7 th Framework Programme This project has received funding from the European Union s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 610425 RASim Prototype User Manual REC_TL01_Deliverables_V01_20140101 2016-04-29 Page 1 of 21
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Table of contents 1 INTRODUCTION... 5 2 HARDWARE INTERFACE... 5 3 USER REGISTRATION... 7 4 MONITORING... 9 4.1 Training profiles... 9 5 LAUNCHING RASIM... 11 6 GRAPHICAL USER INTERFACE... 11 6.1 Login Window... 11 6.2 Main Menu... 12 7 TRAINING SESSIONS... 15 7.1 Guided mode... 15 7.2 Free practice... 19 7.3 Keyboard shortcuts... 19 7.4 Voice commands... 20 7.5 Results Window... 20 8 TROUBLESHOOTING... 21 Page 3 of 21
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1 Introduction The Regional Anaesthesia Simulator (RASim) prototype is a Virtual Reality Medical Trainer design to teach the basic skills needed for performing Regional Anaesthesia in a safe environment. The current version of the prototype is focussed on the Ultrasound-guided (US) single shoot femoral nerve block procedure. In the future, the simulator will include additional body parts and virtual patient models. 2 Hardware interface This section describes the RASim s main hardware components. The prototype is comprised of the following multimodal interfaces: (i) the needle, (ii) the US transducer, (iii) a mannequin, (iv) two monitors, (v) a microphone, (vi) a mouse and (vii) a keyboard. This figure shows the main component of the RASim s hardware interface - The needle. The needle used during the simulated RA procedure is a Braun 50mm and it will be attached to a haptic device called Phantom Omni. This robotic arm is in charge of providing kinaesthetic force-feedback. By using a haptics device together with a mannequin our intention is to deliver a realistic feeling by both a physical hands-on object and a simulated haptics feeling. The haptic device base should never be moved. Before starting a training session, the needle should be placed in the platform needle support provided. - The US transducer. The US transducer is made in solid plastic and it is linked to a magnetic tracker. The tracker comprises a receptor and the US transducer. The receptor must never be moved. Before starting a training session, the US transducer should be placed in the platform support provided. - Monitors. The system includes two monitors. One of them shows the Virtual Scene (the theatre, the patient and the virtual US and needle models). The second monitor displays the US view and the courseware. - The mannequin. This is the virtual patient reference in the real world. This component is made of foam covered by a thin layer of silicone. It is the only removable part of the prototype. The mannequin must be placed on the platform predefined positon. Page 5 of 21
- The keyboard and the mouse. This two commonplace devices can be used to interact with the Graphical User Interface (GUI). - The microphone. At some stages of the procedure the trainees may have both hands occupied. In this situation, they can interact with the system using a defined set of voice commands. The needle (Braun 50 mm) is attached to stylus of the haptic device allowing 3D movements and rotations. RASim uses a 3D printed copy of a real probe. This plastic component will host a magnetic tracker. Page 6 of 21
3 User Registration The trainees need to have a user to use the system. The local administrator has to register them before their first session. Each trainee must have its own account in order to register his/her training sessions. In order to anonymise the trainee data for research purposes, we recommend to register the trainees with the ID used for the clinical trials. The URJC group will provide the local administrator with a user ID and a password for this purpose. If you do not have your local administrator account, please send an email to (marcos.garcia@urjc.es). Trainee registration process. The local administrator should follow these steps: Boot the computer where RASim is installed. It will load a Windows base Operative System. Open an Internet browser in the Internet Explorer, Google Chrome, Firefox. Write the following in the address bar and press enter: localhost:6789. It will load the WEB page shown in the image. Address Bar Enter the local administrator ID and password. Click on the menu bar: Trainee > Trainee Registration. Page 7 of 21
Complete all the fields of the form and press the Submit buttom. The trainee will use the email and password to launch his/her training sessions. Page 8 of 21
4 Monitoring 4.1 Training profiles The registration system allows the local administrator to follow the trainees evolution, just selecting the Trainees > Show all Trainees option on the menu bar. Page 9 of 21
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5 Launching RASim To launch RASim double click on the RASim s icon on the Windows Desktop. 6 Graphical User interface 6.1 Login Window After launching the application, the system shows the login window. The trainees have to fill their personal login ID and password. Page 11 of 21
6.2 Main Menu Then the system will display the application main menu. At the top of the window, the users can check the time spent in their training sessions. For evaluation purposes, the users should spent at least four hours and no more than ten. Once they have spent 10 hours, the system denies them access to the simulator. This window allows the user to perform the following actions: Tutorial: This button provides access to videos that explain the training platform: Page 12 of 21
o o o o Hardware platform: This video presents a brief description of the hardware of the simulator. Ultrasound Machine Control Panel: Includes a brief description of the Virtual US control panel which will be shown during the simulation. Courseware User Interface: Explains the GUI during the training session. Voice Recognition System: Explains the voice recognition system and the available voice commands. Guided Exercise: This button launches the Guided Mode training session (see the following section for further details). Free Practice: This button launches the Guided Mode training session (see the following section for further details). This simulation mode is designed for users with previous experience on RASim. The first time a user logs in this simulator mode is disabled. Back: This button logs the user out and displays the login window. Page 13 of 21
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7 Training sessions RASim implements two training modes: The Guided mode and the Free Practice mode. The first mode is designed for users who have no previous experience on RA or use RASim for the very first time. This mode can be considered a tutorial on RA. The trainees are guided through all the steps of the procedures and their actions are constrained. The Free Practice mode is meant to be used by user with previous experience on RASim and with some basic knowledge on the procedure. The first time a user logs in, he/she is required to perform a Guide training session first. 7.1 Guided mode The following image shows the Guided mode interface. The image on the left shows the Courseware interface and the image on the right shows the virtual theatre: Page 15 of 21
On the one hand, the virtual theatre window displays the patient and the virtual medical equipment (the needle and the US probe). On the other hand, the Courseware window is divided into 4 main panels: - Upper left panel: This panel displays: (a) the US configuration values, (b) the US view, (c) the courseware panel and the US control panel. - Upper right panel: This panel shows the previous, the current and the forthcoming steps of the procedure. - Lower left panel: This panel explains to the trainee the current step of the procedure. - Lower right: This panel displays additional information on the current step. The courseware panel (c) includes 4 buttons: - Help: Displays additional information on the current step. The nature of this information is diverse. o Additional information shown on the lower left panel. o Icons showing relevant anatomical landmarks on the virtual theatre view. o Labels highlighting relevant anatomical landmarks on the US. o Visual helpers (They will be explained below in this section). Icons on the virtual theatre view and label on the US view highlighting relevant anatomy. Page 16 of 21
The US control panel allows the user to switch the US on/off, configure the depth, the contrast and the gain, and enable the freeze and colour (Doppler) functions. Additional information As it was mentioned earlier in this section, the courseware implents visual helpers that are shown on user demand: US Configuration helper: It highlights which parameters of the US have been set up appropriately. Identification helper: Shows a check list of anatomical structures that the trainee has to identify on the US view. Probe Orientation helper: Shows the US probe orientation, tilt and alignment. The blue area highlights the correct values. Page 17 of 21
Needle Orientation helper: Shows the needle tilt and alignment in order to check if the needle trajectory is appropriate. Syringe helper: Shows the content before the aspiration stage. Additionally, it allows the injection of the anaesthetic dose. Page 18 of 21
7.2 Free practice In this mode no supportive information is shown to the trainee. Therefore, this simulation mode just includes: US configuration values view, the US view, the courseware control panel, the US control panel and the Syringe helper. 7.3 Keyboard shortcuts The following list explains the most important keyboard short cuts: Key W: Performs the syringe aspiration Key S: Injects a test dose Key X: Injects the appropriate anaesthetic dose Key H: Open\Close the help panel Key C: Continues Page 19 of 21
7.4 Voice commands The following list explains the voice commands available: ASPIRATE: Performs the syringe aspiration TEST DOSE: Injects an anaesthetic test dose INJECT: Injects the appropriate anaesthetic test dose I NEED HELP: Open\Close the help panel (not available in free mode) CLOSE VIDEO: Close the current video tutorial (not available in free mode) FIRST OPTION: Selects the first menu option (not available in free mode) SECOND OPTION: Selects the first menu option (not available in free mode) 7.5 Results Window Once the training session finishes, the system displays the list of the assessment metrics gathered during the exercise. At this stage of the RASimAs project the assessment metrics are not validated. Therefore, they can be removed. Please contact the URJC group at marcos.garcia@urjc.es to remove this window. Page 20 of 21
8 Troubleshooting In order to solve an issue you may find, please get in contact with: URJC at aaron.sujar@urjc.es SG at hassan.syed@sensegraphics.com Page 21 of 21