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Virtual 3D Atlas of a Human Body – Development of an Educational Medical Software Application

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This paper presents a process of building a prototype of an educational application for teaching anatomy with elements of physiology, with use of a Virtual Reality environment. Preparation of mesh models of individual human organs is described, along with further visualization techniques, which were used to ensure a proper level of a visual representation. Stages of user interface preparation are also described – both visual and functional aspects covered – with a detailed review of a visual programming process, which was used to obtain a logical structure of connections inside the VR environment. Process of preparation of dynamic graphical data-namely animation of the pulmonary alveoli – and integration it with the virtual environment is also presented. The final application can be used in a number of ways, including large-screen stereoscopic projection with on- screen graphical user interface and single-user immersive stereoscopic projection using a head-mounted device with an optical tracking system. Results of assessment of the application advantages and disadvantages at the current stage of development allowed to formulate several directions of further advancement.

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Procedia Computer Science 25 ( 2013 ) 302 – 314

Selection and peer-review under responsibility of the programme committee of the 2013 International Conference on Virtual and Augmented Reality

in Education

doi: 10.1016/j.procs.2013.11.036

ScienceDirect

Available online at www.sciencedirect.com

2013 International Conference on Virtual and Augmented Reality in Education

Virtual 3D Atlas of a Human Body – Development of an

Educational Medical Software Application

Adam Hamrol, Filip Górski*, Damian Grajewski, Przemys aw Zawadzki

Poznan University of Technology, Chair of Production Management and Engineering, Pl. M. Sklodowskiej-Curie 5,

Poznan PL60-965, Poland

Abstract

This paper presents a process of building a prototype of an educational application for teaching anatomy with

elements of physiology, with use of a Virtual Reality environment. Preparation of mesh models of individual

human organs is described, along with further visualization techniques, which were used to ensure a proper

level of a visual representation. Stages of user interface preparation are also described – both visual and

functional aspects covered – with a detailed review of a visual programming process, which was used to obtain

a logical structure of connections inside the VR environment. Process of preparation of dynamic graphical data

– namely animation of the pulmonary alveoli – and integration it with the virtual environment is also presented.

The final application can be used in a number of ways, including large-screen stereoscopic projection with on-

screen graphical user interface and single-user immersive stereoscopic projection using a head-mounted device

with an optical tracking system. Results of assessment of the application advantages and disadvantages at the

current stage of development allowed to formulate several directions of further advancement.

Selection and/or peer-review under responsibility of the programme committee of the 2013 International Conference on

Virtual and Augmented Reality in Education.

Keywords: Virtual Reality; immersion; 3D human anatomy; human body atlas

1. Introduction

During the last decade, Virtual Reality techniques have undergone a significant metamorphosis, from

entertainment and experimental applications with simple graphics to dedicated engineering tools, decision-

* Corresponding author. Tel.: +48 61 665 2708; fax: +48 61 665 2774

E-mail address: Filip.Gorski@put.poznan.pl

Available online at www.sciencedirect.com

Selection and peer-review under responsibility of the programme committee of the 2013 International Conference on Virtual

and Augmented Reality in Education

303

Adam Hamrol et al. / Procedia Computer Science 25 ( 2013 ) 302 – 314

making support systems and advanced training systems [1]. Currently, possibility of use of functionally and

graphically advanced programming environments in connection with various peripherals brings users unique

possibilities of interaction with virtual worlds. Advanced projection systems and tracking devices bring high

level of user immersion into virtual environment, which is further expanded by haptic devices giving the user a

sense of touch [2]. Virtual reality simulations are often expanded with interaction with physical prototypes of

investigated objects, integrated with the virtual world, further improving realism of the simulation [3]. Vast

potential of VR systems and theoretically unlimited range of possibilities of creation of virtual worlds makes

VR a perfect tool for development of interactive training systems, which ensure both realism and safety of

trained persons. Aeronautical and military industry have already appreciated these possibilities, using VR

techniques to build specialized simulators, where each exercise can be performed countless times and the

situation can be thoroughly analyzed. Virtual training allows to work out appropriate habits, reflexes and

reactions and to examine objects contained in the traini ng scene in a better way than traditional educational

methods. The virtual training procedures have also found a wide range of applications in industry – for

prototyping and training operators of virtual workplaces for manufacturing operations [4-6] or for assembly [7].

Thanks to these advantages, lots of attention is paid to application of VR techniques in medicine nowadays.

For years, more or less advanced solutions used in education of students and doctors have been built, e.g.

simulators of surgical procedures [8-9]. They can not only supplement, but even substitute traditional teaching

methods. In a virtual world, interview with a patient can be simulated, as well as laboratory examination or

even certain operations, e.g. palpation, needle pricking [10-11] or even laparoscopic operations. Three-

dimensional, fully interactive anatomy and physiology atlases are theoretically simpler from a technical point of

view, but necessary nonetheless. A case of such an application is a main subject of this paper.

A search for alternative, more efficient and realistic techniques of transferring knowledge to medicine

students in a field of anatomy, physiology and pathophysiology has led to formation of an interdisciplinary

team, consisting of lecturers – doctors of medicine from a Poznan University of Medical Sciences and

engineers – VR specialists from Poznan University of Technology. Aim of the research of the created team is to

develop tools for medical education on the basis of advanced virtual reality systems. A first product of the team

of authors is an interactive 3D human body atlas, presented in this paper.

It is noteworthy, that 3D atlases presenting the human anatomy are not a new concept [12-13]. Such atlases

already exist and in an on-line version are available for most users with a reliable internet connection. A final

effect of the work by the authors is not planned to be a typical 3D anatomy atlas though – it is supposed to be

only a base for planned software modules for medical education in scope of physiology and pathophysiology.

In the present form, described in the paper, the application has only one feature related to physiology – more

will be added in the future. Main disadvantage of the available 3D atlases, raised by the medical university

lecturers, was the fact that they are not flexible and do not allow to expand the range of functionalities and

adjust the in-built 3D models. Aim of the authors was therefore to create a base for a flexible tool, which will

be constantly developed and enriched with new functions, to meet the requirements of both lecturers and

students. On the basis of the created VR application, both new educational tools for physiology teaching and

simulators of simple medical procedures can be created. Expanding the application functionality with

possibilities of haptic devices (giving tactile feedback to user) is also one of the determined future directions of

development.

The paper is focused mostly on methodology of creation of the "virtual 3D body a tlas" type of application,

presenting all the work stages in a detailed manner. The paper also describes methods of testing the atlas and its

planned educational applications. Cooperation with the medical team allowed to assess the usefulness of the

304 Adam Hamrol et al. / Procedia Computer Science 25 ( 2013 ) 302 – 314

prepared application, two aspects being evaluated: quality of medical knowledge contained within the

application and practicality of its use. As a result, several directions of further advancement were formulated.

2. Aim of the work

A fundamental aim of the presented work was an attempt to use a Virtual Reality environment to build an

interactive educational application – a 3D human body atlas. Team of engineers of Laboratory of Virtual

Design of Poznan University of Technology, with a support of medicine doctors and lecturers from Poznan

University of Medical Sciences, defined the most important requirements which should be met by the

application:

presentation of the human body structure with di vision into systems (respiratory, cardiovascular,

nervous etc.)

free manipulation of the 3D model of the human body (rotation, zoom in and out, panning),

possibility of free exploration of the selected body systems,

possibility of turning selected systems on and off,

transparent views,

dynamical intersections,

displaying text descriptions,

detailed structure of the respiratory system,

physiology – work of the alveolar sacs,

large-screen presentation (for multiple users),

individual presentation using the 3D helmet (HMD device).

Some of the above listed assumptions are typical for the already existing 3D anatomy atlases [12-13].

General body structure was additionally detailed for the respiratory system, where the physiological process of

the gas exchange occurring in the alveoli was decided to be shown. An innovation is application adjustment for

use with an advanced Head-Mounted Display system. Considerable experience of the working team in scope of

creation of interactive instructional applications related to manufacturing processes (e.g. assembly/disassembly

sequences, simulation of operation of mechanical systems and their construction, etc.) allowed to select a

number of software and hardware technologies necessary to build the 3D atlas according to defined

requirements. The plan of the work is presented in the fig. 1.

The most significant part of the work was realized using two programs: 3D Studio Max (modeling, texture

mapping) and EON Studio (VR programming, project and implementation of logical connections). The

interdisciplinary team consisted of the following members: head of the project – 1 person, 3DS Max graphics –

1 person, graphical user interface (GUI) design – 1 person, EON Studio programmers – 4 persons, medical

contents preparation – 2 persons.

3. Methodology of building the application in the VR environment

Tasks related with the GUI design and preparation of the human body 3D models were conducted

simultaneously. Only after they were finished, actual programming activities were commenced, related to an

implementation of all the 2D and 3D components inside the virtual environment and building appropriate

logical connections according to the defined requirements.

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Fig. 1. Plan of the work during preparation of the virtual body atlas

3.1 Preparation of the anatomical 3D models

Modeling of the surface objects based on freeform surfaces is a difficult task and it requires a considerable

experience from the designer. Complexity of the human body structures, along with required level of

complexity of representation of certain tissues and organs, despite some simplifications (reduction of details),

additionally made the tasks related with 3D models preparation more difficult. It was decided to use an

available, ready commercial solution for the research concerning mostly possibilities of use of the VR

environment. A polygon mesh 3D model of the human body (fig. 2a) was bought, along with geometric

representations of individual organs and systems and a set of textures assigned to them. After the

implementation into the 3DS Max program and an appropriate 3D image processing (texture mapping), a

graphical representation of the human body was obtained (fig. 2b).

306 Adam Hamrol et al. / Procedia Computer Science 25 ( 2013 ) 302 – 314

Fig. 2. 3D model of a human body – a) polygon mesh without textures, b) mesh with textures mapped

It is important to emphasize that 3D human body models available in general sale usually do not have any

certificates confirming or guaranteeing their anatomical correctness, that is why the selection of the model was

carried out with help of specialists from the medical university. Some corrections and adjustments needed to be

implemented in the polygon mesh anyway. Moreover, to show the respiratory system physiology (alveolar sacs

animation), it was necessary to build the following tissue models from the scratch: bronchioles, alveoli and

pleura along with some elements of the cardiovascular system (arteries, veins and capillaries – fig. 3).

Fig. 3. 3D model of the alveolar sacs prepared for export

End of the work on this stage was achieved after the 3D data was exported manually to the EON Studio

software. An attempt to export the whole human body at once from the 3DS Max to the VR environment failed

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because of multiple errors (wrongly displayed parts, lost pivot points) after one-step export procedure. That is

why the data for the export was divided into several portions transferred separately and joined inside the VR

environment.

3.2 User interface design

A graphical design of the user interface was created in two stages. During the first stage, an initial concept of

its appearance and arrangement was prepared (fig. 4), taking into consideration basic functionalities

(exploration of the anatomical structure of the body, description windows, manipulation panel etc.). On the

conceptual stage ergonomics of operation of the application and methods of its use (standard – using typical

computer mouse and wireless – using a 3D wireless mouse pilot) were also taken into account. Further works

consisted in cutting out individual parts of interface and building 3D models related to them. The interface itself

is a set of 3D models placed directly in front of main camera – this way some 3D effects, as well as

transparency levels can be achieved, as opposed to typical 2D image based interface. Each element of the

interface had its spatial representation and was easily accessible for programming on the level of the EON

Studio software. Appropriate appearance of the interface was achieved using texture mapping.

Fig. 4. Design of the graphical user interface

3.3 Building the application in the VR environment

Programming in VR environment using EON Studio is based on various nodes and their mutual relations.

Each object in the simulation, would it be a 3D model, a 2D element, a hardware representation (keyboard or

mouse sensor) or a purely logical or mathematical function is defined by some kind of a node. Nodes need to be

put somewhere in the structure of the EON Studio simulation (inside the Simulation Tree, which holds all the

nodes and their hierarchy sometimes decides about their relations). After defining the nodes, the programmer

308 Adam Hamrol et al. / Procedia Computer Science 25 ( 2013 ) 302 – 314

needs to define their properties. For the nodes representing the 3D geometry, it is mostly a position and

orientation in the space of the simulation. Basic shape in this space was defined as a half-sphere, inside which

all the 3D models imported from 3DS Max were put together. Then all the appearances were checked (texture

mapping, lighting levels, colors) and improved when needed. Next, all the interface elements were

implemented in the simulation space. All the 3D objects were grouped appropriately to facilitate performing

some certain operations (like turning off and on several objects simultaneously). Appropriate lighting of the

scene was also prepared and camera and viewport settings were adjusted, to make the interface appear properly

and avoid the effect of overlapping or clipping certain geometries, especially during camera zoom-ins.

Navigation system was added, to allow user to manipulate the camera around the main object – a human body.

Three main navigation operations are rotation, zoom and panning. Certain limits were introduced to prevent

user from getting lost in the simulation space (if there were no such limits, a user could zoom out to infinity or

pan so far outside the main space that he would see nothing).

Further works were focused on so-called object beha vior programming – introducing relations describing

application functionalities, which were defined earlier, on a requirements definition stage. Five main

functionalities were distinguished (fig. 5):

dynamic intersections,

hiding selected body systems,

making selected body parts transparent,

calling the information windows (descriptions),

animation of the alveoli.

Fig. 5. Basic functionalities of the virtual body atlas

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Apart from these five groups, several supporting functionalities were implemented, e.g. camera position

change to a predefined location, screen shot or total reset of the display mode of all organs (back to initial

state). For each of the above mentioned positions, the ER (entity-relationship) diagram was prepared to present

relationships between individual entities of a given relation. An exemplary ERD for functionality of dynamic

intersections is presented in the fig. 6. Preview of the dynamic intersection function is presented in the fig. 7.

Fig. 6. ERD for dynamic intersection functionality

Fig. 7. Preview of the dynamic intersection functionality

310 Adam Hamrol et al. / Procedia Computer Science 25 ( 2013 ) 302 – 314

The functionalities are realized in the following ways:

intersections: built-in parameter of the material (section plane position), changed dynamically using

sliders; various organs can be cut so the main problem here was to change the slider affiliation during

the simulation (e.g. to switch from cutting all the materials at once to cutting only two materials at a

time, using the same slider),

hiding / showing body systems and descriptions: simple turn off / turn on command sent to groups of

objects, also a "solo" mode was implemented (hide all except the selected group),

changing transparency: smooth transition of the opacity parameter from value 1 (fully opaque) to a

value of little above 0 (fully transparent),

animation of the alveoli: shape animation – quick switching between slightly different shapes, which

were previously generated; this is the most performance-consuming func tionality – it does not work

smooth on slower computers.

Implementation of all the relations was achieved by visual programming. The EON Studio software (like

many other Virtual Reality systems) offers a method of programming which does not need the user to type in

the lines of code. Programming of interaction between user and simulation objects (e.g. left mouse click on the

hide/show button makes the certain system disappear or reappear) requires three steps: creation or selection of

needed objects (e.g. a click sensor tied to a specific interface element, a logical two-state node and a logical

representation of the 3D model of the specific organ system), definition of their properties (not always required;

in the mentioned example, one would only adjust which mouse button should be clicked) and drawing linear

connections between certain in and out events of all objects. The visual programming patterns can get very

complex at times (fig. 8). For more advanced tasks the scripting languages are used, mostly to simplify the

programming process and sometimes to realize functions which would be very hard, if not impossible to

achieve using only predefined objects.

Fig. 8. Fragment of logical connections scheme in the presented application

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4. Practical use of the virtual body atlas

4.1. Usage scenarios

Created interactive 3D atlas of the human body was designed as a base application for educational purposes,

especially for lecturers and students of the medical study programs. The application is ready to be expanded

with detailed physiological and pathophysiological models. When finished, the application will contain a set of

specific scenarios, which will be used during lectures or exercises. Functionality of testing the student

knowledge was also taken into consideration (a special "test mode" will be added along with specific scenarios

of the classes). Several basic methods of the application use by its final users can be distinguished:

1. Lecture. In this form, the lecturer will use a predefined scenario to carry out a lecture on a specific

physiological, pathophysiological or anatomical problem. The application will be displayed using the large-

screen projection system, so it will be able to be observed by a large number of students. The interaction will

depend solely on the lecturer, meaning that he will use individual functions according to his own choice or

along a specific predefined class scenario. The applica tion allows free manipulation of the 3D model and does

not require the lecture to follow the same steps each time (there are no limits to the order of the displayed

information). When finished and fully introduced into a learning process, the application is supposed to replace

most traditional lecture materials (slide presentations, notes etc.).

2. Exercise. This case of use will concern the application being used as a support material during the

practical class. The users will be students and they will be able to freely interact with the virtual human body.

For this use, the application will be displayed using standard computer monitors. Functionality of the 3D note

will be also implemented, to allow students to write down anything they want and stick it into a specific place

in the simulation space. Additionally, the students will receive a copy of the application to display it on their

private computers. It is also considered to create a partial, simplified version of the application for mobile

devices (tablets, smartphones).

3. Immersive exercise. Immersive mode of the application can be used only by one person at a time. Such

classes will be therefore carried out in smaller groups or only for presentational purposes. In this mode, the

graphical interface is turned off, as well as mouse-based navigation. Moving around the virtual body is

achieved by literal moving around the room by the user wearing the Head-Mounted Device equipped with

markers of the optical tracking system (fig. 9). Activation of all the functionalities is realized by gestures

performed by user, like touching of the selected tissue to hide it or two-hand slide to change the section cut

plane position. In this mode, the application can be also operated using the wireless mouse-pilot, held by the

user (he will see the mouse cursor on the HMD screen and will be able to perform operations by clicking). For

the immersive mode, a qualified VR technician is needed every time, to ensure the comfort and safety of the

HMD user during the class.

4. Test. In the current, described form the application does not have this functionality, it will however be

created later. After launching the test mode, the application will interactively examine the students knowledge

about the certain problem, e.g. showing the animation of the physiological process and asking about the process

details or asking to match the improperly behaving tissue with a specific disease (in case of the

pathophysiology). Course of the test will be prepared earlier by the lecturer and saved as a specific scenario.

Obviously, during the test the free access to all the descriptions will be limited until the test is finished. This

functionality will be introduced after specific lecture scenarios.

312 Adam Hamrol et al. / Procedia Computer Science 25 ( 2013 ) 302 – 314

Fig. 9. Immersive exercise

4.2. Testing procedure

The testing procedure of the application was planned and conducted according to the predicted usage

scenarios. All forms of the application use (lecture, exercise, immersion) and its functionalities were subjected

to a critical assessment by the testers. The testing was conducted in several basic stages.

Initially, functionality testing was carried out inside the interdisciplinary team which was involved in the

application creation. Each functionality was evaluated and the current form of the application is a result of

multiple iterations, related to improvement of performance and easiness of use of the application. Guidelines

for the application improvement resulted from certain remarks and notes by members of the team – both from

the University of Technology and University of Medical Sciences. After the application was ready for

presentation and operation by inexperienced users, it was made available to all the user groups in all modes of

use. Methods of operation and possibilities of the application for the lectures and exercises (large-screen

projection and computer monitor display) were tested both by future lecturers (from medical universities) and

students of medicine and similar programs. The immersive mode was tested in a similar way.

The users – testers – have expressed their opinion about some aspects of the application – the opinions were

collected to define directions of improvement and advancement of the application. The test group consisted of

approx. 150 persons. Lecturers were half of the test group, the other half consisted of students and

representatives of companies dealing with the medical education. The application in its present form is still a

test subject, as it was made available to students of the biomedical engineering as an example of the computer

tool useful in the medical education.

5. Conclusions and summary

Analysis of the substantive opinions expressed by the application testers and observation of the tests

allowed the authors to draw the following conclusions:

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1. Presentation of the knowledge in the form of an interactive, animated 3D atlas is far more attractive for

the students than lectures carried out using traditional means. Preparation of the full lecture in this way

is, however, far more labor-consuming and requires high qualifications in field of VR programming.

2. The lecturers prefer a sequential mode of knowledge presentation. Predefined scenarios for lectures

should have form of a sequence with a specific number of steps and possibility of creating these steps

and putting them in a desired order should be made available for the lecturers, so they will be able to

prepare a lecture about a certain problem with any level of complexity. Introduction of a possibility to

build a sequence of 3D views with predefined view properties (some organs hidden/transparent,

intersection planes set in a specific position) and contents (selection of the information windows and

their contents, saved 3D notes appearing in the proper moment) is a next logical step in development of

the presented application.

3. The immersive mode is very interesting and attractive both for lecturers and students. However, the

gesture based interface requires detailed adjustment, to make each user able to control the application

without trouble. Unfortunately, available devices (gloves) seem uncomfortable and not intuitive for

non-experienced users. Hence there is a need for another, simpler and preferably cheaper solution.

4. The 3D model of a human body requires detailing for purpose of the intersection. As the implemented

model is a polygonal mesh (as in all VR systems), intersecting it with a plane will not allow to obtain a

realistic effect, which was noted by the testers as a visible lack of filling of the cut tissues (e.g. bone

empty inside). Making the mesh more detailed is not a good solution, because the computer

performance is limited. There is a need to develop a smart solution to reduce the non-beneficial visual

effect of sectioned tissues.

To sum up, the opinion of most of the testers was positive, as regards the concept and form of the

application. The lecturers and students mostly thought that replacing the traditional lecture methods with an

interactive 3D application will have a positive influence on the educational process, assuming that all the

technical problems will be eliminated and access to the application will be easy (lowering the computer

performance requirements, making the application easy to operate, especially in the immersive mode). The

defined directions of the application development will allow, in the future, to create interactive materials

allowing education of the medicine students in subjects of physiology and pathophysiology. Most attention was

paid to the immersive mode of the human body model presentation, as the most realistic way of interaction with

the three-dimensional anatomical and physiological data. At this moment, making the immersive mode more

available for students is difficult, because of the high costs of the VR equipment. In the near future it should

change thanks to low cost solutions such as Oculus Rift, then it will be possible to equip laboratories for

students with multiple HMDs. It needs to be concluded that the possible future of the medical education is the

extended use of fully interactive, virtual anatomical-physiological models, displayed in an immersive mode.

Acknowledgements

The work has been partially supported by the VISIONAIR project funded by the European Commission

under grant agreement 262044.

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... Next, engineering education can entail equipment that is expensive to purchase, use, or maintain with HMD VR technologies. Researchers have explored a virtual industrial robot simulation for operation skill training [11] and used an animated 3D atlas model to present biomedical engineering knowledge [21]. Likewise, HMD VR environments have been created to simulate a bank IT system [41], a customer service support system [38], an astronaut system [32], and the metro system for rehearsing the emergency exercise [33]. ...

... Figure 3 shows the data collection methods used in these evaluations. Common qualitative methods included behavioral observation in real time [4,21,49,61,69] or with video recording software [56,60], interviews and focus groups [21,25,26,42,43,49,60], open questions in survey [7,8,41,57,61], and case studies [59,66]. Quantitative data tended to include task completion time [5,8,23,41,[43][44][45], survey ratings [1,3,4,[6][7][8][9]14,23,33,41,44,47,49,51,64,69], and exam scores [2,23,43,45,49,51,56,58] to assess participants' performance and the effectiveness of HMD VR systems. ...

Engineering education refers to developing an understanding of the principles, methods, and ways of thinking that underlie engineering, and preparing students and engineers for productive engineering careers. The purpose of this review is to explore how head‐mounted display‐based virtual reality (HMD VR) can contribute to these goals. Historically, engineering has not been a focus for VR in education. However, recent technical advances and decreasing prices are driving a growing public interest in applying HMD VR in this field. This article reviews 47 publications on this topic, primarily appearing from 2015 to May of 2020. The literature reveals that engineering researchers and instructors have broadly explored the potential of HMD VR in organized engineering instruction and training. However, rigorous evaluation appears to be somewhat lacking in the reviewed research, and most studies are conducted in a small‐scale laboratory setting. Nonetheless, HMD VR seems to be able to motivate students to learn and it is perceived to be useful in engineering education. Researchers are recommended to explore the methods of using HMD VR to facilitate lifelong learning, especially for the retraining and re‐employment of engineers who seek to change careers or collaborate with researchers in different disciplines. Engineering instructors may benefit from professional development that focuses on student‐centered pedagogies and skills attuned to the latest HMD VR systems.

... The VR system contains several 3D anatomic models and allows students to virtually dissect the models. A similar virtual anatomy project, 3D Human Atlas, was developed in Japan to assess students' understanding of the human anatomy [17]. According to [41], VR systems that are based on anatomy allow students to gain experience and feedback. ...

... Thus, this project addresses this gap by investigating factors that may influence the adoption of VR by South African tertiary education using TAM as the theoretical framework. [43]; [52] Simulation-based education: engineering and physical science Ecuador, Germany, Malaysia, Taiwan, UK [41]; [18]; [20]; [2]; [34]; [17] Simulation-based education in medicine and other disciplines Japan, Malaysia, Poland, UK, U.S.A [37]; [38]; [7]; [12]; [25]; [46]; [8]; [10] [16]; [4]; [45] Assisting students with disabilities (physical and intellectual) UK, U.S.A [44]; [9]; [11]; [21]; [29] Educational games Australia, Greece Japan, UK, U.S.A ...

Virtual Reality (VR) is increasingly being acknowledged as a useful platform for education. In South Africa, however, VR is mainly recognized as an entertainment platform. Hence, the potential benefits of VR and its perceived ease of use within the South African higher education setting have not been widely investigated. Therefore, using the Technology Adoption Model (TAM), this paper investigates the perceived usefulness (PU) and ease of use (PEOU) of VR by lecturers. This paper also identifies the perceived challenges to the adoption of VR as a teaching and learning platform from a higher education perspective, and suggests how those challenges may be overcome.

... Immersive experiences can also promote motivation and engagement, which then inspire productive attention and effort toward learning (Dinis et al., 2017;Hamrol et al., 2013;Parmar, 2017). ...

This study investigated changes in learners' motivation, engagement, performance, and spatial reasoning over time and across different levels of virtual reality (VR) immersion. Undergraduate participants explored a virtual solar system via a moderately immersive or highly immersive VR platform over three sessions. In a third condition, participants initially learned with moderate immersion and transitioned to higher immersion after the second session. Following research on novelty effects, we explored whether subjective experiences and performance would decline over time (e.g., decreasing motivation or performance) as participants became familiar with the virtual environment and tools. However, we hypothesized that transitional immersion (i.e., switching from moderate to higher immersion) might lead to a renewed sense of novelty. Results suggested that both moderate and higher levels of immersion were motivating, engaging, and supportive of learning. In contrast to predictions based on novelty effects, these outcomes did not decline overall as learners gained familiarity with the systems. However, transitional immersion emerged as a promising and testable pedagogical approach for future VR education. All participants also showed gains in spatial reasoning.

... Supplemented by 3D animations, it can enhance the understanding of anatomical knowledge. It can simulate multi-level observations of anatomical structures in local anatomy, as well as some special virtual anatomical display methods, enhancing the perception of knowledge [23]. ...

Xiaoqin Zhang
Jingyi Yang
Na Chen
Liwen Tan

Abstract Specimen observation and dissection have been regarded as the best approach to teach anatomy, but due to the severe lack of anatomical specimens in recent years, the quality of anatomy teaching has been seriously affected. In order to disseminate anatomical knowledge effectively under such circumstances, this study discusses three key factors (modeling, perception, and interaction) involved in constructing virtual anatomy teaching systems in detail. To ensure the authenticity, integrity, and accuracy of modeling, detailed three-dimensional (3D) digital anatomical models are constructed using multi-scale data, such as the Chinese Visible Human dataset, clinical imaging data, tissue sections, and other sources. The anatomical knowledge ontology is built according to the needs of the particular teaching purposes. Various kinds of anatomical knowledge and 3D digital anatomical models are organically combined to construct virtual anatomy teaching system by means of virtual reality equipment and technology. The perception of knowledge is realized by the Yi Chuang Digital Human Anatomy Teaching System that we have created. The virtual interaction mode, which is similar to actual anatomical specimen observation and dissection, can enhance the transmissibility of anatomical knowledge. This virtual anatomy teaching system captures the three key factors. It can provide realistic and reusable teaching resources, expand the new medical education model, and effectively improve the quality of anatomy teaching.

... However, participants required assistance from others to adjust and put on the device. Additionally, operation methods were required to be explained to enable users to operate the software without difficulty [50]. Using 6-DoF room-scale VR requires a large, independent space, and the complete set of equipment is expensive. ...

Li-Hsing Ho
Hung Sun
Tsun-Hung Tsai

The purpose of this study was to investigate the use of 6-DoF high immersive virtual reality for stereoscopic spatial mapping to assess the impact of perceived spatial capabilities on 3D software learning motivation. This study wasn't a bound course with mandatory participation, and students were free to participate in the trial, and employed HTC VIVE, which provides highly immersive experiences, to elicit strong emotional responses. A total of 111 students from a university digital media department were invited to participate in a 3D VR painting experiment in which students created paintings using Google Tilt Brush. A 5-point scale based on the ARCS learning motivation model was adopted to collect student data. Perform a factor analysis of the data twice to select the appropriate factor (p = 0.000 < 0.05). Specifically, exploratory factor analysis was used to classify factors based on four constructs. The Cronbach alpha values of ARCS were 0.920, 0.929, 0.693 and 0.664, respectively, both >0.6, which still indicate favorable reliability. The results show that immersive VR can promote students' motivation and interest in learning 3D animation. However, the practical application of this technology requires solving problems related to hardware and space.

... Virtual Reality, as described in the literature, is a representation of the real environment on a device (PC, TV or mobile phone), mirroring reality to such an extent that the user is under the impression of physical presence [1]. VR is mainly useful for educational purposes [2], post-injury recovery [3] or in training sessions for surgeons [4]. Augmented reality [5] is a combination of the real and virtual environment on devices with a video camera integrated into their interface. ...

The paper presents new learning support for medical students exemplifying with several 3D applications for training on specific topics in medicine and investigates the impact on medical students. The applications were built using new concepts: Virtual Reality, Augmented Reality, as environments agreed by young people, and gamification to make learning easy and fun. Leap Motion and the VR headset are the devices to control the applications and provide a better human-computer/mobile phone interaction as compared to the current ones. The concepts and the new technologies to display/visualize the applications are the core of the Mixed Reality concept resulting from combining the 4 applications implemented for medical education.

Victor Manuel Caicedo Ayerbe
Martha Lucia Velasco Morales
Carlos Javier Latorre Rojas
María Lucía Arango Cortés

We present the case of an nine-year-old girl with double outlet right ventricle with noncommitted ventricular septal defect and malposition of the great arteries who had undergone repair at the age of seven months. Six years later, the patient presented with right ventricular failure, conduit calcification with obstruction, and obstruction of the left ventricular outflow tract. Three-dimensional models reconstructed by Digital Imaging and Communications in Medicine (DICOM) images of the patient were visualized in a virtual reality system to help plan the surgical correction of the intracardiac congenital anomalies. This tool allowed us to inspect the intracardiac anatomy in an immersive environment with a clearer sense of perspective.

Learning programming is a complicated task and there is a high rate of students' failure or desertion. It requires the student to think abstractly and acquire a high level of affinity and discipline. It requires the student to think abstractly and acuire a high level of affinity as well as discipline. The basis is to find studies based on the development of tools for learning programming, which attract a high level of students' attention. The purpose is to carry out an analysis of the main characteristics, advantages and disadvantages of augmented reality as a learning methodology for programming, as well as the tools necessary for its development. After the review, we have found different types of applications which purpose range from business applications, maintenance support and equipment assembly to the development of kinesthetic skills. Regarding the support in learning, this is applied in different areas of study, with very few results in programming. It is intended to make a proposal of an augmented reality model for learning programming. Its high potential in education serves as support for pedagogical activities and the development of cognitive skills. However, there are still problems, such as the dependence of a device with a camera and special capabilities that support its proper functioning. Another impediment is that; the use of technology can be a cause of distraction when teaching a class. Nevertheless, all this with the advance of technology and research related to the subject of study, can certainly be overcome.

Con el desarrollo de CADYMCA, en la oficina de vicerrector académico del ITFIP, se obtuvo una modernización, en la gestión de los procesos de planificación docente y los syllabus de cada programa de pregrado. Los cuales se operan de forma manual y el almacenamiento de datos es un formato digital. Debido a esto, hay ineficiencia en las tareas, baja confiabilidad para la toma de decisiones y la inseguridad de la información. Por esa razón, la implementación de esta solución es de suma importancia para satisfacer la necesidad específica de soporte de TIC. El proceso metodológico es cualitativo/cuantitativo, con un enfoque exploratorio / descriptivo / proposicional. Además, se ha seleccionado la metodología RUP para el desarrollo de la WebApp. El resultado principal de la investigación, fue una WebApp cliente / servidor, que se puede usar en móviles y portátiles. Bajo un diseño de ISO 25010 y usabilidad.

Online game for mobile devices, which will allow users to enrich or strengthen knowledge about the orthographic rules that are stipulated for the Spanish language. Through this application the users will be able to make use of different ludic activities, which can be found in two different modules like "practice" and "challenge", the last of these has the option of online game; In addition to this there are other modules, where you can find other users and see the current user's statistics. To Write Well!, by its design and purpose, was supported by the DESED Methodology, which has very similar phases to the traditional engineering model of the lifecycle of iterative software development. Within the conclusions obtained can be identified: that the development of educational games, in humans, can arouse different feelings: responsibility, competitiveness, rivalries and fun.

Computer-aided learning (CAL) has great potential in facilitating learning. In medical education, several approaches using CAL have been used. In this paper, we present a novel software platform which we developed to provide a virtual learning environment to support anatomy teaching and learning. This learning platform provides accurate, interactive models which are derived from actual CT and fMRI scans. The virtual 3D environment is particularly useful to help students identify key anatomy structures and their complex spatial relationships. The intuitive computer graphic interface and virtual reality 3D environment make learning interesting and engaging. The platform also allows instructors to easily customize the anatomy model by adding additional digital supplementary learning material including hyperlinks, images, animation, audio, video, and PowerPoint presentations which are all supported within the platform.

Virtual reality can help medicine learning and teaching in biomedical fields. This paper presents three interactive visualization programs for human structures identification: the virtual woman pelvis, the virtual man head and virtual woman heart. The goal is allow an immersive visualization and exploration of the human body anatomy sticking out its main structures. The virtual woman pelvis shows an internal visualization of the female pelvic region with three layers of details: external viewing, skeleton viewing and bone marrow viewing. The virtual man head has as goal to provide a study of some structures found in the human head, as the skin, the facial muscles, the cranial bones and the brain. The system includes the identification of each structure and allows a partial dissection from the skin to the brain. Nowadays, the system offers stereoscopic visualization by anaglyphs and is being updated to offer that visualization by polarized filters/glasses using the VirtWall system (11).

This paper reports about an ongoing research project, called RASim. The goal of this project is to develop a virtual reality-based training tool for regional anaesthesia. A production pipeline to create patient-specific datasets has been established. A prototype of the simulator has been implemented on a virtual reality-platform and was evaluated in a first study. The current research and development is focused on soft-tissue simulation and haptics to improve the interaction. Furthermore, a bi-manual interaction scheme to combine palpation and virtual needle guidance is introduced as conceptual work and will be evaluated soon.

Lumbar puncture (LP) is performed by inserting a needle into the spinal canal to extract cerebrospinal fluid for diagnostic purposes. A virtual reality (VR) lumbar puncture simulator based on real patient data has been developed and evaluated. A haptic device with six degrees of freedom is used to steer the virtual needle and to generate feedback forces that resist needle insertion and rotation. An extended haptic volume-rendering approach is applied to calculate forces. This approach combines information from segmented data and original CT data which contributes density information in unsegmented image structures. The system has been evaluated in a pilot study with medical students. Participants of two groups, a training and a control group, completed different first training protocols. User performance has been recorded during a second training session to measure the training effect. Furthermore user acceptance has been evaluated in a questionnaire using a 6-point Likert scale with eight items. Forty-two medical students in two groups evaluated the system. Trained users performed better than less trained users (an average of 39% successfully completed virtual LPs compared to 30%). Findings of the questionnaire show that the simulator is very well accepted. E.g. the users agree that training with such a simulator is useful (Likert grade of 1.5 +/- 0.7 with 1 = "strongly agree" and 6 = "strongly disagree"). Results show that the VR LP simulator gives a realistic haptic and visual impression of the needle insertion and enables new insights into the anatomy of the lumbar region. It offers a new way for increasing skills of students and young residents before applying an LP in patients.

Cagatay Basdogan
Ayam A. Srinivasan

Introduction The goal of haptic rendering is to enable a user to touch, feel, and manipulate virtual objects through a haptic interface. With the introduction of high fidelity haptic devices (ref. **Biggs and Srinivasan Chapter**), it is now possible to simulate the feel of even fine surface textures on rigid complex shapes under dynamic conditions. Starting from the early nineties, significant progress has occurred in our ability to model and simulate haptic interactions with 3D virtual objects in real-time (Salisbury and Srinivasan, 1997; Srinivasan and Basdogan, 1997). The rapid increase in the number workshops, conference sessions, community web pages, and electronic journals on haptic displays and rendering techniques 1 indicates growing interest in this exciting new area of research, which we call computer haptics. Just as computer graphics is concerned with synthesizing and rendering visual images, computer haptics is the ar

Grigore Burdea
Philippe Coiffet

From the Publisher: This in-depth review of current virtual reality technology and its applications provides a detailed analysis of the engineering, scientific and functional aspects of virtual reality systems and the fundamentals of VR modeling and programming. It also contains an exhaustive list of present and future VR applications in a number of diverse fields. Virtual Reality Technology is the first book to include a full chapter on force and tactile feedback and to discuss newer interface tools such as 3-D probes and cyberscopes. Supplemented with 23 color plates and more than 200 drawings and tables which illustrate the concepts described.

L. Zhang
Cristol Grosdemouge
Venkata Arikatla
CGL Cao

Laparoscopic surgery requires more specialized training of the surgeons than traditional open surgery. The Virtual Basic Laparoscopic Surgical Trainer (VBLaST) is being developed as a virtual version of the Funda-mentals of Laparoscopic Skills (FLS) trainer. This study assessed the current haptic and virtual reality (VR) tech-nology of a virtual peg transfer task of the VBLaST, based on the subjective preference of surgeons and their ob-jective task performance measures. Twenty-one surgical residents, fellows and attendings performed a peg-transfer task in the FLS and the VBLaST. Each subject performed 10 trials on each simulator. Results showed that subjects performed significantly better on the FLS than on the VBLaST. Subjects showed a significant learn-ing effect on both simulators, but with an accelerated improvement on the VBLaST. Even so, 81% of the subjects preferred the FLS over the VBLaST for surgical training which could be attributed to the novelty of the VR tech-nology and existing deficiencies of the haptic interface. Despite the subjective preference for the physical simula-tor, the performance results indicate an added value of VR and haptics in surgical training, which is expected to be demonstrated in more surgically relevant tasks such as suturing and knot-tying.

Allan Okrainec
Monica Farcas
Oscar Henao
Jacob Apkarian

The Veress needle is the most commonly used technique for creating the pneumoperitoneum at the start of a laparoscopic surgical procedure. Inserting the Veress needle correctly is crucial since errors can cause significant harm to patients. Unfortunately, this technique can be difficult to teach since surgeons rely heavily on tactile feedback while advancing the needle through the various layers of the abdominal wall. This critical step in laparoscopy, therefore, can be challenging for novice trainees to learn without adequate opportunities to practice in a safe environment with no risk of injury to patients. To address this issue, we have successfully developed a prototype of a virtual reality haptic needle insertion simulator using the tactile feedback of 22 surgeons to set realistic haptic parameters. A survey of these surgeons concluded that our device appeared and felt realistic, and could potentially be a useful tool for teaching the proper technique of Veress needle insertion.

Interactive Guide for Product Assembly and Disassembly Visualization

Z Weiss
M Kasica
M Kowalski

Weiss Z, Kasica M, Kowalski M. Interactive Guide for Product Assembly and Disassembly Visualization, Academic Journal of Manufacturing Engineering 2007; 5: 96-100.

Visualization Of The Work Stand Environment Conditions Using Virtual Reality Techniques

R Konieczny
M Kasica
M Kowalski
D Grajewski

Konieczny R, Kasica M, Kowalski M, Grajewski D. Visualization Of The Work Stand Environment Conditions Using Virtual Reality Techniques. In International Conference on Integrated Engineering C2I 2008, Timisoara, Rumunia, 2008.

Source: https://www.researchgate.net/publication/259167306_Virtual_3D_Atlas_of_a_Human_Body_-_Development_of_an_Educational_Medical_Software_Application

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