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Haptic Palpation for Medical Simulation in Virtual Environments
April 2012 (vol. 18 no. 4)
pp. 617-625
S. Ullrich, Virtual Reality Group, RWTH Aachen Univ., Aachen, Germany
T. Kuhlen, Virtual Reality Group, RWTH Aachen Univ., Aachen, Germany
Palpation is a physical examination technique where objects, e.g., organs or body parts, are touched with fingers to determine their size, shape, consistency and location. Many medical procedures utilize palpation as a supplementary interaction technique and it can be therefore considered as an essential basic method. However, palpation is mostly neglected in medical training simulators, with the exception of very specialized simulators that solely focus on palpation, e.g., for manual cancer detection. In this article we propose a novel approach to enable haptic palpation interaction for virtual reality-based medical simulators. The main contribution is an extensive user study conducted with a large group of medical experts. To provide a plausible simulation framework for this user study, we contribute a novel and detailed interaction algorithm for palpation with tissue dragging, which utilizes a multi-object force algorithm to support multiple layers of anatomy and a pulse force algorithm for simulation of an arterial pulse. Furthermore, we propose a modification for an off-the-shelf haptic device by adding a lightweight palpation pad to support a more realistic finger grip configuration for palpation tasks. The user study itself has been conducted on a medical training simulator prototype with a specific procedure from regional anesthesia, which strongly depends on palpation. The prototype utilizes a co-rotational finite-element approach for soft tissue simulation and provides bimanual interaction by combining the aforementioned techniques with needle insertion for the other hand. The results of the user study suggest reasonable face validity of the simulator prototype and in particular validate medical plausibility of the proposed palpation interaction algorithm.

[1] E. Acosta, B. Stephens, B. Temkin, J. A. Griswold, S. A. Deeb, T. M. Krummel, and P. J. Gorman, Development of a haptic virtual environment. In CBMS '99: Proceedings of the 12th IEEE Symposium on Computer-Based Medical Systems, pages 35-39, Washington, DC, USA, 1999. IEEE Computer Society.
[2] M. O. Alhalabi, V. Daniulaitis, H. Kawasaki, and T. Hori, Medical training simulation for palpation of subsurface tumor using HIRO. In First Joint Eurohaptics Conference, 2005 and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems, 2005. World Haptics 2005., pages 623-624, March 2005.
[3] B. Armstrong-Hélouvry, P. Dupont, and C. Canudas de Wit, A survey of models, analysis tools and compensation methods for the control of machines with friction. Automatica, 30 pp. 1083-1138, July 1994.
[4] S. Baillie, A. Crossan, S. Brewster, D. Mellor, and S. Reid, Validation of a bovine rectal palpation simulator for training veterinary students. Studies in Health Technology and Informatics, 111: pp. 33-36, 2005.
[5] S. Baillie, A. Crossan, S. Reid, and S. Brewster, Preliminary Development and Evaluation of a Bovine Rectal Palpation Simulator for Training Veterinary Students. Journal of Cattle Practice, 11(2) pp. 101-106, 2003.
[6] G. Burdea, G. Patounakis, V. Popescu, and R. E. Weiss, Virtual reality-based training for the diagnosis of prostate cancer. Biomedical Engineering, IEEE Transactions on, 46(10) pp. 1253-1260, October 1999.
[7] E. Burns, S. Razzaque, M. C. Whitton, and F. P. Brooks, MACBETH: Management of Avatar Conflict by Employment of a Technique Hybrid. The International Journal of Virtual Reality, 6(2) pp. 11-20, 2007.
[8] H. Chen, W. Wu, H. Sun, and P.-A. Heng, Dynamic touch-enabled virtual palpation. Computer Animation and Virtual Worlds, 18(4-5) pp. 339-348, September 2007.
[9] T. Coles, N. W. John, D. A. Gould, and D. G. Caldwell, Haptic Palpation for the Femoral Pulse in Virtual Interventional Radiology. In Second International Conferences on Advances in Computer-Human Interactions, 2009. ACHI '09., pages 193-198, February 2009.
[10] T. R. Coles, D. A. Gould, N. W. John, and D. G. Caldwell, Virtual Femoral Palpation Simulation for Interventional Radiology Training (Work in Progress Paper). In EG UK Theory and Practice of Computer Graphics, pages 123-126, 2010.
[11] J. Colgate, M. Stanley, and J. Brown, Issues in the haptic display of tool use. In International Conference on Intelligent Robots and Systems, volume 3, pages 140-145, 1995.
[12] A. Crossan, S. Brewster, S. Reid, and D. Mellor, A horse ovary palpation simulator for veterinary training. In S. Brewster and R. Murray-Smith, editors, Haptic Human-Computer Interaction, volume 2058 of Lecture Notes in Computer Science, pages 157-164, Berlin, Heidelberg, July 2001. Springer Berlin Heidelberg.
[13] V. Daniulaitis, M. O. AlhalabiI, H. Kawasaki, Y. Tanaka, and T. Hori, Medical palpation of deformable tissue using physics-based model for haptic interface robot (HIRO). In Proceedings of 2004 IEEE/RSJ International Conference on Intelligent Robots and Systems, pages 3907-3911, 2004.
[14] M. Dinsmore, N. Langrana, G. Burdea, and J. Ladeji, Virtual reality training simulation for palpation of subsurface tumors. In Proceedings of the 1997 Virtual Reality Annual International Symposium (VRAIS '97), pages 54-60, March 1997.
[15] T. Endo, H. Kawasaki, T. Mouri, Y. Doi, T. Yoshida, Y. Ishigure, H. Shimomura, M. Matsumura, and K. Koketsu, Five-fingered haptic interface robot: HIRO III. In Proceedings of the World Haptics 2009 - Third Joint EuroHaptics conference and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems, pages 458-463, Washington, DC, USA, 2009. IEEE Computer Society.
[16] G. J. Gerling and G. W. Thomas, Augmented, Pulsating Tactile Feedback Facilitates Simulator Training of Clinical Breast Examinations. Human Factors: The Journal of the Human Factors and Ergonomics Society, 47(3) pp. 670-681, January 2005.
[17] D. Gomez, G. Burdea, and N. Langrana, Integration of the Rutgers Master II in a virtual reality simulation. In VRAIS '95: Proceedings of the Virtual Reality Annual International Symposium, pages 198-202, 1995.
[18] A. Gregory, A. Mascarenhas, S. Ehmann, M. Lin, and D. Manocha, Six Degree-of-Freedom Haptic Display of Polygonal Models. In the IEEE Visualization, pages 139-146, 2000.
[19] O. Grottke, A. Ntouba, S. Ullrich, W. Liao, E. Fried, A. Prescher, T. M. Deserno, T. Kuhlen, and R. Rossaint, Virtual reality-based simulator for training in regional anaesthesia. British Journal of Anaesthesia, 103(4) pp. 594-600, October 2009.
[20] H.-Y. Han, A. Shimada, and S. Kawamura, Analysis of friction on human fingers and design of artificial fingers. In IEEE International Conference on Robotics and Automation, volume 4, pages 3061-3066, Apr. 1996.
[21] D. Karnopp, Computer Simulation of Stick-Slip Friction in Mechanical Dynamic Systems. Journal of Dynamic Systems, Measurement, and Control, 107(1) pp. 100-103, 1985.
[22] H. Kawasaki, J. Takai, Y. Tanaka, C. Mrad, and T. Mouri, Control of multi-fingered haptic interface opposite to human hand. In Proceedings of the 2003 IEEE/RSJ Intl. Conference on Intelligent Robots and Systems, pages 2707-2712, 2003.
[23] K. J. Kuchenbecker, D. Ferguson, M. Kutzer, M. Moses, and A. M. Okamura, The Touch Thimble: Providing Fingertip Contact Feedback During Point-Force Haptic Interaction. In HAPTICS '08: Proceedings of the 2008 Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems, pages 239-246, Washington, DC, USA, 2008. IEEE Computer Society.
[24] Y. Kuroda, M. Nakao, T. Kuroda, H. Oyama, M. Komori, and T. Matsuda, FEM-based interaction model between elastic objects for indirect palpation simulator. Studies in Health Technology and Informatics, 98: pp. 183-189, 2004.
[25] K.-U. Kyung, J. Park, D.-S. Kwon, and S.-Y. Kim, Real-Time Area-Based Haptic Rendering for a Palpation Simulator. M. Harders, and G. Székely editors, Biomedical Simulation volume 4072, chapter 15, pages 132-141. Springer Berlin Heidelberg, Berlin, Heidelberg, 2006.
[26] L. D., Landau and E. M. Lifshitz, Theory of elasticity, chapter Solid Bodies in Contact, pages 26-31. Butterworth-Heinemann, 3rd edition, 1986.
[27] N. A. Langrana, G. Burdea, K. Lange, D. Gomez, and S. Deshpande, Dynamic force feedback in a virtual knee palpation. Journal of Artifical Intelligence in Medicine, 6(4) pp. 321-333 August 1994.
[28] S. J. Lederman and R. L. Klatzky, Hand movements: A window into haptic object recognition. Cognitive Psychology, 19(3) pp. 342-368, July 1987.
[29] S. McKnight, N. Melder, A. Barrow, W. Harwin, and J. Wann, Psychophysical Size Discrimination using Multi-fingered Haptic Interfaces. In Proceedings of Eurohaptics, pages 274-281, 1994.
[30] A. Nahvi, J. M. Hollerbach, R. Freier, and D. D. Nelson, Display Of Friction In Virtual Environments Based On Human Finger Pad Characteristics. In Proc. ASME Dynamic Systems and Control Division, pages 179-184, 1998.
[31] J. R. Napier, The prehensile movements of the human hand. The Journal of Bone and Joint Surgery, 38-B pp. 902-913, Nov 1956.
[32] M. Nesme, Y. Payan, and F. Faure, Efficient, Physically Plausible Finite Elements. J. Dingliana, and F. Ganovelli editors, Eurographics, pages 77-80, August 2005.
[33] R. Parkes, N. Forrest, and S. Baillie, A mixed reality simulator for feline abdominal palpation training in veterinary medicine. Studies in health technology and informatics, 142 pp. 244-246, 2009.
[34] W. J. Peine, Remote Palpation Instruments for Minimally Invasive Surgery. PhD thesis, Harvard University, 1999.
[35] D. C. Ruspini, K. Kolarov, and O. Khatib, The haptic display of complex graphical environments. In SIGGRAPH '97: Proceedings of the 24th annual conference on Computer graphics and interactive techniques, pages 345-352, New York, NY, USA, 1997. ACM Press.
[36] A. V. Savescu, M. L. Latash, and V. M. Zatsiorsky, A technique to determine friction at the fingertips. Journal of Applied Biomechanics, 24 pp. 43-50, Feb 2008.
[37] G. Schwarz, G. Feigl, R. Kleinert, C. Dorn, G. Litscher, A. Sandner-Kiesling, and N. Bock, Pneumatic pulse simulation for teaching peripheral plexus blocks in cadavers. Anesthesia & Analgesia, 95(6) pp. 1822-1823, 2002.
[38] P.-H. Tsui, L.-Y. Lin, C.-C. Chang, J.-J. Hwang, J.-J. Lin, C.-C. Chu, C.N. Chen, K.-J. Chang, and C.-C. Chang, Arterial pulse waveform analysis by the probability distribution of amplitude. Physiological Measurement, 8(8) pp. 803-812, July 2007.
[39] S. Ullrich, O. Grottke, E. Fried, T. Frommen, W. Liao, R. Rossaint, T. Kuhlen, and T. M.Deserno, An intersubject variable regional anaesthesia simulator with a virtual patient architecture. International Journal of Computer Assisted Radiology and Surgery, 4(6) pp. 561-570, November 2009.
[40] S. Ullrich, J. Mendoza, A. Ntouba, R. Rossaint, and T. Kuhlen, Haptic Pulse Simulation for Virtual Palpation. In Proceedings Bildverar-beitung für die Medizin 2008, pages 187-191, Berlin, Germany, April 2008. Springer Verlag.
[41] S. Ullrich, D. Rausch, and T. Kuhlen, Bimanual Haptic Simulator for Medical Training: System Architecture and Performance Measurements. In JVRC11: Joint Virtual Reality Conference of EGVE - EuroVR, pages 39-46, Nottingham, UK, September 2011. Eurographics Association.
[42] R. Williams II, J. Howell, and R. Conatser Jr, Handbook of Digital Human Modeling for Applied Ergonomics and Human Factors Engineering, chapter Digital Human Modeling for Palpatory Medical Training with Haptic Feedback. CRC Press, 2008.
[43] R. L. Williams II, J. N. Howell, and D. C. Eland, The virtual haptic back for palpatory training. In International Conference on Multimodal Interface 2004, pages 191-197, Pennsylvania, USA, October 2004.
[44] Y. Zhang, R. Phillips, J. Ward, and S. Pisharody, A survey of simulators for palpation training. Studies in health technology and informatics, 142 pp. 444-446, 2009.
[45] C. B. Zilles and J. K. Salisbury, A constraint-based god-object method for haptic display. In Proceedings of the 1995 IEEE/RSJ International Conference on Intelligent Robots and Systems, volume 3, pages 146-151, Pittsburgh, PA, 1995.

Index Terms:
virtual reality,computer based training,finite element analysis,haptic interfaces,medical computing,user interfaces,needle insertion,haptic palpation,medical simulation,virtual environment,palpation examination technique,medical procedure,supplementary interaction technique,medical training simulator,manual cancer detection,virtual reality-based medical simulator,user study,tissue dragging,multiobject force algorithm,pulse force algorithm,arterial pulse simulation,anatomy layer support,haptic device,finger grip configuration,regional anesthesia,corotational finite-element approach,soft tissue simulation,bimanual interaction,Haptic interfaces,Force,Skin,Rendering (computer graphics),Bismuth,Visualization,Phantoms,user studies.,Medicine,physically-based simulation,haptics
S. Ullrich, T. Kuhlen, "Haptic Palpation for Medical Simulation in Virtual Environments," IEEE Transactions on Visualization and Computer Graphics, vol. 18, no. 4, pp. 617-625, April 2012, doi:10.1109/TVCG.2012.46
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