title: A Low-Cost, Passive Navigation Training System for Image-Guided Spinal Intervention.
abstract: BACKGROUND
  Navigation technology is used for training in various medical specialties, not least image-guided spinal interventions. Navigation practice is an important educational component that allows residents to understand how surgical instruments interact with complex anatomy and to learn basic surgical skills such as the tridimensional mental interpretation of bidimensional data. Inexpensive surgical simulators for spinal surgery, however, are lacking. We therefore designed a low-cost spinal surgery simulator (Spine MovDigSys 01) to allow 3-dimensional navigation via 2-dimensional images without altering or limiting the surgeon's natural movement.
  
  
  METHODS
  A training system was developed with an anatomical lumbar model and 2 webcams to passively digitize surgical instruments under MATLAB software control. A proof-of-concept recognition task (vertebral body cannulation) and a pilot test of the system with 12 neuro- and orthopedic surgeons were performed to obtain feedback on the system. Position, orientation, and kinematic variables were determined and the lateral, posteroanterior, and anteroposterior views obtained.
  
  
  RESULTS
  The system was tested with a proof-of-concept experimental task. Operator metrics including time of execution (t), intracorporeal length (d), insertion angle (α), average speed (v¯), and acceleration (a) were obtained accurately. These metrics were converted into assessment metrics such as smoothness of operation and linearity of insertion. Results from initial testing are shown and the system advantages and disadvantages described.
  
  
  CONCLUSIONS
  This low-cost spinal surgery training system digitized the position and orientation of the instruments and allowed image-guided navigation, the generation of metrics, and graphic recording of the instrumental route. Spine MovDigSys 01 is useful for development of basic, noninnate skills and allows the novice apprentice to quickly and economically move beyond the basics.
authors.affiliation: Electrical Department, Research and Advanced Studies Center of the National Polytechnic Institute of Mexico (Cinvestav - IPN). Av. IPN No 2508, Col San Pedro Zacatenco, México DF, Mexico. Electronic address: dlorias@cinvestav.mx.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lorias-Espinoza
authors.affiliation: Department of Neurosurgery, Hospital Infantil de México Federico Gómez, col Doctores, México DF, Mexico.
authors.forename: Vicente González
authors.initials: VG
authors.lastname: Carranza
authors.affiliation: Department of Neurosurgery, Hospital Infantil de México Federico Gómez, col Doctores, México DF, Mexico.
authors.forename: Fernando Chico-Ponce
authors.initials: FC
authors.lastname: de León
authors.affiliation: Departamento de cirugía, Facultad de medicina Universidad Nacional Autónoma de México, UNAM, México DF, Mexico.
authors.forename: Fernando Pérez
authors.initials: FP
authors.lastname: Escamirosa
authors.affiliation: Electrical Department, Research and Advanced Studies Center of the National Polytechnic Institute of Mexico (Cinvestav - IPN). Av. IPN No 2508, Col San Pedro Zacatenco, México DF, Mexico.
authors.forename: Arturo Minor
authors.initials: AM
authors.lastname: Martinez
mesh_terms: D002983:Clinical Competence / Q000592:standards; D003198:Computer Simulation / Q000191:economics* / Q000592:standards; D006801:Humans; D008953:Models, Anatomic; D019635:Neurosurgical Procedures / Q000191:economics* / Q000379:methods / Q000592:standards; D010865:Pilot Projects; D013131:Spine / Q000601:surgery*; D066231:Surgeons / Q000592:standards
keywords: Metric-based teaching; Spine simulator; Spine trainer simulator; Training in neurosurgery