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FP7-ICT-2013-10 – 5.5 – RASimAs Revised Specification
Project No.
610425 Deliverable Report
D5.5, 31/01/2016, Revision: Final Version
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Deliverable 5.5
RASimAs Revised Specification
Dissemination
Level Type Delivery Month
Confidential (CO)
Restricted (RE)
Public (PU)
Report (R)
Prototype (P)
Other (O)
27
Deliverable D5.5
Milestone not applicable
Work Package
Leader SINTEF
Task/Deliverable Leader SG + SINTEF
Deliverable Due
Date 31.01.2016
Date of Submission 01.02.2016
Version 1.0
Keywords Simulator; assistant
Internal Report Review Done by management body
FP7-ICT-2013-10 – 5.5 – RASimAs Revised Specification
Project No.
610425 Deliverable Report
D5.5, 31/01/2016, Revision: Final Version
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Version Control
Version Date Author (Name, Institution) Comments
1.0 30.01.2016 Hassan Syed - SG Initial version, RASim
2.0 30.01.2016 Frank Lindseth – SINTEF Initial version, RAAs based on
D5.3
3.0 01.02.2016 Julia Oliveira – UKA-IMI Format
3.1 11.02.2016 Thomas Deserno – UKA-IMI Final check
3.2 15.02.2016 Frank Lindseth – SINTEF Final version
1.X = 1st version circulating between the members / 2.X = 2nd version following comments of members
/ 3.X = 3rd final version
FP7-ICT-2013-10 – 5.5 – RASimAs Revised Specification
Project No.
610425 Deliverable Report
D5.5, 31/01/2016, Revision: Final Version
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Table of Contents
1 ABSTRACT .......................................................................................................................... 6
2 INTRODUCTION ................................................................................................................... 6
2.1 Context ....................................................................................................... 6
2.1.1 SIMULATOR ............................................................................................... 6
2.1.2 ASSISTANT ................................................................................................ 7
2.2 Objectives ................................................................................................... 8
2.2.1 Deliverable description ............................................................................... 8
3 RASIM SPECIFICATIONS ..................................................................................................... 8
3.1 Modular View of Simulator .......................................................................... 8
3.2 Client Server Architecture ........................................................................... 9
3.3 Simulator Core System Flow .................................................................... 10
3.4 H3D Module .............................................................................................. 11
3.5 SOFA Module ........................................................................................... 12
3.6 Ultrasound Simulation Module .................................................................. 13
3.7 Course-ware Module ................................................................................ 14
3.8 Ultrasound-guided Framework ................................................................. 15
3.9 Electrical Nerve Stimulator-guided Framework ......................................... 15
3.10 RASim Implementation ............................................................................. 16
3.10.1 Hardware Specification ............................................................................. 16
3.10.2 Software Implementation .......................................................................... 19
3.11 Deviations/Problems ................................................................................. 19
4 RAAS SPECIFICATIONS ..................................................................................................... 20
4.1 Deviations/Problems ................................................................................. 20
5 FURTHER WORK................................................................................................................ 20
6 PUBLICATION/DISSEMINATIONS ......................................................................................... 20
7 REFERENCE DOCUMENTS ................................................................................................. 20
FP7-ICT-2013-10 – 5.5 – RASimAs Revised Specification
Project No.
610425 Deliverable Report
D5.5, 31/01/2016, Revision: Final Version
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List of Figures
Figure 1. Simulator training environment system overview. ..................................................... 7
Figure 2. Modular diagram for proposed training environment. ............................................... 9
Figure 3. Simulator training environment client server architecture. ...................................... 10
Figure 4. H3D core simulation based system flow diagram. .................................................. 11
Figure 5. H3D core module communication with SOFA and US module. .............................. 12
Figure 6. SOFA module communication via H3D with other modules. .................................. 13
Figure 7. Ultrasound module communication with H3D module and others via H3D. ............ 14
Figure 8. Course-ware module communication with H3D API and simulator. ........................ 15
Figure 9. Workbench computer for Simulator core. ................................................................ 16
Figure 10. Prototype view (Input and output devices) and base platform. ............................. 17
Figure 11. A basin shaped leg placed in middle of the base platform to augment the Leg
Femoral block area. The basin offers replaceable oasis foam in the middle section. ..... 17
Figure 12. The needle (Braun 50 mm) is attached in front of to the haptics stylus allowing for
movement in x, y, z, direction, pitch, yaw and limited rotation. ....................................... 18
Figure 13. 3D printed copy of a real probe with sensor embedding location for the Ascension
tracker solution. ............................................................................................................... 19
Figure 14. USB based rotating knob for electrical stimulation impulse control. ..................... 19
FP7-ICT-2013-10 – 5.5 – RASimAs Revised Specification
Project No.
610425 Deliverable Report
D5.5, 31/01/2016, Revision: Final Version
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Acronyms
Courseware: An application to maintain/track the user training scenarios and profiles and
serves as primary user interface.
EN: electrical nerve stimulation.
H3D: H3DAPI is an open source haptics software development platform that uses the open
standards OpenGL and X3D with haptics in one unified scene graph to handle both graphics
and haptics. H3DAPI is cross platform and haptic device independent. It enables audio
integration as well as stereography on supported displays. (http://www.h3dapi.org)
RAAs: Regional Anaesthesia Assistant system
RASim: Simulator prototype in the RASimAs project.
RASimAs: Regional Anaesthesia Simulator and Assistant.
RA: Regional Anaesthesia.
SOFA: Simulation open framework architecture, SOFA is an Open Source framework
primarily targeted at real-time simulation, with an emphasis on medical simulation.
(http://www.sofa-framework.org)
US Images: Ultrasound images.
US Module: Ultrasound guided needle insertion simulation module providing virtual
ultrasound images for needle insertion assistance.
Web services: A Web service is a method of communication between two electronic devices
over a network. It is a software function provided at a network address over the web
interface.
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Project No.
610425 Deliverable Report
D5.5, 31/01/2016, Revision: Final Version
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1 Abstract
This document (Deliverable 5.5) aims at presenting the RASimAs Simulator and Assistant
specification. Regarding the simulator, the revised specifications were based on the
adjustments on previously defined specifications Deliverable 5.1 (RASim specifications). We
came up with various hardware solutions for the RASim prototype and according to the
clinicians suggestions, we focused on the optimal positioning of haptic device, improvements
for the needle attachment tool, mannequin redesign and portable base platform setup.
Hence, this document defines the revisions in the software architecture and hardware
platform design leading to the improvement in RASim prototype. With respect to the
assistant, this document is similar to Deliverable 5.3 (RAAs Specification).
2 Introduction
2.1 Context
2.1.1 SIMULATOR
This document aims at presenting the RASimAs simulator specification which is an extension
to the deliverable 5.1 (specifications of RASim). The purpose for this report is to layout the
revisions and improvements done in the specifications of simulator and it modules used in
development of the platform. This document further defines the change/revision in the
module integration, interfaces and communication layers between the modules to be
developed in the RASim platform.
The system has been proposed by experts to replicate the basic regional anesthesia
practices. Figure 1 shows the RASimAs training environment overview, also referred to as
RASim (for Regional Anesthesia Simulator). The user interacts with the system through a
work bench client computer. The system consists of three components, namely the input
interface, the output interface, and the core simulation software. The input interface primarily
connects the input devices, such as the haptic devices, the 3d tracker, the rotating knobs etc.
The output interface is responsible for showing updated views to its users.
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Figure 1. Simulator training environment system overview.
The output views are divided in three views, the first is patient view that shows the scene
being rendered, including the virtual patient and the needle. Second is the ultrasound view
showing the update for ultrasound images while moving the ultrasound tracker probe. The
third view is the course-ware view, which holds the users data and details such as available
scenarios, profile records, and server updates (manage curriculum/training lessons, replay
lessons, scoring). The system back-end (core) is the simulator program. Further details are
given in Section 2 (modular view) and section 4 simulator core.
2.1.2 ASSISTANT
In the RASimAs project, a RAAs system for assisting the physician in performing ultrasound-
guided RA procedures has been developed. In this document, an in-depth specification of
the Assistant is provided. The Assistant is a single-rack system consisting of an ultrasound
scanner with embedded tracking of both the probe and needle, as well as a high-end RAAs
computer. The Assistant software provides fully automatic real-time functionality for placing
the probe correctly relative to the anatomy and interpreting the US images. It is addressing
the main challenges in ultrasound-guided RA as stated by the clinical partners in the project.
By finding an optimal ultrasound view and identifying the target nerve and key landmarks,
like arteries in real-time 2D US images, the Assistant is aiding the operator to overcome
these challenges. This is further enhanced by a 3D view showing 3D reconstructions of
important structures like the artery generated from ultrasound data and a generic model of
the surrounding anatomy that automatically snaps into place for anatomical reference when
enough ultrasound data has been acquired.
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2.2 Objectives
2.2.1 Deliverable description
As stated in the Description of Work, the deliverable that constitutes this plan is described as
follows:
D5.5 RASimAs Revised Specification
Adjustments on previously defined specifications coming from the clinical
evaluation and leading to improvements of the prototype.
3 RASim Specifications
3.1 Modular View of Simulator
Figure 2 sketches the modular architecture of the simulator environment. H3D viewer serves
as core API to communicate with additional modules and metadata exchange. H3D as
simulator core running on CPU level is responsible for metadata exchange between the other
modules. It simulates information such as scene being rendered, the needle position, the
probe position, the knob status and haptic feedbacks. This simulation rendering is mainly
done in collaboration with the SOFA module for soft muscular deformations, the US module
for simulation of ultrasound guided images, the courseware module for keeping track for the
user metrics (profile and scenarios) and the electrical nerve stimulator module to stimulate
electrical impulse guided needle insertions.
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Figure 2. Modular diagram for proposed training environment.
In later sections of this document revised version of every module is defined in further
details. No such deviation or any significant revision was done for this part (i.e. the design
follows the specification presented in Deliverable D5.1). An additional interface has been
provided for courseware and Ultrasound module to exchange metadata. This interface has
boosted the simulation performance with real time ultrasound displays. This interface is
shown in the above figure.
3.2 Client Server Architecture
The interaction of the simulator (training environment) with the server is described in the
system architecture document for RASimAs (Deliverable D2.2, “System Architecture”). The
communication between the server and training environment is based on web-services
(Figure 3). A local copy of server side database (available x3d models) in the training
environment is maintained to help the system run in offline mode (when network services are
not accessible). The training system is responsible to connect with the remote server
database and download updates and models required by consuming web-services.
No such deviation or any significant revision was done for this part (i.e. the design follows the
specification presented in Deliverable D5.1). However, cloud based synchronizing service
has been added as an addition feature to the web services hosted by the remote server. This
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feature allows all the training environment to sync simultaneously with the services being
offered by the server.
Figure 3. Simulator training environment client server architecture.
3.3 Simulator Core System Flow
As depicted in Figure 4 a minor change has been suggested in the core simulation flow
environment compared to the first specification of RASim. An interface has been introduced
in between the ultrasound module and courseware to communicate through TCP/IP.
Courseware is the module responsible for displaying the ultrasound images therefore to
improve the performance of the system the courseware has been given direct access to the
ultrasound module Images/metadata.
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Figure 4. H3D core simulation based system flow diagram.
3.4 H3D Module
The H3D API controls the simulator core. It is responsible for the interaction between the
other functions modules (SOFA, US, Course-ware). Initially the user interacts with the
course-ware module user interface to select user desired scenarios and proceeds with
loading process. The H3D module depicted in Figure 5, loads the selected scenario in 3D
simulation environment and proceeds with the initialization of the haptics force feedback
controls, the connections and data exchange between the SOFA module for soft body
simulations/deformations and initialization of 3D tracker device. No such deviation or any
significant revision was done for this part (i.e. the design follows the specification presented
in deliverable 5.1).
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Figure 5. H3D core module communication with SOFA and US module.
3.5 SOFA Module
In the RASim platform SOFA handles all the mechanical / soft body deformations. Its main
tasks consists in computing and managing:
The deformation of the skin and other tissue layers, using Co-rotational tetrahedral
Finite Element Methods,
The needle manipulation on the different tissue types, with skin penetration and
tissue friction,
The physiological response of the nerves
The muscles contraction, depending on the physiological response and soft tissue
properties,
The user interactions and haptic force feedback.
Multiple parameters can be customized such as the stiffness of the muscles, the
characteristics of the needle, etc.
Figure 6 outlines the interaction between SOFA and H3D core, the control of the needle is
managed by H3D which can support various haptic devices such as the Sensable Omni
currently used for testing purpose. SOFA is heavily based on a mapping mechanism, where
mechanical, visual and collision models are different but linked together in one mechanism.
No such deviation or any significant revision was done for this part (i.e. the design follows the
specification presented in deliverable 5.1).
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Figure 6. SOFA module communication via H3D with other modules.
3.6 Ultrasound Simulation Module
The ultrasound (US) simulation module is the primary component to generate the virtual US
images needed for the training of ultrasound guided needle insertion procedure. The
ultrasound generator module utilizes a fast ray tracing based approach to simulate US
interactively. The process is divided in two stages: a configuration step that is executed just
once and the simulation step, which will be executed for each frame.
During the configuration step, the US module receives meta-data from the H3D module and
loads simulation parameters, tissue properties and the anatomy models from disk. These are
then processed to setup and fill according tissue textures and data structures needed during
the simulation process.
In each simulation step, the actual position and orientation of the virtual probe and the needle
as well as the current deformation state of the anatomy in form of a tetrahedral mesh (result
of the SOFA module), are received from the H3D module.
The position and orientation of the virtual US probe determines the origin and direction of the
rays that are traced through the scene under consideration of the deformation state. As
illustrated in Figure 7, the US module communicates with the H3D module using prefixed
H3D interface.
Since the Ultrasound generation module is based in GPU computing and our simulation
virtual patient view is running on CPU. An additional interface based on TCPIP
(subscriber/receiver) communication has been implemented to let the courseware directly
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subscribe with the US module and receive the ultrasound generated images. The main
purpose of this interface is to boost the simulation performance making it real time.
Figure 7. Ultrasound module communication with H3D module and others via H3D.
3.7 Course-ware Module
The course-ware module is the main component that renders the Ultrasound view as well as
records the metrics and send it to the server side database. Initially, the user is required to
log into the course-ware module and receive the statistics/profile data from server. The data
will include the user training hours and metrics. Based on the user level and metrics, course-
ware module will provide available training scenarios for users to load and practice number
of hours on a given protocol. The course-ware module is designed to connect with the H3D
as core module and load meta-data for selected scenario through server storage. This
module performs the user authentication process by contacting the User management
subsystem of the RASim platform (deliverable document 2.2). This subsystem is responsible
for the storage of the users’ credentials information and users profiles.
The system flow diagram for the Courseware is shown in Figure 8, other than given an
interface to communicate directly with ultrasound module for receiving raw image data
(giving a boost to the real-time ultrasound simulations view) no such deviation or any
significant revision was done for this part (i.e. the design follows the specification presented
in deliverable 5.1).
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Figure 8. Course-ware module communication with H3D API and simulator.
3.8 Ultrasound-guided Framework
The ultrasound guided regional anesthesia procedure has been center of attention in RASim
development. This module has been development as most important procedure in simulation
environment.
Other than a few changes in modules integration, no such deviation or any significant
revision was done for this part (i.e. the design follows the specification presented in
deliverable 5.1).
3.9 Electrical Nerve Stimulator-guided Framework
Regional Anesthesia (RA) is a challenging medical task whose success relies on accurate
localization of peripheral nerve proximity. Often, electrical stimulation is used to guide a
needle in localizing the nerves. To allow medical staff practice this difficult procedure, RASim
involves simulator build with electrical nerve stimulator (EN) module. This modules performs
real-time simulation that emulates the physiological behaviors during the electrical
stimulation.
No such deviation or any significant revision was done for this part (i.e. the design follows the
specification presented in deliverable 5.1).
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3.10 RASim Implementation
The interaction of the RASim (training environment) with the server is described in section 3.
To fulfill the simulation requirements, following are the revised specifications of hardware and
software implementation:
3.10.1 Hardware Specification
a) Computer
A machine is to host the RASimAs development platform (client machine). Following are the
minimum requirements for the machine.
The following are the minimum hardware and operating system requirements for the training
environment (Figure 9):
Windows-7 / Linux platform.
Tested with GTX980 graphics card (CUDA capability 3.0, 3D vision support).
Minimum Intel i7 core processor.
500GB, hard disk space.
8GB Ram.
Figure 9. Workbench computer for Simulator core.
b) Platform
The base platform involves positioning of the haptics device and the mannequin relative to
each other with an ease to perform the regional anesthesia procedure. To serve this
purpose, the prototype includes 3D magnetic tracker (Transmitter) solution to work with
ultrasound probe. A plain wooden plate used as base for placing the devices on it.
The haptic device by default placed on right corner for right handed persons. However, the
device can be moved on left hand side for left hand users. The middle of base platform is
portion for mannequin imitating the leg portion of femoral block area (Figure 10).
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Figure 10. Prototype view (Input and output devices) and base platform.
c) Mannequin
To represent the patient area of needle insertion having capabilities to simulate real human
tissue and to further hold the needle in position during needle insertion simulation. The base
platform was designed keeping in view the support for both left and right handed procedures.
The middle part of the base platform has been developed to imitate the femoral block area of
human Leg. Keeping in view that the needle insertion procedures might need replacement of
mannequin after number of needle pops, RASim base platform offers portability and replace
ability for oasis foams (low cost) after few hundred needle insertions. The new base platform
(mannequin) is shows in Figure 11.
Figure 11. A basin shaped leg placed in middle of the base platform to augment the
Leg Femoral block area. The basin offers replaceable oasis foam in the middle
section.
d) Views (Monitor display)
To display H3DAPI simulation view, Patient, US view, Course-ware view.
Standard/3D computer monitor is proposed as hardware solution.
No such deviation or revision was done for the display units.
e) Haptic Device
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Initial tests were carried out by the experts based on the specification in deliverable 5.1 using
haptic device with needle mounted/attached on the side. It was discovered that the needle
insertion procedure was not user friendly, the haptic stylus was interfering with the ultrasound
probe, as well as it was not easy to hold the needle (confusing with stylus) since most of test
users were holding the stylus pen instead of the needle tool.
Keeping in view the above reported issues a new design requirement was presented to
overcome these issues. The new requirements demanded that needle be attached at the tip
of the stylus to make it easy to insert under the plane of the ultrasound probe and not letting
it interfere the probe. Based on the design requirement an upgrade to the needle tool was
done as shown in Figure 12.
f) Ultrasound Probe
To simulate the probe and the probe interaction during RA procedure. A 3D printed probe
embedded with magnetic tracked sensor has been designed for the RASim prototype. The
Ascencion 3D-Guidance trakSTAR magnetic tracker (model 800 http://www.ascension-
tech.com/medical/trakSTAR.php) has been placed inside the probe giving 6 DOF freedom to
move probe as done in realistic environments shown in Figure 13.
Figure 12. The needle (Braun 50 mm) is attached in front of to the haptics stylus
allowing for movement in x, y, z, direction, pitch, yaw and limited rotation.
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Figure 13. 3D printed copy of a real probe with sensor embedding location for the
Ascension tracker solution.
g) Electric Knob
To simulate and control the electrical nerve stimulation a simple rotating usb based knob is
used for RASim prototype which can be seen in Figure 14. No such deviation or revision was
done for the knob.
Figure 14. USB based rotating knob for electrical stimulation impulse control.
3.10.2 Software Implementation
Mostly the software implementation/integration has been done according the
specifications given in deliverable 5.1 and 5.2. No significant changes were made in the
implementation/integration procedure.
3.11 Deviations/Problems
The RASim prototype has passed the implementation stage and is being tested at this stage.
No such deviation or problems reported at this stage.
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4 RAAs Specifications
Please see Deliverable D5.3 (RAAs Specification) for information on the requirement
specifications of the RAAs based on the guidance system specifications and user needs.
4.1 Deviations/Problems
No significant deviations from original plan. Further details regarding the main challenges
related to the assistant can be found in MS6 document (part 4).
5 Further work
Some of the future work that we would like to address is as follows:
Assemble the two new clinical assistants into one-rack systems (will be done according
to plan).
Support the clinical use of the systems (e.g. symposium in Leuven).
Improve the system based on clinical feedback and additional data (if available).
Improve needle guidance and address anesthetics spread verification (if remaining
resources and data from the whole procedure are available).
Additional publications and disseminations related to the assistant.
Address other nerve blocks (in addition to femoral nerve blocks) (if resources and relevant
data are available).
6 Publication/Disseminations
Several publications, proceedings, abstracts, posters, presentations, popular science articles
and videos related to the assistant already exist. See the MS6 document for a more detailed
list of all the contributions that have been accepted.
7 Reference Documents
Deliverable 4.5 – Guidance Systems Specification
Deliverable 5.4 – RAAs Prototypes (with “user manual” report.
Deliverable 8.4 and 8.5 – Exploitation plan 1 and 2 for the assistant.
Milestone 6 - RAAs function available on the portable prototypes.
RAAs system introduction video: https://www.youtube.com/watch?v=ptRF6dv43HA