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Title: A virtual reality based simulator for learning nasogastric tube placement
Authors: Choi, KS 
He, X
Chiang, VCL 
Deng, Z
Issue Date: 1-Feb-2015
Source: Computers in biology and medicine, 1 Feb. 2015, v. 57, p. 103-115
Abstract: Nasogastric tube (NGT) placement is a common clinical procedure where a plastic tube is inserted into the stomach through the nostril for feeding or drainage. However, the placement is a blind process in which the tube may be mistakenly inserted into other locations, leading to unexpected complications or fatal incidents. The placement techniques are conventionally acquired by practising on unrealistic rubber mannequins or on humans. In this paper, a virtual reality based training simulation system is proposed to facilitate the training of NGT placement. It focuses on the simulation of tube insertion and the rendering of the feedback forces with a haptic device. A hybrid force model is developed to compute the forces analytically or numerically under different conditions, including the situations when the patient is swallowing or when the tube is buckled at the nostril. To ensure real-time interactive simulations, an offline simulation approach is adopted to obtain the relationship between the insertion depth and insertion force using a non-linear finite element method. The offline dataset is then used to generate real-time feedback forces by interpolation. The virtual training process is logged quantitatively with metrics that can be used for assessing objective performance and tracking progress. The system has been evaluated by nursing professionals. They found that the haptic feeling produced by the simulated forces is similar to their experience during real NGT insertion. The proposed system provides a new educational tool to enhance conventional training in NGT placement.
Keywords: Clinical simulation
Haptic rendering
Nasogastric tube
Nursing skills training
Virtual reality
Publisher: Pergamon Press
Journal: Computers in biology and medicine 
ISSN: 0010-4825
EISSN: 1879-0534
DOI: 10.1016/j.compbiomed.2014.12.006
Rights: © 2014 Elsevier Ltd. All rights reserved.
© 2014. This manuscript version is made available under the CC-BY-NC-ND 4.0 license
The following publication Choi, K. -., He, X., Chiang, V. C. L., & Deng, Z. (2015). A virtual reality based simulator for learning nasogastric tube placement. Computers in Biology and Medicine, 57, 103-115 is available at
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