%0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e52904 %T What is Diminished Virtuality? A Directional and Layer-Based Taxonomy for the Reality-Virtuality Continuum %A Egger,Jan %A Gsaxner,Christina %A Kleesiek,Jens %A Puladi,Behrus %+ Institute of Computer Graphics and Vision, Graz University of Technology, Inffeldgasse 16c/2, Graz, 8010, Austria, 43 316 873 5076, egger@icg.tugraz.at %K reality-virtuality continuum %K diminished virtuality %K Apple Vision Pro %K VR %K virtual reality %K reality-virtuality %K mixed reality %K augmented reality %K XR %K extended reality %K taxonomy %K classification %K classifications %K concept %K concepts %K conceptual %D 2024 %7 31.1.2024 %9 Viewpoint %J JMIR XR Spatial Comput %G English %X The concept of reality-virtuality (RV) continuum was introduced by Paul Milgram and Fumio Kishino in 1994. It describes a spectrum that ranges from a purely physical reality (the real world) to a purely virtual reality (a completely computer-generated environment), with various degrees of mixed reality in between. This continuum is “realized” by different types of displays to encompass different levels of immersion and interaction, allowing for the classification of different types of environments and experiences. What is often overlooked in this concept is the act of diminishing real objects (or persons, animals, etc) from the reality, that is, a diminution, rather than augmenting it, that is, an augmentation. Hence, we want to propose in this contribution an update or modification of the RV continuum where the diminished reality aspect is more prominent. We hope this will help users, especially those who are new to the field, to get a better understanding of the entire extended reality (XR) topic, as well as assist in the decision-making for hardware (devices) and software or algorithms that are needed for new diminished reality applications. However, we also propose another, more sophisticated directional and layer-based taxonomy for the RV continuum that we believe goes beyond the mediated and multimediated realities. Furthermore, we initiate the question of whether the RV continuum truly ends on one side with physical reality. %R 10.2196/52904 %U https://xr.jmir.org/2024/1/e52904 %U https://doi.org/10.2196/52904 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e37599 %T Application of Virtual and Augmented Reality Technology in Hip Surgery: Systematic Review %A Sun,Peng %A Zhao,Yao %A Men,Jie %A Ma,Zhe-Ru %A Jiang,Hao-Zhuo %A Liu,Cheng-Yan %A Feng,Wei %+ Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, 1 Xinmin Street, Chang chun, 130000, China, 86 0431 81875596, feng_wei@jlu.edu.cn %K virtual reality %K augmented reality %K hip %K pelvis %K arthroplasty %K mobile phone %D 2023 %7 10.3.2023 %9 Review %J J Med Internet Res %G English %X Background: Virtual and augmented reality (VAR) represents a combination of current state-of-the-art computer and imaging technologies and has the potential to be a revolutionary technology in many surgical fields. An increasing number of investigators have developed and applied VAR in hip-related surgery with the aim of using this technology to reduce hip surgery–related complications, improve surgical success rates, and reduce surgical risks. These technologies are beginning to be widely used in hip-related preoperative operation simulation and training, intraoperative navigation tools in the operating room, and postoperative rehabilitation. Objective: With the aim of reviewing the current status of virtual reality (VR) and augmented reality (AR) in hip-related surgery and summarizing its benefits, we discussed and briefly described the applicability, advantages, limitations, and future perspectives of VR and AR techniques in hip-related surgery, such as preoperative operation simulation and training; explored the possible future applications of AR in the operating room; and discussed the bright prospects of VR and AR technologies in postoperative rehabilitation after hip surgery. Methods: We searched the PubMed and Web of Science databases using the following key search terms: (“virtual reality” OR “augmented reality”) AND (“pelvis” OR “hip”). The literature on basic and clinical research related to the aforementioned key search terms, that is, studies evaluating the key factors, challenges, or problems of using of VAR technology in hip-related surgery, was collected. Results: A total of 40 studies and reports were included and classified into the following categories: total hip arthroplasty, hip resurfacing, femoral neck fracture, pelvic fracture, acetabular fracture, tumor, arthroscopy, and postoperative rehabilitation. Quality assessment could be performed in 30 studies. Among the clinical studies, there were 16 case series with an average score of 89 out of 100 points (89%) and 1 case report that scored 81 (SD 10.11) out of 100 points (81%) according to the Joanna Briggs Institute Critical Appraisal Checklist. Two cadaveric studies scored 85 of 100 points (85%) and 92 of 100 points (92%) according to the Quality Appraisal for Cadaveric Studies scale. Conclusions: VR and AR technologies hold great promise for hip-related surgeries, especially for preoperative operation simulation and training, feasibility applications in the operating room, and postoperative rehabilitation, and have the potential to assist orthopedic surgeons in operating more accurately and safely. More comparative studies are necessary, including studies focusing on clinical outcomes and cost-effectiveness. %M 36651587 %R 10.2196/37599 %U https://www.jmir.org/2023/1/e37599 %U https://doi.org/10.2196/37599 %U http://www.ncbi.nlm.nih.gov/pubmed/36651587 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e34501 %T Augmented Reality in Vascular and Endovascular Surgery: Scoping Review %A Eves,Joshua %A Sudarsanam,Abhilash %A Shalhoub,Joseph %A Amiras,Dimitri %+ Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Marys Hospital, Praed Street, London, W2 1NY, United Kingdom, 44 7881389569, joshua.eves@nhs.net %K augmented reality %K surgery %K vascular %K endovascular %K head-mounted display %K mobile phone %D 2022 %7 23.9.2022 %9 Review %J JMIR Serious Games %G English %X Background: Technological advances have transformed vascular intervention in recent decades. In particular, improvements in imaging and data processing have allowed for the development of increasingly complex endovascular and hybrid interventions. Augmented reality (AR) is a subject of growing interest in surgery, with the potential to improve clinicians’ understanding of 3D anatomy and aid in the processing of real-time information. This study hopes to elucidate the potential impact of AR technology in the rapidly evolving fields of vascular and endovascular surgery. Objective: The aim of this review is to summarize the fundamental concepts of AR technologies and conduct a scoping review of the impact of AR and mixed reality in vascular and endovascular surgery. Methods: A systematic search of MEDLINE, Scopus, and Embase was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All studies written in English from inception until January 8, 2021, were included in the search. Combinations of the following keywords were used in the systematic search string: (“augmented reality” OR “hololens” OR “image overlay” OR “daqri” OR “magic leap” OR “immersive reality” OR “extended reality” OR “mixed reality” OR “head mounted display”) AND (“vascular surgery” OR “endovascular”). Studies were selected through a blinded process between 2 investigators (JE and AS) and assessed using data quality tools. Results: AR technologies have had a number of applications in vascular and endovascular surgery. Most studies (22/32, 69%) used 3D imaging of computed tomography angiogram–derived images of vascular anatomy to augment clinicians’ anatomical understanding during procedures. A wide range of AR technologies were used, with heads up fusion imaging and AR head-mounted displays being the most commonly applied clinically. AR applications included guiding open, robotic, and endovascular surgery while minimizing dissection, improving procedural times, and reducing radiation and contrast exposure. Conclusions: AR has shown promising developments in the field of vascular and endovascular surgery, with potential benefits to surgeons and patients alike. These include reductions in patient risk and operating times as well as in contrast and radiation exposure for radiological interventions. Further technological advances are required to overcome current limitations, including processing capacity and vascular deformation by instrumentation. %M 36149736 %R 10.2196/34501 %U https://games.jmir.org/2022/3/e34501 %U https://doi.org/10.2196/34501 %U http://www.ncbi.nlm.nih.gov/pubmed/36149736 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 1 %N 1 %P e36960 %T The Potential for Using Extended Reality Technology in Interdisciplinary Case Discussions and Case Planning in Stereotactic Radiosurgery: Proof-of-Concept Usability Study %A Chidambaram,Swathi %A Palumbo,Maria Chiara %A Stifano,Vito %A McKenna,John %A Redaelli,Alberto %A Olivi,Alessandro %A Apuzzo,Michael %A Pannullo,Susan %+ Department of Neurosurgery, Weill Cornell Medical College, 1305 York Ave 9th Floor, New York, NY, 10021, United States, 1 2127462438, scp2002@med.cornell.edu %K mixed reality %K augmented reality %K extended reality %K HoloLens %K interdisciplinary teams %K virtual reality %K brain tumour %K tumor %K radiosurgery %K surgery %D 2022 %7 1.6.2022 %9 Original Paper %J JMIR Neurotech %G English %X Background: Extended reality (XR) is a term that captures a variety of techniques, such as augmented reality (AR) and mixed reality (MR), which allow users to interact with virtual models in real time. This technology has an emerging role in several applications within neurosurgery. XR can be useful in enhancing how radiosurgical cases are planned. Multidisciplinary team (MDT) review is an essential part of the radiosurgery case planning process; during case discussions, patient images are reviewed, usually in 2D or 3D modifications. The current commercially available platforms for this review need improvement. Objective: We describe a novel visualization application, titled “NeuroVis” by our development team, which uses an XR Microsoft HoloLens headset to provide an interactive 3D visualization of a patient’s neuroanatomy in stereotactic surgery (SRS) case planning discussions. Methods: We present examples of 6 common radiosurgery indications to demonstrate the utility of NeuroVis to solve common visualization hurdles in MDTs. Results: The utility of NeuroVis is demonstrated through 6 common brain tumor SRS cases as a proof-of-concept illustration of the utility of NeuroVis to enhance radiosurgery case discussion by improving visualization of the standard neuroimaging used in radiosurgery treatment planning by MDTs. Conclusions: The NeuroVis application provides several interactive features that produce an enhanced ability to place participating members of an interdisciplinary treatment team on the same visualization plane. This technology, by facilitating team discussions and case review, has the potential to improve the efficiency, efficacy, and safety of radiosurgery treatment planning and, as a result, to optimize patient care. %R 10.2196/36960 %U https://neuro.jmir.org/2022/1/e36960 %U https://doi.org/10.2196/36960 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e34781 %T Augmented Reality-Based Surgery on the Human Cadaver Using a New Generation of Optical Head-Mounted Displays: Development and Feasibility Study %A Puladi,Behrus %A Ooms,Mark %A Bellgardt,Martin %A Cesov,Mark %A Lipprandt,Myriam %A Raith,Stefan %A Peters,Florian %A Möhlhenrich,Stephan Christian %A Prescher,Andreas %A Hölzle,Frank %A Kuhlen,Torsten Wolfgang %A Modabber,Ali %+ Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany, 49 241 80 88231, bpuladi@ukaachen.de %K digital health in surgery %K surgical technique %K surgical training %K computer-assisted surgery %K optical see-through head-mounted display %K HoloLens %K surgical navigation %K medical regulation %K open-source %K AR %K augmented reality %K surgery %K surgeon %K cadaver %K serious game %K head-mounted display %D 2022 %7 25.4.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Although nearly one-third of the world’s disease burden requires surgical care, only a small proportion of digital health applications are directly used in the surgical field. In the coming decades, the application of augmented reality (AR) with a new generation of optical-see-through head-mounted displays (OST-HMDs) like the HoloLens (Microsoft Corp) has the potential to bring digital health into the surgical field. However, for the application to be performed on a living person, proof of performance must first be provided due to regulatory requirements. In this regard, cadaver studies could provide initial evidence. Objective: The goal of the research was to develop an open-source system for AR-based surgery on human cadavers using freely available technologies. Methods: We tested our system using an easy-to-understand scenario in which fractured zygomatic arches of the face had to be repositioned with visual and auditory feedback to the investigators using a HoloLens. Results were verified with postoperative imaging and assessed in a blinded fashion by 2 investigators. The developed system and scenario were qualitatively evaluated by consensus interview and individual questionnaires. Results: The development and implementation of our system was feasible and could be realized in the course of a cadaver study. The AR system was found helpful by the investigators for spatial perception in addition to the combination of visual as well as auditory feedback. The surgical end point could be determined metrically as well as by assessment. Conclusions: The development and application of an AR-based surgical system using freely available technologies to perform OST-HMD–guided surgical procedures in cadavers is feasible. Cadaver studies are suitable for OST-HMD–guided interventions to measure a surgical end point and provide an initial data foundation for future clinical trials. The availability of free systems for researchers could be helpful for a possible translation process from digital health to AR-based surgery using OST-HMDs in the operating theater via cadaver studies. %M 35468090 %R 10.2196/34781 %U https://games.jmir.org/2022/2/e34781 %U https://doi.org/10.2196/34781 %U http://www.ncbi.nlm.nih.gov/pubmed/35468090 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e29473 %T A Preoperative Virtual Reality App for Patients Scheduled for Cardiac Catheterization: Pre–Post Questionnaire Study Examining Feasibility, Usability, and Acceptability %A Aardoom,Jiska J %A Hilt,Alexander D %A Woudenberg,Tamar %A Chavannes,Niels H %A Atsma,Douwe E %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2300 RC, Netherlands, 31 7152668605, j.j.aardoom@lumc.nl %K virtual reality %K cardiac catheterization %K stress inoculation training %K preoperative anxiety %K acceptability %K feasibility %K presence %K immersive tendencies %K presence %K patient education %K mobile phone %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Pre- and postoperative anxiety is a common phenomenon associated with negative postoperative outcomes. Symptoms of posttraumatic stress disorder, such as fear, nightmares, and sleep deprivation, are prevalent in approximately 30% to 50% of patients following discharge from intensive care units after cardiac surgery. Preliminary evidence suggests a promising role of virtual reality (VR) in preventing stress-related reactions using stress inoculation training. Such training enables cognitive preparation of individuals for stressful situations, thereby becoming more tolerant and resistant to stress, subsequently reducing the risk of potential negative psychological consequences. This study investigated a preoperative VR app—Pre-View—aimed at better informing and preparing patients for cardiac catheterization. Objective: This study aims to assess the feasibility, usability, and acceptability of Pre-View in patients undergoing cardiac catheterization. Methods: Eligible participants were adults scheduled for elective cardiac catheterization. Pre-View comprised an interactive virtual representation of the whole care process related to cardiac catheterization, from entering the hospital for admission to postprocedural stay and discharge. These processes were represented through 360° videos and interactive photos. Self-report questionnaires were completed at baseline (ie, before catheterization and after undergoing the VR experience) and after cardiac catheterization. Outcome measures included user experience and satisfaction, VR presence and immersive tendencies, and user friendliness. The perceived effectiveness was assessed exploratively. Results: A total of 8 individuals, with a mean age of 67 (SD 7.5) years, participated in this study. Half of them underwent the VR experience at the hospital and the other half at home. Participants reported high levels of presence in the virtual environment (Presence Questionnaire score: mean 129.1, SD 13.4). The usability of Pre-View was well evaluated (System Usability Scale score: mean 89.1, SD 12.0), and patient satisfaction was high (Client Satisfaction Questionnaire score: mean 27.1, SD 3.2). Usability and satisfaction scores were higher for participants who underwent Pre-View at home versus those who underwent Pre-View at the hospital, although the latter group was significantly older; 72.8 versus 61.3, respectively. All participants reported Pre-View to be effective in terms of feeling better informed about the care process of cardiac catheterization. Most participants (7/8, 88%) reported Pre-View to be effective in terms of feeling better prepared for cardiac catheterization, acknowledging the potential of Pre-View in reducing negative psychological consequences after catheterization. Conclusions: The results provide initial support for the feasibility and acceptability of a preoperative VR app, creating a virtual environment that supports patient education and preparation for upcoming cardiac catheterization. More studies are needed to further investigate the effects of VR as a tool to better prepare patients for medical procedures, its effectiveness in reducing negative patient outcomes (eg, anxiety, stress, and postoperative recovery outcomes), and the generalizability of effects across different settings and patient populations. %M 35191839 %R 10.2196/29473 %U https://cardio.jmir.org/2022/1/e29473 %U https://doi.org/10.2196/29473 %U http://www.ncbi.nlm.nih.gov/pubmed/35191839 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e27544 %T Use of a Virtual Reality Simulator for Tendon Repair Training: Randomized Controlled Trial %A Mok,Tsz-Ngai %A Chen,Junyuan %A Pan,Jinghua %A Ming,Wai-Kit %A He,Qiyu %A Sin,Tat-Hang %A Deng,Jialin %A Li,Jieruo %A Zha,Zhengang %+ Institute of Orthopedics Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital of Jinan University, 613 West Huangpu Avenue, Tianhe District, Guangzhou, China, 86 2038688563, ilorugaie@163.com %K virtual reality simulators %K tendon suture %K medical education %D 2021 %7 12.7.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality (VR) simulators have become widespread tools for training medical students and residents in medical schools. Students using VR simulators are provided with a 3D human model to observe the details by using multiple senses and they can participate in an environment that is similar to reality. Objective: The aim of this study was to promote a new approach consisting of a shared and independent study platform for medical orthopedic students, to compare traditional tendon repair training with VR simulation of tendon repair, and to evaluate future applications of VR simulation in the academic medical field. Methods: In this study, 121 participants were randomly allocated to VR or control groups. The participants in the VR group studied the tendon repair technique via the VR simulator, while the control group followed traditional tendon repair teaching methods. The final assessment for the medical students involved performing tendon repair with the “Kessler tendon repair with 2 interrupted tendon repair knots” (KS) method and the “Bunnell tendon repair with figure 8 tendon repair” (BS) method on a synthetic model. The operative performance was evaluated using the global rating scale. Results: Of the 121 participants, 117 participants finished the assessment and 4 participants were lost to follow-up. The overall performance (a total score of 35) of the VR group using the KS method and the BS method was significantly higher (P<.001) than that of the control group. Thus, participants who received VR simulator training had a significantly higher score on the global rating scale than those who received traditional tendon repair training (P<.001). Conclusions: Our study shows that compared with the traditional tendon repair method, the VR simulator for learning tendon suturing resulted in a significant improvement of the medical students in the time in motion, flow of operation, and knowledge of the procedure. Therefore, VR simulator development in the future would most likely be beneficial for medical education and clinical practice. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100046648; http://www.chictr.org.cn/hvshowproject.aspx?id=90180 %M 34255649 %R 10.2196/27544 %U https://games.jmir.org/2021/3/e27544 %U https://doi.org/10.2196/27544 %U http://www.ncbi.nlm.nih.gov/pubmed/34255649 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e19723 %T Use of a Low-Cost Portable 3D Virtual Reality Simulator for Psychomotor Skill Training in Minimally Invasive Surgery: Task Metrics and Score Validity %A Alvarez-Lopez,Fernando %A Maina,Marcelo Fabián %A Arango,Fernando %A Saigí-Rubió,Francesc %+ Faculty of Health Sciences, Universitat Oberta de Catalunya, Avinguda Tibidabo, 39-43, Barcelona, 08035, Spain, 34 933 263 622, fsaigi@uoc.edu %K simulation training %K minimally invasive surgical procedures %K medical education %K user-computer interface %K computer-assisted surgery %K Leap Motion Controller %D 2020 %7 27.10.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: The high cost and low availability of virtual reality simulators in surgical specialty training programs in low- and middle-income countries make it necessary to develop and obtain sources of validity for new models of low-cost portable simulators that enable ubiquitous learning of psychomotor skills in minimally invasive surgery. Objective: The aim of this study was to obtain validity evidence for relationships to other variables, internal structure, and consequences of testing for the task scores of a new low-cost portable simulator mediated by gestures for learning basic psychomotor skills in minimally invasive surgery. This new simulator is called SIMISGEST-VR (Simulator of Minimally Invasive Surgery mediated by Gestures - Virtual Reality). Methods: In this prospective observational validity study, the authors looked for multiple sources of evidence (known group construct validity, prior videogaming experience, internal structure, test-retest reliability, and consequences of testing) for the proposed SIMISGEST-VR tasks. Undergraduate students (n=100, reference group), surgical residents (n=20), and experts in minimally invasive surgery (n=28) took part in the study. After answering a demographic questionnaire and watching a video of the tasks to be performed, they individually repeated each task 10 times with each hand. The simulator provided concurrent, immediate, and terminal feedback and obtained the task metrics (time and score). From the reference group, 29 undergraduate students were randomly selected to perform the tasks 6 months later in order to determine test-retest reliability. Results: Evidence from multiple sources, including strong intrarater reliability and internal consistency, considerable evidence for the hypothesized consequences of testing, and partial confirmation for relations to other variables, supports the validity of the scores and the metrics used to train and teach basic psychomotor skills for minimally invasive surgery via a new low-cost portable simulator that utilizes interaction technology mediated by gestures. Conclusions: The results obtained provided multiple sources of evidence to validate SIMISGEST-VR tasks aimed at training novices with no prior experience and enabling them to learn basic psychomotor skills for minimally invasive surgery. %M 33107833 %R 10.2196/19723 %U http://games.jmir.org/2020/4/e19723/ %U https://doi.org/10.2196/19723 %U http://www.ncbi.nlm.nih.gov/pubmed/33107833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17491 %T Use of a Low-Cost Portable 3D Virtual Reality Gesture-Mediated Simulator for Training and Learning Basic Psychomotor Skills in Minimally Invasive Surgery: Development and Content Validity Study %A Alvarez-Lopez,Fernando %A Maina,Marcelo Fabián %A Saigí-Rubió,Francesc %+ Faculty of Health Sciences, Universitat Oberta de Catalunya, Avinguda Tibidabo, 39-43, Barcelona, 08035, Spain, 34 933263622, fsaigi@uoc.edu %K simulation training %K minimally invasive surgery %K user-computer interface %K operating rooms %K medical education %K computer-assisted surgery %D 2020 %7 14.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Simulation in virtual environments has become a new paradigm for surgeon training in minimally invasive surgery (MIS). However, this technology is expensive and difficult to access. Objective: This study aims first to describe the development of a new gesture-based simulator for learning skills in MIS and, second, to establish its fidelity to the criterion and sources of content-related validity evidence. Methods: For the development of the gesture-mediated simulator for MIS using virtual reality (SIMISGEST-VR), a design-based research (DBR) paradigm was adopted. For the second objective, 30 participants completed a questionnaire, with responses scored on a 5-point Likert scale. A literature review on the validity of the MIS training-VR (MIST-VR) was conducted. The study of fidelity to the criterion was rated using a 10-item questionnaire, while the sources of content-related validity evidence were assessed using 10 questions about the simulator training capacity and 6 questions about MIS tasks, and an iterative process of instrument pilot testing was performed. Results: A good enough prototype of a gesture-based simulator was developed with metrics and feedback for learning psychomotor skills in MIS. As per the survey conducted to assess the fidelity to the criterion, all 30 participants felt that most aspects of the simulator were adequately realistic and that it could be used as a tool for teaching basic psychomotor skills in laparoscopic surgery (Likert score: 4.07-4.73). The sources of content-related validity evidence showed that this study’s simulator is a reliable training tool and that the exercises enable learning of the basic psychomotor skills required in MIS (Likert score: 4.28-4.67). Conclusions: The development of gesture-based 3D virtual environments for training and learning basic psychomotor skills in MIS opens up a new approach to low-cost, portable simulation that allows ubiquitous learning and preoperative warm-up. Fidelity to the criterion was duly evaluated, which allowed a good enough prototype to be achieved. Content-related validity evidence for SIMISGEST-VR was also obtained. %M 32673217 %R 10.2196/17491 %U http://www.jmir.org/2020/7/e17491/ %U https://doi.org/10.2196/17491 %U http://www.ncbi.nlm.nih.gov/pubmed/32673217 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16852 %T HoloLens-Based Vascular Localization System: Precision Evaluation Study With a Three-Dimensional Printed Model %A Jiang,Taoran %A Yu,Dewang %A Wang,Yuqi %A Zan,Tao %A Wang,Shuyi %A Li,Qingfeng %+ Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China, 86 21 64397277, dr.liqingfeng@yahoo.com %K augmented reality %K HoloLens %K perforator flap %K vascular localization %K reconstructive surgery %K 3D Printing %D 2020 %7 17.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Vascular localization is crucial for perforator flap transfer. Augmented reality offers a novel method to seamlessly combine real information with virtual objects created by computed tomographic angiography to help the surgeon “see through” the skin and precisely localize the perforator. The head-mounted display augmented reality system HoloLens (Microsoft) could facilitate augmented reality–based perforator localization for a more convenient and safe procedure. Objective: The aim of this study was to evaluate the precision of the HoloLens-based vascular localization system, as the most important performance indicator of a new localization system. Methods: The precision of the HoloLens-based vascular localization system was tested in a simulated operating room under different conditions with a three-dimensional (3D) printed model. The coordinates of five pairs of points on the vascular map that could be easily identified on the 3D printed model and virtual model were detected by a probe, and the distance between the corresponding points was calculated as the navigation error. Results: The mean errors were determined under different conditions, with a minimum error of 1.35 mm (SD 0.43) and maximum error of 3.18 mm (SD 1.32), which were within the clinically acceptable range. There were no significant differences in the errors obtained under different visual angles, different light intensities, or different states (static or motion). However, the error was larger when tested with light compared with that tested without light. Conclusions: This precision evaluation demonstrated that the HoloLens system can precisely localize the perforator and potentially help the surgeon accomplish the operation. The authors recommend using HoloLens-based surgical navigation without light. %M 32301738 %R 10.2196/16852 %U http://www.jmir.org/2020/4/e16852/ %U https://doi.org/10.2196/16852 %U http://www.ncbi.nlm.nih.gov/pubmed/32301738