Evaluation of the Head-Mounted Display for Ultrasound-Guided Peripheral Nerve Blocks in Simulated Regional Anesthesia

Ultrasound Images under an Optimized Image Processing Algorithm in Guiding the Neurological Safety of Resection of Lumbar Disc Nucleus Pulposus in Spinal Surgery

This study was aimed at investigating the effect of an optimized image processing algorithm in ultrasound images and the influence of resection of lumbar disc nucleus pulposus in spinal surgery under the guidance of ultrasound images on the neurological safety of patients. A total of 60 patients with lumbar disc herniation were selected and divided randomly into the control group and observation group. Patients from the control group were treated with resection of lumbar disc nucleus pulposus by an X-ray-guided foraminal microscope, and patients from the observation group underwent the ultrasound image-guided surgeries with an optimized image processing algorithm. Then, the treatment of patients from the two groups was compared. The results showed that the radiotherapy time in the control group was 120 ± 6.3 min and the radiotherapy dose was 129 ± 10.3 min/sec, while the radiotherapy time in the observation group was 4.5 ± 1.2 min and the radiotherapy dose was 22 ± 7.7 min/sec. The time and dose of radiotherapy in the observation group were significantly lower than those in the control group (P < 0.05). In the control group, the numbers of significant effective cases, effective cases, and ineffective cases were 8, 16, and 6, respectively, while those in the observation group were 12, 18, and 0, respectively. The comparison between the groups showed that the number of effective cases and the number of effective cases in the observation group were significantly higher than those in the control group, and the number of ineffective cases was significantly lower than that in the control group (P < 0.05). In conclusion, ultrasound-guided percutaneous foraminal lumbar discectomy could improve patients' clinical symptoms, promote clinical efficacy, and reduce postoperative pain symptoms, thereby accelerating the postoperative rehabilitation of patients. Moreover, it was extremely safe for the nerves.

Contemporary training methods in regional anaesthesia: fundamentals and innovations

Over the past two decades, regional anaesthesia and medical education as a whole have undergone a renaissance. Significant changes in our teaching methods and clinical practice have been influenced by improvements in our theoretical understanding as well as by technological innovations. More recently, there has been a focus on using foundational education principles to teach regional anaesthesia, and the evidence on how to best teach and assess trainees is growing. This narrative review will discuss fundamentals and innovations in regional anaesthesia training. We present the fundamentals in regional anaesthesia training, specifically the current state of simulation-based education, deliberate practice and curriculum design based on competency-based progression. Moving into the future, we present the latest innovations in web-based learning, emerging technologies for teaching and assessment and new developments in alternate reality learning systems.

A review on the applications of virtual reality, augmented reality and mixed reality in surgical simulation: an extension to different kinds of surgery

Background: Research proves that the apprenticeship model, which is the gold standard for training surgical residents, is obsolete. For that reason, there is a continuing effort toward the development of high-fidelity surgical simulators to replace the apprenticeship model. Applying Virtual Reality Augmented Reality (AR) and Mixed Reality (MR) in surgical simulators increases the fidelity, level of immersion and overall experience of these simulators.Areas covered: The objective of this review is to provide a comprehensive overview of the application of VR, AR and MR for distinct surgical disciplines, including maxillofacial surgery and neurosurgery. The current developments in these areas, as well as potential future directions, are discussed.Expert opinion: The key components for incorporating VR into surgical simulators are visual and haptic rendering. These components ensure that the user is completely immersed in the virtual environment and can interact in the same way as in the physical world. The key components for the application of AR and MR into surgical simulators include the tracking system as well as the visual rendering. The advantages of these surgical simulators are the ability to perform user evaluations and increase the training frequency of surgical residents.

Ultrasound in augmented reality: a mixed-methods evaluation of head-mounted displays in image-guided interventions

Purpose

Augmented reality (AR) and head-mounted displays (HMD) in medical practice are current research topics. A commonly proposed use case of AR-HMDs is to display data in image-guided interventions. Although technical feasibility has been thoroughly shown, effects of AR-HMDs on interventions are not yet well researched, hampering clinical applicability. Therefore, the goal of this study is to better understand the benefits and limitations of this technology in ultrasound-guided interventions.

Methods

We used an AR-HMD system (based on the first-generation Microsoft Hololens) which overlays live ultrasound images spatially correctly at the location of the ultrasound transducer. We chose ultrasound-guided needle placements as a representative task for image-guided interventions. To examine the effects of the AR-HMD, we used mixed methods and conducted two studies in a lab setting: (1) In a randomized crossover study, we asked participants to place needles into a training model and evaluated task duration and accuracy with the AR-HMD as compared to the standard procedure without visual overlay and (2) in a qualitative study, we analyzed the user experience with AR-HMD using think-aloud protocols during ultrasound examinations and semi-structured interviews after the task.

Results

Participants (n = 20) placed needles more accurately (mean error of 7.4 mm vs. 4.9 mm, p = 0.022) but not significantly faster (mean task duration of 74.4 s vs. 66.4 s, p = 0.211) with the AR-HMD. All participants in the qualitative study (n = 6) reported limitations of and unfamiliarity with the AR-HMD, yet all but one also clearly noted benefits and/or that they would like to test the technology in practice.

Conclusion

We present additional, though still preliminary, evidence that AR-HMDs provide benefits in image-guided procedures. Our data also contribute insights into potential causes underlying the benefits, such as improved spatial perception. Still, more comprehensive studies are needed to ascertain benefits for clinical applications and to clarify mechanisms underlying these benefits.

Electronic supplementary material

The online version of this article (10.1007/s11548-020-02236-6) contains supplementary material, which is available to authorized users.

Ultrasound-guided central venous catheterization using an optical see-through head-mounted display: A pilot study

PURPOSE

We examined the feasibility of using a head-mounted display (HMD) to improve the ergonomics of sonographic-guided interventional procedures.

METHODS

Five physicians with experience of more than 20 central venous catheterizations participated in this study. Each participant performed five pairs of simulated jugular vein catheterization under sonographic guidance with and without the HMD. The procedure time was determined as well as the number of head movements, needle redirections, posterior wall punctures, and guidewire malpositionings.

RESULTS

All participants could perform simulated sonographic-guided catheterization using this HMD without turning their heads. There were no differences in the procedural time, the number of needle redirections, posterior wall punctures, and guidewire malpositionings.

CONCLUSIONS

The binocular optical see-through HMD could be adopted for sonographic-guided interventional procedures © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:487-491, 2016.

Patient monitoring with Google Glass: a pilot study of a novel monitoring technology

BACKGROUND

Head-mounted devices (HMDs) are of significant interest for applications within medicine, including in anesthesia for patient monitoring. Previous devices trialed in anesthesia for this purpose were often bulky, involved cable tethers, or were otherwise ergonomically infeasible. Google Glass is a modern HMD that is lightweight and solves many of the issues identified with previous HMDs.

AIM

To examine the acceptance of Google Glass as a patient monitoring device in a pediatric anesthesia context at Princess Margaret Hospital for Children, Perth, Australia.

METHODS

We developed a custom-designed software solution for integrating Google Glass into the anesthesia environment, which enabled the device user to continuously view patient monitoring parameters transmitted wirelessly from the anesthesia workstation.

RESULTS

A total of 40 anesthetists were included in the study. Each anesthetist used the device for the duration of a theater list. We found 90% of anesthetists trialing the device agreed that it was comfortable to wear, 86% agreed the device was easy to read, and 82.5% agreed the device was not distracting. In 75% of cases, anesthetists reported unprompted that they were comfortable using the device in theater. Anesthetists reported that they would use the device again in 76% of cases, and indicated that they would recommend the device to a colleague in 58% of cases.

CONCLUSION

Given the pilot nature of this study, we consider these results highly favorable. Anesthetists readily accepted Google Glass in the anesthetic environment, with further enhancements to device software, rather than hardware, now being the barrier to adoption. There are a number of applications for HMDs in pediatric anesthesia.