human patients. In this paper, we present an abdominal phantom for palpation training with controllable stiffness liver nodules that can also sense palpation forces. The coupled sensing and actuation approach is achieved by pneumatic control of positive-granular jammed nodules for tunable stiffness. Soft sensing is done using the variation of internal pressure of the nodules under external forces. This paper makes original contributions to extend the linear region of the neo-Hookean characteristic of the mechanical behavior of the nodules by 140% compared to no-jamming conditions and to propose a method using the organ level controllable nodules as sensors to estimate palpation position and force with a root-means-quare error (RMSE) of 4% and 6.5%, respectively. Compared to conventional soft sensors, the method allows the phantom to sense with no interference to the simulated physiological conditions when providing quantified feedback to trainees, and to enable training following current bare-hand examination protocols without the need to wear data gloves to collect data.This work was supported in part by the Engineering and Physical Sciences Research Council (EPSRC) MOTION grant EP/N03211X/2 and EP/N03208X/1, and EPSRC RoboPatient grant EP/T00603X/

A surrogate model based on a finite element model of abdomen for real-time visualisation of tissue stress during physical examination training

Robotic patients show great potential to improve medical palpation training as they can provide feedback that cannot be obtained in a real patient. Providing information about internal organs deformation can significantly enhance palpation training by giving medical trainees visual insight based on their finger behaviours. This can be achieved by using computational models of abdomen mechanics. However, such models are computationally expensive, thus able to provide real-time predictions. In this work, we proposed an innovative surrogate model of abdomen mechanics using machine learning (ML) and finite element (FE) modelling to virtually render internal tissue deformation in real-time. We first developed a new high-fidelity FE model of the abdomen mechanics from computerized tomography (CT) images. We performed palpation simulations to produce a large database of stress distribution on the liver edge, an area of interest in most examinations. We then used artificial neural networks (ANN) to develop the surrogate model and demonstrated its application in an experimental palpation platform. Our FE simulations took 1.5 hrs to predict stress distribution for each palpation while this only took a fraction of a second for the surrogate model. Our results show that the ANN has a 92.6% accuracy. We also show that the surrogate model is able to use the experimental input of palpation location and force to provide real-time projections onto the robotics platform. This enhanced robotics platform has potential to be used as a training simulator for trainees to hone their palpation skills

Recent Advancements in Augmented Reality for Robotic Applications: A Survey

Robots are expanding from industrial applications to daily life, in areas such as medical robotics, rehabilitative robotics, social robotics, and mobile/aerial robotics systems. In recent years, augmented reality (AR) has been integrated into many robotic applications, including medical, industrial, human–robot interactions, and collaboration scenarios. In this work, AR for both medical and industrial robot applications is reviewed and summarized. For medical robot applications, we investigated the integration of AR in (1) preoperative and surgical task planning; (2) image-guided robotic surgery; (3) surgical training and simulation; and (4) telesurgery. AR for industrial scenarios is reviewed in (1) human–robot interactions and collaborations; (2) path planning and task allocation; (3) training and simulation; and (4) teleoperation control/assistance. In addition, the limitations and challenges are discussed. Overall, this article serves as a valuable resource for working in the field of AR and robotic research, offering insights into the recent state of the art and prospects for improvement

Robotic Ultrasound Imaging: State-of-the-Art and Future Perspectives

Ultrasound (US) is one of the most widely used modalities for clinical intervention and diagnosis due to the merits of providing non-invasive, radiation-free, and real-time images. However, free-hand US examinations are highly operator-dependent. Robotic US System (RUSS) aims at overcoming this shortcoming by offering reproducibility, while also aiming at improving dexterity, and intelligent anatomy and disease-aware imaging. In addition to enhancing diagnostic outcomes, RUSS also holds the potential to provide medical interventions for populations suffering from the shortage of experienced sonographers. In this paper, we categorize RUSS as teleoperated or autonomous. Regarding teleoperated RUSS, we summarize their technical developments, and clinical evaluations, respectively. This survey then focuses on the review of recent work on autonomous robotic US imaging. We demonstrate that machine learning and artificial intelligence present the key techniques, which enable intelligent patient and process-specific, motion and deformation-aware robotic image acquisition. We also show that the research on artificial intelligence for autonomous RUSS has directed the research community toward understanding and modeling expert sonographers' semantic reasoning and action. Here, we call this process, the recovery of the "language of sonography". This side result of research on autonomous robotic US acquisitions could be considered as valuable and essential as the progress made in the robotic US examination itself. This article will provide both engineers and clinicians with a comprehensive understanding of RUSS by surveying underlying techniques.Comment: Accepted by Medical Image Analysi

Real-time hybrid cutting with dynamic fluid visualization for virtual surgery

It is widely accepted that a reform in medical teaching must be made to meet today's high volume training requirements. Virtual simulation offers a potential method of providing such trainings and some current medical training simulations integrate haptic and visual feedback to enhance procedure learning. The purpose of this project is to explore the capability of Virtual Reality (VR) technology to develop a training simulator for surgical cutting and bleeding in a general surgery

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

Reinventing bodies and practice in medical education

Thesis (Ph. D. in History and Social Study of Science and Technology (HASTS))--Massachusetts Institute of Technology, Program in Science, Technology and Society, June 2004."May 2004."Includes bibliographical references (p. 247-253).This dissertation recounts the development of graphic models of human bodies and virtual reality simulators for teaching anatomy and surgery to medical students, residents, and physicians. It considers how researchers from disciplinary cultures in medicine, engineering, and computer programming come together to build these technologies, bringing with them values and assumptions about bodies from each of their disciplines, values and assumptions that must be negotiated and that often are made material and embedded in these new technologies. It discusses how the technological objects being created privilege the body as a dynamic and interactive system, in contrast to the description and taxonomic body of traditional anatomy and medicine. It describes the ways that these technologies create new sensory means of knowing bodies. And it discusses the larger cultural values that these technologies reify or challenge. The methodology of this dissertation is ethnography. I consider in-depth one laboratory at a major medical school, as well as other laboratories and researchers in the field of virtual medicine. I study actors in the emerging field of virtual medicine as they work in laboratories, at conferences, and in collaborations with one another. I consider the social formations that are developing with this new discipline. Methods include participant observation of laboratory activities, teaching, surgery, and conferences and extensive, in-depth interviewing of actors in the field. I draw on the literatures in the anthropology of science, technology, and medicine, the sociology of science, technology, and medicine, and the history of science and technology to argue that "bodies of information" are part of a bio-engineering revolution.(Cont.) that is making human bodies more easily viewed and manipulated. Science studies theorists have revealed the constructed, situated, and contingent nature of technoscientific communities and the objects they work with. They also have discussed how technoscientific objects help create their subjects and vice versa. This dissertation considers these phenomena within the arena of virtual medicine to intervene in debates about the body, about simulation, and about scientific cultures.by Rachel Prentice.Ph.D.in History and Social Study of Science and Technology (HAST