Files and links (1)
Free to read and download, Open Access
Dissertation
The creation and validation of an augmented reality orthopaedic drilling simulator for surgical training
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2014
DOI: 10.17077/etd.x8t4uged
Abstract
<p>Standard surgical repair of intertrochanteric hip fractures requires accurate placement of a wire across the fracture using static fluoroscopic images. Few practice methods exist for perfecting this wire navigation skill outside the operating room. The objective of this research is to further understand skill development for orthopaedic drilling using a validated simulator, enabling more effective instruction and training. This includes the investigation of the relationship between practice and skill acquisition in conjunction with specific differences between experts and novices.</p>
<p>This work details the creation and validation of an augmented reality wire navigation simulator for training orthopaedic drilling. This novel augmented reality simulator combines real-world objects, such as a surgical drill and synthetic bone, with virtually generated, radiation-free radiographic imaging. The central hypothesis is that an augmented reality wire navigation simulator will demonstrate construct validity and improve orthopaedic drilling skill through simulation training.</p>
<p>This work identifies the differentiation of skill between experienced surgeons and novices completing the wire navigation task, demonstrating construct validity for the developed simulator. It also demonstrates that experienced surgeons are more accurate than novices in orthopaedic drilling (F(2, 39) = 3.721, p = 0.033). This provides evidence supporting the simulator's construct validity and value as a training and assessment tool in wire navigation of the proximal femur.</p>
<p>Although the study was unsuccessful in providing sufficient evidence that training on the simulator directly transfers to more realistic drilling tasks, it revealed several discoveries about acquiring wire navigation skill. This work establishes a relationship between skill acquisition and practice for the wire navigation task. This learning curve shows that skill acquisition occurs much more slowly in wire navigation than previously assumed. The wire accuracy (i.e., tip-apex distance) is predicted to improve 0.1 to 0.3 millimeters with each successive practice repetition of the wire navigation task (95% CI, p < 0.001). In addition, the time to complete wire navigation improves between 0.4 and 2.0 seconds each subsequent practice trial (95% CI, p < 0.001).</p>
<p>The developed simulator also identified several flaws in novice technique. First, novices do not account for the anteversion of the femoral neck indicating that the inclination angle is difficult for novices to understand and accurately drill from radiographic images. Another discovered flaw of novice orthopaedic residents is their lack of ability to accurately estimate distances in radiographic images. Novices were found to incorrectly estimate the wire accuracy by an average of 12.4 millimeters. Overall, this work establishes new findings, which can be used for future simulation development and coaching, enabling safer, more effective training methods for surgical residents.</p>
Details
- Title: Subtitle
- The creation and validation of an augmented reality orthopaedic drilling simulator for surgical training
- Creators
- Brian Douglas Johns - University of Iowa
- Contributors
- Geb W. Thomas (Advisor)Donald D. Anderson (Committee Member)Matthew D. Karam (Committee Member)Thomas Schnell (Committee Member)Priyadarshini R. Pennathur (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Industrial Engineering
- Date degree season
- Spring 2014
- Publisher
- University of Iowa
- DOI
- 10.17077/etd.x8t4uged
- Number of pages
- xii, 156 pages
- Copyright
- Copyright 2014 Brian Douglas Johns
- Language
- English
- Description illustrations
- illustrations (some color)
- Description bibliographic
- Includes bibliographical references (pages 145-156).
- Academic Unit
- Industrial and Systems Engineering
- Record Identifier
- 9983777278502771
Metrics
458 File views/ downloads
516 Record Views