title: A novel actuator for simulation of epidural anesthesia and other needle insertion procedures.
abstract: BACKGROUND
  When navigating a needle from skin to epidural space, a skilled clinician maintains a mental model of the anatomy and uses the various forms of haptic and visual feedback to track the location of the needle tip. Simulating the procedure requires an actuator that can produce the feel of tissue layers even as the needle direction changes from the ideal path.
  
  
  METHODS
  A new actuator and algorithm architecture simulate forces associated with passing a needle through varying tissue layers. The actuator uses a set of cables to suspend a needle holder. The cables are wound onto spools controlled by brushless motors. An electromagnetic tracker is used to monitor the position of the needle tip.
  
  
  RESULTS
  Novice and expert clinicians simulated epidural insertion with the simulator. Preliminary depth-time curves show that the user responds to changes in tissue properties as the needle is advanced. Some discrepancy in clinician response indicates that the feel of the simulator is sensitive to technique, thus perfect tissue property simulation has not been achieved.
  
  
  CONCLUSIONS
  The new simulator is able to approximately reproduce properties of complex multilayer tissue structures, including fine-scale texture. Methods for improving fidelity of the simulation are identified.
authors.affiliation: Physical Sciences Inc., Andover, MA 01810, USA. magill@psicorp.com
authors.forename: John C
authors.initials: JC
authors.lastname: Magill
authors.forename: Marten F
authors.initials: MF
authors.lastname: Byl
authors.forename: Michael F
authors.initials: MF
authors.lastname: Hinds
authors.forename: William
authors.initials: W
authors.lastname: Agassounon
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Pratt
authors.forename: Philip E
authors.initials: PE
authors.lastname: Hess
mesh_terms: D000465:Algorithms; D000767:Anesthesia, Epidural / Q000295:instrumentation / Q000379:methods*; D003198:Computer Simulation; D003194:Computer-Assisted Instruction / Q000379:methods*; D004867:Equipment Design; D056228:Feedback, Sensory; D006801:Humans; D009339:Needles; D019415:Torque; D014584:User-Computer Interface