P. Golland et al. (Eds.): MICCAI 2014, Part I, LNCS 8673, pp. 617–625, 2014. © Springer International Publishing Switzerland 2014 Real-Time Visualisation and Analysis of Internal Examinations – Seeing the Unseen Alejandro Granados 1 , Niels Hald 1 , Aimee Di Marco 2 , Shahla Ahmed 2 , Naomi Low-Beer 2 , Jenny Higham 2 , Roger Kneebone 1 , and Fernando Bello 1 1 Simulation and Modelling in Medicine and Surgery, Department of Surgery and Cancer St. Mary’s Hospital, Imperial College London, UK 2 Imperial College Healthcare NHS Trust St. Mary’s Hospital, Imperial College London, UK a.granados@imperial.ac.uk Abstract. Internal examinations such as Digital Rectal Examination (DRE) and bimanual Vaginal Examination (BVE) are routinely performed for early diag- nosis of cancer and other diseases. Although they are recognised as core skills to be taught on a medical curriculum, they are difficult to learn and teach due to their unsighted nature. We present a framework that combines a visualisation and analysis tool with position and pressure sensors to enable the study of inter- nal examinations and provision of real-time feedback. This approach is novel as it allows for real-time continuous trajectory and pressure data to be obtained for the complete examination, which may be used for teaching and assessment. Ex- periments were conducted performing DRE and BVE on benchtop models, and BVE on Gynaecological Teaching Assistants (GTA). The results obtained sug- gest that the proposed methodology may provide an insight into what consti- tutes an adequate DRE or BVE, provide real-time feedback tools for learning and assessment, and inform haptics-based simulator design. Keywords: Internal Examinations, Digital Rectal Examination, Bimanual Va- ginal Examination, Prostate Cancer, Rectal Cancer, Vaginal Abnormalities, Cervix Abnormalities. 1 Introduction Physical examination through Digital Rectal Examination (DRE) or bimanual Vaginal Examination (BVE) plays a key role in the early diagnosis and detection of anorectal [1,2], prostate [3], vaginal and cervix [4] abnormalities. Despite this importance, teaching and assessment of DRE and BVE is often inadequate as visual cues are mi- nimal – both learner and trainer are unable to see what each other is doing. The inti- mate nature of these examinations results in patients being unwilling to be examined by junior trainees. In addition, there is a lack of understanding of what are the pressure and palpation techniques that lead to an adequate examination. Previous attempts have focused on computing performance metrics from pressure sensors embedded on an instrumented