Augmented Reality Group Research Articles

Comparing the effectiveness of augmented reality and anatomical atlases in student preparation for neuroanatomy dissection

Anatomy teachers urge students to come to education sessions at the dissection rooms as well-prepared as possible. To effectuate optimal preparation, assignments are designed to guide the students’ learning processes. These assignment often include the use of anatomical figures in atlases. The role of augmented reality (AR) applications in helping students prepare for body donor-based teaching sessions at the dissection rooms remains quite elusive. Therefore, this study examines the effects of the use of an AR application compared to the use of anatomical atlases in helping students (n = 28) prepare for a neuroanatomy session at the dissection rooms with prosections. The study shows that students from both groups showed a similar improvement in anatomy test scores. The amount of experienced cognitive engagement, however, is higher in the experimental AR group. Based on these results, it can be suggested that an AR application is a valid method to help students prepare and could be an alternative to the use of anatomical atlases. Nevertheless, future studies should re-investigate this research question in larger cohorts. Also, it remains unknown whether cognitive engaged students are indeed the students who are better prepared for educational sessions at the dissection rooms.

The influence of information technologies on creative and critical thinking of students / La influencia de las tecnologías de la información en el pensamiento crítico y creativo de los estudiantes

Innovative information technology is developing rapidly and is penetrating many areas of life, including education. The paper measures the impact of innovative information technology, using augmented reality (AR) as an example, on the development of creativity and critical thinking among students. The study was conducted among 180 students from Tonghua Normal University in China. The research design: a pre-test and post-test experiment with a control group. The following research findings were obtained: academic knowledge of the experimental group was higher (15.73) than that of the control group (12.13). ARLE model improved critical thinking (8.77 in AR group, 7.60 in the traditional group) and creativity (593 in AR group, 570 in the traditional group). The resulting data demonstrated the effectiveness of the proposed model of learning with the augmented reality technology. The research findings have practical implications. For example, they may be used to create new augmented reality apps for other disciplines and majors. The study presents recommendations on the development of creative and critical thinking, which teachers of various disciplines can apply in practice. The impact of other digital tools in education needs to be carefully studied to determine their effectiveness.

Augmented Reality-Guided Mastoidectomy Simulation: A Randomized Controlled Trial Assessing Surgical Proficiency.

Mastoidectomy surgical training is challenging due to the complex nature of the anatomical structures involved. Traditional training methods based on direct patient care and cadaveric temporal bone training have practical shortcomings. 3D-printed temporal bone models and augmented reality (AR) have emerged as promising solutions, particularly for mastoidectomy surgery, which demands an understanding of intricate anatomical structures. Evidence is needed to explore the potential of AR technology in addressing these training challenges. 21 medical students in their clinical clerkship were recruited for this prospective, randomized controlled trial assessing mastoidectomy skills. The participants were randomly assigned to the AR group, which received real-time guidance during drilling on 3D-printed temporal bone models, or to the control group, which received traditional training methods. Skills were assessed on a modified Welling scale and evaluated independently by two senior otologists. The AR group outperformed the control group, with a mean overall drilling score of 19.5 out of 25, compared with the control group's score of 12 (p < 0.01). The AR group was significantly better at defining mastoidectomy margins (p < 0.01), exposing the antrum, preserving the lateral semicircular canal (p < 0.05), sharpening the sinodural angle (p < 0.01), exposing the tegmen and attic, preserving the ossicles (p < 0.01), and thinning and preserving the external auditory canal (p < 0.05). AR simulation in mastoidectomy, even in a single session, improved the proficiency of novice surgeons compared with traditional methods. NA Laryngoscope, 2024.

New augmented reality remote for virtual guidance and education of fracture surgery: a retrospective, non-inferiority, multi-center cohort study.

The demand for telesurgery is rapidly increasing. Augmented reality (AR) remote surgery is a promising alternative, fulfilling a worldwide need in fracture surgery. However, previous AR endoscopic and Google Glass remotes remain unsuitable for fracture surgery, and the application of remote fracture surgery has not been reported. The authors aimed to evaluate the safety and clinical effectiveness of a new AR remote in fracture surgery. This retrospective non-inferiority cohort study was conducted at three centres. Between 1 January 2018 and 31 March 2022, 800 patients who underwent fracture surgery were eligible for participation. The study enroled 551 patients with fractures (132 patellae, 128 elbows, 126 tibial plateaus, and 165 ankles) divided into an AR group (specialists used AR to remotely guide junior doctors to perform surgeries) and a traditional non-remote group (specialists performed the surgery themselves). Among 364 patients (182 per group) matched by propensity score, seven (3.8%) in the AR group and six (3%) in the non-remote group developed complications. The 0.005 risk difference (95% CI: -0.033 to 0.044) was below the pre-defined non-inferiority margin of a 10% absolute increase. A similar distribution in the individual components of all complications was found between the groups. Hierarchical analysis following propensity score matching revealed no statistical difference between the two groups regarding functional results at 1-year follow-up, operative time, amount of bleeding, number of fluoroscopies, and injury surgery interval. A Likert scale questionnaire showed positive results (median scores: 4-5) for safety, efficiency, and education. This study is the first to report that AR remote surgery can be as safe and effective as that performed by a specialist in person for fracture surgery, even without the physical presence of a specialist, and is associated with improving the skills and increasing the confidence of junior surgeons. This technique is promising for remote fracture surgery and other open surgeries, offering a new strategy to address inadequate medical care in remote areas.

Feasibility of augmented reality combine patient-specific implants (PSI) applied to navigation in mandibular genioplasty: A phantom experiment

Purpose: Genitoplasty is becoming more and more common, and it is important to improve the accuracy of the procedure and simplify the procedure. This experiment explores the feasibility of using augmented reality (AR) technology combined with PSI titanium plates for navigational assistance in genioplasty performed on models, aiming to study the precision of such surgical interventions.Methods: Twelve genioplasty procedures were designed and implemented on 3D-printed resin mandibular models by the same surgeon using three different approaches: AR+3DT group (AR+PSI) , 3DT group (patient-specific titanium plate) , and a traditional free-hand group(FH group). Postoperative models were assessed using CBCT to evaluate surgical accuracy.Results: In terms of osteotomy accuracy, the AR group demonstrated a surgical error of 0.9440±0.5441 mm, significantly lower than the control group, which had an error of 1.685±0.8907 mm (P < 0.0001). In experiments positioning the distal segment of the chin, the overall centroid shift in the AR group was 0.3661±0.1360 mm, significantly less than the 2.304±0.9629 mm in the 3DT group and 1.562±0.9799 mm in the FH group (P < 0.0001). Regarding angular error, the AR+3DT group showed 2.825±1.373°, significantly <8.283±3.640° in the 3DT group and 7.234±5.241° in the FH group.Conclusion: AR navigation technology combined with PSI titanium plates demonstrates higher surgical accuracy compared to traditional methods and shows feasibility for use. Further validation through clinical trials is necessary.

Effect of using gamification and augmented reality in mechanical ventilation unit of critical care nursing on nurse students' knowledge, motivation, and self-efficacy: A randomized controlled trial

BackgroundGamification and augmented reality (AR) are innovative teaching modalities. Research on the effects of combining these two strategies in nursing education is scarce. ObjectivesTo examine the effect of the combined use of gamification and AR in teaching mechanical ventilation (MV) on nurse students' knowledge, motivation, self-efficacy, and satisfaction. DesignRandomized controlled trial. SettingA conveniently selected faculty of nursing in Egypt. ParticipantsA total of 410 nurse students. MethodsParticipants were randomly assigned to the intervention or control group (205 in each). Kahoot games and AR were used in the intervention group, whereas a traditional lecture was applied in the control group. The outcomes included levels of students' knowledge, learning motivation, self-efficacy, and satisfaction. ResultsMixed design repeated-measures ANOVA test revealed a statistically significant difference in knowledge test scores within-subject over time (p-value [effect size]: <0.001 [0.515]), between-subject due to the main effect of interventions (<0.001 [0.146]), and within-between interaction effect of group and time (<0.001 [0.515]). After using Kahoot and AR, the total mean self-efficacy score was significantly higher in the intervention group than in the control group (<0.001 [0.662]). The total median motivation score was significantly higher for the Kahoot and the AR groups compared with the traditional lecture (<0.001 [0.558]). ConclusionKahoot games and AR significantly increased nurse students' knowledge, motivation, and self-efficacy compared with traditional MV learning classes. Nursing educators need to incorporate Kahoot and AR in their pedagogies to enhance nurse students' satisfaction and development.

Immersive storytelling for pro-environmental behaviour change: The Green Planet augmented reality experience

Immersive media is becoming more mainstream but its role in challenging social norms and individuals’ behaviours is less understood. We implemented a survey at The Green Planet Augmented Reality Experience, one of the largest immersive experiences in the United Kingdom, investigating the potential of nature-themed augmented reality (AR) experiences to encourage sustainability beliefs and pro-environmental behaviours, with a one-month follow-up. A video condition group was also recruited to watch a 2D screen-capture video of the AR experience. Results suggest that the AR group had increased in sustainability attitudes and pro-environmental behaviours after (vs. before) the experience, and this persisted at follow-up one month later. When compared to the video group, the AR group scored higher in sustainability beliefs immediately after engaging with the media (but did not differ in pro-environmental behavioural intentions). At a one-month follow-up, both groups appeared to have declined in sustainability beliefs and behaviours in comparison to immediately after media exposure (but were still greater when compared to before exposure). While the two groups did not differ in sustainability beliefs, AR visitors reported to have performed more pro-environmental behaviours in the month following the experience and even increased significantly more since before attending the experience when compared to those in the video condition. Finally, we built a model of cognitive mechanisms of longitudinal pro-environmental behaviour change by media, identifying the sense of presence and connection with nature as mechanisms through which immersive media can promote greater behaviour change when compared to traditional video media. Limitations and industry implications are discussed.

Augmented reality's impact on STEM learning

Introduction: Augmented Reality (AR) is an emerging technology with potential to enhance STEM (Science, Technology, Engineering, and Mathematics) education. This study investigates the impact of implementing AR in STEM learning. Objectives: To evaluate the effectiveness of AR in enhancing students' motivation, understanding, academic performance, and problem-solving abilities in STEM disciplines. Methods: A mixed methods approach with a quasi-experimental design was employed. The study involved 180 university students and 12 STEM instructors from various programs. Data collection methods included standardized tests, questionnaires, interviews, observations, and artifact analysis. Results: The AR group showed significant improvements in academic performance, motivation, and attitudes toward STEM subjects compared to the control group. Qualitative data supported AR's potential to create more engaging and interactive learning experiences. Students reported better understanding of complex concepts and increased interest in STEM fields. Conclusions: Integrating AR in STEM education can enhance academic performance, motivation, attitudes, and comprehension of complex concepts. These findings support the importance of exploring and implementing AR technology in STEM educational settings to improve learning outcomes and foster student engagement.

ИСПОЛЬЗОВАНИЕ AR-НАВИГАЦИИ ПРИ ПОСТАНОВКЕ ВЕНТРИКУЛЯРНЫХ ДРЕНАЖЕЙ НА КАДАВЕРНОМ МАТЕРИАЛЕ

Augmented reality (AR) technologies are being actively introduced into medicine. AR can be used as a navigation tool in neurosurgery. The purpose of our study is to evaluate the accuracy of placement of external ventricular drainage, the size of the incision and the duration of this manipulation in an animal model using AR navigation and without its use. A CT scan of an animal model (ram's head) was performed, the results were segmented and loaded into AR-glasses. Participants in the experiment are divided into 2 groups of 5 people each. In the main group, ventricular drainage was placed using AR navigation, in the control group without its use. The average incision size in the non-AR group was 29.58 ± 1.566 mm. In the AR group 29.42 ± 1.279 mm. The differences in the two groups are statistically insignificant (p=0.797). In the AR group, the mean operative time was 10.26 ± 1.121 min. In the group without AR use 13.64 ± 1.588 min. The differences between the groups are statistically significant (p&lt;0.05). In the AR group, drainage was inserted into the ventricle in 47 of 50 cases (94%). In the group without the use of AR in 40 cases out of 50 (80%). These differences are statistically significant (p=0.037). AR navigation does not affect the size of the incision, but increases the accuracy of drainage placement and reduces the duration of the procedure. This shows the possibility of using this technology in clinical practice, however, additional research on the use of AR in phantom models is required.

Enhancing Surgical Approach: Breakthrough Markerless Surface Registration With Augmented Reality for Zygomatic Complex Fracture Surgeries.

Innovative technologies with surgical navigation have been used for enhancing surgical accuracies for zygomaticomaxillary complex (ZMC) fractures and offers advantages in precision, accuracy, effectiveness, predictability, and symmetry improvement. Moreover, augmented reality (AR) navigation technology combines virtual reality, 3-dimensional (3D) reconstruction, and real-time interaction, making it ideal for bone tissue operations. Our study explored the usefulness and clinical efficacy of AR technology in intraoperative guidance for reducing ZMC fractures. We retrospectively studied 35 patients with zygomatic complex fractures, comparing outcomes of AR-guided and conventional methods. Furthermore, the AR system provided real-time visualization and guidance. The evaluation included reduction accuracy using root mean square (RMS) value and symmetry analysis using a mirror image of 3D models. Results demonstrated the feasibility and effectiveness of the AR-guided method in improving outcomes and patient satisfaction. In 35 patients (25 males, 10 females), AR-guided (n = 19) and conventional (n = 16) approaches were compared. Age, sex, and fracture type exhibited no significant differences between groups. No complications occurred, and postoperative RMS error significantly decreased ( P < 0.001). The AR group had a lower postoperative RMS error ( P = 0.034). Augmented reality-guided surgery improved accuracy and outcomes in zygomatic complex fractures. Real-time visualization enhanced precision during reduction and fixation. This innovative approach promises enhanced surgical accuracy and patient outcomes in craniofacial surgery.

Examining the effects of augmented reality on sport event experiences and revisit intention: a comparative analysis between AR and non-AR users

ABSTRACT The emergence of immersive technology, such as Augmented Reality (AR), in tourism events has grown exponentially in recent years. Yet, its effectiveness remains largely unknown as limited research is available to reveal a comprehensive comparison between AR usage and non-usage. To that end, the present study aims to explore the effects of AR on tourism event experience and attendees’ revisit intention through a comparative analysis between users and non-users of AR. Data were collected from 204 participants who used AR at the Beijing Winter Olympics and 248 participants who attended the event but did not use AR. The results showed that all core dimensions of event experience significantly influenced revisit intention except novelty. Cognitive engagement was significantly higher in the AR group and exerted greater influence on revisit intention. These results add to the existing body of knowledge in AR and provide managerial insights to enhance the immersive and engaging aspects of the event.

User Experience in Neurofeedback Applications Using AR as Feedback Modality

Neurofeedback (NF) is a brain–computer interface in which users can learn to modulate their own brain activation while receiving real-time feedback thereof. To increase motivation and adherence to training, virtual reality has recently been used as a feedback modality. In the presented study, we focused on the effects of augmented reality (AR) based visual feedback on subjective user experience, including positive/negative affect, cybersickness, flow experience, and experience with the use of this technology, and compared it with a traditional 2D feedback modality. Also, half of the participants got real feedback and the other half got sham feedback. All participants performed one NF training session, in which they tried to increase their sensorimotor rhythm (SMR, 12–15 Hz) over central brain areas. Forty-four participants received conventional 2D visual feedback (moving bars on a conventional computer screen) about real-time changes in SMR activity, while 45 participants received AR feedback (3D virtual flowers grew out of a real pot). The subjective user experience differed in several points between the groups. Participants from the AR group received a tendentially higher flow score, and the AR sham group perceived a tendentially higher feeling of flow than the 2D sham group. Further, participants from the AR group reported a higher technology usability, experienced a higher feeling of control, and perceived themselves as more successful than those from the 2D group. Psychological factors like this are crucial for NF training motivation and success. In the 2D group, participants reported more concern related to their performance, a tendentially higher technology anxiety, and also more physical discomfort. These results show the potential advantage of the use of AR-based feedback in NF applications over traditional feedback modalities.

Single-Center Experience of Resection of 120 Cases of Intradural Spinal Tumors

Our study presents a single-center experience of resection of intradural spinal tumors either with or without using intraoperative computed tomography-based registration and microscope-based augmented reality (AR). Microscope-based AR was recently described for improved orientation in the operative field in spine surgery, using superimposed images of segmented structures of interest in a two-dimensional or three-dimensional mode. All patients who underwent surgery for resection of intradural spinal tumors at our department were retrospectively included in the study. Clinical outcomes in terms of postoperative neurologic deficits and complications were evaluated, as well as neuroradiologic outcomes for tumor remnants and recurrence. 112 patients (57 female, 55 male; median age 55.8 ± 17.8 years) who underwent 120 surgeries for resection of intradural spinal tumors with the use of intraoperative neuromonitoring were included in the study, with a median follow-up of 39 ± 34.4 months. Nine patients died during the follow-up for reasons unrelated to surgery. The most common tumors were meningioma (n= 41), schwannoma (n= 37), myopapillary ependymomas (n= 12), ependymomas (n= 10), and others (20). Tumors were in the thoracic spine (n= 46), lumbar spine (n= 39), cervical spine (n= 32), lumbosacral spine (n= 1), thoracic and lumbar spine (n= 1), and 1 tumor in the cervical, thoracic, and lumbar spine. Four biopsies were performed, 10 partial resections, 13 subtotal resections, and 93 gross total resections. Laminectomy was the common approach. In 79 cases, patients experienced neurologic deficits before surgery, with ataxia and paraparesis as the most common ones. After surgery, 67 patients were unchanged, 49 improved and 4 worsened. Operative time, extent of resection, clinical outcome, and complication rate did not differ between the AR and non-AR groups. However, the use of AR improved orientation in the operative field by identification of important neurovascular structures. High rates of gross total resection with favorable neurologic outcomes in most patients as well as low recurrence rates with comparable complication rates were noted in our single-center experience. AR improved intraoperative orientation and increased surgeons' comfort by enabling early identification of important anatomic structures; however, clinical and radiologic outcomes did not differ, when AR was not used.

Augmented Reality Training on Combat Sport: Improving the Quality of Physical Fitness and Technical Performance of Young Athletes

This study aims to analyze the effects of augmented reality (AR) training in improving physical fitness and technical performance. An 11-week randomized controlled design was adopted in this study. This research involved sixty female athletes in Pencak Silat and Karate from Sriwijaya University (Indonesia). Participants were allocated into the experimental group, namely AR (Pencak silat: n=15, Karate: n=15) and control group (Pencak silat: n=15, Karate: n=15). Handgrip dynamometer, leg dynamometer test, medicine ball, standing long jump test, hexagon agility test, sit and reach test and multi stage test are used to measure physical fitness levels while the target punching test and target kick test are used to measure technical performance. The results of Student's t showed that there was a change in the mean value of AR (all, p &lt; 0.05) and control only in MBT (p &lt; 0.05) from baseline to final-test, ANOVA analysis we observed that there was an effect of Time on physical fitness (all, p &lt; .001), there was a Group effect related to HDT (p &lt; .001), MBT (p = 0.043), SART (p &lt; .001), and MST (p &lt; .001) and there was a Time * Group interaction related to HDT (p &lt; .001), LDT ( p = 0.029), SLJT (p &lt; .001), HAT ( p &lt; .001), SART (p &lt; .001), and MST (p &lt; .001), there was an effect of Time on technical performance (all, p &lt; .001), Group effect related to TPT (p = 0.004), and Time * Group interaction related to TPT (p = 0.001) and TKT (p &lt; .001). Thus, we conclude that using AR for 11 weeks is an effective training method for improving the quality of physical fitness and technical performance of young athletes in combat sports. Keywords: Combat sport, Athlete performance, Technology training.

Applying augmented reality in teaching of surgical residents-telementoring, a "stress-free" way to surgical autonomy?

Achieving surgical autonomy can be considered the ultimate goal of surgical training. Innovative head-mounted augmented reality (AR) devices enable visualization of the operating field and teaching from remote. Therefore, utilization of AR glasses may be a novel approach to achieve autonomy. The aim of this pilot study is to analyze the feasibility of AR application in surgical training and to assess its impact on intraoperative stress. A head-mounted RealWear Navigator® 500 glasses and the TeamViewer software were used. Initial "dry lab" testing of AR glasses was performed in combination with the Symbionix LAP Mentor™. Subsequently, residents performed various stage-adapted surgical procedures semi-autonomously (SA) (on-demand consultation of senior surgeon, who is in theatre but not scrubbed) versus permanent remote supervision (senior surgeon not present) via augmented reality (AR) glasses, worn by the resident in theatre. Stress was measured by intraoperative heart rate (Polar® pulse belt) and State-Trait Anxiety Inventory (STAI) questionnaire. After "dry lab" testing, N = 5 senior residents performed equally N = 25 procedures SA and with AR glasses. For both, open and laparoscopic procedure AR remote assistance showed satisfactory applicability. Utilization of AR significantly reduced intraoperative peak pulse rate from 131 to 119bpm (p = 0.004), as compared with the semi-autonomous group. Likewise, subjectively perceived stress according to STAI was significantly lower in the AR group (p = 0.011). AR can be applied in surgical training and may help to reduce stress in theatre. In the future, AR has a huge potential to become a stepping stone to surgical autonomy.

Augmented reality technology shortens aneurysm surgery learning curve for residents

Objectives We aimed to prospectively investigate the benefit of using augmented reality (AR) for surgery residents learning aneurysm surgery. Materials and methods Eight residents were included, and divided into an AR group and a control group (4 in each group). Both groups were asked to locate an aneurysm with a blue circle on the same screenshot after their viewing of surgery videos from both AR and non-AR tests. Only the AR group was allowed to inspect and manipulate an AR holographic representation of the aneurysm in AR tests. The actual location of the aneurysm was defined by a yellow circle by an attending physician after each test. Localization deviation was determined by the distance between the blue and yellow circle. Results Localization deviation was lower in the AR group than in the control group in the last 2 tests (AR Test 2: 2.7 ± 1.0 mm vs. 5.8 ± 4.1 mm, p = 0.01, non-AR Test 2: 2.1 ± 0.8 mm vs. 5.9 ± 5.8 mm, p < 0.001). The mean deviation was lower in non-AR Test 2 as compared to non-AR Test 1 in both groups (AR: p < 0.001, control: p = 0.391). The localization deviation of the AR group decreased from 8.1 ± 3.8 mm in Test 2 to 2.7 ± 1.0 mm in AR Test 2 (p < 0.001). Conclusion AR technology provides an effective and interactive way for neurosurgery training, and shortens the learning curve for residents in aneurysm surgery.

Application of augmented reality models of canine skull in veterinary anatomical education.

Veterinary anatomy plays a crucial role in the curriculum for veterinary medicine and surgery. The integration of modern information technology in veterinary education can greatly benefit from innovative tools such as augmented reality (AR) applications. The aim of this study was to develop an accurate and interactive three-dimensional (3D) digital model of an animal skull using AR technology, aiming to enhance the learning of skull anatomy in veterinary anatomy education. In this study, a canine skull specimen was isolated, and the skull bones were scanned using a structured light scanner to create a 3D digital model of the canine skull, which was found to be indistinguishable from the original specimen by measurement of skull proportions. Furthermore, the interactive AR model of the canine skull, displayed using Unity3D, was subjected to testing and evaluation by 60 first-year veterinary medical students attending the gross anatomy of the animal. The students were divided into two groups: the traditional group and AR group. Both groups completed an objective test and a questionnaire. The evaluation of learning effectiveness in the test revealed no significant difference between the traditional group (which learned using textbooks and a canine skull specimen) and AR group (which learned using AR tools). However, in the questionnaire, students displayed high enthusiasm and interest in using the AR tool. Therefore, the application of AR tools can improve students' motivation for learning and enhance the comprehension of anatomical structures in three dimensions. Furthermore, this study exemplifies the use of AR as an auxiliary tool for teaching and learning in veterinary anatomy education.

Is Augmented Reality Technology Effective in Locating the Apex of Teeth Undergoing Apicoectomy Procedures?

This study seeks to assess the accuracy of apical location using an augmented reality (AR) device with a free-hand method. Sixty (60) osteotomy site preparations were randomly assigned to one of two study groups: A. AR device (AR) (n = 30), and B. conventional free-hand method (FHM) (n = 30). Preoperative CBCT scans and intraoral scans were taken and uploaded to specialized implant-planning software to virtually plan preparations for the apical location osteotomy sites. The planning software was then used to automatically segment the teeth in each experimental model for their complete visualization using the AR device. A CBCT scan was carried out postoperatively after conducting the apical location procedures. The subsequent datasets were imported into therapeutic software to analyze the coronal, apical, and angular deviations. The Mann-Whitney non-parametric test was used. There were no statistically significant differences identified at the coronal (p = 0.1335), apical (p = 0.2401), and angular deviations (p = 0.4849) between the AR and FHM study groups. The augmented reality technique did not show a statistically significant accuracy of osteotomies for apical location when compared with the conventional free-hand method.

Characterizing the Effects of Adding Virtual and Augmented Reality in Robot-Assisted Training.

Extended reality (XR) technology combines physical reality with computer synthetic virtuality to deliver immersive experience to users. Virtual reality (VR) and augmented reality (AR) are two subdomains within XR with different immersion levels. Both of these have the potential to be combined with robot-assisted training protocols to maximize postural control improvement. In this study, we conducted a randomized control experiment with sixty-three healthy subjects to compare the effectiveness of robot-assisted posture training combined with VR or AR against robotic training alone. A robotic Trunk Support Trainer (TruST) was employed to deliver assistive force at the trunk as subjects moved beyond the stability limits during training. Our results showed that both VR and AR significantly enhanced the training outcomes of the TruST intervention. However, the VR group experienced higher simulator sickness compared to the AR group, suggesting that AR is better suited for sitting posture training in conjunction with TruST intervention. Our findings highlight the added value of XR to robot-assisted training and provide novel insights into the differences between AR and VR when integrated into a robotic training protocol. In addition, we developed a custom XR application that suited well for TruST intervention requirements. Our approach can be extended to other studies to develop novel XR-enhanced robotic training platforms.

Effects of Augmented Reality on Thoracolumbar Pedicle Screw Instrumentation Across Different Levels of Surgical Experience

Augmented reality (AR) is an emerging technology that may accelerate skill acquisition and improve accuracy of thoracolumbar pedicle screw placements. We aimed to quantify the relative assistance of AR compared with freehand (FH) pedicle screw accuracy across different surgical experience levels. A spine fellowship-trained and board-certified attending neurosurgeon, postgraduate year 4 neurosurgery resident, and second-year medical student placed 32 FH and 32 AR-assisted thoracolumbar pedicle screws in 3 cadavers. A cableless, voice-activated AR system was paired with a headset. Accuracy was assessed using χ2 analysis and the Gertzbein-Robbins scale. Angular error, distance error, and time per pedicle screw were collected and compared. The attending neurosurgeon had 91.6% (11/12) clinically acceptable (Gertzbein-Robbins scale A or B) insertion in both FH and AR groups; the resident neurosurgeon had 100% (9/9) FH and AR in both cases; the medical student had 72.3% (8/11) FH accuracy and 81.8% (9/11) AR accuracy. The medical student displayed significantly lower ideal (Gertzbein-Robbins scale A) FH accuracy compared with the resident neurosurgeon (P= 0.017) and attending neurosurgeon (P= 0.005), but no difference when using AR. FH screw placement was faster by both the attending neurosurgeon (median 46 seconds vs. 94.5 seconds, P= 0.0047) and the neurosurgery resident neurosurgeon (median 144 seconds vs. 140 seconds, P= 0.05). Total clinically acceptable AR and FH accuracy was 90.6% (29/32) and 87.5% (28/32), respectively (P= 0.69). AR screw placement allowed an inexperienced medical student to double their accuracy in 1 training session. With subsequent iterations, this promising technology could serve as an important tool for surgical training.