Patient-specific Virtual Ultrasound Imagery for Virtual Reality Simulation of Central Line Placement

2015-10-21T00:00:00Z (GMT) by Xiaorui Zhao
Ultrasonography can be a very useful tool for medical diagnosis and treatment. Ultrasound imagery is used to visualize internal anatomical structures as an intuitive visual guidance for various non-invasive procedures. The goal of this dissertation is to develop a simulator that incorporates ultrasound visualizations and mirrors or enhances a real clinical situation with guided experiences in an interactive manner. This technique, used in pre-surgical planning and residents training, will improve the residents’ performance and increase their confidence while economically complement the traditional manikin or cadaver-based training process. The broader impact of the research undertaking is to formulate the ultrasound visualization as an off-the-shelf component that is plugged into any surgical environment including complex human anatomies. A proof-of-concept implementation is demonstrated by a procedure known as central line venous catheterization. This percutaneous procedure, performed by multiple specialties, consists of inserting a needle that will guide a catheter into a large vein located in the targeted site for administering medication or fluids, or obtaining blood tests or cardiovascular measurements. Mostly used in the internal jugular approach, ultrasound imagery provides visual guidance for the surgeon to recognize the internal anatomical structure of the neck, as well as the position and orientation of the needle being inserted. A characteristic collapse of the vein, produced when applying slight pressure to the skin with the ultrasound transducer, helps the surgeon differentiate vein from artery, as the latter does not collapse. During training with the simulator, residents are able to develop the kinesthetic and psychomotor skills required for this bimanual procedure inserting the needle with one hand while properly manipulating the ultrasound transducer with the other. Pre-surgical planning of challenging cases of patients with abnormal anatomy can also be conducted with this patient-specific simulator.