Skip to main content
Top
Published in: International Journal of Computer Assisted Radiology and Surgery 5/2015

01-05-2015 | Original Article

Neurosurgical virtual reality simulation metrics to assess psychomotor skills during brain tumor resection

Authors: Hamed Azarnoush, Gmaan Alzhrani, Alexander Winkler-Schwartz, Fahad Alotaibi, Nicholas Gelinas-Phaneuf, Valérie Pazos, Nusrat Choudhury, Jawad Fares, Robert DiRaddo, Rolando F. Del Maestro

Published in: International Journal of Computer Assisted Radiology and Surgery | Issue 5/2015

Login to get access

Abstract

Purpose

   Virtual reality simulator technology together with novel metrics could advance our understanding of expert neurosurgical performance and modify and improve resident training and assessment. This pilot study introduces innovative metrics that can be measured by the state-of-the-art simulator to assess performance. Such metrics cannot be measured in an operating room and have not been used previously to assess performance.

Methods

   Three sets of performance metrics were assessed utilizing the NeuroTouch platform in six scenarios with simulated brain tumors having different visual and tactile characteristics. Tier 1 metrics included percentage of brain tumor resected and volume of simulated “normal” brain tissue removed. Tier 2 metrics included instrument tip path length, time taken to resect the brain tumor, pedal activation frequency, and sum of applied forces. Tier 3 metrics included sum of forces applied to different tumor regions and the force bandwidth derived from the force histogram.

Results

   The results outlined are from a novice resident in the second year of training and an expert neurosurgeon. The three tiers of metrics obtained from the NeuroTouch simulator do encompass the wide variability of technical performance observed during novice/expert resections of simulated brain tumors and can be employed to quantify the safety, quality, and efficiency of technical performance during simulated brain tumor resection. Tier 3 metrics derived from force pyramids and force histograms may be particularly useful in assessing simulated brain tumor resections.

Conclusion

   Our pilot study demonstrates that the safety, quality, and efficiency of novice and expert operators can be measured using metrics derived from the NeuroTouch platform, helping to understand how specific operator performance is dependent on both psychomotor ability and cognitive input during multiple virtual reality brain tumor resections.
Appendix
Available only for authorised users
Literature
1.
go back to reference Brydges R, Kurahashi A, Brümmer V, Satterthwaite L, Classen R, Dubrowski A (2008) Developing criteria for proficiency-based training of surgical technical skills using simulation: changes in performances as a function of training year. J Am Coll Surg 206:205–211. doi:10.1016/j.jamcollsurg.2007.07.045 CrossRefPubMed Brydges R, Kurahashi A, Brümmer V, Satterthwaite L, Classen R, Dubrowski A (2008) Developing criteria for proficiency-based training of surgical technical skills using simulation: changes in performances as a function of training year. J Am Coll Surg 206:205–211. doi:10.​1016/​j.​jamcollsurg.​2007.​07.​045 CrossRefPubMed
3.
8.
go back to reference Bhatti NI, Cummings CW (2007) Competency in surgical residency training: defining and raising the bar. Acad Med 82:569–573CrossRefPubMed Bhatti NI, Cummings CW (2007) Competency in surgical residency training: defining and raising the bar. Acad Med 82:569–573CrossRefPubMed
10.
go back to reference Gaba DM, DeAnda A (1998) A comprehensive anesthesia simulation environment: re-creating the operating room for research and training. Anesthesiology 69:387–394CrossRef Gaba DM, DeAnda A (1998) A comprehensive anesthesia simulation environment: re-creating the operating room for research and training. Anesthesiology 69:387–394CrossRef
11.
go back to reference Chung J, Sackier J (1998) A method of objectively evaluating improvements in laparoscopic skills. Surg Endosc 12:1111–1116CrossRefPubMed Chung J, Sackier J (1998) A method of objectively evaluating improvements in laparoscopic skills. Surg Endosc 12:1111–1116CrossRefPubMed
12.
go back to reference Derossis AM, Bothwell J, Sigman HH, Fried GM (1998) The effect of practice on performance in a laparoscopic simulator. Surg Endosc 12:1117–1120CrossRefPubMed Derossis AM, Bothwell J, Sigman HH, Fried GM (1998) The effect of practice on performance in a laparoscopic simulator. Surg Endosc 12:1117–1120CrossRefPubMed
13.
go back to reference Delp SL, Loan JP, Hoy MG, Zajac FE, Topp EL, Rosen JM (1990) An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans Biomed Eng 37:757–767CrossRefPubMed Delp SL, Loan JP, Hoy MG, Zajac FE, Topp EL, Rosen JM (1990) An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans Biomed Eng 37:757–767CrossRefPubMed
15.
go back to reference Ahlberg G, Enochsson L, Gallagher AG, Hedman L, Hogman C, McClusky DA 3rd, Ramel S, Smith CD, Arvidsson D (2007) Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg 193:797–804. doi:10.1016/j.amjsurg.2006.06.050 CrossRefPubMed Ahlberg G, Enochsson L, Gallagher AG, Hedman L, Hogman C, McClusky DA 3rd, Ramel S, Smith CD, Arvidsson D (2007) Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg 193:797–804. doi:10.​1016/​j.​amjsurg.​2006.​06.​050 CrossRefPubMed
16.
go back to reference Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM, Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236:458–463. doi:10.1097/01.SLA.0000028969.51489 CrossRefPubMedCentralPubMed Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM, Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236:458–463. doi:10.​1097/​01.​SLA.​0000028969.​51489 CrossRefPubMedCentralPubMed
18.
go back to reference Phillips NI, John NW (2000) Web-based surgical simulation for ventricular catheterization. Neurosurgery 46:933–937PubMed Phillips NI, John NW (2000) Web-based surgical simulation for ventricular catheterization. Neurosurgery 46:933–937PubMed
22.
go back to reference Rousseau G, Bailes J, del Maestro RF, Cabral A, Choudhury N, Comas O, Debergue P, De Luca G, Hovdebo J, Jiang D, Laroche D, Neubauer A, Pazos V, Thibault T, DiRaddo R (2013) The development of a virtual simulator for training of neurosurgeons to perform and to perfect endoscopic endonasal transphenoidal surgery. Neurosurgery 73(Suppl. 1):85–93. doi:10.1227/NEU.0000000000000112 CrossRef Rousseau G, Bailes J, del Maestro RF, Cabral A, Choudhury N, Comas O, Debergue P, De Luca G, Hovdebo J, Jiang D, Laroche D, Neubauer A, Pazos V, Thibault T, DiRaddo R (2013) The development of a virtual simulator for training of neurosurgeons to perform and to perfect endoscopic endonasal transphenoidal surgery. Neurosurgery 73(Suppl. 1):85–93. doi:10.​1227/​NEU.​0000000000000112​ CrossRef
23.
go back to reference Kockro RA, Serra L, Tseng-Tsai Y, Yih-Yian Chan CS, Gim-Guan C, Lee E, Hoe LY, Hern N, Nowinski WL (2000) Planning and simulation of neurosurgery in a virtual reality environment. Neurosurgery 46:118–137CrossRefPubMed Kockro RA, Serra L, Tseng-Tsai Y, Yih-Yian Chan CS, Gim-Guan C, Lee E, Hoe LY, Hern N, Nowinski WL (2000) Planning and simulation of neurosurgery in a virtual reality environment. Neurosurgery 46:118–137CrossRefPubMed
24.
go back to reference Luciano C, Banerjee P, Lemole G, Charbel F (2006) Second generation haptic ventriculostomy simulator using the immersive touch system. Stud Health Technol Inform 119:343–348 Luciano C, Banerjee P, Lemole G, Charbel F (2006) Second generation haptic ventriculostomy simulator using the immersive touch system. Stud Health Technol Inform 119:343–348
25.
go back to reference Banerjee PP, Luciano CJ, Lemole GM Jr, Charbel FT, Oh MY (2007) Accuracy of ventriculostomy catheter placement using a head- and hand-tracked high-resolution virtual reality simulator with haptic feedback. J Neurosurg 107:515–521. doi:10.3171/JNS-07/09/0515 CrossRefPubMed Banerjee PP, Luciano CJ, Lemole GM Jr, Charbel FT, Oh MY (2007) Accuracy of ventriculostomy catheter placement using a head- and hand-tracked high-resolution virtual reality simulator with haptic feedback. J Neurosurg 107:515–521. doi:10.​3171/​JNS-07/​09/​0515 CrossRefPubMed
26.
go back to reference Luciano CJ, Banerjee PP, Bellotte B, Oh GM, Lemole M, Jr., Charbel FT, Roitberg B (2011) Learning retention of thoracic pedicle screw placement using a high-resolution augmented reality simulator with haptic feedback. Neurosurgery 69(1 Suppl Operative):ons14–19. doi:10.1227/NEU.0b013e31821954ed Luciano CJ, Banerjee PP, Bellotte B, Oh GM, Lemole M, Jr., Charbel FT, Roitberg B (2011) Learning retention of thoracic pedicle screw placement using a high-resolution augmented reality simulator with haptic feedback. Neurosurgery 69(1 Suppl Operative):ons14–19. doi:10.​1227/​NEU.​0b013e31821954ed​
27.
go back to reference Luciano CJ, Banerjee PP, Florea L, Dawe G (2005) Design of the ImmersiveTouch\(^{TM}\): a high-performance haptic augmented virtual reality system. In: 11th International conference on human-computer interaction, Las Vegas, NV Luciano CJ, Banerjee PP, Florea L, Dawe G (2005) Design of the ImmersiveTouch\(^{TM}\): a high-performance haptic augmented virtual reality system. In: 11th International conference on human-computer interaction, Las Vegas, NV
28.
go back to reference Delorme S, Laroche D, Diraddo R, F. Del Maestro R (2012) NeuroTouch: a Physics-based virtual simulator for cranial microneurosurgery training. Neurosurgery 71(1 Suppl Operative):ons 32–42. doi:10.1227/NEU.0b013e318249c744 Delorme S, Laroche D, Diraddo R, F. Del Maestro R (2012) NeuroTouch: a Physics-based virtual simulator for cranial microneurosurgery training. Neurosurgery 71(1 Suppl Operative):ons 32–42. doi:10.​1227/​NEU.​0b013e318249c744​
29.
go back to reference Choudhury N, Gelinas-Phaneuf N, Delorme S, Del Maestro R (2013) Fundamentals of Neurosurgery: virtual reality tasks for training and evaluation of technical skills. World Neurosurg 80:E9–E19. doi:10.1016/j.wneu.2012.08.022 Choudhury N, Gelinas-Phaneuf N, Delorme S, Del Maestro R (2013) Fundamentals of Neurosurgery: virtual reality tasks for training and evaluation of technical skills. World Neurosurg 80:E9–E19. doi:10.​1016/​j.​wneu.​2012.​08.​022
30.
go back to reference Gélinas-Phaneuf N, Choudhury N, Al-Habib AR, Cabral A, Nadeau E, Mora V, Debergue Pazos VP, Diraddo R, Del Maestro RF (2013) Assessing performance in brain tumor resection using a novel virtual reality simulator. Int J CARS. doi:10.1007/s11548-013-0905-8 Gélinas-Phaneuf N, Choudhury N, Al-Habib AR, Cabral A, Nadeau E, Mora V, Debergue Pazos VP, Diraddo R, Del Maestro RF (2013) Assessing performance in brain tumor resection using a novel virtual reality simulator. Int J CARS. doi:10.​1007/​s11548-013-0905-8
31.
go back to reference Wheatstone C (1838) Contributions to the physiology of vision.-Part the first. On some remarkable, and hitherto unobserved, phenomena of binocular vision. Philos Trans R Soc Lond 128:371–394CrossRef Wheatstone C (1838) Contributions to the physiology of vision.-Part the first. On some remarkable, and hitherto unobserved, phenomena of binocular vision. Philos Trans R Soc Lond 128:371–394CrossRef
32.
go back to reference Kohn LT, Corrigan J, Donaldson MS (2000) To err is human: building a safer health care system. National Academy Press, Washington Kohn LT, Corrigan J, Donaldson MS (2000) To err is human: building a safer health care system. National Academy Press, Washington
33.
go back to reference Gray JD (1996) Global rating scale in residency education. Acad Med 71:555–563CrossRef Gray JD (1996) Global rating scale in residency education. Acad Med 71:555–563CrossRef
35.
37.
go back to reference Gawande AA, Thomas EJ, Zinner MJ, Brennan TA (1999) The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 126:66–75CrossRefPubMed Gawande AA, Thomas EJ, Zinner MJ, Brennan TA (1999) The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 126:66–75CrossRefPubMed
38.
go back to reference Birkmeyer JD, Finks JF, O’Reilly A, Oerline M, Carlin AM, Nunn AR, Dimick J, Banerjee M, Birkmeyer NJ (2013) Surgical skills and complication rates after bariatric surgery. N Engl J Med 369:1434–1442. doi:10.1056/NEJMsa1300625 CrossRefPubMed Birkmeyer JD, Finks JF, O’Reilly A, Oerline M, Carlin AM, Nunn AR, Dimick J, Banerjee M, Birkmeyer NJ (2013) Surgical skills and complication rates after bariatric surgery. N Engl J Med 369:1434–1442. doi:10.​1056/​NEJMsa1300625 CrossRefPubMed
Metadata
Title
Neurosurgical virtual reality simulation metrics to assess psychomotor skills during brain tumor resection
Authors
Hamed Azarnoush
Gmaan Alzhrani
Alexander Winkler-Schwartz
Fahad Alotaibi
Nicholas Gelinas-Phaneuf
Valérie Pazos
Nusrat Choudhury
Jawad Fares
Robert DiRaddo
Rolando F. Del Maestro
Publication date
01-05-2015
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Computer Assisted Radiology and Surgery / Issue 5/2015
Print ISSN: 1861-6410
Electronic ISSN: 1861-6429
DOI
https://doi.org/10.1007/s11548-014-1091-z

Other articles of this Issue 5/2015

International Journal of Computer Assisted Radiology and Surgery 5/2015 Go to the issue