153 research outputs found

    Preliminary development of the Active Colonoscopy Training Model

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    Medical Robotics for use in MRI Guided Endoscopy

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    Interventional Magnetic Resonance Imaging (MRI) is a developing field that aims to provide intra-operative MRI to a clinician to guide diagnostic or therapeutic medical procedures. MRI provides excellent soft tissue contrast at sub-millimetre resolution in both 2D and 3D without the need for ionizing radiation. Images can be acquired in near real-time for guidance purposes. Operating in the MR environment brings challenges due to the high static magnetic field, switching magnetic field gradients and RF excitation pulses. In addition high field closed bore scanners have spatial constraints that severely limit access to the patient. This thesis presents a system for MRI-guided Endoscopic Retrograde Cholangio-pancreatography (ERCP). This includes a remote actuation system that enables an MRI-compatible endoscope to be controlled whilst the patient is inside the MRI scanner, overcoming the spatial and procedural constraints imposed by the closed scanner bore. The modular system utilises non-magnetic ultrasonic motors and is designed for image-guided user-in-the-loop control. A novel miniature MRI compatible clutch has been incorporated into the design to reduce the need for multiple parallel motors. The actuation system is MRI compatible does not degrade the MR images below acceptable levels. User testing showed that the actuation system requires some degree of training but enables completion of a simulated ERCP procedure with no loss of performance. This was demonstrated using a tailored ERCP simulator and kinematic assessment tool, which was validated with users from a range of skill levels to ensure that it provides an objective measurement of endoscopic skill. Methods of tracking the endoscope in real-time using the MRI scanner are explored and presented here. Use of the MRI-guided ERCP system was shown to improve the operator’s ability to position the endoscope in an experimental environment compared with a standard fluoroscopic-guided system.Open Acces

    Cable-driven parallel robot for transoral laser phonosurgery

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    Transoral laser phonosurgery (TLP) is a common surgical procedure in otolaryngology. Currently, two techniques are commonly used: free beam and fibre delivery. For free beam delivery, in combination with laser scanning techniques, accurate laser pattern scanning can be achieved. However, a line-of-sight to the target is required. A suspension laryngoscope is adopted to create a straight working channel for the scanning laser beam, which could introduce lesions to the patient, and the manipulability and ergonomics are poor. For the fibre delivery approach, a flexible fibre is used to transmit the laser beam, and the distal tip of the laser fibre can be manipulated by a flexible robotic tool. The issues related to the limitation of the line-of-sight can be avoided. However, the laser scanning function is currently lost in this approach, and the performance is inferior to that of the laser scanning technique in the free beam approach. A novel cable-driven parallel robot (CDPR), LaryngoTORS, has been developed for TLP. By using a curved laryngeal blade, a straight suspension laryngoscope will not be necessary to use, which is expected to be less traumatic to the patient. Semi-autonomous free path scanning can be executed, and high precision and high repeatability of the free path can be achieved. The performance has been verified in various bench and ex vivo tests. The technical feasibility of the LaryngoTORS robot for TLP was considered and evaluated in this thesis. The LaryngoTORS robot has demonstrated the potential to offer an acceptable and feasible solution to be used in real-world clinical applications of TLP. Furthermore, the LaryngoTORS robot can combine with fibre-based optical biopsy techniques. Experiments of probe-based confocal laser endomicroscopy (pCLE) and hyperspectral fibre-optic sensing were performed. The LaryngoTORS robot demonstrates the potential to be utilised to apply the fibre-based optical biopsy of the larynx.Open Acces

    Use of human patient simulation to teach difficult airway management and improve patient safety in the nurse anesthesia student

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    Introduction. The objective of this study was to determine if scenario-based training (SB) was more effective than task-based (TB) training in teaching a difficult airway algorithm to nurse anesthesia student. Methods. Participants were second year nurse anesthesia students. Simulation was used as both a training and testing modality. Subjects were given a 2 scenario simulation based pre-test and a written test, randomized to receive either (1) lecture and task-based training or (2) lecture and scenario-based training. They were then post-tested with the same 2 simulation scenarios and an objective matched written posttest. Performance was videotaped and evaluated by 2 expert observers based on performance against an idealized algorithm, amount and time of desaturation, and time to secure the airway. Data were analyzed using repeated measures ANOVA and students-t test. Levels of statistical significance were set at a of .05 (one-tail). Results. While performance improved in both groups on all outcome variables the SB group's improvement was statistically significant on the number of deviations from the airway algorithm (Pre-test TB = 23.09, Post-test TB = 16.27, Pre-test SB = 24.25, Post-test, SB = 12.83, interaction F = 2.91, p < 0.05) and written exam (Pre-test TB = 69%, Post-test TB = 73%, Pre-test SB = 70%, Post-test, SB = 81%, interaction F = 3.30, p = 0.05). Conclusion. We found mixed evidence that SB training may offer specific advantages, including improved didactic knowledge and compliance with a complex algorithm, in teaching management of the patient with a difficult airway to novice anesthesia providers. Conversely, the total time of desaturation and lowest desaturation was not statistically significantly different. Subjectively both methods provided a high degree of self confidence in learning and student satisfaction as measured by the Student Satisfaction and Self Confidence in Learning Scale

    Accelerating development of simulation-based medical skill training programs : a comparative evaluation research study

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    A shift in Military utilization of Live Tissue Training (LTT) to Simulation-based Training (SBT) for combat casualty care training programs is currently underway. While each has been reported to be effective, there is little high quality research comparing traditional LTT with SBT learning outcomes. The shift in training methods is partly in response to increased regulatory requirements, higher costs and public sentiments. The benefits of training with a live anesthetized animal are an immediate physiologic feedback to treatment interventions and practice in 'real-world', high-stakes continual patient assessment and decision making. Simulation-based training offers opportunities for deliberate practice and skill mastery without the sense of urgency or 'real-world' life and death outcomes the trainee will face in combat casualty care. The paucity of experimental evidence demonstrating that the two types of training are comparable has contributed to slow adoption of SBT technology for resuscitation procedures, particularly in combat casualty training. This study entails the direct comparison of LTT and SBT in a randomized, pre-test post-test experiment. Changes in trainee knowledge, psychomotor skill, and self-efficacy are assessed using established measures. Stress and emotion are known to play a role in performance and learning. This study also investigated the use of sweat measurement as a possible indicator of a stressful response to the training situation. This was accomplished by measuring changes in skin impedance during didactic and hands-on training. Following completion of the training session, training participants completed a survey regarding perceived value of the training. An independent evaluation of the study was conducted by the University of Central Florida's Institute for Simulation and Training. Statistical analyses showed no significant difference between the training groups in any of the learning measures. The change in electrodermal activity was non-significant between the two training groups. Participant evaluations revealed strong belief among trainees that LTT was of greater value to the training participants, however, participants suggested that LTT should be continued for combat casualty care training while SBT could be useful to other groups of learners. A more limited use of LTT would address the concerns regarding the use of live tissue. The comparison of learning outcomes in this controlled study provides new evidence to support further integration of SBT in combat casualty training. The study results will inform trauma education planning so that the most effective training methods available for military personnel preparing for combat casualty care can be utilized.Includes bibliographical references (pages 139-147)

    Design and fabrication of silicone-based composite tissue-mimicking phantoms for medical training

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    Silicone-based composite phantoms were fabricated to be used as an education model in medical training. A matrix of silicone formulations was tracked to mimic the ultrasonography, mammography, surgical, and microsurgical responses of different human tissue and organs. The performance of two different additives: i) silicone oil and ii) vinyl-terminated poly (dimethylsiloxane) (PDMS) were monitored with the acoustic setup and evaluated by the surgeons. Breast cancer is one of the most common types of cancer among women, and early diagnosis significantly improves the patient outcomes. The surgeons-in-training necessitate the vast amount of practice to facilitate a noteworthy contribution to this outcome. Therefore, breast simulation models that contain skin layer, inner breast tissue, and tumor structures which allow the collection of samples with biopsy needle were fabricated to be used in ultrasonography, as well as mammography models to be used in tumor diagnostics, and breast oncoplasty models for surgeons to practice their suturing skills. Development of microsurgical techniques signifies a foremost advance in the intervention of the injured peripheral nerves and with the aid of the operating microscopes; it is possible to evaluate the severity of the neural trauma. The advanced microsurgical skills of surgeons are essential for the success of the microsurgery, and in turn for the preservation of the nerve continuity. With this motive, a peripheral nerve phantom that contains skin layer, fascia tissue, epineurium, connective tissue, the fascicles, and the muscle layer has been designed. Herein, we highlight the fabrication of a realistic, durable, accessible, and cost-effective training platform that contains breast ultrasonography, mammography, and oncoplasty models, as well as peripheral nerve with complex hierarchical layers. For training purposes, closest media to reality, fresh cadavers, are hard to obtain due to their price and/or unavailability. Hence, a variety of synthetic tissues were also designed through the optimization of formulations of silicone. Surgical simulation models that mimic various human tissue and organs such as i) multi layers of skin, ii) axilla and axillary lymph nodes, iii) veins, iv) isthmus of the thyroid gland, cricoid cartilage, tongue, larynx, esophagus, tracheal rings, and bronchial tree for the tracheostomy and bronchoscopy models were fabricated
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