The force pyramid: a spatial analysis of force application during virtual reality brain tumor resection

2017 ◽  
Vol 127 (1) ◽  
pp. 171-181 ◽  
Author(s):  
Hamed Azarnoush ◽  
Samaneh Siar ◽  
Robin Sawaya ◽  
Gmaan Al Zhrani ◽  
Alexander Winkler-Schwartz ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Medical Student ◽  
Spatial Analysis ◽  
Medical Students ◽  
Brain Tumors ◽  
Tumor Resection ◽  
Study Groups ◽  
Student Groups ◽  
Force Application ◽  
Tier 3

OBJECTIVEVirtual reality simulators allow development of novel methods to analyze neurosurgical performance. The concept of a force pyramid is introduced as a Tier 3 metric with the ability to provide visual and spatial analysis of 3D force application by any instrument used during simulated tumor resection. This study was designed to answer 3 questions: 1) Do study groups have distinct force pyramids? 2) Do handedness and ergonomics influence force pyramid structure? 3) Are force pyramids dependent on the visual and haptic characteristics of simulated tumors?METHODSUsing a virtual reality simulator, NeuroVR (formerly NeuroTouch), ultrasonic aspirator force application was continually assessed during resection of simulated brain tumors by neurosurgeons, residents, and medical students. The participants performed simulated resections of 18 simulated brain tumors with different visual and haptic characteristics. The raw data, namely, coordinates of the instrument tip as well as contact force values, were collected by the simulator. To provide a visual and qualitative spatial analysis of forces, the authors created a graph, called a force pyramid, representing force sum along the z-coordinate for different xy coordinates of the tool tip.RESULTSSixteen neurosurgeons, 15 residents, and 84 medical students participated in the study. Neurosurgeon, resident and medical student groups displayed easily distinguishable 3D “force pyramid fingerprints.” Neurosurgeons had the lowest force pyramids, indicating application of the lowest forces, followed by resident and medical student groups. Handedness, ergonomics, and visual and haptic tumor characteristics resulted in distinct well-defined 3D force pyramid patterns.CONCLUSIONSForce pyramid fingerprints provide 3D spatial assessment displays of instrument force application during simulated tumor resection. Neurosurgeon force utilization and ergonomic data form a basis for understanding and modulating resident force application and improving patient safety during tumor resection.

scholarly journals P.103 A spatial analysis of forces applied during virtual reality brain tumor resection: the force pyramid

2016 ◽  
Vol 43 (S2) ◽  
pp. S44-S44
Author(s):  
RF Del Maestro ◽  
H Azarnoush ◽  
S Siar ◽  
G Alzhrani ◽  
A Winkler-Schwartz ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Medical Student ◽  
Spatial Analysis ◽  
Medical Students ◽  
Tumor Resection ◽  
Study Groups ◽  
Student Groups ◽  
3 Dimensional ◽  
Force Application ◽  
Brain Tumor Resection

Background: Virtual reality simulators allow development of novel methods to analyze neurosurgical performance. Force pyramids provide visual and spatial analysis of 3 dimensional force application by any instrument used during simulated tumor resection. This study was designed to answer three questions: 1) Do study groups have distinct force pyramids? 2) Do handedness and ergonomics influence force pyramid structure? 3) Are force pyramids dependent on visual and haptic characteristics of simulated tumors? Methods: NeuroVR (formerly NeuroTouch), a virtual reality simulator, continually assessed simulated ultrasonic aspirator force application of neurosurgeon, resident and medical student groups during resection of 18 simulated brain tumors with different visual and haptic characteristics. Results: Sixteen neurosurgeons, 15 residents and 84 medical students participated. Neurosurgeon, resident and medical students groups displayed easily distinguishable 3 dimensional ‘force pyramid fingerprints’. Neurosurgeons had the lowest force pyramids, indicating application of the lowest forces, followed by resident and medical student groups. Handedness, ergonomics, visual and haptic tumor characteristics resulted in distinct well-defined 3 dimensional force pyramid patterns. Conclusions: ‘Force pyramid fingerprints’ provide 3 dimensional spatial assessment displays of instrument force application during simulated tumor resections. Neurosurgeon force utilization and ergonomics data form a basis for understanding and modulating resident force application and improving patient safety during tumor resection.

scholarly journals Development of a performance model for virtual reality tumor resections

2019 ◽  
Vol 131 (1) ◽  
pp. 192-200 ◽  
Author(s):  
Robin Sawaya ◽  
Ghusn Alsideiri ◽  
Abdulgadir Bugdadi ◽  
Alexander Winkler-Schwartz ◽  
Hamed Azarnoush ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Brain Tumor ◽  
Medical Students ◽  
Direct Contact ◽  
Tumor Volume ◽  
Tumor Resection ◽  
Performance Model ◽  
Hypothetical Model ◽  
Study Results ◽  
And Task

OBJECTIVEPrevious work from the authors has shown that hand ergonomics plays an important role in surgical psychomotor performance during virtual reality brain tumor resections. In the current study they propose a hypothetical model that integrates the human and task factors at play during simulated brain tumor resections to better understand the hand ergonomics needed for optimal safety and efficiency. They hypothesize that 1) experts (neurosurgeons), compared to novices (residents and medical students), spend a greater proportion of their time in direct contact with critical tumor areas; 2) hand ergonomic conditions (most favorable to unfavorable) prompt participants to adapt in order to optimize tumor resection; and 3) hand ergonomic adaptation is acquired with increasing expertise.METHODSIn an earlier study, experts (neurosurgeons) and novices (residents and medical students) were instructed to resect simulated brain tumors on the NeuroVR (formerly NeuroTouch) virtual reality neurosurgical simulation platform. For the present study, the simulated tumors were divided into four quadrants (Q1 to Q4) to assess hand ergonomics at various levels of difficulty. The spatial distribution of time expended, force applied, and tumor volume removed was analyzed for each participant group (total of 22 participants).RESULTSNeurosurgeons spent a significantly greater percentage of their time in direct contact with critical tumor areas. Under the favorable hand ergonomic conditions of Q1 and Q3, neurosurgeons and senior residents spent significantly more time in Q1 than in Q3. Although forces applied in these quadrants were similar, neurosurgeons, having spent more time in Q1, removed significantly more tumor in Q1 than in Q3. In a comparison of the most favorable (Q2) to unfavorable (Q4) hand ergonomic conditions, neurosurgeons adapted the forces applied in each quadrant to resect similar tumor volumes. Differences between Q2 and Q4 were emphasized in measures of force applied per second, tumor volume removed per second, and tumor volume removed per unit of force applied. In contrast, the hand ergonomics of medical students did not vary across quadrants, indicating the existence of an “adaptive capacity” in neurosurgeons.CONCLUSIONSThe study results confirm the experts’ (neurosurgeons) greater capacity to adapt their hand ergonomics during simulated neurosurgical tasks. The proposed hypothetical model integrates the study findings with various human and task factors that highlight the importance of learning in the acquisition of hand ergonomic adaptation.

scholarly journals Prevalence of anxiety and depression among domestic and foreign medical students in Poland

2020 ◽  
Author(s):  
Aneta Anna Jaroszewska ◽  
Szymon Tyras ◽  
Martyna Dziewit ◽  
Joanna Jaroszewska ◽  
Katarzyna Podhorodecka
Keyword(s):  
Medical Student ◽  
Medical Students ◽  
Anxiety Disorders ◽  
Study Groups ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Student Group ◽  
Significant Difference ◽  
Prevalence Of Depression ◽  
Depression Disorders

Introduction: Depression and anxiety disorders are much more common among medical students than in the general population. Due to additional risk factors, foreign students may be particularly vulnerable. Despite this, there is still an insufficient number of studies analyzing the prevalence of mental disorders among foreign medical students, especially in Poland. Aim: The aim of the study was to assess and compare the prevalence of anxiety and depression disorders between domestic and foreign medical students in Poland. Material and methods: An anonymous internet survey containing questions about socio-demography and the Hospital Anxiety and Depression Scale questionnaire was distributed among students. Based on the field of study and country of origin, participants were divided into 3 groups – Polish medical student group (PMG, n = 214); foreign medical student group (FMG, n = 59) and control group, which were Polish students of other faculties (CG, n = 476). The study groups were compared using the χ2 test. Results and discussion: The prevalence of depression disorders was 30%, 31% and 28% (PMG, FMG and CG, respectively). No statistically significant difference was observed between the study groups (P = 0.77). The prevalence of anxiety disorders was 57%, 90% and 59% (PMG, FMG and CG, respectively). Anxiety disorders were more common among FMG as compared to PMG and CG (P < 0.01 in both cases). Conclusions: The prevalence of depression and anxiety among medical students in Poland is high. Foreign medical students appear to be particularly vulnerable to anxiety disorders.

scholarly journals Subjective anxiety ratings before and after stressful neurosurgical virtual reality tumor resection task

2015 ◽  
Vol 42 (S1) ◽  
pp. S42-S42
Author(s):  
A Winkler-Schwartz ◽  
J Fares ◽  
B Khalid ◽  
M Baggiani ◽  
S Christie ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Medical Students ◽  
Tumor Resection ◽  
Tumor Removal ◽  
Surgical Performance ◽  
Surgical Simulators ◽  
Surgical Expertise ◽  
Before And After ◽  
Operative Performance ◽  
Junior Residents

Background: The availability of virtual reality (VR) surgical simulators affords the opportunity to assess the influence of stress on neurosurgical operative performance in a controlled laboratory environment. This study sought to examine the effect of a stressful VR neurosurgical task on the subjective anxiety ratings of participants with varying levels of surgical expertise. Methods: Twenty four participants comprised of six staff neurosurgeons, six senior neurosurgical residents (PGY4-6), six junior neurosurgical residents (PGY1-3), and six senior medical students took part in a bimanual VR tumor removal task with a component of sudden uncontrollable intra-operative bleeding. State Trait Anxiety Inventory (STAI) questionnaires were completed immediately pre and post the stress stimulus. The STAI questionnaire consisted of six items (calm, tense, upset, relaxed, content and worried) measured on a Likert scale. Results: Significant increases in subjective anxiety ratings were noted in junior residents (p=0.005) and medical students (p=0.025) while no significant changes were observed for staff and senior neurosurgical residents. Conclusions: Staff and senior residents more effectively mitigate stress compared to junior colleagues in a VR operative environment. Further physiological correlates are needed to determine whether this increased anxiety is paralleled by physiological arousal and altered surgical performance.

Virtual Reality Tumor Resection: The Force Pyramid Approach

2017 ◽  
Vol 14 (6) ◽  
pp. 686-696 ◽  
Author(s):  
Robin Sawaya ◽  
Abdulgadir Bugdadi ◽  
Hamed Azarnoush ◽  
Alexander Winkler-Schwartz ◽  
Fahad E Alotaibi ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Critical Role ◽  
Tumor Resection ◽  
National Research Council ◽  
Skills Training ◽  
Force Distribution ◽  
Dominant Hand ◽  
Force Application ◽  
Nondominant Hand ◽  
Specific Tumor

Abstract BACKGROUND The force pyramid is a novel visual representation allowing spatial delineation of instrument force application during surgical procedures. In this study, the force pyramid concept is employed to create and quantify dominant hand, nondominant hand, and bimanual force pyramids during resection of virtual reality brain tumors. OBJECTIVE To address 4 questions: Do ergonomics and handedness influence force pyramid structure? What are the differences between dominant and nondominant force pyramids? What is the spatial distribution of forces applied in specific tumor quadrants? What differentiates “expert” and “novice” groups regarding their force pyramids? METHODS Using a simulated aspirator in the dominant hand and a simulated sucker in the nondominant hand, 6 neurosurgeons and 14 residents resected 8 different tumors using the CAE NeuroVR virtual reality neurosurgical simulation platform (CAE Healthcare, Montréal, Québec and the National Research Council Canada, Boucherville, Québec). Position and force data were used to create force pyramids and quantify tumor quadrant force distribution. RESULTS Force distribution quantification demonstrates the critical role that handedness and ergonomics play on psychomotor performance during simulated brain tumor resections. Neurosurgeons concentrate their dominant hand forces in a defined crescent in the lower right tumor quadrant. Nondominant force pyramids showed a central peak force application in all groups. Bimanual force pyramids outlined the combined impact of each hand. Distinct force pyramid patterns were seen when tumor stiffness, border complexity, and color were altered. CONCLUSION Force pyramids allow delineation of specific tumor regions requiring greater psychomotor ability to resect. This information can focus and improve resident technical skills training.

scholarly journals O51: ARTIFICIAL INTELLIGENCE UTILIZING RECURRENT NEURAL NETWORKS TO CONTINUOUSLY MONITOR COMPOSITES OF SURGICAL EXPERTISE

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
R Yilmaz ◽  
A Winkler-Schwartz ◽  
N Mirchi ◽  
A Reich ◽  
R Del Maestro
Keyword(s):  
Neural Network ◽  
Artificial Intelligence ◽  
Virtual Reality ◽  
Medical Students ◽  
Recurrent Neural Network ◽  
Haptic Feedback ◽  
Performance Metrics ◽  
Tumor Resection ◽  
Technical Skills ◽  
Surgical Expertise

Abstract Introduction Many surgical adverse events occur secondary to technical errors related to poor bimanual skills, fatigue and lack of the required expertise. We developed AI algorithms to continuously assess surgical bimanual technical performance during virtual reality simulated surgical tasks. To our knowledge, this is the first attempt in surgery to train AI algorithms to continuously monitor and evaluate bimanual skills comprehensively. Method Fifty individuals from four expertise levels (14 experts/neurosurgeons, 14 senior residents, 10 junior residents, 12 medical students) performed two virtual reality simulated surgical tasks with haptic feedback: a subpial tumor resection 5 times and a complex, realistically simulated brain tumor operation once. Each task required complete tumor removal while minimizing bleeding and damage to surrounding tissues using a simulated ultrasonic aspirator and a bipolar. A recurrent neural network continually tracked individual bimanual performance utilizing 16 performance metrics generated every 0.2 seconds. Result The recurrent neural network algorithm was successfully trained using neurosurgeons and medical students' data, learning the composites of expertise comparing high and lower skill levels. The trained algorithm outlined and monitored technical skills every 0.2 second continuously organizing performance of each surgical task into three levels: ‘excellent’, ‘average’ and ‘poor’. The percentage time spent on each level was calculated and significant differences found between all four groups for ‘excellent’ and ‘poor’ levels. Conclusion AI-powered surgical simulators provide an advanced assessment and training tool. AI's ability to continuous assess bimanual technical skills during surgery may further define the composites necessary to train surgical expertise. Abbrev AI: artificial intelligence Take-home message By advanced artificial intelligence algorithms surgeon's bi-manual technical skills can be assessed continuously, time periods of poor performance which increase the possibility of errors in performance can be identified.

Meditation buffers medical student compassion from the deleterious effects of depression.

2017 ◽  
Author(s):  
Jennifer S Mascaro ◽  
Sean Kelley ◽  
Alana Darcher ◽  
Lobsang Negi ◽  
Carol Worthman ◽  
...  
Keyword(s):  
Medical Student ◽  
Medical Students ◽  
Medical School ◽  
Well Being ◽  
Daily Functioning ◽  
Wait List ◽  
School Students ◽  
Social Emotions ◽  
The Face ◽  
Second Year

Increasing data suggest that for medical school students the stress of academic and psychologicaldemands can impair social emotions that are a core aspect of compassion and ultimately physiciancompetence. Few interventions have proven successful for enhancing physician compassion inways that persist in the face of suffering and that enable sustained caretaker well-being. To addressthis issue, the current study was designed to (1) investigate the feasibility of cognitively-basedcompassion training (CBCT) for second-year medical students, and (2) test whether CBCT decreasesdepression, enhances compassion, and improves daily functioning in medical students. Comparedto the wait-list group, students randomized to CBCT reported increased compassion, and decreasedloneliness and depression. Changes in compassion were most robust in individuals reporting highlevels of depression at baseline, suggesting that CBCT may benefit those most in need by breakingthe link between personal suffering and a concomitant drop in compassion

Associations between clinical outcome and tractography based on navigated transcranial magnetic stimulation in patients with language-eloquent brain lesions

2020 ◽  
Vol 132 (4) ◽  
pp. 1033-1042 ◽  
Author(s):  
Nico Sollmann ◽  
Alessia Fratini ◽  
Haosu Zhang ◽  
Claus Zimmer ◽  
Bernhard Meyer ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Brain Tumors ◽  
Risk Stratification ◽  
Magnetic Stimulation ◽  
Diffusion Tensor ◽  
Tumor Resection ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Language Mapping ◽  
Significant Difference ◽  
Related Pathway

OBJECTIVENavigated transcranial magnetic stimulation (nTMS) in combination with diffusion tensor imaging fiber tracking (DTI FT) is increasingly used to locate subcortical language-related pathways. The aim of this study was to establish nTMS-based DTI FT for preoperative risk stratification by evaluating associations between lesion-to-tract distances (LTDs) and aphasia and by determining a cut-off LTD value to prevent surgery-related permanent aphasia.METHODSFifty patients with left-hemispheric, language-eloquent brain tumors underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by tumor resection. nTMS-based DTI FT was performed with a predefined fractional anisotropy (FA) of 0.10, 0.15, 50% of the individual FA threshold (FAT), and 75% FAT (minimum fiber length [FL]: 100 mm). The arcuate fascicle (AF), superior longitudinal fascicle (SLF), inferior longitudinal fascicle (ILF), uncinate fascicle (UC), and frontooccipital fascicle (FoF) were identified in nTMS-based tractography, and minimum LTDs were measured between the lesion and the AF and between the lesion and the closest other subcortical language-related pathway (SLF, ILF, UC, or FoF). LTDs were then associated with the level of aphasia (no/transient or permanent surgery-related aphasia, according to follow-up examinations).RESULTSA significant difference in LTDs was observed between patients with no or only surgery-related transient impairment and those who developed surgery-related permanent aphasia with regard to the AF (FA = 0.10, p = 0.0321; FA = 0.15, p = 0.0143; FA = 50% FAT, p = 0.0106) as well as the closest other subcortical language-related pathway (FA = 0.10, p = 0.0182; FA = 0.15, p = 0.0200; FA = 50% FAT, p = 0.0077). Patients with surgery-related permanent aphasia showed the lowest LTDs in relation to these tracts. Thus, LTDs of ≥ 8 mm (AF) and ≥ 11 mm (SLF, ILF, UC, or FoF) were determined as cut-off values for surgery-related permanent aphasia.CONCLUSIONSnTMS-based DTI FT of subcortical language-related pathways seems suitable for risk stratification and prediction in patients suffering from language-eloquent brain tumors. Thus, the current role of nTMS-based DTI FT might be expanded, going beyond the level of being a mere tool for surgical planning and resection guidance.

Improving medical student recruitment to neurosurgery

2020 ◽  
Vol 133 (3) ◽  
pp. 848-854 ◽  
Author(s):  
Daniel Lubelski ◽  
Roy Xiao ◽  
Debraj Mukherjee ◽  
William W. Ashley ◽  
Timothy Witham ◽  
...  
Keyword(s):  
Medical Student ◽  
Medical Students ◽  
Interest Group ◽  
National Level ◽  
Program Directors ◽  
Student Recruitment ◽  
Research Opportunities ◽  
Research Activities ◽  
Lecture Series ◽  
Mentorship Programs

OBJECTIVENeurosurgery seeks to attract the best and brightest medical students; however, there is often a lack of early exposure to the field, among other possible barriers. The authors sought to identify successful practices that can be implemented to improve medical student recruitment to neurosurgery.METHODSUnited States neurosurgery residency program directors were surveyed to determine the number of medical student rotators and medical students matching into a neurosurgery residency from their programs between 2010 and 2016. Program directors were asked about the ways their respective institutions integrated medical students into departmental clinical and research activities.RESULTSComplete responses were received from 30/110 institutions. Fifty-two percent of the institutions had neurosurgery didactic lectures for 1st- and 2nd-year medical students (MS1/2), and 87% had didactics for MS3/4. Seventy-seven percent of departments had a neurosurgery interest group, which was the most common method used to integrate medical students into the department. Other forms of outreach included formal mentorship programs (53%), lecture series (57%), and neurosurgery anatomy labs (40%). Seventy-three percent of programs provided research opportunities to medical students, and 57% indicated that the schools had a formal research requirement. On average, 3 medical students did a rotation in each neurosurgery department and 1 matched into neurosurgery each year. However, there was substantial variability among programs. Over the 2010–2016 period, the responding institutions matched as many as 4% of the graduating class into neurosurgery per year, whereas others matched 0%–1%. Departments that matched a greater (≥ 1% per year) number of medical students into neurosurgery were significantly more likely to have a neurosurgery interest group and formal research requirements. A greater percentage of high-matching programs had neurosurgery mentorship programs, lecture series, and cadaver training opportunities compared to the other institutions.CONCLUSIONSIn recent decades, the number of applicants to neurosurgery has decreased. A major deterrent may be the delayed exposure of medical students to neurosurgery. Institutions with early preclinical exposure, active neurosurgery interest groups, research opportunities, and strong mentorship recruit and match more students into neurosurgery. Implementing such initiatives on a national level may increase the number of highly qualified medical students pursuing neurosurgery.

Peningkatan Prestasi Siswa dalam Mengidentifikasi Teks Deskripsi dengan Metode Discovery

Dinamika ◽  
2019 ◽  
Vol 2 (2) ◽  
pp. 76
Author(s):  
Suryati Suryati
Keyword(s):  
Student Achievement ◽  
Performing Arts ◽  
Mastery Learning ◽  
Study Groups ◽  
Class Action ◽  
Contextual Learning ◽  
Historic Sites ◽  
Student Groups ◽  
Tourist Attractions ◽  
A Value

Tujuan Penelitian Tindakan kelas ini untuk mendeskripsikan pembelajaran kontekstual fokus Discovery dalam meningkatkan kemampuan menelaah struktur dan unsur kebahasaan dari teksdeskripsi tentang objek (sekolah, tempat wisata, tempat bersejarah, dan atau suasana pentas seni daerah).Pada siklus I ini rata-rata pencapaian siswa dalam belajar baru mencapai nilai 76.43dari 21 siswa. Tingkat ketuntasan pembelajaran di kelas hanya mencapai 66,67%, padahal standar yang dipersyaratkan adalah 85%. Hasil pengamatan yang dilakukan observer menunjukkan beberapa fakta pengelolaan pembelajaran yang belum maksimal, terutama dalam pelayanan kelompok siswa yang kurang merata. Hal ini disebabkan oleh jumlah kelompok belajar di kelas yang relatif banyak, yakni 5 kelompok.Dengan demikian, pembelajaran kompetensi dasarmenelaah struktur dan unsur kebahasaan dari teksdeskripsi tentang objek (sekolah, tempat wisata, tempat bersejarah, dan atau suasana pentas seni daerah) yang didengar dan dibaca masih belum mencapai tingkat yang diharapkan sehingga diperlukan perlakuan tindakan pada siklus II.Kata kunci: prestasi siswa, teks deskripsi, DiscoveryResearch Objectives this class action is to describe the contextual learning of Discovery's focus in improving the ability to study the structure and linguistic elements of the description text about objects (schools, tourist attractions, historic sites, or the atmosphere of local performing arts). In this first cycle, the average student achievement in learning only reached a value of 76.43 out of 21 students. The level of mastery learning in class only reaches 66.67%, whereas the required standard is 85%. The observations made by the observer show some facts of learning management that have not been maximized, especially in the uneven service of student groups. This is caused by the relatively large number of study groups in the class, which is 5 groups. Thus, learning basic competence examines the structure and linguistic elements of the text description of objects (schools, tourist attractions, historical places or the atmosphere of local art performances) that are heard and read still not reaching the level expected so that action treatment is needed in cycle II.Keywords: student achievement, description text, Discovery

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