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WO1996016389A1 - Simulateur d'actes medicaux - Google Patents

Simulateur d'actes medicaux Download PDF

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Publication number
WO1996016389A1
WO1996016389A1 PCT/US1995/014368 US9514368W WO9616389A1 WO 1996016389 A1 WO1996016389 A1 WO 1996016389A1 US 9514368 W US9514368 W US 9514368W WO 9616389 A1 WO9616389 A1 WO 9616389A1
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WO
WIPO (PCT)
Prior art keywords
implement
medical
medical procedure
simulation
simulated
Prior art date
Application number
PCT/US1995/014368
Other languages
English (en)
Inventor
John E. Staneff, Jr.
Robert S. Moore
Lewis John Harthan, Iii
Darrell L. Livezey
Robert F. Jones
David L. Ludke
Leo R. Catallo
Original Assignee
Staneff John E Jr
Moore Robert S
Lewis John Harthan, Iii
Livezey Darrell L
Jones Robert F
Ludke David L
Catallo Leo R
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Staneff John E Jr, Moore Robert S, Lewis John Harthan, Iii, Livezey Darrell L, Jones Robert F, Ludke David L, Catallo Leo R filed Critical Staneff John E Jr
Priority to AU41471/96A priority Critical patent/AU4147196A/en
Publication of WO1996016389A1 publication Critical patent/WO1996016389A1/fr

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Classifications

    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine
    • G09B23/285—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine for injections, endoscopy, bronchoscopy, sigmoidscopy, insertion of contraceptive devices or enemas

Definitions

  • MEDICAL PROCEDURE SIMULATOR This invention relates to medical procedure simulation systems and more particularly to simulation systems that may be used in training physicians and other medical personnel in instrument manipulation and other techniques involved in laproscopic, endoscopic and other minimally invasive procedures used in surgical treatments.
  • a useful and practical simulation system for minimally invasive surgical techniques should: (1) Define an environment in which activities are to be simulated, the allowable limits within which changes in that environment are controlled, and the movement of maneuverable bodies therein;
  • a simulation of the external appearance of the subject i.e., a physical simulation of the human torso simulating as nearly as possible the colored skin surface texture, and the under skin muscle, bone and body cavity feel.
  • simulated instrument handle portions that should be of the same configuration as actual instrument handles and controls. These handles optionally may be equipped with appropriate instrumentation as necessary or desirable and may already be in position protruding from the simulated torso when the user is familiar with the initial insertion and location techniques of the instruments.
  • the only view and feel of the interior working area that a surgeon is provided in actual surgery is through a television monitor and tactile physical feedback through the instrument handles he is manipulating.
  • the interior simulations need not be provided by interior physical reproductions or even physical analogs but are adaptable to synthetic sensations electronically produced or controlled in response to manipulation of the simulated instrument handles and controls.
  • defining digital data for one or more instruments to be used including their dimensions, movement limits and active functions such as grasp, clamp, cut and other manipulative functions may be stored in high speed accessible electronic memory.
  • Environment-defining digital data for areas of use immediately surrounding the defined instruments such as "clear" areas, objects (organs, etc.), position, shape and texture and their give and resilience and movement-resistant forces and interactive connections with other objects likewise may be stored in high speed accessible electronic memory.
  • Simulation for visual displays may comprise "multilayer" background "landscape” video information that may be actual photographic data digitized and stored in laser disc, electronic or other memory.
  • the multilayer arrangement provides means to provide a sense of depth in the two- dimensional display through relative movement and interaction with computer graphic anatomical objects in the layers, such as organs. Additional stored visual data is required to provide visual representation of the immediate work area, e.g., the internal landscape, for the surgeon, including specific organs and anatomy to be worked on. This data, likewise may be wholly photographic data or partially photographic data such as tissue textures, stored in digital form.
  • the manipulatable visual information may be provided through a process of computer animation whereby data from "position” sensors and realistic defining photographic data is used to create and present visual and tactile representations showing the actions and movement of the "unseen” portions of the simulated instruments being manipulated by the simulator user.
  • computer animation may be used to create and present a visual representation of the "focus" organ or anatomical region to be manipulated and operated on by the user through the simulated instruments and to show the results on that "focus" region of the instrument manipulation using data from the instrument position sensors and defining data of the anatomical region.
  • data processing elements may be used to provide interactions necessary to coordinate the tactile and visual feedbacks and presentations to the simulation user for the real time simulation of an actual surgical operation or other procedure under the control of the user.
  • the present invention is directed to that portion of such a simulator that provides real life and real time simulation of a variety of minimally invasive surgical procedures.
  • the improved simulation system provides a simulation environment which includes real ⁇ time video, scopes, surgical and therapeutic instruments, foot pedals for cautery and fluoroscopy and realistic torsos that house both sophisticated sensors for scopes and changeable instruments, and tactile force feedback providing realistic feel when instruments are manipulated and contact body parts.
  • it utilizes a plurality of coordinated inexpensive off-the-shelf computers interconnected into a network. Interconnected with the computers are high capacity memories adapted for storing a myriad of different anatomical "pavilions" (i.e., areas of the body that allow remote procedures) .
  • Each of these anatomical pavilions is likewise extendible to a number of minimally invasive procedures, diagnostic and therapeutic, for which anatomical landscapes, virtual organs and a variety of instruments may be created in virtual reality.
  • the computers provide a basic computer platform that can also be used for multimedia training in auxiliary subject areas. These areas include Endoscopic Retrograde Cholangiopancreatography (ERCP) for viewing internal bile and pancreatic ducts and Sphincterotomy for cutting and widening bile and pancreatic ducts for better drainage or stone removal; Laparoscopic Surgical Skills and landscapes for the lungs, the heart, the abdominal cavity, reproductive organs, arthroscopic surgical areas such as the shoulder, eye surgeries, ear, nose and throat procedures and neuroscopic procedures.
  • ERCP Endoscopic Retrograde Cholangiopancreatography
  • Sphincterotomy for cutting and widening bile and pancreatic ducts for better drainage or stone removal
  • the system according to the invention additionally embodies realistic real-time representations of organ movement and response to tugging, pulling, cutting and the like.
  • mannequins are provided with realistically appearing and feeling exterior surfaces as well as with underlying characteristics such as rib cages and hip bone representations, thus facilitating inspection, location of incisions, and other procedures normally followed by surgeons and assistants in performing actual procedures.
  • the present system provides an enhanced level of life-like virtual simulation that includes real time realism in patient simulation including realistic landscapes, physical character including tactile force feedback, selectable multiple patient simulations, and selectable simulated procedures.
  • OBJECTS AND FEATURES OF THE INVENTION It is one general object of the invention to improve medical procedure simulation systems. It is another object of the invention to reduce costs of such systems.
  • a plurality of off-the-shelf inexpensive computers are employed in interactive relationship, thereby reducing cost, enhancing speed of operation and enhancing flexibility and extendibility.
  • a variety of landscape pavilions are made selectable by the system user, thereby enhancing versatility and extending the range of useful simulations.
  • a variety of simulated pathologies are made selectable by the system user, thereby extending the range of pathological simulations.
  • landscapes of a variety of different patients are made selectable by the system user, thereby extending the range of patients that may be simulated.
  • a variety of selectable instruments and controls are included and are conditioned to provide.geometric proportionality, force and velocity in real time, thus contributing to faithful simulation.
  • the plurality of instruments are conditioned to provide multiplicitous actions, thus further contributing to system usefulness.
  • physical modeling of human organs and landscapes is predicated on a tessellated mesh/deformable spring model, thus facilitating processing, manipulation and display thereof.
  • minute regions of landscape physical representations are processed as minute polygons and digitized, thereby facilitating storage and processing.
  • realistic tactile force feedback is provided in real time to the system user, thus providing a realistic feel to procedures such as tugging, tearing, cutting, clipping, stapling, pulling, pushing, grasping and probing.
  • a plurality of realistic mannequins are included and are provided with simulated rib cages, hip bones and other characteristics to help medical personnel in locating desired positions both within and on the mannequin surfaces.
  • a hierarchy of "school solutions" are stored within the system; and surgical procedures are compared therewith to identify actions that might endanger a live patient as well as to display recommended procedures, to score and record surgical performance.
  • FIG. 2 is a general depiction of a simulator system embodying the principles of the invention
  • FIG. 3 is simple depiction of the simulator system hereof;
  • Figure 4 is a simplified functional overview of the simulator system hereof;
  • Figure 5 is a diagram illustrating the multiple computer, distributed processing according to the invention.
  • Figure 6 is a diagram illustrating system operation when selection of skills practice is made
  • Figure 7 is a diagram illustrating system operation when selection of diagnostics is made
  • Figure 8 is an illustration depicting the presence and effect of an instrument within a simulated selected organ
  • Figure 9 is an illustration depicting simulation of the rebound effect that occurs when an instrument contacts a resilient body organ
  • Figure 10 is a diagram illustrating division of a single triangular facet into three new facets when a facet is sliced edge to edge.
  • Figure 11 is a diagram illustrating division of a single triangular facet into four new facets when a facet is sliced from an edge to the interior.
  • Figure 12 is a diagram illustrating division of a single triangular facet into five new facets when a facet is sliced from a location within its interior to another location within its interior;
  • Figure 13 is a diagram illustrating division of a single triangular facet into two new facets when a facet is sliced from an apex point to an edge.
  • Deformable Spring Model means the representation of a three dimensional structure composed of verticies interconnected by bonds to form a matrix wherein each bond may stretch or compress according to dynamic principles of physics, reacting to external forces applied to it directly or through interconnections of verticies to other bonds previously acted upon by forces interacting upon them.
  • Dynamics Engine means processing equipment and the associated body of data and instructions generated responsive to signals received from one or more trocar sensors and internal body sensors for producing electrical indicia activating and producing visual and tactile sensations that would be experienced by a user (such as a surgeon) when closely simulating a real life procedure of the type selected by the user and with a real instrument manipulated in a manner simulated by the selected implement.
  • Graphics Engine means a converter which is responsive to electrical indicia from a Dynamics Engine for producing internal landscape representing electrical data.
  • Lattice means an internal representation of tissue being modeled by the system.
  • Selected Simulation Instrument means a representation of a specific real-world instrument which has been selected by the simulator user for a specific simulation purpose. For example, to cut tissue, the user would select a scissors, which would be represented within the simulation by turning a switch, dial, or other device to select "scissors", and the appropriate electronic signals would be generated forthwith.
  • Simulation Control Computer means a computer providing simulation control for various devices used in the simulation system hereof, and it provides a platform for the state model and other programming. In the preferred embodiment, computers such as the Intel Corporation "Pentium" are used.
  • Tessellated Mesh means the representation of a surface as composed of polygons with a regular pattern of vertex sharing used to improve efficiency.
  • Tissue Modelling Computer means a high speed computation and graphics generation engine used for such tasks as operating the dynamics engine and the diagnostic display.
  • a computer such as the DEC Alpha is used.
  • Vignette means a brief incident or scene.
  • FIG. 1 it will be seen to be a representation of the prior art as set forth in the aforementioned United States Patent 4,907,973.
  • a mock endoscope 11 is inserted within model 12 by user 13.
  • Model 12 there are a plurality of sensors (not shown) that respond to the position of the tip (not shown) of the endoscope 11 and which transmit corresponding signals via conventional transmission linkages 14 to computer 15.
  • Computer 15 responds thereto by accessing storage 16 via conventional transmission linkage 17 to retrieve from conventional storage 16 a plurality of electrical indicia representing the view which would be observed from the relative location of the endoscope tip during a real operation.
  • Such indicia are conducted to video display 18 by conventional connections represented by arrow 19.
  • storage 16 may be any one of several suitable alternative storage media such as a high capability optical disc.
  • FIG. 2 presents an overview of the invention hereof.
  • a user 13 positioned alongside a mannequin 21 having a trunk portion 22 in which there are positioned a pair of trocars 23 and 24 within which there are mounted a pair of instruments 25 and 26.
  • Instruments 25 and 26 are equipped with manipulating handle portions 27 and 28 which are included to facilitate manipulation by an operator such as 13.
  • manipulating handle portions 27 and 28 which are included to facilitate manipulation by an operator such as 13.
  • FIG. 2 Also depicted in figure 2 are a video display 30, a plurality of interactive computers represented by block 31, high capacity memory storage 32 for landscape and other system storage, and tactile force feedback circuits and storage 33. As previously mentioned, these are combined, functionally interrelated and connected as represented by arrows 34a-34e. Some of these arrows are shown as being double-headed and pointing essentially in opposite direction so as to represent the interchange of information and bi-directionality rather than unidirectionality.
  • FIG 3 it will be seen to schematically portray in greater detail selected parts represented in Figure 2.
  • the display(s) 40 which may be either a single monitor provided with single or split screens, or a plurality of monitors for simultaneously presenting several system parameters.
  • Display(s) 40 are connected to electronics 41 via path 42, and electronics 41 are connected to gimballed assemblies 43 and 44 of left and right trocars 45 and 46 via paths 47 and 48.
  • gimballed assemblies 43 and 44 As will be observed from the description below, it is through these gimballed assemblies 43 and 44 that tactile force feedback forces are applied to left and right instruments 49 and 50.
  • instrument panel 51 which is provided for additional display and control, including holes
  • selector switches 53 and 54 which are included to provide for selection of procedures and instruments to be simulated from among a plurality of such procedures and related instruments. Also depicted are optional foot pedals 55 and 56 through which foot-operated actions can be simulated.
  • FIG 4 it will be observed to present a general overview of the preferred system according to the invention.
  • a conventional touch screen 64 that preferably is included as a part of the display 40 of Figure 3.
  • the output of the touch screen 64 is denominated "user input” and is communicated as illustrated by arrow 65 to the simulation coordinator 66 which, in accordance with the foregoing description, comprises a plurality of interactive computers.
  • the simulation coordinator 66 which, in accordance with the foregoing description, comprises a plurality of interactive computers.
  • the trocars there are associated with the trocars a plurality of control and sensing elements. These are represented by the trocar controller polygon 67 from which sensor electrical output indicia are communicated as shown by extended arrow 68 to dynamics engine 69.
  • the dynamics engine is, as defined above, a body of data and instructions responsive to signals received from the trocar sensors and internal body sensors for producing physical sensations to a user closely simulating that which would appear to a surgeon when conducting a real life procedure of the type selected by the system user and with a real instrument manipulated in a manner simulated by the selected simulation implement.
  • electrical indicia are communicated via display path 70 to Graphics Engine 71 where there are produced the corresponding graphics which are displayed on display 40 ( Figure 3) .
  • Simulator Control & User-World Interaction bi-directional arrow 72 represents such sensor action, user/operator interaction and computer control.
  • simulator control arrow 73 which represents flow of electrical control and information indicia, preferably in digital data form, to and from a video controller 74, memory laser disc or other high capacity memory 75, video overlay 76 and audio controller 77.
  • Feedback type signals representing tactile force feedback are represented by block 78 and are described in detail in the above-identified co-pending United States Patent Application Serial No. 08/355,612 filed on December 14, 1994.
  • the system user selects the type of simulation to be performed together with the type of instrument to be employed. As mentioned above, this is preferably accomplished by appropriately positioning selector switches 53/54 of Figure 3 (represented by arrow 65 in figure 4) . However, such can be readily performed by touching selection areas on a conventional touch screen such as touch screen 64 of Figure 4. After such selection has been made, simulation coordination and control occur and condition the accessing of dynamics engine 69 to produce corresponding landscape and control signals.
  • Master computer 80 includes: (a) an input/output and an interface for receiving and transmitting signals to the mannequin 21 ( Figure 2) ; (b) a conference server; and (c) startup software.
  • Computer 80 is interconnected with three slave computers 81, 82, 83, and with independent computer 84 via communication bus 85.
  • Slave 81 is another state of the art simulation control computer which includes: (a) an application interface; (b) a play video sequence; (c) a state engine; (d) a video switch; and (e) the system video overlay.
  • Slave 82 is a tissue modelling computer which processes and controls systems dynamics and the aforementioned graphics display.
  • Slave 83 is a small general purpose computer denominated Audio/Video
  • Independent Video Computer 84 is another small general purpose computer which processes and controls electrical indicia for the aforementioned display video and the display overlays. Interactive interconnections between these computers is represented by communications bus 85 through which control indicia and data are communicated.
  • communications bus 85 through which control indicia and data are communicated.
  • Block 100 represents the system initialization in which, after being turned on, the aforementioned selection is made to use both trocars 23 and 24 (Figure 2) of the mannequin 21. Both trocars are manually reset ( Figure 3) , and then either the aforementioned touch screen 64 ( Figure 4) is touched or an optional conventional switch or other control is manipulated to make a selection 101 as between skills practice and diagnostics..
  • Figure 6 depicts system operation when skills practice is selected
  • Figure 7 depicts system operation when the selection is for diagnostic simulation. Therefore, system operation proceeds as by arrow 102 to rectangle 103 which represents patient mobilization and exposure.
  • system operation proceeds as by arrow 104 to block 105 which portrays by examples of Mobilizations 1, 2 and 3, the selectability of any one of a variety of desired mobilizations. Moreover, provision is also made for random selections that may be made by the system if so indicated by the user.
  • system operation proceeds as by arrow 106 to block 107 which represents skills menu 107 and the main system menu as well as observation and skills practice.
  • Arrow 108 connected to oval "A" represents a path for return to the main menu which is represented by block 101.
  • a skills menu identifies those skills which the system is adapted to allow a user to practice. These may include any of a wide variety such as ligature, hernia repair, tubal ligation and duct exploration. A menu including such skills is presented on monitor display (30 in Figure 2, 40 in Figure 3) for user selection.
  • monitor display (30 in Figure 2, 40 in Figure 3) for user selection.
  • Line 110 and 111 extending between block 107 and "Observe Video” block 112. These lines signify the communication of electrical indicia to displays such as those mentioned above as represented by "Observe Video” block 112.
  • An additional line 113 extending between block 107 and "Simulation” block 114 represent the interchange of electrical indicia as procedure simulation proceeds.
  • Arrow 115 extending between block 107 and "Touch Screen to Begin” block 116 represents communication of electrical indicia to condition the touch screen and ready it to accept user readiness for the procedure to get under way. After the user has instructed the simulation to proceed by appropriately touching the touch screen (as described above) , system operation progresses as represented by arrow 117, whereupon a simulation 114 of the selected procedure occurs.
  • indicia are presented on the system display instructing the user to initiate further operation by touching the screen. This is represented by arrow 118 extending between "Simulation” block 114 and "Touch Screen To Continue” block 119. System operation then resumes as represented by arrow 120 which connects to information/instruction interchange path 106.
  • System operation then proceeds as previously described with respect to mobilization and exposure, indicia being conducted through information/instruction interchange path 106 to block 107 and thence to blocks 112, 114, 116 and 119.
  • Other procedures and skills are selectable as represented by Joining and Division blocks 125 and 126. Selection of these procedures from the menu of block 103 is represented by arrows 127 and 128; and system operation after such selection pro ⁇ ceeds as by information/instruction interchange path 106 to block 107 and thence to blocks 112, 114, 116 and 119 as de ⁇ scribed above.
  • FIG 7 it will be seen to illustrate the setup and selection process to ready the simulator for diagnostics practice use.
  • block 100 (previously de- scribed with respect to Figure 6) is shown; and system opera ⁇ tion for Figure 7 proceeds as when diagnostic practice rather than skills practice selected.
  • the system is conditioned as indi- cated by arrow 130 to display on the aforementioned monitor displays a message (block 131) "Please (1) Set the switch to the one hold manikin; (2) Put the trocar in its reset posi- tion; and then (3) Touch the screen to continue.”
  • a message block 131 "Please (1) Set the switch to the one hold manikin; (2) Put the trocar in its reset posi- tion; and then (3) Touch the screen to continue."
  • an option is provided (block 132) for the user to select as between normal and pathological conditions, whereupon the system proceeds as represented either by arrow 133 to normal simulation block 135 or arrow 134 to pathology simulation 136. If selection of normal simulation is made as represented by arrow 133, then normal diagnostic simulation proceeds and the aforementioned presentation of simulated landscape views of selected internal scenes is that of a normal patient.
  • manipulation of the simulated viewing instrument through the selected trocar is sensed by the related sensors to condition other parts of the system (e.g., the dynamics engine, land ⁇ scape memories) to provide life-like representations of rele- vant simulated patient internal landscapes.
  • the system proceeds as by block 138 to provide for user selection of further normal simulations or return to the main menu. Selection of further normal simulations by Touch to Continue puts the system on path and arrow 139 to provide for further simulations.
  • pathology the system operation proceeds as represented by arrow 134 to pathological simula ⁇ tion 136. There, selection of a particular type of pathology may be made or, alternatively, the system may be instructed to randomly present one of a number of stored pathologies.
  • Simulation then proceeds via "Timeout" line and arrow 143, block 144 and path/arrow 145 to simulation 136, similar to the path described for line and arrow 137, block 138 and path/arrow 139, except that now the landscapes that are por- trayed are pathological rather than normal.
  • path/arrow 146 When selection is made to return to the main menu, then the system proceeds as represented by path/arrow 146 and connected "A" designator and path 141 to path 142 so that another selection as between normal and pathology may be made as represented by block 132.
  • one of the objectives of including diagnostic skills practice is to permit the user to correctly identify the presented pathology.
  • an identifi ⁇ cation of the pathological condition that is depicted in the displayed simulated landscape there may be included an identifi ⁇ cation of the pathological condition that is depicted in the displayed simulated landscape, and provision may be included for the system user to identify his selection either by touch ⁇ ing the touch screen of the aforementioned display in the appropriate location, by keyboard entry or other known tech ⁇ niques. If such identification is correct, then system opera- tion proceeds as by "successful" path/arrow 147 to block
  • path/arrow 154 is interconnected by path/arrow 154 to block 155 representing provision for user change of subject as between a plurality of differing cases, i.e., types of simulated pathologies/patient- s.
  • Such change of patients/pathologies is represented by path/arrow 156 denoting a return of system operation (with the change of patient/pathology) to operation represented at and after block 132.
  • path/arrow 156 denoting a return of system operation (with the change of patient/pathology) to operation represented at and after block 132.
  • the system proceeds as represented by "double touch" path/arrow 157 to the initial screen 100.
  • Figure 8 illustrates some of the considerations involved in providing faithful simulations of forces that would actually be encountered in conducting a real-life procedure.
  • a simulation of a body organ 160 As is well known to those skilled in the art, all internal body organs are relatively soft compared with metallic instru ⁇ ments such as instrument 161; and the organs tend to "give" with a degree of resistance when subjected to forces thereup ⁇ on. Thus, organs tend to flex when forces are applied thereto by contact with an instrument. In addition, and since organs are loosely tied down, they also tend to move in three dimen ⁇ sional space.
  • the organ is tubular (as shown) , and if it is pushed by a rod-like instrument as at contact point 162, the organ will initially provide contact feedback, then flex away offering increasing resistive force and then returning to its previous position when free to do so. It has been found that the result may be an oscillation if the instrument re- mains close by but within the normal extension range of the organ. Such oscillation results, in part, from a periodic accumulation of elastic forces within the simulation of the organ. Collisions occur between objects in simulation (e.g., as between an instrument and an organ) . When it is likely that a collision may occur, the simulator attempts to deter ⁇ mine whether they in fact did occur.
  • a tubular-like implement is represented by rectan ⁇ gle 163, and a series of successive positions of part of an organ are represented by circles and oval 164a-164g. These successive positions are simulations of movement of the rod- shaped instrument with respect to time arrow 165.
  • rod 161 is moves in contact with organ 160 as at location 162 and the organ flexes (as represented by positions 164a-164d, the organ is deformed (as represented by the oval shape of 164d) and due to its elasticity, it then rebounds as represented by successive- sive states 164e-164g.
  • a lattice is an internal representation of tissue being modeled by the system.
  • each lattice is made up of atoms which have mass and can be connected to each other by elastic bonds.
  • Three atoms joined in a triangle by three bonds can have an associated, visible facet.
  • Tissue surfaces, then, are represented by a mesh of triangular facets, with bonds along the edges of the facets and atoms at their corners. Extra bonds and atoms can provide additional invisible structure.
  • a lattice can interact with simulat- ed rigid bodies.
  • Rigid bodies such as the simulated instru ⁇ ments employed in the system, are considered as being made of components with fixed size and shape. These components can move with respect to each other, and the whole rigid body can be positioned by external stimuli and/or interactions with the lattice.
  • the system checks to see if any rigid bodies have collided with facets, calls collision-handler routines which can modify and apply forces to the lattices, accelerates the atoms according to the forces on them, and conditions the facets to their new states.
  • Lattices are included in vignettes which in turn are stored in the above-mentioned memory.
  • vignette When a vignette is recalled from memory, it includes its lattices, such as that which is illustrated in Figure 10. It also contains vignette parameter information such as lattice volume, density, surface area and mass per unit area. The system then initializes the atoms in the lattice, transforming their coordinates so that the visualization of the model overlays the background in the same place when displayed on the display screen regardless of eye point position or orientation. Information identifying the lattice bonds are, of course, also included.
  • atoms In processing lattice information, only atoms are consid- ered to have mass. Each atom initially is assigned zero mass, and creating a facet adds mass to each of its atoms. The amount of mass to be distributed to the atoms is the product of the facet rest area and the lattice mass per unit area; and one third of such mass is assigned to each of the facet*s three atoms.
  • Such dynamics loop contains an inner loop and an outer loop.
  • the outer loop reads control and trocar-position sockets (as described above) , responds to keyboard commands and processes what it reads from the sock ⁇ ets. If a vignette is loaded and running, the outer loop also runs the inner loop and performs several additional steps such as rendering the model and transmitting force feedback and filter output.
  • the inner loop applies forces to and moves the lattice.
  • An "iterations count" is included within vignette control to set how many times the inner loop runs for each pass through the outer loop.
  • the inner loop zeros the accumulated force on each atom, resets a flag indicating whether an atom has received force from a collision with a rigid body and calcu ⁇ lates normals for the facets and atoms.
  • the inner loop then calls for a calculation of the length of each bond and the resulting force to be applied to the atoms of the bond.
  • the bond with the most force on it is the one that is broken upon instrument contact provided the force on the bond exceeds its yield strength. This is done by creating tears from the midpoint of the bond to the opposite atoms of the bond facets, preferably one at a time.
  • the bond forces are then applied to the atoms of each bond, and the effect of gravity is applied to each atom.
  • the inner loop calls for an acceleration of each non-station ⁇ ary atom according to its accumulated force, the dampening by a global friction factor of the simulated velocity of every non-stationary atom, the limiting of simulated speed of atoms which are moving excessively quickly, and the movement to of each relevant atom to its next position.
  • compensation is provided for varying speeds of simulator system operation by introducing a factor related to the aver ⁇ age duration of an iteration of the inner loop measured during the previous iteration of the outer loop.
  • One additional operation performed by the inner loop is sensing of atoms that should be split into two or more result ⁇ ing from such actions as the breaking of nearby bonds or specific types of slicing.
  • the inner loop is split with one group of contiguous facets remaining connected to the original atom and each remaining group of contiguous facets being connected to a newly created atom.
  • Collision handling is performed for each rigid body in turn.
  • Each rigid body can interact with the lattice and with other rigid bodies.
  • To facilitate identification of those facets or bonds that might interact with each rigid body a calculation is made of the distance of each atom from a plane occupied by the rigid body. Those which either cross the plane or come close enough to be of interest are then marked.
  • a collision handler list is provided to record and pro- vide a set of functions which can include pre- and post-pro ⁇ cessing, interaction with facets, bonds or atoms, and handling collisions with other rigid bodies. Such is called up by the system as needed to provide collision handler information. This is used when applying force to facets such as the hemi- sphere, cylinder and grab handlers.
  • a knit collision handler is employed to permanently close the end of a tube after the walls of the tube have been pressed together.
  • the knit colli ⁇ sion handler knits together sets of atoms by adding new bonds and/or by resizing existing ones. Each atom then qualified to be knit is joined by a bond to every other qualified atom, and each of the knit atoms remains in roughly the same physical position relative to the others.
  • the lattice data structure keeps track of the number of atoms, bonds and facets in the lattice and includes identifiers linking such information with linked atom, bond and facet lists that are included in the storage described above. It also includes values derived from vi ⁇ gnette parameters such as the spring constant-rest length product, maximum spring constant and the mass per unit area of the model.
  • a proposed tear bond has the end of a tear at either of its atoms, the existing tear may propagate through the atom instead of the proposed tear bond breaking and forming a new tear. If two or more of the bonds connected to an atom on the proposed tear bond were formed by tearing (i.e., the atom is at the end of an existing tear) , the system examines other bonds to tear. As possible replacements for the proposed tear bond, the system considers a bond in each facet attached to either end of the proposed bond. Only one bond in each facet, the one opposite the proposed tear bond/s end atom, is considered.
  • Selected lattices contain a plurality of roughly parallel paths running along the surface from one end to another; and each atom and bond with facets can be part of one numbered path.
  • a "cut complete" signal is produced and is processed to denote that the cut has been completed.
  • Figure 10 illustrates division of a single triangular facet into three new facets when a facet is sliced edge to edge.
  • the original facet is a triangle which was composed of the three sides marked: (1) new bonds [0] and new bonds [1] ; (2) new bonds [2] and new bonds [3] ; and (3) original bond before slicing and creation of the new bonds and new atoms. These were continuous and joined togeth- er without the separation 169. Old atoms 170, 171 and 172 are located at the three apexes of the original facet as shown.
  • FIG 11 it will be seen to depict division of a single triangular facet into three new facets when a facet is sliced from an edge to the interior.
  • a cut from the lower edge (the line extending horizontally between old atoms 171 and 172) to a location marked by new atom [2] results in the creation and positioning of new atoms [0], [1] and [2] as well as the creation of new bonds [0], [1], [2], [3], [4], [5], and [6].
  • This results in the creation of new facets [0], [1], [2], and [3].
  • Figure 12 is seen to depict division of a single triangular facet into five new facets when a facet is sliced from a location within its interior to another location within its interior.
  • an interior cut results in the creation and positioning of new atoms [0], and [1] as well as the creation of new bonds [0], [1], [2], [3], [4], [5], and [6] .
  • This results in the creation of new facets [0], [1], [2], [3] and [4].
  • Figure 13 is a diagram illustrating division of a single triangular facet into two new facets when a facet is sliced from an apex point to an edge.
  • the original triangular facet which again is shown as an essentially equilateral triangle bounded by old atoms 170, 171 and 172, a cut from the lower edge (the line extending horizontally between old atoms 171 and 172) to the apex location marked by.old atom 170 results in the creation and positioning of new atoms [0] and [1] as well as the creation of new bonds [0], [1], [2] and [3]. This, in turn results in the creation of new facets [0] and [1] .

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Abstract

Système interactif de simulation d'actes médicaux faisant appel à un mannequin (21) ayant un aspect et une consistance naturels. Le mannequin comporte un ou plusieurs trocarts (23, 24) dans lesquels on a introduit sélectivement des simulations d'outils de diagnostic et de traitement (25, 26) permettant de procéder à des actes médicaux traditionnels. Il est possible de créer et de visualiser (30) des représentations réalistes et homogènes d'environnements internes réels, modifiables pour suivre les changements de position des endoscopes et des instruments médicaux simulés. Le réalisme est amélioré par l'emploi d'un retour d'effort à action pneumatique qui donne une sensation réaliste des gestes simulés: déchirer, couper, tailler, agrafer, tirer, pousser, saisir et sonder.
PCT/US1995/014368 1994-11-17 1995-11-17 Simulateur d'actes medicaux WO1996016389A1 (fr)

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AU41471/96A AU4147196A (en) 1994-11-17 1995-11-17 Medical procedure simulator

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US34168694A 1994-11-17 1994-11-17
US08/341,686 1994-11-17

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DE19643478A1 (de) * 1996-10-22 1998-04-23 Juergen Kirstein Interaktive Bildschirmexperimente in QTVR-Technik
WO1999017265A1 (fr) * 1997-09-26 1999-04-08 Boston Dynamics, Inc. Procede et appareil d'entrainement chirurgical et de simulation d'operation chirurgicale
FR2771202A1 (fr) * 1997-11-19 1999-05-21 Inst Nat Rech Inf Automat Dispositif electronique de traitement de donnees-image, pour la simulation du comportement deformable d'un objet
EP0935796A1 (fr) * 1996-07-23 1999-08-18 Medical Simulation Corporation Systeme con u pour former des personnes a l'execution de procedures chirurgicales a caractere invasif minimal
WO1999042978A1 (fr) * 1998-02-19 1999-08-26 Boston Dynamics, Inc. Procede et dispositif pour l'entrainement et la simulation pour interventions chirurgicales
WO2001082266A1 (fr) * 2000-04-26 2001-11-01 Universite Paris 7 - Denis Diderot Systeme et procede d'apprentissage en realite virtuelle pour l'odontologie
WO2003023737A1 (fr) * 2001-09-07 2003-03-20 The General Hospital Corporation Systeme de formation et d'entrainement aux actes medicaux
US7174774B2 (en) 2002-08-30 2007-02-13 Kimberly-Clark Worldwide, Inc. Method and apparatus of detecting pooling of fluid in disposable or non-disposable absorbent articles
US8576253B2 (en) 2010-04-27 2013-11-05 Microsoft Corporation Grasp simulation of a virtual object
US8951047B2 (en) 1996-05-08 2015-02-10 Gaumard Scientific Company, Inc. Interactive education system for teaching patient care
US9004922B2 (en) 2000-10-06 2015-04-14 Gaumard Scientific Company, Inc. Interactive education system for teaching patient care
EP2922048A4 (fr) * 2012-11-13 2015-10-07 Eidos Medicine Llc Dispositif d'entraînement médical hybride pour laparoscopie
US9324247B2 (en) 2003-11-25 2016-04-26 Gaumard Scientific Company, Inc. Interactive education system for teaching patient care
US9501955B2 (en) * 2001-05-20 2016-11-22 Simbionix Ltd. Endoscopic ultrasonography simulation
US10896627B2 (en) 2014-01-17 2021-01-19 Truinjet Corp. Injection site training system
US10902746B2 (en) 2012-10-30 2021-01-26 Truinject Corp. System for cosmetic and therapeutic training
US11710424B2 (en) 2017-01-23 2023-07-25 Truinject Corp. Syringe dose and position measuring apparatus
US11730543B2 (en) 2016-03-02 2023-08-22 Truinject Corp. Sensory enhanced environments for injection aid and social training
US12070581B2 (en) 2015-10-20 2024-08-27 Truinject Corp. Injection system
US12217626B2 (en) 2012-10-30 2025-02-04 Truinject Corp. Injection training apparatus using 3D position sensor

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US8951047B2 (en) 1996-05-08 2015-02-10 Gaumard Scientific Company, Inc. Interactive education system for teaching patient care
US9378659B2 (en) 1996-05-08 2016-06-28 Gaumard Scientific Company, Inc. Interactive education system for teaching patient care
EP0935796A1 (fr) * 1996-07-23 1999-08-18 Medical Simulation Corporation Systeme con u pour former des personnes a l'execution de procedures chirurgicales a caractere invasif minimal
EP0935796A4 (fr) * 1996-07-23 2000-02-23 Medical Simulation Corp Systeme con u pour former des personnes a l'execution de procedures chirurgicales a caractere invasif minimal
DE19643478A1 (de) * 1996-10-22 1998-04-23 Juergen Kirstein Interaktive Bildschirmexperimente in QTVR-Technik
WO1999017265A1 (fr) * 1997-09-26 1999-04-08 Boston Dynamics, Inc. Procede et appareil d'entrainement chirurgical et de simulation d'operation chirurgicale
FR2771202A1 (fr) * 1997-11-19 1999-05-21 Inst Nat Rech Inf Automat Dispositif electronique de traitement de donnees-image, pour la simulation du comportement deformable d'un objet
WO1999026119A1 (fr) * 1997-11-19 1999-05-27 Inria Institut National De Recherche En Informatique Et En Automatique Dispositif electronique de traitement de donnees-image, pour la simulation du comportement deformable d'un objet
US6714901B1 (en) 1997-11-19 2004-03-30 Inria Institut National De Recherche En Informatique Et En Automatique Electronic device for processing image-data, for simulating the behaviour of a deformable object
WO1999042978A1 (fr) * 1998-02-19 1999-08-26 Boston Dynamics, Inc. Procede et dispositif pour l'entrainement et la simulation pour interventions chirurgicales
WO2001082266A1 (fr) * 2000-04-26 2001-11-01 Universite Paris 7 - Denis Diderot Systeme et procede d'apprentissage en realite virtuelle pour l'odontologie
FR2808366A1 (fr) * 2000-04-26 2001-11-02 Univ Paris Vii Denis Diderot Procede et systeme d'apprentissage en realite virtuelle, et application en odontologie
US9004922B2 (en) 2000-10-06 2015-04-14 Gaumard Scientific Company, Inc. Interactive education system for teaching patient care
US9406244B2 (en) 2000-10-06 2016-08-02 Gaumard Scientific Company, Inc. Interactive education system for teaching patient care
US9501955B2 (en) * 2001-05-20 2016-11-22 Simbionix Ltd. Endoscopic ultrasonography simulation
WO2003023737A1 (fr) * 2001-09-07 2003-03-20 The General Hospital Corporation Systeme de formation et d'entrainement aux actes medicaux
US7174774B2 (en) 2002-08-30 2007-02-13 Kimberly-Clark Worldwide, Inc. Method and apparatus of detecting pooling of fluid in disposable or non-disposable absorbent articles
US9324247B2 (en) 2003-11-25 2016-04-26 Gaumard Scientific Company, Inc. Interactive education system for teaching patient care
US10964231B2 (en) 2006-10-03 2021-03-30 Gaumard Scientific Company, Inc. Interactive education system for teaching patient care
US11817007B2 (en) 2006-10-03 2023-11-14 Gaumard Scientific Company, Inc. Interactive education system for teaching patient care
US9870720B2 (en) 2006-10-03 2018-01-16 Gaumard Scientific Company, Inc. Interactive education system for teaching patient care
US8576253B2 (en) 2010-04-27 2013-11-05 Microsoft Corporation Grasp simulation of a virtual object
US11403964B2 (en) 2012-10-30 2022-08-02 Truinject Corp. System for cosmetic and therapeutic training
US10902746B2 (en) 2012-10-30 2021-01-26 Truinject Corp. System for cosmetic and therapeutic training
US11854426B2 (en) 2012-10-30 2023-12-26 Truinject Corp. System for cosmetic and therapeutic training
US12217626B2 (en) 2012-10-30 2025-02-04 Truinject Corp. Injection training apparatus using 3D position sensor
JP2016500157A (ja) * 2012-11-13 2016-01-07 エイドス−メディスン リミティッド・ライアビリティ・カンパニー ハイブリッド医療用腹腔鏡シミュレータ
EP2922048A4 (fr) * 2012-11-13 2015-10-07 Eidos Medicine Llc Dispositif d'entraînement médical hybride pour laparoscopie
US10896627B2 (en) 2014-01-17 2021-01-19 Truinjet Corp. Injection site training system
US12070581B2 (en) 2015-10-20 2024-08-27 Truinject Corp. Injection system
US11730543B2 (en) 2016-03-02 2023-08-22 Truinject Corp. Sensory enhanced environments for injection aid and social training
US11710424B2 (en) 2017-01-23 2023-07-25 Truinject Corp. Syringe dose and position measuring apparatus

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