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PURPOSE: Current lumbar puncture simulators lack visual feedback of the needle path. We propose a lumbar puncture simulator that introduces a visual virtual reality feedback to enhance the learning experience. This method incorporates virtual reality and a position tracking system. We aim to assess the advantages of the stereoscopy of virtual reality (VR) on needle insertion skills learning. METHODS: We scanned and rendered spine models into three-dimensional (3D) virtual models to be used in the lumbar puncture simulator. The motion of the needle was tracked relative to the spine model in real-time using electromagnetic tracking, which allows accurate replay of the needle insertion path. Using 3D Slicer and SlicerVR, we created a virtual environment with the tracked needle and spine. In this study, 23 medical students performed a traditional lumbar puncture procedure using the augmented simulator. The participants’ insertions were tracked and recorded, allowing them to review their procedure afterwards. Twelve students were randomized into a VR group; they reviewed their procedure in VR, while the Control group reviewed their procedures on computer monitor. Students completed a standard System Usability Survey (SUS) about the system, and a self-reported confidence scale (1-5) in performing lumbar puncture. RESULTS: We integrated VR visual feedback in a traditional lumbar puncture simulator. The VR group gave an average 70.4 on the System Usability Survey (SUS) vs. 66.8 of the Control group. The only negative feedback on VR was that students felt they required technical assistance to set it up (SUS4). The results show a general affinity for VR and its easeof- use. Furthermore, the mean confidence level rose from 1.6 to 3.2 in the VR group, vs. 1.8 to 3.1 in the Control group (1.6 vs. 1.3 improvement). CONCLUSION: The VR-augmented lumbar puncture simulator workflow incorporates visual feedback capabilities and accurate tracking of the needle relative to the spine model. Moreover, VR feedback allow for a more comprehensive spatial awareness of the target anatomy for improved learning.
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