OBJECTIVE: Anatomical understanding is an important basis for medical teaching, especially in a surgical context. The interpretation of complex vascular structures via two-dimensional visualization can yet be difficult, particularly for students. The objective of this study was to investigate the feasibility of an MxR-assisted educational approach in vascular surgery undergraduate education, comparing an MxR-based teaching-intervention with CT-based material for learning and understanding the vascular morphology of the thoracic aorta.
METHODS: In a prospective randomized controlled trial learning success and diagnostic skills following an MxR- vs. a CT-based intervention was investigated in 120 thoracic aortic visualizations. Secondary outcomes were motivation, system-usability as well as workload/satisfaction. Motivational factors and training-experience were also assessed. Twelve students (7 females; mean age: 23 years) were randomized into two groups undergoing educational intervention with MxR or CT.
RESULTS: Evaluation of learning success showed a mean improvement of 1.17 points (max.score: 10; 95%CI: 0.36-1.97). The MxR-group has improved by a mean of 1.33 [95% CI: 0.16-2.51], against 1.0 points [95% CI: -0.71- 2.71] in the CT-group. Regarding diagnostic skills, both groups performed equally (CT-group: 58.25 ± 7.86 vs. MxR-group:58.5 ± 6.60; max. score 92.0). 11/12 participants were convinced that MxR facilitated learning of vascular morphologies. The usability of the MxR-system was rated positively, and the perceived workload was low.
CONCLUSIONS: MxR-systems can be a valuable addition to vascular surgery education. Further evaluation of the technology in larger teaching situations are required. Especially regarding the acquisition of practical skills, the use of MxR-systems offers interesting application possibilities in surgical education.

OBJECTIVE: This study aimed to evaluate the accuracy of percutaneous computed tomography (CT)-guided puncture based on machine vision and augmented reality in a phantom.
METHODS: The surgical space coordinate system was established, and accurate registration was ensured using the hierarchical optimization framework. Machine vision tracking and augmented reality display technologies were used for puncture navigation. CT was performed on a phantom, and puncture paths with three different lengths were planned from the surface of the phantom to the metal ball. Puncture accuracy was evaluated by measuring the target positioning error (TPE), lateral error (LE), angular error (AE), and first success rate (FSR) based on the obtained CT images.
RESULTS: A highly qualified attending interventional physician performed a total of 30 punctures using puncture navigation. For the short distance (4.5-5.5 cm), the TPE, LE, AE, and FSR were 1.90 ± 0.62 mm, 1.23 ± 0.70 mm, 1.39 ± 0.86°, and 60%, respectively. For the medium distance (9.5-10.5 cm), the TPE, LE, AE, and FSR were 2.35 ± 0.95 mm, 2.00 ± 1.07 mm, 1.20 ± 0.62°, and 40%, respectively. For the long distance (14.5-15.5 cm), the TPE, LE, AE, and FSR were 2.81 ± 1.17 mm, 2.33 ± 1.34 mm, 0.99 ± 0.55°, and 30%, respectively.
CONCLUSIONS: The augmented reality and machine vision-based CT-guided puncture navigation system allows for precise punctures in a phantom. Further studies are needed to explore its clinical applicability.

BACKGROUND: The accurate and safe positioning of cervical pedicle screws is crucial. While augmented reality (AR) use in spine surgery has previously demonstrated clinical utility in the thoracolumbar spine, its technical feasibility in the cervical spine remains less explored.
OBJECTIVE: The objective of this study was to assess the precision and safety of AR-assisted pedicle screw placement in the cervical spine.
METHODS: In this experimental study, 5 cadaveric cervical spine models were instrumented from C3 to C7 by 5 different spine surgeons. The navigation accuracy and clinical screw accuracy were evaluated.
METHODS: Postprocedural CT scans were evaluated for clinical accuracy by 2 independent neuroradiologists using the Gertzbein-Robbins scale. Technical precision was assessed by calculating the angular trajectory (°) and linear screw tip (mm) deviations in the axial and sagittal planes from the virtual pedicle screw position as recorded by the AR-guided platform during the procedure compared to the actual pedicle screw position derived from postprocedural imaging.
RESULTS: A total of forty-one pedicle screws were placed in 5 cervical cadavers, with each of the 5 surgeons navigating at least 7 screws. Gertzbein-Robbins grade of A or B was achieved in 100% of cases. The mean values for tip and trajectory errors in the axial and sagittal planes between the virtual versus actual position of the screws was less than 3 mm and 30°, respectively (p<.05). None of the cervical screws violated the cortex by more than 2 mm or displaced neurovascular structures.
CONCLUSIONS: AR-assisted cervical pedicle screw placement in cadavers demonstrated clinical accuracy comparable to existing literature values for image-guided navigation methods for the cervical spine.
CONCLUSIONS: This study provides technical and clinical accuracy data that supports clinical trialing of AR-assisted subaxial cervical pedicle screw placement.

UNASSIGNED: Performing spinal anaesthesia in elderly patients with ligament calcification or hyperostosis is challenging for novice practitioners. This pilot study aimed to compare the effectiveness of mixed reality-assisted spinal puncture (MRasp) with that of landmark-guided spinal puncture (LGsp) by novice practitioners in elderly patients.
UNASSIGNED: In this pilot study, 36 patients (aged ≥65 years) scheduled for elective surgery under spinal anaesthesia by anaesthesiology residents were included. Patients were randomly assigned to the MRasp group (n = 18) or the LGsp group (n = 18). The outcomes included the number of needle insertion attempts, redirection attempts, passes, the rate of successful first-attempt needle insertion, the rate of successful first needle pass, the spinal puncture time, the total procedure time, and the incidence of perioperative complications.
UNASSIGNED: The median number of needle insertion attempts was significantly fewer in the MRasp group than in the LGsp group (1.0 vs 2.0, P = 0.023). The proportion of patients with successful first-attempt needle insertion was 72.2% in the MRasp group and 44.4% in the LGsp group (P = 0.176). The incidence of perioperative complications did not significantly differ between the two groups.
UNASSIGNED: This pilot study found that novice practitioners made significantly fewer needle insertion attempts in the MRasp group compared to the LGsp group when performing spinal anaesthesia on elderly patients. A future randomized controlled trial (RCT) is warranted to validate its effectiveness.
UNASSIGNED: This trial was registered at https://www.chictr.org.cn/showproj.html?proj=178960 (ChiCTR-IPR-2300068520). Public title: Mixed reality-assisted versus landmark-guided spinal puncture in elderly patients: a randomized controlled pilot study. Principal investigator: Lei Gao. The registration date was February 22, 2023. The date of the first participant enrolment was February 27, 2023.
We developed virtual spine-presenting technology and patented optimal trajectory design technology to assist in spinal puncture and reported that the median number of needle insertion attempts was significantly fewer in the mixed reality-assisted spinal puncture group than in the landmark-guided spinal puncture group.

Brain-computer interfaces (BCI) enable users to control devices through their brain activity. Motor imagery (MI), the neural activity resulting from an individual imagining performing a movement, is a common control paradigm. This study introduces a user-centric evaluation protocol for assessing the performance and user experience of an MI-based BCI control system utilizing augmented reality. Augmented reality is employed to enhance user interaction by displaying environment-aware actions, and guiding users on the necessary imagined movements for specific device commands. One of the major gaps in existing research is the lack of comprehensive evaluation methodologies, particularly in real-world conditions. To address this gap, our protocol combines quantitative and qualitative assessments across three phases. In the initial phase, the BCI prototype\'s technical robustness is validated. Subsequently, the second phase involves a performance assessment of the control system. The third phase introduces a comparative analysis between the prototype and an alternative approach, incorporating detailed user experience evaluations through questionnaires and comparisons with non-BCI control methods. Participants engage in various tasks, such as object sorting, picking and placing, and playing a board game using the BCI control system. The evaluation procedure is designed for versatility, intending applicability beyond the specific use case presented. Its adaptability enables easy customization to meet the specific user requirements of the investigated BCI control application. This user-centric evaluation protocol offers a comprehensive framework for iterative improvements to the BCI prototype, ensuring technical validation, performance assessment, and user experience evaluation in a systematic and user-focused manner.

The current COVID-19 pandemic has affected almost every aspect of life but its impact on the healthcare landscape is conspicuously adverse. However, digital technologies played a significant contribution in coping with the challenges spawned by this pandemic. In this list of applied digital technologies, the role of immersive technologies in battling COVID-19 is notice-worthy. Immersive technologies consisting of virtual reality (VR), augmented reality (AR), mixed reality (MR), extended reality (XR), metaverse, gamification, etc. have shown enormous market growth within the healthcare system, particularly with the emergence of pandemics. These technologies supplemented interactivity, immersive experience, 3D modeling, touching sensory elements, simulation, and feedback mechanisms to tackle the COVID-19 disease in healthcare systems. Keeping in view the applicability and significance of immersive technological advancement, the major aim of this study is to identify and highlight the role of immersive technologies concerning handling COVID-19 in the healthcare setup. The contribution of immersive technologies in the healthcare domain for the different purposes such as medical education, medical training, proctoring, online surgeries, stress management, social distancing, physical fitness, drug manufacturing and designing, and cognitive rehabilitation is highlighted. A comprehensive and in-depth analysis of the collected studies has been performed to understand the current research work and future research directions. A state-of-the-artwork is presented to identify and discuss the various issues involving the adoption of immersive technologies in the healthcare area. Furthermore, the solutions to these emerging challenges and issues have been provided based on an extensive literature study. The results of this study show that immersive technologies have the considerable potential to provide massive support to stakeholders in the healthcare system during current COVID-19 situation and future pandemics.

BACKGROUND: Gamification and augmented reality (AR) are innovative teaching modalities. Research on the effects of combining these two strategies in nursing education is scarce.
OBJECTIVE: To examine the effect of the combined use of gamification and AR in teaching mechanical ventilation (MV) on nurse students\' knowledge, motivation, self-efficacy, and satisfaction.
METHODS: Randomized controlled trial.
METHODS: A conveniently selected faculty of nursing in Egypt.
METHODS: A total of 410 nurse students.
METHODS: Participants were randomly assigned to the intervention or control group (205 in each). Kahoot games and AR were used in the intervention group, whereas a traditional lecture was applied in the control group. The outcomes included levels of students\' knowledge, learning motivation, self-efficacy, and satisfaction.
RESULTS: Mixed design repeated-measures ANOVA test revealed a statistically significant difference in knowledge test scores within-subject over time (p-value [effect size]: <0.001 [0.515]), between-subject due to the main effect of interventions (<0.001 [0.146]), and within-between interaction effect of group and time (<0.001 [0.515]). After using Kahoot and AR, the total mean self-efficacy score was significantly higher in the intervention group than in the control group (<0.001 [0.662]). The total median motivation score was significantly higher for the Kahoot and the AR groups compared with the traditional lecture (<0.001 [0.558]).
CONCLUSIONS: Kahoot games and AR significantly increased nurse students\' knowledge, motivation, and self-efficacy compared with traditional MV learning classes. Nursing educators need to incorporate Kahoot and AR in their pedagogies to enhance nurse students\' satisfaction and development.

BACKGROUND: Several studies demonstrated the utility of immersive virtual reality (VR) as a complementary approach to conventional therapy for improving motor, psychological and cognitive impairment in some pathological conditions. Our pilot study aims to evaluate for the first time: 1) sense of presence, tolerability and usability of VR immersive experience in patients with early stages of Huntington disease (eHDp) compared to healthy controls (HC); 2) correlation between the use of technology/cybersickness and the variables of presence/usability; 3) correlation between clinical characteristics (genetic, motor, functional and cognitive) and VR\'s variables.
METHODS: We recruited 10 eHDp and 10 age, gender and education matched HC. Participants completed questionnaires about sense of presence, usability, tolerability and technology use profile. Subjects were exposed to different VR scenarios from a first-person perspective through a standalone VR headset.
RESULTS: Our results showed no significant statistical difference between eHDp and HC for the sense of presence (p=0.910), usability (p=0.744) and tolerability (p=0.730) during the VR experience. Familiarity with the use of technology was also comparable between groups (p=0.676). Regarding correlations in eHDp group, our results showed no correlations between use of technology/tolerability and the sense of presence/usability. Moreover, clinical characteristics of eHDp (genetic, motor, functional and cognitive scores) did not influence the sense of presence, tolerability and usability.
CONCLUSIONS: Our research presents preliminary evidence for the applicability of VR in eHDp. These results open up the possibility to explore future applications of this methodology in rehabilitation (i.e., cognitive training, physiotherapy), diagnosis and psychological support in Huntington disease patients.

Educators are witnessing the unfolding of the era of artificial intelligence, raising the question of how to transfer the benefits of yesterday\'s pedagogy to the future of education. An interactive digital mind map of infectious diseases was developed for second-year medical students (n = 865). Analysis of user engagement showed global distribution with 498 QR scans on a single day. Student responses (n = 79, 9.1% response rate) indicated positive feedback on the resources of Extremely Satisfied (range 65-75%, n = 59-51). The findings of the study support further expansion of MedMicroMaps to cross-platform interfaces with adaptations for diverse audiences within allied health fields.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s40670-024-02047-3.

UNASSIGNED: With current technology, ultrasound imaging in remote conditions, such as the International Space Station, is performed with vocal guidance or using a teleoperated echograph controlled by an expert. Both methods require real-time communications between the novice operator and expert to locate the probe over the appropriate acoustic windows (AW). The current study presents the development and testing of a new augmented reality software (Echo-QR) that would allow novice operators (with no medical imaging background) to correctly locate the ultrasound probe over the AW of interest without expert assistance.
UNASSIGNED: On the first day of the study, the positions of the probe over the AWs were identified for each organ by an expert sonographer and saved in the Echo-QR software. On the second day, the novices independently performed the ultrasound investigation using the Echo-QR software to correctly position the probe over each organ\'s AW.
UNASSIGNED: Using the Echo-QR software, novice operators found the AW in 73 (92%) of the 79 organs. The 2D images acquired by the novices \"2D direct image\" were acceptable for medical evaluation in 41% of the cases. However, when the \"2D direct image\" did not show the entire organ, a 3D capture of the volume below the probe was also performed, which allowed for the extraction of the appropriate 2D image \"2D/3D image\" for medical evaluation in 85% of the cases.
UNASSIGNED: Therefore, in the absence of real-time communication between an isolated participant and an expert sonographer, novel software (Echo-QR) and automated 3D volume capture can be used to obtain images usable for ultrasound diagnostics.