A Subset of Mixed Simulations: Augmented Physical Simulations with Virtual Underlays

Most of us have appreciated Mixed Reality (MR) in the form of the virtual “yellow first down line” when watching football on TV. However, MR technology was previously confined to a few pioneering groups and was not readily available. Simply defined, MR integrates the virtual and physical worlds to generate new environments where real and virtual objects are collocated (share the same space) while augmenting our capabilities to interpret, understand, practice, learn, train or teach. MR technology is becoming affordable and finding its way into simulation giving rise to a new field we call Mixed Simulation. We present in this paper five new mixed simulators with physical exteriors and virtual underlays: central venous access (CVA), ventriculostomy, radio frequency lesion, spinal instrument implantation and regional anesthesia. We exploited advances in the capabilities, cost and/or sensor miniaturization in medical imaging, tracking technology, 3D printing (rapid prototyping) and 3D graphic cards to develop and deploy compact, inexpensive mixed simulators that are anatomically authentic, i.e., exact physical and/or virtual replicas of the actual individuals used as models. Sub-millimeter accuracy, miniaturized tracking sensors monitor and record every move, twist and turn of a tracked needle during the simulated procedures, facilitating after action review or even self-debriefing (when instructors are unavailable) and automated scoring algorithms (immune to inter-rater variability) that include tracking and grading of near misses. Mixed simulators offer the potential for improved training and debriefing for military and civilian applications; e.g., the CVA simulator improves learning outcome in residents and can provide civilian reservists unfamiliar with subclavian venous access (common in military trauma medicine and combat casualty care) training prior to frontline deployment to care for warfighters.