1. Virtual Nursing Simulator With Haptic Force- Feedback For Oral Hygiene Students : Diana Serafimovska Thuy Pham Advisor : Dr. Elhajj Nurse : Dr. Harrison

2. Facts 80% of adults have periodontal disease, 99% of those people have no sign to indicate the problem [1]. 40% of Americans do not receive proper oral hygiene care [3]. 1.5 out of 1.6 million people residing in nursing homes have poor oral health care [5] [6]. Only 16% of the nursing home residents had their teeth cleaned with substandard oral hygiene care [8].

3. Bad Oral-Hygiene Leads to... Plaque accumulation leads to Gingivitis Periodontitis Aspiration Pneumonia Cardiovascular diseases Decreased quality of life Increased cost of care

4. Oral-Hygiene In Nursing Home [4]

5. If you can't touch it, but you can see it, it's. If you can touch it, and you can see it, it's. Our Research is about… REAL VIRTUAL “Virtual Interactive Real-Time Simulation with Haptic Force-Feedback”

6. The Set-up Diagram “Virtual Interactive Real-Time Simulation with Haptic Force-Feedback” Virtual Environment Simulator Haptic Tool PHANTOM OMNI Real-Time User interactive

7. The system User Graphical User Interface Physical Force - Input - Output Proxy (x,y,z) Force System Force To Physical Force Visualization Haptic Device Haptic Interface activateHaptic(); findProxyPosition(); DrawShape(); If contact Force = kx Else no contact Force = 0 outputForce(); outputContactPoint(); Data Control Haptic Display - Collision detection/Response Haptic Device Position 1 Proxy 1 Object Surface Spring F = kx Haptic Device Position 2 Proxy 2

8. Our Purposes Worthwhile Educational Values Users: nurses & nursing students Impacts: Smoother transition into the clinical environment [5] Support and reinforce ergonomics [5] Reduction in the need of instructors Improvement in skills Provide: Convenient work environment User-friendly interface Repetition Sufficient supporting materials Performance Assessment

9. Other Simulation Studies The Johnson Center at Lucile Packard Children’s Hospital The first dedicated pediatric and obstetric medical simulation center in the world Allows health-care professionals to use their skills in a simulated medical environment [10]. Biological Simulators, Inc A program that contains mathematical descriptions of physiological functions in the human body. Interaction with equations through an interface that allows you to create a disturbance and then track the subsequent physiological response [17].

10. Other Simulation Studies (cont) Optimizing the design, manufacturing cost, and functionality of new toothbrushes. CAD toothbrush model, 3D - CT scans of person’s jaw. PHANTOM 1.5A, GHOST library. Finite Elements Method, Voxel-Based Algorithm. Limitations: multi-point collision, oral surface contact detection. Goals: pre-operative planning system for cranio-facial surgery, surgeons. Interactive Simulation of Teeth Cleaning [7]

11. Other Dental Simulation Studies The Iowa Virtual Reality Dental Simulator Teach and test dentist students surgical skills Remove vibration to enhance realistic tactile feeling by increasing update rate (1kHz) VRML 3D models PHANTOM desktop C and C++, World Toolkit Goals: levels of touch detail, graphical display. [6]

12. Other Dental Simulation Studies (cont) DentSim DenX America Physical models: head and teeth Equipment: computer, camera, simulators No time-delay between simulators and software Outcome-based assessment of the procedures Being used in many schools in the U.S Limitations: too expensive [13]

13. Other Dental Simulation Studies (cont) University of Pittsburgh School of Dental Medicine Use simulators for their first year dental students. The simulator is made up of standard dental equipment where each station is equipped with a dummy patient simulator that has a removable jaw with lifelike movement that can be approached from any angle. Provides the clinical experience without setting foot in an actual clinic [11]. University of Washington Offers a teaching camp that gives students the opportunity to work with teeth simulators while learning to make impressions, models, and reconstructions of portions of teeth [12].

14. Our Oral-Hygiene Simulation Studies How can we prove that our research will be effective? If doctors can, why can’t nurses? Faster way of learning Columbia University’s School of Dental and Oral Surgery has shown that students learn much faster using simulation machines [9]. Well prepared for real clinical practices [5] Capability of our application Oral health care training gives: Significant improvement specifically for oral hygiene (Nicol, Sweeney, McHugh, Bagg, 2005). 369 caregivers were improved in attitudes and knowledge of oral health care (Frenkel. Harvey, Needs, 2002)

15. Challenges Graphic User Interface Visual Basic interfaces with Visual C++ Realistic 3D modeling Physical properties: colors, size, etc. Facial features: tongue, face, etc. Force-feel realism Synchronization: Haptic (1kHz) & graphic (30Hz) update rate [14] Multi-threading structure [14] Reduction in vibration: haptic device force & update rate Multi-point tactile sensory Tactile feelings at different regions Deformation of soft tissues Accuracy in calculation The specific surfaces of contact Timing Procedural Assessment Detailed evaluation

16. The process… Graphical User Interface (GUI) - Visual Basic

17. The process… (cont) Programming language: C++ Rendering techniques HLAPI / HDAPI - haptic library OpenGL – graphic rendering library GLUT – auxiliary library handles window creations: mouse movement, button and keyboard functions, callbacks, etc. GLUI – GUI for GLUT

18. The process… (cont) 3D model OBJ format OBJ LOADER VERTICES FACES OPENGL MESH

19. The process… (cont) Load 3D Toothbrush Problem: Missing vertices & faces Loader does not work well with a larger number of polygons Solution: Splodge Limitation: no texture

20. The process… (cont) Enable haptic device Load models Draw models Graphically Haptically Determine proxy point Force calculation Collision Detection done by HLAPI GLUI builds on top of GLUT Start/Stop time Evaluation form

21. The process… (cont) Problems  Collision Detection Penetration Third-party physics/dynamics and collision detection engine Sphere Trees Axis Aligned Bounding Box (AABB) Oriented Bounding Box (OBB) – RAPID SWIFT++ - convex-decomposition & bounding volume hierarchy I-COLLIDE – only convex Q-COLLIDE – enhancement of I-COLLIDE QuickCD & CD – dynamic/dynamic, static/dynamic objects; k-dop bounding volume [14] [15] [16]

22. Movie Time

23. Future Implementation & Directions Graphical visualization Loader Textures Facial features Bleeding of gum Algorithms Visual collision detection Surface contact calculation Optimization of the force-feedback system Multi-point collision Reduce vibration

24. Quote From This Research REALIf you can touch it and you can see it, it's REAL VIRTUALIf you can't touch it but you can see it, it's VIRTUAL TIf you can touch it but you can't see it, it's T If you can't touch it and you can't see it, it's RANSPARENT GONE

25. References [1] “Oral Hygiene.” Wikipedia Online Encyclopedia. 6 June 2006. [2] Anton, Pam. Advanced Dental Hygiene Practitioner Fact Sheet 2006. 6 June 2006. [3] “An Overview of Nursing Home Facilities: Data from 1997 National Nursing Home Survey.” National Center for Health Statistics. No 311. 1 March 2000. [4] Fundamentals of Nursing: The Art and Science of Nursing Care. Lippincott William and Wilkins © 2005. [5] Judith Ann Buchanan. Use of Simulation Technology in Dental Education. Journal of Dental Education. November 2001. [6] Steven Dow, Geb Thomas, Lynn Johnson, Clark Standford. Iowa Dental Surgical Simulator. University of Iowa College of Dentistry and the GROK Lab. 2004. [7] Gockel T, Salb T, Weyrich T, Burgert O, Dillmann R. Interactive Interactive Simulation of Teeth Cleaning. Institute for Process Control and Robotics. University Karlsruhe, Germany, 2000. [8] “Oral Care Provided by Certified Nursing Assistants in Nursing Homes.” Oral Care in Nursing Homes. January 2006. Vol. 54. No. 1. [9] Dougherty, Matthew. Dental Students Cut Teeth on New Simulators. Columbia University Health Sciences. © 2002. [10] Conger, Krista. “New center innovates teaching through simulation.” Stanford Report. 13 November 2002

26. References (cont) [11] Uhl, Jocelyn. “Dental Education of the Future at Pitt now: First- year Students Learn Clinical Skills Now, $2.8 million Simulation Clinic.” Pitt Chronicle: Newspaper of the University of Pittsburgh. 23 September 2002. [12] Neary, Walter. “Dental camp will give youth a rare close-up view of profession.” UWnews.org. 19 July 2002. [13] DentSim. DenX Advanced Medical System. DenX America, Inc. 2006. [14] Cagatay Basdogan, Chih-Hao Ho. Principles of Haptic Rendering for Virtual Environments. Laboratory for Human and Machine Haptics. MIT. [15] Stephen A. Ehmann and Ming C. Lin. Accurate and Fast Proximity Queries between Polyhedra Using Surface Decomposition. Computer Graphics Forum (Proc. of Eurographics), 2001. [16] Ales Daneu. Collision Detection Algorithms. Computer and Information Science. University of Ljubljana. 2002. pp: 7-10. [17] Biological Simulators, Inc. Simulation for Education and Research. Tom Coleman. 14 July 2006.

27. THANK YOU…