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Bochet Q, Raoul G, Lauwers L, Nicot R. Augmented reality in implantology: Virtual surgical checklist and augmented implant placement. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101813. [PMID: 38452901 DOI: 10.1016/j.jormas.2024.101813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/17/2024] [Accepted: 03/05/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES Aim of the present study was to create a pedagogical checklist for implant surgical protocol with an augmented reality (AR) guided freehand surgery to inexperienced surgeons using a head mounted display (HMD) with tracking. METHODS The anatomical model of a patient with two missing mandibular teeth requiring conventional single-tooth implants was selected. The computed tomography (CT) scans were extracted and imported into segmentation and implant planning software. A Patient-specific dental splint through an intermediate strut, supported 3D-printed QR code. A checklist was generated to guide surgical procedure. After tracking, the AR-HMD projects the virtual pre-surgical plan (inferior alveolar nerve (IAN), implant axis, implant location) onto the real 3D-printed anatomical models. The entire drilling sequence was based on the manufacturer's recommendations, on 3D-printed anatomical models. After the implant surgical procedure, CT of the 3D-printed models was performed to compare the actual and simulated implant placements. All procedures in the study were performed in accordance with the Declaration of Helsinki. RESULTS In total, two implants were placed in a 3D-printed anatomical model of a female patient who required implant rehabilitation for dental agenesis at the second mandibular premolar positions (#35 and #45). Superimposition of the actual and simulated implants showed high concordance between them. CONCLUSION AR in education offers crucial surgical information for novice surgeons in real time. However, the benefits provided by AR in clinical and educational implantology must be demonstrated in other studies involving a larger number of patients, surgeons and apprentices.
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Affiliation(s)
- Quentin Bochet
- Univ. Lille, CHU Lille, Department of Oral and Maxillofacial Surgery, Lille F-59000, France
| | - Gwénaël Raoul
- Univ. Lille, CHU Lille, INSERM, Department of Oral and Maxillo-Facial Surgery, U1008 - Advanced Drug Delivery Systems, Lille F-59000, France
| | - Ludovic Lauwers
- Univ. Lille, CHU Lille, Department of Oral and Maxillofacial Surgery, URL 2694 - METRICS, Lille F-59000, France
| | - Romain Nicot
- Univ. Lille, CHU Lille, INSERM, Department of Oral and Maxillo-Facial Surgery, U1008 - Advanced Drug Delivery Systems, Lille F-59000, France; CNRS, Centrale Lille, Univ. Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille F-59000, France.
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Armstrong DG, Bazikian S, Armstrong AA, Clerici G, Casini A, Pillai A. An Augmented Vision of Our Medical and Surgical Future, Today? J Diabetes Sci Technol 2024; 18:968-973. [PMID: 38439541 PMCID: PMC11307216 DOI: 10.1177/19322968241236458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Incorporating consumer electronics into the operating room, we evaluated the Apple Vision Pro (AVP) during limb preservation surgeries, just as we evaluated Google Glass and FaceTime more than a decade ago. Although AVP's real-time mixed-reality data overlay and controls offer potential enhancements to surgical precision and team communication, our assessment recognized limitations in adapting consumer technology to clinical environments. The initial use facilitated intraoperative decision-making and educational interactions with trainees. The current mixed-reality pass-through resolution allows for input but not for highly dexterous surgical interactions. These early observations indicate that while AVP may soon improve aspects of surgical performance and education, further iteration, evaluation, and experience are needed to fully understand its impact on patient outcomes and to refine its integration into clinical practice.
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Affiliation(s)
- David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sebouh Bazikian
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | - Andrea Casini
- Diabetic Foot Unit, Policlinico Abano Terme, Padua, Italy
| | - Anand Pillai
- Manchester University NHS Foundation Trust, Manchester, UK
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Sharma N, Mallela AN, Khan T, Canton SP, Kass NM, Steuer F, Jardini J, Biehl J, Andrews EG. Evolution of the meta-neurosurgeon: A systematic review of the current technical capabilities, limitations, and applications of augmented reality in neurosurgery. Surg Neurol Int 2024; 15:146. [PMID: 38742013 PMCID: PMC11090549 DOI: 10.25259/sni_167_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/05/2024] [Indexed: 05/16/2024] Open
Abstract
Background Augmented reality (AR) applications in neurosurgery have expanded over the past decade with the introduction of headset-based platforms. Many studies have focused on either preoperative planning to tailor the approach to the patient's anatomy and pathology or intraoperative surgical navigation, primarily realized as AR navigation through microscope oculars. Additional efforts have been made to validate AR in trainee and patient education and to investigate novel surgical approaches. Our objective was to provide a systematic overview of AR in neurosurgery, provide current limitations of this technology, as well as highlight several applications of AR in neurosurgery. Methods We performed a literature search in PubMed/Medline to identify papers that addressed the use of AR in neurosurgery. The authors screened three hundred and seventy-five papers, and 57 papers were selected, analyzed, and included in this systematic review. Results AR has made significant inroads in neurosurgery, particularly in neuronavigation. In spinal neurosurgery, this primarily has been used for pedicle screw placement. AR-based neuronavigation also has significant applications in cranial neurosurgery, including neurovascular, neurosurgical oncology, and skull base neurosurgery. Other potential applications include operating room streamlining, trainee and patient education, and telecommunications. Conclusion AR has already made a significant impact in neurosurgery in the above domains and has the potential to be a paradigm-altering technology. Future development in AR should focus on both validating these applications and extending the role of AR.
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Affiliation(s)
- Nikhil Sharma
- School of Medicine, University of Pittsburgh, Pittsburgh, United States
| | - Arka N. Mallela
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, United States
| | - Talha Khan
- Department of Computing and Information, University of Pittsburgh, Pittsburgh, United States
| | - Stephen Paul Canton
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, United States
| | | | - Fritz Steuer
- School of Medicine, University of Pittsburgh, Pittsburgh, United States
| | - Jacquelyn Jardini
- Department of Biology, Haverford College, Haverford, Pennsylvania, United States
| | - Jacob Biehl
- Department of Computing and Information, University of Pittsburgh, Pittsburgh, United States
| | - Edward G. Andrews
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, United States
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Campbell K, Gardner A, Scott DJ, Johnson J, Harvey J, Kazley A. Interprofessional staff perspectives on the adoption of or black box technology and simulations to improve patient safety: a multi-methods survey. Adv Simul (Lond) 2023; 8:24. [PMID: 37880765 PMCID: PMC10598903 DOI: 10.1186/s41077-023-00263-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Medical errors still plague healthcare. Operating Room Black Box (ORBB) and ORBB-simulation (ORBBSIM) are innovative emerging technologies which continuously capture as well as categorize intraoperative data, team information, and audio-visual files, in effort to improve objective quality measures. ORBB and ORBBSIM have an opportunity to improve patient safety, yet a paucity of implementation literature exists. Overcoming implementation barriers is critical. This study sought to obtain rich insights while identifying facilitators and barriers to adoption of ORBB and ORBBSIM in alignment with Donabedian's model of health services and healthcare quality. Enrichment themes included translational performance improvement and real-world examples to develop sessions. METHODS Interprofessional OR staff were invited to complete two surveys assessing staff's perceptions using TeamSTEPPS's validated Teamwork Perceptions Questionnaire (T-TPQ) and open-ended questions. Descriptive statistics were calculated for quantitative variables, and inductive phenomenological content analysis was used for qualitative. RESULTS Survey 1 captured 71 responses from 334 invited (RR 21%) while survey 2 captured 47 responses from 157 (RR 29.9%). The T-TPQ score was 65.2, with Communication (70.4) the highest construct and Leadership (58.0) the lowest. Quality Improvement (QI), Patient Safety, and Objective Case Review were the most common perceived ORBB benefits. Trends suggested a reciprocal benefit of dual ORBB and ORBBSIM adoption. Trends also suggested that dual implementation can promote Psychological Safety, culture, trust, and technology comfort. The need for an implementation plan built on change management principles and a constructive culture were key findings. CONCLUSIONS Findings supported ORBB implementation themes from previous literature and deepened our understanding through the exploration of team culture. This blueprint provides a model to help organizations adopt ORBB and ORBBSIM. Outcomes can establish an empirical paradigm for future studies.
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Affiliation(s)
- Krystle Campbell
- UT Southwestern Simulation Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Department of Healthcare Leadership and Management, College of Health Professions, Doctor of Health Administration, Medical University of South Carolina, Charleston, SC, USA.
| | - Aimee Gardner
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Daniel J Scott
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jada Johnson
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC, USA
| | - Jillian Harvey
- Department of Healthcare Leadership and Management, College of Health Professions, Doctor of Health Administration, Medical University of South Carolina, Charleston, SC, USA
| | - Abby Kazley
- Department of Healthcare Leadership and Management, College of Health Professions, Doctor of Health Administration, Medical University of South Carolina, Charleston, SC, USA
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Jiang J, Zhang J, Sun J, Wu D, Xu S. User's image perception improved strategy and application of augmented reality systems in smart medical care: A review. Int J Med Robot 2023; 19:e2497. [PMID: 36629798 DOI: 10.1002/rcs.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/26/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Augmented reality (AR) is a new human-computer interaction technology that combines virtual reality, computer vision, and computer networks. With the rapid advancement of the medical field towards intelligence and data visualisation, AR systems are becoming increasingly popular in the medical field because they can provide doctors with clear enough medical images and accurate image navigation in practical applications. However, it has been discovered that different display types of AR systems have different effects on doctors' perception of the image after virtual-real fusion during the actual medical application. If doctors cannot correctly perceive the image, they may be unable to correctly match the virtual information with the real world, which will have a significant impact on their ability to recognise complex structures. METHODS This paper uses Citespace, a literature analysis tool, to visualise and analyse the research hotspots when AR systems are used in the medical field. RESULTS A visual analysis of the 1163 articles retrieved from the Web of Science Core Collection database reveals that display technology and visualisation technology are the key research directions of AR systems at the moment. CONCLUSION This paper categorises AR systems based on their display principles, reviews current image perception optimisation schemes for various types of systems, and analyses and compares different display types of AR systems based on their practical applications in the field of smart medical care so that doctors can select the appropriate display types based on different application scenarios. Finally, the future development direction of AR display technology is anticipated in order for AR technology to be more effectively applied in the field of smart medical care. The advancement of display technology for AR systems is critical for their use in the medical field, and the advantages and disadvantages of various display types should be considered in different application scenarios to select the best AR system.
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Affiliation(s)
- Jingang Jiang
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, Heilongjiang, China.,Robotics & Its Engineering Research Center, Harbin University of Science and Technology, Harbin, Heilongjiang, China
| | - Jiawei Zhang
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, Heilongjiang, China
| | - Jianpeng Sun
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, Heilongjiang, China
| | - Dianhao Wu
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, Heilongjiang, China
| | - Shuainan Xu
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, Heilongjiang, China
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Gupta A, Ambade R. From Diagnosis to Therapy: The Role of Virtual and Augmented Reality in Orthopaedic Trauma Surgery. Cureus 2022; 14:e29099. [PMID: 36249662 PMCID: PMC9557249 DOI: 10.7759/cureus.29099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/12/2022] [Indexed: 11/28/2022] Open
Abstract
By reducing procedure-related problems, advancements in computer-assisted surgery (CAS) and surgical training aim to boost operative precision and enhance patient safety. Orthopaedic training and practice have started to change as a result of the incorporation of reality technologies like virtual reality (VR), augmented reality (AR), and mixed reality (MR) into CAS. Today's trainees can engage in realistic and highly involved operational simulations without supervision. With the coronavirus disease 2019 (COVID-19) pandemic, there is a greater need for breakthrough technology adoption. VR is an interactive technology that enables personalised care and could support successful patient-centered rehabilitation. It is a valid and trustworthy evaluation method for determining joint range of motion, function, and balance in physical rehabilitation. It may make it possible to customise care, encourage patients, boost compliance, and track their advancement. AR supplementation in orthopaedic surgery has shown promising results in pre-clinical settings, with improvements in surgical accuracy and reproducibility, decreased operating times, and less radiation exposure. As little patient observation is needed, this may lessen the workload clinicians must bear. The ability to use it for home-based therapy is often available commercially as well. The objectives of this review are to evaluate the technology available, comprehend the available evidence regarding the benefit, and take into account implementation problems in clinical practice. The use of this technology, its practical and moral ramifications, and how it will affect orthopaedic doctors and their patients are also covered. This review offers a current and thorough analysis of the reality technologies and their uses in orthopaedic surgery.
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Birlo M, Edwards PJE, Clarkson M, Stoyanov D. Utility of optical see-through head mounted displays in augmented reality-assisted surgery: A systematic review. Med Image Anal 2022; 77:102361. [PMID: 35168103 PMCID: PMC10466024 DOI: 10.1016/j.media.2022.102361] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
This article presents a systematic review of optical see-through head mounted display (OST-HMD) usage in augmented reality (AR) surgery applications from 2013 to 2020. Articles were categorised by: OST-HMD device, surgical speciality, surgical application context, visualisation content, experimental design and evaluation, accuracy and human factors of human-computer interaction. 91 articles fulfilled all inclusion criteria. Some clear trends emerge. The Microsoft HoloLens increasingly dominates the field, with orthopaedic surgery being the most popular application (28.6%). By far the most common surgical context is surgical guidance (n=58) and segmented preoperative models dominate visualisation (n=40). Experiments mainly involve phantoms (n=43) or system setup (n=21), with patient case studies ranking third (n=19), reflecting the comparative infancy of the field. Experiments cover issues from registration to perception with very different accuracy results. Human factors emerge as significant to OST-HMD utility. Some factors are addressed by the systems proposed, such as attention shift away from the surgical site and mental mapping of 2D images to 3D patient anatomy. Other persistent human factors remain or are caused by OST-HMD solutions, including ease of use, comfort and spatial perception issues. The significant upward trend in published articles is clear, but such devices are not yet established in the operating room and clinical studies showing benefit are lacking. A focused effort addressing technical registration and perceptual factors in the lab coupled with design that incorporates human factors considerations to solve clear clinical problems should ensure that the significant current research efforts will succeed.
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Affiliation(s)
- Manuel Birlo
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK.
| | - P J Eddie Edwards
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
| | - Matthew Clarkson
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
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Park SR, Park JY, Ghani R, Ha J, Hester T. Visualising the Future of Orthopaedic Surgery: A Novel Application of Wireless Smart Glasses to Visualise Intraoperative Imaging. Cureus 2022; 14:e22004. [PMID: 35340507 PMCID: PMC8913437 DOI: 10.7759/cureus.22004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
Smart glasses can provide a heads-up display of advanced imaging intraoperatively. In recent years, growing attention has been drawn to the use of smart glasses as an assistive technology to improve both efficiency and ergonomics in a surgical setting. Previous studies have reported improved surgical accuracy, efficiency, and ergonomics with its usage, but its effectiveness as a form of intraoperative heads-up display remains elusive in the context of orthopaedics. This study provides a novel account of a wireless set-up of the Moverio BT-35E Smart Glasses (Suwa, Japan: Epson Inc.), incorporated in a complex orthopaedic procedure. Hind-foot nailing was performed on a patient with a complex open ankle fracture and multiple co-morbidities. Smart glasses were worn by the primary surgeon throughout the procedure to provide heads-up visualisation of the intraoperative fluoroscopy. In our surgical case, the surgeon experienced improved ergonomics and reduced disruption to focus with the use of smart glasses. The wireless set-up provided excellent signal transmission throughout the duration of the procedure. The wireless set-up of smart glasses is a potential solution for common occupational risks imposed on orthopaedic surgeons. Smart glasses minimise musculoskeletal strain from switching of vision from monitor to patient, whilst the wireless set-up allows for efficient use of space in an operating theatre and may potentially limit radiation exposure. Lastly, ergonomic benefits may increase the efficiency of movement for the surgeon, decreasing operative duration, and in turn minimising the risk of surgical complications for patients.
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Maddali HT, Irlitti A, Lazar A. Probing the Potential of Extended Reality to Connect Experts and Novices in the Garden. PROCEEDINGS OF THE ACM ON HUMAN-COMPUTER INTERACTION 2022; 6:10.1145/3555211. [PMID: 38529475 PMCID: PMC10961949 DOI: 10.1145/3555211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
As extended reality (XR) systems become increasingly available, XR-based remote instruction is being adopted for diverse purposes in professional settings such as surgery and field servicing. Hobbyists have been well-studied in HCI and may similarly benefit from remote skill-sharing. However, little is known about how XR technologies might support expert-novice collaboration for skilled hobby activities. This paper examines the potential and limitations of XR to connect experts and novices for one such activity: gardening. Through two studies involving 27 expert and novice gardeners, we designed prototypes to understand 1) practitioner perceptions of XR and remote skill-sharing in the garden and 2) what kinds of interactions can be supported in XR for expert-novice groups. We discuss design opportunities and challenges for XR systems in supporting informal connecting interactions and meaningful sensory interactions with a remote environment during skill-sharing.
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Abu-Rmaileh M, Osborn T, Gonzalez SR, Yuen JC. The Use of Live Streaming Technologies in Surgery: A Review of the Literature. Ann Plast Surg 2022; 88:122-127. [PMID: 34270473 DOI: 10.1097/sap.0000000000002909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Live streaming surgery is a developing communication platform in medicine. To maximize the technological advances that allow for the live streaming of surgery, it is crucial to have an understanding of the various video-capturing devices that are available and their pros and cons of implementation. Possible barriers to the widespread use of live streaming surgery include cost, concerns about patient safety and privacy, and limited understanding of the current available resources. In this article, we present the results of our literature review of techniques for live streaming of surgery as a means to inform readers and promote their implementation. METHODS We conducted a literature review of the literature to identify previous articles indexed in PubMed and Ovid. We used the following search terms: [Surgery AND Streaming], which generated 32 articles for initial review. References were reviewed within each document to find similar articles that were not captured by the initial search. The article selection criteria were peer-reviewed publications, case reports, and case series describing the use of live surgical streaming technologies. RESULTS Literature review showed enhanced surgeon interaction with viewers and improved anatomy scores with the widespread use of live streaming. Surgeons reported positive feedback and wished to engage in more sessions in the future. The largest barriers to implementation of streaming technology are video quality through the Internet and patient information protection. CONCLUSIONS Live streaming of surgery for educational purposes has not been widely accepted in surgical training programs to date. Streaming accessibility has advanced over the past 2 decades with the availability of handheld mobile devices. However, little has been done to allow for live streaming of surgery to trainees in a manner compliant with the Health Portability Insurance and Accountability Act.
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Affiliation(s)
| | - Tamara Osborn
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Santiago R Gonzalez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - James C Yuen
- Division of Plastic Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
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Dmitriyeva M, Kozhakhmetov SK, Turebayev DK, Urazova SN, Omarov TM, Igissinov NS, Toleubayev MT. Monitoring and Prevention the Risk of Diabetic Foot Ulcer Infection during Coronavirus Disease-19 Pandemic: A Narrative Review and Perspective Algorithm. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The coronavirus disease (COVID)-19 pandemic leads to significant changes in the healthcare system and undermining best practices for maintaining a diabetic limb. A large number of patients with diabetic foot are left without timely medical care and are at increased risk of complications, hospitalization, lower limb amputation, and death. A new paradigm must be adopted for the transition from inpatient care to community-based care. The introduction of a pandemic remote management for patients with diabetic foot ulcer includes an assessment of the risk of complications through telemedicine and further stratification of patients according to the developed algorithm.
METHODS: A literature review was performed for articles related to telemedicine. We used PubMed, Google Scholar, Cochrane Library, and Ovid MEDLINE to search published articles. We used the following keywords: “Telemedicine,” “diabetes mellitus,” “COVID-19,” “diabetic foot ulcer,” and “remote monitoring.”
RESULTS: Implementation of the proposed pandemic care includes telemedicine for remote monitoring and treatment of patients with diabetic foot ulcers, as well as an algorithm for determining the risk of diabetic ulcer infection and patient management tactics according to the identified risk.
CONCLUSION: The management of patients with diabetic foot ulcers during a pandemic includes the following goals – to reduce the burden on the health-care system, maintain the safety and functionality of diabetic foot at home, and reduce the risk of COVID-19 in patients with diabetic foot ulcers.
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Iqbal H, Tatti F, Rodriguez Y Baena F. Augmented reality in robotic assisted orthopaedic surgery: A pilot study. J Biomed Inform 2021; 120:103841. [PMID: 34146717 DOI: 10.1016/j.jbi.2021.103841] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND The research and development of augmented-reality (AR) technologies in surgical applications has seen an evolution of the traditional user-interfaces (UI) utilised by clinicians when conducting robot-assisted orthopaedic surgeries. The typical UI for such systems relies on surgeons managing 3D medical imaging data in the 2D space of a touchscreen monitor, located away from the operating site. Conversely, AR can provide a composite view overlaying the real surgical scene with co-located virtual holographic representations of medical data, leading to a more immersive and intuitive operator experience. MATERIALS AND METHODS This work explores the integration of AR within an orthopaedic setting by capturing and replicating the UI of an existing surgical robot within an AR head-mounted display worn by the clinician. The resulting mixed-reality workflow enabled users to simultaneously view the operating-site and real-time holographic operating informatics when carrying out a robot-assisted patellofemoral-arthroplasty (PFA). Ten surgeons were recruited to test the impact of the AR system on procedure completion time and operating surface roughness. RESULTS AND DISCUSSION The integration of AR did not appear to require subjects to significantly alter their surgical techniques, which was demonstrated by non-significant changes to the study's clinical metrics, with a statistically insignificant mean increase in operating time (+0.778 s, p = 0.488) and a statistically insignificant change in mean surface roughness (p = 0.274). Additionally, a post-operative survey indicated a positive consensus on the usability of the AR system without incurring noticeable physical distress such as eyestrain or fatigue. CONCLUSIONS Overall, these study results demonstrated a successful integration of AR technologies within the framework of an existing robot-assisted surgical platform with no significant negative effects in two quantitative metrics of surgical performance, and a positive outcome relating to user-centric and ergonomic evaluation criteria.
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Affiliation(s)
- Hisham Iqbal
- Mechatronics in Medicine Laboratory, Imperial College London, London, UK.
| | - Fabio Tatti
- Mechatronics in Medicine Laboratory, Imperial College London, London, UK
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Ha J, Parekh P, Gamble D, Masters J, Jun P, Hester T, Daniels T, Halai M. Opportunities and challenges of using augmented reality and heads-up display in orthopaedic surgery: A narrative review. J Clin Orthop Trauma 2021; 18:209-215. [PMID: 34026489 PMCID: PMC8131920 DOI: 10.1016/j.jcot.2021.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/28/2021] [Accepted: 04/29/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND & AIM Utilization of augmented reality (AR) and heads-up displays (HUD) to aid orthopaedic surgery has the potential to benefit surgeons and patients alike through improved accuracy, safety, and educational benefits. With the COVID-19 pandemic, the opportunity for adoption of novel technology is more relevant. The aims are to assess the technology available, to understand the current evidence regarding the benefit and to consider challenges to implementation in clinical practice. METHODS & RESULTS PRISMA guidelines were used to filter the literature. Of 1004 articles returned the following exclusion criteria were applied: 1) reviews/commentaries 2) unrelated to orthopaedic surgery 3) use of other AR wearables beyond visual aids leaving 42 papers for review.This review illustrates benefits including enhanced accuracy and reduced time of surgery, reduced radiation exposure and educational benefits. CONCLUSION Whilst there are obstacles to overcome, there are already reports of technology being used. As with all novel technologies, a greater understanding of the learning curve is crucial, in addition to shielding our patients from this learning curve. Improvements in usability and implementing surgeons' specific needs should increase uptake.
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Affiliation(s)
- Joon Ha
- Queen Elizabeth Hospital, London, UK,Corresponding author.
| | | | | | - James Masters
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), UK
| | - Peter Jun
- University of Alberta, Edmonton, Canada
| | | | | | - Mansur Halai
- St Michael's Hospital, University of Toronto, Canada
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Romare C, Enlöf P, Anderberg P, Jildenstål P, Sanmartin Berglund J, Skär L. Nurse anesthetists' experiences using smart glasses to monitor patients' vital signs during anesthesia care: A qualitative study. PLoS One 2021; 16:e0250122. [PMID: 33882100 PMCID: PMC8059852 DOI: 10.1371/journal.pone.0250122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/31/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To describe nurse anesthetists' experiences using smart glasses to monitor patients' vital signs during anesthesia care. METHODS Data was collected through individual semi-structured interviews with seven nurse anesthetists who had used smart glasses, with a customized application for monitoring vital signs, during clinical anesthesia care. Data was analyzed using thematic content analysis. RESULTS An overarching theme became evident during analysis; Facing and embracing responsibility. Being a nurse anesthetist entails a great responsibility, and the participants demonstrated that they shouldered this responsibility with pride. The theme was divided in two sub-themes. The first of these, A new way of working, comprised the categories Adoption and Utility. This involved incorporating smart glasses into existing routines in order to provide safe anesthesia care. The second sub-theme, Encountering side effects, consisted of the categories Obstacles and Personal affect. This sub-theme concerned the possibility to use smart glasses as intended, as well as the affect on nurse anesthetists as users. CONCLUSION Smart glasses improved access to vital signs and enabled continuous monitoring regardless of location. Continued development and improvement, both in terms of the application software and the hardware, are necessary for smart glasses to meet nurse anesthetists' needs in clinical practice.
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Affiliation(s)
- Charlotte Romare
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
- Intensive Care Unit, Department of Anesthesiology, Region Blekinge, Karlskrona, Sweden
| | - Per Enlöf
- Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska academy, Gothenburg, Sweden
- Department of Anesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
- Department of Health Sciences, University of Skövde, Skövde, Sweden
| | - Pether Jildenstål
- Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska academy, Gothenburg, Sweden
- Department of Anesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Lisa Skär
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
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McKnight RR, Pean CA, Buck JS, Hwang JS, Hsu JR, Pierrie SN. Virtual Reality and Augmented Reality-Translating Surgical Training into Surgical Technique. Curr Rev Musculoskelet Med 2020; 13:663-674. [PMID: 32779019 PMCID: PMC7661680 DOI: 10.1007/s12178-020-09667-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW As immersive learning outside of the operating room is increasingly recognized as a valuable method of surgical training, virtual reality (VR) and augmented reality (AR) are increasingly utilized in orthopedic surgical training. This article reviews the evolving nature of these training tools and provides examples of their use and efficacy. The practical and ethical implications of incorporating this technology and its impact on both orthopedic surgeons and their patients are also discussed. RECENT FINDINGS Head-mounted displays (HMDs) represent a possible adjunct to surgical accuracy and education. While the hardware is advanced, there is still much work to be done in developing software that allows for seamless, reliable, useful integration into clinical practice and training. Surgical training is changing: AR and VR will become mainstays of future training efforts. More evidence is needed to determine which training technology translates to improved clinical performance. Volatility within the HMD industry will likely delay advances in surgical training.
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Affiliation(s)
- R Randall McKnight
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA.
| | - Christian A Pean
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - J Stewart Buck
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA
| | - John S Hwang
- Department of Orthopedic Surgery, Mount Carmel, Columbus, OH, USA
- Department of Orthopedic Surgery, Orthopedic ONE, Columbus, OH, USA
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Sarah N Pierrie
- Department of Orthopaedics and Center for the Intrepid, San Antonio Military Medical Center, Fort Sam Houston, TX, USA
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Tully J, Dameff C, Longhurst CA. Wave of Wearables: Clinical Management of Patients and the Future of Connected Medicine. Clin Lab Med 2020; 40:69-82. [PMID: 32008641 DOI: 10.1016/j.cll.2019.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The future of connected health care will involve the collection of patient data or enhancement of clinician workflows through various biosensors and displays found on wearable electronic devices, many of which are marketed directly to consumers. The adoption of wearables in health care is being driven by efforts to reduce health care costs, improve care quality, and increase clinician efficiency. Wearables have significant potential to achieve these goals but are currently limited by lack of widespread integrations into electronic health records, biosensor data collection types, and a lack of scientifically rigorous literature showing benefit.
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Affiliation(s)
- Jeffrey Tully
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 2315 Stockton Boulevard, Sacramento, CA 95817, USA.
| | - Christian Dameff
- Department of Emergency Medicine, University of California San Diego, 200 West Arbor Drive #8676, San Diego, CA 92103, USA; Department of Biomedical Informatics, UC San Diego Health, University of California San Diego, 9500 Gilman Drive, MC 0728, La Jolla, California 92093-0728, USA; Department of Computer Science and Engineering, University of California San Diego, 9500 Gilman Drive, Mail Code 0404, La Jolla, CA 92093-0404, USA
| | - Christopher A Longhurst
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Carrera JF. A Systematic Review of the Use of Google Glass in Graduate Medical Education. J Grad Med Educ 2019; 11:637-648. [PMID: 31871562 PMCID: PMC6919184 DOI: 10.4300/jgme-d-19-00148.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/13/2019] [Accepted: 08/21/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Graduate medical education (GME) has emphasized the assessment of trainee competencies and milestones; however, sufficient in-person assessment is often constrained. Using mobile hands-free devices, such as Google Glass (GG) for telemedicine, allows for remote supervision, education, and assessment of residents. OBJECTIVE We reviewed available literature on the use of GG in GME in the clinical learning environment, its use for resident supervision and education, and its clinical utility and technical limitations. METHODS We conducted a systematic review in accordance with 2009 PRISMA guidelines. Applicable studies were identified through a review of PubMed, MEDLINE, and Web of Science databases for articles published from January 2013 to August 2018. Two reviewers independently screened titles, abstracts, and full-text articles that reported using GG in GME and assessed the quality of the studies. A systematic review of these studies appraised the literature for descriptions of its utility in GME. RESULTS Following our search and review process, 37 studies were included. The majority evaluated GG in surgical specialties (n = 23) for the purpose of surgical/procedural skills training or supervision. GG was predominantly used for video teleconferencing, and photo and video capture. Highlighted positive aspects of GG use included point-of-view broadcasting and capacity for 2-way communication. Most studies cited drawbacks that included suboptimal battery life and HIPAA concerns. CONCLUSIONS GG shows some promise as a device capable of enhancing GME. Studies evaluating GG in GME are limited by small sample sizes and few quantitative data. Overall experience with use of GG in GME is generally positive.
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Mascitelli JR, Schlachter L, Chartrain AG, Oemke H, Gilligan J, Costa AB, Shrivastava RK, Bederson JB. Navigation-Linked Heads-Up Display in Intracranial Surgery: Early Experience. Oper Neurosurg (Hagerstown) 2019; 15:184-193. [PMID: 29040677 PMCID: PMC6047456 DOI: 10.1093/ons/opx205] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/01/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The use of intraoperative navigation during microscope cases can be limited when attention needs to be divided between the operative field and the navigation screens. Heads-up display (HUD), also referred to as augmented reality, permits visualization of navigation information during surgery workflow. OBJECTIVE To detail our initial experience with HUD. METHODS We retrospectively reviewed patients who underwent HUD-assisted surgery from April 2016 through April 2017. All lesions were assessed for accuracy and those from the latter half of the study were assessed for utility. RESULTS Seventy-nine patients with 84 pathologies were included. Pathologies included aneurysms (14), arteriovenous malformations (6), cavernous malformations (5), intracranial stenosis (3), meningiomas (27), metastasis (4), craniopharygniomas (4), gliomas (4), schwannomas (3), epidermoid/dermoids (3), pituitary adenomas (2) hemangioblastoma (2), choroid plexus papilloma (1), lymphoma (1), osteoblastoma (1), clival chordoma (1), cerebrospinal fluid leak (1), abscess (1), and a cerebellopontine angle Teflon granuloma (1). Fifty-nine lesions were deep and 25 were superficial. Structures identified included the lesion (81), vessels (48), and nerves/brain tissue (31). Accuracy was deemed excellent (71.4%), good (20.2%), or poor (8.3%). Deep lesions were less likely to have excellent accuracy (P = .029). HUD was used during bed/head positioning (50.0%), skin incision (17.3%), craniotomy (23.1%), dural opening (26.9%), corticectomy (13.5%), arachnoid opening (36.5%), and intracranial drilling (13.5%). HUD was deactivated at some point during the surgery in 59.6% of cases. There were no complications related to HUD use. CONCLUSION HUD can be safely used for a wide variety of vascular and oncologic intracranial pathologies and can be utilized during multiple stages of surgery.
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Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leslie Schlachter
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexander G Chartrain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Holly Oemke
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey Gilligan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anthony B Costa
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua B Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Rahman R, Wood ME, Qian L, Price CL, Johnson AA, Osgood GM. Head-Mounted Display Use in Surgery: A Systematic Review. Surg Innov 2019; 27:88-100. [DOI: 10.1177/1553350619871787] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose. We analyzed the literature to determine (1) the surgically relevant applications for which head-mounted display (HMD) use is reported; (2) the types of HMD most commonly reported; and (3) the surgical specialties in which HMD use is reported. Methods. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched through August 27, 2017, for publications describing HMD use during surgically relevant applications. We identified 120 relevant English-language, non-opinion publications for inclusion. HMD types were categorized as “heads-up” (nontransparent HMD display and direct visualization of the real environment), “see-through” (visualization of the HMD display overlaid on the real environment), or “non–see-through” (visualization of only the nontransparent HMD display). Results. HMDs were used for image guidance and augmented reality (70 publications), data display (63 publications), communication (34 publications), and education/training (18 publications). See-through HMDs were described in 55 publications, heads-up HMDs in 41 publications, and non–see-through HMDs in 27 publications. Google Glass, a see-through HMD, was the most frequently used model, reported in 32 publications. The specialties with the highest frequency of published HMD use were urology (20 publications), neurosurgery (17 publications), and unspecified surgical specialty (20 publications). Conclusion. Image guidance and augmented reality were the most commonly reported applications for which HMDs were used. See-through HMDs were the most commonly reported type used in surgically relevant applications. Urology and neurosurgery were the specialties with greatest published HMD use.
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Affiliation(s)
- Rafa Rahman
- The Johns Hopkins University, Baltimore, MD, USA
| | | | - Long Qian
- The Johns Hopkins University, Baltimore, MD, USA
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Boillat T, Grantcharov P, Rivas H. Increasing Completion Rate and Benefits of Checklists: Prospective Evaluation of Surgical Safety Checklists With Smart Glasses. JMIR Mhealth Uhealth 2019; 7:e13447. [PMID: 31033451 PMCID: PMC6658283 DOI: 10.2196/13447] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Studies have demonstrated that surgical safety checklists (SSCs) can significantly reduce surgical complications and mortality rates. Such lists rely on traditional posters or paper, and their contents are generic regarding the type of surgery being performed. SSC completion rates and uniformity of content have been reported as modest and widely variable. OBJECTIVE This study aimed to investigate the feasibility and potential of using smart glasses in the operating room to increase the benefits of SSCs by improving usability through contextualized content and, ideally, resulting in improved completion rates. METHODS We prospectively evaluated and compared 80 preoperative time-out events with SSCs at a major academic medical center between June 2016 and February 2017. Participants were assigned to either a conventional checklist approach (poster, memory, or both) or a smart glasses app running on Google Glass. RESULTS Four different surgeons conducted 41 checklists using conventional methods (ie, memory or poster) and 39 using the smart glasses app. The average checklist completion rate using conventional methods was 76%. Smart glasses allowed a completion rate of up to 100% with a decrease in average checklist duration of 18%. CONCLUSIONS Compared with alternatives such as posters, paper, and memory, smart glasses checklists are easier to use and follow. The glasses allowed surgeons to use contextualized time-out checklists, which increased the completion rate to 100% and reduced the checklist execution time and time required to prepare the equipment during surgical cases.
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Affiliation(s)
- Thomas Boillat
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Peter Grantcharov
- Data Science Institute, Columbia University, New York, NY, United States
| | - Homero Rivas
- Design Lab, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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22
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Landry EC, Yong M, Pauwels J, Chadha NK. The use of video glasses improved learning of tonsillectomy and adenoidectomy surgery: A randomized controlled trial. Int J Pediatr Otorhinolaryngol 2019; 117:12-16. [PMID: 30579065 DOI: 10.1016/j.ijporl.2018.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE One of the most common challenges in surgical education for trainees is gaining practical experience through observing procedures in the operating room. Due to the nature of some procedures, a narrow surgical view severely limits the learning experience. Video glasses are new devices that offer the potential to project the primary surgeon's exact view to learners in real-time, allowing for an enhanced operative learning experience. STUDY DESIGN Single center randomized prospective trial. SETTING Tertiary care pediatric hospital. PARTICIPANTS Using block randomization, medical students and surgical residents observed either a tonsillectomy or adenoidectomy, either directly at table-side or by real-time video feed from the surgeon's video glasses projected to a screen in the operating room, in random order. Participants then completed a survey comparing aspects of their learning experience viewing the procedure through the video feed in comparison to direct observation. MAIN OUTCOME MEASURES Evaluating the hypothesis that video glasses provided an improved overall learning experience and a realistic simulation of the open surgical procedures tested. RESULTS 23 trainees participated in the study. Survey results demonstrated that the overall learning experience with the use of video glasses was significantly improved when compared to direct visualization (average Visual Analog Scale (VAS) score 82/100 vs. 64/100, p = 0.021). Video glasses were shown to be superior when comparing the view of the surgical field (83/100 vs. 54/100 on VAS, p < 0.001) and the ability to identify anatomical structures (79/100 vs. 56/100 on VAS, p = 0.001). The ease of following surgical steps with video glasses was also shown to be better than by direct visualization (81/100 vs. 69/100 on VAS, p = 0.039). All participants stated that video glasses closely simulated the learning environment of the real-life open procedure. CONCLUSION This study showed that the use of video glasses was beneficial for surgical education and a realistic tool for learners at varying levels of training. Video glasses may significantly improve the learning experience for procedures with a narrow field of view.
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Affiliation(s)
- Evie C Landry
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada.
| | - Michael Yong
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Julie Pauwels
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Neil K Chadha
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
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Bosc R, Fitoussi A, Hersant B, Dao TH, Meningaud JP. Intraoperative augmented reality with heads-up displays in maxillofacial surgery: a systematic review of the literature and a classification of relevant technologies. Int J Oral Maxillofac Surg 2019; 48:132-139. [DOI: 10.1016/j.ijom.2018.09.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/16/2018] [Accepted: 09/24/2018] [Indexed: 12/30/2022]
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Chu Y, Li X, Yang X, Ai D, Huang Y, Song H, Jiang Y, Wang Y, Chen X, Yang J. Perception enhancement using importance-driven hybrid rendering for augmented reality based endoscopic surgical navigation. BIOMEDICAL OPTICS EXPRESS 2018; 9:5205-5226. [PMID: 30460123 PMCID: PMC6238941 DOI: 10.1364/boe.9.005205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/20/2018] [Accepted: 09/22/2018] [Indexed: 06/09/2023]
Abstract
Misleading depth perception may greatly affect the correct identification of complex structures in image-guided surgery. In this study, we propose a novel importance-driven hybrid rendering method to enhance perception for navigated endoscopic surgery. First, the volume structures are enhanced using gradient-based shading to reduce the color information in low-priority regions and improve the distinctions between complicated structures. Second, an importance sorting method based on the order-independent transparency rendering is introduced to intensify the perception of multiple surfaces. Third, volume data are adaptively truncated and emphasized with respect to the perspective orientation and the illustration of critical information for viewing range extension. Various experimental results prove that with the combination of volume and surface rendering, our method can effectively improve the depth distinction of multiple objects both in simulated and clinical scenes. Our importance-driven surface rendering method demonstrates improved average performance and statistical significance as rated by 15 participants (five clinicians and ten non-clinicians) on a five-point Likert scale. Further, the average frame rate of hybrid rendering with thin-layer sectioning reaches 42 fps. Given that the process of the hybrid rendering is fully automatic, it can be utilized in real-time surgical navigation to improve the rendering efficiency and information validity.
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Affiliation(s)
- Yakui Chu
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Xu Li
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Xilin Yang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Danni Ai
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Yong Huang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Hong Song
- School of Software, Beijing Institute of Technology, Beijing 100081, China
| | - Yurong Jiang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Yongtian Wang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Xiaohong Chen
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Beijing 100730, China
- Co-corresponding authors
| | - Jian Yang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
- Co-corresponding authors
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Pilot Study to Evaluate the Safety, Feasibility, and Financial Implications of a Postoperative Telemedicine Program. Ann Surg 2018; 268:700-707. [DOI: 10.1097/sla.0000000000002931] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Piegari G, Iovane V, Carletti V, Fico R, Costagliola A, De Biase D, Prisco F, Paciello O. Assessment of Google Glass for Photographic Documentation in Veterinary Forensic Pathology: Usability Study. JMIR Mhealth Uhealth 2018; 6:e180. [PMID: 30249586 PMCID: PMC6231880 DOI: 10.2196/mhealth.9975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 02/06/2023] Open
Abstract
Background Google Glass is a head-mounted device designed in the shape of a pair of eyeglasses equipped with a 5.0-megapixel integrated camera and capable of taking pictures with simple voice commands. Objective The objective of our study was to determine whether Google Glass is fit for veterinary forensic pathology purposes. Methods A total of 44 forensic necropsies of 2 different species (22 dogs and 22 cats) were performed by 2 pathologists; each pathologist conducted 11 necropsies of each species and, for each photographic acquisition, the images were taken with a Google Glass device and a Nikon D3200 digital single-lens reflex (DSLR) camera. The pictures were collected, divided into 3 groups (based on the external appearance of the animal, organs, and anatomical details), and evaluated by 5 forensic pathologists using a 5-point score system. The parameters assessed were overall color settings, region of interest, sharpness, and brightness. To evaluate the difference in mean duration between necropsies conduced with Google Glass and DSLR camera and to assess the battery consumption of the devices, an additional number of 16 necropsies were performed by the 2 pathologists. In these cases, Google Glass was used for photographic reports in 8 cases (4 dogs and 4 cats) and a Nikon D3200 reflex camera in the other 8 cases. Statistical evaluations were performed to assess the differences in ratings between the quality of the images taken with both devices. Results The images taken with Google Glass received significantly lower ratings than those acquired with reflex camera for all 4 assessed parameters (P<.001). In particular, for the pictures of Groups A and B taken with Google Glass, the sum of frequency of ratings 5 (very good) and 4 (good) was between 50% and 77% for all 4 assessed parameters. The lowest ratings were observed for the pictures of Group C, with a sum of frequency of ratings 5 and 4 of 21.1% (342/1602) for region of interest, 26% (421/1602) for sharpness, 35.5% (575/1602) for overall color settings, and 61.4% (995/1602) for brightness. Furthermore, we found a significant reduction in the mean execution time for necropsy conduced with the Google Glass with respect to the reflex group (P<.001). However, Google Glass drained the battery very quickly. Conclusions These findings suggest that Google Glass is usable in veterinary forensic pathology. In particular, the image quality of Groups A and B seemed adequate for forensic photographic documentation purposes, although the quality was lower than that with the reflex camera. However, in this step of development, the high frequency of poor ratings observed for the pictures of Group C suggest that the device is not suitable for taking pictures of small anatomical details or close-ups of the injuries.
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Affiliation(s)
- Giuseppe Piegari
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | | | - Vincenzo Carletti
- Department of Information and Electrical Engineering and Applied Mathematics, University of Salerno, Fisciano, Italy
| | - Rosario Fico
- Istituto Zooprofilattico Sperimentale delle Regioni Lazio e Toscana, National Center for the Forensic Veterinary Medicine, Grosseto, Italy
| | - Alessandro Costagliola
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Davide De Biase
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Francesco Prisco
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Orlando Paciello
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
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Zahl DA, Schrader SM, Edwards PC. Student perspectives on using egocentric video recorded by smart glasses to assess communicative and clinical skills with standardised patients. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2018; 22:73-79. [PMID: 27380732 DOI: 10.1111/eje.12217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION This exploratory study evaluated student perceptions of their ability to self- and peer assess (i) interpersonal communication skills and (ii) clinical procedures (a head and neck examination) during standardised patient (SP) interactions recorded by Google Glass compared to a static camera. METHODS Students compared the Google Glass and static camera recordings using an instrument consisting of 20 Likert-type items and four open- and closed-text items. The Likert-type items asked students to rate how effectively they could assess specific aspects of interpersonal communication and a head and neck examination in these two different types of recordings. The interpersonal communication items included verbal, paraverbal and non-verbal subscales. The open- and closed-text items asked students to report on more globally the differences between the two types of recordings. Descriptive and inferential statistical analyses were conducted for all survey items. An inductive thematic analysis was conducted to determine qualitative emergent themes from the open-text questions. RESULTS Students found the Glass videos more effective for assessing verbal (t22 = 2.091, P = 0.048) and paraverbal communication skills (t22 = 3.304, P = 0.003), whilst they reported that the static camera video was more effective for assessing non-verbal communication skills (t22 = -2.132, P = 0.044). Four principle themes emerged from the students' open-text responses comparing Glass to static camera recordings for self- and peer assessment: (1) first-person perspective, (2) assessment of non-verbal communication, (3) audiovisual experience and (4) student operation of Glass. DISCUSSION AND CONCLUSION Our findings suggest that students perceive that Google Glass is a valuable tool for facilitating self- and peer assessment of SP examinations because of students' perceived ability to emphasise and illustrate communicative and clinical activities from a first-person perspective.
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Affiliation(s)
- D A Zahl
- Office of Academic Affairs, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - S M Schrader
- Department of Biomedical and Applied Sciences, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - P C Edwards
- Department of Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry, Indianapolis, IN, USA
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Yoon JW, Chen RE, Kim EJ, Akinduro OO, Kerezoudis P, Han PK, Si P, Freeman WD, Diaz RJ, Komotar RJ, Pirris SM, Brown BL, Bydon M, Wang MY, Wharen RE, Quinones-Hinojosa A. Augmented reality for the surgeon: Systematic review. Int J Med Robot 2018; 14:e1914. [DOI: 10.1002/rcs.1914] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jang W. Yoon
- Department of Neurological Surgery; Mayo Clinic; Jacksonville Florida USA
| | - Robert E. Chen
- Emory University School of Medicine; Atlanta Georgia USA
- Georgia Institute of Technology; Atlanta Georgia USA
| | | | | | | | | | - Phong Si
- Georgia Institute of Technology; Atlanta Georgia USA
| | | | - Roberto J. Diaz
- Department of Neurosurgery and Neurology; Montreal Neurological Institute and Hospital, McGill University; Montreal Quebec Canada
| | - Ricardo J. Komotar
- Department of Neurological Surgery; University of Miami Miller School of Medicine, University of Miami Hospital, University of Miami Brain Tumor Initiative; Miami Florida USA
| | - Stephen M. Pirris
- Department of Neurological Surgery; Mayo Clinic; Jacksonville Florida USA
- St. Vincent's Spine and Brain Institute; Jacksonville Florida USA
| | - Benjamin L. Brown
- Department of Neurological Surgery; Mayo Clinic; Jacksonville Florida USA
| | - Mohamad Bydon
- Department of Neurological Surgery; Mayo Clinic; Rochester Minnesota USA
| | - Michael Y. Wang
- Department of Neurological Surgery; University of Miami Miller School of Medicine, University of Miami Hospital, University of Miami Brain Tumor Initiative; Miami Florida USA
| | - Robert E. Wharen
- Department of Neurological Surgery; Mayo Clinic; Jacksonville Florida USA
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Wei NJ, Dougherty B, Myers A, Badawy SM. Using Google Glass in Surgical Settings: Systematic Review. JMIR Mhealth Uhealth 2018; 6:e54. [PMID: 29510969 PMCID: PMC5861300 DOI: 10.2196/mhealth.9409] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/13/2018] [Accepted: 01/17/2018] [Indexed: 12/13/2022] Open
Abstract
Background In recent years, wearable devices have become increasingly attractive and the health care industry has been especially drawn to Google Glass because of its ability to serve as a head-mounted wearable device. The use of Google Glass in surgical settings is of particular interest due to the hands-free device potential to streamline workflow and maintain sterile conditions in an operating room environment. Objective The aim is to conduct a systematic evaluation of the literature on the feasibility and acceptability of using Google Glass in surgical settings and to assess the potential benefits and limitations of its application. Methods The literature was searched for articles published between January 2013 and May 2017. The search included the following databases: PubMed MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO (EBSCO), and IEEE Xplore. Two reviewers independently screened titles and abstracts and assessed full-text articles. Original research articles that evaluated the feasibility, usability, or acceptability of using Google Glass in surgical settings were included. This review was completed following the Preferred Reporting Results of Systematic Reviews and Meta-Analyses guidelines. Results Of the 520 records obtained, 31 met all predefined criteria and were included in this review. Google Glass was used in various surgical specialties. Most studies were in the United States (23/31, 74%) and all were conducted in hospital settings: 29 in adult hospitals (29/31, 94%) and two in children’s hospitals (2/31, 7%). Sample sizes of participants who wore Google Glass ranged from 1 to 40. Of the 31 studies, 25 (81%) were conducted under real-time conditions or actual clinical care settings, whereas the other six (19%) were conducted under simulated environment. Twenty-six studies were pilot or feasibility studies (84%), three were case studies (10%), and two were randomized controlled trials (6%). The majority of studies examined the potential use of Google Glass as an intraoperative intervention (27/31, 87%), whereas others observed its potential use in preoperative (4/31, 13%) and postoperative settings (5/31, 16%). Google Glass was utilized as a videography and photography device (21/31, 68%), a vital sign monitor (6/31, 19%), a surgical navigation display (5/31, 16%), and as a videoconferencing tool to communicate with remote surgeons intraoperatively (5/31, 16%). Most studies reported moderate or high acceptability of using Google Glass in surgical settings. The main reported limitations of using Google Glass utilization were short battery life (8/31, 26%) and difficulty with hands-free features (5/31, 16%). Conclusions There are promising feasibility and usability data of using Google Glass in surgical settings with particular benefits for surgical education and training. Despite existing technical limitations, Google Glass was generally well received and several studies in surgical settings acknowledged its potential for training, consultation, patient monitoring, and audiovisual recording.
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Affiliation(s)
- Nancy J Wei
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Bryn Dougherty
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Aundria Myers
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Division of Hematology and Oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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30
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Chu Y, Yang J, Ma S, Ai D, Li W, Song H, Li L, Chen D, Chen L, Wang Y. Registration and fusion quantification of augmented reality based nasal endoscopic surgery. Med Image Anal 2017; 42:241-256. [PMID: 28881251 DOI: 10.1016/j.media.2017.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 06/10/2017] [Accepted: 08/02/2017] [Indexed: 11/24/2022]
Abstract
This paper quantifies the registration and fusion display errors of augmented reality-based nasal endoscopic surgery (ARNES). We comparatively investigated the spatial calibration process for front-end endoscopy and redefined the accuracy level of a calibrated endoscope by using a calibration tool with improved structural reliability. We also studied how registration accuracy was combined with the number and distribution of the deployed fiducial points (FPs) for positioning and the measured registration time. A physically integrated ARNES prototype was customarily configured for performance evaluation in skull base tumor resection surgery with an innovative approach of dynamic endoscopic vision expansion. As advised by surgical experts in otolaryngology, we proposed a hierarchical rendering scheme to properly adapt the fused images with the required visual sensation. By constraining the rendered sight in a known depth and radius, the visual focus of the surgeon can be induced only on the anticipated critical anatomies and vessel structures to avoid misguidance. Furthermore, error analysis was conducted to examine the feasibility of hybrid optical tracking based on point cloud, which was proposed in our previous work as an in-surgery registration solution. Measured results indicated that the error of target registration for ARNES can be reduced to 0.77 ± 0.07 mm. For initial registration, our results suggest that a trade-off for a new minimal time of registration can be reached when the distribution of five FPs is considered. For in-surgery registration, our findings reveal that the intrinsic registration error is a major cause of performance loss. Rigid model and cadaver experiments confirmed that the scenic integration and display fluency of ARNES are smooth, as demonstrated by three clinical trials that surpassed practicality.
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Affiliation(s)
- Yakui Chu
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Jian Yang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China.
| | - Shaodong Ma
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Danni Ai
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Wenjie Li
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Hong Song
- School of Software, Beijing Institute of Technology, Beijing 100081, China
| | - Liang Li
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Lei Chen
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Yongtian Wang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing 100081, China
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31
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Sahyouni R, Moshtaghi O, Tran DK, Kaloostian S, Rajaii R, Bustillo D, Chen JW. Assessment of Google Glass as an adjunct in neurological surgery. Surg Neurol Int 2017; 8:68. [PMID: 28540134 PMCID: PMC5421200 DOI: 10.4103/sni.sni_277_16] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 02/15/2017] [Indexed: 11/25/2022] Open
Abstract
Background: We assess Google Glass (“Glass”) in improving postoperative review (“debriefing”) and augmenting education in Neurological Surgery at a tertiary academic medical center. Methods: This was a prospective study. Participants were patients of Neurological Surgery physicians at a Tertiary Care Level 1 Academic Trauma Center. Resident physicians received a pre-questionnaire immediately following surgery. Next, the resident and attending physicians debriefed by reviewing the Glass operative recording. Then, residents completed a 4-part post-questionnaire. Questions 1–3 assessed: (1) the residents’ comfort level with the procedure, (2) the quality of education provided by their superiors, and (3) their comfort level in repeating the operation. Question 4 assessed: (4) the perceived benefit of debriefing using Glass. Results: Twelve surveys were collected. Scores were based on a 5-point Likert scale, with a higher score corresponding to a more positive response. For Questions 1–3, the average pre- and post-questionnaire scores were 3.75 and 4.42, respectively (P <.05). For Question 4, the average post-questionnaire score was 4.63, suggesting that postoperative Glass review improved their technical understanding of the procedure. Conclusions: Glass significantly improved neurosurgery residents’ comfort level and quality of training, and provided a high fidelity, reliable, and modifiable tool that enhanced residents’ understanding, expertise, and educational experience. Of note, certain limitations such as variable battery life, variable image quality, and subpar compatibility with surgeon loupes must still be overcome for Glass to become a realistic addition to neurosurgical education.
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Affiliation(s)
- Ronald Sahyouni
- School of Medicine, Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Omid Moshtaghi
- School of Medicine, Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Diem Kieu Tran
- Division of Neurotrauma, Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Sean Kaloostian
- Division of Neurotrauma, Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Ramin Rajaii
- School of Medicine, Department of Neurological Surgery, University of California, Irvine, California, USA
| | - David Bustillo
- Division of Neurotrauma, Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Jefferson W Chen
- School of Medicine, Department of Neurological Surgery, University of California, Irvine, California, USA.,Division of Neurotrauma, Department of Neurological Surgery, University of California, Irvine, California, USA
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32
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Qian L, Barthel A, Johnson A, Osgood G, Kazanzides P, Navab N, Fuerst B. Comparison of optical see-through head-mounted displays for surgical interventions with object-anchored 2D-display. Int J Comput Assist Radiol Surg 2017; 12:901-910. [PMID: 28343301 DOI: 10.1007/s11548-017-1564-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Optical see-through head-mounted displays (OST-HMD) feature an unhindered and instantaneous view of the surgery site and can enable a mixed reality experience for surgeons during procedures. In this paper, we present a systematic approach to identify the criteria for evaluation of OST-HMD technologies for specific clinical scenarios, which benefit from using an object-anchored 2D-display visualizing medical information. METHODS Criteria for evaluating the performance of OST-HMDs for visualization of medical information and its usage are identified and proposed. These include text readability, contrast perception, task load, frame rate, and system lag. We choose to compare three commercially available OST-HMDs, which are representatives of currently available head-mounted display technologies. A multi-user study and an offline experiment are conducted to evaluate their performance. RESULTS Statistical analysis demonstrates that Microsoft HoloLens performs best among the three tested OST-HMDs, in terms of contrast perception, task load, and frame rate, while ODG R-7 offers similar text readability. The integration of indoor localization and fiducial tracking on the HoloLens provides significantly less system lag in a relatively motionless scenario. CONCLUSIONS With ever more OST-HMDs appearing on the market, the proposed criteria could be used in the evaluation of their suitability for mixed reality surgical intervention. Currently, Microsoft HoloLens may be more suitable than ODG R-7 and Epson Moverio BT-200 for clinical usability in terms of the evaluated criteria. To the best of our knowledge, this is the first paper that presents a methodology and conducts experiments to evaluate and compare OST-HMDs for their use as object-anchored 2D-display during interventions.
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Affiliation(s)
- Long Qian
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, MD, USA. .,Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA.
| | - Alexander Barthel
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, MD, USA.,Computer Aided Medical Procedures, Technische Universität München, Munich, Germany
| | - Alex Johnson
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Greg Osgood
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Peter Kazanzides
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
| | - Nassir Navab
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, MD, USA.,Computer Aided Medical Procedures, Technische Universität München, Munich, Germany
| | - Bernhard Fuerst
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, MD, USA
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33
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Lee CK, Kim Y, Lee N, Kim B, Kim D, Yi S. Feasibility Study of Utilization of Action Camera, GoPro Hero 4, Google Glass, and Panasonic HX-A100 in Spine Surgery. Spine (Phila Pa 1976) 2017; 42:275-280. [PMID: 28207670 DOI: 10.1097/brs.0000000000001719] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Study for feasibility of commercially available action cameras in recording video of spine. OBJECTIVE Recent innovation of the wearable action camera with high-definition video recording enables surgeons to use camera in the operation at ease without high costs. The purpose of this study is to compare the feasibility, safety, and efficacy of commercially available action cameras in recording video of spine surgery. SUMMARY OF BACKGROUND DATA There are early reports of medical professionals using Google Glass throughout the hospital, Panasonic HX-A100 action camera, and GoPro. This study is the first report for spine surgery. METHODS Three commercially available cameras were tested: GoPro Hero 4 Silver, Google Glass, and Panasonic HX-A100 action camera. Typical spine surgery was selected for video recording; posterior lumbar laminectomy and fusion. Three cameras were used by one surgeon and video was recorded throughout the operation. The comparison was made on the perspective of human factor, specification, and video quality. RESULTS The most convenient and lightweight device for wearing and holding throughout the long operation time was Google Glass. The image quality; all devices except Google Glass supported HD format and GoPro has unique 2.7K or 4K resolution. Quality of video resolution was best in GoPro. Field of view, GoPro can adjust point of interest, field of view according to the surgery. Narrow FOV option was the best for recording in GoPro to share the video clip. Google Glass has potentials by using application programs. Connectivity such as Wi-Fi and Bluetooth enables video streaming for audience, but only Google Glass has two-way communication feature in device. CONCLUSION Action cameras have the potential to improve patient safety, operator comfort, and procedure efficiency in the field of spinal surgery and broadcasting a surgery with development of the device and applied program in the future. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Chang Kyu Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Youngjun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, South Korea
| | - Nam Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byeongwoo Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Doyoung Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
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34
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Kolodzey L, Grantcharov PD, Rivas H, Schijven MP, Grantcharov TP. Wearable technology in the operating room: a systematic review. ACTA ACUST UNITED AC 2016. [DOI: 10.1136/bmjinnov-2016-000133] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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35
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Khor WS, Baker B, Amin K, Chan A, Patel K, Wong J. Augmented and virtual reality in surgery-the digital surgical environment: applications, limitations and legal pitfalls. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:454. [PMID: 28090510 DOI: 10.21037/atm.2016.12.23] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The continuing enhancement of the surgical environment in the digital age has led to a number of innovations being highlighted as potential disruptive technologies in the surgical workplace. Augmented reality (AR) and virtual reality (VR) are rapidly becoming increasingly available, accessible and importantly affordable, hence their application into healthcare to enhance the medical use of data is certain. Whether it relates to anatomy, intraoperative surgery, or post-operative rehabilitation, applications are already being investigated for their role in the surgeons armamentarium. Here we provide an introduction to the technology and the potential areas of development in the surgical arena.
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Affiliation(s)
- Wee Sim Khor
- Department of Plastic & Reconstructive Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Benjamin Baker
- Department of Plastic & Reconstructive Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Kavit Amin
- Department of Plastic & Reconstructive Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | | | - Ketan Patel
- Division of Plastic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jason Wong
- Plastic & Reconstructive Surgery Research, The University of Manchester, Manchester, UK
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36
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Gupta K, Lee GA, Billinghurst M. Do You See What I See? The Effect of Gaze Tracking on Task Space Remote Collaboration. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2016; 22:2413-22. [PMID: 27479970 DOI: 10.1109/tvcg.2016.2593778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present results from research exploring the effect of sharing virtual gaze and pointing cues in a wearable interface for remote collaboration. A local worker wears a Head-mounted Camera, Eye-tracking camera and a Head-Mounted Display and shares video and virtual gaze information with a remote helper. The remote helper can provide feedback using a virtual pointer on the live video view. The prototype system was evaluated with a formal user study. Comparing four conditions, (1) NONE (no cue), (2) POINTER, (3) EYE-TRACKER and (4) BOTH (both pointer and eye-tracker cues), we observed that the task completion performance was best in the BOTH condition with a significant difference of POINTER and EYETRACKER individually. The use of eye-tracking and a pointer also significantly improved the co-presence felt between the users. We discuss the implications of this research and the limitations of the developed system that could be improved in further work.
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37
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Feasibility and safety of augmented reality-assisted urological surgery using smartglass. World J Urol 2016; 35:967-972. [PMID: 27761715 DOI: 10.1007/s00345-016-1956-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/13/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To assess the feasibility, safety and usefulness of augmented reality-assisted urological surgery using smartglass (SG). METHODS Seven urological surgeons (3 board urologists and 4 urology residents) performed augmented reality-assisted urological surgery using SG for 10 different types of operations and a total of 31 urological operations. Feasibility was assessed using technical metadata (number of photographs taken/number of videos recorded/video time recorded) and structured interviews with the urologists on their use of SG. Safety was evaluated by recording complications and grading according to the Clavien-Dindo classification. Usefulness of SG for urological surgery was queried in structured interviews and in a survey. RESULTS The implementation of SG use during urological surgery was feasible with no intrinsic (technical defect) or extrinsic (inability to control the SG function) obstacles being observed. SG use was safe as no grade 3-5 complications occurred for the series of 31 urological surgeries of different complexities. Technical applications of SG included taking photographs/recording videos for teaching and documentation, hands-free teleconsultation, reviewing patients' medical records and images and searching the internet for health information. Overall usefulness of SG for urological surgery was rated as very high by 43 % and high by 29 % of surgeons. CONCLUSIONS Augmented reality-assisted urological surgery using SG is both feasible and safe and also provides several useful functions for urological surgeons. Further developments and investigations are required in the near future to harvest the great potential of this exciting technology for urological surgery.
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Joseph B, Armstrong DG. Potential perils of peri-Pokémon perambulation: the dark reality of augmented reality? Oxf Med Case Reports 2016; 2016:omw080. [PMID: 27713831 PMCID: PMC5050458 DOI: 10.1093/omcr/omw080] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 01/31/2023] Open
Abstract
Recently, the layering of augmented reality information on top of smartphone applications has created unprecedented user engagement and popularity. One augmented reality-based entertainment application, Pokémon Go (Pokémon Company, Tokyo, Japan) has become the most rapidly downloaded in history. This technology holds tremendous promise to promote ambulatory activity. However, there exists the obvious potential for distraction-related morbidity. We report two cases, presenting simultaneously to our trauma center, with injuries sustained secondary to gameplay with this augmented reality-based application.
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Affiliation(s)
- Bellal Joseph
- Department of Surgery, Southern Arizona Limb Salvage Alliance, Tucson, AZ, USA
| | - David G Armstrong
- Department of Surgery, Southern Arizona Limb Salvage Alliance, Tucson, AZ, USA
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Peden RG, Mercer R, Tatham AJ. The use of head-mounted display eyeglasses for teaching surgical skills: A prospective randomised study. Int J Surg 2016; 34:169-173. [DOI: 10.1016/j.ijsu.2016.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 11/26/2022]
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Abstract
Google Glass is, in essence, a smartphone in the form of a pair of spectacles. It has a display system, a bone conduction “speaker,” video camera, and connectivity via WiFi or Bluetooth technologies. It can also be controlled by voice command. Seizing Google Glass’ capabilities as windows of opportunity, surgeons have been the first group of doctors trying to incorporate the technology into their daily practices. Experiences from different groups have demonstrated Google Glass’ potential in improving perioperative care, intraoperative communication and documentation, surgical outcome as well as surgical training. On the other hand, the device has technical limitations, notably suboptimal image qualities and a short battery life. Its operational functions also bring forth concerns on the protection of patient privacy. Nonetheless, the technological advances that this device embodies hold promises in surgical innovations. Further studies are required, and surgeons should explore, investigate, and embrace similar technologies with keen and informed anticipation.
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Affiliation(s)
| | - Lok Yee Tsui
- The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Gunter RL, Chouinard S, Fernandes-Taylor S, Wiseman JT, Clarkson S, Bennett K, Greenberg CC, Kent KC. Current Use of Telemedicine for Post-Discharge Surgical Care: A Systematic Review. J Am Coll Surg 2016; 222:915-27. [PMID: 27016900 PMCID: PMC5660861 DOI: 10.1016/j.jamcollsurg.2016.01.062] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Rebecca L Gunter
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | - Skyler Chouinard
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | | | - Jason T Wiseman
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | - Sam Clarkson
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | - Kyla Bennett
- Wisconsin Institute for Surgical Outcomes Research (WiSOR), Madison, WI
| | | | - K Craig Kent
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI.
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Raison N, Khan MS, Challacombe B. Telemedicine in Surgery: What are the Opportunities and Hurdles to Realising the Potential? Curr Urol Rep 2016; 16:43. [PMID: 26025497 DOI: 10.1007/s11934-015-0522-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Since the first telegraphic transmission of an electrocardiogram in 1906, technological developments have allowed telemedicine to flourish. It has become a multi-billion pound industry encompassing many areas of medical practice and education. Telemedicine is now widely used in surgery from performing operations to teaching and can be divided into three main components; telesurgery, telementoring and teleconsultation. Developments across these fields have led to remarkable achievements such as intercontinental telesurgery and telementoring. However, barriers to the further implementation of telemedicine remain. In this review, the developments and recent advances of telemedicine across the three domains are discussed together with the challenges and limitations that need to be overcome.
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Affiliation(s)
- Nicholas Raison
- Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK,
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43
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Abstract
As commercial technology moves further into wearable technologies, cognitive and psychological scientists can capitalize on these devices to facilitate naturalistic research designs while still maintaining strong experimental control. One such wearable technology is Google Glass (Google, Inc.: www.google.com/glass), which can present wearers with audio and visual stimuli while tracking a host of multimodal data. In this article, we introduce PsyGlass, a framework for incorporating Google Glass into experimental work that is freely available for download and community improvement over time (www.github.com/a-paxton/PsyGlass). As a proof of concept, we use this framework to investigate dual-task pressures on naturalistic interaction. The preliminary study demonstrates how designs from classic experimental psychology may be integrated in naturalistic interactive designs with emerging technologies. We close with a series of recommendations for using PsyGlass and a discussion of how wearable technology more broadly may contribute to new or adapted naturalistic research designs.
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44
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Nakayama T, Numao N, Yoshida S, Ishioka J, Matsuoka Y, Saito K, Fujii Y, Kihara K. A novel interactive educational system in the operating room--the IE system. BMC MEDICAL EDUCATION 2016; 16:44. [PMID: 26842063 PMCID: PMC4738794 DOI: 10.1186/s12909-016-0561-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 01/26/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The shortage of surgeon is one of the serious problems in Japan. To solve the problem, various efforts have been undertaken to improve surgical education and training. However, appropriate teaching methods in the operating room have not been well established. The aim of this study is to assess the utility of a novel interactive educational (IE) system for surgical education on urologic surgeries in the operating room. METHODS A total of 20 Japanese medical students were educated on urologic surgery using the IE system in the operating room. The IE system consists of two parts. The first is three-dimensional (3D) magnified vision of the operative field using a 3D head-mounted display and a 3D endoscope. The second is interactive educative communication between medical students and surgeons using a small-sized wireless communication device. The satisfaction level with the IE system and the physical burden on medical students was examined via questionnaire. RESULTS All students utilized the IE system in urologic surgery and responded to the survey. Most students were satisfied with the IE system. They also felt more welcomed by the surgeon when using the IE system than when not using it. No major unpleasant symptoms were observed but five students (25 %) experienced mild eye fatigue as a result of viewing the medical images. CONCLUSIONS The IE system has the potential to motivate students to become interested in surgery and could be an efficient method of surgical education in the operating room.
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Affiliation(s)
- Takayuki Nakayama
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Noboru Numao
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519 Japan
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Abstract
Importance. Wearable devices such as Google Glass could potentially be used in the health care setting to expand access and improve quality of care. Objective. This study aims to assess the demographics of Google Glass users in health care and determine the obstacles to using Google Glass by surveying those who are known to use the device. Design. A 48-question survey was designed to assess demographics of users, technological limitations of Google Glass, and obstacles to implementation of the device. Setting. The physicians surveyed worked in various fields of health care, with 50% of the respondents being surgeons. Participants. Potential participants were found using an Internet search for physicians using Google Glass in their practice. Main Outcome Measures. Outcome measures were divided into demographic information of users, technological limitations of the device, and administrative obstacles. Results. A 43.6% response rate was observed. The majority of users were male, assistant professors, in academic hospitals, and in the United States. Numerous technological limitations were observed by the majority, including device ergonomics, display location, video quality, and audio quality. Patient confidentiality and data security were the major concerns among administrative obstacles. Conclusions and Relevance. Despite the potential of Google Glass, numerous obstacles exist that limit its use in health care. While Google Glass has been discontinued, the results of this study may be used to guide future designs of wearable devices.
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Affiliation(s)
- Jonathan Yu
- University of Alabama at Birmingham, AL, USA
| | | | | | | | - Brent Ponce
- University of Alabama at Birmingham, AL, USA
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Toward a Taxonomy of Wearable Technologies in Healthcare. NEW HORIZONS IN DESIGN SCIENCE: BROADENING THE RESEARCH AGENDA 2015. [DOI: 10.1007/978-3-319-18714-3_43] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ponce BA, Menendez ME, Oladeji LO, Fryberger CT, Dantuluri PK. Emerging technology in surgical education: combining real-time augmented reality and wearable computing devices. Orthopedics 2014; 37:751-7. [PMID: 25361359 DOI: 10.3928/01477447-20141023-05] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/20/2014] [Indexed: 02/03/2023]
Abstract
The authors describe the first surgical case adopting the combination of real-time augmented reality and wearable computing devices such as Google Glass (Google Inc, Mountain View, California). A 66-year-old man presented to their institution for a total shoulder replacement after 5 years of progressive right shoulder pain and decreased range of motion. Throughout the surgical procedure, Google Glass was integrated with the Virtual Interactive Presence and Augmented Reality system (University of Alabama at Birmingham, Birmingham, Alabama), enabling the local surgeon to interact with the remote surgeon within the local surgical field. Surgery was well tolerated by the patient and early surgical results were encouraging, with an improvement of shoulder pain and greater range of motion. The combination of real-time augmented reality and wearable computing devices such as Google Glass holds much promise in the field of surgery.
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