Duncan Stevenson

Validation of a Networked Virtual Reality Simulation of Temporal Bone Surgery

Objectives: To assess the content validity and concurrent validity of a haptically (force feedback) rendered, virtual reality simulation of temporal bone surgery.

Annotating with light for remote guidance

This paper presents a system that will support a remote guidance collaboration, in which a local expert guides a remotely located assistant to perform physical, three-dimensional tasks. The system supports this remote guidance by allowing the expert to annotate, point at and draw upon objects in the remote location using a pen and tablet-based interface to control a laser projection device. The specific design criteria for this system are drawn from a tele-health scenario involving remote medical examination of patients and the paper presents the software architecture and implementation details of the associated hardware. In particular, the algorithm for aligning the representation of the laser projection over the video display of the remote scene is described. Early evaluations by medical specialists are presented, the usability of the system in laboratory experiments is discussed and ideas for future developments are outlined.

Tertiary-Level Telehealth: A Media Space Application

A media space provides the communications channels to support the interactions between people at different locations using video and audio links and shared access to data. This paper looks at a telehealth implementation of outpatient consultations for tertiary-level paediatric surgical patients, consultations which exercise a high degree of interpersonal and data-sharing communication between the participants. Framing the telehealth situation as a media space invites the designer of the telehealth system to access a large body of prior work which identifies and discusses many of the issues that will arise in this complex multi-participant telehealth context. This paper presents, as a case study, a two-year project that developed and deployed a whole-of-room telehealth system in partnership with surgeons from The Royal Children’s Hospital (RCH), Melbourne, Australia. Based on observations at the hospital and discussions with the surgeons, a descriptive model of the proposed telehealth consultation (and of its deployment in a clinical trial) was developed. This descriptive model became the vehicle for gathering requirements and for design and evaluation of the telehealth system. The evaluation contained four major components: two human factors studies, an observational study of training and process change for the clinicians and a clinical trial of the resulting system. The case study demonstrates the flow of design decisions from concept to deployment. It highlights the gaps that appeared in the descriptive model when the transition was made from the laboratory to deployment in the hospital. The conclusion is that, at this relatively unexplored level of telehealth, there are likely to be gaps in such a descriptive model that are not uncovered by laboratory experiments or by analytic evaluation but emerge only during a clinical trial with actual patients, clinicians and patient data.

Training and process change: a collaborative telehealth case study

The next generation of telehealth systems running over broadband Internet will offer opportunities to change the way clinicians provide health services. This case study is a component of a larger research project which explores the implications of broadband telehealth in a tertiary healthcare setting. The research question of this case study addresses how to train and prepare clinicians to do their job using the next generation of telehealth systems. This case study presents observations of twelve clinicians during the training sessions conducted for them as they prepared to use a research prototype telehealth system in a pilot trial at their hospital. The telehealth system was purpose-designed to address the range of needs of the clinicians involved and clinicians very rapidly understood the affordances of the system. Our observations show that the clinicians spent the bulk of the training sessions dealing with process change. They focused on three areas: collaborating with their remotely located clinical assistant, adapting their clinical practice in order to use the system and identifying areas where the telehealth system need to be changed to support their specific needs. Our observations also show that each of the senior surgeons amongst the clinicians (working in a different sub-specialty) dealt differently with the process changes. We conclude that for complex tertiary healthcare telehealth applications the distinction between training given to the clinicians and process change identified by the clinicians is worth considering when preparing clinicians to use the next generation of telehealth systems. We suggest that teams developing advanced telehealth systems consider these issues of process change as they develop ways to prepare clinicians to use their system.

Human-Centered Evaluation for Broadband Tertiary Outpatient Telehealth: A Case Study

We present a pilot trial of a broadband telehealth system for tertiary outpatient consultations and use it as a case study to explore issues that arise in designing and evaluating broadband telehealth at a tertiary level of health care. The trial used outpatient consultations for pediatric surgical patients; these consultations involve high levels of interpersonal communications, multiple participants, and the need to share interactive access to large patient data sets. We used a human-centered evaluation approach applied at the level of the health care application (in the hospital setting using actual clinical consultations). The results from the case study indicate that this is the appropriate evaluation approach for early stage trials rather than the traditional randomized controlled trials. The different groups of participants (specialists, patients and parents, supporting clinicians) had different perspectives on the telehealth consultations and different criteria for success and future telehealth evaluations need to take these multiple points of view into account.

Improving ICT support for aboriginal land councils in New South Wales

A pilot case-study of the ICT systems of two self-managed Aboriginal councils in the Australian state of New South Wales has been undertaken in order to assess the nature and potential of software interventions. Our study indicates that the development of task-driven software interfaces could significantly support the processes and activities of Aboriginal council management and could contribute to alleviating the stress associated with current systems. Our vision is to develop these interfaces together with networking support for peer-to-peer collaboration between councils, compliance agencies and trusted advisers. The workflows themselves would be built and refined in a collaborative fashion between users together with some automated support.

Evaluating an in-vivo surgical training demonstration over broadband internet

This paper evaluates a demonstration of in-vivo (live) surgery over a broadband Internet connection between the USA and Australia. Two specific targets of the evaluation are the use of remote 3D video display of the laparoscopic surgery and the structure of the demonstration to replicate actual surgical training in the operating room. The evaluation materials include preliminary design and preparation records, recordings of the two-way video data and of the surgical video, exit questionnaires, debriefing discussion notes and follow-up interviews with the participants. Prior work in this area is surveyed and the demonstration is positioned with respect to this work. Conclusions are drawn about the effectiveness of the two key aspects of the demonstration and about possibilities for future work.

Evidence from the surgeons: gesture control of image data displayed during surgery

ABSTRACT We gathered ethnographic evidence from surgeons about the concept of gesture-based control over the display of their patients’ radiographic scan data during surgery. This would give the surgeons direct access to their patients’ scan data without compromising their sterile working field and without needing to rely on other clinicians to interpret display instructions. Our approach involved interviewing surgeons and observing them in the operating theatre. We included evidence from earlier publications in this field and we used a grounded theory approach to analyse our data. Our findings address diversity across the surgical specialties, preoperative versus intraoperative use of the data, preferences for simple natural gestures, the role of another person controlling the display, broad system constraints and the willingness of surgeons to collaborate with their time and effort in this research.

Using ForceForm, a dynamically deformable interactive surface, for palpation simulation in medical scenarios

We present the initial exploration of using ForceForm, a dynamically deformable interactive surface, for an application in the medical domain. ForceForm provides direct dynamic interaction which is soft and malleable. We are interested in pursuing its use as a training tool in medical scenarios which involve the direct interaction with human skin. As an example of this, we have developed a palpation training application. Previous work in this area uses haptic devices which do not have the soft and direct interaction exhibited by ForceForm. This workshop paper details our palpation application and a discussion of the findings of an expert user consultation involving a doctor and a massage therapist.

Fairy ring kinetics

Abstract A model of fairy ring growth due to Parker-Rhodes is extended and used to study the amount of field covered by one or more species of rings as a function of time, and factors affecting inter-specific competition of rings. Assuming constant arrival rate σ and growth rate ϱ we find that the factor determining survival in competitive juvenile systems is σϱ2, in agreement with Parker-Rhodes, but in the long term when equilibrium is established, the relevant factor is σ ϱ . Practical consequences of this and other results and numerical comparison with observations are presented and summarized in the final section.