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Creating a Virtual Surgical Atlas of Craniofacial Procedures. Interactive Animations and Testing
Roberto L. Flores, MD1, Aaron Oliker, M.S.2, Joseph G. McCarthy, M.D.2.
1Indiana University, Indianapolis, IN, USA, 2New York University, New York, NY, USA.

PURPOSE: Digital animation is an evolving means of teaching and learning complex 3-dimensional surgical procedures. Our team has previously constructed the first comprehensive set of digital animations demonstrating the most common procedures performed by craniofacial surgeons. Although these surgical animations are rendered as detailed 3-dimesional motion pictures, there are limitations to their educational quality:
1) Only one viewpoint of the procedure can be displayed during the animation.
2) The learning experience is passive and does not actively engage the learner into the virtual procedure.
3) There is no means of testing the cognitive knowledge of the learner.
In order to produce a more dynamic and interactive learning environment for trainees studying surgery through computers and to provide a means for cognitive testing, previously constructed craniofacial surgical animations were placed into a novel interactive surgical simulation and testing platform.
METHODS: Three previously created surgical animations (Cranial Vault Remodeling, Lefort III, Monobloc) were imported into a software program developed by our group which allowed the

CONTENT of the animations to be extracted into a virtual surgery file (.vsf) enabling manipulation of the animation within a real-time interactive environment. Within this program the surgical animations were segmented into the primary steps of the operation. Each .vsf was then uploaded into a real-time surgical simulator (BioDigitalSystems, New York, NY) and composited together with live surgical video footage as well as a voiceover. Customized testing modules were then created for each interactive surgical simulation which appear throughout the virtual surgery.
RESULTS: Three craniofacial procedures were successfully placed in the surgical viewer. Multimedia fusion of audio, live video footage and surgical animation were all melded and coordinated into discreet chapters demonstrating each step of the procedure. The user can manually rotate the head as the virtual surgery is being performed to gain the any visual perspective they desire of the surgery at any time. Zoom and soft tissue transparency capabilities have also been added to increase the educational experience. The user can stop, forward or reverse the animation at any time to gain a thorough understanding of the procedure. The customized testing modules provide three dimensional and text-based questions based on the surgical animations, record the performance of the user and provide feedback to deficiencies in knowledge.
CONCLUSION: For the first time, craniofacial surgical animations can be manipulated in real time to optimize the cognitive learning experience of the learner. Multimedia fusion of live surgical footage and voiceover enhances the educational experience. The learner is free to anatomically explore the virtual anatomy at will throughout the procedure and the pace of the procedure can be controlled. Finally, the cognitive knowledge of the learner can be tested and recorded and areas of deficiency identified. This digital testing capability may serve future roles in surgical training as well as certification and aptitude testing..
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