An Augmented Reality Device for Remote Supervision of Ultrasound Examinations in International Exercise Science Projects: Usability Study

Kovoor J.G., Gupta A.K., Gladman M.A.

Background Current challenges in surgical training have led to the investigation of augmented reality as a potential method of supplementary education. However, its value for this purpose remains uncertain. The aim of this study was to perform a systematic review of the published literature to evaluate the validity and effectiveness of augmented reality in surgical education, and to compare it with other simulation modalities. Methods Electronic literature searches were performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two authors independently extracted pertinent data and assessed study quality. The primary outcome measures of interest were the validity and effectiveness of augmented reality as an educational tool. Results Of 6,500 articles, 24 studies met eligibility criteria for inclusion, of which 2 were randomized. Ten studies investigated validity, with 7 establishing both face and content validity and an additional 1 just content validity. Construct validity was demonstrated in 9 of 11 studies. Of the 11 studies that examined the effectiveness of augmented reality in skills acquisition, 9 demonstrated enhanced learning. Of the 5 studies in which the effectiveness of augmented reality as an educational tool was compared with other modes of simulation, augmented reality was found to be superior in 2 and equivalent in the others. Conclusion Overall, the majority, including 2 high-quality randomized controlled trials, demonstrated the validity and effectiveness of augmented reality in surgical education. However, the quality of published studies was poor with marked heterogeneity. Although these results are encouraging, additional high-quality studies, preferably in the real-life environment, are required before the widespread implementation of augmented reality within surgical curricula can be recommended.

Henry-Tillman R., Kabongo M., Laryea J., Pinder L., Bittenbinder R., Osgood G., Hicks M., Hicks M., Parham G.

Background The vast majority of women with breast cancer in sub-Saharan Africa present with advanced stage disease, due primarily to the lack of opportunities for early detection and treatment. As part of a larger effort to increase access to diagnostic and therapeutic services for women's cancers in the Democratic Republic of Congo (DRC), we implemented a curriculum to train the local workforce and a program to build the supportive infrastructure for the diagnosis and treatment of breast cancer at a private sector health facility (Biamba Marie Mutombo Hospital) in Kinshasa. Study design After onsite trainings in the DRC by a US breast surgeon (RT), Congolese surgeons, general physicians, physician assistants, and nurses used the Phillips Lumify smart-phone ultrasound device to perform and interpret the results of whole breast ultrasound on symptomatic women. Surgeons were trained to perform ultrasound-guided core needle biopsy on those who met the criteria for tissue diagnosis, after which they trained nurses to do the same. Results Over 3 years, 5,211 patients were identified as having a breast abnormality on clinical breast examination. Ultrasound abnormalities were noted in 1,493 (27%) patients, of which 632 (42%) met the criteria for ultrasound-guided core needle biopsy or fine needle aspiration. Pathology reports were available on 368 (58%) patients who underwent biopsy, of which 164 were malignant and 204 benign. Conclusions We demonstrated how the "ability to look" using smart technology can be successfully used to augment clinical breast exam and triage patients for biopsy in a resource-constrained African setting.

Zaer H., Fan W., Orlowski D., Glud A.N., Andersen A.S., Schneider M.B., Adler J.R., Stroh A., Sørensen J.C.

The tsunami effect of the COVID-19 pandemic is affecting many aspects of scientific activities. Multidisciplinary experimental studies with international collaborators are hindered by the closing of the national borders, logistic issues due to lockdown, quarantine restrictions, and social distancing requirements. The full impact of this crisis on science is not clear yet, but the above-mentioned issues have most certainly restrained academic research activities. Sharing innovative solutions between researchers is in high demand in this situation. The aim of this paper is to share our successful practice of using web-based communication and remote control software for real-time long-distance control of brain stimulation. This solution may guide and encourage researchers to cope with restrictions and has the potential to help expanding international collaborations by lowering travel time and costs.

Rigamonti L., Kahle P., Peters H., Wolfarth B., Thouet T., Bonaventura K., Back D.A.

AbstractSocial media applications on smartphones allow for new avenues of instruction in sports medicine and exercise sciences. This study tested the feasibility of instructing health care personnel through videos of ultrasound vascular measurements distributed by a social media messenger application. After two training sessions with an ultrasound device, voluntary physicians (n=10) and nurses (n=10) received a video for the performance of an ultrasound-guided determination of intima-media-thickness and diameter of the femoral arteries via a social media messenger application. All participants examined the same healthy human subject. There was no significant difference between the groups regarding overall time of performance, measurements of the femoral arteries, or a specifically designed “assessment of mobile imparted arterial ultrasound determination” score. The physicians group achieved significantly higher scores in the established “objective structured assessment of ultrasound skills” score (p=0.019). Approval of the setting was high in both groups. Transmission of videos via social media applications can be used for instructions on the performance of ultrasound-guided vascular examinations in sports medicine, even if investigators’ performances differ depending on their grade of ultrasound experience. In the future, the chosen approach should be tested in practical scientific examination settings.

Scherl C., Stratemeier J., Karle C., Rotter N., Hesser J., Huber L., Dias A., Hoffmann O., Riffel P., Schoenberg S.O., Schell A., Lammert A., Affolter A., Männle D.

Augmented reality improves planning and execution of surgical procedures. The aim of this study was to evaluate the feasibility of a 3D augmented reality hologram in live parotic surgery. Another goal was to develop an accuracy measuring instrument and to determine the accuracy of the system. We created a software to build and manually align 2D and 3D augmented reality models generated from MRI data onto the patient during surgery using the HoloLens® 1 (Microsoft Corporation, Redmond, USA). To assess the accuracy of the system, we developed a specific measuring tool applying a standard electromagnetic navigation device (Fiagon GmbH, Hennigsdorf, Germany). The accuracy of our system was measured during real surgical procedures. Training of the experimenters and the use of fiducial markers significantly reduced the accuracy of holographic system (p = 0.0166 and p = 0.0132). Precision of the developed measuring system was very high with a mean error of the basic system of 1.3 mm. Feedback evaluation demonstrated 86% of participants agreed or strongly agreed that the HoloLens will play a role in surgical education. Furthermore, 80% of participants agreed or strongly agreed that the HoloLens is feasible to be introduced in clinical routine and will play a role within surgery in the future. The use of fiducial markers and repeated training reduces the positional error between the hologram and the real structures. The developed measuring device under the use of the Fiagon navigation system is suitable to measure accuracies of holographic augmented reality images of the HoloLens.

Leochico C.F., Espiritu A.I., Ignacio S.D., Mojica J.A.

Background: Despite being known abroad as a viable alternative to face-to-face consultation and therapy, telerehabilitation has not fully emerged in developing countries like the Philippines. In the midst of coronavirus disease 2019 (COVID-19) pandemic, wherein social distancing disrupted the in-clinic delivery of rehabilitation services, Filipinos attempted to explore telerehabilitation. However, several hindrances were observed especially during the pre-implementation phase of telerehabilitation, necessitating a review of existing local evidences. Objective: We aimed to determine the challenges faced by telerehabilitation in the Philippines. Method: We searched until March 2020 through Pubmed, Scopus, Embase, Cochrane Library and HeRDIN for telerehabilitation-related publications wherein Filipinos were involved as investigator or population. Because of hypothesized low number of scientific outputs on telerehabilitation locally, we performed handsearching through grey literature and included relevant papers from different rehabilitation-related professional organizations in the Philippines. We analyzed the papers and extracted the human, organizational and technical challenges to telerehabilitation or telehealth in general. Results: We analyzed 21 published and 4 unpublished papers, which were mostly reviews (8), feasibility studies (6), or case reports/ series (4). Twelve out of 25 studies engaged patients and physicians in remote teleconsultation, teletherapy, telementoring, or telemonitoring. Patients sought telemedicine or telerehabilitation for general medical conditions (in 3 studies), chronic diseases (2), mental health issues (2), orthopedic problems (2), neurologic conditions (1), communication disorders (1), and cardiac conditions (1). Outcomes in aforementioned studies mostly included telehealth acceptance, facilitators, barriers, and satisfaction. Other studies were related to telehealth governance, legalities, and ethical issues. We identified 18 human, 17 organizational and 18 technical unique challenges related to telerehabilitation in the Philippines. The most common challenges were slow internet speed (in 10 studies), legal concerns (9), and skepticism (9). Conclusion: There is paucity of data on telerehabilitation in the Philippines. Local efforts can focus on exploring or addressing the most pressing human, organizational and technical challenges to the emergence of telerehabilitation in the country.

Uruthiralingam U., Rea P.M.

Learning anatomy traditionally has depended on traditional techniques like human cadaveric dissection and the use of textbooks. As technology advances at an ever-rapid speed, there are revolutionary ways to learn anatomy. A number of technologies, techniques and methodologies are utilised in anatomical education, but ones specifically receiving a lot of interest and traction is that of augmented reality and virtual reality. Although there has been a surge in interest in the use of these technologies, the literature is sparse in terms of its evaluation as to the effectiveness of such tools. Therefore, the purpose of this study is to examine in greater detail the literature specifically to see what the best practice in this field could be. By undertaking a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched for articles in both Web of Science and PubMed. Using the terms “augmented reality and teaching anatomy” yielded 88 articles. We then used “virtual reality and teaching anatomy” which resulted in 200 articles. We examined these articles, including that on augmented reality and virtual reality used to teach anatomy to undergraduate and postgraduate students, residents, dentistry, nursing and veterinary students. Articles were excluded if they were systematic reviews, literature reviews, review articles, news articles, articles not written in English and any literature that presented how a virtual model was created without the evidence of students testing it. The inclusion and exclusion criteria for virtual reality were the same as augmented reality. In addition, we examined the articles to identify if they contained data which was quantitative, qualitative or both. The articles were further separated into those which were pro, neutral or against for the use of these digital technologies. Of the 288 articles, duplicate articles totalling 67 were removed and 134 articles were excluded according to our exclusion criteria. Of the 31 articles related to augmented reality, 30 were pro, one neutral and no articles against the use of this technology. Fifty-six articles related to virtual reality were categorised resulted in 45 pro, eight neutral and three against the use of this technology. Overall, the results indicate most articles identified related to both virtual and augmented reality were for the use of those technologies, than neutral or against. This systemic review highlights the recent advances of both augmented reality and virtual reality to implementing the technology into the anatomy course.

Kaplan A.D., Cruit J., Endsley M., Beers S.M., Sawyer B.D., Hancock P.A.

Objective The objective of this meta-analysis is to explore the presently available, empirical findings on transfer of training from virtual (VR), augmented (AR), and mixed reality (MR) and determine whether such extended reality (XR)-based training is as effective as traditional training methods. Background MR, VR, and AR have already been used as training tools in a variety of domains. However, the question of whether or not these manipulations are effective for training has not been quantitatively and conclusively answered. Evidence shows that, while extended realities can often be time-saving and cost-saving training mechanisms, their efficacy as training tools has been debated. Method The current body of literature was examined and all qualifying articles pertaining to transfer of training from MR, VR, and AR were included in the meta-analysis. Effect sizes were calculated to determine the effects that XR-based factors, trainee-based factors, and task-based factors had on performance measures after XR-based training. Results Results showed that training in XR does not express a different outcome than training in a nonsimulated, control environment. It is equally effective at enhancing performance. Conclusion Across numerous studies in multiple fields, extended realities are as effective of a training mechanism as the commonly accepted methods. The value of XR then lies in providing training in circumstances, which exclude traditional methods, such as situations when danger or cost may make traditional training impossible.

Adams K., Kiefer A., Panchuk D., Hunter A., MacPherson R., Spratford W.

Biomechanical analysis has typically been confined to a laboratory setting. While attempts have been made to take laboratory testing into the field, this study was designed to assess whether augmented reality (AR) could be used to bring the field into the laboratory. This study aimed to measure knee load in volleyball players through a jump task incorporating AR while maintaining the perception-action couplings by replicating the visual features of a volleyball court. Twelve male volleyball athletes completed four tasks: drop landing, hop jump, spike jump, and spike jump while wearing AR smart glasses. Biomechanical variables included patellar tendon force, knee moment and kinematics of the ankle, knee, hip, pelvis and thorax. The drop landing showed differences in patellar tendon force and knee moment when compared to the other conditions. The hop jump did not present differences in kinetics when compared to the spike conditions, instead of displaying the greatest kinematic differences. As a measure of patellar tendon loading the AR condition showed a close approximation to the spike jump, with no differences present when comparing landing forces and mechanics. Thus, AR may be used in a clinical assessment to better replicate information from the competitive environment.

Aarons G.A., Seijo C., Green A.E., Moullin J.C., Hasson H., von Thiele Schwarz U., James S., Ehrhart M.G., Ducarroz S., Sevdalis N., Willging C.

International collaboration in science has received increasing attention given emphases on relevance, generalizability, and impact of research. Implementation science (IS) is a growing discipline that aims to translate clinical research findings into health services. Research is needed to identify efficient and effective ways to foster international collaboration in IS. Concept-mapping (CM) was utilized with a targeted sample for preliminary exploration of fostering international collaboration. Concept-mapping is a mixed-method approach (qualitative/quantitative) particularly suited for identifying essential themes and action items to facilitate planning among diverse stakeholders. We sought to identify key factors likely to facilitate productive and rewarding international collaborations in implementation research. We identified eleven dimensions: Strategic Planning; Practicality; Define Common Principles; Technological Tools for Collaboration; Funding; Disseminate Importance of Fostering International Collaboration in IS; Knowledge Sharing; Innovative & Adaptive Research; Training IS Researchers; Networking & Shared Identity; Facilitate Meetings. Strategic Planning and Funding were highest rated for importance and Strategic Planning and Networking and Shared Identity were rated most feasible to institute. Fostering international collaboration in IS can accelerate the efficiency, relevance, and generalizability of implementation research. Strategies should be developed and tested to improve international collaborations and engage junior and experienced investigators in collaborations advancing implementation science and practice.

Viner R.M., Gireesh A., Stiglic N., Hudson L.D., Goddings A., Ward J.L., Nicholls D.E.

Summary Background There is growing concern about the potential associations between social media use and mental health and wellbeing in young people. We explored associations between the frequency of social media use and later mental health and wellbeing in adolescents, and how these effects might be mediated. Methods We did secondary analyses of publicly available data from the Our Futures study, a nationally representative, longitudinal study of 12 866 young people from age 13 years to 16 years in England. The exposure considered was the frequency of social media use (from weekly or less to very frequent [multiple times daily]) at wave 1 (participants aged 13–14 years) through wave 3 of the study (participants aged 15–16 years). Outcomes were mental health at wave 2 (with high 12-item General Health Questionnaire [GHQ12] scores [≥3] indicating psychological distress), and wellbeing at wave 3 (life satisfaction, feeling life is worthwhile, happiness, and anxiety, rated from 1 to 10 by participants). Analyses were adjusted for a minimal sufficient confounding structure, and were done separately for boys and girls. Cyberbullying, sleep adequacy, and physical activity were assessed as potential mediators of the effects. Findings Very frequent use of social media increased from wave 1 to wave 3: from 34·4% (95% CI 32·4–36·4) to 61·9% (60·3–63·6) in boys, and 51·4% (49·5–53·3) to 75·4% (73·8–76·9) in girls. Very frequent social media use in wave 1 predicted a high GHQ12 score at wave 2 among girls (adjusted odds ratio [OR] 1·31 [95% CI 1·06–1·63], p=0·014; N=4429) and boys (1·67 [1·24–2·26], p=0·0009; N=4379). Persistent very frequent social media use across waves 1 and 2 predicted lower wellbeing among girls only (adjusted ORs 0·86 [0·74–0·99], N=3753, p=0·039 for life satisfaction; 0·80 [0·70–0·92], N=3831, p=0·0013 for happiness; 1·28 [1·11–1·48], N=3745, p=0·0007 for anxiety). Adjustment for cyberbullying, sleep, and physical activity attenuated the associations of social media use with GHQ12 high score (proportion mediated 58·2%), life satisfaction (80·1%), happiness (47·7%), and anxiety (32·4%) in girls, such that these associations (except for anxiety) were no longer significant; however, the association with GHQ12 high score among boys remained significant, being mediated only 12·1% by these factors. Interpretation Mental health harms related to very frequent social media use in girls might be due to a combination of exposure to cyberbullying or displacement of sleep or physical activity, whereas other mechanisms appear to be operative in boys. Interventions to promote mental health should include efforts to prevent or increase resilience to cyberbullying and ensure adequate sleep and physical activity in young people. Funding None.

Bopp T., Vadeboncoeur J.D., Stellefson M., Weinsz M.

The Internet, and particularly YouTube, has been found to be and continues to develop as a resourceful educational space for health-related information. Understanding physical literacy as a lifelong health-related outcome and facilitator of an active lifestyle, we sought to assess the content, exposure, engagement, and information quality of uploaded physical literacy videos on YouTube. Two researchers collected 300 YouTube videos on physical literacy and independently coded each video’s: title, media source of upload, content topics related to physical literacy, content delivery style, and adherence to adapted Health on the Net Foundation Code of Conduct (HONcode) principles of information quality. Physical literacy videos that focused on physical activity and behaviors were the strongest predictor of high quality ratings, followed closely by videos covering affective domains (motivation, confidence, and self-esteem) of physical literacy. The content delivery method was also important, with videos utilizing presentations and testimonials containing high quality information about physical activity. Thus, providers of physical literacy and health-related online video content should be aware of and adhere to the expected quality standards. As health information expectations and ethical standards increase, the Internet, and specifically YouTube, has the potential to enhance video resources, virtual networking opportunities, as well as the sharing, dissemination, accumulation, and enrichment of physical literacy information for all.

Alonso Galbán P, Vialart Vidal N

Eckert M., Volmerg J.S., Friedrich C.M.

Augmented reality (AR) is a technology that integrates digital information into the user's real-world environment. It offers a new approach for treatments and education in medicine. AR aids in surgery planning and patient treatment and helps explain complex medical situations to patients and their relatives.This systematic and bibliographic review offers an overview of the development of apps in AR with a medical use case from March 2012 to June 2017. This work can aid as a guide to the literature and categorizes the publications in the field of AR research.From March 2012 to June 2017, a total of 1309 publications from PubMed and Scopus databases were manually analyzed and categorized based on a predefined taxonomy. Of the total, 340 duplicates were removed and 631 publications were excluded due to incorrect classification or unavailable technical data. The remaining 338 publications were original research studies on AR. An assessment of the maturity of the projects was conducted on these publications by using the technology readiness level. To provide a comprehensive process of inclusion and exclusion, the authors adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.The results showed an increasing trend in the number of publications on AR in medicine. There were no relevant clinical trials on the effect of AR in medicine. Domains that used display technologies seemed to be researched more than other medical fields. The technology readiness level showed that AR technology is following a rough bell curve from levels 4 to 7. Current AR technology is more often applied to treatment scenarios than training scenarios.This work discusses the applicability and future development of augmented- and mixed-reality technologies such as wearable computers and AR devices. It offers an overview of current technology and a base for researchers interested in developing AR apps in medicine. The field of AR is well researched, and there is a positive trend in its application, but its use is still in the early stages in the field of medicine and it is not widely adopted in clinical practice. Clinical studies proving the effectiveness of applied AR technologies are still lacking.

Braly A.M., Nuernberger B., Kim S.Y.

Objective: The purpose of the current study was to determine whether an augmented reality instruction method would result in faster task completion times, lower mental workload, and fewer errors for simple tasks in an operational setting. Background: Prior research on procedural work that directly compared augmented reality instructions to traditional instruction methods (e.g., paper) showed that augmented reality instructions can enhance procedural work, but this was not true for simple tasks in an operational setting. Method: Participants completed simple procedural tasks on spaceflight hardware using an augmented reality instruction method and a paper instruction method. Results: Our results showed that the augmented reality instruction method resulted in faster task completion times and lower levels of mental and temporal demand compared with paper instructions. When participants used the augmented reality instruction method before the paper instruction method, there was a transfer of training that improved a subsequent procedure using the paper instruction method. Conclusion: An off-the-shelf augmented reality head-mounted display (HoloLens) can enhance procedural work for simple tasks in an operational setting. Application: The ability of augmented reality to enhance procedural work for simple tasks in an operational setting can help in reducing costs and mitigating risks that could ultimately lead to accidents and critical failures.

Prabhakaran S., Gopalakrishnan U., Kappanayil M.

Bui D.T., Barnett T., Hoang H., Chinthammit W.

Background Telementorship provides a way to maintain the professional skills of isolated rural health care workers. The incorporation of augmented reality (AR) technology into telementoring systems could be used to mentor health care professionals remotely under different clinical situations. Objective This study aims to evaluate the usability of AR technology in telementorship for managing clinical scenarios in a simulation laboratory. Methods This study used a quasi-experimental design. Experienced health professionals and novice health practitioners were recruited for the roles of mentors and mentees, respectively, and then trained in the use of the AR setup. In the experiment, each mentee wearing an AR headset was asked to respond to 4 different clinical scenarios: acute coronary syndrome (ACS), acute myocardial infarction (AMI), pneumonia severe reaction to antibiotics (PSRA), and hypoglycemic emergency (HE). Their mentor used a laptop to provide remote guidance, following the treatment protocols developed for each scenario. Rating scales were used to measure the AR’s usability, mentorship effectiveness, and mentees’ self-confidence and skill performance. Results A total of 4 mentors and 15 mentees participated in this study. Mentors and mentees were positive about using the AR technology, despite some technical issues and the time required to become familiar with the technology. The positive experience of telementorship was highlighted (mean 4.8, SD 0.414 for mentees and mean of 4.25, SD 0.5 for mentors on the 5-point Likert scale). Mentees’ confidence in managing each of the 4 scenarios improved after telementoring (P=.001 for the ACS, AMI, and PSRA scenarios and P=.002 for the HE scenario). Mentees’ individual skill performance rates ranged from 98% in the ACS scenario to 97% in the AMI, PSRA, and HE scenarios. Conclusions This study provides evidence about the usability of AR technology in telementorship for managing clinical scenarios. The findings suggest the potential for this technology to be used to support health workers in real-world clinical environments and point to new directions of research.

Jones J.C., Schultz C., Podvin C., Mikhail D., Radel L.C.

The purpose of this review is to discuss the use of point-of-care ultrasound for sideline youth sports coverage. Participation in youth sports has been increasing, with trends that athletes are specializing earlier and competing at higher levels at younger ages (NSCH 2019, Fabricant 2013). Point-of-care ultrasound (POCUS) utilizes non-invasive imaging to diagnose and manage various musculoskeletal conditions ranging from traumatic injuries, such as fractures and intramuscular hematomas, to early screening for conditions such as asymptomatic knee lesions. Since it is well-tolerated by children and adolescents and allows for easy accessibility for sideline care, POCUS could provide a strong alternative to other imaging modalities such as x-ray and magnetic resonance imaging (MRI) as both have their limitations. Youth sideline sports coverage could be enhanced with immediate medical attention from ultrasound-trained medical professionals. On the sidelines of a traumatic injury, POCUS expedites patient care with immediate examination of acute injuries. In low resource and hard-to-reach locations such as a rural youth sporting event, it can be key in the triaging of injuries. As a supplement to a physical exam, the risk of a misdiagnosis is reduced, and a long, expensive trip to the hospital for unnecessary imaging studies may be avoided. Ultrasound is a versatile, non-invasive, radiation-free imaging modality that serves as an accessible option for sideline coverage at youth sporting events. Ultrasound is well-tolerated by children and adolescents. It can be used to evaluate, diagnose, and manage a range of musculoskeletal conditions at the sidelines of youth sports.

Shabir D., Anjum A., Hamza H., Padhan J., Al-Ansari A., Yaacoub E., Mohammed A., Navkar N.V.

The objective of this feasibility study was to develop and assess a tele-ultrasound system that would enable an expert sonographer (situated at the remote site) to provide real-time guidance to an operator (situated at the imaging site) using a mixed-reality environment.An architecture along with the operational workflow of the system is designed and a prototype is developed that enables guidance in form of audiovisual cues. The visual cues comprise holograms (of the ultrasound images and ultrasound probe) and is rendered to the operator using a head-mounted display device. The position and orientation of the ultrasound probe's hologram are remotely controlled by the expert sonographer and guide the placement of a physical ultrasound probe at the imaging site. The developed prototype was evaluated for its performance on a network. In addition, a user study (with 12 participants) was conducted to assess the operator's ability to align the probe under different guidance modes.The network performance revealed the view of the imaging site and ultrasound images were transferred to the remote site in 233 ± 42 and 158 ± 38 ms, respectively. The expert sonographer was able to transfer, to the imaging site, data related to position and orientation of the ultrasound probe's hologram in 78 ± 13 ms. The user study indicated that the audiovisual cues are sufficient for an operator to position and orient a physical probe for accurate depiction of the targeted tissue (p < 0.001). The probe's placement translational and rotational errors were 1.4 ± 0.6 mm and 5.4 ± 2.2º.The work illustrates the feasibility of using a mixed-reality environment for effective communication between an expert sonographer (ultrasound physician) and an operator. Further studies are required to determine its applicability in a clinical setting during tele-ultrasound.

Dinh A., Yin A.L., Estrin D., Greenwald P., Fortenko A.

Background Over the last decade, augmented reality (AR) has emerged in health care as a tool for visualizing data and enhancing simulation learning. AR, which has largely been explored for communication and collaboration in nonhealth contexts, could play a role in shaping future remote medical services and training. This review summarized existing studies implementing AR in real-time telemedicine and telementoring to create a foundation for health care providers and technology developers to understand future opportunities in remote care and education. Objective This review described devices and platforms that use AR for real-time telemedicine and telementoring, the tasks for which AR was implemented, and the ways in which these implementations were evaluated to identify gaps in research that provide opportunities for further study. Methods We searched PubMed, Scopus, Embase, and MEDLINE to identify English-language studies published between January 1, 2012, and October 18, 2022, implementing AR technology in a real-time interaction related to telemedicine or telementoring. The search terms were “augmented reality” OR “AR” AND “remote” OR “telemedicine” OR “telehealth” OR “telementoring.” Systematic reviews, meta-analyses, and discussion-based articles were excluded from analysis. Results A total of 39 articles met the inclusion criteria and were categorized into themes of patient evaluation, medical intervention, and education. In total, 20 devices and platforms using AR were identified, with common features being the ability for remote users to annotate, display graphics, and display their hands or tools in the local user’s view. Common themes across the studies included consultation and procedural education, with surgery, emergency, and hospital medicine being the most represented specialties. Outcomes were most often measured using feedback surveys and interviews. The most common objective measures were time to task completion and performance. Long-term outcome and resource cost measurements were rare. Across the studies, user feedback was consistently positive for perceived efficacy, feasibility, and acceptability. Comparative trials demonstrated that AR-assisted conditions had noninferior reliability and performance and did not consistently extend procedure times compared with in-person controls. Conclusions Studies implementing AR in telemedicine and telementoring demonstrated the technology’s ability to enhance access to information and facilitate guidance in multiple health care settings. However, AR’s role as an alternative to current telecommunication platforms or even in-person interactions remains to be validated, with many disciplines and provider-to-nonprovider uses still lacking robust investigation. Additional studies comparing existing methods may offer more insight into this intersection, but the early stage of technical development and the lack of standardized tools and adoption have hindered the conduct of larger longitudinal and randomized controlled trials. Overall, AR has the potential to complement and advance the capabilities of remote medical care and learning, creating unique opportunities for innovator, provider, and patient involvement.

Dinh A., Yin A.L., Estrin D., Greenwald P., Fortenko A.

BACKGROUND Over the last decade, augmented reality (AR) has emerged in health care as a tool for visualizing data and enhancing simulation learning. AR, which has largely been explored for communication and collaboration in nonhealth contexts, could play a role in shaping future remote medical services and training. This review summarized existing studies implementing AR in real-time telemedicine and telementoring to create a foundation for health care providers and technology developers to understand future opportunities in remote care and education. OBJECTIVE This review described devices and platforms that use AR for real-time telemedicine and telementoring, the tasks for which AR was implemented, and the ways in which these implementations were evaluated to identify gaps in research that provide opportunities for further study. METHODS We searched PubMed, Scopus, Embase, and MEDLINE to identify English-language studies published between January 1, 2012, and October 18, 2022, implementing AR technology in a real-time interaction related to telemedicine or telementoring. The search terms were “augmented reality” OR “AR” AND “remote” OR “telemedicine” OR “telehealth” OR “telementoring.” Systematic reviews, meta-analyses, and discussion-based articles were excluded from analysis. RESULTS A total of 39 articles met the inclusion criteria and were categorized into themes of patient evaluation, medical intervention, and education. In total, 20 devices and platforms using AR were identified, with common features being the ability for remote users to annotate, display graphics, and display their hands or tools in the local user’s view. Common themes across the studies included consultation and procedural education, with surgery, emergency, and hospital medicine being the most represented specialties. Outcomes were most often measured using feedback surveys and interviews. The most common objective measures were time to task completion and performance. Long-term outcome and resource cost measurements were rare. Across the studies, user feedback was consistently positive for perceived efficacy, feasibility, and acceptability. Comparative trials demonstrated that AR-assisted conditions had noninferior reliability and performance and did not consistently extend procedure times compared with in-person controls. CONCLUSIONS Studies implementing AR in telemedicine and telementoring demonstrated the technology’s ability to enhance access to information and facilitate guidance in multiple health care settings. However, AR’s role as an alternative to current telecommunication platforms or even in-person interactions remains to be validated, with many disciplines and provider-to-nonprovider uses still lacking robust investigation. Additional studies comparing existing methods may offer more insight into this intersection, but the early stage of technical development and the lack of standardized tools and adoption have hindered the conduct of larger longitudinal and randomized controlled trials. Overall, AR has the potential to complement and advance the capabilities of remote medical care and learning, creating unique opportunities for innovator, provider, and patient involvement.

Mai H., Dam V.V., Lee D.

Background The novel concept of immersive 3D augmented reality (AR) surgical navigation has recently been introduced in the medical field. This method allows surgeons to directly focus on the surgical objective without having to look at a separate monitor. In the dental field, the recently developed AR-assisted dental implant navigation system (AR navigation), which uses innovative image technology to directly visualize and track a presurgical plan over an actual surgical site, has attracted great interest. Objective This study is the first systematic review and meta-analysis study that aimed to assess the accuracy of dental implants placed by AR navigation and compare it with that of the widely used implant placement methods, including the freehand method (FH), template-based static guidance (TG), and conventional navigation (CN). Methods Individual search strategies were used in PubMed (MEDLINE), Scopus, ScienceDirect, Cochrane Library, and Google Scholar to search for articles published until March 21, 2022. This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO) database. Peer-reviewed journal articles evaluating the positional deviations of dental implants placed using AR-assisted implant navigation systems were included. Cohen d statistical power analysis was used to investigate the effect size estimate and CIs of standardized mean differences (SMDs) between data sets. Results Among the 425 articles retrieved, 15 articles were considered eligible for narrative review, 8 articles were considered for single-arm meta-analysis, and 4 were included in a 2-arm meta-analysis. The mean lateral, global, depth, and angular deviations of the dental implant placed using AR navigation were 0.90 (95% CI 0.78-1.02) mm, 1.18 (95% CI 0.95-1.41) mm, 0.78 (95% CI 0.48-1.08) mm, and 3.96° (95% CI 3.45°-4.48°), respectively. The accuracy of AR navigation was significantly higher than that of the FH method (SMD=−1.01; 95% CI −1.47 to −0.55; P<.001) and CN method (SMD=−0.46; 95% CI −0.64 to −0.29; P<.001). However, the accuracies of the AR navigation and TG methods were similar (SMD=0.06; 95% CI −0.62 to 0.74; P=.73). Conclusions The positional deviations of AR-navigated implant placements were within the safety zone, suggesting clinically acceptable accuracy of the AR navigation method. Moreover, the accuracy of AR implant navigation was comparable with that of the highly recommended dental implant–guided surgery method, TG, and superior to that of the conventional FH and CN methods. This review highlights the possibility of using AR navigation as an effective and accurate immersive surgical guide for dental implant placement.

Dinh A., Fortenko A., Yin A., Greenwald P., Estrin D.

BACKGROUND In the last decade, mixed reality technologies including augmented reality (AR) have emerged in healthcare as tools for data visualization and simulation learning. AR technology, which has largely been explored for communication and collaboration in non-health contexts, could play a role in shaping future remote medical services and training. This review summarizes existing articles implementing AR in real-time (“synchronous”) telemedicine and telementoring to create a foundation for healthcare providers and developers to understand future opportunities in remote care and education. OBJECTIVE This review describes the AR devices and platforms used in real-time telemedicine and telementoring, the tasks for which AR has been implemented, and the ways these implementations were evaluated in order to identify gaps in research that provide opportunity for further study. METHODS We searched PubMed, Scopus, Embase, and MEDLINE to identify English-language articles from January 1, 2012, through February 13, 2022 involving AR technology in a real-time interaction related to telemedicine or telementoring. The search terms were “augmented reality” OR “AR” AND “remote” OR “telemedicine” OR “telehealth” OR “telementoring.” Conference abstracts, systematic reviews, meta-analyses, and perspective-based studies were excluded. Articles that met criteria and related to healthcare were included for analysis. RESULTS 31 articles met inclusion criteria and were categorized within themes of patient evaluation, medical intervention, and education. 16 AR devices and platforms were identified, with the most common features being the ability for remote users to annotate and virtually display their hands or tools in the local user’s view. Most studies focus on consultation and procedural education, with surgery, emergency, and hospital medicine being the most represented specialties. End variables were most often measured with feedback surveys and interviews. The most common objective measures were time to task completion and performance. Long-term outcome and resource cost measurements were rare. Across the studies, user feedback was consistently positive for perceived efficacy, feasibility, and acceptability. Comparative trials demonstrate that AR-assisted conditions have noninferior reliability and performance and do not consistently extend procedure times compared to in-person controls. CONCLUSIONS Studies implementing AR in telemedicine and telementoring have demonstrated the technology’s ability to enhance access to information and facilitate guidance in multiple healthcare settings. However, AR’s role as an alternative to current telecommunication platforms or even in-person interactions remains to be validated, with many disciplines and provider-to-non-provider uses still lacking robust investigation. Additional longitudinal and randomized controlled studies with comparisons to existing methods would offer the most insight to this intersection, but a lack of standardized tools and adoption may hinder the creation of larger cohort studies. Overall, AR has the potential to complement and advance the capabilities of remote medical care and learning, creating a unique opportunity of involvement for innovators, providers, and patients.