增强现实可视化在超声引导介入中的应用：一项评估学员表现和认知负荷的随机交叉试验研究

BACKGROUND: Augmented reality (AR) technology involving head-mounted displays (HMD) represents a significant innovation in medical education, particularly for training in guided invasive procedures. Novice physicians often face challenges in simultaneously identifying anatomical landmarks and performing procedures when learning point-of-care ultrasound (POCUS). Our primary objective was to determine the effectiveness of AR in enhancing physician training for ultrasound-guided interventions using AR visual overlays. The secondary objective was to compare cognitive load between traditional ultrasound training settings and AR-assisted training settings. METHODS: This randomized crossover study, conducted from 2021 to 2022, compared performance and cognitive load of trainees attempting accurate central venous catheter (CVC) placement using an AR-HMD to display ultrasound images (AR-US), compared with standard ultrasound without visual overlay (S-US). We enrolled 47 trainees, including 22 final-year undergraduate medical students and 25 postgraduate physicians (years 1-4) from three hospitals in Taiwan. All participants had basic training in US-guided CVC placement but lacked AR-US experience. Performance and cognitive load were assessed using time measurements and NASA Task Load Index (NASA-TLX), covering the dimensions of Mental-, Physical- and Temporal Demand, and Performance, Effort and Frustration. RESULTS: We found AR technology reduced the time required for critical steps in CVC placement, while minimizing users' neck strain. Female and junior trainees using AR-US identified anatomy and localized veins faster than those using S-US. Using AR-US, female trainees significantly outperformed males in anatomical identification [mean difference (MD): -10.79 s (95% CI: -2.37 to -19.21)]. The NASA-TLX cognitive load assessment showed mental workload trending lower in all dimensions except performance while using AR-US, compared to S-US. Similarly, junior trainees' effort- and frustration scores were lower [MD: -2.73 (95% CI: -5.04 to -0.41) and -2.41 (95% CI: -4.51 to -0.31), respectively], as were female trainees' effort scores [MD: -3.07 (95% CI: -6.10 to -0.03)] when using AR-US, compared to S-US, whereby these differences were statistically significant. CONCLUSIONS: AR technology helped improve trainee performance and reduced cognitive load during ultrasound-guided CVC placement. These findings support the application of AR technology to enhance physician training in ultrasound-guided interventional procedures, suggesting that AR-HMDs could be a valuable tool in medical education. TRIAL REGISTRATION: The trial was registered with Clinicaltrials.gov on 20/09/2023 as a clinical trial, under the identifier NCT06055400.

背景：增强现实（AR）技术涉及头戴式显示器（HMD），是医学教育的重大创新，尤其适用于引导性介入手术的培训。新手医师在学习即时护理超声（POCUS）时，往往难以同时识别解剖标志和进行操作。我们的主要目的是确定使用 AR 视觉叠加进行超声引导介入的 AR 在增强医师培训方面的有效性。次要目标是比较传统超声培训环境与 AR 辅助培训环境的认知负荷。

方法：本研究于 2021 年至 2022 年进行，是一项随机交叉研究，将 47 名受训者（包括来自台湾三家医院的 22 名医学本科最后一年学生和 25 名住院医师（1-4 年））分为两组，一组使用 AR-HMD 显示超声图像（AR-US）进行操作，另一组使用标准超声（S-US）。评估标准为使用 AR-HMD 进行中央静脉导管（CVC）置管时受训者的操作表现和认知负荷。我们评估了时间测量和 NASA 任务负荷指数（NASA-TLX），涵盖了心理、生理和时间需求以及绩效、努力和挫折等维度。

结果：我们发现 AR 技术减少了 CVC 置管关键步骤所需的时间，同时最大程度地减少了受训者的颈部劳损。使用 AR-US 的女性和初级受训者比使用 S-US 的更快识别解剖结构并定位静脉。使用 AR-US，女性受训者在解剖识别方面的表现明显优于男性受训者[平均差异（MD）：-10.79 秒（95%置信区间：-2.37 至 -19.21）]。使用 AR-US 时，NASA-TLX 认知负荷评估显示，除了绩效外，在所有维度上的心理工作量都呈下降趋势，而使用 S-US 时则不然。类似地，初级受训者的努力和挫折得分更低[MD：-2.73（95%置信区间：-5.04 至 -0.41）和-2.41（95%置信区间：-4.51 至 -0.31）]，而女性受训者的努力得分更低[MD：-3.07（95%置信区间：-6.10 至 -0.03）]，使用 AR-US 时，这些差异具有统计学意义。

结论：AR 技术有助于提高超声引导 CVC 置管过程中的受训者表现并降低认知负荷。这些发现支持将 AR 技术应用于增强超声引导介入手术的医师培训，表明 AR-HMD 可能是医学教育中的一种有价值的工具。

试验注册：该试验于 2023 年 9 月 20 日在 Clinicaltrials.gov 上注册为一项临床试验，标识符为 NCT06055400。