Table Of ContentTeaching Ultrasound-Guided Regional
Anesthesia Through Mobile Phone Games
Solveig Hellan
Hanna Holler Kamperud
Master of Science in Computer Science
Submission date: June 2015
Supervisor: Frank Lindseth, IDI
Norwegian University of Science and Technology
Department of Computer and Information Science
Abstract
Itisnowquitecommontouseultrasoundasguidancewhenregionalanesthe-
sia is performed in hospitals around the world. However, to be able to use ul-
trasoundduringprocedures,ananesthesiologistneedsexperienceinultrasound
interpretation.Ifultrasounddataroutinelycollectedfrommedicalprocedures
aremadeavailablethroughaneducationalmobileapplication,thereispotenti-
alforstudentsofanesthesiatoacquireknowledgethroughindependentstudy.
To study the potential behind the idea, a mobile application prototype, Nerve
Blocker, was created and evaluated based on educational value and people’s
willingnesstouseit.Theevaluationwasperformedthroughusertesting.
TheevaluationshowedthatbymakingNerveBlockerafungamecenteredaround
ultrasound interpretation, the participants showed willingness to use the ap-
plication.Theevaluationalsoindicatedthattheparticipantshadimprovedat
ultrasoundinterpretationthroughexposureintheapplication.
IfNerveBlocker isexpandedtoincludemoreareasofregionalanesthesia,and
additionaldataperarea,itcouldbecomeapromisingteachingtooltobeused
tosupplementformaleducation.
i
Sammendrag
Deterblittmerogmervanligåbrukeultralydsomguidenårregionalanestesi
blirutførespåsykehusrundtomiverden.Forådrafullnytteavultralydtrenger
enanestesilegeerfaringitolkningavultralydbilder.Hvisdatasomrutinemessig
blirsamletinnfraprosedyrerkanblitilgjengeliggjortgjennomenmobilappli-
kasjon,hardettepotensialtilågianestesistudentermulighetentilåtilegneseg
kunnskapgjennomselvstudium.
Foråundersøkepotensialetbakdenneideenbleenapplikasjonsprototyp,Ner-
veBlocker,utvikletogevaluertbasertpåpedagogiskverdiogfolksviljetilåbru-
keden.Evalueringenbleutførtviabrukertester.
EvalueringenvisteatvedågjøreNerveBlockertiletmorsomtspillbasertpåul-
tralydtolkningvistedeltagerenevillighettilåbrukeden.Evalueringenindikerte
ogsåatdeltagernesultralydtolkningvarblittforbedretviaeksponeringiappen.
Hvis Nerve Blocker blir utvidet til å inkludere flere områder innenfor regional
anestesi,ogytterligeredatamaterialeperområde,vildenkunneblietlovende
læringsverktøysomkansupplereformellutdanning.
ii
Preface
This thesis is the result of the work completed for our Master of Science and
Technology degrees in Computer Science at the Norwegian University of Sci-
enceandTechnology. Theworkwascarriedoutduringthespringsemesterof
2015,incollaborationwithSINTEFandSt. Olav’sHospital.
We would like to thank our supervisor Frank Lindseth for his help and guid-
anceduringthisproject.WewouldalsoliketothankKajJohansenforproviding
medicaldataandfeedback.Next,wewouldliketogiveourgratitudetotheem-
ployees atSINTEF who participated inthe user test. Finally, we wishto thank
JohanHelsingforhishelpandconstructivefeedback.
HannaHollerKamperud&SolveigHellan
Trondheim,June2015
iii
Contents
ListofFigures vii
ListofTables ix
Glossary x
1 Introduction 1
1.1 Problemdefinition . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Thesisgoals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.3 Researchquestions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.4 Thesisoutline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Background 4
2.1 Ultrasound-guidedregionalanesthesia . . . . . . . . . . . . . . . . 4
2.1.1 Ultrasoundtechnology. . . . . . . . . . . . . . . . . . . . . . 4
2.1.2 Regionalanesthesia . . . . . . . . . . . . . . . . . . . . . . . 6
2.1.3 Teachingultrasound-guidedfemoralnerveblock . . . . . . 7
2.2 Gamedevelopment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.2.1 Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.2.2 Fantasy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.2.3 Curiosity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.3 Mobileapplicationdevelopment . . . . . . . . . . . . . . . . . . . . 10
2.3.1 iOSdevelopment . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.3.2 Androiddevelopment . . . . . . . . . . . . . . . . . . . . . . 12
2.3.3 Cross-platformdevelopment . . . . . . . . . . . . . . . . . . 13
2.4 Qt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.4.1 Qtbasics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.4.2 QtCreator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.4.3 PublishingQtapplications . . . . . . . . . . . . . . . . . . . 17
2.5 Existingsolutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.5.1 Ultrasound-guidedneedleplacementgame . . . . . . . . . 17
iv
2.5.2 SonoAccess2.0MobileApp . . . . . . . . . . . . . . . . . . . 18
3 Method 20
3.1 Datacollection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3.2 Noveltyofapproach . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.3 Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.3.1 Gameplay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.3.2 Usability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.4 Applicationrequirements . . . . . . . . . . . . . . . . . . . . . . . . 23
3.5 Architecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.5.1 Model-view-controller . . . . . . . . . . . . . . . . . . . . . . 26
3.5.2 Stack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.5.3 Systemflowchartsandgamedesign . . . . . . . . . . . . . . 28
3.6 Developmentprocess . . . . . . . . . . . . . . . . . . . . . . . . . . 30
3.7 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.7.1 Systemusabilityscale . . . . . . . . . . . . . . . . . . . . . . 31
3.7.2 Usefulnessquestionnaire . . . . . . . . . . . . . . . . . . . . 31
3.7.3 Proficiencytest . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.7.4 Testparticipants . . . . . . . . . . . . . . . . . . . . . . . . . 32
4 Implementation 33
4.1 Gamedesign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
4.2 Gamemechanics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4.3 Softwaredesign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
4.3.1 Softwareoverview . . . . . . . . . . . . . . . . . . . . . . . . 40
4.3.2 Gamecomponentimplementations . . . . . . . . . . . . . . 44
4.3.3 Bugsandunimplementedfeatures. . . . . . . . . . . . . . . 46
4.3.4 Operatingsystemsandsupporteddevices . . . . . . . . . . 48
4.4 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
5 Results 50
5.1 SUSscore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
5.2 Usefulness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
5.2.1 Perceivedusefulness . . . . . . . . . . . . . . . . . . . . . . . 51
5.2.2 Gamemodefeedback . . . . . . . . . . . . . . . . . . . . . . 52
5.2.3 Improvements . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
5.3 Skilldevelopment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
5.4 Utilityasateachingtool . . . . . . . . . . . . . . . . . . . . . . . . . 60
6 Discussion 63
6.1 RQ1:Istheeducationalapplicationabletoeffectivelyteachultrasound-
guidedregionalanesthesiausingroutinelycollecteddata? . . . . . 64
v
6.2 RQ2:Istheeducationalapplicationabletomotivatemedicalpro-
fessionalstoactuallyuseit? . . . . . . . . . . . . . . . . . . . . . . . 66
7 FutureWork 69
7.1 Gamemodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
7.1.1 Gamemodeimprovements . . . . . . . . . . . . . . . . . . . 69
7.1.2 Newgamemodes . . . . . . . . . . . . . . . . . . . . . . . . . 69
7.2 Moreareasofregionalanesthesia . . . . . . . . . . . . . . . . . . . 70
7.3 Servercommunication . . . . . . . . . . . . . . . . . . . . . . . . . . 70
7.3.1 Loginandglobalhighscore . . . . . . . . . . . . . . . . . . . 70
7.3.2 Downloads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
8 Conclusion 72
Bibliography 74
Appendices 78
A SUSSurvey 79
B Usefulnessquestionnaire 81
C Resultsfromusefulnesstest 86
D Geminiarticle 90
vi
List of Figures
2.1 Twoexamplesofultrasounddevices. Theoneontheleftisatypi-
calultrasounddevice,theoneontherightisahand-heldversion 5
2.2 Across-sectionoftheupperthighillustratingtheanatomyof,and
around,thefemoralnerve . . . . . . . . . . . . . . . . . . . . . . . . 6
2.3 Needleplacementinfemoralnerveblock . . . . . . . . . . . . . . . 7
2.4 Themarketshareofeachsmartphoneoperatingsystem . . . . . . 10
2.5 Anoverviewofwhichplatformsdevelopersarecurrentlytargeting 11
2.6 AmenubarcreatedfromthesameQMLcodecompiledontotwo
differentplatforms,AndroidandLinux . . . . . . . . . . . . . . . . 15
2.7 QtCreatorineditmode . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.8 QtCreatorindesignmode . . . . . . . . . . . . . . . . . . . . . . . . 16
2.9 ScreenshotsfromSonoAccess2.0MobileApp . . . . . . . . . . . . 19
3.1 Adiagramrepresentingthemodel-view-controllerdesignpattern. 26
3.2 AsimplifieddiagramofthewayQMLcontentiscontrolled. . . . . 28
3.3 Asystemflowchartoftheuser’sinteractionwiththegamecom-
ponents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.4 Asystemflowchartoftheuser’sinteractionwiththeInstructional
VideoandDownloads. . . . . . . . . . . . . . . . . . . . . . . . . . . 30
4.1 Themainmenuandinformationalpages . . . . . . . . . . . . . . . 34
4.2 Easygamemode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
4.3 Normalgamemode. . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
4.4 Expertgamemode . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
4.5 Videogamemode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
4.6 Annotationgamemode . . . . . . . . . . . . . . . . . . . . . . . . . 36
4.7 AsimplifieddiagramshowinghowtheQMLcomponentsinteract 40
4.8 AsimplifiedclassdiagramshowinghowtheC++classesinteract . 43
4.9 Thisfigureillustrateshowtheultrasoundimagesarepresentedto
theplayer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
vii
4.10 Proposed design of the game menu with the Downloads button
anddownloadspages. . . . . . . . . . . . . . . . . . . . . . . . . . . 47
5.1 Theultrasoundimageusedinthetest . . . . . . . . . . . . . . . . . 56
5.2 ProficiencyTest: Participant1 . . . . . . . . . . . . . . . . . . . . . . 56
5.3 ProficiencyTest: Participant2 . . . . . . . . . . . . . . . . . . . . . . 57
5.4 ProficiencyTest: Participant3 . . . . . . . . . . . . . . . . . . . . . . 58
5.5 ProficiencyTest: Participant4 . . . . . . . . . . . . . . . . . . . . . . 59
5.6 ProficiencyTest: Participant5 . . . . . . . . . . . . . . . . . . . . . . 60
viii
Description:If ultrasound data routinely collected from medical procedures are made available through The evaluation was performed through user testing. 4.9 This figure illustrates how the ultrasound images are presented to .. language, QML, were made available to improve Qt user interface develop- ment.
