Medical Augmented Reality: Definition, Principle Components, Domain Modeling, and Design-Development-Validation Process

Comprehensive assessment of medical laboratory performance: a 4D model of quality, economics, velocity, and productivity indicators

Laboratory diagnostics play a crucial role in modern medicine and healthcare economics. The effective management of a medical laboratory is based on reliable assessment of indicators characterizing quality of testing, productivity, velocity (speed) and cost-effectiveness. The usual concepts of laboratory management focus on one or two groups of these indicators and exclude a comprehensive assessment of the effectiveness of a medical laboratory. Various guidelines and concepts (ISO, Lean, Six Sigma, etc.) often provide similar approaches but use different terms. This review discusses common options for performance indicators in medical laboratories, as well as practical experience in using these indicators to assess the overall effectiveness of the laboratory and improve medical care for patients. All indicators were divided into four broad groups: quality, economy, velocity, and productivity. Based on these four groups, we describe the new" four-dimensional model" for assessment of medical laboratory performance based on different combinations of indicator groups for different types of laboratories.

Experienced versus unexperienced dentists in bracket placement using an Augmented Reality (AR) conventional mobile devices

OBJECTIVE

Enhancing the precision of bracket positioning is achieved through the integration of computer-aided design (CAD) in conjunction with a bracket navigation system, complemented by augmented reality (AR) support.

MATERIALS AND METHODS

A comparative workflow has been devised to distinguish between inexperienced dentists and inexperienced orthodontists in the precise placement of orthodontic brackets. This evaluation utilizes AR-assisted software through a smartphone application, obviating the necessity for 3D radiation imaging or physical guides. This innovative approach ensures safety and convenience in clinical practice by overlaying digitally planned bracket positions onto the clinical crown of the patient, offering accurate recommendations for bracket placement.

RESULTS

It was shown that unexperienced dentists are more precise than experienced by bracket positioning without AR usage. However, AR improves the positioning in dentists rather than orthodontists. The significance value was (P < 0,004) CONCLUSION: AR smart phone applications might be used for dental brackets accurate placement in unexperienced dentists to improve the precision and accuracy.

Imaging Derived Holograms Improve Surgical Outcome in Inexperienced Surgeons: A Meta-Analysis

BackgroundMixed reality (MR) is an emerging technology that has been employed in medicine, providing a holographic representation of patient anatomy.PurposeThe aim of this review is to examine the use of imaging-derived holograms in the management of musculoskeletal conditions.Research DesingA literature search was performed on PubMed, Embase, Web of Science, Scopus, and Google Scholar up to June 2023, a total of 31 studies were included. A random-effects model was employed for the meta-analysis.ResultsMR has been extensively used in orthopedic surgery, spinal surgery, and interventional procedures for pain management. A 3D model is derived from DICOM images and superimposed on the surgical field. The procedure's accuracy has yielded remarkable results, especially for operators with less surgical experience. Furthermore, this technology minimises the need for intra-procedure imaging, thus reducing radiation exposure.ConclusionThe meta-analysis showed an impact of MR in reducing operatory time and improving inexperienced surgeons' accuracy.

Exploring Augmented Reality for Dental Implant Surgery: Feasibility of Using Smartphones as Navigation Tools

OBJECTIVES

Dental implant placement requires exceptional precision to ensure functional and esthetic success. Traditional guidance methods, such as static drilling guides and dynamic navigation systems, have improved accuracy but are limited by high costs, rigidity, and reliance on specialized hardware. This study introduces an augmented reality (AR) system using consumer smartphones for real-time navigation in dental implant placement. The system aims to provide a cost-effective, eco-friendly alternative to conventional methods by integrating virtual planning with physical models.

MATERIAL AND METHODS

A modified dental training model with removable parallel pins served as the physical component. Implant positions were digitally planned and color-coded using 3D scanning and modeling software, then integrated into an AR application built with Unity Engine. A smartphone's camera was calibrated to project virtual overlays onto the physical model. In vitro testing evaluated alignment accuracy, drill guidance, and system performance under controlled lighting conditions.

RESULTS

The AR system successfully aligned virtual overlays with the physical model, providing effective visual guidance for implant drill positioning. Operators maintained planned trajectories, demonstrating the feasibility of AR as an alternative to static and dynamic guidance systems. Challenges included the system's sensitivity to stable lighting and visual cues.

CONCLUSIONS

This AR-based approach offers an accessible and sustainable solution for modern dental implantology. Future research will focus on quantitative accuracy assessments, AI integration for enhanced performance, and clinical trials to validate real-world applicability. AR technology has the potential to transform dental practices by improving outcomes while reducing costs and environmental impact.

Head-Mounted Displays in Context-Aware Systems for Open Surgery: A State-of-the-Art Review

Surgical context-aware systems (SCAS), which leverage real-time data and analysis from the operating room to inform surgical activities, can be enhanced through the integration of head-mounted displays (HMDs). Rather than user-agnostic data derived from conventional, and often static, external sensors, HMD-based SCAS relies on dynamic user-centric sensing of the surgical context. The analyzed context-aware information is then augmented directly into a user's field of view via augmented reality (AR) to directly improve their task and decision-making capability. This state-of-the-art review complements previous reviews by exploring the advancement of HMD- based SCAS, including their development and impact on enhancing situational awareness and surgical outcomes in the operating room. The survey demonstrates that this technology can mitigate risks associated with gaps in surgical expertise, increase procedural efficiency, and improve patient outcomes. We also highlight key limitations still to be addressed by the research community, including improving prediction accuracy, robustly handling data heterogeneity, and reducing system latency.

Acceptance and use of extended reality in surgical training: an umbrella review

BACKGROUND

Extended reality (XR) technologies which include virtual, augmented, and mixed reality have significant potential in surgical training, because they can help to eliminate the limitations of traditional methods. This umbrella review aimed to investigate factors that influence the acceptance and use of XR in surgical training using the unified theory of acceptance and use of technology (UTAUT) model.

METHODS

An umbrella review was conducted in 2024 by searching various databases until the end of 2023. Studies were selected based on the predefined eligibility criteria and analyzed using the components of the UTAUT model. The quality and risk of bias of the selected studies were assessed, and the findings were reported descriptively.

RESULTS

A total of 44 articles were included in this study. In most studies, XR technologies were used for surgical training of orthopedics, neurology, and laparoscopy. Based on the UTAUT model, the findings indicated that XR technologies improved surgical skills and procedural accuracy while simultaneously reducing risks and operating room time (performance expectancy). In terms of effort expectancy, user-friendly systems were accessible for the trainees with various levels of expertise. From a social influence standpoint, XR technologies enhanced learning by providing positive feedback from experienced surgeons during surgical training. In addition, facilitating conditions emphasized the importance of resource availability and addressing technical and financial limitations to maximize the effectiveness of XR technologies in surgical training.

CONCLUSIONS

XR technologies significantly improve surgical training by increasing skills and procedural accuracy. Although adoption is facilitated by designing user-friendly interfaces and positive social influences, financial and resource challenges must be overcome, too. The successful integration of XR into surgical training necessitates careful curriculum design and resource allocation. Future research should focus on overcoming these barriers, so that XR can fully realize its potential in surgical training.

Target-specified reference-based deep learning network for joint image deblurring and resolution enhancement in surgical zoom lens camera calibration

BACKGROUND AND OBJECTIVE

For the augmented reality of surgical navigation, which overlays a 3D model of the surgical target on an image, accurate camera calibration is imperative. However, when the checkerboard images for calibration are captured using a surgical microscope having high magnification, blur owing to the narrow depth of focus and blocking artifacts caused by limited resolution around the fine edges occur. These artifacts strongly affect the localization of corner points of the checkerboard in these images, resulting in inaccurate calibration, which leads to a large displacement in augmented reality. To solve this problem, in this study, we proposed a novel target-specific deep learning network that simultaneously enhances both the blur and spatial resolution of an image for surgical zoom lens camera calibration.

METHODS

As a scheme of an end-to-end convolutional deep neural network, the proposed network is specifically intended for the checkerboard image enhancement used in camera calibration. Through the symmetric architecture of the network, which consists of encoding and decoding layers, the distinctive spatial features of the encoding layers are transferred and merged with the output of the decoding layers. Additionally, by integrating a multi-frame framework including subpixel motion estimation and ideal reference image with the symmetric architecture, joint image deblurring and enhanced resolution were efficiently achieved.

RESULTS

From experimental comparisons, we verified the capability of the proposed method to improve the subjective and objective performances of surgical microscope calibration. Furthermore, we confirmed that the augmented reality overlap ratio, which quantitatively indicates augmented reality accuracy, from calibration with the enhanced image of the proposed method is higher than that of the previous methods.

CONCLUSIONS

These findings suggest that the proposed network provides sharp high-resolution images from blurry low-resolution inputs. Furthermore, we demonstrate superior performance in camera calibration by using surgical microscopic images, thus showing its potential applications in the field of practical surgical navigation.

Simulated augmented reality-based calibration of optical see-through head mound display for surgical navigation

PURPOSE

Calibration of an optical see-through head-mounted display is critical for augmented reality-based surgical navigation. While conventional methods have advanced, calibration errors remain significant. Moreover, prior research has focused primarily on calibration accuracy and procedure, neglecting the impact on the overall surgical navigation system. Consequently, these enhancements do not necessarily translate to accurate augmented reality in the optical see-through head mount due to systemic errors, including those in calibration.

METHOD

This study introduces a simulated augmented reality-based calibration to address these issues. By replicating the augmented reality that appeared in the optical see-through head mount, the method achieves calibration that compensates for augmented reality errors, thereby reducing them. The process involves two distinct calibration approaches, followed by adjusting the transformation matrix to minimize displacement in the simulated augmented reality.

RESULTS

The efficacy of this method was assessed through two accuracy evaluations: registration accuracy and augmented reality accuracy. Experimental results showed an average translational error of 2.14 mm and rotational error of 1.06° across axes in both approaches. Additionally, augmented reality accuracy, measured by the overlay regions' ratio, increased to approximately 95%. These findings confirm the enhancement in both calibration and augmented reality accuracy with the proposed method.

CONCLUSION

The study presents a calibration method using simulated augmented reality, which minimizes augmented reality errors. This approach, requiring minimal manual intervention, offers a more robust and precise calibration technique for augmented reality applications in surgical navigation.

Augmented reality-based surgical navigation of pelvic screw placement: an ex-vivo experimental feasibility study

BACKGROUND

Minimally invasive surgical treatment of pelvic trauma requires a significant level of surgical training and technical expertise. Novel imaging and navigation technologies have always driven surgical technique, and with head-mounted displays being commercially available nowadays, the assessment of such Augmented Reality (AR) devices in a specific surgical setting is appropriate.

METHODS

In this ex-vivo feasibility study, an AR-based surgical navigation system was assessed in a specific clinical scenario with standard pelvic and acetabular screw pathways. The system has the following components: an optical-see-through Head Mounted Display, a specifically designed modular AR software, and surgical tool tracking using pose estimation with synthetic square markers.

RESULTS

The success rate for entry point navigation was 93.8%, the overall translational deviation of drill pathways was 3.99 ± 1.77 mm, and the overall rotational deviation of drill pathways was 4.3 ± 1.8°. There was no relevant theoretic screw perforation, as shown by 88.7% Grade 0-1 and 100% Grade 0-2 rating in our pelvic screw perforation score. Regarding screw length, 103 ± 8% of the planned pathway length could be realized successfully.

CONCLUSION

The novel innovative system assessed in this experimental study provided proof-of-concept for the feasibility of percutaneous screw placement in the pelvis and, thus, could easily be adapted to a specific clinical scenario. The system showed comparable performance with other computer-aided solutions while providing specific advantages such as true 3D vision without intraoperative radiation; however, it needs further improvement and must still undergo regulatory body approval. Future endeavors include intraoperative registration and optimized tool tracking.

Augmented reality and radiology: visual enhancement or monopolized mirage

Augmented reality (AR) exists on a spectrum, a mixed reality hybrid of virtual projections onto real surroundings. Superimposing conventional medical imaging onto the living patient offers vast potential for radiology, potentially revolutionising practice. The digital technology and user-interfaces that allow us to appreciate this enhanced environment however are complex, expensive, and development mainly limited to major commercial technology (Tech) firms. Hence, it is the activity of these consumer-based businesses that will inevitably dictate the available technology and therefore clinical application of AR. The release of mixed reality head-mounted displays in 2024, must therefore prompt a review of the current status of AR research in radiology, the need for further study and a discussion of the complicated relationship between consumer technology, clinical utility, and the risks of monopolisation.

Augmented reality in orthodontics for bracket placement using conventional mobile devices: Technical note

BACKGROUND

Improving bracket placement accuracy through computer-aided design and a bracket navigation set supported by augmented reality (AR).

METHODS

A technical workflow was developed for implementing AR-assisted orthodontic bracket positioning through a smartphone application. This innovative approach eliminates the need for three-dimensional radiation imaging or physical guides, making it a safe and convenient option for clinical use by overlapping the digitally planned bracket position over the patient clinical crown for a precise recommendation of bracket positioning.

RESULTS

It was found that it is achievable and can be easily recognized from all view angles, and this proves that new techniques with new opportunities could be considered.

CONCLUSIONS

AR smartphone applications can potentially be used for the accurate placement of dental brackets; thus, such applications show promise for use in the field of orthodontics.

Augmented reality for intracranial meningioma resection: a mini-review

Augmented reality (AR) integrates computer-generated content and real-world scenarios. Artificial intelligence's continuous development has allowed AR to be integrated into medicine. Neurosurgery has progressively introduced image-guided technologies. Integration of AR into the operating room has permitted a new perception of neurosurgical diseases, not only for neurosurgical planning, patient positioning, and incision design but also for intraoperative maneuvering and identification of critical neurovascular structures and tumor boundaries. Implementing AR, virtual reality, and mixed reality has introduced neurosurgeons into a new era of artificial interfaces. Meningiomas are the most frequent primary benign tumors commonly related to paramount neurovascular structures and bone landmarks. Integration of preoperative 3D reconstructions used for surgical planning into AR can now be inserted into the microsurgical field, injecting information into head-up displays and microscopes with integrated head-up displays, aiming to guide neurosurgeons intraoperatively to prevent potential injuries. This manuscript aims to provide a mini-review of the usage of AR for intracranial meningioma resection.

Real-time integration between Microsoft HoloLens 2 and 3D Slicer with demonstration in pedicle screw placement planning

PURPOSE

Up to date, there has been a lack of software infrastructure to connect 3D Slicer to any augmented reality (AR) device. This work describes a novel connection approach using Microsoft HoloLens 2 and OpenIGTLink, with a demonstration in pedicle screw placement planning.

METHODS

We developed an AR application in Unity that is wirelessly rendered onto Microsoft HoloLens 2 using Holographic Remoting. Simultaneously, Unity connects to 3D Slicer using the OpenIGTLink communication protocol. Geometrical transform and image messages are transferred between both platforms in real time. Through the AR glasses, a user visualizes a patient's computed tomography overlaid onto virtual 3D models showing anatomical structures. We technically evaluated the system by measuring message transference latency between the platforms. Its functionality was assessed in pedicle screw placement planning. Six volunteers planned pedicle screws' position and orientation with the AR system and on a 2D desktop planner. We compared the placement accuracy of each screw with both methods. Finally, we administered a questionnaire to all participants to assess their experience with the AR system.

RESULTS

The latency in message exchange is sufficiently low to enable real-time communication between the platforms. The AR method was non-inferior to the 2D desktop planner, with a mean error of 2.1 ± 1.4 mm. Moreover, 98% of the screw placements performed with the AR system were successful, according to the Gertzbein-Robbins scale. The average questionnaire outcomes were 4.5/5.

CONCLUSIONS

Real-time communication between Microsoft HoloLens 2 and 3D Slicer is feasible and supports accurate planning for pedicle screw placement.

Augmented Reality in Breast Surgery Education

Introduction

Augmented reality (AR) has demonstrated a potentially wide range of benefits and educational applications in the virtual health ecosystem. The concept of real-time data acquisition, machine learning-aided processing, and visualization is a foreseen ambition to leverage AR applications in the healthcare sector. This breakthrough with immersive technologies like AR, mixed reality, virtual reality, or extended reality will hopefully initiate a new surgical era: that of the use of the so-called surgical metaverse.

Methods

This paper focuses on the future use of AR in breast surgery education describing two potential applications (surgical remote telementoring and impalpable breast cancer localization using AR), along with the technical needs to make it possible.

Conclusion

Surgical telementoring and impalpable tumors noninvasive localization are two examples that can have success in the future provided the improvements in both data transformation and infrastructures are capable to overcome the current challenges and limitations.