title: Haptic palpation of head and neck cancer patients--implication for education and telemedicine.
abstract: Malignancy in the head and neck area is a disease that often gives high morbidity in functions like speech, eating, breathing and cosmetics. To ensure a treatment of high clinical standard these patients are presented for a multidisciplinary tumor-team at Sahlgren University hospital. The team usually involves ENT-surgeons (Ear, Nose and Throat), oncologists, radiologists, pathologists, plastic surgeon, general surgeon and oral surgeons. The aim of the presentation is to classificate the tumor and suggests a treatment. The patients presented are from the whole western region of Sweden, and therefore some patients have to travel long distances. To minimize travel telemedicine was introduced 1998 with success [1]. One concern, when presenting a patient with telemedicine, has been the lack of possibility to palpate the tumor and the tissue surrounding it. To address this problem a 3D model of the tumor visualizes the region and possibly allows haptic palpation. Based on a series of high resolution CT/MR scans, a model of the region around the patients tumor is created. Haptic properties are added to the skin and subcutaneous structures (including the tumor) of the model. Initially, the haptic tuning is done by an examining physician, but in the final telemedical application, the aim is to develop a sensory device for this purpose (e.g. a position sensitive glove, such as Virtual Technologies, Inc. CyberGlove [2] and a graded system for setting firmness of the tissue). The model with its haptic properties can then be examined visually and haptically, the latter using a haptic device such as the SensAble PHANToM [3]. The present system uses a 3D model in VRML format based on reconstructed structures in the ROI (which includes the jawbones, the vertebra, the throat, major muscles and the skin) from high resolution CT. Haptic properties are added using MAGMA 2.5 (ReachIn Technologies AB, Sweden) [4]. Haptic force feedback is provided using a PHANToM Desktop (SensAble Technologies Inc) [3]. Visual feedback can be either monoscopic or stereoscopic (StereoGraphic CrystalEyes) [5]. The system will be used for concept testing and for evaluating possible limitations and/or the need for a modified examination protocol. Once a reliable set of parameters has been generated (using both professionals and medical students at various levels), the remote components will be added.
authors.affiliation: Dept. of Otolaryngology, Head and Neck Surgery, Sahlgrens University Hospital, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Stalfors
authors.forename: T
authors.initials: T
authors.lastname: Kling-Petersen
authors.forename: M
authors.initials: M
authors.lastname: Rydmark
authors.forename: T
authors.initials: T
authors.lastname: Westin
mesh_terms: D003194:Computer-Assisted Instruction; D006258:Head and Neck Neoplasms / Q000175:diagnosis*; D006801:Humans; D021621:Imaging, Three-Dimensional; D020407:Internet; D009333:Neck; D010173:Palpation; D019047:Phantoms, Imaging; D017216:Telemedicine; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface