Feasibility Evaluation of Commercially Available Video Conferencing Devices to Technically Direct Untrained Nonmedical Personnel to Perform a Rapid Trauma Ultrasound Examination.

Introduction: Point-of-care ultrasound (POCUS) is a rapidly expanding discipline that has proven to be a valuable modality in the hospital setting. Recent evidence has demonstrated the utility of commercially available video conferencing technologies, namely, FaceTime (Apple Inc, Cupertino, CA, USA) and Google Glass (Google Inc, Mountain View, CA, USA), to allow an expert POCUS examiner to remotely guide a novice medical professional. However, few studies have evaluated the ability to use these teleultrasound technologies to guide a nonmedical novice to perform an acute care POCUS examination for cardiac, pulmonary, and abdominal assessments. Additionally, few studies have shown the ability of a POCUS-trained cardiac anesthesiologist to perform the role of an expert instructor. This study sought to evaluate the ability of a POCUS-trained anesthesiologist to remotely guide a nonmedically trained participant to perform an acute care POCUS examination. Methods: A total of 21 nonmedically trained undergraduate students who had no prior ultrasound experience were recruited to perform a three-part ultrasound examination on a standardized patient with the guidance of a remote expert who was a POCUS-trained cardiac anesthesiologist. The examination included the following acute care POCUS topics: (1) cardiac function via parasternal long/short axis views, (2) pneumothorax assessment via pleural sliding exam via anterior lung views, and (3) abdominal free fluid exam via right upper quadrant abdominal view. Each examiner was given a handout with static images of probe placement and actual ultrasound images for the three views. After a brief 8 min tutorial on the teleultrasound technologies, a connection was established with the expert, and they were guided through the acute care POCUS exam. Each view was deemed to be complete when the expert sonographer was satisfied with the obtained image or if the expert sonographer determined that the image could not be obtained after 5 min. Image quality was scored on a previously validated 0 to 4 grading scale. The entire session was recorded, and the image quality was scored during the exam by the remote expert instructor as well as by a separate POCUS-trained, blinded expert anesthesiologist. Results: A total of 21 subjects completed the study. The average total time for the exam was 8.5 min (standard deviation = 4.6). A comparison between the live expert examiner and the blinded postexam reviewer showed a 100% agreement between image interpretations. A review of the exams rated as three or higher demonstrated that 87% of abdominal, 90% of cardiac, and 95% of pulmonary exams achieved this level of image quality. A satisfaction survey of the novice users demonstrated higher ease of following commands for the cardiac and pulmonary exams compared to the abdominal exam. Conclusions: The results from this pilot study demonstrate that nonmedically trained individuals can be guided to complete a relevant ultrasound examination within a short period. Further evaluation of using telemedicine technologies to promote POCUS should be evaluated

Computer- and robot-assisted Medical Intervention

Medical robotics includes assistive devices used by the physician in order to make his/her diagnostic or therapeutic practices easier and more efficient. This chapter focuses on such systems. It introduces the general field of Computer-Assisted Medical Interventions, its aims, its different components and describes the place of robots in that context. The evolutions in terms of general design and control paradigms in the development of medical robots are presented and issues specific to that application domain are discussed. A view of existing systems, on-going developments and future trends is given. A case-study is detailed. Other types of robotic help in the medical environment (such as for assisting a handicapped person, for rehabilitation of a patient or for replacement of some damaged/suppressed limbs or organs) are out of the scope of this chapter.Comment: Handbook of Automation, Shimon Nof (Ed.) (2009) 000-00

Development of a cognitive robotic system for simple surgical tasks

The introduction of robotic surgery within the operating rooms has significantly improved the quality of many surgical procedures. Recently, the research on medical robotic systems focused on increasing the level of autonomy in order to give them the possibility to carry out simple surgical actions autonomously. This paper reports on the development of technologies for introducing automation within the surgical workflow. The results have been obtained during the ongoing FP7 European funded project Intelligent Surgical Robotics (I-SUR). The main goal of the project is to demonstrate that autonomous robotic surgical systems can carry out simple surgical tasks effectively and without major intervention by surgeons. To fulfil this goal, we have developed innovative solutions (both in terms of technologies and algorithms) for the following aspects: fabrication of soft organ models starting from CT images, surgical planning and execution of movement of robot arms in contact with a deformable environment, designing a surgical interface minimizing the cognitive load of the surgeon supervising the actions, intra-operative sensing and reasoning to detect normal transitions and unexpected events. All these technologies have been integrated using a component-based software architecture to control a novel robot designed to perform the surgical actions under study. In this work we provide an overview of our system and report on preliminary results of the automatic execution of needle insertion for the cryoablation of kidney tumours

Virtual and Augmented Reality in Medical Education

Virtual reality (VR) and augmented reality (AR) are two contemporary simulation models that are currently upgrading medical education. VR provides a 3D and dynamic view of structures and the ability of the user to interact with them. The recent technological advances in haptics, display systems, and motion detection allow the user to have a realistic and interactive experience, enabling VR to be ideal for training in hands-on procedures. Consequently, surgical and other interventional procedures are the main fields of application of VR. AR provides the ability of projecting virtual information and structures over physical objects, thus enhancing or altering the real environment. The integration of AR applications in the understanding of anatomical structures and physiological mechanisms seems to be beneficial. Studies have tried to demonstrate the validity and educational effect of many VR and AR applications, in many different areas, employed via various hardware platforms. Some of them even propose a curriculum that integrates these methods. This chapter provides a brief history of VR and AR in medicine, as well as the principles and standards of their function. Finally, the studies that show the effect of the implementation of these methods in different fields of medical training are summarized and presented

A Review of Pneumatic Actuators Used for the Design of Medical Simulators and Medical Tools

International audienc

Augmented Reality Ultrasound Guidance in Anesthesiology

Real-time ultrasound has become a mainstay in many image-guided interventions and increasingly popular in several percutaneous procedures in anesthesiology. One of the main constraints of ultrasound-guided needle interventions is identifying and distinguishing the needle tip from needle shaft in the image. Augmented reality (AR) environments have been employed to address challenges surrounding surgical tool visualization, navigation, and positioning in many image-guided interventions. The motivation behind this work was to explore the feasibility and utility of such visualization techniques in anesthesiology to address some of the specific limitations of ultrasound-guided needle interventions. This thesis brings together the goals, guidelines, and best development practices of functional AR ultrasound image guidance (AR-UIG) systems, examines the general structure of such systems suitable for applications in anesthesiology, and provides a series of recommendations for their development. The main components of such systems, including ultrasound calibration and system interface design, as well as applications of AR-UIG systems for quantitative skill assessment, were also examined in this thesis. The effects of ultrasound image reconstruction techniques, as well as phantom material and geometry on ultrasound calibration, were investigated. Ultrasound calibration error was reduced by 10% with synthetic transmit aperture imaging compared with B-mode ultrasound. Phantom properties were shown to have a significant effect on calibration error, which is a variable based on ultrasound beamforming techniques. This finding has the potential to alter how calibration phantoms are designed cognizant of the ultrasound imaging technique. Performance of an AR-UIG guidance system tailored to central line insertions was evaluated in novice and expert user studies. While the system outperformed ultrasound-only guidance with novice users, it did not significantly affect the performance of experienced operators. Although the extensive experience of the users with ultrasound may have affected the results, certain aspects of the AR-UIG system contributed to the lackluster outcomes, which were analyzed via a thorough critique of the design decisions. The application of an AR-UIG system in quantitative skill assessment was investigated, and the first quantitative analysis of needle tip localization error in ultrasound in a simulated central line procedure, performed by experienced operators, is presented. Most participants did not closely follow the needle tip in ultrasound, resulting in 42% unsuccessful needle placements and a 33% complication rate. Compared to successful trials, unsuccessful procedures featured a significantly greater (p=0.04) needle-tip to image-plane distance. Professional experience with ultrasound does not necessarily lead to expert level performance. Along with deliberate practice, quantitative skill assessment may reinforce clinical best practices in ultrasound-guided needle insertions. Based on the development guidelines, an AR-UIG system was developed to address the challenges in ultrasound-guided epidural injections. For improved needle positioning, this system integrated A-mode ultrasound signal obtained from a transducer housed at the tip of the needle. Improved needle navigation was achieved via enhanced visualization of the needle in an AR environment, in which B-mode and A-mode ultrasound data were incorporated. The technical feasibility of the AR-UIG system was evaluated in a preliminary user study. The results suggested that the AR-UIG system has the potential to outperform ultrasound-only guidance