No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Use of the mixed reality tool “VSI Patient Education” for more comprehensible and imaginable patient educations before epilepsy surgery and stereotactic implantation of DBS or stereo-EEG electrodes
Abstract
Purpose:
It is unknown which patient education strategy before epilepsy surgery or stereotactic electrode implantation is best for patients. This prospective and randomized clinical study investigates whether the use of the mixed reality tool "VSI Patient Education" (VSI PE) running on HoloLens® glasses is superior to the use of a rubber brain model as a 3-dimensional tool for patient education before epilepsy surgery and stereotactic electrode implantation.
Material and methods:
17 patients with indication for epilepsy surgery or stereotactic electrode implantation were included in the study and randomized into two groups. All patients were informed with both comparative tools VSI PE (apoQlar®) and a rubber brain model (3B Scientific®) in a chronological order depending on group assignment. Afterwards, the patient and, if present, a relative (12) each filled out a questionnaire. For statistical analysis, Wilcoxon rank-sum tests were performed.
Results:
Patients found their patient education highly significantly more comprehensible (p = 0.001**, r = 0.84) and almost significantly more imaginable (p=0.020, r = 0.57), when their doctor used VSI PE compared to the rubber brain model. The patients felt significantly less anxious as a result of VSI PE (p = 0.008*, r = 0.64). Highly significantly more patients chose VSI PE as the preferred patient education tool (p < 0.001**, r = 0.91), and almost significantly more patients decided VSI PE to be the future standard tool (p = 0.020, r = 0.56). Significantly more relatives chose VSI PE as the preferred patient education tool (p = 0.004*, r = 0.83), and significantly more relatives decided VSI PE to be the future standard tool (p = 0.002*, r = 0.91).
Conclusion:
VSI Patient Education is a promising new mixed reality tool for informing patients before epileptic surgery or stereotactic electrode implantation in order to enhance comprehension and imagination and reduce fear and worries. It might strengthen patient commitment and have a positive influence on patients' decisions in favor of medically indicated surgical operations.
... The few previous studies that have been carried out on the use of AR in patient education, rarely involved patients in the process of designing and implementing AR applications (Domhardt et al., 2015;Calle-Bustos et al., 2017;Azman et al., 2019;Brown et al., 2019;Calle-Bustos et al., 2019;Wake et al., 2019;Bray et al., 2020;House et al., 2020;Sezer et al., 2020;Tait et al., 2020). For a recent review, see (Urlings et al., 2022). ...
... Similar to the expectations of patients in our study that AR could help in communicating with relatives, it was found that an AR intervention helped parents to talk about a planned procedure with their children and that it significantly decreased anxiety in parents whose children were undergoing invasive procedures (Bray et al., 2020). In another study relatives expressed their preference of an AR application over a physical model and chose it as the future standard tool for patient education (House et al., 2020). The latter contrasts with our finding that some patients feared AR could make relatives uncomfortable or that relatives would not be interested in AR. ...
... Proper guidance when using AR and a physician well-trained in using the device were considered necessary. When looking at the existing literature however, most studies reported a high usability and likability of the AR applications used (Calle-Bustos et al., 2017;Brown et al., 2019;Calle-Bustos et al., 2019;Wake et al., 2019;Bray et al., 2020;House et al., 2020;Tait et al., 2020). These studies comprised patients with an age range between 8 and 63 years. ...
Objectives: The goal of this project is to explore the views, expectations and preferences of patients with an unruptured intracranial aneurysm regarding the use of AR in patient education.
Methods: To gain an in-depth understanding of the patients’ perspective, a face-to-face interview study was conducted using an interview protocol with a predefined topic list. All interviews were audio-recorded and transcribed verbatim afterwards. Transcripts were analyzed using thematic content analyses. Coding was performed using Atlas.ti software.
Results: Seventeen interviews were conducted. The views, expectations and preferences of patients regarding patient education with AR could be subdivided into 15 categories, which could be grouped into 4 general themes: 1) experiences with current patient education, 2) expectations of AR in patient education, 3) opportunities and limitations of AR, and 4) out-of-hospital use of an AR application. Patients’ expectations were predominantly positive regarding improving patients’ understanding of their medical situation and doctor-patient communication.
Discusssion: This study suggests that patients with unruptured intracranial aneurysms are open to receive patient education regarding their disease with AR. Patients expect that AR models can help patients with intra-cranial aneurysms better understand their disease, treatment options and risks. Additionally, patients expect AR could improve doctor-patient communication.
... Thereby, a three-dimensional, interactive model of a patient's individual anatomy can be created for a variety of applications. Among other areas, the use of MR in the field of patient education has recently been suggested [3,4,5,6,7,8,9]. A systematic review by Urlings et al. concluded with encouraging results regarding the potential of AR in patient education. ...
... Previous studies have indicated promising results with the use of MR and AR technologies during patient education [4,8]. Shared decision making in AAA repair needs to consider individual patient preference and risk assessment based on an underlying understanding of the disease. ...
... 96% said they would prefer patient education in other specialties to also be performed using MR. This is in line with results from previous studies exploring AR-, MR-or VR-technology [4,9,21,28,30,32,33]. ...
Background: To investigate the usability of Mixed-Reality (MR) during patient education in patients scheduled for abdominal aortic aneurysm (AAA) repair. Patients and methods: Consecutive patients scheduled for elective AAA repair were block-randomized in either the Mixed-Reality group (MR group) or the conventional group (control group). Patients of both groups were educated about open and endovascular repair of their respective AAA. The MR group was educated using a head-mounted display (HMD) demonstrating a three-dimensional virtual reconstruction of the respective patient's vascular anatomy. The control group was educated using a conventional two-dimensional monitor to display the patient's vasculature. Outcomes were informational gain as well as patient satisfaction with the educational process. (DRKS-ID: DRKS00025174). Results: 50 patients were included with 25 patients in either group. Both groups demonstrated improvements in scores in the Informational Gain Questionnaire (IGQ) when comparing pre- and post-education scores. (MR group: 6.5 points (±1.8) versus 7.9 points (±1.5); Control group: 6.2 points (±1.8) versus 7.6 points (±1.6); p<0.01) There was no significant difference between the MR group and the control group either in informational gain (MR group: 1.4±1.8; Control group: 1.4±1.8; p=0.5) nor in patient satisfaction scores (MR group: mean 18.3 of maximum 21 points (±3.7); Control group: mean 17 of 21 points (±3.6); p=0.1) Multiple regression revealed no correlation between the use of MR and informational gain or patient satisfaction. Usability of the system was rated high, and patients' subjective assessment of MR was positive. Conclusions: The use of MR in patient education of AAA patients scheduled for elective repair is feasible. While patients reported positively on the use of MR in education, similar levels of informational gain and patient satisfaction can be achieved with MR and conventional methods.
... Another training task, which has benefited from AR support through the HoloLens, is the control of functional prostheses (Sharma et al., 2018;Palermo et al., 2019). In the context of patient education, the HoloLens has been used to provide a more comprehensible and imaginable explanation to patients before surgery (Wake et al., 2019;House et al., 2020;Rositi et al., 2021). ...
... Alas, performance requirements of volume rendering cannot be easily addressed with mobile hardware, such as the HoloLens. Consequently, only seven reviewed studies attempt more advanced volume rendering on the HoloLens (Fröhlich et al., 2018;Fink et al., 2019;Witowski et al., 2019;House et al., 2020;Ivan et al., 2021;Gehrsitz et al., 2021;Allison et al., 2020). ...
... 49 reviewed publications use such questionnaires for evaluating various system aspects. Examples include general comfort, image quality and audio quality of the HoloLens and its suitability for medical applications Jang et al., 2018;Sirilak and Muneesawang, 2018;Moosburner et al., 2019;Galati et al., 2020;Kumar et al., 2020;Al Janabi et al., 2020;Scherl et al., 2021a;Dennler et al., 2021b), the effectiveness of certain types of visualization (Brun et al., 2019;Wake et al., 2019;House et al., 2020;Gehrsitz et al., 2021) or, most commonly, how well the proposed application can support a certain procedure. ...
The HoloLens (Microsoft Corp., Redmond, WA), a head-worn, optically see-through augmented reality (AR) display, is the main player in the recent boost in medical AR research. In this systematic review, we provide a comprehensive overview of the usage of the first-generation HoloLens within the medical domain, from its release in March 2016, until the year of 2021. We identified 217 relevant publications through a systematic search of the PubMed, Scopus, IEEE Xplore and SpringerLink databases. We propose a new taxonomy including use case, technical methodology for registration and tracking, data sources, visualization as well as validation and evaluation, and analyze the retrieved publications accordingly. We find that the bulk of research focuses on supporting physicians during interventions, where the HoloLens is promising for procedures usually performed without image guidance. However, the consensus is that accuracy and reliability are still too low to replace conventional guidance systems. Medical students are the second most common target group, where AR-enhanced medical simulators emerge as a promising technology. While concerns about human-computer interactions, usability and perception are frequently mentioned, hardly any concepts to overcome these issues have been proposed. Instead, registration and tracking lie at the core of most reviewed publications, nevertheless only few of them propose innovative concepts in this direction. Finally, we find that the validation of HoloLens applications suffers from a lack of standardized and rigorous evaluation protocols. We hope that this review can advance medical AR research by identifying gaps in the current literature, to pave the way for novel, innovative directions and translation into the medical routine.
... Another training task, which has benefited from AR support through the HoloLens, is the control of functional prostheses [188,152]. In the context of patient education, the HoloLens has been used to provide a more comprehensible and imaginable explanation to patients before surgery [212,87,176]. ...
... Still, performance requirements of volume rendering cannot be easily addressed with mobile hardware, such as the HoloLens. Consequently, only six reviewed studies attempt volume rendering [59,216,87,94,68,4]. ...
... 42 reviewed publications use such questionnaires for evaluating various system aspects. Examples include general comfort, image quality and audio quality of the HoloLens and its suitability for medical applications [37,95,190,141,62,111,3,184,45], the effectiveness of certain types of visualization [23,212,87,68] or, most commonly, how well the proposed application can support a certain procedure. ...
The HoloLens (Microsoft Corp., Redmond, WA), a head-worn, optically see-through augmented reality display, is the main player in the recent boost in medical augmented reality research. In medical settings, the HoloLens enables the physician to obtain immediate insight into patient information, directly overlaid with their view of the clinical scenario, the medical student to gain a better understanding of complex anatomies or procedures, and even the patient to execute therapeutic tasks with improved, immersive guidance. In this systematic review, we provide a comprehensive overview of the usage of the first-generation HoloLens within the medical domain, from its release in March 2016, until the year of 2021, were attention is shifting towards it's successor, the HoloLens 2. We identified 171 relevant publications through a systematic search of the PubMed and Scopus databases. We analyze these publications in regard to their intended use case, technical methodology for registration and tracking, data sources, visualization as well as validation and evaluation. We find that, although the feasibility of using the HoloLens in various medical scenarios has been shown, increased efforts in the areas of precision, reliability, usability, workflow and perception are necessary to establish AR in clinical practice.
... Computer-mediated education applications based on mixed reality (MR) indicate promising potential to resolve these issues by allowing 3D pathology holograms to be visualized and annotated [7,8]. As Zucker et al. [8:1] state, "these sophisticated visual aids may significantly improve patient understanding of complex anatomy and operative procedures." ...
... As Zucker et al. [8:1] state, "these sophisticated visual aids may significantly improve patient understanding of complex anatomy and operative procedures." One example includes Virtual Surgery Intelligence Patient Education (VSI PE), a cloud-based software suite that enables both the physician and patient to experience pictures of magnetic resonance imaging and computed tomography scans in a co-located setting based on the Microsoft HoloLens [7]. In this way, the doctor can demonstrate to the patient the incremental steps of surgery, clarify risks (e.g., injured nerves), and practically illustrate the effectiveness of rehabilitation measures [9]. ...
... In this way, the doctor can demonstrate to the patient the incremental steps of surgery, clarify risks (e.g., injured nerves), and practically illustrate the effectiveness of rehabilitation measures [9]. A recent randomized trial by House et al. [7] revealed that patients perceive PPE through this application to be more imaginable and understandable compared with traditional approaches, such as rubber pathology models, due to the rich visualization capabilities. Despite these advantages, the deployment of wearable MR technologies in professional domains has its drawbacks, such as privacy concerns and physical discomfort [10,11]. ...
Using mixed reality (MR) glasses for preoperative patient education (PPE) can help patients understand the purpose and risks of surgical procedures through informative visualizations. However, patients tend to be critical regarding the use of MR glasses in healthcare and often prefer the status quo of healthcare services provided. This study explores the resistance to MR technologies in PPE through the lens of the status quo bias theory by surveying n = 171 participants. We conducted a fuzzy set qualitative comparative analysis revealing configurations that provide a typological understanding of patient resistance. This allows healthcare stakeholders to take more targeted interventions to promote MR adoption. Notably, the results indicate that healthcare providers need to be transparent in communicating the benefits and drawbacks of using MR, as uncertainty costs are the main driver of resistance to MR glasses in PPE.
... To our knowledge, the HoloLens with a head-mounted AR-display has only been used with neurological patients in a few exploratory trials; for example, Rohrbach et al. (2019Rohrbach et al. ( , 2021 used the HoloLens to improve the pantomime performance of patients with apraxia and to support ADL tasks in patients with dementia. Further applications were in patient education before surgery of epilepsy patients [15], in gait training in patients after stroke [16] or with Parkinson's Disease [17] or during the evaluation of vision in patients after stroke [18]. Concerns have been raised that elderly and/or persons with cognitive, sensory and visual impairments (which might occur due to stroke) face difficulties in perceiving the three-dimensionality of an AR environment [18]. ...
... Specifically, concerns regarding the spatial perception of stroke patients when using the HoloLens were of interest. The feasibility of using the HoloLens in neurological patients as shown by Rohrbach et al. [28,40], House et al. [15], Held et al. [16], Janssen et al. [17] and Höhler et al. [18] was confirmed and extended towards its application in combination with robotic support. Regarding the usability, we found the setup was generally practicable and the donning and doffing procedure fast. ...
Background
Robotic therapy and serious gaming support motor learning in neurorehabilitation. Traditional monitor-based gaming outputs cannot adequately represent the third dimension, whereas virtual reality headsets lack the connection to the real world. The use of Augmented Reality (AR) techniques could potentially overcome these issues. The objective of this study was thus to evaluate the usability, feasibility and functionality of a novel arm rehabilitation device for neurorehabilitation (RobExReha system) based on a robotic arm (LBR iiwa, KUKA AG) and serious gaming using the AR headset HoloLens (Microsoft Inc.).
Methods
The RobExReha system was tested with eleven adult inpatients (mean age: 64.4 ± 11.2 years; diagnoses: 8 stroke, 2 spinal cord injury, 1 Guillain-Barré-Syndrome) who had paretic impairments in their upper limb. Five therapists administered and evaluated the system. Data was compared with a Reference Group (eleven inpatients; mean age: 64.3 ± 9.1 years; diagnoses: 10 stroke, 1 spinal cord injury) who trained with commercially available robotic therapy devices ( ArmeoPower or ArmeoSpring , Hocoma AG ). Patients used standardized questionnaires for evaluating usability and comfort (Quebec User Evaluation of Satisfaction with assistive technology [QUEST]), workload (Raw Task Load Index [RTLX]) and a questionnaire for rating visual perception of the gaming scenario. Therapists used the QUEST, the System Usability Scale and the short version of the User Experience Questionnaire.
Results
Therapy with the RobExReha system was safe and feasible for patients and therapists, with no serious adverse events being reported. Patients and therapists were generally satisfied with usability. The patients’ usability ratings were significantly higher in the Reference Group for two items of the QUEST: reliability and ease of use. Workload (RTLX) ratings did not differ significantly between the groups. Nearly all patients using the RobExReha system perceived the gaming scenario in AR as functioning adequately despite eight patients having impairments in stereoscopic vision. The therapists valued the system’s approach as interesting and inventive.
Conclusions
We demonstrated the clinical feasibility of combining a novel robotic upper limb robot with an AR-serious game in a neurorehabilitation setting. To ensure high usability in future applications, a reliable and easy-to-use system that can be used for task-oriented training should be implemented.
Trial registration
Ethical approval was obtained and the trial was registered at the German Clinical Trials Register (DRKS00022136).
... In the aspects of EEG in Neuromarketing, a huge potential can be seen with integrating Virtual Reality (VR) (Maples-Keller et al., 2017) and wearable EEG as it allows mimicking of real-life situations and environment to be used in studies (Lin et al., 2018). VR is currently being used in tourism and education (House et al., 2020). Virtual, augmented, and mixed reality has provided diversified and interactive teaching and learning environments to improve students' cognitive ability, especially in terms of information processing and storage and recalling acquired knowledge such as VSI Patient Education (VSI PE), as shown in Figure 5. ...
... Despite that, this mixed-reality convergence eases the process of incorporating computerised virtual graphic objects via 3D environment with ease at any selected location, Figure 5. VSI PE on brain model (House et al., 2020) Figure 6. VR 3D environment (Doma, 2019) be it in a lab, office and even outdoors. ...
Electroencephalogram (EEG) is a neurotechnology used to measure brain activity via brain impulses. Throughout the years, EEG has contributed tremendously to data-driven research models (e.g., Generalised Linear Models, Bayesian Generative Models, and Latent Space Models) in Neuroscience Technology and Neuroinformatic. Due to versatility, portability, cost feasibility, and non-invasiveness. It contributed to various Neuroscientific data that led to advancement in medical, education, management, and even the marketing field. In the past years, the extensive uses of EEG have been inclined towards medical healthcare studies such as in disease detection and as an intervention in mental disorders, but not fully explored for uses in neuromarketing. Hence, this study construes the data acquisition technique in neuroscience studies using electroencephalogram and outlines the trend of revolution of this technique in aspects of its technology and databases by focusing on neuromarketing uses.
... Another use of MR technology tool which includes AR application is the "Virtual Surgery Intelligence (VSI) Patient Education" tool. House et al. (2020) found that the intervention group had better understand of their condition, better visual imagination of the procedure, hence reduced fear and worries they had due to poor understanding and uncertainties of the brain surgery (House et al., 2020). The authors suggested that such technological tool might strengthening patient"s commitment and influencing their decisions in favour of medically indicated surgical operations. ...
... Another use of MR technology tool which includes AR application is the "Virtual Surgery Intelligence (VSI) Patient Education" tool. House et al. (2020) found that the intervention group had better understand of their condition, better visual imagination of the procedure, hence reduced fear and worries they had due to poor understanding and uncertainties of the brain surgery (House et al., 2020). The authors suggested that such technological tool might strengthening patient"s commitment and influencing their decisions in favour of medically indicated surgical operations. ...
Augmented Reality (AR) technology
and its applications in various industries and sectors
has been increasingly popular and on-demand as the
world approaches IR4.0. With its enormous and
continuously progressive advancements in the
healthcare industry, basic yet vital services like
consultations can be further improved with the
integration of technologies. This study proposed a
TAM derived conceptual framework using the
constructs Perceived Enjoyment, Perceived
Usefulness and Perceived Ease of Use towards
patient‟s actual use of AR technology application in
aiding their consultations withtheir healthcare
professionals. A survey questionnaire was
developed and distributed via social media
platforms to 539 respondents. All hypothesis
proposed in this study‟s conceptual framework has
been found significantly positive in influencing
patient‟s eventual usage of AR technology
application in facilitating consultations. These
results revealed the interrelationships of the
constructs involved, thus enhancing our
understanding on the factors of AR to be used in
aiding consultations sessions. The findings of this
study have some important practical implications for
the improvement of conventional healthcare
consultation methods to improve patients‟
understanding which has an impact on their overall
health compliance and outcome.
KEYWORDS:Industrial Revolution 4.0,
Augmented Reality, Perceived Enjoyment,
Perceived Ease of Use, Perceived Usefulness
... During office visits, patients, and their families could visualize and comprehend the brain's anatomy with a "flythrough", which is 360° video that demonstrates the spatial relationship of depth electrodes to the seizure focus and facilitated a better understanding of the subsequent neurosurgical intervention. The application of mixed reality for SEEG implantations in MRE patients has been shown to support comprehension and reduce anxiety considerably [15]. Virtual reality functionality is expanding and demonstrating to be effective in addressing health literacy [15,16]. ...
... The application of mixed reality for SEEG implantations in MRE patients has been shown to support comprehension and reduce anxiety considerably [15]. Virtual reality functionality is expanding and demonstrating to be effective in addressing health literacy [15,16]. SEEG depth electrode implantation three-dimensional renderings developed by Surgical Theater have the ability to synch to Stealth's neuronavigation software, which allows the neurosurgeon to take advantage of an additional neuronavigation system with an integrated 3D paradigm in the operating room to guide the resective or ablative surgery. ...
IntroductionThe increasing use of stereoelectroencephalography (SEEG) in the USA and the need for three-dimensional (3D) appreciation of complex spatial relationships between implanted stereotactic EEG depth electrodes and surrounding brain and cerebral vasculature are a challenge to clinicians who are used to two-dimensional (2D) appreciation of cortical anatomy having been traditionally trained on 2D radiologic imaging. Virtual reality and its 3D renderings have grown increasingly common in the multifaceted practice of neurosurgery. However, there exists a paucity in the literature regarding this emerging technology in its utilization of epilepsy surgery.Methods
An IRB-approved, single-center retrospective study identifying all SEEG pediatric patients in which virtual reality was applied was observed.ResultsOf the 46 patients identified who underwent an SEEG procedure, 43.5% (20/46) had a 3D rendering (3DR) of their SEEG depth electrodes. All 3DRs were used during patient-family education and discussion among the Epilepsy multidisciplinary team meetings, while 35% (7/20) were used during neuronavigation in surgery. Three successful representative cases of its application were presented.DiscussionOur institution’s experience regarding virtual reality in the 3D representation of SEEG depth electrodes and the application to pre-surgical planning, patient-family education, multidisciplinary communication, and intraoperative neuronavigation demonstrate its applicability in comprehensive epilepsy patient care.
... Over the past several years, virtual reality (VR) has undergone considerable progress and has been proven as a useful tool to improve many psychiatric and neurological treatments, like those implemented for Depression (Falconer et al., 2016;Lindner et al., 2019;Schleider et al., 2019), Social Anxiety (Kampmann et al., 2016;Kim et al., 2017;Chesham et al., 2018), Post-Traumatic Stress Disorder (Beidel et al., 2019;Kothgassner et al., 2019;Loucks et al., 2019), Schizophrenia (Ruse et al., 2014;Spanlang et al., 2019;Gainsford et al., 2020), Alcohol/Drug Addiction (Bordnick and Washburn, 2019;Ghiţ ǎ et al., 2019;Segawa et al., 2020), Alzheimer's disease (Serino et al., 2017;Caggianese et al., 2018;Clay et al., 2020), Epilepsy (Maidenbaum et al., 2019;Höller et al., 2020;House et al., 2020), Stroke (Lupu et al., 2016;Gamito et al., 2017;Iruthayarajah et al., 2017;Kritikos et al., 2019b;Matamala-Gomez et al., 2020a), Autism (Newbutt et al., 2016(Newbutt et al., , 2020Meindl et al., 2019), chronic pain (Jones et al., 2016;Ahmadpour et al., 2019;Matamala-Gomez et al., 2019). VR is usually combined with invasive or non-invasive electrodes to assist each treatment accordingly (Solcà et al., 2018;Burin et al., 2020;Matamala-Gomez et al., 2020b). ...
... Recently, virtual reality (VR) technology has undergone considerable progress and can be a useful tool in clinical settings by assisting therapists in stimulating desirable psychological states, to create a more precise diagnosis, and, finally, proposing a more integrated treatment (Krijn et al., 2004a,b;Kim et al., 2017;Freeman et al., 2018). Previous research has already highlighted the potential of VR to excite the senses as effectively as a real-life stimulus can (Kritikos et al., 2020), by introducing Virtual Reality Exposure Therapy (VRET) as a solid procedure in the assessment of fear responses (Gamito et al., 2017;Iruthayarajah et al., 2017;House et al., 2020). Specifically, Exposure Therapy frequently benefits from VR systems to graphically reproduce vivid simulations for any kind of stress-related stimuli and induce real emotions, such as fear induced by the presence of spiders or other phobic stimuli (Bun et al., 2017). ...
Virtual reality (VR) constitutes an alternative, effective, and increasingly utilized treatment option for people suffering from psychiatric and neurological illnesses. However, the currently available VR simulations provide a predetermined simulative framework that does not take into account the unique personality traits of each individual; this could result in inaccurate, extreme, or unpredictable responses driven by patients who may be overly exposed and in an abrupt manner to the predetermined stimuli, or result in indifferent, almost non-existing, reactions when the stimuli do not affect the patients adequately and thus stronger stimuli are recommended. In this study, we present a VR system that can recognize the individual differences and readjust the VR scenarios during the simulation according to the treatment aims. To investigate and present this dynamically adaptive VR system we employ an Anxiety Disorder condition as a case study, namely arachnophobia. This system consists of distinct anxiety states, aiming to dynamically modify the VR environment in such a way that it can keep the individual within a controlled, and appropriate for the therapy needs, anxiety state, which will be called “desired states” for the study. This happens by adjusting the VR stimulus, in real-time, according to the electrophysiological responses of each individual. These electrophysiological responses are collected by an external electrodermal activity biosensor that serves as a tracker of physiological changes. Thirty-six diagnosed arachnophobic individuals participated in a one-session trial. Participants were divided into two groups, the Experimental Group which was exposed to the proposed real-time adaptive virtual simulation, and the Control Group which was exposed to a pre-recorded static virtual simulation as proposed in the literature. These results demonstrate the proposed system’s ability to continuously construct an updated and adapted virtual environment that keeps the users within the appropriately chosen state (higher or lower intensity) for approximately twice the time compared to the pre-recorded static virtual simulation. Thus, such a system can increase the efficiency of VR stimulations for the treatment of central nervous system dysfunctions, as it provides numerically more controlled sessions without unexpected variations.
... House et al. conducted a prospective randomised clinical study investigating the superiority of using VSI over, using MRI on 2D computer screens or use of rubber-brain 3D model for explaining interventions and diseases to the patients. 16 Significantly more patients reported that using 3D-rendered models with VSI was more comprehensible and imaginable. ...
... Además, la mayoría de las herramientas utilizadas para medir resultados fueron cuestionarios específicos creados por los equipos de investigación, con poca o ninguna evidencia publicada sobre su validez y confiabilidad. Para futuras investigaciones sobre la RA en la educación del paciente, es necesario estandarizar tanto los tipos de intervención como las medidas de resultados para poder evaluar de manera consistente su impacto (Dunleavy et al., 2009;House et al., 2020). Otra limitación es que los pacientes rara vez participaron en el diseño de las aplicaciones de RA. ...
La educación del paciente es un componente clave en la atención médica centrada en el paciente. Objetivos: Determinar el impacto de la realidad aumentada (RA) en la educación de los pacientes. Métodos: Se llevaron a cabo búsquedas sistemáticas en cuatro bases de datos electrónicas siguiendo las directrices PRISMA. Los estudios empíricos que utilizaron cualquier tipo de intervención de RA en la educación de pacientes de todas las especialidades médicas fueron incluidos. También se realizó una evaluación de la calidad de los estudios identificados. Resultados: Se incluyeron diez estudios que involucraron a 788 pacientes. Estos comprendían ensayos controlados aleatorizados (n = 3), ensayos controlados no aleatorizados (n = 3), estudios pre y post intervención (n = 3) y una encuesta cualitativa (n = 1). La literatura fue altamente heterogénea. Las enfermedades crónicas estudiadas incluyeron cáncer de próstata, diabetes mellitus, esclerosis múltiple y epilepsia. Los resultados cuantitativos mostraron que la RA tuvo un impacto positivo en la retención de conocimientos y en la satisfacción del paciente. Los hallazgos cualitativos indicaron que los pacientes encontraron la tecnología agradable y fácil de usar. Conclusión: La evidencia limitada en este campo sugiere que la RA tiene un potencial prometedor en la educación de los pacientes.
... Those intraoperative applications especially offering image guidance and data display (8) are currently being explored by many surgical specialties such as urology (9), ophthalmology (10), neurosurgery (11), and visceral (12), vascular (13) and spinal surgery (14). The corresponding software allows for reconstructing 3D models that surgeons can then view on a stereoscopic HMD (15), surgical planning, telemedicine and patient education, and can stream ultrasound, laparoscopy and endoscopy images inside an MR view (16), as well as stereoelectroencephalographic interventions in patients with epilepsy, cerebral or kidney aneurysms, skull base tumors, cervical fractures and craniomaxillofacial surgery (17). Furthermore, using MR/AR HMDs in video-assisted surgery can mitigate ergonomic disadvantages of conventional monitors, such as limited freedom of movement resulting in muscular fatigue of the upper body (18). ...
Introduction
Head-mounted displays (HMDs) that superimpose holograms onto patients are of particular surgical interest as they are believed to dramatically change surgical procedures by including safety warning and allowing real-time offsite consultations. Although there are promising benefits of mixed and augmented reality (MR/AR) technologies in surgery, they also raise new ethical concerns. The aim of this systematic review is to determine the full spectrum of ethical issues that is raised for surgeons in the intraoperative application of MR/AR technology.
Methods
Five bibliographic databases were searched for publications on the use of MR/AR, HMDs and other devices, their intraoperative application in surgery, and ethical issues. We applied qualitative content analysis to the n = 50 articles included. Firstly, we coded the material with deductive categories derived from ethical frameworks for surgical innovations, complications and research. Secondly, clinical aspects with ethical relevance were inductively coded as ethical issues within the main categories. Thirdly, we pooled the ethical issues into themes and sub-themes. We report our findings according to the reporting guideline RESERVE.
Results
We found n = 143 ethical issues across ten main themes, namely patient-physician relationship, informed consent, professionalism, research and innovation, legal and regulatory issues, functioning equipment and optimal operating conditions, allocation of resources, minimizing harm, good communication skills and the ability to exercise sound judgement. The five most prevalent ethical issues are “Need for continuous research and innovation”, “Ensuring improvement of the learning curve”, “MR/AR enables new maneuvers for surgeons”, “Ensuring improvement of comfort, ergonomics, and usability of devices,” and “Not withholding MR/AR if it performs better”.
Conclusions
Recognizing the evidence-based limitations of the intraoperative MR/AR application is of paramount importance to avoid ethical issues, but clinical trials in surgery pose particular ethical risks for patients. Regarding the digital surgeon, long-term impact on human workforce, potentially harmful “negative training,” i.e., acquiring inappropriate behaviors, and the fear of surveillance need further attention. MR/AR technologies offer not only challenges but significant advantages, promoting a more equitable distribution of surgical expertise and optimizing healthcare. Aligned with the core principle of social justice, these technologies enable surgeons to collaborate globally, improving training conditions and addressing enduring global healthcare inequalities.
... To offset costs incurred by new infrastructure, the ideal situation will be for the chosen technology to have other uses within the hospital setting by other healthcare professionals. Some studies have explored the use of MR modules for pre-operative counseling to improve patients' understanding and reduce their anxiety about their pending inpatient experience [36]. Concurrently, the same technology has been shown to improve patients' understanding of their own disease and hence, empower them to adhere to treatment [37]. ...
Giant supratentorial brain tumors (GSBTs) in children are uncommon and extremely challenging entities unique to pediatric neurosurgery. Factors such as young patient age, need for urgent intervention, intraoperative blood loss, and ongoing raised intracranial pressure symptoms are examples of difficulties faced. Recently, there has been a growing body of literature on augmented reality (AR) in adult neurosurgery. In contrast, the use of AR in pediatric neurosurgery is comparatively less. Nonetheless, we postulate that AR systems will be helpful for understanding spatial relationships of complex GSBT anatomy for preoperative planning in a timely fashion. This study describes our experience in trialing AR as a potential tool for three cases of pediatric GSBTs. Overall, the AR platform offers our neurosurgical team excellent visuospatial insights for preoperative decision-making. However, we observe that substantial time is required to set up the AR system prior to each clinical case discussion by the neurosurgical team. In congruency with existing literature, our preliminary results report that there are still obstacles that need to be addressed before the technology can be seamlessly implemented into the clinical workflow for these time-sensitive childhood brain tumors. To our knowledge, this is the first study to report the potential use of AR for complex pediatric GSBT cases.
... Patients who feel more informed and involved in the decision-making process are likely to have increased confidence in their healthcare providers and the proposed interventions. [2,4,8,9,[18][19][20] is, in turn, can lead to improved patient experiences and potentially better surgical outcomes. ...
Background
Informed consent is a crucial aspect of modern medicine, but it can be challenging due to the complexity of the information involved. Mixed reality (MR) has emerged as a promising technology to improve communication. However, there is a lack of comprehensive research on the impact of MR on medical informed consent. The proposed research protocol provides a solid foundation for conducting future investigations and developing MR-based protocols that can enhance patients’ understanding and engagement in the decision-making process.
Methods
This study will employ a randomized controlled trial design. Two arms will be defined: MR-assisted informed consent (MRaIC) as the experimental arm and conventional informed consent (CIC) as the control arm consent, with 52 patients in each group. The protocol includes the use of questionnaires to analyze the anxiety levels and the awareness of the procedure that the patient is going to perform to study the impact of MRaIC versus CIC before medical procedures.
Results
The study will evaluate the impact of MR on patients’ information comprehension, engagement during the process of obtaining informed consent, emotional reactions, and consent decisions. Ethical concerns will be addressed.
Conclusion
This study protocol provides a comprehensive approach to investigate the impact of MR on medical informed consent. The findings may contribute to a better understanding of the effects of MR on information comprehension, engagement during the process of obtaining informed consent, psychological experience, consent decisions, and ethical considerations. The integration of MR technology has the potential to enhance surgical communication practices and improve the informed consent process.
... 26 Mixed reality has also found applications in doctor-patient communication and telemedicine. 27 Additionally, mixed reality has emerged as a modality of interactive academic content consumption. 28 The utility of mixed reality as a training tool has particular appeal because it combines the immersiveness and potential of VR with the intuitiveness and orientation of AR. ...
OBJECTIVE
The objective of this study was to analyze the potential and convenience of using mixed reality as a teaching tool for craniovertebral junction (CVJ) anomaly pathoanatomy.
METHODS
CT and CT angiography images of 2 patients with CVJ anomalies were used to construct mixed reality models in the HoloMedicine application on the HoloLens 2 headset, resulting in four viewing stations. Twenty-two participants were randomly allocated into two groups, with each participant rotating through all stations for 90 seconds, each in a different order based on their group. At every station, objective questions evaluating the understanding of CVJ pathoanatomy were answered. At the end, subjective opinion on the user experience of mixed reality was provided using a 5-point Likert scale. The objective performance of the two viewing modes was compared, and a correlation between performance and participant experience was sought. Subjective feedback was compiled and correlated with experience.
RESULTS
In both groups, there was a significant improvement in median (interquartile range [IQR]) objective performance with mixed reality compared with DICOM: 1) group A: case 1, median 6 (IQR 6–7) versus 5 (IQR 3–6), p = 0.009; case 2, median 6 (IQR 6–7) versus 5 (IQR 3–6), p = 0.02; 2) group B: case 1, median 6 (IQR 5–7) versus 4 (IQR 2–5), p = 0.04; case 2, median 6 (IQR 6–7) versus 5 (IQR 3–7), p = 0.03. There was significantly higher improvement in less experienced participants in both groups for both cases: 1) group A: case 1, r = −0.8665, p = 0.0005; case 2, r = −0.8002, p = 0.03; 2) group B: case 1, r = −0.6977, p = 0.01; case 2, r = −0.7417, p = 0.009. Subjectively, mixed reality was easy to use, with less disorientation due to the visible background, and it was believed to be a useful teaching tool.
CONCLUSIONS
Mixed reality is an effective teaching tool for CVJ pathoanatomy, particularly for young neurosurgeons and trainees. The versatility of mixed reality and the intuitiveness of the user experience offer many potential applications, including training, intraoperative guidance, patient counseling, and individualized medicine; consequently, mixed reality has the potential to transform neurosurgery.
... Together with AR and VR, 3D printing is believed to have great potential to transform how physicians access and view medical imaging data [16]. Furthermore, research has shown that AR, VR, and 3D printing could improve patient education and help to create well-informed patients suffering from various diseases [17,18], potentially improving therapeutic compliance [19,20]. ...
Although an increased usage and development of 3D technologies is observed in healthcare over the last decades, full integration of these technologies remains challenging. The goal of this project is to qualitatively explore challenges, pearls, and pitfalls of AR/VR/3D printing applications usage in the medical field of a university medical center. Two rounds of face-to-face interviews were conducted using a semi-structured protocol. First an explorative round was held, interviewing medical specialists (8), PhD students (7), 3D technology specialists (5), and university teachers (3). In the second round, twenty employees in high executive functions of relevant departments were interviewed on seven statements that resulted from the first interviewing round. Data analysis was performed using direct content analyses. The first interviewing round resulted in challenges and opportunities in 3D technology usage that were grouped in 5 themes: aims of using AR/VR/3D printing (1), data acquisition (2), data management plans (3), software packages and segmentation tools (4), and output data and reaching end-user (5). The second interviewing round resulted in an overview of ideas and insights on centralization of knowledge, improving implementation of 3D technology in daily healthcare, reimbursement of 3D technologies, recommendations for further studies, and requirement of using certified software. An overview of challenges and opportunities of 3D technologies in healthcare was provided. Well-designed studies on clinical effectiveness, implementation and cost-effectiveness are warranted for further implementation into the clinical setting.
... 45 It also has the potential to explain complex medical situations to patients and their relatives. 37,46,47 Immersive technologies in medicine have many different applications. Among others, these include training, 18,34,36,37,39 motor skills learning, 28,34,39 quality control, 34 surgery planning, 18,21,36,48 better imagination of tumor locations and determination of dissection lines, 19 intraoperative image guidance and navigation, 18,19,21,26,48 and virtual evaluation of treatment outcomes. ...
Tooth anatomy is fundamental knowledge used in everyday dental practice to reconstruct the occlusal surface during cavity fillings. The main objective of this project was to evaluate the suitability of two types of anatomical tooth reference models used to support reconstruction of the occlusal anatomy of the teeth: (1) a three‐dimensional (3D)‐printed model and (2) a model displayed in augmented reality (AR) using Microsoft HoloLens. The secondary objective was to evaluate three aspects impacting the outcome: clinical experience, comfort of work, and other variables. The tertiary objective was to evaluate the usefulness of AR in dental education. Anatomical models of crowns of three different molars were made using cone beam computed tomography image segmentation, printed with a stereolithographic 3D‐printer, and then displayed in the HoloLens. Each participant reconstructed the occlusal anatomy of three teeth. One without any reference materials and two with an anatomical reference model, either 3D‐printed or holographic. The reconstruction work was followed by the completion of an evaluation questionnaire. The maximum Hausdorff distances (Hmax) between the superimposed images of the specimens after the procedures and the anatomical models were then calculated. The results showed that the most accurate but slowest reconstruction was achieved with the use of 3D‐printed reference models and that the results were not affected by other aspects considered. For this method, the Hmax was observed to be 630 μm (p = 0.004). It was concluded that while AR models can be helpful in dental anatomy education, they are not suitable replacements for physical models.
... mm。 应用误差是导航系统在实际应用过程中产生 的误差，与导航系统的校准不佳、动态参考架追 踪范围不足、影像学数据漂移、术者经验等因素 均有关系 [16] 。MR 系统的应用误差主要受系统的目 标配准误差及系统的实时动态追踪功能影响。本 研究搭建的基于 MR 显示与光学定位追踪的手术导 航系统，不仅可有效解决传统导航系统中导航信 息和手术场景分离的问题，同时基于光学定位系统 的 高 精 度 定 位 追 踪 功 能 ， 可 弥 补 MR 设 备 在 SLAM 方面的不足，从而实现 MR 系统对移动目标 的实时动态融合显示。本研究在 MR 系统引导下的 头 颅 Le Fort Ⅰ 型 截 骨 实 验 的 截 骨 应 用 误 差 为 (3.13±1.66) mm， 优 于 Gibby 等 [25] 报 道 的 (3.62± 前规划三维影像叠加于真实术区，可以清晰地看 到病变所在边界和位置、虚拟手术规划，提高手 术的精确性与安全性。本研究完成了 ZMC 复位的 模型实验和额骨缺损修复的临床应用。首先，基 于 MR 技术的三维显示，医生能够更直观、高效地 与患者进行术前沟通，患者也更能立体、直观地 了解治疗方案、潜在风险和修复重建效果，这也 是 目 前 MR 技 术 在 医 学 领 域 的 一 个 主 要 应 用 场 景[26][27] ；其次，利用 MR 技术可以让术者对病灶的 理解更加精准，进行术前风险评估，制定最佳手 术方案，可视化的术前评估有助于增强术者的信 心和提高手术安全性 [10, 28] ；第三，术中使用基于光 学定位追踪和 MR 技术提供的实时三维可视化拟合 图像，术者可更微创、精准、完整地获取术区的 视觉和空间信息，并基于术前规划影像完成修复 重建过程，手术的精确性和安全性均得到提升； 此外，MR 技术结合 3D 打印技术在医学外科培训 中具有较大优势。由于颌面部解剖结构复杂、骨 块小、骨缝多、手术难度大，MR 技术结合 3D 打 印模型为外科培训提供了一个理想平台，能够极 大地提高低年资医师的培训效率 [29] 。 综上，本研究搭建了基于 MR 显示及红外光学 追踪定位的手术导航系统，具有虚实融合效果佳、 动态导航稳定性好的优点，在颅颌面外科的医患 沟通、医学教育、术前规划和术中导航等各方面 都有一定的应用优势。尽管目前基于 MR 技术的手 术导航仍有不足之处，其大规模的临床应用尚有 待相关技术的发展和改进，基于 MR 技术的手术导 航 将 是 数 字 化 外 科 及 精 准 医 学 的 一 个 重 要 发 展 方向。 利益冲突声明：作者声明本文无利益冲突。 [参考文献] ...
Objectives:
This study aimed to build a surgical navigation system based on mixed reality (MR) and optical positioning technique and evaluate its clinical applicability in craniomaxillofacial trauma bone reconstruction. Me-thods We first integrated the software and hardware platforms of the MR-based surgical navigation system and explored the system workflow. The systematic error, target registration error, and osteotomy application error of the system were then analyzed via 3D printed skull model experiment. The feasibility of the MR-based surgical navigation system in craniomaxillofacial trauma bone reconstruction was verified via zygomatico-maxillary complex (ZMC) reduction experiment of the skull model and preliminary clinical study.
Results:
The system error of this MR-based surgical navigation system was 1.23 mm±0.52 mm, the target registration error was 2.83 mm±1.18 mm, and the osteotomy application error was 3.13 mm±1.66 mm. Virtual surgical planning and the reduction of the ZMC model were successfully conducted. In addition, with the guidance of the MR-based navigation system, the frontal bone defect was successfully reconstructed, and the clinical outcome was satisfactory.
Conclusions:
The MR-based surgical navigation system has its advantages in virtual reality fusion effect and dynamic navigation stability. It provides a new method for doctor-patient communications, education, preoperative planning, and intraoperative navigation in craniomaxillofacial surgery.
... Furthermore, evidence suggests a benefit to patient education as well, as an increase in comprehension and a decrease in anxiety was experienced by patients after being subjected to MR-based counseling [60], while simultaneously providing a potential method of intervention to improve patients' understanding of their own disease and adherence to treatment, and hence, facilitate knowledge transfer between health care professionals and individual patients [61]. ...
Background
Mixed reality (MR) and its potential applications have gained increasing interest within the medical community over the recent years. The ability to integrate virtual objects into a real-world environment within a single video-see-through display is a topic that sparks imagination. Given these characteristics, MR could facilitate preoperative and preinterventional planning, provide intraoperative and intrainterventional guidance, and aid in education and training, thereby improving the skills and merits of surgeons and residents alike.
Objective
In this narrative review, we provide a broad overview of the different applications of MR within the entire spectrum of surgical and interventional practice and elucidate on potential future directions.
Methods
A targeted literature search within the PubMed, Embase, and Cochrane databases was performed regarding the application of MR within surgical and interventional practice. Studies were included if they met the criteria for technological readiness level 5, and as such, had to be validated in a relevant environment.
Results
A total of 57 studies were included and divided into studies regarding preoperative and interventional planning, intraoperative and interventional guidance, as well as training and education.
Conclusions
The overall experience with MR is positive. The main benefits of MR seem to be related to improved efficiency. Limitations primarily seem to be related to constraints associated with head-mounted display. Future directions should be aimed at improving head-mounted display technology as well as incorporation of MR within surgical microscopes, robots, and design of trials to prove superiority.
... It allows people to experience a scenario where virtual and real objects coexist (5). In recent years, AR technology has been increasingly used in medicine, such as education and training (6)(7)(8) and hologram-guided surgery (9)(10)(11). Talbot et al. first utilized the AR technique to guide the positioning of radiotherapy patients (12), which was subsequently explored and improved by Tarutani et al. (13) and Johnson et al. (14). ...
Purpose
The aim of this study is to develop an augmented reality (AR)–assisted radiotherapy positioning system based on HoloLens 2 and to evaluate the feasibility and accuracy of this method in the clinical environment.
Methods
The obtained simulated computed tomography (CT) images of an “ISO cube”, a cube phantom, and an anthropomorphic phantom were reconstructed into three-dimensional models and imported into the HoloLens 2. On the basis of the Vuforia marker attached to the “ISO cube” placed at the isocentric position of the linear accelerator, the correlation between the virtual and real space was established. First, the optimal conditions to minimize the deviation between virtual and real objects were explored under different conditions with a cube phantom. Then, the anthropomorphic phantom–based positioning was tested under the optimal conditions, and the positioning errors were evaluated with cone-beam CT.
Results
Under the normal light intensity, the registration and tracking angles are 0°, the distance is 40 cm, and the deviation reached a minimum of 1.4 ± 0.3 mm. The program would not run without light. The hologram drift caused by the light change, camera occlusion, and head movement were 0.9 ± 0.7 mm, 1.0 ± 0.6 mm, and 1.5 ± 0.9 mm, respectively. The anthropomorphic phantom–based positioning errors were 3.1 ± 1.9 mm, 2.4 ± 2.5 mm, and 4.6 ± 2.8 mm in the X (lateral), Y (vertical), and Z (longitudinal) axes, respectively, and the angle deviation of Rtn was 0.26 ± 0.14°.
Conclusion
The AR-assisted radiotherapy positioning based on HoloLens 2 is a feasible method with certain advantages, such as intuitive visual guidance, radiation-free position verification, and intelligent interaction. Hardware and software upgrades are expected to further improve accuracy and meet clinicalbrendaannmae requirements.
... A research [36] provides smart visualization for tumors in the brain using smart that gave better accuracy than medical 2D imaging disorders, which often need AR application assistance. This has also been experienced by [20] where the 2D model was considered better by participants than the 3D model. ...
Neurology is considered as one of the most challenging fields of medical science due to the complexity of the nervous system in human body. The treatment processes of the patients suffering from neurological disorders are greatly influenced by the advancements in technology. In this regard, the infusion of augmented reality (AR) has immensely improved patients’ and healthcare workers’ experiences in the field of neurology. Several efforts are being made by the community to introduce various applications of AR for patients as well as for healthcare workers in neurology. This study systematically examines the applications of AR in neurology and synthesizes their uses and impacts in the treatment and assistance of the patients suffering from neurological disorders as well as in the assistance of healthcare workers. The results reveal that most of the AR applications are used for motor disorders while lesser systems are designed for patients with degenerative diseases, most of them being task assistance systems. Moreover, the use of AR applications leaves both long-term and short-term impacts in improving the quality of patient’s life. Furthermore, there is a need of introducing more interactive AR systems for patients with degenerative diseases as well as exploring the possibility of using such systems for mental rehabilitation. It has also been identified that there is a potential to develop AR applications for healthcare workers, to train and assist them through simulations. In addition to reviewing the AR applications, this work proposes a taxonomy of AR applications in neurology with different dimensions including scope of AR, type of neurological disorder, and impact of AR assistance on patient’s life. Furthermore, this article also highlights challenges the patients with neurological disorders face while using AR applications. Based on the identified challenges, a model has been proposed for application designers and developers to help them develop more useful AR systems. An AR applications architecture has also been suggested for designing the AR systems for patients suffering specifically from degenerative or movement neuro-disorders. Lastly, this article presents some directions for future work in terms of AR usage in neuroscience.
... The researchers concluded that MR technologies act as a practical tool to unite disease perspectives between patients and professionals as well as optimize knowledge transfer. In addition, House et al [44] investigated the use of an MR tool, VSI Patient Education, to provide superior education before epilepsy surgery or stereotactic electrode implantation compared with standard 3D rubber brain models. The results showed that the MR tool provided more comprehensible and imaginable patient education than the rubber brain model. ...
Background
Mixed reality (MR) devices provide real-time environments for physical-digital interactions across many domains. Owing to the unprecedented COVID-19 pandemic, MR technologies have supported many new use cases in the health care industry, enabling social distancing practices to minimize the risk of contact and transmission. Despite their novelty and increasing popularity, public evaluations are sparse and often rely on social interactions among users, developers, researchers, and potential buyers.
Objective
The purpose of this study is to use aspect-based sentiment analysis to explore changes in sentiment during the onset of the COVID-19 pandemic as new use cases emerged in the health care industry; to characterize net insights for MR developers, researchers, and users; and to analyze the features of HoloLens 2 (Microsoft Corporation) that are helpful for certain fields and purposes.
Methods
To investigate the user sentiment, we collected 8492 tweets on a wearable MR headset, HoloLens 2, during the initial 10 months since its release in late 2019, coinciding with the onset of the pandemic. Human annotators rated the individual tweets as positive, negative, neutral, or inconclusive. Furthermore, by hiring an interannotator to ensure agreements between the annotators, we used various word vector representations to measure the impact of specific words on sentiment ratings. Following the sentiment classification for each tweet, we trained a model for sentiment analysis via supervised learning.
Results
The results of our sentiment analysis showed that the bag-of-words tokenizing method using a random forest supervised learning approach produced the highest accuracy of the test set at 81.29%. Furthermore, the results showed an apparent change in sentiment during the COVID-19 pandemic period. During the onset of the pandemic, consumer goods were severely affected, which aligns with a drop in both positive and negative sentiment. Following this, there is a sudden spike in positive sentiment, hypothesized to be caused by the new use cases of the device in health care education and training. This pandemic also aligns with drastic changes in the increased number of practical insights for MR developers, researchers, and users and positive net sentiments toward the HoloLens 2 characteristics.
Conclusions
Our approach suggests a simple yet effective way to survey public opinion about new hardware devices quickly. The findings of this study contribute to a holistic understanding of public perception and acceptance of MR technologies during the COVID-19 pandemic and highlight several new implementations of HoloLens 2 in health care. We hope that these findings will inspire new use cases and technological features.
... It has been described that augmented reality had a main influence in 16.7% of neurovascular surgeries (Meola et al., 2017), permitting an advanced rate of accurate localization of cuts and shorter operational interval compared to a conventional 2D method (Yu et al., 2018). Neurosurgeons advantage mostly from accurate localization of separate blood vessels, gyros, major neuronal tracts, and the possibility to design the surgical corridor, for example, in neurovascular surgery (Guha et al., 2017), epilepsy surgery (House et al., 2020), or in the elimination of superficial tumors (Mascitelli et al., 2018). ...
Present signs of development in virtual and augmented reality have offered an important amount of inventive outfits into the customer market. Virtual reality (VR) technology has now affected the optimistic features of treatment. Surgeries in especially urology are constantly emerging, and the virtual reality model has become an important supplement in urologist teaching and training lists. This chapter provides a summary of the significance and varieties of virtual reality methods, their present applications in the area of urology (surgery), and upcoming implications.
... The use of VR as a visual aid for improving patients' understanding of procedures is now growing. House et al. (2020) have used XR to educate patients on pre-operative education before epilepsy surgery (stereotactic electrode implantation). Migoya-Borja et al. (2020) have used VR to help educate patients on pre-operative education and depressive symptoms, respectively. ...
Executive Summary
https://www.xrhealthuk.org/
The time has come for a change of pace. The global face of XR in healthcare is evolving. The COVID-19 pandemic has ushered in the use of XR in healthcare as providers are forced to accelerate their digital transformation journeys and adopt novel and innovative solutions to navigate the impact of the pandemic. A unique opportunity presents itself for the UK to lead this expanding market.
AR and VR have been revolutionising the global healthcare market and demonstrating impact, value and efficiencies for some time before the pandemic struck. The predicted growth of the AR healthcare market is expected to generate US1.2 billion in 2024 (ABI Research Oct 7th, 2020). In the UK use-at-home market, The Times reported in January 2021 that the sales of VR headsets had risen by 350% as those trapped at home seek a safe way to escape the lockdown. At the start of last year, one in 17 UK households had a VR headset at home, according to Ofcom, up from one in 20 in 2018.
There is a nascent but world-class XR innovation emerging in the UK’s healthcare market, as cutting-edge research is undertaken in UK universities and ground-breaking innovation is happening in start-ups and SMEs. In addition, novel collaborations and trials are demonstrating the potential value and cost savings to be gained from the application of XR in healthcare and the impact on and improvement to people’s lives. Despite the market potential for the UK, the evidence generated is not being measured efficiently and the benefits, although becoming clearer, are not being valued to the extent needed to trigger the funding, investment and strategic interventions needed to grow a sustainable and thriving UK XR healthcare sector.
One of the biggest drivers within the NHS is to provide value for money. The health economics in this report emphasises the potential that XR offers in supporting healthcare services to deliver highly effective outcomes in a more cost-effective way. XR can be used to help patients face operations and treatments that they would otherwise avoid, this could lead to £2 million of possible savings per year. Delivering therapies remotely via VR can be 2-3 times cheaper than traditional rehabilitation, cut wait times, improve engagement and reduce the likelihood of symptoms exacerbating. Finally, XR can reduce costs to training, and improve overall surgical performance by as much as 230% versus traditional training methods. This evidence is a fundamental requirement for the health system and it is unlikely any XR solution can be adopted into clinical practice or attract the investment needed to scale without the data to support its effectiveness.
Research and development of XR is hampered by a fragmented ecosystem and the lack of opportunities for cross-sector collaboration. Pockets of innovation sit in industry, isolated from the clinicians or researchers needed to turn ideas into reality. There is, as yet, no marketplace for efficiently distributing XR in healthcare solutions. It is extremely difficult for products or experiences to convert into clinical trials to substantiate the value and impact. It is even harder to get in front of commissioners, procurers or purchasers. Funded and market-ready solutions struggle to find a route to market, as, in order to get onto a procurement platform, XR solutions have to meet standards and assurances which currently are not fit for purpose for the unique applications of XR.
The aim of this report is to outline what we mean by XR in healthcare and how it is being implemented in the UK. It identifies the potential value of XR, explores the evidence that demonstrates its impact on human health and estimates the potential cost savings to the UK healthcare system. The report delves into use cases of XR in healthcare across a number of key application areas, including mental health and wellbeing, physiotherapy and rehabilitation, pain management, healthcare professional clinical skills training and patient education. Our goal is to showcase the people and projects innovating in this space and to demonstrate the potential value XR could bring to clinical and non-clinical settings. The report also highlights the unique collaborations emerging on the clinical front line, bringing clinicians, academics, gaming and XR companies and others together to address real needs within the health system.
More importantly, this report brings together for the first time a snapshot of XR in healthcare in the UK today, outlines the barriers to its growth and makes recommendations that will help government and public health services make informed decisions on future strategies. This will ensure the UK is in the best position to unlock the potential of XR in healthcare and ultimately improve patient outcomes and quality of life.
The report proposes three key recommendations to move XR healthcare in the UK into a world leading position:
1. Undertake a comprehensive mapping and analysis of the businesses, healthcare organisations and universities working with XR in healthcare to better understand the UK’s capacity and capabilities, the size and scale of the market, its potential value and future growth.
2. Develop collaborative ‘Centres of Excellence’ (CoEs) in healthcare XR to create a development pipeline which enables a clear pathway from concept to investment and scaling to market.Working in partnership, CoEs would facilitate the production of clinically robust, engaging, marketable products to be made available on national platforms for secure purchase to healthcare providers, improving patient experience, quality and value in health intervention. Vitally, CoEs will also act to further develop a body of evidence.
3. Establish a representative and impartial alliance network that facilitates the connection of academic institutions, researchers, healthcare providers, clinicians, XR, digital and creative industries in order to support new collaborations, inform, signpost and share insights and expertise.
https://www.xrhealthuk.org/
... Despite increasing use and preference of digital technologies, a combination of multiple modalities with structured (compared to ad hoc instruction), patient-and health literacy-specific, and culturally appropriate (special considerations for racial, ethnic, language, and economically disadvantaged groups) strategies can provide incremental benefit, especially if verification of caregivers' understanding is possible [42,43]. Patient-specific strategies also include showing children's neuroimaging pictures to the caregivers, as well as using three-dimensional teaching tools, such as rubber brain models and virtual reality tools (when freely available) to provide caregivers more insights into the underlying brain anatomy, pathology, surgi- cal procedure to improve knowledge and reduce anxieties [44]. Besides providing direct information, HCPs also can steer caregivers to reputable online forums and peer-to-peer support programs to allow them to receive support and evidence-based information. ...
Objective
In selected children with drug-resistant epilepsy (DRE), epilepsy surgery is the most effective treatment option, but unfortunately remains highly underutilized. One of the critical obstacles to pursuing surgical therapy is parents/caregivers’ decision against surgery or to delay the surgery until no other treatment option exists. Understanding caregiver decision-making around epilepsy surgery can improve patient/caregiver experience and satisfaction while facilitating appropriate decision-making that optimizes clinical outcomes. The current review systematically explores the existing evidence on caregiver experience and the decision-making process toward epilepsy surgery.
Methods
The study was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic literature review. Databases (PubMed Ovid, PubMed Medline, Web of Science, CINHAL, PsycInfo) were systematically searched in February 2021 using a defined search strategy and inclusion/exclusion criteria. Total 1304 articles were screened for titles and abstracts, and 54 full-text articles were retrieved for further assessment. We included 14 articles with critical quality assessment using two different tools for qualitative and questionnaire-based studies. A qualitative content analysis was performed to characterize caregiver experience, perception, and decision-making toward favorable or unfavorable opinions of epilepsy surgery.
Results
Four concepts generated from the analysis may act as enablers or barriers to decision-making around epilepsy surgery: 1. Access to knowledge and information, 2. Communication and coordination issues, 3. Caregiver's emotional state, and 4. Socioeconomic effects. Subsequently, we provided a narrative synthesis of practice recommendations and a conceptual framework to adopt multi-pronged interventions to overcome identified diverse barriers to effective caregiver decision-making.
Conclusion
Multiple influences impact how caregivers decide about epilepsy surgery for their children, with no single factor identified as the primary driver for or against surgery. However, limited research has explored these influences. Future studies should focus on quantitatively examining factors to identify significant variables most likely to influence caregiver decision-making, ultimately overcoming barriers that limit utilization of epilepsy surgery as a treatment tool.
... Providing detailed information can make >50% of patients and family members more favorable toward epilepsy surgery [18]. Besides traditional teaching tools, a prospective and randomized clinical study showed superiority of a new mixed reality tool (''VSI Patient Education" running on HoloLens Ò glasses) over the traditional 3dimensional rubber brain model to educate patients before epilepsy surgery [19]. Patients could comprehend and imagine the procedure better using the new tool. ...
Interventions focused on utilization of epilepsy surgery can be divided into groups: those that improve patients’ access to surgical evaluation and those that facilitate completion of the surgical evaluation and treatment. Educational intervention, technological innovation, and effective coordination and communication can significantly improve patients’ access to surgery. Patient and public facing, individualized (analog and/or digital) communication can raise awareness and acceptance of epilepsy surgery. Educational interventions aimed at providers may mitigate knowledge gaps using practical and concise consensus statements and guidelines, while specific training can improve awareness around implicit bias. Innovative technology, such as clinical decision-making toolkits within the electronic medical record (EMR), machine learning techniques, online decision-support tools, nomograms, and scoring algorithms can facilitate timely identification of appropriate candidates for epilepsy surgery with individualized guidance regarding referral appropriateness, postoperative seizure freedom rate, and risks of complication after surgery. There are specific strategies applicable for epilepsy centers’ success: building a multidisciplinary setup, maintaining/tracking volume and complexity of cases, collaborating with other centers, improving surgical outcome with reduced complications, utilizing advanced diagnostics tools, and considering minimally invasive surgical techniques. Established centers may use other strategies, such as multi-stage procedures for multifocal epilepsy, advanced functional mapping with tailored surgery for epilepsy involving the eloquent cortex, and generation of fresh hypotheses in cases of surgical failure. Finally, improved access to epilepsy surgery can be accomplished with policy changes (e.g., anti-discrimination policy, exemption in transportation cost, telehealth reimbursement policy, patient-centered epilepsy care models, pay-per-performance models, affordability and access to insurance, and increased funding for research). Every intervention should receive regular evaluation and feedback-driven modification to ensure appropriate utilization of epilepsy surgery.
Neurosurgical procedures are some of the most complex procedures in medicine and since the advent of the field, planning, performing, and learning them has challenged the neurosurgeon. Virtual reality (VR) and augmented reality (AR) are making these challenges more manageable. VR refers to a virtual digital environment that can be experienced usually through use of stereoscopic glasses and controllers. AR, on the other hand, fuses the natural environment with virtual images, such as superimposing a preoperative MRI image on to the surgical field [1]. They initially were used primarily as neuronavigational tools but soon their potential in other areas of surgery, such as planning, education, and assessment, was noted and explored. Through this chapter, we outline the history and evolution of these two technologies over the past few decades, describe the current state of the technology and its uses, and postulate future directions for research and implementation.
This chapter explores components of a Shared Decision-Making Discussion, including early detection, benefits and harms, within the context of lung cancer screening (LCS). Approaches to incorporating uncertainty as it pertains to risk assessment and risk reduction in the screening conversation are also examined.We address the importance of and techniques for working with patients on smoking cessation and the use of evidence-based tobacco treatment while exploring opportunities throughout the screening process to provide counseling on tobacco cessation and treatment. We evaluate barriers to quitting, personal risk assessment, and smoking cessation post screening by suggesting additional counseling on quitting when reviewing low-dose CT results with screening participants.Finally, we explore new innovative tools under development to support LCS including the use of 3D printed hand-held instruments and virtual reality to help patients understand the anatomy and biology of the lung, pulmonary nodules, tumors, and emphysema while encouraging lung health stewardship through experiential learning. Finally, we introduce potential new ways to leverage the technology of a phone app to support, encourage, and quantify smoking cessation efforts, track low-dose CT findings, and potential time lost or gained in life in association with various interventions while encouraging return visits to medical providers for follow-up.KeywordsShared decision-makingRisk reductionRisk assessmentSmoking cessationDecision aidsLung health stewardship
Objective
Low health literacy is prevalent and associated with suboptimal health outcomes. In neurosurgery, social determinants of health are increasingly recognized as factors underpinning outcomes, as well as access to and use of care. We conducted a scoping review to delineate the scope of existing literature regarding health literacy in the field and facilitate future research.
Methods
A scoping review was conducted using the PubMed, Embase, and Scopus databases. Titles and abstracts were screened for relevance. Studies meeting prespecified inclusion criteria underwent full text review. Relevant data were extracted.
Results
Of 5,056 resultant articles, 57 manuscripts were included. Thirty-seven studies (64.9%) investigated personal health literacy, while the remaining 20 (35.1%) investigated organizational health literacy. Domains of health literacy investigated were science (36, 63.2%), fundamental (20, 35.1%), and civic (1, 1.7%). No studies investigated numeracy. Recall among patients after discussions with neurosurgeons is low. Patient perspectives are often erroneous. Patient informational needs are often unmet. Written patient educational materials are written at a level too complex for the average patients. Videos are mostly of poor quality. Multimodal audiovisual interventions, eBooks, models, and virtual reality are shown to be effective methods for promoting recall.
Conclusion
Studies examining health literacy in neurosurgery primarily focus on the topic indirectly, most often via written educational materials and recall after educational interventions. Increasing awareness of health literacy among neurosurgeons, assessing health literacy, and incorporating health literacy-informed counselling approaches are warranted to improve patient care.
Objectives
The objective is to evaluate the feasibility and interobserver agreement of a Mixed Reality Viewer (MRV) in the assessment of aortoiliac vascular anatomy of abdominal aortic aneurysm (AAA) patients.
Methods
Fifty preoperative computed tomography angiographies (CTAs) of AAA patients were included. CTAs were assessed in a mixed reality (MR) environment with respect to aortoiliac anatomy according to a standardized protocol by two experienced observers (Mixed Reality Viewer, MRV, Brainlab AG, Germany). Additionally, all CTAs were independently assessed applying the same protocol by the same observers using a conventional DICOM viewer on a two-dimensional screen with multi-planar reconstructions (Conventional viewer, CV, GE Centricity PACS RA1000 Workstation, GE, United States). The protocol included four sets of items: calcification, dilatation, patency, and tortuosity as well as the number of lumbar and renal arteries. Interobserver agreement (IA, Cohen’s Kappa, κ) was calculated for every item set.
Results
All CTAs could successfully be displayed in the MRV (100%). The MRV demonstrated equal or better IA in the assessment of anterior and posterior calcification ( κ MRV : 0.68 and 0.61, κ CV : 0.33 and 0.45, respectively) as well as tortuosity ( κ MRV : 0.60, κ CV : 0.48) and dilatation ( κ MRV : 0.68, κ CV : 0.67). The CV demonstrated better IA in the assessment of patency ( κ MRV : 0.74, κ CV : 0.93). The CV also identified significantly more lumbar arteries (CV: 379, MRV: 239, p < 0.01).
Conclusions
The MRV is a feasible imaging viewing technology in clinical routine. Future efforts should aim at improving hologram quality and enabling accurate registration of the hologram with the physical patient.
Objectives
To provide an overview of the existing research concerning the use and effects of AR in patient education.
Methods
Following PRISMA guidelines four electronic databases were systematically searched. Inclusion criteria: empirical studies using any type of AR intervention in patient education across all medical specialties. Quality assessment of the retrieved literature was carried out.
Results
Ten papers, comprising 788 patients, were identified and included (Randomized controlled trial (RCT)(n=3), non-randomized controlled trial (n=3), before-and-after study (n=3), and qualitative survey (n=1)). Retrieved literature showed itself to be highly heterogeneous. The studied population included patients suffering from a diverse spectrum of chronic diseases (e.g., prostate cancer, diabetes mellitus, multiple sclerosis, epilepsy). Quantitative results indicated that the use of AR had a positive effect on knowledge retention and patient satisfaction. Qualitative findings suggested that patients liked the technology and felt comfortable with its use for educational purposes. The quality of the retrieved results was shown to be moderate to low.
Conclusion
The limited evidence of this topic suggests the possible potential of AR in patient education.
Practice implication
More research, using high-quality study designs and more evidence-based interventions, is needed to fully appreciate the value of AR on patient education.
Objectives
Neuromodulatory devices are increasingly used by neurosurgeons to manage a variety of chronic conditions. Given their potential benefits, it is imperative to create clear ethical guidelines for the use of these devices. We present a tiered ethical framework for neurosurgeon recommendations for the use of neuromodulatory devices.
Materials and Methods
We conducted a literature review to identify factors neurosurgeons should consider when choosing to offer a neuromodulatory device to a patient.
Results
Neurosurgeons must weigh reductions in debilitating symptoms, improved functionality, and preserved quality of life against risks for intraoperative complications and adverse events due to stimulation or the device itself. Neurosurgeons must also evaluate whether patients and families will maintain responsibility for the management of neuromodulatory devices. Consideration of these factors should occur on an axis of resource allocation, ranging from provision of neuromodulatory devices to those with greatest potential benefit in resource‐limited settings to provision of neuromodulatory devices to all patients with indications in contexts without resource limitations. Neurosurgeons must also take action to promote device effectiveness throughout the duration of care.
Conclusions
Weighing risks and benefits of providing neuromodulatory devices and assessing ability to remain responsible for the devices on the level of the individual patient indicate which patients are most likely to achieve benefit from these devices. Consideration of these factors on an axis of resource allocation will allow for optimal provision of neuromodulatory devices to patients in settings of varied resources. Neurosurgeons play a primary role in promoting the effectiveness of these devices.
Background
Increasing focus has been placed on patient education to optimize care. In the second part of a 2-part systematic review, we characterize the scope of interventions specifically created to improve neurosurgery patient education, assess the effectiveness of these interventions, and extract features of existing interventions that may be incorporated into future patient education interventions. Our findings may help promote the creation of effective, patient-centered educational interventions.
Methods
A 2-part systematic review was conducted using the PubMed, Embase, and Scopus databases. Titles and abstracts were read and selected for full text review. Studies meeting prespecified inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes.
Results
Of 1617 resultant articles, 33 were included. Print materials, electronic materials, models, and interventions using multiple modalities improved patient knowledge, decreased anxiety, and increased satisfaction. Electronic materials were preferred. Interventions using multiple modalities engaging multiple sensory systems were reported most beneficial. Video was rated the most effective medium for reinforcing spoken conversation between neurosurgeons and patients. Three-dimensional models decreased the time required for preoperative patient conversation but could be perceived as emotionally confronting. Virtual reality was preferred to patient models.
Conclusions
Electronic interventions using multiple modalities in concert with each other may be most effective. Interventions should incorporate baseline knowledge and health literacy and address patient concerns and needs in a manner that is valid cross-contextually, uses clear communication, and is continuous. These interventions will improve the patient-friendliness of discussions with patients.
Objective
The purpose of this study is to view research trends on surgery with mixed reality, and present the intellectual structure using bibliometric network analysis for the period 2000-2019.
Methods
Analyses are implemented in the following four steps: (1) literature dataset acquisition from article database (Web of Science, Scopus, PubMed, and IEEE digital library), (2) dataset pre-processing and refinement, (3) network construction and visualization, and (4) analysis and interpretation. Descriptive analysis, bibliometric network analysis, and in-depth qualitative analysis were conducted.
Results
The 14,591 keywords of 5,897 abstracts data were ultimately used to ascertain the intellectual structure of research on surgery with mixed reality. The dynamics of the evolution of keywords in the structure throughout the four periods is summarized with four aspects: (a) maintaining a predominant utilization tool for training, (b) widening clinical application area, (c) reallocating the continuum of mixed reality, and (d) steering advanced imaging and simulation technology.
Conclusions
The results of this study can provide valuable insights into technology adoption and research trends of mixed reality in surgery. These findings can help clinicians to overview prospective medical research on surgery using mixed reality. Hospitals can also understand the periodical maturity of technology of mixed reality in surgery, and, therefore, these findings can suggest an academic landscape to make a decision in adopting new technologies in surgery.
The purpose of this systematic review is to collate and analyse the current literature which examines clinical applications of 3D printing for renal disease, alongside cost and time duration factors associated with the printing process. A comprehensive search of the literature was performed across five different databases to identify studies that qualitatively and quantitatively assessed the value of 3D-printed kidney models for renal disease. Twenty-seven studies met the selection criteria for inclusion in the review. Twenty-five were original studies, and two were case reports. Of the 22 studies reporting a qualitative evaluation, the analysis of findings demonstrated the value of the 3D-printed models in areas of clinician and patient education, and pre-surgical simulation for complex cases of renal disease. Of five studies performing a quantitative analysis, the analysis of results displayed a high level of spatial and anatomical accuracy amongst models, with benefits including reducing estimated blood loss and risk of intra-operative complications. Fourteen studies evaluated manufacturing costs and time duration, with costs ranging from USD 1 to 1000 per model, and time duration ranging from 15 min to 9 days. This review shows that the use of customised 3D-printed models is valuable in the education of junior surgeons as well as the enhancement of operative skills for senior surgeons due to a superior visualisation of anatomical networks and pathologic morphology compared to volumetric imaging alone. Furthermore, 3D-printed kidney models may facilitate interdisciplinary communication and decision-making regarding the management of patients undergoing operative treatment for renal disease. It cannot be suggested that a more expensive material constitutes a higher level of user-satisfaction and model accuracy. However, higher costs in the manufacturing of the 3D-printed models reported, on average, a slightly shorter time duration for the 3D-printing process and total manufacturing time.
Objective:
Recently, three-dimensional (3D) printed models of the intracranial vascular have served as useful tools in simulation and training for cerebral aneurysm clipping surgery. Precise and realistic 3D printed aneurysm models may improve patients' understanding of the 3D cerebral aneurysm structure. Therefore, we created patient-specific 3D printed aneurysm models as an educational and clinical tool for patients undergoing aneurysm clipping surgery. Herein, we describe how these 3D models can be created and the effects of applying them for patient education purpose.
Methods:
Twenty patients with unruptured intracranial aneurysm were randomly divided into two groups. We explained and received informed consent from patients in whom 3D printed models-(group I) or computed tomography angiography-(group II) was used to explain aneurysm clipping surgery. The 3D printed intracranial aneurysm models were created based on time-offlight magnetic resonance angiography using a 3D printer with acrylonitrile-butadiene-styrene resin as the model material. After describing the model to the patients, they completed a questionnaire about their understanding and satisfaction with aneurysm clipping surgery.
Results:
The 3D printed models were successfully made, and they precisely replicated the actual intracranial aneurysm structure of the corresponding patients. The use of the 3D model was associated with a higher understanding and satisfaction of preoperative patient education and consultation. On a 5-point Likert scale, the average level of understanding was scored as 4.7 (range, 3.0-5.0) in group I. In group II, the average response was 2.5 (range, 2.0-3.0).
Conclusion:
The 3D printed models were accurate and useful for understanding the intracranial aneurysm structure. In this study, 3D printed intracranial aneurysm models were proven to be helpful in preoperative patient consultation.
Background:
Patient-specific 3D models are being used increasingly in medicine for many applications including surgical planning, procedure rehearsal, trainee education, and patient education. To date, experiences on the use of 3D models to facilitate patient understanding of their disease and surgical plan are limited. The purpose of this study was to investigate in the context of renal and prostate cancer the impact of using 3D printed and augmented reality models for patient education.
Methods:
Patients with MRI-visible prostate cancer undergoing either robotic assisted radical prostatectomy or focal ablative therapy or patients with renal masses undergoing partial nephrectomy were prospectively enrolled in this IRB approved study (n = 200). Patients underwent routine clinical imaging protocols and were randomized to receive pre-operative planning with imaging alone or imaging plus a patient-specific 3D model which was either 3D printed, visualized in AR, or viewed in 3D on a 2D computer monitor. 3D uro-oncologic models were created from the medical imaging data. A 5-point Likert scale survey was administered to patients prior to the surgical procedure to determine understanding of the cancer and treatment plan. If randomized to receive a pre-operative 3D model, the survey was completed twice, before and after viewing the 3D model. In addition, the cohort that received 3D models completed additional questions to compare usefulness of the different forms of visualization of the 3D models. Survey responses for each of the 3D model groups were compared using the Mann-Whitney and Wilcoxan rank-sum tests.
Results:
All 200 patients completed the survey after reviewing their cases with their surgeons using imaging only. 127 patients completed the 5-point Likert scale survey regarding understanding of disease and surgical procedure twice, once with imaging and again after reviewing imaging plus a 3D model. Patients had a greater understanding using 3D printed models versus imaging for all measures including comprehension of disease, cancer size, cancer location, treatment plan, and the comfort level regarding the treatment plan (range 4.60-4.78/5 vs. 4.06-4.49/5, p < 0.05).
Conclusions:
All types of patient-specific 3D models were reported to be valuable for patient education. Out of the three advanced imaging methods, the 3D printed models helped patients to have the greatest understanding of their anatomy, disease, tumor characteristics, and surgical procedure.
Background:
Imaging has a critical impact on surgical decision making and three-dimensional (3D) digital models of patient pathology can now be made commercially. We developed a 3D digital model of a cancer of the head of the pancreas by integrating actual CT data with 3D modeling process. After this process, the virtual pancreatic model was also produced using a high-quality 3D printer.
Patients and methods:
A 56-year-old female with pancreatic head adenocarcinoma presented with biliary obstruction and jaundice. The CT scan showed a borderline resectable tumor with a clear involvement of the gastroduodenal artery but doubtful relationships with the hepatic artery. Our team in collaboration with the Immersive Touch team used multiple series from the CT and segmented the relevant anatomy to understand the physical location of the tumor. An STL file was then developed and printed.
Results:
Reconstructing and compositing the different series together enhanced the imaging, which allowed clearer observations of the relationship between the mass and the blood vessels, and evidence that the tumor was unresectable. Data files were converted for printing a 100% size rendering model, used for didactic purposes and to discuss with the patient.
Conclusions:
This study showed that (1) reconstructing enhanced traditional imaging by merging and modeling different series together for a 3D view with diverse angles and transparency, allowing the observation of previously unapparent anatomical details; (2) with this new technology surgeons and residents can preobserve their planned surgical intervention, explore the patient-specific anatomy, and sharpen their procedure choices; (3) high-quality 3D printed models are increasingly useful not only in the clinical realm but also for personalized patient education.
The process of informed consent is an integral part of the preoperative encounter. In theory, it has the potential to educate patients, enabling them to reach a true autonomous decision regarding the treatment offered. Unfortunately, in recent years informed consent has become overly complicated for the average patient. Questions have been raised regarding the ability of the process, as practiced nowadays, to actually increase knowledge and achieve its goals. In search of new ways to increase patient comprehension, researchers have suggested use of multimedia during the process of informed consent. Visualization of complex ideas, interactive learning and tailoring the procedure to fit patient needs are all advantages presented by use of multimedia during the process. Several randomized prospective trials have looked into this topic and have presented promising data in favor of multimedia use. Informed consent is a process with unfulfilled potential, and use of multimedia may be part of the solution. In our opinion, it is time to change the way we educate patients.
Objective:
To study surgical patients' informational expectations and the level of received knowledge at the time of hospital discharge. To examine if there is an association with postoperative complications and the patient´s level of received knowledge.
Design:
Comparative descriptive design.
Setting:
The data on patients admitted for non-cardiac surgery were collected in three phases during an eight-month period.
Participants:
258 in-ward non-cardiac general surgery and orthopedic surgery adult patients.
Interventions:
Questionnaires before admission (knowledge expectations) and at discharge (received knowledge). A telephone interview 30 days after discharge.
Main outcome measures:
Received knowledge (as much or more / less) compared to expectations, and its association with post-discharge complications.
Results:
There were differences between patient groups in their perception of receiving enough knowledge and they were connected to gender (male vs. female OR 2.67, 95% CI 1.55-4.60, P = 0.0004) and procedure (elective orthopedic implant surgery vs. elective minor orthopedic and hand surgery: OR 3.25, 95% CI 1.72-6.17, P = 0.0003). Patients who received less knowledge than expected had more postoperative complications than those who received sufficient (as much or more than expected) information.
Conclusions:
Patients differ in terms of informational needs, and preoperative education prepares the patient for the information provided postoperatively. Patient education may have an influence on recovery from surgery.
Background
Virtual reality (VR) provides an immersive image-viewing experience that has recently been expanding in use in clinical medicine. We developed a three-dimensional (3D) model of an abdominal aortic aneurysm (AAA) for patients with a diagnosis of an AAA to view in VR to assess the use of VR in patient education.
Methods
This was a cross-sectional study using an educational intervention. A standardized 3D model of an AAA was generated from a computed tomography scan and uploaded onto a 3D image-hosting website. Patients with an AAA who participated in the study wore a Google Cardboard VR headset, with a mobile device displaying the digital 3D AAA image in VR. Patients completed a survey afterward for assessing satisfaction with VR on a 5-point agreement Likert scale.
Results
Between September 2017 and January 2018, 19 patients participated in our study (90% participation rate). Most participants had no prior experience with VR (n = 15; 79%), and the mean age was 69 ± 8 years. Seventeen (89%) participants agreed or strongly agreed that they felt better informed about their health status after using VR and would like to see VR used more in their health care, while sixteen (84%) agreed or strongly agreed that they felt more engaged in their health care because of using VR. Almost all participants felt comfortable using VR (n = 17; 90%) and enjoyed using the technology (n = 16; 84%).
Conclusions
VR proved to be an engaging learning tool that patients perceived as beneficial in understanding their health status. Further efforts to investigate the role of VR in education and health care should be explored.
Objective:
To investigate the effect of exposure to a virtual reality (VR) environment preoperatively on patient-reported outcomes for surgical operations.
Background:
There is a scarcity of well-developed quality improvement initiatives targeting patient satisfaction.
Methods:
We performed a randomized controlled trial of patients undergoing cranial and spinal operations in a tertiary referral center. Patients underwent a 1:1 randomization to an immersive preoperative VR experience or standard preoperative experience stratified on type of operation. The primary outcome measures were the Evaluation du Vecu de l'Anesthesie Generale (EVAN-G) score and the Amsterdam Preoperative Anxiety and Information (APAIS) score, as markers of the patient's experience during the surgical encounter.
Results:
During the study period, a total of 127 patients (mean age 55.3 years, 41.9% females) underwent randomization. The average EVAN-G score was 84.3 (standard deviation, SD, 6.4) after VR, and 64.3 (SD, 11.7) after standard preoperative experience (difference, 20.0; 95% confidence interval, CI, 16.6-23.3). Exposure to an immersive VR experience also led to higher APAIS score (difference, 29.9; 95% CI, 24.5-35.2). In addition, VR led to lower preoperative VAS stress score (difference, -41.7; 95% CI, -33.1 to -50.2), and higher preoperative VAS preparedness (difference, 32.4; 95% CI, 24.9-39.8), and VAS satisfaction (difference, 33.2; 95% CI, 25.4-41.0) scores. No association was identified with VAS stress score (difference, -1.6; 95% CI, -13.4 to 10.2).
Conclusions:
In a randomized controlled trial, we demonstrated that patients exposed to preoperative VR had increased satisfaction during the surgical encounter. Harnessing the power of this technology, hospitals can create an immersive environment that minimizes stress, and enhances the perioperative experience.