Desktop-based computer-assisted orthopedic training system for spinal surgery.

BACKGROUND: Simulation and surgical training has moved on since its inception during the end of the last century. The trainees are getting more exposed to computers and laboratory training in different subspecialties. More needs to be done in orthopedic simulation in spinal surgery. AIMS: To develop a training system for pedicle screw fixation and validate its effectiveness in a cohort of junior orthopedic trainees. TRAINING SYSTEM: Fully simulated computer-navigated training system is used to train junior orthopedic trainees perform pedicle screw insertion in the lumbar spine. Real patient computed tomography scans are used to produce the real-time fluoroscopic images of the lumbar spine. MATERIAL AND METHODS: The training system was developed to simulate pedicle screw insertion in the lumbar spine. A total of 12 orthopedic senior house officers performed pedicle screw insertion in the lumbar spine before and after the training on training system. The results were assessed based on the scoring system, which included the amount of time taken, accuracy of pedicle screw insertion, and the number of exposures requested to complete the procedure. RESULTS: The result shows a significant improvement in amount of time taken, accuracy of fixation, and the number of exposures after the training on simulator system. This was statistically significant using paired Student t test (p < 0.05). CONCLUSION: Fully simulated computer-navigated training system is an efficient training tool for young orthopedic trainees. This system can be used to augment training in the operating room, and trainees acquire their skills in the comfort of their study room or in the training room in the hospital. The system has the potential to be used in various other orthopedic procedures for learning of technical skills in a manner aimed at ensuring a smooth escalation in task complexity leading to the better performance of procedures in the operating theater.

Computer-assisted orthopedic training system for fracture fixation.

BACKGROUND: Surgical training has been greatly affected by the challenges of reduced training opportunities, shortened working hours, and financial pressures. There is an increased need for the use of training system in developing psychomotor skills of the surgical trainee. AIMS: To develop the training system for fracture fixation and validate its effectiveness in a cohort of junior orthopedic trainees. TRAINING SYSTEM: Computer-navigated training system uses the 2 sets of images from the c-arm while the registration phantom is placed in the fluoroscopic imaging space which permits determination of the position of the x-ray source and the image plane that then guides the trainee to navigate the surgical instruments into the three-dimensional space. No further c-arm exposures are taken during the entire procedure. MATERIAL AND METHODS: The training system was developed to simulate dynamic hip screw fixation. Twelve orthopedic senior house officers performed dynamic hip screw fixation before and after the training on the training system. The results were assessed based on the scoring system that included the amount of time taken, accuracy of guidewire placement, and the number of exposures requested to complete the procedure. RESULTS: The result shows a significant improvement in the amount of time taken, accuracy of fixation, and the number of exposures after the training on the simulator system. The paired student t-test was used and statistically significant results were obtained (p-value< 0.05). CONCLUSION: Computer-navigated training system appears to be a good training tool for young orthopedic trainees. This system can be used to augment training in the operating room and trainees acquire their skills in a "nonthreatening and unhurried environment." The system has the potential to be used in various other orthopedic procedures for learning of technical skills in a manner aimed at ensuring a smooth escalation in task complexity leading to the better performance of procedures in the operating theater.

Enhanced stereographic x-ray images.

This project extends previous work on stereographic projection of 2D x-ray images and aims to overcome a number of problems, namely: confusing stereo cues; distortion between stereo pairs; and increased radiation exposure from additional x-ray images. Images are distortion corrected and a polygonal representation of a bone fitted to the x-ray image, to approximate the bone surface. The polygonal representation is rendered and blended with the x-ray image to add surface detail, without obscuring salient features within the original x-ray. A reduction in x-ray exposure by using a stereo pair of computer-generated polygonal bone images blended with a mono x-ray image is investigated. An experiment provides evidence that depth perception is increased with the inclusion of bone surface rendering, and is achievable with a mono x-ray image.