INFORMATION TECHNOLOGIES IN MEDICINE Information Technologies in Medicine, Volume II: Rehabilitation and Treatment. Edited by Metin Akay, Andy Marsh Copyright ( 2001 John Wiley & Sons, Inc. Print ISBN 0-471-41492-1 Electronic ISBN 0-471-20645-8 INFORMATION TECHNOLOGIES IN MEDICINE VOLUME II: REHABILITATION AND TREATMENT Edited by Metin Akay Dartmouth College Andy Marsh National Technical University of Athens a wiley-interscience publication JOHN WILEY & SONS, INC. New York . Chichester . Weinheim . Brisbane . Singapore . Toronto Designations used by companies to distinguish their products are often claimed as trademarks. In all instances where John Wiley & Sons, Inc., is aware of a claim, the product names appear in initial capital or all capital letters. Readers, however, should contact the appropriate companies for more complete information regarding trademarks and registration. Copyright ( 2001 by John Wiley & Sons, Inc. All rights reserved. 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ISBN 0-471-20645-8 This title is also available in print as ISBN 0-471-41492-1. For more information about Wiley products, visit our website at www.Wiley.com. CONTRIBUTORS Luciano Beolchi, European Commission DGXIII-C4, O½ce BU29-3/68, Rue de la Loi 200 B-1049, Brussels, Belgium luciano.beolchi@BXL.DB13.cec.be Alberto Bianchi, LBHL, 50A-1148, 1 Cyclotron Road, University of Califor- nia, Berkeley, CA 94720 asarti@math.lbl.gov Curtis Boswell, Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, CA 91109 Hari Das, Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, CA 91109 Mark Draper, Human Interface Technology Laboratory, Box 352142, Uni- versity of Washington, Seattle, WA 98195-2142 Thomas A. Furness, III, Human Interface Technology Laboratory, Box 352142, University of Washington, Seattle, WA 98195-2142 Roberto Gori, LBHL, 50A-1148, 1 Cyclotron Road, University of California, Berkeley, CA 94720 asarti@math.lbl.gov Qinglian Guo, Department of Information Science, Faculty of Science, Uni- versity of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan Walter J. Greenleaf, Greenleaf Medical Systems, 2248 Park Boulevard, Palo Alto, CA 94306 walter@greenleafmed.com Claudio Lamberti, LBHL, 50A-1148, 1 Cyclotron Road, University of Cali- fornia, Berkeley, CA 94720 asarti@math.lbl.gov Zsolt Lorant, 9904 Carlyle Way W Apt.a446, Mobile, AL 36609 Claudio Marchetti, LBHL, 50A-1148, 1 Cyclotron Road, University of Cali- fornia, Berkeley, CA 94720 asarti@math.lbl.gov v Katsunobu Muroi, Mitsubishi Electric Corporation, Tsukaguchi-Honmachi, Amagasaki, Hyogo, JAPAN Tim Ohm, Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, CA 91109 Mieko Ohsuga, Mitsubishi Electric Corporation, Tsukaguchi-Honmachi, Amagasaki, Hyogo, JAPAN Guiseppe Riva, Instituto Auxologico Italiano, Applied Technology for Neuro- Psychology, Verbania, Italy Guillermo Rodriguez, Jet Propulsion Laboratory, California Institute of Tech- nology, 4800 Oak Grove Drive, Pasadena, CA 91109 Alessandro Sarti, LBHL, 50A-1148, 1 Cyclotron Road, University of Califor- nia, Berkeley, CA 94720 asarti@math.lbl.gov Rob Steele, Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, CA 91109 Robert John Stone, Virtual Presence Ltd., Chester House, 79 Dane Road, Sale, Cheshire, M33 7BP UK r.stone@vrsolns.co.uk Erik Viirre, 3081 Nute Way, San Diego, CA 92117 Jihong Wang, Department of Radiology, University of Texas Southwestern Medical School, Dallas, TX 75235-9071 wang@phyics.swmed.edu Brenda K. Wiederhold, Center for Advanced Multimedia Psychotherapy, CSPP Research and Service Foundation, 6160 Cornerstone Court East, San Diego, CA 92121 brendaweid@aol.com Mark D. Wiederhold, Department of Internal Medicine, Scripps Clinic Medi- cal Group, 1200 Prospect Street, Suite 400, La Jolla, CA 92037 mark weiderhold@cpqm.caic.com vi CONTRIBUTORS CONTENTS PREFACE ix PART I TREATMENT 1 1. Neuro/Orthopedic Rehabilitation and Disability Solutions Using Virtual Reality Technology Walter J. Greenleaf 3 2. The Use of Virtual Reality Technology in the Treatment of Anxiety Disorders Brenda K. Wiederhold and Mark D. Wiederhold 19 3. Virtual Reality for Health Care L. Beolchi and G. Riva 39 4. Robot-Assisted Microsurgery Development at JPL Hari Das, Tim Ohm, Curtis Boswell, Rob Steele, and Guillermo Rodriguez 85 5. Virtual Reality and the Vestibular System: A Brief Review Erik Viirre, Zsolt Lorant, Mark Draper, and Thomas A. Furness, III 101 PART II TELEMEDICINE AND TELESURGERY 109 6. Computer Imagery and Multimedia Techniques for Supporting Telemedicine Diagnoses Qinglian Guo, Katsunobu Muroi, and Mieko Ohsuga 111 7. Implementing a Picture-Achieving and Communication System (PACS) and Teleradiology System: Practical Issues and Considerations Jihong Wang 141 8. From Engineering to Surgery: The Harsh Realities of Virtual Reality Robert John Stone 165 vii 9. Maxillofacial Virtual Surgery from 3-D CT Images Alessandro Sarti, Roberto Gori, Alberto Bianchi, Claudio Marchetti, and Claudio Lamberti 183 INDEX 201 viii CONTENTS PREFACE For many patients, the real world is too risky or disconcerting for them to move around in. The agoraphobic patient has a fear of open or public places and so may become housebound. The psychiatric technique of desensitization has been in use for a number of years. The patient is asked to imagine the things that are most disturbing and gradually their fears are controlled. Now a virtual environment can be created for treatment of these patients. They can gradually experience their feared objects in a manner with complete control. Similarly, people who need rehabilitation from weakness or loss of body function or control can have a custom environment created for them that will represent an appropriate challenge to help them recover. Delivery of medical care has be progressively hampered by the lack of ability to provide specialized information uniformly to all people. Specialists tend to be located in university, urban centers that are distant from many patients and their primary care physicians. With the explosion of understanding of many diseases, the primary care physician will need more and more access to agents able to understand and synthesize information about patients. Beyond telemedicine, telesurgery has been touted as a means of getting sur- geon to a remote location and allowing him to operate on his patient. Since there are many surgeons, this application of telepresence will only be useful in places that doctors are not willing to go, such as the battle®eld. However, there are remote locations that no surgeon is currently able to go; microscopic sites inside the body. Surgeons now manipulate blood vessels inside the eye or bones in the middle ear. However, at current size, even when viewed through the best microscope, the VRT can also be used in the areas of physical disabilities. Vir- tual environments can be created for the treatment of the patients with the motor disturbances such as parases. The speech disabilities can be assisted by simply using the data gloves which translate the gestures into spoken words. In this volume, we will discuss the use of information technologies in in the rehabilitation, treatment of physical disabilities in details and the delivery of health care using the information technologies. The ®rst chapter by W. J. Greenleaf summarizes the current status of the virtual reality technologies and discusses the use of these technologies in neuro/ orthopedic rehabilitation as well as the new systems under development. The second chapter by B. K. Wiederhold and M. D. Wiederhold gives the use of virtual reality technologies for the treatment of many anxiety disorders including fear of heights, ¯ying, spiders, driving, social phobia, and the possi- ix bility of using these technologies for the treatment of acute stress disorders and generalized anxiety disorders. The third chapter by L. Beolchi and G. Riva gives an indepth summary of virtual reality technologoies and their applications in health care as well as the healt care market analysis. The fourth chapter by Das et al. presents the recenty developed RAM tele- robot system and its demonstration of a simulated microsurgery procedure performed at the JPL. The ®fth chapter by Viirre et al. discusses motion sickness caused by the virtual reality technology and the application of VR for vestibular patients. The sixth chapter by Guo et al. introduces a telemedicine diagnosis support systems based on the computer graphics and multimedia technologies. The seventh chapter by J. Wang presents the implementation of a picture- achieving and comunication system (PACS) and teleradiology system by em- phasing the practical issues in the implementation of a clinical PACS. The eighth chapter by Stone discusses the adoptation of virtual reality tech- nologies in medicine and other sectors and presents a case study of one surgical training system. The last chapter by Sarti et al. discusses a simulation method that allows one to deal with extremely complex anatomical geometrics and gives a detailed comparison between virtual and real surgical opertions performed on patients. We thank the authors for their valuable contributions to this volume and George Telecki, the Executive Editor and Shirley Thomas, Senior Associate Managing Editor of John Wiley & Sons, Inc. for their valuable support and encouragement througout the preparation of this volume. Metin Akay This work was partially supported by a USA NSF grant (IEEE EMBS Work- shop on Virtual Reality in Medicine, BES ± 9725881) made to Professor Metin Akay. x PREFACE INFORMATION TECHNOLOGIES IN MEDICINE [...]... 21 W J Greenleaf and M A Tovar Augmenting reality in rehabilitation medicine Artif Intel Med 1994;6:289±299 Information Technologies in Medicine,Volume II: Rehabilitation and Treatment Edited by Metin Akay, Andy Marsh Copyright © 2001 John Wiley & Sons, Inc Print ISBN 0-471-41492-1 Electronic ISBN 0-471-20645-8 CHAPTER 2 The Use of Virtual Reality Technology in the Treatment of Anxiety Disorders BRENDA... dopamine, but usually not without unwanted side e¨ects Now, collaborators at the Human Interface Technology Laboratory and the Department of Rehabilitation Medicine at the University of Washington, along with the San Francisco Parkinson's Institute are using virtual imagery to simulate an e¨ect called kinesia paradoxa, or the triggering of normal walking behavior in akinetic Parkinson patients (16) Using... Treatment of PD usually involves medication or cognitive-behavioral therapy, sometimes in combination Cognitive-behavioral therapies may include relaxation, breathing retraining (biofeedback), exposure therapy, and cognitive restructuring Medications used include benzodiazepines and antidepressants (14) Exposure therapies include systematic desensitization, in vivo exposure, and imaginal exposure Systematic... imagined scenes depicting situations the client has indicated cause him or her anxiety In vivo exposure involves exposing the patient to the actual real-life phobic situation This may be done after teaching the patient anxiety management techniques, (e.g., thought stopping, relaxation, and diaphragmatic breathing), or it may be done without ®rst teaching any of these techniques Imaginal exposure involves... fear of ¯ying that centers around crashing and during therapy numerous imagined or in vivo ¯ights are taken with no crashes, the patient's fear structure would be provided with incompatible information that should modify it (26) According to Foa and Kozak (26), there are three indications that emotional processing is occurring: physiologic arousal and self-reported fear during exposure, diminution of... health disorders was $101.2 billion (2) In a more recent study, the following costs were estimated for anxiety disorders: $15 billion in direct costs, such as medical, administrative, and research costs, and $50 billion in indirect costs, including illness, death, and lost or reduced productivity (3) Of patients presenting with insomnia, chest pain, or abdominal pain 33% actually had an anxiety disorder,... Computer-generated information is displayed during the procedure on computer monitors in the operating room and on a heads-up display mounted on the operating microscope These images provide surgeons with CT- and MRIde®ned maps of the surgical ®eld scaled to actual size and location This information guides the surgeon in ®nding and de®ning the boundaries of brain tumors The computer-generated images are indexed... specialized sensors and interface devices allow the individual to become Information Technologies in Medicine, Volume II: Rehabilitation and Treatment, Edited by Metin Akay and Andy Marsh ISBN 0-471-41492-1 ( 2001 John Wiley & Sons, Inc 3 4 NEURO/ORTHOPEDIC REHABILITATION AND DISABILITY SOLUTIONS immersed and to navigate and interact with objects in a computer-generated environment Most people associate... of standing in a grocery checkout line, then this can be practiced over and over in the virtual world In the real world, a patient may feel conspicuous checking out over and over again at the grocery store Just unreal enough so that many patients who have resisted therapy owing to in vivo approaches are willing to try it They know they can stop the virtual experience instead of being trapped in a real-life... applications environment in the near future 1.4.1 Surgical Training and Planning Various projects are under way to use VR and imaging technology to plan, simulate, and customize invasive (an minimally invasive) surgical procedures Ranging from advanced imaging technologies for endoscopic surgery to routine hip replacements, these new developments will have a tremendous e¨ect on improving surgical morbidity . INFORMATION TECHNOLOGIES IN MEDICINE Information Technologies in Medicine, Volume II: Rehabilitation and Treatment. Edited by Metin Akay, Andy Marsh Copyright ( 2001 John Wiley & Sons, Inc. Print. Metin Akay. x PREFACE INFORMATION TECHNOLOGIES IN MEDICINE PART I TREATMENT Information Technologies in Medicine,Volume II: Rehabilitation and Treatment. Edited by Metin Akay, Andy Marsh Copyright. individual to become 3 Information Technologies in Medicine, Volume II: Rehabilitation and Treatment, Edited by Metin Akay and Andy Marsh. ISBN 0-471-41492-1 ( 2001 John Wiley & Sons, Inc. immersed