286 research outputs found

    A technology-aided multi-modal training approach to assist abdominal palpation training and its assessment in medical education

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    Computer-assisted multi-modal training is an effective way of learning complex motor skills in various applications. In particular disciplines (eg. healthcare) incompetency in performing dexterous hands-on examinations (clinical palpation) may result in misdiagnosis of symptoms, serious injuries or even death. Furthermore, a high quality clinical examination can help to exclude significant pathology, and reduce time and cost of diagnosis by eliminating the need for unnecessary medical imaging. Medical palpation is used regularly as an effective preliminary diagnosis method all around the world but years of training are required currently to achieve competency. This paper focuses on a multimodal palpation training system to teach and improve clinical examination skills in relation to the abdomen. It is our aim to shorten significantly the palpation training duration by increasing the frequency of rehearsals as well as providing essential augmented feedback on how to perform various abdominal palpation techniques which has been captured and modelled from medical experts. A comparative evaluation on usability and effectiveness of the method is presented in this study. Four professional tutors were invited to take part in the design, development and assessment stages of this study. Widely-used user centred design methods were employed to form a know-how document and an assessment criterion with help of medical professionals. Our interface was used to capture and develop a best practice model for each palpation tasks for further assessment. Twenty three first year medical students divided into a control group (n = 8), a semi-visually trained group (n = 8), and a fully visually trained group (n = 7) were invited to perform three palpation tasks (superficial, deep and liver). The medical studentsā€™ performances were assessed using both computer-based and human-based methods where a positive correlation was shown between the generated scores, r = .62, p (one-tailed) < .05. The visually-trained group significantly outperformed the control group in which abstract visualisation of applied forces and their palmar locations were provided to the students during each palpation examination (p < .05). Moreover, a positive trend was observed between groups when visual feedback was presented, J = 132, z = 2.62, r = 0.55

    A technology-aided multi-modal training approach to assist abdominal palpation training and its assessment in medical education

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    Kinaesthetic Learning Activities (KLA) are techniques for enhancing the motor learning process to provide a deep understanding of fundamental skills in particular disciplines. With KLA learning takes place by carrying out a physical activity to transform empirical achievements into representative cognitive understanding. In disciplines such as medical education, frequent hands-on practice of certain motor skills plays a key role in the development of medical students' competency. Therefore it is essential that clinicians master these core skills early on in their educational journey as well as retain them for the entirety of their career. Transferring knowledge of performing dexterous motor skills, such as clinical examinations, from experts to novices demands a systematic approach to quantify relevant motor variables with the help of medical experts in order to form a reference best practice model for target skills. Additional information (augmented feedback) on certain aspects of movements could be extracted from this model and visualised via multi-modal sensory channels in order to enhance motor performance and learning processes. This thesis proposes a novel KLA methodology to significantly improve the quality of palpation training in medical students. In particular, it investigates whether it is possible to enhance the existing abdominal palpation skills acquisition process (motor performance and learning) with provision of instructional concurrent and terminal augmented feedback on applied forces by the learner's hand via an autonomous multimodal displays. This is achieved by considering the following: identifying key motor variables with help of medical experts; forming a gold standard model for target skills by collecting pre-defined motor variables with an innovative quantification technique; designing an assessment criteria by analysing the medical experts' data; and systematically evaluating the impact of instructional augmented feedback on medical students' motor performance with two distinct assessment approaches(a machine-based and a human-based). In addition, an evaluation of performance on a simpler task is carried out using a game-based training method, to compare feedback visualisation techniques, such as concurrent visual and auditory feedback as used in a serious games environment, with abstract visualisation of motor variables. A detailed between-participants study is presented to evaluate the effect of concurrent augmented feedback on participants' skills acquisition in the motor learning process. Significant improvement on medical students' motor performance was observed when augmented feedback on applied forces were visually presented (H(2) = 6:033, p < :05). Moreover, a positive correlation was reported between computer-generated scores and human-generated scores, r = :62, p (one-tailed) < :05. This indicates the potential of the computer-based assessment technique to assist the current assessment process in medical education. The same results were also achieved in a blind-folded (no-feedback) transfer test to evaluate performance and short-term retention of skills in the game-based training approach. The accuracy in the exerted target force for participants in the game-playing group, who were trained using the game approach (Mdn = 0:86), differed significantly from the participants in control group, who trained using the abstract visualisation of the exerted force value (Mdn = 1:56), U = 61, z = -2:137, p < :05, r = -0:36. Finally, the usability of both motor learning approaches were surveyed via feedback questionnaires and positive responses were achieved from users. The research presented shows that concurrent augmented feedback significantly improves the participants' motor control abilities. Furthermore, advanced visualisation techniques such as multi-modal displays increases the participants' motivation to engage in learning and to retain motor skills

    Visuohaptic augmented feedback for enhancing motor skills acquisition

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    Serious games are accepted as an effective approach to deliver augmented feedback in motor (re-) learning processes. The multi-modal nature of the conventional computer games (e.g. audiovisual representation) plus the ability to interact via haptic-enabled inputs provides a more immersive experience. Thus, particular disciplines such as medical education in which frequent hands on rehearsals play a key role in learning core motor skills (e.g. physical palpations) may benefit from this technique. Challenges such as the impracticality of verbalising palpation experience by tutors and ethical considerations may prevent the medical students from correctly learning core palpation skills. This work presents a new data glove, built from off-the-shelf components which captures pressure sensitivity designed to provide feedback for palpation tasks. In this work the data glove is used to control a serious game adapted from the infinite runner genre to improve motor skill acquisition. A comparative evaluation on usability and effectiveness of the method using multimodal visualisations, as part of a larger study to enhance pressure sensitivity, is presented. Thirty participants divided into a game-playing group (n = 15) and a control group (n = 15) were invited to perform a simple palpation task. The game-playing group significantly outperformed the control group in which abstract visualisation of force was provided to the users in a blind-folded transfer test. The game-based training approach was positively described by the game-playing group as enjoyable and engaging

    Haptics in Robot-Assisted Surgery: Challenges and Benefits

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    Robotic surgery is transforming the current surgical practice, not only by improving the conventional surgical methods but also by introducing innovative robot-enhanced approaches that broaden the capabilities of clinicians. Being mainly of man-machine collaborative type, surgical robots are seen as media that transfer pre- and intra-operative information to the operator and reproduce his/her motion, with appropriate filtering, scaling, or limitation, to physically interact with the patient. The field, however, is far from maturity and, more critically, is still a subject of controversy in medical communities. Limited or absent haptic feedback is reputed to be among reasons that impede further spread of surgical robots. In this paper objectives and challenges of deploying haptic technologies in surgical robotics is discussed and a systematic review is performed on works that have studied the effects of providing haptic information to the users in major branches of robotic surgery. It has been tried to encompass both classical works and the state of the art approaches, aiming at delivering a comprehensive and balanced survey both for researchers starting their work in this field and for the experts

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

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    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

    Validation of the Haptic Cow: A simulator for training veterinary students

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    A virtual reality simulator, the Haptic Cow, has been developed using touch feedback technology for training veterinary students to perform bovine rectal palpation of the reproductive tract. The simulator was designed to supplement existing training and address some of the difficulties associated with teaching palpation-based skills. Students need to achieve a certain level of proficiency by graduation but this has become increasingly difficult because of problems with current training methods and a reduction in the number of opportunities to practice. A simulator- based teaching tool was developed as a potential solution. The first step involved designing a simulator on the basis of requirements established through consultation with both veterinary surgeons, as teachers, and students, as learners. Research was then undertaken to validate the simulator by following a set of established criteria described for the evaluation of new technologies used in medical education. The virtual models were assessed by experts as realistic enough representations of the same structures in the cow. An experiment to assess the effect of simulator training compared the performance of one group of students, whose training was supplemented with a simulator session, with another group of traditionally trained students. The subsequent performance for finding and identifying the uterus when examining cows for the first time, was significantly better for the simulator trained group, indicating that skills learned in the simulator environment transferred to the real task. A project was also undertaken to integrate the simulator into a curriculum, with training included as part of the farm animal course at the University of Glasgow Veterinary School. The training was well received by students, useful feedback was gathered and the simulator continues to be used as part of the course. Further developments were undertaken with the aim of creating a more versatile teaching tool and addressing some of the questions and issues raised. An automated version of the Haptic Cow was designed for students to use on their own, with computer guidance replacing the instructor's role. An evaluation found that the new version of the teaching tool was both usable and an effective way of equipping students with the skills required to find and identify the uterus. The potential to use haptic technology to investigate various aspects of performance was also explored in relation to the question of hand choice for certain palpation-based skills: differentiating between objects on the basis of softness and size. Ongoing research and development options are discussed, with the aim of building on the current work by expanding the role of haptic technology in veterinary education in the future

    VISIO-HAPTIC DEFORMABLE MODEL FOR HAPTIC DOMINANT PALPATION SIMULATOR

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    Vision and haptic are two most important modalities in a medical simulation. While visual cues assist one to see his actions when performing a medical procedure, haptic cues enable feeling the object being manipulated during the interaction. Despite their importance in a computer simulation, the combination of both modalities has not been adequately assessed, especially that in a haptic dominant environment. Thus, resulting in poor emphasis in resource allocation management in terms of effort spent in rendering the two modalities for simulators with realistic real-time interactions. Addressing this problem requires an investigation on whether a single modality (haptic) or a combination of both visual and haptic could be better for learning skills in a haptic dominant environment such as in a palpation simulator. However, before such an investigation could take place one main technical implementation issue in visio-haptic rendering needs to be addresse

    Medical Robotics

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    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 ā€œmedical roboticistsā€ or not
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