title: Virtual reality myringotomy simulation with real-time deformation: development and validity testing.
abstract: OBJECTIVE
  Surgical simulation is becoming an increasingly common training tool in residency programs. The first objective was to implement real-time soft-tissue deformation and cutting into a virtual reality myringotomy simulator. The second objective was to test the various implemented incision algorithms to determine which most accurately represents the tympanic membrane during myringotomy.
  
  
  METHODS
  Descriptive and face-validity testing.
  
  
  METHODS
  A deformable tympanic membrane was developed, and three soft-tissue cutting algorithms were successfully implemented into the virtual reality myringotomy simulator. The algorithms included element removal, direction prediction, and Delaunay cutting. The simulator was stable and capable of running in real time on inexpensive hardware. A face-validity study was then carried out using a validated questionnaire given to eight otolaryngologists and four senior otolaryngology residents. Each participant was given an adaptation period on the simulator, was blinded to the algorithm being used, and was presented the three algorithms in a randomized order.
  
  
  RESULTS
  A virtual reality myringotomy simulator with real-time soft-tissue deformation and cutting was successfully developed. The simulator was stable, ran in real time on inexpensive hardware, and incorporated haptic feedback and stereoscopic vision. The Delaunay cutting algorithm was found to be the most realistic algorithm representing the incision during myringotomy (P < .05). The Likert and visual analog scales had strong correlations, suggesting good internal reliability.
  
  
  CONCLUSIONS
  The first virtual reality myringotomy simulator is being developed and now integrates a real-time deformable tympanic membrane that appears to have face validity. Further development and validation studies are necessary before the simulator can be studied with respect to training efficacy and clinical impact.
authors.affiliation: Biomedical Engineering Graduate Program, University of Western Ontario, London, Ontario, Canada.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Ho
authors.forename: Hussain
authors.initials: H
authors.lastname: Alsaffar
authors.forename: Philip C
authors.initials: PC
authors.lastname: Doyle
authors.forename: Hanif M
authors.initials: HM
authors.lastname: Ladak
authors.forename: Sumit K
authors.initials: SK
authors.lastname: Agrawal
mesh_terms: D000465:Algorithms; D003198:Computer Simulation; D005246:Feedback; D006801:Humans; D021621:Imaging, Three-Dimensional; D007396:Internship and Residency; D008876:Middle Ear Ventilation / Q000193:education* / Q000379:methods*; D008953:Models, Anatomic; D010036:Otolaryngology / Q000193:education*; D011795:Surveys and Questionnaires; D014432:Tympanic Membrane / Q000601:surgery*; D014584:User-Computer Interface