Autopsy Brain Removal Training Using Virtual Reality Simulation

Hospital autopsy is the only method of confirming diagnoses for neurodegenerative disease such as Alzheimer's and Lewy body disease, despite advanced diagnostic technologies. However, the number of hospital autopsies has steadily declined, due to changes in hospital accreditation requirements, lack of reimbursement, and other factors. Consequently, it is challenging to train autopsy assistants, pathology residents and neuropathology fellows to become competent in evisceration and dissection techniques, as there are few opportunities to observe and perform hospital autopsies. The procedure for autopsy brain removal is particularly challenging because: (i) incorrect cutting planes and depth of cut during opening of the cranium can lead to inadequate exposure of, or damage to, brain tissue, and (ii) there may be initial hesitation to perform the procedure due to proximity to the face. These challenges are compounded because current teaching resources are limited to drawings (which lack key spatial and volumetric cues) and photographs (which provide only a single view, and may have superfluous information); no physical practice of the procedure is involved. To address this deficit, a virtual reality (VR) simulation application was developed to teach proper methodology in performing steps of the autopsy brain removal, and as a proof-of-concept for a complete hospital autopsy VR simulation. The simulation provides an immersive VR interactive experience within an Oculus Rift platform. It uses realistic virtual patient models created from surface 3D scans of a real person, data-driven 3D models of anatomy, sound effects, and haptic responses within a VR autopsy suite. The simulation also features real-time visual feedback and evaluation of user performance, to assist improvement of skills and knowledge during the step of opening the cranium with an oscillating saw. This thesis documents the process of developing the VR simulation, in particular the creation and use of i) 3D models of patient, cranium and brain, ii) interactions between instruments and patient in VR, iii) in-game feedback: visual, sound and haptic, and iv) user interface (UI) interaction in VR.