Virtual reality operating room with AI guidance: design and validation of a fire scenario

The application of metaverse in occupational health

Background

The metaverse, as a new digital interactive platform, is garnering significant attention and exploration across industries due to technological advancements and societal digital transformation. In occupational health, there is immense potential for leveraging the metaverse to enhance work environments and occupational health management. It offers companies more efficient and intelligent solutions for occupational health management while providing employees with safer and more comfortable work environments.

Methods

A comprehensive literature search was conducted using PubMed, Web of Science, IEEE Xplore, and Google Scholar databases to identify relevant studies published between January 2015 and March 2024. The search terms included "metaverse," "virtual reality," "occupational health," "workplace safety," "job training," and "telemedicine." The selected articles were analyzed, and key findings were summarized narratively.

Results

The review summarizes the broad application prospects of metaverse technology in immersive training, occupational risk identification and assessment, and occupational disease monitoring and diagnosis. However, applying the metaverse in occupational health also faces challenges such as inadequate technical standards, data privacy issues, human health hazards, high costs, personnel training, and lagging regulations.

Conclusion

Metaverse offers new possibilities for addressing the numerous challenges faced in occupational health and has broad application prospects. In the future, collaborative efforts from multiple stakeholders will be necessary to promote the sustainable development of metaverse technology in occupational health and better protect workers' occupational health.

Validation of a Virtual Simulator With Haptic Feedback for Endotracheal Intubation Training

INTRODUCTION

Endotracheal intubation (ETI) is a procedure that varies in difficulty because of patient characteristics and clinical conditions. Existing physical simulators do not encompass these variations. The Virtual Airway Skills Trainer for Endotracheal Intubation (VAST-ETI) was developed to provide different patient characteristics and high-fidelity haptic feedback to improve training.

METHODS

We demonstrate the effectiveness of VAST-ETI as a training and evaluation tool for ETI. Construct validation was evaluated by scoring the performance of experts ( N = 15) and novices ( N = 15) on the simulator to ensure its ability to distinguish technical proficiency. Convergent and predictive validity were evaluated by performing a learning curve study, in which a group of novices ( N = 7) were trained for 2 weeks using VAST-ETI and then compared with a control group ( N = 9).

RESULTS

The VAST-ETI was able to distinguish between expert and novice based on mean simulator scores ( t [88] = -6.61, P < 0.0005). When used during repeated practice, individuals demonstrated a significant increase in their score on VAST-ETI over the learning period ( F [11,220] = 7206, P < 0.001); however when compared with a control group, there was not a significant interaction effect on the simulator score. There was a significant difference between the simulator-trained and control groups ( t [12.85] = -2.258, P = 0.042) when tested in the operating room.

CONCLUSIONS

Our results demonstrate the effectiveness of virtual simulation with haptic feedback for assessing performance and training of ETI. The simulator was not able to differentiate performance between more experienced trainees and experts because of limits in simulator difficulty.

Transformative Potential of AI in Healthcare: Definitions, Applications, and Navigating the Ethical Landscape and Public Perspectives

Artificial intelligence (AI) has emerged as a crucial tool in healthcare with the primary aim of improving patient outcomes and optimizing healthcare delivery. By harnessing machine learning algorithms, natural language processing, and computer vision, AI enables the analysis of complex medical data. The integration of AI into healthcare systems aims to support clinicians, personalize patient care, and enhance population health, all while addressing the challenges posed by rising costs and limited resources. As a subdivision of computer science, AI focuses on the development of advanced algorithms capable of performing complex tasks that were once reliant on human intelligence. The ultimate goal is to achieve human-level performance with improved efficiency and accuracy in problem-solving and task execution, thereby reducing the need for human intervention. Various industries, including engineering, media/entertainment, finance, and education, have already reaped significant benefits by incorporating AI systems into their operations. Notably, the healthcare sector has witnessed rapid growth in the utilization of AI technology. Nevertheless, there remains untapped potential for AI to truly revolutionize the industry. It is important to note that despite concerns about job displacement, AI in healthcare should not be viewed as a threat to human workers. Instead, AI systems are designed to augment and support healthcare professionals, freeing up their time to focus on more complex and critical tasks. By automating routine and repetitive tasks, AI can alleviate the burden on healthcare professionals, allowing them to dedicate more attention to patient care and meaningful interactions. However, legal and ethical challenges must be addressed when embracing AI technology in medicine, alongside comprehensive public education to ensure widespread acceptance.

A Systematic Review of Immersive Virtual Reality for Nontechnical Skills Training in Surgery

OBJECTIVE

Immersive virtual reality (IVR) can be utilized to provide low cost and easily accessible simulation on all aspects of surgical education. In addition to technical skills training in surgery, IVR simulation has been utilized for nontechnical skills training in domains such as clinical decision-making and pre-operative planning. This systematic review examines the current literature on the effectiveness of IVR for nontechnical skill acquisition in surgical education.

DESIGN

A literature search was performed using MEDLINE, EMBASE, and Web of Science for primary studies published between January 1, 1995 and February 9, 2022. Four reviewers screened titles, abstracts, full texts, extracted data, and analyzed included studies to answer 5 key questions: How is IVR being utilized in nontechnical skills surgical education? What is the methodological quality of studies? What technologies are being utilized? What metrics are reported? What are the findings of these studies?

RESULTS

The literature search yielded 2340 citations, with 12 articles included for qualitative synthesis. Of included articles, 33% focused on clinical decision-making and 67% on anatomy/pre-operative planning. Motion sickness was a recorded metric in 25% of studies, with an aggregate incidence of 13% (11/87). An application score was reported in 33% and time to completion in 16.7%. A commercially developed application was utilized in 25%, while 75% employed a noncommercial application. The Oculus Rift was used in 41.7% of studies, HTC Vive in 25%, Samsung Gear in 16.7% of studies, Google Daydream in 8%, and 1 study did not report. The mean Medical Education Research Quality Instrument (MERSQI) score was 10.3 ± 2.3 (out of 18). In all studies researching clinical decision-making, participants preferred IVR to conventional teaching methods and in a nonrandomized control study it was found to be more effective. Averaged across all studies, mean scores were 4.33 for enjoyment, 4.16 for utility, 4.11 for usability, and 3.73 for immersion on a 5-point Likert scale.

CONCLUSIONS

The IVR nontechnical skills applications for surgical education are designed for clinical decision-making or anatomy/pre-operative planning. These applications are primarily noncommercially produced and rely upon a diverse array of HMDs for content delivery, suggesting that development is primarily coming from within academia and still without clarity on optimal utilization of the technology. Excitingly, users find these applications to be immersive, enjoyable, usable, and of utility in learning. Although a few studies suggest that IVR is additive or superior to conventional teaching or imaging methods, the data is mixed and derived from studies with weak design. Motion sickness with IVR remains a complication of IVR use needing further study to determine the cause and means of mitigation.

Virtual reality in simulation-based emergency skills training: A systematic review with a narrative synthesis

Objective

An important role is predicted for virtual reality (VR) in the future of medical education. We performed a systematic review of the literature with a narrative synthesis, to examine the current evidence for VR in simulation-based emergency skills training. We broadly define emergency skills as any clinical skill used in the emergency care of patients across all clinical settings.

Methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. The data sources accessed during this study included: PubMed, CINAHL, EMBASE, AMED, EMCARE, HMIC, BNI, PsychINFO, Medline, CENTRAL, SCOPUS, Web of Science, BIOSIS Citation Index, ERIC, ACM Digital Library, IEEE Xplore, and ProQuest Dissertations and Thesis Global. Cochrane's Rob 2 and ROBVIS tools were used during study quality assessment. No ethical review was required for this work.

Results

Thirty-four articles published between 14th March 1998 and 1st March 2022 were included in this review. Studies were predominantly conducted in the USA and Europe and focussed on a variety of healthcare disciplines including medical, nursing, and allied health. VR education was delivered using head-mounted displays, Cave Automatic Virtual Environment systems, and bespoke setups. These systems delivered education in a variety of areas (emergency medicine, equipment training, obstetrics, and basic/advanced life support). Subjective potential advantages of this technology included realism, replayability, and time-effectiveness. Reports of adverse events were low in frequency across the included studies. Whilst clear educational benefit was generally noted, this was not reflected in changes to patient-based outcomes.

Conclusion

There may be educational benefit to using VR in the context of simulation-based emergency skills training including knowledge gain and retention, skill performance, acceptability, usability, and validity. Currently, there is insufficient evidence to demonstrate clear cost-effectiveness, or direct improvement of patient or institutional outcomes, at this stage.

Airway fires in otolaryngologic surgery: A database review

PURPOSE

An estimated 34 % of reported operating room fires involve the airway. Despite the inherent risks in otolaryngologic surgery, education regarding prevention and management of airway fires is limited in graduate medical training. One contributing factor is a lack of reporting of such rare events in our literature.

METHODS

The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for reports of adverse events related to fires occurring during surgical procedures of the airway from January 1, 2010, to March 31, 2020.

RESULTS

3687 reports were identified and 49 unique reports of airway fire were included. Sustained fires were described in 16 (32.7 %) reports and 33 (67.3 %) described transient flares. 2 fires extended beyond the airway and 9 (18.4 %) were noted to have occurred at the start of the case. Fires were reported most commonly during tonsillectomy (n = 22 [44.9 %]), vocal fold excision (n = 5 [10.2 %]), and adenoidectomy (n = 4 [8.2 %]). 46 reports attributed flare initiation to a specific element of the fire triangle. 16 patient and 2 operator injuries were reported. Saline washing was utilized in 7 (14.3 %) cases overall. Patients were extubated immediately in 2 (12.5 %) of the 16 reports of sustained fires. 0 mortalities were reported.

CONCLUSION

Airway fires were reported in a variety of upper airway procedures performed regularly by otolaryngologists. The triggering factor that led to fire was identified as a spark or char in about half of the reported cases, and only 2 reports described immediate removal of the endotracheal tube.

Intelligent Virtual Operating Room for Enhancing Nontechnical Skills

This article discusses an intelligent immersive virtual operating room to enable teams to train in a distributed fashion wearing head-mounted displays.

Virtual Reality Head-Mounted Displays in Medical Education: A Systematic Review

SUMMARY STATEMENT

Simulation-based training using virtual reality head-mounted displays (VR-HMD) is increasingly being used within the field of medical education. This article systematically reviews and appraises the quality of the literature on the use of VR-HMDs in medical education. A search in the databases PubMed/MEDLINE, Embase, ERIC, Scopus, Web of Science, Cochrane Library, and PsychINFO was carried out. Studies were screened according to predefined exclusion criteria, and quality was assessed using the Medical Education Research Study Quality Instrument. In total, 41 articles were included and thematically divided into 5 groups: anatomy, procedural skills, surgical procedures, communication skills, and clinical decision making. Participants highly appreciated using VR-HMD and rated it better than most other training methods. Virtual reality head-mounted display outperformed traditional methods of learning surgical procedures. Although VR-HMD showed promising results when learning anatomy, it was not considered better than other available study materials. No conclusive findings could be synthesized regarding the remaining 3 groups.

Does your team know how to respond safely to an operating room fire? Outcomes of a virtual reality, AI-enhanced simulation training

BACKGROUND

Operating room (OR) fires are rare but devastating events requiring immediate and effective response. Virtual Reality (VR) simulation training can provide a safe environment for practice of skills in such highly stressful situation. This study assessed interprofessional participants' ability to respond to VR-simulated OR fire scenarios, attitudes, numbers of attempt of the VR simulation do participants need to successfully respond to OR fires and does prior experience, confidence level, or professional role predict the number of attempts needed to demonstrate safety and pass the simulation.

METHODS

180 surgical team members volunteered to participate in this study at Beth Israel Deaconess Medical Center, Boston, MA. Each participant completed five VR OR simulation trials; the final two trials incorporated AI assistance. Primary outcomes were performance scores, number of attempts needed to pass, and pre- and post-survey results describing participant confidence and experiences. Differences across professional or training role were assessed using chi-square tests and analyses of variance. Differences in pass rates over time were assessed using repeated measures logistic regression.

RESULTS

One hundred eighty participants completed simulation testing; 170 (94.4%) completed surveys. Participants included surgeons (17.2%), anesthesiologists (10.0%), allied health professionals (41.7%), and medical trainees (31.1%). Prior to training, 45.4% of participants reported feeling moderately or very confident in their ability to respond to an OR fire. Eight participants (4.4%) responded safely on the first simulation attempt. Forty-three participants (23.9%) passed by the third attempt (VR only); an additional 97 participants (53.9%) passed within the 4-5th attempt (VR with AI assistance).

CONCLUSIONS

Providers are unprepared to respond to OR fires. VR-based simulation training provides a practical platform for individuals to improve their knowledge and performance in the management of OR fires with a 79% pass rate in our study. A VR AI approach to teaching this essential skill is innovative, feasible, and effective.

Disruptions to shared mental models from poor quality of service in collaborative virtual environments

Collaborative virtual environments are being used in various applications ranging from online games to complex team training scenarios. The key to the success of such environments is the ability of the participants to form a shared mental model of the collaborative task being performed. Poor quality of service can deteriorate user performance and quality of experience, leading to a disruption of this mental model. While the effects of quality of service have been analyzed for traditional desktop environments, these effects remain unclear in collaborative virtual environments during user-to-user interactions. Here, we analyze the role of latency and packet bursts, two common problems in collaborative applications, on both simulator perception and actual task performance in a collaborative fire-fighting simulator. This exploratory study indicates that large latencies have a significant (p < 0.05) impact on the quality of experience, but not task performance. In contrast, packet bursts have a much larger impact on both the quality of experience and performance. Additionally, the network role, such as whether a user is a client or server, showed a significant (p < 0.05) impact on task performance in conditions impaired by packet bursts.

Operating room team training using simulation: Hope or hype?

BACKGROUND

This study sought to determine the long-term impact of multidisciplinary simulated operating room (OR) team training.

METHOD

Two-wave survey study (immediate post-training survey 2010-2017, follow-up 2018). Differences across time, specialty, and experience with adverse events were assessed using chi-square and t -tests.

RESULTS

Immediately after training, more than 90% of respondents found simulation scenarios realistic and reported team training would provide safer patient care. However, follow-up participants reported less enthusiasm toward training, with 58% stating they would like to take similar training again. A majority of participants (77%) experienced adverse events after training; those reporting adverse events reported more positive long-term evaluations.

CONCLUSIONS

Simulated OR team training is initially highly valued by participants and is perceived as contributing to patient safety. Diminution of participant enthusiasm over time suggests that repeat training requirements be reconsidered, and less costly, alternative methods (such as asynchronous learning or virtual reality) should be explored.