C O U R S E S Y L L A B U S - Home | NextMed / MMVRnextmed.com/wp-content/uploads/2018/07/MMVR-17_2009.pdf · 2018-07-27 · C O U R S E S Y L L A B U S JANUARY 19 – 22, 2009 THE

C O U R S E S Y L L A B U S

JANUARY 19 – 22, 2009 THE HYATT REGENCY LONG BEACHLONG BEACH, CALIFORNIA

ORGANIZERAligned Management Associates, Inc.

www.amainc.com

AMA.I N C

ORGANIZERAligned Management Associates, Inc.

www.amainc.com

Michael J.Ackerman PhDDavid C. Balch MAKóan Jeff Baysa MDSteve Charles MDPatrick C. Cregan FRACSLi Felländer-Tsai MD PhDHenry Fuchs PhDWalter J. Greenleaf PhDRandy S. Haluck MD FACSDavid M. HananelWm. LeRoy Heinrichs MD PhDHelene M. Hoffman PhDHeinz U. Lemke PhDAlan Liu PhDBertalan MeskóGreg T. Mogel MDKevin N. Montgomery PhDMakoto Nonaka MD PhD

Roger Phillips PhD CEng FBCS CIPTCarla M. Pugh MD PhDAlbert A. Rizzo PhDRichard A. Robb PhDJannick P. Rolland PhDRichard M. Satava MD FACSSteven Senger PhDRamin Shahidi PhDThomas Sangild Sørensen PhDDon StredneyJulie A. Swain MDRobert M. Sweet MDKirby G.Vosburgh PhDDave Warner MD PhDSuzanne J.Weghorst MA MSBrenda K.Wiederhold PhD MBA BCIAPatricia Youngblood PhD

[email protected]

[email protected]

iMMVR17

Organizing Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Conference Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Mission Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Course Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Target Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Poster Judging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Satava Award . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Disclaimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Organizer Contact Info . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Plenary & Parallel Session Presentation Schedule (With Index to Presentation Summaries) . . . . . . . . . . . . . . . . . . . . . . . 9

Monday Afternoon, Jan 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Session A - Mental Health & Simulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Session B - Virtual Patients for Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Session C - Simulator Construction Without the Agonizing Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Tuesday Morning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Plenary Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Adjunct Meeting -VR Assisted Exposure Therapy in the Treatment of PTSD . . . . . . . . . . . . . . . . . . . . . . . . 13

Tuesday Afternoon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Session A - Computer-Aided Therapy / Robotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Session B - Simulator Development Issues / Pre-Operative Warm-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Session C – Rehabilitation / Mixed Reality as a Tool for Cognitive and Motor Rehabilitation . . . . . . . . . . . . 12

Wednesday Morning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Plenary Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Wednesday Afternoon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Session A - Visualization / Sensors / Modeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Session B - Simulation & Training / Simulator Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Session C - TATRC West Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Thursday Morning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Session A - The Pulse!! Collaboration: Academe & Industry, Building Trust / Building Medical . . . . . . . . . . 20

Models and Scenarios from Clinical DescriptionsSession B - Simulator Development Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Poster Presentations (With Index to Presentation Summaries) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Tuesday Posters - Rehabilitation / Mental Health / Computer-Aided Therapy / Telemedicine / . . . . . . . . . . . . . . 13Simulator Design / Simulator Validation

Wednesday Posters - Modeling / Simulator Dev Tools / Simulation & Training / Visualization . . . . . . . . . . . . . . . 18

Salon and The Well . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Independent Session Summaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Virtual Patients for Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Simulator Construction Without the Agonizing Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Pre-Operative Warm-Up: Science, Theory, and Implications on Policy and Practice . . . . . . . . . . . . . . . . . . . . . . 30Mixed Reality as a Tool for Cognitive and Motor Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31VR Assisted Exposure Therapy in the Treatment of PTSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31The Pulse!! Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Virtual Building Medical Models and Scenarios from Clinical Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Exhibits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Exhibit Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Exhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Presentation Summaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Presenter Contact Info . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Presenter Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Table of Contents

Michael J. Ackerman PhD * Office of High Performance Computing & Communications, National Library of Medicine

David C. Balch MA * Medical Missions for Children

Kóan Jeff Baysa MD Vera List Center for Art and Politics, The New School (NY)

Steve Charles MD * MicroDexterity Systems; University of Tennessee

Patrick C. Cregan FRACS *Nepean Hospital, Sydney West Area Health Service

Li Felländer-Tsai MD PhD *Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute

Henry Fuchs PhD Department of Computer Science, University of North Carolina

Walter J. Greenleaf PhD *Greenleaf Medical Systems

Randy S. Haluck MD FACS *Department of Surgery, Penn State College of Medicine

David M. Hananel *Surgical Programs, Medical Education Technologies Inc. (METI)

Wm. LeRoy Heinrichs MD PhD Stanford University School of Medicine

Helene M. Hoffman PhD *School of Medicine, University of California, San Diego

Heinz U. Lemke PhD Institute for Technical Informatics, Technical University Berlin

Alan Liu PhD *National Capital Area Medical Simulation Center, Uniformed Services University

Bertalan Meskó *Medical School & Health Science Center, University of Debrecen

Greg T. Mogel MD *Keck School of Medicine &Viterbi School of Engineering, University of Southern California

Kevin N. Montgomery PhD *National Biocomputation Center, Stanford University

Makoto Nonaka MD PhD *Foundation for International Scientific Advancement

Roger Phillips PhD CEng FBCS CIPT *Dept of Computer Science, University of Hull (UK); Vertual Ltd

Carla M. Pugh MD PhD *Center for Advanced Surgical Education, Northwestern University

Organizing Committee

1MMVR17


2 MMVR17

Albert A. Rizzo PhD *Institute for Creative Technologies & School of Gerontology, University of Southern California

Richard A. Robb PhD *Biomedical Imaging Research LaboratoryMayo Clinic College of Medicine

Jannick P. Rolland PhD Institute of Optics, University of Rochester & ODA Lab, University of Central Florida

Richard M. Satava MD FACS Department of Surgery, University of Washington

Steven Senger PhD *Department of Computer Science, University of Wisconsin - La Crosse

Ramin Shahidi PhD *California Inst of Computer Assisted Surgery (CICAS), Stanford University School of Medicine

Thomas Sangild Sørensen PhD *Computer Science & Inst of Clinical Medicine, University of Aarhus, Denmark

Don StredneyInterface Laboratory, OSC

Julie A. Swain MD Division of Cardiovascular Devices, U.S. Food and Drug Administration

Robert M. Sweet MD *Urologic Surgery & Academic Health Center, University of Minnesota

Kirby G. Vosburgh PhD *CIMIT/Brigham & Women’s Hospital/Harvard Medical School

Dave Warner MD PhD Biodesign Institute & Decision Theater, Arizona State University; MindTel LLC; Inst for Interventional Informatics

Suzanne J. Weghorst MA MS *Human Interface Technology Lab, University of Washington

Brenda K. Wiederhold PhD MBA BCIA *The Virtual Reality Medical Center

Patricia Youngblood PhD *Educational Design and Evaluation, Innovation in Learning, Inc.

* Member, Abstract Review Committee

ConferenceInformation

MMVR17

5MMVR17

WelcomeWelcome to the 17th annual Medicine Meets Virtual Reality.This year’s program offers you more than 200 presentationsby scientists, clinicians, engineers, and students. Over fourdays, you will experience lectures, posters, workshop andpanel discussions, exhibits, demos, artwork, and multimedia.These presentations represent countless hours of effort andremarkable creativity, accomplishment, and vision. This year,we include expanded opportunities for impromptu demon-strations and non-traditional interaction. We encourage youtake advantage of all that is here—to observe, consider, com-pare, discuss, and engage.

We sincerely thank you for joining us here at MMVR17. Inthese challenging economic times, we are especially glad tohave your participation.

Mission StatementMMVR is organized to be an educational environment thatstimulates communication and collaboration among scientists,engineers, physicians, surgeons, educators, students, military,government, and industry. It supports the development andadoption of advanced medical technologies for medical careand education. Its goal is improved precision, efficiency, andoutcomes in patient care, practitioner training, and publichealth. The MMVR curriculum, by combining rigorous assess-ment with speculative vision, aims to create forward-thinkingsolutions to health problems.

Course ObjectivesPresentations are chosen to educate participants on:

• State-of-the-art for biomedical simulation and itsenabling technologies, haptics and modeling

• Emerging tools for clinical diagnosis and therapy: imag-ing methods, data visualization and fusion techniques,robotics, and sensors

• Intelligence networks for medical decision-making,patient care, and collaboration

• Goals, accomplishments, and challenges in the develop-ment and application of novel devices and methods formedical care and education.

Target AudienceMMVR17 is designed to educate and inform:

• Physicians, surgeons, and other medical professionalsinterested in emerging and future tools for diagnosis andtherapy

• Educators responsible for training the next generation of

doctors and scientists

• IT and medical device engineers creating state-of-the-artand next-generation simulation, imaging, robotics, andcommunication systems

• Data technologists creating systems for gathering, pro-cessing, and distributing medical intelligence

• Military medicine specialists addressing the challenges ofwarfare and defense health needs

• Biomedical futurists and investors who need to under-stand where medicine is headed

AcknowledgementsWe thank our colleagues on the Organizing Committee fortheir ongoing direction and support, especially those who gen-erously shared their time and expertise by reviewing submittedabstracts, editing the Proceedings, and assisting with the cre-ation of Salon, The Well, and the blog. Their scientific guid-ance is key to the continuing success of MMVR.

We thank ALL of you who are presenters during this year’s pro-gram. You are the foundation of this program.

We also thank these organizations—our educational partners—for independently organizing important components of the2009 curriculum:

• TATRC / USAMRMC

• National Capital Area Medical Simulation Center

• SiTEL / MedStar Health

• University of Central Florida

• Biomedical Informatics, Arizona State University

• Texas A&M University - Corpus Christi

• Innovation in Learning, Inc

• Breakaway, Ltd.

All of you help make MMVR17 a useful learning experience.

Poster JudgingYou are invited to vote for the best poster presentations. Pleasecomplete your Tuesday and Wednesday ballots and submitthem at the ballot box at the registration desk. The six winningposters (three each day) will receive prizes and be displayed onThursday.

Conference Information

6 MMVR17


The Satava AwardThe 15th annual Satava Award will be presented at MMVR17.Established in 1995 to acknowledge the contribution ofRichard M. Satava MD FACS, the award is presented to anindividual or research group demonstrating unique vision andcommitment to the improvement of medicine throughadvanced technology. Previous recipients are:

Alan Liu PhD & Mark Bowyer MD (2008)

Naoki Suzuki PhD (2007)

Nigel John PhD (2006)

Brenda Wiederhold PhD MBA (2005)

Steven Dawson MD (2004)

Richard Robb PhD (2003)

SUMMIT, Stanford University (2002)

HIT Lab, University of Washington (2001)

Dave Warner MD PhD (2000)

Faina Shtern MD (1999)

Gerhard Buess MD (1998)

Henry Fuchs PhD (1997)

Victor Spitzer PhD & Michael Ackerman PhD for the Visible Human (1996)

Richard Satava MD FACS (1995)

EvaluationWe welcome the input of all conference participants. Pleasetake a few minutes to write down your reactions to this year’sMMVR. Your feedback—negative and positive—will help uscreate the next MMVR.

DisclaimerThe information provided at this conference is intended forgeneral medical education purposes only. All physicians shouldfully investigate any new product or device before implement-ing it in their practice. In no event will the conference organiz-er, Aligned Management Associates, Inc., assume responsibilityfor any decision made or action taken as a result of the infor-mation provided through this activity.

Organizer Contact InformationMedicine Meets Virtual Reality c/oAligned Management Associates, Inc.793-A East Foothill Blvd, PMB #119San Luis Obispo, CA93405 USAPhone +1 805 534 0300 Fax +1 805 534 [email protected]:// www.NextMed.com

PresentationSchedule

MMVR17

9MMVR17

MONDAY, JANUARY 19 - SESSION A

Mental Health & SimulationModerator: Albert Rizzo

1:00 Welcome & Introduction

1:15 Thomas Parsons ............................................... p. 41 Inst for Creative Technologies, Univ of SouthernCalifornia

Neurocognitive and PsychophysiologicalAnalysis of Human Performance withinVirtual Reality Environments

1:30 Young Seok Shin................................................ p. 41Biomedical Engineering, Hanyang Univ

Virtual Auditory Hallucination ExposureProgram for Schizophrenia

1:45 Giuseppe Riva ................................................... p. 41Applied Technology for Neuro-Psychology Lab,Ist Auxologico Italiano

The Intrepid Project: Biosensor-EnhancedVirtual Therapy for the Treatment ofGeneralized Anxiety Disorders

2:00 José Luis Mosso ................................................ p. 41Regional Hosp No. 25, Inst Mexicano delSeguridad Social

Virtual Reality on Mobile Phones to ReduceAnxiety in Outpatient Surgery

2:15 Carla Pugh......................................................... p. 41Surgery, Northwestern Univ

Use of Clinical Simulations for PatientEducation: Targeting an Untapped Audience

Moderator: Brenda K. Wiederhold

2:30 Thomas Parsons ................................................ p. 42Inst for Creative Technologies, Univ of SouthernCalifornia

A Virtual Human Agent for Assessing Bias inNovice Therapists

2:45 Chris Culbertson ............................................... p. 42Neuroscience, Univ of California, Los Angeles

Using Virtual Reality to Assess and TreatCraving in Substance Dependent Individuals

3:00 Break

3:15 Robert McLay .................................................... p. 42Mental Health, Naval Medical Ctr San Diego

Use of Virtual Reality in Iraq to Treat Post-Traumatic Stress Disorder

3:30 Dennis Wood .................................................... p. 42Virtual Reality Medical Ctr

Effectiveness of Virtual Reality GradedExposure Therapy with PhysiologicalMonitoring for Combat Related PostTraumatic Stress Disorder

3:45 Albert Rizzo ....................................................... p. 42Inst for Creative Technologies / School ofGerontology, Univ of Southern California

VR PTSD Exposure Therapy Results withActive Duty OIF/OEF Combatants

4:00 Discussion & Demonstrations

5:00 Adjourn

MONDAY, JANUARY 19 - SESSION B

INDEPENDENT SESSION Virtual Patients for Medical Education: The Next Generation1:00 – 5:00

Gerry Higgins & Bruce Jarrell, Organizers

Presentations

Gerald HigginsSimulation & Training Environment Lab, ER OneInst, Washington Hosp Center, MedStar Health

The Virtual Patient: A Roadmap for FutureResearch from the Human Simulation andTraining Domains

Brian AtheyPsychiatry, Michigan Inst for Clinical & HealthRsch; NIH Nat’l Ctr for Integrative BiomedicalInformatics

Translational Bioinformatics in Support ofReal and Virtual Patients

Janis Cannon-BowersInst for Simulation & Training / CREAT DigitalMedia Program, Univ of Central Florida

Developing Serious Games for MedicalSimulation

Presentation Schedule


10 MMVR17

Sergei NirenburgComputer Science & Electrical Engineering,Univ of Maryland Baltimore County

The Maryland Virtual Patient: Adaptivity in aMulti-Agent Clinical System

Richard SatavaSurgery, Univ of Washington Medical Center;US Army Medical Research & MaterielCommand

Total Body Scanning and the LongitudinalHealth Record

Yuri MilloSimulation & Training Environment Lab, ER OneInst, Washington Hosp Ctr, Medstar Health

Game-Based Skills Training: InexpensiveSimulators for Medical Interventions


A Meta-Analysis of the Training Value ofMedical Simulators: 2000-2008

MONDAY, JANUARY 19 - SESSION C

INDEPENDENT SESSIONSimulator Construction Without the Agonizing Pain 1:00 – 5:00 PM

Alan Liu, Organizer

Presentations

1:00 Alan LiuNational Capital Area Medical Simulation Ctr,Uniformed Services Univ

Welcome and Introduction

1:15 Robert WaddingtonSimQuest, LLC

Educational Requirements Analysis

2:00 Eric AcostaNational Capital Area Medical Simulation Ctr,Uniformed Services Univ

Simulation Environment Development:Advanced Techniques

2:45 Break

3:00 Jennifer SieckNational Capital Area Medical Simulation Ctr,Uniformed Services Univ

The 3D Model Development Workflow: FromDesign to Deployment

3:45 Daniel EvestedtSenseGraphics AB

H3DAPI: An Open Source API for DexterousSkills Simulators


Wrap-Up

4:35 Discussion

5:00 Adjourn

TUESDAY, JANUARY 20 – PLENARY SESSION

Note: Key portions of the inauguration ceremo-ny of President-Elect Barack Obama will beincorporated into this session via television link.This will require impromptu rearrangement ofpanel discussions and mid-morning break.

8:30 Karen S. Morgan & James D. WestwoodMMVR17 Organizers, Aligned ManagementAssociates, Inc.

Welcome & Introduction

PANEL DISCUSSIONHas Medicine Met VR? Accomplishments,Shortfalls, and Vision in the MMVR Community 8:45 – 10:00

Panelists

Michael AckermanHigh Performance Computing &Communications, National Library of Medicine

Wm. LeRoy HeinrichsStanford University School of Medicine

Helene HoffmanOffice of Educational Computing, School ofMedicine, University of California, San Diego

Albert “Skip” RizzoInstitute for Creative Technologies, University ofSouthern California

Richard RobbMayo Clinic College of Medicine

Richard Satava (Panel Moderator) Dept of Surgery, University of WashingtonMedical Center

10:00 Break (Exhibits and The Well open)

Monday Afternoon & Tuesday Morning

11MMVR17


PANEL DISCUSSION Beyond the Scientific Method 10:45 – 12:00

Panelists

Parvati DevInnovation in Learning, Inc.

Kevin Montgomery (Panel Moderator) National Biocomputation Center, Stanford Univ

Richard SatavaDept of Surgery, University of WashingtonMedical Center

Ramin ShahidiCalifornia Inst of Computer Assisted Surgery,Stanford Univ School of Medicine

Kirby VosburghCIMIT/Brigham & Women’s Hospital/HarvardMedical School

12:00 Adjourn

TUESDAY, JANUARY 20 – SESSION A

Computer-Aided TherapyModerator: Michael Ackerman


1:30 Guoyan Zheng ................................................... p. 43MEM Research Ctr, Univ of Bern

A System for 3-D Reconstruction of aPatient-Specific Surface Model fromCalibrated X-Ray Images

1:45 Jennifer Lo ........................................................ p. 43Imaging Research Laboratories, RobartsResearch Inst; Univ of Western Ontario

Surgeon-Controlled VisualizationTechniques for Virtual Reality-GuidedCardiac Surgery

2:00 Thomas Sangild Sørensen ................................. p. 43Computer Science / Inst of Clinical Medicine,Univ of Aarhus, Denmark

Developing and Evaluating VirtualCardiotomy for Preoperative Planning inCongenital Heart Disease

2:15 Jung Leng Foo................................................... p. 43Mechanical Engineering & Human-ComputerInteraction, Virtual Reality Applications Ctr, IowaState Univ

A Collaborative Interaction and VisualizationMulti-Modal Environment for Surgical Planning

2:30 Asaki Hattori ...................................................... p. 44Inst for High Dimensional Medical Imaging,Jikei Univ School of Medicine

Development of a Real-Time Image-GuidedSurgery System for Stereo-EndoscopicSinus Surgery

2:45 Reinhard Friedl ................................................. p. 44Heart Surgery, Univ Hospital of Ulm

Cardio Pointer: Development of aNavigation System for Coronary ArteryBypass Grafting

3:00 Johannes Vockeroth........................................... p. 44Neurology, Ludwig-Maximilians - Univ Munich

Medical Documentation Using a Gaze-Driven Camera

3:15 Break

Robotics Moderator: Ramin Shahidi

3:30 Amy Lehman .................................................... p. 44Mechanical Engineering, Univ of Nebraska -Lincoln

A Robotic Assistant for Surgical Dissection

3:45 Sachin Daluja..................................................... p. 44Electrical & Computer Engineering, WayneState Univ

An Integrated Movement Capture andControl Platform Applied TowardsAutonomous Movements of Surgical Robots

4:00 Carl Nelson ........................................................ p. 44Mechanical Engineering & Surgery, Univ ofNebraska-Lincoln / Univ of Nebraska MedicalCtr

Portable Tool Positioning Robot forTelesurgery

4:15 Naoki Suzuki...................................................... p. 45Inst for High Dimensional Medical Imaging,Jikei Univ School of Medicine

Tele-Control of an Endoscopic SurgicalRobot System between Japan and Thailandfor Tele-NOTES

4:30 Jeff Hawks ........................................................ p. 45Mechanical Engineering, Univ of Nebraska -Lincoln

A Modular Wireless In Vivo Surgical Robotwith Multiple Surgical Applications

4:45 Discussion

5:00 Adjourn

Tuesday Morning (cont.) & Afternoon


12 MMVR17

TUESDAY, JANUARY 20 - SESSION B

Simulator Development IssuesModerator: Li Felländer-Tsai


1:30 C. Donald Combs .............................................. p. 45Health Professions, Eastern Virginia MedicalSchool

The Evolution of Medical Simulators

1:45 Gerald Moses.................................................... p. 45Surgery, Univ of Maryland Medical Ctr

A Research Portfolio for Innovation in theSurgical Environment

2:00 Mario Riojas...................................................... p. 45Electrical & Computer Engineering, Univ ofArizona

Knowledge Elicitation for PerformanceAssessment in Computerized SurgicalTraining System

2:15 Marcus Schlickum.................................................. p. 46Clinical Science Intervention & Technology, Ctrfor Advanced Medical Simulation, Karolinska Inst

The Importance of Visual Working Memoryand Visual-Spatial Ability for HighPerformance Differs between VariousVirtual Reality Image Guided SurgicalSimulators

2:30 Gyusung Lee..................................................... p. 46Surgery, Univ of Maryland

Joint Kinetic Data Augments TraditionalBiomechanical Approach to Assess theErgonomics of Laparoscopic CameraAssistants

2:45 Gunther Sudra................................................... p. 46Computer Science, Univ of Karlsruhe (TH)

Estimating Similarity of Surgical Situationswith Case-Retrieval-Nets

3:00 Dhanannjay Deo .............................................. p. 46Mechanical Aerospace & Nuclear Engineering,Rensselaer Polytechnic Inst

A Machine Learning-Based ScalableApproach for Real-Time SurgerySimulation

3:15 Mark Bowyer .................................................... p. 46Norman M. Rich Dept of Surgery, UniformedServices Univ

Exporting Simulation Technology to thePhilippines: A Comparative Study ofTraditional Versus Simulation Methods forTeaching Intravenous Cannulation

3:30 Break

SESSION B, CONTINUED

INDEPENDENT SESSIONPre-Operative Warm-Up: Science, Theoryand Implications on Policy and Practice3:45 – 5:15 PM

Kanav Kahol, Organizer

Presentations

Marshall L. SmithSimulation & Training Center, Banner GoodSamaritan Medical Center

Warm-Up in Surgery: A Briefing

Kanav KaholBiomedical Informatics, Arizona State Univ

Warm-Up Devices for Surgery

Richard M. SatavaSurgery, Univ of Washington Medical Center;US Army Medical Research & MaterielCommand

Implications of Warm-Up in Surgery onPolicy and Practice

Ajit K. SachdevaDiv of Education, American College ofSurgeons

Putting Together a Warm-Up Regimen:What We Have Learnt from SimulationCurriculum Development

Thomas V. WhalenChairman, Dept of Surgery, Lehigh ValleyHealth Network

The Role of Warm-Up in AscertainingQuality of Residents: A Residency ReviewCommittee Perspective

TUESDAY, JANUARY 20 - SESSION C

RehabilitationModerator: Walter Greenleaf


1:30 Marlene Sandlund.............................................. p. 47Community Medicine & Rehabilitation, UmeåUniv

Effect of Interactive Computer Training onGoal-Directed Arm Movements in Childrenwith Cerebral Palsy: A KinematicEvaluation

Tuesday Afternoon

13MMVR17


1:45 Sheryl Flynn....................................................... p. 47Biokinesiology & Physical Therapy, Univ ofSouthern California

Virtual Reality Systems Using Low-CostWebcam and Off-the-Shelf GameInterfaces for Motor Rehabilitation afterTraumatic Brain Injury, Spinal Cord Injuryand Amputation

2:00 Mark Sivak ........................................................ p. 47Mechanical & Industrial Engineering,Northeastern Univ

Design of a Low Cost Multiple User VirtualEnvironment for Rehabilitation (MUVER) ofPatients with Stroke

2:15 M. Susan Hallbeck ............................................ p. 47Industrial & Management SystemsEngineering, Univ of Nebraska - Lincoln

Simulating Visual Impairment to DetectHospital Way-Finding Difficulties

2:30 Dimitrios Katsavelis .......................................... p. 47Health Physical Education & Recreation, Univof Nebraska at Omaha

Nano Legends: An Interactive VirtualReality Game Induces High Level ofPhysical Activity

2:45 Kimberly Briggs ................................................. p. 48Occupational Therapy, Banner GoodSamaritan Rehabilitation Inst

Scientific Framework for SelectingSimulation Games for Rehabilitation andAssistance: A Case Study with the Wii(r)

3:00 Discussion

3:15 Break

SESSION C, CONTINUED

INDEPENDENT SESSION Mixed Reality as a Tool for Cognitive andMotor Rehabilitation3:30 - 5:30 PM

Cali Fidopiastis & Charles Hughes, Organizers

Presentations

Darin HughesInstitute for Simulation & Training, Univ ofCentral Florida

Experience Design and Production: PatientNeeds and Task Perspectives

Charles Hughes Electrical Engineering & Computer Science /Institute for Simulation & Training, Univ ofCentral Florida &

Delivery and After Action Review Systems

Cali FidopiastisInstitute for Simulation & Training, Univ ofCentral Florida

Integration of Measurement Devices andProcedures

Randall ShumakerInstitute for Simulation & Training, Univ ofCentral Florida

Scalability: Regional Centers, CommunityFacilities, Private Caregiver Facilities,Home and Work

Mark WiederholdThe Virtual Reality Medical Center &

Cali Fidopiastis Institute for Simulation & Training, Univ ofCentral Florida

Completed Studies: Protocol Design andEfficacy

TUESDAY, JANUARY 20

ADJUNCT MEETING Virtual Reality Assisted Exposure Therapyin the Treatment of PTSD 8:30 AM - 5:30 PM

The Interactive Media Institute, Organizer

IMPORTANT: This workshop is offered by ourcolleagues at the Interactive Media Instituteand the Virtual Reality Medical Center. Pleasenote that a separate paid registration is re-quired, available at the door. CE credit isplanned.

Please see the independent session summa-ry, page 31, for more details.

TUESDAY POSTER PRESENTATIONS

RehabilitationRichard Fan ...................................................... p. 56Biomedical Engineering, Univ of California LosAngeles

Characterization of a Pneumatic BalloonActuator for Use in Refreshable BrailleDisplays

Tuesday Afternoon


14 MMVR17

Belinda Lange ................................................... p. 56Inst for Creative Technologies, Univ of SouthernCalifornia

Rehabilitation of Upper Limb ExtremityBimanual Coordination Tasks Using a NovelBimanual Novint Falcon Application andSpecifically Designed Game Based Task

Panadda Marayong ........................................... p. 56Mechanical & Aerospace Engineering, CaliforniaState Univ, Long Beach

Foot Vibrotactile Device for Central ApneaInterruption in Premature Infants

Jeanette Plantin & Birgitta Johansson................ p. 56Neurological Rehabilitation CtrErstagårdskliniken, Ersta Hosp

Postacute Neurological Rehabilitation withVirtual Reality and Haptics: A Pilot Study

Alberto Rovetta ................................................. p. 57Mechanics, Politecnico Univ of Milan

Novel Device DeeDee for NeuromotorControl with Augmented Reality andMultiparametric Sensors Fusion

Mental HealthGiuseppe Riva ................................................... p. 57Applied Technology for Neuro-Psychology Lab,Ist Auxologico Italiano

NeuroVR 1.5: A Free Virtual Reality Platformfor the Assessment and Treatment inClinical Psychology and Neuroscience

Computer-Aided TherapyFarzam Farahmand ........................................... p. 57Mechanical Engineering, Sharif Univ ofTechnology

Robotic Assisted Reduction of FemoralShaft Fractures Using Stewart Platform

Tomoko Ikawa .................................................. p. 57Fixed Prosthodontic, Tsurumi Univ

The Reproduction of High Precision 3DMaxillofacial Reconstruction Models

Judith Muehl .................................................... p. 57Inst for Computer Graphics & Vision, TechnicalUniv of Graz

Towards Validation for Physiological Modelsin Intervention Planning

Amit Mulgaonkar .............................................. p. 57Ctr for Advanced Surgical & InterventionalTechnology, Univ of California, Los Angeles

A Prototype Surgical Manipulator forRobotic Intraocular Micro Surgery

Jay Mung ......................................................... p. 58Biomedical Engineering, Univ of SouthernCalifornia

An Ultrasonic Navigation System forEndovascular Aortic Repair

Takumi Ogawa .................................................. p. 58Fixed Prosthodontic Dentistry, Tsurumi Univ

Designing Artificial Jaw Joints (AJJs) in VRSpace for Patients with RheumatoidArthritis

Ali Rastjoo ........................................................ p. 58Medical Engineering & Medical Physics, TehranUniv of Medical Sciences

Evaluation of Hidden Markov Model forP300 Detection in EEG Signal

Mathias Seitel ................................................... p. 58Medical & Biological Informatics, GermanCancer Research Ctr

Towards a Mixed Reality Environment forPreoperative Planning of Cardiac Surgery

Hisham Sherif ................................................... p. 58Cardiac Surgery, Christiana Hospital

Recovery after Resuscitation from CardiacArrest in ST-Elevation Myocardial Infarction:A Computer-Based Medical Decision-Support Tool

András Székely ................................................. p. 59Nuclear Medicine, Univ of Debrecen Medical &Health Science Ctr

Imaging 2.0: Diagnostic Imaging and Web2.0

Efstratios Theofilogiannakos ............................. p. 59Experimental Physiology, Aristotle Univ ofThessaloniki

One Heart, Two Bodies: A Simulation Studyof Body Surface Potential Differences be-tween Donor and Recipient of HeartTransplantation

Yevgeniy Yanin .................................................. p. 59Tyumen Central Regional Hosp, Tyumen StateMedical Academy

Technologies in Minimally Invasive Surgery

Telemedicine Gregorij Kurillo .................................................. p. 59Electrical Engineering & Computer Science,Univ of California, Berkeley

Teleimmersive Environment for RemoteMedical Collaboration

Tuesday Posters

15MMVR17


Susil Meher ...................................................... p. 59Computer Applications, All India Inst of MedicalSciences

Barriers in Telehealth Care for Treatment ofRural Patients at AIIMS, New Delhi, India

Simulator DesignSarah Baillie ..................................................... p. 60Veterinary Clinical Studies, Royal VeterinaryCollege

A Mixed Reality Simulator for FelineAbdominal Palpation Training in VeterinaryMedicine

Nadine Fritz ...................................................... p. 60Mechanical Engineering, European SpaceAgency

Virtual Reality Stimulator for NeuroscienceResearch

M. Susan Hallbeck ............................................ p. 60Industrial & Management Systems Engineering,Univ of Nebraska – Lincoln

Paper Prototypes for the Detection ofStereotype Violations in (Medical) DeviceOperation – Are They Good Enough?

Motohiro Kikuchi ............................................... p. 60School of Dentistry, Nihon Univ

Development of Virtual Dental Waxing-upSystem with Haptic Interface

Sergei Kurenov ................................................. p. 60Surgery, Univ of Florida

Development and Initial Validation of aVirtual Reality Haptically AugmentedSurgical Knot-Tying Trainer for theAutosuture™ ENDOSTITCH™ Instrument

Jason Line ........................................................ p. 61Medic Vision Ltd.

Commercialising Medical Simulators

Liliane Machado ............................................... p. 61Informatics, Federal Univ of Paraiba

A Framework for Development of VirtualReality-Based Training Simulators

José Luis Mosso ................................................ p. 61Regional Hosp No. 25, Inst Mexicano delSeguridad Social

Cyborg Mini-Trainer

Manivannan Muniyandi ..................................... p. 61Biomedical Engineering, Applied Mechanics,Indian Inst of Technology Madras

Design of a Do-It-Yourself VR BasedLaparoscopic Simulator

Sebastian Ullrich ............................................... p. 61Virtual Reality Group, RWTH Aachen Univ

Virtual Reality-Based Regional AnaesthesiaSimulator for Axillary Nerve Blocks

Pierre-Frédéric Villard ........................................ p. 62Biosurgery & Surgical Technology, ImperialCollege London

Developing An Immersive UltrasoundGuided Needle Puncture Simulator

Yoshinori Yoshida .............................................. p. 62Graduate School of Dentistry, Osaka Univ

Virtual Reality Simulation Training forDental Surgery

Simulator ValidationJoerg Beardi ..................................................... p. 62Abdominal & Minimally Invasive Surgery, HeiligGeist Hosp, Bensheim

Comparison between “Computer GamingKids” and Experienced LaparoscopicSurgeons under Simulated LaparoscopyConditions

Mary Barak-Bernhagen...................................... p. 62Omaha Veterans Admin Medical Ctr / Univ ofNebraska Medical Ctr

Endotracheal Intubation Comparing aPrototype Storz CMAC and a GlideScopeVideolaryngoscope in a Medical TransportHelicopter – A Pilot Study


Endotracheal Intubation in a MedicalTransport Helicopter – Comparing DirectLaryngoscopy with the Prototype StorzCMAC© Videolaryngoscope in a SimulatedDifficult Intubating Position

Ben Boedeker .................................................... p. 63Omaha Veterans Admin Medical Ctr / Univ ofNebraska Medical Ctr

Videolaryngoscopy for Intubation SkillsTraining of Novice Military Airway Managers


Remote Videolaryngoscopy Skills Trainingfor Pre-Hospital Personnel

Doo Yong Lee .................................................... p. 63Mechanical Engineering, Korea Adv Inst ofScience & Technology

Sectional Analysis of Learning on theKAIST-Ewha Colonoscopy Simulation II

Tuesday Posters

Ganesh Sankaranarayanan ............................... p. 63Mechanical Aerospace & Nuclear Engineering,Rensselaer Polytechnic Inst

Face Validation of the Virtual BasicLaparoscopic Skill Trainer (VBLaST™)

WEDNESDAY, JANUARY 21 - PLENARY SESSION

Session Moderator: Greg Mogel

PANEL DISCUSSION Where is the Patient at MMVR? Tech-nology and Design for the Final End-User 8:30 – 9:45

Panelists

Kóan Jeff BaysaVera List Center for Art and Politics, The NewSchool

Patrick CreganNepean Hospital, Sydney West Area Health Service

Walter J. GreenleafGreenleaf Medical Systems

Greg Mogel (Panel Moderator) Keck School of Medicine / Viterbi School ofEngineering, University of Southern California

Carla PughCenter for Advanced Surgical Education,Northwestern University

Brenda WiederholdThe Virtual Reality Medical Center

9:45 INVITED SPEAKER: Virgil Wong .......................... p. 48Head, Web & Multimedia Division, WeillCornell Medical College and NewYork-Presbyterian Hospital

Envisioning the Web 3.0 Patient andPhysician Portal as an Interactive,Semantics-Based, and Intelligence-DrivenAnatomical Avatar

10:15 Break (Exhibits, The Well, and Salon open)

11:00 James Kinross ................................................... p. 48Biosurgery & Surgical Technology, ImperialCollege London

Virtual Worlds Technology EnhancesMedical Student Training in the OperatingRoom

11:20 Warren Grundfest............................................... p. 48Bioengineering, Univ of California, Los Angeles

Development and Testing of a TactileFeedback System for Robotic Surgery

11:45 Presentation of the 15th Annual Satava Award

12:00 Adjourn

WEDNESDAY, JANUARY 21 - SESSION A

VisualizationModerator: Steven Senger


1:30 Pierre-Frédéric Villard ....................................... p. 49Biosurgery & Surgical Technology, ImperialCollege London

CT Scan Merging to Enhance Navigation inInterventional Radiology Simulation

1:45 Jacopo Annese .................................................. p. 49Radiology, Univ of California, San Diego

A Scalable Visualization Environment forthe Correlation of Radiological andHistopathological Data at Multiple Levelsof Resolution

2:00 Jonathan Suen................................................... p. 49Electrical & Computer Engineering, Univ ofCalifornia, Santa Barbara

Towards Medical Terahertz Sensing ofSkin Hydration

2:15 Oscar Meruvia-Pastor ........................................ p. 49Biochemistry, Univ of Calgary

Fast Interactive Integration of Cross-Sectional Image Datasets and SurfaceData for Morphometric Analysis

Sensors2:30 Robert Tan ......................................................... p. 49

Bioengineering, Univ of California, Los Angeles

Development of a Minimally InvasiveImplantable Wireless Vital Signs SensorPlatform

Modeling 2:45 Yong Hum Na .................................................... p. 50

Nuclear Engineering & Engineering Physics,Rensselaer Polytechnic Inst

Development of Whole-Body ReferenceAdult Male and Female Models forRadiological Studies Using Surface-Geometry Modeling and Monte CarloRadiation Transport Methods


16 MMVR17

Wednesday Morning & Afternoon

17MMVR17


3:00 Yingchun Zhang ................................................. p. 50Urologic Surgery, Univ of Minnesota

Advanced Finite Element Mesh Model ofFemale SUI Research During Physical andDaily Activities

3:15 Break

Moderator: Thomas Sangild Sørensen

3:30 Yunhe Shen ....................................................... p. 50Urologic Surgery, Univ of Minnesota

Interactive Collision Response Solutions toInterpenetration Problems among Tissuesand Instruments in Virtual LaparoscopicSurgery

3:45 Maud Marchal.................................................... p. 50INRIA

Fiber-Based Fracture Model for SimulatingSoft Tissue Tearing

4:00 Xiangmin Zhou................................................... p. 50Ctr for Research in Education & SimulationTechnologies, Univ of Minnesota

A Discrete Mechanics Framework for RealTime Virtual Surgical Simulations withApplication to Virtual LaparoscopicNephrectomy

4:15 Hao Li ............................................................... p. 51Computer Science, National Univ of Singapore

Modeling Torsion of Blood Vessels inSurgical Simulation and Planning


Realtime Blood Vessel Modeling inSurgical Simulation

4:45 Discussion

5:00 Adjourn

WEDNESDAY, JANUARY 21 - SESSION B

Simulation & TrainingModerator: Helene Hoffman


1:30 Sergei Nirenburg................................................ p. 51Computer Science & Electrical Engineering,Univ of Maryland Baltimore County

Integrating Cognitive Simulation into theMaryland Virtual Patient

1:45 Deborah N. Burgess........................................... p. 51Med Modernization Div / Med Modeling & SimProgram, US Air Force

Current and Future Applications ofModeling and Simulation for MedicalEducation, Training and Medical Care

2:00 Rachel Ellaway ................................................. p. 51Informatics, Northern Ontario Sch of Medicine

Rethinking Fidelity, Cognition andStrategy: Medical Simulation as GamingNarratives

2:15 Kanav Kahol ..................................................... p. 52Biomedical Informatics, Arizona State Univ

The Effect of Noise and Distractions onSurgeons’ Proficiency: An EducationalPerspective

2:30 Carol Noe........................................................... p. 52Simulation Education & Training Ctr, BannerGood Samaritan Medical Ctr

The Effect of Central Venous CatheterPlacement Simulation Training on PatientSafety

2:45 Yi-Je Lim ........................................................... p. 52Energid Technologies

A Regional Anesthesia Training SimulationSystem

3:00 Christian Banker ................................................ p. 52Electrical & Computer Engineering, WorcesterPolytechnic Inst

Interactive Training System for MedicalUltrasound

3:15 Break

Moderator: Robert Sweet

3:30 Nigel John ......................................................... p. 52School of Computer Science, Bangor Univ

Cost Effective Ultrasound Imaging TrainingMentor for Use in Developing Countries

3:45 Eve Wurtele ....................................................... p. 52Genetics, Development & Cell Biology, IowaState Univ

Meta!Blast: An Interactive Virtual RealityGame to Explore Structural and MetabolicBiology

4:00 Bertalan Meskó ................................................ p. 53Medical School & Health Science Ctr, Univ ofDebrecen

Medicine 2.0: Practicing Medicine in theWeb 2.0 Era

Wednesday Afternoon

18 MMVR17


Simulator Validation4:15 Patrick Cregan ................................................... p. 53

Sydney West Area Health Service, NepeanHospital

Does VR Improve OR Performance? ASystematic Review of Skills Transfer afterSurgical Simulation Training

4:30 Mukul Mukherjee............................................... p. 53Nebraska Biomechanics Core Facility, Univ ofNebraska - Omaha

Virtual Reality in Robot Assisted Surgery:Validation and Training

4:50 Curtis Ikehara .................................................... p. 53Information & Computer Sciences, Univ ofHawaii

Evaluating a Virtual Reality Motor-SkillsSimulator

5:05 Discussion

5:20 Adjourn

WEDNESDAY, JANUARY 21 - SESSION C

INDEPENDENT SESSIONTATRC-West Program 1:30 – 5:30 PM

Check at Registration Desk for TATRC-WestProgram

WEDNESDAY POSTER PRESENTATIONS

ModelingCiamak Abkai ................................................... p. 63Inst for Computational Medicine, Univ ofHeidelberg

Real-Time ECG Emulation: A Multiple DipoleModel for Electrocardiography Simulation

Eric Acosta ....................................................... p. 64Virtual Medical Environments Lab, NationalCapital Area Medical Simulation Ctr

A Multi-Core CPU Pipeline Architecture forVirtual Environments

Farzam Farahmand ........................................... p. 64Mechanical Engineering, Sharif Univ ofTechnology

A Surface Registration Technique forEstimation of 3-D Kinematics of Joints

Craig Hourie ...................................................... p. 64Electrical & Computer Engineering, Univ ofWestern Ontario

LACROSS - Laparoscopic Robotic SurgicalSimulator

Vassilios Hurmusiadis ....................................... p. 64R & D, Primal Pictures Ltd.

From Cell to ECG: Real-Time InteractiveSimulation of Cardiac Electrophysiology forECG Training

Derek Magee ..................................................... p. 65Leeds Inst of Molecular Medicine, Univ ofLeeds

A Physics Based Method for CombiningMultiple Anatomy Models with Applicationto Medical Simulation

Yong Hum Na..................................................... p. 65Nuclear Engineering & Engineering Physics,Rensselaer Polytechnic Inst

A Method to Create Size-Adjustable Whole-Body Patient Models for RadiologicalStudies of Organ Doses

Herke Jan Noordmans ...................................... p. 65Medical Technology & Clinical Physics, UMCUtrecht

Real-Time Brainshift Correction of Pre-Operative Image Data for Neuronavigation,Using Today’s Graphics Hardware

Kresimir Petrinec .............................................. p. 65Computer Science, Univ of California, LosAngeles

The FMA Database Browser: A KeyComponent of an Interactive ImageVisualization Pipeline

Joseph Romano ................................................ p. 65Mechanical Engineering & Applied Mechanics,Univ of Pennsylvania

Real-Time Graphic and Haptic Simulation ofDeformable Tissue Puncture

Chengyu Shi ..................................................... p. 66Radiation Oncology, Univ of Texas HealthScience Ctr at San Antonio

Development of a Patient-SpecificPredictive Geometry (PPG) Model Based onReal Patient 4D CT Data


The Clockwise Rotation of Myocardial FiberOrientation from Epicardial to EndocardialSurface in Left Ventricular Free Wall in aPost-mortem Human Heart

Wednesday Afternoon & Posters

19MMVR17


Georgios Theofilogiannakos .............................. p. 66Electrical & Computer Engineering, AristotleUniv of Thessaloniki

Computational Tools for Addressing theForward and Inverse Problems inElectrocardiology

Mei Xiao ........................................................... p. 66Biochemistry & Molecular Biology, Univ ofCalgary

An Efficient Virtual Dissection Tool to CreateGeneric Models for Anatomical Atlases

Simulator Development ToolsVenkata Arikatla ............................................... p. 66Mechanical Engineering, RensselaerPolytechnic Inst

Plug-and-Play Tool Handles forLaparoscopic Surgery Simulators

Dhanannjay Deo ............................................... p. 67Mechanical Aerospace & Nuclear Engineering,Rensselaer Polytechnic Inst

Development of a Glove-Based WearableSystem for Objective Assessment ofLaparoscopic Skills and Some Observationsfor a Peg Transfer Task

Rachel Ellaway ................................................. p. 67Informatics, Northern Ontario Sch of Medicine

Integrating Simulation Devices andSystems

Matthias Färber ................................................ p. 67Medical Informatics, Univ Medical CtrHamburg-Eppendorf

Needle Bending in a VR-Puncture TrainingSystem Using a 6DOF Haptic Device

Chuan Feng ...................................................... p. 67Electrical & Computer Engineering, Univ ofArizona

Usability Study of Computerized SurgeryTraining and Assessment System

Shin Hasegawa ................................................. p. 67Biomedical Information Technology Lab, Univ ofAizu

Simulation of Vaginal Wall BiomechanicalProperties from Pelvic Floor Closure ForcesMap


Interactive Peritoneum in a Haptic SurgeryIllustration Environment

Leow Wee Kheng .............................................. p. 68Computer Science, National Univ of Singapore

Predictive Surgical Simulation of AortaReconstruction in Cardiac Surgery


Hybrid Network Architecture for InteractiveMulti-User Surgical Simulator with ScalableDeformable Models


A Real-time Knot Detection Algorithm forSuturing Simulation

Ji Son ............................................................... p. 68Ctr for Advanced Surgical & InterventionalTechnology, Univ of California, Los Angeles

Quantification of Intraocular SurgeryMotions with an Electromagnetic TrackingSystem

Satoshi Yamaguchi ........................................... p. 68Graduate School of Dentistry, Osaka Univ

Dental Haptic Simulator to Train Hand Skillof Student-Calibration Method to RealizeVisual/Haptic Environment

Simulation & TrainingJohan Creutzfeldt ............................................. p. 69Ctr for Advanced Medical Simulation,Karolinska Inst

Retention of Knowledge after RepeatedVirtual World CPR Training in High SchoolStudents

Stefan Holubar .................................................. p. 69Colon & Rectal Surgery, Mayo Clinic

Virtual Pelvic Anatomy and SurgerySimulator: An Innovative Tool for TeachingPelvic Surgical Anatomy

Kanav Kahol ..................................................... p. 69Biomedical Informatics, Arizona State Univ

Visualization and Analysis of Medical Errorsin Immersive Virtual Environments

Elizabeth Krupinski ........................................... p. 69Radiology, Univ of Arizona

Assessing Radiology ResidentPreparedness to Manage IV Contrast MediaReactions Using Simulation Technology


Game-Based Mass Casualty Burn Training

Wednesday Posters

20 MMVR17


Fuji Lai ............................................................. p. 70Robotic Telepresence for Medical Trainingand Education

Yuri Millo .......................................................... p. 70Simulation & Training Environment Lab, ER OneInst, Washington Hosp Ctr, Medstar Health

Advanced Medical Simulation: InexpensiveSkills Training for Students and Clinicians

Victor Vergara ................................................... p. 70Ctr for High Performance Computing, Univ ofNew Mexico

The Use of Virtual Reality Simulation ofHead Trauma in a Surgical Boot Camp

Yan Zhang ......................................................... p. 70Univ of Hull (UK)

A Survey of Simulators for PalpationTraining

VisualizationHossein Arabalibeik .......................................... p. 70RCSTIM, Tehran Univ of Medical Sciences

Classification of Restrictive and ObstructivePulmonary Diseases Using Spirometry Data

Jeremy Cooperstock ......................................... p. 70Ctr for Intelligent Machines, McGill Univ

A Comparative Study of Monoscopic andStereoscopic Display for a Probe-Positioning Task

Lucio De Paolis ................................................. p. 71Innovation Engineering, Salento Univ

A Virtual Interface for Interactions with 3DModels of the Human Body

Anton Koning .................................................... p. 71Bioinformatics, Erasmus MC Univ Medical Ctr

V-Scope: Design and Implementation of anImmersive and Desktop Virtual RealityVolume Visualization System

Ganesh Krishnamurthy ...................................... p. 71Interventional Radiology, Radiology, Children’sHosp of Philadelphia

Use of See-Through Head Mounted Displayfor Ultrasound Guided Vascular Access inInterventional Radiology

John Qualter ...................................................... p. 71Educational Informatics, BioDigital Systems

Visualizing Treatment Options for BreastReconstructive Surgery

Justin Tan ......................................................... p. 71Radiology and Biomedical Imaging, Univ ofCalifornia San Francisco

Exploring Human Interface Devices forNavigating Three-Dimensional MedicalImaging Data

THURSDAY, JANUARY 22 – SESSION A

INDEPENDENT SESSION The Pulse!! Collaboration: Academe &Industry, Building Trust8:30 – 10:00 AM

Claudia L. McDonald & Doug Whatley,Organizers

Presentations

Claudia L. McDonaldSpecial Projects, Texas A&M Univ - CorpusChristi

Overview of the Academe-IndustryCollaboration that Produced “Pulse!! TheVirtual Clinical Learning Lab”

Doug WhatleyBreakAway Ltd.

Origin and Development of the Pulse!!Collaboration

Janis Cannon-BowersDigital Media, Univ of Central Florida

Role of Reliability and Validity Research inthe Pulse!! Project &

Reflections on the Interface of Researchwith the Industry Development Team

James DunneTrauma Surgery, National Naval Medical Center

Complexity of Medical Case-Development inthe Pulse!! Project &

Reflections on Subject-Matter Experts’Interface with the Industry DevelopmentTeam

10:00 Break

Wednesday Posters & Thursday Morning

SESSION A, CONTINUED

INDEPENDENT SESSION Building Medical Models and Scenariosfrom Clinical Descriptions

Note: Audience is invited to bring their own laptops and to build their models

10:15 AM – 12:00 Noon

Parvati Dev & Wm. LeRoy Heinrichs, Organizers

Presentations

Wm. LeRoy HeinrichsSUMMIT, Stanford Univ School of Medicine

What Are Medical Models and MedicalScenarios? & Designing Scenarios forSimulators


The Science of Creating a ComputableModel from a Qualitative Description &

Hands-on Experience of Model Buildingwith Simple Tools

THURSDAY, JANUARY 22 – SESSION B

Simulator Development ToolsModerator: Patrick Cregan


8:30 Dhanannjay Deo ............................................... p. 54Mechanical Aerospace & Nuclear Engineering,Rensselaer Polytechnic Inst

Characterization of Anisotropy inViscoelastic Properties of Intra-AbdominalSoft Tissues


Haptic Simulation of the Liver withRespiratory Motion

9:00 Eleonora Westebring-van der Putten .................. p. 54Applied Ergonomics & Biomedical Engineering,Delft Univ of Technology

Tactile Feedback Exceeds Visual Feedbackto Display Tissue Slippage in aLaparoscopic Grasper

9:15 Eftychios Sifakis ................................................ p. 56Mathematics, Univ of California, Los Angeles

Local Flaps: A Real-Time Finite ElementBased Solution to the Plastic SurgeryDefect Puzzle

9:30 Ciamak Abkai ................................................... p. 54Inst for Computational Medicine, Univ ofHeidelberg

Virtual Intensive Care Unit (ICU): Real-TimeSimulation Environment Applying HybridApproach Using Dynamic BayesianNetworks and ODEs

9:45 Allan Okrainec ................................................... p. 54General Surgery, Toronto Western Hospital

Development of a Virtual Reality HapticVeress Needle Insertion Simulator forSurgical Skills Training

10:00 Jessica Burgner ................................................ p. 54Process Control & Robotics, Univ of Karlsruhe(TH)

Including Parameterization of the DiscreteAblation Process into a Planning andSimulation Environment for Robot-AssistedLaser Osteotomy

10:15 Break

Moderator: Carla Pugh

10:30 Satoshi Yamaguchi ........................................... p. 55Graduate School of Dentistry, Osaka Univ

Simulation of Osteotomy and Support forSurgery Using VR Haptic Device

10:45 Ilana Souza........................................................ p. 55Electric Engineering, Univ of São Paulo

A Virtual Reality Simulator for Training ofNeedle Biopsy of Thyroid Gland Nodules

11:00 Oliver Schuppe .................................................. p. 55Computer Science V, Inst for ComputationalMedicine, Univ of Heidelberg

EYESi Ophthalmoscope – A Simulator forIndirect Ophthalmoscopic Examinations

11:15 Stefano Sclaverano ........................................... p. 55TIMC-IMAG Lab, CNRS, Univ Joseph Fourier

BiopSym: A Simulator for EnhancedLearning of Ultrasound-Guided ProstateBiopsy

11:30 Liliane Machado ............................................... p. 55Informatics, Federal Univ of Paraiba

A Qualitative and Quantitative Assessmentfor a Bone Marrow Harvest Simulator

21MMVR17

Presentation Schedule Thursday Morning

11:45 Aaron Oliker....................................................... p. 55R & D, BioDigital Systems LLC

Real-Time Complex Cognitive SurgicalSimulator with Testing

12:00 Erik Lövquist...................................................... p. 71Interaction Design Ctr, Univ of Limerick

Applying User-Centered Design for MedicalSimulation Development

12:15 Discussion

12:30 Adjourn

22 MMVR17

Presentation ScheduleThursday Morning

Salon & The Well

MMVR17

MMVR17 25

Salon & The WellThe Well will open, along with the Exhibits, at the Tuesdaymid-morning break. On Wednesday, Salon and The Well willboth open at the mid-morning break.

SalonChris CulbertsonDept of Neurology,University of California, Los Angeleswww.etc.ucla.edu/research/projects/Meth-Apartment.htm

Demonstration: Use of VR in Addiction Medicine. During theexposure, participants are encompassed within a sensory isola-tion apparatus, including a 32” LCD monitor and a surround-sound audio system. Participants interact with the specially cre-ated virtual world in Second Life, run from a standard Dell PC,using a simple gaming remote control. An additional monitor isplaced outside of the apparatus for outside observation.

Joyce Cutler ShawArtist-in-Residence, University of California, San Diego School of Medicine

Art: Wound Man and Pregnant Woman: Imaged from TheAnatomy Lesson. The implications of body imaging, so impor-tant to the science of the medical professions, can be evokedand traced through the visual history of anatomy: from thehand technology of drawing, through the x-ray, to new andevolving electronic imaging technologies as we are nowscanned, graphed, computerized and dematerialized. The printson exhibit, from illustrations in a fine art book by Joyce Cutler-Shaw, titled The Anatomy Lesson: Unveiling the FasciculusMedicinae, represent a “conversation across time” between hercontemporary drawings and 15th Century medieval medicalwoodcuts of the physical self.

Max S. GerberPhotographer, Pasadena CAwww.HeartKidsProject.org

Photographs: Excerpts from the book project, My Heart vs. theReal World, a photo documentary volume that explores thelives of children with congenital heart disease (CHD) throughstriking black-and-white photographs and interviews with sub-jects and their families. Congenital heart defects are the mostcommon of all birth defects, occurring in one out of every 115to 150 births. The project documents the lives of these kids,focusing on the emotional impact of growing up with a chronicdisease.

Karl Heinz HoehneMedical InformaticsUniversity Medical Center Hamburg-Eppendorf & Voxel Man www.voxel-man.de

Movie: Professor Roentgen Meets the Virtual Body was createdin 1995 for the occasion of the 100th anniversary of Roentgens

discovery. It illustrates the history of medical imaging andimage computing and generated completely with the tools ofthe VOXEL-MAN visualization system. Pictures on the walls ofa virtual room lead to the different highlights: The discovery ofthe X-rays, CT and MR imaging, 3D models for surgery andtraining, virtual endoscopy and more.

Prints: Leonardo meets VOXEL-MAN. The famous anatomicaldrawings Leonardo daVinci opened a new era of depictinghuman anatomy 500 years ago. The exhibit depicts composi-tions of some of these drawings and today’s computer models;although computer generated, they have their own esthetics.

Alan Liu, Jennifer Sieck & Eric AcostaNational Capital Area Medical Simulation Center

Demonstration #1: 3D Model Creation and Animation forMedical Simulation. 3D models lie at the heart of nearly allmedical simulation and serious game applications. A well-devel-oped 3D model lends realism and life to the virtual environ-ment. This demo highlights the artistry behind the science.

Demonstration #2: Desktop 3D Virtual Environments withHaptic Feedback form the basis of a wide range of medical sim-ulation applications. The attraction of a virtual environmentwith haptic feedback lies in its ability to depict various surgicalprocedures.

3D medical simulation represents the culmination of effortsfrom technology and the graphic arts. In this joint presentation,we demonstrate how artistic and scientific creativity combine ina vivid rendition of a virtual patient for learning about headtrauma management.

Marcos LutyensArtist, Los Angeles CA

Alessandro MarianantoniCenter for Research in Engineering, Media and Performance (REMAP) University of California, Los Angeles

Installation: The Excarnation Machine (BETA) is a participato-ry game that involves assembling and breathing life into anassortment of hi-tech media representations of the human body,generating a 21st century take on the “exquisite corpse.” Ourproject addresses some of the ethical provocations that contem-porary science brings to us, such as genetic manipulation andmutation from within and plastic surgery from without.

By representing the human body with MRI’s, X-rays or ultra-sounds, we break through the body’s physical boundaries,removing its sense of gravity and turning it into an anti-terres-trial and quasi-ethereal entity. Thus, in a sense, the bodyascends into a cosmic dimension, and yet, at the same time, theantiseptic process of medical imaging causes a qualitative dilu-tion that presents us with a human portraiture that is void ofvitality, emotion and warmth.

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Salon & The Well

Berci MeskóUniversity of Debrecen, Hungary

Demonstration: Discovering the Virtual World of Medicinethrough Second Life provides medical educators and studentswith numerous educational opportunities and tools while visit-ing the places and islands that can change the way medical edu-cation is delivered today.

José Luis Mosso VázquezRegional Hospital No. 25, Instituto Mexicano del Seguro Social (Mexico DF)

Paintings: The three paintings in The Mind of a Surgeon seriesreflect the interaction between patients and surgeons and tech-nology

Johannes VockerothUniversity Hospital Munich

Demonstration: The Gaze-Driven Head-Mounted Camera is anovel approach to document medical treatment. The devicestores and transmits the exclusive point of view of the surgeon.

EyeSeeCam is a novel head-mounted camera controlled by theuser’s eye movements. It allows, for the first time, to literally seethe world through somebody else’s eyes. A mobile eye trackersystem continuously directs the camera towards the user’s pointof gaze, so that the camera captures exactly what the user’s eyessee.

Virgil WongNew York Presbyterian Hospital andWeill Medical College, Cornell Universitywww.PaperVeins.orgwww.PhineasMap.org

Exhibition: Phineasmap is a VR application that allows patientsto create an anatomical avatar, zoom into systems/organs/tis-sues/cells akin to Google Maps, and connect medical and testi-monial information to various related anchors throughout thebody. Users may view a “world body” that aggregates data fromall users of this system into a collective avatar based on geogra-phy or other factors. The art dimension is embedded in theidea of portraiture as well as the potential prospect for creatingempathy

Jiayi and Shih-wen YoungDoodle LabSacramento, [email protected]

Installation: Sampling Rate in Audible and Visual Perception.Medium: print media; digital media involving programmingand video; active audience interaction

The first piece looks at the role that sampling rate plays inaudible perception. In the “Hiroshima” series, mathematical,physical theories are used to transform the Hiroshima atomicbombing sound into hypotrochoid-like visual patterns. Audi-

ence is invited to interact with the piece by entering a differentsampling frequency. For each sampling frequency, a differentvisual pattern is generated.

The second piece investigates the role that sampling rate playsin visual perception:

“Missing Frames” video #1 is a combination of two differentvideos rapidly switching frames from one video to the other;each is missing 50% of its frames. In the construction of the 30frames per second video, the frames alternate from one video tothe other at the rate of one frame per 1/30th of a second. Theframes of the two videos are essentially zipped or shuffledtogether into one, asking for the brain to respond to both sto-ries.

Video #2 is a combination of three different videos rapidlyswitching frames from one video to the other. Video #3 wouldrequire four videos, etc. We plan to create up to five or ten.

It’s intriguing to observe the similarity between microscopicquantum effects and the quantum-like nature of “samplingrate” in human perception.

The Well

Hanger Orthotics & Prostheticswww.Hanger.com

Installation: The C-Leg® is a microprocessor-controlledhydraulic knee with swing and stance phase control. This inno-vative knee joint features on-board sensor technology that readsand adapts to the individual’s every move. By using special soft-ware and a personal computer, fine adjustments can be made totailor the C-Leg® to the amputee. Angles and movements aremeasured 50 times per second ensuring the dynamic gait is assimilar to natural walking as possible.

Jacopo Annese & Philip WeberThe Brain Observatory, University of California, San Diego &CalIt(2)

Installation: The Digital Light Box is a scalable visualizationenvironment for radiological and pathological examinationsthat enables researchers to visualize and inspect high resolution(gigabyte size) images created by multiple imaging modalities,including virtual microscopy.


Demonstration: The Cyborg MiniTrainer for LaparoscopicSurgery is a portable trainer for laparoscopic surgery integratedby an open module, a lamp and a micro-camera connected toan HMD, specifically for tying knots.

IndependentSession

Summaries

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29MMVR17

Independent Session SummariesMONDAY, JANUARY 19, 1:00 – 5:00 PMSession B

INDEPENDENT SESSION

Virtual Patients for Medical Education: TheNext GenerationGerald Higgins & Bruce Jarrell, Organizers

Medical education and practice is being transformed throughthe use of information technologies and the integration of per-sonalized genomics and other molecular diagnostic data intothe Electronic Medical Record. One change agent is the trans-lation of Systems Biology informatics research into the clinicalenvironment, an approach called Systems Medicine. The emer-gence of game-based learning in medical education, based on asolid foundation of learning sciences research, is fundamentalto the enhancement of clinical skills training and preparednessin the hospital setting. Accurate biomedical simulation, com-bining predictive numerics, visualization and diagnostic imag-ing, can now be realized for development of a Virtual Patientfor education, diagnosis, therapy and individualized medicine.It is incumbent upon those whose foresight extends to whatcould be realized to articulate a vision of future healthcare tech-nology which enables more learned practitioners and patients.In this session, we have assembled a group of researchers thateach can best present their component of the future of a learn-ing / informatics platform in medicine in the context of a Vir-tual Patient.

Presentations

Gerald HigginsSimulation & Training Environment Lab, ER One Inst, Washing-ton Hosp Center, MedStar HealthThe Virtual Patient: A Roadmap for Future Research fromthe Human Simulation and Training Domains

Brian AtheyPsychiatry, Michigan Inst for Clinical & Health Rsch; NIH Nat’lCtr for Integrative Biomedical InformaticsTranslational Bioinformatics in Support of Real and VirtualPatients

Janis Cannon-BowersInst for Simulation & Training / CREAT Digital Media Program,Univ of Central FloridaDeveloping Serious Games for Medical Simulation

Sergei NirenburgComputer Science & Electrical Engineering, Univ of MarylandBaltimore CountyThe Maryland Virtual Patient: Adaptivity in a Multi-AgentClinical System

Richard SatavaSurgery, Univ of Washington Medical Center; US Army MedicalResearch & Materiel CommandTotal Body Scanning and the Longitudinal Health Record

Yuri MilloSimulation & Training Environment Lab, ER One Inst, Washing-ton Hosp Ctr, Medstar HealthGame-Based Skills Training: Inexpensive Simulators forMedical Interventions

Gerald HigginsSimulation & Training Environment Lab, ER One Inst, Washing-ton Hosp Center, MedStar HealthA Meta-Analysis of the Training Value of Medical Simula-tors: 2000-2008

MONDAY, JANUARY 19, 1:00 – 5:00 PMSession C

INDEPENDENT SESSION

Simulator Construction Without the Agonizing Pain Alan Liu, Organizer

The advent of simulation for medical education has spurredconsiderable research on fundamental issues in hardware,algorithms, content development, and validation. To thedeveloper interested in building medical training systems, itis unclear how these academic endeavors translate into aworking trainer. A gap exists between theoretical develop-ment and educationally useful systems.

In this workshop, we bridge the separation between theoryand practice. Lessons learned in simulator design will be dis-cussed using examples taken from successful developmentinitiatives. Advanced software techniques for virtual environ-ment interaction, and haptic and visual rendering will bediscussed. The visual and performance impact of welldesigned 3D models will be demonstrated. The model devel-opment workflow will be highlighted using examples fromcompleted systems and simulators presently under develop-ment.

This workshop is appropriate for individuals planning tobuild medical simulators for training applications. It is alsoappropriate for individuals seeking insight to better evaluatethe suitability presently available systems for their specificrequirements. The workshop will conclude with a forum toanswer questions from the audience.

MMVR17

Independent Session Summaries

30

Presentations

Alan LiuNational Capital Area Medical Simulation Ctr, Uniformed Services UnivIntroduction, Overview, and Wrap-UpTopics: motivation: Why do this workshop? workshop overview;panel discussion (at end)

Robert WaddingtonSimQuest, LLCEducational Requirements Analysis Topics: why do requirements analysis? who are the stakeholders?design pitfalls and common mistakes; case studies in require-ments analysis

Eric AcostaNational Capital Area Medical Simulation Ctr, Uniformed Ser-vices UnivSimulation Environment Development – Advanced Techniques Topics: elements of a virtual environment; GPU-based collisiondetection; multi-rate haptics; advanced volume rendering tech-niques; developing virtual environments for multi-core CPUs;case study – a virtual head trauma simulator

Jennifer SieckNational Capital Area Medical Simulation Ctr, Uniformed Ser-vices Univ3D The 3D Model Development Workflow – From Designto DeploymentTopics: 3D anatomy modeling (software, commercial models,texturing); exporting models – what to watch out for, run-timeconsiderations

Daniel EvestedtSenseGraphics ABH3DAPI: An Open Source API for Dexterous Skills Simu-latorsTopics: The H3DAPI architecture; programming examples; casestudies

TUESDAY, JANUARY 20, 3:45 - 5:15 PMSession B

INDEPENDENT SESSION

Pre-Operative Warm-Up: Science, Theory andImplications on Policy and PracticeKanav Kahol, Organizer

Oxford English Dictionary defines the term warm-up as “Theact or process of ‘warming up’ for a contest, etc., by light exer-cise or practice.” More generically warm-up is “The act orprocess of raising the temperature of an engine, electrical appli-

ance, etc., to a level high enough for efficient working.” whichcaptures the concept of activating and preparing to a high levelof efficiency before beginning an activity. In sports and sportstraining literature there are several published papers and bookshighlighting the importance of warm-up in improving perform-ance and avoiding errors. Modern day surgery certainly quali-fies as a high-stakes, expertise-driven activity. There is signifi-cant research that has shown that surgery requires both strenu-ous mental and cognitive activity. This raises an importantquestion that if surgery involves strenuous physical and mentalactivity, then would a “pre-operative warm-up” (or simply‘warm-up’ for the purposes of this manuscript) activity whichinvolves surgeons performing surgical exercises before the maintask improve surgical performance in the main task at hand?

This panel explores the benefits and challenges of surgicalwarmup. A recent article to be published in Journal of Ameri-can College of Surgeons, present results of a series of experi-ments that show a clear benefit of warmup on surgical proce-dures in lab conditions. The panel will present these results andanalyze them critically. The implication on policy and proce-dures will be discussed. The topic is timely as it represents anovel direction for simulation research in increasing patientsafety. To date, simulation has focused on medical education asa way of reduction of medical errors. However, if the promiseof warmup is fulfilled, simulation will indeed find its way ineveryday medical practice providing a safer environment andbetter patient safety. Through this panel, the authors hope tocatalyze discussion and future research in this direction.

Presentations

Marshall L. SmithSimulation & Training Center, Banner Good Samaritan MedicalCenterWarm-Up in Surgery: A Briefing

Kanav KaholBiomedical Informatics, Arizona State UnivWarm-Up Devices for Surgery

Richard M. SatavaSurgery, Univ of Washington Medical Center; US Army MedicalResearch & Materiel CommandImplications of Warm-Up in Surgery on Policy and Practice

Ajit K. SachdevaDiv of Education, American College of SurgeonsPutting Together a Warm-Up Regimen: What We HaveLearnt from Simulation Curriculum Development

Thomas V. WhalenChairman, Dept of Surgery, Lehigh Valley Health NetworkThe Role of Warm-Up in Ascertaining Quality of Residents:A Residency Review Committee Perspective

31MMVR17


TUESDAY, JANUARY 20, 3:30 - 5:30 PMSession C

INDEPENDENT SESSION

Mixed Reality as a Tool for Cognitive andMotor RehabilitationCali Fidopiastis & Charles Hughes, Organizers

Physical and cognitive rehabilitation is a long and arduous processfor many. Therapists face the challenge of finding effective andmotivating therapeutic tools that will facilitate this process. Virtu-al reality (VR) technology may provide a solution to this dilemmaby affording interactive learning, quantifiable clinical outcomemeasures, enhanced safety, and ecologically-valid training environ-ments. In addition, virtual rehabilitation protocols may be gradedto meet specific therapeutic objectives and client capabilities. Fif-teen years of research in the virtual rehabilitation field demon-strates the advantages of the virtual rehabilitation approach; how-ever, therapists still face challenges when creating affordable VRsystems that are scalable to clinical settings.

The Institute for Simulation and Training (IST) at the Univer-sity of Central Florida (UCF) has partnered with UCF researchfaculty in communicative disorders and computer science, andwith the Virtual Reality Medical Center (VRMC) to explorethe feasibility of creating a scalable virtual rehabilitation systemfor home, clinic, and hospital use.

The objective of this session is to present an overview of thevirtual rehabilitation principles for cognitive and motor rehabil-itation in terms of technology, software, user assessment, andoutcome measures with a focus on mixed and virtual realityexamples. Actual data from both patients and healthy controlswill be presented to illustrate the use of psychophysiologicalmeasures (i.e., EEG and electrodermal response) to assessmixed reality-based rehabilitation applications.

We will discuss the current state of the virtual rehabilitation sys-tem. We will also introduce the use of psychophysiological meas-ures as a means to assess the virtual rehabilitation design throughan iterative human- in-the-loop design cycle. Thus, as part of thisdiscussion we will introduce the audience to psychophysiologicalmeasures, procedures, and issues as they apply to the VR designcycle and the assessment of patient outcomes. The results fromseveral pilot studies using biosensors such as electroencephalogra-phy (EEG) and skin conductance will be presented.

Presentations

Darin HughesInstitute for Simulation & Training, Univ of Central FloridaExperience Design and Production: Patient Needs and TaskPerspectives

Charles HughesElectrical Engineering & Computer Science / Institute for Simula-tion & Training, Univ of Central Florida;Delivery and After Action Review Systems

Cali FidopiastisInstitute for Simulation & Training, Univ of Central FloridaIntegration of Measurement Devices and Procedures

Randall ShumakerInstitute for Simulation & Training, Univ of Central FloridaScalability: Regional Centers, Community Facilities, PrivateCaregiver Facilities, Home and Work

Mark WiederholdThe Virtual Reality Medical CenterCali FidopiastisInstitute for Simulation & Training, Univ of Central FloridaCompleted Studies: Protocol Design and Efficacy

TUESDAY, JANUARY 20, 8:30 AM – 5:30 PM

ADJUNCT MEETING

Virtual Reality Assisted Exposure Therapy inthe Treatment of PTSD The Interactive Media Institute, Organizer

IMPORTANT: This workshop is offered by our colleagues at theInteractive Media Institute and the Virtual Reality Medical Cen-ter. Please note that a separate paid registration is required, avail-able at the door. CE credit is planned.

Presenter

Jim SpiraThe Virtual Reality Medical Center

This intermediate/advanced workshop trains clinicians to useVR systems and physiological monitoring in order to facilitateexposure based treatment of PTSD, including combat andcivilian in origin. Three major approaches to exposure will bediscussed, and strengths and weaknesses of each being discussedand demonstrated. These include flooding type approaches(maintaining maximum arousal), gradual exposure with mini-mal arousal , and graded exposure eliciting high arousal andtraining in arousal control. Cognitive (attentional) and auto-nomic control techniques will be taught. Imagery and self-hyp-nosis techniques will be taught for inter-session practice bypatients, and for clinicians without access to VR equipment.


MMVR1732

THURSDAY, JANUARY 22, 8:30 – 10:00 AMSession A

INDEPENDENT SESSION

The Pulse!! Collaboration: Academe & Industry, Building TrustClaudia L. McDonald & Doug Whatley, Organizers

Objectives

• Discuss lessons learned for academe-industry collabora-tion in the development of high-level learning platformsusing virtual-world technologies.

• Describe a successful collaboration and the stagesthrough which it developed.

• Provide an opportunity for questions from academic andindustry members contemplating collaboration on simi-lar projects.

Summary

Pulse!! The Virtual Clinical Learning Lab is a learning platformfor medical education and training developed using virtual-world technologies more commonly used for computer-basedvideo games. The Pulse!! project, funded so far by more than$12 million since 2005 by the Office of Naval Research, haslearning research built into its development plan in order toshow whether virtual-world technologies are reliable and validmeans for delivering medical curricula.

Pulse!! is the result of collaboration between Texas A&M Uni-versity-Corpus Christi and BreakAway Ltd., of Hunt Valley,Md., a leading developer of entertainment games and game-based technology products. This collaboration is producing cut-ting-edge technological and educational advances and hasresulted in a licensing agreement for Pulse!! technology betweenBreakAway and the Texas A&M University System.

Presentations

Claudia L. McDonaldSpecial Projects, Texas A&M Univ - Corpus ChristiOverview of the Academe-Industry Collaboration that Pro-duced “Pulse!! The Virtual Clinical Learning Lab”

Doug WhatleyBreakAway Ltd.Origin and Development of the Pulse!! Collaboration

Janis Cannon-BowersDigital Media, Univ of Central FloridaRole of Reliability and Validity Research in the Pulse!! Project & Reflections on the Interface of Research with the IndustryDevelopment Team

James DunneTrauma Surgery, National Naval Medical CenterComplexity of Medical Case-Development in the Pulse!! Project & Reflections on Subject-Matter Experts’ Interface with theIndustry Development Team

THURSDAY, JANUARY 22, 10:15 AM – 12:00 NOON Session A

INDEPENDENT SESSION

Building Medical Models and Scenarios fromClinical Descriptions


Virtual Patients in Virtual Worlds are an exciting frontier inmedical learning environments. They can be used to teachaspects of clinical knowledge ranging from basic reasoningabout medical pathologies to learning how to train for complexteam interactions. Constructing these virtual patients anddesigning useful learning scenarios can be difficult even forexperienced simulation designers. We will present the process ofgoing from clinical knowledge possessed by physicians or avail-able in the literature to an expression of this knowledge in acomputable form for use in creating Virtual Patients. We willthen discuss the creation of learning scenarios around availableVirtual Patients.

Participants are encouraged to bring their laptops and attemptto build their own models of Virtual Patients.

Presentations

Wm. LeRoy HeinrichsSUMMIT, Stanford Univ School of Medicine What Are Medical models and Medical Scenarios? & Designing Scenarios for Simulators

Parvati DevInnovation in Learning, Inc.The Science of Creating a Computable Model from a Quali-tative Description & Hands-on Experience of Model Building with Simple Tools

ExhibitInformation

MMVR17

35MMVR17

Exhibit Hours

TUESDAY, JANUARY 20, 200910:00 AM – 10:30 AM Break in Exhibit Hall12:00 PM – 1:15 PM Lunch Break in Exhibit Hall3:15 PM – 3:45 PM Break in Exhibit Hall

4:00 PM Exhibits Close

WEDNESDAY, JANUARY 21, 200910:15 AM – 10:45 AM Break in Exhibit Hall12:00 PM – 1:25 PM Lunch Break - Hall Open

1:30 – 6:00 PM Exhibits Dismantle

Exhibitors

3D Infotech, Inc.6 KansasIrvine, CA [email protected]

3D Infotech specializes in technology solutions for

· Reverse Engineering (RE)

· Computer Aided Inspection (CAI)

· Virtual Reality (VR)

· Product Lifecycle Management (PLM)

Our business is to add value by providing tools and processes thatwill reduce time to market, improve quality and increase innova-tion at your company. Our flagship product is Polyworks forwhich we are the master distributor in the Western United States.

B-Line Medical12510 Prosperity Drive, Suite 320Silver Spring, MD [email protected]

B-Line Medical’s SimBridge™ and SimCapture™ solutionshave been selected by dozens of top medical education institu-tions as the most advanced, comprehensive and easiest to usesolution for managing simulation and Clinical Skills trainingcenters. Through its sophisticated web-based architecture, Sim-Bridge™ and SimCapture™ address the complex set of chal-lenges presented by small and large simulation facilities: auto-mated testing, assessment and video capture, simulator dataintegration, debriefing, and portfolio assembly.

From the affordable and portable SimCapture™ to the power-ful and highly automated SimBridge™, B-Line Medical solu-tions maximize resources, allowing faculty and staff to focus onstudent and curriculum development. For more informationvisit www.blinemedical.com.

CFD Research Corporation215 Wynn Drive, Suite 501Huntsville, AL [email protected]

Computational Medicine and Biology Division of CFDRC isdeveloping Leonardo—an anatomy/physiology based multiscalemodel of a virtual human. Leonardo integrates compartmentaland 3D distributed models of cardiopulmonary circulation,lung respiration, oxygen/glucose metabolism, neural regulation,and other systemic physiological components. Leonardo is builtfrom a spatially distributed arterial-venous vascular system per-fusing several organs. The organs, in the multiscale modelingframework, can be represented as multi compartment reactors,1D vascular trees embedded in the tissue compartment, or geo-metrically fully resolved 3D vasculature/tissue models. Themultiscale modeling capability spans from systemic, organ, tis-sue, cellular, to subcellular pathway models. Our goal is to sim-ulate Leonardo’s virtual life with “faster than life” speed usingnovel multiscale modeling and parallel computing. The “LifeEditor”, Leonardo’s GUI, will allow programming of his dailylife including circadian clock, nutrition, exercise, trauma injury,surgical procedures, and pharmacologic treatment. At present,Leonardo is being tested on his responses to traumatic injuriesresulting from explosion blasts and on novel resuscitation,reperfusion, and pharmacological treatment ideas. We areworking on the integration of top-down system level physiolo-gy models with the bottom-up systems biology. Leonardo isavailable for academic scientific research. For details please con-tact [email protected].

Hanger Prosthetics & Orthotics, Inc. Two Bethesda Metro Center, Suite 1200 Bethesda, MD [email protected]

As the largest provider of prosthetics, orthopedic supports andbraces in the United States, we serve more than 650,000 peopleeach year. Our nationwide network of more than 640 patientcare centers spans 45 states and the District of Columbia. Inaddition to our primary focus on prosthetic and orthotic servic-es, we also offer products for post-mastectomy care, specialtyfootwear and durable medical equipment.

We combine the resources of a national company with the con-venience and personal touch of local patient care centers. Aninternal research and development team means that discoveringbetter ways of doing things is simply part of our day-to-dayoperations. And as the industry leader, we’re able to keepinvesting in the most advanced technologies for our patients.Behind our corporate persona is a group of more than 1,000skilled practitioners who focus on a singular purpose: movinglives forward.

Exhibit Information

36 MMVR17

Exhibit Information

PhoeniX Technologies, Inc.4302 Norfolk StreetBurnaby, BC V5G 4J9, [email protected]

PhoeniX Technologies, Inc. (PTI) is the industry’s leading man-ufacturer of “Active Optical” based Real-Time 3D Motion Cap-ture systems. PTI offers their Visualeyez™ range of “Profes-sional Grade” Motion Capture systems, which are highly accu-rate, reliable and user-friendly, at extremely “cost-effective”prices. With advanced patented wide angle active marker track-ing technology, world’s first and only automatic and adaptivecalibration product VZAutoCal™ and several innovative acces-sories, PTI systems deliver Real Time, problem-free, and noweven calibration-free, operation that provide users with instanthigh quality 3D motion feedback. Our high-end products areused all over the world in a variety of motion capture andmeasurement areas. Applications for our systems are in researchand analysis in the areas of Virtual Reality, Biomechanics,Robotics, Sports Science & Research, Structural and VibrationAnalysis, Crash Test Analysis, and many more. Visualeyez™systems also find applications and users in Animation, Video &Film development, computer and console Game Development,Special Effects Production, VFX, etc.

SensAble Technologies, Inc.15 Constitution WayWoburn, MA [email protected] www.SensAble.com

SensAble Technologies is a leading developer of 3D touch-enabled (force feedback) solutions and technology that allowusers to not only see and hear an on-screen computer applica-tion, but to actually ‘feel’ it. SensAble’s PHANTOM® line ofhaptic devices and OpenHaptics® toolkit are used to develop awide range of applications including surgical simulators thatcan improve patient safety and doctor training—especially forhigh-risk and blind procedures such as arthroscopic surgery,epidural injections, temporal bone drilling, and spinal implants.SensAble also offers 3D touch-enabled modeling solutions usedto design patient-specific implants and prosthetics, orthopedicbraces, study models, and dental restorations. In addition tooff-the-shelf solutions, SensAble offers contract development toOEMs for new and customized software applications and hap-tic devices. Selected medical customers include Biomet Inc.,GMV, Kallisto, Medic Vision Ltd, Melerit Medical AB, PDRand Morriston Hospital, Simulution, ToLTech, Walter ReedArmy Medical Center, Wilford Hall Medical Center, and lead-ing universities and research facilities. SensAble maintains head-quarters in the United States and a sales office in Japan. Sens-Able products are available through direct and reseller channels.Visit SensAble online at: www.sensable.com.

SenseGraphics ABFärögatan 33, B25, Kista Science Tower164 51 Kista, [email protected]

SenseGraphics provides a high performance application devel-opment platform (H3DAPI) which enables integration of hap-tics and 3D visualization into multimodal software applica-tions. H3DAPI has been used to develop a diverse range ofapplications in various fields including but not limited to med-ical, dental, industrial and visualization. To encourage learningand growth in the use of haptics technology, H3DAPI is opensource with options for commercial licensing. H3DAPI is avail-able for download at www.H3D.org.

The Telemedicine & Advanced Technology Research Center (TATRC) MRMC-ZB-T, Bldg 1054 Patchel Street Ft. Detrick, MD 21702-5012 [email protected] www.TATRC.org

For the 2009 Annual MMVR Conference, the US Army Med-ical Research & Materiel Command (USAMRMC) and TheTelemedicine & Advanced Technology Research Center(TATRC) have decided to take a novel approach. TATRC willextend the definition of telemedicine and advanced medicaltechnologies, to include an array of technological innovationswhich impact the provision of healthcare to the military. Thisexhibit will focus on and highlight the Congressional Partnersand their projects who have teamed with TATRC in an effortto improve joint medical readiness, provide greater battlespacemedical awareness, and more effectively employ our medicalforces in the 21st century. Funded as areas of Special Congres-sional interest for Army research, over 60 projects totaling morethan 300 million dollars have been executed and managed byTATRC, and carried out in universities and private laboratoriesall over the country. Please stop by TATRC’s advanced technol-ogy showcase for a thought-provoking and exciting experiencedemonstrating how technology will enhance life on the battle-field, in military medicine and beyond. For more informationabout TATRC, please visit us at MMVR, or visit us at:www.tatrc.org, or call Ms. Lori DeBernardis, Director of Mar-keting and Public Affairs at (301) 619 - 7927.

TrueVision Systems, Inc.114 E. Haley Street, Ste. LSanta Barbara, CA [email protected]

TrueVision® is a remarkable real-time 3DHD vision system formicrosurgery. It converts the stereoscopic optical view of surgi-cal microscopes to a digital 3DHD image and displays it on aprojection screen or monitor. Surgical procedures are now per-formed without the need to be permanently attached to themicroscope oculars.

The surgical vision system delivers over twice the depth of fieldcompared to the microscope view and three times the resolu-

37MMVR17

Exhibit Information

tion of standard definition, enabling surgeons to successfullyperform “heads-up” microsurgery without looking into themicroscope’s eyepieces. The 3DHD video recording accuratelycaptures the surgical view. One touch playback replays video ofthe TrueView™ in full 3DHD clarity on the TrueVision ImageDisplay System.

Both surgeons, residents and the entire OR staff can view whattraditionally only one surgeon could observe through themicroscope’s binoculars. TrueVision works with surgical micro-scopes and is ideal in the operating room for performing sur-gery, collaborating and teaching surgical procedures.

By embracing 3DHD visualization as a standard of care anddocumentation, TrueVision is leading the way to a digitalfuture for all microscopy.

University of Nebraska Medical CenterCenter for Advanced Surgical Technology984075 Nebraska Medical CenterOmaha, NE [email protected] www.UNMC.edu

Check out innovative technologies and Centers of Excellence inAdvanced Surgical Technology and Airways Management. Meetour faculty and hear about our expanding research facilities andcollaborative multi-disciplinary research projects: miniaturerobots for surgery, novel airway management solutions,telemedicine capabilities for perioperative medicine care, profi-ciency in robotic surgery, and surgical applications of roboticand mechanical systems, optimal design, and modular design.For more information, go to UNMC’s Web site atwww.unmc.edu or contact Marsha Morien [email protected].

Virtually Better, Inc. 2440 Lawrenceville Highway, Suite 200Decatur, GA 30033www.VirtuallyBetter.com

Virtually Better designs and creates effective virtual reality envi-ronments for healthcare, clinical training, and education.Located at more than seventy clinical sites worldwide, VirtuallyBetter’s technology is setting the tone and pace for clinical vir-tual reality systems.

Virtual reality environments offer significant advantages forcognitive behavior therapy in that they allow exposure-basedtreatments to be conducted in the safety and comfort of a clinicsetting. Numerous studies have indicated that these virtualenvironments, utilized in a therapeutic manner, are effectivetools for treating a variety of disorders, including anxiety,addiction/substance abuse, and post-traumatic stress (PTSD).In addition to demonstrating our clinical products for exposuretherapy, we will be demonstrating Virtual Iraq and VirtualAfghanistan, used specifically for the treatment of combat relat-ed PTSD.

We will be demonstrating Multi-User Virtual Environments(MUVE’s) that can be used in a wide variety of clinical situa-tions to address behavioral healthcare problems. MUVE envi-

ronments provide the ability to:

• Engage the patient cognitively, and thus make therapyengaging, as well as increase compliance

• Conduct group therapy sessions

• Monitor progress using a wide array of assessment tools

• Allow clinicians to build rapport with patients in a neu-tral environment that can de-stigmatize therapy

• Teach interpersonal and cognitive skills

• Desensitize patients to environmental triggers

• Create and support patient social networks

• Practice clinical skills with trainees and provide animmediate opportunity for testing in a simulated socialor clinical setting

• Enhance counseling by meeting family members in thesimulated environment, using the recordings of pastindividual therapy sessions as conversation starters, andreducing the burden of time and distance

• Improve clinical supervision of staff through review ofvirtual session

• Conduct therapy and supervision locally or at a distance

PresentationSummaries

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41MMVR17

MONDAY – SESSION A MENTAL HEALTH & SIMULATION

Thomas Parsons

Neurocognitive and PsychophysiologicalAnalysis of Human Performance within VirtualReality Environments

High-fidelity, immersive virtual environments (VE) developedat the Institute for Creative Technologies (ICT) were leveragedto allow researchers to record psychophysiological measurementmodalities during the performance of various highly-realistictasks. Specifically, we aimed to continue development of a com-prehensive, standardized, norm-based virtual reality cognitiveperformance assessment test (VRCPAT) battery that recyclesgraphic assets developed for ICT’s Virtual Iraq. The VRCPATleverages VE assets to measure neurocognitive performancewithin military relevant environments. Cognitive componentsinclude attention, memory, executive functioning, spatial abilityand a host of higher-level language and reasoning abilities.

Young Seok Shin

Virtual Auditory Hallucination Exposure Programfor Schizophrenia

Auditory hallucination is a false or distorted hearing perceptionwith a compelling sense of its reality, and associated with psy-chotic disorders such as schizophrenia. Patients with schizo-phrenia who suffered from the auditory hallucinations couldeasily be disturbed to their behavior or thought by their hallu-cination. Behavioral treatments have been designed in whichschizophrenic subjects are trained in strategies for coping withverbal auditory hallucinations. However, this coping skillstraining has limitations due to the absence of assistive tool forgiving similar and relative stimuli in several situations. VirtualReality could simulate the real situations as well as manipulatethe situations so that it could provide unreal stimuli. It is alsohave some advantage. Therefore, we propose the virtual audito-ry hallucination exposure system, in which patients could expe-rience weird or inappropriate sounds out of accord with sur-roundings, and have shown the feasibility and possibility inapplying in patients with schizophrenia.

Giuseppe Riva

The Intrepid Project: Biosensor-Enhanced VirtualTherapy for the Treatment of Generalized AnxietyDisorders

Generalized anxiety disorder (GAD) is a psychiatric disordercharacterized by a constant and unspecific anxiety that inter-feres with daily-life activities. Together with the cognitive-

behavioural treatments, relaxation represents a useful approachfor the treatment of GAD, but it has the limitation that it ishard to be learned. To overcome this limitation we propose theuse of virtual reality (VR) to facilitate the relaxation process byvisually presenting key relaxing images to the subjects. To testthis concept we planned a randomized controlled trial(NCT00602212) , including three groups of 25 patients each(for a total of 75 patients): (1) the VR group, (2) the non-VRgroup and (3) the waiting list (WL) group. This controlled trialwill be able to evaluate the effects of the use of VR in relaxationwhile preserving the benefits of randomization to reduce bias.

José Mosso


When undergo ambulatory surgical operations, the majority ofpatients experience high level of anxiety. Since Virtual reality(VR) has been demonstrated a good distraction technique, ithas been repeatedly used in hospital contexts for reducing painin burned patients, but it has never been used during surgicaloperations. With the present study we intended to verify theeffectiveness of VR in reducing anxiety during outpatient sur-gery. We measured the degree to which anxiety associated withsurgical intervention was reduced by distracting patients withimmersive VR provided through a cell phone connected to anHMD compared to a control condition. A significant reductionof subjective and physiological anxiety was obtained after 45minutes of operation and maintained until the end of the surgi-cal intervention in the VR group, but not in the control group.

Carla Pugh

Use of Clinical Simulations for Patient Education:Targeting an Untapped Audience

According to previous studies, many women experience thepelvic examination as something negative. One part of the neg-ative experience stems from being exposed, in a subordinateposition and with no control over what happens during a verypersonal examination. “Empowerment” of female patients inthis situation would enable them to feel more like a partner inprocess - gaining power and having more control over the situa-tion. Knowledge can be a valuable tool in the empowermentprocess. The purpose of this study was to evaluate changes inwomen’s expectations of their next pelvic examination beforeand after a simulation-based learning experience. In addition,we sought to better understand the effect of knowledge andinstruction on a patient’s pelvic examination experience.

Presentation Summaries


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Thomas Parsons


This study uses virtual characters to aid our understanding ofprejudice in training clinicians. The activation and control ofaffective race bias was measured using 1) startle eye blinkresponses; and 2) self-reports as white participants interact withwhite and black virtual humans. By measuring eyeblinkresponses to startle probes occurring at short and long latenciesfollowing the onset of Black compared with White virtualhumans, we were able to examine affective processes associatedwith both the activation and potential control of race bias.Importantly, patterns of eyeblink modulation have differentmeanings at short and long latencies. Eyeblink responses atshort latencies vary as a function of attention. A race-biasedresponse to a short latency probe was evidenced by relativelysmaller blinks (blink inhibition).

Christopher Culbertson

Using Virtual Reality to Assess and Treat Cravingin Substance Dependent Individuals

Drug craving has long been recognized as a major target forpharmacological and behavioral treatments intended toimprove abstinence in substance dependence individuals. Previ-ously, researchers and clinicians have used a variety of tech-niques including visual, auditory, in vivo and imaginal drug cuepresentation methods to produce craving in a clinical setting.Recently, virtual reality (VR) cue exposure models have beendeveloped to improve upon traditional cue exposure methodsby creating realistic and interactive environments. We havedeveloped two separate VR drug cue environments (metham-phetamine & nicotine) using Second Life to closely examinecue induced craving in these respective populations and assessthe efficacy of pharmacological and behavioral treatmentsintended attenuate drug craving.

Robert McLay


Virtual Reality (VR) based therapies have been shown to be asafe and effective way to treat Post Traumatic Stress Disorder(PTSD). The published case series, however, have been con-fined to relatively peaceful settings. As wars continue, militaryproviders need to provide treatments at the front. Such envi-ronments provide unusual challenges, and broach questionsabout what VR can add for those already facing the reality ofwar. We report on a series of six Service Members whodeployed to Iraq with PTSD, and their treatment with VirtualReality while in Fallujah. Situation faced included new, poten-tially-traumatic experiences occurring in the midst of treatmentand interruption of sessions by the realities of the environment.Despite difficulties, all six showed improvement, with five ofthe six effectively finding remission of symptoms. The degree to

which the VR was essential to their recovery remains in ques-tion. Details of the cases are discussed.

Dennis Wood

Effectiveness of Virtual Reality Graded ExposureTherapy with Physiological Monitoring forCombat Related Post Traumatic Stress Disorder

Background: The percentage of Army and Marine Corps per-sonnel, who participated in Operation Iraqi Freedom or Opera-tion Enduring Freedom and who met screening criteria formajor depression, generalized anxiety disorder or PTSD, was ashigh as 17.1%. DOD officials have also expected that thePTSD rates will be higher among troops who have completedtwo or more combat tours to Iraq. Virtual reality exposure(VRE) therapy has been reported as a new and effective therapyfor treating veterans with PTSD. The Virtual Reality MedicalCenter (VRMC) has developed a Virtual Reality Graded Expo-sure Therapy (VRGET) protocol for treating warriors diag-nosed with combat-related PTSD. Tools and methods: Eightmilitary active duty male volunteers, diagnosed with ChronicPTSD, completed the 10 week VRGET protocol. The VRGETsystem relied on a combined visual and auditory presentationusing two PC computers. The VRMC VRGET assessment andtreatment protocol has been previously described. Results: Ourpresentation will review the VRGET protocol utilized to treatcombat-related PTSD and the treatment outcome results forthe first eight patients in our randomized treatment group. Wewill also discuss recommendations for the future VRGET treat-ment of combat- personnel diagnosed with PTSD.

Albert Rizzo

VR PTSD Exposure Therapy Results with ActiveDuty OIF/OEF Combatants

Post Traumatic Stress Disorder (PTSD) is reported to be causedby traumatic events that are outside the range of usual humanexperience including military combat, violent personal assault,being kidnapped or taken hostage and terrorist attacks. Reportsindicate that at least 1 out of 6 Iraq War veterans are exhibitingsymptoms of depression, anxiety and PTSD. Virtual Realityexposure therapy has been previously used for PTSD withreports of positive outcomes. This paper will present a briefdescription of the USC/ICT Virtual Iraq PTSD therapy appli-cation and present clinical outcome data from all patients treat-ed as of Jan. 2009. Clinical trials are currently underway at theNMCSD, Camp Pendleton, Emory University, WRAMC andFort Lewis along with 10 other clinical test sites. Initial out-comes from the first eighteen patients treated at the time of thiswriting indicate that 14 no longer meet diagnostic criteria forPTSD at post treatment.

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MONDAY – SESSION B INDEPENDENT SESSION: VIRTUALPATIENTS FOR MEDICAL EDUCATION

No individual summaries available. Please see independent ses-sion summary on page 29.

MONDAY – SESSION C INDEPENDENT SESSION: SIMULATOR CONSTRUCTION WITHOUT THEAGONIZING PAIN


TUESDAY – SESSION ACOMPUTER-AIDED THERAPY

Guoyan Zheng

A System for 3-D Reconstruction of a Patient-Specific Surface Model from Calibrated X-RayImages

With the recent introduction of navigation techniques, three-dimensional (3-D) surface models of the patient anatomies areroutinely used to provide image guidance and enhanced visuali-zation to a surgeon to assist in planning and navigation. Thecommon approach to derive 3-D models is to use imagingtechnique such as computed tomography (CT) or magnetic res-onance imaging (MRI). These have the disadvantages that theyare expensive and/or induce high-radiation doses to the patient.The alternative is to reconstruct a surface model using pre-operative two-dimensional (2-D) X-ray radiographs and a 3-Dpoint distribution model (PDM). Although a number ofauthors reported different solutions, it is still a challenging taskwhen we would like to reconstruct a patient-specific model of abone with pathology using a PDM constructed from trainingsurface models of normal anatomy. In this paper, we present asystem for 3-D surface model reconstruction from calibrated X-ray images, which can handle seamlessly both non-pathologicand pathologic cases.

Jennifer Lo

Surgeon-Controlled Visualization Techniques forVirtual Reality-Guided Cardiac Surgery

The interaction difficulties that a surgeon experiences whileworking with virtual reality (VR) environments arise from dis-orientation, insufficient depth information, and delegation ofview control. Our study focuses on optimizing informationdelivery for VR-guided beating heart surgery. From human fac-

tors evaluation to participatory design, we describe the designand verification cycle involved in developing an effective sur-geon-controlled visualization technique for VR-guided beatingheart interventions. The outcome of this process is three inter-active modalities, each of which allows the surgeon to intra-operatively control the visualization of a three-dimensional(3D) virtual environment: 1) Immersive and interactive viewcontrol using a head mount display 2) Preset standardized med-ical view angles displayed on a two dimensional (2D) monitor3) Tangible view control using a physical replica of the 3D vir-tual model Through our consistent evaluation method, wecompare the effect of these novel techniques on task efficiency,targeting accuracy and surgeons’ comfort level.

Thomas Sorensen

Developing and Evaluating Virtual Cardiotomy forPreoperative Planning in Congenital HeartDisease

Preoperative planning may be greatly facilitated by virtual car-diotomy in the most complex cases of congenital heart disease.A prerequisite however is sufficient quality 3D imaging dataand accurate virtual reconstructions. In this work we present aquantitative evaluation of the image quality of 3D cardiac MRI- including an evaluation of the segmentation accuracy andprocessing time of the corresponding 3D modeling process.Forty-one pediatric patients were included in the study. Finallywe show examples of and discuss, qualitatively, the benefits ofvirtual cardiotomy for preoperative surgical planning in con-genital heart disease.

Jung Leng Foo


This paper presents a software that provides surgeons a multi-modal platform for collaborative interaction and visualizationof patient image data. This is built upon previous work wheresurgeons can visualize and interact with automatically segment-ed tumors in the context of original patient data in virtual reali-ty (VR), for diagnosis and surgical planning purposes. Theimproved software framework now consists of a desktop viewerand a VR viewer, both capable of reading and displaying anyDICOM/PACS image data for visualization and interaction.Features include real time pseudo-coloring, tissue windowing,and 3D volume rendering. Both viewers can function inde-pendently or synced via a network connection for a collabora-tive working environment. Using this software, one team in theVR environment can collaborate with another team at a differ-ent location for diagnosis, surgical planning, and tele-mentor-ing, while viewing the same 3D representation. This overcomesthe restrictions of location to encourage communicationbetween medical professionals.


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Asaki Hattori

Development of a Real-Time Image-GuidedSurgery System for Stereo-Endoscopic SinusSurgery

In endoscopic sinus surgery, a surgeon has to correctly recog-nize the precise orientation of the target and surrounding tis-sues in the nasal cavity. However, because of an endoscope’snarrow field of view, it may be difficult for the surgeon tounderstand the specific location of an internal structure such asan optic nerve or vessels. We have developed a 3D image-guid-ed surgery system for endoscopic sinus surgery. In this system, astereoscopic endoscope is applied, and the internal structuremodels of the patient are superimposed onto the endoscope’sstereoscopic video images in real-time. After phantom experi-ments, we applied this system to clinical tests. In the experi-ment, the surgeon was able to stereoscopically observe the innerconditions of the field of view.

Reinhard Friedl

Cardio Pointer: Development of a NavigationSystem for Coronary Artery Bypass Grafting

Open heart bypass graft surgery is the standard treatment foradvanced cases of coronary heart disease. Optimal placement ofthe bypass graft anastomosis is of utmost importance for thesuccess of the procedure. Therefore, detailed and precise knowl-edge about the course and morphology of the target vessel iscrucial for the operating surgeon. To provide such informationduring the procedure, a novel surgical navigation system foropen heart bypass graft surgery is introduced which merges pre-operative maps of the coronary arteries with intraoperativedata. The patient-specific vessel map is generated from multi-slice computer tomography (MSCT), while the intraoperativedata are obtained using a stereo camera system and an opticaltracking system (Cardio Pointer). During surgery, its purpose isto provide a patient-specific map of the coronaries in which thecurrent position of a surgical pointing device (Cardio-Pointer)is visualised. A registration approach based on mutually-sharedanatomical landmarks on the heart surface is presented.

Johannes Vockeroth

Medical Documentation Using a Gaze-DrivenCamera

Medical treatments of a surgeon or a dentist could be docu-mented for teaching or telemedicine using a scene orientedvideo camera. But the most interesting parts of the scene areoften covered by the operators hand or body. The best view tothe scene is next to the operators field of view or perfectly:Within his head. Head-mounted scene cameras are used to cre-ate this exclusive point of view. Eye tracking systems could beused to emphasize the point of gaze within the scene image.The presented system improves classical eye trackers with anadditional gaze-driven camera. The resulting scene image main-tains the overall context, while the image from the gaze driven

camera acts like a magnifying glass and provides a high-resolu-tion image of the gazed detail using an independent exposure.We show its application in a real dental treatment scenario.

ROBOTICS

Amy Lehman


Minimally invasive surgical techniques provide many patientbenefits including reduced trauma and pain, a more rapidrecovery, and improved cosmetic results as compared to con-ventional open surgery. The application of these techniques,however, remains limited by factors including two dimensionalvideo feedback and decreased dexterity. While these limitationshave been overcome for simpler procedures, the adoption ofminimally invasive techniques for advanced laparoscopic sur-gery, such as colectomy, has been slower. This study presentswork towards an in vivo robotic assistant for laparoscopic sur-gery. In contrast to externally actuated robotic systems, thisrobot can be completely inserted through a single port to assistin complex laparoscopic procedures. Once inserted, the robotcan be positioned to operate in each quadrant without necessi-tating additional incisions. A robot prototype with a cauteryend effector has been demonstrated in a non-survivable porcinemodel laparoscopic procedure.

Sachin Daluja

An Integrated Movement Capture and ControlPlatform Applied Towards AutonomousMovements of Surgical Robots

Surgical robots are being widely employed for performing vari-ous types of operations where they offer many advantages overconventional surgery. There, however, remains a significantscope of improvement especially in the areas of surgeon-robotinterface and autonomous procedures. Previous studies haveattempted to identify factors affecting a surgeon’s performancein a master-slave robotic system by tracking hand movements.These studies, however, relied on conventional optical or mag-netic tracking systems, making their use impracticable in theoperating room. This research presents an intrinsic platformdeveloped for tracking hand movements to help improve surgi-cal performance. Signals from potentiometers and encoders onboard the robot’s hand controller were utilized to capture handmovements by employing specially developed electronic hard-ware. Recorded hand trajectories were replicated and applied tothe robotic instruments, enabling autonomous playback of sur-gical tasks.

Carl Nelson

Portable Tool Positioning Robot for Telesurgery

A compact, portable robot called CoBRASurge (CompactBevel-geared Robot for Advanced Surgery) has been developed

45MMVR17


for tool guidance in minimally invasive surgery (MIS). It uses aspherical mechanism composed of bevel gears to achieve thenecessary workspace in four degrees of freedom (DOF). FourDC motors drive the robot, with surgeon-in-the-loop controlguided by an ergonomic joystick. The robot workspace hasbeen validated experimentally, and motion trajectory experi-ments have shown robust and stable control. Use of the robotfor camera guidance in porcine models is described. Theseexperiments indicate superior functionality of the robot. Futurework will involve integration of higher-function surgical toolswith multiple CoBRASurge modules to create a complete,highly autonomous and portable MIS robot system fortelesurgery.

Naoki Suzuki

Tele-Control of an Endoscopic Surgical RobotSystem between Japan and Thailand for Tele-NOTES

We have already experimentally performed endoscopic mucosalresection (EMR) and natural orifice transluminal endoscopicsurgery (NOTES) procedures using the endoscopic surgicalrobot system we have developed. In this study, we aimed tocarry out tele-control of this robot between Japan and Thailandas a Tele-NOTES procedure using a soft human cadaver. Ourendoscopic robot has two forcep-type remote controlled manip-ulators on the distal endoscopic part. Operation of the endo-scopic part that goes into the body through the esophagus wasundertaken by an endoscopist on the Thailand side. Themanipulators were controlled by a surgeon on the Japan sideusing the Japan Gigabit Network (JGN2). Remote control overa long distance through a high-speed network connection wasconfirmed. The surgeon could manipulate the robot from aremote place and could perform Tele-NOTES procedures inthe abdominal cavity of a soft cadaver.

Jeff Hawks

A Modular Wireless In Vivo Surgical Robot withMultiple Surgical Applications

The use of miniature in vivo robots that fit entirely inside theperitoneal cavity represents a novel approach to laparoscopicsurgery. Previous work demonstrates that both mobile andfixed-based robots can successfully operate inside the abdomi-nal cavity. A modular wireless mobile platform has also beendeveloped to provide surgical vision and task assistance. Thispaper describes an overview of recent test results of several pos-sible surgical applications, such as a biopsy grasper, stapler andclamp, drug delivery, video camera, and physiological sensors.The modular platform facilitates rapid development and con-version from one type of task assistance to another. These self-contained surgical devices are much more transportable andmuch lower in cost than current robotic surgical assistants.These devices could ultimately be carried and deployed by non-medical personnel at the site of an injury. A remotely locatedsurgeon could use these robots to provide critical first responsemedical intervention.

TUESDAY – SESSION BSIMULATOR DEVELOPMENT

C. Donald Combs


Medical simulation has seen considerable development over thepast few years and is evolving to better address training needsin the medical and health professions. A recent analysis of med-ical modeling and simulation research, covering the years 2000-2007, showed a substantially increased interest in proceduralsimulation. Through a comprehensive analysis of the MedicalModeling and Simulation Database’s (MMSD) Products andCompanies and Research Articles collections, the area of proce-dural simulation was analyzed in detail in 2008. Researchfound that the most prominent current trends among simula-tors are models that are wireless, portable, compact, emphasizeteam training, and user-friendly. This analysis of proceduralsimulators and their deployment provides an assessment oftheir increasing utility in medical skills training.

Gerald Moses


For five years, the University of Maryland Medical Center andSchool of Medicine have sponsored a program of research tar-geted at the enabling of technologies for enhanced training,clinical effectiveness and patient safety. Initially, under therubric of “The Operating Room of the Future” various pillarsof research were established that proposed to advance the stateof medicine, notably surgery. The pillars included scientificapproaches related to Informatics, Smart Image, and Simula-tion. The evolving research effort opened the door to a revisedconcept of basic sciences that underpin surgical training andeffectiveness. Developments led to two important changes; theadoption of a new mantra, Innovations in the Surgical Environ-ment, to replace the Operating Room of the Future; and theaddition of another research pillar, that of Ergonomics andHuman Factors. Progress will be reported in each of the pillarsof research. Lessons learned from high-stakes environments willbe applied.

Mario Riojas

Knowledge Elicitation for PerformanceAssessment in Computerized Surgical TrainingSystem

More often than not, the judgment of experienced surgeonsduring the performance assessment of laparoscopic surgicalskills of medical students occurs in the form of ordinal vari-ables. These variables can take values such as low, medium, orhigh when describing the medical student’s skills. We presenthow to model the variables involved in the judgment criteria ofa laparoscopic hand-eye coordination task as fuzzy sets. Our


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proposed framework presents the knowledge elicitation for aninference system that obtains quantitative results based on judg-ment criteria given in qualitative form with the potential toaugment its knowledge-base from trainees’ performances, with-out relying solely on the data of the subjects used during thesystem’s design phase, making it an adaptable scoring systemcapable of growing at its trainees’ pace.

Marcus Schlickum

The Importance of Visual Working Memory andVisual-Spatial Ability for High PerformanceDiffers between Various Virtual Reality ImageGuided Surgical Simulators

Visual working memory and visual-spatial ability has recentlybeen discovered important for performance in virtual realityimage guided surgical simulators. The aim of this study was toinvestigate the importance of these human factors in several dif-ferent simulators. 35 medical students were tested in three dif-ferent simulators, as well as tested for high-level visual-spatialability and visual working memory. Simulator performancescores were then compared with the cognitive tests using a mul-tivariate approach. The visual-spatial ability and visual workingmemory scores were ranked according to importance in eachsimulator. Results from the study show that the importance ofeach factor differs depending on which simulator that was test-ed. This information can be useful when designing future surgi-cal skills training curricula and also in assessment.

Gyusung Lee

Joint Kinetic Data Augments TraditionalBiomechanical Approach to Assess theErgonomics of Laparoscopic Camera Assistants

Surgical ergonomic studies routinely use angular joint move-ment, force plate, and electromyography to investigateergonomic risks faced by primary laparoscopic surgeons. In thisstudy, we performed a kinetic data analysis that describes howdifferent internal and external forces interact during jointmovements. Such analysis has not previously been used thus,though it provides a more comprehensive ergonomic risk assess-ment. Additionally, our research focus investigated theergonomics associated with tasks performed by surgical assis-tants during a simulated Nissen fundoplication. Our study’sdata is augmented by a mathematical model, currently in devel-opment, of the knee joint, allowing us to investigate how com-pressive joint load is distributed between the medial and lateralcompartments. This model will enable data gathering, whichcannot be garnered and measured noninvasively. Quantitatively,our results demonstrate that camera assistants’ standing posturecontributes to a high-risk ergonomic situation.

Gunther Sudra

Estimating Similarity of Surgical Situations withCase-Retrieval-Nets

Representation and recognition of surgical situations is a pre-requisite for the development of context-aware surgical assis-tance systems. According to the theory of Neumann et al. anapproach for situation recognition based on description logics(DL) is used. This approach provides a formal basis for knowl-edge engineering and enables explicit modelling of surgical situ-ations. In this publication a method for recognition of surgicalsituations with Case-Retrieval-Nets (CRN) is presented. Itenables the estimation of similarity between models of surgicalsituations. The main advantage of CRNs is the combined useof domain knowledge and DL-reasoning algorithms to deter-mine the state of an intervention. The described methods havebeen applied to build and compare models of surgical situa-tions. Evaluation is performed on situations of two cholecystec-tomies.

Dhanannjay Deo

A Machine Learning-Based Scalable Approachfor Real-Time Surgery Simulation

In this work a novel method is presented for real-time physics-based surgery simulation, which combines the complexity andaccuracy of physics-based non-linear soft tissue models andcommercial finite element codes with the high speed of execu-tion of machine learned neural networks. In an off-line pre-computation phase, each node of the organ model is simulatedwith carefully chosen prescribed displacements and theresponse, computed using commercial finite element softwaretools, is recorded and stored in a large database. The data inthen vastly condensed into a set of coefficients describing neu-rons of a Radial Basis Function (RBF) network for easier stor-age and rapid reproduction. During real-time computations, asthe surgical tool interacts with the organ models, these neuralnetworks are used to reconstruct the deformation fields as wellas the reaction forces at the surgical tool tip.

Mark Bowyer

Exporting Simulation Technology to thePhilippines: A Comparative Study of TraditionalVersus Simulation Methods for TeachingIntravenous Cannulation

A Validation of the Virtual IV simulator was undertaken in thePhilippines in which 40 novice medical students were random-ized to receive training on either the simulator (n=20)or by tra-ditional methods (n=20). Their subsequent attempt at insertionin an actual patient was videotaped and scored by blinded eval-uators pretrained such that inter-rater reliability exceeded 0.80.Students who trained on the simulator were more likely to besuccessful,were rated higher by evaluators and had less con-stricting band and overall times. Exportation of simulation

47MMVR17


technology to developing countries is feasible but barriers towidespread utilization exist.

TUESDAY – SESSION B (CONT. )INDEPENDENT SESSION: PRE-OPERATIVE WARM-UP


TUESDAY – SESSION CREHABILITATION

Marlene Sandlund

Effect of Interactive Computer Training on Goal-Directed Arm Movements in Children withCerebral Palsy: A Kinematic Evaluation

Computer interactive environments may provide a way to makemotor training more motivating for children with sensorimotordisorders. However, appropriate computer environments thatcould be used for this purpose need to be systematically tested inrehabilitation settings in order to evaluate their influence on chil-dren’s motor control. The aim of this study was to evaluate thequality of goal-directed arm movements in children with cerebralpalsy after four weeks of daily practice with the Sony’s EyeToysystem for PlayStation2. Before and after practice, arm move-ments were recorded by means of an optoelectronic motion cap-ture system. Preliminary results show that the variability in meanvelocity and peak velocity decreased in goal-directed arm move-ments after practice. The fact that the improvements were seen inarm movements towards both virtual targets and real targets sug-gests a transfer of improvements in movement quality achievedin virtual practice to real life situations.

Sheryl Flynn

Virtual Reality Systems Using Low-Cost Webcamand Off-the-Shelf Game Interfaces for MotorRehabilitation after Traumatic Brain Injury, SpinalCord Injury and Amputation

This presentation describes three phases of a project aimed to1) identify and define the characteristics of the games and 4interactive systems (Sony PlayStation(r) 2 EyeToyTM, Ninten-do(r) WiiTM, Novint(r) FalconTM, and the light based web-cam tracking system) that were most enjoyable, user friendly,and motivating for individuals with TBI, SCI and amputation;2) develop new games, or manipulate the current games toaddress these user-defined characteristics gathered during thefirst part of the research; and 3) develop and pilot test a train-ing protocol aimed to improve function in each of the threegroups (TBI, SCI and Amputation). The results of each ofthese phases will be presented.

Mark Sivak


A low cost system that patients could use independently in thehome on a personal computer and that is designed to improveupper extremity and hand function is necessary to help treatthe rising number of patients with stroke. To meet this need,we have created the concept of a Multiple User Virtual Envi-ronment for Rehabilitation (MUVER). The MUVER has threecomponents: the low cost P5 Glove (tracks arm, hand and fin-ger movements), the open source Panda3D game engine, andlaboratory created software. A unique aspect of the MUVERdesign is the system’s capability for four types of multiple userinteractions: competition, cooperation, counter-operative, andmixed. Such virtual interactions may help to increase patients’motivation to improve and possibly alleviate feelings of socialisolation for those who remain homebound. Thus far, a proofof concept virtual environment that uses competitive interac-tion has been created and tested with three healthy subjects.

M. Susan Hallbeck

Simulating Visual Impairment to Detect HospitalWay-Finding Difficulties

Around 70% of all sensory perception is through vision; thus,we are highly dependent on sight, which is a problem for the2.6% world population who are visually impaired. The overallgoal of this pilot study was to identify via low-vision simulationhow and where way-finding failures may occur for low-visionpeople and prevent difficulties in way-finding before theyoccur. The results of this study show that, for low-vision peo-ple, decorative elements often create major disturbances in way-finding. Most of these problems could easily be eliminatedonce identified. With the simulation of low-vision these failurescan be detected, categorized and remedied and finally the rightinformation can be given to the hospital to allow them toimprove their facility. The methodology created to improve sys-tems for the most impacted (low-vision) participants will alsoincrease the ease of way-finding for those with unimpairedvision.

Dimitrios Katsavelis

Nano Legends: An Interactive Virtual RealityGame Induces High Level of Physical Activity

We wanted to measure the energy expenditure of a novel inter-active virtual reality game that can be used for education.Movements of the upper and lower extremities while playingthe Nano game can be translated to the screen, where the heroof the game fights against carcinogens and viruses. Results from11 middle school students showed that oxygen consumption,heart rate and rate of perceived exertion were similar to thosefound when subjects walked at 3.5 mph. When compared toother commercial video games, Nano had much higher oxygen


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consumption and therefore energy expenditure. This game candefinitely serve the triptych of education, entertainment andphysical activity that is getting even more essential nowadays.

Kimberly Briggs

Scientific Framework for Selecting SimulationGames for Rehabilitation and Assistance: A CaseStudy with the Wii(r)

Traditional neurorehabilitative treatment regimes are timeintensive, repetitious and tedious; leading to high levels of noncompliance and a need for change. Simulation based gaminghas emerged as a promising alternative, however to date there isa lack of a scientific methodology for the selection of exercises.A methodology is presented consisting of three basic compo-nents; cognitive design; observational design and ambient mon-itoring; that employs task analysis to address specific patientproblems. Utilizing this methodology, ten therapeutic applica-tions for Occupational Therapy treatment were analyzed alongwith the gaming platforms Nintendo Wii(r) and the NovintFalcon(r). Adaptions to the Wii remote and other peripheralsthat ensured a high correlation (r>0.8) between real and virtualworld movements were incorporated. Initial results demonstratethis methodology can offer novel adaptions to rehabilitativemodalities. Task analysis, movement sensing and ambient mon-itoring are customizable solutions offering effective rehabilita-tion with off the shelf engaging simulations.

TUESDAY, SESSION C (CONT.) INDEPENDENT SESSION – MIXEDREALITY AS A TOOL FOR COGNITIVEAND MOTOR REHABILITATION


WEDNESDAY PLENARY

Virgil Wong

Envisioning the Web 3.0 Patient and PhysicianPortal as an Interactive, Semantics-Based, andIntelligence-Driven Anatomical Avatar

This session will present a VR anatomical avatar as the basis fora patient and physician portal called Phineasmap(http://www.phineasmap.org). A customizable model of thepatient's anatomy allows access to contextual health informa-tion, patient-managed personal health records (PHR) and clini-cian-managed electronic medical records (EMR). Workingtowards a medical semantic Web, the portal attempts to useexisting metadata frameworks to enable information therapytoday and personalized medicine in the future. Both real andspeculative scenarios using the anatomical avatar will be shown.

MyNYP is a patient portal being created by NewYork-Presby-terian Hospital in collaboration with Dr. Mehmet Oz andMicrosoft. Dr. Antonio Bernardo's Microsurgery Skull BaseLaboratory at Weill Cornell Medical College integrates exqui-site cadaveric dissections, 3-D visualizations, virtual reality, andcomputerized simulations for the training of surgical proce-dures and visuospatial skills. Nanorobocardioplasty at RYTHospital-Dwayne Medical Center (http://www.rythospital.com)is an imagined procedure using the anatomical avatar interfaceas a means to monitor and activate medical nanotechnologywithin a patient's bloodstream.

James Kinross

Virtual Worlds Technology Enhances MedicalStudent Training in the Operating Room

A randomised control study was performed to assess the SecondLifeTM (SL) platform as a tool for teaching an operating room(OR) induction curriculum to a population of UK medical stu-dents. Students (n=33) were taught a standardised curriculumin three groups: (1) didactic lecture theatre; (2) SimulatedOperating Suite (SOS): a full-scale real world OR simulator;(3) SL simulated OR environment. Knowledge, the under-standing of required skills and attitudes showed statisticalimprovement after teaching in all groups (P<0.026). There wasno significant difference between the didactic lecture and SLgroups. No significant difference existed between the SOS andSL groups in the students’ perception of simulation fidelity(p=0.310). Student anxiety about future visits to the OR wasreduced most significantly in the SL group (P<0.034). The SLsimulated teaching environment is an effective method for thedelivery of a theatre induction curriculum and is less resourceintensive than SOS-styled simulators.

Warren Grundfest

Development and Testing of a Tactile FeedbackSystem for Robotic Surgery

The addition of tactile feedback to existing robotic surgical sys-tems may enable surgeons to “feel” tissue characteristics, appro-priately tension sutures, and identify pathological conditions,possibly decreasing the learning curve associated with the adop-tion of robotic surgery, and also enabling its expansion to otherminimally invasive procedures. A tactile feedback system hasbeen developed using silicone-based pneumatic balloon actua-tors and piezoelectric force sensors, paired with a control sys-tem. This system has been fitted directly onto the da Vinci sur-gical robotic system, allowing the forces applied at the roboticend-effectors to be felt on the fingers of surgeons or other sys-tem operators. Data from peg transfer trials have confirmedthat tactile feedback reduces grasping forces applied duringrobotic surgery.

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WEDNESDAY – SESSION AVISUALIZATION

Pierre-Frédéric Villard


Some medical procedures involve a significant portion of navi-gation through the patient’s anatomy to reach the desiredregion of interest. Often this entire navigation length of thepatient is not scanned completely since it would expose thepatient to additional radiation, require multiple imaging scans,not be cost or time effective. As a result, imaging scans arefocused on a particular localized region of interest and does notcapture the remaining supportive anatomy that a physician hasto navigate through. We propose to enlarge a patient-specificscan to include similar supporting anatomy by merging a sec-ond scan from a different patient onto the original primarypatient scan so that a more complete anatomical environmentis available. With patient-specific simulation receiving increas-ing focus from the research and clinical communities, there is aneed for larger training datasets which could be accomplishedby permitting allowances outside the primary area of interest.Thus, targeted patient scans could be augmented with approxi-mate supporting anatomy in the regions which are less critical.Our simulated CT scan will not interfere with the soft tissuesimulation, but will facilitate navigation thanks to the inclusionof additional anatomical landmarks.

Jacopo Annese

A Scalable Visualization Environment for theCorrelation of Radiological andHistopathological Data at Multiple Levels ofResolution

We describe a methodological pipeline that includes MRI, his-totechnology, image acquisition, and visualization strategies forinspecting and analyzing neurological data at multiple levels ofresolution. The virtualization of brain specimens is obtained byregistering stacks of whole giant histological sections to the vol-ume datasets acquired previously by MRI. Digitization ofhistopathological material is obtained by flat bed scanningtechnology and motorized large-field microscopy, resulting inimage montages and pyramidal files that can be viewed at dif-ferent levels of resolution. The visualization environment,including scalable display arrays, was built to access the datafrom multiple imaging modalities and to take advantage of thedetail contained in the histological images within the entireanatomical context of the brain.

Jonathan Suen

Towards Medical Terahertz Sensing of SkinHydration

Terahertz imaging has shown promise as an ideal tool for in-vivodetection of skin abnormalities, including skin cancer, burns,

scars, and wounds due to its low non-ionizing photon energyand ability to penetrate clothing and synthetics. We measure low-level bulk changes in the water content of hyperhydrated anddehydrated chicken skin specimens using a whiskbroom scan-ning, reflective THz imaging system. Our results show a 500%difference in the THz reflectivity between hyperhydrated anddehydrated skin. The results provide further evidence that waterconcentration is the primary contrast mechanism in reflectiveTHz biomedical imaging and are a promising step towards theclinical use of reflective THz imaging.

Oscar Meruvia-Pastor

Fast Interactive Integration of Cross-SectionalImage Datasets and Surface Data forMorphometric Analysis

To investigate external facial morphology and cell proliferationpatterns and their relationship with cleft lip malformation inmice, we need to compare samples of mice tissue photographsand surface reconstructions from micro-CT scans. Tissue sam-ples obtained through photography are typically misalignedwith respect to each other, which prevents further analysis. Wedeveloped a system for fast interactive alignment of these imagestacks for volume reconstruction and data visualization andanalysis in 3D. The system is designed to work in multiproces-sor environments with arbitrary numbers of processors, cuttingdown significantly the turnaround time and allowing users toquickly process sets of high resolution images using a combina-tion of automatic and interactive tools. Additional modules areused to reconstruct the shape of the original subject. Our sys-tem is interactive, fully scalable, can be applied to any photo-graphic sliced dataset regardless of subject and reduces signifi-cantly the waiting times for stack alignment.

SENSORS

Robert Tan

Development of a Minimally Invasive ImplantableWireless Vital Signs Sensor Platform

We present here the further development and progress of awireless, implantable, and continuous vital signs sensor monitorcapable of measuring pressure, temperature, oxygenation, andheart rate. This system is composed of three parts: a sensorsuite, a central processing unit and transmitter, and a PDA toreceive data. Currently, we have successfully implemented apiezoresistive pressure sensor on this system. In vitro data showsthat it operates from 0-1.5 psi gauge pressure with a 0.01 psiresolution. In vivo testing demonstrates its ability to obtaindata for >90 hours while implanted in a porcine model. Wewill report any medically relevant data obtained from the study.Furthermore, we will present the design, fabrication, and test-ing of a second generation of the device that features a smallersensor suite designed for percutaneous implantation and theimplementation of a thermistor and platinum/silver electrodesfor core temperature and oxygen sensing, respectively.


50 MMVR17

MODELING

Yong Hum Na

Development of Whole-Body Reference AdultMale and Female Models for RadiologicalStudies Using Surface-Geometry Modeling andMonte Carlo Radiation Transport Methods

Purpose: To develop a pair of reference adult male/female mod-els using novel surface-geometry modeling methods for MonteCarlo radiation dosimetry Methods and Materials: Surface-geometry modeling method is more flexible for phantom mod-eling. We adopted the models by AnatomiumTM. Organs vol-ume/mass data were adjusted to ICRP recommended values bymesh deformation. Software was developed to convert themesh-formatted phantoms into the voxel-formatted phantomsfor Monte Carlo dose calculations. Organ dose results werecompared with the published data. Results: The volume/massdata of the reference voxel-based Adult Male/Female phantomsmatch with ICRP recommended data with relative error lessthan 0.5%. The average absorbed organ doses were calculatedusing 6 standard external photon irradiation geometries. Organdose results show good agreement with the published data.Conclusion: A pair of reference Adult Male/Female phantomshave been developed and implemented into Monte Carlo codesfor dose calculatons. The results demonstrated the usefulness ofthe phantoms. These phantoms are useful in X-ray imaging,radiation treatment planning, radiation protection of workers.

Yingchun Zhang

Advanced Finite Element Mesh Model of FemaleSUI Research During Physical and DailyActivities

Urinary incontinence (UI) or the undesired leakage of urinecan occur due to anatomic and/or neurologic factors involvingconnective tissues, muscles and nerves. It currently affects over13 million Americans with the majority being females.Although UI is more common in post-menopausal and multi-parous women, studies have also shown a high prevalence of UIin young, physically fit female athletes. However, there is noclear understanding of the mechanisms of UI in young femaleathletes. With a goal towards dynamic patient-specific mechan-ical characterization of the etiology of UI in this patient popu-lation, we have developed an advanced finite element analysis(FEA) model of the female pelvis. The entire FEA female pelvismodel consists of 35 individual anatomical parts, over 850,000tetrahedron elements and 160,000 nodes. We are using it tocharacterize relative relationships and structures during thephysical activities that elicit UI during activities of daily living.

Yunhe Shen

Interactive Collision Response Solutions toInterpenetration Problems among Tissues andInstruments in Virtual Laparoscopic Surgery

In virtual surgery, interpenetrations among models of instru-ments and tissues need to be resolved with contact or colli-sion response adjustments to avoid unrealistic or distractiveartifacts. To handle the interpenetrations, we propose swiftand precise solutions in our efforts of building interactiveand visually-plausible nephrectomy simulation focusing on aset of tightly packed tissues around kidney hilar. We havedeveloped an overlap test deriving penetration data from theresults of a surface intersection test without using distancefield or nearest features. This method directly processes pre-cise geometric models instead of their simplified versions.Thereafter, for instrument-to-tissue interactions, displace-ment vectors are calculated and then applied to the tissues toresolve interpenetrations; for tissue-to-tissue interactions,normal contact forces are solved from a linear complementa-ry method for the inequality constraint of the Kuhn-Tuckercondition to satisfy impenetration condition. Frictionalforces are solved by the augmented-Lagrange method.

Maud Marchal

Fiber-Based Fracture Model for Simulating SoftTissue Tearing

In this paper we propose a novel approach for simulating softtissue tearing, using a model that takes into account the exis-tence of fibers within the tissue. These fibers influence thedeformation by introducing anisotropy, and impact the direc-tion of propagation for the fracture during tearing. We applythis model to the simulation of capsulorhexis, one of the criti-cal steps of cataract surgery.

Xiangmin Zhou

A Discrete Mechanics Framework for Real TimeVirtual Surgical Simulations with Application toVirtual Laparoscopic Nephrectomy

The inability to simulate realistic soft-tissue behavior in realtime has remained a barrier to face and content aspects of valid-ity for many virtual reality surgical training systems. In theexisting approaches, the computer graphics based approachlacks predictive capability; the mass-spring model (MSM) basedapproach lacks the physically realistic soft-tissue dynamicbehavior; and the finite element method (FEM) and the likefail to meet the real time requirement. The present develop-ment stems from a fundamental physics law, namely, the ther-modynamic first law, for a space discrete dynamic system thatdirectly formulates the space discrete but time continuous gov-erning equation with embedded material constitutive relation.It results in a discrete mechanics framework which possesses auniquely balance between the computational efforts and thephysically realistic soft-tissue dynamic behavior. We describethe development of the discrete mechanics framework with

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focused attention towards the AUA laparoscopic nephrectomyproject as an application.

Hao Li

Modeling Torsion of Blood Vessels in SurgicalSimulation and Planning

Traditional approach of modeling blood vessels using paramet-ric models or 3D mesh has various shortcomings. Parametricmodels lack surface details and assume no change in cross-sec-tional shape during deformation, whereas modeling of torsionin 3D mesh is nontrivial. To overcome these shortcomings, wepropose a novel approach for modeling blood vessels by inte-grating 3D mesh, generalized cylinder, and Cosserat rod theory.This hybrid approach allows the model to capture surfacedetails and to change cross-sectional shape during deformation.Moreover, torsion of the model can be computed in a physical-ly correct manner using Cosserat rod theory. Then, the model’sconfiguration that minimizes torsion can be determined by thealgorithm automatically without user inputs. This approach isuseful for surgical simulation of blood vessel joining thatrequires minimum torsion.

Xianmin Zhou

Realtime Blood Vessel Modeling in SurgicalSimulation

The physical behaviors of blood vessels are of great importancein surgery simulations. Correctly modeling these phenomena isvery useful in developing virtual surgical simulation. We aresimulating blood vessels as we build a model of the renal hilumfor the purposes of the AUA Laparoscopic Nephrectomy simu-lator. In this context, since there are very large vessels and manymuch smaller vessels around the kidney, simulating these vesselsin a uniform method turns out to be a very difficult task. Tosolve this problem, we adopt different approaches according tothe scale of the vessels. Large vessels are treated as thin shells. Athin shell simulation model is applied, which is based on themass spring network and hinges. For small vessels, they aretreated as lines and a beam model is used, which is a type of1D FEM methods. This hybrid approach leads to a promisingsolution of the above problem.

WEDNESDAY – SESSION BSIMULATION & TRAINING

Sergei Nirenburg


The Maryland Virtual Patient project is developing a computerenvironment that facilitates clinical decision making by accessto and communication with an artificial intelligent agent thathas a body (simulated self-regulating physiological and patho-

logical processes), a mind (an ability to perceive symptoms, toengage in a conversation with the physician user and to makedecisions about its behavior and treatment). We have reportedprogress in this project in past MMVR meetings. Specifically,we described our approach to physiological simulation and theway we facilitate it by encoding the complex knowledge of dis-ease variability, progression and treatment by creating a libraryof diverse patients. We continue this year by describing thenewly integrated cognitive perception, decision-making andcommunication capabilities of the virtual patient. MVP is anongoing project. As the next R&D goal, we plan to extend thecoverage of diseases (currently, MVP covers diseases of theesophagus).

Deborah Burgess

Current and Future Applications of Modeling andSimulation for Medical Education, Training andMedical Care

The Air Force is integrating modeling and simulation technolo-gy into all education, training and sustainment platforms forphysicians, nurses and technicians. The ultimate vision is tobuild a distributed human patient simulation network, createsimulation centers of excellence and exploit technological inno-vation to support: battlefield trauma, critical care air transportof casualties, in garrison care, graduate medical education,patient safety, humanitarian missions, natural disasters, home-land defense, pandemic response and CBRN events.

Rachel Ellaway

Rethinking Fidelity, Cognition and Strategy:Medical Simulation as Gaming Narratives

The OpenLabyrinth platform is an open-source toolset thatallows authors to create, run and analyze clinical performance(such as decision-making, interpretation, diagnosis and criticalappraisal) using narrative and gaming techniques to create newand powerful ways of creating educationally rich simulationsand scenarios. With educational roots in problem-based learn-ing, script concordance tests, serious gaming and the broadprinciples of the practicum the kinds of simulation run inOpenLabyrinth afford innovative approaches to teaching andlearning and provide simulation access to previously inaccessi-ble dimensions of practice. Narratives and games are most suc-cessful when they are engaging, absorbing and immersive. Bydrawing on aspects of non-fiction writing, drama, theatre, film,TV, and literature, as well as classic and contemporary gamingOpenLabyrinth authors can create (simple or complex) simula-tion environments that have previously been partial andimpractical to work with on any systematic basis. This paperexplores authoring and applications of these techniques.


52 MMVR17

Kanav Kahol


A key element of surgery lies in the ability of the surgeon tofocus on the necessary task and filter the noise effectively. Sim-ulation based training provides a safe environment for trainingresidents on how to cope with noise. This paper presents resultsfrom experiments that aims to (a) quantify the effect of noiseon proficiency and (b) measure the effect of simulation trainingdesigned to counter the deleterious effects of noisy environ-ment. The results clearly show that noisy environments can sig-nificantly affect the performance of residents. Notable in theresults is that cognitive errors are increased by 97% in the pres-ence of noise. Experiments also suggested that training residentsin the presence of noise significantly improves their ability todeal with noise in real environments. These results should beintegrated into the design of simulation training curriculumswhich can focus on providing realistic training environmentswith noise.

Carol Noe

The Effect of Central Venous Catheter PlacementSimulation Training on Patient Safety

Central venous catheter (CVC) placement complications are amajor burden on the healthcare system. In response to theseneeds, simulators for CVC placement have been developed.Employing these simulators efficiently requires definition of acurriculum for CVC placement training that includes simula-tors as well as other educational aids and controlled study ofthe effect of such a curriculum on learning. This paper presentsa curriculum defined for CVC placement training. The curricu-lum includes simulation training, other educational aids, per-formance metrics and evaluation mechanisms. We also presentresults of data analysis from retrospective patient chart analysisthat tracked residents who trained with the CVC placementcurriculum and compared their performance to residents whodid not receive the training. The results show the significanteffect CVC placement training on reduction in CVC relatedclinical complications (76 to 98% reduction) providing evi-dence on the role of CVC simulation curriculum in affectingpatient safety.

Yi-Je Lim


We discuss our research in the development of a simulation-based training system for Regional Anesthesia. The regionalanesthesia trainer includes innovative devices capable of gener-ating haptic feedback during needle insertion, injection andpalpation using MR fluid control and an innovative tactile ren-dering system. The training system includes modular simula-tion software and algorithms, configurable procedures and sce-

narios, integrated training modules, a didactic trainer, an anato-my viewer, a technique trainer, and a scenario-based trainer.

Christian Banker


The Interactive Training System for Medical Ultrasound is aninexpensive, PC-based ultrasound training system, in which thetrainee scans a lifelike manikin using a sham transducer to pro-duce images representing a selected medical condition.Although having a feel of an actual transducer, the sham trans-ducer contains only a 6 degree of freedom position sensor. Theobserved 2D ultrasound image is generated as a slice through apre-stored 3D image volume and is determined by a shamtransducer’s position and orientation. Based on the selected 3Dimage volume, the manikin may represent normal anatomy,exhibit a specific trauma or present a given abnormality. Imagedata for a given condition is acquired from individuals with agiven trauma or pathology and need only be captured once, butcan be used repeatedly for training. This system is a powerfultool for training sonographers in recognizing a variety of med-ical conditions.

Nigel John


There are severe limitations in the training of ultrasound scan-ning techniques in developing countries that frequently resultin diagnostic errors, adverse patient outcomes or expensiveequipment remaining unused. The paper presents a low costtraining environment can be deployed to help overcome thisproblem. We use inexpensive components, specifically a Nin-tendo Wii Remote and associated hardware in order to imple-ment a “dummy” ultrasound transducer. Ultrasound images aregenerated on the PC graphics card. This research is in progress.

Eve Wurtele

Meta!Blast: An Interactive Virtual Reality Gameto Explore Structural and Metabolic Biology

The structure and metabolism of the cell changes across timeand space to orchestrate cellular function. These concepts oftemporal and spatial relationships are difficult to teach from atext book or even a movie. Meta!Blast is an interactive 3Dvideo game to teach cell biology that can be used by educatorsand students in classrooms and at home. It is designed for highschool and first year university biology classes, and is availableat no charge to academics and students worldwide. Realisticviews of cell structures and proteins, state-of-the-art informa-tion, humorous dialog, lively characters all combine to enhancestudent learning, and train and inspire a new generation offuture researchers and physicians.

53MMVR17


Bertalan Meskó

Medicine 2.0: Practicing Medicine in the Web 2.0Era

The new generation of web services, the so-called web 2.0, pro-vides plenty of tools and sites that can ease the work of medicalprofessionals. Medical blogs, blog carnivals, community sitesand wikis create an own platform for physicians and buildingan on-line reputation also becomes crucial for them. Represent-ing a medical practice on the web properly is easier with thesetools and services. While the number of e-patients, who seek tofind reliable medical content on-line and want to communicatewith their doctors via e-mail or videochat, is growing; physi-cians of the 21st century must be ready and qualified to meetthese expectations. E-health or medicine 2.0 can change theway medicine is practiced and healthcare is delivered.

SIMULATOR VALIDATION

Patrick Cregan


For simulation to be accepted by the wide surgical communityit has to meet the burden of proof that other interventionsmust meet. The standards of evidence are usually grouped fromlevels 1 to 5 with level 1 (Evidence from Meta-analyses of ran-domised controlled trials) being the highest level. We havereviewed the literature on the use of simulation in surgical edu-cation and performed a meta-analysis of the RCTs relating toimprovement of performance in the OR for trainees trainedwith Virtual Reality. The study was based on the comprehen-sive report by ASERNIPS which can be found at www.sur-geons.org/asernips . Skills acquired by simulation based trainingappear to be transferable to the operative setting

Mukul Mukherjee

A Virtual Reality Training Program forImprovement of Robotic Surgical Skills

The purpose of this study was to use a simulated virtual realityenvironment for training of surgical skills and then to identify ifthe learning that occurred was transferable to a real world surgi-cal task. The virtual surgical tasks consisted of bimanual carrying,needle passing and mesh alignment. In this ongoing study, theexperimental group was trained by performing four blocks of thevirtual surgical tasks using the da Vinci surgical robot. Pre andpost training, all subjects were tested by performing a suturingtask on a “life-like” suture pad. The control group performedonly the suturing task. Preliminary results revealed bigger pre andpost differences in time to task completion and speed of the sur-gical instruments in the experimental group as compared to thecontrol group. In conclusion, virtual reality surgical skills trainingmay produce a significant learning effect that can transfer toactual robot-assisted laparoscopic procedures.

Mukul Mukherjee

Consistency of Performance of Robot-AssistedSurgical Tasks in Virtual Reality

The purpose of this study was to investigate consistency of per-formance of robot-assisted surgical tasks in a virtual reality envi-ronment. Eight subjects performed two surgical tasks, bimanualcarrying and needle passing, with both the da Vinci surgicalrobot and a virtual reality equivalent environment. Nonlinearanalysis was utilized to evaluate consistency of performance bycalculating the regularity and the amount of divergence in themovement trajectories of the surgical instrument tips. Our resultsrevealed that movement patterns for both training tasks were sta-tistically similar between the two environments. Consistency ofperformance as measured by nonlinear analysis could be anappropriate methodology to evaluate the complexity of the train-ing tasks between actual and virtual environments and assist indeveloping better surgical training programs.

Curtis Ikehara

Evaluating a Virtual Reality Motor-Skills Simulator

Evaluation was performed on a prototype low-cost virtual-reali-ty motor-skills simulator (VRMSS) created at the TelehealthResearch Institute, John A. Burns School of Medicine, in con-junction with the National Biocomputation Center, StanfordUniversity. The VRMSS is specifically designed to teach base-line fine-motor skills used in surgery that are based on a matrixof elemental technical skills that comprise the tenets of surgicaltechnique. Fifty-seven participants were randomly assigned toone of three groups (VRMSS, box trainer or no training). Aftertraining each group was evaluated using the LapSim from Sur-gical Sciences. The VRMSS and box trainer were similar in per-formance, but significantly better than the no training controlgroup. The VRMSS has significant advantages over the boxtrainer, in that the VRMSS can provide scoring on severalparameters of the task without the need of an instructor andthe VRMSS is approximately 1/16th the cost of the Lapsim.

THURSDAY – SESSION A INDEPENDENT SESSION – THE PULSE!!COLLABORATION


THURSDAY – SESSION A (CONT.)INDEP SESSION – BUILDING MEDICALMODELS AND SCENARIOS FROMCLINICAL DESCRIPTIONS



MMVR1754

THURSDAY – SESSION B SIMULATOR DEVELOPMENT TOOLS

Dhanannjay Deo

Characterization of Anisotropy in ViscoelasticProperties of Intra-Abdominal Soft Tissues

A portable instrumentation rig is presented for characterizingnonlinear viscoelastic anisotropic response of intra-abdominalorgan-tissues. Two sets of linearly independent in-situ experi-ments are performed at each indentation site on the intra-abdominal organs, by subjecting the organ to normal and tan-gential displacement stimuli. For normal indentation experi-ments, the indenter is ramped into the tissue and held for 10seconds before sinusoidal indentation stimuli at various ampli-tudes and frequencies are applied. For tangential (shear) load-ing, the indenter tip is rigidly glued to the soft tissue surfaceand sinusoidal displacement stimuli are applied laterally in thetangential plane and the force response is recorded. Tangentialloading is repeated along orthogonal directions to measure in-plane mechanical properties. Combined analysis of results fromboth experiments leads to assessment of anisotropy of tissueproperties. In situ experiments on fresh human cadavers arecurrently under way at the Albany Medical College.


Haptic Simulation of the Liver with RespiratoryMotion

During a standard procedure of liver biopsy, the motion due torespiration may be difficult to handle. The patient is oftenrequested to hold his breath or to breathe shallowly. This physi-ological behaviour should be taken into account in a virtualreality biopsy simulator. We present here our method to simu-late customised respiratory motion inside a haptic environment.

Eleonora Westebring-van der Putten

Tactile Feedback Exceeds Visual Feedback toDisplay Tissue Slippage in a LaparoscopicGrasper

During laparoscopic grasping, tissue slips frequently. This lack ofgrasp control is caused by the lack of haptic feedback. When sur-geons notice slip, they are often too late to react and will damagethe tissue by trying to re-grasp it. Augmented feedback on gripforce benefits the surgeon in maintaining a safe grasp. However,grasp control can be more efficiently based on a slip signal. Inorder to develop a good feedback system to improve patient safe-ty we compared visual and tactile feedback signals on slip infor-mation. 24 participants where divided in two conditions onewith tactile feedback one with visual feedback. Their task was tohold tissue while reading out loud and respond as quickly as pos-sible to feedback signals indicating slippage. The reaction time inthe condition with tactile feedback was significantly faster thanthe reaction time in the condition with visual feedback.

Ciamak Abkai

Virtual Intensive Care Unit (ICU): Real-TimeSimulation Environment Applying HybridApproach Using Dynamic Bayesian Networksand ODEs

Combining deterministic (e.g. differential equations) and prob-abilistic (Bayesian Networks) approaches to model physiologicalprocesses into a real-time software environment based on C++leads to a novel model for simulation of human patient physi-ology which is important for ICU. By providing HW/SWinterfaces for emulation of patient signals, the outside parame-ters are not only simulated virtually but also are measurablewith standard monitoring systems. Therefore this system is wellsuited for teaching and education based on realistic simulations.Additionally the environment can be used not only for infer-ence of patient data but also for learning of model structuresand parameters based on real patient data. By including thephysiological model to a prognostic model environment whichis similarly based on dynamic Bayesian Networks it is possibleto predict patient states and critical situations.

Allan Okrainec

Development of a Virtual Reality Haptic VeressNeedle Insertion Simulator for Surgical SkillsTraining

The Veress needle is the most commonly used instrument forcreating the pneumoperitoneum at the start of a laparoscopicsurgical procedure. This needle insertion technique can be diffi-cult to teach since it relies heavily on the “feel” of the needle asit advances through the layers of the abdominal wall. The pur-pose of this project was to design a VR simulator with hapticfeedback which would allow surgeons to practice Veress needleinsertion with no risk of injury to patients. In phase 1 of theproject, a group of engineers designed the simulator. In phase2, the haptic parameters were tuned by 22 expert surgeons toachieve the most realistic feel of the procedure. Feedback bysurgeons on the realism of the graphics, haptics, and usefulnessof the simulator was excellent. Further validation studies arenow required to assess the usefulness of this simulator as ateaching and assessment tool.

Jessica Burgner

Including Parameterization of the DiscreteAblation Process into a Planning and SimulationEnvironment for Robot-Assisted LaserOsteotomy

This contribution presents a planning and simulation environ-ment for our robot assisted laser osteotomy setup as well as thenecessary measurements. Until now thermo-mechanical CO2laser bone ablation is not characterized as a discrete process. Inorder to plan and simulate the ablation process in the correctlevel of detail, the parameterization is indispensable. We devel-oped a planning and simulation environment, determined

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parameters by confocal measurements of bony specimen anduse these results to transfer planned cutting trajectories into apulse sequence and corresponding robot locations.

Satoshi Yamaguguchi


A novel computer-assisted 3-D simulation for osteotomy andCAD/CAM fabrication of surgical splints consider the relativeinter-bone interference and space after bone translation weredeveloped. CT image of a patient for osteotomy was operatedand simulation of surgery for deformation, segmentation, dis-placement of the bone was processed effectively by virtual reali-ty haptic device PHANTOM (SensAble Technologies). CAD ofa bite splint before surgery and after bone displacement wasdone in the process of simulation. CAM of resin bite splintswas done by precise Rapid Prototyping CAM machine(EDEN260, Objet). The pre-surgical planning by the PC sim-ulation predicted sufficient result of the maxillo-mandibularrelationship by osteotomy. All fabricated splint were sufficientlyfunctioned to determine the position of jaws. Our PC simula-tion contributes to solve surgical problems such as bone inter-ference and excessive inter-bone spaces, and CAD/CAM fabri-cation system for splints may contribute to realize accurate sur-gery and diminish the operation time.

Ilana Souza

A Virtual Reality Simulator for Training of NeedleBiopsy of Thyroid Gland Nodules

The fine needle biopsy is an important procedure for investiga-tions in tumors, low-cost considered, minimally invasive andideal for supplying an accurate diagnosis in cases of thyroidgland nodules. The main goal of this work was to develop a vir-tual reality simulator for the training of ultrasound guided nee-dle biopsy of thyroid gland nodules, using 3D models and hap-tic devices. Many of the virtual reality applications in medicineare kept only in the experimental field, far from practice. Forthe system to be validated as a tool for training medical stu-dents, residents and clinicians, the simulator was taken to thefinal user. With the intention to be experimentally evaluated atfield, we will present the results of the case of study at a wellknown Brazilian hospital.

Oliver Schuppe


Indirect ophthalmoscopy is a major tool for the examination ofthe ocular fundus. An ophthalmologist evaluates the retina bylooking through a hand-held lens into the patient’s eye. Bothhandling of the lens and diagnostic findings require specialskills and knowledge. We present a simulator which can beused as a training system for indirect ophthalmoscopy. An opti-

cal tracking system is used to reconstruct the position of a lensphantom and a model of the patient’s face. Refraction and illu-mination in the eye is computed in real-time and displayed ona head-mounted display using augmented reality. A case data-base completes the training system which allows to practice theexamination and to study clinical patterns.

Stefano Sclaverano

BiopSym: A Simulator for Enhanced Learning ofUltrasound-Guided Prostate Biopsy

We have developed a simulator for prostate biopsy training;such biopsies are performed under US guidance. In the simula-tor US images are generated from 3D US volumes recorded onreal patients. A virtual US endorectal probe - the “pen” of anOmni haptic device - is manipulated by the clinician. Forcesare fed back to the operator to account for the anatomical con-straints (mainly the anus insertion point and the rectal wall).The operator can manipulate the probe and the attached needleand can start a biopsy. He/she can simply train or he/she canrecord the virtual samples he has acquired on series of patients.A database gathers patient information, real exams, operatorinformation, operator performances and it allows statistics. Thesimulator is working and the clinicians who experienced it gaveus very positive inputs.

Liliane Machado

A Qualitative and Quantitative Assessment for aBone Marrow Harvest Simulator

Several approaches to perform assessment in training simulatorsbased on virtual reality have been proposed. The main prob-lems related to online training assessment methodologiesapplied to VR systems are the computational complexity andthe accuracy. Another inconvenient about those methods isrelated to an unsatisfactory solution for specific cases as in somemedical procedures, where there are quantitative and qualitativeinformation available to perform the assessment. In this paper,we present an approach to online training assessment based ona Modified Naive Bayes, which can manipulate qualitative andquantitative variables simultaneously.

Aaron Oliker

Real-Time Complex Cognitive Surgical Simulatorwith Testing

Testing surgical knowledge is evolving from paper-based andoral exams to computer-based testing. Surgical animations andlive surgical video can convey complex surgical concepts withtremendous success for large scale global remote learning. Overthe past ten years, many techniques have been discovered whichallow medical illustrators and digital animators to create com-plex three-dimensional surgical animations that demonstratedifficult three-dimensional, dynamic surgical concepts.Although the concepts can be clearly communicated, anima-


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tions developed by artists and scientists are not interactive andlack measurable assessment tools. Our team has developed athree-dimensional dynamic surgical simulator for complex sur-gery. The application can simulate any open surgery procedurein real-time and test the user’s cognitive knowledge in a testingmode. The ability to collect and analyze the test results makesthis simulation technology the logical next step in the progres-sion of teaching and evaluating cognitive surgical knowledge.

Eftychios Sifakis

Local Flaps: A Real-Time Finite Element BasedSolution to the Plastic Surgery Defect Puzzle

One of the most fundamental challenges in plastic surgery isthe removal or topology change of skin. For a patient diag-nosed with malignant melanoma, the plastic surgeon in manycases has to resect the tumor and the surrounding area. Theplastic surgeon must look at the defect created as an organicpuzzle. The surgeon must “design” a pattern in the skin toclose the hole aesthetically and efficiently. In the past, theonly training option available to surgeons was the study oftwo-dimensional illustrations or the hands-on practice on alive patient in an operating room. We have created a “localflaps” simulator that will allow surgeons to practice their clos-ing designs in an interactive three-dimensional environment.Using an intuitive set of surgical tools, the surgeon is able topractice existing procedures for closing the defect and evaluatethe efficacy of new approaches based on physically quantifi-able metrics.

TUESDAY POSTERSREHABILITATION

Richard Fan

Characterization of a Pneumatic BalloonActuator for Use in Refreshable Braille Displays

We have developed a process to fabricate reliable pneumaticballoon actuators, featuring low material costs and a novelmanufacturing process to attain uniform and consistent sili-cone-based membranes. This technique has been adapted foruse in refreshable Braille displays that feature low power con-sumption, ease of manufacture and small form factor for ease inintegration. The prototype Braille display consists of an array ofsilicone-based pneumatically-driven balloon actuator elementsand an electronic control system. Perceptual and temporal stud-ies were performed to determine the feasibility of the actuator.Subjects could perceive the Braille with 98.3% accuracy. Thesystem features a fast switching pneumatic valve, which allowsthe balloons to be fully deflected within 60 ms. Therefore, thesystem is capable of supplying effective tactile stimuli at a suffi-cient refresh rate, potentially allowing for the development of aconsistent and reliable refreshable Braille display. Accuracy test-ing for the Braille prototype is in progress.

Belinda Lange

Rehabilitation of Upper Limb Extremity BimanualCoordination Tasks Using a Novel BimanualNovint Falcon Application and SpecificallyDesigned Game Based Task

This presentation describes the development of a bimanualcoordination application enabling interaction with a gamebased bimanual task. The interaction device consists of twoNovint Falcon haptic feedback devices yoked together to enablebimanual interaction with a game environment. The develop-ment of the application will be described and the results ofusability testing with a sample of 15 subjects will be presented.

Panadda Marayong


This work involves a design of a vibrotactile device for centralapnea interruption in premature babies. This small non-inva-sive device provides a localized vibration on the infant’s foot,stimulating the nervous system and causing breathing toresume. The blood oxygen saturation level (SpO2) and theheart rate (BPM) monitored by a pulse oximeter are used tocontrol the device. LabVIEW is used to create a user interfacefor physiologic data acquisition from the pulse oximeter and fordevice control. When the SpO2 level and BPM drop belowpredefined thresholds, the device provides continuous tactilesimulation until the signals return to a normal value indicatingthat breathing is resumed. The interface allows the user to setthe thresholds in the software or use the values set in the pulseoximeter. From an initial test using simulated physiologic sig-nals, the device works efficiently and provides an adequate levelof tactile stimulation.

Jeanette Plantin


Overview 1 The aim of this study is to investigate the effects on1. sensorymotor performance in activities of daily life and 2.awareness concerning visuospatial neglect with institutionallybased training using virtual reality and haptics for strokepatients in the early phase of recovery. This project will beimplemented as a clinical controlled study with pre-post testdesign. The subjects will be 20 inn-patients with hemi-paresisin one of the upper extremities (n=16) or neglect (n=4). Theintervention group will receive training with three dimensionalcomputer games with haptics in addition to the usual training.This study will be discharged at the Neurological RehabilitationCentre Erstagårdskliniken at Ersta Hospital, Stockholm, Swe-den during the period October the 1st 2008 until February the28th 2009. The results will be considered in the future clinicalwork as well as in future studies together with other clinics inour research network.

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Alberto Rovetta

Novel Device DeeDee for Neuromotor Controlwith Augmented Reality and MultiparametricSensors Fusion

DeeDee is a new multi parametric device which detects themotion of a finger, in its kinetic parameters. Also the timedelay response when starting the motion is evaluated. The lastparameter is the tremor of the hand. The electronic compo-nents are sensors for detection and measurement of the fingermotion, able to obtain the velocity of the finger when it per-forms the required action. A nanosensor detects the accelera-tion and the vibrations of the hand. A time measurement isexecuted to determine the time delay, after that a visual signaloccurs on the screen of the computer, and the operator muststart the motion. A small car moves on the road according tothe finger motion and the operator must perform the best tra-jectory with a perfect control of the motion, at the most correctspeed, and the finger coordination again is required.

MENTAL HEALTH

Giuseppe Riva

NeuroVR 1.5: A Free Virtual Reality Platform forthe Assessment and Treatment in ClinicalPsychology and Neuroscience

At MMVR 2006 we presented NeuroVR (http://www.neu-rovr.org - http://www.neurotiv.org), a free virtual reality plat-form based on open-source software. The software allows non-expert users to adapt the content of 14 pre-designed virtualenvironments to the specific needs of the clinical or experimen-tal setting. Following the feedbacks of the 700 users who down-loaded the first version, we developed a new version - NeuroVR1.5 - that improves the possibility for the therapist to enhancethe patient’s feeling of familiarity and intimacy with the virtualscene, by using external sounds, photos or videos. Specifically,the new version now includes full sound support and the abili-ty of triggering external sounds and videos using the keyboard.The outcomes of different trials made using NeuroVR will bepresented and discussed.

COMPUTER-AIDED THERAPY

Farzam Farahmand

Robotic Assisted Reduction of Femoral ShaftFractures Using Stewart Platform

A robotic system for reduction of femoral shaft fractures is pro-posed. The system is based on Stewart platform with sixdegrees of freedom mobility. A plan for implementing the plat-form on bone fragments is introduced and a step by step strate-gy for performing the reduction process based on the system’sinverse kinematic solution is proposed. It is shown that the sys-

tem’s workspace fulfills the fracture reduction requirements offemoral shaft. The efficacy of the system for some case studiesis evaluated and it is shown that in its final configuration, withthe parallel moving and fixed platforms, the system can belocked to act as an external fixator.

Tomoko Ikawa


A Multiple Simulation System can provide useful insight to theclinical diagnosis and treatment_However, when metal prosthe-ses are present in the patient, the quality of the CT is greatlyreduced, resulting in an image that is distorted and thus pro-vides little understanding on extraction and form of dentition.In order to circumvent this, we scanned the surface of plasterdental model with a 3-D scanner. Subsequently, this model wasdigitally combined with the CT reconstruction model, andused as a guide to remove any disturbances that were due to thepresence of metal artifacts. The VR and physical occlusal con-tacts were accorded about 55%. Subsequently, we were able toreproduce a skull model specific to the patient occlusal con-tacts. This was verified via color mapping. In addition, this sys-tem was able to provide a quantitative and dental clinical evalu-ation of the teeth adjustment configuration

Judith Muehl

Towards Validation for Physiological Models inIntervention Planning

Computer supported treatment planning systems aim at pre-dicting treatment results. Recently attacked challenges base notonly on anatomical findings, but include physiological process-es. This way, interventions which are highly depending onpatient physiology become predictable and can be supported incomputer based planning. Though the necessity to validatecomputations used for treatment planning is unquestionedavailable models lack validation. Designing a medical study tovalidate an engineering model is difficult and demands newapproaches on almost every level. For those interventions wherea prediction is most desired the intervention result cannot beseen in images. Therefore data from patients in clinical practiceis not sufficient. The contribution discusses challenges fordesigning a validation study for the example intervention ofradiofrequency ablation in the liver. Different research areashave to collaborate and leave their typical path of thinking tocontribute to a common solution oriented on the challenge.

Amit Mulgaonkar

A Prototype Surgical Manipulator for RoboticIntraocular Micro Surgery

Advances in the miniaturization of ophthalmologic surgicalinstrumentation has allowed for the development of novel,minimally invasive surgical techniques for the treatment of ocu-


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lar dysfunction and disease. Such techniques afford relativelyatraumatic access to the inner surfaces and structures of the eyewith few limitations on the maneuverability and workspace ofthe instrument. Several potential benefits exist for adaptingsuch techniques for use with surgical robotic systems includingimproved instrument dexterity, superior visualization, greatermagnification, tremor reduction, less tissue damage at the pointof entry, and the ability to perform remote (teleoperated) pro-cedures. With these in mind, we have designed a prototype sur-gical manipulator for robotic intraocular microsurgery that isspecifically engineered to harness the benefits of surgical robot-ics while reducing eye trauma associated with tool motion.Robotic as well as pig-eye tests were performed, demonstratingthe feasibility of such a manipulation system and satisfactoryperformance in basic surgical manipulations.

Jay Mung


The objective of our research is to develop an ultrasound, time-of-flight triangulation based system for real-time, intraoperative3-dimensional tracking of minimally invasive surgical instru-ments. We have chosen to first apply this technology towardstracking catheters used in endovascular aortic stent-grafting. Todemonstrate the feasibility of this concept, we have developed asystem involving a custom catheter based transducer and per-formed an experiment in excised porcine tissue with a modelaorta. Preliminary results suggest better than 1mm resolution inthe perpendicular axis.

Takumi Ogawa

Designing Artificial Jaw Joints (AJJs) in VRSpace for Patients with Rheumatoid Arthritis

In this present study, we will report on a case of a patient withsleep-disordered breathing (SDB). She suffered a condyle frac-ture that led to rheumatoid arthritis. Furthermore, we willreview how we planned her treatment and designed her artifi-cial jaw joints (AJJs) via 3D imaging in VR space. We decidedthe mandibular position based on the facial aesthetic line (E-line) and the occlusion. Then we designed her AJJs to complywith the translated mandible with 3D-modeling software. Theupper airway obstruction is assumed to occur in the presentcase due to a pharyngeal obstruction, as in other patients withmicrognathia or sleep apnea syndrome. Therefore we had toconsider the sleep disorder in addition to occlusal managementin such situations as the present case. Furthermore, designing acustom-made AJJs via a 3D model could prove insightful whenit came to arranging the treatment plan of SDB patients.

Ali Rastjoo

Evaluation of Hidden Markov Model for P300Detection in EEG Signal

In this paper, we analyze the performance of hidden Markovmodel (HMM) for P300 detection in electroencephalogram(EEG) signal. In some application like the brain-computerinterface (BCI), where real time detection of mental commandsis desired, HMM could be useful processing tool. The resultsshow that the HMM could be more preferable over the staticmethods of the traditional EEG signal classifiers. To analyze theproficiency of this classification method, we evaluate the per-formance of the suggested HMM classifier on BCI 2005 EEGbenchmark dataset. First, data refinement was conducted byusing the wavelet enhanced ICA for EOG artifact removingand B-spline wavelet transform for background EEG noise can-cellation. Then feature extraction was made by down-samplingthe refined EEG data. In the classification stage, HMM resultsare enhanced by a multilayer perceptron neural network(HMM-MLP). Accuracy of the proposed HMM classifier wasfound to be 81.6% on the validation dataset.

Mathias Seitel


Patient-specific 3D models of the heart can provide a signifi-cant advantage in planning complex surgical interventions. Vir-tual models which can be interactively explored on computerscreens, as well as physicalmodels which provide a tangible andnatural approach to the heart’s anatomy, have been used for thispurpose. In this work, a mixed reality approach is proposedwhich integrates the advantages of both the virtual and theplastic model with the help of tracked 3D pointing devices.Interactions such as pointing to specific landmarks, measuringdistances, or exploring hidden areas, are exerted on the physical(natural) model but are effected on the virtual (interactive)model. The potential of this technique is demonstrated for aconcrete application of cardiac surgery. By adding further inter-action modes, this technique can easily be extended into surgi-cal or anatomical teaching applications.

Hisham Sherif

Recovery after Resuscitation from CardiacArrest in ST-Elevation Myocardial Infarction: AComputer-Based Medical Decision-Support Tool

Prediction of outcomes in ST-elevation myocardial infarctionwith cardiac arrest often presents difficult clinical decision mak-ing. Using the observed clinical results from our institution’sdata, we introduce a customized, computer-based decision sup-port tool to assist in evaluating and predicting outcomes insuch situations. We conclude that this tool can be beneficial toclinicians in decision making or triage of this condition. (Workin progress)

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András Székely

Imaging 2.0: Diagnostic Imaging and Web 2.0

In 2004, a new chapter was opened in the history of the Inter-net as more emphasis was put on communication, community,and creativity. Medical professionals have realized the opportu-nities of this “social Web”, and recently Imaging 2.0 hasemerged as a set of Web 2.0 tools tailored for the needs ofDiagnostic Imaging professionals and students. In this presen-tation I am going to illustrate Imaging 2.0; describe these spe-cial online tools; provide solutions to improve collegial andteacher-student communication, and show how tracking infor-mation can be more efficient online.

Efstratios Theofilogiannakos

One Heart, Two Bodies: a Simulation Study ofBody Surface Potential Differences betweenDonor and Recipient of Heart Transplantation

Following cardiac transplantation, “abnormalities” in the organrecipient’s ECG become evident. Through simulations, we inves-tigated the influence of the heart positioning within the chestcavity as well as the recipient’s somatometric parameters on thebody surface potentials of the human torso in a fashion that, webelieve corresponds to what actually happens in the case of car-diac transplantation. Two subjects with significantly differentsomatometric parameters underwent chest MRI examination.We then edited the chest MRI DICOM images with a speciallydeveloped software tool that allows us to create a high qualitytetrahedral mesh. A post-mortem human heart was also subject-ed to MRI scanning and its tetrahedral mesh was created. Usingcustom software we extracted the heart mesh of the two subjectstorsos and we replaced them with the mesh of the post-mortemheart. We then assessed the influence of heart (re)positioningwithin the thorax, on the body surface potentials. The Finite Ele-ments Method (FEM) technique was used to solve the forwardelectrocardiography problem for both torsos, under the assump-tion that at one instant all the ventricular myocardium of the onepost- mortem heart is excited. FEM was also applied in simulat-ing Body Surface Potentials on the first torso for nine differentheart positions. The results show higher Body Surface Potentialsin the subject with lower BMI and significant changes in BodySurface Potential distributions when the heart is rotated aroundits long axis. Conversely, heart shifts in the horizontal or thecoronal planes did not cause significant changes on simulatedBody Surface Potential distributions.

Eugeniy Yanin


Modern technologies of biomedical and surgical simulation,imaging, robotic facilities, including telemedicine are aimed todiagnose diseases in early stages and to correct them. Amongthe medical alternatives minimally invasive technologies are themost actual methods of surgery nowadays and are considered tobe “the golden standard” providing the decline of surgery

patient traumatism, minimizing post surgery pain, reducing theperiod of attending in a hospital and increasing the positiveemotional condition of a patient. Laparoscopic and thoraco-scopic surgery is the basis of robotic operative system daVINCI S which is gradually and successfully implemented inRussia in Yekaterinburg and Khunty-Mansyisk . From the per-spective of teaching methodology and personnel politics inhealth care system it is very important not to forget, but todevelop and exercise traditional way of surgery in operationssuch as laparotomy, thoracotomy, lumbartomy and others, aslong as any micromechanical, 3D imaging and computer oper-ating technology might be converted. A surgeon should bealways ready to this. They should be strong, confident and ableto ensure the favorable outcome of an operation.

TELEMEDICINE

Gregorij Kurillo

Teleimmersive Environment for Remote MedicalCollaboration

In this paper we present the work in progress on teleimmersiveenvironment for remote medical collaboration. The systemwould allow medical professionals to collaborate in more natu-ral way by the means of multi-camera teleimmersive technologyand hand tracking with gesture recognition for 3D interactionwith medical data, such as MRI, CT scan, 4D ultrasound, and3D x-ray. In the past, we have successfully demonstrated real-time collaboration in dance, Tai Chi learning, and data explo-ration using the proposed technology. We have successfullyintegrated hand tracking using time-of-flight (infra red) camerato interact with 3D data in a virtual environment. In the futurewe will perform a user study to assess the benefit of remote col-laboration over traditional video conferencing. We believe theproposed framework is an important step to bring the teleim-mersion technology closer to remote collaboration medical fieldand other environments, such as engineering, architecture,industrial design, and social networking.

Susil Meher

Barriers in Telehealth Care for Treatment of RuralPatients at AIIMS, New Delhi, India

Introduction: Telemedicine is an upcoming technology inhealth sector in India, so requires study to be done to know theopinions of the Patients are ready to accept or not. Methods: Aquestionnaire has been prepared and made survey of 264patients from 17 different states hospitals of India. Results: .The patients are readily accept technology if it is fulfilling thereexpectations. They mainly look at satisfaction from treatmentand the mode of treatment is almost immaterial to them.Therefore, further awareness programs are required to sensitizethe patients in this regard and also for the progress of telemedi-cine Discussion/conclusion: It has observed that the young age<35 years group is quite interested for the distance health care.But the patients >35 years and < 45 years are interested for face


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to face consultation. The 98% patients are interested for secondopinion for consultation.

SIMULATOR DESIGN

Sarah Baillie

A Mixed Reality Simulator for Feline AbdominalPalpation Training in Veterinary Medicine

Abdominal palpation is an important skill for veterinary stu-dents to master. However, the procedure is difficult to teachand learn particularly when the structures palpated are internaland out of sight. Hands-on practice is a key part of the stu-dent’s learning process but the opportunities to examine ani-mals can be limited. For example, cats have a low tolerance tohandling. Therefore, as a complement to traditional training amixed reality simulator consisting of two PHANToM hapticdevices and a toy cat is being developed to teach feline abdomi-nal palpation. Virtual models of the chest and abdominal struc-tures are ‘superimposed’ on the physical model. Veterinarianshave been involved in the development process and initial feed-back is encouraging with regard to the realism achieved and thecontribution of mixed reality to face validity. The range of sim-ulations is being extended and trials are planned to evaluate theeffects on students’ learning.

Nadine Fritz


The Virtual Reality Stimulator is a European Space Agencyactivity performed by Space Application Services (Belgium)with the purpose to develop a tool for scientists to performcognitive neuroscience research. Its objective is to build andvalidate a multi-purpose virtual reality stimulator platform forcognitive neurophysiology investigations in the InternationalSpace Station. This virtual reality based system allows to devel-op, realise and modify a wide range of experiment protocols forcognitive neurophysiology. The system gives the opportunity toexplore neuroscience and cognitive aspects in a complete con-trolled environment (e.g. 3D mazes) with defined stimulations(like aural, visual, mechanical stimulations). It allows for sub-millisecond accuracy reaction time measurements and supportsthe recording and synchronization of electrophysiological sig-nals such as EEG, EOG, EMG and ECG. The presentationwill include a brief overview of the Neuroscience research inSpace and will then focus on the requirements, methods andthe system developed for the Virtual Reality Stimulator activity.

M. Susan Hallbeck

Paper Prototypes for the Detection of StereotypeViolations in (Medical) Device Operation – AreThey Good Enough?

Controls for most technologies, including medical devices, arebecoming increasingly complex, difficult to intuitively under-stand and don’t necessarily follow population stereotypes. Theresulting delays and errors are unacceptable when seconds canmean the difference between life and death. In this study par-ticipants were asked to “control” a system using a paper mock-up (color photographs of controls) and then with a higherfidelity mock-up of the same physical controls to determineperformance differences among ethnicities and genders. Noethnic nor gender differences were found, and the comparisonof paper versus higher fidelity mock-ups also showed no signifi-cant differences. Thus, paper mock-ups as a device designusability tool will illustrate stereotype violations long before thefirst physical prototype. This will not only save money in thedevelopment and design processes, but also makes sure thateven the most complex devices, are intuitively understandableand operable for their basic functions.

Motohiro Kikuchi

Development of Virtual Dental Waxing-up Systemwith Haptic Interface

Objectives: The purpose of this research is to develop a dentalwaxing up system using virtual reality. The command tool ofthis system has the shape of a dental instrument, and themaniphalanx sense is fed back to the system depending on thedental procedure. Methods: The software enables four opera-tions, namely, “Cutting down”, “Pilling up”, “Melting” and“Finishing”. Finally, whether a virtual waxing up is practicableusing this system was verified. Results and Conclusions: Withinput of six degrees of freedom and the antipower feedback, avirtual waxing up was successfully realized. Even a student of adental college without knowledge of CAD/CAM was able towax up for approximately one hour with various systematicsupport. The demands of special technologies from the opera-tor will be kept at a minimum, and the method can be appliedto education, and consequently, to objective evaluation.

Sergei Kurenov

Development and Initial Validation of a VirtualReality Haptically Augmented Surgical Knot-Tying Trainer for the Autosuture™ENDOSTITCH™ Instrument

Surgical education techniques have not kept pace with therapid development of increasingly complicated operative tools.The need for systems that can be used to train surgeons in asafe environment will be imperative. Improvement in technicalability outside of the operating room should translate toenhanced patient safety. To help surgeons prepare we havedeveloped a tying-knot platform and used as a proof-of-concept

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the Covidien Autosuture(tm) ENDO STITCH(tm), an instru-ment which is useful but with a steep learning phase. Uncom-mon manipulations at the handle, specifically the needle move-ment between the jaws during the tying-knot procedure,require complex operations. Our platform combines the actualAutosuture instrument handle with a virtual instrument tip andsuture that allows the user to tie knots in a virtual environ-ment. Beta testing has shown that the device can differentiateexperts from novices and helps trainees understand how to tie aknot quickly and efficiently.

Jason Line


Commercialisation of medical simulators is a very unique con-cept. It is often an ad-hoc process due to significant workinvolved with developing technologies, having to re-affirmexisting educational concepts including assessment-related the-ories, and having an undefined market potential. This paper isthe first to describe one approach to commercialisation of med-ical simulators, highlighting the processes, variables and con-straints involved, and outcomes achieved through their man-agement. The described path to commercialising medical simu-lators is based on our own experience with two very differentsimulation products, as well as observations on the use of arange of other simulators and feedback given by clinicians. Dis-cussion is built around the main concept guiding the commer-cialisation process which is defined as the purpose of medicalsimulators: to serve as educational instruments in the trainingand credentialing of medical professionals, whilst maintainingproven educational concepts that underlie traditional medicaltraining.

Liliane Machado

A Framework for Development of Virtual Reality-Based Training Simulators

CyberMed is a free framework (GPL license) for the develop-ment of medical applications for simulation based on virtualreality. Some of its functionalities are: monoscopic and stereo-scopic visualization, support to several 3D visualization devices(anaglyph, polarized and shutter glasses), 2D and 3D interac-tion, support to haptics, interactive deformation and onlineassessment methodologies. The framework allows to decreasedevelopment time and offers complete synchronization amongseveral functionalities that can be selected by the programmer.CyberMed can be used by programmers of any expertise leveland offers high-level access for non-experts and low-level accessfor expert programmers. The low-level access allows the inclu-sion or extension of the framework functionalities. The presen-tation will show the framework structure, how it can be usedand expanded with specific methods. Examples of applicationsdeveloped with CyberMed will also be presented.

José Mosso

Cyborg Mini-Trainer

We show the smallest, lighter, easy to install, to carry andportable trainer for laparoscopic surgery with a weight of 400gr. And 25 cm of large, 24 cm wide and 23 cm high. This sys-tem is Integrated by an open module, a lamp and a microcam-era connected to a Head Mounted Display. This module permitsurgeon to make specifically knots. The major impact we con-sider is the use of a Head Mounted Display HMD instead ofbig screens on TV or monitors. In the future instead of micro-camera, surgeons could employ mobile phones or digital cam-eras. A HMD with one screen could be used instead of towbecoming surgeons in cyborgsurgeons.

Manivannan Muniyandi


Virtual reality based simulation of laparoscopic surgery has sofar been using some highly specialized and expensive systemsinvolving highly sensitive sensors and actuators. This presents abarrier for widespread usability of simulators, not only in devel-oping countries such as India but also in the developed coun-tries. Home made simulators are usually too simple and do notoffer the advantages of Virtual Reality environments. Our goalis to design and develop a do-it-yourself simulator for VR basedlaparoscopic simulation. The simulator uses webcams (easilyavailable and sufficiently cheap), which help reduce operatingcosts drastically. The tracking, through the cameras, of the tro-car is done using highly optimized image-processing routines inC++. Apart from the primary aim of cost-effectiveness, thesource code used also ensures that compatibility is maintainedover a wide range of platforms and systems. The accuracy ofthe simulator has been tested against that of The Phantom(from Sensable Technologies) - a well-known generic hapticshardware.

Sebastian Ullrich


We present a regional anaesthesia simulator for axillary nerveblocks in virtual environments. The main contribution is theelectric impulse transmission through soft tissue. To achievethis, we have implemented a novel approach based on electricdistance. By employing modified pathfinding algorithms, theshortest path of the electrons emitted from the needle tipthrough inhomogeneous tissues to nerve cords is estimated.Once a nerve is stimulated, the according virtual muscles areactivated by an impulse traversal through the anatomical datastructure. The resulting motor response is visualized by a para-meterized skeletal joint animation of the forearm and hand ofthe virtual patient. The purpose of the simulator is to conveypractical experience to anaesthetists and thus improve theirskills. First prototypes have been presented to medical residents


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and are to be evaluated very soon. Plausible interaction, visuali-zation and basic haptic rendering ensure intuitive usage of thesimulator.


Developing An Immersive Ultrasound GuidedNeedle Puncture Simulator

We present an integrated system for training ultrasound (US)guided needle puncture. Our aim is to provide a validatedtraining tool for interventional radiology (IR) that uses actualpatient data of straightforward and complex anatomy andpathology. Data sets are segmented using interactive processesto label target anatomy. This is used to create surface meshesand volume meshes. The tissue deformation due to the needleinsertion is computed in real-time using linear finite elements.The intrinsic motion of organs and their deformation due tothe respiration are also modeled. The force feedback is based onforce measurements that have been made on real tissue. Also, asthe trainee moves the image probe over the skin of the virtualpatient, a corresponding US-like image is computed and dis-played in real-time. Preliminary content validation studies ofour framework, demonstrated favourable observations that areleading to ongoing revisions.

Yoshinori Yoshida

Virtual Reality Simulation Training for DentalSurgery

In dentistry the exquisite hand skill is required for daily treat-ments, and acquisition of the skill is essential for dental stu-dents. In the present study, by using haptic device, develop-ment of an educational system to train the extraction of wis-dom tooth. was attempted. 3-D CT image of wisdom tooth,row of the teeth, face, jaw bone, tongue and gums were separat-ed from the CT image of a patient. They were input into soft-ware Free Form to operate by haptic device PHANTOM. Theextraction simulation was carried out while feeling the sense offorce from various tools of haptic device. Initially, gums werecut with the knife tool, and alveolar bone was carved to con-tour of the wisdom tooth could be extracted. The crown andthe root of a tooth were divided, and extraction was done bymoving tool noting the direction of the wisdom tooth. Incisedgum was closed, and the simulation of extraction surgery wascompleted.


Joerg Beardi

Comparison between “Computer Gaming Kids”and Experienced Laparoscopic Surgeons underSimulated Laparoscopy Conditions

Today the influence of Computergaming and Computergame

experience on the social development of children and teenagersis intensively discussed. Our hypothesis is that through com-puter games visuospatial perception, which is needed forlaparoscopic surgery can be trained. We examined the influenceof computergame experience on surgical skills of children andteenagers. From January 2007 to August 2007 we examined230 children and teenagers from 6 to 17 years of age (mediumoverall 10,75 years, median age 10 years). The children per-formed tasks on a laparoscopic virtual reality simulator. Groupswere comparable in age and overall computer game experience.Group with 3 hours or less computer gaming experience perweek, group 2 with 3 -10 h/ week and group three with morethan 10 hours experience per week. Group 3 was faster, madefewer mistakes and operated more precise than group 2 whichperformed better than group 1 in nearly every chosen task.

Mary Barak-Bernhagen

Endotracheal Intubation Comparing a PrototypeStorz CMAC and a GlideScopeVideolaryngoscope in a Medical TransportHelicopter – A Pilot Study

Airway management and intubation skills are essential for com-bat medical care. This pilot study tested a prototype miniatur-ized CMAC video laryngoscope versus the GlideScope (GS) ina simulated helicopter intubation scenario. Subjects in this pilotstudy were 8 flight paramedics and nurses, who had intubationexperience with 30+ patients. Participants performed intuba-tions on a Laerdal Airway Mannequin in the standard and diffi-cult airway configurations, using direct and indirect laryn-goscopy with the Storz CMAC video laryngoscope and an indi-rect intubation using the GlideScope. Intubation times andsuccesses were recorded. Comparison of intubation success ratesusing DV vs. CMAC and GS (indirect) laryngoscopy in theDifficult Manikin Airway showed 0 successful intubations withDV compared to 62.5% with the CMAC and 59% with GS.This study demonstrates that the CMAC and GlideScope vide-olaryngoscopes provide improved views of the glottic openingin a simulated difficult airway compared to direct laryngoscopy.


Endotracheal Intubation in a Medical TransportHelicopter – Comparing Direct Laryngoscopywith the Prototype Storz CMAC©Videolaryngoscope in a Simulated DifficultIntubating Position

During combat trauma situations, patients’ airways must some-times be managed when they are in less than optimal positionsfor intubation. In this study, we tried to create a difficult intu-bating position and evaluate whether or not intubation couldbe successfully performed using direct and indict laryngoscopy.Flight medical personnel attempted to intubate a Laerdal diffi-cult intubation manikin in a helicopter using both standardintubating positioning (with the intubator at the head of thestretcher) and difficult intubating position (with the intubatorat the foot of the stretcher). During backward intubation of the

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difficult manikin airway, we found a statistically significant dif-ference in the average airway view scores between the direct(MAC) versus the indirect (CMAC) view intubations. This dif-ference in airway visualization can significantly increase thespeed of establishing a patent airway and increase the speed ofoxygenation, resulting in prevention of brain cell death and sav-ing lives.

Ben Boedeker

Videolaryngoscopy for Intubation Skills Trainingof Novice Military Airway Managers

An estimated 10% of preventable battlefield deaths are due toAirway obstruction. Improved airway rescue strategies are need-ed with new tools for airway management by less experiencedproviders. Airway management and training are improved usingvideo laryngoscopy(VL) compared to direct laryngoscopy (DL).We evaluated if novices could rapidly acquire fundamentalskills and improve intubation time compared to non-novicesusing VL in a manikin. For 43 subjects mean intubation timedid not differ for DL (25.9 ± 24.5 seconds) vs. VL (26.4 ±31.5 seconds) {p = 0.94 paired t-test}. Novice intubation timewas 6.82 ± 31.0 seconds greater with VL (31.6 ± 34.6 seconds)vs. DL (24.8 ± 18.5 seconds) {p = 0.255 paired t-test}. VL vs.DL time difference was not different between novice and non-novice groups. Mean Cormack-Lehane airway visualizationscores (range 1-4) were higher with VL (1.95 ± 0.97) vs. DL(1.02 ± 0.15){Students t-test p <0.0001}.

Ben Boedeker

Remote Videolaryngoscopy Skills Training forPre-Hospital Personnel

Videolaryngoscopy (VL) is a novel technology that can facili-tate rapid acquisition of intubation skills with simultaneousteacher and learner visualization of laryngeal structures. Video-laryngoscopy improves laryngeal visualization, and improvesintubation success in difficult airway management compared tostandard direct laryngoscopy. First responders need enhancedairway management tools to improve intubation success rates incivilian pre-hospital, and military battlefield settings. We com-pared the effectiveness of a remote first responder videolaryn-goscopy skills training paradigm using a distance learning plat-form with synchronous transmission of laryngoscopy images toa remotely located trainer. Airway visualization, intubation suc-cess rates, and intubation times documented equivalence ofremote and face-to-face introductory familiarization and intu-bation training with the Storz-Berci videolaryngoscopy system.Remote training paradigms for advanced technology solutionssuch as videolaryngoscopy can accelerate the diffusion of life-saving new technologies, especially when there is limited accessto specialized training programs.

Doo Yong Lee

Sectional Analysis of Learning on the KAIST-Ewha Colonoscopy Simulation II

The previous studies assess the trainees’ performance in aggre-gate manner, i.e., for the entire colon using global performanceindices such as total intubation time and total number ofadverse events during the overall procedure. Colon can bedivided into four segments, i.e., sigmoid, descending, transverseand ascending colon. Each colon segment has different length,shape and characteristics. The necessary skills and degree of dif-ficulty to navigate through each segment are different. There-fore, the rate and amount of learning during practices can bedifferent for each colon segment. Analysis in aggregate mannercan blind the different learning and hence, the differentrequirement for an effective and efficient simulation. Thispaper reports on the study to validate the KAIST-EwhaColonoscopy Simulation II as a training tool by examining thelearning in the specific sections of colon. This study is a firstattempt to observe the learning made in the individual sectionsof the colon during simulation. One of the interesting pointsconfirmed in this study is that a large portion of betterment inthe intubation time, number of red-outs and red-out timeappears in the sigmoid colon and the descending colon.

Ganesh Sankaranarayanan

Face Validation of the Virtual Basic LaparoscopicSkill Trainer (VBLaST™)

In this paper we present the face and construct validity of theVirtual Basic Laparoscopic Skill Trainer (VBLaST) . TheVBLaST is a virtual-reality based system that can reproduce thefive Fundamentals of Laparoscopic Surgery (FLS) task to beperformed on the computer. The main advantage of this systemis its ability to objectively measure multidimensional perform-ance metrics during task performance. The face validity wasevaluated based on the subjective scores expressed in 10-pointLikert scale for various questions related to the relevance of thesimulator. The construct validity was evaluated based on MIS-TELS normalized scoring system for the five FLS tasks. We arecurrently conducting the IRB approved study at the Universityof Albany Medical Center and at the Beth Israel Deaconessmedical center. By comparing and contrasting the performanceof VBLaST with the FLS trainer box, we plan to show theeffectiveness of VBLaST.

WEDNESDAY POSTERSMODELING

Ciamak Abkai


A new model for electrocardiography is presented, which is basedon multiple number of dipoles instead of using one as done in


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vector electrocardiography. The multiple dipole parameters arecalculated based on real data (4 dipoles from 12-channel ECG)solving the backward problem of electrocardiography applyingdifferent iterative numeric methods. The results are transformedto a waveform description based on Gaussian approximation foreach dimension of one dipole. Usually up to 5 Gaussian parame-ter are used to approximate the waveform within a small errorrange. The compact parameterized descriptions are saved inXML format and can be used for real-time simulation by solvingthe forward problem of electrocardiography. The solutions can beused in hardware to emulate the electrical potential with regardto the distance to dipole sources, measurable by standard ECGmonitor devices on the one hand side or for virtual simulationsin software on the other hand side.

Eric Acosta


Computer-based medical simulations rely on physically-basedvirtual environments (VEs) for realistic object interactions andbehaviors. Physically-based VEs are computational resourceintensive when solving large numbers of equations needed tosimulate the VE. Limited CPU resources often require VEs tobe simplified for real-time performance, which can reduce asimulation’s realism. Multi-core processors greatly increase thecomputational capacity of computers. We have developed amodular pipeline VE architecture designed for multi-core CPUsystems. Experiments show the architecture scales efficientlywith the number of CPU cores. Speedup is relatively independ-ent of the number of VE objects. Near linear (and super-linear)speedups are obtained as additional CPU cores are utilized. Thearchitecture enables building and simulating physically-basedVEs. The architecture’s modularity easily allows integration ofindependently developed algorithms into a parallel environ-ment. Leveraging all multi-core processor resources makes itpossible to increase the complexity and realism of physically-based VEs and medical simulations.

Farzam Farahmand

A Surface Registration Technique for Estimationof 3-D Kinematics of Joints

Surface registration is the process of aligning the 3-D datapoints acquired from different viewpoints or at different times.The aim of this study was to propose a new approach for esti-mation of the transformation matrix of articular surface ofjoints in two scenes of clinical images. The relationshipbetween the initial and transferred location/orientation of apoints cloud was analyzed and relations were formulated overthe unknown translation/rotation components as a spatial regis-tration problem. The method was then generalized to a largernumber of points using the least squares method, and any freeform points cloud using the influence surface modelingmethod. Evaluation of the method in two case studies resultedin high accuracies of ±1 mm and ±1 degree. In general, theproposed method was found to be a powerful technique for

registration of complicated freeform surfaces and provide the 3-D kinematics of joints.

Craig Hourie


This description of our framework for implementing real-timesurgical simulation scenarios includes an analysis for the needfor an integrated layer of hardware and low-level programmablesupport. We focus on the special requirements of surgical simu-lators; the requirements for interactive dynamic scene com-positing, multi-body collision detection and physics basedmodel updates are common with other simulators, but in addi-tion the new challenges include multimodal and volumetricvisualization support, integration of specialized laparoscopicinterfaces and tracked tools, and the need to connectdeformable modeling and surface-to-surface contact manifolds.Our framework is DirectX-based and is deployed across NVidiaPhysX, and CUDA platforms, for solving the core Lagrangiansystems of partial differential equations in the constitutivemodels of tissue biomechanics. As a demonstration, we show aninteractive surgical case study where the scene includes interac-tions between mesh free particle clusters, finite-element vol-umes, and mass-spring surfaces, representing tissue, and therigid body surgical tools.

Vassilios Hurmusiadis

From Cell to ECG: Real-Time InteractiveSimulation of Cardiac Electrophysiology for ECGTraining

We aim to simulate the principles of electrocardiography usinga real-time interactive 3D simulation of cardiac electrophysiolo-gy. The whole heart was equipped with cell-nodes and fiber ori-entations. A model of the conduction tree was constructed.Cell activation sequences were constructed and formed thebasis for the construction of the intercellular activation propa-gation. A cellular automaton was developed to simulate thepropagation of electrical excitation through the cell-nodes. Thesimulated electric axis is calculated over a beat cycle and is pro-jected on the Einthoven and precordial leads. Malfunctioningregions were simulated by altering the cell activation profiles incertain groups of cell-nodes. The application will allow end-users (medical students, trainee cardiologists, coronary carenurses) to become intuitively aware by interacting with the car-diac excitation process in real-time, in a bottom-up approach:from cell to ECG. The work in progress is supported by PrimalPictures Ltd and the London Development Agency, UK.

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Derek Magee

A Physics Based Method for Combining MultipleAnatomy Models with Application to MedicalSimulation

Medical simulations are frequently based on patient derivedimaging datasets. Unfortunately, no single imaging modality /dataset / patient will optimally demonstrate all the requiredanatomical and pathological features. We present a novelapproach for constructing virtual anatomical environments bycombining anatomic data obtained from different imagingsequences, modalities or patients. A generic anatomical datasetis used to generate a mass-spring model defining the shapes,spatial relationships, and physical properties of the solid organs,muscle and skeleton. Subsequently, individual anatomical ele-ments can be modified or “swapped” for datasets demonstratingalternative anatomy or pathology. Gradient Vector Flow andDistance Transform maps are used to estimate the externalforces that are applied to the mass-spring system to ensure thenew components fit into the existing shape. We demonstratehow replacement of anatomical components simplifies anatom-ical modeling for medical simulation. This technique could alsobe applied to other areas, such as atlas building, and simulationof tissue deformation due to tumour growth.

Yong Hum Na

A Method to Create Size-Adjustable Whole-BodyPatient Models for Radiological Studies of OrganDoses

Background: Whole-body organ-size adjustable and percentile-scaled adult patient models are needed for radiological studiessuch as Computed Tomography (CT) imaging, radiation cancertreatment, and assessment of internal dose burden. This paperdiscusses an automatic mesh deformation method and its appli-cations. Method and Materials: The automatic mesh deforma-tion algorithm was implemented by MATLAB(r) 7.4 with theAnatomiumTM 3D models whose organ geometries were mor-phed to the International Commission on Radiological Protec-tion (ICRP) reference male/female organ volume/mass datawithout unwanted mesh overlap surface. These models aretransformed to solid geometries through the voxelizationprocess. Results: The size-adjustable whole-body patient meshmodels were able to be transformed to the solid geometries inthe voxel domain for the various radiological procedures andother types of ionizing radiation simulations using MonteCarlo techniques. Conclusion: This study has demonstrated thefeasibility to create the size-adjustable whole-body patient meshmodels which can be applied to various radiological proceduresto improve the accuracy of dose assessment by anatomicallymatching a specific person.

Herke Jan Noordmans

Real-Time Brainshift Correction of Pre-OperativeImage Data for Neuronavigation, Using Today’sGraphics Hardware

Processing large images files requires intense computationalpower. Driven by the gaming industry, the processing power ofgraphics cards (GPUs) has increased significantly. With the pixelshader model 4.0 the GPU can be used for image processing 10xfaster than the CPU. Dedicated software was developed toprocess 3D MR and CT image sets for the real time adaptationof brain shift during navigated neurosurgery. A ray-traced 3Dbrain image can be deformed according to the per-operative cor-tex location. GPU based programming enables real-time process-ing of high definition image datasets and various applications canbe developed in medicine, optics and image sciences.

Kresimir Petrinec

The FMA Database Browser: A Key Componentof an Interactive Image Visualization Pipeline

University of California at Los Angeles (UCLA) Center forAdvanced Surgical and Interventional Technology (CASIT)researchers are developing an interactive image visualizationpipeline with the ability to rapidly visualize and efficientlyinteract with patient-specific image datasets. The pipelineenables patient-specific image datasets acquired in a DigitalImaging and Communications in Medicine (DICOM) formatto be converted into a three-dimensional (3D) deformable for-mat that facilitates future simulation-based interactivity. UCLACASIT researchers have developed a standalone FMA databasebrowser which provides manual assignment of FoundationModel of Anatomy (FMA) identification codes (IDCs) to sur-faces generated from patient-specific DICOM format data andto the reference 3D model. The FMA database browser is a keycomponent of this innovative image visualization pipeline.

Joseph Romano


Representing deformable and breakable objects is both a com-mon goal and a computational challenge for any modern med-ical simulation. Immersive user feedback can be provided bycreating a real-time mathematical model to track these states.Many modern approaches, such as finite element methods, can-not reach the high update rates necessary for haptic and graphicfeedback, thus limiting the scope of user interaction. Ourapproach combines prior work in mass-spring-damper repre-sentations for deformable tissue with a previously publishedforce model for tissue puncture. By using the computationalsimplicity of the mass-spring-damper model, we are able toexceed the update rates necessary for graphical display of rea-sonably complex models. Furthermore, we introduce a novelmethod for performing real-time three-dimensional hapticinteraction when using the mass-spring framework. Results


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show that our simulation technique is both physically realisticand immediately viable on existing hardware.

Chengyu Shi

Development of a Patient-Specific PredictiveGeometry (PPG) Model Based on Real Patient 4DCT Data

Background: patient respiratory motion is a critical problem inradiation oncology and a virtual predictive model is helpful insolving this problem. Tools and Methods: based on our previ-ous study, a Patient-specific Predictive Geometry (PPG) modelhas been developed from real lung patient 4D CT data. The riblength information derived from the patient’s 4D CT measure-ment. The breathing curve of the patient has been analyzed toextract amplitude and period information. Kalman filter hasbeen used to predict the breathing curve. The rib cage rotationangle was calculated based on the rib length and breathingcurve amplitude. Results: the rib rotation angle has been calcu-lated with maximum rotation angle 11 degree. The averagedbreathing curve period is 3.86 s. With the kalman filter predic-tion ability, the virtual model has predicting ability. Conclu-sion: it is possible to develop a lung PPG model based on a realpatient 4D CT data.


The Clockwise Rotation of Myocardial FiberOrientation from Epicardial to EndocardialSurface in Left Ventricular Free Wall in a Post-mortem Human Heart

Following fixation and MRI imaging, a post-mortem humanheart was sliced in the sagittal plane. Each anatomical sectionwas then cut into smaller segments and each one of them wassubjected to classical histology. The resulting microscopy slideswere digitalized with a high resolution scanner and the histo-logical section was reconstructed with the Adobe PhotoshopCS2(r). Using software especially developed for our purposes(FiberCad), we can identify and draw (with the assistance ofoptical microscope) those fibers that either lay upon, or are per-pendicular to, each microscopy slide’s plain of section. Toachieve a histological 3D reconstruction, the software isequipped with an option that allows the user to search for thebest possible fit between the histological and the MRI images.We present a series of consequent sagittal sections of the LVfree wall (from the epicardium to the endocardium), fromwhich the clockwise rotation of the mean orientation of thefibers laying on the plane of section, is clearly evident.

Georgios Theofilogiannakos

Computational Tools for Addressing the Forwardand Inverse Problems in Electrocardiology

Solutions of both the forward and inverse problem of electro-cardiography rely on the modeling of the anatomic and electri-

cal properties of the thoracic tissues. This requires good knowl-edge of the electrical anisotropy of the heart, lungs and the restof the thorax. Cardiac electrical anisotropy is related to itsmicrostructure. We developed three computational tools toaddress the related modeling requirements. MRICad is a semi-automatic user guided program that creates a detailed 3D meshof the thorax and heart, using image data from contiguous twodimensional MRI slices. FiberCad models myocardial fiber ori-entation, deriving its data from high-resolution ex vivo humanheart MR images and from histology specimens of heart tissue.TORSOheart is used for integrating the 3D thorax and heartmeshes, created by MRICad and FiberCad respectively. Com-bined together they provide a realistic analytical model of thehuman torso and the heart in the form of three dimensionaltetrahedral meshes.

Mei Xiao


Generic anatomical digital 3D models have been used in areassuch as therapy planning, customizing replacement body partsand shape developments. However, building generic anatomicalmodels generally requires a graphic designer to study shapes ofreal objects intensively and design polygon meshes using mod-eling software. We have developed an efficient virtual dissectiontool that biologists could use to create generic 3D models fortheir atlases without the need for artistic drawings. Our cus-tom-developed tool can be used to extract 3D models frommedical image stacks, cut the models and align the sub-models.Corresponding 2D medical image portions of the sub-modelscan then be aligned and averaged. At the end, the genericmodel over all the subjects can be obtained from the averaged2D images. The technique we developed optimizes the func-tionalities of existing toolkits and the resulting software packagewill allow biologists to build their atlases more quickly andaccurately.

SIMULATOR DEVELOPMENT TOOLS

Venkata Arikatla

Plug-and-Play Tool Handles for LaparoscopicSurgery Simulators

We have developed a cheap, easy-to-use interface for minimallyinvasive surgery simulators. We adapted actual laparoscopichand tools to be interfaced with the PHANTOM(r) OmniTMdevice. The opening and closing of the tooltip is captured byan 1 M-Ohm linear taper rotary potentiometer that is instru-mented into the handle of the tool. Similarly, the rotation ofthe tooltip is also captured by using a linear taper rotary poten-tiometer. The potentiometers are used as variable voltagedividers, where the output voltage varies corresponding to theposition of the potentiometer. Ontrak(r) data acquisition devicethen reads the output voltages and feeds them to the simulatoras a binary string. The surgical simulation code interprets and

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then determines the angles of the virtual tooltip. This low costdesign can easily emulate opening and closing as well as therotation of the tip about the tools axis without the use ofexpensive interfaces commercially available.

Dhanannjay Deo

Development of a Glove-Based Wearable Systemfor Objective Assessment of Laparoscopic Skillsand Some Observations for a Peg Transfer Task

A novel wearable glove-based system for recording hand andjoint motion during laparoscopic task performance has beendeveloped which can be used for objective analysis and assess-ment of surgical skills. The data measured involved 3 positionvariables of the hand and 3 orientation angles using the Flockof Birds (tm) and pressure magnitudes at each of the fingertipsand bend motions at each finger joint using noDNA X-IST(tm) data gloves. The glove system was used in an experi-ment at Albany Medical College involving a bimanual pegtransfer task. Four expert surgeons at least at the level of chiefsurgical resident and twelve residents with no prior experiencewith laparoscopic instruments participated in these experi-ments. The data streams acquired were analyzed quantitativelyand qualitatively for comparison between expert and novicesurgeons.

Rachel Ellaway

Integrating Simulation Devices and Systems

We are developing a simulation integration platform across anumber of projects that are looking to integrate and aggregatedisparate simulation tools and resources, including the HealthServices Virtual Organization (HSVO) and the Virtual Educa-tional Research Services Environment (VERSE) projects. Theend result is the integration of tools such as commercial man-nequins, screen-based simulations, 3D worlds and physiognom-ic algorithms, each able to interact and share data, therebyenabling more fluid and innovative use of simulation in manydifferent settings to: > Provide common data standards andAPIs for different simulation devices and tools to interact witheach other. > Drive an open standards and access agenda, par-ticularly in encouraging and enabling commercial, open sourceand local developments to interact. > Support more fluid, well-aligned and innovative uses of simulations tools and technolo-gies. > Stimulate research and development into existing andemergent patterns of simulation use in different settings.

Matthias Färber


The use of virtual reality techniques opens up new perspectivesto support and improve the puncture training in medical educa-tion. In this work a 3D VR-Simulator for the training of lumbarand ascites punctures has been extended to support the bending

of the puncture needle. For this purpose the needle is designed asan angular spring model. The forces that restrict the user frombending the needle are calculated using a multiproxy techniqueand given to the user via a 6DOF haptic device (Sensable Phan-tom Premium 1.5). Proxy based haptic volume rendering is usedto calculate the proxy movement. This way it is possible to inte-grate original CT-patient data into the rendering process andgenerate forces from structures that have not been segmented.The bending technique has been integrated in a VR-training sys-tem for puncture interventions and shows good results concern-ing update rate and user acceptance.

Chuan Feng

Usability Study of Computerized Surgery Trainingand Assessment System

The lack of objective performance assessment capability is anissue of concern in minimally invasive surgical training.Although some virtual reality (VR) surgical simulators providemulti-metrics performance evaluation, the difference betweenthe reality and the virtual environment is notable. In order tobridge this gap and to improve the quantitative assessment, wehave developed a situational awareness enhancing system(SAES) for MIS. The SAES uses a unified framework incorpo-rating the perception, comprehension, and projection softwaremodules that provide feedback during the exercises and enablean evaluation of the training procedure.

Shin Hasegawa

Simulation of Vaginal Wall BiomechanicalProperties from Pelvic Floor Closure Forces Map

We simulate the way Pelvic Floor Muscles (PFM) generates zonalcompression on the vagina to maintain urinary continence. Rawdata were obtained using a probe to map the distribution of pres-sures. Simulation model was made using the structural and shearspring approach. We simulated two models that are applied tocontrols and patients based on the measured force maps. ThePFM values of both of cases are measured when relaxed and con-tracted. Simulation clearly distinguished between control andpatents. Simulation results further demonstrate that in the con-trols, there is a temporal priority so that the closure force reachesmaximum fast. Conversely in patients, PFM initiated closure isslow. We conclude that we can simulate the mechanism of thevaginal wall closure using the spring mass model and the forcemaps, with vaginal closure pressures. Furthermore by visualizingthe anatomical deformation of the vaginal wall, better under-standing of function is facilitated.

Sergei Kurenov


We have created a low-overhead, robust, non-physical represen-tation of the peritoneum membrane that interactively adjusts toenclose, possibly moving, underlying anatomical features. The


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membrane class is implemented within the real-time “Toolkitfor Illustration of Procedures in Surgery” environment, along-side haptically enabled organs, blood vessels, fatty tissue andsurgical tools. The membrane class supports probing of theseunderlying anatomical features and, although non-physical,mimics retraction under its own tension when cut.

Leow Wee Kheng


Many surgical simulation systems have been developed. Amongthem, reactive systems attempt to simulate real-time displace-ment and deformation of body tissues in response to userinputs. They are useful for surgical training and preoperativeplanning of surgical operations. However, to use a reactive sys-tem to predict the results of a complex surgical procedure, onewould need to go through all the surgical steps, which istedious and time-consuming. In contrast, our research goal is todevelop a predictive system for the simulation and planning ofcomplex cardiac surgeries. This approach allows the surgeon toeasily explore various surgical options to determine the bestones without going through all the detailed surgical steps. Thispaper illustrates our work on predictive surgical simulationusing aorta reconstruction in arterial switch operation as anapplication example. Successful test results demonstrate thatpredictive simulation of complex cardiac surgeries is feasibleand useful for the surgeons.


Hybrid Network Architecture for Interactive Multi-UserSurgical Simulator with Scalable Deformable Models

In this paper we present a hybrid network architecture withscalable deformable model for a multi-user interactive surgicalsimulator. The hybrid network architecture consists of a centralserver that has all the necessary information for simulation ofdeformable objects in the scene. Multiple clients connected tothe server each of whom have a local copy of the deformablemodels which are updated periodically and synchronized glob-ally from the server using a TCP/IP connection . In additioneach clients also establish a UDP connection to all other clientsin a peer-to-peer fashion to multicast information at hapticdata rates. The machine learning based deformable model inthe server is scalable and has the ability to update each clientswith just enough information necessary for them to interactwith their local model independently. Experiments are currentlybeing performed using the Internet to demonstrate the effec-tiveness of our system.



In this work, we present an efficient real-time method to detect

knots in a virtual-reality suturing simulator. The knot detectionmethod exploits the self-collision information on pairs ofthread segments to detect the knot. Once the knot is detected,it is frozen for further evaluation in the simulator. This methodwas successfully tested for standard knots that are applied dur-ing a minimally invasive surgical (MIS) procedure in the simu-lator. Overall the thread contained fifty segments that areupdated using the “Follow the Leader “ (FTL) algorithm. Theknot detection was achieved at the haptic update rate of 1000Hz which is considerably faster than other approaches based onknot theory.

Ji Son

Quantification of Intraocular Surgery Motionswith an Electromagnetic Tracking System

An intraocular surgical tracking system that can track the spatialposition and orientation of the surgical instruments using mag-netic sensors has been developed. DC magnetic tracking sensorswere attached near the tools tips, so not to compromise the func-tionality of the tools, to continuously monitor their X, Y, and Zpositions. A hardware-software interface was developed thattransforms the coordinate data points into instrument pathways.These data are recorded and saved in a database for subsequentimmersive training and training performance analysis. Three 6degree-of-freedom (DOF) DC magnetic trackers were used witha sensor diameter of 1.3 mm. Motion tracking was performedduring a combined phacoemulsification (PKE) and pars planavitrectomy (PPV) procedure on a pig eyeball. A referential sensorwas placed on the surface of a pig eyeball.

Satoshi Yamaguchi

Dental Haptic Simulator to Train Hand Skill ofStudent-Calibration Method to RealizeVisual/Haptic Environment

In dentistry the exquisite hand skill is required for daily treat-ments, and acquisition of the skill is essential for dental stu-dents. However, conventional dental practice using phantommannequin has the limitation for the case setting and the fre-quency of practice. The aim of our study was to develop a pro-totype educational system to train tooth preparation with virtu-al haptic force and assist students to acquire hand skill. Oursystem consists of a workstation with Dual Core Intel Xeon5160 CPU (wx6400 Hewlett-Packard Co., Ltd, Japan), hapticdevice (PHANToM Omni, SensAble Technologies, Inc.,U.S.A), and half-mirror (light transmittance: 30%). Computergraphics (CG) of a patient is projected forward a user throughthe half-mirror. In the present study, we perform calibrationbetween haptic coordinate system and half-mirror coordinatesystem to realize real clinical situation. The user can interactdirectly the CG by using a stylus of the haptic device.

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SIMULATION & TRAINING

Johan Creutzfeldt

Retention of Knowledge after Repeated VirtualWorld CPR Training in High School Students

Massive Multiplayer On-line Simulations (MMOS) were usedto train 12 high school students in Cardio- Pulmonary Resusci-tation (CPR) in a pilot study. In groups of 3 the subjects weretrained in multiple similar scenarios in two sessions 6 monthsapart. Eighteen months after the last training session 9 of thesesubjects were assessed for knowledge, performance and per-ceived mental strain during CPR in a simulated full scale sce-nario. We found clear signs of retention of the training whencompared to a matched control group. Although generalknowledge and performance did not differ, it was evident thatthe procedure that had been trained still was remembered to acertain extent. The perceived mental strain was also higher inthe experimental group. We hypothesize that this kind of train-ing has important benefits and may in turn modify reactions tothe traditional type of Basic Life Support (BLS) training.

Stefan Holubar

Virtual Pelvic Anatomy and Surgery Simulator:An Innovative Tool for Teaching Pelvic SurgicalAnatomy

Understanding 3-D pelvic anatomy is difficult due to the com-plex interfaces of bony, neurovascular and visceral components.We are in the process of developing an educational simulator,based on a virtual anatomic model, which will be integratedinto the educational curriculum of Mayo Clinic Multidiscipli-nary Simulator Center. This educational module will emphasizethe spatial relationships of the pelvic viscera in a way that tradi-tional educational methods cannot. Using high-resolution com-puted tomography (CT) and magnetic resonance (MR) data-sets, pelvic anatomic structures are segmented into a 3-D “vir-tual” anatomic model. A corresponding physical model withvarious pathologic components provides tactile correlation.Upon completion of the beta-module, survey-based testing ofmedical students and residents will evaluate the modules educa-tional effectiveness. This module will facilitate medical studentand resident learning of pelvic anatomy, and will allow residentand surgeon to rehearse complex surgical procedures by per-forming virtual surgery, thereby improving preparedness for realoperations.

Kanav Kahol

Visualization and Analysis of Medical Errors inImmersive Virtual Environments

Preventable medical errors are a significant cause for a largenumber of deaths in the healthcare industry. With the adventof monitoring devices and virtual environments like SecondLife there is a possibility to develop software that can capture

real time interactions and workflow and visualize them virtuallythrough playback and analysis tools. The paper presents such asystem. Using off-the-shelf Radio Identification tags, subjectlocation can be tracked. Audio recorders are used to capturesubject interaction with other individuals. The synchronizationof RID data and audio recordings yields data that is then visu-alized using customizable virtual world. The virtual world isbuilt from floor plans as well as pictures of the actual environ-ment. The system is augmented by analytical visualizationssuch as person-person interaction graphs, hotspots etc. that Inconjunction with replaying scenarios in virtual environmentsallow for better analysis of root cause of errors and error man-agement training.

Elizabeth Krupinski

Assessing Radiology Resident Preparedness toManage IV Contrast Media Reactions UsingSimulation Technology

We investigated whether radiology residents could correctlydiagnosis and treat contrast reactions using simulation technol-ogy. Eleven residents experienced a test scenario where a simu-lator patient given contrast had a reaction. Sessions were evalu-ated and timed using predetermined key actions. Eye-positionwas recorded in 4 residents. There was no significant differencefor junior versus senior residents, but juniors (mean = 71.10%)performed higher than seniors (mean = 62.75%). Medicineprelim residents received higher (mean = 73.85%) scores thanthe transitional (mean = 64.40%) and surgery (mean =61.47%). Those who performed higher looked for shortertimes at more relevant places in the room than those who per-formed worse (tended to look at the patient not the monitoringequipment). These data demonstrate a gap in training in themanagement of reactions among radiology residents. Patientsimulators to train the management of contrast reactions haspromise to correct the unevenness of training experiences.

Sergei Kurenov


An interactive, video game-based training module, Burn Cen-ter, was developed to simulate the real-life emergency events ofa mass casualty disaster scenario, involving in 40 victims. Thegame contains two components - triage and resuscitation. Thegoal of the triage game is to correctly stabilize, sort, tag andtransport burn victims during a mass casualty event at a busytheme park. After complete the triage component, the playerwill then take on the role of a burn care provider, balancing theclinical needs of multiple burn patients through a 36-hourresuscitation period, using familiar computer-simulated hospitaldevices. Once complete, players of Burn Center will come awaywith applicable skills and knowledge of burn care, for bothfield triage and initial resuscitation of the burn patients.


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Fuji Lai

Robotic Telepresence for Medical Training andEducation

See one, do one, teach one has long been the paradigm formedical education. The challenge is that it is not always easy tobe exposed to the entire spectrum of cases that is possible. Oneway to standardize the experiential training is to “open up” theOR or Angio Suite to more than the immediate team at thepatient site. The Remote Presence system has been used toenable trainees and mentors to remotely observe cases and to be“virtually present” for a procedure taking place across the coun-try or even around the world. This new paradigm for timelyclinical expertise delivery and dissemination will have a palpa-ble impact on clinical training and the availability of qualitypatient care across geographical barriers.

Yuri Millo

Advanced Medical Simulation: Inexpensive SkillsTraining for Students and Clinicians

One barrier for adoption of simulation-based training in medi-cine has been the prohibitively high cost of simulators in theresource-constrained environments of the medical school,teaching hospital, and clinical practice setting. Gaming consolesprovide interactive three-dimensional (3D) graphics and forcefeedback that can support all but the most complex simulation-based training in medicine. In collaboration with MicrosoftCorporation, we are developing Xbox 360TM modules fortraining psychomotor skills for a variety of procedures in emer-gency medicine and acute care surgery. This presentationdescribes our development of a flexible fiberoptic bronchoscopysimulator for placement of an endotracheal tube. Based on ourresults, this approach is both feasible and efficient, given themultitude of art and programming tools that are available forgame developers. Thus, we have been able to produce a com-pelling and engaging bronchoscopy simulator, featuring a tieredhierarchy of skills progression that can run on a low-cost gam-ing platform.

Victor Vergara

The Use of Virtual Reality Simulation of HeadTrauma in a Surgical Boot Camp

Surgical “boot camps” provide excellent opportunities toenhance orientation, learning, and preparation of new surgeryinterns as they enter the clinical arena. This paper describes theutilization of an interactive virtual reality (VR) simulation andassociated virtual patient (VP) as an additional tool for surgicalboot camps. Complementing other forms of simulation, virtualpatients (VPs) require less specialized equipment and can alsoprovide a wide variety of medical scenarios. In this paper wediscuss a study that measured the learning effectiveness of areal-world VP simulation used by a class of new surgery internswho operated it with a standard computer interface. Theusability of the simulator as a learning tool has been demon-

strated and measured. This study brings the use of VR simula-tion with VPs closer to wider application and integration into atraining curriculum, such as a surgery intern boot camp.

Yan Zhang

A Survey of Simulators for Palpation Training

Palpation is a widely used diagnostic method in medical prac-tice. The sensitivity of palpation is highly dependent upon theskill of the clinician, and palpation skills are often difficult tomaster. There is a strong need for pupation simulator. Thispaper summarizes the important work and latest achievementsin the simulation for palpation training. Three types of palpa-tion simulators, physical models, Virtual Reality (VR) basedsimulation, and hybrid (computerized and physical) simulator,are surveyed. Comparisons among different kinds of simulatorsare presented.

VISUALIZATION

Hossein Arabalibeik


Spiromerty is a common test in evaluating the functionality ofthe pulmonary system. An intelligent decision support systemcould assist physicians for accurate diagnosis by providing morecredible results. In this work neural networks are used as a clas-sifier to discriminate between obstructive and restrictive pat-terns of pulmonary disease. Mixed pattern abnormality isdetected as well. To achieve better classification performance,the results of a group of neural networks are combined usingthe Bayesian reasoning as an aggregation algorithm. Bayes’ The-orem explains how we can integrate new evidences to the previ-ous decision. The results of this study showed that the pro-posed algorithm could be used in diagnosing pulmonary dis-eases and discriminating between its restrictive and obstructivepatterns.

Jeremy Cooperstock

A Comparative Study of Monoscopic andStereoscopic Display for a Probe-PositioningTask

A critical challenge in neurosurgical imaging is to provide aneffective means of visualizing and interacting with data of thepatient’s brain, in a manner that is natural to surgeons. Whileimproved display of volumetric brain data is likely to aid inunderstanding of the 3D content, little investigation appears tohave been made into the question of how different display tech-nologies and interaction paradigms affect perception and under-standing of such data. To address this need, we are performingcomparative studies of different display technologies (conven-tional 2D screen, head-mounted display, stereoscopic projection

71MMVR17


with polarizing filters, and autostereoscopic display) intended toevaluate their efficacy in communicating three-dimensional con-tent, specifically, in the context of a neurosurgical planning task.While we hypothesize that stereographic display offers benefitsover a monoscopic equivalent for understanding of volumetriccontent and their spatial relationships, our study is intended toquantify the differences in resulting task performance betweenthese and against traditional monoscopic display.

Lucio De Paolis


The developed application is the first prototype of a virtualinterface which provides a very simple form of interaction fornavigation and manipulation of 3D models of the human body.The system can also be used in the operating room and doesnot require any contact with computer devices or with a screen.The surgeon will be able to rotate, to translate, to zoom in onthe 3D models and to choose to visualize all of the organs oronly some of them simply by moving his finger in free space.By means of an optical tracking system, the position of the fin-ger tip, where an IR reflector is located, is detected and utilizedto define the four vertexes of the virtual interface and to man-age the interaction with this. 3D Slicer has been used for build-ing the 3D models and OpenSceneGraph for the constructionof the graphic environment.

Anton Koning

V-Scope: Design and Implementation of anImmersive and Desktop Virtual Reality VolumeVisualization System

While techniques to display stereoscopic images (i.e. images thatallow depth perception) are close to two centuries old, they stillhaven’t penetrated into daily clinical practice. However, manystudies show the additional value of depth perception and three-dimensional interaction when visualizing medical datasets such asCT and MRI. In this paper we summarize some results obtainedusing an immersive virtual reality system, specifically in the fieldsof prenatal medicine and cardiology with 3D ultrasound data.We also present a desktop virtual reality system build from off-the-shelf components, using software that builds upon theseexperiences. This system makes integration of virtual reality intothe regular clinical work flow feasible.

Ganesh Krishnamurthy

Use of See-Through Head Mounted Display forUltrasound Guided Vascular Access inInterventional Radiology

Ultrasound is the main imaging modality for vascular accessespecially in pediatric population. Pediatric interventional radi-ologists provide this specialized service in selected hospitalsacross the country. It is a well accepted fact that vascular access

in children especially the neonates is technically challenging.Even with higher frequency ultrasound transducer probes, vas-cular access is challenging. Coordinating the needle placementinto the vein simultaneously concentrating the ultrasoundimage on the monitor is not easy and the interventional radiol-ogist has to constantly switch visualizing the patient’s arm andthe ultrasound monitor. This difficulty is made worse by theposition of the machine, the room illumination causing glareon the monitor. Related to these difficulties we came up with anew see-through monocular head mounted display acting as amonitor for various imaging modalities

John Qualter


The primary goal of this project is to use 3d computer visualiza-tion technology to assist breast cancer patients in understandingtheir options for breast reconstructive surgery following a mastec-tomy. This research visualizes a latissimus musculocutaneous flapbreast reconstruction in an interactive 3d environment.

Justin Tan

Exploring Human Interface Devices forNavigating Three-Dimensional Medical ImagingData

Volumetric image renderings from CT and MR data hasbecome an essential component in modern medicine. As thequantity of 3D imaging data grows, so does the need for effi-cient review which aids the understanding of complex anatomicrelationships. We have created a software interface built on theFovia HDVR(r) engine that recreates the basic functions of aradiology image review interface, but also allows the manipula-tion of 3D volumetric renderings created from CT datasets.The program allows viewers to use either a mouse and key-board, or a human interface device (HID) designed for 3Dnavigation: the Space-Navigator by 3Dconnexion. We plan toutilize our software to study the applications and utility of theSpace-Navigator versus the conventional mouse and keyboardin the manipulation of 3D image data. Future studies willinclude other HIDs such as a freehand position sensing tool ora multiple input touch screen.

THURSDAY – SESSION B (cont)SIMULATOR DEVELOPMENT TOOLS

Erik Lövquist


The research presented in this paper investigates the effects ofutilizing user-centered design methods for the development of a

virtual reality based simulator for spinal anesthesia. The aim isto identify benefits of applying established, evidence-baseddesign methods. The use of such methods can potentiallyenhance the completion of an end-resulting medical simulator,which meets the needs of trainers and trainees by providingend-user input to the design throughout the entire develop-ment process. The user-centered design methods investigated inthis paper uses the specific idea of prototyping, i.e. the collabo-rative development of a tangible artifact intended to aid contex-tual grounding of the design, facilitate discussions of new ideasand generate a shared understanding of the problem. As a resultof the applied design methods, beneficial aspects have beenidentified as enhanced working relationships and communica-tion between end-users and designers and proper contextualgrounding.

72 MMVR17


PresenterContact Info &

Index

MMVR17

79MMVR17

Presenter IndexSchedule Summary Schedule Summary

AAbkai, Ciamak .................................. 18, 21 ............ 54, 63

Ackerman, Michael ........................... 1, 10

Acosta, Eric ...................................... 10, 18 ............ 25, 30, 64

Annese, Jacopo ................................ 16 ................... 26, 49

Arabalibeik, Hossein ......................... 20 ................... 70

Arikatla, Venkata .............................. 19 ................... 66

Athey, Brian ..................................... 9 ..................... 29

BBaillie, Sarah .................................... 15 ................... 60

Balch, David ..................................... 1

Banker, Christian .............................. 17 ................... 52

Barak-Bernhagen, Mary .................... 15 ................... 62

Baysa, Kóan Jeff ............................. 1, 16

Beardi, Joerg ................................... 15 ................... 62

Boedeker, Ben .................................. 15 ................... 63

Bowyer, Mark ................................... 12 ................... 46

Briggs, Kimberly ............................... 13 ................... 48

Burgess, Deborah ............................. 17 ................... 51

Burgner, Jessica ............................... 21 ................... 54

CCannon-Bowers, Janis ...................... 9, 20 ............... 29, 32

Charles, Steve .................................. 1

Combs, C. Donald ............................ 12 ................... 45

Cooperstock, Jeremy ........................ 20 ................... 70

Cregan, Patrick ................................ 1, 16, 18, 21 ... 53

Creutzfeldt, Johan ............................ 19 ................... 69

Culbertson, Chris .............................. 9 ..................... 25, 42

Cutler Shaw, Joyce ........................... ....................... 25

DDaluja, Sachin .................................. 11 ................... 44

De Paolis, Lucio ............................... 20 ................... 71

Deo, Dhanannjay .............................. 12, 19, 21 ....... 46, 54, 67

Dev, Parvati ...................................... 11, 21 ............. 32

Dunne, James .................................. 20 ................... 32

EEllaway, Rachel ................................ 17, 19 ............. 51, 67

Evestedt, Daniel ............................... 10 ................... 30

FFan, Richard .................................... 13 ................... 56

Farahmand, Farzam .......................... 14, 18 ............. 57, 64

Färber, Matthias ............................... 19 ................... 67

Felländer-Tsai, Li .............................. 1 ..................... 12

Feng, Chuan .................................... 19 ................... 67

Fidopiastis, Cali ................................ 13 ................... 31

Flynn, Sheryl .................................... 13 ................... 47

Foo, Jung ........................................ 11 ................... 43

Friedl, Reinhard ................................ 11 ................... 44

Fritz, Nadine ..................................... 15 ................... 60

Fuchs, Henry .................................... 1

GGerber, Max ..................................... ....................... 25

Greenleaf, Walter .............................. 1, 12, 16

Grundfest, Warren ............................ 16 ................... 48

HHallbeck, M. Susan ........................... 13, 15 ............. 47, 60

Haluck, Randy .................................. 1

Hananel, David ................................. 1, 21

Hasegawa, Shin ............................... 19 ................... 67

Hattori, Asaki .................................... 11 ................... 44

Hawks, Jeff ...................................... 11 ................... 45

Heinrichs, William LeRoy ................... 1, 10, 21 ......... 32

Higgins, Gerald ................................. 10 ................... 29

Hoehne, Karl .................................... ....................... 25

Hoffman, Helene ............................... 1, 10, 17

Holubar, Stefan ................................. 19 ................... 69

Hourie, Craig .................................... 18 ................... 64

Hughes, Charles ............................... 13 ................... 31

Hughes, Darin .................................. 13 ................... 31

Hurmusiadis, Vassilios ...................... 18 ................... 64

IIkawa, Tomoko ................................. 14 ................... 57

Ikehara, Curtis .................................. 18 ................... 53

JJarrell, Bruce ................................... 9 ..................... 29

Johansson, Birgitta ........................... 14

80 MMVR17

Presenter Index

Schedule Summary Schedule Summary

John, Nigel ...................................... 17 ................... 52

KKahol, Kanav .................................... 12, 17, 19 ....... 30, 52, 69

Katsavelis, Dimitrios ......................... 13 ................... 47

Kheng, Leow Wee ............................. 19 ................... 68

Kikuchi, Motohiro ............................. 15 ................... 60

Kinross, James ................................. 16 ................... 48

Koning, Anton ................................... 20 ................... 71

Krishnamurthy, Ganesh ..................... 20 ................... 71

Krupinski, Elizabeth .......................... 19 ................... 69

Kurenov, Sergei ................................ 15, 19 ............. 60, 67, 69

Kurillo, Gregorij ................................ 14 ................... 59

LLai, Fuji ............................................ 20 ................... 70

Lange, Belinda ................................. 14 ................... 56

Lee, Doo .......................................... 15 ................... 63

Lee, Gyusung ................................... 12 ................... 46

Lehman, Amy ................................... 11 ................... 44

Lemke, Heinz ................................... 1

Li, Hao ............................................. 17 ................... 51

Lim, Yi-Je ........................................ 17 ................... 52

Line, Jason ...................................... 15 ................... 61

Liu, Alan .......................................... 1, 10 ............... 25, 29, 30

Lo, Jennifer ...................................... 11 ................... 43

Erik Lövquist ..................................... 22 ................... 71

Lutyens, Marcos ............................... .......................25

MMachado, Liliane .............................. 15, 21 ............. 55, 61

Magee, Derek .................................. 18 ................... 65

Marayong, Panadda .......................... 14 ................... 56

Marchal, Maud ................................. 17 ................... 50

Marianantoni, Alessandro .................. ....................... 25

McDonald, Claudia ........................... 20 ................... 32

McLay, Robert .................................. 9 ..................... 42

Meher, Susil ..................................... 15 ................... 59

Meruvia-Pastor, Oscar ...................... 16 ................... 49

Meskó, Bertalan ............................... 1, 17 ............... 26, 53

Millo, Yuri ......................................... 10, 20 ............. 29, 70

Mogel, Greg ..................................... 1, 16

Montgomery, Kevin ........................... 1, 11

Morgan, Karen ................................. 10

Moses, Gerald .................................. 12 ................... 45

Mosso Vazquez, José Luis ................ 9, 15 ............... 26, 41, 61

Muehl, Judith ................................... 14 ................... 57

Mukherjee, Mukul ............................. 18 ................... 53

Mulgaonkar, Amit ............................. 14 ................... 57

Mung, Jay ........................................ 14 ................... 58

Muniyandi, Manivannan .................... 15 ................... 61

NNa, Yong Hum .................................. 16, 18 ............. 50, 65

Nelson, Carl ..................................... 11 ................... 44

Nirenburg, Sergei ............................. 10, 17 ............. 29, 51

Noe, Carol ........................................ 17 ................... 52

Nonaka, Makoto ............................... 1

Noordmans, Herke Jan ..................... 18 ................... 65

OOgawa, Takumi ................................. 14 ................... 58

Okrainec, Allan ................................. 21 ................... 54

Oliker, Aaron .................................... 22 ................... 55

PParsons, Thomas .............................. 9 ..................... 41, 42

Petrinec, Kresimir ............................. 18 ................... 65

Phillips, Roger .................................. 1, 11

Plantin, Jeanette .............................. 14 ................... 56

Pugh, Carla ...................................... 1, 9, 16 ........... 41

QQualter, John .................................... 20 ................... 71

RRastjoo, Ali ....................................... 14 ................... 58

Riojas, Mario .................................... 12 ................... 45

Riva, Giuseppe ................................. 9, 14 ............... 41, 57

Rizzo, Albert ..................................... 2, 9, 10 ........... 42

Robb, Richard .................................. 2, 10

Rolland, Jannick ............................... 2

Romano, Joseph .............................. 18 ................... 65

Rovetta, Alberto ................................ 14 ................... 57

SSachdeva, Ajit .................................. 12 ................... 30

Sandlund, Marlene ........................... 12 ................... 47

81MMVR17

Presenter Index


Sankaranarayanan, Ganesh ............... 16, 19 ............. 63, 68

Satava, Richard ................................ 2, 10, 11, 12 ... 29, 30

Schlickum, Marcus ........................... 12 ................... 46

Schuppe, Oliver ................................ 21 ................... 55

Sclaverano, Stefano .......................... 21 ................... 55

Seitel, Mathias ................................. 14 ................... 58

Senger, Steven ................................. 2, 16

Shahidi, Ramin ................................. 2, 11

Shaw, Joyce Cutler ........................... ....................... 25

Shen, Yunhe ..................................... 17 ................... 50

Sherif, Hisham ................................. 14 ................... 58

Shi, Chengyu .................................... 18 ................... 66

Shin, Young Seok ............................. 9 ..................... 41

Shumaker, Randall ............................ 13 ................... 31

Sieck, Jennifer ................................. 10 ................... 25, 30

Sifakis, Eftychios .............................. 21 ................... 56

Sivak, Mark ...................................... 13 ................... 47

Smith, Marshall ................................ 12 ................... 30

Son, Ji ............................................. 19 ................... 68

Sørensen, Thomas ............................ 2, 11, 17 ......... 43

Souza, Ilana ..................................... 21 ................... 55

Spira, Jim ........................................ ....................... 31

Stredney, Don .................................. 2

Sudra, Gunther ................................. 12 ................... 46

Suen, Jonathan ................................ 16 ................... 49

Suzuki, Naoki ................................... 11 ................... 45

Swain, Julie ..................................... 2

Sweet, Robert .................................. 2

Székely, András ................................ 14 ................... 59

TTan, Justin ....................................... 20 ................... 71

Tan, Robert ...................................... 16 ................... 49

Theofilogiannakos, Efstratios ............. 14, 18, 19 ....... 59, 66

UUllrich, Sebastian .............................. 15 ................... 61

VVergara, Victor .................................. 20 ................... 70

Villard, Pierre-Frédéric ..................... 16, 21 ............. 49, 54, 62

Vockeroth, Johannes ........................ 11 ................... 26, 44

Vosburgh, Kirby ................................ 2, 11

WWaddington, Robert .......................... 10 ................... 30

Warner, Dave ................................... 2

Weber, Philip .................................... ....................... 26

Weghorst, Suzanne ........................... 2

Westebring-van der Putten, Eleonora . 21 ................... 54

Westwood, James ............................ 10

Whalen, Thomas .............................. 12 ................... 30

Whatley, Doug .................................. 20 ................... 32

Wiederhold, Brenda .......................... 2, 9, 16

Wiederhold, Mark ............................. 13 ................... 31

Wong, Virgil ...................................... 16 ................... 26, 48

Wood, Dennis ................................... 9 ..................... 42

Wurtele, Eve ..................................... 17 ................... 52

XXiao, Mei ......................................... 19 ................... 66

YYamaguchi, Satoshi .......................... 19, 21 ............. 55, 68

Yanin, Yevgeniy ................................. 14 ................... 59

Yoshida, Yoshinori ............................. 15 ................... 62

Young, Jiayi ...................................... ....................... 26

Young, Shih-wen .............................. ....................... 26

Youngblood, Patricia ......................... 2

ZZhang, Yan ....................................... 20 ................... 70

Zhang, Yingchun .............................. 17 ................... 50

Zheng, Guoyan ................................. 11 ................... 43

Zhou, Xiangmin ................................ 17 ................... 50, 51

iMMVR17

Organizing Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Conference Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Mission Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Course Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Target Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Poster Judging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Satava Award . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Disclaimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Organizer Contact Info . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Plenary & Parallel Session Presentation Schedule (With Index to Presentation Summaries) . . . . . . . . . . . . . . . . . . . . . . . 9

Monday Afternoon, Jan 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Session A - Mental Health & Simulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Session B - Virtual Patients for Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Session C - Simulator Construction Without the Agonizing Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Tuesday Morning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Plenary Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Adjunct Meeting -VR Assisted Exposure Therapy in the Treatment of PTSD . . . . . . . . . . . . . . . . . . . . . . . . 13

Tuesday Afternoon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Session A - Computer-Aided Therapy / Robotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Session B - Simulator Development Issues / Pre-Operative Warm-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Session C – Rehabilitation / Mixed Reality as a Tool for Cognitive and Motor Rehabilitation . . . . . . . . . . . . 12

Wednesday Morning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Plenary Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Wednesday Afternoon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Session A - Visualization / Sensors / Modeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Session B - Simulation & Training / Simulator Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Session C - TATRC West Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Thursday Morning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Session A - The Pulse!! Collaboration: Academe & Industry, Building Trust / Building Medical . . . . . . . . . . 20

Models and Scenarios from Clinical DescriptionsSession B - Simulator Development Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Poster Presentations (With Index to Presentation Summaries) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Tuesday Posters - Rehabilitation / Mental Health / Computer-Aided Therapy / Telemedicine / . . . . . . . . . . . . . . 13Simulator Design / Simulator Validation

Wednesday Posters - Modeling / Simulator Dev Tools / Simulation & Training / Visualization . . . . . . . . . . . . . . . 18

Salon and The Well . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Independent Session Summaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Virtual Patients for Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Simulator Construction Without the Agonizing Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Pre-Operative Warm-Up: Science, Theory, and Implications on Policy and Practice . . . . . . . . . . . . . . . . . . . . . . 30Mixed Reality as a Tool for Cognitive and Motor Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31VR Assisted Exposure Therapy in the Treatment of PTSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31The Pulse!! Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Virtual Building Medical Models and Scenarios from Clinical Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Exhibits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Exhibit Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Exhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Presentation Summaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Presenter Contact Info . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Presenter Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Table of Contents

Michael J. Ackerman PhD * Office of High Performance Computing & Communications, National Library of Medicine

David C. Balch MA * Medical Missions for Children

Kóan Jeff Baysa MD Vera List Center for Art and Politics, The New School (NY)

Steve Charles MD * MicroDexterity Systems; University of Tennessee

Patrick C. Cregan FRACS *Nepean Hospital, Sydney West Area Health Service

Li Felländer-Tsai MD PhD *Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute

Henry Fuchs PhD Department of Computer Science, University of North Carolina

Walter J. Greenleaf PhD *Greenleaf Medical Systems

Randy S. Haluck MD FACS *Department of Surgery, Penn State College of Medicine

David M. Hananel *Surgical Programs, Medical Education Technologies Inc. (METI)

Wm. LeRoy Heinrichs MD PhD Stanford University School of Medicine

Helene M. Hoffman PhD *School of Medicine, University of California, San Diego

Heinz U. Lemke PhD Institute for Technical Informatics, Technical University Berlin

Alan Liu PhD *National Capital Area Medical Simulation Center, Uniformed Services University

Bertalan Meskó *Medical School & Health Science Center, University of Debrecen

Greg T. Mogel MD *Keck School of Medicine &Viterbi School of Engineering, University of Southern California

Kevin N. Montgomery PhD *National Biocomputation Center, Stanford University

Makoto Nonaka MD PhD *Foundation for International Scientific Advancement

Roger Phillips PhD CEng FBCS CIPT *Dept of Computer Science, University of Hull (UK); Vertual Ltd

Carla M. Pugh MD PhD *Center for Advanced Surgical Education, Northwestern University


1MMVR17


2 MMVR17

Albert A. Rizzo PhD *Institute for Creative Technologies & School of Gerontology, University of Southern California

Richard A. Robb PhD *Biomedical Imaging Research LaboratoryMayo Clinic College of Medicine

Jannick P. Rolland PhD Institute of Optics, University of Rochester & ODA Lab, University of Central Florida

Richard M. Satava MD FACS Department of Surgery, University of Washington

Steven Senger PhD *Department of Computer Science, University of Wisconsin - La Crosse

Ramin Shahidi PhD *California Inst of Computer Assisted Surgery (CICAS), Stanford University School of Medicine

Thomas Sangild Sørensen PhD *Computer Science & Inst of Clinical Medicine, University of Aarhus, Denmark

Don StredneyInterface Laboratory, OSC

Julie A. Swain MD Division of Cardiovascular Devices, U.S. Food and Drug Administration

Robert M. Sweet MD *Urologic Surgery & Academic Health Center, University of Minnesota

Kirby G. Vosburgh PhD *CIMIT/Brigham & Women’s Hospital/Harvard Medical School

Dave Warner MD PhD Biodesign Institute & Decision Theater, Arizona State University; MindTel LLC; Inst for Interventional Informatics

Suzanne J. Weghorst MA MS *Human Interface Technology Lab, University of Washington

Brenda K. Wiederhold PhD MBA BCIA *The Virtual Reality Medical Center

Patricia Youngblood PhD *Educational Design and Evaluation, Innovation in Learning, Inc.

* Member, Abstract Review Committee

ConferenceInformation

MMVR17

5MMVR17

WelcomeWelcome to the 17th annual Medicine Meets Virtual Reality.This year’s program offers you more than 200 presentationsby scientists, clinicians, engineers, and students. Over fourdays, you will experience lectures, posters, workshop andpanel discussions, exhibits, demos, artwork, and multimedia.These presentations represent countless hours of effort andremarkable creativity, accomplishment, and vision. This year,we include expanded opportunities for impromptu demon-strations and non-traditional interaction. We encourage youtake advantage of all that is here—to observe, consider, com-pare, discuss, and engage.

We sincerely thank you for joining us here at MMVR17. Inthese challenging economic times, we are especially glad tohave your participation.

Mission StatementMMVR is organized to be an educational environment thatstimulates communication and collaboration among scientists,engineers, physicians, surgeons, educators, students, military,government, and industry. It supports the development andadoption of advanced medical technologies for medical careand education. Its goal is improved precision, efficiency, andoutcomes in patient care, practitioner training, and publichealth. The MMVR curriculum, by combining rigorous assess-ment with speculative vision, aims to create forward-thinkingsolutions to health problems.

Course ObjectivesPresentations are chosen to educate participants on:

• State-of-the-art for biomedical simulation and itsenabling technologies, haptics and modeling

• Emerging tools for clinical diagnosis and therapy: imag-ing methods, data visualization and fusion techniques,robotics, and sensors

• Intelligence networks for medical decision-making,patient care, and collaboration

• Goals, accomplishments, and challenges in the develop-ment and application of novel devices and methods formedical care and education.

Target AudienceMMVR17 is designed to educate and inform:

• Physicians, surgeons, and other medical professionalsinterested in emerging and future tools for diagnosis andtherapy

• Educators responsible for training the next generation of

doctors and scientists

• IT and medical device engineers creating state-of-the-artand next-generation simulation, imaging, robotics, andcommunication systems

• Data technologists creating systems for gathering, pro-cessing, and distributing medical intelligence

• Military medicine specialists addressing the challenges ofwarfare and defense health needs

• Biomedical futurists and investors who need to under-stand where medicine is headed

AcknowledgementsWe thank our colleagues on the Organizing Committee fortheir ongoing direction and support, especially those who gen-erously shared their time and expertise by reviewing submittedabstracts, editing the Proceedings, and assisting with the cre-ation of Salon, The Well, and the blog. Their scientific guid-ance is key to the continuing success of MMVR.

We thank ALL of you who are presenters during this year’s pro-gram. You are the foundation of this program.

We also thank these organizations—our educational partners—for independently organizing important components of the2009 curriculum:

• TATRC / USAMRMC

• National Capital Area Medical Simulation Center

• SiTEL / MedStar Health

• University of Central Florida

• Biomedical Informatics, Arizona State University

• Texas A&M University - Corpus Christi

• Innovation in Learning, Inc

• Breakaway, Ltd.

All of you help make MMVR17 a useful learning experience.

Poster JudgingYou are invited to vote for the best poster presentations. Pleasecomplete your Tuesday and Wednesday ballots and submitthem at the ballot box at the registration desk. The six winningposters (three each day) will receive prizes and be displayed onThursday.


6 MMVR17


The Satava AwardThe 15th annual Satava Award will be presented at MMVR17.Established in 1995 to acknowledge the contribution ofRichard M. Satava MD FACS, the award is presented to anindividual or research group demonstrating unique vision andcommitment to the improvement of medicine throughadvanced technology. Previous recipients are:

Alan Liu PhD & Mark Bowyer MD (2008)

Naoki Suzuki PhD (2007)

Nigel John PhD (2006)

Brenda Wiederhold PhD MBA (2005)

Steven Dawson MD (2004)

Richard Robb PhD (2003)

SUMMIT, Stanford University (2002)

HIT Lab, University of Washington (2001)

Dave Warner MD PhD (2000)

Faina Shtern MD (1999)

Gerhard Buess MD (1998)

Henry Fuchs PhD (1997)

Victor Spitzer PhD & Michael Ackerman PhD for the Visible Human (1996)

Richard Satava MD FACS (1995)

EvaluationWe welcome the input of all conference participants. Pleasetake a few minutes to write down your reactions to this year’sMMVR. Your feedback—negative and positive—will help uscreate the next MMVR.

DisclaimerThe information provided at this conference is intended forgeneral medical education purposes only. All physicians shouldfully investigate any new product or device before implement-ing it in their practice. In no event will the conference organiz-er, Aligned Management Associates, Inc., assume responsibilityfor any decision made or action taken as a result of the infor-mation provided through this activity.

Organizer Contact InformationMedicine Meets Virtual Reality c/oAligned Management Associates, Inc.793-A East Foothill Blvd, PMB #119San Luis Obispo, CA93405 USAPhone +1 805 534 0300 Fax +1 805 534 [email protected]:// www.NextMed.com

PresentationSchedule

MMVR17

9MMVR17

MONDAY, JANUARY 19 - SESSION A

Mental Health & SimulationModerator: Albert Rizzo


1:15 Thomas Parsons ............................................... p. 41 Inst for Creative Technologies, Univ of SouthernCalifornia

Neurocognitive and PsychophysiologicalAnalysis of Human Performance withinVirtual Reality Environments

1:30 Young Seok Shin................................................ p. 41Biomedical Engineering, Hanyang Univ

Virtual Auditory Hallucination ExposureProgram for Schizophrenia

1:45 Giuseppe Riva ................................................... p. 41Applied Technology for Neuro-Psychology Lab,Ist Auxologico Italiano

The Intrepid Project: Biosensor-EnhancedVirtual Therapy for the Treatment ofGeneralized Anxiety Disorders

2:00 José Luis Mosso ................................................ p. 41Regional Hosp No. 25, Inst Mexicano delSeguridad Social


2:15 Carla Pugh......................................................... p. 41Surgery, Northwestern Univ

Use of Clinical Simulations for PatientEducation: Targeting an Untapped Audience

Moderator: Brenda K. Wiederhold

2:30 Thomas Parsons ................................................ p. 42Inst for Creative Technologies, Univ of SouthernCalifornia


2:45 Chris Culbertson ............................................... p. 42Neuroscience, Univ of California, Los Angeles

Using Virtual Reality to Assess and TreatCraving in Substance Dependent Individuals

3:00 Break

3:15 Robert McLay .................................................... p. 42Mental Health, Naval Medical Ctr San Diego


3:30 Dennis Wood .................................................... p. 42Virtual Reality Medical Ctr

Effectiveness of Virtual Reality GradedExposure Therapy with PhysiologicalMonitoring for Combat Related PostTraumatic Stress Disorder

3:45 Albert Rizzo ....................................................... p. 42Inst for Creative Technologies / School ofGerontology, Univ of Southern California

VR PTSD Exposure Therapy Results withActive Duty OIF/OEF Combatants

4:00 Discussion & Demonstrations

5:00 Adjourn

MONDAY, JANUARY 19 - SESSION B

INDEPENDENT SESSION Virtual Patients for Medical Education: The Next Generation1:00 – 5:00

Gerry Higgins & Bruce Jarrell, Organizers

Presentations


The Virtual Patient: A Roadmap for FutureResearch from the Human Simulation andTraining Domains

Brian AtheyPsychiatry, Michigan Inst for Clinical & HealthRsch; NIH Nat’l Ctr for Integrative BiomedicalInformatics

Translational Bioinformatics in Support ofReal and Virtual Patients

Janis Cannon-BowersInst for Simulation & Training / CREAT DigitalMedia Program, Univ of Central Florida

Developing Serious Games for MedicalSimulation



10 MMVR17

Sergei NirenburgComputer Science & Electrical Engineering,Univ of Maryland Baltimore County

The Maryland Virtual Patient: Adaptivity in aMulti-Agent Clinical System

Richard SatavaSurgery, Univ of Washington Medical Center;US Army Medical Research & MaterielCommand

Total Body Scanning and the LongitudinalHealth Record

Yuri MilloSimulation & Training Environment Lab, ER OneInst, Washington Hosp Ctr, Medstar Health

Game-Based Skills Training: InexpensiveSimulators for Medical Interventions


A Meta-Analysis of the Training Value ofMedical Simulators: 2000-2008

MONDAY, JANUARY 19 - SESSION C

INDEPENDENT SESSIONSimulator Construction Without the Agonizing Pain 1:00 – 5:00 PM

Alan Liu, Organizer

Presentations


Welcome and Introduction

1:15 Robert WaddingtonSimQuest, LLC

Educational Requirements Analysis

2:00 Eric AcostaNational Capital Area Medical Simulation Ctr,Uniformed Services Univ

Simulation Environment Development:Advanced Techniques

2:45 Break

3:00 Jennifer SieckNational Capital Area Medical Simulation Ctr,Uniformed Services Univ

The 3D Model Development Workflow: FromDesign to Deployment

3:45 Daniel EvestedtSenseGraphics AB

H3DAPI: An Open Source API for DexterousSkills Simulators


Wrap-Up

4:35 Discussion

5:00 Adjourn

TUESDAY, JANUARY 20 – PLENARY SESSION

Note: Key portions of the inauguration ceremo-ny of President-Elect Barack Obama will beincorporated into this session via television link.This will require impromptu rearrangement ofpanel discussions and mid-morning break.

8:30 Karen S. Morgan & James D. WestwoodMMVR17 Organizers, Aligned ManagementAssociates, Inc.

Welcome & Introduction

PANEL DISCUSSIONHas Medicine Met VR? Accomplishments,Shortfalls, and Vision in the MMVR Community 8:45 – 10:00

Panelists

Michael AckermanHigh Performance Computing &Communications, National Library of Medicine

Wm. LeRoy HeinrichsStanford University School of Medicine

Helene HoffmanOffice of Educational Computing, School ofMedicine, University of California, San Diego

Albert “Skip” RizzoInstitute for Creative Technologies, University ofSouthern California

Richard RobbMayo Clinic College of Medicine

Richard Satava (Panel Moderator) Dept of Surgery, University of WashingtonMedical Center

10:00 Break (Exhibits and The Well open)

Monday Afternoon & Tuesday Morning

11MMVR17


PANEL DISCUSSION Beyond the Scientific Method 10:45 – 12:00

Panelists


Kevin Montgomery (Panel Moderator) National Biocomputation Center, Stanford Univ

Richard SatavaDept of Surgery, University of WashingtonMedical Center

Ramin ShahidiCalifornia Inst of Computer Assisted Surgery,Stanford Univ School of Medicine

Kirby VosburghCIMIT/Brigham & Women’s Hospital/HarvardMedical School

12:00 Adjourn

TUESDAY, JANUARY 20 – SESSION A

Computer-Aided TherapyModerator: Michael Ackerman


1:30 Guoyan Zheng ................................................... p. 43MEM Research Ctr, Univ of Bern

A System for 3-D Reconstruction of aPatient-Specific Surface Model fromCalibrated X-Ray Images

1:45 Jennifer Lo ........................................................ p. 43Imaging Research Laboratories, RobartsResearch Inst; Univ of Western Ontario

Surgeon-Controlled VisualizationTechniques for Virtual Reality-GuidedCardiac Surgery

2:00 Thomas Sangild Sørensen ................................. p. 43Computer Science / Inst of Clinical Medicine,Univ of Aarhus, Denmark

Developing and Evaluating VirtualCardiotomy for Preoperative Planning inCongenital Heart Disease

2:15 Jung Leng Foo................................................... p. 43Mechanical Engineering & Human-ComputerInteraction, Virtual Reality Applications Ctr, IowaState Univ


2:30 Asaki Hattori ...................................................... p. 44Inst for High Dimensional Medical Imaging,Jikei Univ School of Medicine

Development of a Real-Time Image-GuidedSurgery System for Stereo-EndoscopicSinus Surgery

2:45 Reinhard Friedl ................................................. p. 44Heart Surgery, Univ Hospital of Ulm

Cardio Pointer: Development of aNavigation System for Coronary ArteryBypass Grafting

3:00 Johannes Vockeroth........................................... p. 44Neurology, Ludwig-Maximilians - Univ Munich

Medical Documentation Using a Gaze-Driven Camera

3:15 Break

Robotics Moderator: Ramin Shahidi

3:30 Amy Lehman .................................................... p. 44Mechanical Engineering, Univ of Nebraska -Lincoln


3:45 Sachin Daluja..................................................... p. 44Electrical & Computer Engineering, WayneState Univ

An Integrated Movement Capture andControl Platform Applied TowardsAutonomous Movements of Surgical Robots

4:00 Carl Nelson ........................................................ p. 44Mechanical Engineering & Surgery, Univ ofNebraska-Lincoln / Univ of Nebraska MedicalCtr

Portable Tool Positioning Robot forTelesurgery

4:15 Naoki Suzuki...................................................... p. 45Inst for High Dimensional Medical Imaging,Jikei Univ School of Medicine

Tele-Control of an Endoscopic SurgicalRobot System between Japan and Thailandfor Tele-NOTES

4:30 Jeff Hawks ........................................................ p. 45Mechanical Engineering, Univ of Nebraska -Lincoln

A Modular Wireless In Vivo Surgical Robotwith Multiple Surgical Applications

4:45 Discussion

5:00 Adjourn

Tuesday Morning (cont.) & Afternoon


12 MMVR17

TUESDAY, JANUARY 20 - SESSION B

Simulator Development IssuesModerator: Li Felländer-Tsai


1:30 C. Donald Combs .............................................. p. 45Health Professions, Eastern Virginia MedicalSchool


1:45 Gerald Moses.................................................... p. 45Surgery, Univ of Maryland Medical Ctr


2:00 Mario Riojas...................................................... p. 45Electrical & Computer Engineering, Univ ofArizona

Knowledge Elicitation for PerformanceAssessment in Computerized SurgicalTraining System

2:15 Marcus Schlickum.................................................. p. 46Clinical Science Intervention & Technology, Ctrfor Advanced Medical Simulation, Karolinska Inst

The Importance of Visual Working Memoryand Visual-Spatial Ability for HighPerformance Differs between VariousVirtual Reality Image Guided SurgicalSimulators

2:30 Gyusung Lee..................................................... p. 46Surgery, Univ of Maryland

Joint Kinetic Data Augments TraditionalBiomechanical Approach to Assess theErgonomics of Laparoscopic CameraAssistants

2:45 Gunther Sudra................................................... p. 46Computer Science, Univ of Karlsruhe (TH)

Estimating Similarity of Surgical Situationswith Case-Retrieval-Nets

3:00 Dhanannjay Deo .............................................. p. 46Mechanical Aerospace & Nuclear Engineering,Rensselaer Polytechnic Inst

A Machine Learning-Based ScalableApproach for Real-Time SurgerySimulation

3:15 Mark Bowyer .................................................... p. 46Norman M. Rich Dept of Surgery, UniformedServices Univ

Exporting Simulation Technology to thePhilippines: A Comparative Study ofTraditional Versus Simulation Methods forTeaching Intravenous Cannulation

3:30 Break

SESSION B, CONTINUED

INDEPENDENT SESSIONPre-Operative Warm-Up: Science, Theoryand Implications on Policy and Practice3:45 – 5:15 PM

Kanav Kahol, Organizer

Presentations

Marshall L. SmithSimulation & Training Center, Banner GoodSamaritan Medical Center

Warm-Up in Surgery: A Briefing

Kanav KaholBiomedical Informatics, Arizona State Univ

Warm-Up Devices for Surgery

Richard M. SatavaSurgery, Univ of Washington Medical Center;US Army Medical Research & MaterielCommand

Implications of Warm-Up in Surgery onPolicy and Practice

Ajit K. SachdevaDiv of Education, American College ofSurgeons

Putting Together a Warm-Up Regimen:What We Have Learnt from SimulationCurriculum Development

Thomas V. WhalenChairman, Dept of Surgery, Lehigh ValleyHealth Network

The Role of Warm-Up in AscertainingQuality of Residents: A Residency ReviewCommittee Perspective

TUESDAY, JANUARY 20 - SESSION C

RehabilitationModerator: Walter Greenleaf


1:30 Marlene Sandlund.............................................. p. 47Community Medicine & Rehabilitation, UmeåUniv

Effect of Interactive Computer Training onGoal-Directed Arm Movements in Childrenwith Cerebral Palsy: A KinematicEvaluation

Tuesday Afternoon

13MMVR17


1:45 Sheryl Flynn....................................................... p. 47Biokinesiology & Physical Therapy, Univ ofSouthern California

Virtual Reality Systems Using Low-CostWebcam and Off-the-Shelf GameInterfaces for Motor Rehabilitation afterTraumatic Brain Injury, Spinal Cord Injuryand Amputation

2:00 Mark Sivak ........................................................ p. 47Mechanical & Industrial Engineering,Northeastern Univ


2:15 M. Susan Hallbeck ............................................ p. 47Industrial & Management SystemsEngineering, Univ of Nebraska - Lincoln

Simulating Visual Impairment to DetectHospital Way-Finding Difficulties

2:30 Dimitrios Katsavelis .......................................... p. 47Health Physical Education & Recreation, Univof Nebraska at Omaha

Nano Legends: An Interactive VirtualReality Game Induces High Level ofPhysical Activity

2:45 Kimberly Briggs ................................................. p. 48Occupational Therapy, Banner GoodSamaritan Rehabilitation Inst

Scientific Framework for SelectingSimulation Games for Rehabilitation andAssistance: A Case Study with the Wii(r)

3:00 Discussion

3:15 Break

SESSION C, CONTINUED

INDEPENDENT SESSION Mixed Reality as a Tool for Cognitive andMotor Rehabilitation3:30 - 5:30 PM

Cali Fidopiastis & Charles Hughes, Organizers

Presentations

Darin HughesInstitute for Simulation & Training, Univ ofCentral Florida

Experience Design and Production: PatientNeeds and Task Perspectives

Charles Hughes Electrical Engineering & Computer Science /Institute for Simulation & Training, Univ ofCentral Florida &

Delivery and After Action Review Systems

Cali FidopiastisInstitute for Simulation & Training, Univ ofCentral Florida

Integration of Measurement Devices andProcedures

Randall ShumakerInstitute for Simulation & Training, Univ ofCentral Florida

Scalability: Regional Centers, CommunityFacilities, Private Caregiver Facilities,Home and Work

Mark WiederholdThe Virtual Reality Medical Center &

Cali Fidopiastis Institute for Simulation & Training, Univ ofCentral Florida

Completed Studies: Protocol Design andEfficacy

TUESDAY, JANUARY 20

ADJUNCT MEETING Virtual Reality Assisted Exposure Therapyin the Treatment of PTSD 8:30 AM - 5:30 PM

The Interactive Media Institute, Organizer

IMPORTANT: This workshop is offered by ourcolleagues at the Interactive Media Instituteand the Virtual Reality Medical Center. Pleasenote that a separate paid registration is re-quired, available at the door. CE credit isplanned.

Please see the independent session summa-ry, page 31, for more details.

TUESDAY POSTER PRESENTATIONS

RehabilitationRichard Fan ...................................................... p. 56Biomedical Engineering, Univ of California LosAngeles

Characterization of a Pneumatic BalloonActuator for Use in Refreshable BrailleDisplays

Tuesday Afternoon


14 MMVR17

Belinda Lange ................................................... p. 56Inst for Creative Technologies, Univ of SouthernCalifornia

Rehabilitation of Upper Limb ExtremityBimanual Coordination Tasks Using a NovelBimanual Novint Falcon Application andSpecifically Designed Game Based Task

Panadda Marayong ........................................... p. 56Mechanical & Aerospace Engineering, CaliforniaState Univ, Long Beach


Jeanette Plantin & Birgitta Johansson................ p. 56Neurological Rehabilitation CtrErstagårdskliniken, Ersta Hosp


Alberto Rovetta ................................................. p. 57Mechanics, Politecnico Univ of Milan

Novel Device DeeDee for NeuromotorControl with Augmented Reality andMultiparametric Sensors Fusion

Mental HealthGiuseppe Riva ................................................... p. 57Applied Technology for Neuro-Psychology Lab,Ist Auxologico Italiano

NeuroVR 1.5: A Free Virtual Reality Platformfor the Assessment and Treatment inClinical Psychology and Neuroscience

Computer-Aided TherapyFarzam Farahmand ........................................... p. 57Mechanical Engineering, Sharif Univ ofTechnology

Robotic Assisted Reduction of FemoralShaft Fractures Using Stewart Platform

Tomoko Ikawa .................................................. p. 57Fixed Prosthodontic, Tsurumi Univ


Judith Muehl .................................................... p. 57Inst for Computer Graphics & Vision, TechnicalUniv of Graz

Towards Validation for Physiological Modelsin Intervention Planning

Amit Mulgaonkar .............................................. p. 57Ctr for Advanced Surgical & InterventionalTechnology, Univ of California, Los Angeles

A Prototype Surgical Manipulator forRobotic Intraocular Micro Surgery

Jay Mung ......................................................... p. 58Biomedical Engineering, Univ of SouthernCalifornia


Takumi Ogawa .................................................. p. 58Fixed Prosthodontic Dentistry, Tsurumi Univ

Designing Artificial Jaw Joints (AJJs) in VRSpace for Patients with RheumatoidArthritis

Ali Rastjoo ........................................................ p. 58Medical Engineering & Medical Physics, TehranUniv of Medical Sciences

Evaluation of Hidden Markov Model forP300 Detection in EEG Signal

Mathias Seitel ................................................... p. 58Medical & Biological Informatics, GermanCancer Research Ctr


Hisham Sherif ................................................... p. 58Cardiac Surgery, Christiana Hospital

Recovery after Resuscitation from CardiacArrest in ST-Elevation Myocardial Infarction:A Computer-Based Medical Decision-Support Tool

András Székely ................................................. p. 59Nuclear Medicine, Univ of Debrecen Medical &Health Science Ctr

Imaging 2.0: Diagnostic Imaging and Web2.0


One Heart, Two Bodies: A Simulation Studyof Body Surface Potential Differences be-tween Donor and Recipient of HeartTransplantation

Yevgeniy Yanin .................................................. p. 59Tyumen Central Regional Hosp, Tyumen StateMedical Academy


Telemedicine Gregorij Kurillo .................................................. p. 59Electrical Engineering & Computer Science,Univ of California, Berkeley

Teleimmersive Environment for RemoteMedical Collaboration

Tuesday Posters

15MMVR17


Susil Meher ...................................................... p. 59Computer Applications, All India Inst of MedicalSciences

Barriers in Telehealth Care for Treatment ofRural Patients at AIIMS, New Delhi, India

Simulator DesignSarah Baillie ..................................................... p. 60Veterinary Clinical Studies, Royal VeterinaryCollege

A Mixed Reality Simulator for FelineAbdominal Palpation Training in VeterinaryMedicine

Nadine Fritz ...................................................... p. 60Mechanical Engineering, European SpaceAgency


M. Susan Hallbeck ............................................ p. 60Industrial & Management Systems Engineering,Univ of Nebraska – Lincoln

Paper Prototypes for the Detection ofStereotype Violations in (Medical) DeviceOperation – Are They Good Enough?

Motohiro Kikuchi ............................................... p. 60School of Dentistry, Nihon Univ

Development of Virtual Dental Waxing-upSystem with Haptic Interface


Development and Initial Validation of aVirtual Reality Haptically AugmentedSurgical Knot-Tying Trainer for theAutosuture™ ENDOSTITCH™ Instrument

Jason Line ........................................................ p. 61Medic Vision Ltd.


Liliane Machado ............................................... p. 61Informatics, Federal Univ of Paraiba

A Framework for Development of VirtualReality-Based Training Simulators

José Luis Mosso ................................................ p. 61Regional Hosp No. 25, Inst Mexicano delSeguridad Social

Cyborg Mini-Trainer

Manivannan Muniyandi ..................................... p. 61Biomedical Engineering, Applied Mechanics,Indian Inst of Technology Madras


Sebastian Ullrich ............................................... p. 61Virtual Reality Group, RWTH Aachen Univ


Pierre-Frédéric Villard ........................................ p. 62Biosurgery & Surgical Technology, ImperialCollege London

Developing An Immersive UltrasoundGuided Needle Puncture Simulator

Yoshinori Yoshida .............................................. p. 62Graduate School of Dentistry, Osaka Univ

Virtual Reality Simulation Training forDental Surgery

Simulator ValidationJoerg Beardi ..................................................... p. 62Abdominal & Minimally Invasive Surgery, HeiligGeist Hosp, Bensheim

Comparison between “Computer GamingKids” and Experienced LaparoscopicSurgeons under Simulated LaparoscopyConditions


Endotracheal Intubation Comparing aPrototype Storz CMAC and a GlideScopeVideolaryngoscope in a Medical TransportHelicopter – A Pilot Study


Endotracheal Intubation in a MedicalTransport Helicopter – Comparing DirectLaryngoscopy with the Prototype StorzCMAC© Videolaryngoscope in a SimulatedDifficult Intubating Position


Videolaryngoscopy for Intubation SkillsTraining of Novice Military Airway Managers


Remote Videolaryngoscopy Skills Trainingfor Pre-Hospital Personnel

Doo Yong Lee .................................................... p. 63Mechanical Engineering, Korea Adv Inst ofScience & Technology

Sectional Analysis of Learning on theKAIST-Ewha Colonoscopy Simulation II

Tuesday Posters


Face Validation of the Virtual BasicLaparoscopic Skill Trainer (VBLaST™)

WEDNESDAY, JANUARY 21 - PLENARY SESSION

Session Moderator: Greg Mogel

PANEL DISCUSSION Where is the Patient at MMVR? Tech-nology and Design for the Final End-User 8:30 – 9:45

Panelists

Kóan Jeff BaysaVera List Center for Art and Politics, The NewSchool

Patrick CreganNepean Hospital, Sydney West Area Health Service

Walter J. GreenleafGreenleaf Medical Systems

Greg Mogel (Panel Moderator) Keck School of Medicine / Viterbi School ofEngineering, University of Southern California

Carla PughCenter for Advanced Surgical Education,Northwestern University

Brenda WiederholdThe Virtual Reality Medical Center

9:45 INVITED SPEAKER: Virgil Wong .......................... p. 48Head, Web & Multimedia Division, WeillCornell Medical College and NewYork-Presbyterian Hospital

Envisioning the Web 3.0 Patient andPhysician Portal as an Interactive,Semantics-Based, and Intelligence-DrivenAnatomical Avatar

10:15 Break (Exhibits, The Well, and Salon open)

11:00 James Kinross ................................................... p. 48Biosurgery & Surgical Technology, ImperialCollege London

Virtual Worlds Technology EnhancesMedical Student Training in the OperatingRoom

11:20 Warren Grundfest............................................... p. 48Bioengineering, Univ of California, Los Angeles

Development and Testing of a TactileFeedback System for Robotic Surgery

11:45 Presentation of the 15th Annual Satava Award

12:00 Adjourn

WEDNESDAY, JANUARY 21 - SESSION A

VisualizationModerator: Steven Senger




1:45 Jacopo Annese .................................................. p. 49Radiology, Univ of California, San Diego

A Scalable Visualization Environment forthe Correlation of Radiological andHistopathological Data at Multiple Levelsof Resolution

2:00 Jonathan Suen................................................... p. 49Electrical & Computer Engineering, Univ ofCalifornia, Santa Barbara

Towards Medical Terahertz Sensing ofSkin Hydration

2:15 Oscar Meruvia-Pastor ........................................ p. 49Biochemistry, Univ of Calgary

Fast Interactive Integration of Cross-Sectional Image Datasets and SurfaceData for Morphometric Analysis

Sensors2:30 Robert Tan ......................................................... p. 49

Bioengineering, Univ of California, Los Angeles

Development of a Minimally InvasiveImplantable Wireless Vital Signs SensorPlatform

Modeling 2:45 Yong Hum Na .................................................... p. 50

Nuclear Engineering & Engineering Physics,Rensselaer Polytechnic Inst

Development of Whole-Body ReferenceAdult Male and Female Models forRadiological Studies Using Surface-Geometry Modeling and Monte CarloRadiation Transport Methods


16 MMVR17

Wednesday Morning & Afternoon

17MMVR17


3:00 Yingchun Zhang ................................................. p. 50Urologic Surgery, Univ of Minnesota

Advanced Finite Element Mesh Model ofFemale SUI Research During Physical andDaily Activities

3:15 Break

Moderator: Thomas Sangild Sørensen

3:30 Yunhe Shen ....................................................... p. 50Urologic Surgery, Univ of Minnesota

Interactive Collision Response Solutions toInterpenetration Problems among Tissuesand Instruments in Virtual LaparoscopicSurgery

3:45 Maud Marchal.................................................... p. 50INRIA

Fiber-Based Fracture Model for SimulatingSoft Tissue Tearing


A Discrete Mechanics Framework for RealTime Virtual Surgical Simulations withApplication to Virtual LaparoscopicNephrectomy

4:15 Hao Li ............................................................... p. 51Computer Science, National Univ of Singapore

Modeling Torsion of Blood Vessels inSurgical Simulation and Planning


Realtime Blood Vessel Modeling inSurgical Simulation

4:45 Discussion

5:00 Adjourn

WEDNESDAY, JANUARY 21 - SESSION B

Simulation & TrainingModerator: Helene Hoffman


1:30 Sergei Nirenburg................................................ p. 51Computer Science & Electrical Engineering,Univ of Maryland Baltimore County


1:45 Deborah N. Burgess........................................... p. 51Med Modernization Div / Med Modeling & SimProgram, US Air Force

Current and Future Applications ofModeling and Simulation for MedicalEducation, Training and Medical Care

2:00 Rachel Ellaway ................................................. p. 51Informatics, Northern Ontario Sch of Medicine

Rethinking Fidelity, Cognition andStrategy: Medical Simulation as GamingNarratives

2:15 Kanav Kahol ..................................................... p. 52Biomedical Informatics, Arizona State Univ


2:30 Carol Noe........................................................... p. 52Simulation Education & Training Ctr, BannerGood Samaritan Medical Ctr

The Effect of Central Venous CatheterPlacement Simulation Training on PatientSafety

2:45 Yi-Je Lim ........................................................... p. 52Energid Technologies


3:00 Christian Banker ................................................ p. 52Electrical & Computer Engineering, WorcesterPolytechnic Inst


3:15 Break

Moderator: Robert Sweet

3:30 Nigel John ......................................................... p. 52School of Computer Science, Bangor Univ


3:45 Eve Wurtele ....................................................... p. 52Genetics, Development & Cell Biology, IowaState Univ

Meta!Blast: An Interactive Virtual RealityGame to Explore Structural and MetabolicBiology

4:00 Bertalan Meskó ................................................ p. 53Medical School & Health Science Ctr, Univ ofDebrecen

Medicine 2.0: Practicing Medicine in theWeb 2.0 Era

Wednesday Afternoon

18 MMVR17


Simulator Validation4:15 Patrick Cregan ................................................... p. 53

Sydney West Area Health Service, NepeanHospital


4:30 Mukul Mukherjee............................................... p. 53Nebraska Biomechanics Core Facility, Univ ofNebraska - Omaha

Virtual Reality in Robot Assisted Surgery:Validation and Training

4:50 Curtis Ikehara .................................................... p. 53Information & Computer Sciences, Univ ofHawaii

Evaluating a Virtual Reality Motor-SkillsSimulator

5:05 Discussion

5:20 Adjourn

WEDNESDAY, JANUARY 21 - SESSION C

INDEPENDENT SESSIONTATRC-West Program 1:30 – 5:30 PM

Check at Registration Desk for TATRC-WestProgram

WEDNESDAY POSTER PRESENTATIONS

ModelingCiamak Abkai ................................................... p. 63Inst for Computational Medicine, Univ ofHeidelberg


Eric Acosta ....................................................... p. 64Virtual Medical Environments Lab, NationalCapital Area Medical Simulation Ctr


Farzam Farahmand ........................................... p. 64Mechanical Engineering, Sharif Univ ofTechnology

A Surface Registration Technique forEstimation of 3-D Kinematics of Joints

Craig Hourie ...................................................... p. 64Electrical & Computer Engineering, Univ ofWestern Ontario


Vassilios Hurmusiadis ....................................... p. 64R & D, Primal Pictures Ltd.

From Cell to ECG: Real-Time InteractiveSimulation of Cardiac Electrophysiology forECG Training

Derek Magee ..................................................... p. 65Leeds Inst of Molecular Medicine, Univ ofLeeds

A Physics Based Method for CombiningMultiple Anatomy Models with Applicationto Medical Simulation

Yong Hum Na..................................................... p. 65Nuclear Engineering & Engineering Physics,Rensselaer Polytechnic Inst

A Method to Create Size-Adjustable Whole-Body Patient Models for RadiologicalStudies of Organ Doses

Herke Jan Noordmans ...................................... p. 65Medical Technology & Clinical Physics, UMCUtrecht

Real-Time Brainshift Correction of Pre-Operative Image Data for Neuronavigation,Using Today’s Graphics Hardware

Kresimir Petrinec .............................................. p. 65Computer Science, Univ of California, LosAngeles

The FMA Database Browser: A KeyComponent of an Interactive ImageVisualization Pipeline

Joseph Romano ................................................ p. 65Mechanical Engineering & Applied Mechanics,Univ of Pennsylvania


Chengyu Shi ..................................................... p. 66Radiation Oncology, Univ of Texas HealthScience Ctr at San Antonio

Development of a Patient-SpecificPredictive Geometry (PPG) Model Based onReal Patient 4D CT Data


The Clockwise Rotation of Myocardial FiberOrientation from Epicardial to EndocardialSurface in Left Ventricular Free Wall in aPost-mortem Human Heart

Wednesday Afternoon & Posters

19MMVR17


Georgios Theofilogiannakos .............................. p. 66Electrical & Computer Engineering, AristotleUniv of Thessaloniki

Computational Tools for Addressing theForward and Inverse Problems inElectrocardiology

Mei Xiao ........................................................... p. 66Biochemistry & Molecular Biology, Univ ofCalgary


Simulator Development ToolsVenkata Arikatla ............................................... p. 66Mechanical Engineering, RensselaerPolytechnic Inst

Plug-and-Play Tool Handles forLaparoscopic Surgery Simulators

Dhanannjay Deo ............................................... p. 67Mechanical Aerospace & Nuclear Engineering,Rensselaer Polytechnic Inst

Development of a Glove-Based WearableSystem for Objective Assessment ofLaparoscopic Skills and Some Observationsfor a Peg Transfer Task

Rachel Ellaway ................................................. p. 67Informatics, Northern Ontario Sch of Medicine

Integrating Simulation Devices andSystems

Matthias Färber ................................................ p. 67Medical Informatics, Univ Medical CtrHamburg-Eppendorf


Chuan Feng ...................................................... p. 67Electrical & Computer Engineering, Univ ofArizona

Usability Study of Computerized SurgeryTraining and Assessment System

Shin Hasegawa ................................................. p. 67Biomedical Information Technology Lab, Univ ofAizu

Simulation of Vaginal Wall BiomechanicalProperties from Pelvic Floor Closure ForcesMap



Leow Wee Kheng .............................................. p. 68Computer Science, National Univ of Singapore



Hybrid Network Architecture for InteractiveMulti-User Surgical Simulator with ScalableDeformable Models



Ji Son ............................................................... p. 68Ctr for Advanced Surgical & InterventionalTechnology, Univ of California, Los Angeles

Quantification of Intraocular SurgeryMotions with an Electromagnetic TrackingSystem

Satoshi Yamaguchi ........................................... p. 68Graduate School of Dentistry, Osaka Univ

Dental Haptic Simulator to Train Hand Skillof Student-Calibration Method to RealizeVisual/Haptic Environment

Simulation & TrainingJohan Creutzfeldt ............................................. p. 69Ctr for Advanced Medical Simulation,Karolinska Inst

Retention of Knowledge after RepeatedVirtual World CPR Training in High SchoolStudents

Stefan Holubar .................................................. p. 69Colon & Rectal Surgery, Mayo Clinic

Virtual Pelvic Anatomy and SurgerySimulator: An Innovative Tool for TeachingPelvic Surgical Anatomy

Kanav Kahol ..................................................... p. 69Biomedical Informatics, Arizona State Univ

Visualization and Analysis of Medical Errorsin Immersive Virtual Environments

Elizabeth Krupinski ........................................... p. 69Radiology, Univ of Arizona

Assessing Radiology ResidentPreparedness to Manage IV Contrast MediaReactions Using Simulation Technology



Wednesday Posters

20 MMVR17


Fuji Lai ............................................................. p. 70Robotic Telepresence for Medical Trainingand Education

Yuri Millo .......................................................... p. 70Simulation & Training Environment Lab, ER OneInst, Washington Hosp Ctr, Medstar Health

Advanced Medical Simulation: InexpensiveSkills Training for Students and Clinicians

Victor Vergara ................................................... p. 70Ctr for High Performance Computing, Univ ofNew Mexico

The Use of Virtual Reality Simulation ofHead Trauma in a Surgical Boot Camp

Yan Zhang ......................................................... p. 70Univ of Hull (UK)

A Survey of Simulators for PalpationTraining

VisualizationHossein Arabalibeik .......................................... p. 70RCSTIM, Tehran Univ of Medical Sciences


Jeremy Cooperstock ......................................... p. 70Ctr for Intelligent Machines, McGill Univ

A Comparative Study of Monoscopic andStereoscopic Display for a Probe-Positioning Task

Lucio De Paolis ................................................. p. 71Innovation Engineering, Salento Univ


Anton Koning .................................................... p. 71Bioinformatics, Erasmus MC Univ Medical Ctr

V-Scope: Design and Implementation of anImmersive and Desktop Virtual RealityVolume Visualization System

Ganesh Krishnamurthy ...................................... p. 71Interventional Radiology, Radiology, Children’sHosp of Philadelphia

Use of See-Through Head Mounted Displayfor Ultrasound Guided Vascular Access inInterventional Radiology

John Qualter ...................................................... p. 71Educational Informatics, BioDigital Systems


Justin Tan ......................................................... p. 71Radiology and Biomedical Imaging, Univ ofCalifornia San Francisco

Exploring Human Interface Devices forNavigating Three-Dimensional MedicalImaging Data

THURSDAY, JANUARY 22 – SESSION A

INDEPENDENT SESSION The Pulse!! Collaboration: Academe &Industry, Building Trust8:30 – 10:00 AM

Claudia L. McDonald & Doug Whatley,Organizers

Presentations

Claudia L. McDonaldSpecial Projects, Texas A&M Univ - CorpusChristi

Overview of the Academe-IndustryCollaboration that Produced “Pulse!! TheVirtual Clinical Learning Lab”

Doug WhatleyBreakAway Ltd.

Origin and Development of the Pulse!!Collaboration

Janis Cannon-BowersDigital Media, Univ of Central Florida

Role of Reliability and Validity Research inthe Pulse!! Project &

Reflections on the Interface of Researchwith the Industry Development Team

James DunneTrauma Surgery, National Naval Medical Center

Complexity of Medical Case-Development inthe Pulse!! Project &

Reflections on Subject-Matter Experts’Interface with the Industry DevelopmentTeam

10:00 Break

Wednesday Posters & Thursday Morning

SESSION A, CONTINUED

INDEPENDENT SESSION Building Medical Models and Scenariosfrom Clinical Descriptions

Note: Audience is invited to bring their own laptops and to build their models

10:15 AM – 12:00 Noon


Presentations

Wm. LeRoy HeinrichsSUMMIT, Stanford Univ School of Medicine

What Are Medical Models and MedicalScenarios? & Designing Scenarios forSimulators


The Science of Creating a ComputableModel from a Qualitative Description &

Hands-on Experience of Model Buildingwith Simple Tools

THURSDAY, JANUARY 22 – SESSION B

Simulator Development ToolsModerator: Patrick Cregan


8:30 Dhanannjay Deo ............................................... p. 54Mechanical Aerospace & Nuclear Engineering,Rensselaer Polytechnic Inst

Characterization of Anisotropy inViscoelastic Properties of Intra-AbdominalSoft Tissues


Haptic Simulation of the Liver withRespiratory Motion

9:00 Eleonora Westebring-van der Putten .................. p. 54Applied Ergonomics & Biomedical Engineering,Delft Univ of Technology

Tactile Feedback Exceeds Visual Feedbackto Display Tissue Slippage in aLaparoscopic Grasper

9:15 Eftychios Sifakis ................................................ p. 56Mathematics, Univ of California, Los Angeles

Local Flaps: A Real-Time Finite ElementBased Solution to the Plastic SurgeryDefect Puzzle

9:30 Ciamak Abkai ................................................... p. 54Inst for Computational Medicine, Univ ofHeidelberg

Virtual Intensive Care Unit (ICU): Real-TimeSimulation Environment Applying HybridApproach Using Dynamic BayesianNetworks and ODEs

9:45 Allan Okrainec ................................................... p. 54General Surgery, Toronto Western Hospital

Development of a Virtual Reality HapticVeress Needle Insertion Simulator forSurgical Skills Training

10:00 Jessica Burgner ................................................ p. 54Process Control & Robotics, Univ of Karlsruhe(TH)

Including Parameterization of the DiscreteAblation Process into a Planning andSimulation Environment for Robot-AssistedLaser Osteotomy

10:15 Break

Moderator: Carla Pugh

10:30 Satoshi Yamaguchi ........................................... p. 55Graduate School of Dentistry, Osaka Univ


10:45 Ilana Souza........................................................ p. 55Electric Engineering, Univ of São Paulo

A Virtual Reality Simulator for Training ofNeedle Biopsy of Thyroid Gland Nodules

11:00 Oliver Schuppe .................................................. p. 55Computer Science V, Inst for ComputationalMedicine, Univ of Heidelberg


11:15 Stefano Sclaverano ........................................... p. 55TIMC-IMAG Lab, CNRS, Univ Joseph Fourier

BiopSym: A Simulator for EnhancedLearning of Ultrasound-Guided ProstateBiopsy

11:30 Liliane Machado ............................................... p. 55Informatics, Federal Univ of Paraiba

A Qualitative and Quantitative Assessmentfor a Bone Marrow Harvest Simulator

21MMVR17

Presentation Schedule Thursday Morning

11:45 Aaron Oliker....................................................... p. 55R & D, BioDigital Systems LLC

Real-Time Complex Cognitive SurgicalSimulator with Testing

12:00 Erik Lövquist...................................................... p. 71Interaction Design Ctr, Univ of Limerick


12:15 Discussion

12:30 Adjourn

22 MMVR17

Presentation ScheduleThursday Morning

Salon & The Well

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Salon & The WellThe Well will open, along with the Exhibits, at the Tuesdaymid-morning break. On Wednesday, Salon and The Well willboth open at the mid-morning break.

SalonChris CulbertsonDept of Neurology,University of California, Los Angeleswww.etc.ucla.edu/research/projects/Meth-Apartment.htm

Demonstration: Use of VR in Addiction Medicine. During theexposure, participants are encompassed within a sensory isola-tion apparatus, including a 32” LCD monitor and a surround-sound audio system. Participants interact with the specially cre-ated virtual world in Second Life, run from a standard Dell PC,using a simple gaming remote control. An additional monitor isplaced outside of the apparatus for outside observation.

Joyce Cutler ShawArtist-in-Residence, University of California, San Diego School of Medicine

Art: Wound Man and Pregnant Woman: Imaged from TheAnatomy Lesson. The implications of body imaging, so impor-tant to the science of the medical professions, can be evokedand traced through the visual history of anatomy: from thehand technology of drawing, through the x-ray, to new andevolving electronic imaging technologies as we are nowscanned, graphed, computerized and dematerialized. The printson exhibit, from illustrations in a fine art book by Joyce Cutler-Shaw, titled The Anatomy Lesson: Unveiling the FasciculusMedicinae, represent a “conversation across time” between hercontemporary drawings and 15th Century medieval medicalwoodcuts of the physical self.

Max S. GerberPhotographer, Pasadena CAwww.HeartKidsProject.org

Photographs: Excerpts from the book project, My Heart vs. theReal World, a photo documentary volume that explores thelives of children with congenital heart disease (CHD) throughstriking black-and-white photographs and interviews with sub-jects and their families. Congenital heart defects are the mostcommon of all birth defects, occurring in one out of every 115to 150 births. The project documents the lives of these kids,focusing on the emotional impact of growing up with a chronicdisease.

Karl Heinz HoehneMedical InformaticsUniversity Medical Center Hamburg-Eppendorf & Voxel Man www.voxel-man.de

Movie: Professor Roentgen Meets the Virtual Body was createdin 1995 for the occasion of the 100th anniversary of Roentgens

discovery. It illustrates the history of medical imaging andimage computing and generated completely with the tools ofthe VOXEL-MAN visualization system. Pictures on the walls ofa virtual room lead to the different highlights: The discovery ofthe X-rays, CT and MR imaging, 3D models for surgery andtraining, virtual endoscopy and more.

Prints: Leonardo meets VOXEL-MAN. The famous anatomicaldrawings Leonardo daVinci opened a new era of depictinghuman anatomy 500 years ago. The exhibit depicts composi-tions of some of these drawings and today’s computer models;although computer generated, they have their own esthetics.

Alan Liu, Jennifer Sieck & Eric AcostaNational Capital Area Medical Simulation Center

Demonstration #1: 3D Model Creation and Animation forMedical Simulation. 3D models lie at the heart of nearly allmedical simulation and serious game applications. A well-devel-oped 3D model lends realism and life to the virtual environ-ment. This demo highlights the artistry behind the science.

Demonstration #2: Desktop 3D Virtual Environments withHaptic Feedback form the basis of a wide range of medical sim-ulation applications. The attraction of a virtual environmentwith haptic feedback lies in its ability to depict various surgicalprocedures.

3D medical simulation represents the culmination of effortsfrom technology and the graphic arts. In this joint presentation,we demonstrate how artistic and scientific creativity combine ina vivid rendition of a virtual patient for learning about headtrauma management.

Marcos LutyensArtist, Los Angeles CA

Alessandro MarianantoniCenter for Research in Engineering, Media and Performance (REMAP) University of California, Los Angeles

Installation: The Excarnation Machine (BETA) is a participato-ry game that involves assembling and breathing life into anassortment of hi-tech media representations of the human body,generating a 21st century take on the “exquisite corpse.” Ourproject addresses some of the ethical provocations that contem-porary science brings to us, such as genetic manipulation andmutation from within and plastic surgery from without.

By representing the human body with MRI’s, X-rays or ultra-sounds, we break through the body’s physical boundaries,removing its sense of gravity and turning it into an anti-terres-trial and quasi-ethereal entity. Thus, in a sense, the bodyascends into a cosmic dimension, and yet, at the same time, theantiseptic process of medical imaging causes a qualitative dilu-tion that presents us with a human portraiture that is void ofvitality, emotion and warmth.

26 MMVR17

Salon & The Well

Berci MeskóUniversity of Debrecen, Hungary

Demonstration: Discovering the Virtual World of Medicinethrough Second Life provides medical educators and studentswith numerous educational opportunities and tools while visit-ing the places and islands that can change the way medical edu-cation is delivered today.


Paintings: The three paintings in The Mind of a Surgeon seriesreflect the interaction between patients and surgeons and tech-nology

Johannes VockerothUniversity Hospital Munich

Demonstration: The Gaze-Driven Head-Mounted Camera is anovel approach to document medical treatment. The devicestores and transmits the exclusive point of view of the surgeon.

EyeSeeCam is a novel head-mounted camera controlled by theuser’s eye movements. It allows, for the first time, to literally seethe world through somebody else’s eyes. A mobile eye trackersystem continuously directs the camera towards the user’s pointof gaze, so that the camera captures exactly what the user’s eyessee.

Virgil WongNew York Presbyterian Hospital andWeill Medical College, Cornell Universitywww.PaperVeins.orgwww.PhineasMap.org

Exhibition: Phineasmap is a VR application that allows patientsto create an anatomical avatar, zoom into systems/organs/tis-sues/cells akin to Google Maps, and connect medical and testi-monial information to various related anchors throughout thebody. Users may view a “world body” that aggregates data fromall users of this system into a collective avatar based on geogra-phy or other factors. The art dimension is embedded in theidea of portraiture as well as the potential prospect for creatingempathy

Jiayi and Shih-wen YoungDoodle LabSacramento, [email protected]

Installation: Sampling Rate in Audible and Visual Perception.Medium: print media; digital media involving programmingand video; active audience interaction

The first piece looks at the role that sampling rate plays inaudible perception. In the “Hiroshima” series, mathematical,physical theories are used to transform the Hiroshima atomicbombing sound into hypotrochoid-like visual patterns. Audi-

ence is invited to interact with the piece by entering a differentsampling frequency. For each sampling frequency, a differentvisual pattern is generated.

The second piece investigates the role that sampling rate playsin visual perception:

“Missing Frames” video #1 is a combination of two differentvideos rapidly switching frames from one video to the other;each is missing 50% of its frames. In the construction of the 30frames per second video, the frames alternate from one video tothe other at the rate of one frame per 1/30th of a second. Theframes of the two videos are essentially zipped or shuffledtogether into one, asking for the brain to respond to both sto-ries.

Video #2 is a combination of three different videos rapidlyswitching frames from one video to the other. Video #3 wouldrequire four videos, etc. We plan to create up to five or ten.

It’s intriguing to observe the similarity between microscopicquantum effects and the quantum-like nature of “samplingrate” in human perception.

The Well

Hanger Orthotics & Prostheticswww.Hanger.com

Installation: The C-Leg® is a microprocessor-controlledhydraulic knee with swing and stance phase control. This inno-vative knee joint features on-board sensor technology that readsand adapts to the individual’s every move. By using special soft-ware and a personal computer, fine adjustments can be made totailor the C-Leg® to the amputee. Angles and movements aremeasured 50 times per second ensuring the dynamic gait is assimilar to natural walking as possible.

Jacopo Annese & Philip WeberThe Brain Observatory, University of California, San Diego &CalIt(2)

Installation: The Digital Light Box is a scalable visualizationenvironment for radiological and pathological examinationsthat enables researchers to visualize and inspect high resolution(gigabyte size) images created by multiple imaging modalities,including virtual microscopy.


Demonstration: The Cyborg MiniTrainer for LaparoscopicSurgery is a portable trainer for laparoscopic surgery integratedby an open module, a lamp and a micro-camera connected toan HMD, specifically for tying knots.

IndependentSession

Summaries

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29MMVR17

Independent Session SummariesMONDAY, JANUARY 19, 1:00 – 5:00 PMSession B

INDEPENDENT SESSION

Virtual Patients for Medical Education: TheNext GenerationGerald Higgins & Bruce Jarrell, Organizers

Medical education and practice is being transformed throughthe use of information technologies and the integration of per-sonalized genomics and other molecular diagnostic data intothe Electronic Medical Record. One change agent is the trans-lation of Systems Biology informatics research into the clinicalenvironment, an approach called Systems Medicine. The emer-gence of game-based learning in medical education, based on asolid foundation of learning sciences research, is fundamentalto the enhancement of clinical skills training and preparednessin the hospital setting. Accurate biomedical simulation, com-bining predictive numerics, visualization and diagnostic imag-ing, can now be realized for development of a Virtual Patientfor education, diagnosis, therapy and individualized medicine.It is incumbent upon those whose foresight extends to whatcould be realized to articulate a vision of future healthcare tech-nology which enables more learned practitioners and patients.In this session, we have assembled a group of researchers thateach can best present their component of the future of a learn-ing / informatics platform in medicine in the context of a Vir-tual Patient.

Presentations

Gerald HigginsSimulation & Training Environment Lab, ER One Inst, Washing-ton Hosp Center, MedStar HealthThe Virtual Patient: A Roadmap for Future Research fromthe Human Simulation and Training Domains

Brian AtheyPsychiatry, Michigan Inst for Clinical & Health Rsch; NIH Nat’lCtr for Integrative Biomedical InformaticsTranslational Bioinformatics in Support of Real and VirtualPatients

Janis Cannon-BowersInst for Simulation & Training / CREAT Digital Media Program,Univ of Central FloridaDeveloping Serious Games for Medical Simulation

Sergei NirenburgComputer Science & Electrical Engineering, Univ of MarylandBaltimore CountyThe Maryland Virtual Patient: Adaptivity in a Multi-AgentClinical System

Richard SatavaSurgery, Univ of Washington Medical Center; US Army MedicalResearch & Materiel CommandTotal Body Scanning and the Longitudinal Health Record

Yuri MilloSimulation & Training Environment Lab, ER One Inst, Washing-ton Hosp Ctr, Medstar HealthGame-Based Skills Training: Inexpensive Simulators forMedical Interventions

Gerald HigginsSimulation & Training Environment Lab, ER One Inst, Washing-ton Hosp Center, MedStar HealthA Meta-Analysis of the Training Value of Medical Simula-tors: 2000-2008

MONDAY, JANUARY 19, 1:00 – 5:00 PMSession C

INDEPENDENT SESSION

Simulator Construction Without the Agonizing Pain Alan Liu, Organizer

The advent of simulation for medical education has spurredconsiderable research on fundamental issues in hardware,algorithms, content development, and validation. To thedeveloper interested in building medical training systems, itis unclear how these academic endeavors translate into aworking trainer. A gap exists between theoretical develop-ment and educationally useful systems.

In this workshop, we bridge the separation between theoryand practice. Lessons learned in simulator design will be dis-cussed using examples taken from successful developmentinitiatives. Advanced software techniques for virtual environ-ment interaction, and haptic and visual rendering will bediscussed. The visual and performance impact of welldesigned 3D models will be demonstrated. The model devel-opment workflow will be highlighted using examples fromcompleted systems and simulators presently under develop-ment.

This workshop is appropriate for individuals planning tobuild medical simulators for training applications. It is alsoappropriate for individuals seeking insight to better evaluatethe suitability presently available systems for their specificrequirements. The workshop will conclude with a forum toanswer questions from the audience.

MMVR17


30

Presentations

Alan LiuNational Capital Area Medical Simulation Ctr, Uniformed Services UnivIntroduction, Overview, and Wrap-UpTopics: motivation: Why do this workshop? workshop overview;panel discussion (at end)

Robert WaddingtonSimQuest, LLCEducational Requirements Analysis Topics: why do requirements analysis? who are the stakeholders?design pitfalls and common mistakes; case studies in require-ments analysis

Eric AcostaNational Capital Area Medical Simulation Ctr, Uniformed Ser-vices UnivSimulation Environment Development – Advanced Techniques Topics: elements of a virtual environment; GPU-based collisiondetection; multi-rate haptics; advanced volume rendering tech-niques; developing virtual environments for multi-core CPUs;case study – a virtual head trauma simulator

Jennifer SieckNational Capital Area Medical Simulation Ctr, Uniformed Ser-vices Univ3D The 3D Model Development Workflow – From Designto DeploymentTopics: 3D anatomy modeling (software, commercial models,texturing); exporting models – what to watch out for, run-timeconsiderations

Daniel EvestedtSenseGraphics ABH3DAPI: An Open Source API for Dexterous Skills Simu-latorsTopics: The H3DAPI architecture; programming examples; casestudies

TUESDAY, JANUARY 20, 3:45 - 5:15 PMSession B

INDEPENDENT SESSION

Pre-Operative Warm-Up: Science, Theory andImplications on Policy and PracticeKanav Kahol, Organizer

Oxford English Dictionary defines the term warm-up as “Theact or process of ‘warming up’ for a contest, etc., by light exer-cise or practice.” More generically warm-up is “The act orprocess of raising the temperature of an engine, electrical appli-

ance, etc., to a level high enough for efficient working.” whichcaptures the concept of activating and preparing to a high levelof efficiency before beginning an activity. In sports and sportstraining literature there are several published papers and bookshighlighting the importance of warm-up in improving perform-ance and avoiding errors. Modern day surgery certainly quali-fies as a high-stakes, expertise-driven activity. There is signifi-cant research that has shown that surgery requires both strenu-ous mental and cognitive activity. This raises an importantquestion that if surgery involves strenuous physical and mentalactivity, then would a “pre-operative warm-up” (or simply‘warm-up’ for the purposes of this manuscript) activity whichinvolves surgeons performing surgical exercises before the maintask improve surgical performance in the main task at hand?

This panel explores the benefits and challenges of surgicalwarmup. A recent article to be published in Journal of Ameri-can College of Surgeons, present results of a series of experi-ments that show a clear benefit of warmup on surgical proce-dures in lab conditions. The panel will present these results andanalyze them critically. The implication on policy and proce-dures will be discussed. The topic is timely as it represents anovel direction for simulation research in increasing patientsafety. To date, simulation has focused on medical education asa way of reduction of medical errors. However, if the promiseof warmup is fulfilled, simulation will indeed find its way ineveryday medical practice providing a safer environment andbetter patient safety. Through this panel, the authors hope tocatalyze discussion and future research in this direction.

Presentations

Marshall L. SmithSimulation & Training Center, Banner Good Samaritan MedicalCenterWarm-Up in Surgery: A Briefing

Kanav KaholBiomedical Informatics, Arizona State UnivWarm-Up Devices for Surgery

Richard M. SatavaSurgery, Univ of Washington Medical Center; US Army MedicalResearch & Materiel CommandImplications of Warm-Up in Surgery on Policy and Practice

Ajit K. SachdevaDiv of Education, American College of SurgeonsPutting Together a Warm-Up Regimen: What We HaveLearnt from Simulation Curriculum Development

Thomas V. WhalenChairman, Dept of Surgery, Lehigh Valley Health NetworkThe Role of Warm-Up in Ascertaining Quality of Residents:A Residency Review Committee Perspective

31MMVR17


TUESDAY, JANUARY 20, 3:30 - 5:30 PMSession C

INDEPENDENT SESSION

Mixed Reality as a Tool for Cognitive andMotor RehabilitationCali Fidopiastis & Charles Hughes, Organizers

Physical and cognitive rehabilitation is a long and arduous processfor many. Therapists face the challenge of finding effective andmotivating therapeutic tools that will facilitate this process. Virtu-al reality (VR) technology may provide a solution to this dilemmaby affording interactive learning, quantifiable clinical outcomemeasures, enhanced safety, and ecologically-valid training environ-ments. In addition, virtual rehabilitation protocols may be gradedto meet specific therapeutic objectives and client capabilities. Fif-teen years of research in the virtual rehabilitation field demon-strates the advantages of the virtual rehabilitation approach; how-ever, therapists still face challenges when creating affordable VRsystems that are scalable to clinical settings.

The Institute for Simulation and Training (IST) at the Univer-sity of Central Florida (UCF) has partnered with UCF researchfaculty in communicative disorders and computer science, andwith the Virtual Reality Medical Center (VRMC) to explorethe feasibility of creating a scalable virtual rehabilitation systemfor home, clinic, and hospital use.

The objective of this session is to present an overview of thevirtual rehabilitation principles for cognitive and motor rehabil-itation in terms of technology, software, user assessment, andoutcome measures with a focus on mixed and virtual realityexamples. Actual data from both patients and healthy controlswill be presented to illustrate the use of psychophysiologicalmeasures (i.e., EEG and electrodermal response) to assessmixed reality-based rehabilitation applications.

We will discuss the current state of the virtual rehabilitation sys-tem. We will also introduce the use of psychophysiological meas-ures as a means to assess the virtual rehabilitation design throughan iterative human- in-the-loop design cycle. Thus, as part of thisdiscussion we will introduce the audience to psychophysiologicalmeasures, procedures, and issues as they apply to the VR designcycle and the assessment of patient outcomes. The results fromseveral pilot studies using biosensors such as electroencephalogra-phy (EEG) and skin conductance will be presented.

Presentations

Darin HughesInstitute for Simulation & Training, Univ of Central FloridaExperience Design and Production: Patient Needs and TaskPerspectives

Charles HughesElectrical Engineering & Computer Science / Institute for Simula-tion & Training, Univ of Central Florida;Delivery and After Action Review Systems

Cali FidopiastisInstitute for Simulation & Training, Univ of Central FloridaIntegration of Measurement Devices and Procedures

Randall ShumakerInstitute for Simulation & Training, Univ of Central FloridaScalability: Regional Centers, Community Facilities, PrivateCaregiver Facilities, Home and Work

Mark WiederholdThe Virtual Reality Medical CenterCali FidopiastisInstitute for Simulation & Training, Univ of Central FloridaCompleted Studies: Protocol Design and Efficacy

TUESDAY, JANUARY 20, 8:30 AM – 5:30 PM

ADJUNCT MEETING

Virtual Reality Assisted Exposure Therapy inthe Treatment of PTSD The Interactive Media Institute, Organizer

IMPORTANT: This workshop is offered by our colleagues at theInteractive Media Institute and the Virtual Reality Medical Cen-ter. Please note that a separate paid registration is required, avail-able at the door. CE credit is planned.

Presenter

Jim SpiraThe Virtual Reality Medical Center

This intermediate/advanced workshop trains clinicians to useVR systems and physiological monitoring in order to facilitateexposure based treatment of PTSD, including combat andcivilian in origin. Three major approaches to exposure will bediscussed, and strengths and weaknesses of each being discussedand demonstrated. These include flooding type approaches(maintaining maximum arousal), gradual exposure with mini-mal arousal , and graded exposure eliciting high arousal andtraining in arousal control. Cognitive (attentional) and auto-nomic control techniques will be taught. Imagery and self-hyp-nosis techniques will be taught for inter-session practice bypatients, and for clinicians without access to VR equipment.


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THURSDAY, JANUARY 22, 8:30 – 10:00 AMSession A

INDEPENDENT SESSION

The Pulse!! Collaboration: Academe & Industry, Building TrustClaudia L. McDonald & Doug Whatley, Organizers

Objectives

• Discuss lessons learned for academe-industry collabora-tion in the development of high-level learning platformsusing virtual-world technologies.

• Describe a successful collaboration and the stagesthrough which it developed.

• Provide an opportunity for questions from academic andindustry members contemplating collaboration on simi-lar projects.

Summary

Pulse!! The Virtual Clinical Learning Lab is a learning platformfor medical education and training developed using virtual-world technologies more commonly used for computer-basedvideo games. The Pulse!! project, funded so far by more than$12 million since 2005 by the Office of Naval Research, haslearning research built into its development plan in order toshow whether virtual-world technologies are reliable and validmeans for delivering medical curricula.

Pulse!! is the result of collaboration between Texas A&M Uni-versity-Corpus Christi and BreakAway Ltd., of Hunt Valley,Md., a leading developer of entertainment games and game-based technology products. This collaboration is producing cut-ting-edge technological and educational advances and hasresulted in a licensing agreement for Pulse!! technology betweenBreakAway and the Texas A&M University System.

Presentations

Claudia L. McDonaldSpecial Projects, Texas A&M Univ - Corpus ChristiOverview of the Academe-Industry Collaboration that Pro-duced “Pulse!! The Virtual Clinical Learning Lab”

Doug WhatleyBreakAway Ltd.Origin and Development of the Pulse!! Collaboration

Janis Cannon-BowersDigital Media, Univ of Central FloridaRole of Reliability and Validity Research in the Pulse!! Project & Reflections on the Interface of Research with the IndustryDevelopment Team

James DunneTrauma Surgery, National Naval Medical CenterComplexity of Medical Case-Development in the Pulse!! Project & Reflections on Subject-Matter Experts’ Interface with theIndustry Development Team

THURSDAY, JANUARY 22, 10:15 AM – 12:00 NOON Session A

INDEPENDENT SESSION

Building Medical Models and Scenarios fromClinical Descriptions


Virtual Patients in Virtual Worlds are an exciting frontier inmedical learning environments. They can be used to teachaspects of clinical knowledge ranging from basic reasoningabout medical pathologies to learning how to train for complexteam interactions. Constructing these virtual patients anddesigning useful learning scenarios can be difficult even forexperienced simulation designers. We will present the process ofgoing from clinical knowledge possessed by physicians or avail-able in the literature to an expression of this knowledge in acomputable form for use in creating Virtual Patients. We willthen discuss the creation of learning scenarios around availableVirtual Patients.

Participants are encouraged to bring their laptops and attemptto build their own models of Virtual Patients.

Presentations

Wm. LeRoy HeinrichsSUMMIT, Stanford Univ School of Medicine What Are Medical models and Medical Scenarios? & Designing Scenarios for Simulators

Parvati DevInnovation in Learning, Inc.The Science of Creating a Computable Model from a Quali-tative Description & Hands-on Experience of Model Building with Simple Tools

ExhibitInformation

MMVR17

35MMVR17

Exhibit Hours

TUESDAY, JANUARY 20, 200910:00 AM – 10:30 AM Break in Exhibit Hall12:00 PM – 1:15 PM Lunch Break in Exhibit Hall3:15 PM – 3:45 PM Break in Exhibit Hall

4:00 PM Exhibits Close

WEDNESDAY, JANUARY 21, 200910:15 AM – 10:45 AM Break in Exhibit Hall12:00 PM – 1:25 PM Lunch Break - Hall Open

1:30 – 6:00 PM Exhibits Dismantle

Exhibitors

3D Infotech, Inc.6 KansasIrvine, CA [email protected]

3D Infotech specializes in technology solutions for

· Reverse Engineering (RE)

· Computer Aided Inspection (CAI)

· Virtual Reality (VR)

· Product Lifecycle Management (PLM)

Our business is to add value by providing tools and processes thatwill reduce time to market, improve quality and increase innova-tion at your company. Our flagship product is Polyworks forwhich we are the master distributor in the Western United States.

B-Line Medical12510 Prosperity Drive, Suite 320Silver Spring, MD [email protected]

B-Line Medical’s SimBridge™ and SimCapture™ solutionshave been selected by dozens of top medical education institu-tions as the most advanced, comprehensive and easiest to usesolution for managing simulation and Clinical Skills trainingcenters. Through its sophisticated web-based architecture, Sim-Bridge™ and SimCapture™ address the complex set of chal-lenges presented by small and large simulation facilities: auto-mated testing, assessment and video capture, simulator dataintegration, debriefing, and portfolio assembly.

From the affordable and portable SimCapture™ to the power-ful and highly automated SimBridge™, B-Line Medical solu-tions maximize resources, allowing faculty and staff to focus onstudent and curriculum development. For more informationvisit www.blinemedical.com.

CFD Research Corporation215 Wynn Drive, Suite 501Huntsville, AL [email protected]

Computational Medicine and Biology Division of CFDRC isdeveloping Leonardo—an anatomy/physiology based multiscalemodel of a virtual human. Leonardo integrates compartmentaland 3D distributed models of cardiopulmonary circulation,lung respiration, oxygen/glucose metabolism, neural regulation,and other systemic physiological components. Leonardo is builtfrom a spatially distributed arterial-venous vascular system per-fusing several organs. The organs, in the multiscale modelingframework, can be represented as multi compartment reactors,1D vascular trees embedded in the tissue compartment, or geo-metrically fully resolved 3D vasculature/tissue models. Themultiscale modeling capability spans from systemic, organ, tis-sue, cellular, to subcellular pathway models. Our goal is to sim-ulate Leonardo’s virtual life with “faster than life” speed usingnovel multiscale modeling and parallel computing. The “LifeEditor”, Leonardo’s GUI, will allow programming of his dailylife including circadian clock, nutrition, exercise, trauma injury,surgical procedures, and pharmacologic treatment. At present,Leonardo is being tested on his responses to traumatic injuriesresulting from explosion blasts and on novel resuscitation,reperfusion, and pharmacological treatment ideas. We areworking on the integration of top-down system level physiolo-gy models with the bottom-up systems biology. Leonardo isavailable for academic scientific research. For details please con-tact [email protected].

Hanger Prosthetics & Orthotics, Inc. Two Bethesda Metro Center, Suite 1200 Bethesda, MD [email protected]

As the largest provider of prosthetics, orthopedic supports andbraces in the United States, we serve more than 650,000 peopleeach year. Our nationwide network of more than 640 patientcare centers spans 45 states and the District of Columbia. Inaddition to our primary focus on prosthetic and orthotic servic-es, we also offer products for post-mastectomy care, specialtyfootwear and durable medical equipment.

We combine the resources of a national company with the con-venience and personal touch of local patient care centers. Aninternal research and development team means that discoveringbetter ways of doing things is simply part of our day-to-dayoperations. And as the industry leader, we’re able to keepinvesting in the most advanced technologies for our patients.Behind our corporate persona is a group of more than 1,000skilled practitioners who focus on a singular purpose: movinglives forward.

Exhibit Information

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Exhibit Information

PhoeniX Technologies, Inc.4302 Norfolk StreetBurnaby, BC V5G 4J9, [email protected]

PhoeniX Technologies, Inc. (PTI) is the industry’s leading man-ufacturer of “Active Optical” based Real-Time 3D Motion Cap-ture systems. PTI offers their Visualeyez™ range of “Profes-sional Grade” Motion Capture systems, which are highly accu-rate, reliable and user-friendly, at extremely “cost-effective”prices. With advanced patented wide angle active marker track-ing technology, world’s first and only automatic and adaptivecalibration product VZAutoCal™ and several innovative acces-sories, PTI systems deliver Real Time, problem-free, and noweven calibration-free, operation that provide users with instanthigh quality 3D motion feedback. Our high-end products areused all over the world in a variety of motion capture andmeasurement areas. Applications for our systems are in researchand analysis in the areas of Virtual Reality, Biomechanics,Robotics, Sports Science & Research, Structural and VibrationAnalysis, Crash Test Analysis, and many more. Visualeyez™systems also find applications and users in Animation, Video &Film development, computer and console Game Development,Special Effects Production, VFX, etc.

SensAble Technologies, Inc.15 Constitution WayWoburn, MA [email protected] www.SensAble.com

SensAble Technologies is a leading developer of 3D touch-enabled (force feedback) solutions and technology that allowusers to not only see and hear an on-screen computer applica-tion, but to actually ‘feel’ it. SensAble’s PHANTOM® line ofhaptic devices and OpenHaptics® toolkit are used to develop awide range of applications including surgical simulators thatcan improve patient safety and doctor training—especially forhigh-risk and blind procedures such as arthroscopic surgery,epidural injections, temporal bone drilling, and spinal implants.SensAble also offers 3D touch-enabled modeling solutions usedto design patient-specific implants and prosthetics, orthopedicbraces, study models, and dental restorations. In addition tooff-the-shelf solutions, SensAble offers contract development toOEMs for new and customized software applications and hap-tic devices. Selected medical customers include Biomet Inc.,GMV, Kallisto, Medic Vision Ltd, Melerit Medical AB, PDRand Morriston Hospital, Simulution, ToLTech, Walter ReedArmy Medical Center, Wilford Hall Medical Center, and lead-ing universities and research facilities. SensAble maintains head-quarters in the United States and a sales office in Japan. Sens-Able products are available through direct and reseller channels.Visit SensAble online at: www.sensable.com.

SenseGraphics ABFärögatan 33, B25, Kista Science Tower164 51 Kista, [email protected]

SenseGraphics provides a high performance application devel-opment platform (H3DAPI) which enables integration of hap-tics and 3D visualization into multimodal software applica-tions. H3DAPI has been used to develop a diverse range ofapplications in various fields including but not limited to med-ical, dental, industrial and visualization. To encourage learningand growth in the use of haptics technology, H3DAPI is opensource with options for commercial licensing. H3DAPI is avail-able for download at www.H3D.org.

The Telemedicine & Advanced Technology Research Center (TATRC) MRMC-ZB-T, Bldg 1054 Patchel Street Ft. Detrick, MD 21702-5012 [email protected] www.TATRC.org

For the 2009 Annual MMVR Conference, the US Army Med-ical Research & Materiel Command (USAMRMC) and TheTelemedicine & Advanced Technology Research Center(TATRC) have decided to take a novel approach. TATRC willextend the definition of telemedicine and advanced medicaltechnologies, to include an array of technological innovationswhich impact the provision of healthcare to the military. Thisexhibit will focus on and highlight the Congressional Partnersand their projects who have teamed with TATRC in an effortto improve joint medical readiness, provide greater battlespacemedical awareness, and more effectively employ our medicalforces in the 21st century. Funded as areas of Special Congres-sional interest for Army research, over 60 projects totaling morethan 300 million dollars have been executed and managed byTATRC, and carried out in universities and private laboratoriesall over the country. Please stop by TATRC’s advanced technol-ogy showcase for a thought-provoking and exciting experiencedemonstrating how technology will enhance life on the battle-field, in military medicine and beyond. For more informationabout TATRC, please visit us at MMVR, or visit us at:www.tatrc.org, or call Ms. Lori DeBernardis, Director of Mar-keting and Public Affairs at (301) 619 - 7927.

TrueVision Systems, Inc.114 E. Haley Street, Ste. LSanta Barbara, CA [email protected]

TrueVision® is a remarkable real-time 3DHD vision system formicrosurgery. It converts the stereoscopic optical view of surgi-cal microscopes to a digital 3DHD image and displays it on aprojection screen or monitor. Surgical procedures are now per-formed without the need to be permanently attached to themicroscope oculars.

The surgical vision system delivers over twice the depth of fieldcompared to the microscope view and three times the resolu-

37MMVR17

Exhibit Information

tion of standard definition, enabling surgeons to successfullyperform “heads-up” microsurgery without looking into themicroscope’s eyepieces. The 3DHD video recording accuratelycaptures the surgical view. One touch playback replays video ofthe TrueView™ in full 3DHD clarity on the TrueVision ImageDisplay System.

Both surgeons, residents and the entire OR staff can view whattraditionally only one surgeon could observe through themicroscope’s binoculars. TrueVision works with surgical micro-scopes and is ideal in the operating room for performing sur-gery, collaborating and teaching surgical procedures.

By embracing 3DHD visualization as a standard of care anddocumentation, TrueVision is leading the way to a digitalfuture for all microscopy.

University of Nebraska Medical CenterCenter for Advanced Surgical Technology984075 Nebraska Medical CenterOmaha, NE [email protected] www.UNMC.edu

Check out innovative technologies and Centers of Excellence inAdvanced Surgical Technology and Airways Management. Meetour faculty and hear about our expanding research facilities andcollaborative multi-disciplinary research projects: miniaturerobots for surgery, novel airway management solutions,telemedicine capabilities for perioperative medicine care, profi-ciency in robotic surgery, and surgical applications of roboticand mechanical systems, optimal design, and modular design.For more information, go to UNMC’s Web site atwww.unmc.edu or contact Marsha Morien [email protected].

Virtually Better, Inc. 2440 Lawrenceville Highway, Suite 200Decatur, GA 30033www.VirtuallyBetter.com

Virtually Better designs and creates effective virtual reality envi-ronments for healthcare, clinical training, and education.Located at more than seventy clinical sites worldwide, VirtuallyBetter’s technology is setting the tone and pace for clinical vir-tual reality systems.

Virtual reality environments offer significant advantages forcognitive behavior therapy in that they allow exposure-basedtreatments to be conducted in the safety and comfort of a clinicsetting. Numerous studies have indicated that these virtualenvironments, utilized in a therapeutic manner, are effectivetools for treating a variety of disorders, including anxiety,addiction/substance abuse, and post-traumatic stress (PTSD).In addition to demonstrating our clinical products for exposuretherapy, we will be demonstrating Virtual Iraq and VirtualAfghanistan, used specifically for the treatment of combat relat-ed PTSD.

We will be demonstrating Multi-User Virtual Environments(MUVE’s) that can be used in a wide variety of clinical situa-tions to address behavioral healthcare problems. MUVE envi-

ronments provide the ability to:

• Engage the patient cognitively, and thus make therapyengaging, as well as increase compliance

• Conduct group therapy sessions

• Monitor progress using a wide array of assessment tools

• Allow clinicians to build rapport with patients in a neu-tral environment that can de-stigmatize therapy

• Teach interpersonal and cognitive skills

• Desensitize patients to environmental triggers

• Create and support patient social networks

• Practice clinical skills with trainees and provide animmediate opportunity for testing in a simulated socialor clinical setting

• Enhance counseling by meeting family members in thesimulated environment, using the recordings of pastindividual therapy sessions as conversation starters, andreducing the burden of time and distance

• Improve clinical supervision of staff through review ofvirtual session

• Conduct therapy and supervision locally or at a distance

PresentationSummaries

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MONDAY – SESSION A MENTAL HEALTH & SIMULATION

Thomas Parsons

Neurocognitive and PsychophysiologicalAnalysis of Human Performance within VirtualReality Environments

High-fidelity, immersive virtual environments (VE) developedat the Institute for Creative Technologies (ICT) were leveragedto allow researchers to record psychophysiological measurementmodalities during the performance of various highly-realistictasks. Specifically, we aimed to continue development of a com-prehensive, standardized, norm-based virtual reality cognitiveperformance assessment test (VRCPAT) battery that recyclesgraphic assets developed for ICT’s Virtual Iraq. The VRCPATleverages VE assets to measure neurocognitive performancewithin military relevant environments. Cognitive componentsinclude attention, memory, executive functioning, spatial abilityand a host of higher-level language and reasoning abilities.

Young Seok Shin

Virtual Auditory Hallucination Exposure Programfor Schizophrenia

Auditory hallucination is a false or distorted hearing perceptionwith a compelling sense of its reality, and associated with psy-chotic disorders such as schizophrenia. Patients with schizo-phrenia who suffered from the auditory hallucinations couldeasily be disturbed to their behavior or thought by their hallu-cination. Behavioral treatments have been designed in whichschizophrenic subjects are trained in strategies for coping withverbal auditory hallucinations. However, this coping skillstraining has limitations due to the absence of assistive tool forgiving similar and relative stimuli in several situations. VirtualReality could simulate the real situations as well as manipulatethe situations so that it could provide unreal stimuli. It is alsohave some advantage. Therefore, we propose the virtual audito-ry hallucination exposure system, in which patients could expe-rience weird or inappropriate sounds out of accord with sur-roundings, and have shown the feasibility and possibility inapplying in patients with schizophrenia.

Giuseppe Riva

The Intrepid Project: Biosensor-Enhanced VirtualTherapy for the Treatment of Generalized AnxietyDisorders

Generalized anxiety disorder (GAD) is a psychiatric disordercharacterized by a constant and unspecific anxiety that inter-feres with daily-life activities. Together with the cognitive-

behavioural treatments, relaxation represents a useful approachfor the treatment of GAD, but it has the limitation that it ishard to be learned. To overcome this limitation we propose theuse of virtual reality (VR) to facilitate the relaxation process byvisually presenting key relaxing images to the subjects. To testthis concept we planned a randomized controlled trial(NCT00602212) , including three groups of 25 patients each(for a total of 75 patients): (1) the VR group, (2) the non-VRgroup and (3) the waiting list (WL) group. This controlled trialwill be able to evaluate the effects of the use of VR in relaxationwhile preserving the benefits of randomization to reduce bias.

José Mosso


When undergo ambulatory surgical operations, the majority ofpatients experience high level of anxiety. Since Virtual reality(VR) has been demonstrated a good distraction technique, ithas been repeatedly used in hospital contexts for reducing painin burned patients, but it has never been used during surgicaloperations. With the present study we intended to verify theeffectiveness of VR in reducing anxiety during outpatient sur-gery. We measured the degree to which anxiety associated withsurgical intervention was reduced by distracting patients withimmersive VR provided through a cell phone connected to anHMD compared to a control condition. A significant reductionof subjective and physiological anxiety was obtained after 45minutes of operation and maintained until the end of the surgi-cal intervention in the VR group, but not in the control group.

Carla Pugh

Use of Clinical Simulations for Patient Education:Targeting an Untapped Audience

According to previous studies, many women experience thepelvic examination as something negative. One part of the neg-ative experience stems from being exposed, in a subordinateposition and with no control over what happens during a verypersonal examination. “Empowerment” of female patients inthis situation would enable them to feel more like a partner inprocess - gaining power and having more control over the situa-tion. Knowledge can be a valuable tool in the empowermentprocess. The purpose of this study was to evaluate changes inwomen’s expectations of their next pelvic examination beforeand after a simulation-based learning experience. In addition,we sought to better understand the effect of knowledge andinstruction on a patient’s pelvic examination experience.



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Thomas Parsons


This study uses virtual characters to aid our understanding ofprejudice in training clinicians. The activation and control ofaffective race bias was measured using 1) startle eye blinkresponses; and 2) self-reports as white participants interact withwhite and black virtual humans. By measuring eyeblinkresponses to startle probes occurring at short and long latenciesfollowing the onset of Black compared with White virtualhumans, we were able to examine affective processes associatedwith both the activation and potential control of race bias.Importantly, patterns of eyeblink modulation have differentmeanings at short and long latencies. Eyeblink responses atshort latencies vary as a function of attention. A race-biasedresponse to a short latency probe was evidenced by relativelysmaller blinks (blink inhibition).

Christopher Culbertson

Using Virtual Reality to Assess and Treat Cravingin Substance Dependent Individuals

Drug craving has long been recognized as a major target forpharmacological and behavioral treatments intended toimprove abstinence in substance dependence individuals. Previ-ously, researchers and clinicians have used a variety of tech-niques including visual, auditory, in vivo and imaginal drug cuepresentation methods to produce craving in a clinical setting.Recently, virtual reality (VR) cue exposure models have beendeveloped to improve upon traditional cue exposure methodsby creating realistic and interactive environments. We havedeveloped two separate VR drug cue environments (metham-phetamine & nicotine) using Second Life to closely examinecue induced craving in these respective populations and assessthe efficacy of pharmacological and behavioral treatmentsintended attenuate drug craving.

Robert McLay


Virtual Reality (VR) based therapies have been shown to be asafe and effective way to treat Post Traumatic Stress Disorder(PTSD). The published case series, however, have been con-fined to relatively peaceful settings. As wars continue, militaryproviders need to provide treatments at the front. Such envi-ronments provide unusual challenges, and broach questionsabout what VR can add for those already facing the reality ofwar. We report on a series of six Service Members whodeployed to Iraq with PTSD, and their treatment with VirtualReality while in Fallujah. Situation faced included new, poten-tially-traumatic experiences occurring in the midst of treatmentand interruption of sessions by the realities of the environment.Despite difficulties, all six showed improvement, with five ofthe six effectively finding remission of symptoms. The degree to

which the VR was essential to their recovery remains in ques-tion. Details of the cases are discussed.

Dennis Wood

Effectiveness of Virtual Reality Graded ExposureTherapy with Physiological Monitoring forCombat Related Post Traumatic Stress Disorder

Background: The percentage of Army and Marine Corps per-sonnel, who participated in Operation Iraqi Freedom or Opera-tion Enduring Freedom and who met screening criteria formajor depression, generalized anxiety disorder or PTSD, was ashigh as 17.1%. DOD officials have also expected that thePTSD rates will be higher among troops who have completedtwo or more combat tours to Iraq. Virtual reality exposure(VRE) therapy has been reported as a new and effective therapyfor treating veterans with PTSD. The Virtual Reality MedicalCenter (VRMC) has developed a Virtual Reality Graded Expo-sure Therapy (VRGET) protocol for treating warriors diag-nosed with combat-related PTSD. Tools and methods: Eightmilitary active duty male volunteers, diagnosed with ChronicPTSD, completed the 10 week VRGET protocol. The VRGETsystem relied on a combined visual and auditory presentationusing two PC computers. The VRMC VRGET assessment andtreatment protocol has been previously described. Results: Ourpresentation will review the VRGET protocol utilized to treatcombat-related PTSD and the treatment outcome results forthe first eight patients in our randomized treatment group. Wewill also discuss recommendations for the future VRGET treat-ment of combat- personnel diagnosed with PTSD.

Albert Rizzo

VR PTSD Exposure Therapy Results with ActiveDuty OIF/OEF Combatants

Post Traumatic Stress Disorder (PTSD) is reported to be causedby traumatic events that are outside the range of usual humanexperience including military combat, violent personal assault,being kidnapped or taken hostage and terrorist attacks. Reportsindicate that at least 1 out of 6 Iraq War veterans are exhibitingsymptoms of depression, anxiety and PTSD. Virtual Realityexposure therapy has been previously used for PTSD withreports of positive outcomes. This paper will present a briefdescription of the USC/ICT Virtual Iraq PTSD therapy appli-cation and present clinical outcome data from all patients treat-ed as of Jan. 2009. Clinical trials are currently underway at theNMCSD, Camp Pendleton, Emory University, WRAMC andFort Lewis along with 10 other clinical test sites. Initial out-comes from the first eighteen patients treated at the time of thiswriting indicate that 14 no longer meet diagnostic criteria forPTSD at post treatment.

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MONDAY – SESSION B INDEPENDENT SESSION: VIRTUALPATIENTS FOR MEDICAL EDUCATION


MONDAY – SESSION C INDEPENDENT SESSION: SIMULATOR CONSTRUCTION WITHOUT THEAGONIZING PAIN


TUESDAY – SESSION ACOMPUTER-AIDED THERAPY

Guoyan Zheng

A System for 3-D Reconstruction of a Patient-Specific Surface Model from Calibrated X-RayImages

With the recent introduction of navigation techniques, three-dimensional (3-D) surface models of the patient anatomies areroutinely used to provide image guidance and enhanced visuali-zation to a surgeon to assist in planning and navigation. Thecommon approach to derive 3-D models is to use imagingtechnique such as computed tomography (CT) or magnetic res-onance imaging (MRI). These have the disadvantages that theyare expensive and/or induce high-radiation doses to the patient.The alternative is to reconstruct a surface model using pre-operative two-dimensional (2-D) X-ray radiographs and a 3-Dpoint distribution model (PDM). Although a number ofauthors reported different solutions, it is still a challenging taskwhen we would like to reconstruct a patient-specific model of abone with pathology using a PDM constructed from trainingsurface models of normal anatomy. In this paper, we present asystem for 3-D surface model reconstruction from calibrated X-ray images, which can handle seamlessly both non-pathologicand pathologic cases.

Jennifer Lo

Surgeon-Controlled Visualization Techniques forVirtual Reality-Guided Cardiac Surgery

The interaction difficulties that a surgeon experiences whileworking with virtual reality (VR) environments arise from dis-orientation, insufficient depth information, and delegation ofview control. Our study focuses on optimizing informationdelivery for VR-guided beating heart surgery. From human fac-

tors evaluation to participatory design, we describe the designand verification cycle involved in developing an effective sur-geon-controlled visualization technique for VR-guided beatingheart interventions. The outcome of this process is three inter-active modalities, each of which allows the surgeon to intra-operatively control the visualization of a three-dimensional(3D) virtual environment: 1) Immersive and interactive viewcontrol using a head mount display 2) Preset standardized med-ical view angles displayed on a two dimensional (2D) monitor3) Tangible view control using a physical replica of the 3D vir-tual model Through our consistent evaluation method, wecompare the effect of these novel techniques on task efficiency,targeting accuracy and surgeons’ comfort level.

Thomas Sorensen

Developing and Evaluating Virtual Cardiotomy forPreoperative Planning in Congenital HeartDisease

Preoperative planning may be greatly facilitated by virtual car-diotomy in the most complex cases of congenital heart disease.A prerequisite however is sufficient quality 3D imaging dataand accurate virtual reconstructions. In this work we present aquantitative evaluation of the image quality of 3D cardiac MRI- including an evaluation of the segmentation accuracy andprocessing time of the corresponding 3D modeling process.Forty-one pediatric patients were included in the study. Finallywe show examples of and discuss, qualitatively, the benefits ofvirtual cardiotomy for preoperative surgical planning in con-genital heart disease.

Jung Leng Foo


This paper presents a software that provides surgeons a multi-modal platform for collaborative interaction and visualizationof patient image data. This is built upon previous work wheresurgeons can visualize and interact with automatically segment-ed tumors in the context of original patient data in virtual reali-ty (VR), for diagnosis and surgical planning purposes. Theimproved software framework now consists of a desktop viewerand a VR viewer, both capable of reading and displaying anyDICOM/PACS image data for visualization and interaction.Features include real time pseudo-coloring, tissue windowing,and 3D volume rendering. Both viewers can function inde-pendently or synced via a network connection for a collabora-tive working environment. Using this software, one team in theVR environment can collaborate with another team at a differ-ent location for diagnosis, surgical planning, and tele-mentor-ing, while viewing the same 3D representation. This overcomesthe restrictions of location to encourage communicationbetween medical professionals.


MMVR1744

Asaki Hattori

Development of a Real-Time Image-GuidedSurgery System for Stereo-Endoscopic SinusSurgery

In endoscopic sinus surgery, a surgeon has to correctly recog-nize the precise orientation of the target and surrounding tis-sues in the nasal cavity. However, because of an endoscope’snarrow field of view, it may be difficult for the surgeon tounderstand the specific location of an internal structure such asan optic nerve or vessels. We have developed a 3D image-guid-ed surgery system for endoscopic sinus surgery. In this system, astereoscopic endoscope is applied, and the internal structuremodels of the patient are superimposed onto the endoscope’sstereoscopic video images in real-time. After phantom experi-ments, we applied this system to clinical tests. In the experi-ment, the surgeon was able to stereoscopically observe the innerconditions of the field of view.

Reinhard Friedl

Cardio Pointer: Development of a NavigationSystem for Coronary Artery Bypass Grafting

Open heart bypass graft surgery is the standard treatment foradvanced cases of coronary heart disease. Optimal placement ofthe bypass graft anastomosis is of utmost importance for thesuccess of the procedure. Therefore, detailed and precise knowl-edge about the course and morphology of the target vessel iscrucial for the operating surgeon. To provide such informationduring the procedure, a novel surgical navigation system foropen heart bypass graft surgery is introduced which merges pre-operative maps of the coronary arteries with intraoperativedata. The patient-specific vessel map is generated from multi-slice computer tomography (MSCT), while the intraoperativedata are obtained using a stereo camera system and an opticaltracking system (Cardio Pointer). During surgery, its purpose isto provide a patient-specific map of the coronaries in which thecurrent position of a surgical pointing device (Cardio-Pointer)is visualised. A registration approach based on mutually-sharedanatomical landmarks on the heart surface is presented.

Johannes Vockeroth

Medical Documentation Using a Gaze-DrivenCamera

Medical treatments of a surgeon or a dentist could be docu-mented for teaching or telemedicine using a scene orientedvideo camera. But the most interesting parts of the scene areoften covered by the operators hand or body. The best view tothe scene is next to the operators field of view or perfectly:Within his head. Head-mounted scene cameras are used to cre-ate this exclusive point of view. Eye tracking systems could beused to emphasize the point of gaze within the scene image.The presented system improves classical eye trackers with anadditional gaze-driven camera. The resulting scene image main-tains the overall context, while the image from the gaze driven

camera acts like a magnifying glass and provides a high-resolu-tion image of the gazed detail using an independent exposure.We show its application in a real dental treatment scenario.

ROBOTICS

Amy Lehman


Minimally invasive surgical techniques provide many patientbenefits including reduced trauma and pain, a more rapidrecovery, and improved cosmetic results as compared to con-ventional open surgery. The application of these techniques,however, remains limited by factors including two dimensionalvideo feedback and decreased dexterity. While these limitationshave been overcome for simpler procedures, the adoption ofminimally invasive techniques for advanced laparoscopic sur-gery, such as colectomy, has been slower. This study presentswork towards an in vivo robotic assistant for laparoscopic sur-gery. In contrast to externally actuated robotic systems, thisrobot can be completely inserted through a single port to assistin complex laparoscopic procedures. Once inserted, the robotcan be positioned to operate in each quadrant without necessi-tating additional incisions. A robot prototype with a cauteryend effector has been demonstrated in a non-survivable porcinemodel laparoscopic procedure.

Sachin Daluja

An Integrated Movement Capture and ControlPlatform Applied Towards AutonomousMovements of Surgical Robots

Surgical robots are being widely employed for performing vari-ous types of operations where they offer many advantages overconventional surgery. There, however, remains a significantscope of improvement especially in the areas of surgeon-robotinterface and autonomous procedures. Previous studies haveattempted to identify factors affecting a surgeon’s performancein a master-slave robotic system by tracking hand movements.These studies, however, relied on conventional optical or mag-netic tracking systems, making their use impracticable in theoperating room. This research presents an intrinsic platformdeveloped for tracking hand movements to help improve surgi-cal performance. Signals from potentiometers and encoders onboard the robot’s hand controller were utilized to capture handmovements by employing specially developed electronic hard-ware. Recorded hand trajectories were replicated and applied tothe robotic instruments, enabling autonomous playback of sur-gical tasks.

Carl Nelson

Portable Tool Positioning Robot for Telesurgery

A compact, portable robot called CoBRASurge (CompactBevel-geared Robot for Advanced Surgery) has been developed

45MMVR17


for tool guidance in minimally invasive surgery (MIS). It uses aspherical mechanism composed of bevel gears to achieve thenecessary workspace in four degrees of freedom (DOF). FourDC motors drive the robot, with surgeon-in-the-loop controlguided by an ergonomic joystick. The robot workspace hasbeen validated experimentally, and motion trajectory experi-ments have shown robust and stable control. Use of the robotfor camera guidance in porcine models is described. Theseexperiments indicate superior functionality of the robot. Futurework will involve integration of higher-function surgical toolswith multiple CoBRASurge modules to create a complete,highly autonomous and portable MIS robot system fortelesurgery.

Naoki Suzuki

Tele-Control of an Endoscopic Surgical RobotSystem between Japan and Thailand for Tele-NOTES

We have already experimentally performed endoscopic mucosalresection (EMR) and natural orifice transluminal endoscopicsurgery (NOTES) procedures using the endoscopic surgicalrobot system we have developed. In this study, we aimed tocarry out tele-control of this robot between Japan and Thailandas a Tele-NOTES procedure using a soft human cadaver. Ourendoscopic robot has two forcep-type remote controlled manip-ulators on the distal endoscopic part. Operation of the endo-scopic part that goes into the body through the esophagus wasundertaken by an endoscopist on the Thailand side. Themanipulators were controlled by a surgeon on the Japan sideusing the Japan Gigabit Network (JGN2). Remote control overa long distance through a high-speed network connection wasconfirmed. The surgeon could manipulate the robot from aremote place and could perform Tele-NOTES procedures inthe abdominal cavity of a soft cadaver.

Jeff Hawks

A Modular Wireless In Vivo Surgical Robot withMultiple Surgical Applications

The use of miniature in vivo robots that fit entirely inside theperitoneal cavity represents a novel approach to laparoscopicsurgery. Previous work demonstrates that both mobile andfixed-based robots can successfully operate inside the abdomi-nal cavity. A modular wireless mobile platform has also beendeveloped to provide surgical vision and task assistance. Thispaper describes an overview of recent test results of several pos-sible surgical applications, such as a biopsy grasper, stapler andclamp, drug delivery, video camera, and physiological sensors.The modular platform facilitates rapid development and con-version from one type of task assistance to another. These self-contained surgical devices are much more transportable andmuch lower in cost than current robotic surgical assistants.These devices could ultimately be carried and deployed by non-medical personnel at the site of an injury. A remotely locatedsurgeon could use these robots to provide critical first responsemedical intervention.

TUESDAY – SESSION BSIMULATOR DEVELOPMENT

C. Donald Combs


Medical simulation has seen considerable development over thepast few years and is evolving to better address training needsin the medical and health professions. A recent analysis of med-ical modeling and simulation research, covering the years 2000-2007, showed a substantially increased interest in proceduralsimulation. Through a comprehensive analysis of the MedicalModeling and Simulation Database’s (MMSD) Products andCompanies and Research Articles collections, the area of proce-dural simulation was analyzed in detail in 2008. Researchfound that the most prominent current trends among simula-tors are models that are wireless, portable, compact, emphasizeteam training, and user-friendly. This analysis of proceduralsimulators and their deployment provides an assessment oftheir increasing utility in medical skills training.

Gerald Moses


For five years, the University of Maryland Medical Center andSchool of Medicine have sponsored a program of research tar-geted at the enabling of technologies for enhanced training,clinical effectiveness and patient safety. Initially, under therubric of “The Operating Room of the Future” various pillarsof research were established that proposed to advance the stateof medicine, notably surgery. The pillars included scientificapproaches related to Informatics, Smart Image, and Simula-tion. The evolving research effort opened the door to a revisedconcept of basic sciences that underpin surgical training andeffectiveness. Developments led to two important changes; theadoption of a new mantra, Innovations in the Surgical Environ-ment, to replace the Operating Room of the Future; and theaddition of another research pillar, that of Ergonomics andHuman Factors. Progress will be reported in each of the pillarsof research. Lessons learned from high-stakes environments willbe applied.

Mario Riojas

Knowledge Elicitation for PerformanceAssessment in Computerized Surgical TrainingSystem

More often than not, the judgment of experienced surgeonsduring the performance assessment of laparoscopic surgicalskills of medical students occurs in the form of ordinal vari-ables. These variables can take values such as low, medium, orhigh when describing the medical student’s skills. We presenthow to model the variables involved in the judgment criteria ofa laparoscopic hand-eye coordination task as fuzzy sets. Our


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proposed framework presents the knowledge elicitation for aninference system that obtains quantitative results based on judg-ment criteria given in qualitative form with the potential toaugment its knowledge-base from trainees’ performances, with-out relying solely on the data of the subjects used during thesystem’s design phase, making it an adaptable scoring systemcapable of growing at its trainees’ pace.

Marcus Schlickum

The Importance of Visual Working Memory andVisual-Spatial Ability for High PerformanceDiffers between Various Virtual Reality ImageGuided Surgical Simulators

Visual working memory and visual-spatial ability has recentlybeen discovered important for performance in virtual realityimage guided surgical simulators. The aim of this study was toinvestigate the importance of these human factors in several dif-ferent simulators. 35 medical students were tested in three dif-ferent simulators, as well as tested for high-level visual-spatialability and visual working memory. Simulator performancescores were then compared with the cognitive tests using a mul-tivariate approach. The visual-spatial ability and visual workingmemory scores were ranked according to importance in eachsimulator. Results from the study show that the importance ofeach factor differs depending on which simulator that was test-ed. This information can be useful when designing future surgi-cal skills training curricula and also in assessment.

Gyusung Lee

Joint Kinetic Data Augments TraditionalBiomechanical Approach to Assess theErgonomics of Laparoscopic Camera Assistants

Surgical ergonomic studies routinely use angular joint move-ment, force plate, and electromyography to investigateergonomic risks faced by primary laparoscopic surgeons. In thisstudy, we performed a kinetic data analysis that describes howdifferent internal and external forces interact during jointmovements. Such analysis has not previously been used thus,though it provides a more comprehensive ergonomic risk assess-ment. Additionally, our research focus investigated theergonomics associated with tasks performed by surgical assis-tants during a simulated Nissen fundoplication. Our study’sdata is augmented by a mathematical model, currently in devel-opment, of the knee joint, allowing us to investigate how com-pressive joint load is distributed between the medial and lateralcompartments. This model will enable data gathering, whichcannot be garnered and measured noninvasively. Quantitatively,our results demonstrate that camera assistants’ standing posturecontributes to a high-risk ergonomic situation.

Gunther Sudra

Estimating Similarity of Surgical Situations withCase-Retrieval-Nets

Representation and recognition of surgical situations is a pre-requisite for the development of context-aware surgical assis-tance systems. According to the theory of Neumann et al. anapproach for situation recognition based on description logics(DL) is used. This approach provides a formal basis for knowl-edge engineering and enables explicit modelling of surgical situ-ations. In this publication a method for recognition of surgicalsituations with Case-Retrieval-Nets (CRN) is presented. Itenables the estimation of similarity between models of surgicalsituations. The main advantage of CRNs is the combined useof domain knowledge and DL-reasoning algorithms to deter-mine the state of an intervention. The described methods havebeen applied to build and compare models of surgical situa-tions. Evaluation is performed on situations of two cholecystec-tomies.

Dhanannjay Deo

A Machine Learning-Based Scalable Approachfor Real-Time Surgery Simulation

In this work a novel method is presented for real-time physics-based surgery simulation, which combines the complexity andaccuracy of physics-based non-linear soft tissue models andcommercial finite element codes with the high speed of execu-tion of machine learned neural networks. In an off-line pre-computation phase, each node of the organ model is simulatedwith carefully chosen prescribed displacements and theresponse, computed using commercial finite element softwaretools, is recorded and stored in a large database. The data inthen vastly condensed into a set of coefficients describing neu-rons of a Radial Basis Function (RBF) network for easier stor-age and rapid reproduction. During real-time computations, asthe surgical tool interacts with the organ models, these neuralnetworks are used to reconstruct the deformation fields as wellas the reaction forces at the surgical tool tip.

Mark Bowyer

Exporting Simulation Technology to thePhilippines: A Comparative Study of TraditionalVersus Simulation Methods for TeachingIntravenous Cannulation

A Validation of the Virtual IV simulator was undertaken in thePhilippines in which 40 novice medical students were random-ized to receive training on either the simulator (n=20)or by tra-ditional methods (n=20). Their subsequent attempt at insertionin an actual patient was videotaped and scored by blinded eval-uators pretrained such that inter-rater reliability exceeded 0.80.Students who trained on the simulator were more likely to besuccessful,were rated higher by evaluators and had less con-stricting band and overall times. Exportation of simulation

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technology to developing countries is feasible but barriers towidespread utilization exist.

TUESDAY – SESSION B (CONT. )INDEPENDENT SESSION: PRE-OPERATIVE WARM-UP


TUESDAY – SESSION CREHABILITATION

Marlene Sandlund

Effect of Interactive Computer Training on Goal-Directed Arm Movements in Children withCerebral Palsy: A Kinematic Evaluation

Computer interactive environments may provide a way to makemotor training more motivating for children with sensorimotordisorders. However, appropriate computer environments thatcould be used for this purpose need to be systematically tested inrehabilitation settings in order to evaluate their influence on chil-dren’s motor control. The aim of this study was to evaluate thequality of goal-directed arm movements in children with cerebralpalsy after four weeks of daily practice with the Sony’s EyeToysystem for PlayStation2. Before and after practice, arm move-ments were recorded by means of an optoelectronic motion cap-ture system. Preliminary results show that the variability in meanvelocity and peak velocity decreased in goal-directed arm move-ments after practice. The fact that the improvements were seen inarm movements towards both virtual targets and real targets sug-gests a transfer of improvements in movement quality achievedin virtual practice to real life situations.

Sheryl Flynn

Virtual Reality Systems Using Low-Cost Webcamand Off-the-Shelf Game Interfaces for MotorRehabilitation after Traumatic Brain Injury, SpinalCord Injury and Amputation

This presentation describes three phases of a project aimed to1) identify and define the characteristics of the games and 4interactive systems (Sony PlayStation(r) 2 EyeToyTM, Ninten-do(r) WiiTM, Novint(r) FalconTM, and the light based web-cam tracking system) that were most enjoyable, user friendly,and motivating for individuals with TBI, SCI and amputation;2) develop new games, or manipulate the current games toaddress these user-defined characteristics gathered during thefirst part of the research; and 3) develop and pilot test a train-ing protocol aimed to improve function in each of the threegroups (TBI, SCI and Amputation). The results of each ofthese phases will be presented.

Mark Sivak


A low cost system that patients could use independently in thehome on a personal computer and that is designed to improveupper extremity and hand function is necessary to help treatthe rising number of patients with stroke. To meet this need,we have created the concept of a Multiple User Virtual Envi-ronment for Rehabilitation (MUVER). The MUVER has threecomponents: the low cost P5 Glove (tracks arm, hand and fin-ger movements), the open source Panda3D game engine, andlaboratory created software. A unique aspect of the MUVERdesign is the system’s capability for four types of multiple userinteractions: competition, cooperation, counter-operative, andmixed. Such virtual interactions may help to increase patients’motivation to improve and possibly alleviate feelings of socialisolation for those who remain homebound. Thus far, a proofof concept virtual environment that uses competitive interac-tion has been created and tested with three healthy subjects.

M. Susan Hallbeck

Simulating Visual Impairment to Detect HospitalWay-Finding Difficulties

Around 70% of all sensory perception is through vision; thus,we are highly dependent on sight, which is a problem for the2.6% world population who are visually impaired. The overallgoal of this pilot study was to identify via low-vision simulationhow and where way-finding failures may occur for low-visionpeople and prevent difficulties in way-finding before theyoccur. The results of this study show that, for low-vision peo-ple, decorative elements often create major disturbances in way-finding. Most of these problems could easily be eliminatedonce identified. With the simulation of low-vision these failurescan be detected, categorized and remedied and finally the rightinformation can be given to the hospital to allow them toimprove their facility. The methodology created to improve sys-tems for the most impacted (low-vision) participants will alsoincrease the ease of way-finding for those with unimpairedvision.

Dimitrios Katsavelis

Nano Legends: An Interactive Virtual RealityGame Induces High Level of Physical Activity

We wanted to measure the energy expenditure of a novel inter-active virtual reality game that can be used for education.Movements of the upper and lower extremities while playingthe Nano game can be translated to the screen, where the heroof the game fights against carcinogens and viruses. Results from11 middle school students showed that oxygen consumption,heart rate and rate of perceived exertion were similar to thosefound when subjects walked at 3.5 mph. When compared toother commercial video games, Nano had much higher oxygen


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consumption and therefore energy expenditure. This game candefinitely serve the triptych of education, entertainment andphysical activity that is getting even more essential nowadays.

Kimberly Briggs

Scientific Framework for Selecting SimulationGames for Rehabilitation and Assistance: A CaseStudy with the Wii(r)

Traditional neurorehabilitative treatment regimes are timeintensive, repetitious and tedious; leading to high levels of noncompliance and a need for change. Simulation based gaminghas emerged as a promising alternative, however to date there isa lack of a scientific methodology for the selection of exercises.A methodology is presented consisting of three basic compo-nents; cognitive design; observational design and ambient mon-itoring; that employs task analysis to address specific patientproblems. Utilizing this methodology, ten therapeutic applica-tions for Occupational Therapy treatment were analyzed alongwith the gaming platforms Nintendo Wii(r) and the NovintFalcon(r). Adaptions to the Wii remote and other peripheralsthat ensured a high correlation (r>0.8) between real and virtualworld movements were incorporated. Initial results demonstratethis methodology can offer novel adaptions to rehabilitativemodalities. Task analysis, movement sensing and ambient mon-itoring are customizable solutions offering effective rehabilita-tion with off the shelf engaging simulations.

TUESDAY, SESSION C (CONT.) INDEPENDENT SESSION – MIXEDREALITY AS A TOOL FOR COGNITIVEAND MOTOR REHABILITATION


WEDNESDAY PLENARY

Virgil Wong

Envisioning the Web 3.0 Patient and PhysicianPortal as an Interactive, Semantics-Based, andIntelligence-Driven Anatomical Avatar

This session will present a VR anatomical avatar as the basis fora patient and physician portal called Phineasmap(http://www.phineasmap.org). A customizable model of thepatient's anatomy allows access to contextual health informa-tion, patient-managed personal health records (PHR) and clini-cian-managed electronic medical records (EMR). Workingtowards a medical semantic Web, the portal attempts to useexisting metadata frameworks to enable information therapytoday and personalized medicine in the future. Both real andspeculative scenarios using the anatomical avatar will be shown.

MyNYP is a patient portal being created by NewYork-Presby-terian Hospital in collaboration with Dr. Mehmet Oz andMicrosoft. Dr. Antonio Bernardo's Microsurgery Skull BaseLaboratory at Weill Cornell Medical College integrates exqui-site cadaveric dissections, 3-D visualizations, virtual reality, andcomputerized simulations for the training of surgical proce-dures and visuospatial skills. Nanorobocardioplasty at RYTHospital-Dwayne Medical Center (http://www.rythospital.com)is an imagined procedure using the anatomical avatar interfaceas a means to monitor and activate medical nanotechnologywithin a patient's bloodstream.

James Kinross

Virtual Worlds Technology Enhances MedicalStudent Training in the Operating Room

A randomised control study was performed to assess the SecondLifeTM (SL) platform as a tool for teaching an operating room(OR) induction curriculum to a population of UK medical stu-dents. Students (n=33) were taught a standardised curriculumin three groups: (1) didactic lecture theatre; (2) SimulatedOperating Suite (SOS): a full-scale real world OR simulator;(3) SL simulated OR environment. Knowledge, the under-standing of required skills and attitudes showed statisticalimprovement after teaching in all groups (P<0.026). There wasno significant difference between the didactic lecture and SLgroups. No significant difference existed between the SOS andSL groups in the students’ perception of simulation fidelity(p=0.310). Student anxiety about future visits to the OR wasreduced most significantly in the SL group (P<0.034). The SLsimulated teaching environment is an effective method for thedelivery of a theatre induction curriculum and is less resourceintensive than SOS-styled simulators.

Warren Grundfest

Development and Testing of a Tactile FeedbackSystem for Robotic Surgery

The addition of tactile feedback to existing robotic surgical sys-tems may enable surgeons to “feel” tissue characteristics, appro-priately tension sutures, and identify pathological conditions,possibly decreasing the learning curve associated with the adop-tion of robotic surgery, and also enabling its expansion to otherminimally invasive procedures. A tactile feedback system hasbeen developed using silicone-based pneumatic balloon actua-tors and piezoelectric force sensors, paired with a control sys-tem. This system has been fitted directly onto the da Vinci sur-gical robotic system, allowing the forces applied at the roboticend-effectors to be felt on the fingers of surgeons or other sys-tem operators. Data from peg transfer trials have confirmedthat tactile feedback reduces grasping forces applied duringrobotic surgery.

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WEDNESDAY – SESSION AVISUALIZATION



Some medical procedures involve a significant portion of navi-gation through the patient’s anatomy to reach the desiredregion of interest. Often this entire navigation length of thepatient is not scanned completely since it would expose thepatient to additional radiation, require multiple imaging scans,not be cost or time effective. As a result, imaging scans arefocused on a particular localized region of interest and does notcapture the remaining supportive anatomy that a physician hasto navigate through. We propose to enlarge a patient-specificscan to include similar supporting anatomy by merging a sec-ond scan from a different patient onto the original primarypatient scan so that a more complete anatomical environmentis available. With patient-specific simulation receiving increas-ing focus from the research and clinical communities, there is aneed for larger training datasets which could be accomplishedby permitting allowances outside the primary area of interest.Thus, targeted patient scans could be augmented with approxi-mate supporting anatomy in the regions which are less critical.Our simulated CT scan will not interfere with the soft tissuesimulation, but will facilitate navigation thanks to the inclusionof additional anatomical landmarks.

Jacopo Annese

A Scalable Visualization Environment for theCorrelation of Radiological andHistopathological Data at Multiple Levels ofResolution

We describe a methodological pipeline that includes MRI, his-totechnology, image acquisition, and visualization strategies forinspecting and analyzing neurological data at multiple levels ofresolution. The virtualization of brain specimens is obtained byregistering stacks of whole giant histological sections to the vol-ume datasets acquired previously by MRI. Digitization ofhistopathological material is obtained by flat bed scanningtechnology and motorized large-field microscopy, resulting inimage montages and pyramidal files that can be viewed at dif-ferent levels of resolution. The visualization environment,including scalable display arrays, was built to access the datafrom multiple imaging modalities and to take advantage of thedetail contained in the histological images within the entireanatomical context of the brain.

Jonathan Suen

Towards Medical Terahertz Sensing of SkinHydration

Terahertz imaging has shown promise as an ideal tool for in-vivodetection of skin abnormalities, including skin cancer, burns,

scars, and wounds due to its low non-ionizing photon energyand ability to penetrate clothing and synthetics. We measure low-level bulk changes in the water content of hyperhydrated anddehydrated chicken skin specimens using a whiskbroom scan-ning, reflective THz imaging system. Our results show a 500%difference in the THz reflectivity between hyperhydrated anddehydrated skin. The results provide further evidence that waterconcentration is the primary contrast mechanism in reflectiveTHz biomedical imaging and are a promising step towards theclinical use of reflective THz imaging.

Oscar Meruvia-Pastor

Fast Interactive Integration of Cross-SectionalImage Datasets and Surface Data forMorphometric Analysis

To investigate external facial morphology and cell proliferationpatterns and their relationship with cleft lip malformation inmice, we need to compare samples of mice tissue photographsand surface reconstructions from micro-CT scans. Tissue sam-ples obtained through photography are typically misalignedwith respect to each other, which prevents further analysis. Wedeveloped a system for fast interactive alignment of these imagestacks for volume reconstruction and data visualization andanalysis in 3D. The system is designed to work in multiproces-sor environments with arbitrary numbers of processors, cuttingdown significantly the turnaround time and allowing users toquickly process sets of high resolution images using a combina-tion of automatic and interactive tools. Additional modules areused to reconstruct the shape of the original subject. Our sys-tem is interactive, fully scalable, can be applied to any photo-graphic sliced dataset regardless of subject and reduces signifi-cantly the waiting times for stack alignment.

SENSORS

Robert Tan

Development of a Minimally Invasive ImplantableWireless Vital Signs Sensor Platform

We present here the further development and progress of awireless, implantable, and continuous vital signs sensor monitorcapable of measuring pressure, temperature, oxygenation, andheart rate. This system is composed of three parts: a sensorsuite, a central processing unit and transmitter, and a PDA toreceive data. Currently, we have successfully implemented apiezoresistive pressure sensor on this system. In vitro data showsthat it operates from 0-1.5 psi gauge pressure with a 0.01 psiresolution. In vivo testing demonstrates its ability to obtaindata for >90 hours while implanted in a porcine model. Wewill report any medically relevant data obtained from the study.Furthermore, we will present the design, fabrication, and test-ing of a second generation of the device that features a smallersensor suite designed for percutaneous implantation and theimplementation of a thermistor and platinum/silver electrodesfor core temperature and oxygen sensing, respectively.


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MODELING

Yong Hum Na

Development of Whole-Body Reference AdultMale and Female Models for RadiologicalStudies Using Surface-Geometry Modeling andMonte Carlo Radiation Transport Methods

Purpose: To develop a pair of reference adult male/female mod-els using novel surface-geometry modeling methods for MonteCarlo radiation dosimetry Methods and Materials: Surface-geometry modeling method is more flexible for phantom mod-eling. We adopted the models by AnatomiumTM. Organs vol-ume/mass data were adjusted to ICRP recommended values bymesh deformation. Software was developed to convert themesh-formatted phantoms into the voxel-formatted phantomsfor Monte Carlo dose calculations. Organ dose results werecompared with the published data. Results: The volume/massdata of the reference voxel-based Adult Male/Female phantomsmatch with ICRP recommended data with relative error lessthan 0.5%. The average absorbed organ doses were calculatedusing 6 standard external photon irradiation geometries. Organdose results show good agreement with the published data.Conclusion: A pair of reference Adult Male/Female phantomshave been developed and implemented into Monte Carlo codesfor dose calculatons. The results demonstrated the usefulness ofthe phantoms. These phantoms are useful in X-ray imaging,radiation treatment planning, radiation protection of workers.

Yingchun Zhang

Advanced Finite Element Mesh Model of FemaleSUI Research During Physical and DailyActivities

Urinary incontinence (UI) or the undesired leakage of urinecan occur due to anatomic and/or neurologic factors involvingconnective tissues, muscles and nerves. It currently affects over13 million Americans with the majority being females.Although UI is more common in post-menopausal and multi-parous women, studies have also shown a high prevalence of UIin young, physically fit female athletes. However, there is noclear understanding of the mechanisms of UI in young femaleathletes. With a goal towards dynamic patient-specific mechan-ical characterization of the etiology of UI in this patient popu-lation, we have developed an advanced finite element analysis(FEA) model of the female pelvis. The entire FEA female pelvismodel consists of 35 individual anatomical parts, over 850,000tetrahedron elements and 160,000 nodes. We are using it tocharacterize relative relationships and structures during thephysical activities that elicit UI during activities of daily living.

Yunhe Shen

Interactive Collision Response Solutions toInterpenetration Problems among Tissues andInstruments in Virtual Laparoscopic Surgery

In virtual surgery, interpenetrations among models of instru-ments and tissues need to be resolved with contact or colli-sion response adjustments to avoid unrealistic or distractiveartifacts. To handle the interpenetrations, we propose swiftand precise solutions in our efforts of building interactiveand visually-plausible nephrectomy simulation focusing on aset of tightly packed tissues around kidney hilar. We havedeveloped an overlap test deriving penetration data from theresults of a surface intersection test without using distancefield or nearest features. This method directly processes pre-cise geometric models instead of their simplified versions.Thereafter, for instrument-to-tissue interactions, displace-ment vectors are calculated and then applied to the tissues toresolve interpenetrations; for tissue-to-tissue interactions,normal contact forces are solved from a linear complementa-ry method for the inequality constraint of the Kuhn-Tuckercondition to satisfy impenetration condition. Frictionalforces are solved by the augmented-Lagrange method.

Maud Marchal

Fiber-Based Fracture Model for Simulating SoftTissue Tearing

In this paper we propose a novel approach for simulating softtissue tearing, using a model that takes into account the exis-tence of fibers within the tissue. These fibers influence thedeformation by introducing anisotropy, and impact the direc-tion of propagation for the fracture during tearing. We applythis model to the simulation of capsulorhexis, one of the criti-cal steps of cataract surgery.

Xiangmin Zhou

A Discrete Mechanics Framework for Real TimeVirtual Surgical Simulations with Application toVirtual Laparoscopic Nephrectomy

The inability to simulate realistic soft-tissue behavior in realtime has remained a barrier to face and content aspects of valid-ity for many virtual reality surgical training systems. In theexisting approaches, the computer graphics based approachlacks predictive capability; the mass-spring model (MSM) basedapproach lacks the physically realistic soft-tissue dynamicbehavior; and the finite element method (FEM) and the likefail to meet the real time requirement. The present develop-ment stems from a fundamental physics law, namely, the ther-modynamic first law, for a space discrete dynamic system thatdirectly formulates the space discrete but time continuous gov-erning equation with embedded material constitutive relation.It results in a discrete mechanics framework which possesses auniquely balance between the computational efforts and thephysically realistic soft-tissue dynamic behavior. We describethe development of the discrete mechanics framework with

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focused attention towards the AUA laparoscopic nephrectomyproject as an application.

Hao Li

Modeling Torsion of Blood Vessels in SurgicalSimulation and Planning

Traditional approach of modeling blood vessels using paramet-ric models or 3D mesh has various shortcomings. Parametricmodels lack surface details and assume no change in cross-sec-tional shape during deformation, whereas modeling of torsionin 3D mesh is nontrivial. To overcome these shortcomings, wepropose a novel approach for modeling blood vessels by inte-grating 3D mesh, generalized cylinder, and Cosserat rod theory.This hybrid approach allows the model to capture surfacedetails and to change cross-sectional shape during deformation.Moreover, torsion of the model can be computed in a physical-ly correct manner using Cosserat rod theory. Then, the model’sconfiguration that minimizes torsion can be determined by thealgorithm automatically without user inputs. This approach isuseful for surgical simulation of blood vessel joining thatrequires minimum torsion.

Xianmin Zhou

Realtime Blood Vessel Modeling in SurgicalSimulation

The physical behaviors of blood vessels are of great importancein surgery simulations. Correctly modeling these phenomena isvery useful in developing virtual surgical simulation. We aresimulating blood vessels as we build a model of the renal hilumfor the purposes of the AUA Laparoscopic Nephrectomy simu-lator. In this context, since there are very large vessels and manymuch smaller vessels around the kidney, simulating these vesselsin a uniform method turns out to be a very difficult task. Tosolve this problem, we adopt different approaches according tothe scale of the vessels. Large vessels are treated as thin shells. Athin shell simulation model is applied, which is based on themass spring network and hinges. For small vessels, they aretreated as lines and a beam model is used, which is a type of1D FEM methods. This hybrid approach leads to a promisingsolution of the above problem.

WEDNESDAY – SESSION BSIMULATION & TRAINING

Sergei Nirenburg


The Maryland Virtual Patient project is developing a computerenvironment that facilitates clinical decision making by accessto and communication with an artificial intelligent agent thathas a body (simulated self-regulating physiological and patho-

logical processes), a mind (an ability to perceive symptoms, toengage in a conversation with the physician user and to makedecisions about its behavior and treatment). We have reportedprogress in this project in past MMVR meetings. Specifically,we described our approach to physiological simulation and theway we facilitate it by encoding the complex knowledge of dis-ease variability, progression and treatment by creating a libraryof diverse patients. We continue this year by describing thenewly integrated cognitive perception, decision-making andcommunication capabilities of the virtual patient. MVP is anongoing project. As the next R&D goal, we plan to extend thecoverage of diseases (currently, MVP covers diseases of theesophagus).

Deborah Burgess

Current and Future Applications of Modeling andSimulation for Medical Education, Training andMedical Care

The Air Force is integrating modeling and simulation technolo-gy into all education, training and sustainment platforms forphysicians, nurses and technicians. The ultimate vision is tobuild a distributed human patient simulation network, createsimulation centers of excellence and exploit technological inno-vation to support: battlefield trauma, critical care air transportof casualties, in garrison care, graduate medical education,patient safety, humanitarian missions, natural disasters, home-land defense, pandemic response and CBRN events.

Rachel Ellaway

Rethinking Fidelity, Cognition and Strategy:Medical Simulation as Gaming Narratives

The OpenLabyrinth platform is an open-source toolset thatallows authors to create, run and analyze clinical performance(such as decision-making, interpretation, diagnosis and criticalappraisal) using narrative and gaming techniques to create newand powerful ways of creating educationally rich simulationsand scenarios. With educational roots in problem-based learn-ing, script concordance tests, serious gaming and the broadprinciples of the practicum the kinds of simulation run inOpenLabyrinth afford innovative approaches to teaching andlearning and provide simulation access to previously inaccessi-ble dimensions of practice. Narratives and games are most suc-cessful when they are engaging, absorbing and immersive. Bydrawing on aspects of non-fiction writing, drama, theatre, film,TV, and literature, as well as classic and contemporary gamingOpenLabyrinth authors can create (simple or complex) simula-tion environments that have previously been partial andimpractical to work with on any systematic basis. This paperexplores authoring and applications of these techniques.


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Kanav Kahol


A key element of surgery lies in the ability of the surgeon tofocus on the necessary task and filter the noise effectively. Sim-ulation based training provides a safe environment for trainingresidents on how to cope with noise. This paper presents resultsfrom experiments that aims to (a) quantify the effect of noiseon proficiency and (b) measure the effect of simulation trainingdesigned to counter the deleterious effects of noisy environ-ment. The results clearly show that noisy environments can sig-nificantly affect the performance of residents. Notable in theresults is that cognitive errors are increased by 97% in the pres-ence of noise. Experiments also suggested that training residentsin the presence of noise significantly improves their ability todeal with noise in real environments. These results should beintegrated into the design of simulation training curriculumswhich can focus on providing realistic training environmentswith noise.

Carol Noe

The Effect of Central Venous Catheter PlacementSimulation Training on Patient Safety

Central venous catheter (CVC) placement complications are amajor burden on the healthcare system. In response to theseneeds, simulators for CVC placement have been developed.Employing these simulators efficiently requires definition of acurriculum for CVC placement training that includes simula-tors as well as other educational aids and controlled study ofthe effect of such a curriculum on learning. This paper presentsa curriculum defined for CVC placement training. The curricu-lum includes simulation training, other educational aids, per-formance metrics and evaluation mechanisms. We also presentresults of data analysis from retrospective patient chart analysisthat tracked residents who trained with the CVC placementcurriculum and compared their performance to residents whodid not receive the training. The results show the significanteffect CVC placement training on reduction in CVC relatedclinical complications (76 to 98% reduction) providing evi-dence on the role of CVC simulation curriculum in affectingpatient safety.

Yi-Je Lim


We discuss our research in the development of a simulation-based training system for Regional Anesthesia. The regionalanesthesia trainer includes innovative devices capable of gener-ating haptic feedback during needle insertion, injection andpalpation using MR fluid control and an innovative tactile ren-dering system. The training system includes modular simula-tion software and algorithms, configurable procedures and sce-

narios, integrated training modules, a didactic trainer, an anato-my viewer, a technique trainer, and a scenario-based trainer.

Christian Banker


The Interactive Training System for Medical Ultrasound is aninexpensive, PC-based ultrasound training system, in which thetrainee scans a lifelike manikin using a sham transducer to pro-duce images representing a selected medical condition.Although having a feel of an actual transducer, the sham trans-ducer contains only a 6 degree of freedom position sensor. Theobserved 2D ultrasound image is generated as a slice through apre-stored 3D image volume and is determined by a shamtransducer’s position and orientation. Based on the selected 3Dimage volume, the manikin may represent normal anatomy,exhibit a specific trauma or present a given abnormality. Imagedata for a given condition is acquired from individuals with agiven trauma or pathology and need only be captured once, butcan be used repeatedly for training. This system is a powerfultool for training sonographers in recognizing a variety of med-ical conditions.

Nigel John


There are severe limitations in the training of ultrasound scan-ning techniques in developing countries that frequently resultin diagnostic errors, adverse patient outcomes or expensiveequipment remaining unused. The paper presents a low costtraining environment can be deployed to help overcome thisproblem. We use inexpensive components, specifically a Nin-tendo Wii Remote and associated hardware in order to imple-ment a “dummy” ultrasound transducer. Ultrasound images aregenerated on the PC graphics card. This research is in progress.

Eve Wurtele

Meta!Blast: An Interactive Virtual Reality Gameto Explore Structural and Metabolic Biology

The structure and metabolism of the cell changes across timeand space to orchestrate cellular function. These concepts oftemporal and spatial relationships are difficult to teach from atext book or even a movie. Meta!Blast is an interactive 3Dvideo game to teach cell biology that can be used by educatorsand students in classrooms and at home. It is designed for highschool and first year university biology classes, and is availableat no charge to academics and students worldwide. Realisticviews of cell structures and proteins, state-of-the-art informa-tion, humorous dialog, lively characters all combine to enhancestudent learning, and train and inspire a new generation offuture researchers and physicians.

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Bertalan Meskó

Medicine 2.0: Practicing Medicine in the Web 2.0Era

The new generation of web services, the so-called web 2.0, pro-vides plenty of tools and sites that can ease the work of medicalprofessionals. Medical blogs, blog carnivals, community sitesand wikis create an own platform for physicians and buildingan on-line reputation also becomes crucial for them. Represent-ing a medical practice on the web properly is easier with thesetools and services. While the number of e-patients, who seek tofind reliable medical content on-line and want to communicatewith their doctors via e-mail or videochat, is growing; physi-cians of the 21st century must be ready and qualified to meetthese expectations. E-health or medicine 2.0 can change theway medicine is practiced and healthcare is delivered.


Patrick Cregan


For simulation to be accepted by the wide surgical communityit has to meet the burden of proof that other interventionsmust meet. The standards of evidence are usually grouped fromlevels 1 to 5 with level 1 (Evidence from Meta-analyses of ran-domised controlled trials) being the highest level. We havereviewed the literature on the use of simulation in surgical edu-cation and performed a meta-analysis of the RCTs relating toimprovement of performance in the OR for trainees trainedwith Virtual Reality. The study was based on the comprehen-sive report by ASERNIPS which can be found at www.sur-geons.org/asernips . Skills acquired by simulation based trainingappear to be transferable to the operative setting

Mukul Mukherjee

A Virtual Reality Training Program forImprovement of Robotic Surgical Skills

The purpose of this study was to use a simulated virtual realityenvironment for training of surgical skills and then to identify ifthe learning that occurred was transferable to a real world surgi-cal task. The virtual surgical tasks consisted of bimanual carrying,needle passing and mesh alignment. In this ongoing study, theexperimental group was trained by performing four blocks of thevirtual surgical tasks using the da Vinci surgical robot. Pre andpost training, all subjects were tested by performing a suturingtask on a “life-like” suture pad. The control group performedonly the suturing task. Preliminary results revealed bigger pre andpost differences in time to task completion and speed of the sur-gical instruments in the experimental group as compared to thecontrol group. In conclusion, virtual reality surgical skills trainingmay produce a significant learning effect that can transfer toactual robot-assisted laparoscopic procedures.

Mukul Mukherjee

Consistency of Performance of Robot-AssistedSurgical Tasks in Virtual Reality

The purpose of this study was to investigate consistency of per-formance of robot-assisted surgical tasks in a virtual reality envi-ronment. Eight subjects performed two surgical tasks, bimanualcarrying and needle passing, with both the da Vinci surgicalrobot and a virtual reality equivalent environment. Nonlinearanalysis was utilized to evaluate consistency of performance bycalculating the regularity and the amount of divergence in themovement trajectories of the surgical instrument tips. Our resultsrevealed that movement patterns for both training tasks were sta-tistically similar between the two environments. Consistency ofperformance as measured by nonlinear analysis could be anappropriate methodology to evaluate the complexity of the train-ing tasks between actual and virtual environments and assist indeveloping better surgical training programs.

Curtis Ikehara

Evaluating a Virtual Reality Motor-Skills Simulator

Evaluation was performed on a prototype low-cost virtual-reali-ty motor-skills simulator (VRMSS) created at the TelehealthResearch Institute, John A. Burns School of Medicine, in con-junction with the National Biocomputation Center, StanfordUniversity. The VRMSS is specifically designed to teach base-line fine-motor skills used in surgery that are based on a matrixof elemental technical skills that comprise the tenets of surgicaltechnique. Fifty-seven participants were randomly assigned toone of three groups (VRMSS, box trainer or no training). Aftertraining each group was evaluated using the LapSim from Sur-gical Sciences. The VRMSS and box trainer were similar in per-formance, but significantly better than the no training controlgroup. The VRMSS has significant advantages over the boxtrainer, in that the VRMSS can provide scoring on severalparameters of the task without the need of an instructor andthe VRMSS is approximately 1/16th the cost of the Lapsim.

THURSDAY – SESSION A INDEPENDENT SESSION – THE PULSE!!COLLABORATION


THURSDAY – SESSION A (CONT.)INDEP SESSION – BUILDING MEDICALMODELS AND SCENARIOS FROMCLINICAL DESCRIPTIONS



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THURSDAY – SESSION B SIMULATOR DEVELOPMENT TOOLS

Dhanannjay Deo

Characterization of Anisotropy in ViscoelasticProperties of Intra-Abdominal Soft Tissues

A portable instrumentation rig is presented for characterizingnonlinear viscoelastic anisotropic response of intra-abdominalorgan-tissues. Two sets of linearly independent in-situ experi-ments are performed at each indentation site on the intra-abdominal organs, by subjecting the organ to normal and tan-gential displacement stimuli. For normal indentation experi-ments, the indenter is ramped into the tissue and held for 10seconds before sinusoidal indentation stimuli at various ampli-tudes and frequencies are applied. For tangential (shear) load-ing, the indenter tip is rigidly glued to the soft tissue surfaceand sinusoidal displacement stimuli are applied laterally in thetangential plane and the force response is recorded. Tangentialloading is repeated along orthogonal directions to measure in-plane mechanical properties. Combined analysis of results fromboth experiments leads to assessment of anisotropy of tissueproperties. In situ experiments on fresh human cadavers arecurrently under way at the Albany Medical College.


Haptic Simulation of the Liver with RespiratoryMotion

During a standard procedure of liver biopsy, the motion due torespiration may be difficult to handle. The patient is oftenrequested to hold his breath or to breathe shallowly. This physi-ological behaviour should be taken into account in a virtualreality biopsy simulator. We present here our method to simu-late customised respiratory motion inside a haptic environment.

Eleonora Westebring-van der Putten

Tactile Feedback Exceeds Visual Feedback toDisplay Tissue Slippage in a LaparoscopicGrasper

During laparoscopic grasping, tissue slips frequently. This lack ofgrasp control is caused by the lack of haptic feedback. When sur-geons notice slip, they are often too late to react and will damagethe tissue by trying to re-grasp it. Augmented feedback on gripforce benefits the surgeon in maintaining a safe grasp. However,grasp control can be more efficiently based on a slip signal. Inorder to develop a good feedback system to improve patient safe-ty we compared visual and tactile feedback signals on slip infor-mation. 24 participants where divided in two conditions onewith tactile feedback one with visual feedback. Their task was tohold tissue while reading out loud and respond as quickly as pos-sible to feedback signals indicating slippage. The reaction time inthe condition with tactile feedback was significantly faster thanthe reaction time in the condition with visual feedback.

Ciamak Abkai

Virtual Intensive Care Unit (ICU): Real-TimeSimulation Environment Applying HybridApproach Using Dynamic Bayesian Networksand ODEs

Combining deterministic (e.g. differential equations) and prob-abilistic (Bayesian Networks) approaches to model physiologicalprocesses into a real-time software environment based on C++leads to a novel model for simulation of human patient physi-ology which is important for ICU. By providing HW/SWinterfaces for emulation of patient signals, the outside parame-ters are not only simulated virtually but also are measurablewith standard monitoring systems. Therefore this system is wellsuited for teaching and education based on realistic simulations.Additionally the environment can be used not only for infer-ence of patient data but also for learning of model structuresand parameters based on real patient data. By including thephysiological model to a prognostic model environment whichis similarly based on dynamic Bayesian Networks it is possibleto predict patient states and critical situations.

Allan Okrainec

Development of a Virtual Reality Haptic VeressNeedle Insertion Simulator for Surgical SkillsTraining

The Veress needle is the most commonly used instrument forcreating the pneumoperitoneum at the start of a laparoscopicsurgical procedure. This needle insertion technique can be diffi-cult to teach since it relies heavily on the “feel” of the needle asit advances through the layers of the abdominal wall. The pur-pose of this project was to design a VR simulator with hapticfeedback which would allow surgeons to practice Veress needleinsertion with no risk of injury to patients. In phase 1 of theproject, a group of engineers designed the simulator. In phase2, the haptic parameters were tuned by 22 expert surgeons toachieve the most realistic feel of the procedure. Feedback bysurgeons on the realism of the graphics, haptics, and usefulnessof the simulator was excellent. Further validation studies arenow required to assess the usefulness of this simulator as ateaching and assessment tool.

Jessica Burgner

Including Parameterization of the DiscreteAblation Process into a Planning and SimulationEnvironment for Robot-Assisted LaserOsteotomy

This contribution presents a planning and simulation environ-ment for our robot assisted laser osteotomy setup as well as thenecessary measurements. Until now thermo-mechanical CO2laser bone ablation is not characterized as a discrete process. Inorder to plan and simulate the ablation process in the correctlevel of detail, the parameterization is indispensable. We devel-oped a planning and simulation environment, determined

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parameters by confocal measurements of bony specimen anduse these results to transfer planned cutting trajectories into apulse sequence and corresponding robot locations.

Satoshi Yamaguguchi


A novel computer-assisted 3-D simulation for osteotomy andCAD/CAM fabrication of surgical splints consider the relativeinter-bone interference and space after bone translation weredeveloped. CT image of a patient for osteotomy was operatedand simulation of surgery for deformation, segmentation, dis-placement of the bone was processed effectively by virtual reali-ty haptic device PHANTOM (SensAble Technologies). CAD ofa bite splint before surgery and after bone displacement wasdone in the process of simulation. CAM of resin bite splintswas done by precise Rapid Prototyping CAM machine(EDEN260, Objet). The pre-surgical planning by the PC sim-ulation predicted sufficient result of the maxillo-mandibularrelationship by osteotomy. All fabricated splint were sufficientlyfunctioned to determine the position of jaws. Our PC simula-tion contributes to solve surgical problems such as bone inter-ference and excessive inter-bone spaces, and CAD/CAM fabri-cation system for splints may contribute to realize accurate sur-gery and diminish the operation time.

Ilana Souza

A Virtual Reality Simulator for Training of NeedleBiopsy of Thyroid Gland Nodules

The fine needle biopsy is an important procedure for investiga-tions in tumors, low-cost considered, minimally invasive andideal for supplying an accurate diagnosis in cases of thyroidgland nodules. The main goal of this work was to develop a vir-tual reality simulator for the training of ultrasound guided nee-dle biopsy of thyroid gland nodules, using 3D models and hap-tic devices. Many of the virtual reality applications in medicineare kept only in the experimental field, far from practice. Forthe system to be validated as a tool for training medical stu-dents, residents and clinicians, the simulator was taken to thefinal user. With the intention to be experimentally evaluated atfield, we will present the results of the case of study at a wellknown Brazilian hospital.

Oliver Schuppe


Indirect ophthalmoscopy is a major tool for the examination ofthe ocular fundus. An ophthalmologist evaluates the retina bylooking through a hand-held lens into the patient’s eye. Bothhandling of the lens and diagnostic findings require specialskills and knowledge. We present a simulator which can beused as a training system for indirect ophthalmoscopy. An opti-

cal tracking system is used to reconstruct the position of a lensphantom and a model of the patient’s face. Refraction and illu-mination in the eye is computed in real-time and displayed ona head-mounted display using augmented reality. A case data-base completes the training system which allows to practice theexamination and to study clinical patterns.

Stefano Sclaverano

BiopSym: A Simulator for Enhanced Learning ofUltrasound-Guided Prostate Biopsy

We have developed a simulator for prostate biopsy training;such biopsies are performed under US guidance. In the simula-tor US images are generated from 3D US volumes recorded onreal patients. A virtual US endorectal probe - the “pen” of anOmni haptic device - is manipulated by the clinician. Forcesare fed back to the operator to account for the anatomical con-straints (mainly the anus insertion point and the rectal wall).The operator can manipulate the probe and the attached needleand can start a biopsy. He/she can simply train or he/she canrecord the virtual samples he has acquired on series of patients.A database gathers patient information, real exams, operatorinformation, operator performances and it allows statistics. Thesimulator is working and the clinicians who experienced it gaveus very positive inputs.

Liliane Machado

A Qualitative and Quantitative Assessment for aBone Marrow Harvest Simulator

Several approaches to perform assessment in training simulatorsbased on virtual reality have been proposed. The main prob-lems related to online training assessment methodologiesapplied to VR systems are the computational complexity andthe accuracy. Another inconvenient about those methods isrelated to an unsatisfactory solution for specific cases as in somemedical procedures, where there are quantitative and qualitativeinformation available to perform the assessment. In this paper,we present an approach to online training assessment based ona Modified Naive Bayes, which can manipulate qualitative andquantitative variables simultaneously.

Aaron Oliker

Real-Time Complex Cognitive Surgical Simulatorwith Testing

Testing surgical knowledge is evolving from paper-based andoral exams to computer-based testing. Surgical animations andlive surgical video can convey complex surgical concepts withtremendous success for large scale global remote learning. Overthe past ten years, many techniques have been discovered whichallow medical illustrators and digital animators to create com-plex three-dimensional surgical animations that demonstratedifficult three-dimensional, dynamic surgical concepts.Although the concepts can be clearly communicated, anima-


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tions developed by artists and scientists are not interactive andlack measurable assessment tools. Our team has developed athree-dimensional dynamic surgical simulator for complex sur-gery. The application can simulate any open surgery procedurein real-time and test the user’s cognitive knowledge in a testingmode. The ability to collect and analyze the test results makesthis simulation technology the logical next step in the progres-sion of teaching and evaluating cognitive surgical knowledge.

Eftychios Sifakis

Local Flaps: A Real-Time Finite Element BasedSolution to the Plastic Surgery Defect Puzzle

One of the most fundamental challenges in plastic surgery isthe removal or topology change of skin. For a patient diag-nosed with malignant melanoma, the plastic surgeon in manycases has to resect the tumor and the surrounding area. Theplastic surgeon must look at the defect created as an organicpuzzle. The surgeon must “design” a pattern in the skin toclose the hole aesthetically and efficiently. In the past, theonly training option available to surgeons was the study oftwo-dimensional illustrations or the hands-on practice on alive patient in an operating room. We have created a “localflaps” simulator that will allow surgeons to practice their clos-ing designs in an interactive three-dimensional environment.Using an intuitive set of surgical tools, the surgeon is able topractice existing procedures for closing the defect and evaluatethe efficacy of new approaches based on physically quantifi-able metrics.

TUESDAY POSTERSREHABILITATION

Richard Fan

Characterization of a Pneumatic BalloonActuator for Use in Refreshable Braille Displays

We have developed a process to fabricate reliable pneumaticballoon actuators, featuring low material costs and a novelmanufacturing process to attain uniform and consistent sili-cone-based membranes. This technique has been adapted foruse in refreshable Braille displays that feature low power con-sumption, ease of manufacture and small form factor for ease inintegration. The prototype Braille display consists of an array ofsilicone-based pneumatically-driven balloon actuator elementsand an electronic control system. Perceptual and temporal stud-ies were performed to determine the feasibility of the actuator.Subjects could perceive the Braille with 98.3% accuracy. Thesystem features a fast switching pneumatic valve, which allowsthe balloons to be fully deflected within 60 ms. Therefore, thesystem is capable of supplying effective tactile stimuli at a suffi-cient refresh rate, potentially allowing for the development of aconsistent and reliable refreshable Braille display. Accuracy test-ing for the Braille prototype is in progress.

Belinda Lange

Rehabilitation of Upper Limb Extremity BimanualCoordination Tasks Using a Novel BimanualNovint Falcon Application and SpecificallyDesigned Game Based Task

This presentation describes the development of a bimanualcoordination application enabling interaction with a gamebased bimanual task. The interaction device consists of twoNovint Falcon haptic feedback devices yoked together to enablebimanual interaction with a game environment. The develop-ment of the application will be described and the results ofusability testing with a sample of 15 subjects will be presented.

Panadda Marayong


This work involves a design of a vibrotactile device for centralapnea interruption in premature babies. This small non-inva-sive device provides a localized vibration on the infant’s foot,stimulating the nervous system and causing breathing toresume. The blood oxygen saturation level (SpO2) and theheart rate (BPM) monitored by a pulse oximeter are used tocontrol the device. LabVIEW is used to create a user interfacefor physiologic data acquisition from the pulse oximeter and fordevice control. When the SpO2 level and BPM drop belowpredefined thresholds, the device provides continuous tactilesimulation until the signals return to a normal value indicatingthat breathing is resumed. The interface allows the user to setthe thresholds in the software or use the values set in the pulseoximeter. From an initial test using simulated physiologic sig-nals, the device works efficiently and provides an adequate levelof tactile stimulation.

Jeanette Plantin


Overview 1 The aim of this study is to investigate the effects on1. sensorymotor performance in activities of daily life and 2.awareness concerning visuospatial neglect with institutionallybased training using virtual reality and haptics for strokepatients in the early phase of recovery. This project will beimplemented as a clinical controlled study with pre-post testdesign. The subjects will be 20 inn-patients with hemi-paresisin one of the upper extremities (n=16) or neglect (n=4). Theintervention group will receive training with three dimensionalcomputer games with haptics in addition to the usual training.This study will be discharged at the Neurological RehabilitationCentre Erstagårdskliniken at Ersta Hospital, Stockholm, Swe-den during the period October the 1st 2008 until February the28th 2009. The results will be considered in the future clinicalwork as well as in future studies together with other clinics inour research network.

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Alberto Rovetta

Novel Device DeeDee for Neuromotor Controlwith Augmented Reality and MultiparametricSensors Fusion

DeeDee is a new multi parametric device which detects themotion of a finger, in its kinetic parameters. Also the timedelay response when starting the motion is evaluated. The lastparameter is the tremor of the hand. The electronic compo-nents are sensors for detection and measurement of the fingermotion, able to obtain the velocity of the finger when it per-forms the required action. A nanosensor detects the accelera-tion and the vibrations of the hand. A time measurement isexecuted to determine the time delay, after that a visual signaloccurs on the screen of the computer, and the operator muststart the motion. A small car moves on the road according tothe finger motion and the operator must perform the best tra-jectory with a perfect control of the motion, at the most correctspeed, and the finger coordination again is required.

MENTAL HEALTH

Giuseppe Riva

NeuroVR 1.5: A Free Virtual Reality Platform forthe Assessment and Treatment in ClinicalPsychology and Neuroscience

At MMVR 2006 we presented NeuroVR (http://www.neu-rovr.org - http://www.neurotiv.org), a free virtual reality plat-form based on open-source software. The software allows non-expert users to adapt the content of 14 pre-designed virtualenvironments to the specific needs of the clinical or experimen-tal setting. Following the feedbacks of the 700 users who down-loaded the first version, we developed a new version - NeuroVR1.5 - that improves the possibility for the therapist to enhancethe patient’s feeling of familiarity and intimacy with the virtualscene, by using external sounds, photos or videos. Specifically,the new version now includes full sound support and the abili-ty of triggering external sounds and videos using the keyboard.The outcomes of different trials made using NeuroVR will bepresented and discussed.

COMPUTER-AIDED THERAPY

Farzam Farahmand

Robotic Assisted Reduction of Femoral ShaftFractures Using Stewart Platform

A robotic system for reduction of femoral shaft fractures is pro-posed. The system is based on Stewart platform with sixdegrees of freedom mobility. A plan for implementing the plat-form on bone fragments is introduced and a step by step strate-gy for performing the reduction process based on the system’sinverse kinematic solution is proposed. It is shown that the sys-

tem’s workspace fulfills the fracture reduction requirements offemoral shaft. The efficacy of the system for some case studiesis evaluated and it is shown that in its final configuration, withthe parallel moving and fixed platforms, the system can belocked to act as an external fixator.

Tomoko Ikawa


A Multiple Simulation System can provide useful insight to theclinical diagnosis and treatment_However, when metal prosthe-ses are present in the patient, the quality of the CT is greatlyreduced, resulting in an image that is distorted and thus pro-vides little understanding on extraction and form of dentition.In order to circumvent this, we scanned the surface of plasterdental model with a 3-D scanner. Subsequently, this model wasdigitally combined with the CT reconstruction model, andused as a guide to remove any disturbances that were due to thepresence of metal artifacts. The VR and physical occlusal con-tacts were accorded about 55%. Subsequently, we were able toreproduce a skull model specific to the patient occlusal con-tacts. This was verified via color mapping. In addition, this sys-tem was able to provide a quantitative and dental clinical evalu-ation of the teeth adjustment configuration

Judith Muehl

Towards Validation for Physiological Models inIntervention Planning

Computer supported treatment planning systems aim at pre-dicting treatment results. Recently attacked challenges base notonly on anatomical findings, but include physiological process-es. This way, interventions which are highly depending onpatient physiology become predictable and can be supported incomputer based planning. Though the necessity to validatecomputations used for treatment planning is unquestionedavailable models lack validation. Designing a medical study tovalidate an engineering model is difficult and demands newapproaches on almost every level. For those interventions wherea prediction is most desired the intervention result cannot beseen in images. Therefore data from patients in clinical practiceis not sufficient. The contribution discusses challenges fordesigning a validation study for the example intervention ofradiofrequency ablation in the liver. Different research areashave to collaborate and leave their typical path of thinking tocontribute to a common solution oriented on the challenge.

Amit Mulgaonkar

A Prototype Surgical Manipulator for RoboticIntraocular Micro Surgery

Advances in the miniaturization of ophthalmologic surgicalinstrumentation has allowed for the development of novel,minimally invasive surgical techniques for the treatment of ocu-


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lar dysfunction and disease. Such techniques afford relativelyatraumatic access to the inner surfaces and structures of the eyewith few limitations on the maneuverability and workspace ofthe instrument. Several potential benefits exist for adaptingsuch techniques for use with surgical robotic systems includingimproved instrument dexterity, superior visualization, greatermagnification, tremor reduction, less tissue damage at the pointof entry, and the ability to perform remote (teleoperated) pro-cedures. With these in mind, we have designed a prototype sur-gical manipulator for robotic intraocular microsurgery that isspecifically engineered to harness the benefits of surgical robot-ics while reducing eye trauma associated with tool motion.Robotic as well as pig-eye tests were performed, demonstratingthe feasibility of such a manipulation system and satisfactoryperformance in basic surgical manipulations.

Jay Mung


The objective of our research is to develop an ultrasound, time-of-flight triangulation based system for real-time, intraoperative3-dimensional tracking of minimally invasive surgical instru-ments. We have chosen to first apply this technology towardstracking catheters used in endovascular aortic stent-grafting. Todemonstrate the feasibility of this concept, we have developed asystem involving a custom catheter based transducer and per-formed an experiment in excised porcine tissue with a modelaorta. Preliminary results suggest better than 1mm resolution inthe perpendicular axis.

Takumi Ogawa

Designing Artificial Jaw Joints (AJJs) in VRSpace for Patients with Rheumatoid Arthritis

In this present study, we will report on a case of a patient withsleep-disordered breathing (SDB). She suffered a condyle frac-ture that led to rheumatoid arthritis. Furthermore, we willreview how we planned her treatment and designed her artifi-cial jaw joints (AJJs) via 3D imaging in VR space. We decidedthe mandibular position based on the facial aesthetic line (E-line) and the occlusion. Then we designed her AJJs to complywith the translated mandible with 3D-modeling software. Theupper airway obstruction is assumed to occur in the presentcase due to a pharyngeal obstruction, as in other patients withmicrognathia or sleep apnea syndrome. Therefore we had toconsider the sleep disorder in addition to occlusal managementin such situations as the present case. Furthermore, designing acustom-made AJJs via a 3D model could prove insightful whenit came to arranging the treatment plan of SDB patients.

Ali Rastjoo

Evaluation of Hidden Markov Model for P300Detection in EEG Signal

In this paper, we analyze the performance of hidden Markovmodel (HMM) for P300 detection in electroencephalogram(EEG) signal. In some application like the brain-computerinterface (BCI), where real time detection of mental commandsis desired, HMM could be useful processing tool. The resultsshow that the HMM could be more preferable over the staticmethods of the traditional EEG signal classifiers. To analyze theproficiency of this classification method, we evaluate the per-formance of the suggested HMM classifier on BCI 2005 EEGbenchmark dataset. First, data refinement was conducted byusing the wavelet enhanced ICA for EOG artifact removingand B-spline wavelet transform for background EEG noise can-cellation. Then feature extraction was made by down-samplingthe refined EEG data. In the classification stage, HMM resultsare enhanced by a multilayer perceptron neural network(HMM-MLP). Accuracy of the proposed HMM classifier wasfound to be 81.6% on the validation dataset.

Mathias Seitel


Patient-specific 3D models of the heart can provide a signifi-cant advantage in planning complex surgical interventions. Vir-tual models which can be interactively explored on computerscreens, as well as physicalmodels which provide a tangible andnatural approach to the heart’s anatomy, have been used for thispurpose. In this work, a mixed reality approach is proposedwhich integrates the advantages of both the virtual and theplastic model with the help of tracked 3D pointing devices.Interactions such as pointing to specific landmarks, measuringdistances, or exploring hidden areas, are exerted on the physical(natural) model but are effected on the virtual (interactive)model. The potential of this technique is demonstrated for aconcrete application of cardiac surgery. By adding further inter-action modes, this technique can easily be extended into surgi-cal or anatomical teaching applications.

Hisham Sherif

Recovery after Resuscitation from CardiacArrest in ST-Elevation Myocardial Infarction: AComputer-Based Medical Decision-Support Tool

Prediction of outcomes in ST-elevation myocardial infarctionwith cardiac arrest often presents difficult clinical decision mak-ing. Using the observed clinical results from our institution’sdata, we introduce a customized, computer-based decision sup-port tool to assist in evaluating and predicting outcomes insuch situations. We conclude that this tool can be beneficial toclinicians in decision making or triage of this condition. (Workin progress)

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András Székely

Imaging 2.0: Diagnostic Imaging and Web 2.0

In 2004, a new chapter was opened in the history of the Inter-net as more emphasis was put on communication, community,and creativity. Medical professionals have realized the opportu-nities of this “social Web”, and recently Imaging 2.0 hasemerged as a set of Web 2.0 tools tailored for the needs ofDiagnostic Imaging professionals and students. In this presen-tation I am going to illustrate Imaging 2.0; describe these spe-cial online tools; provide solutions to improve collegial andteacher-student communication, and show how tracking infor-mation can be more efficient online.


One Heart, Two Bodies: a Simulation Study ofBody Surface Potential Differences betweenDonor and Recipient of Heart Transplantation

Following cardiac transplantation, “abnormalities” in the organrecipient’s ECG become evident. Through simulations, we inves-tigated the influence of the heart positioning within the chestcavity as well as the recipient’s somatometric parameters on thebody surface potentials of the human torso in a fashion that, webelieve corresponds to what actually happens in the case of car-diac transplantation. Two subjects with significantly differentsomatometric parameters underwent chest MRI examination.We then edited the chest MRI DICOM images with a speciallydeveloped software tool that allows us to create a high qualitytetrahedral mesh. A post-mortem human heart was also subject-ed to MRI scanning and its tetrahedral mesh was created. Usingcustom software we extracted the heart mesh of the two subjectstorsos and we replaced them with the mesh of the post-mortemheart. We then assessed the influence of heart (re)positioningwithin the thorax, on the body surface potentials. The Finite Ele-ments Method (FEM) technique was used to solve the forwardelectrocardiography problem for both torsos, under the assump-tion that at one instant all the ventricular myocardium of the onepost- mortem heart is excited. FEM was also applied in simulat-ing Body Surface Potentials on the first torso for nine differentheart positions. The results show higher Body Surface Potentialsin the subject with lower BMI and significant changes in BodySurface Potential distributions when the heart is rotated aroundits long axis. Conversely, heart shifts in the horizontal or thecoronal planes did not cause significant changes on simulatedBody Surface Potential distributions.

Eugeniy Yanin


Modern technologies of biomedical and surgical simulation,imaging, robotic facilities, including telemedicine are aimed todiagnose diseases in early stages and to correct them. Amongthe medical alternatives minimally invasive technologies are themost actual methods of surgery nowadays and are considered tobe “the golden standard” providing the decline of surgery

patient traumatism, minimizing post surgery pain, reducing theperiod of attending in a hospital and increasing the positiveemotional condition of a patient. Laparoscopic and thoraco-scopic surgery is the basis of robotic operative system daVINCI S which is gradually and successfully implemented inRussia in Yekaterinburg and Khunty-Mansyisk . From the per-spective of teaching methodology and personnel politics inhealth care system it is very important not to forget, but todevelop and exercise traditional way of surgery in operationssuch as laparotomy, thoracotomy, lumbartomy and others, aslong as any micromechanical, 3D imaging and computer oper-ating technology might be converted. A surgeon should bealways ready to this. They should be strong, confident and ableto ensure the favorable outcome of an operation.

TELEMEDICINE

Gregorij Kurillo

Teleimmersive Environment for Remote MedicalCollaboration

In this paper we present the work in progress on teleimmersiveenvironment for remote medical collaboration. The systemwould allow medical professionals to collaborate in more natu-ral way by the means of multi-camera teleimmersive technologyand hand tracking with gesture recognition for 3D interactionwith medical data, such as MRI, CT scan, 4D ultrasound, and3D x-ray. In the past, we have successfully demonstrated real-time collaboration in dance, Tai Chi learning, and data explo-ration using the proposed technology. We have successfullyintegrated hand tracking using time-of-flight (infra red) camerato interact with 3D data in a virtual environment. In the futurewe will perform a user study to assess the benefit of remote col-laboration over traditional video conferencing. We believe theproposed framework is an important step to bring the teleim-mersion technology closer to remote collaboration medical fieldand other environments, such as engineering, architecture,industrial design, and social networking.

Susil Meher

Barriers in Telehealth Care for Treatment of RuralPatients at AIIMS, New Delhi, India

Introduction: Telemedicine is an upcoming technology inhealth sector in India, so requires study to be done to know theopinions of the Patients are ready to accept or not. Methods: Aquestionnaire has been prepared and made survey of 264patients from 17 different states hospitals of India. Results: .The patients are readily accept technology if it is fulfilling thereexpectations. They mainly look at satisfaction from treatmentand the mode of treatment is almost immaterial to them.Therefore, further awareness programs are required to sensitizethe patients in this regard and also for the progress of telemedi-cine Discussion/conclusion: It has observed that the young age<35 years group is quite interested for the distance health care.But the patients >35 years and < 45 years are interested for face


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to face consultation. The 98% patients are interested for secondopinion for consultation.

SIMULATOR DESIGN

Sarah Baillie

A Mixed Reality Simulator for Feline AbdominalPalpation Training in Veterinary Medicine

Abdominal palpation is an important skill for veterinary stu-dents to master. However, the procedure is difficult to teachand learn particularly when the structures palpated are internaland out of sight. Hands-on practice is a key part of the stu-dent’s learning process but the opportunities to examine ani-mals can be limited. For example, cats have a low tolerance tohandling. Therefore, as a complement to traditional training amixed reality simulator consisting of two PHANToM hapticdevices and a toy cat is being developed to teach feline abdomi-nal palpation. Virtual models of the chest and abdominal struc-tures are ‘superimposed’ on the physical model. Veterinarianshave been involved in the development process and initial feed-back is encouraging with regard to the realism achieved and thecontribution of mixed reality to face validity. The range of sim-ulations is being extended and trials are planned to evaluate theeffects on students’ learning.

Nadine Fritz


The Virtual Reality Stimulator is a European Space Agencyactivity performed by Space Application Services (Belgium)with the purpose to develop a tool for scientists to performcognitive neuroscience research. Its objective is to build andvalidate a multi-purpose virtual reality stimulator platform forcognitive neurophysiology investigations in the InternationalSpace Station. This virtual reality based system allows to devel-op, realise and modify a wide range of experiment protocols forcognitive neurophysiology. The system gives the opportunity toexplore neuroscience and cognitive aspects in a complete con-trolled environment (e.g. 3D mazes) with defined stimulations(like aural, visual, mechanical stimulations). It allows for sub-millisecond accuracy reaction time measurements and supportsthe recording and synchronization of electrophysiological sig-nals such as EEG, EOG, EMG and ECG. The presentationwill include a brief overview of the Neuroscience research inSpace and will then focus on the requirements, methods andthe system developed for the Virtual Reality Stimulator activity.

M. Susan Hallbeck

Paper Prototypes for the Detection of StereotypeViolations in (Medical) Device Operation – AreThey Good Enough?

Controls for most technologies, including medical devices, arebecoming increasingly complex, difficult to intuitively under-stand and don’t necessarily follow population stereotypes. Theresulting delays and errors are unacceptable when seconds canmean the difference between life and death. In this study par-ticipants were asked to “control” a system using a paper mock-up (color photographs of controls) and then with a higherfidelity mock-up of the same physical controls to determineperformance differences among ethnicities and genders. Noethnic nor gender differences were found, and the comparisonof paper versus higher fidelity mock-ups also showed no signifi-cant differences. Thus, paper mock-ups as a device designusability tool will illustrate stereotype violations long before thefirst physical prototype. This will not only save money in thedevelopment and design processes, but also makes sure thateven the most complex devices, are intuitively understandableand operable for their basic functions.

Motohiro Kikuchi

Development of Virtual Dental Waxing-up Systemwith Haptic Interface

Objectives: The purpose of this research is to develop a dentalwaxing up system using virtual reality. The command tool ofthis system has the shape of a dental instrument, and themaniphalanx sense is fed back to the system depending on thedental procedure. Methods: The software enables four opera-tions, namely, “Cutting down”, “Pilling up”, “Melting” and“Finishing”. Finally, whether a virtual waxing up is practicableusing this system was verified. Results and Conclusions: Withinput of six degrees of freedom and the antipower feedback, avirtual waxing up was successfully realized. Even a student of adental college without knowledge of CAD/CAM was able towax up for approximately one hour with various systematicsupport. The demands of special technologies from the opera-tor will be kept at a minimum, and the method can be appliedto education, and consequently, to objective evaluation.

Sergei Kurenov

Development and Initial Validation of a VirtualReality Haptically Augmented Surgical Knot-Tying Trainer for the Autosuture™ENDOSTITCH™ Instrument

Surgical education techniques have not kept pace with therapid development of increasingly complicated operative tools.The need for systems that can be used to train surgeons in asafe environment will be imperative. Improvement in technicalability outside of the operating room should translate toenhanced patient safety. To help surgeons prepare we havedeveloped a tying-knot platform and used as a proof-of-concept

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the Covidien Autosuture(tm) ENDO STITCH(tm), an instru-ment which is useful but with a steep learning phase. Uncom-mon manipulations at the handle, specifically the needle move-ment between the jaws during the tying-knot procedure,require complex operations. Our platform combines the actualAutosuture instrument handle with a virtual instrument tip andsuture that allows the user to tie knots in a virtual environ-ment. Beta testing has shown that the device can differentiateexperts from novices and helps trainees understand how to tie aknot quickly and efficiently.

Jason Line


Commercialisation of medical simulators is a very unique con-cept. It is often an ad-hoc process due to significant workinvolved with developing technologies, having to re-affirmexisting educational concepts including assessment-related the-ories, and having an undefined market potential. This paper isthe first to describe one approach to commercialisation of med-ical simulators, highlighting the processes, variables and con-straints involved, and outcomes achieved through their man-agement. The described path to commercialising medical simu-lators is based on our own experience with two very differentsimulation products, as well as observations on the use of arange of other simulators and feedback given by clinicians. Dis-cussion is built around the main concept guiding the commer-cialisation process which is defined as the purpose of medicalsimulators: to serve as educational instruments in the trainingand credentialing of medical professionals, whilst maintainingproven educational concepts that underlie traditional medicaltraining.

Liliane Machado

A Framework for Development of Virtual Reality-Based Training Simulators

CyberMed is a free framework (GPL license) for the develop-ment of medical applications for simulation based on virtualreality. Some of its functionalities are: monoscopic and stereo-scopic visualization, support to several 3D visualization devices(anaglyph, polarized and shutter glasses), 2D and 3D interac-tion, support to haptics, interactive deformation and onlineassessment methodologies. The framework allows to decreasedevelopment time and offers complete synchronization amongseveral functionalities that can be selected by the programmer.CyberMed can be used by programmers of any expertise leveland offers high-level access for non-experts and low-level accessfor expert programmers. The low-level access allows the inclu-sion or extension of the framework functionalities. The presen-tation will show the framework structure, how it can be usedand expanded with specific methods. Examples of applicationsdeveloped with CyberMed will also be presented.

José Mosso

Cyborg Mini-Trainer

We show the smallest, lighter, easy to install, to carry andportable trainer for laparoscopic surgery with a weight of 400gr. And 25 cm of large, 24 cm wide and 23 cm high. This sys-tem is Integrated by an open module, a lamp and a microcam-era connected to a Head Mounted Display. This module permitsurgeon to make specifically knots. The major impact we con-sider is the use of a Head Mounted Display HMD instead ofbig screens on TV or monitors. In the future instead of micro-camera, surgeons could employ mobile phones or digital cam-eras. A HMD with one screen could be used instead of towbecoming surgeons in cyborgsurgeons.

Manivannan Muniyandi


Virtual reality based simulation of laparoscopic surgery has sofar been using some highly specialized and expensive systemsinvolving highly sensitive sensors and actuators. This presents abarrier for widespread usability of simulators, not only in devel-oping countries such as India but also in the developed coun-tries. Home made simulators are usually too simple and do notoffer the advantages of Virtual Reality environments. Our goalis to design and develop a do-it-yourself simulator for VR basedlaparoscopic simulation. The simulator uses webcams (easilyavailable and sufficiently cheap), which help reduce operatingcosts drastically. The tracking, through the cameras, of the tro-car is done using highly optimized image-processing routines inC++. Apart from the primary aim of cost-effectiveness, thesource code used also ensures that compatibility is maintainedover a wide range of platforms and systems. The accuracy ofthe simulator has been tested against that of The Phantom(from Sensable Technologies) - a well-known generic hapticshardware.

Sebastian Ullrich


We present a regional anaesthesia simulator for axillary nerveblocks in virtual environments. The main contribution is theelectric impulse transmission through soft tissue. To achievethis, we have implemented a novel approach based on electricdistance. By employing modified pathfinding algorithms, theshortest path of the electrons emitted from the needle tipthrough inhomogeneous tissues to nerve cords is estimated.Once a nerve is stimulated, the according virtual muscles areactivated by an impulse traversal through the anatomical datastructure. The resulting motor response is visualized by a para-meterized skeletal joint animation of the forearm and hand ofthe virtual patient. The purpose of the simulator is to conveypractical experience to anaesthetists and thus improve theirskills. First prototypes have been presented to medical residents


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and are to be evaluated very soon. Plausible interaction, visuali-zation and basic haptic rendering ensure intuitive usage of thesimulator.


Developing An Immersive Ultrasound GuidedNeedle Puncture Simulator

We present an integrated system for training ultrasound (US)guided needle puncture. Our aim is to provide a validatedtraining tool for interventional radiology (IR) that uses actualpatient data of straightforward and complex anatomy andpathology. Data sets are segmented using interactive processesto label target anatomy. This is used to create surface meshesand volume meshes. The tissue deformation due to the needleinsertion is computed in real-time using linear finite elements.The intrinsic motion of organs and their deformation due tothe respiration are also modeled. The force feedback is based onforce measurements that have been made on real tissue. Also, asthe trainee moves the image probe over the skin of the virtualpatient, a corresponding US-like image is computed and dis-played in real-time. Preliminary content validation studies ofour framework, demonstrated favourable observations that areleading to ongoing revisions.

Yoshinori Yoshida

Virtual Reality Simulation Training for DentalSurgery

In dentistry the exquisite hand skill is required for daily treat-ments, and acquisition of the skill is essential for dental stu-dents. In the present study, by using haptic device, develop-ment of an educational system to train the extraction of wis-dom tooth. was attempted. 3-D CT image of wisdom tooth,row of the teeth, face, jaw bone, tongue and gums were separat-ed from the CT image of a patient. They were input into soft-ware Free Form to operate by haptic device PHANTOM. Theextraction simulation was carried out while feeling the sense offorce from various tools of haptic device. Initially, gums werecut with the knife tool, and alveolar bone was carved to con-tour of the wisdom tooth could be extracted. The crown andthe root of a tooth were divided, and extraction was done bymoving tool noting the direction of the wisdom tooth. Incisedgum was closed, and the simulation of extraction surgery wascompleted.


Joerg Beardi

Comparison between “Computer Gaming Kids”and Experienced Laparoscopic Surgeons underSimulated Laparoscopy Conditions

Today the influence of Computergaming and Computergame

experience on the social development of children and teenagersis intensively discussed. Our hypothesis is that through com-puter games visuospatial perception, which is needed forlaparoscopic surgery can be trained. We examined the influenceof computergame experience on surgical skills of children andteenagers. From January 2007 to August 2007 we examined230 children and teenagers from 6 to 17 years of age (mediumoverall 10,75 years, median age 10 years). The children per-formed tasks on a laparoscopic virtual reality simulator. Groupswere comparable in age and overall computer game experience.Group with 3 hours or less computer gaming experience perweek, group 2 with 3 -10 h/ week and group three with morethan 10 hours experience per week. Group 3 was faster, madefewer mistakes and operated more precise than group 2 whichperformed better than group 1 in nearly every chosen task.


Endotracheal Intubation Comparing a PrototypeStorz CMAC and a GlideScopeVideolaryngoscope in a Medical TransportHelicopter – A Pilot Study

Airway management and intubation skills are essential for com-bat medical care. This pilot study tested a prototype miniatur-ized CMAC video laryngoscope versus the GlideScope (GS) ina simulated helicopter intubation scenario. Subjects in this pilotstudy were 8 flight paramedics and nurses, who had intubationexperience with 30+ patients. Participants performed intuba-tions on a Laerdal Airway Mannequin in the standard and diffi-cult airway configurations, using direct and indirect laryn-goscopy with the Storz CMAC video laryngoscope and an indi-rect intubation using the GlideScope. Intubation times andsuccesses were recorded. Comparison of intubation success ratesusing DV vs. CMAC and GS (indirect) laryngoscopy in theDifficult Manikin Airway showed 0 successful intubations withDV compared to 62.5% with the CMAC and 59% with GS.This study demonstrates that the CMAC and GlideScope vide-olaryngoscopes provide improved views of the glottic openingin a simulated difficult airway compared to direct laryngoscopy.


Endotracheal Intubation in a Medical TransportHelicopter – Comparing Direct Laryngoscopywith the Prototype Storz CMAC©Videolaryngoscope in a Simulated DifficultIntubating Position

During combat trauma situations, patients’ airways must some-times be managed when they are in less than optimal positionsfor intubation. In this study, we tried to create a difficult intu-bating position and evaluate whether or not intubation couldbe successfully performed using direct and indict laryngoscopy.Flight medical personnel attempted to intubate a Laerdal diffi-cult intubation manikin in a helicopter using both standardintubating positioning (with the intubator at the head of thestretcher) and difficult intubating position (with the intubatorat the foot of the stretcher). During backward intubation of the

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difficult manikin airway, we found a statistically significant dif-ference in the average airway view scores between the direct(MAC) versus the indirect (CMAC) view intubations. This dif-ference in airway visualization can significantly increase thespeed of establishing a patent airway and increase the speed ofoxygenation, resulting in prevention of brain cell death and sav-ing lives.

Ben Boedeker

Videolaryngoscopy for Intubation Skills Trainingof Novice Military Airway Managers

An estimated 10% of preventable battlefield deaths are due toAirway obstruction. Improved airway rescue strategies are need-ed with new tools for airway management by less experiencedproviders. Airway management and training are improved usingvideo laryngoscopy(VL) compared to direct laryngoscopy (DL).We evaluated if novices could rapidly acquire fundamentalskills and improve intubation time compared to non-novicesusing VL in a manikin. For 43 subjects mean intubation timedid not differ for DL (25.9 ± 24.5 seconds) vs. VL (26.4 ±31.5 seconds) {p = 0.94 paired t-test}. Novice intubation timewas 6.82 ± 31.0 seconds greater with VL (31.6 ± 34.6 seconds)vs. DL (24.8 ± 18.5 seconds) {p = 0.255 paired t-test}. VL vs.DL time difference was not different between novice and non-novice groups. Mean Cormack-Lehane airway visualizationscores (range 1-4) were higher with VL (1.95 ± 0.97) vs. DL(1.02 ± 0.15){Students t-test p <0.0001}.

Ben Boedeker

Remote Videolaryngoscopy Skills Training forPre-Hospital Personnel

Videolaryngoscopy (VL) is a novel technology that can facili-tate rapid acquisition of intubation skills with simultaneousteacher and learner visualization of laryngeal structures. Video-laryngoscopy improves laryngeal visualization, and improvesintubation success in difficult airway management compared tostandard direct laryngoscopy. First responders need enhancedairway management tools to improve intubation success rates incivilian pre-hospital, and military battlefield settings. We com-pared the effectiveness of a remote first responder videolaryn-goscopy skills training paradigm using a distance learning plat-form with synchronous transmission of laryngoscopy images toa remotely located trainer. Airway visualization, intubation suc-cess rates, and intubation times documented equivalence ofremote and face-to-face introductory familiarization and intu-bation training with the Storz-Berci videolaryngoscopy system.Remote training paradigms for advanced technology solutionssuch as videolaryngoscopy can accelerate the diffusion of life-saving new technologies, especially when there is limited accessto specialized training programs.

Doo Yong Lee

Sectional Analysis of Learning on the KAIST-Ewha Colonoscopy Simulation II

The previous studies assess the trainees’ performance in aggre-gate manner, i.e., for the entire colon using global performanceindices such as total intubation time and total number ofadverse events during the overall procedure. Colon can bedivided into four segments, i.e., sigmoid, descending, transverseand ascending colon. Each colon segment has different length,shape and characteristics. The necessary skills and degree of dif-ficulty to navigate through each segment are different. There-fore, the rate and amount of learning during practices can bedifferent for each colon segment. Analysis in aggregate mannercan blind the different learning and hence, the differentrequirement for an effective and efficient simulation. Thispaper reports on the study to validate the KAIST-EwhaColonoscopy Simulation II as a training tool by examining thelearning in the specific sections of colon. This study is a firstattempt to observe the learning made in the individual sectionsof the colon during simulation. One of the interesting pointsconfirmed in this study is that a large portion of betterment inthe intubation time, number of red-outs and red-out timeappears in the sigmoid colon and the descending colon.


Face Validation of the Virtual Basic LaparoscopicSkill Trainer (VBLaST™)

In this paper we present the face and construct validity of theVirtual Basic Laparoscopic Skill Trainer (VBLaST) . TheVBLaST is a virtual-reality based system that can reproduce thefive Fundamentals of Laparoscopic Surgery (FLS) task to beperformed on the computer. The main advantage of this systemis its ability to objectively measure multidimensional perform-ance metrics during task performance. The face validity wasevaluated based on the subjective scores expressed in 10-pointLikert scale for various questions related to the relevance of thesimulator. The construct validity was evaluated based on MIS-TELS normalized scoring system for the five FLS tasks. We arecurrently conducting the IRB approved study at the Universityof Albany Medical Center and at the Beth Israel Deaconessmedical center. By comparing and contrasting the performanceof VBLaST with the FLS trainer box, we plan to show theeffectiveness of VBLaST.

WEDNESDAY POSTERSMODELING

Ciamak Abkai


A new model for electrocardiography is presented, which is basedon multiple number of dipoles instead of using one as done in


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vector electrocardiography. The multiple dipole parameters arecalculated based on real data (4 dipoles from 12-channel ECG)solving the backward problem of electrocardiography applyingdifferent iterative numeric methods. The results are transformedto a waveform description based on Gaussian approximation foreach dimension of one dipole. Usually up to 5 Gaussian parame-ter are used to approximate the waveform within a small errorrange. The compact parameterized descriptions are saved inXML format and can be used for real-time simulation by solvingthe forward problem of electrocardiography. The solutions can beused in hardware to emulate the electrical potential with regardto the distance to dipole sources, measurable by standard ECGmonitor devices on the one hand side or for virtual simulationsin software on the other hand side.

Eric Acosta


Computer-based medical simulations rely on physically-basedvirtual environments (VEs) for realistic object interactions andbehaviors. Physically-based VEs are computational resourceintensive when solving large numbers of equations needed tosimulate the VE. Limited CPU resources often require VEs tobe simplified for real-time performance, which can reduce asimulation’s realism. Multi-core processors greatly increase thecomputational capacity of computers. We have developed amodular pipeline VE architecture designed for multi-core CPUsystems. Experiments show the architecture scales efficientlywith the number of CPU cores. Speedup is relatively independ-ent of the number of VE objects. Near linear (and super-linear)speedups are obtained as additional CPU cores are utilized. Thearchitecture enables building and simulating physically-basedVEs. The architecture’s modularity easily allows integration ofindependently developed algorithms into a parallel environ-ment. Leveraging all multi-core processor resources makes itpossible to increase the complexity and realism of physically-based VEs and medical simulations.

Farzam Farahmand

A Surface Registration Technique for Estimationof 3-D Kinematics of Joints

Surface registration is the process of aligning the 3-D datapoints acquired from different viewpoints or at different times.The aim of this study was to propose a new approach for esti-mation of the transformation matrix of articular surface ofjoints in two scenes of clinical images. The relationshipbetween the initial and transferred location/orientation of apoints cloud was analyzed and relations were formulated overthe unknown translation/rotation components as a spatial regis-tration problem. The method was then generalized to a largernumber of points using the least squares method, and any freeform points cloud using the influence surface modelingmethod. Evaluation of the method in two case studies resultedin high accuracies of ±1 mm and ±1 degree. In general, theproposed method was found to be a powerful technique for

registration of complicated freeform surfaces and provide the 3-D kinematics of joints.

Craig Hourie


This description of our framework for implementing real-timesurgical simulation scenarios includes an analysis for the needfor an integrated layer of hardware and low-level programmablesupport. We focus on the special requirements of surgical simu-lators; the requirements for interactive dynamic scene com-positing, multi-body collision detection and physics basedmodel updates are common with other simulators, but in addi-tion the new challenges include multimodal and volumetricvisualization support, integration of specialized laparoscopicinterfaces and tracked tools, and the need to connectdeformable modeling and surface-to-surface contact manifolds.Our framework is DirectX-based and is deployed across NVidiaPhysX, and CUDA platforms, for solving the core Lagrangiansystems of partial differential equations in the constitutivemodels of tissue biomechanics. As a demonstration, we show aninteractive surgical case study where the scene includes interac-tions between mesh free particle clusters, finite-element vol-umes, and mass-spring surfaces, representing tissue, and therigid body surgical tools.

Vassilios Hurmusiadis

From Cell to ECG: Real-Time InteractiveSimulation of Cardiac Electrophysiology for ECGTraining

We aim to simulate the principles of electrocardiography usinga real-time interactive 3D simulation of cardiac electrophysiolo-gy. The whole heart was equipped with cell-nodes and fiber ori-entations. A model of the conduction tree was constructed.Cell activation sequences were constructed and formed thebasis for the construction of the intercellular activation propa-gation. A cellular automaton was developed to simulate thepropagation of electrical excitation through the cell-nodes. Thesimulated electric axis is calculated over a beat cycle and is pro-jected on the Einthoven and precordial leads. Malfunctioningregions were simulated by altering the cell activation profiles incertain groups of cell-nodes. The application will allow end-users (medical students, trainee cardiologists, coronary carenurses) to become intuitively aware by interacting with the car-diac excitation process in real-time, in a bottom-up approach:from cell to ECG. The work in progress is supported by PrimalPictures Ltd and the London Development Agency, UK.

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Derek Magee

A Physics Based Method for Combining MultipleAnatomy Models with Application to MedicalSimulation

Medical simulations are frequently based on patient derivedimaging datasets. Unfortunately, no single imaging modality /dataset / patient will optimally demonstrate all the requiredanatomical and pathological features. We present a novelapproach for constructing virtual anatomical environments bycombining anatomic data obtained from different imagingsequences, modalities or patients. A generic anatomical datasetis used to generate a mass-spring model defining the shapes,spatial relationships, and physical properties of the solid organs,muscle and skeleton. Subsequently, individual anatomical ele-ments can be modified or “swapped” for datasets demonstratingalternative anatomy or pathology. Gradient Vector Flow andDistance Transform maps are used to estimate the externalforces that are applied to the mass-spring system to ensure thenew components fit into the existing shape. We demonstratehow replacement of anatomical components simplifies anatom-ical modeling for medical simulation. This technique could alsobe applied to other areas, such as atlas building, and simulationof tissue deformation due to tumour growth.

Yong Hum Na

A Method to Create Size-Adjustable Whole-BodyPatient Models for Radiological Studies of OrganDoses

Background: Whole-body organ-size adjustable and percentile-scaled adult patient models are needed for radiological studiessuch as Computed Tomography (CT) imaging, radiation cancertreatment, and assessment of internal dose burden. This paperdiscusses an automatic mesh deformation method and its appli-cations. Method and Materials: The automatic mesh deforma-tion algorithm was implemented by MATLAB(r) 7.4 with theAnatomiumTM 3D models whose organ geometries were mor-phed to the International Commission on Radiological Protec-tion (ICRP) reference male/female organ volume/mass datawithout unwanted mesh overlap surface. These models aretransformed to solid geometries through the voxelizationprocess. Results: The size-adjustable whole-body patient meshmodels were able to be transformed to the solid geometries inthe voxel domain for the various radiological procedures andother types of ionizing radiation simulations using MonteCarlo techniques. Conclusion: This study has demonstrated thefeasibility to create the size-adjustable whole-body patient meshmodels which can be applied to various radiological proceduresto improve the accuracy of dose assessment by anatomicallymatching a specific person.

Herke Jan Noordmans

Real-Time Brainshift Correction of Pre-OperativeImage Data for Neuronavigation, Using Today’sGraphics Hardware

Processing large images files requires intense computationalpower. Driven by the gaming industry, the processing power ofgraphics cards (GPUs) has increased significantly. With the pixelshader model 4.0 the GPU can be used for image processing 10xfaster than the CPU. Dedicated software was developed toprocess 3D MR and CT image sets for the real time adaptationof brain shift during navigated neurosurgery. A ray-traced 3Dbrain image can be deformed according to the per-operative cor-tex location. GPU based programming enables real-time process-ing of high definition image datasets and various applications canbe developed in medicine, optics and image sciences.

Kresimir Petrinec

The FMA Database Browser: A Key Componentof an Interactive Image Visualization Pipeline

University of California at Los Angeles (UCLA) Center forAdvanced Surgical and Interventional Technology (CASIT)researchers are developing an interactive image visualizationpipeline with the ability to rapidly visualize and efficientlyinteract with patient-specific image datasets. The pipelineenables patient-specific image datasets acquired in a DigitalImaging and Communications in Medicine (DICOM) formatto be converted into a three-dimensional (3D) deformable for-mat that facilitates future simulation-based interactivity. UCLACASIT researchers have developed a standalone FMA databasebrowser which provides manual assignment of FoundationModel of Anatomy (FMA) identification codes (IDCs) to sur-faces generated from patient-specific DICOM format data andto the reference 3D model. The FMA database browser is a keycomponent of this innovative image visualization pipeline.

Joseph Romano


Representing deformable and breakable objects is both a com-mon goal and a computational challenge for any modern med-ical simulation. Immersive user feedback can be provided bycreating a real-time mathematical model to track these states.Many modern approaches, such as finite element methods, can-not reach the high update rates necessary for haptic and graphicfeedback, thus limiting the scope of user interaction. Ourapproach combines prior work in mass-spring-damper repre-sentations for deformable tissue with a previously publishedforce model for tissue puncture. By using the computationalsimplicity of the mass-spring-damper model, we are able toexceed the update rates necessary for graphical display of rea-sonably complex models. Furthermore, we introduce a novelmethod for performing real-time three-dimensional hapticinteraction when using the mass-spring framework. Results


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show that our simulation technique is both physically realisticand immediately viable on existing hardware.

Chengyu Shi

Development of a Patient-Specific PredictiveGeometry (PPG) Model Based on Real Patient 4DCT Data

Background: patient respiratory motion is a critical problem inradiation oncology and a virtual predictive model is helpful insolving this problem. Tools and Methods: based on our previ-ous study, a Patient-specific Predictive Geometry (PPG) modelhas been developed from real lung patient 4D CT data. The riblength information derived from the patient’s 4D CT measure-ment. The breathing curve of the patient has been analyzed toextract amplitude and period information. Kalman filter hasbeen used to predict the breathing curve. The rib cage rotationangle was calculated based on the rib length and breathingcurve amplitude. Results: the rib rotation angle has been calcu-lated with maximum rotation angle 11 degree. The averagedbreathing curve period is 3.86 s. With the kalman filter predic-tion ability, the virtual model has predicting ability. Conclu-sion: it is possible to develop a lung PPG model based on a realpatient 4D CT data.


The Clockwise Rotation of Myocardial FiberOrientation from Epicardial to EndocardialSurface in Left Ventricular Free Wall in a Post-mortem Human Heart

Following fixation and MRI imaging, a post-mortem humanheart was sliced in the sagittal plane. Each anatomical sectionwas then cut into smaller segments and each one of them wassubjected to classical histology. The resulting microscopy slideswere digitalized with a high resolution scanner and the histo-logical section was reconstructed with the Adobe PhotoshopCS2(r). Using software especially developed for our purposes(FiberCad), we can identify and draw (with the assistance ofoptical microscope) those fibers that either lay upon, or are per-pendicular to, each microscopy slide’s plain of section. Toachieve a histological 3D reconstruction, the software isequipped with an option that allows the user to search for thebest possible fit between the histological and the MRI images.We present a series of consequent sagittal sections of the LVfree wall (from the epicardium to the endocardium), fromwhich the clockwise rotation of the mean orientation of thefibers laying on the plane of section, is clearly evident.

Georgios Theofilogiannakos

Computational Tools for Addressing the Forwardand Inverse Problems in Electrocardiology

Solutions of both the forward and inverse problem of electro-cardiography rely on the modeling of the anatomic and electri-

cal properties of the thoracic tissues. This requires good knowl-edge of the electrical anisotropy of the heart, lungs and the restof the thorax. Cardiac electrical anisotropy is related to itsmicrostructure. We developed three computational tools toaddress the related modeling requirements. MRICad is a semi-automatic user guided program that creates a detailed 3D meshof the thorax and heart, using image data from contiguous twodimensional MRI slices. FiberCad models myocardial fiber ori-entation, deriving its data from high-resolution ex vivo humanheart MR images and from histology specimens of heart tissue.TORSOheart is used for integrating the 3D thorax and heartmeshes, created by MRICad and FiberCad respectively. Com-bined together they provide a realistic analytical model of thehuman torso and the heart in the form of three dimensionaltetrahedral meshes.

Mei Xiao


Generic anatomical digital 3D models have been used in areassuch as therapy planning, customizing replacement body partsand shape developments. However, building generic anatomicalmodels generally requires a graphic designer to study shapes ofreal objects intensively and design polygon meshes using mod-eling software. We have developed an efficient virtual dissectiontool that biologists could use to create generic 3D models fortheir atlases without the need for artistic drawings. Our cus-tom-developed tool can be used to extract 3D models frommedical image stacks, cut the models and align the sub-models.Corresponding 2D medical image portions of the sub-modelscan then be aligned and averaged. At the end, the genericmodel over all the subjects can be obtained from the averaged2D images. The technique we developed optimizes the func-tionalities of existing toolkits and the resulting software packagewill allow biologists to build their atlases more quickly andaccurately.

SIMULATOR DEVELOPMENT TOOLS

Venkata Arikatla

Plug-and-Play Tool Handles for LaparoscopicSurgery Simulators

We have developed a cheap, easy-to-use interface for minimallyinvasive surgery simulators. We adapted actual laparoscopichand tools to be interfaced with the PHANTOM(r) OmniTMdevice. The opening and closing of the tooltip is captured byan 1 M-Ohm linear taper rotary potentiometer that is instru-mented into the handle of the tool. Similarly, the rotation ofthe tooltip is also captured by using a linear taper rotary poten-tiometer. The potentiometers are used as variable voltagedividers, where the output voltage varies corresponding to theposition of the potentiometer. Ontrak(r) data acquisition devicethen reads the output voltages and feeds them to the simulatoras a binary string. The surgical simulation code interprets and

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then determines the angles of the virtual tooltip. This low costdesign can easily emulate opening and closing as well as therotation of the tip about the tools axis without the use ofexpensive interfaces commercially available.

Dhanannjay Deo

Development of a Glove-Based Wearable Systemfor Objective Assessment of Laparoscopic Skillsand Some Observations for a Peg Transfer Task

A novel wearable glove-based system for recording hand andjoint motion during laparoscopic task performance has beendeveloped which can be used for objective analysis and assess-ment of surgical skills. The data measured involved 3 positionvariables of the hand and 3 orientation angles using the Flockof Birds (tm) and pressure magnitudes at each of the fingertipsand bend motions at each finger joint using noDNA X-IST(tm) data gloves. The glove system was used in an experi-ment at Albany Medical College involving a bimanual pegtransfer task. Four expert surgeons at least at the level of chiefsurgical resident and twelve residents with no prior experiencewith laparoscopic instruments participated in these experi-ments. The data streams acquired were analyzed quantitativelyand qualitatively for comparison between expert and novicesurgeons.

Rachel Ellaway

Integrating Simulation Devices and Systems

We are developing a simulation integration platform across anumber of projects that are looking to integrate and aggregatedisparate simulation tools and resources, including the HealthServices Virtual Organization (HSVO) and the Virtual Educa-tional Research Services Environment (VERSE) projects. Theend result is the integration of tools such as commercial man-nequins, screen-based simulations, 3D worlds and physiognom-ic algorithms, each able to interact and share data, therebyenabling more fluid and innovative use of simulation in manydifferent settings to: > Provide common data standards andAPIs for different simulation devices and tools to interact witheach other. > Drive an open standards and access agenda, par-ticularly in encouraging and enabling commercial, open sourceand local developments to interact. > Support more fluid, well-aligned and innovative uses of simulations tools and technolo-gies. > Stimulate research and development into existing andemergent patterns of simulation use in different settings.

Matthias Färber


The use of virtual reality techniques opens up new perspectivesto support and improve the puncture training in medical educa-tion. In this work a 3D VR-Simulator for the training of lumbarand ascites punctures has been extended to support the bending

of the puncture needle. For this purpose the needle is designed asan angular spring model. The forces that restrict the user frombending the needle are calculated using a multiproxy techniqueand given to the user via a 6DOF haptic device (Sensable Phan-tom Premium 1.5). Proxy based haptic volume rendering is usedto calculate the proxy movement. This way it is possible to inte-grate original CT-patient data into the rendering process andgenerate forces from structures that have not been segmented.The bending technique has been integrated in a VR-training sys-tem for puncture interventions and shows good results concern-ing update rate and user acceptance.

Chuan Feng

Usability Study of Computerized Surgery Trainingand Assessment System

The lack of objective performance assessment capability is anissue of concern in minimally invasive surgical training.Although some virtual reality (VR) surgical simulators providemulti-metrics performance evaluation, the difference betweenthe reality and the virtual environment is notable. In order tobridge this gap and to improve the quantitative assessment, wehave developed a situational awareness enhancing system(SAES) for MIS. The SAES uses a unified framework incorpo-rating the perception, comprehension, and projection softwaremodules that provide feedback during the exercises and enablean evaluation of the training procedure.

Shin Hasegawa

Simulation of Vaginal Wall BiomechanicalProperties from Pelvic Floor Closure Forces Map

We simulate the way Pelvic Floor Muscles (PFM) generates zonalcompression on the vagina to maintain urinary continence. Rawdata were obtained using a probe to map the distribution of pres-sures. Simulation model was made using the structural and shearspring approach. We simulated two models that are applied tocontrols and patients based on the measured force maps. ThePFM values of both of cases are measured when relaxed and con-tracted. Simulation clearly distinguished between control andpatents. Simulation results further demonstrate that in the con-trols, there is a temporal priority so that the closure force reachesmaximum fast. Conversely in patients, PFM initiated closure isslow. We conclude that we can simulate the mechanism of thevaginal wall closure using the spring mass model and the forcemaps, with vaginal closure pressures. Furthermore by visualizingthe anatomical deformation of the vaginal wall, better under-standing of function is facilitated.

Sergei Kurenov


We have created a low-overhead, robust, non-physical represen-tation of the peritoneum membrane that interactively adjusts toenclose, possibly moving, underlying anatomical features. The


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membrane class is implemented within the real-time “Toolkitfor Illustration of Procedures in Surgery” environment, along-side haptically enabled organs, blood vessels, fatty tissue andsurgical tools. The membrane class supports probing of theseunderlying anatomical features and, although non-physical,mimics retraction under its own tension when cut.

Leow Wee Kheng


Many surgical simulation systems have been developed. Amongthem, reactive systems attempt to simulate real-time displace-ment and deformation of body tissues in response to userinputs. They are useful for surgical training and preoperativeplanning of surgical operations. However, to use a reactive sys-tem to predict the results of a complex surgical procedure, onewould need to go through all the surgical steps, which istedious and time-consuming. In contrast, our research goal is todevelop a predictive system for the simulation and planning ofcomplex cardiac surgeries. This approach allows the surgeon toeasily explore various surgical options to determine the bestones without going through all the detailed surgical steps. Thispaper illustrates our work on predictive surgical simulationusing aorta reconstruction in arterial switch operation as anapplication example. Successful test results demonstrate thatpredictive simulation of complex cardiac surgeries is feasibleand useful for the surgeons.


Hybrid Network Architecture for Interactive Multi-UserSurgical Simulator with Scalable Deformable Models

In this paper we present a hybrid network architecture withscalable deformable model for a multi-user interactive surgicalsimulator. The hybrid network architecture consists of a centralserver that has all the necessary information for simulation ofdeformable objects in the scene. Multiple clients connected tothe server each of whom have a local copy of the deformablemodels which are updated periodically and synchronized glob-ally from the server using a TCP/IP connection . In additioneach clients also establish a UDP connection to all other clientsin a peer-to-peer fashion to multicast information at hapticdata rates. The machine learning based deformable model inthe server is scalable and has the ability to update each clientswith just enough information necessary for them to interactwith their local model independently. Experiments are currentlybeing performed using the Internet to demonstrate the effec-tiveness of our system.



In this work, we present an efficient real-time method to detect

knots in a virtual-reality suturing simulator. The knot detectionmethod exploits the self-collision information on pairs ofthread segments to detect the knot. Once the knot is detected,it is frozen for further evaluation in the simulator. This methodwas successfully tested for standard knots that are applied dur-ing a minimally invasive surgical (MIS) procedure in the simu-lator. Overall the thread contained fifty segments that areupdated using the “Follow the Leader “ (FTL) algorithm. Theknot detection was achieved at the haptic update rate of 1000Hz which is considerably faster than other approaches based onknot theory.

Ji Son

Quantification of Intraocular Surgery Motionswith an Electromagnetic Tracking System

An intraocular surgical tracking system that can track the spatialposition and orientation of the surgical instruments using mag-netic sensors has been developed. DC magnetic tracking sensorswere attached near the tools tips, so not to compromise the func-tionality of the tools, to continuously monitor their X, Y, and Zpositions. A hardware-software interface was developed thattransforms the coordinate data points into instrument pathways.These data are recorded and saved in a database for subsequentimmersive training and training performance analysis. Three 6degree-of-freedom (DOF) DC magnetic trackers were used witha sensor diameter of 1.3 mm. Motion tracking was performedduring a combined phacoemulsification (PKE) and pars planavitrectomy (PPV) procedure on a pig eyeball. A referential sensorwas placed on the surface of a pig eyeball.

Satoshi Yamaguchi

Dental Haptic Simulator to Train Hand Skill ofStudent-Calibration Method to RealizeVisual/Haptic Environment

In dentistry the exquisite hand skill is required for daily treat-ments, and acquisition of the skill is essential for dental stu-dents. However, conventional dental practice using phantommannequin has the limitation for the case setting and the fre-quency of practice. The aim of our study was to develop a pro-totype educational system to train tooth preparation with virtu-al haptic force and assist students to acquire hand skill. Oursystem consists of a workstation with Dual Core Intel Xeon5160 CPU (wx6400 Hewlett-Packard Co., Ltd, Japan), hapticdevice (PHANToM Omni, SensAble Technologies, Inc.,U.S.A), and half-mirror (light transmittance: 30%). Computergraphics (CG) of a patient is projected forward a user throughthe half-mirror. In the present study, we perform calibrationbetween haptic coordinate system and half-mirror coordinatesystem to realize real clinical situation. The user can interactdirectly the CG by using a stylus of the haptic device.

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SIMULATION & TRAINING

Johan Creutzfeldt

Retention of Knowledge after Repeated VirtualWorld CPR Training in High School Students

Massive Multiplayer On-line Simulations (MMOS) were usedto train 12 high school students in Cardio- Pulmonary Resusci-tation (CPR) in a pilot study. In groups of 3 the subjects weretrained in multiple similar scenarios in two sessions 6 monthsapart. Eighteen months after the last training session 9 of thesesubjects were assessed for knowledge, performance and per-ceived mental strain during CPR in a simulated full scale sce-nario. We found clear signs of retention of the training whencompared to a matched control group. Although generalknowledge and performance did not differ, it was evident thatthe procedure that had been trained still was remembered to acertain extent. The perceived mental strain was also higher inthe experimental group. We hypothesize that this kind of train-ing has important benefits and may in turn modify reactions tothe traditional type of Basic Life Support (BLS) training.

Stefan Holubar

Virtual Pelvic Anatomy and Surgery Simulator:An Innovative Tool for Teaching Pelvic SurgicalAnatomy

Understanding 3-D pelvic anatomy is difficult due to the com-plex interfaces of bony, neurovascular and visceral components.We are in the process of developing an educational simulator,based on a virtual anatomic model, which will be integratedinto the educational curriculum of Mayo Clinic Multidiscipli-nary Simulator Center. This educational module will emphasizethe spatial relationships of the pelvic viscera in a way that tradi-tional educational methods cannot. Using high-resolution com-puted tomography (CT) and magnetic resonance (MR) data-sets, pelvic anatomic structures are segmented into a 3-D “vir-tual” anatomic model. A corresponding physical model withvarious pathologic components provides tactile correlation.Upon completion of the beta-module, survey-based testing ofmedical students and residents will evaluate the modules educa-tional effectiveness. This module will facilitate medical studentand resident learning of pelvic anatomy, and will allow residentand surgeon to rehearse complex surgical procedures by per-forming virtual surgery, thereby improving preparedness for realoperations.

Kanav Kahol

Visualization and Analysis of Medical Errors inImmersive Virtual Environments

Preventable medical errors are a significant cause for a largenumber of deaths in the healthcare industry. With the adventof monitoring devices and virtual environments like SecondLife there is a possibility to develop software that can capture

real time interactions and workflow and visualize them virtuallythrough playback and analysis tools. The paper presents such asystem. Using off-the-shelf Radio Identification tags, subjectlocation can be tracked. Audio recorders are used to capturesubject interaction with other individuals. The synchronizationof RID data and audio recordings yields data that is then visu-alized using customizable virtual world. The virtual world isbuilt from floor plans as well as pictures of the actual environ-ment. The system is augmented by analytical visualizationssuch as person-person interaction graphs, hotspots etc. that Inconjunction with replaying scenarios in virtual environmentsallow for better analysis of root cause of errors and error man-agement training.

Elizabeth Krupinski

Assessing Radiology Resident Preparedness toManage IV Contrast Media Reactions UsingSimulation Technology

We investigated whether radiology residents could correctlydiagnosis and treat contrast reactions using simulation technol-ogy. Eleven residents experienced a test scenario where a simu-lator patient given contrast had a reaction. Sessions were evalu-ated and timed using predetermined key actions. Eye-positionwas recorded in 4 residents. There was no significant differencefor junior versus senior residents, but juniors (mean = 71.10%)performed higher than seniors (mean = 62.75%). Medicineprelim residents received higher (mean = 73.85%) scores thanthe transitional (mean = 64.40%) and surgery (mean =61.47%). Those who performed higher looked for shortertimes at more relevant places in the room than those who per-formed worse (tended to look at the patient not the monitoringequipment). These data demonstrate a gap in training in themanagement of reactions among radiology residents. Patientsimulators to train the management of contrast reactions haspromise to correct the unevenness of training experiences.

Sergei Kurenov


An interactive, video game-based training module, Burn Cen-ter, was developed to simulate the real-life emergency events ofa mass casualty disaster scenario, involving in 40 victims. Thegame contains two components - triage and resuscitation. Thegoal of the triage game is to correctly stabilize, sort, tag andtransport burn victims during a mass casualty event at a busytheme park. After complete the triage component, the playerwill then take on the role of a burn care provider, balancing theclinical needs of multiple burn patients through a 36-hourresuscitation period, using familiar computer-simulated hospitaldevices. Once complete, players of Burn Center will come awaywith applicable skills and knowledge of burn care, for bothfield triage and initial resuscitation of the burn patients.


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Fuji Lai

Robotic Telepresence for Medical Training andEducation

See one, do one, teach one has long been the paradigm formedical education. The challenge is that it is not always easy tobe exposed to the entire spectrum of cases that is possible. Oneway to standardize the experiential training is to “open up” theOR or Angio Suite to more than the immediate team at thepatient site. The Remote Presence system has been used toenable trainees and mentors to remotely observe cases and to be“virtually present” for a procedure taking place across the coun-try or even around the world. This new paradigm for timelyclinical expertise delivery and dissemination will have a palpa-ble impact on clinical training and the availability of qualitypatient care across geographical barriers.

Yuri Millo

Advanced Medical Simulation: Inexpensive SkillsTraining for Students and Clinicians

One barrier for adoption of simulation-based training in medi-cine has been the prohibitively high cost of simulators in theresource-constrained environments of the medical school,teaching hospital, and clinical practice setting. Gaming consolesprovide interactive three-dimensional (3D) graphics and forcefeedback that can support all but the most complex simulation-based training in medicine. In collaboration with MicrosoftCorporation, we are developing Xbox 360TM modules fortraining psychomotor skills for a variety of procedures in emer-gency medicine and acute care surgery. This presentationdescribes our development of a flexible fiberoptic bronchoscopysimulator for placement of an endotracheal tube. Based on ourresults, this approach is both feasible and efficient, given themultitude of art and programming tools that are available forgame developers. Thus, we have been able to produce a com-pelling and engaging bronchoscopy simulator, featuring a tieredhierarchy of skills progression that can run on a low-cost gam-ing platform.

Victor Vergara

The Use of Virtual Reality Simulation of HeadTrauma in a Surgical Boot Camp

Surgical “boot camps” provide excellent opportunities toenhance orientation, learning, and preparation of new surgeryinterns as they enter the clinical arena. This paper describes theutilization of an interactive virtual reality (VR) simulation andassociated virtual patient (VP) as an additional tool for surgicalboot camps. Complementing other forms of simulation, virtualpatients (VPs) require less specialized equipment and can alsoprovide a wide variety of medical scenarios. In this paper wediscuss a study that measured the learning effectiveness of areal-world VP simulation used by a class of new surgery internswho operated it with a standard computer interface. Theusability of the simulator as a learning tool has been demon-

strated and measured. This study brings the use of VR simula-tion with VPs closer to wider application and integration into atraining curriculum, such as a surgery intern boot camp.

Yan Zhang

A Survey of Simulators for Palpation Training

Palpation is a widely used diagnostic method in medical prac-tice. The sensitivity of palpation is highly dependent upon theskill of the clinician, and palpation skills are often difficult tomaster. There is a strong need for pupation simulator. Thispaper summarizes the important work and latest achievementsin the simulation for palpation training. Three types of palpa-tion simulators, physical models, Virtual Reality (VR) basedsimulation, and hybrid (computerized and physical) simulator,are surveyed. Comparisons among different kinds of simulatorsare presented.

VISUALIZATION

Hossein Arabalibeik


Spiromerty is a common test in evaluating the functionality ofthe pulmonary system. An intelligent decision support systemcould assist physicians for accurate diagnosis by providing morecredible results. In this work neural networks are used as a clas-sifier to discriminate between obstructive and restrictive pat-terns of pulmonary disease. Mixed pattern abnormality isdetected as well. To achieve better classification performance,the results of a group of neural networks are combined usingthe Bayesian reasoning as an aggregation algorithm. Bayes’ The-orem explains how we can integrate new evidences to the previ-ous decision. The results of this study showed that the pro-posed algorithm could be used in diagnosing pulmonary dis-eases and discriminating between its restrictive and obstructivepatterns.

Jeremy Cooperstock

A Comparative Study of Monoscopic andStereoscopic Display for a Probe-PositioningTask

A critical challenge in neurosurgical imaging is to provide aneffective means of visualizing and interacting with data of thepatient’s brain, in a manner that is natural to surgeons. Whileimproved display of volumetric brain data is likely to aid inunderstanding of the 3D content, little investigation appears tohave been made into the question of how different display tech-nologies and interaction paradigms affect perception and under-standing of such data. To address this need, we are performingcomparative studies of different display technologies (conven-tional 2D screen, head-mounted display, stereoscopic projection

71MMVR17


with polarizing filters, and autostereoscopic display) intended toevaluate their efficacy in communicating three-dimensional con-tent, specifically, in the context of a neurosurgical planning task.While we hypothesize that stereographic display offers benefitsover a monoscopic equivalent for understanding of volumetriccontent and their spatial relationships, our study is intended toquantify the differences in resulting task performance betweenthese and against traditional monoscopic display.

Lucio De Paolis


The developed application is the first prototype of a virtualinterface which provides a very simple form of interaction fornavigation and manipulation of 3D models of the human body.The system can also be used in the operating room and doesnot require any contact with computer devices or with a screen.The surgeon will be able to rotate, to translate, to zoom in onthe 3D models and to choose to visualize all of the organs oronly some of them simply by moving his finger in free space.By means of an optical tracking system, the position of the fin-ger tip, where an IR reflector is located, is detected and utilizedto define the four vertexes of the virtual interface and to man-age the interaction with this. 3D Slicer has been used for build-ing the 3D models and OpenSceneGraph for the constructionof the graphic environment.

Anton Koning

V-Scope: Design and Implementation of anImmersive and Desktop Virtual Reality VolumeVisualization System

While techniques to display stereoscopic images (i.e. images thatallow depth perception) are close to two centuries old, they stillhaven’t penetrated into daily clinical practice. However, manystudies show the additional value of depth perception and three-dimensional interaction when visualizing medical datasets such asCT and MRI. In this paper we summarize some results obtainedusing an immersive virtual reality system, specifically in the fieldsof prenatal medicine and cardiology with 3D ultrasound data.We also present a desktop virtual reality system build from off-the-shelf components, using software that builds upon theseexperiences. This system makes integration of virtual reality intothe regular clinical work flow feasible.

Ganesh Krishnamurthy

Use of See-Through Head Mounted Display forUltrasound Guided Vascular Access inInterventional Radiology

Ultrasound is the main imaging modality for vascular accessespecially in pediatric population. Pediatric interventional radi-ologists provide this specialized service in selected hospitalsacross the country. It is a well accepted fact that vascular access

in children especially the neonates is technically challenging.Even with higher frequency ultrasound transducer probes, vas-cular access is challenging. Coordinating the needle placementinto the vein simultaneously concentrating the ultrasoundimage on the monitor is not easy and the interventional radiol-ogist has to constantly switch visualizing the patient’s arm andthe ultrasound monitor. This difficulty is made worse by theposition of the machine, the room illumination causing glareon the monitor. Related to these difficulties we came up with anew see-through monocular head mounted display acting as amonitor for various imaging modalities

John Qualter


The primary goal of this project is to use 3d computer visualiza-tion technology to assist breast cancer patients in understandingtheir options for breast reconstructive surgery following a mastec-tomy. This research visualizes a latissimus musculocutaneous flapbreast reconstruction in an interactive 3d environment.

Justin Tan

Exploring Human Interface Devices forNavigating Three-Dimensional Medical ImagingData

Volumetric image renderings from CT and MR data hasbecome an essential component in modern medicine. As thequantity of 3D imaging data grows, so does the need for effi-cient review which aids the understanding of complex anatomicrelationships. We have created a software interface built on theFovia HDVR(r) engine that recreates the basic functions of aradiology image review interface, but also allows the manipula-tion of 3D volumetric renderings created from CT datasets.The program allows viewers to use either a mouse and key-board, or a human interface device (HID) designed for 3Dnavigation: the Space-Navigator by 3Dconnexion. We plan toutilize our software to study the applications and utility of theSpace-Navigator versus the conventional mouse and keyboardin the manipulation of 3D image data. Future studies willinclude other HIDs such as a freehand position sensing tool ora multiple input touch screen.

THURSDAY – SESSION B (cont)SIMULATOR DEVELOPMENT TOOLS

Erik Lövquist


The research presented in this paper investigates the effects ofutilizing user-centered design methods for the development of a

virtual reality based simulator for spinal anesthesia. The aim isto identify benefits of applying established, evidence-baseddesign methods. The use of such methods can potentiallyenhance the completion of an end-resulting medical simulator,which meets the needs of trainers and trainees by providingend-user input to the design throughout the entire develop-ment process. The user-centered design methods investigated inthis paper uses the specific idea of prototyping, i.e. the collabo-rative development of a tangible artifact intended to aid contex-tual grounding of the design, facilitate discussions of new ideasand generate a shared understanding of the problem. As a resultof the applied design methods, beneficial aspects have beenidentified as enhanced working relationships and communica-tion between end-users and designers and proper contextualgrounding.

72 MMVR17


PresenterContact Info &

Index

MMVR17

79MMVR17

Presenter IndexSchedule Summary Schedule Summary

AAbkai, Ciamak .................................. 18, 21 ............ 54, 63

Ackerman, Michael ........................... 1, 10

Acosta, Eric ...................................... 10, 18 ............ 25, 30, 64

Annese, Jacopo ................................ 16 ................... 26, 49

Arabalibeik, Hossein ......................... 20 ................... 70

Arikatla, Venkata .............................. 19 ................... 66

Athey, Brian ..................................... 9 ..................... 29

BBaillie, Sarah .................................... 15 ................... 60

Balch, David ..................................... 1

Banker, Christian .............................. 17 ................... 52

Barak-Bernhagen, Mary .................... 15 ................... 62

Baysa, Kóan Jeff ............................. 1, 16

Beardi, Joerg ................................... 15 ................... 62

Boedeker, Ben .................................. 15 ................... 63

Bowyer, Mark ................................... 12 ................... 46

Briggs, Kimberly ............................... 13 ................... 48

Burgess, Deborah ............................. 17 ................... 51

Burgner, Jessica ............................... 21 ................... 54

CCannon-Bowers, Janis ...................... 9, 20 ............... 29, 32

Charles, Steve .................................. 1

Combs, C. Donald ............................ 12 ................... 45

Cooperstock, Jeremy ........................ 20 ................... 70

Cregan, Patrick ................................ 1, 16, 18, 21 ... 53

Creutzfeldt, Johan ............................ 19 ................... 69

Culbertson, Chris .............................. 9 ..................... 25, 42

Cutler Shaw, Joyce ........................... ....................... 25

DDaluja, Sachin .................................. 11 ................... 44

De Paolis, Lucio ............................... 20 ................... 71

Deo, Dhanannjay .............................. 12, 19, 21 ....... 46, 54, 67

Dev, Parvati ...................................... 11, 21 ............. 32

Dunne, James .................................. 20 ................... 32

EEllaway, Rachel ................................ 17, 19 ............. 51, 67

Evestedt, Daniel ............................... 10 ................... 30

FFan, Richard .................................... 13 ................... 56

Farahmand, Farzam .......................... 14, 18 ............. 57, 64

Färber, Matthias ............................... 19 ................... 67

Felländer-Tsai, Li .............................. 1 ..................... 12

Feng, Chuan .................................... 19 ................... 67

Fidopiastis, Cali ................................ 13 ................... 31

Flynn, Sheryl .................................... 13 ................... 47

Foo, Jung ........................................ 11 ................... 43

Friedl, Reinhard ................................ 11 ................... 44

Fritz, Nadine ..................................... 15 ................... 60

Fuchs, Henry .................................... 1

GGerber, Max ..................................... ....................... 25

Greenleaf, Walter .............................. 1, 12, 16

Grundfest, Warren ............................ 16 ................... 48

HHallbeck, M. Susan ........................... 13, 15 ............. 47, 60

Haluck, Randy .................................. 1

Hananel, David ................................. 1, 21

Hasegawa, Shin ............................... 19 ................... 67

Hattori, Asaki .................................... 11 ................... 44

Hawks, Jeff ...................................... 11 ................... 45

Heinrichs, William LeRoy ................... 1, 10, 21 ......... 32

Higgins, Gerald ................................. 10 ................... 29

Hoehne, Karl .................................... ....................... 25

Hoffman, Helene ............................... 1, 10, 17

Holubar, Stefan ................................. 19 ................... 69

Hourie, Craig .................................... 18 ................... 64

Hughes, Charles ............................... 13 ................... 31

Hughes, Darin .................................. 13 ................... 31

Hurmusiadis, Vassilios ...................... 18 ................... 64

IIkawa, Tomoko ................................. 14 ................... 57

Ikehara, Curtis .................................. 18 ................... 53

JJarrell, Bruce ................................... 9 ..................... 29

Johansson, Birgitta ........................... 14

80 MMVR17

Presenter Index


John, Nigel ...................................... 17 ................... 52

KKahol, Kanav .................................... 12, 17, 19 ....... 30, 52, 69

Katsavelis, Dimitrios ......................... 13 ................... 47

Kheng, Leow Wee ............................. 19 ................... 68

Kikuchi, Motohiro ............................. 15 ................... 60

Kinross, James ................................. 16 ................... 48

Koning, Anton ................................... 20 ................... 71

Krishnamurthy, Ganesh ..................... 20 ................... 71

Krupinski, Elizabeth .......................... 19 ................... 69

Kurenov, Sergei ................................ 15, 19 ............. 60, 67, 69

Kurillo, Gregorij ................................ 14 ................... 59

LLai, Fuji ............................................ 20 ................... 70

Lange, Belinda ................................. 14 ................... 56

Lee, Doo .......................................... 15 ................... 63

Lee, Gyusung ................................... 12 ................... 46

Lehman, Amy ................................... 11 ................... 44

Lemke, Heinz ................................... 1

Li, Hao ............................................. 17 ................... 51

Lim, Yi-Je ........................................ 17 ................... 52

Line, Jason ...................................... 15 ................... 61

Liu, Alan .......................................... 1, 10 ............... 25, 29, 30

Lo, Jennifer ...................................... 11 ................... 43

Erik Lövquist ..................................... 22 ................... 71

Lutyens, Marcos ............................... .......................25

MMachado, Liliane .............................. 15, 21 ............. 55, 61

Magee, Derek .................................. 18 ................... 65

Marayong, Panadda .......................... 14 ................... 56

Marchal, Maud ................................. 17 ................... 50

Marianantoni, Alessandro .................. ....................... 25

McDonald, Claudia ........................... 20 ................... 32

McLay, Robert .................................. 9 ..................... 42

Meher, Susil ..................................... 15 ................... 59

Meruvia-Pastor, Oscar ...................... 16 ................... 49

Meskó, Bertalan ............................... 1, 17 ............... 26, 53

Millo, Yuri ......................................... 10, 20 ............. 29, 70

Mogel, Greg ..................................... 1, 16

Montgomery, Kevin ........................... 1, 11

Morgan, Karen ................................. 10

Moses, Gerald .................................. 12 ................... 45

Mosso Vazquez, José Luis ................ 9, 15 ............... 26, 41, 61

Muehl, Judith ................................... 14 ................... 57

Mukherjee, Mukul ............................. 18 ................... 53

Mulgaonkar, Amit ............................. 14 ................... 57

Mung, Jay ........................................ 14 ................... 58

Muniyandi, Manivannan .................... 15 ................... 61

NNa, Yong Hum .................................. 16, 18 ............. 50, 65

Nelson, Carl ..................................... 11 ................... 44

Nirenburg, Sergei ............................. 10, 17 ............. 29, 51

Noe, Carol ........................................ 17 ................... 52

Nonaka, Makoto ............................... 1

Noordmans, Herke Jan ..................... 18 ................... 65

OOgawa, Takumi ................................. 14 ................... 58

Okrainec, Allan ................................. 21 ................... 54

Oliker, Aaron .................................... 22 ................... 55

PParsons, Thomas .............................. 9 ..................... 41, 42

Petrinec, Kresimir ............................. 18 ................... 65

Phillips, Roger .................................. 1, 11

Plantin, Jeanette .............................. 14 ................... 56

Pugh, Carla ...................................... 1, 9, 16 ........... 41

QQualter, John .................................... 20 ................... 71

RRastjoo, Ali ....................................... 14 ................... 58

Riojas, Mario .................................... 12 ................... 45

Riva, Giuseppe ................................. 9, 14 ............... 41, 57

Rizzo, Albert ..................................... 2, 9, 10 ........... 42

Robb, Richard .................................. 2, 10

Rolland, Jannick ............................... 2

Romano, Joseph .............................. 18 ................... 65

Rovetta, Alberto ................................ 14 ................... 57

SSachdeva, Ajit .................................. 12 ................... 30

Sandlund, Marlene ........................... 12 ................... 47

81MMVR17

Presenter Index


Sankaranarayanan, Ganesh ............... 16, 19 ............. 63, 68

Satava, Richard ................................ 2, 10, 11, 12 ... 29, 30

Schlickum, Marcus ........................... 12 ................... 46

Schuppe, Oliver ................................ 21 ................... 55

Sclaverano, Stefano .......................... 21 ................... 55

Seitel, Mathias ................................. 14 ................... 58

Senger, Steven ................................. 2, 16

Shahidi, Ramin ................................. 2, 11

Shaw, Joyce Cutler ........................... ....................... 25

Shen, Yunhe ..................................... 17 ................... 50

Sherif, Hisham ................................. 14 ................... 58

Shi, Chengyu .................................... 18 ................... 66

Shin, Young Seok ............................. 9 ..................... 41

Shumaker, Randall ............................ 13 ................... 31

Sieck, Jennifer ................................. 10 ................... 25, 30

Sifakis, Eftychios .............................. 21 ................... 56

Sivak, Mark ...................................... 13 ................... 47

Smith, Marshall ................................ 12 ................... 30

Son, Ji ............................................. 19 ................... 68

Sørensen, Thomas ............................ 2, 11, 17 ......... 43

Souza, Ilana ..................................... 21 ................... 55

Spira, Jim ........................................ ....................... 31

Stredney, Don .................................. 2

Sudra, Gunther ................................. 12 ................... 46

Suen, Jonathan ................................ 16 ................... 49

Suzuki, Naoki ................................... 11 ................... 45

Swain, Julie ..................................... 2

Sweet, Robert .................................. 2

Székely, András ................................ 14 ................... 59

TTan, Justin ....................................... 20 ................... 71

Tan, Robert ...................................... 16 ................... 49

Theofilogiannakos, Efstratios ............. 14, 18, 19 ....... 59, 66

UUllrich, Sebastian .............................. 15 ................... 61

VVergara, Victor .................................. 20 ................... 70

Villard, Pierre-Frédéric ..................... 16, 21 ............. 49, 54, 62

Vockeroth, Johannes ........................ 11 ................... 26, 44

Vosburgh, Kirby ................................ 2, 11

WWaddington, Robert .......................... 10 ................... 30

Warner, Dave ................................... 2

Weber, Philip .................................... ....................... 26

Weghorst, Suzanne ........................... 2

Westebring-van der Putten, Eleonora . 21 ................... 54

Westwood, James ............................ 10

Whalen, Thomas .............................. 12 ................... 30

Whatley, Doug .................................. 20 ................... 32

Wiederhold, Brenda .......................... 2, 9, 16

Wiederhold, Mark ............................. 13 ................... 31

Wong, Virgil ...................................... 16 ................... 26, 48

Wood, Dennis ................................... 9 ..................... 42

Wurtele, Eve ..................................... 17 ................... 52

XXiao, Mei ......................................... 19 ................... 66

YYamaguchi, Satoshi .......................... 19, 21 ............. 55, 68

Yanin, Yevgeniy ................................. 14 ................... 59

Yoshida, Yoshinori ............................. 15 ................... 62

Young, Jiayi ...................................... ....................... 26

Young, Shih-wen .............................. ....................... 26

Youngblood, Patricia ......................... 2

ZZhang, Yan ....................................... 20 ................... 70

Zhang, Yingchun .............................. 17 ................... 50

Zheng, Guoyan ................................. 11 ................... 43

Zhou, Xiangmin ................................ 17 ................... 50, 51

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C O U R S E S Y L L A B U S - Home | NextMed / MMVRnextmed.com/wp-content/uploads/2018/07/MMVR-17_2009.pdf · 2018-07-27 · C O U R S E S Y L L A B U S JANUARY 19 – 22, 2009 THE