Tecnologias Imersivas na Educação em Saúde / Immersive Technologies in Health Education

Além de enfrentar todos os desafios relacionados com a formação de recursos humanos, a educação em saúde precisa lidar com os altos custos e as dificuldades de se propiciar a prática de procedimentos que envolvem seres humanos. As tecnologias imersivas, como realidade virtual, realidade aumentada e vídeos imersivos, são alternativas que precisam ser consideradas por propiciar realismo e segurança, além de motivar e engajar, ao mesmo tempo em que seus custos encontram-se em queda, com qualidade e facilidade de uso em alta, incluindo a possibilidade de utilização de dispositivos móveis. Este artigo discute a utilização das tecnologias imersivas na educação em saúde, introduzindo conceitos e referências fundamentais para compreendê-las e utilizá-las. Com o objetivo de oferecer uma visão prática sobre o tema, são apresentados dois relatos de projetos de pesquisa e desenvolvimento coordenados pelo autor. O primeiro, VIDA Odonto, é um simulador de realidade virtual para treinamento de procedimentos de aplicação de anestesia odontológica. O segundo, VIDA Enfermagem, é voltado para a prática de punção venosa periférica para coleta sanguínea.

Augmented Reality in Orthopedic Surgery Is Emerging from Proof of Concept Towards Clinical Studies: a Literature Review Explaining the Technology and Current State of the Art.

PURPOSE OF REVIEW: Augmented reality (AR) is becoming increasingly popular in modern-day medicine. Computer-driven tools are progressively integrated into clinical and surgical procedures. The purpose of this review was to provide a comprehensive overview of the current technology and its challenges based on recent literature mainly focusing on clinical, cadaver, and innovative sawbone studies in the field of orthopedic surgery. The most relevant literature was selected according to clinical and innovational relevance and is summarized. RECENT FINDINGS: Augmented reality applications in orthopedic surgery are increasingly reported. In this review, we summarize basic principles of AR including data preparation, visualization, and registration/tracking and present recently published clinical applications in the area of spine, osteotomies, arthroplasty, trauma, and orthopedic oncology. Higher accuracy in surgical execution, reduction of radiation exposure, and decreased surgery time are major findings presented in the literature. In light of the tremendous progress of technological developments in modern-day medicine and emerging numbers of research groups working on the implementation of AR in routine clinical procedures, we expect the AR technology soon to be implemented as standard devices in orthopedic surgery.

Immersion and haptic feedback impacts on dental anesthesia technical skills virtual reality training.

OBJECTIVES: Administering anesthesia to the inferior alveolar nerve is 1 of the most stressful processes in dental training. Most studies using virtual reality (VR) for dental training have used non-immersive technologies. The purpose of this work is to assess the impact of immersive technologies on skills training. METHODS: On May 2019, an experimental study was conducted with 163 clinical dental students, divided into 4 groups across 2 phases (preceptorship and training) with haptic feedback either On or Off. The participants trained on the inferior alveolar dental anesthesia procedure in a haptic VR simulator. Their technical skills were evaluated in terms of needle insertion features which were computed from a haptic device providing kinematic data. Also, the participants reported their subjective experience with syringe handling and simulator sickness. A machine learning method was implemented to automatically evaluate the needle insertion point performance of the student. RESULTS: Groups receiving immersive preceptorship and/or immersive training showed more accuracy and confidence in administering the anesthesia. Participants perceived a high sense of realism with the haptic feedback when handling the syringe. The machine learning method was validated, with an accuracy of 84%, as a good classifier to assess a student's needle insertion point performance. CONCLUSIONS: The immersive VR simulator allows the practice of the inferior alveolar nerve block under near real conditions and with immediate feedback to the dental student with respect to the needle insertion point. This machine learning based automatic evaluation provides a method to improve technical skills, contributing to dental training.

VIDA-Nursing v1.0: immersive virtual reality in vacuum blood collection among adults.

OBJECTIVE: to develop and validate the first immersive virtual reality simulation addressing vacuum blood collection in adult patients - VIDA-Nursing v1.0. METHOD: methodological study to validate 14 steps of the vacuum blood collection procedure in adults, designed to develop the immersive virtual reality simulator VIDA-Nursing v1.0. It was assessed by 15 health workers and 15 nursing undergraduate students in terms of visual, interactive, movement simulation reality, teaching and user-friendly aspects. RESULTS: the workers considered 79.6% of the items to be valid, while the students considered 66.7% of the items valid; most of the demands can be implemented in the system by improving future versions. CONCLUSION: the simulator was considered a promising and innovative tool to teach vacuum blood collection in adults as it can be combined with other resources currently used to introduce this topic and technique in the education of undergraduate nursing students.

VIDA - Nursing v1. 0 immersive virtual reality in vacuum blood collection among adults / VIDA - Enfermagem v1. 0 realidade virtual imersiva na coleta de sangue a vácuo em adulto / VIDA - Enfermería v1. 0 realidad virtual inmersiva en la recolección de sangre al vacío en adultos

Objective: to develop and validate the first immersive virtual reality simulation addressing vacuum blood collection in adult patients - VIDA-Nursing v1.0. Method: methodological study to validate 14 steps of the vacuum blood collection procedure in adults, designed to develop the immersive virtual reality simulator VIDA-Nursing v1.0. It was assessed by 15 health workers and 15 nursing undergraduate students in terms of visual, interactive, movement simulation reality, teaching and user-friendly aspects. Results: the workers considered 79.6% of the items to be valid, while the students considered 66.7% of the items valid; most of the demands can be implemented in the system by improving future versions. Conclusion: the simulator was considered a promising and innovative tool to teach vacuum blood collection in adults as it can be combined with other resources currently used to introduce this topic and technique in the education of undergraduate nursing students.

Objetivo: desenvolver e validar a primeira versão do simulador de realidade virtual imersiva no procedimento de coleta de sangue a vácuo no paciente adulto - VIDA-Enfermagem v1.0. Método: estudo com delineamento metodológico para validar 14 etapas do procedimento de coleta de sangue a vácuo no adulto, projetadas para o desenvolvimento do simulador de realidade virtual imersiva VIDA-Enfermagem v1.0, o qual foi avaliado por 15 profissionais da saúde e 15 graduandos de enfermagem em relação aos aspectos visual, interativo, realidade de simulação do movimento, pedagógico e esforço de utilização. Resultados: de maneira geral foram considerados válidos 79,6% dos itens avaliados pelos profissionais e 66,7% dos itens avaliados pelos graduandos, sendo que a maioria das necessidades de melhorias do sistema é passível de correção no incremento das próximas versões. Conclusão: o simulador foi considerado como ferramenta promissora e inovadora para o ensino da coleta de sangue a vácuo no adulto, enquanto estratégia a ser combinada com recursos utilizados atualmente na educação de graduandos de enfermagem que estão iniciando o estudo da temática e da técnica.

Objetivo: desarrollar y validar la primera versión del simulador de realidad virtual inmersivo en el procedimiento de recolección de vacío de sangre en pacientes adultos: VIDA-Enfermería v1.0. Método: estudio con diseño metodológico para validar 14 pasos del procedimiento de extracción de sangre al vacío en adultos, diseñado para el desarrollo del simulador inmersivo de realidad virtual VIDA-Enfermería v1.0, que fue evaluado por 15 profesionales de la salud y 15 estudiantes universitarios de enfermería con relación a los aspectos visual, interactiva, realidad de movimiento, pedagógico y esfuerzo de uso. Resultados: en general, el 79.6% de los ítems evaluados por los profesionales y el 66.7% de los ítems evaluados por los estudiantes de pregrado se consideraron válidos, y la mayoría de las necesidades de mejoras del sistema están sujetas a corrección en el incremento de las próximas versiones. Conclusión: el simulador fue considerado como una herramienta prometedora e innovadora para enseñar la extracción de sangre al vacío en adultos, como una estrategia que se combina con los recursos utilizados actualmente en la educación de estudiantes de enfermería que están comenzando a estudiar el tema y la técnica.

Haptic interaction for needle insertion training in medical applications: The state-of-the-art.

Computer-based simulation for medical procedures training has been gaining relevance, as well the use of haptic devices for developing fine motor skills in such simulations. The purpose of this paper is to present a review of the state-of-the-art in virtual needle insertion training simulation based on haptic interaction. A systematic review method was applied to gather documentation that enables a rigorous audit of the process stages and results. We established a classification system based on certain characteristics of the studies analyzed, including: main procedures and target body regions in medical applications; ways to generate haptic feedback; devices; types of environment; and user validation. In addition, the review aimed to identify challenges and trends in the field, indicating research opportunities. Results showed the predominance of Virtual Reality and commercial haptic devices in simulations. Since most studies are based on subjective tests, finding ways to objectively evaluate haptic interaction perception represents a promising research field. We also found that devices and ways to generate haptic feedback and to represent tissue and needle behavior pose limitations and challenges for computer simulation. Finally, the realism provided is a constant concern in the validation process, which brings another problem: defining and performing suitable user tests.

Virtual Reality simulator for dental anesthesia training in the inferior alveolar nerve block.

OBJECTIVES: This study shows the development and validation of a dental anesthesia-training simulator, specifically for the inferior alveolar nerve block (IANB). The system developed provides the tactile sensation of inserting a real needle in a human patient, using Virtual Reality (VR) techniques and a haptic device that can provide a perceived force feedback in the needle insertion task during the anesthesia procedure. MATERIAL AND METHODS: To simulate a realistic anesthesia procedure, a Carpule syringe was coupled to a haptic device. The Volere method was used to elicit requirements from users in the Dentistry area; Repeated Measures Two-Way ANOVA (Analysis of Variance), Tukey post-hoc test and averages for the results' analysis. A questionnaire-based subjective evaluation method was applied to collect information about the simulator, and 26 people participated in the experiments (12 beginners, 12 at intermediate level, and 2 experts). The questionnaire included profile, preferences (number of viewpoints, texture of the objects, and haptic device handler), as well as visual (appearance, scale, and position of objects) and haptic aspects (motion space, tactile sensation, and motion reproduction). RESULTS: The visual aspect was considered appropriate and the haptic feedback must be improved, which the users can do by calibrating the virtual tissues' resistance. The evaluation of visual aspects was influenced by the participants' experience, according to ANOVA test (F=15.6, p=0.0002, with p<0.01). The user preferences were the simulator with two viewpoints, objects with texture based on images and the device with a syringe coupled to it. CONCLUSION: The simulation was considered thoroughly satisfactory for the anesthesia training, considering the needle insertion task, which includes the correct insertion point and depth, as well as the perception of tissues resistances during the insertion.

Virtual Reality simulator for dental anesthesia training in the inferior alveolar nerve block

Abstract Objectives This study shows the development and validation of a dental anesthesia-training simulator, specifically for the inferior alveolar nerve block (IANB). The system developed provides the tactile sensation of inserting a real needle in a human patient, using Virtual Reality (VR) techniques and a haptic device that can provide a perceived force feedback in the needle insertion task during the anesthesia procedure. Material and Methods To simulate a realistic anesthesia procedure, a Carpule syringe was coupled to a haptic device. The Volere method was used to elicit requirements from users in the Dentistry area; Repeated Measures Two-Way ANOVA (Analysis of Variance), Tukey post-hoc test and averages for the results' analysis. A questionnaire-based subjective evaluation method was applied to collect information about the simulator, and 26 people participated in the experiments (12 beginners, 12 at intermediate level, and 2 experts). The questionnaire included profile, preferences (number of viewpoints, texture of the objects, and haptic device handler), as well as visual (appearance, scale, and position of objects) and haptic aspects (motion space, tactile sensation, and motion reproduction). Results The visual aspect was considered appropriate and the haptic feedback must be improved, which the users can do by calibrating the virtual tissues' resistance. The evaluation of visual aspects was influenced by the participants' experience, according to ANOVA test (F=15.6, p=0.0002, with p<0.01). The user preferences were the simulator with two viewpoints, objects with texture based on images and the device with a syringe coupled to it. Conclusion The simulation was considered thoroughly satisfactory for the anesthesia training, considering the needle insertion task, which includes the correct insertion point and depth, as well as the perception of tissues resistances during the insertion.

Avaliação de habilidades sensório-motoras em ambientes de realidade virtual para treinamento médico: uma revisão sistemática / Evaluation of sensorimotor skills in virtual reality environments for medical training: a systematic review / Evaluación de las habilidades motoras y sensoriales en entornos de realidad virtual para laformación médica: una revisión sistemática

Estudos sobre as contribuições oriundas do campo de desenvolvimento de Habilidades Sensório-Motoras (HSM) são imprescindíveis para a área de treinamento médico. Considerando experiências encontradas especialmente nesse contexto, a proposta deste trabalho consiste em uma investigação que utiliza um processo de Revisão Sistemática (RS) para recuperar o estado da arte sobre metodologias de avaliação de aquisição de HSM. Com a RS foi possível identificar métricas que são usadas em estratégias de avaliação de aquisição de HSM tanto em ambientes reais quanto virtuais. Após a identificação dessas métricas, desenvolveu-se uma análise para categorizá-las, de acordo com o seu grau de similaridade e contextos de aplicação. Nesse sentido, o estudo revela possíveis métricas que contribuirão para criação de uma nova metodologia de avaliação de aquisição de HSM para ambientes de Realidade Virtual.

Studies on the contributions from the sensorimotor skills are essential to the medical training area. Considering experiences found in this particular context, the goal of this paper is an investigation that uses a Systematic Review (SR) process in order to retrieve the state of the art in relation to methodologies to evaluate the skills acquisition. The SR made it possible to identify metrics that are used to evaluate strategies of SMS acquisition, both in real environments (RE) as well as in virtual environments. After identifying these metrics, an analysis was developed to categorize them according to their similarities and application context. In this sense, the study reveals the metrics that will contribute to the creation of a new evaluation methodology of SMS acquisition for Virtual Reality environments.

Los estudios sobre la contribución del desarrollo del campo de las Habilidades Motoras y Sensoriales  (HSM) son indispensables para la formación médica. Teniendo en cuenta las experiencias vividas, especialmente en este contexto, la propuesta consiste en una investigación que utiliza un proceso de Revisión Sistemática (RS) para recuperar el estado de la técnica sobre metodologías de evaluación para la adquisición de HSM. Para ello, tuvimos que desarrollar una revisión de la literatura existente, identificando indicadores que se utilizan a menudo en las estrategias de evaluación de la adquisición de HSM tanto en entornos reales como em entornos virtuales. Después de identificar estos parámetros, estos fueron analisados para clasificarlos según su grado de similitud, y contextos de aplicación. Así, el estudio revela posibles métricas que contribuirán para la creación o formulación de una nueva metodología de evaluación de HSM en entornos de Realidad Virtual (RV).

Interaction in collaborative educational virtual environments.

The collaborative educational virtual environment supposes the active participation of students and teachers, interacting highly and aiming at knowledge exchange and creation of new abilities. The learning becomes a process in which one assists the other to reach the objective, by exchanging experiences, dialogues, discussion of ideas, accomplishments of the group, and individual activities that can be shared with the group, allowing the creation of knowledge based on collective involvement. In this context, this paper describes and discusses the aspects and methods of interaction between students and teachers in collaborative educational virtual environments and presents an application based on the Virtual Teacher Project.