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Overview

This book deals with applications of Virtual Reality in medicine. Its two volumes cover VR in medical education, treatment through us of virtual environments, and telemedicine and telesurgery. Volume II covers the technologies for rehabilitation and medical treatment. This volume also covers the recent developments in telemedicine and surgery.
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Product Details

  • ISBN-13: 9780471414926
  • Publisher: Wiley, John & Sons, Incorporated
  • Publication date: 4/18/2001
  • Series: Information Technologies in Medicine Ser
  • Edition number: 1
  • Pages: 216
  • Product dimensions: 6.36 (w) x 9.57 (h) x 0.62 (d)

Meet the Author

METIN AKAY is Assistant Professor at the Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.

ANDY MARSH is a researcher at the National Technical University of Athens in Athens, Greece.

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Read an Excerpt

Information Technologies in Medicine, Volume II

Rehabilitation and Treatment

John Wiley & Sons

Copyright © 2001 John Wiley & Sons, Inc.
All right reserved.

ISBN: 0-471-41492-1


Chapter One

Neuro/Orthopedic Rehabilitation and Disability Solutions Using Virtual Reality Technology

WALTER J. GREENLEAF, Ph.D. Greenleaf Medical Systems Palo Alto, California

1.1 VR Environments and Interfaces 1.1.1 Head-Mounted Display

1.1.2 Instrumented Clothing

1.1.3 3-D Spatialized Sound

1.1.4 Other VR Interfaces

1.2 Diversity of VR Applications

1.3 Current Status of VR Technology

1.4 VR-Based Medical Applications in Development 1.4.1 Surgical Training and Planning

1.4.2 Medical Education, Modeling, and Nonsurgical Training

1.4.3 Anatomically Keyed Displays with Real-Time Data Fusion

1.4.4 Telesurgery and Telemedicine

1.5 Neurologic Testing and Behavioral Intervention

1.6 Rehabilitation, Functional Movement Analysis, and Ergonomic Studies

1.6.1 The Role of VR in Disability Solutions

1.7 Conclusion

References

Virtual reality (VR) is an emerging technology that allows individuals to experience three-dimensional (3-D) visual, auditory, and tactile environments. Highly specialized sensors and interface devices allow the individual to become immersed and to navigate and interact with objects in a computer-generated environment. Most people associate VR with video games;however, researchers and clinicians in the medical community are becoming increasingly aware of its potential benefits for people with disabilities and for individuals recovering from injuries.

1.1 VR ENVIRONMENTS AND INTERFACES

The computer-generated environment, or virtual world, consists of a 3-D graphics program that relies on a spatially organized, object-oriented database in which each object in the database represents an object in the virtual world (Fig. 1.1). A separate modeling program is used to create the individual objects for the virtual world. For greater realism, these modeling programs apply state-of-the-art computer-graphics techniques, such as texture mapping and shading, to all of the objects of the scene. The object database is manipulated using a real-time dynamics controller that specifies how objects behave within the world according to user-specified constraints and according to natural laws, such as gravity, inertia, and material properties. These laws are application specific. The dynamics controller also tracks the position and orientation of the user's head and hand.

Common computer input devices, such as a mouse and a keyboard, do not provide a sense of immersion in a virtual world. To create a VR experience, the conventional computer interface is replaced by one that is more natural and intuitive for interaction within complex 3-D environments. The need for improved human-computer interaction with virtual environments (VEs) has motivated the development of a new generation of interface hardware. To date, the most common 3-D input devices used in VR applications are head-mounted displays (HMDs) and instrumented clothing (gloves and suits). VEs may also be created through circuambiant projections, 3-D spatialized sound, haptic feedback, and motion effectors.

1.1.1 Head-Mounted Display

The best-known tool for data output in VR is the head-mounted display. It supports first-person immersion by generating a wide field of view image for each eye, often in true 3-D. Most lower-cost HMDs ($1000 range) use liquid crystal displays (LCDs) others use small cathode ray tubes (CRTs). The more expensive HMDs ($60,000 and up) use optical fibers to pipe the images from non-HMDs. An HMD requires a position tracker in addition to the helmet. Alternatively, the binocular display can be mounted on an armature for support and tracking (a Boom display).

1.1.2 Instrumented Clothing

Among the most popular and widely available input devices for VR are hand-tracking technologies. Such glove-based input devices let VR users apply their manual dexterity to the VR activity. Hand-tracking gloves currently in use include Sayre Glove, MIT LED Glove, Digital Data-Entry Glove, DataGlove, Dexterous HandMaster, Power Glove, CyberGlove, and Space Glove. This chapter describes two prototype clinical and rehabilitation applications using instrumented clothing technology (Fig. 1.2).

Originally developed by VPL Research, the DataGlove is a thin cloth glove with engraved optical fibers running along the surface of each digit that loop back to a light-processing box. The optical fibers that cross each joint are treated to increase the refractive surface area of that segment of the fiber over the joint. Each optical fiber originates at, and returns to, a light-processing box. In the light-processing box, light-emitting diodes send photons along the fibers to the photo detector. When the joints of the hand bend, the optical fibers bend so that the photons refract out of the fiber, thus attenuating the signal that passes through the fibers. The transmitted signal is proportional to the amount of flexion of a single joint and is recorded as such.

Because the attenuation of light along each optical fiber is interpreted as a measurement of joint flexion, the set of joint measurements can be thought of as a hand gesture. To provide feedback to the user, most VR applications render a graphic representation of the hand moving in real time; this representation shadows the movements of the hand in the DataGlove and replicates even the most subtle actions.

To determine the orientation and the position of the hand in 3-D space, the glove relies on a spatial tracking system. Tracking systems usually rely on electromagnetic, ultrasonic, or infrared sensors to determine the position and orientation of a the glove in relation to the signal source. Typically, the source is placed at a desired point of reference and the sensor is mounted on the dorsum of the glove.

The DataSuit is a custom-tailored body suit fitted with the same sophisticated fiberoptic sensors found in the DataGlove. The sensors are able to track the full range of motion of the person wearing the DataGlove or DataSuit as he or she bends, moves, grasps, or waves. Missing from the instrumented clothing is haptic feedback, which provides touch and force-feedback information to the VR participant.

1.1.3 3-D Spatialized Sound

The impression of immersion within a VE is greatly enhanced by inclusion of 3-D spatialized sound. Stereo-pan effects alone are inadequate because they tend to sound as if they are originating inside the head. Research into 3-D audio has shown the importance of modeling the head and pinna and using this model as part of the 3-D sound generation. A head-related transfer function (HRTF) can be used to generate the proper acoustics. A number of problems remain, such as the cone of confusion, wherein sounds behind the head are perceived to be in front of the head.

1.1.4 Other VR Interfaces

Senses of balance and motion can be generated in a VR system by a motion platform. These have been used in flight simulators to provide motion cues that the mind integrates with other cues to perceive motion. Haptics is the generation of touch and force-feedback information. Most systems to date have focused on force feedback and kinesthetic senses, although some prototype systems exist that generate tactile stimulation. Many of the haptic systems thus far are exoskeletons used for position sensing as well as for providing resistance to movement or active force application.

Some preliminary work has been conducted on generating the sense of temperature in VR. Small electrical heat pumps have been developed that produce sensations of heat and cold as part of the simulated environment.

1.2 DIVERSITY OF VR APPLICATIONS

VR has been researched for decades in government laboratories and universities, but because of the enormous computing power demands and associated high costs, applications have been slow to migrate from the research world to other areas. Recent improvements in the price:performance ratio of graphic computer systems have made VR technology more affordable and thus used more commonly in a wider range of applications. In fact, there is even a strong "garage VR" movement-groups of interested parties sharing information on how to build extremely low cost VR systems using inexpensive off-the-shelf components. These homemade systems are often inefficient, uncomfortable to use (sometimes painful), and slow; but they exist as a strong testament to a fervent interest in VR technology.

Current VR applications are diverse and represent dramatic improvements over conventional visualization and planning techniques:

Public entertainment. VR is arguably the most important current trend in public entertainment, with ventures ranging from shopping mall game simulators to low-cost VR games for the home.

Computer-aided design (CAD). Using VR to create virtual prototypes in software allows engineers to test potential products in the design phase, even collaboratively over computer networks, without investing time or money for conventional hard models.

Military. Using VR, the military's solitary cab-based systems have evolved into extensive networked simulations involving a variety of equipment and situations. Extensive battle simulations can now be created that network tanks, ships, soldiers, and fighters all into the same shared training experience.

Architecture and construction. VR allows architects and engineers and their clients to walk through structural blueprints. Designs may be understood more clearly by clients who often have difficulty comprehending even conventional cardboard models. The city of Atlanta credits its VR model for winning the site of the 1996 Olympics, and San Diego used a VR model of a planned convention center addition to compete for (and obtain) the 1996 Republican Party convention.

Financial visualization. By allowing navigation through an abstract world of data, VR helps users rapidly visualize large amounts of complex financial market data and thus supports faster decision making.

VR is commonly associated with exotic fully immersive applications because of the overdramatized media coverage of helmets, body suits, entertainment simulators, and the like. As important are the window-into-world applications by which the user or operator is allowed to interact effectively with virtual data, either locally or remotely.

1.3 CURRENT STATUS OF VR TECHNOLOGY

The commercial market for VR, although taking advantage of advances in VR technology at large, is nonetheless contending with the lack of integrated systems and the lack of reliable equipment suppliers. Typically, researchers buy peripherals and software from separate companies and configure their own systems. Companies that can offer integrated systems for commercial applications are expected to fill this gap over the next few years. Concurrently, the nature of the commercial VR medical market is expected to change as the prices of today's expensive, high-performance graphics systems decrease dramatically. High-resolution display systems will also significantly drop in cost as the VR display business can piggyback on HDTV projection and home-entertainment technologies.

Technical advances have occurred in networking applications, which include improved visual photo realism, decreased tracker latency through predictive algorithms, and variable resolution image generators. Work to improve database access methods is under way. Important hardware advances include eye gear with an increased field of view, wireless communications, lighted and smaller devices, and improved tracking systems.

1.4 VR-BASED MEDICAL APPLICATIONS IN DEVELOPMENT

The first wave of VR development efforts in the medical community addressed seven key categories:

Surgical training and surgical planning.

Medical education, modeling, and nonsurgical training.

Anatomically keyed displays with real-time data fusion. Telesurgery and telemedicine.

Patient testing and behavioral intervention.

Rehabilitation, functional movement analysis, and motion/ergonomic studies.

Disability solutions.

The potential of VR through education and information dissemination indicates there will be few areas of medicine not taking advantage of this improved computer interface. However, the latent potential of VR lies in its capacity to be used to manipulate and combine heterogeneous datasets from many sources. This feature is most significant and likely to transform the traditional applications environment in the near future.

1.4.1 Surgical Training and Planning

Various projects are under way to use VR and imaging technology to plan, simulate, and customize invasive (an minimally invasive) surgical procedures. Ranging from advanced imaging technologies for endoscopic surgery to routine hip replacements, these new developments will have a tremendous effect on improving surgical morbidity and mortality. According to Merril, studies show that doctors are more likely to make errors when performing their first few to several dozen diagnostic and therapeutic surgical procedures then when performing later procedures. Merril claims that operative risk could be substantially reduced by the development of a simulator that would allow transference of skills from the simulation to the actual point of patient contact. With surgical modeling, we would generally expect a much higher degree of precision, reliability, and safety, in addition to cost efficiency.

Several VR-based systems currently under development allow real-time tracking of surgical instrumentation and simultaneous display and manipulation of 3-D anatomy corresponding to the simulated procedure. Using this design, surgeons can practice procedures and experience the possible complications and variations in anatomy encountered during surgery. Necessary software tools have been developed to enable the creation of virtual tissues that reflect the physical characteristics of physiologic tissues. This technology operates in real-time using 3-D graphics, on a high-speed computer platform.

1.4.2 Medical Education, Modeling, and Nonsurgical Training

Researchers at the University of California at San Diego are exploring the value of hybridizing elements of VR, multimedia (MM), and communications technologies into a unified educational paradigm. The goal is to develop powerful tools that extend the flexibility and effectiveness of medical teaching and promote lifelong learning. To this end, they have undertaken a multiyear initiative, named the VR-MM Synthesis Project. Based on instructional design and user need (rather than technology per se), they plan to link the computers of the Data Communications Gateway, the Electronic Medical Record System, and the Simulation Environment.

Continues...


Excerpted from Information Technologies in Medicine, Volume II Copyright © 2001 by John Wiley & Sons, Inc.. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Preface.
Introduction.
Simple Linear Regression.
Multiple Linear Regression.
Model Adequacy Checking.
Transformations and Weighting to Correct Model Inadequacies.
Diagnostics for Leverage and Influence.
Polynomial Regression Models.
Indicator Variables.
Variable Selection and Model Building.
Multicollinearity.
Robust Regression.
Introduction to Nonlinear Regression.
Generalized Linear Models.
Other Topics in the Use of Regression Analysis.
Validation of Regression Models.
Appendix A: Statistical Tables.
Appendix B: Data Sets For Exercises.
Appendix C: Supplemental Technical Material.
References.
Index.
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