Rojas-Muñoz Edgar, Lin Chengyuan, Sanchez-Tamayo Natalia, Cabrera Maria Eugenia, Andersen Daniel, Popescu Voicu, Barragan Juan Antonio, Zarzaur Ben, Murphy Patrick, Anderson Kathryn, Douglas Thomas, Griffis Clare, McKee Jessica, Kirkpatrick Andrew W, Wachs Juan P
School of Industrial Engineering, Purdue University, West Lafayette, IN USA.
Department of Computer Science, Purdue University, West Lafayette, IN USA.
NPJ Digit Med. 2020 May 21;3:75. doi: 10.1038/s41746-020-0284-9. eCollection 2020.
Telementoring platforms can help transfer surgical expertise remotely. However, most telementoring platforms are not designed to assist in austere, pre-hospital settings. This paper evaluates the system for telementoring with augmented reality (STAR), a portable and self-contained telementoring platform based on an augmented reality head-mounted display (ARHMD). The system is designed to assist in austere scenarios: a stabilized first-person view of the operating field is sent to a remote expert, who creates surgical instructions that a local first responder wearing the ARHMD can visualize as three-dimensional models projected onto the patient's body. Our hypothesis evaluated whether remote guidance with STAR could lead to performing a surgical procedure better, as opposed to remote audio-only guidance. Remote expert surgeons guided first responders through training cricothyroidotomies in a simulated austere scenario, and on-site surgeons evaluated the participants using standardized evaluation tools. The evaluation comprehended completion time and technique performance of specific cricothyroidotomy steps. The analyses were also performed considering the participants' years of experience as first responders, and their experience performing cricothyroidotomies. A linear mixed model analysis showed that using STAR was associated with higher procedural and non-procedural scores, and overall better performance. Additionally, a binary logistic regression analysis showed that using STAR was associated to safer and more successful executions of cricothyroidotomies. This work demonstrates that remote mentors can use STAR to provide first responders with guidance and surgical knowledge, and represents a first step towards the adoption of ARHMDs to convey clinical expertise remotely in austere scenarios.
远程指导平台有助于远程传授手术专业知识。然而,大多数远程指导平台并非为在严峻的院前环境中提供协助而设计。本文评估了增强现实远程指导系统(STAR),这是一种基于增强现实头戴式显示器(ARHMD)的便携式独立远程指导平台。该系统旨在协助应对严峻场景:将稳定的手术视野第一人称视角发送给远程专家,专家创建手术指导,佩戴ARHMD的当地急救人员可以将这些指导可视化为投射在患者身体上的三维模型。我们的假设是评估与仅通过远程音频指导相比,使用STAR进行远程指导是否能使手术操作执行得更好。远程专家外科医生在模拟的严峻场景中指导急救人员进行环甲膜切开术训练,现场外科医生使用标准化评估工具对参与者进行评估。评估内容包括特定环甲膜切开术步骤的完成时间和技术表现。分析还考虑了参与者作为急救人员的工作年限以及他们进行环甲膜切开术的经验。线性混合模型分析表明,使用STAR与更高的操作和非操作得分以及总体更好的表现相关。此外,二元逻辑回归分析表明,使用STAR与更安全、更成功地执行环甲膜切开术相关。这项工作表明,远程指导者可以使用STAR为急救人员提供指导和手术知识,这是在严峻场景中采用ARHMD远程传授临床专业知识的第一步。
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