IPSJ SIG Technical Report Vol.2013-CG-153 No.22 Vol.2013-CVIM-189 No /11/29 3 次元印刷された患者実体モデルによる手術技能研修支援 - Realized Virtuality cadaver tra

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1 3 次元印刷された患者実体モデルによる手術技能研修支援 - Realized Virtuality cadaver training 2012 VR (Virtual Reality) 3 Endoscopic Surgical Training Using 3D-Printed Patient Models - Realized Virtuality - JULI YAMASHITA 1 KAZUNORI YOKOYAMA 2 This paper reports a 3D-printed precise human paranasal sinus model and a tele-mentoring system using the model with virtual mirror interface for manual skills training in endoscopic nasal surgery. The model has precise anatomy reconstructed from patient s CT images and has material and structure that allow surgeons to incise the model using clinical surgical equipment with similar haptic feeling to that of real patients. When materials and structure is carefully designed, 3D-printed patient models, or materialized virtual patients, can be better than virtual reality simulators. 1. はじめに On the Job Training (OJT) OJT Off the Job Training Off the Job Training a. E-Learning 3 1 ( ) National Institute of Advanced Industrial Science and Technology (AIST) 2 Hana Clinic Tsukuba South Avenue 2 3 b. c. OJT d. (cadaver training) : OJT 2012 [1] e. VR Computer Tomography c 2013 Information Processing Society of Japan 1

2 (CT) [2] VR Box Trainer [3][4] 2. 手術可能な精密ヒト鼻腔モデルの開発 2.1 対象部位 : 副鼻腔前頭蓋底 1 2 OJT OJT 2.2 内視鏡下鼻内手術手技研修用ヒト鼻腔モデルの開発 (2002 年 2004 年 ) ("Look") ("Feel") Step 1: CT (segmentation) 3 ( ) ZetView Step 2: CT ( ) SensAble Technologies, Inc. 3D Systems FreeForm FreeForm Computer Aided Design / 3 3 Z406 (Z Corp. 3D Systems) Step 3: Figure 1 Paranasal sinuses 約 20cm 2 Figure 2 Rigid endoscopes for paranasal surgery. c 2013 Information Processing Society of Japan 2

ũėèǯį ȏȝėÿ Step 4: ĨŖŦ0ʆ żļɉ w 0ɋˤȖãŋ0ʆ E ó i EƐɣ # 2004 ŏœ.ɋˤȗżļã 12 ú.ĵˎ.

ʦ <0+-&# Č 3 ˤɕĀʤEȋǩƗ.) 5 ±0 ʹĄ.Ë ) @ Ŵɯȏ )Ȑě #ʹĄE Ɔ B 2.ȏ EÅ * A Ʈ i E CT ƌř 3 ǅ A ºÅƽȧ #ŗǩ1 ŧɉ CT?Åƽȧ B# ŗǩ.

î2- Č 3 ǿ #Ŵɯôɏ-ȭĹqjˤɕ i elft* AǢ1¹BA A: ƣ B: i Ãʹ C: ʹĄ õȩ ǔʹë ʠʹȵɁ Ȭɛ-, ǣ Figure 3 Incisable paranasal model. ' ' #Ⱥǩ.

VR システム開発前 ȢɈ1ʀÙɼ VR 0ȏȜɈ* #@ VR + 3 ǅºèÒĴ []h~0 ǿeĩ;a. i 0ʷŷɍ A#; 2002 ŏ.ŵŵȏ &# Ƨȴȁ.Ĵ i Eʷŷ #ǯǵ1 0ʬ@* A Øˤɕ0Ŵɯ*1 Ãɻ +ˀīȣ0ŴɯĈÁE 2 Ʈ ùơ.

>A 1 ë ŪÃɻ. 0.1N? p eƾ0ɯá 2mm ë0 0ˀˊ Eďʨ ȞĬ A 0.1mm ëșœ 1N?.ĈÁ * 10N -,0ƍ @ B?E )Po * AÙɼtI koftioj]1ŉ ʕ B)? &#+ )< ō.

3 ũėèǯį ȏȝėÿ Step 4: ĨŖŦ0ʆ żļɉ w 0ɋˤȖãŋ0ʆ E ó i EƐɣ # 2004 ŏœ.ɋˤȗżļã 12 ú.ĵˎ.ʇ i E Ŵɯ ) #$ )H V j ʎƷEĴƚ Look & Feel 1ĨŖ* A+ʆ B#[5] " * ȱư ƽʮ1"088. >@ŐȦċEÕ # + ɸƪ.Ť ) i á AȦċEŐ # 2.3 結果 ǿ #qjˤɕ i 1 ȬɛɤE #k J]P.ʦ <0+-&# Č 3 ˤɕĀʤEȋǩƗ.) 5 ±0 ʹĄ.Ë Ŵɯȏ )Ȑě #ʹĄE Ɔ B 2.ȏ EÅ * A Ʈ i E CT ƌř 3 ǅ A ºÅƽȧ #ŗǩ1 ŧɉ CT?Åƽȧ B# ŗǩ. ʼ-@ i ŗǩ ĨŖ* A + Ȓʊ* # Č 4 ɋˤȗżļã60h V j*1 0ʆ EŞ# Õ ơ0ŵť 1 Ǳ +Ǭ y ˆ0 # * čĳ +0 A ɤ1Ǭ >@Ǳ.ʦ B C ɿ ƽʮ1ǭ.î2- Č 3 ǿ #Ŵɯôɏ-ȭĹqjˤɕ i elft* AǢ1¹BA A: ƣ B: i Ãʹ C: ʹĄ õȩ ǔʹë ʠʹȵɁ Ȭɛ-, ǣ Figure 3 Incisable paranasal model. ' ' #Ⱥǩ.-&) A: overview, B: bone parts inside, C: a bone part with right Ethmoid sinus. ÅǮŦ ðšŧ ȷƳE + 0ǝ? -ƥ A + Č 4 ǚ 2.4 考察実体モデル vs. VR システム開発前 ȢɈ1ʀÙɼ VR 0ȏȜɈ* #@ VR + 3 ǅºèÒĴ []h~0 ǿeĩ;a. i 0ʷŷɍ A#; 2002 ŏ.ŵŵȏ &# Ƨȴȁ.Ĵ i Eʷŷ #ǯǵ1 0ʬ@* A Øˤɕ0Ŵɯ*1 Ãɻ +ˀīȣ0ŴɯĈÁE 2 Ʈ ùơ.«ǳ A Č 3A ǫ ʹ. 2 ± 0Ùɼ ti koftioj]eĵɲ A +1 ō.ċ * A Ĵˎ. VR []h~0¼ɮȏȝ [6]*< ÙɼtI koft1 Ūˀī09.ˉĳ ðù1þȕ B- Ŵɯƍ. AÙ0Ȧċ ō.ő 0ɬ 60ɀȳ-ƍ.>A 1 ë ŪÃɻ. 0.1N? p eƾ0ɯá 2mm ë0 0ˀˊ Eďʨ ȞĬ A 0.1mm ëșœ 1N?.ĈÁ * 10N B?E )Po * AÙɼtI koftioj]1ŉ ʕ B)? &#+ )< ō.ˡ <0+-A ˀˊ0[} [ ØˤɕŴɯ0 - ƍ 1 p eƾ0ˀī* EÌˊ A+ <0* A 0ȐƗ0> -[} [ *1ÙɼþȔio J]0Ñş ō. İĳ.-@= Č 4 ŧɉ +"0 i +0Ǎʣ Figure 4 Comparison between the original patient (top) and his model (bottom). ] Ƥʙ A01 ō.éˌ* Ù0ŕ ioj A 実体モデル vs. VR システム開発後 (1) 開発プロセス ŧɉãǳƕ E segmentation ) 3 ǅºŗǩEÅƽȧ A 2013 Information Processing Society of Japan 3

4 VR VR VR (2) リアリティ OpenGL CG (3) コスト C VR 2006 (4) 研修内容 VR (5) 3 次元構造の理解 CAD CG 3 CG CT CAD 3 CG 課題と展開 (1) 解剖構造疾患のバリエーションの蓄積 VR 10 CT (2) 3 次元プリンタへの要望 CT 3 3 (3) その他の手技研修用鼻副鼻腔モデル [7] [8] [9] 2013 [10] 3. 実体モデルを用いた手技支援システム 3.1 手技技能レベル客観評価指標の探索 6 Nitta NDI c 2013 Information Processing Society of Japan 4

ũėèǯį ȏȝėÿ ã ǥƚã.' T r a i n e r ' s s i t e T r a i n e e ' s s i t e 2 Monitor 1 )ʂ Ǚ ËƲ # B8*. ØƉ 3 Internet 3 0éˌŦ Ãɻ Ƕ 2 1 0İĳŦ ĈÁƍ 0 ŰB 0> -ŝư1 ʁɨ*ɰǮ B) # 4 4 ʆ żƿe i 0 Õ Ȧċ ŧɉ i.

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5 ũėèǯį ȏȝėÿ ã ǥƚã.' T r a i n e r ' s s i t e T r a i n e e ' s s i t e 2 Monitor 1 )ʂ Ǚ ËƲ # B8*. ØƉ 3 Internet 3 0éˌŦ Ãɻ Ƕ 2 1 0İĳŦ ĈÁƍ 0 ŰB 0> -ŝư1 ʁɨ*ɰǮ B) # 4 4 ʆ żƿe i 0 Õ Ȧċ ŧɉ i. AÙ0Ģ Č 5 ŴɯŴŵʴˍƒſ[]h~ ƣ [ 11 ] ƙ û 0 p c Figure 5 A distance manual surgical skills training system overview. Ãɻ Ƕ 0 ɾœ-,0ǧǯʾEǳ )ĵɽȁ.ɠ²á A +.ű Ú ) A 3.2 手術手技遠隔教授システム Öʃ0ʆ żƿʂǚ. ) Ŵɯƍ 0ɱ Ɉ0ĪEʃ #rioeëʋ #+ C ÍŢ Ɉ ÍȰɈ0ƍ 0 İĳ 0ì ĉ -@0ʹË ƍ ơ0ũ Č 6 HyperMirrorTM J ctl ].>AøűƟ ņ Ǉ Č õ Č Īà=ŴɯĈÁ0ʋ&#Ż%ƙ. Figure 6 HyperMirrorTM images. A + ÎƝ # B.Ļ ǥƚã.1àʬ Aƍ 0 Ē Left: front view, Right: side view ƍ ơˆ1" *1- + żļã.>aʲűœʆ > œ*<iĳ )ù ƍ Eɂ@ʧ + * A ˡ * ]{ g=ɢʞ0 Ē E 0Ö*ȽɆ A +.q 患者対モデルによる研修医若手医師への遠隔指導 jeş) 0 ctg * A HyperMirror TM ( įɇɉʉ0ĭđ-, Ɲ? +-&# i.>aŵŵȏ *1 ĖƮȁ-Ŵŵ0įɆ1ôɏ HM) / ʚ J ctl ][12]EŤǳ ǥƚã Ż' * ƍ 0 Ē EÝǭ> ƒ A +0* AŴŵj m ɯķ]cft+0ʯɗ ɿ 0Ĵˎ=Éɭ-,Ȼťơ0Ļ U[]h~E ǿ # Ť-, OJT +0S fv18$ģ モデル対モデルによる初心者への手技遠隔教授実験 ¾AÖ0ȏ ã Ĵˎ0ŴɯEɞĘŭ++<. * A żļɉ įɇɉ0 ZJj.ˤɕ i EɃ []h~e ǿ #[14] 8 #[]h A Ŵɯ 0ʰɮ=Ŵ " * OJT. Ŵɯ ĳ0ŧɉƾ0 i ~EĴɲ Č ŏ.ʿǒãȗģį Ȏńȇ +ǲ E ȼȏ ɧēȇ EȷF*Ãɻ ˤÃŴɯŴŵ0ʴˍj ˎ. [} [ z.ŀaȏ ã "0ŧɈ0 m UĴ EĴƚ #[13] ZJj1ù ǃĈƽű+ i Eùơ.Ŵɯ -?żļãeʪ ǌ0 mc 1 2 *Ȇ 0Ãɻ Ƕ E ɻ Ƕ HM Ƕ EÀƩ żļã ŴɯĶ? H cj~*ǎʣ* A ïƙ ù ŧɉ i.ù ɯá? ; ű ) ŴɯĶ*żļã Ŵɯ A cj~.żļ A Č ŏ A ïƙ1ã H 2012 ŏ.ȥǔģį. + 1 ǌ0 HM ) 3 0ʴˍżļEĴƚ ȏ ã 4+'0ŴɯEƧÍ A EǍʣ A Č 6 B?Ƨś8* ŴɯĶ0ƾīEɹ-?Ǻ ĕêȶ * 1ù H U *ƌř #żļɉ+įɇɉ0ɵ EˏùĜ A + 8#ŴɯĶ *<ŧɉ i Ƞ ŴɯlrW.øű #ś ņõeðʡ ). #<0* Ɉ0 [ + )ľųɿ 0Ȓʊ.řȠ' + D &# *ù ƍ E A įɇɉ * mc 3 4 * ʳ&) Þ 0ʳ Ǉ ƙû0 HM Ɵ.>@ 3 ǅºȁ-Þ * AÃɻ ȣ0ɯáƍ ǅ. OJT *ŴɯEĕÊ AɦŴãŋE ˏ*żļ ã "0ŧɈ0 i EŴɯ -?żļ A ŴɯĶÃ EǇȒ.Ǎʣ żļ A + ôɏ+-&# ˏƃĒ0ʴˍżļ[]h~E ǿ [15] 2011 ŏ.ˇɷã ʴˍżļĴ +"0 2 ƨś0ĳȋȓʊĵ 0ȷƳ Í ȖĢį.) 1 0żļĴ EĴƚ # ŝư0 OJT *1 ŢɈ ʿãĢǱ 11 ú 7 ú.ļ )ʴˍ*0ŵɏƒſ żļɉ1ãɻ Ƕ Eż )ʁɨ*żļ A żļɉ ôɏ* ĕê AɦŴãŋ0ɖE' F* ɅɁ ǩů*ƍ A +EȒʊ # 8# ƍ.ŧɈ i. &#Ù0Ģ 1ǥʲœ0żƿ+ )ʵÌ* 2013 Information Processing Society of Japan A Eƒ A ǣ &# Ʈ[]h~*1żļã ɟʟ0 5

ũėèǯį ȏȝėÿ Ŵ=ŴɯĈÁ*ɦŴãŋ0Ãɻ Ƕ ŧɉŵɯɵ E +ľųɿ Eżļ* # ŝư cadaver training *- B2 ż Ȕ +*šħ-ɯáƍ 0żļ ôɏ$&# Č 8 ôɏ* 8# ïƙ*ù ʹ EíǤ '' i *ȉȟȯƾ 1Ƕƫȁ* Ʊ=ģɫ-,éˌʹ EÕ A +* Õ Ȧċ0ˉǷ 3.3 今後の展望 ǮĐ &#ľųɿ E ɯę*i.

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2013 Information Processing Society of Japan 参考文献 1) ƜƮĠȖį ƜƮɿ į ɞőãį0ƒɎî5ȏȜ. AǊ ɿ 0QJk J.' )(2012) http://www.jssoc.or.jp/journal/guideline/info20120620.html 2) Ń ǂʻ: Ŵɯôɏ-ȭĹ i +"0Ťǳ ɟňʆ?

6 ũėèǯį ȏȝėÿ Ŵ=ŴɯĈÁ*ɦŴãŋ0Ãɻ Ƕ ŧɉŵɯɵ E +ľųɿ Eżļ* # ŝư cadaver training *- B2 ż Ȕ +*šħ-ɯáƍ 0żļ ôɏ$&# Č 8 ôɏ* 8# ïƙ*ù ʹ EíǤ '' i *ȉȟȯƾ 1Ƕƫȁ* Ʊ=ģɫ-,éˌʹ EÕ A +* Õ Ȧċ0ˉǷ 3.3 今後の展望 ǮĐ &#ľųɿ E ɯę*i.żļ* A + A H cj~ʴˍżļ0 D@. Ƕ #ƒư Ɵ =ŴɯƟ Eǳ #ŴŵɟɆ[]h~E ǿ * ȘĽ ˡ œǽ 0Ɵ Eǳ 指導者 Ʃ[]h~+ )<Ʃǳ* A B2 ǥƚãû 0Ǽ À A ś Ȗ60ŤǳEý ; ÍŢɈ-OJT- ȰɈ8*E[ ~ ].Əƈ* Aʴˍ Ŵŵȏ []h~+ )ǿł!) # 謝辞 åù &#ŧɉƾ >5 ãǿǃˇ0ȃƾ. ʒf*ŭʑ0ūeɰ A 学習者補助指導者 Č 6 ŴɯĶ -[} [ z ˆ*0ʴ ˍŴŵżļĴ 0ƾī 2010 ŏ ȤǓĢį Figure 6 Tele-mentoring experiment between OR (top) and the simulation lab. (bottom) (University of Tsukuba, 2010) Č 7 ŴɯĶÃˏƃĒ0 OJT Ŵŵżļ[]h~ 2011 ŏ ˇɷãȖĢį Figure 7 Tele-mentoring system On the scene (Kansai Medical University, 2011) Information Processing Society of Japan 参考文献 1) ƜƮĠȖį ƜƮɿ į ɞőãį0ƒɎî5ȏȜ. AǊ ɿ 0QJk J.' )(2012) 2) Ń ǂʻ: Ŵɯôɏ-ȭĹ i +"0Ťǳ ɟňʆ? ʴˍżļ8* ƜƮX s cġȗį ʉ, Vol.8, No.2, pp (2006). 3) Munz, Y. et al.: Laparoscopic virtual reality and box trainers: is one superior to the other?, Surgical Endoscopy, Vol.18, No.3, pp (2004). 4) Kimura, T. et al.: Usefulness of a virtual reality simulator or training box for endoscopic surgery training, Surgical Endoscopy, Vol.20, No.4, pp (2006). 5) Ń ǂʻ ŴɯôɏȭĹqjˤɕ i 0H V jʆ, ɋˤăćȗłƪ, Vol.19, No.5, pp (2006). 6) Edmond, C. V. et al.: ENT Surgical Simulator, Final Report Cooperative Agreement No. DAMD HITL Technical Report R U.S. Army Medical Research and Materiel Command. Fort Detrick, Maryland (1998). 7) Nogueira, J.F. et al.: Building a real endoscopic sinus and skull-base surgery simulator, Otolaryngology-Head and Neck Surgery, Vol.139, No.5, pp (2008). 8) ĢʽɡƼ ãǿǳȭĺƞ i KEZLEX ȶˤÃɻ Ŵɯǳ 9) Okuda, T., Kataoka, K., and Kato, A.: Training in endoscopic endonasal transsphenoidal surgery using a skull model and eggs, Acta Neurochirurgica, Vol.152, No.10, pp (2010). 10) ĦǴǈö ȶˤȁÃɻ Ŵɯ. Aj m U[]h ~0 ǿ ɔȕȶġȗʭė Vol.23, No.3, pp (2013). 11) Kumagai, T. et al.: A New Force-based Objective Assessment of Technical Skills in Endoscopic Sinus Surgery, Proc. Medicine Meets Virtual Reality 15, IOS Press, Vol.125, pp (2007). 12) Morikawa, O. and Maesako, T.: HyperMirror: Toward Pleasant-to-Use Video Mediated Communication System, Proc. CSCW 1998, pp (1998). 13) Ń ǂʻ Ū0.>AÃɻ ˤÃŴɯ0ʴˍŴ ŵżļ[]h~ ƜƮo e H hiį ʏƕʉ Vol.14, No.4, pp (2009). 14) ĂǴąʸ Ŵɯ[} [.>AƘ#-ĠȖƒɎ Ãɻ ØˤɕŴɯ60Ťǳ Ɣŗ ǠķĠȖ Vol.54, No.02 pp (2011). 15) Yamashita, J. et al.: An In Situ Tele-mentoring System for Training Endoscopic Surgery in the Operating Room, Simulation in Healthcare, Vol.7, No.6, pp (2012). 6

研究成果報告書(基金分)

研究成果報告書(基金分) ŵ ƂļǔɝʜƸ ¾Ð±«¾ĒóʜƸ Ò Ô±ɥǎʜƸ ÄÌ ÐÔµÓ Í ½Ô ŤȘʜƸ ʅǤŬȣȈʎ ŤȘʜƸ ¾Ð±«¾ 1 7 1 ʱǓŒ ǻɓ Șq ÔÑÔ²ʲ ǑŒżƎ îȵȱǆ ¼ ±ƍ ǃ Ģȯ ʗ Ģȯ Ð Ò ėǌ ǆȸevǯɲƈ ǢȮżƎ ǃ Ģȯ ɯȣɐė Ʉȃ ŐĚ Ôª³Î ƈ ȑ ÀÔ Ųd šìɛ ǆȸev Ò Ï Ô ʗȸe ƨǂżǝv±ì ÁÔÎ²ƍ k ǓŒ VƉȻ