11 research outputs found
A Review of Pneumatic Actuators Used for the Design of Medical Simulators and Medical Tools
International audienc
PĂ©riSIM : an haptic simulator to learn the epidural anaesthesia procedure
LâanesthĂ©sie pĂ©ridurale est un geste mĂ©dical commun consistant Ă rĂ©aliser une anesthĂ©sie locale du bas du corps. GĂ©nĂ©ralement pratiquĂ© lors dâaccouchements afin de limiter les douleurs de la future maman, le geste reste relativement simple mais requiert un long entraĂźnement afin dâĂȘtre suffisamment maĂźtrisĂ©. Les moyens de formations actuels tels que des mannequins ne permettant pas de proposer un apprentissage suffisant, la plupart du temps la premiĂšre pĂ©ridurale est rĂ©alisĂ©e directement sur le patient. Cela augmente les risques de rĂ©aliser une mauvaise anesthĂ©sie mais aussi le stress des mĂ©decins novices. Cette thĂšse propose un simulateur haptique utilisant une interface haptique Ă©lectrique couplĂ©e Ă un vĂ©rin pneumatique afin de proposer une simulation complĂšte et rĂ©aliste de la procĂ©dure. Les travaux proposent une commande de vĂ©rin pneumatique visant Ă simuler le comportement dâune seringue. Le contrĂŽle du vĂ©rin pneumatique est rĂ©alisĂ©e Ă l'aide d'une servovalve par une approche par backstepping et permet d'accroĂźtre grandement le rĂ©alisme de la simulation. Le contrĂŽle de lâinterface haptique Ă©lectrique a, lui, pour but de reprĂ©senter lâinsertion dâune aiguille dans le dos dâun patient. Lâensemble vise Ă mettre Ă disposition une simulation Ă©toffĂ©e et rĂ©aliste de diffĂ©rents types de patients. Les travaux de thĂšses ont donc pu aboutir Ă la prĂ©sentation d'un simulateur complet dĂ©diĂ© Ă la simulation du geste de l'anesthĂ©sie pĂ©ridurale. Le simulateur dĂ©veloppĂ© a pu ĂȘtre testĂ© au cours d'une campagne de mesure auprĂšs de mĂ©decins novices et expĂ©rimentĂ©s. Cette campagne a permis de rĂ©colter suffisamment de donnĂ©es pour entreprendre le dĂ©veloppement d'une mĂ©thode dâĂ©valuation du geste.The epidural anesthesia is a common medical gesture that consists in a local anesthesia of the lower part of the body. It is usually performed at childbirth to relieve the future mother from birthing pain. Although the gesture itself is simple, it requires a long training to be mastered by anyone. Current training tools however do not provide sufficient training quality, and most of the time the first epidural anesthesia is performed directly on a patient. This, not only increase the risk of an error happening during the procedure but it also increases the level of stress for the novices.This thesis propose a haptic simulator composed of an electrical haptic interface coupled with a pneumatic cylinder to create a complete a realistic simulation of the procedure. In this work, we propose control laws to use a pneumatic cylinder as a syringe emulator. The control of the cylinder is achieved using a servovalve and a backstepping approach to greatly increase the realism of the simulation. The electrical haptic interface is used to reproduce a needle insertion through tissues in the back of a patient. The overall objective is to put together a complete a realistic simulation of different patient types. This project has lead to the development of a complete haptic simulator dedicated to reproduce the epidural anesthesia gesture. The simulator has been tested in a test campaign involving both novices and experts. This campaign allowed to get enough data points to undertake the implementation of a gesture evaluation metho
PériSIM : un simulateur haptique d'apprentissage du geste de l'anesthésie péridurale
The epidural anesthesia is a common medical gesture that consists in a local anesthesia of the lower part of the body. It is usually performed at childbirth to relieve the future mother from birthing pain. Although the gesture itself is simple, it requires a long training to be mastered by anyone. Current training tools however do not provide sufficient training quality, and most of the time the first epidural anesthesia is performed directly on a patient. This, not only increase the risk of an error happening during the procedure but it also increases the level of stress for the novices.This thesis propose a haptic simulator composed of an electrical haptic interface coupled with a pneumatic cylinder to create a complete a realistic simulation of the procedure. In this work, we propose control laws to use a pneumatic cylinder as a syringe emulator. The control of the cylinder is achieved using a servovalve and a backstepping approach to greatly increase the realism of the simulation. The electrical haptic interface is used to reproduce a needle insertion through tissues in the back of a patient. The overall objective is to put together a complete a realistic simulation of different patient types. This project has lead to the development of a complete haptic simulator dedicated to reproduce the epidural anesthesia gesture. The simulator has been tested in a test campaign involving both novices and experts. This campaign allowed to get enough data points to undertake the implementation of a gesture evaluation methodLâanesthĂ©sie pĂ©ridurale est un geste mĂ©dical commun consistant Ă rĂ©aliser une anesthĂ©sie locale du bas du corps. GĂ©nĂ©ralement pratiquĂ© lors dâaccouchements afin de limiter les douleurs de la future maman, le geste reste relativement simple mais requiert un long entraĂźnement afin dâĂȘtre suffisamment maĂźtrisĂ©. Les moyens de formations actuels tels que des mannequins ne permettant pas de proposer un apprentissage suffisant, la plupart du temps la premiĂšre pĂ©ridurale est rĂ©alisĂ©e directement sur le patient. Cela augmente les risques de rĂ©aliser une mauvaise anesthĂ©sie mais aussi le stress des mĂ©decins novices. Cette thĂšse propose un simulateur haptique utilisant une interface haptique Ă©lectrique couplĂ©e Ă un vĂ©rin pneumatique afin de proposer une simulation complĂšte et rĂ©aliste de la procĂ©dure. Les travaux proposent une commande de vĂ©rin pneumatique visant Ă simuler le comportement dâune seringue. Le contrĂŽle du vĂ©rin pneumatique est rĂ©alisĂ©e Ă l'aide d'une servovalve par une approche par backstepping et permet d'accroĂźtre grandement le rĂ©alisme de la simulation. Le contrĂŽle de lâinterface haptique Ă©lectrique a, lui, pour but de reprĂ©senter lâinsertion dâune aiguille dans le dos dâun patient. Lâensemble vise Ă mettre Ă disposition une simulation Ă©toffĂ©e et rĂ©aliste de diffĂ©rents types de patients. Les travaux de thĂšses ont donc pu aboutir Ă la prĂ©sentation d'un simulateur complet dĂ©diĂ© Ă la simulation du geste de l'anesthĂ©sie pĂ©ridurale. Le simulateur dĂ©veloppĂ© a pu ĂȘtre testĂ© au cours d'une campagne de mesure auprĂšs de mĂ©decins novices et expĂ©rimentĂ©s. Cette campagne a permis de rĂ©colter suffisamment de donnĂ©es pour entreprendre le dĂ©veloppement d'une mĂ©thode dâĂ©valuation du geste
Control laws for pneumatic cylinder in order to emulate the Loss Of Resistance principle
International audienceMedicine requires advanced teaching methods in order to reach an efficient student training without having to train them directly on patients. In France, the Haute Autorité de la Santé (H.A.S.) has stated to "never [do] the first time with a patient" as a requirement for the training of new doctors. The goal of this work is to other a novel robotic solution to teach students how to perform an epidural anaesthesia. This medical operation can be divided intotwo different gestures: First the insertion of a needle between two vertebrae and second the application of pressure on the plunger all along the insertion of the needle. This works aims at simulating this second part as it has already been done on the first part in previous studies. We introduce a way to emulate the principle of loss of resistance felt by the anaesthetist when the needle reaches the appropriate depth
Skill assessment of an epidural anesthesia using the PeriSIM simulator
International audienceCurrently, the training in the lumbar epidural anesthesia procedure, a very common procedure, is mainly performed on patients under the supervision of experts. The reason for this situation is that the simulators that exist on the market are not realistic enough to efficiently learn this particularly haptic-sense-based gesture. To avoid this ethical issue and provide an efficient, repeatable, and affordable way of safely learning this gesture, the AmpĂ©re laboratory designed PeriSIM: a haptic training computer-based simulator. In this article, the traineesâ skill assessment is tackled. This work presents various machine learning approaches to the evaluation of trainees and introduces a complete skill assessment algorithm to use in conjunction with the PeriSIM simulator. This work also aims to determine the important variables of an lumbar epidural anesthesia procedure for objective assessment purpose
Simulating a Syringe Behaviour Using a Pneumatic Cylinder Haptic Interface
International audienceMastering medical gestures, such as epidural needle insertion, requires much practice. Haptic interfaces can be efficient training solutions. Nevertheless, they must provide users with an accurate experience for an effective training. This article introduces a control framework that turns a pneumatic cylinder into a haptic interface able to simulate a syringe and more specifically the loss of resistance phenomenon encountered during an epidural needle insertion. To achieve this, the framework switches between two control laws (position and force tracking) according to the system state. Experiments involving two anesthetists confirm the practicality of this system for hands-on training or rehearsal purposes
Designing an accurate and customizable epiduralanesthesia haptic simulator
International audienceEpidural anesthesia, despite being a relatively common medical procedure, remains quite demanding in terms of skills as it is mostly blind and thus heavily reliant on the haptic sensations. Although some training support solutions exist, anesthetists consider them mostly inefficient or impractical. A few attempts at creating a simulator for this particular procedure exist but each one lacks one of the important requirements of the procedure. This article introduces a haptic simulator featuring a more complete and realistic simulation of the procedure than we could observe in existing simulators. The simulator is composed of a generic electrical haptic interface coupled with a pneumatic cylinder
Introducing Pneumatic Actuators in HapticTraining Simulators and Medical Tools
International audienceSimulators have been traditionally used for centuries dur-ing medical training as the trainees have to improve their skills beforepracticing on a real patient. Nowadays mechatronic technology has openthe way to more evolved solutions enabling objective assessment anddedicated pedagogic scenarios. Trainees can now practice in virtual en-vironments on various body parts, with current and rare pathologies, forany kind of patient (slim, elderly ...). But medical students need kines-thetic feedback in order to get significant learning. Gestures to acquirevary according to medical specialties: needle insertion in rheumatologyor anesthesia, forceps installation during difficult births ... Simulatorsreproducing such gestures require haptic interfaces with a variable ren-dered stiffness, featuring commonly called Variable Stiffness Actuators(VSA) which are difficult to embed with off-the-shelf devices. Existingsolutions do not always fit the requirements because of their significantsize. In contrast, pneumatic technology is low-cost, available off-the-shelfand has a better mass-power ratio. Its main drawback is its non-lineardynamics, which implies more complex control laws than with electri-cal motors. It also requires a compressed air supply. AmpĂšre researchlaboratory has developed during the last decade haptic solutions basedon pneumatic actuation, applied on a birth simulator, an epidural nee-dle insertion simulator, a pneumatic master for remote ultrasonography,and more recently a needle insertion under ultrasonography simulator.This paper recalls the scientific approaches in the literature about pneu-matic actuation for simulation and tools in the medical context. It isillustrated with the aforementioned applications to highlight the bene-fits of this technology as a replacement or for an hybrid use with classicalelectric actuators
Introducing Pneumatic Actuators in HapticTraining Simulators and Medical Tools
International audienceSimulators have been traditionally used for centuries dur-ing medical training as the trainees have to improve their skills beforepracticing on a real patient. Nowadays mechatronic technology has openthe way to more evolved solutions enabling objective assessment anddedicated pedagogic scenarios. Trainees can now practice in virtual en-vironments on various body parts, with current and rare pathologies, forany kind of patient (slim, elderly ...). But medical students need kines-thetic feedback in order to get significant learning. Gestures to acquirevary according to medical specialties: needle insertion in rheumatologyor anesthesia, forceps installation during difficult births ... Simulatorsreproducing such gestures require haptic interfaces with a variable ren-dered stiffness, featuring commonly called Variable Stiffness Actuators(VSA) which are difficult to embed with off-the-shelf devices. Existingsolutions do not always fit the requirements because of their significantsize. In contrast, pneumatic technology is low-cost, available off-the-shelfand has a better mass-power ratio. Its main drawback is its non-lineardynamics, which implies more complex control laws than with electri-cal motors. It also requires a compressed air supply. AmpĂšre researchlaboratory has developed during the last decade haptic solutions basedon pneumatic actuation, applied on a birth simulator, an epidural nee-dle insertion simulator, a pneumatic master for remote ultrasonography,and more recently a needle insertion under ultrasonography simulator.This paper recalls the scientific approaches in the literature about pneu-matic actuation for simulation and tools in the medical context. It isillustrated with the aforementioned applications to highlight the bene-fits of this technology as a replacement or for an hybrid use with classicalelectric actuators