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PubMed1993

Application of artificial neural networks for reduction of false-positive detections in digital chest radiographs.

A methodology based on the fuzzy set theory and the convolution neural network (CNN) architecture is proposed to tackle the problem of reducing false-positive rate in automatic lung nodule detection. The CNN which simulates human visual mechanism was trained by a supervised back-propagation algorithm based on fuzzy membership functions. The training and testing database consists of image blocks (each 32 x 32 pixels) of suspected lung nodule areas (nodule candidates) which were generated from our pre-scanning program [1]. A linguistic label was assigned to each nodule candidate of the training set, then the label was converted to a membership value through a pre-defined membership function and used as teaching signal (desired outputs) during the network learning. Before the nodule candidate was fed to the network input, it was pre-processed to reduce the complex background noise and the contrast discrepancy resulted from film development. During the network testing phase, a defuzzification process was applied to decipher the trained network's output triggered by the nodule candidate in the testing set. Finally, a Receiver Operating Characteristic (ROC) analysis was used to evaluate the CNN's performance based on the defuzzified output of the testing database. Preliminary results showed an average Az (the performance index) of 0.84 which is equivalent to 0.80 true-positive detection (sensitivity) with an average 2-3 false-positive detections per chest image.

Computer Simulation↗

PubMed2006

From the combat medic to the forward surgical team: the Madigan model for improving trauma readiness of brigade combat teams fighting the Global War on Terror.

BACKGROUND: Medics assigned to combat units have a notable paucity of trauma experience. Our goal was to provide intense trauma refresher training for the conventional combat medic to better prepare them for combat casualty care in the War on Terror. MATERIALS AND METHODS: Our Tactical Combat Casualty Care Course (TC3) consisted of the following five phases: (1) One and one-half-day didactic session; (2) Half-day simulation portion with interactive human surgical simulators for anatomical correlation of procedures and team building; (3) Half-day of case presentations and triage scenarios from Iraq/Afghanistan and associated skills stations; (4) Half-day live tissue lab where procedures were performed on live anesthetized animals in a controlled environment; and (5) One-day field phase where live anesthetized animals and surgical simulators were combined in a real-time, field-training event to simulate realistic combat injuries, evacuation problems, and mass casualty scenarios. Data collection consisted of surveys, pre- and posttests, and after-action comments. RESULTS: A total of 1317 personnel participated in TC3 from October 2003 through May 2005. Over the overlapping study period from December 2004 to April 2005, 327 soldiers participated in the formal five-phase course. Three hundred four (94%) students were combat medics who were preparing for combat operations in Iraq or Afghanistan. Of those completing the training, 97% indicated their confidence and ability to treat combat casualties were markedly improved. Moreover, of those 140 medics who took the course and deployed to Iraq for 1 year, 99% indicated that the principles taught in the TC3 course helped with battlefield management of injured casualties during their deployment. CONCLUSION: The hybrid training model is an effective method for training medical personnel to deal with modern battle injuries. This course increases the knowledge and confidence of combat medics deploying and fighting the Global War on Terrorism.

Anesthesia↗

PubMed2003

Virtual reality training for health-care professionals.

Emerging changes in health-care delivery are having a significant impact on the structure of health-care professionals' education. Today it is recognized that medical knowledge doubles every 6-8 years, with new medical procedures emerging everyday. While the half-life of medical information is so short, the average physician practices 30 years and the average nurse 40 years. Continuing education thus represents an important challenge to face. Recent advances in educational technology are offering an increasing number of innovative learning tools. Among these, Virtual Reality represents a promising area with high potential of enhancing the training of health-care professionals. Virtual Reality Training can provide a rich, interactive, engaging educational context, thus supporting experiential learning-by-doing; it can, in fact, contribute to raise interest and motivation in trainees and to effectively support skills acquisition and transfer, since the learning process can be settled within an experiential framework. Current virtual training applications for health-care differ a lot as to both their technological/multimedia sophistication and to the types of skills trained, varying for example from telesurgical applications to interactive simulations of human body and brain, to virtual worlds for emergency training. Other interesting applications include the development of immersive 3D environments for training psychiatrists and psychologists in the treatment of mental disorders. This paper has the main aim of discussing the rationale and main benefits for the use of virtual reality in health-care education and training. Significant research and projects carried out in this field will also be presented, followed by discussion on key issues concerning current limitations and future development directions.

Computer Simulation↗

PubMed2006

Online resuscitation training. Does it improve high school students' ability to perform cardiopulmonary resuscitation in a simulated environment?

There are no published data on the efficacy of online first aid or resuscitation learning programmes in Australia. Our goal was to compare the knowledge and first aid skills of subjects who have undertaken the St. John Ambulance Australia (WA) "online crash course", with those who have no first aid training. We evaluated first aid knowledge and basic life support (BLS) skills of two groups of students. The control group (n = 11) had received no first aid training of any type and the test group (n = 12) had undertaken and passed the St. John Ambulance online "crash course". This course is purely theoretical. BLS skills were assessed using standardised patients and manikins. Knowledge was assessed by a written assessment. Assessors were blinded to which group the students belonged. There were significant differences in the performance of the written test, between the group who completed the course and the group who did not complete the course (P = 0.036: Mann-Whitney U-test). There were no significant differences in the performance of any other practical tasks between the two groups. We conclude from this that the online course improved course participant's knowledge of BLS significantly, but not their ability to perform; that online first aid courses may be useful for knowledge acquisition but that they do not confer any benefit, in performance of BLS skills.

Adolescent↗

PubMed1982

Contributions of motor-unit recruitment and rate modulation of compensation for muscle yielding.

1. Subdivided portions of the cut ventral root innervation of the soleus muscle were electrically stimulated in 14 anesthetized cats. The stimulus trains imposed on these nerves simulated the recruitment and rate-modulation patterns of single motor units recorded during stretch-reflex responses in decerebrate preparations. Each activation pattern was evaluated for its ability to prevent muscle yield. 2. Three basic stimulus patterns, recruitment, step increases in stimulus rate, and doublets were imposed during the course of ramp stretches applied over a wide range of velocities. The effect of each stimulus pattern on muscle force was compared to the force output recorded without stretch-related recruitment or rate modulation. 3. Motor-unit recruitment was found to be most effective in preventing yield during muscle stretch. Newly recruited motor units showed no evidence of yielding for some 250 ms following activation, at which time muscle stiffness declined slightly. This time-dependent resistance to yield was observed regardless of whether the onset of the neural stimulus closely preceded or followed stretch onset. 4. Step increases in stimulus rate arising shortly after stretch onset did not prevent the occurrence of yield at most stretch velocities, but did augment muscle stiffness later in the stretch. Doublets in the stimulus train were found to augment muscle stiffness only when they occurred in newly recruited motor units. 5. These results suggest that at low or moderate initial forces, the prevention of yield in lengthening, reflexively intact muscle results primarily from rapid motor-unit recruitment. To a lesser extent, the spring-like character of the stretch-reflex response also derives from step increases in firing rate of motor units active before stretch onset and doublets in units recruited during the course of stretch. Smooth rate increases appear to augment muscle force later in the course of the reflex response.

Animals↗

PubMed2003

Dynamic molecules: molecular dynamics for everyone. An internet-based access to molecular dynamic simulations: basic concepts.

Molecular dynamics is a rapidly developing field of science and has become an established tool for studying the dynamic behavior of biomolecules. Although several high quality programs for performing molecular dynamic simulations are freely available, only well-trained scientists are currently able to make use of the broad scientific potential that molecular dynamic simulations offer to gain insight into structural questions at an atomic level. The "Dynamic Molecules" approach is the first internet portal that provides an interactive access to set up, perform and analyze molecular dynamic simulations. It is completely based on standard web technologies and uses only publicly available software. The aim is to open molecular dynamics techniques to a broader range of users including undergraduate students, teachers and scientists outside the bioinformatics field. The time-limiting factors are the availability of free capacity on the computing server to run the simulations and the time required to transport the history file through the internet for the animation mode. The interactive access mode of the portal is acceptable for animations of molecules having up to about 500 atoms.

Computer Simulation↗

PubMed2001

Experimental simulation of cat electromyogram: evidence for algebraic summation of motor-unit action-potential trains.

Prompted by the observation that the slope of the relationship between average rectified electromyography (EMG) and the ensemble activation rate of a pool of motor units progressively decreased (showing a downward nonlinearity), an experimental study was carried out to test the widely held notion that the EMG is the simple algebraic sum of motor-unit action-potential trains. The experiments were performed on the cat soleus muscle under isometric conditions, using electrical stimulation of alpha-motor axons isolated in ventral root filaments. The EMG signals were simulated experimentally under conditions where the activation of nearly the entire pool of motor units or of subsets of motor units was completely controlled by the experimenter. Sets of individual motor units or of small groups of motor units were stimulated independently, using stimulation profiles that were strictly repeatable between trials. This permitted a rigorous quantitative comparison of EMGs that were recorded during combined activation of multiple motor filaments with EMGs that were synthesized from the algebraic summation of motor unit action potential trains generated by individual nerve filaments. These were recorded separately by individually stimulating the same filaments with the same activation profiles that were employed during combined stimulation. During combined activation of up to 10 motor filaments, experimentally recorded and computationally synthesized EMGs were virtually identical. This indicates that EMG signals indeed are the outcome of the simple algebraic summation of motor-unit action-potential trains generated by concurrently active motor units. For both recorded and synthesized EMGs, it was confirmed that EMG magnitude increased nonlinearly with the ensemble activation rate of a pool of motor units. The nonlinearity was largely abolished when EMG magnitude was estimated as the sum of rectified, instead of raw, motor-unit action-potential trains. This suggests that the downward nonlinearity in the EMG-ensemble activation rate relation is due to signal cancellation arising from the perfectly linear summation of positive and negative components of action-potential waveforms. The findings provide a much needed post hoc validation of the concept of EMG generation by strict algebraic summation of motor unit action potentials that is generally relied on in theoretical modeling studies of EMG and in EMG decomposition algorithms.

Action Potentials↗

PubMed2006

Tissue consistency perception in laparoscopy to define the level of fidelity in virtual reality simulation.

BACKGROUND: What degree of fidelity must a laparoscopic simulator have to achieve a training objective? This difficult question is addressed by studying the sensory interaction of surgeons in terms of a surgical skill: tissue consistency perception. METHODS: A method for characterizing surgeon sensory interaction has been defined and applied in an effort to determine the relative importance of three components of perceptual surgical skill: visual cues, haptic information, and previous surgical knowledge and experience. Expert, intermediate, and novel surgeons were enrolled in the study. Users were asked to rank tissue consistency in four different conditions: a description of the tissue alone (Q), visual information alone (VI), tactile information alone (TI), and both visual and tactile information (VTI). Agreement between these stages was assessed by a coefficient of determination (R2). RESULTS: Tissue is a determinant factor (p < 0.001) in the perception of tissue consistency, whereas the expertise of the surgeon is not (p = 0.289). Tissue consistency perception is based mainly on tactile information (TI-VTI agreement is high, R2 = 0.873), although little sensory substitution is present (VI-VTI agreement is low, R2 = 0.509). Agreement of Q-VI increases with experience (R2 = 0.050, 0.290, and 0.573, corresponding with to novel, intermediate, and expert surgeons), which has been associated with the "visual haptics" concept. CONCLUSIONS: Virtual reality simulators need haptic devices with force feedback capability if tissue consistency information is to be delivered. On the other hand, the visual haptics concept has been associated with a kind of tactile memory developed by surgical experience.

Clinical Competence↗

PubMed2002

A generic arthroscopy simulator architecture.

Virtual Environments offer considerable potential to improve training for arthroscopic surgery. However, current systems are developed for individual joints, which requires healthcare providers to purchase and maintain multiple environments with differing interfaces and capabilities. This paper describes a generic arthroscopy system architecture that allows the fast development of training environments for any joint, each sharing a common user-interface. The use of the architecture in developing a simple ankle simulator is also described.

Anatomy, Regional↗

PubMed2006

Evaluation of target scores and benchmarks for the traversal task scenario of the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) laparoscopy simulator.

BACKGROUND: The Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) simulator is validated for laparoscopy training, but benchmarks and target scores for assessing single tasks are needed. METHODS: Control data for the MIST-VR traversal task scenario were collected from 61 novices who performed the task 10 times over 3 days (1 h daily). Data were collected on the time taken, error score, economy of movement, and total score. Test differences were analyzed through percentage scores and t-tests for paired samples. RESULTS: Improvement was greatest over tests 1 to 5 (improvement: test(1.2), 38.07%; p = 0.000; test(4.5), 10.66%; p = 0.010): between tests 5 and 10, improvement slowed and scores stabilized. Variation in participants' performance fell steadily over the 10 tests. CONCLUSION: Trainees should perform at least 10 tests of the traversal task-five to get used to the equipment and task (automation phase; target total score, 95.16) and five to stabilize and consolidate performance (test 10 target total score, 74.11).

Adult↗

PubMed1986

Surgical practice kit. Ophthalmic suture simulator.

A practice surgery device used for training novice ophthalmic surgeons employs an inflatable bladder that supports a human bank scleral shell. The sclera is used for placement of sutures. A light source and universal joint to support a syringe are mounted on a 25 X 15-cm base. Glycerin-preserved sclera is available from many eye banks. Up to 100 practice sutures may be placed in each scleral shell. This device allows the beginning surgeon the opportunity to obtain a feel for needle passage through tissue. Technique for the use of loupe or microscope magnification can also be developed. In addition, a deflation of the scleral "globe" occurs when a needle is placed too deeply. This emphasizes the need of superficial suture placement.

Humans↗

PubMed2000

[Topical organization of the cat inferior colliculus under conditions of the simulated sound source motion].

Binaurally presented click trains with gradually changing ITDs were used to imitate the sound source motion. Focal EP-trains from the cat inferior colliculus, IC, were recorded, and changing amplitude of the successive EPs following successive clicks was taken for estimation of the motion effect (ME). It was shown that a) in 25% of cases the ME depends on the motion direction; b) the ME is better presented ipsilaterally in respect to the recording point, with equal dependence on motion velocity both on the left and on the right; c) the ME phenomenon is connected with prevalence of contralateral afferentation as compared to the ipsilateral one; d) the ME is connected with inhibitory phenomena such as binaural suppression of monaural afferentation; e) the ME of the best amplitude is most pronounced in the ventrolateral area of the IC central nucleus, its localisation being near to that of the great multipolar neurones, whereas slightly and moderately pronounced MEs are presented rather uniformly over the central nucleus like the "basic" neurones are; MEs of different pronouncement are supposed to depend differently on effectiveness of ipsi- and contralateral stimulation--in accordance with properties of multipolar and "basic" neurons.

Acoustic Stimulation↗

PubMed2001

The effects of levels of immersion on memory and presence in virtual environments: a reality centered approach.

Simulation fidelity is characterized as the extent to which a Virtual Environment (VE) and relevant interactions with it are indistinguishable from a user's interaction with a real environment. The growing number of VE training applications which target a high level of simulation fidelity, mainly for transfer of training in the real world, have made it crucial to examine the manner in which these particular implementations and designs are evaluated. The methodology presented in this study focuses on real versus simulated virtual worlds, comparing participants' level of presence, task performance, and cognition state employed to complete a memory task. A 15-minute seminar was presented in four different conditions including real, 3D desktop, 3D Head Mounted Display (HMD) and Audio-only (between-subjects design). Four independent groups of 18 participants took part in the experiment, which investigated the effects of levels of immersion on participants' memory recall and memory awareness state (relevant to episodic and semantic memory types) as well as on their perception of the experimental space and sense of presence for every condition. The level of reported presence was not positively associated with accurate memory recall in all conditions, although the scores for both presence and seminar memory recall in the "real" condition were statistically higher. Memory awareness states' analysis gave a invaluable insight into "how" participants remembered both communicated information and space, as opposed to "what," most interestingly across specific conditions where results for presence and accurate memory recall were not proven to be significant.

Adult↗

PubMed1990

Preliminary results from the evaluation of cockpit resource management training: performance ratings of flightcrews.

The first data from the NASA/University of Texas Crew Performance project on the behavior of flightcrews with and without formal training in Cockpit Resource Management (CRM) is reported. Expert observers made detailed ratings of 15 components of crew behavior in both line operations and in full mission simulations. The results indicate that such training in crew coordination concepts increases the percentage of crews rated as above average in performance and decreases the percentage rated as below average. The data also show high and unexpected degrees of variations in rated performance among crews flying different aircraft within the same organization. It was also found that the specific behaviors that triggered observer ratings of above or below average performance differed markedly between organizations. Characteristics of experts' ratings and future research needs are also discussed.

Aircraft↗

PubMed2005

Teaching communication skills to medical students, a challenge in the curriculum?

INTRODUCTION: As communication skills become more and more important in medical practice, the new medical curriculum at Ghent University (1999) implemented a communication curriculum. METHOD: Communication training or experiences in 'real life' settings are provided every year of the medical curriculum. The training starts with simple basic skills but gradually slips into medical communication or consultation training and results in communication in different contextual situations or with special groups of patients. Rehearsal is important and seen as inevitable. Poorly performing students get extra training. Several didactical methods are used: the skills are demonstrated by means of videotapes and paper cases of patient stories. Skills are trained in small groups (10-15 students), with focus on role-playing with colleague students or simulated patients (SP). Videotapes of real consultations give an idea of the performance of each student. Every year the students are assessed by means of an OSCE (objective structured clinical examination). CONCLUSION: After 6 years of experience with the new curriculum, several remarks and questions need to be answered. Small group training gives a huge workload and with different trainers discrepancies between groups can appear. Choosing the most suitable trainer for communication skills is not easy; several options are available: specialists in communication like psychologists with interest in medical practice, GPs with interest in medical communication, medical specialists for communication topics concerning medical problems within their domain. As the most important didactical approach lies in practising the skills, the selection and training of simulated patients remains a challenge. PRACTICE IMPLICATION: A communication continuum during the whole curriculum seems to be worthwhile. Students with specific communicative problems are detected early, remediation is provided. Rehearsal every year seems to lead to better acquisition. The most positive point is that communication is embedded in a global patient-, student- and community-oriented curriculum and that communication skills are seen as core elements of good doctoring.

Belgium↗

PubMed2002

Training and pretreatment planning of interventional neuroradiology procedures--initial clinical validation.

A PC based system for simulating image-guided interventional neuroradiological procedures for physician training and patient specific pretreatment planning is described. The system allows physicians to manipulate and interface interventional devices such as catheters, guidewires, stents and coils within 2-D and hybrid surface and volume rendered 3-D patient vascular images in real time. A finite element method is employed to model the interaction of the catheters and guidewires with the vascular system. Fluoroscopic, roadmapping and volume rendered 3-D presentations of the vasculature are provided. System software libraries allow for the use of commonly employed catheters, guidewires, stents and occluding coils of various shapes and sizes. The results of an initial clinical validation suggest that the experience gained from our simulator is comparable with that of using a vascular phantom. We are conducting further validation with the aim of providing patient specific pretreatment planning.

Angioplasty, Balloon↗

PubMed2005

Effects of a twenty-four hour call period on resident performance during simulated endoscopic sinus surgery in an accreditation council for graduate medical education-compliant training program.

OBJECTIVES/HYPOTHESIS: Since the early 1990s, extended resident work hours have undergone increasing scrutiny. Although previous studies have demonstrated conflicting results regarding cognitive decline secondary to fatigue, few studies have specifically examined the effects of fatigue on surgical performance. No previous studies have examined resident performance under current Accreditation Council for Graduate Medical Education (ACGME) work-hour guidelines that limit residents to an average number of work hours of 80 hours per week. The study sought to determine whether an endoscopic sinus surgery simulator (ES3) measured performance changes before and after a 24-hour on-call period in residents following mandated work-hour limitations. STUDY DESIGN: Case control, crossover trial at a Level I trauma center. METHODS: Eight general surgical residents were trained on the novice mode of the ES3. These residents were then tested twice both before and after on-call duties. Performance and hazard scores were compared using a paired t test. RESULTS: No statistically significant change in the number of errors, time to task completion, or overall performance was identified in the study between the precall and postcall groups. There was a trend toward improved speed at the expense of accuracy in the postcall group. Postcall score between the two trials improved, on average, by 3.3 (P = .045). CONCLUSION: In the study of residents following current ACGME work-hour mandates, there was no diminution in performance before and after a 24-hour on-call period. There was a trend toward improved speed at the expense of accuracy. Furthermore, repetition on the ES3 in the postcall period can result in improved ES3 proficiency.

Accreditation↗

PubMed2003

Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills.

BACKGROUND: The study was carried out to analyze the learning rate for laparoscopic skills on a virtual reality training system and to establish whether the simulator was able to differentiate between surgeons with different laparoscopic experience. METHODS: Forty-one surgeons were divided into three groups according to their experience in laparoscopic surgery: masters (group 1, performed more than 100 cholecystectomies), intermediates (group 2, between 15 and 80 cholecystectomies), and beginners (group 3, fewer than 10 cholecystectomies) were included in the study. The participants were tested on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) 10 consecutive times within a 1-month period. Assessment of laparoscopic skills included time, errors, and economy of hand movement, measured by the simulator. RESULTS: The learning curves regarding time reached plateau after the second repetition for group 1, the fifth repetition for group 2, and the seventh repetition for group 3 (Friedman's tests P <0.05). Experienced surgeons did not improve their error or economy of movement scores (Friedman's tests, P >0.2) indicating the absence of a learning curve for these parameters. Group 2 error scores reached plateau after the first repetition, and group 3 after the fifth repetition. Group 2 improved their economy of movement score up to the third repetition and group 3 up to the sixth repetition (Friedman's tests, P <0.05). Experienced surgeons (group 1) demonstrated best performance parameters, followed by group 2 and group 3 (Mann-Whitney test P <0.05). CONCLUSIONS: Different learning curves existed for surgeons with different laparoscopic background. The familiarization rate on the simulator was proportional to the operative experience of the surgeons. Experienced surgeons demonstrated best laparoscopic performance on the simulator, followed by those with intermediate experience and the beginners. These differences indicate that the scoring system of MIST-VR is sensitive and specific to measuring skills relevant for laparoscopic surgery.

Clinical Competence↗