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The authors present a simulation-based ultrasonographic (US) training tool that can help improve the understanding of spatial relationships in US. Use of a game controller to simulate a US probe allows examination of different virtual three-dimensional (3D) objects. These 3D objects are either completely artificial simple geometric objects (eg, spheres, tubes, and ellipsoids, or more complex combinations thereof) or derived from photographed gross anatomic data (eg, the Visible Human dataset [U.S. National Library of Medicine]) or clinical computed tomographic (CT) data. The virtual US probe allows infinitely variable real-time positioning of a "slice" that is displayed as a two-dimensional (2D) cross-sectional image and as part of a 3D view. Combining the 2D and 3D views helps elucidate the spatial relationships between a 3D object and derived 2D images. This training tool provides reliable real-time interactivity and is widely available and easily affordable, since it utilizes standard personal computer technology and off-the-shelf gaming hardware. For instance, it can be used at home by medical students or residents as a complement to conventional US training. In the future, this system could be adapted to support training for US-guided needle biopsy, with use of a second game controller to control the biopsy needle. Furthermore, it could be used as a more general interactive visualization tool for the evaluation of clinical 3D CT and magnetic resonance imaging data, allowing efficient and intuitive real-time creation of oblique multiplanar reformatted images., (©RSNA, 2014.)

Mobile image intensifier systems (C-arms) are used frequently in orthopedic and reconstructive surgery, especially in trauma and emergency settings, but image quality and radiation exposure levels may vary widely, depending on the extent of the C-arm operator's knowledge and experience. Current training programs consist mainly of theoretical instruction in C-arm operation, the physical foundations of radiography, and radiation avoidance, and are largely lacking in hands-on application. A computer-based simulation program such as that tested by the authors may be one way to improve the effectiveness of C-arm training. In computer simulations of various scenarios commonly encountered in the operating room, trainees using the virtX program interact with three-dimensional models to test their knowledge base and improve their skill levels. Radiographs showing the simulated patient anatomy and surgical implants are "reconstructed" from data computed on the basis of the trainee's positioning of models of a C-arm, patient, and table, and are displayed in real time on the desktop monitor. Trainee performance is signaled in real time by color graphics in several control panels and, on completion of the exercise, is compared in detail with the performance of an expert operator. Testing of this computer-based training program in continuing medical education courses for operating room personnel showed an improvement in the overall understanding of underlying principles of intraoperative radiography performed with a C-arm, with resultant higher image quality, lower overall radiation exposure, and greater time efficiency. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.313105125/-/DC1., (Copyright © RSNA, 2011.)

Purpose: To discuss an approach to improve education in C-arm operation and reduction of radiation hazards based on a computer based training and simulation system called virtX., Methods: virtX is equipped with a visualization of scattered radiation and means to include patient positioning changes in radiograph simulation. virtX was integrated in a course for ORP and evaluated based on questionnaires., Results: Response rate was 73 (n = 77), mean age 35.4 (+/-9.2) and professional experience 11.2+/- 10.4 years. 91% use a C-arm regularly, 8% casually and 1% not. 78% agree that the translation of patient dummy positioning changes to simulated X-ray images is sufficiently realistic, 1% disagree (neutral 17%). 79% state that they acquired new knowledge concerning avoiding unnecessary radiation exposure, 10% do not (neutral 11%)., Conclusions: The virtX-approach of simulating radiograph generation including patient positioning and scattered radiation was evaluated positively concerning its suitability for imparting knowledge regarding radiation protection and C-arm operation.

During the intraoperative radiograph generation process with mobile image intensifier systems (C-arm) most of the radiation exposure for patient, surgeon and operation room personal is caused by scattered radiation. The intensity and propagation of scattered radiation depend on different parameters, e.g. the intensity of the primary radiation, and the positioning of the mobile image intensifier. Exposure through scattered radiation can be minimized when all these parameters are adjusted correctly. Because radiation is potentially dangerous and could not be perceived by any human sense the current education on correct adjustment of a C-arm is designed very theoretical. This paper presents an approach of scattered radiation calculation and visualization embedded in a computer based training system for mobile image intensifier systems called virtX. With the help of this extension the virtX training system should enrich the current radiation protection training with visual and practical training aspects.

With a system of modeling, simulation, animation of information, communication in medicine (mosaic-m) the structures of organisation and information in a level 1 trauma center were analysed and animated as a virtual environment on screen in a first step. One result: in existing paper orientated documentation 50% of documentation was redundant. In a second step the requirements of the future information system were described systematically, user- and organisation-oriented. All components (hard- and software) were simulated an screen that the user could work virtually in the future working place. With mosaic-m the user is fully integrated in analysing and developing a new information system in the clinic.