Laboratoire Ampère
                                       UMR CNRS 5005
   Electrical Engineering, Electromagnetism, Contr...
Table of contents




               2
Table of contents

1. Introduction




                                 2
Table of contents

1. Introduction

2. Task description: details on implant insertion




                                ...
Table of contents

1. Introduction

2. Task description: details on implant insertion

3. Materials and methods
   3.1. Si...
Table of contents

1. Introduction

2. Task description: details on implant insertion

3. Materials and methods
   3.1. Si...
Table of contents

1. Introduction

2. Task description: details on implant insertion

3. Materials and methods
   3.1. Si...
Table of contents

1. Introduction

2. Task description: details on implant insertion

3. Materials and methods
   3.1. Si...
1. Introduction

Context

+   Improvement of contraceptive methods for bringing more comfort
      Development of implants...
1. Introduction

Context

+   Improvement of contraceptive methods for bringing more comfort
      Development of implants...
1. Introduction

Context

+   Improvement of contraceptive methods for bringing more comfort
       Development of implant...
1. Introduction

Advantages of a simulator
- Train novices without putting the well-being of patients in danger




      ...
1. Introduction

Advantages of a simulator
- Train novices without putting the well-being of patients in danger

- Make ea...
1. Introduction

Advantages of a simulator
- Train novices without putting the well-being of patients in danger

- Make ea...
1. Introduction

Advantages of a simulator
- Train novices without putting the well-being of patients in danger

- Make ea...
1. Introduction

Advantages of a simulator
- Train novices without putting the well-being of patients in danger

- Make ea...
Table of contents

1. Introduction

2. Task description: details on implant insertion

3. Materials and methods
   3.1. Si...
2. Task description
                                   Medical details on implant insertion


The implant type
–   Single-...
2. Task description
                             Medical details on implant insertion


The implant insertion




    http...
2. Task description
                             Medical details on implant insertion


The implant insertion

           ...
2. Task description
                             Medical details on implant insertion


The implant insertion

           ...
2. Task description
                             Medical details on implant insertion


The implant insertion

           ...
2. Task description
                             Medical details on implant insertion


The implant insertion

           ...
2. Task description
                             Medical details on implant insertion


The implant insertion

           ...
2. Task description
                             Medical details on implant insertion


The implant insertion

           ...
2. Task description
                             Medical details on implant insertion


The implant insertion

           ...
2. Task description
                             Medical details on implant insertion


The implant insertion

           ...
2. Task description
                          Medical details on implant insertion


Good insertion
- Palpable implant
- N...
2. Task description
                          Medical details on implant insertion


Good insertion
- Palpable implant
- N...
2. Task description
                          Medical details on implant insertion


Good insertion
- Palpable implant
- N...
2. Task description
                          Medical details on implant insertion


Good insertion
- Palpable implant
- N...
Table of contents

1. Introduction

2. Task description: details on implant insertion

3. Materials and methods
   3.1. Si...
3. Materials and methods
                            3.1. Simulator components


Principle: 2 components




             ...
3. Materials and methods
                                        3.1. Simulator components


Principle: 2 components
  - M...
3. Materials and methods
                                         3.1. Simulator components


Principle: 2 components
  - ...
3. Materials and methods
                                         3.1. Simulator components


Principle: 2 components
  - ...
3. Materials and methods
                                          3.1. Simulator components


Principle: 2 components
   ...
3. Materials and methods
                                          3.1. Simulator components


Principle: 2 components
   ...
3. Materials and methods
                                         3.1. Simulator components


Mechanical component
       ...
3. Materials and methods
                                                          3.1. Simulator components


Mechanical ...
3. Materials and methods
                                                          3.1. Simulator components


Mechanical ...
3. Materials and methods
                                                          3.1. Simulator components


Mechanical ...
3. Materials and methods
                                                          3.1. Simulator components


Mechanical ...
3. Materials and methods
                                     3.1. Simulator components


Instrumentation

- MiniBird® (6 ...
3. Materials and methods
                                     3.1. Simulator components


Instrumentation

- MiniBird® (6 ...
3. Materials and methods
                           3.1. Simulator components


Software component
- ControlDesk
    data ...
3. Materials and methods
                                  3.1. Simulator components


 Software component
- ControlDesk
 ...
3. Materials and methods
                                  3.1. Simulator components


 Software component
- ControlDesk
 ...
3. Materials and methods
                                  3.1. Simulator components


 Software component
- ControlDesk
 ...
3. Materials and methods
                                  3.1. Simulator components


 Software component
- ControlDesk
 ...
3. Materials and methods
                           3.2. Criteria of the gesture evaluation


Three selected criteria
1.  ...
3. Materials and methods
                              3.2. Criteria of the gesture evaluation


Three selected criteria
1...
3. Materials and methods
                              3.2. Criteria of the gesture evaluation


Three selected criteria
1...
3. Materials and methods
                              3.2. Criteria of the gesture evaluation


Three selected criteria
1...
3. Materials and methods
                              3.2. Criteria of the gesture evaluation


Three selected criteria
1...
3. Materials and methods
                              3.2. Criteria of the gesture evaluation


Three selected criteria
1...
3. Materials and methods
                                     3.2. Criteria of the gesture evaluation


Impact point detec...
3. Materials and methods
                              3.2. Criteria of the gesture evaluation


Depth evaluation


      ...
3. Materials and methods
                              3.2. Criteria of the gesture evaluation


Depth evaluation


      ...
Table of contents

1. Introduction

2. Task description: details on implant insertion

3. Materials and methods
   3.1. Si...
4. Experimental results
                                                       4.1. Protocol


Operators
- One experienced...
4. Experimental results
                4.2. Results


          xOz plane
          Orthogonal to the
          tangent p...
Table of contents

1. Introduction

2. Task description: details on implant insertion

3. Materials and methods
   3.1. Si...
5. Conclusion


The prototype
- Visual interface coupled with a mechanical component
- Gesture learning (on-line)
- Trajec...
5. Conclusion


The prototype
- Visual interface coupled with a mechanical component
- Gesture learning (on-line)
- Trajec...
Thank you for your attention…


                           …any questions ?


        Contact: audrey.jardin@insa-lyon.fr
...
Upcoming SlideShare
Loading in …5
×

Design of a medical simulator for subcutaneous contraceptive implant insertion Design of a medical simulator for subcutaneous contraceptive implant insertion

1,604 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,604
On SlideShare
0
From Embeds
0
Number of Embeds
14
Actions
Shares
0
Downloads
139
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Design of a medical simulator for subcutaneous contraceptive implant insertion Design of a medical simulator for subcutaneous contraceptive implant insertion

  1. 1. Laboratoire Ampère UMR CNRS 5005 Electrical Engineering, Electromagnetism, Control, Environmental Microbiology and Applications Design of a medical simulator for subcutaneous contraceptive implant insertion A.Jardin*, R.Moreau*, M.T.Pham*, A.Mallet*, T.Redarce* and O.Dupuis** * Laboratoire Ampère ** Centre Hospitalier Universitaire de Lyon 1
  2. 2. Table of contents 2
  3. 3. Table of contents 1. Introduction 2
  4. 4. Table of contents 1. Introduction 2. Task description: details on implant insertion 2
  5. 5. Table of contents 1. Introduction 2. Task description: details on implant insertion 3. Materials and methods 3.1. Simulator components 3.2. Criteria of the gesture evaluation 2
  6. 6. Table of contents 1. Introduction 2. Task description: details on implant insertion 3. Materials and methods 3.1. Simulator components 3.2. Criteria of the gesture evaluation 4. Experimental results 4.1. Protocol 4.2. Results 2
  7. 7. Table of contents 1. Introduction 2. Task description: details on implant insertion 3. Materials and methods 3.1. Simulator components 3.2. Criteria of the gesture evaluation 4. Experimental results 4.1. Protocol 4.2. Results 5. Conclusion and perspectives 2
  8. 8. Table of contents 1. Introduction 2. Task description: details on implant insertion 3. Materials and methods 3.1. Simulator components 3.2. Criteria of the gesture evaluation 4. Experimental results 4.1. Protocol 4.2. Results 5. Conclusion and perspectives 3
  9. 9. 1. Introduction Context + Improvement of contraceptive methods for bringing more comfort Development of implants 4
  10. 10. 1. Introduction Context + Improvement of contraceptive methods for bringing more comfort Development of implants - Lack of practice before the first insertion quot;77 % of unintended pregnancies under contraceptive implants are due to a bad insertionquot; (L.Bensouda-Grimaldi et al., 2005) 4
  11. 11. 1. Introduction Context + Improvement of contraceptive methods for bringing more comfort Development of implants - Lack of practice before the first insertion quot;77 % of unintended pregnancies under contraceptive implants are due to a bad insertionquot; (L.Bensouda-Grimaldi et al., 2005) Objective Design a suitable training and certification tool for doctors new medical simulator 4
  12. 12. 1. Introduction Advantages of a simulator - Train novices without putting the well-being of patients in danger 5
  13. 13. 1. Introduction Advantages of a simulator - Train novices without putting the well-being of patients in danger - Make easier the gesture learning by bypassing the constraints during an actual insertion 5
  14. 14. 1. Introduction Advantages of a simulator - Train novices without putting the well-being of patients in danger - Make easier the gesture learning by bypassing the constraints during an actual insertion Learning constraints in an actual insertion 1. The gesture occurs in the arm the novice can not see the instructor gesture 5
  15. 15. 1. Introduction Advantages of a simulator - Train novices without putting the well-being of patients in danger - Make easier the gesture learning by bypassing the constraints during an actual insertion Learning constraints in an actual insertion 1. The gesture occurs in the arm the novice can not see the instructor gesture the experienced doctor can not validate the novice insertion 5
  16. 16. 1. Introduction Advantages of a simulator - Train novices without putting the well-being of patients in danger - Make easier the gesture learning by bypassing the constraints during an actual insertion Learning constraints in an actual insertion 1. The gesture occurs in the arm the novice can not see the instructor gesture the experienced doctor can not validate the novice insertion 2. First insertions are often akward because of stress 5
  17. 17. Table of contents 1. Introduction 2. Task description: details on implant insertion 3. Materials and methods 3.1. Simulator components 3.2. Criteria of the gesture evaluation 4. Experimental results 4.1. Protocol 4.2. Results 5. Conclusion and perspectives 6
  18. 18. 2. Task description Medical details on implant insertion The implant type – Single-rod of 40mm long and 2mm in diameter – Containing etonogestrel – Duration of three years – As effective as a contraceptive pill The tool for insertion Applicator Complete device Implant Obturator http://hcp.organon.com 7
  19. 19. 2. Task description Medical details on implant insertion The implant insertion http://hcp.organon.com 8
  20. 20. 2. Task description Medical details on implant insertion The implant insertion Step 1 - Introduce the needle under the skin, in the upper-arm, 60-80 mm above the elbow http://hcp.organon.com 8
  21. 21. 2. Task description Medical details on implant insertion The implant insertion 1 Step 2 - Lower the the needle to a the - Introduce applicator under positionthe upper-arm, skin mm skin, in parallel to the 60-80 above the elbow http://hcp.organon.com 8
  22. 22. 2. Task description Medical details on implant insertion The implant insertion 1 Step 2 3 - Lift thethe the needle to a the - Lower skin Introduce applicator under - Insert the full length of the mm positionthe upper-arm, skin skin, in parallel to the 60-80 needle the elbow above http://hcp.organon.com 8
  23. 23. 2. Task description Medical details on implant insertion The implant insertion 1 Step 2 4 3 - Lift thethe the needle to a the - Lower down the obturator Introduce applicator under Press skin - Insert the full length of the mm support parallel to the 60-80 positionthe upper-arm, skin skin, in needle the elbow above - Turn the obturator 90° http://hcp.organon.com 8
  24. 24. 2. Task description Medical details on implant insertion The implant insertion 1 Step 2 4 3 - Lift thethe the needle to a the - Lower down the obturator Introduce applicator under Press skin - Insert the full length of the mm support parallel to the 60-80 positionthe upper-arm, skin skin, in needle the elbow above - Turn the obturator 90° http://hcp.organon.com 8
  25. 25. 2. Task description Medical details on implant insertion The implant insertion 1 Step 2 5 4 3 - Lift thethe the needle to a the - Lower down the obturator Introduce applicator under Keep skin Pressthe obturator fixed - Insert the full length of the mm support parallel to the 60-80 positionthe upper-arm, skin skin, in the canula Pull out needle the elbow above - Turn the obturator 90° http://hcp.organon.com 8
  26. 26. 2. Task description Medical details on implant insertion The implant insertion 1 Step 2 5 4 3 - Lift thethe the needle to a the - Lower down the obturator Introduce applicator under Keep skin Pressthe obturator fixed - Insert the full length of the mm support parallel to the 60-80 positionthe upper-arm, skin skin, in the canula Pull out needle the elbow above - Turn the obturator 90° http://hcp.organon.com 8
  27. 27. 2. Task description Medical details on implant insertion The implant insertion 1 Step 2 5 4 3 6 - Lift thethe the needle toof the - Lower down the obturator the Introduce applicator under Keep skin Pressthe obturator fixed correctness a Check - Insert the full length of the mm positionthe upper-arm,the implant insertion by palpating 60-80 skin, in the canula support parallel to the skin Pull out needle the elbow above - Turn the obturator 90° http://hcp.organon.com 8
  28. 28. 2. Task description Medical details on implant insertion Good insertion - Palpable implant - No pain - Easy removal Bad insertion Diagram of the different skin layers - Impalpable implant - Pain The implant must be placed - Lower efficiency at a limited depth ! - Surgical intervention (~3 or 4 mm) 9
  29. 29. 2. Task description Medical details on implant insertion Good insertion - Palpable implant - No pain - Easy removal Bad insertion Diagram of the different skin layers - Impalpable implant - Pain The implant must be placed - Lower efficiency at a limited depth ! - Surgical intervention (~3 or 4 mm) 9
  30. 30. 2. Task description Medical details on implant insertion Good insertion - Palpable implant - No pain - Easy removal Bad insertion Diagram of the different skin layers - Impalpable implant - Pain The implant must be placed - Lower efficiency at a limited depth ! - Surgical intervention (~3 or 4 mm) 9
  31. 31. 2. Task description Medical details on implant insertion Good insertion - Palpable implant - No pain - Easy removal Bad insertion Diagram of the different skin layers - Impalpable implant - Pain The implant must be placed - Lower efficiency at a limited depth ! - Surgical intervention (~3 or 4 mm) 9
  32. 32. Table of contents 1. Introduction 2. Task description: details on implant insertion 3. Materials and methods 3.1. Simulator components 3.2. Criteria of the gesture evaluation 4. Experimental results 4.1. Protocol 4.2. Results 5. Conclusion and perspectives 10
  33. 33. 3. Materials and methods 3.1. Simulator components Principle: 2 components 11
  34. 34. 3. Materials and methods 3.1. Simulator components Principle: 2 components - Mechanical component: - arm, insertion tool, sensors - PC 11
  35. 35. 3. Materials and methods 3.1. Simulator components Principle: 2 components - Mechanical component: - arm, insertion tool, sensors - PC - Software component: - programming - data acquisition - visual interfacing 11
  36. 36. 3. Materials and methods 3.1. Simulator components Principle: 2 components - Mechanical component: - arm, insertion tool, sensors - PC - Software component: - programming - data acquisition - visual interfacing 2 operating modes 11
  37. 37. 3. Materials and methods 3.1. Simulator components Principle: 2 components - Mechanical component: - arm, insertion tool, sensors - PC - Software component: - programming - data acquisition - visual interfacing 2 operating modes - ‘Training’ mode 11
  38. 38. 3. Materials and methods 3.1. Simulator components Principle: 2 components - Mechanical component: - arm, insertion tool, sensors - PC - Software component: - programming - data acquisition - visual interfacing 2 operating modes - ‘Training’ mode - ‘Certification’ mode 11
  39. 39. 3. Materials and methods 3.1. Simulator components Mechanical component Indexing Sensor pivot joint Sensor Arm Transmitter Support Bracelet Global view of the simulator 12
  40. 40. 3. Materials and methods 3.1. Simulator components Mechanical component Indexing Sensor - 5 orientations (3 are correct) pivot joint Sensor Arm Transmitter Support Bracelet Indexing pivot joint at the shoulder Global view of the simulator The bracelet of the wrist 12
  41. 41. 3. Materials and methods 3.1. Simulator components Mechanical component Indexing Sensor - 5 orientations (3 are correct) pivot joint Sensor - Improve the arm stiffness Arm Transmitter Support Bracelet Indexing pivot joint at the shoulder Global view of the simulator The bracelet of the wrist 12
  42. 42. 3. Materials and methods 3.1. Simulator components Mechanical component Indexing Sensor - 5 orientations (3 are correct) pivot joint Sensor - Improve the arm stiffness Arm Transmitter - Indexing system Support Bracelet Indexing pivot joint at the shoulder Global view of the simulator The bracelet of the wrist 12
  43. 43. 3. Materials and methods 3.1. Simulator components Mechanical component Indexing Sensor - 5 orientations (3 are correct) pivot joint Sensor - Improve the arm stiffness Arm Transmitter - Indexing system - Repeatable orientations Support Bracelet Indexing pivot joint at the shoulder Global view of the simulator The bracelet of the wrist 12
  44. 44. 3. Materials and methods 3.1. Simulator components Instrumentation - MiniBird® (6 DOF electromagnetic sensors) for: - the arm - the obturator - the applicator 13
  45. 45. 3. Materials and methods 3.1. Simulator components Instrumentation - MiniBird® (6 DOF electromagnetic sensors) for: - the arm Adaptation pieces - the obturator - the applicator - Adaptation pieces: ABS small 13
  46. 46. 3. Materials and methods 3.1. Simulator components Software component - ControlDesk data treatment 14
  47. 47. 3. Materials and methods 3.1. Simulator components Software component - ControlDesk data treatment - Matlab/Simulink programming trajectories analysis 14
  48. 48. 3. Materials and methods 3.1. Simulator components Software component - ControlDesk data treatment - Matlab/Simulink programming trajectories analysis - MotionDesk 3D visualization 14
  49. 49. 3. Materials and methods 3.1. Simulator components Software component - ControlDesk data treatment - Matlab/Simulink programming Visual guide trajectories analysis - MotionDesk 3D visualization Arm profile 14
  50. 50. 3. Materials and methods 3.1. Simulator components Software component - ControlDesk data treatment - Matlab/Simulink programming Visual guide trajectories analysis - MotionDesk 3D visualization Arm profile 14
  51. 51. 3. Materials and methods 3.2. Criteria of the gesture evaluation Three selected criteria 1. The arm orientation In supination 15
  52. 52. 3. Materials and methods 3.2. Criteria of the gesture evaluation Three selected criteria 1. The arm orientation In supination 2. The location of the impact point In the groove between the biceps and the triceps Target zone: ~ 5cm x 3.5 cm 15
  53. 53. 3. Materials and methods 3.2. Criteria of the gesture evaluation Three selected criteria 1. The arm orientation In supination 2. The location of the impact point In the groove between the biceps and the triceps Target zone: ~ 5cm x 3.5 cm 3. The maximum depth Limit fixed to 4 mm 15
  54. 54. 3. Materials and methods 3.2. Criteria of the gesture evaluation Three selected criteria 1. The arm orientation In supination 2. The location of the impact point In the groove between the biceps and the triceps Target zone: ~ 5cm x 3.5 cm 3. The maximum depth Limit fixed to 4 mm Difficulties 15
  55. 55. 3. Materials and methods 3.2. Criteria of the gesture evaluation Three selected criteria 1. The arm orientation In supination 2. The location of the impact point In the groove between the biceps and the triceps Target zone: ~ 5cm x 3.5 cm 3. The maximum depth Limit fixed to 4 mm Difficulties Detect the impact point 15
  56. 56. 3. Materials and methods 3.2. Criteria of the gesture evaluation Three selected criteria 1. The arm orientation In supination 2. The location of the impact point In the groove between the biceps and the triceps Target zone: ~ 5cm x 3.5 cm 3. The maximum depth Limit fixed to 4 mm Difficulties Detect the impact point Evaluate the tool depth 15
  57. 57. 3. Materials and methods 3.2. Criteria of the gesture evaluation Impact point detection - Meshing of the target skin area (measures) - Comparison between the altitudes Z ApplicatorTip − Z Skin ≤ ε 16
  58. 58. 3. Materials and methods 3.2. Criteria of the gesture evaluation Depth evaluation Needle Tangent plane Arm profile ~ plane tangent to the skin at the impact point: - Meshing Impact point Arm - Polynomial approximation 17
  59. 59. 3. Materials and methods 3.2. Criteria of the gesture evaluation Depth evaluation Needle Z axis Tangent plane Arm profile ~ plane tangent to the skin at the impact point: - Meshing Impact point Arm - Polynomial approximation Depth ~ altitude in the plane: - orthogonal to the tangent plane - parallel to the arm axis 17
  60. 60. Table of contents 1. Introduction 2. Task description: details on implant insertion 3. Materials and methods 3.1. Simulator components 3.2. Criteria of the gesture evaluation 4. Experimental results 4.1. Protocol 4.2. Results 5. Conclusion and perspectives 18
  61. 61. 4. Experimental results 4.1. Protocol Operators - One experienced doctor - Seven novices Experimental protocol 1. Position the arm 2. Palpate the arm and point out the intended location for insertion 3. Insert the implant (data recording) 19
  62. 62. 4. Experimental results 4.2. Results xOz plane Orthogonal to the tangent plane at the impact point Axis X Tool progress along the arm Axis Z Altitude of the instrument tip 20
  63. 63. Table of contents 1. Introduction 2. Task description: details on implant insertion 3. Materials and methods 3.1. Simulator components 3.2. Criteria of the gesture evaluation 4. Experimental results 4.1. Protocol 4.2. Results 5. Conclusion and perspectives 21
  64. 64. 5. Conclusion The prototype - Visual interface coupled with a mechanical component - Gesture learning (on-line) - Trajectories analysis (off-line) - First experiments validate simulator principles 22
  65. 65. 5. Conclusion The prototype - Visual interface coupled with a mechanical component - Gesture learning (on-line) - Trajectories analysis (off-line) - First experiments validate simulator principles Perspectives - Purchase a new arm - Refine the graphical interface - Carry out a new study with a larger population of novices 22
  66. 66. Thank you for your attention… …any questions ? Contact: audrey.jardin@insa-lyon.fr 23

×