Virtual reality training simulator for tooth preparation techniques

Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care.

Automatic performance assessment in Virtual Reality medical simulators: A model based on procedure trajectories and machine learning

Medical simulations bridge theory and practice in immersive settings. During this unique form of education, learners experience challenging medical scenarios without risking patient harm. The effectiveness of simulations stem from their ability to induce autonomic stress responses, which potentiate memory formation. Educators have adopted virtual reality (VR) and augmented reality (AR) to supplement traditional, mannequin-based simulations. In this Pro-Con commentary article, we discuss the competitive advantages and limitations of VR and AR simulation for medical training. VR uses computer-generated images (CGI) within head-mounted displays (HMDs) to enhance learning. Gamification of medical procedures in VR improves acquisition of complex skills, positioning VR simulation as a pivotal training tool. Participant embodiment while in VR develops non-technical skills such as improved communication and enhanced empathy. The placement of participants within CGI worlds that would otherwise be difficult or impossible to recreate situate VR as the ideal next step in simulation evolution. VR is superior to AR given its lower hardware costs, expansive software libraries, and complete immersion in CGI compared to limited holographic fields of view within AR. By displaying holograms within the participant's natural world, AR is primed to replace screen and VR technologies as the premier learning adjunct. The integration of real-world instruments with AR holograms provides innumerable methods for teaching procedural skills. In addition, AR enhances pre- and intra-operative planning by overlaying holographic, radiographic patient images over their own bodies. Because AR has the unique feature of maintaining direct eye contact between participants, scenarios that improve communication skills are easily created with holograms in the real world, eliminating the need for an entirely CGI VR environment. Immersive simulation efforts should skip the costs of creating VR scenarios and redirect efforts to developing AR simulation software. Although both VR and AR have limitations related to cost and ergonomics, immersive technologies are relatively more affordable and versatile than traditional mannequins and physical simulation centers. As adjuncts to enhance traditional simulation curricula, we advocate for continued research to demonstrate the validity and utility of these immersive technologies.

Practical skills training in enclosure fires: An experimental study with cadets and firefighters using CAVE and HMD-based virtual training simulators

Virtual reality (VR) technology has great potential in practical courses. This study aims to explain the benefits of virtual reality (VR) in the transformation of practical courses learning and student experience. This study will take physics courses as an example. Two independent studies were conducted, and college students were divided into two groups, using a computer all-in-one machine and a head-mounted display (HMD) device. Students using head-mounted display (HMD) reported higher levels of presence, engagement and empathy, compared to computer all-in-one, and had better mastery of knowledge than students using computer all-in-one. These findings suggest that virtual reality (VR) has a positive effect on student emotions in practical courses like physics. Moreover, head-mounted display (HMD) virtual reality (VR) devices have the potential to provide students with new immersive experiences, with cognitive and emotional benefits.

Operating room (OR) fires are rare but devastating events requiring immediate and effective response. Virtual Reality (VR) simulation training can provide a safe environment for practice of skills in such highly stressful situation. This study assessed interprofessional participants' ability to respond to VR-simulated OR fire scenarios, attitudes, numbers of attempt of the VR simulation do participants need to successfully respond to OR fires and does prior experience, confidence level, or professional role predict the number of attempts needed to demonstrate safety and pass the simulation. 180 surgical team members volunteered to participate in this study at Beth Israel Deaconess Medical Center, Boston, MA. Each participant completed five VR OR simulation trials; the final two trials incorporated AI assistance. Primary outcomes were performance scores, number of attempts needed to pass, and pre- and post-survey results describing participant confidence and experiences. Differences across professional or training role were assessed using chi-square tests and analyses of variance. Differences in pass rates over time were assessed using repeated measures logistic regression. One hundred eighty participants completed simulation testing; 170 (94.4%) completed surveys. Participants included surgeons (17.2%), anesthesiologists (10.0%), allied health professionals (41.7%), and medical trainees (31.1%). Prior to training, 45.4% of participants reported feeling moderately or very confident in their ability to respond to an OR fire. Eight participants (4.4%) responded safely on the first simulation attempt. Forty-three participants (23.9%) passed by the third attempt (VR only); an additional 97 participants (53.9%) passed within the 4-5th attempt (VR with AI assistance). Providers are unprepared to respond to OR fires. VR-based simulation training provides a practical platform for individuals to improve their knowledge and performance in the management of OR fires with a 79% pass rate in our study. A VR AI approach to teaching this essential skill is innovative, feasible, and effective.

Changes to Training Practices during a Pandemic - The Experience of the Irish National Trauma & Orthopaedic Training Scheme

To investigate the effect on final-product performance of a distributed, virtual reality (VR) simulation training program on cadaveric dissection performance and learning curves compared with standard VR simulation training during a temporal bone course. Educational interventional cohort study. The national Danish temporal bone courses of 2016 and 2017. Postgraduate year 2 to 5 residents in otorhinolaryngology. Nine participants volunteered for additional VR simulation training (intervention) before the temporal bone course, with training blocks distributed (i.e., separated). The remaining 28 participants received standard VR simulation training during the temporal bone course (control). VR simulation and cadaveric dissection final-product performances were analyzed by blinded raters using a 26-item modified Welling Scale. Distributed VR simulation training before the temporal bone course (intervention) significantly increased dissection final-product performance by 25% compared with standard VR simulation training during the course (control) (mean scores 12.8 points versus 10.3 points, p < 0.01). Distributed and repeated VR simulation practice markedly decreased drilling time. Guidance by the simulator-integrated tutor-function significantly increased final-product performance by 2.3 points compared with nontutored procedures but at the cost of increased drilling time. Skills acquired in a VR simulation environment translate to cadaveric dissection skills and repeated and distributed VR simulation can be used to further increase performance compared with standard VR simulation training during a temporal bone course. Further dissemination of inexpensive VR simulators would allow all future temporal bone course participants to train locally before attending future centralized courses.

Interaction with computers and virtual environments is almost totally based on visual displays, along with auditory feedback. Somesthetic feedback, a necessary feature in all other skilled activity, is usually absent. Haptic interfaces attempt to solve this problem by coupling the human sense of touch with a computer-generated world. Haptics is the science of applying tactile sensation and kinesthesis to interaction with computer applications. By using special input/output devices (joysticks, data gloves, or other devices), users can receive feedback from computer applications in the form of sensations felt in the hand or other parts of the body. These sensations include forces, vibrations and/or motions. The aim of this tutorial is to provide participants with an overview of the technical aspects of haptic feedback and provide information about different haptic feedback devices and applications of these devices using virtual reality and computer simulations for motor rehabilitation, learning and teleoperation. The tutorial will include opportunities for hands-on practice with haptic devices and different environments. The haptic devices available for hands-on practice will include the Novint Falcon, and the SensAble OMNI devices.

BackgroundVirtual reality (VR) dental simulators are currently used in preclinical skills training. However, with the development of extended reality technologies, the use of mixed reality (MR) has shown significant advantages over VR.ObjectiveThis study aimed to describe the research and development of a newly developed MR and haptic–based dental simulator for tooth preparation and to conduct a preliminary evaluation of its face validity.MethodsA prototype of the MR dental simulator for tooth preparation was developed by integrating a head-mounted display (HMD), special force feedback handles, a foot pedal, computer hardware, and software program. We recruited 34 participants and divided them into the Novice group (n=17) and Skilled group (n=17) based on their clinical experience. All participants prepared a maxillary right central incisor for an all-ceramic crown in the dental simulator, completed a questionnaire afterward about their simulation experience, and evaluated hardware and software aspects of the dental simulator.ResultsOf the participants, 74% (25/34) were satisfied with the overall experience of using the Unidental MR Simulator. Approximately 90% (31/34, 91%) agreed that it could stimulate their interest in learning, and 82% (28/34) were willing to use it for skills training in the future. Differences between the 2 study groups in their experience with the HMD (resolution: P=.95; wearing comfort: P=.10), dental instruments (P=.95), force feedback of the tooth (P=.08), simulation of the tooth preparation process (P=.79), overall experience with the simulation (P=.47), and attitude toward the simulator (improves skills: P=.47; suitable for learning: P=.36; willing to use: P=.89; inspiring for learning: P=.63) were not significant. The Novice group was more satisfied with the simulator’s ease of use (P=.04). There were significant positive correlations between the overall experience with the simulation and the HMD’s resolution (P=.03) and simulation of the preparation process (P=.001).ConclusionsThe newly developed Unidental MR Simulator for tooth preparation has good face validity. It can achieve a higher degree of resemblance to the real clinical treatment environment by improving the positional adjustment of the simulated patients, for a better training experience in dental skills.

Relatively inexpensive head mounted display (HMD) devices made possible by advances in digital imaging technology are moving the immersive virtual and augmented reality mediums into the entertainment mainstream. This departure from the traditional art of linear storytelling requires a richer production workflow and toolset capable of seamlessly integrating numerous potential narratives. An effective virtual reality (VR) workflow requires low-latency realtime synchronized capture of multiple live high-resolution video streams, realtime stitching and viewing of the captured assets, and realtime composition with computer generated elements optimally rendered for the HMD. This paper presents a realtime system for VR production that encompasses optimal high-bandwidth data transfers, graphics processor unit-based video stitching, and techniques for optimally rendering to the individual display characteristics of specific VR HMDs for on-set preview.

The objective of this paper is to describe the current status, advantages, and disadvantages of Virtual Reality simulators as tools for training and assessment of laparoscopic skills. This is a review of publications about Virtual Reality simulators in laparoscopic training and assessment. Information was obtained through author’s experience and by search of MEDLINE using the keywords Virtual Reality simulation, training, assessment and laparoscopic surgery. The references cited in these studies were reviewed to find out whether any other trials fitted the selection criteria. There are several validated Virtual Reality systems that allow the transfer of skills from the virtual environment to the operating room and objective assessment of operative skills in laparoscopic surgery. In conclusion, Virtual Reality simulators are valid and objective tools in surgical education. Several systems are currently considered sufficiently validated and ready to be implemented in comprehensive educational curricula in minimally invasive surgery.

BackgroundVideo-assisted thoracoscopic surgery (VATS) has become a standard approach for the treatment of lung cancer. However, its minimally invasive nature limits the field of view and reduces tactile feedback. These limitations make it vital that surgeons thoroughly familiarize themselves with the patient’s anatomy preoperatively. We have developed a virtual reality (VR) surgical navigation system using head-mounted displays (HMD). The aim of this study was to investigate the potential utility of this VR simulation system in both preoperative planning and intraoperative assistance, including support during thoracoscopic sublobar resection.MethodsThree-dimensional (3D) polygon data derived from preoperative computed tomography data was loaded into BananaVision software developed at Colorado State University and displayed on an HMD. An interactive 3D reconstruction image was created, in which all the pulmonary structures could be individually imaged. Preoperative resection simulations were performed with patient-individualized reconstructed 3D images.ResultsThe 3D anatomic structure of pulmonary vessels and a clear vision into the space between the lesion and adjacent tissues were successfully appreciated during preoperative simulation. Surgeons could easily evaluate the real patient’s anatomy in preoperative simulations to improve the accuracy and safety of actual surgery. The VR software and HMD allowed surgeons to visualize and interact with real patient data in true 3D providing a unique perspective.ConclusionsThis initial experience suggests that a VR simulation with HMD facilitated preoperative simulation. Routine imaging modalities combined with VR systems could substantially improve preoperative planning and contribute to the safety and accuracy of anatomic resection.

Background. Robotic-assisted thoracic surgery (RATS) is now standard for lung cancer treatment, offering advantages over traditional methods. However, RATS’s minimally invasive approach poses challenges like limited visibility and tactile feedback, affecting surgeons’ navigation through com-plex anatomy. To enhance preoperative familiarization with patient-specific anatomy, we devel-oped a virtual reality (VR) surgical navigation system. Using head-mounted displays (HMDs), this system provides a comprehensive, interactive view of the patient’s anatomy pre-surgery, aiming to improve preoperative simulation and intraoperative navigation. Methods. We integrated 3D data from preoperative CT scans into Perspectus VR Education software, displayed via HMDs for in-teractive 3D reconstruction of pulmonary structures. This detailed visualization aids in tailored preoperative resection simulations. During RATS, surgeons access these 3D images through Tile-ProTM multi-display for real-time guidance. Results. The VR system enabled precise visualization of pulmonary structures and lesion relations, enhancing surgical safety and accuracy. The HMDs offered true 3D interaction with patient data, facilitating surgical planning. Conclusions. VR sim-ulation with HMDs, akin to a robotic 3D viewer, offers a novel approach to developing robotic surgical skills. Integrated with routine imaging, it improves preoperative planning, safety, and accuracy of anatomical resections. This technology particularly aids in lesion identification in RATS, optimizing surgical outcomes.

Temporal bone surgery requires excellent surgical skills and simulation-based training can aid novices' skills acquisition. However, simulation-based training is challenged by early stagnation of performance after few performances. Structured self-assessment during practice might enhance learning by inducing reflection and engagement in the learning task. In this study, structured self-assessment was introduced during virtual reality (VR) simulation of mastoidectomy to investigate the effects on subsequent performance during cadaveric dissection. A prospective educational study with comparison with historical controls (reference cohort). At a temporal bone dissection course, eighteen participants performed structured self-assessment during 3h of VR simulation mastoidectomy training before proceeding to cadaver dissection (intervention cohort). At a previous course, eighteen participants received identical VR simulation training but without the structured self-assessment (reference cohort). Final products from VR simulation and cadaveric dissection were recorded and assessed by two blinded raters using a 19-point modified Welling Scale. The intervention cohort completed fewer procedures (average 4.2) during VR simulation training than the reference cohort (average 5.7). Nevertheless, the intervention cohort achieved a significantly higher average performance score both in VR simulation (11.1 points, 95% CI [10.6-11.5]) and subsequent cadaveric dissection (11.8 points, 95% CI [10.7-12.8]) compared with the reference cohort, who scored 9.1 points (95% CI [8.7-9.5]) during VR simulation and 5.8 points (95% CI [4.8-6.8]) during cadaveric dissection. Structured self-assessment is a valuable learning support during self-directed VR simulation training of mastoidectomy and the positive effect on performance transfers to subsequent cadaveric dissection performance.