Showcases

In Denmark, around 30,000 surgical procedures are performed each year for fractures. There is therefore an ongoing need for training of new, competent, orthopaedic surgeons to provide this treatment.

A 2019 national needs survey, including all of the country's orthopaedic surgery departments, showed that principles of surgical treatment of fractures is the orthopaedic surgery area where the need for simulation-based technical training is greatest.

The training of surgical competence traditionally consists of self-study and surgery under supervision. In other words, doctors actually train on patients. By having the earliest part of the training take place on a simulator, doctors can learn from their mistakes and achieve sufficient surgical competence before performing real operations. In this way, patients are not exposed to unnecessary risk.

The project:

The VR BOSS project (Virtual Reality Basic Osteosynthesis Surgery Simulation) is working on the development and implementation of a VR simulator for training and competence assessment in the surgical treatment of bone fractures.

The project has established a collaboration with the world-leading orthopaedic surgery organisation AO Foundation. Through this collaboration, orthopaedic surgical education experts from around the world have defined the parameters on which users of the simulator should be assessed, as well as how each parameter should be assessed. This novel approach to simulator development ensures that development is evidence-based, that the simulator meets the requirements and expectations of the target audience - and that the entire development process is transparent from the outset.

The development of the first of a total of seven orthopaedic surgical procedures is in its final phase, after which studies will begin to determine the validity of the simulator test and the impact of the simulation training.

Check out the VR simulator:

Here you can see how the VR simulator - developed by CAMES PhD student Mads Emil Jacobsen - works when surgeons train fracture surgery.

Cooperation and support

The VR-BOSS project is supported by grants from the Toyota Foundation and the Health Fund as well as Region Zealand's Research Fund and the Næstved- Slagelse- Ringsted Hospital Research Fund.

The project is anchored as a PhD with Mads Emil Jacobsen, md, PhD student, in the lead.

Contact

Mads Emil Jacobsen, md, PhD student, madsemil4@gmail.com. Read bio

Through training using a mobile application, the project aims to make it more efficient for doctors to learn how to diagnose skin cancer. What we also call "Intelligent" learning in pattern recognition.
It currently takes more than 6 years to become proficient at telling the difference between benign and malignant skin tumours. This leads to delayed diagnosis of skin cancer and high costs for the healthcare sector due to unnecessary removal of benign tumours. The reason for the slow upskilling of doctors is probably that it is difficult for a young doctor to get visual feedback on a large number of skin tumours of different types.

We're working to improve this by giving doctors and nurses access to training in skin diagnostics via the learning app - Dermloop Learn. (See photos from the app store)

The app exposes the doctor to a huge library (20,000+ cases) of images of previous skin tumours and their diagnosis. Doctors are guided through a learning process optimised by artificial intelligence, which continuously measures the doctor's multi-dimensional competence and selects the optimal learning material based on this.

Results and effects:

As part of the research project, 76 medical students with no previous experience were trained in skin cancer diagnosis for 8 days. And they reached the same level as doctors with 3-4 years of experience. Combined with a tele-dermatology extension of the system, there is plenty of potential - in terms of economics, skills development and patient safety. For example, the research group behind the project has estimated that up to €800 million could be saved in healthcare. DKK 800 million a year if the technology were implemented nationally and used by all general practitioners, dermatologists, plastic surgeons and pathologists.

Contact

Niels Ternov, MD, Ph.d - Mail: niels.kvorning.ternov@regionh.dk. Read bio

Martin Tolsgaard, Head of CAMES AI - Mail: martintolsgaard@gmail.com

The PhD project is about investigating the non-technical skills of the robotic surgical team.
The robotic surgical team differs from other health professional teams in that one of the team members - the surgeon - is physically separated from the rest of the team and the patient bed. This affects teamwork, including coordination. Among other things, the team does not have eye contact with the surgeon during the operation, who also cannot see the operating theatre, but only the video screen with the operating field.

We examine and compare how the experienced and inexperienced robotic surgical teams coordinate their work to optimize teamwork and patient safety. Team coordination has an impact on workflow and on the risk of errors during surgery. Training teamwork can reduce errors and increase patient safety

The project contributes to the development of the Capital Region's robotic surgery training, where teamwork is trained to increase patient safety in both routine and emergency situations.

The PhD students carrying out the project are: Doctor Jannie Lysgaard Poulsen, who is a PhD student at the University of Copenhagen and at the Copenhagen Academy for Medical Education and Simulation at Herlev Hospital.

Contact: 

Jannie Lysgaard Poulsen, PhD student and doctor - Mail: jannie.lysgaard.poulsen@regionh.dk. Read bio

Colorectal cancer is a common disease, and in Denmark about 3,400 people are diagnosed with colorectal cancer each year. Surgical removal of the cancer is one of the cornerstones of treatment, and there is an increase in the number of robotic-assisted operations.

To meet a greater need for surgeon training and to develop training opportunities, we have developed a 3D printed phantom, based on patient scans, to train robotic surgical removal of the right part of the colon.

Objective
The PhD project investigates whether it is possible to perform reliable competence assessments of surgeons when performing an advanced robotic surgical procedure for colon cancer. Furthermore, it is investigated whether the competence assessment performed in the simulated environment is consistent with the surgeon's performance during real operations,

The researchers behind the project are also looking at the following

• What basic surgical skills a robotic surgeon should have
• What assessment tools are available to assess this, whether the assessment tools are reliable
• Whether the assessment tools can be used to identify a learning need in the individual surgeon

The PhD project is carried out as a collaboration between Kolding Hospital in the Southern Region and CAMES.
The PhD students carrying out the project are.

Contact:

Peter Hertz, PhD student - hertz.peter@gmail.com. Read bio

Example from the laboratory - setup for colon cancer study

Patients with keloids, scar tissue that grows uncontrollably, are most often treated with surgery or steroid injections and pressure (sometimes both). For the latter, precise pressure is important, as too much pressure will provoke more growth, while too little pressure will leave room for continued growth.

In this project, we are investigating whether these clips can be produced patient-specifically using 3D scanning and CAD software. The clips are produced on our SLA printer with biocompatible resin that is ISO-approved for continuous skin contact. These clips fall into the category of 'custom medical devices' in the MDR (medical device regulations). CAMES is therefore responsible for registration with the Danish Medicines Agency and the associated quality assurance.

CAMES project team: Magnus Obinah, Kiki Vestersøe

Contact: 

Kiki Vestersøe, Medical Engineer, MSc - Mail: kirstina.beatrice.persson.vestersoee@regionh.dk / Mobile: 35456498

When blood pressure cuffs need to be washed, a plug is used at the end of the pressure cable. This is done to avoid water in the cuff and later in the blood pressure devices. These are no longer sold individually from the supplier, but with a new cuff.

Therefore, the Child and Adolescent Clinic at Rigshospitalet asked the Department of Medical Technology (CIMT) and CAMES if this task could be solved internally. CAMES has produced a mat with 6x6 silicone plugs, which can soon be ordered via the 'brick system' throughout the region. Currently they are available to order through the Medical Technology Department and their 'Medusa' system.

The project has offered a test and validation of the plugs' properties, in collaboration with the Children and Youth Clinic. This has led to new guidelines for cuff washing and drying times.

CAMES project team: Kiki Vestersøe, Morten Bo Søndergaard Svendsen, Sanne Kristensen

Contact: 

Kiki Vestersøe, Medical Engineer, MSc - Mail: kirstina.beatrice.persson.vestersoee@regionh.dk / Mobile: 35456498