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(1)早稲田大学大学院先進理工学研究科. 博士論文概要. 論. 文. 題. 目. Study on Patient Simulation Robots for Airway Management Training. 気管挿管手技訓練用患者ロボットに関する研究. 申. 請. 者. Yohan NOH 盧生命理工学専攻バイオ・ロボティクス研究. 2010 年. 12 月.

(2) Ｎｏ.1 Simulations are often used in the training of civilian and military personnel when it is prohibitively expensive or dangerous to allow trainees to use actual equipment in real world conditions. In such situations, simulations allow trainees to learn valuable lessons in a safe, “virtual” environment. One common convenience of this system is that mistakes are allowed in systems where safety is nor mally a critical issue. Simulations used in education are somewhat like training simulations in that they focus on specific tasks. In this thesis, the author focuses on the simulation of medical tasks. In clinical medical fields, doctors constantly face a variety of patient situations, s i t u a t i o n s i n w h i c h m e d i c a l a c c i d e n t s a r e a p o s s i b i l i t y. M e d i c a l t r a i n i n g i s t h e b e s t countermeasure for such accidents, but the best training methods require human volunteers, which presents far too many risks and ethical problems. This is why medical doctors and students employ several types of medical training simulators, but most existing models only have a few sensors attached to their systems, providing little quantitative information to the trainee and forcing instructors to provide subjective assessments. In addition, they do not simulate the real-world conditions of the tasks they simulate. As an alternative, the author proposes an i n n o v a t i v e t r a i n i n g s y s t e m u s i n g R o b o t Te c h n o l o g y ( RT ) , w i t h a h i g h n u m b e r o f embedded sensors, actuators, and evaluation units within the training system. T h i s i n n o v a t i v e , RT- b a s e d t r a i n i n g s y s t e m i s i n t r o d u c e d a s a w a y t o p r o v i d e m o r e effective training. At the minimum, an innovative training system must fulfill three specific conditions: it must 1) reproduce the real -world conditions of the task, 2) provide useful feedback to trainees, and 3) provide objective assessments of training p r o g r e s s . D u e t o t h e c o m p l e x i t y o f d e v e l o p i n g s u c h a s y s t e m , Wa s e d a U n i v e r s i t y began with several initial forays. Beginning in 2004, the University developed a suturing system, WKS (Waseda Kyotokagaku Suturing), and commercialized it in cooperation with Kyotokagaku Co.,Ltd. And beginning in 2005, the author has been developing an airway management training system, WKA (Waseda Kyoto Kagaku Airway), which likewise aims for commercialization in the near future. In this thesis, the author presents an airway management training system which fulfi ll s t he t hr ee r equir ements s tated above f or an eff ecti ve, innovati ve tr ai ning system. Airway management is a basic skill provided during emergency situations s u c h a s c a r d i o p u l m o n a r y a r r e s t . I t c l e a r s t h e a i r w a y, e n s u r i n g t h a t a i r c a n r e a c h t h e lungs, and prevents the entry of gastric juices or blood. There are currently many kinds of the airway management training simulators, developed by a range of companies. Some high cost simulators have functions which enable trainees to train not only airway management, but also general anesthesiology and various other.

(3) Ｎｏ.2 medical tasks. In contrast, low cost simulators only allow training in airway management. But neither type of conventional system can fulfill the requirements for an. effective,. innovative. innovative. airway. training. management. system.. training. Therefore,. system. which. the. author. not. only. proposes. satisfies. an. these. requirements, but can be provided at a relatively low cost—more than existing low cost simulators, but less than existing high cost simulators. Conventional quantitative. systems. have. information. to. a the. small. number. trainee.. They. of. sensors,. rely. on. and. provide. instructors,. little. normally. professional doctors, for subjective assessment of trainee performance. For these reasons, it is preferable for trainees working with conventional systems to receive instructor guidance during the training sessions and during practice sessions with human volunteers. The expenses for the training and practice sessions are therefore p r o p o r t i o n a l t o t h e n u m b e r o f t r a i n e e s . H o w e v e r, t h e p r o p o s e d i n n o v a t i v e t r a i n i n g system can provide a great deal of quantitative information on trainee performance, which can be used to give objective assessment without the instructors. Trainees will still gain a better understating of their performance when instructors are present, but with the proposed system, the author expects only a few instructors will need to be p r e s e n t d u r i n g t h e t r a i n i n g a n d p r a c t i c e s e s s i o n s . C o n s e q u e n t l y, t h e a u t h o r e x p e c t s that the expenses for the training and practice sessions will be smaller in relation to the number of trainees than with conventional simulators, effectively reducing total expenses. Furthermore, the author also expects that our proposed training system will provide a more effective training experience than the conventional systems. In this thesis,. the. author. presents. the. development. details. of. the. innovative. airway. management training system. In the first section, the author introduces general simulation systems and the simulation systems used in training and education, focusing on simulations for medical training. The author also proposes the general concept of the innovative training system in comparison with conventional training systems, and states the purpose of this research. In the second section, the author states the general concept of airway management, and shows how to perform airway management by referring to medical literature and medical science textbooks. In the third section, the author presents the WKA-1R (Waseda Kyotokagaku Airway No.. 1. Refined). which. has. embedded. sensor. systems. to. provide. quantitative. information on trainee performance. There is a variety of such sensors, such as Force Detection Sensor Systems (FDSS), Position Detection Sensor Systems (PDSS) and Displacement Detection Sensor Systems (DDSS). The data collected is integrated into.

(4) Ｎｏ.3 an evaluation function that provides a quantitative assessment of a trainees' skill. Experimental results showed that the WKA-1R was able to quantitatively detect the di ff er ences i n exper tis e a mong parti ci pant s wi th a r ange of s ki ll level s ( uns ki l led trainees, medical students and anesthetists). I n t h e f o u r t h s e c t i o n , t h e a u t h o r p r e s e n t s t h e Wa s e d a K y o t o k a g a k u A i r w a y N o . 2 (WKA-2), which was developed in order to simulate the real-world conditions of the tas k by r epr oduci ng vari ous ai r way di ff icul t y cas es and i ndi vi dual ai r way di ffi cult ies. The WKA-2 accomplishes this with a wire driven mechanism containing 16 embedded a c t u a t o r s a n d 1 6 e m b e d d e d Te n s i o n / C o m p r e s s i o n D e t e c t i o n S e n s o r S y s t e m s ( T C D S S ) . In the fifth section, the author. p r e s e n t s Wa s e d a K y o t o k a g a k u A i r w a y N o . 3. (WKA-3) which has 6 embedded actuators and 56 embedded sensors. This training system is expected to fulfill the three requirements for an effective innovative t r a i n i n g s y s t e m . To d o s o , t h e W K A - 3 p r o p o s e d b y t h e a u t h o r n o t o n l y i n t e g r a t e s t h e functions of WKA-1R and WKA-2, but improves on their sensor system and system mechanism performance. The WKA-3 can also perform Patient Scenario Generation of the real-world conditions of tasks, not only of static or time-invariant patient characteristics, but. also of. dynamic. or. time-variant. ones.. F i n a l l y,. the. author. di scuss es t he r es ul ts of a s et of experi ment s carr ied out t o ve rif y t he eff ecti venes s of the proposed Patient Scenario Generation, using doctors as subjects. I n t h e s i x t h s e c t i o n , t h e a u t h o r p r e s e n t s Wa s e d a K y o t o k a g a k u A i r w a y N o . 4 ( W K A - 4 ) w h i c h h a s 11 e m b e d d e d a c t u a t o r s a n d 5 6 e m b e d d e d s e n s o r s . A l t h o u g h t h e WKA-3 fulfills the three requirements for an innovative training system, it does not consider external appearance such as the “patient’s” skin, and internal appearance such as the pharynx, larynx, and esophagus. For these reasons, the author is p r o p o s i n g W K A - 4 , w h i c h h a s h i g h - f i d e l i t y s i m u l a t e d h u m a n a n a t o m y. I n t h i s s e s s i o n , the author shows how the WKA-4 has improved internal and external anatomical appearance over the WK A-3. In or der t o veri f y t he eff ecti ven es s of t he WK A-4, t he author surveyed eight doctors on whether the various cases reproduced by WKA-4 are similar to the same cases as found in live patients. The results of that survey are also discussed in this section. In the seventh section, the author presents the results of the experiments carried out t o ver if y t he eff ecti venes s of t he ai r way manage ment tr ai ni ng usi ng t he pr oposed training system WKA-4. The author discusses two such experiments carried out with doctors, interns and novices as subjects. In final section, the author presents the conclusion and discusses future works, such as the possibility of using the proposed innovative medical training system in the other fields of medical training..

(5) Ｎｏ.1. 早稲田大学博士（工学）学位申請研究業績書氏名. 印. 盧. （２０１１年７月現在）種類別. 題名. 発表・発行掲載誌名発表・発行年月. 連名者（申請者含む）. 1. 論文 Development of the Swallowing Robot which can Simulate Swallowing on Various Food Bolus Properties for Study of Rehabilitation of the Swallowing Disorder ○ Development of the Airway Management Training System WKA-４: for Improving Reproduction of High Fidelity of Real Patient and Improving Tongue Mechanism and Mandible Mechanism Development of the Airway ○ Management Training System WKA-3: Integration of Evaluation Module to Provide Assessment of Clinical Competence and Feedback Module to Reproduce Different Cases of Airway Difficulties Development of Patient Scenario Generation which can Reproduce Characteristics of the Patient for Simulating Real-World Conditions of Task for Airway Management Training System WKA-3 Mechanism Design Improvements of the Airway Management Training System WKA-3. Development of Tension/Compression Detection Sensor System Designed to Acqure Quantitative Force Information while Training the Airway management. 2011 IEEE International Conference on Robotics and Automation (ICRA 2011) pp.4676-4681. 2011 年 5 月 (published). ノヨハン，瀬川正尚佐藤圭，Wang Chunbao 石井裕之，ソリスホルヘ畠和幸，高西淳夫勝又明敏，飯田幸弘. 2011 IEEE International Conference on Robotics and Automation (ICRA 2011) pp.1726-1731. 2011 年 5 月 (published). ノヨハン，海老原一樹瀬川正尚，Wang Chunbao 佐藤圭，石井裕之ソリスホルヘ高西淳夫，畠和幸庄司聡. The 2010 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS 2010) pp.337-342. 2010 年 10 月 (published). ノヨハン，佐藤圭下村彰宏，瀬川正尚石井裕之，ソリスホルヘ畠和幸，高西淳夫. The 2010 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS 2010) pp.331-336. 2010 年 10 月 (published). ノヨハン，下村彰宏佐藤圭，瀬川正尚石井裕之，ソリスホルヘ畠和幸，高西淳夫. 18th CISM-IFToMM Symposium on Robot Design, Dynamics and Control(ROMANSY 18) pp.183-190. 2010 年 7 月 (published). ノヨハン，佐藤圭下村彰宏，瀬川正尚石井裕之，ソリスホルヘ畠和幸，高西淳夫. The 2009 IEEE/ASME International Conference on Advanced Intelligent Mechatronics(AIM 2009) pp.1264 - 1269. 2009 年 7 月 (published). ノヨハン，下村彰宏瀬川正尚，石井裕之ソリスホルヘ畠和幸，高西淳夫.

(6) Ｎｏ.2. 早稲田大学博士（工学）博士（工学）学位申請研究業績書種類別. 題名. 発表・発行掲載誌名. 発表・発行年月連名者（申請者含む）. The 2009 IEEE International Conference on Robotics and Automation (ICRA2009) pp. 3833–3838. International Journal of Computer Assisted Radiology and Surgery, Vol. 3, No. 6, 543-550. 2009 年 5 月 (published). ノヨハン，瀬川正尚下村彰宏，石井裕之ソリスホルヘ高西淳夫，畠和幸. 2008 年 11 月 (published). ノヨハン，瀬川正尚下村彰宏，石井裕之ソリスホルヘ，畠和幸高西淳夫. IEEE/RSJ International Conference on Biomedical and Biomechatronics (BioRob 2008) pp. 574-579 2008 Computer Assited Radiology and Surgery 22nd International Cogress and Exhibition (CARS 2008) S209-210. 2008 年 9 月 (published). ノヨハン，瀬川正尚下村彰宏，石井裕之ソリスホルヘ，畠和幸高西淳夫. 2008 年 6 月 (published). ノヨハン，瀬川正尚石井裕之，ソリスホルヘ畠和幸，高西淳夫. Determination of Effective Evaluation Parameters on the Airway Training System WKA-1R. The 6th Conference of the International Society for Gerontechnology (ISG 2008) Vol. 7, No.2:174. 2008 年 5 月 (published). ノヨハン，瀬川正尚石井裕之，ソリスホルヘ畠和幸，高西淳夫. Development of Airway Management Training System which embeds array of sensors on a conventional mannequin. 2007 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS 2007) pp. 1296–1301. 2007 年 10 月 (published). ノヨハン，長弘考司小椋優，ソリスホルヘ畠和幸，高西淳夫. 2010 年 12 月. ノヨハン，海老原一樹瀬川正尚，佐藤圭石井裕之，高西淳夫庄司聡，畠和幸. 1. 論文の続き. Development of the Airway Management Training System WKA-2 which can reproduce the Cases of Difficult Airway ○ WKA-1R Robot Assisted Quantitative Assessment of Airway Management. Development of the Evaluation System for the Airway Management Training System WKA-1R. Improvements on the sensor system on the WKA-1R to identify the evaluation parameters of the airway management”. 他2件 2. 講演気道管理教育訓練システ第 11 回計測自動制ム WKA-4 の開発御学会システムイン－動作パターンの生成アテグレーション部門ルゴリズムと筋肉の再現講演会 3D1-3 可能なシステム制御－.

(7) Ｎｏ.3. 早稲田大学博士（工学）学位申請研究業績書種類別. 題名. 発表・発行掲載誌名. 発表・発行年月連名者（申請者含む）. 1. 講演の続き嚥下障害を再現した患者ロボット WKA-2 の開発－物性特性が異なる食べ物により嚥下障害患者への影響－ロボット技術を用いた新たな気道管理訓練モデル WKA-4 の開発. 第 11 回計測自動制 2010 年 12 月御学会システムインテグレーション部門講演会 3D1-4. ノヨハン，瀬川正尚佐藤圭，石井裕之高西淳夫，勝又明敏畠和幸. 第 38 回日本救急医 2010 年 10 月学学会 O-3-196. 訓練者の定量的な手技評価と患者の臨場感の再現ができる気管挿管訓練用頭部モデル WKA-3 の開発気管挿管訓練システムの力センサの開発－手技評価用センサと力制御用センサの開発－. 第 42 回日本医学教 2010 年 7 月育学会講演会 O12-8. ノヨハン，海老原一樹瀬川正尚，庄司聡佐藤圭，石井裕之高西淳夫，片山保ノヨハン，佐藤圭下村彰宏，瀬川正尚石井裕之ソリスホルヘ，高西淳夫畠和幸. 第 27 回日本ロボッ 2009 年 9 月ト学会学術講演会 1H2-06. ノヨハン，下村章宏佐藤圭，瀬川正尚石井裕之，ソリスホルヘ高西淳夫，畠和幸. 第 6 回日本シミュレ 2009 年 10 月ーション学会 TOULOUSE cedex 2010 年 7 月 04, France. ノヨハン. 他 18 件 3.招待講演気管挿管訓練システムの開発 Development of Airway Management training System WKA-3. 4. その他特許位置検出装置、そのプロ特願 2008-254328 グラム、モニタリングシステム、及び気管挿管訓練装置 PCT/JP2008/67697 気管挿管訓練装置. ノヨハン. 平成 20 年 9 月ノヨハン，長弘考司小椋優，石井裕之 30 日出願ソリスホルヘ高西淳夫平成 20 年 9 月ノヨハン，長弘考司下村彰宏，小椋優 30 日出願石井裕之，ソリスホルヘ高西淳夫. 他3件. 受賞. 日本コンピューター外科学会講演論文賞. 18 回日本コンピューター外科学会大会. 2009 年 11 月. 第 11 回計測自動制御学会気道管理教育訓練シ 2010 年 12 月システムインテグレーシステム WKA-4 の開発ョン部分講演会優秀講演賞. 佐藤圭，ノヨハン石井裕之，ソリスホルヘ高西淳夫，畠和幸ノヨハン，海老原一樹瀬川正尚，佐藤圭石井裕之，高西淳夫庄司聡，畠和幸.

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博博博博 士士士士 論論論論 文文文文 概概概概 要要要要

博博博博士士士士論論論論文文文文概概概概要要要要