High-fidelity Virtual Reality Research Articles

Exploring ambulance clinicians’ clinical reasoning when training mass casualty incidents using virtual reality: a qualitative study

BackgroundHow ambulance clinicians (ACs) handle a mass casualty incident (MCI) is essential for the suffered, but the training and learning for the ACs are sparse and they don’t have the possibility to learn without realistic simulation training. In addition, it is unclear what type of dilemmas ACs process in their clinical reasoning during an MCI. With virtual reality (VR) simulation, the ACs clinical reasoning can be explored in a systematic way. Therefore, the objective was to explore ambulance clinicians’ clinical reasoning when simulating a mass casualty incident using virtual reality.MethodsThis study was conducted as an explorative interview study design using chart- stimulated recall technique for data collection. A qualitative content analysis was done, using the clinical reasoning cycle as a deductive matrix. A high-fidelity VR simulation with MCI scenarios was used and participants eligible for inclusion were 11 senior ACs.Results/conclusionAll phases of the clinical reasoning cycle were found to be reflected upon by the participants during the interviews, however with a varying richness of analytic reflectivity. Non-analytic reasoning predominated when work tasks followed specific clinical guidelines, but analytical reasoning appeared when the guidelines were unclear or non-existent. Using VR simulation led to training and reflection on action in a safe and systematic way and increased self-awareness amongst the ACs regarding their preparedness for MCIs. This study increases knowledge both regarding ACs clinical reasoning in MCIs, and insights regarding the use of VR for simulation training.

Changes in forklift driving performance and postures among novices resulting from training using a high-fidelity virtual reality simulator: An exploratory study

Virtual reality (VR) has emerged as a promising tool for training. Our study focused on training for forklift driving, to address an ongoing worker shortage, and the unknown impact of repeated VR training on task performance and kinematic adaptations. We trained 20 novice participants using a VR forklift simulator over two days, with two trials on each day, and including three different driving lessons of varying difficulties. Driving performance was assessed using task completion time, and we quantified kinematics of the head, shoulder, and lumbar spine. Repeated training reduced task completion time (up to ∼29.8% of initial trial) and decreased both kinematic variability and peak range of motion, though these effects were larger for lessons requiring higher precision than simple driving maneuvers. Our results highlight the potential of VR as an effective training environment for novice drivers and suggest that monitoring kinematics could help track skill acquisition during such training.

Three-dimensional microscope skill acquisition: A randomised controlled study comparing two-dimensional laboratory microscope training, video gaming and virtual reality gaming

IntroductionFine microsurgical motor skill acquisition can be challenging. With increasing technological innovation the method of microsurgical skills acquisition may change. Studies show that laboratory-based microsurgical training programs on a 2D microscope significantly improves novice’s microsurgical skill acquisition. However, are these skills transferable to a 3D microscope or is gaming agility more important? We present a randomised control trial of three interventions, namely laboratory tabletop microscope training (LM), high-fidelity video gaming (Sony PlayStation 4 console) (VG) and high-fidelity virtual reality gaming (Sony PlayStation VR console) (VR) versus a control group. MethodsForty novice medical students were block randomised to four groups: control (no intervention) n=10, LM n=10, VG n=10 and VR n=10. Participants performed chicken femoral artery anastomosis using the Aesculap Aeos® 3D microscope platform at baseline and again after intervention. Performance was evaluated using a modified structured assessment of microsurgery skills (mSAMS) score, time taken to complete anastomosis and time for suture placement by two blinded independent assessors. ResultNo statistically significant difference was noted between the groups at baseline. There was a statistically significant improvement in the LM arm between baseline and post-training for mSAMS score and time for suture placement. In the VG, VR and control groups no statistically significant difference was observed. ConclusionOur study demonstrates that during early microsurgical training, an intense laboratory-based microsurgical training program significantly improves novice’s anastomotic performance on a 2D microscope, and these skills are transferable when a 3D anastomosis is carried out. However, focussed gaming had no significant effect, and the results were akin to the non-intervention group.

Using Full Dive Virtual Reality to Operationalize Warfighter Resilience: From Proof of Concept and Usability of Hardware and Software to Upcoming Integrated Psychological Skills Training.

Modern warfare operations are volatile, highly complex environments, placing immense physiological, psychological, and cognitive demands on the warfighter. To maximize cognitive performance and warfighter resilience and readiness, training must address psychological stress to enhance performance. Resilience in the face of adversity is fundamentally rooted in an individual's psychophysiological stress response and optimized through decreased susceptibility to the negative impact of trauma exposure. The current project aims to optimize warfighter expertise, resilience, adaptability, and performance by utilizing a validated Full Dive Virtual Reality (FDVR) training platform to provide high-fidelity, safe, and scalable, controlled stress exposure in highly realistic simulated training scenarios with the most advanced, immersive technology available. Following Institutional Review Board approval and consent, 2 operators were fitted with high-fidelity virtual reality headsets with hand and eye tracking, full-body haptic feedback suits, a 360° omnidirectional treadmill, and Food and Drug Administration (FDA) cleared biometric monitors. Following acclimation, operators were placed in an industrial fire scenario and instructed to respond as a firefighter and paramedic, to search for and resuscitate any casualties, extinguish the fire, and exfiltrate safely. Following initial acclimation and after each demonstration (n = 2), 3 semistructured interviews asked operators their perceptions and experiences related to FDVR, focusing on usability, feasibility, and safety. Biometric data were continuously recorded using the Caretaker Medical VitalStream. Proof-of-concept (POC) testing proved that the FDVR training platform is usable, safe, and feasible. It creates an immersive environment with physiological responses to mimic realistic Mass Casualty Events (MCEs). Using a case study approach, transcript data were analyzed using thematic analysis. Three major themes emerged: Sensory deficits reduced realism, but sensory feedback improved fidelity, vestibular discord affected the virtual reality experience but only when the system did not respond naturally to operator movement after acclimation, and movement accommodations were made by operators to enhance usability, especially for fine motor movements. Biometric data analysis correlated timestamps from the VitalStream unit with operator responses to stress-inducing events (i.e., explosions, fires, and a deceased victim). Both operators exhibited significant physiological responses, including elevated heart rate, systolic blood pressure, and mean arterial pressure, particularly following explosions, encountering fire, and encountering the deceased victim within the training environment. The FDVR training platform overcomes the obstacles of in-person simulation training and provides the closest to real-life experience available. It will allow warfighters to train with their teams in immersive environments that replicate the conditions in which they are expected to perform their duties. The POC demonstrated that physiological responses can be mapped to scenario events to allow tracking of stress responses, cognitive load, as well as performance, and decision-making of the warfighter. The POC only involved 2 operators, but served to prove that the platform was safe and effective. Future testing plans to include 200 warfighters in operational teams of 10 to 12 to further validate the training effectiveness of the FDVR platform.

Evaluating Text Reading Speed in VR Scenes and 3D Particle Visualizations.

This work reports how text size and other rendering conditions affect reading speeds in a virtual reality environment and a scientific data analysis application. Displaying text legibly yet space-efficiently is a challenging problem in immersive displays. Effective text displays that enable users to read at their maximum speed must consider the variety of virtual reality (VR) display hardware and possible visual exploration tasks. We investigate how text size and display parameters affect reading speed and legibility in three state-of-the-art VR displays: two head-mounted displays and one CAVE. In our perception experiments, we establish limits where reading speed declines as the text size approaches the so-called critical print sizes (CPS) of individual displays, which can inform the design of uniform reading experiences across different VR systems. We observe an inverse correlation between display resolution and CPS. Yet, even in high-fidelity VR systems, the measured CPS was larger than in comparable physical text displays, highlighting the value of increased VR display resolutions in certain visualization scenarios. Our findings indicate that CPS can be an effective metric for evaluating VR display usability. Additionally, we evaluate the effects of text panel placement, orientation, and occlusion-reducing rendering methods on reading speeds in generic volumetric particle visualizations. Our study provides insights into the trade-off between text representation and legibility in cluttered immersive environments with specific suggestions for visualization designers and highlight areas for further research.

Role of technology enhanced assessment in medical and dental education: A scoping review

Background: Evolving innovative, feasible and cost effective technology related with teaching and learning in context of recent COVID-19 pandemic has led the medical educationists to think about its increased use in the assessment process. Need of the hour is to develop and establish a framework in our institutions for technology enhanced assessment (TEA) efficiently. European countries were using the e- assessment before the COVID-19 pandemic so their education system was less disturbed by it as compared to the Asian countries like Pakistan. TEA can be done with a number of tools and mobile phone technology, learning management systems (LMS) and social media have played remarkable role in this regard. The objective of this scoping review was to find best practice regarding the use of TEA in context of COVID-19 pandemic according to the Best Evidence Medical Education (BEME) principles. Methods: Databases which were searched were Google Scholar, Educational Resource Information System (ERIC), Cochrane library and ScienceDirect (Elsevier). The key words and phrases which we used for search were "TEA", "Online assessment", "assessment in context of COVID-19", "Role of TEA", "Advantages and disadvantages of TEA". 1252 articles were retrieved after screening total searched articles by Mendeley software. These articles were then assessed according to the eligibility criteria and 84 articles were selected out of which finally 12 articles were included in this scoping review after assessment of quality by Qualsyst appraisal tool. Data was extracted by using data extraction form which was synthesized to create the themes by axial coding. Results: After synthesis of data following themes were identified describing the TEA. What is TEA, role of TEA. Advantages and disadvantages of TEA, measurement and implementation issues in TEA. Prime benefit of TEA is its potential to foster learning by its ability to deliver vast variety of test formats in high fidelity virtual reality situations and by providing feedback after formative assessment using number of digital tools. Major issues related to TEA are cheating, validity, quality and security of test materials. Conclusion: E-assessment tools were already being used in European countries with the intent to improve the teaching and learning activities but after the COVID-19 pandemic it became the necessity. TEA has extreme potential for improving the learning and assessment process especially in context of current COVID-19 pandemic if the available technology is used efficiently. Implementation of TEA in place of conventional assessment should be tailored according to the local requirements and context. Finally the word of caution is to be prepared to address the issues of validity, quality, cheating and security of test materials connected with this technological change.

Passive Haptics and Conversational Avatars for Interacting with Ancient Egypt Remains in High-Fidelity Virtual Reality Experiences

As extended reality continues to grow, new possibilities arise to provide users with novel ways to experience cultural heritage (CH). In particular, applications based on virtual reality (VR), such as virtual museums, have gained increasing popularity, since they can offer new ways for preserving and presenting CH content that are not feasible in physical museums. Despite the numerous benefits, the level of immersion and presence provided by VR experiences still present challenges that could hinder the effectiveness of this technology in the CH context. In this perspective, it is crucial to provide the users with high-fidelity experiences, in which also the interaction with the objects and the characters populating virtual environments are realistic and natural. This article focuses on this challenge and specifically investigates how the combined use of tangible and speech interfaces can help improve the overall experience. To this aim, a immersive VR experience is proposed, which allows the users to manipulate virtual objects belonging to a museum collection (in the specific case, Ancient Egypt remains) by physically operating on 3D printed replicas and to talk with a curator’s avatar to get explanations by using their voice. A user study was conducted to evaluate the impact of the considered interfaces on immersion, presence, user experience, usability, and intention to visit, comparing the richest configuration against simpler setups obtained by either removing the tangible interface, the speech interface, or both (and using only handheld controllers). The results show that the combined use of the two interfaces can effectively contribute at making the CH experience in VR more engaging.

Changes in Forklift Driving Performance and Postural Behaviors Among Novices Who Are Trained Using a High-fidelity Virtual Reality Simulator: an Exploratory Study

Changes in Forklift Driving Performance and Postural Behaviors Among Novices Who Are Trained Using a High-fidelity Virtual Reality Simulator: an Exploratory Study

High-fidelity virtual reality simulation training in enhancing competency assessment in orthopaedic training.

Surgical competence is the ability to successfully apply academic knowledge, clinical skills and professional behaviour to inpatient care. Along with ensuring patient safety, the ability to communicate effectively, collaborative teamwork and probity, and achieving satisfactory competencies form the fundamental principles of good medical practice. Current strategies to develop surgical competencies include a range of formative and summative assessments. The cancellation of traditional face-to-face meetings and training opportunities during the COVID-19 pandemic had a profound impact on the delivery of medical education and opportunities to achieve surgical competencies. Simulation learning has been used since before the pandemic to deliver surgical training across all grades and specialities, including orthopaedic surgery. Simulation-based training provides a safe, controlled environment to develop skill acquisition. Simulated surgery using virtual reality has evolved following developments in software and hardware. This article explores the role of high-fidelity virtual reality simulation to assess competencies in orthopaedic training in the post-COVID-19 era, and examines whether simulation could be used within the curriculum to augment and improve training.

Training mental imagery skills of elite athletes in virtual reality

Mental imagery practice is widely used to help athletes prepare for competitions, as it can produce motor actions that enhance performance. The goal of imagery training for athletes is to create realistic images in their minds and to familiarize them with certain procedures, environments, and other aspects related to competition. Traditional imagery training methods use still images or videos, and athletes study the pictures or watch the videos in order to mentally rehearse. However, factors such as distractions and low realism can affect the training quality. In this paper, we present a Virtual Reality (VR) solution and a study that explores our hypotheses that H1: high-fidelity VR systems improve mental imagery skills, that H2: the presence of elements such as virtual onlookers or photographers in the VR environment arouse stronger emotional reactions and affect, and that H3: the presence of elements such as onlookers or photographers in the VR environment results in better mental imagery skill improvement. For that purpose, seven elite snow sports athletes were exposed to three training methods, Video, VR-Empty, and VR-Crowded. Our results show that a VR simulation with virtual onlookers (VR-Crowded) can significantly increase heart rate, which can induce increased emotional arousal. The results from validated questionnaires show no significant difference for the three training methods in terms of mental imagery and affect, but the results show an ascending trend for the athlete’s arousal from Video to the VR-Crowded condition. Gaze detection heat maps of interest areas for the two VR conditions support hypothesis H2 that environmental factors such as the presence of photographers, staff, and onlookers can increase head and eye movement, possibly indicating an increase in emotional arousal during imagery training. According to verbal feedback and interviews, athletes are more likely to use innovative training methods (e.g., the high-fidelity VR method) than traditional video-training methods.

Learning versus researching in a desktop virtual reality: How reception goals influence the processing of uncertain information marked by verbal and visual cues

Research on the impact of virtual reality (VR) on learning and the integrated model of processing evidence and its uncertainty values (Glaser, Lengyel, Toulouse, & Schwan, 2022) indicates that learners are in danger of mistakenly confusing the representational fidelity of information with scientific certainty and neglect uncertain information during the learning process. In order to find a solution to this problem, we have examined how high-fidelity VR presentations may be supplemented by markers of scientific uncertainty in a way that provides learners with an understanding of the evidential nature of the VR's content and, at the same time, have them elaborate on particular elements of the VR, irrespective of their status of scientific uncertainty. We assumed that certain information is better retained than uncertain information, and additionally inferred that reception goals might influence the retention of uncertain information. Participants (n = 75) were assigned to one of two experimental conditions: learning goal and research goal (between-subjects factor). In both conditions, participants walked through the virtual reconstruction of a historic building with architectural elements including uncertain, medium, and certain architectural elements (within-subject factor). Uncertainty was expressed visually by stop light colors and verbally in accompanying audio explanations. Retention of the appearance of architectural elements, uncertainty values, their verbal scientific justifications, and also exploratorily historical experience were measured in both reception goal conditions. Results showed that with a learning goal but not a research goal the appearance of certain architectural elements was better remembered than that of uncertain architectural elements. The memory of uncertainty values and their verbal scientific justifications was equal for uncertain, medium, or certain architectural elements in both reception goal conditions. Affective engagement during the historical experience was higher with a research than with a learning goal. The study extends existing theories on processing uncertain information and shows that orchestrating basic characteristics of VR with carefully chosen instructional strategies for successful knowledge acquisition is especially important for VRs containing uncertain information.

Design and validation of a virtual reality trainer for ultrasound‐guided regional anaesthesia

Virtual reality is a form of high-fidelity simulation that may be used to enhance the quality of medical education. We created a bespoke virtual reality trainer software using high resolution motion capture and ultrasound imagery to teach cognitive-motor needling skills necessary for the performance of ultrasound-guided regional anaesthesia. The primary objective of this study was to determine the construct validity between novice and experienced regional anaesthetists. Secondary objectives were: to create learning curves for needling performance; compare the virtual environment immersion with other high-fidelity virtual reality software; and compare cognitive task loads imposed by the virtual trainer compared with real-life medical procedures. We recruited 21 novice and 15 experienced participants, each of whom performed 40 needling attempts on four different virtual nerve targets. Performance scores for each attempt were calculated based on measured metrics (needle angulation, withdrawals, time taken) and compared between the groups. The degree of virtual reality immersion was measured using the Presence Questionnaire, and cognitive burden was measured using the NASA-Task Load Index. Scores by experienced participants were significantly higher than novices (p=0.002) and for each nerve target (84% vs. 77%, p=0.002; 86% vs. 79%, p=0.003; 87% vs. 81%, p=0.002; 87% vs. 80%, p=0.003). Log-log transformed learning curves demonstrated individual variability in performance over time. The virtual reality trainer was rated as being comparably immersive to other high-fidelity virtual reality software in the realism, possibility to act and quality of interface subscales (all p > 0.06) but not in the possibility to examine and self-performance subscales (all p < 0.009). The virtual reality trainer created workloads similar to those reported in real-life procedural medicine (p=0.53). This study achieved initial validation of our new virtual reality trainer and allows progression to a planned definitive trial that will compare the effectiveness of virtual reality training on real-life regional anaesthesia performance.

Mixed Reality Platforms in Telehealth Delivery: Scoping Review

Background The distinctive features of the digital reality platforms, namely augmented reality (AR), virtual reality (VR), and mixed reality (MR) have extended to medical education, training, simulation, and patient care. Furthermore, this digital reality technology seamlessly merges with information and communication technology creating an enriched telehealth ecosystem. This review provides a composite overview of the prospects of telehealth delivered using the MR platform in clinical settings. Objective This review identifies various clinical applications of high-fidelity digital display technology, namely AR, VR, and MR, delivered using telehealth capabilities. Next, the review focuses on the technical characteristics, hardware, and software technologies used in the composition of AR, VR, and MR in telehealth. Methods We conducted a scoping review using the methodological framework and reporting design using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Full-length articles in English were obtained from the Embase, PubMed, and Web of Science databases. The search protocol was based on the following keywords and Medical Subject Headings to obtain relevant results: “augmented reality,” “virtual reality,” “mixed-reality,” “telemedicine,” “telehealth,” and “digital health.” A predefined inclusion-exclusion criterion was developed in filtering the obtained results and the final selection of the articles, followed by data extraction and construction of the review. Results We identified 4407 articles, of which 320 were eligible for full-text screening. A total of 134 full-text articles were included in the review. Telerehabilitation, telementoring, teleconsultation, telemonitoring, telepsychiatry, telesurgery, and telediagnosis were the segments of the telehealth division that explored the use of AR, VR, and MR platforms. Telerehabilitation using VR was the most commonly recurring segment in the included studies. AR and MR has been mainly used for telementoring and teleconsultation. The most important technical features of digital reality technology to emerge with telehealth were virtual environment, exergaming, 3D avatars, telepresence, anchoring annotations, and first-person viewpoint. Different arrangements of technology—3D modeling and viewing tools, communication and streaming platforms, file transfer and sharing platforms, sensors, high-fidelity displays, and controllers—formed the basis of most systems. Conclusions This review constitutes a recent overview of the evolving digital AR and VR in various clinical applications using the telehealth setup. This combination of telehealth with AR, VR, and MR allows for remote facilitation of clinical expertise and further development of home-based treatment. This review explores the rapidly growing suite of technologies available to users within the digital health sector and examines the opportunities and challenges they present.

High-Fidelity Virtual Reality Simulation for the Middle Cranial Fossa Approach-Modules for Surgical Rehearsal and Education.

Virtual reality simulation has gained prominence as a valuable surgical rehearsal and education tool in neurosurgery. Approaches to the internal auditory canal, cerebellopontine angle, and ventral brainstem region using the middle cranial fossa are not well explored by simulation. We hope to contribute to this paucity in simulation tools devoted to the lateral skull base, specifically the middle cranial fossa approach. Eight high-resolution microcomputed tomography scans of human cadavers were used as volumetric data sets to construct a high-fidelity visual and haptic rendering of the middle cranial fossa using CardinalSim software. Critical neurovascular structures related to this region of the skull base were segmented and incorporated into the modules. The virtual models illustrate the 3-dimensional anatomic relationships of neurovascular structures in the middle cranial fossa and allow a realistic interactive drilling environment. This is facilitated by the ability to render bone opaque or transparent to reveal the proximity to critical anatomy allowing for practice of the virtual dissection in a graduated fashion. We have developed a virtual library of middle cranial fossa approach models, which integrate relevant neurovascular structures with aims to improve surgical training and education. A ready extension is the potential for patient-specific application and pathology.

Face validity of a virtual reality simulation platform to improve competency in endoscopy: a prospective observational cohort study.

Background and study aims Virtual reality endoscopic simulation training has the potential to expedite competency development in novice trainees. However, simulation platforms must be realistic and confer face validity. This study aimed to determine the face validity of high-fidelity virtual reality simulation (EndoSim, Surgical Science, Gothenburg), and establish benchmark metrics to guide the development of a Simulation Pathway to Improve Competency in Endoscopy (SPICE). Methods A pilot cohort of four experts rated simulated exercises (Likert scale score 1–5) and following iterative development, 10 experts completed 13 simulator-based endoscopy exercises amounting to 859 total metric values. Results Expert metric performance demonstrated equivalence ( P = 0.992). In contrast, face validity of each exercise varied among experts (median 4 (interquartile range [IQR] 3–5), P < 0.003) with Mucosal Examination receiving the highest scores (median 5 [IQR 4.5–5], P = 1.000) and Loop Management and Intubation exercises receiving the lowest scores (median 3 [IQR 1–3], P < 0.001, P = 0.004), respectively. The provisional validated SPICE comprised 13 exercises with pass marks and allowance buffers defined by median and IQR expert performance. Conclusions EndoSim Face Validity was very good related to early scope handling skills, but more advanced competencies and translation of acquired clinical skills require further research within an established training program. The existing training deficit with superadded adverse effects of the COVID pandemic make this initiative an urgent priority.

93EMF Understanding the Relationship Between the Emergency Department Built Environment and Physician Burnout Through High Fidelity Virtual Reality Modeling

93EMF Understanding the Relationship Between the Emergency Department Built Environment and Physician Burnout Through High Fidelity Virtual Reality Modeling

International audit of simulation use in pre-registration medical radiation science training

IntroductionSimulation-based education (SBE) can replicate the challenging aspects of real-world clinical environments, while providing a safe and less intimidating setting. Literature supports its use within medical radiation science (MRS) training for safe practice of psychomotor skills, development of problem solving, team working, interpersonal and decision-making skills and embedding awareness of patient safety. This project aimed to quantify usage of SBE resources and activities internationally and to evaluate how this changed during COVID-19 restrictions. MethodsAn anonymous online survey tool gathered data relating to programme demographics, simulation resources, simulation activities and future plans. A link to the survey was distributed to programme leads via social media, professional bodies and national networks. ResultsA total of 72 responses were received from a range of countries and representing a range of programme structures. Most respondents reported up to 100 h of SBE per student per year with low fidelity resources and image viewing software featuring most prominently. There was low reported engagement of service users within simulation activities. Respondents also indicated that COVID-19 had been a trigger for rapid uptake of simulation resources. ConclusionSBE forms an important aspect of MRS training internationally with low-fidelity resources being widely deployed. Where available, high fidelity virtual reality and specialised profession-specific resources were used heavily. There was a low level of reported engagement with service users or expert patients in simulation activities. Future research will identify whether the rapid uptake of SBE during COVID-19 continues and clarify the role of service users in SBE provision. Implications for practiceIncreased collaboration between MRS education providers may help to improve parity of SBE provision and identify additional opportunities to engage service users within SBE.

Gaze During Locomotion in Virtual Reality and the Real World.

How vision guides gaze in realistic settings has been researched for decades. Human gaze behavior is typically measured in laboratory settings that are well controlled but feature-reduced and movement-constrained, in sharp contrast to real-life gaze control that combines eye, head, and body movements. Previous real-world research has shown environmental factors such as terrain difficulty to affect gaze; however, real-world settings are difficult to control or replicate. Virtual reality (VR) offers the experimental control of a laboratory, yet approximates freedom and visual complexity of the real world (RW). We measured gaze data in 8 healthy young adults during walking in the RW and simulated locomotion in VR. Participants walked along a pre-defined path inside an office building, which included different terrains such as long corridors and flights of stairs. In VR, participants followed the same path in a detailed virtual reconstruction of the building. We devised a novel hybrid control strategy for movement in VR: participants did not actually translate: forward movements were controlled by a hand-held device, rotational movements were executed physically and transferred to the VR. We found significant effects of terrain type (flat corridor, staircase up, and staircase down) on gaze direction, on the spatial spread of gaze direction, and on the angular distribution of gaze-direction changes. The factor world (RW and VR) affected the angular distribution of gaze-direction changes, saccade frequency, and head-centered vertical gaze direction. The latter effect vanished when referencing gaze to a world-fixed coordinate system, and was likely due to specifics of headset placement, which cannot confound any other analyzed measure. Importantly, we did not observe a significant interaction between the factors world and terrain for any of the tested measures. This indicates that differences between terrain types are not modulated by the world. The overall dwell time on navigational markers did not differ between worlds. The similar dependence of gaze behavior on terrain in the RW and in VR indicates that our VR captures real-world constraints remarkably well. High-fidelity VR combined with naturalistic movement control therefore has the potential to narrow the gap between the experimental control of a lab and ecologically valid settings.

Two Wheelistic: Development of a High-Fidelity Virtual Reality Cycling Simulator for Transportation Safety Research

Two Wheelistic: Development of a High-Fidelity Virtual Reality Cycling Simulator for Transportation Safety Research

A custom virtual reality training solution for ophthalmologic surgical clinical trials

We present a summary of the development and clinical use of two custom designed high-fidelity virtual-reality simulator training platforms. This simulator development program began in 2016 to support the phase III clinical trial Archway (ClinicalTrials.gov identifier, NCT03677934) intended to evaluate the Port Delivery System (PDS) developed by Genentech Inc. and has also been used to support additional clinical trials. The two simulators address two specific ophthalmic surgical procedures required for the successful use of PDS and provide state-of-the-art physical simulation models and graphics. The simulators incorporate customized active haptic feedback input devices that approximate different hand pieces including a custom hand piece specifically designed for PDS implantation. We further describe the specific challenges of the procedure and the development of corresponding training strategies realized within the simulation platform.