Digital Transformation Will Change Medical Education and Rehabilitation in Spine Surgery

Effectiveness of a virtual reality-based interventional radiology simulator for medical student education

PURPOSE

We developed an interventional radiology (IR) simulator using a virtual reality system (the VR-IR simulator) to teach IR procedures to medical students. In this study, we investigated the effectiveness of this teaching method.

MATERIALS AND METHODS

All ninety-nine fifth-year medical students attended a conventional classroom lecture. To teach students the actual procedure, they were randomly divided into two groups: One received conventional verbal explanations and educator demonstrations (the conventional group [n = 44]), and the other received VR-IR simulator training (the VR-IR simulator group [n = 55]). Afterward, they underwent a test using an augmented reality- (AR-) IR simulator (the VIST® G5 image-guided AR-IR simulator, Mentice, Gothenburg, Sweden). The total procedure time, amount of contrast media used, fluoroscopic time, and patient peak skin dose in the simulated patients were compared between groups. A board-certified radiologist evaluated ten aspects of the procedure technique using a 5-point Likert scale (total: 50 points).

RESULTS

Two students in the VR-IR simulator group were excluded due to VR sickness and simulator malfunction. There were no significant differences between the VR-IR simulator group and the conventional group regarding total procedure time (median [25-75% interquartile range]: 13.5 [11.8-14.5] vs. 14.3 [12.3-16.8] minutes, p = 0.11), fluoroscopic time (10.1 [8.5-13.0] vs. 11.0 [8.6-13.7] minutes, p = 0.31), and patient peak skin dose (276 [243-373] vs. 303 [239-395] mGy, p = 0.57), respectively. However, the amount of contrast media used was significantly lower (28.0 [21.0-36.2] vs. 40.0 [32.3-50.9] mL, p < 0.01) and the technical achievement scores by the radiologist (36 [34-44] vs. 31 [29-32], p < 0.01) were significantly higher in the VR-IR simulator group.

CONCLUSION

The VR-IR simulator helped reduce the amount of contrast media in interventional procedures and improved technical achievement scores.

A new approach to peripheral nerve block education with the Anatomage Table as a learning adjunct

Human anatomy education serves as a gateway for entering the intricacies of health science. Human cadavers have been the gold standard for learning regional and gross anatomy. However, increasing barriers in acquisition, maintenance, and longevity have pushed anatomy education toward technology-based alternatives such as the Anatomage Table (AT), an interactive, life-sized virtual dissection table with many anatomy education-centric features. The AT has found purchase in various contexts, such as clinical settings, research, outreach, and education. Studies into the efficacy of the AT in teaching settings have been generally positive but limited in its application, particularly in clinical procedure education. In this study, we conducted an informal workshop for second-year Certified Registered Nurse Anesthetist (CRNA) students to aid in being able to identify the important neuraxial landmarks for performing peripheral nerve blocks (PNBs), an anesthetic technique often used before other procedures. In our workshop, we paired the AT with identification of the same neuraxial landmarks on volunteer models with an ultrasound probe to provide students with relevant tactile experience for the procedure. From our pre-/post-surveys of the participants (n = 29), we found that our workshop significantly increased student confidence in identifying the relevant neuraxial landmarks for and in performing PNBs. Our results support the use of the AT in clinical education as a supplement, particularly where other anatomic teaching tools, such as cadaver models, may be too difficult to implement.NEW & NOTEWORTHY We implemented the Anatomage Table (AT) and portable ultrasound to teach neuraxial landmarks for performing peripheral nerve blocks (PNB), an anesthetic technique for Certified Registered Nurse Anesthetist (CRNA) students. The workshop significantly increased student confidence in identifying the relevant neuraxial landmarks for performing PNBs. Our results support the use of the AT in clinical education as a supplement.

Exploring Augmented Reality Integration in Diagnostic Imaging: Myth or Reality?

This study delves into the transformative potential of integrating augmented reality (AR) within imaging technologies, shedding light on this evolving landscape. Through a comprehensive narrative review, this research uncovers a wealth of literature exploring the intersection between AR and medical imaging, highlighting its growing prominence in healthcare. AR's integration offers a host of potential opportunities to enhance surgical precision, bolster patient engagement, and customize medical interventions. Moreover, when combined with technologies like virtual reality (VR), artificial intelligence (AI), and robotics, AR opens up new avenues for innovation in clinical practice, education, and training. However, amidst these promising prospects lie numerous unanswered questions and areas ripe for exploration. This study emphasizes the need for rigorous research to elucidate the clinical efficacy of AR-integrated interventions, optimize surgical workflows, and address technological challenges. As the healthcare landscape continues to evolve, sustained research efforts are crucial to fully realizing AR's transformative impact in medical imaging. Systematic reviews on AR in healthcare also overlook regulatory and developmental factors, particularly in regard to medical devices. These include compliance with standards, safety regulations, risk management, clinical validation, and developmental processes. Addressing these aspects will provide a comprehensive understanding of the challenges and opportunities in integrating AR into clinical settings, informing stakeholders about crucial regulatory and developmental considerations for successful implementation. Moreover, navigating the regulatory approval process requires substantial financial resources and expertise, presenting barriers to entry for smaller innovators. Collaboration across disciplines and concerted efforts to overcome barriers will be essential in navigating this frontier and harnessing the potential of AR to revolutionize healthcare delivery.

Analyzing the Differences in the Degree of Force Application Between Novice and Expert Physiotherapists Using a Muscle Deformation Sensor

BACKGROUND

Training physiotherapists require substantial experience and a lengthy period of time to achieve proficiency. However, establishing an objective method for quantifying the degree of force applied during treatment remains elusive, making training difficult.

OBJECTIVES

This study aims to clarify the difference in the degree of force application between novice and expert physiotherapists using muscle deformation sensors and to assist in teaching.

METHODS

A muscle deformation sensor array was utilized to capture the muscle bulging (muscle deformation), and the degree of force was visualized. The experiment involved two types of physiotherapy: upper and lower extremity exercises. Subsequently, the muscle deformation value and standard deviations of the muscle deformation data obtained were compared.

RESULTS

Significant differences between novices and experts were observed in forearm muscle deformation values and standard deviations across both types of physiotherapies (p<0.05). Additionally, a distinction was observed in the left lower limb flexor muscles during upper extremity exercise (p<0.05).

CONCLUSION

The results of this survey showed notable differences in the degree of force application between novices and experts, as demonstrated by our findings. Moreover, these implications extend beyond physiotherapy to sports, hobbies, and the teaching of traditional skills.

Digital Phenotyping, Wearables, and Outcomes

There is a significant need for robust and objective outcome assessments in spine surgery. Constant monitoring via smartphones and wearable devices has the potential to fill this role by providing an in-depth picture of human well-being, creating an unprecedented amount of objective data to augment clinical decision-making. The metrics obtained from continuous patient monitoring increase the amount and ecological validity of data relevant to spine surgery. This can provide physicians with patient and disease-specific medical information, facilitating personalized patient care.

Does Extended Reality Simulation Improve Surgical/Procedural Learning and Patient Outcomes When Compared With Standard Training Methods?: A Systematic Review

INTRODUCTION

The use of extended reality (XR) technologies, including virtual, augmented, and mixed reality, has increased within surgical and procedural training programs. Few studies have assessed experiential learning- and patient-based outcomes using XR compared with standard training methods.

METHODS

As a working group for the Society for Simulation in Healthcare, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a PICO strategy to perform a systematic review of 4238 articles to assess the effectiveness of XR technologies compared with standard training methods. Outcomes were grouped into knowledge, time-to-completion, technical proficiency, reactions, and patient outcomes. Because of study heterogeneity, a meta-analysis was not feasible.

RESULTS

Thirty-two studies met eligibility criteria: 18 randomized controlled trials, 7 comparative studies, and 7 systematic reviews. Outcomes of most studies included Kirkpatrick levels of evidence I-III (reactions, knowledge, and behavior), while few reported level IV outcomes (patient). The overall risk of bias was low. With few exceptions, included studies showed XR technology to be more effective than standard training methods in improving objective skills and performance, shortening procedure time, and receiving more positive learner ratings. However, XR use did not show significant differences in gained knowledge.

CONCLUSIONS

Surgical or procedural XR training may improve technical skill development among trainees and is generally favored over standard training methods. However, there should be an additional focus on how skill development translates to clinically relevant outcomes. We recommend longitudinal studies to examine retention and transfer of training to clinical settings, methods to improve timely, adaptive feedback for deliberate practice, and cost analyses.

Opportunities and challenges of 5G network technology toward precision medicine

Moving away from traditional "one-size-fits-all" treatment to precision-based medicine has tremendously improved disease prognosis, accuracy of diagnosis, disease progression prediction, and targeted-treatment. The current cutting-edge of 5G network technology is enabling a growing trend in precision medicine to extend its utility and value to the smart healthcare system. The 5G network technology will bring together big data, artificial intelligence, and machine learning to provide essential levels of connectivity to enable a new health ecosystem toward precision medicine. In the 5G-enabled health ecosystem, its applications involve predictive and preventative measurements which enable advances in patient personalization. This review aims to discuss the opportunities, challenges, and prospects posed to 5G network technology in moving forward to deliver personalized treatments and patient-centric care via a precision medicine approach.

Microsoft HoloLens 2 in Medical and Healthcare Context: State of the Art and Future Prospects

In the world reference context, although virtual reality, augmented reality and mixed reality have been emerging methodologies for several years, only today technological and scientific advances have made them suitable to revolutionize clinical care and medical contexts through the provision of enhanced functionalities and improved health services. This systematic review provides the state-of-the-art applications of the Microsoft^® HoloLens 2 in a medical and healthcare context. Focusing on the potential that this technology has in providing digitally supported clinical care, also but not only in relation to the COVID-19 pandemic, studies that proved the applicability and feasibility of HoloLens 2 in a medical and healthcare scenario were considered. The review presents a thorough examination of the different studies conducted since 2019, focusing on HoloLens 2 medical sub-field applications, device functionalities provided to users, software/platform/framework used, as well as the study validation. The results provided in this paper could highlight the potential and limitations of the HoloLens 2-based innovative solutions and bring focus to emerging research topics, such as telemedicine, remote control and motor rehabilitation.