Augmented reality in interventional radiology education
a systematic review of randomized controlled trials
Keywords:
Radiology, interventional, Augmented reality, Education, medical, Simulation trainingAbstract
BACKGROUND: Augmented reality (AR) involves digitally overlapping virtual objects onto physical objects in real space so that individuals can interact with both at the same time. AR in medical education seeks to reduce surgical complications through high-quality education. There is uncertainty in the use of AR as a learning tool for interventional radiology procedures. OBJECTIVE: To compare AR with other learning methods in interventional radiology. DESIGN AND SETTING: Systematic review of comparative studies on teaching techniques. METHODS: We searched the Cochrane Library, MEDLINE, Embase, Tripdatabase, ERIC, CINAHL, SciELO and LILACS electronic databases for studies comparing AR simulation with other teaching methods in interventional radiology. This systematic review was performed in accordance with PRISMA and the BEME Collaboration. Eligible studies were evaluated using the quality indicators provided in the BEME Collaboration Guide no. 11, and the Kirkpatrick model. RESULTS: Four randomized clinical trials were included in this review. The level of educational evidence found among all the papers was 2B, according to the Kirkpatrick model. The Cochrane Collaboration tool was applied to assess the risk of bias for individual studies and across studies. Three studies showed an improvement in teaching of the proposed procedure through AR; one study showed that the participants took longer to perform the procedure through AR. CONCLUSION: AR, as a complementary teaching tool, can provide learners with additional skills, but there is still a lack of studies with a higher evidence level according to the Kirkpatrick model. SYSTEMATIC REVIEW REGISTRATION NUMBER: DOI 10.17605/OSF.IO/ACZBM in the Open Science Framework database.
Downloads
References
Silva AB, de Amorim AC. A Brazilian educational experiment: teleradiology on web TV. J Telemed Telecare. 2009;15(7):373-6. PMID: 19815908; https://doi.org/10.1258/jtt.2009.090204
Duarte ML, Santos LR, Guimarães Júnior JB, Peccin MS. Learning anatomy by virtual reality and augmented reality. A scope review. Morphologie. 2020;104(347):254-66. PMID: 32972816; https://doi.org/10.1016/j.morpho.2020.08.004
Cates CU, Lönn L, Gallagher AG. Prospective, randomised and blinded comparison of proficiency-based progression full-physics virtual reality simulator training versus invasive vascular experience for learning carotid artery angiography by very experienced operators. BMJ Stel. 2016;2:1-5. https://doi.org/10.1136/bmjstel-2015-000090
Kreiser K, Gehling K, Zimmer C. Simulation in Angiography - Experiences from 5 Years Teaching, Training, and Research. Rofo. 2019;191(6):547-52. PMID: 30754054; https://doi.org/10.1055/a-0759-2248
Chaer RA, Derubertis BG, Lin SC, et al. Simulation improves resident performance in catheter-based intervention: results of a randomized, controlled study. Ann Surg. 2006;244(3):343–52. PMID: 16926560; https://doi.org/10.1097/01.sla.0000234932.88487.75
Mirza S, Athreya S. Review of Simulation Training in Interventional Radiology. Acad Radiol. 2018;25(4):529-39. PMID: 29221857; doi: https://doi.org/10.1016/j.acra.2017.10.009
Johnson SJ, Guediri SM, Kilkenny C, Clough PJ. Development and validation of a virtual reality simulator: human factors input to interventional radiology training. Hum Factors. 2011;53(6):612-25. PMID: 22235524; https://doi.org/10.1177/0018720811425042
Willaert WI, Aggarwal R, Daruwalla F, et al. European Virtual Reality Endovascular Research Team EVEResT. Simulated procedure rehearsal is more effective than a preoperative generic warm-up for endovascular procedures. Ann Surg. 2012;255(6):1184-9. PMID: 22566016; https://doi.org/10.1097/SLA.0b013e31824f9dbf
Chytas D, Johnson EO, Piagkou M, et al. The role of augmented reality in anatomical education: An overview. Ann Anat. 2020;229:151463. PMID: 31978568; https://doi.org/10.1016/j.aanat.2020.151463
Aebersold M, Voepel-Lewis T, Cherara L, et al. Interactive Anatomy-Augmented Virtual Simulation Training. Clin Simul Nurs. 2018;15:34-41. PMID: 29861797; https://doi.org/10.1016/j.ecns.2017.09.008
Mahmood F, Mahmood E, Dorfman RG, et al. Augmented Reality and Ultrasound Education: Initial Experience. J Cardiothorac Vasc Anesth. 2018;32(3):1363-7. PMID: 29452879; https://doi.org/10.1053/j.jvca.2017.12.006
Dhar P, Rocks T, Samarasinghe RM, Stephenson G, Smith C. Augmented reality in medical education: students’ experiences and learning outcomes. Med Educ Online. 2021 Dec;26(1):1953953. PMID: 34259122; https://doi.org/10.1080/10872981.2021.1953953
Sandrone S, Carlson CE. Future of Neurology & Technology: Virtual and Augmented Reality in Neurology and Neuroscience Education: Applications and Curricular Strategies. Neurology. 2021:10.1212/WNL.0000000000012413. PMID: 34187858; https://doi.org/10.1212/WNL.0000000000012413
Huang CY, Thomas JB, Alismail A, et al. The use of augmented reality glasses in central line simulation: “see one, simulate many, do one competently, and teach everyone”. Adv Med Educ Pract. 2018;9:357-63. PMID: 29785148; https://doi.org/10.2147/AMEP.S160704
Keri Z, Sydor D, Ungi T, et al. Computerized training system for ultrasound-guided lumbar puncture on abnormal spine models: a randomized controlled trial. Can J Anaesth. 2015;62(7):777-84. PMID: 25804431; https://doi.org/10.1007/s12630-015-0367-2
Ebner F, De Gregorio A, Schochter F, et al. Effect of an Augmented Reality Ultrasound Trainer App on the Motor Skills Needed for a Kidney Ultrasound: Prospective Trial. JMIR Serious Games. 2019;7(2):e12713. PMID: 31042155; https://doi.org/10.2196/12713
Moult E, Ungi T, Welch M, et al. Ultrasound-guided facet joint injection training using Perk Tutor. Int J Comput Assist Radiol Surg. 2013;8(5):831-6. PMID: 23329279; https://doi.org/10.1007/s11548-012-0811-5
Wu TS, Dameff CJ, Tully JL. Ultrasound-guided central venous access using Google Glass. J Emerg Med. 2014;47(6):668-75. PMID: 25281180; https://doi.org/10.1016/j.jemermed.2014.07.045
Küçük S, Kapakin S, Göktaş Y. Learning anatomy via mobile augmented reality: Effects on achievement and cognitive load. Anat Sci Educ. 2016;9(5):411-21. PMID: 26950521; https://doi.org/10.1002/ase.1603
Jamali SS, Shiratuddin MF, Wong KW, Oskam CL. Utilising Mobile-Augmented Reality for Learning Human Anatomy. Procedia - Social and Behavioral Sciences 2015;197:659-68. https://doi.org/10.1016/j.sbspro.2015.07.054
Gallagher AG, Smith CD. From the operating room of the present to the operating room of the future. Human-factors lessons learned from the minimally invasive surgery revolution. Semin Laparosc Surg. 2003;10(3):127-39. PMID: 14551655; https://doi.org/10.1177/107155170301000306
Aeckersberg G, Gkremoutis A, Schmitz-Rixen T, Kaiser E. The relevance of low-fidelity virtual reality simulators compared with other learning methods in basic endovascular skills training. J Vasc Surg. 2019;69(1):227-35. PMID: 30579447; https://doi.org/10.1016/j.jvs.2018.10.047
Markovic J, Peyser C, Cavoores T, et al. Impact of endovascular simulator training on vascular surgery as a career choice in medical students. J Vasc Surg. 2012;55(5):1515-21. PMID: 22464708; https://doi.org/10.1016/j.jvs.2011.11.060
Stromberga Z, Phelps C, Smith J, Moro C. Teaching with Disruptive Technology: The Use of Augmented, Virtual, and Mixed Reality (HoloLens) for Disease Education. Adv Exp Med Biol. 2021;1317:147-62. PMID: 33945136.25; https://doi.org/10.1007/978-3-030-61125-5_8
Berry M, Reznick R, Lystig T, Lönn L. The use of virtual reality for training in carotid artery stenting: a construct validation study. Acta Radiol. 2008;49(7):801-5. PMID: 18608009; https://doi.org/10.1080/02841850802108438
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan - a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. PMID: 27919275; https://doi.org/10.1186/s13643-016-0384-4
Sterne JAC, Hernan MA, McAleenan A, Reeves BC, Higgins JPT. Chapter 25: assessing risk of bias in a non-randomized study. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane handbook for systematic reviews of interventions version 6.0. Hoboken: John Wiley & Sons; 2019.
Buckley S, Coleman J, Davison I, et al. The educational effects of portfolios on undergraduate student learning: a Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 11. Med Teach. 2009;31(4):282-98. PMID: 19404891; https://doi.org/10.1080/01421590902889897
Steinert Y, Mann K, Centeno A, et al. A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8. Med Teach. 2006;28(6):497-526. PMID: 17074699; https://doi.org/10.1080/01421590600902976
Kirkpatrick D, Kirkpatrick J. Evaluating training programs: The four levels. 3rd ed. San Francisco, CA: Berrett-Koehler; 2006.
Grasso RF, Faiella E, Luppi G, et al. Percutaneous lung biopsy: comparison between an augmented reality CT navigation system and standard CT-guided technique. Int J Comput Assist Radiol Surg. 2013;8(5):837-48. PMID: 23377707; https://doi.org/10.1007/s11548-013-0816-8
Gelmini AYP, Duarte ML, de Assis AM, Guimarães Junior JB, Carnevale FC. Virtual reality in interventional radiology education: a systematic review. Radiol Bras. 2021;54(4):254-60. PMID: 34393293; https://doi.org/10.1590/0100-3984.2020.0162
Rodríguez-Abad C, Fernández-de-la-Iglesia JD, Martínez-Santos AE, Rodríguez-González R. A Systematic Review of Augmented Reality in Health Sciences: A Guide to Decision-Making in Higher Education. Int J Environ Res Public Health. 2021;18(8):4262. PMID: 33920528; https://doi.org/10.3390/ijerph18084262
Mladenovic R, Matvijenko V, Subaric L, Mladenovic K. Augmented reality as e-learning tool for intraoral examination and dental charting during COVID-19 era. J Dent Educ. 2021. PMID: 34420217; https://doi.org/10.1002/jdd.12780 Epub ahead of print.
Arjomandi Rad A, Vardanyan R, Thavarajasingam SG, et al. Extended, virtual and augmented reality in thoracic surgery: a systematic review. Interact Cardiovasc Thorac Surg. 2021:ivab241. PMID: 34542639; https://doi.org/10.1093/icvts/ivab241
Ha J, Parekh P, Gamble D, et al. Opportunities and challenges of using augmented reality and heads-up display in orthopaedic surgery: A narrative review. J Clin Orthop Trauma. 2021;18:209-15. PMID: 34026489; https://doi.org/10.1016/j.jcot.2021.04.031
Ferrer-Torregrosa J, Jiménez-Rodríguez MÁ, Torralba-Estelles J, et al. Distance learning ects and flipped classroom in the anatomy learning: comparative study of the use of augmented reality, video and notes. BMC Med Educ. 2016;16(1):230. PMID: 27581521; https://doi.org/10.1186/s12909-016-0757-3
Moro C, Štromberga Z, Raikos A, Stirling A. The effectiveness of virtual and augmented reality in health sciences and medical anatomy. Anat Sci Educ. 2017;10(6):549-59. PMID: 28419750; https://doi.org/10.1002/ase.1696
McNulty JA, Sonntag B, Sinacore JM. Evaluation of computer-aided instruction in a gross anatomy course: a six-year study. Anat Sci Educ. 2009;2(1):2-8. PMID: 19217066; https://doi.org/10.1002/ase.66
McNulty JA, Halama J, Espiritu B. Evaluation of computer-aided instruction in the medical gross anatomy curriculum. Clin Anat. 2004;17(1):73-8. PMID: 14695594; https://doi.org/10.1002/ca.10188
Lynch TG, Steele DJ, Johnson Palensky JE, Lacy NL, Duffy SW. Learning preferences, computer attitudes, and test performance with computer-aided instruction. Am J Surg. 2001;181(4):368-71. PMID: 11438276; https://doi.org/10.1016/s0002-9610(01)00575-x
Kotcherlakota S, Pelish P, Hoffman K, Kupzyk K, Rejda P. Augmented Reality Technology as a Teaching Strategy for Learning Pediatric Asthma Management: Mixed Methods Study. JMIR Nurs. 2020;3(1):e23963. PMID: 34406970; https://doi.org/10.2196/23963
Barteit S, Lanfermann L, Bärnighausen T, Neuhann F, Beiersmann C. Augmented, Mixed, and Virtual Reality-Based Head-Mounted Devices for Medical Education: Systematic Review. JMIR Serious Games. 2021;9(3):e29080. PMID: 34255668; https://doi.org/10.2196/29080
Bölek KA, De Jong G, Henssen D. The effectiveness of the use of augmented reality in anatomy education: a systematic review and meta-analysis. Sci Rep. 2021 Jul 27;11(1):15292. PMID: 34315955; https://doi.org/10.1038/s41598-021-94721-4
Patel R, Dennick R. Simulation based teaching in interventional radiology training: is it effective? Clin Radiol. 2017;72(3):266.e7-.e14. PMID: 27986263; https://doi.org/10.1016/j.crad.2016.10.014
Aggarwal R, Black SA, Hance JR, Darzi A, Cheshire NJ. Virtual reality simulation training can improve inexperienced surgeons’ endovascular skills. Eur J Vasc Endovasc Surg. 2006;31(6):588-93. PMID: 16387517; https://doi.org/10.1016/j.ejvs.2005.11.009