DEVELOPMENT OF AN EPIDURAL SIMULATOR FOR VIRTUAL TRAINING AND ADMINISTRATION

Introduction:
This project has developed an award winning novel virtual reality epidural training simulator combining a patient-specific 3D interactive model of the lumbar spine with a force feedback from measured patient data. Using aneedle insertion device this allows anaesthetists to train without actual patients, viewing the MRI and Ultrasound position of the needle in the spine. The spine model adapts to patients of different size weight and BMI to simulate variation between patients. Incorrectly administered epidurals can damage the dura mater, causing post-dural puncture headaches. Scoring and feedback is produced for trainees. This novel epidural simulator can help reduce morbidity and injury risks for patients, lowering the NHS insurance claim burden (see video below). Epidural injection is a medical procedure involving injection of anaesthetic between spinal vertebrae.

Dr Neil Vaughan - Winner of 2014 ICT Pioneer Transforming Society Award from EPSRC.


Research problem:
The complex skills involved with administering epidurals, such as locating optimal insertion point and needle angle, can only be learned by practice. However it can be dangerous for novice anaesthetists to practice their first epidural procedure on real patients. This simulator provides a training scenario whereby novice anaesthetists can practice needle insertions on virtual patients of adjustable body mass index (BMI) based on measured patient data. Also the device enables experienced epiduralists to fine tune their epidural technique for obese patients, providing a platform to help experts train novices. The virtual spine model can bend and flex with three degrees of freedom (DOF) and adapt to match the particular size shape and BMI of individual patients.



Techniques and Methods:
The project comprises several physical and virtual components which together make up the epidural simulator. 1) Virtual 3D Graphics lumbar spine model. 2) Physical Tissue Resistance Force Feedback Device. 3) Mannequin with real tuohy epidural needle. 4) Stereographic 3D Display. The physical needle device connects to the computer creating an interface whereby the needle can be realistically inserted into the human mannequin and the computer graphics 3D spine displays the needle position amongst the spinal bones and tissue. On completion of the epidural procedure, a score is calculated relating to the skill and accuracy demonstrated during the procedure.

Novel ideas:
The epidural simulator adjusts to various sizes of patient to closely match patients with various BMI such as obese or young. Also the simulator accurately generates resistance to each ligament as the needle passes through tougher tissues. The graphics display supports stereographic 3D viewing which adds another dimension of realism to the spine model.

Results:
Initial feedback from experienced epidural doctors who have seen the system was positive. The 3D skeleton computer graphics model contains a complete human skeleton finely tuned to model bone shape and can be zoomed or rotated in 3D. To use the device a doctor inserts a real epidural needle into the physical tissue resistance force feedback device. As the needle passes through the various ligaments and tissues between the skin and the epidural space, the device generates pressure against the needle to simulate the tough interspinous ligament and ligamentum flavum. As the needle enters the epidural space there is a "loss of resistance" closely matching what the anaesthetist would encounter with a real patient.


Dr. Neil Vaughan PhD, BSc (Hons)
Post doctoral researcher
Bournemouth University
Faculty of Science & Technology
mobile: 07783527327
email: nvaughan@bmth.ac.uk
Bournemouth University