Virtual reality (VR) medical simulations deliver a tailored learning experience that can be standardized, and can cater to different learning styles in ways that cannot be matched by traditional teaching. These simulations also facilitate self-directed learning, allow trainees to develop skills at their own pace and allow unlimited repetition of specific scenarios that enable them to remedy skills deficiencies in a safe environment. A number of simulators have been validated and have shown clear benefits to medical training. However, while graphical realism is high, realistic haptic feedback and interactive tissues are limited for many simulators. This paper reviews the current status and benefits of haptic VR simulation-based medical training for bone and dental surgery, intubation procedures, eye surgery, and minimally invasive and endoscopic surgery.

This new computer-based training tool for practicing ESS provides a risk-free environment for surgical trainees to practice and develop core skills. The novel use of customized precision force feedback (haptic) devices enables trainees to use movements during training that closely mimic those used during the actual procedure, which we anticipate will improve learning, retention, and recall.

The study demonstrated the Flinders sinus simulator's construct validity, differentiating between experts and novices with respect to procedure time, instrument distance travelled and number of cutting motions to complete the task.

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Efficient rendering of a changing volumetric data-set is central to the development of effective medical simulations that incorporate haptic feedback. A new method referred to as real-time interactive isosurfacing (RTII) is described in this paper. RTII is an algorithm that can be applied to output from Marching Cubes-like algorithms to improve performance for real-time applications. The approach minimises processing by re-evaluating the isosurface around changing sub-volumes resulting from user interactions. It includes innovations that significantly reduce mesh complexity and improve mesh quality as triangles are created from the Marching Tetrahedra isosurfacing algorithm. Rendering efficiency is further improved over other marching isosurfacing algorithm outputs by maintaining an indexed triangle representation of the mesh. The effectiveness of RTII is discussed within the context of an endoscopic sinus surgery simulation currently being developed by the authors.

This article describes a new approach for producing highly realistic visualizations that are interactively cuttable by utilizing the programmability of the graphics rendering pipeline. It combines interactively changing scalar-field derived mesh geometry with static mesh geometry that contains additional lighting terms created offline using three-dimensional modeling software packages. This improves visual realism of surgical simulations whilst enabling more efficient surface representations for interactive areas of the same model, in this case the newly formed surface created when interactively cutting a model. The boundary between the interactively cut surface (generated from the scalar field), and the remaining surface triangles of the static model, is jagged and unrealistic when un-enhanced. Here we describe a method for blending the two models using a simple bleeding effect along the cut edge. This allows the cut edge and the internal cut surface to blend and thereby conceals unrealistic and distracting jagged cut edges. The bloodied edge is more realistic than an unmodified hard edge, which improves the quality of the simulation overall. Moreover, as the available processing power increases the resolution that can be achieved will increase and should allow this method to be extended for slice cutting simulation.

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