The clinical skills of medical professionals rely strongly on the sense of touch, combined with anatomical and diagnostic knowledge. Haptic exploratory procedures allow the expert to detect anomalies via gross and fine palpation, squeezing, and contour following. Haptic feedback is also key to medical interventions, for example when an anaesthetist inserts an epidural needle, a surgeon makes an incision, a dental surgeon drills into a carious lesion, or a veterinarian sutures a wound. Yet, current trends in medical technology and training methods involve less haptic feedback to clinicians and trainees. For example, minimally invasive surgery removes the direct contact between the patient and clinician that gives rise to natural haptic feedback, and furthermore introduces scaling and rotational transforms that confuse the relationship between movements of the hand and the surgical site. Similarly, it is thought that computer-based medical simulation and training systems require high-resolution and realistic haptic feedback to the trainee for significant training transfer to occur. The science and technology of haptics thus has great potential to affect the performance of medical procedures and learning of clinical skills.
This special section is about understanding the role of touch in medicine and clinical skill acquisition. We identify three major areas of haptics in medicine and clinical skill acquisition, and present papers on each of these topics in the special section:
1. Human haptic perception and motor performance as relevant to medical examinations and procedures. This includes characterization of the nature of haptic information, and how it is perceived, which is necessary to understand how medical professionals use haptics in medical examinations and interventions.
2. Haptic systems and the role of haptics in training and evaluating clinical skills. Haptic simulators address a growing need for effective training and evaluation of clinical skills. Such simulators can be applied in a wide variety of medical professions and disciplines, including surgery, interventional radiology, anaesthesiology, dentistry, veterinary medicine, and the allied health professions. These simulators rely on both technology development (devices, software, and systems) and an understanding of how humans use haptic feedback to perform established clinical skills or learn novel skills.
3. Using haptics to improve the performance of medical interventions. Current trends in interventional medicine remove direct contact between the patient and the clinician. Bilateral teleoperators and “smart” instruments that use tactile sensing/display devices, sensory substitutions systems, and other methods to enhance haptic feedback to a clinician should improve the performance of interventions.
The first two papers address human motor control and learning in medically relevant scenarios. In “Perception and Action in Teleoperated Needle Insertion,” Ilana Nisky, Assaf Pressman, Carla M. Pugh, Fernando A. Muss-Ivaldi, and Amir Karniel examined the effects of time delay on human perception and action in a virtual environment that simulates teleoperated needle insertion. They found that time delay can cause human motor behavior that is consistent with an underestimate of nonlinear tissue stiffness, even though perception of the tissue stiffness is unchanged. By changing teleoperation control parameters, the authors were able to improve human motor performance during the needle insertion task without distorting perception. In “Effect of Grip Force and Training in Unstable Dynamics on Micromanipulation Accuracy,” Eileen Lee Ming Su, Gowrishankar Ganesh, Che Fai Yeong, Chee Leong Teo, Wei Tech Ang, and Etienne Burdet stu-died whether people's micromanipulation (as in microsurgery) abilities can be improved through training in an unstable dynamic environment. Users who trained in an environment that amplified position errors through the introduction of unstable dynamics performed straight-line point-to-point movements with less error and variability than users who trained in an environment with no intro-duced dynamics. These papers not only provide inspiration for the design of medical teleoperators and trainers, but also give insight to fundamental aspects of human motor control and perception.
The next three papers are related to the design of haptic simulators for training medical procedures, and present implementations involving needle insertion. In “Constraint-Based Haptic Rendering of Multirate Compliant Mechanisms,” Igor Peterlík, Mourad Nouicer, Christian Duriez, Stéphane Cotin, and Abderrahmane Kheddar address the challenge of simulating complex interactions between medical devices and anatomical structures. Through a generic formulation using virtual mechanisms to describe both instruments and deformable soft tissue, the authors implement physically based models and solve in real time for the motions and forces resulting from interactions. The approach was applied to simulate flexible needle insertion. In “Haptic Simulator for Prostate Brachytherapy with Simulated Needle and Probe Interaction,” Orcun Goksel, Kirill Sapchuk, and Septimiu E. Salcudean present a simulator design for a specific medical procedure
prostate brachytherapy. The authors use a finite-element 3D model of deformable tissue and its interaction with both a flexible needle delivering radioactive seeds and a transrectal ultrasound probe. The simulator allows both the needle and the probe to be controlled (and felt) using haptic devices, and trade-offs between accuracy and speed are discussed. In “Integrating Haptics with Augmented Reality in a Femoral Palpation and Needle Insertion Training Simulation,” Timothy Coles, Nigel John, Derek Gould, and Darwin Caldwell integrate haptics with augmented reality to create a simulator for realistic palpation and needle inser-tion into the femoral artery. The system allows both force and tactile feedback through multiple linked commercial haptic devices and a novel hydraulic device for a pulse-like effect. A face and content validation study was performed with interventional radiology experts, demonstrating high face validity of the system.
The last paper describes new technology, and its evaluation, for providing haptic feedback during a medical intervention. In “Tool Contact Acceleration Feedback for Telerobotic Surgery,” William McMahan, Jamie Gewirtz, Dorsey Standish, Paul Martin, Jacquelyn A. Kunkel, Magalie Lilavois, Alexei Wedmid, David I. Lee, and Katherine J. Kuchenbecker describe an approach that acquires tool contact acceleration signals from the patient-side manipulator of a teleoperated robot-assisted surgery system and displays corresponding vibrations to the user via sound and voice coil actuators. Experiments with the system, called VerroTouch, revealed that users appreciated the inclusion of tool contact acceleration feedback, although it did not have measurable impact on user task performance. This work represents significant progress toward a practical and compelling means to provide haptic feedback during robot-assisted surgery.
Allison M. Okamura
William S. Harwin
The papers in this special section were selected from a large number of submissions, which reflects the research community's strong interest in haptics in medicine and clinical skill acquisition. We are grateful to the numerous reviewers who provided high quality and timely reviews. Several ToH editorial board members, in particular Ed Colgate and Lynette Jones, went above and beyond the call of duty to support this special section. We would also like to express our thanks to the ToH editorial staff, Mercy Frederickson and Pilar Hawthorne, for their guidance and gentle encouragement to stay on schedule. Creating this special section was extremely rewarding due to the haptics community's enormous interest in this topic and enthusiastic involvement in the peer review process.
A.M. Okamura is with the Mechanical Engineering Department, Stanford University, Stanford, CA 94305. E-mail: firstname.lastname@example.org.
C. Basdogan is with the College of Engineering, Koc University, Istanbul, 34450 Turkey. E-mail: email@example.com.
S. Baillie is with the Royal Veterinary College, London, AL9 7TA United Kingdom. E-mail: firstname.lastname@example.org.
W.S. Harwin is with the School of Systems Engineering, University of Reading, Reading RG6 6AY, United Kingdom.
For information on obtaining reprints of this article, please send e-mail to: email@example.com.
Allison M. Okamura
received the BS degree from the University of California, Berkeley, in 1994, and the MS and PhD degrees from Stanford University, Stanford, CA, in 1996 and 2000, respectively, all in mechanical engineering. She is currently an associate professor in the Mechanical Engineering Department at Stanford University, and was previously at The Johns Hopkins University. She has been an associate editor of the IEEE Transactions on Haptics
, and an editor of the IEEE International Conference on Robotics and Automation. Professor Okamura received the 2004 US National Science Foundation CAREER Award, the 2005 IEEE Robotics and Automation Society Early Academic Career Award, and the 2009 IEEE Technical Committee on Haptics Early Career Award. Her research interests include haptics, teleoperation, robot-assisted surgery, tissue modeling and simulation, rehabilitation robotics, and prosthetics. She is a fellow of the IEEE.
received the PhD degree in mechanical engineering from Southern Methodist University. He is a faculty member in the mechanical engineering and computational sciences and engineering programs in the College of Engineering, Koc University, Istanbul. Before joining Koc University, he worked at NASA-JPL/Caltech, the Massachusetts Institute of Technology, and Northwestern University Research Park. His research interests include haptic interfaces, robotics, mechatronics, biomechanics, medical simulation, computer graphics, and multimodal virtual environments. He is currently an associate editor of the IEEE Transactions on Haptics
and Computer Animation and Virtual Worlds
(MRCVS) is a senior lecturer at The Royal Veterinary College, London, United Kingdom. She received her veterinary degree from the University of Bristol in 1986 and worked as a veterinarian in general practice for 20 years. She earned her master's and doctorate degrees in computing science in 2003 and 2006, respectively, from the University of Glasgow. She is the creator of several haptic simulators, including the Haptic Cow, now widely used in veterinary training. Her research interests include validation of haptic simulators, psychophysics, and contextualized simulation. She has received several awards for her work in education and with haptic simulators including the Times Higher Education Awards Most Innovative Teacher of the Year 2009 and was one of the UKRC's Women of Outstanding Achievement in Science, Engineering, and Technology in 2010.
William S. Harwin
received the BA and PhD degrees in engineering from Cambridge University and a master's degree in bioengineering from Strathclyde University. He is currently the professor of interactive and human robotics at the University of Reading's School of Systems Engineering having previously worked at the Alfred I. DuPont Institute Delaware, the University of Delaware, and the University of Cambridge. His research interests are in robotics, haptics, and the human system. His research interests include medical and rehabilitation robots, and neuro-muscular modelling, robots for stroke rehabilitation, haptic interfaces with multitouch and with large range of movements at high speeds. He is a member of the IEEE.