Physical Mannequin Research Articles

Examining the validity and fidelity of a virtual reality simulator for basic life support training

BackgroundVirtual reality (VR) offers an immersive and practical method for training medical skills, especially in emergency healthcare settings. However, it is unclear whether learning in VR will translate into real-world performance benefits. To explore these potential transfer effects, we examined the validity and fidelity of a bespoke VR environment for Basic Life Support (BLS) training, a generic skill in medical training programmes.MethodsTwenty-two medical trainees performed standardised BLS procedures within two simulation conditions: one in VR, using a Pico Neo 3 standalone system; the other in a real-world synthetic environment, which included a physical mannequin and resuscitation equipment. Patterns of task behaviour, workload, sense of presence, and visual attention were derived from user self-report questionnaires, video recordings, and eye-tracking data.ResultsData showed that the VR training environment was sufficiently high in face validity to immerse the participants, and that trainees were displaying realistic task behaviours and procedural actions. However, the fidelity of user interactions and movements in VR proved atypical, which seemed to disrupt participants’ attentional and motor responses.ConclusionsResults suggest that VR may have limitations for improving physical skills in the context of BLS training, yet be potentially valuable for developing task procedures and/or perceptual abilities.

Block pattern design system using 3D zoning method on digital environment for fitted garment

The 2D pattern-making methods which are entirely based on body measurements are widely used and practiced to design garments in today’s digital environment. Such a method is highly criticized due to a lack of consideration for the body's different morphological and anthropometric data. However, such a method would be effective with many precise and repetitive adjustments and with the help of manual expert know-how. For the last few decades, designers have also used a garment designing technique that is carried out directly on a physical mannequin or fashion model, called the draping technique. The current study is devising and implementing a digital garment design technique in the 3D pattern-making process to create and fit the human body morphology in a 3D digital environment. This technique is based on the analysis of 2D pattern-making methods used by model makers. It also highlights the morphological contour and anthropometric links that have been used to develop a similar method in a 3D environment. However, the proposed methods are performed directly on the 3D wearer's morphology as in the manual 3D draping techniques, which avoids morphological interpretation errors. Such a process helps to control the fit of the 3D garment by determining the ease allowance. Besides, the methods integrated a 3D zoning technique to improve the 3D modelling and to ensure the best possible drape and analysis between the garment and the wearer's body. Further work is required to validate the block pattern for general application based on various parameters including fabric, garment style, body position, etc.

O-050 Virtual reality applications in ultrasound

Abstract text Surgical simulation has been introduced in surgical training since 1920 following the example of airline and military industry. Recently, the Association of American Medical Colleges commented on the increased use of simulation in different medical specialties, recognizing its potential ability to improve patients safety and to enhance healthcare in general. Historically, graduating obstetrics and gynecology residents have been expected to learn following the adage ‘see one, do one, teach one’, which required a high volume experience. Nowadays, as the complexity of procedures increases and surgical volume decreases, in order to acquire surgical skills rapidly there is the need to integrate surgical and ultrasound virtual simulation into modern residency training alongside traditional teaching methods. In addition, recent changes in the field (e.g. workhours restrictions, decreased bedside teaching) have high lightened these necessities. Ultrasonography is a skill that requires a complex interplay of motor skills and visual-cognitive skill. The learning process include two steps: an initial global assessment followed by a focal search for pathology and key landmarks. Recently more attention has been paid to design increasingly sophisticated simulators for ultrasound in obstetrics and gynecology. These are broadly divided into to major categories: physical mannequins and virtual reality simulators. The physical mannequins practically consist in low cost silicon dummies that enable learners to discover basic anatomical and pathological findings using real ultrasound equipment. This type of simulators allows the trainees to learn haw to use the equipment in order to obtain proper scans. However, the case complexity is limited due to the low fidelity of the physical mannequins. In addition there is no automated feedback and a supervisor is always needed during the practice. The virtual reality simulators usually rely on haptic devices or physical mannequins that record probe movements during transabdominal or transvaginal scans and combined them with computer-animated/real ultrasound images. Instructions and automated feedback are provided during the practice. They often contains multiple cases allowing the trainees to be exposed to different clinical scenarios. In the field of Reproductive Endocrinology and Infertility some ultrasound and surgical skills are required for independent practice including transvaginal oocyte pick-up, hysterosalpingocontrastsonography (HyCoSy) and embryo-transfer. Considering advantages and disadvantages of both apprenticeship models (traditional training and simulator-based training), a blended approach which combines simulator-based training with didactic and more traditional training on real patients could be introduced. So far the use of simulation-based training has shown promising results in terms of moderate effects on patient outcomes and large effects on trainee behavior in the clinical setting. It could be useful especially in the initial part of a structured training for novices, enabling them to acquire basic skills and to reach a predefined level of performance in a safe and controlled environment, before applying the procedure to real patients.

A virtual reality methodology for cardiopulmonary resuscitation training with and without a physical mannequin.

Cardiopulmonary resuscitation (CPR) is an emergency procedure that can increase survival after a cardiac arrest. Performing CPR effectively requires both procedural knowledge and manual skills. Traditional CPR training methodology includes lessons led by instructors and supervised practice on mannequins, thus requiring considerable resources. This paper proposes a new methodology for low-cost CPR training based on virtual reality (VR) with and without the addition of a physical mannequin. Moreover, it describes an experimental evaluation of the methodology that assessed gain in manual skills during training, transfer of procedural knowledge and manual skills in a final assessment, and changes in self-efficacy with three measurements over time (pre-training, post-training, and post-assessment). We implemented a VR application that supports the proposed methodology, and can thus be used with or without a mannequin. The experimental evaluation involved 30 participants who tried CPR in VR twice, performing two repetitions of 30 chest compressions per trial. Half participants tried the VR application with the mannequin and half without it. Final assessment required all participants to perform CPR on the mannequin without the assistance of VR. To assess self-efficacy, participants filled in a questionnaire at the three times of measurement. Mixed-design ANOVAs showed effects of repetition, effects of group, or interaction between the two variables on manual skills assessed during training. In the final assessment, participants in both groups correctly remembered most of the steps of the procedure. ANOVAs revealed differences between the two groups only in pressure-related skills (better with mannequin) and in the number of wrong steps added to the procedure (better without mannequin). Mixed-design ANOVA showed a self-efficacy increase in both groups after training, which was maintained after final assessment. The proposed VR methodology for CPR training has a positive effect on procedural knowledge, manual skills, and self-efficacy, with as well as without the physical mannequin. Trials on a mannequin are required to understand the correct pressure for chest compression. This supports the adoption of the proposed VR methodology to reduce instructor and mannequin time required to teach CPR to trainees.

Safety and Fidelity in Electroconvulsive Therapy (SAFE ECT): A Novel Virtual Reality-Based Training Program in Electroconvulsive Therapy (Phase 1).

Safety and Fidelity in Electroconvulsive Therapy (SAFE ECT): A Novel Virtual Reality-Based Training Program in Electroconvulsive Therapy (Phase 1).

Vascular Ultrasound Simulator with B-Mode Images and Real-Time Color and Spectral Doppler for Standardized Assessment of Performance and for Training

Introduction - Duplex ultrasound (DUS) is relied upon for diagnosis of vascular pathology but providers need to be proficient to ensure that patients are referred appropriately for treatment. A standardized method for assessment of competence in DUS could provide feedback during training, assist in certification of personnel, and support laboratory accreditation. We developed a simulator that enables assessment of the skills required for DUS. Methods - The simulator displays a B-mode image that updates in real-time as the user manipulates a mock transducer on the mannequin, overlaid by color-coding of velocity data. Doppler spectral waveforms are generated according to user-defined settings such as beam steering, pulse repetition frequency, Doppler angle, and sample volume size. Each simulated case is built from a series of B-mode images acquired from a patient that are reconstructed as a 3D gray-scale volume. Three-dimensional surface models of the vessels are created and computational flow modeling is used to calculate time-varying blood flow velocity for all points within the lumen. We developed a user interface that reports the user’s measurements of peak systolic velocity (PSV) and flow volume, selected parameter settings, assessment of pathology, and diagnosis. The accuracy of the simulation was assessed by comparing the velocity measured from the spectral waveform with the actual velocity at the location of the sample volume within the lumen from the flow model. Results - Four expert examiners made 43 PSV measurements on the inflow artery and outflow vein of 2 dialysis access shunt models. Three experts made 36 measurements on 2 carotid artery models (one normal, one stenosed). The mean absolute deviation from the actual PSV was 8 ± 6% and 8 ± 5%, respectively, and was similar between vessel segments and between operators. The Image Library has 15 case studies with carotid artery, dialysis shunt, and femoral artery models. Conclusion - This is the first simulator that can generate color Doppler images and Doppler spectral waveforms that respond appropriately to parameter settings and to scanning a physical mannequin in real-time. The validation results demonstrate that the user can accurately measure blood flow velocity from the spectral waveform using the settings on the simulator. The simulator enables skill in DUS to be measured in an automated and standardized manner. Test difficulty and content can be adjusted to different training levels through case selection. Feedback can be given to the learner during training, and objective and quantitative performance data can be obtained for assessing the progress of trainees and for surveying the competence of health care providers.

Towards an Advanced Virtual Ultrasound-guided Renal Biopsy Trainer.

Ultrasound (US)-guided renal biopsy is a critically important tool in the evaluation and management of non-malignant renal pathologies with diagnostic and prognostic significance. It requires a good biopsy technique and skill to safely and consistently obtain high yield biopsy samples for tissue analysis. This project aims to develop a virtual trainer to help clinicians to improve procedural skill competence in real-time ultrasound-guided renal biopsy. This paper presents a cost-effective, high-fidelity trainer built using low-cost hardware components and open source visualization and interactive simulation libraries: interactive medical simulation toolkit (iMSTK) and 3D Slicer. We used a physical mannequin to simulate the tactile feedback that trainees experience while scanning a real patient and to provide trainees with spatial awareness of the US scanning plane with respect to the patient's anatomy. The ultrasound probe and biopsy needle were modeled using commonly used clinical tools and were instrumented to communicate with the simulator. 3D Slicer was used to visualize an image sliced from a pre-acquired 3-D ultrasound volume based on the location of the probe, with a realistic needle rendering. The simulation engine in iMSTK modeled the interaction between the needle and the virtual tissue to generate visual deformations on the tissue and tactile forces on the needle which are transmitted to the needle that the user holds. Initial testing has shown promising results with respect to quality of simulated images and system responsiveness. Further evaluation by clinicians is planned for the next stage.

A systematic pattern generation system for manufacturing customized seamless multi-layer female soft body armour through dome-formation (moulding) techniques using 3D warp interlock fabrics

Female participants in different perilous tasks including law enforcement offices have been considerably increased in the last few decades. However, they mostly wear men’s body armour with smaller sizes which brings a negative upshot not only in ballistic protection performance, comfort, fitness but also in a psychological point of view. Hence, manufacturing female soft body armour based on their unique morphological differences for better ballistic protection without conceding fitness and comfort are in great demand. This research work presented a novel method using a systematic 3D design approach through parametrization process to generate block patterns for manufacturing successive layer in the panels. The deformable mesh on the 3D virtual adaptive female model was developed with grading values of zero. Parametrization process based on the thickness of each layer in the 3D design database was applied to generate the different successive meshes on the virtual mannequin with appropriate coordinates. Later, the multi-layers mesh developed on the virtual 3D female body has been flattened to acquire the different layer’s pattern. Due to its excellent mouldability behaviour, 3D warp interlock fabrics made of high-performance fibre has been designed and developed to manufacture the seamless female body armour with a dome-formation process. The manufactured multi-layer panels were draped on the standard female physical mannequin for experimental validations. The result shows that the new 3D design approach and its manufacturing system was found easy and precise to generate the different multi-layer panels pattern for developing seamless female soft body armour.

Up or down? A randomized trial comparing image orientations during transvaginal ultrasound training

There is no international consensus on the orientation of transvaginal ultrasound images and no evidence exists to support the superiority of one image orientation over the other. The aim of this study was to compare learning curves and skills transfer in a group of novices randomized to top-down or bottom-up image orientation, and to determine whether individual preferences for image orientation affect learning and skills transfer. 60 senior medical students, with no prior ultrasound experience, were randomized to orient the image top-down or bottom-up during training on an ultrasound simulator until attaining expert levels of performance. Participants then completed a transfer test involving a systematic ultrasound examination on a physical mannequin using real ultrasound equipment. Performance was assessed during the transfer test by two independent raters using the objective structured assessment of ultrasound skills (OSAUS) score and a global rating score. The bottom-up group reached the expert level with significantly fewer attempts than did the top-down group [median±interquartile range: 4±2 vs 5±3] (U=285.5, P=0.014). The bottom-up group used less time to achieve the expert level (median±interquartile range: 3h2m±1h14m vs 3h28m±2h21m) (U=301.5, P=0.029). The two groups performed similarly during the transfer test with respect to their OSAUS scores (top-down 56.7% vs bottom-up 53.2%, P=0.13). The global rating scores were higher in the top-down group (top-down 57.1% vs bottom-up 50.0%, P=0.02). Orientation of the images bottom-up rather than top-down, led to a steeper learning curve, but had little or no impact on the subsequent transfer of skills.

Modeling of half-scale human bodies in active body positions for apparel design and testing

PurposeThe design and testing of clothing for activewear requires complex assessments of the suitability of the clothing when the body is in motion. The purpose of this paper is to investigate full body 3D scanning of active body poses in order to develop “watertight” digital models and half-scale dress forms to facilitate design, pattern making and fit analyses. Issues around creating a size set of scans in order to facilitate fit testing of activewear across a size range were also explored.Design/methodology/approachResearchers experimented to discover effective methods for 3D body capture in the cycling position and reconstruction of the body in a reliable way. In total, 25 cyclists were scanned and size representatives were selected from these participants. Methods of creating half-scale forms were developed that make optimum use of modern materials and technologies. Half-scale dress forms were created in two active positions in a range of sizes for fit testing and design. A set of half-scale and full-scale bike shorts in two styles were manufactured and fit tested on the half-scale forms compared to fit testing on the scan participants to test validity of this method of assessing fit.FindingsIssues in capturing and reconstructing areas occluded in the scanning process, and reconstructing the interface with the bicycle seat were addressed. Active digital forms were developed across the size range, from which both digital avatars and physical mannequins were developed for pattern development and fit testing. The production and use of precisely half-scaled tools for garment testing was achieved and validated by comparing fit test results in active positions on the half-scale forms and on participants who were scanned to create these forms.Originality/valueDesign modifications for active positions to date are based on linear measurements alone, which do not define the 3D body adequately. Despite much research using body scanners, only limited data exist on the body in active poses, and the concept of creating half-scale forms by scanning fit models throughout the size range in active body positions is a novel concept. The progress made in resolving material and process experiments in creating the actual half-scale forms, and testing their suitability for fit testing provides a basis for further research aimed at developing similar dress forms for other activewear garments.

The Predictive Value of Ultrasound Learning Curves Across Simulated and Clinical Settings.

The aim of the study was to explore whether learning curves on a virtual-reality (VR) sonographic simulator can be used to predict subsequent learning curves on a physical mannequin and learning curves during clinical training. Twenty midwives completed a simulation-based training program in transvaginal sonography. The training was conducted on a VR simulator as well as on a physical mannequin. A subgroup of 6 participants underwent subsequent clinical training. During each of the 3 steps, the participants' performance was assessed using instruments with established validity evidence, and they advanced to the next level only after attaining predefined levels of performance. The number of repetitions and time needed to achieve predefined performance levels were recorded along with the performance scores in each setting. Finally, the outcomes were correlated across settings. A good correlation was found between time needed to achieve predefined performance levels on the VR simulator and the physical mannequin (Pearson correlation coefficient .78; P < .001). Performance scores on the VR simulator correlated well to the clinical performance scores (Pearson correlation coefficient .81; P = .049). No significant correlations were found between numbers of attempts needed to reach proficiency across the 3 different settings. A post hoc analysis found that the 50% fastest trainees at reaching proficiency during simulation-based training received higher clinical performance scores compared to trainees with scores placing them among the 50% slowest (P = .025). Performances during simulation-based sonography training may predict performance in related tasks and subsequent clinical learning curves.

Authoring, deploying, and managing dynamic Virtual Patients in Virtual Clinical Environments

Abstract Following their introduction at the beginning of the 21st century, interactive or dynamic Virtual Patients are beginning to be used more widely in clinical education. They can be seen as being at the end of a continuum of simulation technical complexity, having been earlier developed on a wide range of “media”: human actors, paper, video, physical mannequins, etc. This paper focuses on the current emergent more complex Virtual Patients in three-dimensional (3D) immersive clinical environments. In these environments, in silico 3D patient avatars interact directly in response to virtual clinical interventions undertaken by avatars, each of which is controlled by one or more users. The paper explores the issues of authoring, deploying, and managing these real-time, dynamic Virtual Patients using as an example the immersive clinical environment CliniSpace. As clinician-accessible Virtual Patient authoring is now becoming available in immersive clinical environments, so these wider clinical and managerial non-technical issues are coming rapidly to the fore.

A SURVEY ON 3D HUMAN BODY MODELING FOR INTERACTIVE FASHION DESIGN

With the advancement in computer technology, the use of 3D virtual mannequin has mostly replaced the use of physical mannequin in the fashion industry. This paper reviews current interaction frameworks of 3D human body modeling for interactive fashion design and an optimized interaction framework is provided. Four methods are used in this study to collect the human body data to create the 3D body model: photograph-based method, laser scan method, feature curve method and combined method. The crafted garment modeling could be used for garment fitting and 2D pattern flattening.

Interventional radiology virtual simulator for liver biopsy

Training in Interventional Radiology currently uses the apprenticeship model, where clinical and technical skills of invasive procedures are learnt during practice in patients. This apprenticeship training method is increasingly limited by regulatory restrictions on working hours, concerns over patient risk through trainees' inexperience and the variable exposure to case mix and emergencies during training. To address this, we have developed a computer-based simulation of visceral needle puncture procedures. A real-time framework has been built that includes: segmentation, physically based modelling, haptics rendering, pseudo-ultrasound generation and the concept of a physical mannequin. It is the result of a close collaboration between different universities, involving computer scientists, clinicians, clinical engineers and occupational psychologists. The technical implementation of the framework is a robust and real-time simulation environment combining a physical platform and an immersive computerized virtual environment. The face, content and construct validation have been previously assessed, showing the reliability and effectiveness of this framework, as well as its potential for teaching visceral needle puncture. A simulator for ultrasound-guided liver biopsy has been developed. It includes functionalities and metrics extracted from cognitive task analysis. This framework can be useful during training, particularly given the known difficulties in gaining significant practice of core skills in patients.

An Augmented Reality Haptic Training Simulator for Spinal Needle Procedures

This paper presents the prototype for an augmented reality haptic simulation system with potential for spinal needle insertion training. The proposed system is composed of a torso mannequin, a MicronTracker2 optical tracking system, a PHANToM haptic device, and a graphical user interface to provide visual feedback. The system allows users to perform simulated needle insertions on a physical mannequin overlaid with an augmented reality cutaway of patient anatomy. A tissue model based on a finite-element model provides force during the insertion. The system allows for training without the need for the presence of a trained clinician or access to live patients or cadavers. A pilot user study demonstrates the potential and functionality of the system.

The utility of a 12-lead electrocardiogram electrode misplacement simulator in education

IntroductionA standard 12-lead electrocardiogram (ECG) is recorded using 6 precordial electrodes and 3 limb electrodes, all of which are positioned at precise anatomical landmarks. Nevertheless, up to 4% of all 12-lead ECGs are recorded with incorrect electrode placement. In these circumstances, the 12-lead ECG can emulate or conceal a pathological condition and, therefore, produce a misdiagnosis. This can be detrimental to the patient because it may yield unnecessary therapy. Despite this fact, ECG textbooks contain little or no information regarding the effects of electrode misplacement. In addition, current pedagogic tools, for example, physical mannequins, do not facilitate the free positioning of electrodes. In an attempt to address this issue, an intuitive Web-based application referred to as the Electrode Misplacement Simulator (EMS), has been developed to aid the classical teaching of electrocardiology. The EMS facilitates the free positioning of electrodes while rendering the corresponding ECG leads in real time. This study assessed the utility of the EMS as an educational tool.MethodsThe study population comprised 23 undergraduate students enrolled on the second year of a clinical physiology program. Eleven students were randomly selected and given access to the EMS for 1 week. The remaining 12 students did not use the EMS and relied solely on lectures for tuition. All students were informed that an examination relating to the effects of electrode misplacement would take place the following week. After 7 days, 9 students from the experimental group and 8 students from the control group completed the examination. The experimental group completed an additional questionnaire regarding the usability of the EMS.ResultsThe mean score of the control group was 11.56 (±2.83), whereas the mean score of the experimental group was 16.44 (±2.24). On interpretation, the experimental group performed approximately 30% better when compared with the control group. An unpaired 2-sample t test (t15 = 3.96, P = .00125) was used to examine this hypothesis. The P value rejected the null hypothesis and indicated a statistical significance at the 1% level (P < .01). Students who completed the usability questionnaire rated the usefulness, learnability, and the look and feel of the EMS between 4 and 5 on the Likert scale.ConclusionIn conclusion, the EMS was found to be a beneficial adjunct to the classical teaching of electrocardiology. This study hypothesized and proved that access to the EMS facilitated a better understanding of the effects of electrode misplacement as evidenced through an examination. In general, this study justifies the need for novel interactive tools to aid teaching in the field of electrocardiology.

A simulation tool for visualizing and studying the effects of electrode misplacement on the 12-lead electrocardiogram

Introduction Studies have shown that between 0.4% and 4% of all 12-lead electrocardiograms (ECGs) are recorded using incorrect electrode positions. Electrode misplacement can cause a misdiagnosis either by concealing a pathology or, on the contrary, by emulating a pathology. Irrespective of this fact, ECG textbooks contain little or no information regarding the effects of electrode misplacement. Moreover, current pedagogic tools, which include physical mannequins, do not allow for the free positioning of electrodes to demonstrate these effects. In recognition of this, an electrode misplacement simulator (EMS) has been developed in this study. Methods The EMS is a Web-based simulation developed using the Adobe Flash technology. The software allows the user to position the electrodes anywhere on the torso while rendering the corresponding ECG leads using body surface potential maps. A beta version of the EMS has been made available on the Internet. Results The EMS has been briefly evaluated by a random selection of delegates (n = 17) from the 37th Annual Conference on Computing in Cardiology. After completing representative tasks and using the EMS for approximately 30 minutes, all 17 participants completed a questionnaire. Overall, the responsiveness of the EMS was rated between 4 and 5 on a Likert scale, 94% of participants rated the “ease of use” between 4 and 5, and 88% of participants also rated the “look and feel” between 4 and 5 on a Likert scale. Conclusion The EMS has the potential to be used to support researchers in enhancing criteria currently used for detecting electrode misplacement. It could also be used to assist academic staff in teaching the effects of electrode misplacement. In this respect, it is currently being used as part of an undergraduate “Clinical Physiology” degree program at the University of Ulster.