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Last Updated: Friday, 20 August, 2004, 08:18 GMT 09:18 UK
Virtual veins give nurses a hand
By Jo Twist
BBC News Online science and technology staff

The virtual reality hand
The hand has realistic and complex vein structures
A virtual reality hand, complete with vital veins, that "feels" could help trainee nurses practise their jabs.

The tactile 3D virtual reality system uses force feedback technology that is usually found in video game controllers, known as haptics.

It could help in learning sensitive venopuncture skills on a variety of hand types, instead of plastic models.

The system, marketed by UK Haptics, is still at an early stage, but could be used for training nurses next year.

Haptics is the term for physical sensors that provide a sense of touch at skin level and force feedback information from muscles and joints.

"This is very much like force feedback in gaming, but it is much more refined," said Gary Todd of UK Haptics.

"You can feel the needle go through the skin; you can put it in the skin and lift it out," he told BBC News Online.

"You can feel the soft skin and muscles and you can scratch the bone if you put it in the knuckle."

Old, young and damaged

Conventional training techniques for perfecting the art of blood drawing and skin puncturing have been limited.

When you explain you have this virtual program you can feel and touch, they look like you have dropped down from Mars
Sue Todd, UK Haptics
Plastic mannequins are used with replaceable pads which carry the complex vein structures.

But they give little idea of the pressure needed to puncture the skin, and are not too realistic.

Each arm costs about 300 and the pads cost 65 each, so there is not much flexibility to practise on different hand types, like elderly, infant, or damaged ones where veins have collapsed.

The 3D model could be adapted for nurses to experience different types before they are let loose on real people.

"The idea is we can have a fleet of hands. If we can produce a suite of hands, the student is going to feel more confident when they are sent out into the field," said Sue Todd, programmer and partner at UK Haptics.

The company has licensed the technology from its developers, Swedish firm Reachin Technologies.

High-end hardware

Nurses sit in front of a PC wearing 3D goggles. A mirror in front of them lets them see the projected hand image in 3D too.

All the nurse has to do is sit in front of the machine and stick the cannula, which they see as a syringe, into the hand.

The system feeds back information about pressure, and blood appears to fill the syringe when the vein has been punctured.

Twin 2.8GHz processor
2GB ram
350Mb graphics card
Developed with start-up funding support through the North East's Centre of Digital Excellence, Codeworks
Application program interface by Reachin, a Swedish haptics specialist
Haptics device made by US firm SensAble Technologies
It will tell users if too much pressure has been applied, and when the vein has been missed.

The hardware is a high-end, off the shelf computer with twin 2.8GHz processors, explained Mr Todd.

One refreshes the graphics at 30 times a second while the other refreshes at 1,000 times a second to generate the "feel".

"We use just a normal flat screen monitor. You look into the mirror in front of the screen to allow for the 3D space."

UK Haptics said the system could also be adapted for different models where practising might be difficult.

It could prove highly valuable in cervical smear simulation. Currently nurses have to practise on at least 35 women until they are considered fully trained.

From Mars

UK Haptics said it planne to add more clinical elements and a feedback interface so that students and lecturers could gauge and record their performance over time.

The system could eventually be extended for remote training, with a lecturer in one location and the trainee in another.

Nurse tries out the 3D hand (Image: Mark Pinder)
Nurse Leigh Ann Pearson tries the system that acts like a real hand
Student nurses at the University of Northumberland have tried the system and said they would prefer it over the plastic dummy hand, said UK Haptics.

"Our difficulty has been in getting across what it is," explained Ms Todd.

"When you explain you have this virtual program you can feel and touch, they look like you have dropped down from Mars."

There has been wide ranging research into haptics, much of it in academia. The problem, according to Mr Todd, is that there has been no real focus to its mass market development.

Surgeons who do key-hole surgery have used 3D systems like this to train, but UK Haptics see their system as having a more widespread appeal to a large number of nurses.

Dr Sile O'Modhrain, lead researcher of Media Labs Europe's Palpable Machines group, said there is a big future for haptics, but there are still barriers.

"One of the reasons why haptics hasn't achieved mass market visibility is because the devices are still very expensive," she told BBC News Online.

"Haptics has turned up in things like computer games. But there is a distinction between kinds of haptics, like force feedback where device pushes back against you, and cheaper vibration haptics which turn up in mobiles."

For haptics to get cheaper, there must be recognisable added value and the field of medical simulation is an obvious start, she said.

"There you see you have the ability to hide a cost which is smaller than usual. You would have many users using one system so it is easier to justify costs. The benefits are huge."

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