Abstract
BackgroundDigital rectal examination is a difficult examination to learn and teach because of limited opportunities for practice; however, the main challenge is that students and tutors cannot see the finger when it is palpating the anal canal and prostate gland inside the patients.ObjectiveThis paper presents an augmented reality system to be used with benchtop models commonly available in medical schools with the aim of addressing the problem of lack of visualization. The system enables visualization of the examining finger, as well as of the internal organs when performing digital rectal examinations. Magnetic tracking sensors are used to track the movement of the finger, and a pressure sensor is used to monitor the applied pressure. By overlaying a virtual finger on the real finger and a virtual model on the benchtop model, students can see through the examination and finger maneuvers.MethodsThe system was implemented in the Unity game engine (Unity Technologies) and uses a first-generation HoloLens (Microsoft Inc) as an augmented reality device. To evaluate the system, 19 participants (9 clinicians who routinely performed digital rectal examinations and 10 medical students) were asked to use the system and answer 12 questions regarding the usefulness of the system.ResultsThe system showed the movement of an examining finger in real time with a frame rate of 60 fps on the HoloLens and accurately aligned the virtual and real models with a mean error of 3.9 mm. Users found the movement of the finger was realistic (mean 3.9, SD 1.2); moreover, they found the visualization of the finger and internal organs were useful for teaching, learning, and assessment of digital rectal examinations (finger: mean 4.1, SD 1.1; organs: mean 4.6, SD 0.8), mainly targeting a novice group.ConclusionsThe proposed augmented reality system was designed to improve teaching and learning of digital rectal examination skills by providing visualization of the finger and internal organs. The initial user study proved its applicability and usefulness.
Highlights
Digital rectal examination (DRE) is a physical examination for detecting rectal and prostate abnormalities
Users found the movement of the finger was realistic; they found the visualization of the finger and internal organs were useful for teaching, learning, and assessment of digital rectal examinations, mainly targeting a novice group
Even though it is a recommendation of the American Cancer Society to perform DRE to screen and detect prostate cancer in patients with colorectal symptoms, multiple studies [1,2] have found that, during their final year, medical students are not confident in their abilities to perform the examination
Summary
Digital rectal examination (DRE) is a physical examination for detecting rectal and prostate abnormalities. DRE requires that an index finger to palpate the prostate gland to detect abnormalities in gland size, tenderness, and surface texture. Even though students can touch and feel the prostate gland through the rubber rectum, no visualization of finger movement or internal organs can be obtained because it lacks transparency. This model does not provide enough information to examiners to assess the techniques used by students to perform DRE. Digital rectal examination is a difficult examination to learn and teach because of limited opportunities for practice; the main challenge is that students and tutors cannot see the finger when it is palpating the anal canal and prostate gland inside the patients
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