The lumbar puncture is performed by inserting a needle into the spinal chord of the patient to inject medicaments
or to extract liquor. The training of this procedure is usually done on the patient guided by experienced supervisors.
A virtual reality lumbar puncture simulator has been developed in order to minimize the training costs
and the patient's risk. We use a haptic device with six degrees of freedom (6DOF) to feedback forces that resist
needle insertion and rotation. An improved haptic volume rendering approach is used to calculate the forces.
This approach makes use of label data of relevant structures like skin, bone, muscles or fat and original CT data
that contributes information about image structures that can not be segmented. A real-time 3D visualization
with optional stereo view shows the punctured region. 2D visualizations of orthogonal slices enable a detailed
impression of the anatomical context. The input data consisting of CT and label data and surface models of
relevant structures is defined in an XML file together with haptic rendering and visualization parameters. In a
first evaluation the visible human male data has been used to generate a virtual training body. Several users with
different medical experience tested the lumbar puncture trainer. The simulator gives a good haptic and visual
impression of the needle insertion and the haptic volume rendering technique enables the feeling of unsegmented
structures. Especially, the restriction of transversal needle movement together with rotation constraints enabled
by the 6DOF device facilitate a realistic puncture simulation.
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