动态心内三维超声虚拟现实诊断方法研究

目的应用虚拟现实（VR）技术,通过临床初步应用研究,评价小儿先天性心脏病心内三维虚拟现实诊断方法的可行性.方法正常小儿20例、先天性心脏病患儿30例（ASD 10例、VSD 9例、TOF 11例）,分别进行全心三维图像重建,实现动态三维超声虚拟现实显示,对虚拟心内结构进行三维空间定位观察,显示心内结构异常者与心导管术后或手术后诊断或三维超声诊断进行比较,确定该方法的空间定位及空间结构关系判断的准确性.结果动态心内三维超声虚拟显示技术能正确显示正常及先天性心脏病患儿的心内结构,诊断心内结构异常者与心导管术后或手术后诊断或三维超声诊断一致.结论动态心内三维超声虚拟现实技术为小儿先天性心脏病无创性三维超声诊断提供了一种新方法.     

先天性心脏病三维超声虚拟内窥镜可视化研究

目的 研究开发三维心脏超声虚拟内窥镜系统并对先天性心脏病进行可视化研究.方法 正常小儿10例、先天性心脏病患儿22例(房间隔缺损10例,室间隔缺损6例,法洛四联症6例),将计算机虚拟现实技术和科学计算可视化技术结合,使用C++6.0语言编写和可视化工具库(VTK)开发平台对心脏超声数据集进行三维重建,创建虚拟现实环境系统,建立三维超声虚拟心脏,通过心内导航实现虚拟心内漫游.结果 三维心脏超声虚拟内窥镜系统实现了心脏超声数据的心内三维可视化和心内导航.结论 三维心脏超声虚拟内窥镜系统为先天性心脏病的诊断提供了一种新的可视化方法.     

三维超声仿真心腔内窥镜技术诊断房间隔缺损的实验研究

目的 探讨三维超声虚拟现实技术实现仿真心腔内窥镜观测房间隔缺损（ASD）的可行性。方法建立10个新鲜离体猪心ASD模型，经超声水槽用HP Sonos 5500超声系统采集三维超声图像，用移动立方体算法进行表面重建及可视化，建立心内三维超声仿真心腔内窥镜系统；同时将该系统的ASD面积、最大径和最小径测值与实测值进行比较。结果10例离体心ASD均成功获得虚拟显示。三维超声虚拟现实技术能够模拟心内视角显示缺损的形态、部位及邻近上腔静脉、下腔静脉间的关系，且与实际观察结果一致。测量三维重建并虚拟显示后的ASD面积、最大径和最小径，测得数据与实测值高度相关（r〉0．95，P〈0．01）。结论三维超声仿真心腔内窥镜技术为小儿先天性心脏病三维超声诊断提供了一种新方法。     

心脏三维超声虚拟内窥镜系统导航与介入方法研究

目的通过心脏三维超声虚拟内窥镜系统导航和介入方法研究,旨在探索并建立复杂型先心病虚拟现实环境下观察的规范化"路径"和介入方法。方法采用体绘制技术重建心腔内表面的三维图像,并置感兴趣的心内结构于可视化显示窗中心,键盘操作与人工导航结合使三维重建图像沿着视线方向前进,产生被观察心内结构目标不断靠近观察者和放大的多帧图像。结果系统通过控制鼠标、键盘立体定位,结合VanPraagh"节段分析法"对感兴趣区域观察,使操作者在虚拟心脏内漫游,实现部分心内畸形结构的诊断。对诊断房、室间隔缺损者,应用虚拟介入装置模拟ASD、VSD介入治疗。结论三维超声虚拟内窥镜为先天性心脏病临床诊断、术前模拟介入、手术计划、外科手术导航及计算机辅助医学教学提供了一种新方法。     

动态三维超声STIC技术评价胎儿室间隔缺损

目的 探讨动态三维超声心动图空间-时间相关图像(STIC)技术在评价胎儿室间隔缺损(VSD)中的临床价值.方法 分析采用动态三维超声STIC技术对13例胎儿VSD的检查结果.并与出生后超声心动图及尸解结果进行比较.结果 动态三维超声STIC技术与常规超声在诊断VSD中的准确率分别为92.31%、84.62%,二者比较差异无统计学意义(P=0.539),可能是病例数过少的关系.动态三维超声检查时间短于常规超声,P=0.0339,差异有统计学意义.结论 动态三维超声STIC技术可准确、直观显示胎儿VSD,是胎儿期VSD准确、简便的筛选方法之一.     

多平面经食管体元模型动态三维重建房,室间隔缺损的临床应用

对30倒房间隔缺损（ASD），12例室间隔缺损（VSD）患者进行多平面经食管体元模型动态三维重建超声显像研究。结果表明：超声动态三维重建可从多个角度和方向，甚至模拟手术路径立体显示ASD和VSD的形态、部位和相对大小，及它们和邻近解剖结构间的关系。25例经手术证实的患者中，三维重建纠正了1例ASD和1例VSD患者的多平面经食管二维超声诊断，2例ASD患者三维重建补充了原来的诊断。     

实时三维超声心动图在室间隔缺损诊断中的临床应用

目的 评价实时三维超声心动图在诊断室间隔缺损中的临床价值。 方法 24例先天性室间隔缺损患者应用实时三维超声心动图观察其缺损的解剖特征及其伴发心血管畸形，其结果与手术或导管封堵术中观察结果比较。 结果 实时三维成像能从多个切面清晰显示室间隔缺损的解剖部位、大小、毗邻关系以及伴随畸形，其结果与手术或导管观察结果一致。 结论 实时三维超声心动图能准确反映室间隔缺损的空间结构及毗邻关系，并可准确定量测量缺损内径，对开展室间隔缺损（VSD）手术或导管封堵治疗具有重要的临床意义。     

经胸多平面探头三维重建及实时全容积三维超声心动图检测房间隔缺损的实验比较研究

目的探讨经胸多平面探头三维重建与实时三维超声心动图技术对房间隔缺损定性、定量的诊断价值.方法分别应用TTO探头及X4探头对15只离体猪心房间隔缺损模型进行采样后三维重建,以L1a、L2a剖视面对房间隔缺损进行观察;两种不同采样方式三维重建测量房间隔缺损长径、短径、面积与解剖实际测量值进行比较;同时比较两种三维技术在采样及重建及定性、定量分析时间过程中所耗时间.结果 TTO-3DE和RT-3DE均可显示缺损的形态、部位及与周边结构的毗邻关系,两种方法的超声测量值与实测值差异无显著性意义(P>0.05),且与实测值均具有良好相关性,TTO-3DE采样时间远远长于RT-3DE,但重建及定性、定量分析所耗时间无显著性差异.结论 TTO-3DE和RT-3DE能准确显示房间隔缺损的解剖结构信息,RT-3DE因其采样迅速、即时成像的特点,在指导外科手术和介入性治疗方面更具有实用意义.     

实时三维超声心动图评价法洛四联征室间隔缺损的价值

目的 评价实时三维经胸超声心动图(RT-3DE)对于对法洛四联症(TOF)患者室间隔缺损(VSD)研究的价值. 方法 29例TOF患者通过二维超声测量其VSD径线,通过RT-3DE测量VSD面积,面积数值与术中补片面积均数采用配对t检验计算.应用Pearson相关系数、组内相关系数分别对VSD的径线与面积与手术结果之间的符合程度进行评价.两样本间采用F检验.应用实时三维彩色血流成像技术(RT-3D color)显示VSD分流. 结果 VSD的面积与术中补片面积之间没有统计学差异,VSD的面积测量与手术相关性更好,RT-3DE的测量方法数据的的一致性较好.RT-3Dcolor可清晰显示VSD分流. 结论 RT-3DE评价TOF患者VSD比二维超声更加准确.     

实时三维超声心动图在先天性心脏病诊断中的应用

目的探讨实时三维超声心动图(RT-3DE)对先天性心脏病的诊断价值.方法选取56例先天性心脏病患者分别行二维超声心动图及RT-3DE检查,采集二维、实时三维及全容积三维图像,分析比较3种超声显像技术对心血管解剖结构的显示能力,并对20例室间隔缺损(VSD)、房间隔缺损(ASD)患者缺损最大直径的二维及三维超声测值与手术测值进行比较.结果RT-3DE可以:(1)实时显示心脏的立体结构;(2)实时显示室间隔或房间隔缺损的空间位置、形态,测量的缺损最大直径与手术测值无显著差异(P>0.05);(3)完整显示先天性心脏瓣膜病的瓣叶位置、数目、狭窄口面积及功能状态,清晰显示心内膜垫缺损的共同房室瓣形态及数目,并清晰显示肺动脉瓣病变患者的肺动脉瓣发育情况;(4)清晰显示法乐四联症患者病变的复杂结构,尤其在主动脉根部的短轴观方位显示室间隔的骑跨程度;(5)清晰显示部分动脉导管未闭患者的导管走行及形态.结论 RT-3DE能实时显示先天性心脏病的立体结构及功能状态,为外科手术提供更多信息.     

Three-dimensional echocardiographic virtual endoscopy for the diagnosis of congenital heart disease in children

Virtual endoscopy (VE) is a new post-processing method that uses volumetric data sets to simulate the tracks of a “conventional” flexible endoscope. However, almost all studies of this method have involved virtual visualizations of the cardiovascular structures applied to computed tomography (CT) and magnetic resonance (MR) datasets. This paper introduces a novel visualization method called the “three-dimensional echocardiographic intracardiac endoscopic simulation system (3DE IESS)”, which uses 3D echocardiographic images in a virtual reality (VR) environment to diagnose congenital heart disease. The aim of this study was to analyze the feasibility of VE in the evaluation of congenital heart disease in children and its accuracy compared with 2DE. Three experienced pediatric cardiologists blinded to the patients’ diagnoses separately reviewed 40 two-dimensional echocardiographic (2DE) datasets and 40 corresponding VE datasets and judged whether abnormal intracardiac anatomy was present in terms of a five-point scale (1 = definitely absent; 2 = probably absent; 3 = cannot be determined; 4 = probably present; and 5 = definitely present). Compared with clinical diagnosis, the diagnostic accuracy of VE was 98.7% for ASD, 92.4% for VSD, 92.6% for TOF, and 94% for DORV, respectively. Diagnostic accuracy of VE was significantly higher than that of 2DE for TOF and DORV except for ASD and VSD. The receiver operating characteristic (ROC) curve for VE was closer to the optimal performance point than was the ROC curve for 2DE. The area under the ROC curve was 0.96 for VE and 0.93 for 2DE. Kappa values (range, 0.73–0.79) for VE and 2DE indicated substantial agreement. 3D echocardiographic VE can enhance our understanding of intracardiac structures and facilitate the evaluation of congenital heart disease.     

Stereoscopic virtual reality does not improve knowledge acquisition of congenital heart disease

Advances in virtual reality have made it possible for clinicians and trainees to interact with 3D renderings of hearts with congenital heart disease in 3D stereoscopic vision. No study to date has assessed whether this technology improved instruction compared to standard 2D interfaces. The purpose of this study was to assess whether stereoscopic virtual reality improves congenital heart disease anatomy education. Subjects in a prospective, blinded, randomized trial completed a pre-test assessing factual and visuospatial knowledge of common atrioventricular canal and were randomized to an intervention or control group based on their score. The intervention group used a 3D virtual reality (VR) headset to visualize a lecture with 3D heart models while the control group used a desktop (DT) computer interface with the same models. Subjects took a post-test and provided subjective feedback. 51 subjects were enrolled, 24 in the VR group & 27 in the DT group. The median score difference for VR subjects was 12 (IQR 9–13.3), compared to 10 (IQR 7.5–12) in the DT group. No difference in score improvement was found (p?=?0.11). VR subjects’ impression of the ease of use of their interface was higher than DT subjects (median 8 vs 7, respectively, p?=?0.01). VR subjects’ impression of their understanding of the subject matter was higher than desktop subjects (median 7 vs 5, respectively, p?=?0.01). There was no statistically significant difference in the knowledge acquisition observed between the stereoscopic virtual reality group and the monoscopic desktop-based group. Participants in virtual reality reported a better learning experience and self-assessment suggesting virtual reality may increase learner engagement in understanding congenital heart disease.

     

超声心动图导引下介入治疗室间隔缺损

目的研究体表超声(TTE)导引介入治疗室间隔缺损(VSD)的临床意义.方法 57例膜部 VSD,18例合并膜部室间隔膨出瘤;5例肌部VSD,其中1例为多发性,1例为心肌梗死所致室间隔穿孔,1例合并膜部室缺.缺损直径2～16 mm.在TTE引导下,采用4～18 mm封堵伞进行经导管介入封堵.结果 TTE明确诊断62例VSD,准确率100%.61 例VSD介入治疗成功,成功率98.4%.术后51例左向右分流束消失,10例残余少量左向右分流,其中6例合并主动脉瓣轻度关闭不全,4例合并轻度二、三尖瓣关闭不全.结论 TTE导引在VSD封堵术中确定适应证,预防并发症必不可少.     

虚拟现实分散患者注意力舒缓拔牙疼痛的效果

目的 探讨虚拟现实分散患者注意力缓解智齿拔除术中疼痛的效果.方法 将122例18～60岁需拔除上颌智齿的成人患者纳入试验,按就诊先后顺序分配到试验组和对照组各61例.试验组患者在进行常规拔牙时,于拔牙前5min至拔牙结束使用虚拟现实系统分散患者注意力.对照组患者接受常规方法拔牙,未使用虚拟现实系统分散患者注意力.使用视觉模拟量表(VAS)、牙科焦虑问卷对两组患者拔牙过程中的疼痛和焦虑进行评估.结果 试验组患者VAS得分为(2.09±1.68)分,对照组为(3.07±2.34)分,两组比较,差异有统计学意义(t=-2.677,P＜0.05);试验组拔牙时焦虑问卷得分为(4.44±3.26)分,对照组为(5.06±3.00)分,两组比较,差异无统计学意义(t=-1.093,P＞0.05).结论 虚拟现实分散患者注意力能有效缓解智齿拔除术中的疼痛.     

虚拟现实技术在数字人体数据集中的应用

目的 研究虚拟现实技术在数字人体数据集上的应用.方法 基于中国第一例数字化女虚拟人数据集的重建结果,运用虚拟现实整合软件开发解剖教学系统及虚拟手术室漫游.结果 开发出了一个3D 解剖图谱及一个虚拟手术室漫游系统.结论 虚拟现实技术增强了可视化效果,具有较强的交互性,拓宽了虚拟人体数据集的应用范围.     

经胸实时三维超声心动图在室间隔缺损诊断中的应用价值

目的：探讨实时三维超声心动图在室间隔缺损诊断中的临床应用价值。方法：应用实时三维超声诊断仪获取28例先天性室间隔缺损患者的三维数据库，并利用三维数据工作站对缺损大小进行测量分析，其中18例患者的三维测量值与二维超声及手术结果对照。结果：实时三维成像能从多个视角、甚至模拟手术路径立体显示室间隔缺损的全貌，包括缺损的整体形态、部位、大小以及毗邻关系；同二维超声所测直径相比，三维超声所测室缺最大长轴径与手术结果具有更好的相关性(r=0.92 vs r=0.84)。结论：与二维超声心动图比较，实时三维超声心动图反映了室间隔缺损的立体空间结构，可对缺损大小进行准确的定量分析；与以往三维重建超声相比，实时三维超声可迅速得到室间隔缺损的三维图像，具有重要的临床应用潜力。     

The Effects of Virtual Reality-based Balance Training on Balance of the Elderly

[Purpose] The objective of this study was to determine the effects of virtual reality-based balance training on balance of the elderly. [Methods] The subjects were 32 healthy elderly people aged between 65 and 80, who were divided into a VR (virtual reality) training group (n=17) and a control group (n=15). The VR training group engaged in a 30-minute exercise session using Wii Fit three times a week for eight weeks, while the control group received no intervention. The balance of the two groups was measured before and after the intervention. [Results] According to the Romberg Test conducted to examine the effects of the training on balance, both the area covered by the body’s center of pressure movement, and movement distances per unit area of the body’s center of pressure envelope significantly decreased in the VR training group. Moreover, the two groups showed significant differences in balance. [Conclusion] Virtual reality training is effective at improving the balance of the healthy elderly. Thus, virtual reality training can be proposed as a form of fall prevention exercise for the elderly.Key words: Virtual reality training, Balance, Elderly     

Three-Month Follow-Up Results of a Double-Blind,Randomized Placebo-Controlled Trial of 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality (VR) for Chronic Low Back Pain

Prior work established post-treatment efficacy for an 8-week home-based therapeutic virtual reality (VR) program in a double-blind, parallel arm, randomized placebo-controlled study. Participants were randomized 1:1 to 1 of 2 56-day VR programs: 1) a therapeutic immersive pain relief skills VR program; or 2) a Sham VR program within an identical commercial VR headset. Immediate post-treatment results demonstrated clinically meaningful and superior reduction for therapeutic VR compared to Sham VR for average pain intensity, indices of pain-related interference (activity, mood, stress but not sleep), physical function, and sleep disturbance. The objective of the current report was to quantify treatment effects to post-treatment month 3 and describe durability of effects. Intention-to-treat analyses revealed sustained benefits for both groups and superiority for therapeutic VR for pain intensity and multiple indices of pain-related interference (activity, stress, and newly for sleep; effect sizes ranged from d_rm = .56–.88) and physical function from pre-treatment to post-treatment month 3. The between-group difference for sleep disturbance was non-significant and pain-interference with mood did not survive multiplicity correction at 3 months. For most primary and secondary outcomes, treatment effects for therapeutic VR showed durability, and maintained superiority to Sham VR in the 3-month post-treatment period.PerspectiveWe present 3-month follow-up results for 8-week self-administered therapeutic virtual reality (VR) compared to Sham VR in adults with chronic low back pain. Across multiple pain indices, therapeutic VR had clinically meaningful benefits, and superiority over Sham VR. Home-based, behavioral skills VR yielded enduring analgesic benefits; longer follow-up is needed.