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Development of Virtual and Augmented Reality Systems for Health and Clinical Assessment

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A special issue of Sensors (ISSN 1424-8220). This special issue belongs to the section "Biomedical Sensors".

Deadline for manuscript submissions: closed (20 May 2023) | Viewed by 31179

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Special Issue Editors

Dr. Patricia Sánchez González

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Guest Editor

Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain
Interests: virtual reality; computer vision; medical education and assessment; patient rehabilitation
Special Issues, Collections and Topics in MDPI journals

Dr. Ignacio Oropesa

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Guest Editor

Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain
Interests: video-based tracking; biomedical signal processing; virtual reality; augmented reality machine/deep learning; wearables; natural language processing
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Virtual reality (VR) and augmented reality (AR) are redefining what is possible in healthcare. These technologies are becoming more widespread every day, thanks to the recent availability of cheap commercial solutions. Novel applications are being continuously pursued to develop new effective and engaging interventions. Thus, the number of potential applications of VR and AR is also growing constantly, including health promotion, management and care.

The purpose of this Special Issue is to present the recent advancements in VR and AR systems in healthcare applications. Areas of interest of these systems are numerous. These include: lifestyles education, patient rehabilitation, medical and surgical training, clinical assessment of elderly people, paediatric patients and pain management

Contributions may focus on preliminary feasibility of applied innovative technologies or novel applications for existing ones. Studies may cover different stages of the technological and clinical validation.

Dr. Patricia Sánchez González
Dr. Ignacio Oropesa
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Sensors is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

virtual reality
augmented reality
healthcare
medical applications
rehabilitation
medical education
pain management
patient education

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Published Papers (9 papers)

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Research

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16 pages, 8969 KiB

Open AccessArticle

SIMUNEO: Control and Monitoring System for Lung Ultrasound Examination and Treatment of Neonatal Pneumothorax and Thoracic Effusion

by Adriana Rojas-García, Diego Moreno-Blanco, Martin Otero-Arteseros, Francisco Javier Rubio-Bolívar, Helena Peinado, Dolores Elorza-Fernández, Enrique J. Gómez, Manuel Quintana-Díaz and Patricia Sánchez-Gonzalez

Sensors 2023, 23(13), 5966; https://doi.org/10.3390/s23135966 - 27 Jun 2023

Cited by 1 | Viewed by 1662

Abstract

Training with real patients is a critical aspect of the learning and growth of doctors in training. However, this essential step in the educational process for clinicians can potentially compromise patient safety, as they may not be adequately prepared to handle real-life situations independently. Clinical simulators help to solve this problem by providing real-world scenarios in which the physicians can train and gain confidence by safely and repeatedly practicing different techniques. In addition, obtaining objective feedback allows subsequent debriefing by analysing the situation experienced and learning from other people’s mistakes. This article presents SIMUNEO, a neonatal simulator in which professionals are able to learn by practicing the management of lung ultrasound and the resolution of pneumothorax and thoracic effusions. The article also discusses in detail the hardware and software, the main components that compose the system, and the communication and implementation of these. The system was validated through both usability questionnaires filled out by neonatology residents as well as through follow-up sessions, improvement, and control of the system with specialists of the department. Results suggest that the environment is easy to use and could be used in clinical practice to improve the learning and training of students as well as the safety of patients. Full article

(This article belongs to the Special Issue Development of Virtual and Augmented Reality Systems for Health and Clinical Assessment)

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20 pages, 7478 KiB

Open AccessArticle

Virtual Reality Game for Physical and Emotional Rehabilitation of Landmine Victims

by Vera Z. Pérez, Juan C. Yepes, John F. Vargas, Juan C. Franco, Natalia I. Escobar, Leonardo Betancur, Juanita Sánchez and Manuel J. Betancur

Sensors 2022, 22(15), 5602; https://doi.org/10.3390/s22155602 - 27 Jul 2022

Cited by 7 | Viewed by 2850

Abstract

Landmine victims require an engaging and immersive rehabilitation process to maintain motivation and therapeutic adherence, such as virtual reality games. This paper proposes a virtual reality exercise game called Exogames, which works with Nukawa, a lower limb rehabilitation robot (LLRR). Together, they constitute the general Kina system. The design and development process of Exogames is reported, as well as the evaluation of its potential for physical and emotional rehabilitation. In an initial survey designed ad-hoc, 13 health professionals evaluated compliance with various requirements. They agreed that Exogames would help the user focus on rehabilitation by providing motivation; 92.3% said that the user will feel safe in the virtual world, 66.7% of them agreed or totally agreed that it presents characteristics that may enhance the physical rehabilitation of lower limbs for amputees, 83.3% stated that it would promote the welfare of landmine victims, and 76.9% responded that the graphical interface and data report are useful for real-time assessment, and would be helpful for four interventional areas in all rehabilitation stages. In a second evaluation, using standardized surveys, five physical therapists and one lower limb amputee tried the Kina system as users. They filled out the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), and the Game Experience Questionnaire (GEQ). The usability of the Kina system overall score was 69 (66, 79) out of 100, suggesting an acceptable though improvable usability. The overall PACES score of 110 (108, 112) out of 126 suggests that users enjoyed the game well. Finally, users indicated a positive effect with a good sense of immersion and smooth of gameplay during the tests, as indicated by the GEQ results. In summary, the evaluations showed that Exogames has the potential to be used as a virtual reality game for the physical and emotional rehabilitation of landmine victims. Full article

(This article belongs to the Special Issue Development of Virtual and Augmented Reality Systems for Health and Clinical Assessment)

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14 pages, 2301 KiB

Open AccessArticle

HoloLens 1 vs. HoloLens 2: Improvements in the New Model for Orthopedic Oncological Interventions

by Alicia Pose-Díez-de-la-Lastra, Rafael Moreta-Martinez, Mónica García-Sevilla, David García-Mato, José Antonio Calvo-Haro, Lydia Mediavilla-Santos, Rubén Pérez-Mañanes, Felix von Haxthausen and Javier Pascau

Sensors 2022, 22(13), 4915; https://doi.org/10.3390/s22134915 - 29 Jun 2022

Cited by 23 | Viewed by 4352

Abstract

This work analyzed the use of Microsoft HoloLens 2 in orthopedic oncological surgeries and compares it to its predecessor (Microsoft HoloLens 1). Specifically, we developed two equivalent applications, one for each device, and evaluated the augmented reality (AR) projection accuracy in an experimental scenario using phantoms based on two patients. We achieved automatic registration between virtual and real worlds using patient-specific surgical guides on each phantom. They contained a small adaptor for a 3D-printed AR marker, the characteristic patterns of which were easily recognized using both Microsoft HoloLens devices. The newest model improved the AR projection accuracy by almost 25%, and both of them yielded an RMSE below 3 mm. After ascertaining the enhancement of the second model in this aspect, we went a step further with Microsoft HoloLens 2 and tested it during the surgical intervention of one of the patients. During this experience, we collected the surgeons’ feedback in terms of comfortability, usability, and ergonomics. Our goal was to estimate whether the improved technical features of the newest model facilitate its implementation in actual surgical scenarios. All of the results point to Microsoft HoloLens 2 being better in all the aspects affecting surgical interventions and support its use in future experiences. Full article

(This article belongs to the Special Issue Development of Virtual and Augmented Reality Systems for Health and Clinical Assessment)

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20 pages, 1693 KiB

Open AccessArticle

A New Immersive Virtual Reality Station for Cardiopulmonary Resuscitation Objective Structured Clinical Exam Evaluation

by Manuel Rodríguez-Matesanz, Carmen Guzmán-García, Ignacio Oropesa, Javier Rubio-Bolivar, Manuel Quintana-Díaz and Patricia Sánchez-González

Sensors 2022, 22(13), 4913; https://doi.org/10.3390/s22134913 - 29 Jun 2022

Cited by 10 | Viewed by 2627

Abstract

The Objective Structured Clinical Exam (OSCE) is an assessment tool used as a reliable method for clinical competence evaluation of students. This paper presents an investigation focused on the chain of survival, its related exploration, management, and technical skills, and how Virtual Reality (VR) can be used for the creation of immersive environments capable of evaluating students’ performance while applying the correct protocols. In particular, the Cardiopulmonary Resuscitation (CPR) procedure is studied as an essential step in the development of the chain of survival. The paper also aims to highlight the limitations of traditional methods using mechanical mannequins and the benefits of the new approaches that involve the students in virtual, immersive, and dynamic environments. Furthermore, an immersive VR station is presented as a new technique for assessing CPR performance through objective data collection and posterior evaluation. A usability test was carried out with 33 clinicians and OSCE evaluators to test the viability of the presented scenario, reproducing conditions of a real examination. Results suggest that the environment is intuitive, quick, and easy to learn and could be used in clinical practice to improve CPR performance and OSCE evaluation. Full article

(This article belongs to the Special Issue Development of Virtual and Augmented Reality Systems for Health and Clinical Assessment)

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13 pages, 2481 KiB

Open AccessArticle

Augmented Reality as a Tool to Guide PSI Placement in Pelvic Tumor Resections

by Mónica García-Sevilla, Rafael Moreta-Martinez, David García-Mato, Alicia Pose-Diez-de-la-Lastra, Rubén Pérez-Mañanes, José Antonio Calvo-Haro and Javier Pascau

Sensors 2021, 21(23), 7824; https://doi.org/10.3390/s21237824 - 24 Nov 2021

Cited by 14 | Viewed by 3534

Abstract

Patient-specific instruments (PSIs) have become a valuable tool for osteotomy guidance in complex surgical scenarios such as pelvic tumor resection. They provide similar accuracy to surgical navigation systems but are generally more convenient and faster. However, their correct placement can become challenging in some anatomical regions, and it cannot be verified objectively during the intervention. Incorrect installations can result in high deviations from the planned osteotomy, increasing the risk of positive resection margins. In this work, we propose to use augmented reality (AR) to guide and verify PSIs placement. We designed an experiment to assess the accuracy provided by the system using a smartphone and the HoloLens 2 and compared the results with the conventional freehand method. The results showed significant differences, where AR guidance prevented high osteotomy deviations, reducing maximal deviation of 54.03 mm for freehand placements to less than 5 mm with AR guidance. The experiment was performed in two versions of a plastic three-dimensional (3D) printed phantom, one including a silicone layer to simulate tissue, providing more realism. We also studied how differences in shape and location of PSIs affect their accuracy, concluding that those with smaller sizes and a homogeneous target surface are more prone to errors. Our study presents promising results that prove AR’s potential to overcome the present limitations of PSIs conveniently and effectively. Full article

(This article belongs to the Special Issue Development of Virtual and Augmented Reality Systems for Health and Clinical Assessment)

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10 pages, 1772 KiB

Open AccessCommunication

Rest Intervals during Virtual Reality Gaming Augments Standing Postural Sway Disturbance

by Ross Allan Clark, Ancret Szpak, Stefan Carlo Michalski and Tobias Loetscher

Sensors 2021, 21(20), 6817; https://doi.org/10.3390/s21206817 - 14 Oct 2021

Cited by 4 | Viewed by 2461

Abstract

Immersive virtual reality (VR) can cause acute sickness, visual disturbance, and balance impairment. Some manufacturers recommend intermittent breaks to overcome these issues; however, limited evidence examining whether this is beneficial exists. The aim of this study was to examine whether taking breaks during VR gaming reduced its effect on postural sway during standing balance assessments. Twenty-five people participated in this crossover design study, performing 50 min of VR gaming either continuously or with intermittent 10 min exposure/rest intervals. Standing eyes open, two-legged balance assessments were performed immediately pre-, immediately post- and 40 min post-exposure. The primary outcome measure was total path length; secondary measures included independent axis path velocity, amplitude, standard deviation, discrete and continuous wavelet transform-derived variables, and detrended fluctuation analysis. Total path length was significantly (p < 0.05) reduced immediately post-VR gaming exposure in the intermittent rest break group both in comparison to within-condition baseline values and between-condition timepoint results. Conversely, it remained consistent across timepoints in the continuous exposure group. These changes consisted of a more clustered movement speed pattern about a lower central frequency, evidenced by signal frequency content. These findings indicate that caution is required before recommending rest breaks during VR exposure until we know more about how balance and falls risk are affected. Full article

(This article belongs to the Special Issue Development of Virtual and Augmented Reality Systems for Health and Clinical Assessment)

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18 pages, 1204 KiB

Open AccessArticle

Hybrid Simulation and Planning Platform for Cryosurgery with Microsoft HoloLens

by Sara Condino, Fabrizio Cutolo, Nadia Cattari, Simone Colangeli, Paolo Domenico Parchi, Roberta Piazza, Alfio Damiano Ruinato, Rodolfo Capanna and Vincenzo Ferrari

Sensors 2021, 21(13), 4450; https://doi.org/10.3390/s21134450 - 29 Jun 2021

Cited by 20 | Viewed by 3601

Abstract

Cryosurgery is a technique of growing popularity involving tissue ablation under controlled freezing. Technological advancement of devices along with surgical technique improvements have turned cryosurgery from an experimental to an established option for treating several diseases. However, cryosurgery is still limited by inaccurate planning based primarily on 2D visualization of the patient’s preoperative images. Several works have been aimed at modelling cryoablation through heat transfer simulations; however, most software applications do not meet some key requirements for clinical routine use, such as high computational speed and user-friendliness. This work aims to develop an intuitive platform for anatomical understanding and pre-operative planning by integrating the information content of radiological images and cryoprobe specifications either in a 3D virtual environment (desktop application) or in a hybrid simulator, which exploits the potential of the 3D printing and augmented reality functionalities of Microsoft HoloLens. The proposed platform was preliminarily validated for the retrospective planning/simulation of two surgical cases. Results suggest that the platform is easy and quick to learn and could be used in clinical practice to improve anatomical understanding, to make surgical planning easier than the traditional method, and to strengthen the memorization of surgical planning. Full article

(This article belongs to the Special Issue Development of Virtual and Augmented Reality Systems for Health and Clinical Assessment)

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Review

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15 pages, 2507 KiB

Open AccessReview

Rehabilitation Is the Main Topic in Virtual and Augmented Reality and Physical Activity Research: A Bibliometric Analysis

by Angel Denche-Zamorano, Yeray Rodriguez-Redondo, Sabina Barrios-Fernandez, María Mendoza-Muñoz, Antonio Castillo-Paredes, Jorge Rojo-Ramos, Miguel Angel Garcia-Gordillo and Jose Carmelo Adsuar

Sensors 2023, 23(6), 2987; https://doi.org/10.3390/s23062987 - 9 Mar 2023

Cited by 11 | Viewed by 4133

Abstract

Researchers’ interest in finding practical applications for virtual reality (VR) and augmented reality (AR) technologies has increased as new devices have become cheaper and more accessible, being used in entertainment, healthcare, and rehabilitation fields, among others. This study aims to provide an overview of the current state of scientific literature related to VR, AR, and physical activity (PA). A bibliometric analysis of studies published between 1994 and 2022 was conducted using The Web of Science (WoS), applying the traditional bibliometric laws and using the VOSviewer software for data and metadata processing. The results revealed an exponential increase in scientific production between 2009 and 2021 (R² = 94%). The United States (USA) was the country/region with the most relevant co-authorship networks (72 papers); the most prolific author was Kerstin Witte, and the most prominent was Richard Kulpa. The most productive journal’s core was composed of high-impact and open access journals. A great thematic diversity was found according to the most used keywords by the co-authors, highlighting concepts such as rehabilitation, cognition, training, and obesity. Then, the research related to this topic is in an exponential development phase, with great interest in the rehabilitation and sports sciences fields. Full article

(This article belongs to the Special Issue Development of Virtual and Augmented Reality Systems for Health and Clinical Assessment)

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56 pages, 1961 KiB

Open AccessReview

Acceptability, Feasibility, and Effectiveness of Immersive Virtual Technologies to Promote Exercise in Older Adults: A Systematic Review and Meta-Analysis

by Benjamin Doré, Alex Gaudreault, Gauthier Everard, Johannes C. Ayena, Ahmad Abboud, Nicolas Robitaille and Charles Sebiyo Batcho

Sensors 2023, 23(5), 2506; https://doi.org/10.3390/s23052506 - 24 Feb 2023

Cited by 15 | Viewed by 3993

Abstract

Context: This review aimed to synthesize the literature on the acceptability, feasibility, and effectiveness of immersive virtual technologies to promote physical exercise in older people. Method: We performed a literature review, based on four databases (PubMed, CINAHL, Embase, and Scopus; last search: 30 January 2023). Eligible studies had to use immersive technology with participants aged 60 years and over. The results regarding acceptability, feasibility, and effectiveness of immersive technology-based interventions in older people were extracted. The standardized mean differences were then computed using a random model effect. Results: In total, 54 relevant studies (1853 participants) were identified through search strategies. Concerning the acceptability, most participants reported a pleasant experience and a desire to use the technology again. The average increase in the pre/post Simulator Sickness Questionnaire score was 0.43 in healthy subjects and 3.23 in subjects with neurological disorders, demonstrating this technology’s feasibility. Regarding the effectiveness, our meta-analysis showed a positive effect of the use of virtual reality technology on balance (SMD = 1.05; 95% CI: 0.75–1.36; p < 0.001) and gait outcomes (SMD = 0.7; 95% CI: 0.14–0.80; p < 0.001). However, these results suffered from inconsistency and the number of trials dealing with these outcomes remains low, calling for further studies. Conclusions: Virtual reality seems to be well accepted by older people and its use with this population is feasible. However, more studies are needed to conclude its effectiveness in promoting exercise in older people. Full article

(This article belongs to the Special Issue Development of Virtual and Augmented Reality Systems for Health and Clinical Assessment)

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