TI - Virtual Reality in Neuro-Psycho-Physiology. Cognitive, clinical and methodological issues in assessment and rehabilitation
SO - Stud Health Technol Inform 1997;44:1-209
MH - Animal
*Computer Graphics
Human
*Neurophysiology
*Psychophysiology

AU - A. Abke and D. Mouse-Young
TI - Telemedicine: new technology = new questions = new exposures
SO - J Healthc Risk Manag 1997;17(4):3-6
MH - Computer Communication Networks/*legislation & jurisprudence/standards
Credentialing
Human
Insurance Coverage
Risk Management/*legislation & jurisprudence
Telemedicine/*legislation & jurisprudence/standards
United States
User-Computer Interface
AB - Cyberspace, telemetry, and virtual reality all refer to mankind's evolving ability to be in two places at once, without ever leaving one location. Now this ability has expanded into the world of medicine, with increased awareness of risk management concerns, and questions about where we go from here.

AU - N. Accornero, M. Capozza, S. Rinalduzzi and G. W. Manfredi
TI - Clinical multisegmental posturography: age-related changes in stance control
SO - Electroencephalogr Clin Neurophysiol 1997;105(3):213-9
MH - Adolescence
Adult
Aged
Aged, 80 and over
Aging/*physiology
*Electromyography
Female
Human
Male
Middle Age
Movement/physiology
Posture/*physiology
AB - Unlike conventional platform posturography, which analyses the sway in the projection of the body baricentre on a supporting plane, multisegmental posturography provides information about body segmental movements during stance, including those that keep the baricentre still. This paper presents a new technical approach to multisegmental posturography using Virtual Reality electromagnetic tracking devices. This device was used to study age-related differences in normal subjects in the control of upright posture. Body sway was studied by recording the oscillations of two trackers placed on the head and the hip during the Romberg test. The tracking device allowed us to detect age-related differences in postural stance strategies. Although the amplitude and velocity of the oscillations measured at the head did not differ in the two groups, the flexibility of the ankle-hip head axis differed significantly: elderly subjects exhibited a more rigid stance. Closing the eyes increased rigidity in both age groups and this change appear more pronounced in the young.

AU - G. K. Aguirre and M. D'Esposito
TI - Environmental knowledge is subserved by separable dorsal/ventral neural areas
SO - J Neurosci 1997;17(7):2512-8
MH - Adult
Brain/anatomy & histology/*physiology
*Brain Mapping
*Environment
Female
Human
Judgment
Magnetic Resonance Imaging
Male
*Memory
Orientation/*physiology
*Psychomotor Performance
*Space Perception
Support, Non-U.S. Gov't
Support, U.S. Gov't, P.H.S.
Video Games
AB - Environmental psychology models propose that knowledge of large-scale space is stored as distinct landmark (place appearance) and survey (place position) information. Studies of brain-damaged patients suffering from "topographical disorientation" tentatively support this proposal. In order to determine if the components of psychologically derived models of environmental representation are realized as distinct functional, neuroanatomical regions, a functional magnetic resonance imaging (fMRI) study of environmental knowledge was performed. During scanning, subjects made judgments regarding the appearance and position of familiar locations within a virtual reality environment. The fMRI data were analyzed in a manner that has been empirically demonstrated to rigorously control type I error and provide optimum sensitivity, allowing meaningful results in the single subject. A direct comparison of the survey position and landmark appearance conditions revealed a dorsal/ventral dissociation in three of four subjects. These results are discussed in the context of the observed forms of topographical disorientation and are found to be in good agreement with the human lesion studies. This experiment confirms that environmental knowledge is not represented by a unitary system but is instead functionally distributed across the neocortex.

AU - S. Aharon and R. A. Robb
TI - 3-D surface reconstruction of patient specific anatomic data using a pre-specified number of polygons
SO - Stud Health Technol Inform 1997;39:430-9
MH - Algorithms
*Computer Simulation
*Diagnostic Imaging
Human
Image Enhancement/*methods
*User-Computer Interface
AB - Virtual reality environments provide highly interactive, natural control of the visualization process, significantly enhancing the scientific value of the data produced by medical imaging systems. Due to the computational and real time display update requirements of virtual reality interfaces, however, the complexity of organ and tissue surfaces which can be displayed is limited. In this paper, we present a new algorithm for the production of a polygonal surface containing a pre-specified number of polygons from patient or subject specific volumetric image data. The advantage of this new algorithm is that it effectively tiles complex structures with a specified number of polygons selected to optimize the trade-off between surface detail and real-time display rates.

AU - D. A. Ahlquist, A. K. Hara and C. D. Johnson
TI - Computed tomographic colography and virtual colonoscopy
SO - Gastrointest Endosc Clin N Am 1997;7(3):439-52
MH - Barium Sulfate/diagnostic use
Colonic Neoplasms/diagnosis
*Colonoscopy
Contrast Media
Enema
Human
*Image Processing, Computer-Assisted
Occult Blood
*Radiographic Image Enhancement
Sigmoidoscopy
*Tomography, X-Ray Computed
*User-Computer Interface
AB - CT colography (CTC) is a powerful new approach to imaging the colorectum and a promising screening tool for the detection of colorectal neoplasia. From data generated by a helical CT scan, CTC uses virtual reality technology to produce highly discriminant two- and three-dimensional images that permit a thorough and minimally invasive evaluation of the entire colorectum. A dynamic CTC display technique from the endoluminal perspective, called cf2virtual colonoscopy,cf1 simulates colonoscopy by "flying" through the three-dimensional colon image. CTC offers potential advantages in diagnostic performance, safety, and patient acceptance over current screening approaches. Although early data suggest excellent colorectal polyp detection rates, this nascent technology will require rigorous clinical investigation and further refinements to assess adequately its place in the endoscopist's armamentarium.

AU - M. Ahmed, J. F. Meech and A. Timoney
TI - Virtual reality in medicine
SO - Br J Urol 1997;80 Suppl 3:46-52
MH - Computer Peripherals
*Computer Simulation
Computer Systems
Education, Medical
Forecasting
Software
*User-Computer Interface

AU - J. J. Annesi and J. Mazas
TI - Effects of virtual reality-enhanced exercise equipment on adherence and exercise-induced feeling states
SO - Percept Mot Skills 1997;85(3 Pt 1):835-44
MH - Adult
Computer Simulation
*Equipment Design
*Exercise
Female
Health Behavior
*Health Promotion
Human
Male
Motivation
Personality Inventory/statistics & numerical data
Physical Fitness
User-Computer Interface
AB - A field study was conducted to test the effectiveness of virtual reality-enhanced cardiovascular exercise equipment for increasing adherence and attendance in a mixed-sex adult sample. Attendance was significantly higher in the virtual reality-enhanced condition than in the conditions without virtual reality over the 14-wk. period. Adherence was also highest (83.33%) in the virtual-reality bicycle group. Postexercise feelings of positive engagement, revitalization, tranquility, and physical exhaustion, as measured by the Exercise- induced Feeling Inventory, did not differ among groups. Contrary to previous findings, Self-motivation Inventory scores were not associated with either attendance or adherence. While findings suggest that virtual-reality features may promote exercise adherence or attendance, it is not yet known what psychological variables they affect. Implications were drawn regarding the practical possibilities for exercise promotion.

AU - D. C. Balch and J. M. Tichenor
TI - Telemedicine expanding the scope of health care information [see comments]
SO - J Am Med Inform Assoc 1997;4(1):1-5
MH - Computer Communication Networks/*organization & administration
Computer User Training
Human
Information Services
Medical Records Systems, Computerized
North Carolina
Remote Consultation/organization & administration
Rural Health Services/*organization & administration
Support, Non-U.S. Gov't
Support, U.S. Gov't, Non-P.H.S.
Systems Integration
Telemedicine/*organization & administration
User-Computer Interface
AB - The definition of health information is growing to include multimedia audio, video, and high-resolution still images. This article describes the telemedicine program at East Carolina University School of Medicine, including the telemedicine applications presently in use and the virtual reality applications currently under development' Included are the major design criteria that shape the telemedicine network some of the lessons learned in developing the network, and a discussion of the future of telemedicine, including efforts to incorporate telemedicine within a fully integrated health information system.

AU - V. L. Barker
TI - Virtual reality: from the development laboratory to the classroom
SO - Stud Health Technol Inform 1997;39:539-42
MH - Computer Simulation
Computer-Assisted Instruction/*methods
Education, Nursing/*methods
Human
Phlebotomy/*nursing
*User-Computer Interface
AB - In conclusion, in order for virtual reality simulations to move from the R & D laboratory to the teaching classroom on a large scale basis, there are four conditions which must be met: faculty involvement, student cooperation, affordable equipment and administrative support. 1. Faculty must understand the advantages of using VR simulations and be committed to developing the procedures and teaching modules and evaluating their effectiveness. They must understand that the simulations are another teaching tool and not a substitute for the teacher. 2. Students must be guided in the use of VR simulations to develop the level of skill required. Students must be willing to accept new ways of learning and must be able to see their individual learning progress in skill development. 3. Equipment-Must be realistic, affordable, available and clearly demonstrate advantages over traditional methods of teaching. 4. Administrative Support-Initially the cost of instituting VR simulations may be more than using other traditional teaching tools, thus ongoing financial support is very important. I believe that the faculty of the Nursing Department at the State University of New York at Plattsburgh is showing the way in incorporating VR simulations into a traditional undergraduate nursing program and as a result they are changing forever the way we will prepare health professionals for the future.

AU - S. Z. Barnes, D. R. Morr, E. Oggero, G. Pagnacco and N. Berme
TI - The realization of a haptic (force feedback) interface device for the purpose of angioplasty surgery simulation
SO - Biomed Sci Instrum 1997;33:19-24
MH - *Angioplasty, Balloon
*Computer Simulation
*Education, Medical
Educational Technology
Human
Surgery/*education
*User-Computer Interface
AB - Simulation is becoming an increasingly accepted method for training personnel for complex or high risk tasks. With the advent of modern Virtual Reality (VR) technology, such simulations are becoming more and more immersive. One significant limitation to the advance of this science is the challenges associated with simulating the touch or feel of various tasks in conjunction with VR simulations. This work has focused on creating and assessing the feasibility of haptic technology for high fidelity surgery simulation. It has culminated in a prototypical interface device to provide tactile feedback during the simulation of complex interventional radiology procedures such as Angioplasty. This device extends state of the art motion control, distributed computing processes, high resolution sensors for real-time feedback, and modular design techniques to accomplish these goals. The realization of the device, its capabilities, interfacing requirements, its limitations, and future extensions will be presented here.

AU - A. L. Benabid, D. Hoffmann, A. Ashraf, A. Koudsie, F. Esteve and J. F. Le-Bas
TI - [The robotization of neurosurgery: state of the art and future outlook]
SO - Bull Acad Natl Med 1997;181(8):1625-35; discussion 1635-6
MH - English Abstract
*Forecasting
Human
Magnetic Resonance Imaging
Neurosurgery/*trends
*Robotics
Stereotaxic Techniques
AB - Neurosurgery is by excellence a field of application for robots, based on multimodal image guidance. Specific motorized tools have been already developed and routinely applied in stereotaxy to position a probe holder or in conventional neurosurgery to hold a microscope oriented towards a given target. The potentialities of these approaches have triggered industrial developments currently commercially available. These systems use data bases, primarily coming from multimodal numerical images from X-ray radiology to magnetic resonance imaging. These spatially encoded data are transferred through digital networks to workstations where images can be processed and surgical procedures are preplanned, then transferred to the robotic systems to which they are connected. We have been using a stereotactic robot since 1989 and a microscope robot since 1995 in various surgical routine procedures. The future of these applications mainly rely on the technical progress in informatics, about image recognition to adapt the preplanning to the actual surgical situation, to correct brain shifts for instance, about image fusion, integrated knowledge such such as brain atlases, as well as virtual reality. The future developments, covering surgical procedure, research and teaching, will sure be far beyond our wildest expectations.

AU - R. B. Birrer and M. Doherty
TI - Accessing the scientific literature. The reality of virtual scholarship
SO - Arch Fam Med 1997;6(3):285-8
MH - *Databases, Bibliographic
Human
Literature
Online Systems
AB - The age-honored practice of plowing through the Index Medicus in a good medical library to meander through citations for treasured finds is an anachronism. Today, clinicians have the astonishing capacity to bring to bear existing knowledge almost effortlessly. Virtual scholarship makes available up-to-date medical citations and their abstracts. There can be access around the clock on any topic in the office, at the bedside, or from home. Computerized searches of the medical literature promote directed continuing education and may enhance clinical care of patients.

AU - P. M. Black
TI - Hormones, radiosurgery and virtual reality: new aspects of meningioma management
SO - Can J Neurol Sci 1997;24(4):302-6
MH - Female
Hormones/*blood
Human
*Image Processing, Computer-Assisted
Magnetic Resonance Imaging
Male
Meningeal Neoplasms/pathology/*physiopathology/*therapy
Meningioma/pathology/*physiopathology/*therapy
*Radiosurgery
AB - The understanding and management of meningiomas is changing significantly today. One of the most striking features of their pathophysiology is their predominance in women. In a series of 517 patients with meningiomas seen by the Brain Tumor Group at Brigham and Women's Hospital, the female:male ratio was 24:1. The progesterone receptor appears to be the major candidate to explain this difference. Although meningioma cells variably express receptors for estrogen, androgen, platelet-derived growth factor, epidermal growth factor, and somatostatin, these molecules do not explain the differences because they are not differentially expressed or are not activated. Progesterone receptor can be shown to be expressed in 81% of women and 40% of men with meningiomas; it can also be shown to be activated by transfecting a construct with the progesterone responsive element and a reporter in it and using the cell's own receptors to activate this construct. Surgery remains the mainstay of meningioma management. At the Brigham and Women's Hospital three-dimensional reconstruction techniques have markedly improved the ability to visualize the tumor as well as its relation to vascular structures. With MRI reconstruction, it is possible to know the tumor's relation to the sagittal and other sinuses, to identify feeders and proximity to major arteries, and to establish its location and relation to cortex by frameless stereotaxis. These techniques can be used in a virtual reality format are some of the most powerful in neurosurgery both for teaching and for the surgical procedure itself. External beam radiation has been shown by others to be an effective adjunctive treatment to prevent meningioma recurrence. Recently, linear accelerator radiosurgery and stereotactic radiotherapy have changed the pattern of radiation at our institution. In a series of 56 skull base meningiomas, for example, 95% were controlled (i.e., showed no growth) over a four year period. Fractionated focal radiation potentially offers the same control rate with fewer complications. With increasing understanding and treatment possibilities, meningiomas remain one of the most intriguing and challenging tumors in the nervous system.

AU - R. W. Bloom
TI - Psychiatric therapeutic applications of virtual reality technology (VRT): research prospectus and phenomenological critique
SO - Stud Health Technol Inform 1997;39:11-6
MH - Human
Mental Disorders/*therapy
Psychotherapy/methods
*Therapy, Computer-Assisted
*User-Computer Interface
AB - There is theoretical and empirical research supporting the hypothesis that virtual reality technology (VRT) can be efficaciously applied to attenuate the symptoms of mental disorders (Baer, 1996; Rothbaum et al, 1995a, 1995b; Rothbaum et al, 1996.) Yet there is also research suggesting psychiatric therapeutic applications of VRT may induce noxious or unexpected psychological consequences (Kolasinski, 1996; Muscott & Gifford, 1994; Regan & Price, 1994; Regan & Ramsey, 1996; Strickland, 1995.) A prudent conclusion would be to advocate ever more sophisticated studies on psychiatric therapeutic applications of VRT concerning (1) increasing the overall socioadaptiveness of patients, (2) the robustness of moderating, modifying, or other intermediary variables effecting or affecting VRT therapeutic efficacy, and (3) variables, processes, and hypotheses generated from VRT applications in non-psychiatric fields.

AU - J. F. Brinkley, S. W. Bradley, J. W. Sundsten and C. Rosse
TI - The digital anatomist information system and its use in the generation and delivery of Web-based anatomy atlases
SO - Comput Biomed Res 1997;30(6):472-503
MH - *Anatomy
Artificial Intelligence
Brain/anatomy & histology
*Computer Communication Networks
Computer Graphics
Computer Systems
Database Management Systems
Databases
Diagnostic Imaging
Human
Information Storage and Retrieval
*Information Systems
Knee Joint/anatomy & histology
*Medical Illustration
Online Systems
Software
Support, Non-U.S. Gov't
Support, U.S. Gov't, P.H.S.
Technology, Radiologic
Thorax/anatomy & histology
User-Computer Interface
AB - Advances in network and imaging technology, coupled with the availability of 3-D datasets such as the Visible Human, provide a unique opportunity for developing information systems in anatomy that can deliver relevant knowledge directly to the clinician, researcher or educator. A software framework is described for developing such a system within a distributed architecture that includes spatial and symbolic anatomy information resources, Web and custom servers, and authoring and end-user client programs. The authoring tools have been used to create 3-D atlases of the brain, knee and thorax that are used both locally and throughout the world. For the one and a half year period from June 1995-January 1997, the on-line atlases were accessed by over 33,000 sites from 94 countries, with an average of over 4000 "hits" per day, and 25,000 hits per day during peak exam periods. The atlases have been linked to by over 500 sites, and have received at least six unsolicited awards by outside rating institutions. The flexibility of the software framework has allowed the information system to evolve with advances in technology and representation methods. Possible new features include knowledge-based image retrieval and tutoring, dynamic generation of 3-D scenes, and eventually, real- time virtual reality navigation through the body. Such features, when coupled with other on-line biomedical information resources, should lead to interesting new ways for managing and accessing structural information in medicine. Copyright 1997 Academic Press.

AU - J. G. Buckwalter and A. A. Rizzo
TI - Virtual reality and the neuropsychological assessment of persons with neurologically based cognitive impairments
SO - Stud Health Technol Inform 1997;39:17-21
MH - Brain Diseases/*diagnosis
Cognition Disorders/*diagnosis
Diagnosis, Computer-Assisted/*instrumentation
Human
*Neuropsychological Tests
*Psychometrics
Reproducibility of Results
*User-Computer Interface

AU - G. Burdea, S. Deshpande, V. Popescu, N. Langrana, D. Gomez, D. DiPaolo and M. Kanter
TI - Computerized hand diagnostic/rehabilitation system using a force feedback glove
SO - Stud Health Technol Inform 1997;39:141-50
MH - Adult
Computer Simulation
Diagnosis, Computer-Assisted/*instrumentation
Disability Evaluation
Female
Hand Injuries/*diagnosis/*rehabilitation
Human
Male
Middle Age
Support, Non-U.S. Gov't
Therapy, Computer-Assisted/*instrumentation
*User-Computer Interface
AB - This paper describes recent results of a unified computerized system for hand diagnosis and rehabilitation. Automatic diagnosis data collection and Virtual Reality rehabilitation exercises are the main characteristics of the system. The diagnosis subsystem includes a tactile sensing glove in addition to standard devices such as electronic dynamometer, pinchmeter and goniometer. Three standard rehabilitation exercises were simulated in a Virtual Reality environment, using the WorldToolKit graphics library. The first two exercises (ball squeezing and DigiKey) allow measurement of finger forces exerted during the rehabilitation routine. The third exercise (Peg board) involves the patient's visual-motor coordination. The rehabilitation subsystem uses a VPL DataGlove retrofitted with Rutgers Master (RM-I) and its interface. The exercises involve manipulation of objects with different stiffnesses and geometry. Grasping forces were modeled and fed back using the Rutgers Master worn on patient's hand. Data is gathered in real time from both diagnosis and rehabilitation subsystems. Finger specific forces recorded during rehabilitation exercises allow better diagnosis of the patient impairment. An ORACLE database is used to store and manipulate patients' records. Proof of concept trials were performed in a clinical environment. Some results of patient records analysis are presented in this paper. A new version of the system using an RM II haptic interface is presently under consideration.

AU - A. S. Carlin, H. G. Hoffman and S. Weghorst
TI - Virtual reality and tactile augmentation in the treatment of spider phobia: a case report
SO - Behav Res Ther 1997;35(2):153-8
MH - Adult
Animal
Case Report
Desensitization, Psychologic/*methods
Female
Human
*Image Processing, Computer-Assisted
Personality Assessment
Phobic Disorders/psychology/*therapy
*Spiders
Support, U.S. Gov't, Non-P.H.S.
*Touch
Treatment Outcome
AB - This is the first case report to demonstrate the efficacy of immersive computer-generated virtual reality (VR) and mixed reality (touching real objects which patients also saw in VR) for the treatment of spider phobia. The subject was a 37-yr-old female with severe and incapacitating fear of spiders. Twelve weekly 1-hr sessions were conducted over a 3-month period. Outcome was assessed on measures of anxiety, avoidance, and changes in behavior toward real spiders. VR graded exposure therapy was successful for reducing fear of spiders providing converging evidence for a growing literature showing the effectiveness of VR as a new medium for exposure therapy.

AU - E. Y. Chao, P. Barrance, E. Genda, N. Iwasaki, S. Kato and A. Faust
TI - Virtual reality (VR) techniques in orthopaedic research and practice
SO - Stud Health Technol Inform 1997;39:107-14
MH - Biomechanics
*Computer Simulation
Diagnosis, Computer-Assisted/*methods
Human
Musculoskeletal System/*physiopathology
Orthopedics/*methods
*User-Computer Interface
AB - Modeling the musculoskeletal joint system using biomechanical analysis and computer graphics techniques allows us to visualize normal, diseased and reconstructed joint function. This model can be used to study the loading of bones and joints under theoretical and simulated activities. In this study, intact cadavers were imaged using MRI, CT scanning and cryo-sectioning techniques. Using sequential pixel information of bone and soft tissue boundaries collected from digital camera images, MRI and CT scans, the volumetric models of the musculoskeletal joint system are reconstructed. "Descriptive geometry" techniques which treat bones as rigid bodies and cartilage, ligament and muscles as deformable bodies were used to construct the model. Joint resultant forces and moments were determined using an inverse dynamics formulation, while ligament tension, joint contact pressure, and bone stresses are solved through a simplified Rigid Body Spring Modeling technique and the Finite Element Method. The results under static and dynamic loading activities can be visualized using interactive computer graphics. The advantages of such a model are the elimination of the need for large numbers of intact cadaveric specimens, and the unprecedented capability to study joint loading responses under normal, abnormal and surgically reconstructed states. Such a model and its analytical capability are ideal for pre-operative planning and computer-assisted orthopaedic surgery. This Visual, Interactive, Computational, and Anatomic Model(VICAM) and its associated analysis capability represent the next generation of technology which will have an enormous impact in orthopaedic research, education and patient care.

AU - J. M. Davies and R. L. Helmreich
TI - Virtual reality in medical training [letter; comment]
SO - Cmaj 1997;157(10):1352-3
MH - *Clinical Competence
*Computer Simulation
*Computer-Assisted Instruction
Education, Medical/*methods
Human
*User-Computer Interface

AU - J. Dervaderics
TI - [Computerization and robotics in medical practice]
SO - Orv Hetil 1997;138(43):2751-3
MH - Computer Communication Networks
Computers
Computers, Analog
English Abstract
Human
*Robotics
*Telemedicine
Telepathology
Teleradiology
AB - The article gives the outlines of all principles used in computing included the non-electrical and analog computers and the artifical intelligence followed by citing examples as well. The principles and medical utilization of virtual reality are also mentioned. There are discussed: surgical planning, image guided surgery, robotic surgery, telepresence and telesurgery, and telemedicine implemented partially via Internet.

AU - J. P. Djajadiningrat, C. J. Overbeeke and G. J. Smets
TI - Cubby. A medical virtual environment based on multiscreen movement parallax
SO - Stud Health Technol Inform 1997;39:387-94
MH - *Computer Simulation
Human
Microcomputers
Space Perception
Support, Non-U.S. Gov't
*User-Computer Interface
AB - In this paper a desktop virtual reality system named Cubby is described. Cubby is based on self-induced, head-coupled movement parallax on three orthogonal screens. It is argued that this system is better suited to medical practice than Immersive VR solutions or single screen Desktop VR systems. Whilst Cubby is currently limited to visualisation it opens up possibilities of direct instrumental manipulation and as such could prove useful as a medical simulator.

AU - R. Duran Merino
TI - [Internet: a not so virtual reality for the urologist (editorial)]
SO - Actas Urol Esp 1997;21(10):937-41
MH - *Computer Communication Networks
*Urology
*User-Computer Interface

AU - K. H. Englmeier, M. Haubner, A. Losch, F. Eckstein, M. D. Seemann, W. van Eimeren and M. Reiser
TI - Hybrid rendering of multidimensional image data
SO - Methods Inf Med 1997;36(1):1-10
MH - Computer Graphics
*Diagnostic Imaging
Human
*Image Processing, Computer-Assisted
Magnetic Resonance Imaging
Radiography
*Therapy, Computer-Assisted
Tomography, X-Ray Computed
AB - The most important rendering methods applied in medical imaging are surface and volume rendering techniques. Each approach has its own advantages and limitations: Fast surface-oriented methods are able to support real-time interaction and manipulation. The underlying representation, however, is dependent on intensive image processing to extract the object surfaces. In contrast, volume visualization is not necessarily based on extensive image processing and interpretation. No data reduction to geometric primitives, such as polygons, is required. Therefore, the process of volume rendering is currently not operating in real time. In order to provide the radiological diagnosis with additional information as well as to enable simulation and preoperative treatment planning we developed a new hybrid rendering method which combines the advantages of surface and volume presentation, and minimizes the limitations of these approaches. We developed a common data representation method for both techniques. A preprocessing module enables the construction of a data volume by interpolation as well as the calculation of object surfaces by semiautomatic image interpretation and surface construction. The hybrid rendering system is based on transparency and texture mapping features. It is embedded in a user-friendly open system which enables the support of new application fields such as virtual reality and stereolithography. The efficiency of our new method is described for 3-D subtraction angiography and the visualization of morpho-functional relationships.

AU - W. Freysinger, A. R. Gunkel and W. F. Thumfart
TI - Image-guided endoscopic ENT surgery
SO - Eur Arch Otorhinolaryngol 1997;254(7):343-6
MH - Adult
Carcinoma, Adenoid Cystic/pathology/radiography/surgery
Case Report
Endoscopy/*methods
Equipment Design
Female
Foreign Bodies/radiography/surgery
Human
Image Processing, Computer-Assisted
Male
Maxillary Sinus/radiography/surgery
Monitoring, Intraoperative
Otolaryngology/*instrumentation
Skull Neoplasms/pathology/radiography/surgery
Sphenoid Bone/pathology/radiography/surgery
Tomography, X-Ray Computed
AB - Intraoperative three-dimensional (3D) "navigation" has significantly improved patient safety during operative procedures on the paranasal sinuses and the frontal skull base. The ISG Viewing Wand (ISG Technologies, Mississauga, Ontario, Canada) is now used routinely for such procedures in our hospital at the present time. Current use with our radiological and intraoperative protocols has demonstrated a clinical accuracy of 1-2 mm. Initial experience with the ARTMA Virtual Patient (ARTMA Biomedical, Vienna, Austria) has allowed endoscopic 3D navigation by using augmented reality techniques and has been found to be very promising. We present our experience with these systems and discuss the impact of these unique techniques on computer-assisted surgery (CAS) in otorhinolaryngology and head and neck surgery.

AU - Z. Ghahramani and D. M. Wolpert
TI - Modular decomposition in visuomotor learning
SO - Nature 1997;386(6623):392-5
MH - Feedback
Hand/physiology
Human
Learning/*physiology
Models, Neurological
Motor Activity/physiology
Psychomotor Performance/*physiology
Visual Perception/*physiology
AB - The principle of 'divide-and-conquer' the decomposition of a complex task into simpler subtasks each learned by a separate module, has been proposed as a computational strategy during learning. We explore the possibility that the human motor system uses such a modular decomposition strategy to learn the visuomotor map, the relationship between visual inputs and motor outputs. Using a virtual reality system, subjects were exposed to opposite prism-like visuomotor remappings-discrepancies between actual and visually perceived hand locations- for movements starting from two distinct locations. Despite this conflicting pairing between visual and motor space, subjects learned the two starting-point-dependent visuomotor mappings and the generalization of this learning to intermediate starting locations demonstrated an interpolation of the two learned maps. This interpolation was a weighted average of the two learned visuomotor mappings, with the weighting sigmoidally dependent on starting location, a prediction made by a computational model of modular learning known as the "mixture of experts". These results provide evidence that the brain may employ a modular decomposition strategy during learning.

AU - G. J. Grimes, S. A. McClellan, J. Goldman, G. L. Vaughn, D. A. Conner, E. Kujawski, J. McDonald, T. Winokur and W. Fleming
TI - Applications of virtual reality technology in pathology
SO - Stud Health Technol Inform 1997;39:319-27
MH - Alabama
Diagnosis, Computer-Assisted/*methods
Human
Microscopy/*methods
Pathology/*methods
Remote Consultation/*methods
Robotics
*User-Computer Interface
AB - TelePath(SM) a telerobotic system utilizing virtual microscope concepts based on high quality still digital imaging and aimed at real-time support for surgery by remote diagnosis of frozen sections. Many hospitals and clinics have an application for the remote practice of pathology, particularly in the area of reading frozen sections in support of surgery, commonly called anatomic pathology. The goal is to project the expertise of the pathologist into the remote setting by giving the pathologist access to the microscope slides with an image quality and human interface comparable to what the pathologist would experience at a real rather than a virtual microscope. A working prototype of a virtual microscope has been defined and constructed which has the needed performance in both the image quality and human interface areas for a pathologist to work remotely. This is accomplished through the use of telerobotics and an image quality which provides the virtual microscope the same diagnostic capabilities as a real microscope. The examination of frozen sections is performed a two- dimensional world. The remote pathologist is in a virtual world with the same capabilities as a "real" microscope, but response times may be slower depending on the specific computing and telecommunication environments. The TelePath system has capabilities far beyond a normal biological microscope, such as the ability to create a low power image of the entire sample using multiple images digitally matched together; the ability to digitally retrace a viewing trajectory; and the ability to archive images using CD ROM and other mass storage devices.

AU - B. E. Harvey and S. Alpert
TI - Patient safety and efficacy as measured by clinical trials and regulatory policy
SO - Stud Health Technol Inform 1997;39:75-9
MH - *Clinical Trials
Colonoscopes
Colonoscopy/instrumentation
*Device Approval
Human
Interinstitutional Relations
Research Design
United States
*User-Computer Interface
AB - Virtual Reality and other technological innovations in medicine provide new challenges to the regulatory framework of the premarket review process for medical devices. By reinventing the government-academia- industry partnership, clinical trial data necessary for a medical device to enter the market can be more efficiently obtained.

AU - H. Heimer
TI - Virtual reality researchers seek to minimize invasive diagnostic procedures [news]
SO - J Natl Cancer Inst 1997;89(14):997-8
MH - Colonoscopy/methods
*Diagnosis, Computer-Assisted
Endoscopy/*methods
Human
Image Interpretation, Computer-Assisted

AU - M. Hilbert and W. Muller
TI - Virtual reality in endonasal surgery
SO - Stud Health Technol Inform 1997;39:237-45
MH - Computer Simulation
*Computer-Assisted Instruction
Endoscopy/*methods
Human
Paranasal Sinuses/anatomy & histology/*surgery
Surgery/*education
*User-Computer Interface
AB - Virtual environments provide a new dimension of graphic simulation. The interaction between the human and the computer is now intuitive for the user. The use of virtual reality (VR) gives the user the feeling of participating in a (computer generated) scenario very much like reality. This feeling is an essential requirement for simulation of surgical interventions using digital data. Especially in the fields of sinus and skull-base surgery, computer assisted simulation could present a valuable and effective alternative method for honing endoscopic skills. Traditionally, surgeons gain experience through anatomic preparation and education by more experienced colleagues. Landmarks like skull base, carotid arteria or optical nerve have to be identified intraoperatively in order to orientate in this critical region. Highly sensitive structures can be damaged most easily. The quality of surgical skills can be characterized as the sum of knowledge, individual experience and manual dexterity. It is conceivable that a surgeon's level of training and experience could be significantly increased by use of VR. With this in mind, a VR-based simulator for procedures in sinus surgery will improve most of these parts. To provide the virtual environment, a realistic representation of the region of interest with all relevant anatomical structures is required. Based on data from tomographic imaging studies, a three- dimensional representation of the paranasal sinuses is semiautomatically reconstructed. Textures derived from endoscopic images are superimposed on the virtual anatomic structures and provide better realism. Two main components of the VR interface can be distinguished: the 3-D interaction to guide the surgical instruments and the 2-D graphical user interface for visual feedback and control of the session. Moreover, the 3-D interaction has to be realized by means of Virtual Reality techniques providing a simulation of an endoscope and an intuitive handling of other surgical instruments.

AU - M. Hirose, R. Kijima, K. Shirakawa and K. Nihei
TI - Development of a virtual sand box: an application of virtual environment for psychological treatment
SO - Stud Health Technol Inform 1997;44:113-20
MH - Autistic Disorder/*therapy
Child
Computer Graphics/*instrumentation
*Computer Simulation
Human
AB - The sand play technique has often been used in psychological treatments or in the diagnosis of autism patients. In this paper, the prototype application called "virtual sand box" is developed as a virtual environment to support this technique. Experimental results show the advantages of applying virtual reality technology to clinical medicine; particularly with respect to the diagnosis of people with psychological and psychiatrical difficulties such as autism and neurosis. The actual system has been implemented by using a graphics workstation, a wide- view field display, and 3D input devices.

AU - H. Hoffman and D. Vu
TI - Virtual reality: teaching tool of the twenty-first century?
SO - Acad Med 1997;72(12):1076-81
MH - Anatomy/education
California
Clinical Competence
*Computer Simulation
Computer-Assisted Instruction/*methods
Education, Medical/*methods
Human
Teaching/methods
United States
AB - Virtual reality (VR) is gaining recognition for its enormous educational potential. While not yet in the mainstream of academic medical training, many prototype and first-generation VR applications are emerging, with target audiences ranging from first- and second-year medical students to residents in advanced clinical training. Visualization tools that take advantage of VR technologies are being designed to provide engaging and intuitive environments for learning visually and spatially complex topics such as human anatomy, biochemistry, and molecular biology. These applications present dynamic, three-dimensional views of structures and their spatial relationships, enabling users to move beyond "real-world" experiences by interacting with or altering virtual objects in ways that would otherwise be difficult or impossible. VR-based procedural and surgical simulations, often compared with flight simulators in aviation, hold significant promise for revolutionizing medical training. Already a wide range of simulations, representing diverse content areas and utilizing a variety of implementation strategies, are either under development or in their early implementation stages. These new systems promise to make broad-based training experiences available for students at all levels, without the risks and ethical concerns typically associated with using animal and human subjects. Medical students could acquire proficiency and gain confidence in the ability to perform a wide variety of techniques long before they need to use them clinically. Surgical residents could rehearse and refine operative procedures, using an unlimited pool of virtual patients manifesting a wide range of anatomic variations, traumatic wounds, and disease states. Those simulated encounters, in combination with existing opportunities to work with real patients, could increase the depth and breadth of learners' exposure to medical problems, ensure uniformity of training experiences, and enhance the acquisition of clinical skills.

AU - S. Hussain, J. A. Loeffler, R. K. Babayan and H. M. Fenlon
TI - Thin-section helical computed tomography of the bladder: initial clinical experience with virtual reality imaging
SO - Urology 1997;50(5):685-8; discussion 689
MH - Adult
Aged
Bladder Neoplasms/pathology/*radiography
Cystoscopy
Female
Human
Male
Middle Age
Pilot Projects
Tomography, X-Ray Computed/*methods
AB - OBJECTIVES: To evaluate the application of virtual reality imaging of the bladder (virtual cystoscopy) in the detection of bladder masses. METHODS: Six patients (mean age 61 years, range 43 to 75) with hematuria and positive findings on conventional cystoscopy were studied by means of thin-section helical computed tomography of the air- distended bladder. Using volume-rendering algorithms, interactive intraluminal views of the bladder mucosa were generated (virtual cystoscopy). Results of virtual cystoscopy were compared with those of conventional cystoscopy in each case. RESULTS: Twenty-six (100%) of 26 masses (mean size 1.7 cm, range 0.3 to 6), detected on conventional cystoscopy, were visualized on virtual cystoscopy. Twelve of 26 masses measured less than 1 cm in maximum diameter. All masses were pathologically proven transitional cell carcinomas. Virtual cystoscopy was well tolerated by all patients, and no complications occurred. CONCLUSIONS: Our results indicate that virtual cystoscopy is an accurate technique for detection of intrinsic bladder masses. It may represent a radiologic adjunct to conventional cystoscopy for initial evaluation of patients with hematuria and for surveillance of patients after bladder tumor resection.

AU - H. Iseki, Y. Masutani, M. Iwahara, T. Tanikawa, Y. Muragaki, T. Taira, T. Dohi and K. Takakura
TI - Volumegraph (overlaid three-dimensional image-guided navigation). Clinical application of augmented reality in neurosurgery
SO - Stereotact Funct Neurosurg 1997;68(1-4):18-24
MH - Brain Neoplasms/diagnosis/pathology/surgery
*Computer Simulation
Human
*Image Processing, Computer-Assisted
Magnetic Resonance Imaging/*instrumentation
Neurosurgery/instrumentation/*methods
Support, Non-U.S. Gov't
Tomography, X-Ray Computed/*instrumentation
User-Computer Interface
AB - OBJECTIVE: We have developed an overlaid three-dimensional image (Volumegraph)-guided navigation system that allows navigation during operative procedures. The three-dimensional image is superimposed on the patient's head and body via a semi-transparent mirror. The Volumegraph can display three-dimensional images in the air by a light beam which is based on CT/MRI. METHOD: The system consists of a Volumegraph (thin plate of three-dimensional recorded medium), a Volumegraphscope and an original designed triangular-shaped marker system for registration. The three-dimensional data obtained from CT and MRI before the operation were processed by a computer. Such image data are applied for preoperative investigation to recognize the three- dimensional structure of organs and tumor. These reconstructed three- dimensional images were superimposed and registered at the patient's head according to a fiducial marker (registration). Then the operator can operate with this three-dimensional-image-guided navigation system. RESULTS: Based on clinical application in 7 cases, the system was found to be advantageous because the surgical procedures could be navigated easily by augmented reality in the surgical field. Invisible parts of the surgical field were supplemented with the overlaid three- dimensional images (Volumegraph) as if it were the virtual operative field. At another time, spatial positioning and overlaid visualization by the Volumegraph was useful for identifying anatomical structures and functional location in the image. CONCLUSION: This preliminary study of overlaid three-dimensional-image-guided navigation demonstrated its clinical usefulness. The application of augmented reality in the surgical field makes it possible to do a neurosurgical intervention easily and accurately.

AU - K. Isono
TI - [Surgical treatment and research of esophageal cancer in the past and the present era in our department--for the view point of the future]
SO - Nippon Geka Gakkai Zasshi 1997;98(7):649-54
MH - English Abstract
Esophageal Neoplasms/diagnosis/*surgery
Gene Therapy
Genes, p53
Human
Immunotherapy
Lymph Node Excision
Lymphatic Metastasis
Medical Oncology/*trends
Mutation
Tomography, Emission-Computed
AB - We describe the result of esophageal cancer treatment in the past era of the Department of Surgery, Chiba University School of Medicine directed by Professor Seo, Nakayama and Sato and the improved results of the treatment at the present time from the view point of diagnosis (early superficial cancer, lymph node metastasis and adjacent organ invasion) and treatment (three-field lymph node dissection, improved result of operative mortality and morbidity, improvement of long-term survival rate). In addition, we prospect the future through the present study such as mutation of P53 gene and malignancy, immunotherapy using cytokine gene transfer, cancer inhibition therapy by induction of cancer suppressor gene, prodrug therapy, heavy particle iron therapy, and clinical application of virtual reality to the surgical field.

AU - D. B. Katz, J. D. Pearlman, M. Popitz and G. D. Shorten
TI - The development of a multimedia teaching program for fiberoptic intubation
SO - J Clin Monit 1997;13(5):287-91
MH - Anesthesiology/education
*Computer-Assisted Instruction
Fiber Optics
Human
Internship and Residency
*Intubation, Intratracheal
*Multimedia
Support, Non-U.S. Gov't
*User-Computer Interface
AB - Current training methods in fiberoptic intubation entail a trial and error process in which trainees acquire skills by practicing this technique in mannequins or patients. These training methods are not efficient and may expose patients to unnecessary instrumentation. An interactive software program is described which uses Director, a commercially available multimedia authoring tool, to (1) familiarize trainees with video images of the upper airway, (2) permit operator controlled progress through a normal fiberoptic intubation, (3) simultaneously display (side by side) two-dimensional or three- dimensional computer tomographic images with a fiberscope in place and the corresponding endoscopic video images, and (4) demonstrate some of the obstacles which occur in clinical practice (e.g. "white-out" and saliva). The intent of this package is to simulate fiberoptic intubation techniques as well as help one create a mental image of the path a fiberscope takes within the lumen of the upper airway. The potential for improving operator immersion (virtual reality) by using a more sophisticated input device is discussed.

AU - D. M. Kaufman and W. Bell
TI - Teaching and assessing clinical skills using virtual reality
SO - Stud Health Technol Inform 1997;39:467-72
MH - Computer-Assisted Instruction/*methods
*Education, Medical
Educational Measurement/*methods
Human
Multimedia
*User-Computer Interface
AB - The need to improve the teaching and assessing of students' procedural skills has been well 0 encounters, often with little or no supervision. Assessment of these skills has depended on rudimentary physical models, or standardized patients. The limitations of these methods also are well known. A new technology known as "Virtual Reality" has tremendous potential to assist medical educators in teaching and assessing clinical skills of students, residents and physicians in practice. Virtual Reality consists of a computer-generated three-dimensional simulation in which the user both views and manipulates the contents of the environment. Various degrees of immersion may be experienced that may include elements such as vision, touch or sound. It can provide an environment that so closely represents an actual clinical situation that skills learned will transfer to patients. Many variations in anatomy or other complications can be presented, and trainees can practice hundreds of times until their skills are perfected. This paper describes current activities in this area in the Dalhousie Faculty of Medicine and elsewhere. Various forms of Virtual Reality are described and their application to particular clinical areas are described.

AU - G. Kemball-Cook and E. G. Tuddenham
TI - The Factor VIII Mutation Database on the World Wide Web: the haemophilia A mutation, search, test and resource site. HAMSTeRS update (version 3.0)
SO - Nucleic Acids Res 1997;25(1):128-32
MH - *Computer Communication Networks
*Databases, Factual
Factor VIII/chemistry/*genetics
Hemophilia A/*genetics
Human
Models, Molecular
*Mutation
AB - The HAMSTeRS WWW site was set up in 1996 in order to facilitate easy access to, and aid understanding of, the causes of haemophilia A at the molecular level; previously, the first and second text editions of the database have been published in Nucleic Acids Research. This report describes the facilities originally available at the site and the recent additions which we have made to increase its usefulness to clinicians, the molecular genetics community and structural biologists interested in factor VIII. The database (version 3.0) has been completely updated with easy submission of point mutations, deletions and insertions via e-mail of custom-designed forms. The searching of point mutations in the database has been made simpler and more robust, with a concomitantly expanded real-time bioinformatic analysis of the database. A methods section devoted to mutation detection has been added, highlighting issues such as choice of technique and PCR primer sequences. Finally, a FVIII structure section gives access to 3D VRML (Virtual Reality Modelling Language) files for any user-definable residue in a FVIII A domain homology model based on the crystal structure of human caeruloplasmin, together with secondary structural data and a sound+video animation of the model. It is intended that the general availability of this model will assist both in interpretation of causative mutations and selection of candidate residues forin vitromutagenesis. The HAMSTeRS URL is http://europium.mrc.rpms.ac.uk.

AU - T. Kling-Petersen and M. Rydmark
TI - The BRAIN project: an interactive learning tool using desktop virtual reality on personal computers
SO - Stud Health Technol Inform 1997;39:529-38
MH - Anatomy/education
Atlases
Brain/*anatomy & histology/radiography
Computer-Assisted Instruction/*methods
Human
*Microcomputers
*User-Computer Interface
AB - The BRAIN-project is an endeavor in using computer aided learning to improve the understanding of the human brain anatomy. The project consists of four parts, each based on modular packages: BRAINIMAGES: Brain atlas consisting of horizontal and frontal brain slices spaced I mm apart enabling the identification of structures and areas of the brain. The software also contains views of the brain's outer surface with all pertinent structures marked. BRAINRADIOLOGY: Visualisation of the brain using CT, MRI and angiography. The different imaging techniques enable the user to explore the brain from several angles and also view the major blood vessels of the brain. NEUROHISTOLOGY: Cells of the brain using histologically stained sections. The program emphasizes the organization of cells in layers and the interaction of different cell types. 3D-BRAIN: Three dimensional reconstructions based on physical slices of a human brain. The reconstructed brain views are made interactive using a simple form of desktop virtual reality: QuickTime VR technology. The user can rotate the different views in all directions producing a 3D effect. The different views are designed to highlight important structures and their organization within the outlined (and semi transparent) brain surface. Contrary to similar applications, the actual three dimensional objects are not based on MRI or CT scans (with comparatively poor resolution), but on tracings made on high resolution images of photographs of actual sections of a postmortem brain. N.B., this approach produces 3D renderings in a more detailed and reliable way. The BRAIN project is designed as a support package for students in preclinical education by supplying additional means for gathering information pertinent to the curriculum. By cross linking, the students can switch from a three dimensional object to a corresponding slice, and then to the relevant histological sample and son on. The software components are based on a modular design enabling easy modification of the various parts and the entire project is designed to run on both Apple Macintosh and MS Windows based PCs.

AU - R. A. Kozarek
TI - Virtual reality and gastrointestinal endoscopy, or, is Virtual Vision a speed bump on the road to telepresence? [editorial]
SO - J Clin Gastroenterol 1997;24(3):130-2
MH - *Attention
*Endoscopes, Gastrointestinal
Endoscopy, Gastrointestinal/*instrumentation/psychology
Equipment Design
Human
Image Processing, Computer-Assisted/*instrumentation
Television/*instrumentation
Video Recording/*instrumentation

AU - R. B. Kuppersmith, R. Johnston, D. Moreau, R. B. Loftin and H. Jenkins
TI - Building a virtual reality temporal bone dissection simulator
SO - Stud Health Technol Inform 1997;39:180-6
MH - *Computer Simulation
*Computer-Assisted Instruction
Human
Surgery/education
Temporal Bone/anatomy & histology/*surgery
*User-Computer Interface
AB - The temporal bone is one of seven bones that comprise the human skull, and has an intimate relationship with many vital structures. Anatomically, its three-dimensional relationships make it one of the most challenging areas for surgeons to understand and master. In addition, the temporal bone contains minute structures that are among the most sophisticated and delicate in the human body. These structures include the cochlea and vestibular organs, which are responsible for hearing and balance; the middle ear, including the ossicles, which conduct acoustic energy to the cochlea; and the facial nerve, which is responsible for controlling the muscles of facial expression, and contributes to the sensation of taste. Additionally, the temporal bone forms a major portion of the skull base, and has intimate relationships to vital structures including the carotid artery, jugular vein, cerebral cortex, brainstem, and cranial nerves. Surgical procedures performed on the temporal bone include: procedures to eradicate chronic and acute infections; procedures to remove malignant and benign tumors within the temporal bone, from the skull base, or from the posterior cranial fossa; procedures to restore the hearing mechanism; procedures to eliminate balance disorders; and procedures to correct congenital anomalies. For surgeons-in-training, and even surgeons-in-practice, mastery of the anatomy of the temporal bone and the many complex approaches necessary to treat patients takes years of focused endeavor. This is typically accomplished through the dissection of human cadaver temporal bones, which are scarce, and require a dedicated laboratory facility. Efforts are currently underway to develop a realistic simulator for temporal bone procedures. Users immersed in the simulator will interact with a three-dimensional temporal bone, derived from patient-specific data, using a haptic interface to simulate traditional surgical procedures. Feedback from experts in otologic surgery will be built into the system for additional instruction. This presentation will include an overview of the application being developed, a report of its current state of development, and plans for the future.

AU - R. Lahoz-Beltra
TI - Molecular automata assembly: principles and simulation of bacterial membrane construction
SO - Biosystems 1997;44(3):209-29
MH - Algorithms
*Computer Simulation
Escherichia coli/enzymology/*growth & development
Flagella/physiology
H(+)-Transporting ATP Synthase/*physiology
Membranes/growth & development
*Models, Biological
Support, Non-U.S. Gov't
AB - The motivation to understand the basic rules and principles governing molecular self-assembly may be relevant to explain in the context of molecular biology the self-organization and biological functions exhibited within cells. This paper presents a molecular automata model to simulate molecular self-assembly introducing the concept of molecular programming to simulate the biological function or operation performed by an assembled molecular state machine. The method is illustrated modelling Escherichia coli membrane construction including the assembly and operation of ATP synthase as well as the assembly of the bacterial flagellar motor. Flagellar motor operation was simulated using a different approach based on state machine definition used in virtual reality systems. The proposed methodology provides a modelling framework for simulation of biological functions performed by cellular components and other biological systems suitable to be modelled as molecular state machines.

AU - A. M. Lawrence and R. S. Lebsack
TI - Operating room: 2010
SO - Semin Perioper Nurs 1997;6(2):111-5
MH - Forecasting
Human
Operating Room Information Systems/*trends
Operating Room Nursing/*trends
*Quality Assurance, Health Care
AB - Using expert systems, virtual reality, and commercial and futuristic technology, visionary operating room (OR) nurses will have the opportunity in the 21st century to dramatically improve the way the OR functions. Eliminating counting, decreasing occurrences of patient injuries, and improving staff and patient education are just some of the possibilities!

AU - F. O. Lehmann and M. H. Dickinson
TI - The changes in power requirements and muscle efficiency during elevated force production in the fruit fly Drosophila melanogaster
SO - J Exp Biol 1997;200(Pt 7):1133-43
MH - Animal
Biomechanics
Drosophila melanogaster/*physiology
*Energy Metabolism
*Flight, Animal
Mathematics
Muscles/*physiology
Support, Non-U.S. Gov't
Support, U.S. Gov't, Non-P.H.S.
AB - The limits of flight performance have been estimated in tethered Drosophila melanogaster by modulating power requirements in a 'virtual reality' flight arena. At peak capacity, the flight muscles can sustain a mechanical power output of nearly 80 W kg-1 muscle mass at 24 degrees C, which is sufficient to generate forces of approximately 150% of the animal's weight. The increase in flight force above that required to support body weight is accompanied by a rise in wing velocity, brought about by an increase in stroke amplitude and a decrease in stroke frequency. Inertial costs, although greater than either profile or induced power, would be minimal with even modest amounts of elastic storage, and total mechanical power energy should be equivalent to aerodynamic power alone. Because of the large profile drag expected at low Reynolds numbers, the profile power was approximately twice the induced power at all levels of force generation. Thus, it is the cost of overcoming drag, and not the production of lift, that is the primary requirement for flight in Drosophila melanogaster. By comparing the estimated mechanical power output with respirometrically measured total power input, we determined that muscle efficiency rises with increasing force production to a maximum of 10%. This change in efficiency may reflect either increased crossbridge activation or a favorable strain regime during the production of peak forces.

AU - C. H. Lewis and M. J. Griffin
TI - Human factors consideration in clinical applications of virtual reality
SO - Stud Health Technol Inform 1997;44:35-56
MH - *Computer Graphics
*Computer Simulation
Human
Neurology/*trends
AB - Virtual reality environments have many potential applications in medicine, including surgical training, tele-operated robotic surgery, assessment and rehabilitation of behavioural and neurological disorders and diagnosis, therapy and rehabilitation of physical disabilities. Although there is much potential for the use of immersive virtual reality environments in clinical applications, there are problems which could limit their ultimate usability. Some users have experienced side- effects during and after exposure to virtual reality environments. The symptoms include ocular problems, disorientation and balance disturbances, and nausea. Susceptibility to side-effects can be affected by age, ethnicity, experience, gender and physical fitness, as well as the characteristics of the display, the virtual environment and the tasks. The characteristics of the virtual reality system have also been shown to affect the ability of users to perform tasks in a virtual environment. Many of these effects can be attributed to delays between the sampling of head and limb positions and the presentation of an appropriate image on the display. The introduction of patients to virtual reality environments, for assessment, therapy or rehabilitation, raises particular safety and ethical issues. Patients exposed to virtual reality environments for assessment and rehabilitation may have disabilities which increase their susceptibility to certain side-effects. Special precautions therefore need to be taken to ensure the safety and effectiveness of such virtual reality applications. These precautions include minimisation of possible side-effects at the design stage. Factors are identified which are likely to affect the incidence of side-effects during and after exposures, and which need to be understood in order to minimise undesirable consequences. There is also a need for the establishment of protocols for monitoring and controlling exposures of patients to virtual reality environments. Issues are identified which need to be included in such protocols.

AU - J. Marescaux, J. M. Clement, M. Nord, Y. Russier, V. Tassetti, D. Mutter, S. Cotin and N. Ayache
TI - [A new concept in digestive surgery: the computer assisted surgical procedure, from virtual reality to telemanipulation]
SO - Bull Acad Natl Med 1997;181(8):1609-21; discussion 1622-3
MH - *Computer Simulation
*Digestive System Surgical Procedures
English Abstract
Human
*Telemedicine
*User-Computer Interface
AB - Surgical simulation increasingly appears to be an essential aspect of tomorrow's surgery. The development of a hepatic surgery simulator is an advanced concept calling for a new writing system which will transform the medical world: virtual reality. Virtual reality extends the perception of our five senses by representing more than the real state of things by the means of computer sciences and robotics. It consists of three concepts: immersion, navigation and interaction. Three reasons have led us to develop this simulator: the first is to provide the surgeon with a comprehensive visualisation of the organ. The second reason is to allow for planning and surgical simulation that could be compared with the detailed flight-plan for a commercial jet pilot. The third lies in the fact that virtual reality is an integrated part of the concept of computer assisted surgical procedure. The project consists of a sophisticated simulator which has to include five requirements: visual fidelity, interactivity, physical properties, physiological properties, sensory input and output. In this report we will describe how to get a realistic 3D model of the liver from bi- dimensional 2D medical images for anatomical and surgical training. The introduction of a tumor and the consequent planning and virtual resection is also described, as are force feedback and real-time interaction.

AU - L. Marran and C. Schor
TI - Multiaccommodative stimuli in VR systems: problems & solutions
SO - Hum Factors 1997;39(3):382-8
MH - *Accommodation, Ocular
Eyeglasses
Human
Optics
*User-Computer Interface
AB - Virtual reality environments can introduce multiple and sometimes conflicting accommodative stimuli. For instance, with the high-powered lenses commonly used in head-mounted displays, small discrepancies in screen lens placement, caused by manufacturer error or user adjustment focus error, can change the focal depths of the image by a couple of diopters. This can introduce a binocular accommodative stimulus or, if the displacement between the two screens is unequal, an unequal (anisometropic) accommodative stimulus for the two eyes. Systems that allow simultaneous viewing of virtual and real images can also introduce a conflict in accommodative stimuli: When real and virtual images are at different focal planes, both cannot be in focus at the same time, though they may appear to be in similar locations in space. In this paper four unique designs are described that minimize the range of accommodative stimuli and maximize the visual system's ability to cope efficiently with the focus conflicts that remain: pinhole optics, monocular lens addition combined with aniso-accommodation, chromatic bifocal, and bifocal lens system. The advantages and disadvantages of each design are described and recommendation for design choice is given after consideration of the end use of the virtual reality system (e.g., low or high end, entertainment, technical, or medical use). The appropriate design modifications should allow greater user comfort and better performance.

AU - M. L. Max and J. C. Burke
TI - Virtual reality for autism communication and education, with lessons for medical training simulators
SO - Stud Health Technol Inform 1997;39:46-53
MH - Attention
Autistic Disorder/*rehabilitation
Child
Child, Preschool
*Computer Simulation
Education, Special/*methods
Human
Sensation
Technology Transfer
*User-Computer Interface
AB - This study is adapting Virtual Reality (VR) technologies to teach children with autism new coping skills that may then be generalized in their everyday lives. It helps to understand that children with autism are challenged by a sensory overload and by aversions to a variety of auditory, visual, and tactile stimuli. In addition, their ability to attenuate and/or ignore these stimuli differs from that of the "typical" child. Therefore, our goals were to: 1. assess the potential of each of the children (both with and without verbal skills) for sustained interaction with task environments, 2. to identify which visual, auditory, and kinetic VR components would be attractive to our test group, 3. to identify each child's ability to attenuate and/or ignore a variety of distractors, and 4. to build new "pivotal behaviors" [2] for learning. These pivotal behaviors include: improvement of time-on-task, meaningful and consistent interaction with the real world, and screening out extraneous environmental stimuli. Our findings to date have been very encouraging, and we will continue to investigate the role of VR as a tool for generalized learning and the modification of pivotal behaviors. This ongoing study also provides technology transfer of communications applications from government, universities and businesses out into telemedicine and elementary schools.

AU - M. L. Max and J. R. Gonzalez
TI - Blind persons navigate in virtual reality (VR); hearing and feeling communicates "reality"
SO - Stud Health Technol Inform 1997;39:54-9
MH - Adult
Blindness/*rehabilitation
Child, Preschool
Female
Human
Male
Pilot Projects
*Sensory Aids
Sound Localization
Space Perception
*User-Computer Interface
AB - Can Virtual Reality (VR) developments in audio navigation for blind persons support therapies for all? Working with Crystal River Engineering we are developing navigable Virtual Reality worlds for blind users, using spatialized audio [1], [2]. All persons, however, use specialized channels, such as: visual, aural, and kinetic learning senses. Predominantly visual VR worlds and health informatics models from World Wide Webs, may be downloaded, tailored, augmented, and delivered to each of these learning senses using VR. We are also testing a proof of concept system with Boston Dynamics which downloads 3-dimensional, satellite-derived map models from the World Wide Web, and makes them navigable by "feeling" the terrain using haptic (tactual or force feedback to your hand) robotic interfaces. Ultimately, these multi-sensory VR access methods: sight, localization by audio, and "feeling" of data sets could open up the World Wide Web to individuals with sight impairments. This could also, however, benefit government, businesses, universities, and (elementary) education. It could contribute more powerful communications, education, and medical simulation applications on the World Wide Web. This work is part of government technology transfer to telemedicine, (elementary) education, disabilities access to the Web, and new Internet access and productivity efforts under Vice President Gore's National Performance Review.

AU - J. M. McGregor
TI - Enhancing neurosurgical endoscopy with the use of virtual reality' headgear
SO - Minim Invasive Neurosurg 1997;40(2):47-9
MH - Adult
Arachnoid Cysts/*surgery
Case Report
Computer Terminals
*Data Display
*Endoscopes
Endoscopy/*instrumentation/methods
Female
Human
Monitoring, Intraoperative/*instrumentation
Surgical Procedures, Minimally Invasive/instrumentation/methods
*User-Computer Interface
AB - Widespread use of neurosurgical endoscopy has been hampered by the necessity of looking up from the surgical field to view the endoscopic image on a video monitor. Here is demonstrated a simple, lightweight headpiece with a small, built-in video monitor that reflects the video image to the dominant eye, thus allowing the operator to continuously observe the surgical field either via peripheral vision or via the non- dominant eye. Successful use of the device is documented here in a minimally invasive fenestration of an arachnoid cyst into the lateral ventricle via a flexible endoscopic procedure.

AU - J. R. Merril
TI - Using emerging technologies such as virtual reality and the World Wide Web to contribute to a richer understanding of the brain
SO - Ann N Y Acad Sci 1997;820:229-33
MH - Brain/*physiology
*Computers
Human
Neurosciences/*methods

AU - R. F. Merryman and A. J. Cacioppo
TI - The optokinetic cervical reflex in pilots of high-performance aircraft
SO - Aviat Space Environ Med 1997;68(6):479-87
MH - *Aerospace Medicine
*Aircraft
Analysis of Variance
Cues
Head/*physiology
Human
Human Engineering
Linear Models
Male
Military Personnel
Neck/*physiology
Reflex, Stretch/*physiology
Space Perception/*physiology
AB - BACKGROUND: For over 60 yr, researchers and engineers have based investigations and the design of cockpit displays and structures upon the presupposition that during flight the pilot maintains a head alignment coincident with the aircraft's vertical axis (z-axis). Recent simulator studies have verified the existence of a pilot neck reflex which refutes this long-standing assumption. This reflex, named the opto-kinetic cervical reflex (OKCR), occurs during visual flight and is theorized to be an attempt by the pilot to stabilize a retinal image of the horizon to maintain spatial orientation. As a result, during initial banking maneuvers, pilots view a fixed-horizon image and not a moving-horizon. The research objectives were to determine if the OKCR occurs during actual flight of high performance jet aircraft and to model the response. HYPOTHESIS: Pilots of high performance aircraft will exhibit the OKCR. Additionally, the OKCR is dependent on the phase of banking (entering into or exiting from a banked position). METHODS: This was an observational study in which the head positions of nine pilots were recorded during actual F-15 aircraft flight and subsequently analyzed. RESULTS: Objective data indicate the OKCR caused pilots to tilt their heads during aircraft bank (p 0.0001). Also, the reflex was found to be independent of the bank phase. CONCLUSION: The OKCR was shown to be a strong, natural response and the flight results correlated closely with simulator results. The effect of these results on pilot training, spatial disorientation, physiological injury and safety, and the redesign of displays for aircraft attitude and virtual reality are discussed.

AU - K. Miller and K. Chinzei
TI - Constitutive modelling of brain tissue: experiment and theory
SO - J Biomech 1997;30(11-12):1115-21
MH - Algorithms
Animal
Brain/*anatomy & histology/physiology
Brain Injuries/pathology/physiopathology
Compressive Strength
Elasticity
Equipment Design
Human
Kidney/anatomy & histology/physiology
Liver/anatomy & histology/physiology
*Models, Neurological
Neurosurgery/education/instrumentation
Patient Care Planning
Robotics
Stress, Mechanical
Support, Non-U.S. Gov't
Surgical Instruments
Surgical Procedures, Operative
Swine
Therapy, Computer-Assisted
User-Computer Interface
Viscosity
AB - Recent developments in computer-integrated and robot-aided surgery--in particular, the emergence of automatic surgical tools and robots--as well as advances in virtual reality techniques, call for closer examination of the mechanical properties of very soft tissues (such as brain, liver, kidney, etc.). The ultimate goal of our research into the biomechanics of these tissues is the development of corresponding, realistic mathematical models. This paper contains experimental results of in vitro, uniaxial, unconfined compression of swine brain tissue and discusses a single-phase, non-linear, viscoelastic tissue model. The experimental results obtained for three loading velocities, ranging over five orders of magnitude, are presented. The applied strain rates have been much lower than those applied in previous studies, focused on injury modelling. The stress-strain curves are concave upward for all compression rates containing no linear portion from which a meaningful elastic modulus might be determined. The tissue response stiffened as the loading speed increased, indicating a strong stress-strain rate dependence. The use of the single-phase model is recommended for applications in registration, surgical operation planning and training systems as well as a control system of an image-guided surgical robot. The material constants for the brain tissue are evaluated. Agreement between the proposed theoretical model and experiment is good for compression levels reaching 30% and for loading velocities varying over five orders of magnitude.

AU - M. H. Miller
TI - A method for representing search results in three dimensions
SO - Proc AMIA Annu Fall Symp 1997;:533-7
MH - *Computer Graphics
*Information Storage and Retrieval
Models, Theoretical
User-Computer Interface
AB - This paper presents a new method for representing results of an information retrieval search in a three dimensional environment. Aside from the fact that users find 3-D interfaces visually appealing, there are strong practical reasons for developing 3-D representations of search results. Traditional information retrieval systems present results in ordered lists which are difficult to browse, and exclude useful information. The current method employs a multivariate statistical method called Local Latent Semantic Indexing (LLSI) to create meaningful local dimensions in which to view search results. A prototype Internet-ready system is described which utilizes Virtual Reality Modeling Language (VRML) to display search results. Preliminary tests of this system with a small collection of MEDLINE articles are very encouraging.

AU - J. T. Mitchell
TI - Can hazard risk be communicated through a virtual experience?
SO - Disasters 1997;21(3):258-66
MH - *Computer Simulation
*Disaster Planning
Human
*User-Computer Interface
AB - Cyberspace, defined by William Gibson as a consensual hallucination, now refers to all computer-generated interactive environments. Virtual reality, one of a class of interactive cyberspaces, allows us to create and interact directly with objects not available in the everyday world. Despite successes in the entertainment and aviation industries, this technology has been called a 'solution in search of a problem'. The purpose of this commentary is to suggest such a problem: the inability to acquire experience with a hazard to motivate mitigation. Direct experience with a hazard has been demonstrated as a powerful incentive to adopt mitigation measures. While we lack the ability to summon hazard events at will in order to gain access to that experience, a virtual environment can provide an arena where potential victims are exposed to a hazard's effects. Immersion as an active participant within the hazard event through virtual reality may stimulate users to undertake mitigation steps that might otherwise remain undone. This paper details the possible direction in which virtual reality may be applied to hazards mitigation through a discussion of the technology, the role of hazard experience, the creation of a hazard stimulation and the issues constraining implementation.

AU - S. O. Molin, A. Jiras, M. Hall-Angeras, A. Falk, D. Martens, O. H. Gilja, L. B. Nesje and S. Odegaard
TI - Virtual reality in surgical practice in vitro and in vivo evaluations
SO - Stud Health Technol Inform 1997;39:246-53
MH - Computer Simulation
Endosonography/*methods
Human
Image Processing, Computer-Assisted/*methods
In Vitro
Laparoscopy/*methods
Software Design
*User-Computer Interface
AB - This paper describes a method for the acquisition and integrative processing of laparoscopic and endoluminal ultrasound images. We used a stepping motor attached to a stabilizing rig, interfaced to the laparoscope, or the ultrasound probe. 360 degrees laparoscopic scenes were constructed during minimally invasive surgery, and three- dimensional reconstructions were made of related ultrasound data. Integration of 360 degrees panoramas with geometric ultrasound models could be displayed as interactive scenes. This resulted in a better demonstration of the surgical field and topographic anatomy. In conclusion, this type of visualizations may be used in virtual reality simulations for documentation, education and in operative planning.

AU - J. Moline
TI - Virtual reality for health care: a survey
SO - Stud Health Technol Inform 1997;44:3-34
MH - Animal
*Computer Graphics
Delivery of Health Care/*trends
Education, Medical/trends
Human
Surgical Procedures, Operative
AB - This report surveys the state of the art in applications of virtual environments and related technologies for health care. Applications of these technologies are being developed for health care in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); medical therapy; preventive medicine and patient education; medical education and training; visualization of massive medical databases; skill enhancement and rehabilitation; and architectural design for health-care facilities. To date, such applications have improved the quality of health care, and in the future they will result in substantial cost savings. Tools that respond to the needs of present virtual environment systems are being refined or developed. However, additional large-scale research is necessary in the following areas: user studies, use of robots for telepresence procedures, enhanced system reality, and improved system functionality.

AU - W. Muller, S. Grosskopf, A. Hildebrand, R. Malkewitz and R. Ziegler
TI - Virtual reality in the operating room of the future
SO - Stud Health Technol Inform 1997;39:224-31
MH - Computer Simulation
Equipment Design
Human
*Image Processing, Computer-Assisted
Surgical Equipment/*trends
Surgical Procedures, Operative/*methods/trends
*User-Computer Interface
AB - In cooperation with the Max-Delbruck-Centrum/Robert-Rossle-Klinik (MDC/RRK) in Berlin, the Fraunhofer Institute for Computer Graphics is currently designing and developing a scenario for the operating room of the future. The goal of this project is to integrate new analysis, visualization and interaction tools in order to optimize and refine tumor diagnostics and therapy in combination with laser technology and remote stereoscopic video transfer. Hence, a human 3-D reference model is reconstructed using CT, MR, and anatomical cryosection images from the National Library of Medicine's Visible Human Project. Applying segmentation algorithms and surface-polygonization methods a 3-D representation is obtained. In addition, a "fly-through" the virtual patient is realized using 3-D input devices (data glove, tracking system, 6-DOF mouse). In this way, the surgeon can experience really new perspectives of the human anatomy. Moreover, using a virtual cutting plane any cut of the CT volume can be interactively placed and visualized in realtime. In conclusion, this project delivers visions for the application of effective visualization and VR systems. Commonly known as Virtual Prototyping and applied by the automotive industry long ago, this project shows, that the use of VR techniques can also prototype an operating room. After evaluating design and functionality of the virtual operating room, MDC plans to build real ORs in the near future. The use of VR techniques provides a more natural interface for the surgeon in the OR (e.g., controlling interactions by voice input). Besides preoperative planning future work will focus on supporting the surgeon in performing surgical interventions. An optimal synthesis of real and synthetic data, and the inclusion of visual, aural, and tactile senses in virtual environments can meet these requirements. This Augmented Reality could represent the environment for the surgeons of tomorrow.

AU - M. M. North, S. M. North and J. R. Coble
TI - Virtual reality therapy for fear of flying [letter]
SO - Am J Psychiatry 1997;154(1):130
MH - Adult
Aircraft
Case Report
*Computer Simulation
Desensitization, Psychologic/*methods
Human
Male
Phobic Disorders/*therapy
*Therapy, Computer-Assisted

AU - M. M. North, S. M. North and J. R. Coble
TI - Virtual reality therapy: an effective treatment for psychological disorders
SO - Stud Health Technol Inform 1997;44:59-70
MH - Animal
Behavior Therapy/instrumentation/*methods
Cats
*Computer Graphics
*Computer Simulation
Human
Mental Disorders/*therapy
Support, Non-U.S. Gov't
Support, U.S. Gov't, Non-P.H.S.
AB - Behavioral therapy techniques for treating phobias often includes graded exposure of the patient to anxiety-producing stimuli (Systematic Desensitization). However, in utilizing systematic desensitization, research reviews demonstrate that many patients appear to have difficulty imaging the prescribed anxiety-evoking scene. They also express strong aversion to experiencing real situations. This chapter describes the Virtual Reality Therapy (VRT), a new therapeutical approach that can be used to overcome some of the difficulties inherent in the traditional treatment of phobias. VRT, like current imaginal and in vivo modalities, can generate stimuli that could be utilized in desensitization therapy. Like systematic desensitization therapy, VRT can provide stimuli for patients who have difficulty in imagining scenes and/or are too phobic to experience real situations. Unlike in vivo systematic desensitization, VRT can be performed within the privacy of a room, thus avoiding public embarrassment and violation of patient confidentiality. VRT can generate stimuli of much greater magnitude than standard in vivo techniques. Since VRT is under patient control, it appears safer than in vivo desensitization and at the same time more realistic than imaginal desensitization. Finally, VRT adds the advantage of greater efficiency and economy in delivering the equivalent of in vivo systematic desensitization within the therapist's office. The chapter also describes how to use virtual reality in the treatment of specific phobias: fear of flying, fear of heights, fear of being in certain situations (such as a dark barn, an enclosed bridge over a river, and in the presence of an animal [a black cat] in a dark room), and fear of public speaking.

AU - W. L. Nowinski, A. Fang, B. T. Nguyen, J. K. Raphel, L. Jagannathan, R. Raghavan, R. N. Bryan and G. A. Miller
TI - Multiple brain atlas database and atlas-based neuroimaging system
SO - Comput Aided Surg 1997;2(1):42-66
MH - Anatomy, Artistic
Brain/*anatomy & histology/*radiography
Comparative Study
*Databases, Factual
Human
Image Processing, Computer-Assisted/*methods
*Magnetic Resonance Imaging
*Medical Illustration
Support, Non-U.S. Gov't
Tomography, X-Ray Computed
User-Computer Interface
AB - For the purpose of developing multiple, complementary, fully labeled electronic brain atlases and an atlas-based neuroimaging system for analysis, quantification, and real-time manipulation of cerebral structures in two and three dimensions, we have digitized, enhanced, segmented, and labeled the following print brain atlases: Co-Planar Stereotaxic Atlas of the Human Brain by Talairach and Tournoux, Atlas for Stereotaxy of the Human Brain by Schaltenbrand and Wahren, Referentially Oriented Cerebral MRI Anatomy by Talairach and Tournoux, and Atlas of the Cerebral Sulci by Ono, Kubik, and Abernathey. Three- dimensional extensions of these atlases have been developed as well. All two- and three-dimensional atlases are mutually preregistered and may be interactively registered with an actual patient's data. An atlas- based neuroimaging system has been developed that provides support for reformatting, registration, visualization, navigation, image processing, and quantification of clinical data. The anatomical index contains about 1,000 structures and over 400 sulcal patterns. Several new applications of the brain atlas database also have been developed, supported by various technologies such as virtual reality, the Internet, and electronic publishing. Fusion of information from multiple atlases assists the user in comprehensively understanding brain structures and identifying and quantifying anatomical regions in clinical data. The multiple brain atlas database and atlas-based neuroimaging system have substantial potential impact in stereotactic neurosurgery and radiotherapy by assisting in visualization and real- time manipulation in three dimensions of anatomical structures, in quantitative neuroradiology by allowing interactive analysis of clinical data, in three-dimensional neuroeducation, and in brain function studies.

AU - G. Optale, A. Munari, A. Nasta, C. Pianon, J. Baldaro Verde and G. Viggiano
TI - Multimedia and virtual reality techniques in the treatment of male erectile disorders
SO - Int J Impot Res 1997;9(4):197-203
MH - Adult
Aged
Human
Impotence/*psychology/*therapy
Male
Middle Age
*Multimedia
Penile Erection
Psychotherapy
*User-Computer Interface
AB - The present study is based on the observation that computer-simulated reality applied by virtual reality (VR) methods may offer a new means of treating male erectile disorders. The experimental design was based on the theory of psychological development, supported by multimedia acoustic experience and clinical tests. The method involved the use of virtual reality equipment and specially designed CD-ROM programmes. Excluding 15% drop-outs, the success rate was 82% for male erectile disorders due to psychological factors and 84%, excluding 17% drop- outs, for combined factor disorders. Psychotherapy with VR seems to hasten the healing process and reduce drop-outs, suggesting that this method opens or consolidates new or rarely used brain pathways, facilitating the flow of new mnemonic associations that promote the satisfaction of natural drives.

AU - H. Oyama
TI - Virtual reality for the palliative care of cancer
SO - Stud Health Technol Inform 1997;44:87-94
MH - *Computer Graphics
*Computer Simulation
Human
Neoplasms/*therapy
Palliative Care/*methods
AB - We have been developing a VR system to provide patients with emotional support and to encourage them to assume an active life against cancer, since patients with an active lifestyle survive longer than those with a passive lifestyle. A possible explanation for this latter fact is that psychological stimulation may also activate the endocrine system and the immune system. Both systems may be able to rapidly repair tissue damaged by cancer and change the characteristics of the cancer itself. Although microelectrical analysis and molecular and genetic analyses are rapidly solving the riddles of the relationship between the brain and thought, we think that our VR research for palliative medicine may also play an important role in this area with regard to the development of new tools for treatment and support. This notion is based on the hypothesis that the brain can reorganize itself to compensate for irrationality or inappropriateness through pharmacological adaptation and/or anatomical regeneration of synapses. Another reason why VR research in palliative medicine is useful is that VR techniques represent not only an enhanced human-machine interface, but also an enhanced human communication technology. VR technology may also be used to help patients accept their disease. The mental state of a patient in the terminal stage of cancer changes step by step from denial of cancer, hope for a new treatment for cancer, suspicion of medical treatment, uneasiness regarding their future life, irritation, depression, and acceptance or despair. We plan to develop a new type of counseling system in medical cyberspace to provide mental care. It can also be used for group therapy or humor therapy to reduce loneliness. In summary, we conclude that VR technology can be applied to palliative medicine (1) to support communication between the patient and others, (2) to provide psychological support to treat neurosis and help to stabilize the patient's mental state, and (3) to actually treat cancer.

AU - H. Oyama, F. Wakao, T. Mishina, Y. Lu and A. Honjo
TI - Virtual cancer image data warehouse
SO - Stud Health Technol Inform 1997;39:151-4
MH - Audiovisual Aids
*Computer Communication Networks
Human
*Neoplasms/pathology
*Patient Education
*Radiology Information Systems
Support, Non-U.S. Gov't
*User-Computer Interface
AB - We previously developed a system with which we have created more than 100 virtual cancer images from CT or MR data of individual patients with cancer (Cancer Edutainment Virtual Reality Theater: CEVRT). These images can be used to help explain procedures, findings, etc. to the patient, to obtain informed consent, to simulate surgery, and to estimate cancer invasion to surrounding organs. We recently developed a web-based object-oriented database both to access these cancer images and to register medical images at international research sites via the Internet. In this report, we introduce an international medical VR data warehouse created using an object-oriented database.

AU - H. Oyama, F. Wakao and H. Okamura
TI - Virtual reality support system in palliative medicine
SO - Stud Health Technol Inform 1997;39:60-3
MH - Computer-Assisted Instruction
Human
Neoplasms/*psychology
*Palliative Care
Patient Education/*methods
Psychotherapy/*methods
Support, Non-U.S. Gov't
*User-Computer Interface
AB - We have been examining the potential value of a VR system for the palliative care of cancer. We recently developed palliative care system which consists of a 100-inch-wide screen, HMD (Head-mounted display) and 8-mm video or a PC. Our goal is to use VR techniques to help alleviate a patient's stress and concern regarding their cancer during hospitalization. We can use this system to present (1) personal video movies, (2) video letters from friends and family, (3) personal video instruction about medical examinations, and (4) interactive information about their cancer using a PC-based VR system. Our preliminary results indicate that interesting VR presentations are useful for reducing stress.

AU - D. Piraino, M. Recht and B. Richmond
TI - Implementation of an electronic teaching file using web technology
SO - J Digit Imaging 1997;10(3 Suppl 1):190-2
MH - *Computer Communication Networks
*Computer-Assisted Instruction
Human
Radiology/*education
Radiology Information Systems
User-Computer Interface
AB - The implementation of an electronic teaching file using web technology is discussed in this article. A web client server model is used for a standard web browser capable of displaying joint photographic Experts Group (JPEG) compression images. Like other web-based teaching files, this teaching file in a similar way uses a database containing information. This database section of the teaching file allows flexible database querying and viewing of pages generated by hypertext markup language (HTML). Because the browser client is so flexible, images types such as video and 3D representations with virtual reality markup language (VRML) can be displayed.

AU - G. Riva
TI - Virtual reality as assessment tool in psychology
SO - Stud Health Technol Inform 1997;44:71-9
MH - *Computer Graphics
*Computer Simulation
Human
Mental Disorders/*diagnosis
Psychology, Clinical/instrumentation/*methods
Support, Non-U.S. Gov't
AB - Virtual environments (VEs), offering a new human-computer interaction paradigm, have attracted much attention, in clinical psychology, especially in the treatment of phobias. However, a possible new application of VR in psychology is as assessment tool: VEs can be considered as an highly sophisticated form of adaptive testing. This chapter describes the context of current psychological assessment and underlines possible advantages of a VR based assessment tool. The chapter also details the characteristics of BIVRS, Body Image Virtual Reality Scale, an assessment tool designed to assess cognitive and affective components of body image. It consists of a non-immersive 3D graphical interface through which the patient is able to choose between 9 figures of different size which vary in size from underweight to overweight. The software was developed in two architectures, the first (A) running on a single user desktop computer equipped with a standard virtual reality development software and the second (B) splitted into a server (B1) accessible via Internet and actually running the same virtual ambient as in (A) and a VRML client (B2) so that anyone can access the application.

AU - G. Riva, M. Bolzoni, F. Carella, C. Galimberti, M. J. Griffin, C. H. Lewis, R. Luongo, P. Mardegan, L. Melis, L. Molinari-Tosatti, C. Poerschmann, A. Rovetta, S. Rushton, C. Selis and J. Wann
TI - Virtual reality environments for psycho-neuro-physiological assessment and rehabilitation
SO - Stud Health Technol Inform 1997;39:34-45
MH - Cerebrovascular Disorders/diagnosis/*rehabilitation
Diagnosis, Computer-Assisted/*methods
Eating Disorders/diagnosis/*rehabilitation
Human
Movement Disorders/diagnosis/*rehabilitation
Therapy, Computer-Assisted
*User-Computer Interface
AB - Virtual Reality Environments for Psychoneurophysiological Assessment and Rehabilitation-is an European Community funded project (Telematics for health-HC 1053 http:/(/)www.etho.be/ht_projects/vrepar/) whose aim is: to develop a PC based virtual reality system (PC-VRS) for the medical market that can be marketed at a price which is accessible to its possible end-users (hospitals, universities and research centres) and which would have the modular, connectability and interoperability characteristics that the existing systems lack; to develop three hardware/software modules for the application of the PC VRS in psychoneurophysiological assessment and rehabilitation. The chosen development areas are eating disorders (bulimia, anorexia and obesity), movement disorders (Parkinson's disease and torsion dystonia) and stroke disorders (unilateral neglect and hemiparesis). This paper presents the rationale of the different approaches and the methodology used.

AU - G. Riva and L. Melis
TI - Virtual reality for the treatment of body image disturbances
SO - Stud Health Technol Inform 1997;44:95-111
MH - Adult
*Body Image
*Computer Graphics
*Computer Simulation
Female
Human
Male
Mental Disorders/psychology/*therapy
Support, Non-U.S. Gov't
AB - This chapter describes the characteristics and preliminary evaluation of The Virtual Environment for Body Image Modification (VEBIM), a set of tasks aimed at treating body image disturbances and body dissatisfaction associated with eating disorders. Two methods are commonly used to treat body image: (1) a cognitive/behavioural therapy to influence patients' feelings of dissatisfaction; (2) a visual/motorial therapy with the aim of influencing the level of bodily awareness. VEBIM tries to integrate these two therapeutic approaches within an immersive virtual environment. This choice would not only make it possible to intervene simultaneously on all of the forms of bodily representations, but also to use the psycho-physiological effects provoked on the body by the virtual experience for therapeutic purposes. The chapter, together with the description of the VEBIM theoretical approach, it also presents a study on two preliminary samples (71 normal subjects, uncontrolled study, 48 normal subjects, controlled study) to test its efficacy.

AU - A. A. Rizzo and J. G. Buckwalter
TI - The status of virtual reality for the cognitive rehabilitation of persons with neurological disorders and acquired brain injury
SO - Stud Health Technol Inform 1997;39:22-33
MH - Brain Diseases/*rehabilitation
Brain Injuries/*rehabilitation
Human
Space Perception
Therapy, Computer-Assisted/*instrumentation
*User-Computer Interface

AU - A. A. Rizzo and J. G. Buckwalter
TI - Virtual reality and cognitive assessment and rehabilitation: the state of the art
SO - Stud Health Technol Inform 1997;44:123-45
MH - *Computer Graphics
*Computer Simulation
Human
Mental Disorders/*psychology/*rehabilitation
Nervous System Diseases/*psychology/*rehabilitation
*Neuropsychological Tests
AB - VR offers the potential to develop human testing and training environments that allow for the precise control of complex stimulus presentations in which human cognitive and functional performance can be accurately assessed and rehabilitated. However, basic feasibility issues need to be addressed in order for this technology to be reasonably and efficiently applied to the neuropsychological assessment (NA) and cognitive rehabilitation (CR) of persons with acquired brain injury and neurological disorders. This chapter will provide an introduction to the basic concepts of neuropsychological assessment and cognitive rehabilitation along with rationales for virtual reality's applicability in these complimentary fields. We review the relevant literature regarding theoretical and pragmatic issues for these applications, and provide a description of our ongoing work developing a mental rotation/spatial skills cognitive assessment and training system. References are provided in each section for further reading in each area reviewed.

AU - F. D. Rose, E. A. Attree and B. M. Brooks
TI - Virtual environments in neuropsychological assessment and rehabilitation
SO - Stud Health Technol Inform 1997;44:147-55
MH - *Computer Graphics
*Computer Simulation
Human
Mental Disorders/*psychology/*rehabilitation
Nervous System Diseases/*psychology/*rehabilitation
*Neuropsychological Tests
AB - Brain damage constitutes a major problem for those affected, for their families and friends and for society as a whole. The need for effective rehabilitation strategies is clear. Yet, until the early 1960s, the brain was generally considered to be a somewhat fixed and inflexible organ. In consequence the impairments associated with brain damage were generally regarded as "incurable". Since that time neuroscientists have had reason to change their views dramatically. However, much remains to be done. Progress depends upon a co-ordinated multidisciplinary approach within which assistive technology will be a key player. Within the area of assistive technology, one of the developments which holds particular promise for the field of neurological rehabilitation is the computer technology underlying virtual environments (commonly known as virtual reality). In this chapter we describe the new opportunities offered by virtual reality to pursue several aspects of the rehabilitation process. The value of the technology of virtual environments in this context is that it allows us to immerse people with brain damage in relatively realistic interactive environments which, because of their patterns of impairment, would otherwise be unavailable to them.

AU - F. D. Rose, D. A. Johnson and E. A. Attree
TI - Rehabilitation of the head-injured child: basic research and new technology
SO - Pediatr Rehabil 1997;1(1):3-7
MH - Adult
Aging/physiology
Animal
Brain/metabolism/pathology/physiopathology
Brain Injuries/metabolism/pathology/physiopathology/*rehabilitation
Child
Child Behavior
Cognition/physiology
Environment
Human
Motor Activity/physiology
Neuronal Plasticity/physiology
Psychomotor Performance/physiology
Rats
Research
Sensation/physiology
Technology, Medical
User-Computer Interface
AB - The view that brain damage in children is less impairing than equivalent damage in adults is no longer acceptable. However, it is acknowledged that recovery following brain damage, when it does occur, owes much to the plasticity of the brain and that the young brain displays greater plasticity than the mature brain. To maximize brain damage recovery in children we need to focus both on what is known about brain plasticity and how to influence it. Research on environmental enrichment in rats has told us that enforced interaction with a complex environment can both stimulate anatomical and biochemical plasticity and ameliorate some of the behavioural consequences of brain damage. The view that environmental interaction has rehabilitative value also accords with clinical experience. However, the sensory, motor and cognitive consequences of brain damage often conspire to make environmental interaction difficult. One potential solution lies in using computers to generate virtual environments tailored to the precise sensory and motor capacities of the brain-injured child. In this way children may be enabled to benefit from environmental interaction whatever their level of disability. The use of Virtual Reality (VR) in the context of rehabilitation is discussed and relevant work reviewed.

AU - B. O. Rothbaum, L. Hodges and R. Kooper
TI - Virtual reality exposure therapy
SO - J Psychother Pract Res 1997;6(3):219-26
MH - Fear
Human
Phobic Disorders/*therapy
*User-Computer Interface
AB - It has been proposed that virtual reality (VR) exposure may be an alternative to standard in vivo exposure. Virtual reality integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer- generated virtual environment. Virtual reality exposure is potentially an efficient and cost-effective treatment of anxiety disorders. VR exposure therapy reduced the fear of heights in the first controlled study of virtual reality in treatment of a psychiatric disorder. A case study supported the efficacy of VR exposure therapy for the fear of flying. The potential for virtual reality exposure treatment for these and other disorders is explored, and therapeutic issues surrounding the delivery of VR exposure are discussed.

AU - A. Rovetta, A. K. Bejczy and R. Sala
TI - Telerobotic surgery: applications on human patients and training with virtual reality
SO - Stud Health Technol Inform 1997;39:508-17
MH - Human
Male
Prostatic Neoplasms/pathology
Remote Consultation/*methods
*Robotics
Support, Non-U.S. Gov't
Surgery/*education
Surgical Procedures, Operative/*methods
*User-Computer Interface
AB - This paper deals with the developed researches and applications on telerobotic surgery, devoted to human patients and with training by virtual reality. The researches have been developed in cooperation between Telerobotics Laboratory, Department of Mechanics, Politecnico di Milano, Italy, and Automation and Control Section, Jet Propulsion Laboratory, Pasadena, USA. The researches carried to a telesurgery robotic operation on a dummy on 7th July 1993, by means of satellites communications, to a prostatic biopsy on a human patient on 1st September 1995 with optical fibers, to results on time delay effects, to results on virtual reality applications for training on laparoscopy and surgery. The search implied time delay when the control input originated in Politecnico di Milano, Italy. The results were satisfactory, but also pointed out the need for specific new control transformations to ease the operator's or surgeon's visual/mental workload for hand-eye coordination. In the same research, dummy force commands from JPL to Milan were sent, and were echoed immediately back to JPL, measuring the round-trip time of the command signal. This, to some degree, simulates a contact force feedback situation. The results were very surprising; despite the fact that the ISDN calls are closed and "private" calls, the round-trip time exhibited great variations not only between calls but also within the same call. The results proved that telerobotics and telecontrol may be applied to surgery. Time latency variations are caused by features of communication network, of sending and receiving end computer software. The problem and its solution is also an architectural issue, and considerable improvements are possible. Virtual reality in the application of the research is a strong support to training on virtual objects and not on living beings.

AU - A. Rovetta, F. Lorini and M. R. Canina
TI - Virtual reality in the assessment of neuromotor diseases: measurement of time response in real and virtual environments
SO - Stud Health Technol Inform 1997;44:165-84
MH - *Computer Graphics
*Computer Simulation
Human
Movement Disorders/*diagnosis
Nervous System Diseases/*diagnosis
Support, Non-U.S. Gov't
Time Perception/*physiology
AB - This paper deals with the design and the development of an equipment, called DDI, as acronym for Disease Detector, developed for the quantitative analysis of neuromotor diseases. It measures the reaction of a person evaluating in the motion of one finger of the hand the time response, the velocity of phalanxes, the force exerted from the finger against a button. The condition of motion are ballistic motion, controlled motion guided by vision, controlled motion without vision, motion with a virtual reality modelization on the computer screen. The system performs also the requirements for medical applications and with its portability and accordance to European normative for safety and quality, represents a new step towards the possibility of quantitative analysis of the performances of the human hand both of mechanical phenomenon and electromyographic of neuromotor diseases, which provoke a decrease in upper and lower limbs action.

AU - A. P. Royster, H. M. Fenlon, P. D. Clarke, D. P. Nunes and J. T. Ferrucci
TI - CT colonoscopy of colorectal neoplasms: two-dimensional and three- dimensional virtual-reality techniques with colonoscopic correlation
SO - AJR Am J Roentgenol 1997;169(5):1237-42
MH - Colonic Polyps/diagnosis
Colonoscopy/*methods
Colorectal Neoplasms/*diagnosis
Comparative Study
Data Display
Evaluation Studies
Female
Human
Image Processing, Computer-Assisted/methods
Male
Middle Age
Predictive Value of Tests
Software
Time Factors
Tomography, X-Ray Computed/*methods
*User-Computer Interface
AB - OBJECTIVE: The aim of this study was to compare the diagnostic accuracy of two-dimensional (2D) CT colonography and three-dimensional (3D) virtual colonoscopy with conventional colonoscopy in patients who have suspected colorectal neoplasms. SUBJECTS AND METHODS: Twenty patients were studied (eight women and 12 men; mean age, 53 years; range, 42-85 years). All patients had findings on conventional colonoscopy suggestive of colorectal carcinoma and underwent colonic CT within 3 hr of endoscopy. Two-dimensional CT colonography and 3D virtual colonoscopy images were generated from the same data set that was obtained from thin-section helical CT of the abdomen and pelvis after rectal insufflation of room air. Three-dimensional virtual colonoscopy images were obtained by downloading CT data to a workstation equipped with commercially available software. Volume- and perspective-rendering techniques were used to achieve interactive, 3D virtual "fly-through" examinations of the colonic mucosa. The results of 2D CT colonography and 3D virtual colonoscopy were compared with the findings of conventional colonoscopy and correlated with surgical and pathologic outcome where possible. RESULTS: Twenty masses (defined as intraluminal projections 2 cm or larger in diameter) and 15 polyps (defined as projections smaller than 2 cm in diameter) were identified in our study group. All masses and 14 of 15 polyps were successfully shown on 2D colonography. Three findings of polyps on 2D colonography were false- positive, and one was false-negative. Three-dimensional virtual colonoscopy revealed 19 of 20 masses and 13 of 15 polyps. On conventional colonoscopy, all 20 masses and 13 of 15 polyps were identified, with one false-positive finding of a malignant stricture in a normal colon. Complete examination of the colon was possible in 18 of 20 patients using the 2D technique and in 17 of 20 patients using 3D virtual colonoscopy, whereas conventional colonoscopy showed the entire colon in only 12 of 20 patients. CONCLUSION: Two-dimensional CT colonography and 3D virtual colonoscopy are complementary and effective techniques for examining the colon in patients with suspected colorectal carcinoma. CT techniques offer several advantages over conventional colonoscopy including the ability to detect abnormalities proximal to obstructing carcinomas, accurate localization of abnormalities within the colon, and good patient tolerance. These CT techniques may play an important role in future diagnosis of colorectal cancer and for screening patients at risk.

AU - L. Salvolini, S. Gasparini, S. Baldelli, E. Bichi Secchi and F. Amici
TI - [Virtual bronchoscopy: the correlation between endoscopic simulation and bronchoscopic findings]
SO - Radiol Med (Torino) 1997;94(5):454-62
MH - Adult
Aged
Bronchography
Bronchoscopy/*methods
Carcinoma, Bronchogenic/diagnosis
Comparative Study
English Abstract
Female
Human
Lung Neoplasms/diagnosis
Male
Middle Age
Software
Tomography, X-Ray Computed/instrumentation/methods
*User-Computer Interface
AB - PURPOSE: We carried out a preliminary clinical validation of 3D spiral CT virtual endoscopic reconstructions of the tracheobronchial tree, by comparing virtual bronchoscopic images with actual endoscopic findings. MATERIALS AND METHODS: Twenty-two patients with tracheobronchial disease suspected at preliminary clinical, cytopathological and plain chest film findings were submitted to spiral CT of the chest and bronchoscopy. CT was repeated after endobronchial therapy in 2 cases. Virtual endoscopic shaded-surface-display views of the tracheobronchial tree were reconstructed from reformatted CT data with an Advantage Navigator software. Virtual bronchoscopic images were preliminarily evaluated with a semi-quantitative quality score (excellent/good/fair/poor). The depiction of consecutive airway branches was then considered. Virtual bronchoscopies were finally submitted to double-blind comparison with actual endoscopies. RESULTS: Virtual image quality was considered excellent in 8 cases, good in 14 and fair in 2. Virtual exploration was stopped at the lobar bronchi in one case only; the origin of segmental bronchi was depicted in 23 cases and that of some subsegmental branches in 2 cases. Agreement between actual and virtual bronchoscopic findings was good in all cases but 3 where it was nevertheless considered satisfactory. The yield of clinically useful information differed in 8/24 cases: virtual reconstructions provided more information than bronchoscopy in 5 cases and vice versa in 3. Virtual reconstructions are limited in that the procedure is long and difficult and needing a strictly standardized threshold value not to alter virtual findings. Moreover, the reconstructed surface lacks transparency, there is the partial volume effect and the branches or = 4 pixels phi and/or meandering ones are difficult to explore. CONCLUSIONS: Our preliminary data are encouraging. Segmental bronchi were depicted in nearly all cases, except for the branches involved by disease. Obstructing lesions could be bypassed in some cases, making an indication for endoscopic laser therapy. Future didactic perspectives and applications to minimally invasive or virtual reality-assisted therapy seem promising, even though actual clinical applications require further studies.

AU - S. Samothrakis, T. N. Arvanitis, A. Plataniotis, M. D. McNeill and P. F. Lister
TI - WWW creates new interactive 3D graphics and collaborative environments for medical research and education
SO - Int J Med Inf 1997;47(1-2):69-73
MH - *Computer Communication Networks
*Computer Graphics
Databases
*Education, Medical
Human
Information Storage and Retrieval
Magnetic Resonance Imaging
Programming Languages
Quality of Life
Radiology Information Systems
Remote Consultation
*Research
Satellite Communications
Software
Telemedicine
Teleradiology
*User-Computer Interface
AB - Virtual Reality Modelling Language (VRML) is the start of a new era for medicine and the World Wide Web (WWW). Scientists can use VRML across the Internet to explore new three-dimensional (3D) worlds, share concepts and collaborate together in a virtual environment. VRML enables the generation of virtual environments through the use of geometric, spatial and colour data structures to represent 3D objects and scenes. In medicine, researchers often want to interact with scientific data, which in several instances may also be dynamic (e.g. MRI data). This data is often very large and is difficult to visualise. A 3D graphical representation can make the information contained in such large data sets more understandable and easier to interpret. Fast networks and satellites can reliably transfer large data sets from computer to computer. This has led to the adoption of remote tale- working in many applications including medical applications. Radiology experts, for example, can view and inspect in near real-time a 3D data set acquired from a patient who is in another part of the world. Such technology is destined to improve the quality of life for many people. This paper introduces VRML (including some technical details) and discusses the advantages of VRML in application developing.

AU - S. N. Sarbadhikari
TI - Let your dreams come true through virtual reality
SO - J Indian Med Assoc 1997;95(6):190
MH - Artificial Intelligence
Computer-Assisted Instruction
Human
Image Processing, Computer-Assisted
Multimedia
Robotics
*User-Computer Interface

AU - R. M. Satava
TI - Virtual reality and telepresence for military medicine
SO - Ann Acad Med Singapore 1997;26(1):118-20
MH - Computer Simulation
*Computer-Assisted Instruction
Human
Military Medicine/education/instrumentation/*methods
Monitoring, Physiologic/instrumentation
Remote Consultation/instrumentation/methods
Surgery/education
Telemedicine/*instrumentation/methods
*Therapy, Computer-Assisted
Triage
United States
*User-Computer Interface
*War
AB - For decades, warfighters have been putting in place a sophisticated "digital battlefield", an electronic communication and information system to support advanced technology. Medicine is now in a position to leverage these technologies to produce a fundamental revolution, and the keystone is the digital physician. Today nearly all information about a patient can be acquired electronically, and with the new technologies of teleoperation and telesurgery we can provide remote treatment and even surgery through telemedicine. The following framework for military medicine will leverage upon the current electronic battlefield. A personnel status monitor (PSM) will have a global positioning locator to tell the position of each soldier and a suite of vital signs sensors. When a soldier is wounded, the medic will instantly know the location of the soldier, and how serious is the casualty. This will permit the medic to locate the most critically wounded soldier. Once stabilised, he will be placed in a critical care pod, a fully automated intensive care unit in a stretcher, which will monitor his vital signs, administer fluids and medications and provide environmental protection. If immediate surgery is needed, a remote telepresence surgery vehicle will come to the wounded soldier, the medic will place him in the vehicle, and a surgeon will operate remotely using telepresence surgery from a distant Mobile Advance Surgical Hospital (MASH) to the combat zone. Also, the expertise from any specialist will be available from the rear echelons as far back as the home country. For education and training in combat casualty care, virtual reality simulators are being implemented. This same scenario can be utilised in civilian health care, especially in providing care to patients in remote areas who do not currently have access to simple, let alone sophisticated, health care.

AU - J. Scarborough, J. F. Aiton, J. C. McLachlan, S. D. Smart and S. C. Whiten
TI - The study of early human embryos using interactive 3-dimensional computer reconstructions
SO - J Anat 1997;191(Pt 1):117-22
MH - Computer Communication Networks
*Computer Simulation
Heart/*embryology
Human
*Image Processing, Computer-Assisted
Support, Non-U.S. Gov't
AB - Tracings of serial histological sections from 4 human embryos at different Carnegie stages were used to create 3-dimensional (3D) computer models of the developing heart. The models were constructed using commercially available software developed for graphic design and the production of computer generated virtual reality environments. They are available as interactive objects which can be downloaded via the World Wide Web. This simple method of 3D reconstruction offers significant advantages for understanding important events in morphological sciences.

AU - P. M. Schlag
TI - On the Way to New Horizons: Telemedicine in Oncology
SO - Oncologist 1997;2(2):III-IV
AB - Breathtaking insights into carcinogenesis and tumor biology have been gained mainly by recent technical advances in molecular-biological and genetic techniques. Thus, dimensions of earlier diagnosis and the development of new concepts in therapy arise, which were previously unavailable. There is no doubt that through these techniques the future role and tasks of surgical oncology will change. New indications will result, for example, in the context of prophylactic therapy of hereditary malignant disease or the removal of tissue predisposed to tumors. However, modes of therapy orientated toward molecular biology will still be dependent on specialist surgical interventions in the future. Examples are such innovative concepts of therapy as transport of a therapeutic device to or into tumor cells (e.g., gene gun), or even simply obtaining the necessary tumor tissue for therapy (vaccination with transfected autologous tumor cells). Therefore, the future of surgical oncology will be influenced quantitatively as well as conceptually by new qualitative requirements. Improving precision of the surgical intervention will have to go hand-in-hand with a further reduction in surgical trauma. The consistent use of laser, video, computer and communication technology can be seen as an important predeterminant here for optimizing diagnostic and therapeutic procedures. If correctly guided, the professional experience of the individual surgeon and his personal efficiency can also be positively influenced by the swift conversion of society to multimedia and information technology. Major advances in interdisciplinary communication, as one important factor in the choice and the course of suitable complex therapies in oncology, will have to target and help to overcome former weak spots. Communication in and outside one department or hospital, as well as external communication between different medical disciplines and specialists, is being developed further and increasingly refined. The possibilities of modern technology in addition to verbal exchange include visual and interactive "tele"- communication. This renders a new option to the physician, as without direct patient contact he is able to observe, counsel and actively interact - the latter even more so in the future. In oncology the increase of knowledge thus far has gone hand-in-hand with further specialization. This explains the difficulties one encounters in the correct evaluation of relevant data of one specific patient. Telemedicine will help to focus on the advantages of specialist knowledge by rendering access to all available data. These possibilities should furthermore be accessible during a consultation, an examination or in the course of a surgical intervention. Real-time modalities are referred to as telepresence and exceed by far a mere electronic version of the patient's medical folder. Especially in oncology, interdisciplinary collaboration is immensely important for successful therapy. Preoperative diagnostic data are still to be evaluated according to the intraoperative findings. At this decisive moment, it is necessary to involve specialists of other oncological disciplines. Real-time communication devices have to be present in order to transfer image data and clinical observations and ensure the best possible transmission quality to resident and geographically distant experts. With further technological perfection and widespread availability of interactive consultation, other applications include the "second opinion" in the daily routine. Another fascinating option in oncology is offered by visual computer simulation in virtual reality (VR). Medical data are visualized according to the human perception by the means of scenic simulation. From that point of view, VR technologies represent a practicable user interface between computer technology and the individual human being. Through VR, three- dimensional worlds containing virtual objects, which consist of computer-generated data, are created, which the user may explore and liberally interact with. The perfect simulation of realistic settings offers a method of training that may be extended to the field of oncology, as it has been known for a comparatively long period of time from flight simulators in space and air technology. In contrast, medical training is currently achieved mainly by "training-on-the-job." There is well-proven and widely acknowledged certainty of the tremendous influence that the number of surgical interventions-in other words, the training skills of the surgeon-has on the success of a diagnostic or therapeutic intervention. Previously, the subjective experience of the physician acquired from earlier cases determined his efficiency to a large extent. It was, in addition, influenced essentially by perception, "performance on the day" and personal attitude. The goal must be to strengthen the objective criteria as the basis for consistent decision-making processes and clear instructions for therapy. Strict quality management as practiced in air technology has clearly led to a reduction in accidents, and, accordingly, a similar effect is imaginable in oncology with continuous training using VR simulators, leading to improved therapeutic outcome. Other possibilities for use are principally implied and similarly useful for medical school and postgraduate training. The idea of computer-guided medical procedures or medical robots is therefore no longer a mere utopia. Telepresence, telerobotic and VR techniques should, in principle, effectively support the physician in diagnostic processes and therapy. The responsibility for coordination and sensible use of new technological developments will still remain with the physician, such as improving and simplifying medical procedures. Technology should be used according to the situation, not to adapt the patient to a technocratic environment, but to emphasize human treatment of the individual patient. From the opinion of the telephone being a futile technical invention to the other extreme of computed technology as a substitute for the physician (Dr. Cyber), the future role of telemedical techniques and their potential for medical advantage or support, especially in the field of oncology, should be critically viewed and evaluated.

AU - L. Serra and J. A. Waterworth
TI - Designing virtual selectors for surgeons
SO - Appl Ergon 1997;28(4):269-75
MH - Adult
Analysis of Variance
Computer Graphics
Equipment Design
Human
Male
*Man-Machine Systems
Middle Age
*Surgical Equipment
Time Factors
*User-Computer Interface
AB - Virtual Reality (VR) applications involve the use of manipulators or 'virtual tools' such as pointers, grippers and containers. Manipulation of such tools is a key feature of VR applications. Less attention has been directed towards designing the ways in which users select particular options or information, as they interact in the virtual world, by means of selectors. This is particularly important in the case of professional users, such as surgeons, who typically make heavy use of both selection and manipulation, switching frequently between the two in the course of their work. In this paper we describe the design and evaluation of two types of selector tool for use in medical VR applications. In this account, we provide details of the background behind the research and focus on design aspects of selector tools for use in a particular task context, that of medical surgery planning.

AU - M. Steffin
TI - Computer assisted therapy for multiple sclerosis and spinal cord injury patients application of virtual reality
SO - Stud Health Technol Inform 1997;39:64-72
MH - Human
Movement Disorders/physiopathology/rehabilitation
Multiple Sclerosis/*rehabilitation
Neuronal Plasticity/physiology
Psychomotor Performance/physiology
Spinal Cord Injuries/*rehabilitation
Therapy, Computer-Assisted/*instrumentation
*User-Computer Interface
AB - For patients with multiple sclerosis and spinal cord injury, virtual reality systems provide new methods of assistance with dysmetria, tremor, spasticity, and weakness. Robust mechanisms exist within the central nervous system to produce neuroplastic adaptive responses operative in retraining motor activities. Haptic systems cued by the patient's visual environment can produce force corridors to guide a patient's wrist and hand in the performance of specific tasks. Such haptic application can substantially reduce motor instability and improve performance. Preliminary clinical approaches, using video tremor tracking and manual force application, indicate the extent of the expected improvements attainable with this approach. Refinement of these techniques is proceeding to development of VR systems that will allow more extensive application to the problems of dysmetria, more general instances of tremor, spasticity, and weakness.

AU - M. Steffin
TI - Virtual reality therapy of multiple sclerosis and spinal cord injury: design consideration for a haptic-visual interface
SO - Stud Health Technol Inform 1997;44:185-208
MH - *Computer Graphics
*Computer Simulation
Human
Multiple Sclerosis/*therapy
Spinal Cord Injuries/*therapy
*User-Computer Interface
AB - Multiple sclerosis and spinal cord injury patients can benefit by interaction with a haptic-visual system to increase the accuracy of movements in cases of spasticity, cerebellar tremor, and weakness. The device would apply a counterforce to constrain the upper extremity to a force corridor, a region of force/velocity space, designed to increase movement accuracy. Execution of movements with counterforce assistance under certain conditions improves accuracy and should enable patients to develop enhanced strategies for dealing with the movement disorders resulting from their neurologic deficits. Generation of appropriate force feedback requires dynamic adjustment of feedback plant characteristics and integration of visuospatial information in a virtual reality environment. Sensory augmentation, including compensation for visual and proprioceptive loss, can theoretically also be achieved with this approach. The underlying principles in the development of such a system are presented.

AU - D. Strickland
TI - Virtual reality for the treatment of autism
SO - Stud Health Technol Inform 1997;44:81-6
MH - Autistic Disorder/diagnosis/*therapy
Child
*Computer Graphics
*Computer Simulation
Human
AB - Autism is a mental disorder which has received attention in several unrelated studies using virtual reality. One of the first attempts was to diagnose children with special needs at Tokyo University using a sandbox playing technique. Although operating the computer controls proved to be too difficult for the individuals with autism in the Tokyo study, research at the University of Nottingham, UK, is successful in using VR as a learning aid for children with a variety of disorders including autism. Both centers used flat screen computer systems with virtual scenes. Another study which concentrated on using VR as a learning aid with an immersive headset system is described in detail in this chapter. Perhaps because of the seriousness of the disorder and the lack of effective treatments, autism has received more study than attention deficit disorders, although both would appear to benefit from many of the same technology features.

AU - C. Sutton, R. McCloy, A. Middlebrook, P. Chater, M. Wilson and R. Stone
TI - MIST VR. A laparoscopic surgery procedures trainer and evaluator
SO - Stud Health Technol Inform 1997;39:598-607
MH - Computer-Assisted Instruction/*methods
Educational Measurement/*methods
Human
*Laparoscopy
Surgery/*education
*User-Computer Interface
AB - The key bimanual instrument tasks involved in laparoscopic surgery have been abstracted for use in a virtual reality surgical skills evaluator and trainer. The trainer uses two laparoscopic instruments mounted on a frame with position sensors which provide instrument movement data that is translated into interactive real time graphics on a PC (P133, 16 Mb RAM, graphics acceleration card). An accurately scaled operating volume of 10 cm3 is represented by a 3D cube on the computer screen. "Camera" position and size of target objects can be varied for different skill levels. Targets appear randomly within the operating volume according to the skill task and can be grasped and manipulated with the instruments. Accuracy and errors during the tasks and time to completion are logged. Mist VR has tutorial, training, examination, analysis and configuration modes. Six tasks have been selected and include combinations of instrument approach, target acquisition, target manipulation and placement, transfer between instruments, target contact with optional diathermy, and controlled instrument withdrawal/replacement. Tasks can be configured for varying degrees of difficulty and the configurations saved to a library for reuse. Specific task configurations can be assigned to individual students. In the examination mode the supervisor can select the tasks, repetitions and order and save to a specific file for that trainee. Progress can be assessed and there is the option for playback of the training session or examination. Data analyses permit overall, including task, and right or left hand performances to be quantified. Mist VR represents a significant advance over the subjective assessment of training performances with existing "plastic box" basic trainers.

AU - N. Suzuki, A. Hattori, S. Kai, T. Ezumi and A. Takatsu
TI - Surgical planning system for soft tissues using virtual reality
SO - Stud Health Technol Inform 1997;39:159-63
MH - *Computer Simulation
*Decision Making, Computer-Assisted
Human
Surgical Procedures, Operative/*methods
*User-Computer Interface

AU - R. F. Thoeni
TI - Colorectal cancer. Radiologic staging
SO - Radiol Clin North Am 1997;35(2):457-85
MH - Antibodies, Monoclonal/diagnostic use
Colorectal Neoplasms/*pathology/*radiography
Endosonography
Human
Magnetic Resonance Imaging
Neoplasm Recurrence, Local/pathology/radiography
Neoplasm Staging
Radioimmunodetection
Tomography, Emission-Computed
Tomography, X-Ray Computed
AB - The role of conventional CT scan and conventional MR imaging in assessing patients with colorectal tumors is now well established. Because both techniques have an unacceptably low accuracy for identifying the early stages of primary colorectal cancers (T1, T2N0 or N1 and early T3N0 or N1, or Dukes stage A, B1 and 2, and C1), their routine use for preoperative staging is not recommended. This low staging accuracy is related to the fact that neither method can assess the depth of tumor infiltration within the bowel wall and both have difficulty in diagnosing malignant adenopathy. These distinctions are necessary in order to determine correctly patient prognosis and tumor resectability. If the various publications on CT scan and MR imaging staging of primary colon tumors are summarized, a mean overall accuracy of approximately 70% can be established. The sensitivity for lymph node detection of malignant lymphadenopathy is only about 45%. The sensitivity for detection of positive lymph nodes is better for rectal tumors because any adenopathy in the perirectal area can be considered malignant because benign adenopathy is not seen in this area. For the early stages of colon cancer or recurrent tumor at the anastomotic site, endoscopic ultrasound or TRUS is the method of choice. Both TRUS and MR imaging with endorectal coils can demonstrate the various layers of the rectal wall, but the ultrasonographic examination can be performed at lower cost and is less time-consuming. Despite these limitations CT scan and MR imaging are useful for assessing patients suspected of having extensive disease, including invasion of fat or neighboring organs or metastatic spread to distant sites including, liver, adrenals, lung, and so forth. CT scan and MR imaging are also helpful in the following ways: in determining whether a patient will benefit from preoperative radiation or whether a patient with rectal cancer can undergo a sphincter-saving procedure; for designing radiation ports; and for detecting complications related to the neoplasm, such as perforation with abscess formation or preobstructive ischemia in patients with complete obstruction by tumor. In these cases, management often is based on CT scan and MR imaging findings and cross-sectional follow-up studies can establish the success of treatment. CT scan and MR imaging have a premier role in the detection of recurrent colorectal cancer. CT scan and MR imaging are superior to colonoscopy for diagnosing extrinsic mass-like tumor recurrences and they are the only methods by which patients with total AP resection can be fully evaluated. The overall accuracy of CT scan and MR imaging for detecting recurrent colorectal tumors ranges from 90% to 95%. Following AP resection, CT scan cannot reliably determine whether a soft tissue density in the surgical bed represents recurrent tumor, and it is important to obtain CT scan baseline studies 4 months after surgery and to repeat this examination at 6-month intervals. Scar tissue, even if initially masslike, shrinks over time and after 1 year should be smaller and its margins more sharply defined. Any apparent increase in size of a mass or any demonstration of adenopathy must be considered an indication for biopsy. Recurrent tumors that do not extend to the pelvis or abdominal sidewalls or invade bone or nerves can be resected. Subtle tumor recurrence or tumor foci in small nodes can be detected by PET scan and immunoscintigraphy, but their future role in the diagnostic imaging of colorectal cancer patients depends on the results of ongoing studies. Helical CT scan has the advantages of fast volume scanning associated with optimal bolus delivery, absence of artifacts related to motion, absence of missed slices, and availability of reformations in multiple planes and three-dimensional reconstruction (virtual reality). The role of this technique in patients with colorectal neoplasms has not been defined. (ABSTRACT TRUNCATED)

AU - J. M. Tyszka
TI - Virtual Reality publication of spiral ct-derived three-dimensional models
SO - Front Biosci 1997;2:f2-3
AB - Three-dimensional models can be generated from slice images, such as those obtained from computed tomography (CT) and magnetic resonance imaging (MRI) using a variety of techniques (1-5). A popular method for rendering 3D anatomical models is the creation of polygonal mesh surfaces representing the boundary between tissues. Mesh surfaces can be rendered extremely quickly using conventional personal computers, without recourse to more expensive graphic workstations. The dissemination of three-dimensional (3D) models across the Internet has been made significantly easier by the definition of the Virtual Reality Markup Language (VRML) format. The VRML definition allows the parameters and relationships of 3D objects to be described in a text format. The text file can be transfered from a host computer to a remote client computer through the World Wide Web and viewed using readily available software (See Appendix). VRML is based on the definition of primitive 3D objects such as polygons and spheres. Consequently, the transition from a mesh surface derived from a clinical image data set to a VRML object is relatively simple, allowing for convenient and cost-effective dissemination of 3D clinical models across the internet.

AU - J. G. Vincent, P. Bardos, J. Kruse and D. Maass
TI - End stage coronary disease treated with the transmyocardial CO2 laser revascularization: a chance for the 'inoperable' patient
SO - Eur J Cardiothorac Surg 1997;11(5):888-94
MH - Cohort Studies
Coronary Artery Bypass/contraindications/methods
Coronary Disease/mortality/*surgery
Female
Follow-Up Studies
Hospital Mortality
Human
Intraoperative Care
Laser Surgery/*methods
Male
Middle Age
Myocardial Revascularization/mortality/*methods
Patient Selection
Postoperative Complications/epidemiology
Quality of Life
Reoperation
Survival Rate
Time Factors
AB - OBJECTIVE: The aim of this study is to evaluate the short and mid-term efficacy of the Transmyocardial High Power CO2 Laser Revascularisation (TMLR) as a last resource method for end-stage coronary disease patients. METHOD AND PATIENTS: The High Power CO2 Laser 800 W Heart Laser (PLC Medical Systems) was used since February 1994 to treat 268 patients. In 52% of the cases (140) the indication for TMLR treatment was virtual inoperability by the classical bypass revascularisation. In the other 128 patients (48%), where only an incomplete revascularisation was expected, the TMLR was combined with a feasible bypass revascularisation (CABG). Of all patients, 71% were operated on 1-5 times before and or treated by several percutaneous transluminal coronary angioplasty (PTCA). All patients were sufferers of angina pectoris and most were classified Canadian Cardiac Society (CCS) 3-4, despite the maximal medical treatment. The ejection fraction was normal in 13% of patients only, and in 47% of them it was below 40% (10-68%). RESULTS: The operation itself was generally well tolerated. We lost only one patient at the table. The hospital survival was 89.2%; 88.2% in the combined group and 90.3% in the TMLR only group. After the routine follow up screening 3, 6 and 12 months postoperatively (262 patients--131 TMLR and 131 TMRL/CABG), 40% of the TMLR patients upgraded into the functional class CCS 0-1; the combined group of patients scored up even in 84%. All considering their quality of life to be 'better than years ago'. The ergometry stress test, impossible for most of them before, became feasible and better in 80% of the patients. In the follow up period of the combined group, another 6 (4.7%), and in the TMLR only group, 12 (9.4%) patients died. CONCLUSION: The short and middle term results of this--until now the largest single institution series of TMLR treated patients--were that patients almost without exception were refused for any kind of surgery by several other centres; this shows an acceptable survival rate and a surprising level of pain relief, increased activity and better quality of life then ever expected. In our experience, TMLR is a suitable method for treatment of end stage coronary disease, if all standard measures, medical therapy, PTCA and redo coronary revascularisation possibilities are exhausted. The favourable results imply the question as to whether this method will become an alternative for a second bypass operation in the future. The TMLR as an alternative for heart transplant is already a reality for some of our patients.

AU - D. J. Vining
TI - Virtual colonoscopy
SO - Gastrointest Endosc Clin N Am 1997;7(2):285-91
MH - Colon/*radiography
*Colonoscopy
*Computer Simulation
Human
*Image Processing, Computer-Assisted
Support, U.S. Gov't, Non-P.H.S.
*Tomography, X-Ray Computed
AB - A new method for colon examination, virtual colonoscopy, has been created by combining spiral computed tomography and virtual reality computer technology. If virtual colonoscopy proves equal to or superior to traditional colonoscopy in sensitivity and specificity for cancer screening, it would yield significant clinical and public health benefits because of its potential for increased acceptance among patients as well as its considerably lower cost and risks.

AU - A. Wagner, M. Rasse, W. Millesi and R. Ewers
TI - Virtual reality for orthognathic surgery: the augmented reality environment concept
SO - J Oral Maxillofac Surg 1997;55(5):456-62; discussion 462-3
MH - Anatomy, Cross-Sectional
Computer Graphics
*Computer Simulation
Facial Bones/*surgery
Human
Image Processing, Computer-Assisted
Intraoperative Period
*Models, Anatomic
Osteotomy, Le Fort/*instrumentation
Photogrammetry
Video Recording
AB - PURPOSE: The objective of this study was to apply virtual reality technology to osteotomies of the facial skeleton. MATERIALS AND METHODS: Augmented reality can be considered a hybrid of virtual and real environment spaces, which are coregistered and simultaneously visualized. Using a see-through HMD (head-mounted display) and Interventional Video Tomography intraoperatively, partial visual immersion into a patient-related virtual data space augments the surgeon's perception as shown in an experimental study and clinical applications. RESULTS: Without limiting the surgical judgment, offering continuous observation of the operating field, the presented technology additionally provides visual access to invisible data of anatomy, physiology, and function and thus guarantees unencumbered and fluent surgery. CONCLUSION: Despite current shortcomings, augmented reality technology proved to be particularly well suited for use in osteotomies of the facial skeleton.

AU - F. Watzinger, F. Wanschitz, A. Wagner, G. Enislidis, W. Millesi, A. Baumann and R. Ewers
TI - Computer-aided navigation in secondary reconstruction of post-traumatic deformities of the zygoma [see comments]
SO - J Craniomaxillofac Surg 1997;25(4):198-202
MH - Adult
Computer Graphics
Computer Systems
Data Display
Electromagnetics
Enophthalmos/surgery
Equipment Design
Facial Asymmetry/surgery
Female
Follow-Up Studies
Human
Male
Maxilla/surgery
Middle Age
Osteotomy/*methods
Patient Satisfaction
Television
*Therapy, Computer-Assisted
Tomography, X-Ray Computed
Treatment Outcome
Zygoma/injuries/radiography/*surgery
AB - Augmented reality technology was used in 5 patients for secondary reconstruction of post-traumatic unilateral deformities of the zygomaticomaxillary complex. Three electromagnetic sensors interfaced to a computer-aided navigation system (ARTMA Biomedical Inc.) were utilized. The computer navigation procedure was planned by drawing graphic lines on the CT scan at the level of the zygomatic arch, representing the outer surface of the zygoma. The desired position of the displaced zygoma was planned by mirroring from the healthy side, using a virtual mid-sagittal plane. These virtual graphics were presented intraoperatively on a TV monitor and also on the surgeon's see-through head-mounted display. Correct reduction was assumed when the virtual line representing the position of the zygoma before the osteotomy reached the virtual line defined preoperatively as the desired position. The advantages of the technique presented are that a complete exposure of the zygomatic bone is no longer necessary, and coronal and subciliary incisions may be avoided unless enophthalmos correction has to be carried out, which was in fact necessary in 2 patients. The results of zygomatic reconstruction have been satisfactory in all 5 patients.

AU - G. J. Wiet, R. Yagel, D. Stredney, P. Schmalbrock, D. J. Sessanna, Y. Kurzion, L. Rosenberg, M. Levin and K. Martin
TI - A volumetric approach to virtual simulation of functional endoscopic sinus surgery
SO - Stud Health Technol Inform 1997;39:167-79
MH - *Computer Simulation
Endoscopy/*methods
Human
Image Enhancement
Sinusitis/pathology/*surgery
Support, U.S. Gov't, Non-P.H.S.
Surgery/education
*User-Computer Interface
AB - Advanced display technologies have made the virtual exploration of relatively complex models feasible in many applications. Unfortunately, only a few human interfaces allow natural interaction with the environment. Moreover, in surgical applications, such realistic interaction requires real-time rendering of volumetric data-placing an overwhelming performance burden on the system. We report on a collaboration of an interdisciplinary group developing a virtual reality system that provides intuitive interaction with volume data by employing real-time volume rendering and force feedback (haptic) sensations. We describe our rendering methods and the haptic devices and explain its utility of this system in the real-world application of Endoscopic Sinus Surgery (ESS) simulation.

AU - N. W. Williams
TI - The virtual hand. The Pulvertaft Prize Essay for 1996
SO - J Hand Surg [Br] 1997;22(5):560-7
MH - Biomechanics
*Computer Simulation
Equipment Design
*Hand/physiology
Human
Metacarpophalangeal Joint/physiology
Prosthesis Design
Software
Support, Non-U.S. Gov't
AB - Virtual reality technologies are now at a stage in which the various disciplines can be brought together to construct a virtual human hand. Devices can be constructed to record multiple joint positions accurately in clinical environments. Joint prostheses may be tested virtually before undergoing clinical trials, albeit in a simple way at present, but may eventually be incorporated into a virtual model of the hand and driven by goniometric gloves. This will allow more detailed analyses of implant in situ behaviour. These exciting developments will provide a huge advance in our understanding of the functions of the real hand and also a potential way of assessing outcomes in a simple and repeatable fashion. We are on the edge of a new era in hand surgery when the computer scientist, biomechanic, control engineer, hand therapist and surgeon will be able to alternate between the virtual and the real world in producing better outcomes for patients.

AU - M. S. Wilson, A. Middlebrook, C. Sutton, R. Stone and R. F. McCloy
TI - MIST VR: a virtual reality trainer for laparoscopic surgery assesses performance
SO - Ann R Coll Surg Engl 1997;79(6):403-4
MH - Computer Graphics
Computer-Assisted Instruction/*instrumentation
Education, Medical, Graduate/*methods
Educational Measurement/methods
Human
*Laparoscopy
Support, Non-U.S. Gov't
Surgery/*education

AU - P. N. Wilson, N. Foreman and D. Stanton
TI - Virtual reality, disability and rehabilitation
SO - Disabil Rehabil 1997;19(6):213-20
MH - Activities of Daily Living
Computer-Assisted Instruction
Disabled Persons/*rehabilitation
Ethics, Medical
Human
Patient Education
Safety
Spatial Behavior
*User-Computer Interface
AB - Virtual reality, or virtual environment computer technology, generates simulated objects and events with which people can interact. Existing and potential applications for this technology in the field of disability and rehabilitation are discussed. The main benefits identified for disabled people are that they can engage in a range of activities in a simulator relatively free from the limitations imposed by their disability, and they can do so in safety. Evidence that the knowledge and skills acquired by disabled individuals in simulated environments can transfer to the real world is presented. In particular, spatial information and life skills learned in a virtual environment have been shown to transfer to the real world. Applications for visually impaired people are discussed, and the potential for medical interventions and the assessment and treatment of neurological damage are considered. Finally some current limitations of the technology, and ethical concerns in relation to disability, are discussed.

AU - T. Yamaguchi
TI - Hyper Hospital on the satellite multi-media network
SO - Stud Health Technol Inform 1997;39:271-6
MH - *Computer Communication Networks
*Hospitals
Human
Japan
*Multimedia
*Satellite Communications
Support, Non-U.S. Gov't
*User-Computer Interface
AB - We have been developing the Hyper Hospital, a network based VR mediated medical care system. The Hyper Hospital is composed of two seamlessly integrated environments, that is, the virtual and the real worlds. Of them, its virtual environment expands the conventional medical care system using the virtual reality technology as a principal human interface and a collaboration tool, in the present study, an attempt to extend the Hyper Hospital system to various modalities of communication network is reported. A satellite communication based multi-media network using Internet protocols with the WWW interface is used. Data transmission rate and other performances were measured under various conditions and the satellite network was shown to be suitable to the Hyper Hospital network.

AU - T. Yamaguchi
TI - Performance tests of a satellite-based asymmetric communication network for the 'hyper hospital'
SO - J Telemed Telecare 1997;3(2):78-82
MH - *Hospitals
Human
Pilot Projects
*Satellite Communications
Support, Non-U.S. Gov't
*Telemedicine
*Telemetry
*User-Computer Interface
AB - The Hyper Hospital is a prototype networked telemedicine system which uses virtual reality. We measured the performance of a novel multimedia network based on satellite communications. The network was a hybrid system consisting of a satellite channel in one direction and a terrestrial channel in the other. Each user was equipped with a standard satellite communication receiver and a telephone connection. Requests from the users were sent by modern and telephone line and responses were received by satellite. The user requests were initiated by clicking buttons on a World Wide Web browser screen. The transmission rates of satellite and normal telephone-line communications were compared for standardized text data. Satellite communication was three to five times faster. The transmission rate was also measured for standardized graphical data (GIF format). With a file size of about 400 kByte, satellite-mediated communication was 10 times faster than telephone lines. The effect of simultaneous access on performance was also explored. For simultaneous access of nine users to a single graphics file, 78% of the transmission speed was obtained in comparison with that of a single user. The satellite-based system showed excellent high-speed communication performance, particularly for multimedia data.

AU - A. P. Yim
TI - Training in thoracoscopy in the Asia-Pacific
SO - Int Surg 1997;82(1):22-3
MH - Asia
Clinical Competence
*Education, Medical
*Endoscopy/methods/trends
Forecasting
Human
Internship and Residency
Pacific Islands
Preceptorship
*Thoracoscopy/trends
Video Recording
AB - Video-assisted thoracoscopic surgery should be within the armamentarium of every thoracic surgeon today. Rapid expansion in this field has led to an unprecedented demand from practising surgeons to acquire the new skills. Five levels of training can be described: (1) didactic lectures; (2) demonstration of procedures; (3) practice on simulators; (4) animal surgery; (5) preceptorship. The first four are usually provided in training courses or workshops, while the last requires proctering or attachment to a training centre. The ultimate goal is to integrate all these into the surgical residency programs. Developments in the virtual reality module may revolutionise training in the future.