title: Percutaneous spinal fixation simulation with virtual reality and haptics.
abstract: BACKGROUND
  In this study, we evaluated the use of a part-task simulator with 3-dimensional and haptic feedback as a training tool for percutaneous spinal needle placement.
  
  
  OBJECTIVE
  To evaluate the learning effectiveness in terms of entry point/target point accuracy of percutaneous spinal needle placement on a high-performance augmented-reality and haptic technology workstation with the ability to control the duration of computer-simulated fluoroscopic exposure, thereby simulating an actual situation.
  
  
  METHODS
  Sixty-three fellows and residents performed needle placement on the simulator. A virtual needle was percutaneously inserted into a virtual patient's thoracic spine derived from an actual patient computed tomography data set.
  
  
  RESULTS
  Ten of 126 needle placement attempts by 63 participants ended in failure for a failure rate of 7.93%. From all 126 needle insertions, the average error (15.69 vs 13.91), average fluoroscopy exposure (4.6 vs 3.92), and average individual performance score (32.39 vs 30.71) improved from the first to the second attempt. Performance accuracy yielded P = .04 from a 2-sample t test in which the rejected null hypothesis assumes no improvement in performance accuracy from the first to second attempt in the test session.
  
  
  CONCLUSIONS
  The experiments showed evidence (P = .04) of performance accuracy improvement from the first to the second percutaneous needle placement attempt. This result, combined with previous learning retention and/or face validity results of using the simulator for open thoracic pedicle screw placement and ventriculostomy catheter placement, supports the efficacy of augmented reality and haptics simulation as a learning tool.
authors.affiliation: Department of Mechanical and Industrial Engineering, College of Engineering, University of Illinois at Chicago, Chicago, Illinois 60607, USA.
authors.forename: Cristian J
authors.initials: CJ
authors.lastname: Luciano
authors.forename: P Pat
authors.initials: PP
authors.lastname: Banerjee
authors.forename: Jeffery M
authors.initials: JM
authors.lastname: Sorenson
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Foley
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Ansari
authors.forename: Silvio
authors.initials: S
authors.lastname: Rizzi
authors.forename: Anand V
authors.initials: AV
authors.lastname: Germanwala
authors.forename: Leonard
authors.initials: L
authors.lastname: Kranzler
authors.forename: Prashant
authors.initials: P
authors.lastname: Chittiboina
authors.forename: Ben Z
authors.initials: BZ
authors.lastname: Roitberg
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000193:education / Q000379:methods / Q000592:standards; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D003198:Computer Simulation; D005257:Fellowships and Scholarships / Q000379:methods; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D007396:Internship and Residency / Q000379:methods; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000193:education* / Q000379:methods / Q000592:standards; D009339:Needles; D011829:Radiation Dosage; D013131:Spine / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface; D014696:Ventriculostomy / Q000193:education* / Q000379:methods / Q000592:standards; D054854:Vertebroplasty / Q000193:education* / Q000379:methods / Q000592:standards