The effects of target size and error rate on the cognitive demand and stress during augmented reality interactions

Augmented Reality Integration in Skull Base Neurosurgery: A Systematic Review

Background and Objectives: To investigate the role of augmented reality (AR) in skull base (SB) neurosurgery. Materials and Methods: Utilizing PRISMA methodology, PubMed and Scopus databases were explored to extract data related to AR integration in SB surgery. Results: The majority of 19 included studies (42.1%) were conducted in the United States, with a focus on the last five years (77.8%). Categorization included phantom skull models (31.2%, n = 6), human cadavers (15.8%, n = 3), or human patients (52.6%, n = 10). Microscopic surgery was the predominant modality in 10 studies (52.6%). Of the 19 studies, surgical modality was specified in 18, with microscopic surgery being predominant (52.6%). Most studies used only CT as the data source (n = 9; 47.4%), and optical tracking was the prevalent tracking modality (n = 9; 47.3%). The Target Registration Error (TRE) spanned from 0.55 to 10.62 mm. Conclusion: Despite variations in Target Registration Error (TRE) values, the studies highlighted successful outcomes and minimal complications. Challenges, such as device practicality and data security, were acknowledged, but the application of low-cost AR devices suggests broader feasibility.

Effects of error rates and target sizes on neck and shoulder biomechanical loads during augmented reality interactions

Augmented reality (AR) interactions have been associated with increased biomechanical loads on the neck and shoulders. To provide a better understanding of the factors that may impact such biomechanical loads, this repeated-measures laboratory study evaluated the effects of error rates and target sizes on neck and shoulder biomechanical loads during two standardized AR tasks (omni-directional pointing and cube placing). Twenty participants performed the two AR tasks with different error rates and target sizes. During the tasks, angles, moments, and muscle activity in the neck and shoulders were measured. The results showed that the target sizes and error rates significantly affected angles, moments, and muscle activity in the neck and shoulder regions. Specifically, the presence of errors increased neck extension, shoulder flexion angles and associated moments. Muscle activity in the neck (splenius capitis) and shoulder (anterior and medial deltoids) also increased when the errors were introduced. Moreover, interacting with larger targets resulted in greater neck extension moments and shoulder abduction angles along with higher muscle activity in the splenius capitis and upper trapezius muscles. These findings indicate the importance of reducing errors and incorporating appropriate target sizes in the AR interfaces to minimize risks of musculoskeletal discomfort and injuries in the neck and shoulders.

Perceived Patient Workload and Its Impact on Outcomes During New Cancer Patient Visits: Analysis of a Convenience Sample

BACKGROUND

Studies exploring the workload in health care focus on the doctors' perspectives. The ecology of the health care environment is critical and different for doctors and patients.

OBJECTIVE

In this study, we explore the patient workload among newly diagnosed patients with cancer during their first visit and its impact on the patient's perceptions of the quality of care (their trust in their doctors, their satisfaction with the care visits, their perception of technology use).

METHODS

We collected data from the Hackensack Meridian Health, John Theurer Cancer Center between February 2021 and May 2022. The technology use considered during the visit is related to doctors' use of electronic health records. A total of 135 participants were included in the study. Most participants were 50-64 years old (n=91, 67.41%). A majority (n=81, 60%) of them were White, and only (n=16, 11.85%) went to graduate schools.

RESULTS

The findings captured the significant effect of overall workload on trust in doctors and perception of health IT use within the visits. On the other hand, the overall workload did not impact patients' satisfaction during the visit. A total of 80% (n=108) of patients experienced an overall high level of workload. Despite almost 55% (n=75) of them experiencing a high mental load, 71.1% (n=96) reported low levels of effort, 89% (n=120) experienced low time pressure, 85.2% (n=115) experienced low frustration levels, and 69.6% (n=94) experienced low physical activity. The more overall workload patients felt, the less they trusted their doctors (odds ratio [OR] 0.059, 95% CI 0.001-2.34; P=.007). Low trust was also associated with the demanding mental tasks in the visits (OR 0.055, 95% CI 0.002-2.64; P<.001), the physical load (OR 0.194, 95% CI 0.004-4.23; P<.001), the time load (OR 0.183, 95% CI 0.02-2.35; P=.046) the effort needed to cope with the environment (OR 0.163, 95% CI 0.05-1.69; P<.001), and the frustration levels (OR 0.323, 95% CI 0.04-2.55; P=.03). The patients' perceptions of electronic health record use during the visit were negatively impacted by the overall workload experienced by the patients (OR 0.315, 95% CI 0.08-6.35; P=.01) and the high frustration level experienced (OR 0.111, 95% CI 0.015-3.75; P<.001).

CONCLUSIONS

The study's findings established pathways for future research and have implications for cancer patients' workload. Better technology design and use can minimize perceived workload, which might contribute to the trust relationship between doctors and patients in this critical environment. Future human factors work needs to explore the workload and driving factors in longitudinal studies and assess whether these workloads might contribute to unintended patient outcomes and medical errors.

A passive upper-limb exoskeleton reduced muscular loading during augmented reality interactions

The aim of this study was to evaluate a passive upper-limb exoskeleton as an ergonomic control to reduce the musculoskeletal load in the shoulders associated with augmented reality (AR) interactions. In a repeated-measures laboratory study, each of the 20 participants performed a series of AR tasks with and without a commercially-available upper-limb exoskeleton. During the AR tasks, muscle activity (anterior, middle, posterior deltoid, and upper trapezius), shoulder joint postures/moment, and self-reported discomfort were collected. The results showed that the exoskeleton significantly reduced muscle activity in the upper trapezius and deltoid muscle groups and self-reported discomfort. However, the shoulder postures and task performance measures were not affected by the exoskeleton during the AR interactions. Given the significant decrease in muscle activity and discomfort without compromising task performance, a passive exoskeleton can be an effective ergonomic control measure to reduce the risks of developing musculoskeletal discomfort or injuries in the shoulder regions.

Inattentional blindness to unexpected hazard in augmented reality head-up display assisted driving: The impact of the relative position between stimulus and augmented graph

OBJECTIVE

An augmented reality head-up display (AR-HUD) is a promising technology in assisted driving. It provides additional information in the driving environment. However, considering the registration problem related to the limitations of interactive technology, we suspect that an AR-HUD may not be able to recognize unpredictable stimuli in a timely manner, inducing inattentional blindness to these non-augmented stimuli. Actually, non-augmented stimuli may accidentally have a brief superimposition to AR graphics. This condition may also influence the rate of inattentional blindness accordingly. Thus, this study examined the problem of inattentional blindness in AR-HUD systems that may result from the immaturity of AR technology.

METHOD

We investigated the impact of AR graphic position (peripheral AOI v.s. central AOI) and the relative position of the AR graphic on unpredictable stimuli (on-HUD hazard v.s. off-HUD hazard) on the occurrence of inattentional blindness. Thirty Participants watched an AR-augmented driving video that included four augmented conditions. Participants were instructed to respond to four critical events (speeding, running of red lights, unexpected pedestrians or motorcycles). The rate of inattentional blindness and response time were recorded. We only analyzed data on unexpected pedestrian and motorcycle incidents.

RESULTS

The relative position of the AR graphic on unpredictable stimuli and AR graphic positions significantly affected the rate of inattentional blindness and response time. Drivers had a higher rate of inattentional blindness to the unpredictable stimulus briefly superimposed on the AR graphic (i.e., on-HUD hazard) in the peripheral visual field (i.e., peripheral AOI). Also, drivers exhibited a higher rate of inattentional blindness to the unpredictable stimuli outside the AR graphic (i.e., off-HUD hazard) in the central visual field (i.e., central AOI).

CONCLUSION

The study is expected to be beneficial for furthering the design of an AR-HUD-assisted system to reduce inattentional blindness in driving. Our results found that in the peripheral visual field, unpredictable stimuli accidentally superimposed on the AR graphic (i.e., on-HUD hazard) lead to a higher probability of ignoring the accidental events and seemed to require a longer response time for drivers. This study illustrated that inattentional blindness to non-augmented stimuli is also influenced by the AR graphic position when AR technology fails to augment them in a timely manner. An important recommendation emerging from this work is to consider the design of AR graphics according to the AR graphic positions and stimulus types to reduce the occurrence of inattentional blindness.

An Architecture for Collaborative Terrain Sketching with Mobile Devices

3D terrains used in digital animations and videogames are typically created by several collaborators with a single-user application, which constrains them to update the shared terrain from their PCs, using a turn-taking strategy. Moreover, collaborators have to visualize the terrain through 2D views, confusing novice users when conceiving its shape in 3D. In this article, we describe an architecture for collaborative applications, which allow co-located users to sketch a terrain using their mobile devices concurrently. Two interaction modes are supplied: the standard one and an augmented reality-based mode, which helps collaborators understand the 3D terrain shape. Using the painting with brushesparadigm, users can modify the terrain while visualizing its shape evolution through the camera of their devices. Work coordination is promoted by enriching the 3D space with each collaborator’s avatar, which provides awareness information about identity, location, and current action. We implemented a collaborative application from this architecture that was tested by groups of users, who assessed its hedonic and pragmatic qualities in both interaction modes and compared them with the qualities of a similar Web terrain editor. The results showed that the augmented reality mode of our prototype was considered more attractive and usable by the participants.