O-050 Virtual reality applications in ultrasound
Authors: Marci R , Soave I 
Published: August 2021

Abstract text
Surgical simulation has been introduced in surgical training since 1920 following the example of airline and military industry. Recently, the Association of American Medical Colleges commented on the increased use of simulation in different medical specialties, recognizing its potential ability to improve patients safety and to enhance healthcare in general. Historically, graduating obstetrics and gynecology residents have been expected to learn following the adage ‘see one, do one, teach one’, which required a high volume experience. Nowadays, as the complexity of procedures increases and surgical volume decreases, in order to acquire surgical skills rapidly there is the need to integrate surgical and ultrasound virtual simulation into modern residency training alongside traditional teaching methods. In addition, recent changes in the field (e.g. workhours restrictions, decreased bedside teaching) have high lightened these necessities.
Ultrasonography is a skill that requires a complex interplay of motor skills and visual-cognitive skill. The learning process include two steps: an initial global assessment followed by a focal search for pathology and key landmarks. Recently more attention has been paid to design increasingly sophisticated simulators for ultrasound in obstetrics and gynecology. These are broadly divided into to major categories: physical mannequins and virtual reality simulators. The physical mannequins practically consist in low cost silicon dummies that enable learners to discover basic anatomical and pathological findings using real ultrasound equipment. This type of simulators allows the trainees to learn haw to use the equipment in order to obtain proper scans. However, the case complexity is limited due to the low fidelity of the physical mannequins. In addition there is no automated feedback and a supervisor is always needed during the practice.
The virtual reality simulators usually rely on haptic devices or physical mannequins that record probe movements during transabdominal or transvaginal scans and combined them with computer-animated/real ultrasound images. Instructions and automated feedback are provided during the practice. They often contains multiple cases allowing the trainees to be exposed to different clinical scenarios.
In the field of Reproductive Endocrinology and Infertility some ultrasound and surgical skills are required for independent practice including transvaginal oocyte pick-up, hysterosalpingocontrastsonography (HyCoSy) and embryo-transfer. Considering advantages and disadvantages of both apprenticeship models (traditional training and simulator-based training), a blended approach which combines simulator-based training with didactic and more traditional training on real patients could be introduced. So far the use of simulation-based training has shown promising results in terms of moderate effects on patient outcomes and large effects on trainee behavior in the clinical setting. It could be useful especially in the initial part of a structured training for novices, enabling them to acquire basic skills and to reach a predefined level of performance in a safe and controlled environment, before applying the procedure to real patients.