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      Augmented Reality to Localize Individual Organ in Surgical Procedure

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          Abstract

          Objectives

          Augmented reality (AR) technology has become rapidly available and is suitable for various medical applications since it can provide effective visualization of intricate anatomical structures inside the human body. This paper describes the procedure to develop an AR app with Unity3D and Vuforia software development kit and publish it to a smartphone for the localization of critical tissues or organs that cannot be seen easily by the naked eye during surgery.

          Methods

          In this study, Vuforia version 6.5 integrated with the Unity Editor was installed on a desktop computer and configured to develop the Android AR app for the visualization of internal organs. Three-dimensional segmented human organs were extracted from a computerized tomography file using Seg3D software, and overlaid on a target body surface through the developed app with an artificial marker.

          Results

          To aid beginners in using the AR technology for medical applications, a 3D model of the thyroid and surrounding structures was created from a thyroid cancer patient's DICOM file, and was visualized on the neck of a medical training mannequin through the developed AR app. The individual organs, including the thyroid, trachea, carotid artery, jugular vein, and esophagus were localized by the surgeon's Android smartphone.

          Conclusions

          Vuforia software can help even researchers, students, or surgeons who do not possess computer vision expertise to easily develop an AR app in a user-friendly manner and use it to visualize and localize critical internal organs without incision. It could allow AR technology to be extensively utilized for various medical applications.

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          Most cited references7

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          Systematic review on the effectiveness of augmented reality applications in medical training

          Background Computer-based applications are increasingly used to support the training of medical professionals. Augmented reality applications (ARAs) render an interactive virtual layer on top of reality. The use of ARAs is of real interest to medical education because they blend digital elements with the physical learning environment. This will result in new educational opportunities. The aim of this systematic review is to investigate to which extent augmented reality applications are currently used to validly support medical professionals training. Methods PubMed, Embase, INSPEC and PsychInfo were searched using predefined inclusion criteria for relevant articles up to August 2015. All study types were considered eligible. Articles concerning AR applications used to train or educate medical professionals were evaluated. Results Twenty-seven studies were found relevant, describing a total of seven augmented reality applications. Applications were assigned to three different categories. The first category is directed toward laparoscopic surgical training, the second category toward mixed reality training of neurosurgical procedures and the third category toward training echocardiography. Statistical pooling of data could not be performed due to heterogeneity of study designs. Face-, construct- and concurrent validity was proven for two applications directed at laparoscopic training, face- and construct validity for neurosurgical procedures and face-, content- and construct validity in echocardiography training. In the literature, none of the ARAs completed a full validation process for the purpose of use. Conclusion Augmented reality applications that support blended learning in medical training have gained public and scientific interest. In order to be of value, applications must be able to transfer information to the user. Although promising, the literature to date is lacking to support such evidence.
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            Augmented and virtual reality in surgery-the digital surgical environment: applications, limitations and legal pitfalls.

            The continuing enhancement of the surgical environment in the digital age has led to a number of innovations being highlighted as potential disruptive technologies in the surgical workplace. Augmented reality (AR) and virtual reality (VR) are rapidly becoming increasingly available, accessible and importantly affordable, hence their application into healthcare to enhance the medical use of data is certain. Whether it relates to anatomy, intraoperative surgery, or post-operative rehabilitation, applications are already being investigated for their role in the surgeons armamentarium. Here we provide an introduction to the technology and the potential areas of development in the surgical arena.
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              Virtual Reality and Augmented Reality in Plastic Surgery: A Review

              Recently, virtual reality (VR) and augmented reality (AR) have received increasing attention, with the development of VR/AR devices such as head-mounted displays, haptic devices, and AR glasses. Medicine is considered to be one of the most effective applications of VR/AR. In this article, we describe a systematic literature review conducted to investigate the state-of-the-art VR/AR technology relevant to plastic surgery. The 35 studies that were ultimately selected were categorized into 3 representative topics: VR/AR-based preoperative planning, navigation, and training. In addition, future trends of VR/AR technology associated with plastic surgery and related fields are discussed.
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                Author and article information

                Journal
                Healthc Inform Res
                Healthc Inform Res
                HIR
                Healthcare Informatics Research
                Korean Society of Medical Informatics
                2093-3681
                2093-369X
                October 2018
                31 October 2018
                : 24
                : 4
                : 394-401
                Affiliations
                [1 ]Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
                [2 ]Department of Surgery, Inha University Hospital, Incheon, Korea.
                [3 ]Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.
                [4 ]Department of Surgery, SMGSNU Boramae Medical Center, Seoul, Korea.
                [5 ]Department of Biomedical Engineering, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
                [6 ]Department of Biomedical Engineering, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
                Author notes
                Corresponding Author: Hyoun-Joong Kong, PhD. Department of Biomedical Engineering, Chungnam National University Hospital, Chungnam National University College of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon 35015, Korea. Tel: +82-42-280-7252, gongcop@ 123456cnu.ac.kr

                *These two authors contributed equally to this work.

                Author information
                https://orcid.org/0000-0001-5456-4862
                Article
                10.4258/hir.2018.24.4.394
                6230535
                30443429
                20e7db07-3382-41ad-a98e-8df60cc1ef4a
                © 2018 The Korean Society of Medical Informatics

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 September 2018
                : 22 October 2018
                : 22 October 2018
                Funding
                Funded by: Chungnam National University, CrossRef https://doi.org/10.13039/501100002462;
                Categories
                Tutorial

                Bioinformatics & Computational biology
                virtual reality,medical education,three-dimensional imaging,thyroidectomy,augmented reality

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