• 대한치과교정학회지
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• 제43권1호
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• pp.42-52
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• 2013

The aim of this paper was to propose a new method of bimaxillary orthognathic surgery planning and model surgery based on the concept of 6 degrees of freedom (DOF). A 22-year-old man with Class III malocclusion was referred to our clinic with complaints of facial deformity and chewing difficulty. To correct a prognathic mandible, facial asymmetry, flat occlusal plane angle, labioversion of the maxillary central incisors, and concavity of the facial profile, bimaxillary orthognathic surgery was planned. After preoperative orthodontic treatment, surgical planning based on the concept of 6 DOF was performed on a surgical treatment objective drawing, and a Jeon's model surgery chart (JMSC) was prepared. Model surgery was performed with Jeon's orthognathic surgery simulator (JOSS) using the JMSC, and an interim wafer was fabricated. Le Fort I osteotomy, bilateral sagittal split ramus osteotomy, and malar augmentation were performed. The patient received lateral cephalometric and posteroanterior cephalometric analysis in postretention for 1 year. The follow-up results were determined to be satisfactory, and skeletal relapse did not occur after 1.5 years of surgery. When maxillary and mandibular models are considered as rigid bodies, and their state of motion is described in a quantitative manner based on 6 DOF, sharing of exact information on locational movement in 3-dimensional space is possible. The use of JMSC and JOSS will actualize accurate communication and performance of model surgery among clinicians based on objective measurements.

• Archives of Plastic Surgery
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• 제45권5호
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• pp.395-402
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• 2018

Increased emphasis on competency-based learning modules and widespread departure from traditional models of Halstedian apprenticeship have made surgical simulation an increasingly appealing component of medical education. Surgical simulators are available in numerous modalities, including virtual, synthetic, animal, and non-living models. The ideal surgical simulator would facilitate the acquisition and refinement of surgical skills prior to clinical application, by mimicking the size, color, texture, recoil, and environment of the operating room. Simulation training has proven helpful for advancing specific surgical skills and techniques, aiding in early and late resident learning curves. In this review, the current applications and potential benefits of incorporating simulation-based surgical training into residency curriculum are explored in depth, specifically in the context of plastic surgery. Despite the prevalence of simulation-based training models, there is a paucity of research on integration into resident programs. Current curriculums emphasize the ability to identify anatomical landmarks and procedural steps through virtual simulation. Although transfer of these skills to the operating room is promising, careful attention must be paid to mastery versus memorization. In the authors' opinions, curriculums should involve step-wise employment of diverse models in different stages of training to assess milestones. To date, the simulation of tactile experience that is reminiscent of real-time clinical scenarios remains challenging, and a sophisticated model has yet to be established.

• 대한인간공학회지
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• 제25권4호
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• pp.129-135
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• 2006

he purpose of this study is to measure bio-signal to investigate the driver's physiological response change under real situation using train simulator. The train simulator used in this study is KTX model and according to changes of driving situation, The bio-signal controlled by autonomic nervous system, such as GSR(Galvanic Skin Response), SpO2(Saturation percent O2), HR(Heart Rate), ECG(Electrocardiograph), EEG(Electroencephagram) and movement and response of eye were measured. Statistically significant difference in bio-signal data and eye movement activity pattern were investigated under several different driving speeds using analysis of variance (p<0.05). The GSR and HR value measured in average and mission speed operation is higher than in high-speed operation. β wave of EEG in average speed operation become more activated than in high speed operation. In accordance with a characteristic of rail vehicle, movement and response of eye in high-speed operation requiring relatively simple maneuver become less activated than in either average or mission speed operations. Conclusively, due to more careful driving controls in average and mission speed operation are required than in high-speed operation, level of mental and physical stresses of train driver was increased and observed through changes of bio-signal and eye movement measured in this study.

• 한국CDE학회논문집
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• 제17권5호
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• pp.303-311
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• 2012

Laparoscopic surgery is a surgical procedure which uses long laparoscopic instruments through tiny holes in abdomen while watching images from a laparoscopic camera through umbilicus. Laparoscopic surgeries have many advantages rather than open surgeries, however it is hard to learn the surgical skills for laparoscopic surgery. Recently, some virtual simulation systems for laparoscopic surgery are developed to train novice surgeons or resident surgeons. In this study, we introduce the techniques that we developed for laparoscopic surgical training simulator for cholecystectomy (gallbladder removal), which is one of the most frequently performed by laparoscopic surgery. The techniques for cholecystectomy simulation include modeling of human organs (liver, gallbladder, bile ducts, etc.), real-time deformable body calculation, realistic 3D visualization of surgical scene, high-fidelity haptic rendering and haptic device technology, and so on. We propose each simulation technique for the laparoscopic cholecystectomy procedures such as identifying cystic duct and cystic artery to clamp and cut, dissecting connective tissues between the gallbladder and liver. In this paper, we describe the techniques and discuss about the results of the proposed cholecystectomy simulation for laparoscopic surgical training.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.13.1-13.12
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• 2016

Background: Mandibular motion tracking system (ManMoS) has been developed for orthognathic surgery. This article aimed to introduce the ManMoS and to examine the accuracy of this system. Methods: Skeletal and dental models are reconstructed in a virtual space from the DICOM data of three-dimensional computed tomography (3D-CT) recording and the STL data of 3D scanning, respectively. The ManMoS uniquely integrates the virtual dento-skeletal model with the real motion of the dental cast mounted on the simulator, using the reference splint. Positional change of the dental cast is tracked by using the 3D motion tracking equipment and reflects on the jaw position of the virtual model in real time, generating the mixed-reality surgical simulation. ManMoS was applied for two clinical cases having a facial asymmetry. In order to assess the accuracy of the ManMoS, the positional change of the lower dental arch was compared between the virtual and real models. Results: With the measurement data of the real lower dental cast as a reference, measurement error for the whole simulation system was less than 0.32 mm. In ManMoS, the skeletal and dental asymmetries were adequately diagnosed in three dimensions. Jaw repositioning was simulated with priority given to the skeletal correction rather than the occlusal correction. In two cases, facial asymmetry was successfully improved while a normal occlusal relationship was reconstructed. Positional change measured in the virtual model did not differ significantly from that in the real model. Conclusions: It was suggested that the accuracy of the ManMoS was good enough for a clinical use. This surgical simulation system appears to meet clinical demands well and is an important facilitator of communication between orthodontists and surgeons.

• Journal of Chest Surgery
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• 제18권2호
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• pp.182-192
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• 1985

[here are so many reports that pulsatile blood flow provides physiologic organ perfusions during cardiopulmonary bypass. So, we compared the recent 30 cases undergoing cardiac surgery by Cobe-Stckert pulsatile roller pump with another 30 cases by Polystan nonpulsatile roller pump. Pulsatile flow was applied during aortic-cross clamping period when synchronized to internal EKG simulator, and perfusion mode was changed to continuous nonpulsatile flow after declamping of aorta. Age, sex, weight, and disease entities were comparable and operative techniques were similar between two groups. 1. There were no differences in average ACC time, ECC time, and Operation time. 2. Postoperative artificial respiration time was 6hrs 30mins in nonpulsatile group and 4hrs 48mins in pulsatile group, and detubation time after ventilator weaning was 2hrs 44mins in nonpulsatile group and 1hrs 43mins in pulsatile group. 3. Average pulse pressure was 8mmHg in nonpulsatile group and 55mmHg in pulsatile group, and a mean arterial pressure was 66.0mmHg in nonpulsatile group and 60.7mmHg in pulsatile group. 4. Mean urine-output during ACC;ECC period was 9.717.3;9.913.2ml/kg/hr in nonpulsatile group and 14.215.0;15.817.5 in pulsatile group [p<0, 05], and thereafter progressive decrease of differences in urine output between two groups until POD 2, and lesser amounts of diuretics was needed in pulsatile group during same postoperative period. Serum BUN/Cr level showed no specific difference and urine concentration power was well preserved in both groups. 5. Plasma proteins and other Enzymes showed no differences between two groups, but serum GOT/GPT level was higher in nonpulsatile group till POD 2. 6. Serum Electrolytes showed no differences between two groups. 7. WBC, RBC, Platelet counts, Hgb and Hct were not different and Coagulogram was well preserved in both groups. 8. Plasma free Hgb level was 7.09mg% in pulsatile group compared with 3.48mg% in pulsatile group on POD 1 but was normalized on POD 2. Gross hemoglobinuria after ECC was noted in 6 cases [20%] of pulsatile group and 4 cases [13%] of nonpulsatile group. 9. In both groups, most patients were included in NYHA class III to IV [28 cases;93% in nonpulsatile group, 22 cases;73% in pulsatile group] preoperatively, and well improved to class I to 11[22 cases; 73% in nonpulsatile group, 30 cases; 100% in pulsatile group] postoperatively. There were 7 operative mortalities in nonpulsatile group only, which were 5 cases of TOF with hepatic failure, 1 case of multiple VSDs with low out-put syndrome, and 1 case of mitral valvular heart disease with cardiomyopathy. We concluded that the new, commercially available Cobe-Stckert pulsatile roller pump device was safe, simple, and reliable.

• 한국정보통신학회:학술대회논문집
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• 한국해양정보통신학회 2011년도 춘계학술대회
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• pp.77-80
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• 2011

의료용 로봇은 크게 네 분야로 나눌 수 있는데, 수술을 보조하는 수술보조 로봇, 수술 로봇, 수술시뮬레이터, 재활 로봇이라 할 수 있다. 이와 같이 의료용 로봇은 주로 고 정밀도 및 신뢰성을 요구하는 작업을 위해 개발되고 있다. 의료용 서비스 로봇의 또 다른 분야로 수술이 아닌 진료를 위한 서비스 로봇이 있다. 진료 서비스 로봇은 병원의 접수 업무 및 진료 시 사용할 수 있는 환자의 생체 데이터 취득, 병원 내 위치 및 콘텐츠 정보 등을 환자에게 제공할 수 있는 로봇이다. 하지만 지금까지의 의료 서비스 로봇은 실제적인 접수 처리과정을 진행하는 역할을 하지는 못하였다. 본 논문에서는 의료 서비스 로봇 시스템을 설계 및 구현하였다. 구현된 로봇 시스템은 의료정보 교환을 위한 표준 프로토콜을 사용해 직접 병원 정보 시스템과의 연동이 가능하고, 병원의 환자 접수 및 처리, 진료 대기자 수와 같은 정보를 제공할 수 있다.

• Journal of Periodontal and Implant Science
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• 제44권5호
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• pp.222-226
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• 2014

Purpose: This study aimed to assess the interdental bone level in premolar bitewing radiographs while retracting the cheeks. Methods: Seventy-two horizontal bone defects were created on dried mandibles and maxillae. The distance from the bone level to the cement-enamel junction of premolars was detected by a modified digital caliper (considered the gold standard). The reliability of all radiographs was assessed by intraclass correlation coefficient (ICC), and the validity was compared to the gold standard using the analysis of variance test. P-values less than 0.05 were considered statistically significant. Results: This study showed that the reliability of radiographs without a cheek simulator and with 0.16 second exposure time was significantly higher than that of the two other groups (ICC=0.96 compared to 0.93 and 0.88, respectively). The results from the radiographs without a cheek simulator and with 0.16 second exposure time were more similar to the gold standard measures than those of the two other groups, although the difference was not statistically significant. Conclusions: Retracting the buccal soft tissue plays an important role in increasing the accuracy of radiographs in detecting the interdental alveolar bone level and produces more accurate results than increasing the exposure time, although it does not have a significant role in reliability of results.

• 한국융합학회논문지
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• 제9권11호
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• pp.291-297
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• 2018

의료 현장에서의 최소침습수술(MIS)의 어려움 때문에 시뮬레이터 훈련이 활발히 연구되고 있다. 이를 위해 본 연구에서는 S-chain모델을 사용하여 가상 장기와 변형과정을 표현하고 반발력 제공이 가능한 햅틱 시뮬레이터를 개발하고자 한다. S-chain알고리즘의 주요 원리는 반발력이 체인 요소의 수에 비례하는 것이며, 대상인 장기의 변형이 클수록 많은 계산시간을 요구한다. 이에 본 연구에서는 계산속도가 개선된 S-chain알고리즘을 회전움직임에 적용하여 제어성능을 평가하였다. 본 연구에서는 자기 점성 점성(MR) 유체를 사용하는 햅틱 마스터 시스템을 제안하고 S-chain모델을 개발한다. 결과적으로, 이 S-chain모델을 사용하여 가상의 장기와 실제 마스터 장치를 결합함으로써 반발력과 수술로봇의 좌표 위치를 서로 전달하는 햅틱 시스템을 구축하여, 햅틱 시뮬레이터의 제어 성능을 실험을 통해 평가하였다.

• 정보처리학회논문지:소프트웨어 및 데이터공학
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• 제12권6호
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• pp.275-284
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• 2023

가상 현실 시뮬레이션은 다양한 분야에서의 교육과 훈련에 활용이 되며, 특히 최근에는 의료 분야에서 많이 사용되고 있다. 교육/훈련용 시뮬레이터는 의사가 실제 수술 도구를 이용하여 실제 환자에 대해 처치를 하는 것과 같은 느낌이 나게 하는 촉감/역감 생성 및 영상/음향 출력 하드웨어와 여기에 실감 나는 영상과 촉감을 생성해주는 소프트웨어로 이루어진다. 기존의 시뮬레이터들은 수술 시에 사용되는 다양한 수술 도구들을 모사하기 위해 다양한 형태의 하드웨어들을 사용해야 하므로 복잡하고 비용이 많이 소요되는 문제가 있다. 이 논문에서는 포스 피드백 장치와 변형 가능한 햅틱 컨트롤러를 이용한 치과 수술 시뮬레이션 시스템을 제안한다. 햅틱 하드웨어들은 수술 도구와 수술 부위의 충돌 여부를 파악하고 그에 따른 저항감과 진동감을 제공한다. 특히 길이 변화, 굽힘과 같은 변형이 가능한 햅틱 컨트롤러는 여러 수술 도구들의 형태에 따라 느껴지는 다양한 감각을 표현할 수 있다. 사용자가 햅틱 피드백 장치를 조작하면 햅틱 피드백 장치의 움직임이나 버튼 클릭 등의 이벤트가 시뮬레이션 시스템에 전달되어 치과용 수술 도구와 구강 내부 모델들 사이의 상호작용이 발생하고 이에 따른 햅틱 피드백이 햅틱 피드백 장치로 전달된다. 이러한 기반 기술들을 활용하여 정교한 3차원 모델로 표현된 가상 환경에서 대표적인 치과 수술기법인 매복 사랑니 발치 수술의 현실적인 훈련 경험을 제공한다.