Prof. Stephen O'Leary, University of Melbourne - Growing Virtual Reality in the Higher Education sphere

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Professor Stephen O'Leary, William Gibson Chair in Otolaryngology, University of Melbourne presented "Growing Virtual Reality in the Higher Education sphere" at Connected Australia 2013.

This conference is designed to help organisiations harness the opportunities that super-fast broadband will create, and explores the future impact of the NBN through the healthcare, education and consumer industries.

For more information, please visit the conference website: http://www.connectedaustralia.com.au/2013

Published in: Technology, Health & Medicine
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Prof. Stephen O'Leary, University of Melbourne - Growing Virtual Reality in the Higher Education sphere

  1. 1. Virtual reality, the net and surgical training Stephen O’Leary Professor of Otolaryngology The University of Melbourne
  2. 2. Outline •  VR surgical simulation –  for surgical training –  What it is, how it works –  Status and prospects •  Networking and remote surgery
  3. 3. Lessons from Aerospace • Failure is catastrophic • Resources are expensive • Complex tasks • ZERO tolerance of major error
  4. 4. Lesson from Space Exploration • No “dressed rehearsal” • Train for all possibilities “No surprises” • Reduce “cognitive load” Courtesy of NASA
  5. 5. Cognitive Load
  6. 6. VR Simulation for Surgery •  Freedom to fail –  Practice until minimal standards are met •  Controlled training –  Curriculum can be standardised •  Repeatability & Availability
  7. 7. Surgery for Cochlear Implantation Courtesy of Cochlear
  8. 8. Temporal Bone - Anatomy •  At risk: –  Facial nerve function –  Sense of taste –  Great Vessels –  Integrity of Inner Ear: hearing and balance –  The dura
  9. 9. VR Simulation for Ear Surgery •  Scarcity of temporal bones •  To maximise real drilling experience –  In the temporal bone laboratory –  In the operating theatre •  To provide real-time feedback in training
  10. 10. Classical cortical mastoidectomy •  The skills required for this task: –  Surgical Anatomy –  Surgical Planning (strategy) –  Technical drilling skills (psychomotor)
  11. 11. Surgical Planning •  Surgical “Landmarks” •  Finding surgical landmarks –  In the correct order –  Using the correct techniques
  12. 12. Courtesy Thomas Somers
  13. 13. Building 3D models Imaging Data
  14. 14. Building 3D models Manually segment anatomical structures Mauro Maijorca, Brian Pyman, Yi Zhao, S. O’Leary
  15. 15. Building 3D models Generate 3D models Assign colours
  16. 16. Building 3D models Physical properties Sigmoid: Bleeding
  17. 17. The Prototype System
  18. 18. Force-Feedback (Haptics)
  19. 19. Mentoring across a Network
  20. 20. Simulation and Training Texts Observation Temporal Bone Laboratory Operating Theatre
  21. 21. Simulation and Training Texts Observation Virtual Surgery Temporal Bone Laboratory Validation of VR simulation • Transfer of learning • Sensitivity to levels of expertise • Automated feedback to trainee Operating Theatre
  22. 22. Transfer of Learning Repeat task until performance is error free Oral assessment temporal bone Virtual Surgery Oral assessment temporal bone Participants: • Novice surgeons Procedure: • Cortical mastoidectomy Temporal Bone Laboratory Outcome Measures: • Surgical Anatomy • Surgical Planning • Technical drilling skills
  23. 23. VR training and recognition of anatomy (on human temporal bone)
  24. 24. VR simulation for assessment Sensitivity to levels of expertise Trainees Experts VirtualSurgery Cortical Mastoid Correlate observer & automated metrics Participants: • Standardised pre-reading • Novices (9) • Registrars (6) • Performed a canal-wall down mastoidectomy • Experts (12) • Metrics: Force, speed, stroke
  25. 25. Time to completion Total  Time 60.00 Time  (min) 50.00 40.00 30.00 20.00 10.00 0.00 Novice Registrar Expert
  26. 26. Total  No.  of  s trokes  applied T otal   N umber   o f   s trokes 50000 40000 30000 20000 10000 0 Novic e R egistrar E xpert
  27. 27. No.  of  jumps  during  t he  simulation Total  jumps 3000.00 2500.00 2000.00 1500.00 1000.00 500.00 0.00 Novice Registrar Expert
  28. 28. T otal   v ox els   e roded Total  Voxel  eroded 3.E +06 2.E +06 2.E +06 1.E +06 5.E +05 0.E +00 Novic e R egistrar E xpert
  29. 29. Average  force  <1cm  from  critical  structures 0.35 0.30 Average  Force  (N) 0.25 Novice 0.20 Registrar 0.15 Expert 0.10 0.05 0.00 Sigmoid Dura Facial
  30. 30. Self-directed surgical curriculum Instructional video •  e.g. exposing the dura Practice with immediate feedback •  Force, distance Comparison with “ideal” end result •  Quality assurance Operative Photos and videos •  Improve visual recognition
  31. 31. Aim/research question Virtual Reality Simulation Traditional Methods
  32. 32. Study Method: Randomized, Blinded, Control Trial Didactic Teaching (20) VR simulation Group (10) Traditional Group (10) Cortical mastoidectomy Cortical mastoidectomy
  33. 33. Assessment •  •  •  •  •  1 hour time limit “standardized” temporal bones Video taped 3 Blinded assessors Multifaceted Assessment tool focusing on 4 areas of performance
  34. 34. Overall Performance 70 60 50 40 ICC = 0.93 P-value <0.001 30 20 10 0 VR Traditional
  35. 35. End product analysis 80.0 70.0 60.0 50.0 VR 40.0 Trad 30.0 ICC = 0.78 P-value <0.001 20.0 10.0 0.0 Dura Sigmoid EAC LSCC Incus
  36. 36. Injury size 40.0 35.0 30.0 25.0 VR 20.0 Traditional ICC = 0.88 P-value =0.01 15.0 10.0 5.0 0.0 Dura Sigmoid EAC LSCC Incus
  37. 37. !
  38. 38. !
  39. 39. Formative feedback •  Timely feedback is key to learning •  Aim is to provide feedback “expert-like” feedback •  This should facilitate independent learning on the simulator
  40. 40. Efficacy Real-time feedback Wijewickrema et al, unpublished data 24 medical students, performing cortical mastoidectomy randomised to receiving feedback or not
  41. 41. Feedback Method Random Forest algorithm of Bailey , Zhou et al,
  42. 42. Networking and remote surgery •  The Speed of Light (and networks) •  Ping and Lag –  Real-time interaction impossible when latency exceeds reaction time –  For training this is not critical –  But for surgery…….
  43. 43. Working with lag Courtesy of NASA
  44. 44. Working with lag COURTESY OF ST. JOSEPH'S HOSPITAL
  45. 45. Conceding to lag: Tele-presence surgery Courtesy of NASA
  46. 46. Tele-presence surgery Assisting surgeons in Remote communities
  47. 47. Tele-present Surgery in space Courtesy NASA
  48. 48. Courtesy NASA
  49. 49. Courtesy NASA
  50. 50. Courtesy NASA
  51. 51. On Mars, this won’t work……
  52. 52. Conclusions •  VR surgery research: –  Can discriminate between levels of experience –  Transfer of learning to temporal bone dissection –  Self-directed learning works –  Frontier: automated feedback •  Networking and telemedicine –  Remote-control surgery limited by lag –  Tele-presence surgery realistic alternative –  Simulation ideal for establishing protocols
  53. 53. The people •  Gregor Kennedy – Educational psychologist •  Ioanna Ioannou, Sudanthi Widewickrema - computer engineers •  Yi Chen Zhao, Yun Zhou- PhD’s •  Ioanna Ioannou, Brian Pyman, Richard Hall, Kumiko Yukawa, Mauro Maijorca, Peter Harris, Liz Sonenburg (Melb. Uni.) •  M. Hutchins, C. Gunn, A. Krompholz, D. Stevenson (CSIRO)
  54. 54. The organisations •  Melbourne University •  CSIRO •  Medic Vision (held license from University/ CSIRO 2006-2010) •  Royal Victorian Eye and Ear Hospital •  Royal Prince Alfred Hospital •  Royal Australasian College of Surgeons •  Medtronic Xomed (grant for early validation)
  55. 55. The funding bodies US  Air  Force  
  56. 56. Courtesy The Age

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