SBIR-STTR Award

Although injection and aspiration of soft tissues and joints is a mainstay in the therapy of rheumatic diseases, surveys of training programs and practicing physicians have continually shown that medical trainees and active physicians alike are not able to practice these procedures with sufficient repetition and supervision to become technically proficient. Most physicians, therefore, have to learn these important procedures in a very sub- optimal fashion by "practicing" on their patients in an unsupervised environment once they are in the community. To address this and other lack of training opportunities in medical procedures, Touch of Life Technologies, Inc. (referred to as ToLTech herein) is pioneering the creation of virtual reality based simulators, among which is the Needle Insertion and Palpation Simulator (NISP). The NISP uses a virtual knee and shoulder as well as a syringe integrated with a haptic device; the trainee actively controls the needle and syringe such that he or she can perform any type of injection, correctly or incorrectly, in a monitored environment. A study with the current generation simulator with residents as well as an analysis by leaders in Rheumatology education of the simulator as a teaching tool has revealed a great interest in this technology as well as identified important aspects of the process that should be improved. This Phase I proposal is submitted to further develop this simulator for commercial use and will improve the current generation simulator by addressing the concerns of trainees and educators in five areas: #1: Create a bimanual joint injection and aspiration simulator; #2: Measure the exact forces encountered when traversing the skin, joint and other tissue interfaces so that these can be utilized in the simulations procedure; #3: Develop a hardware controlled shoulder to allow teaching of procedures for that joint; #4: Develop soft tissue diagnosis and procedures for periarticular regions; and #5 Integrate the simulation procedures itself into a HTML-based, real time anatomic educational system. During development, key aspects of the simulator as viewed by the teacher and trainee will undergo a human factors heuristic review and analysis by a group of expert Rheumatology educators. We believe that combining these multiple approaches will allow us in Phase II to then devise a simulated training environment such that trainees will be demonstrably better in performing these musculoskeletal procedures.

Thesaurus Terms:
computer human interaction, computer simulation, computer system design /evaluation, educational resource design /development, health care professional practice, injection /infusion, joint, training biomechanics, computer program /software, computer system hardware, fine needle aspiration, hypodermic needle, rheumatism, skin, tissue clinical research, human subject, time resolved data

Although injection and aspiration of soft tissues and joints is a mainstay in the therapy of rheumatic diseases, surveys of training programs have continually shown that medical trainees are not able to practice these procedures with sufficient repetition and supervision to become technically proficient. Most physicians, therefore, have to learn these important procedures in a very sub-optimal fashion by practicing on their patients in an unsupervised environment once they are in the community. To address this and other lack of training opportunities in medical procedures, Touch of Life Technologies, Inc. is pioneering the creation of virtual reality based simulators, among which is the Virtual Reality-based Joint Injection Simulator (VR-JIS). The VR-JIS offers a virtual knee or shoulder combined with haptically enabled virtual palpation, virtual syringe, and simulated ultrasound to create an environment for structured and monitored practice of joint injection procedures. The VR-JIS includes a Mentor program that provides instruction, guidance, and testing. Solutions to all technically challenging aspects of the Mentor and simulator combination have been demonstrated during the phase I effort. In this phase II effort, the system will be matured to a production system ready for standalone use in training programs around the world. The specific aims of the phase II effort to accomplish this are: 1) Add a wide and relevant range of pathologies including varying size potential spaces, 2) Refine the Mentor/Simulator to seamlessly control all relevant states of the simulation, 3) Create a complete curriculum of needle procedures relevant to the knee and shoulder, and 4) Validate the efficacy of the resulting system. This effort will develop a computer-based system for practicing needle insertion techniques for joints. The system is designed to reduce the trainee's dependence on patients as training devices.

Thesaurus Terms:
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