Developing a Next Generation Colonoscopy Simulator

Abstract

Colonoscopy is considered the gold standard for detection and removal of precancerous polyps in the colon. Being a difficult procedure to master, exposure to a large variety of patient and pathology scenarios is crucial for gastroenterologists' training. Currently, most training is done on patients under supervision of experienced gastroenterologists. Being able to undertake a majority of training on simulators would greatly reduce patient risk and discomfort. A next generation colonoscopy simulator is currently under development, which aims to address the shortfalls of existing simulators. The simulator consists of a computer simulation of the colonoscope camera view and a haptic device that allows insertion of an instrumented colonoscope to drive the simulation and provide force feedback to the user. The simulation combines physically accurate models of the colonoscope, colon and surrounding tissues and organs with photorealistic visualization. It also includes the capability to generate randomized case scenarios where complexity of the colon physiology, pathology and environmental factors, such as colon preparation, can be tailored to suit training requirements. The long term goal is to provide a metrics based training and skill evaluation system that is not only useful for trainee instruction but can be leveraged for skills maintenance and eventual certification.

Virtual reality for medical training: the state-of-the-art

“…We have seen a progression from static models, to deformable models, to surgically interactive models, to those also with realistic tactile interaction (see Figure 1, where the progression of tissue simulation technology can be roughly summarized from A: Deformable, through G: Deformable, cuttable, and haptically interactive). For example, De Visser et al's (2010) colonoscopy simulation consists of deforming models with good haptic realism (Region E in Figure 1), whereas the Voxel-Man (Tolsdorff et al, 2007) simulators support surgical alteration of rigid tissues with haptic feedback (Region F of Figure 1). Although this has been made possible by advances in processing hardware, it is the reusable software libraries and APIs (application programming interfaces) that will make these complex systems reproducible by the wider simulation developer community resulting in the greatest impact to the quality of VR simulation-based medical training.…”

“…De Visser et al (2010) at the Australian Commonwealth Scientific and Industrial Research Organization have developed a multi-threaded colonoscopy simulation framework. The simulator provides robust simulation of the deformation of the colon, high visual fidelity, and a specially built haptic interface that enables the user to manipulate a real endoscope with tactile feedback (Samur et al, 2008).…”

Progress in virtual reality simulators for surgical training and certification

“…Developments in these industries have led to the availability of hardware and software that can provide much more realistic simulation models than those currently in use. Evidence for this can already be seen in the next generation of simulator prototypes showcased in recent journals and conferences, 7 , 8 such as the colonoscopy simulator currently being developed at the CSIRO (Commonwealth Scientific and Industrial Research Organisation) Australian e‐Health Research Centre. This makes use of the “massively parallel” processing power of current graphics processing units to provide highly detailed, dynamic interactive models of the colon and the colonoscope (Box) 7 …”

Interindividual registration and dose mapping for voxelwise population analysis of rectal toxicity in prostate cancer radiotherapy

“…Solving Laplace's equation in a discrete domain has led to several possibilities for characterizing various structures in medical imaging such as the determination of organ thickness. 32,38,40,41 In this paper, the scalar field u solution of Laplace's equation as calculated within the rectum between the centerline and the surface 42,43 enables the rectum's cylindrical structure to be described in a similar fashion across individuals. Thus, registration can be driven by direct point-to-point correspondences within each individual's rectum.…”