Virtual Reality Modeling Research Articles

THE EVOLUTION OF VIRTUAL REALITY TOWARDS THE USAGE IN EARLY DESIGN PHASES

AbstractThe aim of the present work is to show possibilities with which 3D models in virtual reality (VR) can be created and exported. First an overview of the existing hard- and software is given. Subsequently, existing solution concepts are analysed which, however, are not used in product development. Based on these knowledge a concept for the creation of 3D models in VR and the export of these models is developed.

Introducing a Robotic Lumbar Puncture Simulator with Force Feedback: LP Simd

Purpose: Lumbar Puncture (LP) is widely used for spinal and epidural anesthesia or Cerebrospinal fluid (CSF) sampling procedures. As this procedure is highly complicated and needs high experience to be performed correctly, it is necessary to teach this skill to the physicians. Considering the limitation of number of usage of rubber models and advantages of Virtual Reality (VR) environment for digital training of skills, we tried to investigate the capability of VR environment to train the LP procedures.with TLE. Materials and Methods: Geometrical model of the lumbar area of L2 to L5 are extracted from fusion of MR and CT imaging modalities. Also physical model of resistance of each layers against needle insertion at lumbar area are investigated through specially designed sensorized handle for LP needle and recorded from a 41-yearold female patient. Then geometrical and physical models of lumbar area are fused together and the Virtual Reality (VR) model of it, with insertion force rendering capability is extracted. Then the model is integrated with a haptic device and the complete VR environment is investigated. Results: In this work we introduced a robotic Lumbar Puncture Simulator (LP Sim) with force feedback which may be used for training the LP procedures .Using LP Sim, when the trainee insert the needle inside the lumbar area at the provided virtual reality environment, he/she may feel the insertion forces against his/her movement inside the lumbar area. Conclusion: The LP Sim is a virtual reality-enabled environment, with force feedback, that provides an appropriate framework for training this skill.

Virtual Reality Models Based on Photogrammetric Surveys—A Case Study of the Iconostasis of the Serbian Orthodox Cathedral Church of Saint Nicholas in Sremski Karlovci (Serbia)

During recent years, the synergy of virtual reality (VR) and photogrammetry has become an increasingly prevalent way to visualize, represent, preserve and disseminate cultural heritage objects. Photogrammetry offers a reliable method for a faithful and accurate image-based modeling of real-world objects, while VR applications provide not only visualization, but also an immersive and interactive experience of the photogrammetrically reconstructed cultural heritage. This research aims to create and apply the method for providing VR experience in the context of cultural heritage by developing a workflow for the VR applications based on photogrammetric models. The proposed workflow was applied on the iconostasis of the Serbian Orthodox Cathedral church of Saint Nicholas in Sremski Karlovci (Serbia). The presented method is based on the following main steps: generation ofan accurate 3D reconstruction of the iconostasisusing photogrammetry, the 3D model optimization, retopology, control and analysis and the process of creating the VR experience using a game-engine. The final result is an interactive walk through the church, which provides the user with an opportunity to visualize the iconostasis and its individual icons through different perspectives and multiple levels of detail, which is not otherwise possible when observing the church interior.

Teaching cutaneous sensory distribution of the upper limb using interactive virtual reality

Understanding the normal distribution of dermatomes and the named sensory nerves that innervate the skin of the upper limb is a critical clinical tool for the medical student, as it can allow them to diagnose a spinal or peripheral nervous system pathology without advanced imaging. The anatomy of dermatomes and named sensory nerves is traditionally taught using 2‐dimensional (2D) images, with separate ventral and dorsal views that students labor to connect into a whole construct, which may not easily translate to 3‐dimensions (3D) for interacting with patients. We observed that this is a potential area for implementation of Virtual Reality (VR) innovation, which can more easily convey 3D concepts and thereby provide students with a novel method of learning that will more accurately reflect real‐world anatomy. We therefore designed a student‐lead, interactive VR group activity that would allow for better visualization of sensory nerve distributions to improve the anatomical and clinical connections for pre‐clinical medical students.An unmarked 3D model of a human male body in anatomical position was provided for students (n=103) in the program Medium with the Oculus Virtual Reality system. During a 45 minute lab session on upper limb anatomy, small groups (4–6 students) were assigned the goal of “painting” the unmarked 3D model with color‐coded segments to reflect 2D reference images of dermatome distribution for the upper limbs. One student per group volunteered to digitally paint the model in VR while their group mates watched their actions on a projection and verbally instructed them on translating the 2D reference images onto the 3D virtual model using anatomical terminology to reinforce understanding. After the activity, students were provided with a marked version of the 3D dermatome/named nerve maps created by the instructors as an independent study resource.No significant differences were noted on exam scores between cohorts that were provided VR activity (2019) and those that were taught using traditional 2D images (2018), with inconsistent performance on two exam questions among the anatomy cohorts. The dermatome question increased in percent correct (2018: 47%, 2019: 54%) while the named cutaneous nerve question decreased in correct responses (2018: 70%, 2019: 60%). These remain among the lowest scoring questions in terms of correct responses in our exam despite the VR intervention. Furthermore, student feedback on the activity was mixed. The instructor‐created independent study resource netted a high click‐through rate and student interactivity relative to other provided resources, though 66% of students reported not finding the activity useful. In future iterations of the exercise, time constraints will be removed by creating group assignments to be done outside of existing lab times. With adjustments, we predict these exercises will enhance student understanding of nerve/skin associations and will therefore deepen their clinically relevant knowledge on the presentations of pathological conditions. The 3D cutaneous nerve distribution model provides a more accurate and understandable reference for students to build their clinical knowledge than 2D references.

Determining Components of Medical Instructional Design based on Virtual Reality by Research Synthesis

Introduction: The purpose of the present study was to determine the components of medical education design based on virtual reality by research synthesis method. Methods: In the present study a synthesis method was used. In order to study the research background and to collect appropriate data among the databases of Science Direct, Springer, Scopus, ProQuest and Eric (ERIC) search. With the keywords of Educational Design, Virtual Reality, Medical Education, Augmented Reality, Research Synthesis identified from 150 external research cases (English language) between 2006 and 2019 and finally 20 of them with the most coordination and proportion were selected for evaluation. Result: By reviewing articles and themes analysis, medical education design has five main components that are as follows: 1- Analytical component including determining educational needs, defining learner characteristics, defining theoretical framework, defining characteristics of virtual reality technology, forming a corporate team. Designer, conduct feasibility study and determine the type of content suitable for presentation through virtual reality. Design component includes defining general goals, targeting goals that are achievable by virtual reality, defining features of a virtual reality-based learning environment (free routing, first-person, third-person vision), determining the type of interaction (visual, photo, touch). Virtual and immersion, defining educational strategies (small and large), determining the level of reality, determining the content and organizing it (navigation) 3. Component of production and production including: scenario design, user interface design, content design, design Avatar, Training Agent Design, Virtual Reality Modeling, Platform Development (Hardware and Software) 4. Support and Implementation including Training Implementation, System Integration Virtual education in curriculum, support (technical and educational) 5. Evaluation component including formative evaluation, aggregate evaluation, ease of use evaluation, small group evaluation, large group evaluation, virtual reality based learning environment and platform evaluation (software and hardware). Conclusion: With respect to that the components of medical education design based on virtual reality have been identified, it is recommended that the medical education process be organized according to the components of educational design and that educational principles and processes be designed according to the capacity of virtual reality technology.

Abstract WP129: The Heat Grading Scale as a Neurovascular Remodeling Based Score in Aneurysms Treated With Flow Diversion

Objective: To apply principles of neurovascular remodeling in the classification of flow diverted aneurysms to predict outcomes using the HEAT (Hemodynamics, Endothelialization and Aneurysmal Thrombosis) grading scale. Introduction: The goal of flow diversion is to exclude an aneurysm from circulation through endothelialization of the aneurysmal neck and hemodynamic induction of aneurysmal thrombosis. Current grading scales do not include the above parameters to evaluate aneurysms after flow diversion. Methods: Reconstructions using 360° virtual reality (VR) models based on volumetric digital subtraction angiography (DSA) scans of unruptured, wide-neck intracranial aneurysms treated with Pipeline™ from March 2010 to May 2018 at our comprehensive stroke center were built using Surgical Theatre ® . The HEAT grading scale was used to generate a 0 to 15-point score that evaluated residual filling (none 0%, entry remnant <5%, subtotal 5-95%, total >95%), stasis phase (persistent contrast at venous phase, clearance before venous phase, arterial clearance before capillary phase), endoleak (absence, presence), free-hanging edge (absent, present without thrombus, present with thrombus), in-stent stenosis (0-29% minimal, 30-49% mild, 50-69% moderate, 70-94% severe, 95-99% critical), and branch filling (complete, partial TICI 2b >50%, partial TICI 2a <50%, insufficient). Each case was assigned a HEAT score by four neurointerventionalists using DSA, CT angiography (CTA), and the VR model. Results: Fifty out of 86 Pipeline™ cases had 3D rotational DSA and met technical standards required to build the VR model. Clinical adverse events including central retinal artery occlusion, middle cerebral artery syndrome, and amaurosis fugax were positively associated with HEAT score (n=3, p=<0.001) as were subclinical adverse events including endoleak (n=2) and free-hanging edge with thrombus (n=2) (p=<0.001). Interrater variability was high (k=0.8). Conclusion: The HEAT grading scale is sensitive, reproducible, and associated with clinical outcome. Larger prospective studies are warranted to validate our results.

The Extended Pterional Craniotomy: A Contemporary and Balanced Approach.

Pterional craniotomy is the workhorse approach among cranial operative corridors. It is a highly flexible skull base approach that affords excellent exposure of the anterior cranial fossa, the circle of Willis, and the interpeduncular region. Its strategic use via dynamic retraction can obviate the need to use a more extensive skull base route, such as orbitozygomatic osteotomy, in select cases. The focus of the surgeon should be reaching the surgical target effectively while minimizing disruption of normal anatomy. In other words, the focus should be less on "how to get there" and more on "what to do when you are there." This multimedia presentation summarizes an efficient execution of this route and its expansion and demonstrates the surgical corridor via 3-dimensional virtual reality models.

Comparison of stand-alone cage and cage-with-plate for monosegmental cervical fusion and impact of virtual reality in evaluating surgical results

ObjectivesAfter ventral decompression of monosegmental cervical spondylotic stenosis, a stand-alone cage (SC) or cage-with-plate (CP) can be inserted for fusion. Postoperative radiological evaluation can be achieved using different imaging modalities. We retrospectively compared complications, as well as clinical and radiological outcomes for both fusion techniques, and analyzed the possible role of virtual reality (VR) in evaluating the postoperative results. Patients and methodsOne hundred seventeen patients were included (SC/CP: 54/63). Complications, as well as clinical and radiological outcomes of both fusion techniques were compared. Computed tomography (CT) scans were visualized via VR to measure the smallest cross-sectional area of the intervertebral neuroforamen in the lateral resection region, and to assess the degree of the intersegmental ossification. ResultsThere were no significant differences between the two fusion techniques regarding perioperative complication rates, fusion rates, or pain parameter (visual analogue scale (VAS) of arm pain, neck disability index). However, advantages regarding subsidence, kyphosis, and VAS of neck pain were found when using the CP versus SC. Using the VR technique, there was no significant difference between the two fusion techniques in the mean size of the cross-sectional area at the end of follow-up. ConclusionDue to the long-term advantages of CP fusion, we prefer a monosegmental cervical spinal fusion using CP. Reconstruction of postsurgical two-dimensional CT images into three-dimensional images, and the spatial and anatomical presentation in VR models, improved the evaluation of these postoperative results.

Applications of virtual reality modeling language technology for COVID-19 pandemic

During COVID-19 pandemic, researchers have used innovative technologies for fast tracking the development to end this pandemic. Virtual Reality (VR) has offered an imperative role for fighting this pandemic, through audiovisual-based virtual communication. Virtual reality modeling language (VRML), as an international standard of virtual reality, has developed rapidly. VRML expanded the function of script node by introducing Java and script programs written in java script language. This paper presents a VRML method. Libraries and platoons are virtualized to meet the normal use of users. In principle, any text editing system can be used for VRML programming, but some editing systems have few related functions and are not suitable for large-scale VRML Scene Design. The VRML algorithm proposed in this paper can be applied to large buildings. The VRML algorithm proposed in this paper is compared with the traditional algorithm. The VRML algorithm proposed in this paper is superior to the traditional algorithm in the aspects of realism, interactivity, design rationality and execution speed. The practicability of the VRML algorithm is proved. It provides help for people who are inconvenient to go out during the protection period of covid-19.

LOW-COST DEVELOPMENT OF AN INTERACTIVE, IMMERSIVE VIRTUAL REALITY EXPERIENCE OF THE HISTORIC CITY MODEL STADE 1620

Abstract. As virtual reality and 3D documentation and modelling technologies become increasingly powerful and affordable tools for architecture, planning, and cultural heritage preservation and communication, it has become increasingly important to develop low-cost methodologies for the creation of 3D immersive virtual environments and interactive experiences. Doing so makes this technology more viable for institutions such as museums and other cultural institutions, who often work within strict budgets. In this paper, we describe a workflow used to build an interactive, immersive virtual reality experience around a virtual city model of the town of Stade (Germany) in the year 1620. This virtual city model is based on a physical 3D model of the town, exhibited in the Stade town hall. The workflow begins with the digitization of this model using digital photogrammetry, followed by the subsequent low- and high-polygon modelling of the individual architectural assets in Autodesk Maya, texture mapping in Substance Painter and finally visualisation within Unreal Engine 4. The results of this workflow are a detailed 3D historical environment with a high degree of realism and in which interactivity can easily be added. In addition, the workflow takes a highly iterative approach that allows the performance of the virtual environments in the game engine to be monitored at each stage of the process, and that allows adjustments to be made quickly. To increase the potential of the virtual environment as a tool for education and communication, interactive elements and simple game mechanics are currently being integrated.

Immersive Three-Dimensional Modeling and Virtual Reality for Enhanced Visualization of Operative Neurosurgical Anatomy

Learning the endless intricacies of operative neurosurgical anatomy requires that surgeons complement their intraoperative experiences with a variety of educational resources. In the past 2 decades, rapid improvements in digital graphics and computing power have enabled a new generation of 3-dimensional (3D) virtual resources that overcome limitations of more traditional 2-dimensional materials. Today, dozens of immersive 3D visualization platforms exist for applications such as learning neuroanatomy, simulating operative techniques, and planning surgical interventions with patient-specific models. The purpose of this article is to identify current applications of 3D digital modeling and virtual reality in neurosurgery. In addition, we showcase a new series of freely available 3D virtual-reality models created to assist in learning complex cranial anatomy. We anticipate these models to have a wide range of educational, clinical, and research applications. Three-dimensional visualization is poised to modernize the ways we learn and teach neurosurgical anatomy outside of the operating room. Future generations of neurosurgeons are expected to benefit from these technologies from the earliest stages of training.

Evaluating the Impact of Virtual Reality on Design Review Meetings

AbstractWith the help of virtual reality (VR), architectural design can be visualized interactively and at full scale. Viewers of VR models also gain an additional sense of spatial depth and volume...

Immersive VR Experience of Redeveloped Post-industrial Sites: The Example of \u201cZeche Holland\u201d in Bochum-Wattenscheid

Modern hardware and software innovations in the field of virtual reality (VR), such as VR headsets and accessible game engines, allow cartographers to create 3D environments which can be experienced from the ego perspective in real time and with a simulated illusion of physical presence (immersion) in the virtual representation. The new immersive experience of these virtual environments requires new ideas on how to present and orchestrate geographical information for the benefit of planning applications. This paper intends to present examples how VR-based 3D environments use can be enriched (based on the game engine Unreal Engine 4) to support the district development of a restructured post-industrial area. A VR model of a representative former industrial area in the German Ruhr district which was revitalized and part of a large urban transformation programme (IBA Emscher Park), serves an example. Today, the area of “Zeche Holland” in Bochum-Wattenscheid is characterized by a mix of residential and commercial uses. The area is used as a leisure route for locals and tourists, with an old winding tower as an important urban landmark in its centre. VR techniques allow to transport additional spatial information which cannot be experienced when visiting the real physical area. This paper addresses the potential of immersive VR environments representing a multifaceted and redeveloped area for planning and related usage scenarios. It shows how peculiarities of game engine-based VR can help to extend the immersive (3D) experience of geographic information.

2262 Hysteroscopic Loop Resection Training Utilizing a Virtual Reality and Low-Fidelity Model: a Pilot Study

Study Objective To evaluate the effectiveness of Virtual Reality (VR) and low-fidelity inanimate model for training and assessing OB/GYN residents in hysteroscopic loop resection. Design Prospective, cohort trial. Setting Single academic affiliated community hospital. Patients or Participants Twenty-four PGY-1 through PGY-4 OB/GYN residents were enrolled. Interventions All participants served as their own controls and underwent a pre-intervention objective structured assessment of technical skills (OSATS), during which the participant performed a baseline hysteroscopic loop resection using a low-fidelity model. Next, they completed a designated VR hysteroscopic loop resection simulator module to achieve a score >95%. Immediately after intervention, participants were then allowed to practice on the low-fidelity model prior to repeating a recorded hysteroscopic loop resection. Post-intervention performance was assessed using an OSATS. Participants also completed a subjective survey assessing comfort levels with the procedure pre- and post-intervention. All low-fidelity model hysteroscopic resections were recorded and scored by a single blinded evaluator. Measurements and Main Results Seven surgical skills were measured using OSATS and nine subjective measures were assessed, both using a Likert Scale of 1 (low) to 5 (high). All residents showed improvement in camera management, tissue handling, and instrument management (p= Conclusion Simulation improved baseline surgical skills and led to retention and improvement of same skills. In addition, resident comfort with the knowledge and procedural steps increased. As mechanical resection device use continues to increase, residents have fewer opportunities to train with hysteroscopic resectoscopes. Resident training should include simulation to increase both baseline development and retention of surgical skills.

Developing 3D–models for training facilities of a space complex

The paper discusses problem statement for and software implementation of a Graphic Package Adaptation System (GPAS) intended for reading and processing graphic design data, produced by the CAD system PTC Creo. The idea is to introduce into the process of building a 3-D model of a spacecraft for training facilities an additional operation of ‘automated adaptation of the graphic package’. The proposed process does not exclude manual refinement of the model, however, including additional automated components into the process makes it possible to significantly reduce human effort required to build a model for training facilities. The exchange of models between PTC Creo, GPAS and Autodesk 3ds Max is conducted at the level of the open format Virtual Reality Modeling Language (VRML). The paper describes GPAS architecture, provides views of work windows of the program, and methods of running its main functions. Key words: Digital design model, polygonal model, simplification, graphic design data.

Effect of 3-Dimensional Virtual Reality Models for Surgical Planning of Robotic-Assisted Partial Nephrectomy on Surgical Outcomes

Planning complex operations such as robotic-assisted partial nephrectomy requires surgeons to review 2-dimensional computed tomography or magnetic resonance images to understand 3-dimensional (3-D), patient-specific anatomy. To determine surgical outcomes for robotic-assisted partial nephrectomy when surgeons reviewed 3-D virtual reality (VR) models during operative planning. A single-blind randomized clinical trial was performed. Ninety-two patients undergoing robotic-assisted partial nephrectomy performed by 1 of 11 surgeons at 6 large teaching hospitals were prospectively enrolled and randomized. Enrollment and data collection occurred from October 2017 through December 2018, and data analysis was performed from December 2018 through March 2019. Patients were assigned to either a control group undergoing usual preoperative planning with computed tomography and/or magnetic resonance imaging only or an intervention group where imaging was supplemented with a 3-D VR model. This model was viewed on the surgeon's smartphone in regular 3-D format and in VR using a VR headset. The primary outcome measure was operative time. It was hypothesized that the operations performed using the 3-D VR models would have shorter operative time than those performed without the models. Secondary outcomes included clamp time, estimated blood loss, and length of hospital stay. Ninety-two patients (58 men [63%]) with a mean (SD) age of 60.9 (11.6) years were analyzed. The analysis included 48 patients randomized to the control group and 44 randomized to the intervention group. When controlling for case complexity and other covariates, patients whose surgical planning involved 3-D VR models showed differences in operative time (odds ratio [OR], 1.00; 95% CI, 0.37-2.70; estimated OR, 2.47), estimated blood loss (OR, 1.98; 95% CI, 1.04-3.78; estimated OR, 4.56), clamp time (OR, 1.60; 95% CI, 0.79-3.23; estimated OR, 11.22), and length of hospital stay (OR, 2.86; 95% CI, 1.59-5.14; estimated OR, 5.43). Estimated ORs were calculated using the parameter estimates from the generalized estimating equation model. Referent group values for each covariate and the corresponding nephrometry score were summed across the covariates and nephrometry score, and the sum was exponentiated to obtain the OR. A mean of the estimated OR weighted by sample size for each nephrometry score strata was then calculated. This large, randomized clinical trial demonstrated that patients whose surgical planning involved 3-D VR models had reduced operative time, estimated blood loss, clamp time, and length of hospital stay. ClinicalTrials.gov identifiers (1 registration per site): NCT03334344, NCT03421418, NCT03534206, NCT03542565, NCT03556943, and NCT03666104.

Occupant responses on satisfaction with window size in physical and virtual built environments

The satisfaction of occupants with a built environment can vary depending on their response to certain design variables, such as window size. However, relevant studies are limited because of the necessity for immense resources and the technical difficulty of creating a physical environment with different window sizes under the same experimental conditions. To resolve this problem, a randomized crossover study design and a new method for virtual reality modeling are implemented to conduct two sets of experiments in the physical and virtual environments. By investigating the satisfaction of 50 participants in different built environments, this study identifies the responses of occupants not only to changes in the window-to-wall ratio (WWR) (i.e., 15%, 30%, 45%, and 60%) but also to differences in the physical and virtual office spaces. The results of this experimental study confirm the following. (i) The virtual environment is an adequate representation of the physical environment of windowed spaces; it exhibits no significant difference in occupant satisfaction between physical and virtual spaces. (ii) The participants express a significantly higher occupant satisfaction with the senses of visual comfort, inner space, and openness with higher WWRs (i.e., 30%, 45%, and 60%) than that with a lower WWR (i.e., 15%) by up to 1.86 times. However, although it is not statistically significant, the increase in the WWR decreases occupant satisfaction in terms of sense of privacy. By applying the proposed experimental approach of utilizing a virtual environment, it is possible to investigate various occupant responses to different window design variables.

A multiparametric magnetic resonance imaging-based virtual reality surgical navigation tool for robotic-assisted radical prostatectomy.

Increased computational power and improved visualization hardware have generated more opportunities for virtual reality (VR) applications in healthcare. In this study, we test the feasibility of a VR-assisted surgical navigation system for robotic-assisted radical prostatectomy. The prostate, all magnetic resonance imaging (MRI) visible tumors, and important anatomic structures like the neurovascular bundles, seminal vesicles, bladder, and rectum were contoured on a multiparametric MRI using an in-house segmentation software. Three-dimensional (3-D) VR models were rendered and evaluated in a side room of the operating room. While interacting with the VR platform, a real-time stereo video capture of the in situ prostate was obtained to render a second 3-D model. The MRI-based model was then overlaid on the real-time model by using an automated alignment algorithm. Ten patients were included in this study. All MRI-based VR models were examined by surgeons immediately prior to surgery and at important steps where visualization of the tumors and their proximity to surrounding anatomic structures were critical. This was mainly during the preparation of the prostatic pedicles, neurovascular plexus, the apex, and bladder neck. All participants found the system useful, especially for tumors with locally aggressive growth patterns. For small and centrally located tumors, the system was not considered beneficial due to lack of integration into the robotic console. A fully integrated system with real-time overlays within the robotic stereo viewer was found to be the ideal scenario. We deployed a preliminary VR-assisted surgical navigation tool for robotic-assisted radical prostatectomies.

Nonbiological Microsurgery Simulators in Plastic Surgery Training: A Systematic Review.

Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model's complexity, characteristics, advantages, disadvantages, and validation measures taken. A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrieved based on strict inclusion and exclusion criteria. Fifty-seven articles met the inclusion criteria for review, reporting on 20 basic prosthetic models, 20 intermediate models, 13 advanced models, and six virtual reality simulators. A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today's training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.

Virtual reality: A new method to investigate cognitive load during navigation

Cognitive load has for long been studied in relation with learning processes. In our study, we investigated the impact of cognitive load in real-life situations taking the example of train travelers looking for relevant information in a train station. For this purpose, we created a virtual reality model of the tested train station from which we conducted a real-life study. Our aim was to compare travelers’ cognitive load impact in real-life environmental condition versus virtual reality simulation of the same environment. Regular and occasional travelers were recruited and were assumed as experts and novices, respectively. Investigation of cognitive load was based on physiological, subjective and behavioral aspects. These were measured using electrodermal activity, NASA-Task Load Index and recognition of relevant factual and contextual information seen by travelers in the train station, respectively. These three indicators used in both real-life and virtual reality were expected to follow the same trend, irrespective of the environmental condition, but were expected to vary with respect to expertise level. A higher cognitive load was forecasted for novice travelers than for expert travelers. The findings revealed no difference on the three indicators between virtual and real-life conditions. However, novice travelers showed higher cognitive load responses than expert travelers, in both environmental conditions. Our results suggest virtual reality as a promising technique for cognitive load analysis during navigation, and an effective method for neurocognitive assessments in daily life situations.