Pokemon GO has been viral since its release date in July 2016 – you may have even been on the receiving end of some of those who have got themselves into a spot of bother, such as the group of teenage boys who entered an underground cave network to search for Pokemon and got stuck 100ft below ground and awaited rescue. Luckily they were unharmed, but unfortunately there are increasing reports of those who have come to harm whilst playing, such as a man who stepped into busy traffic in Ireland and two men who fell down a cliff in California.
One of the main features of the game is its use of Augmented Reality (AR), a technology were a view of the real world is augmented by computer generated data. This could be in the form of images, sounds, videos, and is different to virtual reality where the world itself is also simulated. AR also generally occurs in real time through overlays which appear on the device being used, and when the device is moved, the images change to reflect this. AR has taken on many forms in recent years, through utilisation in real-world map overlays, technology such as Google Glass, flight simulations, entertainment, and even medical devices. With the recent popularity and success of Pokemon GO, we can only expect companies to find more way to insert AR into our everyday lives.
A simple, yet affective way in which AR is being experimented with is for the use in immersions therapy for overcoming phobias. Patients undergoing the procedure war goggles which can overlay images of small insects or animals, such as cockroaches, rats or spiders in their hands or around the person. This can be used as a means of overcoming phobia on its own, or as an intermediary step to physical exposure. Trials comparing in-vivo exposure versus augmented reality exposure, despite small numbers, show good outcomes and positive experiences from the patients.
There are many concepts in skill mastery, one of which is that of deliberate practice. The amount of practice you do certainly helps, but just as important is the quality. Deliberate practice involves repeatedly performing the same skills, using methods aimed at your current level, with the aim of improving performance through immediate feedback. Gaining feedback after each repetition allows small changes to be made. There are many technical skills we perform on a day to day basis, and practising these wisely can make a huge difference. But where does AR fit into this?
Surgical educators are experimenting with augmented reality technology to aid in teaching and learning surgical procedures. When practising laparoscopic surgery, realistic haptic feedback is crucial for learners to progress in improving their skills. Such feedback allows students to engage in deliberate practice independently, and although a surgical tutor in the room is helpful, using technology can provide immediate objective feedback. A quick PubMed search for augmented reality in surgery shows that laparoscopic surgery is not the only focus of research efforts. Real time image overlay could help to integrate what are usually two-dimensional radiological images with the the three-dimensional human form. Groups are also looking into using AR to assist with maxillofacial, orthopaedic, cardiac, and neurosurgery. The main theme appears to be locating lesions, but one interesting study looks into using the technology to aid in K-wire placement in orthopaedic surgery. This has the potential to reduce radiation load, and increase surgical efficiency. Augmented reality could also help with other procedures such as percutaneous interventions and nerve blocks. It will be interesting to see how the technology progresses, as there already seems to be a lot of interest in its integration with medicine and education.
The UK are using augmented reality as part of the induction process for new doctors. Sadly I can’t find any literature, but the premise was that new starters could go on a self-guided tour. At certain points in the hospital they use software on their phone to view and listen to videos of staff describing whichever area they were in and showing them around. Overlays on the screen could give them important information, and guide them to the next point on the tour – this is probably a much more interactive and engaging way to learn the layout of your workplace than currently happens.
As for the Emergency Department, vascular access, nerve blockade and fracture manipulation would suggest themselves as ideal applications for AR. You could even wear glasses which recognise patients’ faces, automatically pulling up their name, age, presenting complaint, and most recent observations, overlaying these against the real world in real time. Medical and nursing staff alike could be alerted to urgent jobs, patients with high early warning scores, or simply the next patient to be seen, just by a message in the corner of your eye. It’s sounding futuristic now, but the technology is there (or nearly there), it’s just a case of finding a way to use it that enhances our working lives.
My final thoughts are that Augmented reality is the new kid on the block, and with the many ways it is finding a path into medicine, surgery and education, it is a technology to be embraced and investigated, and can only improve with time. If you’ve had any experience with AR, it would be great to hear about it. If not, I’m sure it will work its way into your medical life in the next decade.