The Well is a space for one-on-one, laptop-based demos and select, large-scale technology displays. The Well complements the traditional commercial and academic exhibits, expanding the forum of ideas and devices. Demos in The Well will be scheduled and impromptu.

A few images, links and descriptions about the devices and tools we could see there.

Philip Weber & Jacopo Annese PhD (The Brain Observatory, University of California, San Diego & CalIt)

Installation: The Digital Light Box is a scalable visualization environment for radiological and pathological examinations that enables researchers to visualize and inspect high resolution (gigabyte size) images created by multiple imaging modalities, including virtual microscopy.

It was my personal favourite device today. It makes it quite easy to perform a proper intubation as the camera helps you how to navigate easily. More information here.

The Virtual Reality Medical Center presented the next generation injury creation science. Such models can make simulations as realistic as possible. You can also trigger bleeding or simulate different types of injuries. Click here for more information.

The project of Albert Rizzo demonstrates how post-traumatic stress disorders could be treated by using virtual reality therapy. You can see a military scene with weapon, if you stand on that square, you can feel the bombings and hear gunfire, etc. Read more about it here.

Forterra Systems created a new environment for medical simulations. This platform is quite different from Second Life as it is a closed and secure system and many simulations have already been implemented into it. Communication is easy but, of course, it’s not for free.

A prostethic arm from Hanger.com. Read more about their microprocessor controlled hydraulic knee in our interview.

An XBOX based bronchoscopy simulation. If you are good at video games, you will find it easy to handle the device. Future surgeons should start with military games and video games that require major skills.

That’s for today. Stay tuned for more images tomorrow from The Salon.

Feel free to join the discussion on Twitter and share your slideshows on Slideshare.net.

Check the video report.

1) Please tell us more about the Gaze-Driven Head-Mounted Camera and what you will present at this year’s MMVR conference.

EyeSeeCam is a novel head-mounted camera controlled by the user’s eye movements. It allows, for the first time, to literally see the world through somebody else’s eyes. EyeSeeCam is based on the combination of two technologies: an eye tracking and a camera motion device that operates as an artificial eye. The challenges in designing such a system are mobility, high bandwidth, and low total latency. These challenges are met by a newly developed lightweight eye tracker that is able to synchronously measure binocular eye positions at up to
650 Hertz and novel piezo actuators, that means the camera is driven by ultra-fast motors that are not based on conventional electro-mechanical transduction

At this year’s MMVR we applied the new camera in a dental treatment while filling a tooth. In the video footage you can clearly see how well you can look into the cavity of the tooth via the mirror. The EyeSeeCam consits of two individual cameras, one for the wide-angle scene and one for the gazed detail. You’ll see that the area around the mouth is overexposed in the scene image but the gaze-driven camera provides an individual exposure for this area. As a result, the EyeSeeCam provides not only a higher spatial resolution but also a higher dynamic range.

2) Can the camera record what it actually sees. Is there a chance it could record a whole surgery?

Yes, a very fast eye tracker system continuously directs the camera towards the user’s point of gaze, so that the camera captures exactly what the user’s eyes see. The delay between measured eye movements and corresponding camera rotation are down to 10 ms. This is quite an impressive number if one considers that it includes eye movement measurement by aquisition, transmission and processing of eye images, as well as the mechanical actuation of a video camera. The camera can thereby reproduce the whole range of human eye movements. This video can be recorded, transmitted and displayed in real time.

A surgeon, for example, wore the 850g device during a sugery that lasted 2.5 hours. He documented the whole surgery from his view without missing any crucial event. Thanks to EyeSeeCam’s mobility and lightweight setup the surgeon reported that he was not restricted by the system.

3) Do you think doctors will use it in the future? Are there any legal aspects they should consider?

If EyeSeeCam should succeed in offering an additional benefit as compared to conventional video documentation techniques, doctors will likely use it in the future. It’s already very common to document surgeries with video cameras above the operating table or by an external camera operator. But often the interesting parts are covered by hands or arms. Essentially the motivation for a head mounted camera is similar to the motivation for a surgical headlight.

We are no lawyers but we think doctors have to consider the same legal aspects as with conventional video documentation techniques.

4) What are your plans for the next few years? Are you working on a new device or still improving EyeSeeCam?

EyeSeeCam still needs further improvements. The cameras, for example, are still too big. We will also expand possible uses of EyeSeeCam to other fiels like the examination of natural visual exploration in humans. In some side projects I’m using the camera to make short movies or support media art projects. So we are further looking for new applications and improving EyeSeeCam.

Further Salon interviews:

• The Salon and The Well: Interviews
• The Salon Interviews: The Use of Virtual Reality in Addiction Medicine
• The Salon Interview: Microprocessor-controlled hydraulic knee
• The Salon Interview: VOXEL-MAN visualization system

1) Please tell us more about what you will present in the Salon at this year’s MMVR conference.

I am a professor emeritus and the work presented is a collection of earlier more illustrative than scientific work, that was not been published so far to a broader audience.

One of the two presentations is a movie – created at the occasion of the 100th anniversary of Roentgens discovery in 1995 – that illustrates the history of medical imaging and image computing. It was generated completely with the tools of the VOXEL-MAN visualization system. Pictures on the walls of a virtual room lead to the different highlights: The discovery of the X-rays, CT and MR imaging, 3D models for surgery and training, virtual endoscopy and more. While today’s virtual body models, show a much higher spatial resolution and interactivity, the presented visualization techniques are still state of the art and might inspire the viewers.

The other exhibit is a poster showing compositions of some of the famous anatomical drawings of Leonardo da Vinci and today`s computer models.

2) What was the main concept behind launching the Leonardo meets VOXEL-MAN project?

Leonardo da Vinci (1452-1519) was both an ingenious painter and engineer. We can imagine that he – when living today – would have creatively used methods of virtual reality. Besides his paintings and visions in mechanical engineering, his anatomical drawings became famous. I was always intrigued by these drawings and have created- just as a hobby – compositions with VOXEL-MAN body models.

3) How can VOXEL-MAN be used in everyday medicine?

The VOXEL-MAN project dates back to the early eighties and many of the algorithms (especially for realistic visualization) developed in this project are state of the art in many applications since long time. The VOXEL-MAN software is still used for the creation of 3D atlases of anatomy and radiology and for the development of surgical simulators
4) Are your body models used in medical education? If so, do you get feedback from students?

We have three interactive atlases of anatomy and radiology (“VOXEL-MAN 3D Navigators”) available for the brain and skull, the inner organs, the upper limb and for abdominal ultrasound. They are very well accepted by students and teachers.

5) What are your plans for the near future?

As the founder of the VOXEL-MAN group I work as a senior advisor and part time collaborator the surgery simulator projects of the VOXEL-MAN group. I am convinced that training and planning based on virtual reality techniques will soon be indispensable in surgery.

Further Salon interviews:

• The Salon and The Well: Interviews
• The Salon Interviews: The Use of Virtual Reality in Addiction Medicine
• The Salon Interview: Microprocessor-controlled hydraulic knee

The responses are from Katy, a bi-lateral above knee amputee, who wears C-legs. She will be the patient working in the “Well” with Coryn Reich, the Prosthetist.

1) Please tell us more about what you will present in the Well at this year’s MMVR conference.

We will be presenting microprocessor knees and showing what a difference they can make for amputees. We will be demonstrating how they help amputees walk down inclines, sit and recover from stumbling.

2) How is a a microprocessor-controlled hydraulic knee different from the artificial knees that have been used so far?

The main difference is the computer inside the knee. The microprocessor is constantly monitoring what you are doing physically (eg. walking, sitting, doing down stairs) and giving you more or less resistance. For example, I could be walking along at a regular rate and approach a ramp and without slowing down or needing to hold on the a railing, I can walk down the incline with my knees slightly bent. This gives a more ‘nautral’ appearance to walking.

3) What kind of feedback do you receive from patients?

The patients that I know using these knees are very happy. For myself, I fall a lot less then I did and I have the feeling of freedom and confidence. There is a bit of a learning curve in that you have to trust that the knee is there and going to support you, but after that you are able walk with much more ease.

4) What is your opinion about the attempt of Oscar Pistorius to compete at the Beijing Olympic Games? Can such a medical device lead to unfair advantage over able-bodied runners?

Being a member of the US Paralympic team during this time I was thrilled that the IOC would even have the conversation. Oscar is a fantastic athlete and would being doing amazing things with or without prosthetics. If there was an advantage in using carbon fiber running feet there would be many challenged athletes attempting to do what Oscar is doing. The microprocessors are not used in running, they are for everyday walking around.

Further Salon interviews:

• The Salon and The Well: Interviews
• The Salon Interviews: The Use of Virtual Reality in Addiction Medicine

1) Please tell us more about the “Use of VR in Addiction Medicine” demonstration you will present at this year’s MMVR conference.

The demonstration presented in the Salon portion of MMVR17 will allow attendees to observe and interact within the virtual world we have created using Second Life. Participants will be able to freely navigate through the environment and interact with drug paraphernalia and animated avatars while observers may watch on an external monitor. My talk will cover the initial testing of this environment in methamphetamine users, highlight some of our current projects and discuss future application.

2) As a Neuroscience Ph.D. student, how did you get involved in this project?

I became involved in this project through a combination of adversity, ingenuity and luck. A handful of researchers around the globe had demonstrated the applicability of virtual reality (VR) in nicotine addicts (i.e. smokers) when I began working with Drs. Newton and De La Garza at UCLA. We discussed the possibility of applying this approach to our methamphetamine studies since our previous methods of inducing craving (videos) had demonstrated modest success. Our initial attempts to collaborate with researchers already using VR proved unsuccessful so we returned to the drawing board to determine the feasibility of developing such a system on our own. I contacted the Experiential Technology Institute (ETC) at UCLA, which specializes in 3-D modeling, and proposed the idea. With their technical expertise and my scientific vision we were able to create an initial environment for testing in a relatively short amount of time. Since I had my hands in both the technical development and scientific application I naturally became heavily involved in the project. More recently, Drs. Newton and De La Garza have relocated to Baylor College of Medicine in Houston, TX allowing me to lead the VR development/application at UCLA under the mentorship of Dr. Arthur Brody while continuing my collaboration with their research group.

3) Why did you choose Second Life for this purpose?

We decided to develop our research tool on Second Life (SL) for a few decisive reasons: 1) Time; 2) Money; 3) Accessibility; 4) Adaptability. SL provided a preexistent, user-friendly platform to immediately apply our ideas simply using a few PCs, which allowed us to hit the ground running. Additionally, for a small membership fee we could rely on SL to maintain and improve our virtual world. Since SL only requires an Internet connection to access, we realized that opportunities for mobility and future collaboration would be seamless. Lastly, SL may be easily adjusted in real time allowing researchers to easily individualize environments without any knowledge of scripting or modeling. Subsequently I have also realized the greatest benefit of SL is the opportunity for outsourcing – thousands of individuals around the world are creating new environments, objects, and animations daily and are willing to provide their products and services for little to no cost.

4) How can such a 3-D environment be used in behavioral pharmacology research and how can you exam drug taking behavior?

Previous preclinical and clinical research has demonstrated the importance of environment on the response elicited by a drug. Currently, phase I clinical trails assessing novel treatments for drug addiction are conducted in hospitals for safety purposes (i.e. in the case there is an adverse reaction between the medication and the drug of abuse). However, hospital environments tend to be very constrictive and completely irrelevant to the average drug user. Since we cannot take the drug addict to their environment, we must bring the environment to them. Virtual worlds allow a drug user to interact freely in a naturalistic environment while in the safety of a clinical setting. Additionally, such an environment allows researchers to closely track the drug users behavior while on a medication versus a placebo as one would track a rodent in a maze. Researchers may also allow the drug user access to their drug of choice under temporally controlled conditions (i.e. by simply initiating an animated drug taking behavior in the 3-D environment a single dose would be automatically administered) and monitor their drug seeking and taking behavior similar to a rodent in a self-administration chamber. We expect that by creating a more realistic environment we will obtain more realistic responses allowing for better assessment of treatment efficacy. This in turn may increase the predictability of treatment success to a larger, outpatient phase II trial and help aid in early and efficient identification of potential therapies for addictive disorders.

5) Do you plan to extend the research (e.g. different drugs)?

We have recently started a cigarette smoking cessation trial using a smoking virtual environment. 3-D environments have been successfully utilized for anxiety and phobic disorders through repeated exposure to aversive stimuli (e.g. heights, spiders, public speaking, war-like environments) in the safety of a clinical setting with a therapist on hand. Along these lines, we hope to help smokers “extinguish” smoking behavior or relearn more positive behavioral responses to smoking cues they will inevitably come across while trying to quit. If successful this type of treatment may be easily applied to additional addictive and psychiatric disorders.

Now Kóan Jeff Baysa asked several of the Well & Salon artists:

Q: The Salon was created, in part, to present works of invited artists to stimulate thinking outside of the box. How do you anticipate that your project proposal will effect this with the attendees of MMVR?

Jiayi and Shih-wen Young respond about their work, “Sampling Rate in Audible and Visual Perception”

A: The audible perception part of our project explores visual representation of sound with different sampling rates. It hopes to provide the MMVR community with a different way of perceiving sound out side the conventional waveform format.

The visual perception part of our project challenges the brain to play a multitasking game demanding the brain to process more and more information simultaneously, while providing less and less cohesive information.

Click here to learn more about the project

Alessandro Marianantoni and Marcos Lutyens respond regarding “The Excarnation Machine (BETA)”

A: Our project is a playful way of representing the human body, through new techniques and mechanisms that specifically take into account the body’s adaptation and conditions of survival within the contextual world. We hope to inspire attendees to stretch the conceptual envelope of the use of tools showcased at the MMVR..

On a closer look, at a time of radical changes in the earth’s climate, as well as the mass extinction of over half the known species on the planet, perhaps the developments of scientific techniques that are showcased at the MMVR will actually be necessary to help us to respond and adapt to the changes around us, at a pace that is much faster than that afforded to us by natural genetic adaptation to the planet’s changing climatic conditions.

The tools and technologies that are on view at the MMVR are aimed at certain medical interventions, with specific applicable goals, which are usually to do with curing diseases and treating negative health conditions. We believe that it is important for us to think of these tools as possible vehicles for increasing wellness in the context of adaptation and survival. By juggling around with how the body is fundamentally designed, we may pause for a moment to think about how the body may be better adapted to deal with increased UV exposure, drier terrain, flooding, interplanetary travel and other challenges.

We are currently working on several projects that bring virtuality into the context of hospital environments for therapeutic ends and hope to exchange ideas with and learn from exhibitors at the MMVR.

Virgil Wong and Philip Forget reply about their “Phineasmap” project:

A: Stephen Hawking wrote: “Science fiction serves a serious purpose, that of expanding the human imagination. We can explore how the human spirit might respond to future developments in science, and we can speculate on what those developments might be.” The technological applications visualized by the Phineasmap patient portal and my fictitious medical institution, RYT Hospital, may appear as fanciful speculation, but I hope that they will serve as deliberate scenario-mapping tools for interested physicians, surgeons, educators, engineers, and data technologists.

Click here to read more about the project

Click here to see how Dr. Liu answered these questions:

• 1) What do you consider the indicators of “success” in the development of medical simulator?
• 2) What types of communication between engineers, educators, and physicians increase success in simulator development?
• 3) What role does patient opinion or experience have in the development of simulators?
• 4) Please tell us more about the workshop you will organize at the MMVR 17 conference.
• 5) What are the major mistakes one can make while building medical simulators?
• 6) Which medical specialties will benefit the most from medical simulators in the near future?

1) What do you consider the indicators of “success” in the development of medical simulator?

A “successful” medical simulator goes beyond technical excellence. It’s difficult to pin down exactly what constitutes a successful trainer, but there are common elements that are generally regarded as necessary. First, the simulation system should address real-world training requirements. Second, it should focus on the essentials of the task being trained. Third, to be effective, it’s use should be formalized as part of the teaching curriculum. Finally, it should demonstrate that it is effective at accomplishing its objective (i.e., there should be demonstrable training transfer).

2) What types of communication between engineers, educators, and physicians increase success in simulator development?

The stakeholders (physicians, engineers, and educators) need to arrive at a common understanding of the lessons/skills/knowledge that need to be taught. They also need to agree on what constitutes a successful training event in measurable terms (number of minutes, accuracy, etc.). It is also equally important to understand what is *not* required or unessential to the simulation.

For example, very precise biomechanical tissue models are frequently overkill in a training simulator. These models are complex, and can be difficult to run in real-time. In many cases, the data necessary to tune these models must be derived from in-vivo tissue measurements. Unfortunately, they cannot be done for ethical or practical reasons. As a result, physiologically plausible models that are simpler and more efficient, but less precise are often preferred.

Pericardiocentesis

3) What role does patient opinion or experience have in the development of simulators?

Simulators can have an effect on patient outcomes, in terms of the reduction of errors, and the quality of treatment. Patient feedback can affect the way clinical skills are taught, so to that extent, patient opinion or experience will affect how simulators are developed to support training.

4) Please tell us more about the workshop you will organize at the MMVR 17 conference.

The workshop will be highlight advanced techniques in medical simulation development. It is intended to be a practical introduction to methods, tools, and procedures. The workshop will focus on three main areas: requirements analysis, engineering, and 3D model development. Throughout the course of the workshop, we’ll be highlighting our discussion with case studies taken from successful initiatives, or those currently underway.

5) What are the major mistakes one can make while building medical simulators?

A major error is to let technology drive the development. It is possible to over-engineer the simulator. The result is a device that either does not accomplish its teaching objectives, or is excessively complex/costly/difficult to operate. In both cases, the end result is the same: the simulator gets ignored in favor of lower cost, more effective teaching tools.

6) Which medical specialties will benefit the most from medical simulators in the near future?

Medical simulation has (to date) focused mainly on individual skills training. However, the practice of medicine is a team effort. I would expect future simulation initiatives to focus on team training instead of the “one patient, one clinician” approach currently used. To that end, networked simulators, immersive virtual environments, and multi-player/multi-user platforms will become more prevalent.

(Two of the three computer systems, with HMD and headphones, utilized by VRMC with various VR research and clinical projects.)

Click here to see how Dr. Wood answered these questions:

• 1) Dr. Wood, what key advances in your research will you be presenting at this year’s meeting?
• 2) Your therapy appears to focus on immersing patients in a simulated war environment. How does this immersive experience reduce depression and PTSD? Is there a possibility the patient’s condition could be worsened by immersion?
• 3) Please tell us some details about the VRGET therapy.
• 4) Do you use any kind of web 2.0 tools in your research (e.g. blogs, wikis, social bookmarking, etc.)?
• 5) At MMVR17, will you demonstrate how your virtual reality system actually works?
• 6) What developments do you predict will be most noteworthy in the future of the gaming/simulation industry/technology?

1. Concerning the key advances I will be presenting during MMVR17:

More recently, the percentage of Army and Marine Corps personnel, who participated in combat during Operation Iraqi Freedom or Operation Enduring Freedom between March and October 2003, who met screening criteria for major depression, generalized anxiety disorder or PTSD, ranged from 11.2% to 17.1%. Grieger et al reported that 12% of U.S. soldiers, hospitalized followings serious combat injury in Iraq, were diagnosed with PTSD at 7 months following hospitalization. DOD officials have also expected that the PTSD rates will be higher among troops who have been to Iraq more than once.

Research has suggested that virtual reality exposure (VRE) therapy as a new and effective medium of exposure therapy for treating veterans with PTSD. Walshe et al have reported on the successful use of Virtual Reality to treat Driving Phobia and PTSD in individuals who had experienced a motor vehicle accident. The Virtual Reality Medical Center (VRMC) has developed a Virtual Reality Graded Exposure Therapy (VRGET) protocol for treating warriors diagnosed with combat-related PTSD. During MMVR15, I presented the description of the successful use of Virtual Reality Graded Exposure Therapy with a combat-wounded Navy Hospital Corpsman who developed PTSD while attached to a U.S. Marine Corps Battalion deployed to Iraq. During MMVR16, I described the successful VRGET intervention with the first six warriors, diagnosed with combat-related PTSD, enrolled in the VRMC/ONR funded project at Naval Medical Center San Diego (NMCSD). During MMVR17, I will report on the treatment outcome of the first eight volunteers, randomized to VRGET, who were participants in the VRMC/ONR funded study.

Eight male volunteers, with the DSM-IV criteria for Chronic PTSD, met the study requirements for participation, and following randomization to VRGET, initiated VR Therapy. These participants were all members of the United States Navy or the United States Marine Corps. These eight participants were originally diagnosed with PTSD between January 2004 and July 2008; all of our participants initiated VRGET since August 2007. As part of the treatment VRGET protocol, treatment was delivered in 10, 100 minute sessions conducted weekly by one of the authors (DPW). The VRGET system relied on a combined visual and auditory presentation. The participants “walked” in the virtual environment or “drove” a Humvee in the environment by pushing buttons on the hand-held joy-stick. The participants “fired” an M-16 rifle or 50 caliber machine gun by depressing another button on the joy-stick. The clinician-rated and self-report measures were taken and full assessments were conducted at pre-treatment, post-treatment (following 10 sessions of treatment) and three months following the conclusion of treatment. During the treatment sessions, the patient utilized a Head-Display-Monitor (HMD) and headphones. Additionally, the participants’ psychophysioloigcal measurements (i.e., heart rate, breaths per minute, skin conductance and peripheral temperature) were taken during each treatment session and also pre-treatment, post-treatment and during the three month post treatment assessment. During each assessment period, the participants’ psychophysioloigcal measures were assessed at baseline, during a recall stressor, and during recovery from the recall stressor.

My presentation will review not only the protocol utilized to treat combat-related PTSD with Virtual Reality Graded Exposure Therapy (VRGET), but also my presentation will review the treatment outcome results for the first eight participants in our randomized treatment group. I will also discuss recommendations for the future VRGET treatment of combat-personnel diagnosed with PTSD. Additionally, my presentation will demonstrate VRMC’s Virtual Reality treatment system involving three computers, one that displays the visual and auditory displays to the patient trough Virtual Reality Goggles with built-in headphones, a second system which has the control panel and menu which therapist can use to add arousing elements into the Virtual Reality environment (e.g., various combat events and background sounds, weather, and time of day), and the third computer which is utilized to track and record the biofeedback data (i.e., heart rate, breaths per minute, skin conductance and peripheral temperature) of our participants.

2. Your therapy appears to focus on immersing patients in a simulated war environment. How does this immersive experience reduce depression and PTSD? Is there a possibility the patient’s condition could be worsened by immersion?

The VR treatment used by VRMC at NMCSD and NHCP is multi-faceted, drawing upon the principles of cognitive behavioral and experiential therapies. In contrast to flooding type exposure therapy which attempts to extinguish conditioned reactions, VRGET trains patients to control their physical arousal and attentional focus in order to tolerate exposure to a wide range of cues (i.e., combat, gun fire, being wounded, sounds of helicopters, vehicle sounds, explosions, etc). This approach is based upon the interactive nature of VR. Research, conducted at VRMC, has documented that the more interactive the VR environment, the better the immersion and therapeutic results (i.e., reduction in PTSD symptoms and symptoms of depression). Optimally, the patient will be given a joystick to navigate through the VR environment. This gives the patient a measure of control, but also increases the immersive quality of the VR environment. Immersion represents one more level of arousal that can be utilized by the therapist, when needed, to assist the patient in directly confronting and gradually making sense out of, in the VR world, those stimuli/memories/recollections/intrusive thoughts/nightmares that have continued to energize their feeling of being out of control, avoidant, excessively startled, excessively anxious, irritable and hopeless.

Using virtual reality assisted exposure therapy has been demonstrated to be an effective means of delivering exposure therapy in treating phobias and PTSD. The use of in virtuo-physiologically-facilitated graded exposure therapy in combat PTSD has only recently begun to be studied in a randomized controlled design at NMCSD and Navy Hospital Camp Pendleton (NHCP).

Due to the emphasis on personal control and skill development, with the warriors in VRGET, we, at VRMC, believe that VRGET will be optimal for those suffering from acute or chronic combat-related PTSD. For instance, the warriors in treatment can end a VR session by simply removing their HMD and/or informing the therapist that, “the hop is over” and the session immediately terminates. Alternatively, by the therapist “keeping a eye” on the warrior’s breaths per minute (BPM) and heart rate (HR), the therapist can assess the level of arousal being experienced by the warrior and guide the VR session appropriately, or terminate the session, to gain the most therapeutic value. We, at VRMC, also believe, that the VRGET approach will greatly assist our warriors in treatment to better generalize their VR learning to a wider range of symptoms and situations and experience the best likelihood of a long-term benefit for VRGET.

Of note, with any therapeutic technique or intervention, there is always the possibility that the patient’s condition can be worsened. However, through the development of the therapeutic relationship between the patient and the therapist and relying on the therapist’s skill level with VRGET in particular and traditional psychotherapy in general, this risk can be appropriately modulated.

(A Screenshot of what the VRGET treated warrior would be viewing through their HMD during treatment.)

3. Please tell us some details about the VRGET therapy.

For details describing VRGET, the reader is referred to our article, published in the MMVR16 Proceedings, titled “Combat Related Post Traumatic Stress Disorder: A Multiple Case Report Using virtual Reality Graded Exposure Therapy with Physiological Monitoring”, pp. 556 – 561. Also, the reader is referred to the Virtual Reality Medical Center web page for these details (www.vrphobia.com).

4. Do you use any kind of web 2.0 tools in your research (e.g., blogs, wikis, social bookmarking, etc.)?

No, not at this time.

5. At MMVR17, will you demonstrate how your virtual reality system actually works?

I have been asked by Jim Westwood to demo our VRGET system and I and VRMC have agreed. The date, time and place of this VRGET demo have not yet been determined.

6. What developments do you predict will be most noteworthy in the future of the gaming/simulation industry/technology?

In terms of the research being conducted at VRMC with VR for treating PTSD and other anxiety disorders, chronic pain and ADHD and also utilizing VRGET with various types of rehabilitation, including rehabilitation secondary to stroke and TBI, I would look to the day when VRGET has demonstrated its clinical effectiveness and the VRGET technology and treatment paradigms are “in residence” at an increasing number of military and civilian medical centers and also co-located in the private offices of a wide range of practitioners. Additionally, I look forward to the day when VRGET can be a web based treatment paradigm similar to the pain management program currently being researched and utilized by Dr. Hunter Hoffman at the University of Washington. Of interest, VRMC has been working with a number of university based research programs to develop web based protocols for VRGET. Hopefully, by the time MMVR17 convenes, VRMC hopes to have information available documenting the currently status of these research and clinical endeavors.

Click here to see how Dr. Kinross answered these questions:

• 1) Mr. Kinross, you and your collegues have developed a virtual teaching environment for medical students. Why did you choose Second Life for such purpose?
• 2) How realistic can objects and operating rooms be in Second Life? Does your simulation focus on interactive learning or animation-based training?
• 3) Many educational meetings in SL find it difficult to interact because of the lag users have to face due to technical problems. Have you experienced something similar?
• 4) Who can access the virtual site now? Is there a teleport link we could use?
• 5) What do you think about other medical teaching opportunities such as the Ann Myers Medical Center? Are you open to co-operate with them?
• 6) Do you plan to construct other educational resources in Second Life in the near future?

1) Mr. Kinross, you and your collegues have developed a virtual teaching environment for medical students. Why did you choose Second Life for such purpose?

I should probably make it clear that i have no association with Linden lab and I have no commercial interest in Second Life (SL). My interest is purely academic, and I am trying to understand how we can utilize the tremendous power of the online metaverse to improve human health and medical education. There is now a large choice of commercial and open source virtual worlds available to researchers and picking the right one can be challenging. For us, there were basically three driving factors that lead us to second life:

1) Cost. Although it is certainly not free to develop within Second Life, the bespoke virtual worlds were prohibitively expensive and it was simply not feasible for Imperial College London (ICL) to use them as an experimental platform. We have however been able to secure funding for several islands in SL, and for this research we have been able to acquire enough ‘in house’ expertise so that we could effectively produce the quality of build we needed.

2) SL possess a scientific network: Probably Second Life’s greatest asset is its remarkable community of scientific, medical and educational users that are adapting the technology for ‘serious’ purposes that go beyond entertainment, and they are doing this in the most innovative manner. By using a social or professional platform like Second Life (providing that you are able to work with the community) it is possible to gain access to the experience of many thousands of users from all over the world.

3) Second Life is open source: This means that thousands of developers are continuously pushing the boundaries of the technology in a manner that we simply couldn’t replicate if we were working with a single in house platform or a smaller public sim. It also means that we can speak to the community to ask for help when we need it! Having said all of this, we are continually analyzing and testing other platforms, and we don’t exclusively limit ourselves to Second Life.

2) How realistic can objects and operating rooms be in Second Life? Does your simulation focus on interactive learning or animation-based training?

This is a good question! The most important thing for us was to define exactly what we needed our virtual operating theater to do. In this case we were specifically interested in teaching novice medical students how to be safe, and how to learn and act in a complex and potentially dangerous environment. We were not asking them to develop real world skills or to learn how to use objects so we focused on interactive learning with a real world teacher guiding them through the virtual surgery (although some animations were built into the model). So in that respect, we didn’t need objects to be programmed to function as they would in the real world, although this is perfectly possible. (For a different project we are creating a suite of infusion pumps for device training that will do just that). In this case, most students didn’t have expectations of interacting with high fidelity objects as they simply compared the simulation to what they already have experience of at home i.e. a computer ‘game’. As it turned out, we found that most students were positively surprised at the level of realism we were able to achieve for specific objects. However, there is little point creating objects that bear absolutely no resemblance to what students will actually use in the real world.

Therefore we spent allot of time making sure that after they visited our virtual theatre, students would recognize the specific Operating Room (OR) when they entered it for real and that they would be safe with the actual objects within it. Thus, there is an argument that this sort of specific environment should be created in a bespoke fashion (even the actual view from the St. Mary’s hospital OR is recreated in the virtual OR). We studied students in three environments: A lecture theater, a simulated operating suite or SOS ( a real world training OR) and the virtual world. Students reported no significant difference in the fidelity of the simulation between the SOS and the virtual OR. We think this is because in the virtual world, although it is clearly not ‘real’ we were able to model all aspects of the OR experience e.g. where you get changed, who you meet, the objects you see, where you go to scrub, where you have coffee! It is because of this that the students felt significantly less anxious about entering a real world theater than in the other two groups.

3) Many educational meetings in SL find it difficult to interact because of the lag users have to face due to technical problems. Have you experienced something similar?

Yes, this is a problem and it can make running a meeting stressful! It is a particular problem for first time users as the interface and the speed of interaction between experienced users can also be a little overwhelming. Naturally, I am biased as I have been to so many excellent educational meetings in Second Life and I am convinced of the power of this sort of technology. I have literally met researchers I would never have had the opportunity to work with in the real world. Once you get used to the technology lag it is possible to work around it or accommodate it in a way that is not intrusive. The danger is that these things can create a bad first impression or discourage further engagement. The lag experienced due to platform instability or broad band speed has significantly improved and this will continue to do so. However, I think the emphasis is now on the educational / Linden community to develop solutions to some of the more significant technical barriers facing us right now…like how to minimise the learning curve for first time users, how to ensure that users can clearly and unambiguously identify each other, intuitive HUD’s, how to protect data etc…

Some of the escapism aspects of Second Life are very useful e.g. in some meetings it gives some people more confidence to voice their opinion. However, if Second Life is to be embraced by the wider educational/scientific community it needs to be able to take on a more formal tone when necessary. We have run several meetings in SL for medical professional education and patient engagement as part of NHS London health reform. Nearly all first time users describe positive experiences and that they can communicate in an organic method that is currently not possible using a telephone or other online conferencing systems. Furthermore, they are able to meet and talk to people in a way that is not often possible in real life. Communication brings the health metaverse to life, and the reason why the technology lag is worth over comming. The future of medical research is dependent on multidisciplinary collaboration, and the online metaverse facilitates this like no other media.

4) Who can access the virtual site now? Is there a teleport link we could use?

The first piece of work we produced was Second Health (www.secondhealth.org.uk). The aim here was to create a vision of healthcare reform within London’s National Health Service (NHS) which all users could come and experience. This island is always open and can be found here.

We are in a period of rapid development right now, as we are also currently creating a training environment for nurses which will enable us to tackle the issue of device training in the virtual world. The Imperial College London training centre for the department of Biosurgery and Surgical Technology can be found here.

Once we have completed the next round of testing we will open it up so that you can all come and have a look or indeed use it for educational purposes!

5) What do you think about other medical teaching opportunities such as the Ann Myers Medical Center? Are you open to co-operate with them?

The really exciting thing for me, is watching the growing number of innovative medical education projects that are able to engage with students, patients, professionals and the pubic in entirely novel ways. The Ann Myers Medical Center provides an extremely important teaching resource in Second Life, and it was one of the first institutions to recognize the importance of engaging with the virtual world community with respect to health care education. We would ofcourse be delighted to collaborate with the Ann Myers Center, and this would be in the spirit of the health metaverse. The ‘open source’ revolution has really challenged the way that more traditional scientists work, and I see an open spirit of collaboration as being essential to the success of this medium.

6 ) Do you plan to construct other educational resources in Second Life in the near future?

Definitely. The Department of Biosurgery and Surgical Technology (BSST) at Imperial College London sees the online health metaverse as an extremely valuable educational resource and it has therefore recently created a Medical Media and Design Laboratory (MMDL) to ensure that it is able to harness virtual worlds in the most effective way possible for the improvement of human health and education. Dave Taylor (Davee Commerce) is currently leading the virtual worlds program and we are very lucky to have clinicians who can work with builders (such as Robin Winter) and computer scientists in house. I mentioned previously that we are currently creating a training simulation to teach nurses how to use medical devices, and we are looking to open the current OR simulation for multi disciplinary team education within Second Life. This will therefore undergo continued development and refinement. We are also continuing to develop technologies which we hope will facilitate communication at future educational meetings. As soon as we have something new to show you, you will be the first to know!