Evaluation of Mixed Reality Technologies for Remote Feedback and Guidance During Transrectal Ultrasound Biopsy Simulation: A Prospective, Randomized, Crossover Study

Abstract

OBJECTIVETo compare equivalency of remote to in-person training during simulated transrectal ultrasound-guided prostate biopsy, we combined three technologies (mixed reality software, smart glasses, and hydrogel simulation model). Taken together, telemonitoring harnesses data streaming to provide real-time supervision and technical assistance for surgical procedures from an expert at a remote geographical location. METHODS19 students were randomized into two groups (mixed reality-first and in-person-first) and proctored to measure prostate volume and perform 14-biopsies over seven sessions: pre-test, two mixed reality/in-person-guided training sessions, mid-test, crossover into two in-person/mixed reality-guided training sessions, and post-test. Mixed reality sessions utilized Vuzix smart glasses with mixed reality software (HelpLightning) to share the student’s first-person perspective and Zoom to project the ultrasound screen to a remote instructor. Training and test sessions utilized single-color and seven-color prostate models, respectively. Accuracy of biopsy cores from test sessions were compared. Perception of instruction following each training session using 5-point Likert scales across five domains was assessed. Preference of instruction modality was assessed qualitatively. RESULTSComparison of mid-test performance following two training sessions was similar across the two groups (mixed reality-first 63.8% versus in-person-first 57.6%, p=0.340). Following crossover, difference in post-test performance of the mixed reality-first group and the in-person-first group approached significance (mixed reality-first 80.2% versus in-person-first 70.8%, p=0.050). Student evaluation of mixed reality and in-person instruction following training sessions was similar across the five metrics. CONCLUSIONSMixed reality-based remote learning is equally effective when compared to traditional in-person instruction.