Fully Immersive Virtual Reality for Skull-base Surgery: Surgical Training and Beyond

Purpose: A virtual reality (VR) system, where surgeons can practice procedures on virtual anatomies, is a scalable and cost-effective alternative to cadaveric training. The fully digitized virtual surgeries can also be used to assess the surgeon's skills using measurements that are otherwise hard to collect in reality. Thus, we present the Fully Immersive Virtual Reality System (FIVRS) for skull-base surgery, which combines surgical simulation software with a high-fidelity hardware setup. Methods: FIVRS allows surgeons to follow normal clinical workflows inside the VR environment. FIVRS uses advanced rendering designs and drilling algorithms for realistic bone ablation. A head-mounted display with ergonomics similar to that of surgical microscopes is used to improve immersiveness. Extensive multi-modal data is recorded for post-analysis, including eye gaze, motion, force, and video of the surgery. A user-friendly interface is also designed to ease the learning curve of using FIVRS. Results: We present results from a user study involving surgeons with various levels of expertise. The preliminary data recorded by FIVRS differentiates between participants with different levels of expertise, promising future research on automatic skill assessment. Furthermore, informal feedback from the study participants about the system's intuitiveness and immersiveness was positive. Conclusion: We present FIVRS, a fully immersive VR system for skull-base surgery. FIVRS features a realistic software simulation coupled with modern hardware for improved realism. The system is completely open-source and provides feature-rich data in an industry-standard format.Comment: IPCAI/IJCARS 202

Research on real-time physics-based deformation for haptic-enabled medical simulation

This study developed a multiple effective visuo-haptic surgical engine to handle a variety of surgical manipulations in real-time. Soft tissue models are based on biomechanical experiment and continuum mechanics for greater accuracy. Such models will increase the realism of future training systems and the VR/AR/MR implementations for the operating room

VeLight:A 3D virtual reality tool for CT-based anatomy teaching and training

Abstract: For doctors and other medical professionals, the human body is the focus of their daily practice. A solid understanding of how it is built up, that is, the anatomy of the human body, is essential to ensure safe medical practice. Current anatomy education takes place either using text books or via dissecting human cadavers, with text books being the most traditional way to learn anatomy due to the cost of the alternatives. However, printed media offer only a 2D perception of a part of the human body. Although dissection of human cadavers can give a more direct observation and interaction with human bodies, it is extremely costly because of the need of preserving human bodies and maintaining dissection rooms. To solve this issue, we developed VeLight, a system with which students can learn anatomy based on CT datasets using a 3D Virtual Reality display (zSpace). VeLight offers simple and intuitive interactions, and allows teachers to design their own courses using their own material. The system offers an interactive, depth-perceptive learning experience and improves the learning process. We conducted an informal user study to validate the effectiveness of VeLight. The results show that participants were able to learn and remember how to work with VeLight very quickly. All participants reported enthusiasm for the potential of VeLight in the domain of medical education. Graphic Abstract: [Figure not available: see fulltext.

Training in temporal bone surgery: A review of current practices

The temporal bone consists of complex anatomy, and the presence of various vital structures in close proximity makes the surgery of temporal bone highly challenging. Such a surgery requires years of training under the direct observation of trainers. Over the course of history, different training models have been adopted by experts to help train the young surgeons in this complex procedure. Cadaveric dissections of the temporal bone remains the gold standard in training of residents as the cadavers present the actual anatomical details which the surgeons encounter while operating on patients. However, due to scarcity of available cadavers, their one-time-only usage and high cost of involved in such trainings, experts have developed newer techniques of training, including three-dimensional reconstruction models and virtual reality simulators. Most of the literature on simulation in training of residents focuses on anatomical understanding and development of the surgical technique. There has been significant improvement in these techniques over time. With the addition of haptic feedback in the newer virtual simulation models, simulation has edged closer to basic modules of temporal bone dissection. the current review article was planned to have an overview of the different techniques in detail that are currently being in used

Performance Factors in Neurosurgical Simulation and Augmented Reality Image Guidance

Virtual reality surgical simulators have seen widespread adoption in an effort to provide safe, cost-effective and realistic practice of surgical skills. However, the majority of these simulators focus on training low-level technical skills, providing only prototypical surgical cases. For many complex procedures, this approach is deficient in representing anatomical variations that present clinically, failing to challenge users’ higher-level cognitive skills important for navigation and targeting. Surgical simulators offer the means to not only simulate any case conceivable, but to test novel approaches and examine factors that influence performance. Unfortunately, there is a void in the literature surrounding these questions. This thesis was motivated by the need to expand the role of surgical simulators to provide users with clinically relevant scenarios and evaluate human performance in relation to image guidance technologies, patient-specific anatomy, and cognitive abilities. To this end, various tools and methodologies were developed to examine cognitive abilities and knowledge, simulate procedures, and guide complex interventions all within a neurosurgical context. The first chapter provides an introduction to the material. The second chapter describes the development and evaluation of a virtual anatomical training and examination tool. The results suggest that learning occurs and that spatial reasoning ability is an important performance predictor, but subordinate to anatomical knowledge. The third chapter outlines development of automation tools to enable efficient simulation studies and data management. In the fourth chapter, subjects perform abstract targeting tasks on ellipsoid targets with and without augmented reality guidance. While the guidance tool improved accuracy, performance with the tool was strongly tied to target depth estimation – an important consideration for implementation and training with similar guidance tools. In the fifth chapter, neurosurgically experienced subjects were recruited to perform simulated ventriculostomies. Results showed anatomical variations influence performance and could impact outcome. Augmented reality guidance showed no marked improvement in performance, but exhibited a mild learning curve, indicating that additional training may be warranted. The final chapter summarizes the work presented. Our results and novel evaluative methodologies lay the groundwork for further investigation into simulators as versatile research tools to explore performance factors in simulated surgical procedures

Immersive Virtual Reality as a teaching aid for anatomy

Anatomy is a discipline where students are required to identify structures of the human body. It is typically a topic which challenges students due to the large volume of terms and content they are required to understand. This study was designed to investigate whether Virtual Reality (VR) as an innovative approach to teaching could improve both student experience and attainment in this subject area. A specifically developed VR platform was created in which Medical Engineering students (N = 42) were asked to individually compete to assemble a human skeleton in both the fastest time and with the fewest errors. This gamification in an immersive environment was hypothesised to increase students’ understanding and retention of anatomical information and was compared to studying from a set of traditional notes. The results showed a 10 % greater improvement in test scores with VR over the use of notes (non-significant, P = 0.141). In the longer term those who participated in the study performed significantly better on the end of module examination (P = 0.012) suggesting measurable learning gain from the experience more widely. Students responded positively to the use of VR in this context and expressed an interest in seeing more VR as part of their anatomy education and their Higher Education experience more broadly