Physics-based virtual environment for training in vascular interventional radiological procedures

该项目的目的是开发一个具有可变虚拟解剖结构的计算机生成虚拟环境（VE），其中可以再现和评估患者侵入性放射治疗（介入放射学，IR）的外观，“感觉”和人为因素。红外是一种锁眼手术，使用针、专门的电线和管子（导管），通过触摸和成像（x射线、“Cat Scan”——CT、超声波）引导。IR的优点是局部麻醉、切口小、并发症少、术后疼痛减轻、住院时间短、费用低。大多数IR程序从穿刺血管插入导丝和导管开始：这些临床技能是所有放射科医生在培训期间获得的，作为患者的学徒，不可避免地会带来一些不适，偶尔还会出现并发症。“直截了当”的病例诊断是培训的理想选择，但正在被最先进的非侵入性成像方法所取代。虽然一些技能（主要是视觉技能，与方向和空间协商有关）可以通过模型获得（如在手术中），但这些对严重依赖触觉的IR有限制。患者和受训者都将受益于使用计算机来创建带有传递触觉（触觉）的设备的VE，以逼真地模仿患者的手术过程。将这种初步经验从临床环境中剔除，既节省时间，又能改善病人的安全，减少医疗受训人员达到和保持更高水平能力所需的时间。这个项目的主要目标是：1。开发并验证用于血管介入放射学培训的完整VE，包括针头穿刺、导丝和导管插入和操作。这是本项目的首要目标，并将基于对介入程序的任务分析。开发半自动处理医学成像数据的方法，以创建可变范围的三维解剖几何。使用微型传感器确定和定位操作人员在患者的红外手术过程中所经历的力，从而能够准确地再现真实手术的“感觉”。模拟针头穿刺，导丝和导管进入血管，具有真实的组织和血管行为。用一种新的装置模拟病人的生理脉搏，再现脉搏的感觉，以指导动脉的仪器。模拟超声引导动脉穿刺，透视引导动脉内导丝和导管的操作。验证VE并评估其培训和认证的潜力。我们亦会就课程内容及认证标准提出建议。本项目所制订的企业评价将是通用的，能够纳入现有系统，或构成适用于培训的新一代系统的基础。这项工作将由利物浦大学、班戈大学、赫尔大学、利兹大学和帝国大学的研究人员承担；PI （Gould）是一位具有丰富临床研究经验的介入放射科医生，他将是整个项目的协调员。技术项目经理是一位计算机科学教授（John），他的研究助理也将协助项目管理。这一建议符合EPSRC改善健康状况的目标，也将促进经济发展和激发人们对科学的兴趣。

The aim of this project is to develop a computer generated virtual environment (VE) with variable virtual anatomy, in which the appearance, 'feel' and human factors of invasive radiological procedures (interventional radiology, IR) in patients can be reproduced and assessed.IR is keyhole surgery using needles, specialised wires and tubes (catheters), guided by touch and imaging (x-ray, 'Cat Scan'--CT, ultrasound). IR benefits from local anaesthesia, a tiny incision, few complications, reduced postoperative pain, short hospital stay and low cost. Most IR procedures commence with needle puncture of a blood vessel to insert guide wires and catheters: these clinical skills are acquired by all radiologists during training, as an apprenticeship in patients, inevitably associated with some discomfort and occasionally, complications. 'Straightforward' cases for diagnosis are ideal for training but are being replaced by state-of-the-art, non-invasive imaging methods. While some skills (mainly visual skills, relating to orientation and spatial negotiation) can be acquired using models (as in surgery), these have limitations for IR which relies heavily on a sense of touch. Both patients and trainees would benefit from the use of computers to create a VE with devices conveying touch sensation (haptics) to realistically mimic procedures on patients. Removal of this initial experience from the clinical environment would be time efficient while improving patient safety and reducing the time taken for medical trainees to attain and maintain higher levels of competence.The key aims of this project are to:1. develop and validate a complete VE for training in vascular interventional radiology, encompassing needle puncture as well as guidewire and catheter insertion and manipulation. This is the overarching objective of this project and will be based on a task analysis of interventional procedures.2. develop methods of semi-automatically processing medical imaging data to create a variable range of 3D geometry of anatomy.3. determine and localise the forces experienced by an operator during IR procedures in patients using miniature sensors, enabling the 'feel' of a real procedure to be accurately reproduced.4. simulate needle puncture, and introduction of a guidewire and catheter into a blood vessel, with realistic behaviour of tissue and vessels.5. reproduce the feel of a pulse to guide instrumentation of an artery using a novel device which mimics a patient's physiological pulse.6. simulate ultrasound to guide needle puncture of an artery, and fluoroscopy to guide guidewire and catheter manipulation within an artery.7. validate the VE and assess its potential for training and certification. We will also make suggestions for inclusion in curricula and criteria for certification.The VE developed in this project will be generic, capable of incorporation into an existing system, or of forming the basis of a new generation of systems applicable to training. The work will be undertaken by researchers at the Universities ofLiverpool, Bangor, Hull, Leeds and Imperial; the PI (Gould) is an interventional radiologist with extensive clinical research experience and who will be the overall project co-ordinator. The technical project manager is a Computer Science professor (John) whose Research Assistant will also assist in project management. This proposal accords with the aims of EPSRC in introducing improvements in health and will also enhance economic development and stimulate interest in the sciences.