Abstract
Novel technologies that hit the consumer market can translate to technological innovation for the health care field and often positively impact medical practice. The use of alternate realities, such as augmented reality (AR), has the potential to improve health care and provide increased opportunities for education, visualization, presentations, and improved patient outcomes. The term AR refers to an enhanced version of reality created using technology to overlay digital information on an image of something being viewed through a device (such as a smartphone camera). 1 This emerging tool is closely related to the more well-known virtual reality (VR). VR is an artificial environment which is experienced through sensory stimuli (such as sights and sounds) provided by a computer and in which one’s actions partially determine what happens in the environment. 2 While both of these technologies have the end user place screens directly in front of their eyes via a head-mounted system, the screen of AR systems is clear allowing the user to see both the world around them and images projected into that world. With VR systems, the user only sees the screens and observes only the new “virtual” world. This concept is illustrated in Figure 1.
Visual comparison of Virtual Reality (VR) and Augmented Reality (AR). No permission required.
Vendors are using AR to enhance the usefulness, utility, and desirability of conducting sonography examinations, so it is important to be able to adequately judge this technical enhancement. While both of these technologies have fantastic possibilities to be multidisciplinary game-changers in the medical field, this editorial centers on AR and its potential to enhance the utility of sonography
Where does AR coupled to sonography stand today? The technology is still in the early stages of this concept, but that doesn’t mean the landscape is bare. Vendors such as Philips, Microsoft, and MediView are all making strides to incorporate AR into a sonographer’s or physician’s workflow to make scanning and procedures more accurate, easier to complete, and the ultrasound equipment system ergonomically safe. These aims are accomplished through a few key features of AR. First, an individual performing a sonographic exam is no longer limited by the position of their computer screen. Using the AR environment, the sonogram can be moved and viewed anywhere in a room and can even be set to follow the eyes of the sonographer. This may lead to less neck strain and mitigate the need to alter between looking at the patient and monitor; instead, both can be accomplished at the same time. This is especially promising innovation when considering awkward scanning positions. The second key feature of AR is the ability to have others remote into your AR headset. This allows outside users to view the sonographic exam, as well as make indicating marks that will appear real time in the sonographer’s three-dimensional world. This will allow for strong collaboration on vital sonographic examinations, assist in the training of sonographers, and promote higher standards of care everywhere by allowing colleagues to assist in examinations that are thousands of miles away. Finally, AR gives the ability to superimpose real patient anatomy over their body, in real time. This specific ability is in its very early stages, only being compatible with pre-operative computed tomograms (CTs), but the prospect is exciting.
Exploring these features firsthand through the piloting of a sonography-coupled AR device has given me the opportunity to witness the amazing features of AR and not just read about them. The immersion of AR provides the end user the feeling that projected objects are truly in the real world (see Figure 2). While there are certainly limitations to the technology and resolution disparities compared with a traditional computer display, the technology is awe-inspiring and feels like technology of the future. I encourage readers to pursue any opportunity to engage with AR, AR in a medical setting, and especially AR coupled to sonography. Continued research, feedback, and sonographer input could help to address any setbacks with the current AR systems. In addition, continued use of this technology allows sonographers to have an easier transition if/when AR becomes more commonplace in ultrasound scanning. According to Eckert et al., AR application in medicine is steadily having more research completed on it and more publications exploring its functionalities are coming out each year than the last. 3 Furthermore, Farshad-Amacker et al. demonstrated that in sonographic clinical procedures, coupling AR to scanning reduced total examination time, further giving incentive to explore AR. 4 This technology is likely going to be pervasive in many areas of the health care setting due to its broad applicability and any clinical provider will benefit from early exposure.
Display of virtual ultrasound window and visualization of internal patient anatomy via Augmented Reality. Reprinted with permission provided by MediView, LLC [Darcy Bajko, MBA, Director of Sales and Commercial Operations.
Where is the technology moving to? With prototypes already hitting the market, some even with FDA approval, it is the perfect time to get familiar with this technology. While we are still years away from this technology being the standard of care, it is hard to imagine a future where AR plays no role in a sonographer’s practice. We are not far from allowing sonographers to complete examinations on the other side of the world, seeing what a patient’s aneurysm is doing in real time, and improving the accuracy of images by being able to compare them with gold standard images, instantly. AR may become one of the best items in a sonographer’s toolkit, giving them and the patient a peace of mind knowing sonography can be completed efficiently, accurately, and with minimal WRMSD risk to the sonographer. AR is not only exciting for what it can do today, but for what it will allow sonography to be in the future.