# Lentis/Augmented Reality in Medicine
## Overview

Augmented reality (AR) is the enhancement of a user's field of view through superimposed computer generated data on a display system. AR is becoming more accessible and affordable, with increasing relevance to many sectors of the economy in the near future. AR has been used in medicine since the early 2000s, but has not seen rapid growth and development. Its use in medicine creates an interesting intersection between technology and society as the technology gains prominence in the modern world.

## Current Applications

AR has seen limited use in medicine until very recently. Many more applications will likely arise in the near future as new innovations occur, as the price and computing power required for AR has decreased continuously since its invention in 1957. This will allow for more hospitals and universities to adopt the technology for current use in a variety of ways.

### Student Training Applications

The use of AR in medical training dates back to the early 2000s. AR has mainly been used for surgical training but has also been applied to numerous other areas of health science. The main roles of AR in student trainings include: navigation and guidance through surgeries, feedback on doctor's progress, remote assessment and training, and simulator practice, while providing an innovative user-interface for trainees. Training has been developed into apps (such as ARnatomy) that can be completed remotely for improved training, e.g. during a pandemic. Swanwick and Buckley note "medical education now, more so than in the past, needs to span three sectors: undergraduate, postgraduate and the continuing professional development of established clinicians." They also found that 96% of training methods studied found AR to be improving healthcare education.

### Clinical Care

AR is used in the dentistry industry mainly through smart glasses. Headsets and smart glasses enhance dentistry by providing the user with the patient's information displayed in a HUD (heads up display) system in front of their vision. This allows for quick access to data providing useful information and saving time for the patient and doctor. AccuVein also uses AR to create a virtual map of a patient's vasculature on their skin improving patient comfort during venipuncture procedures. Augmedics is a company developing AR headsets for use in spinal surgery. Their xvision headsets have helped surgeons complete spinal surgeries in over 200 cases since 2020. The xvision Spine system (XVS) "allows surgeons to visualize their patients’ 3D spinal anatomy during surgery as if they had “x-ray vision,” helping them to accurately navigate instruments and implants while looking directly at the patient, rather than a remote screen."

### Better Visualizations

AR allows for enhanced perception of medical conditions through the use of projection and mapping. This allows for improved patient to doctor communication during the initial treatment stages and aids in descriptions of surgical procedures to patients. The use of AR also makes telehealth appointments more feasible because people are able to have effective communication while looking through a shared point of view without being in the same room.

## Future Applications

Currently, AR is mostly used for surgery and anatomy skill building exercises but that is likely to change as innovations occur. AR has an extraordinary amount of potential in the medical field, but it's not purely the technology itself that attracts attention; it additionally holds potential as a "stepping stone" to potentially revolutionary future technologies.

### Linked Realities

Linked realities lets multiple people see the same virtual augmentations cohesively. This would enable multiple AR systems in the operating room to allow everyone to view the same projections. Furthermore, it could allow surgical experts to give advice remotely; the advisor would use a computer or gloves that project hands into the operating theater through the surgeon's AR goggles. This technology allows for multiple experts, across the world if needed, to be consulted, giving accurate advice and preventing miscommunication.

## Technical Challenges

While AR has great potential in medical innovation, there are many obstacles to the development of AR technology.

### Poor Business Model

As of right now AR has no solid marketing basis. There is nothing that AR does, in its current state, that other technologies cannot do better. This slows investment and disrupts development. To further develop AR, companies need to determine their niche ability that can't be matched by modern technology in use.

### Accuracy of Projection

The accuracy of the projections is another major problem. AR needs to project a three dimensional image using a two dimensional screen, while the user is moving in real time, with near one hundred percent reliability. If the technology can't do this at a minimum then there is no way it can be used in any future application besides a useful teaching tool.

### Newness of technology

AR is an extraordinarily new application being used in medicine and currently has minimal uses and applications in other sectors. Because of this, many people are wary of it. Before it can improve, it needs to be accepted by the general public. Until recently, AR systems had to be run on large bulky platforms which isn't feasible to use in a surgical room. Now that the technology required is becoming smaller, there's more potential for its uses to expand.

## Dangers of Augmented Reality in Medicine

As a novel technology, certain risks could potentially impact the rollout of AR.

### Learning Deficiencies and "Deskilling"

Deskilling is a reduction in worker autonomy, knowledge, and decision-making ability, often attributed to innovations designed to improve efficiency, reduce cost, and standardize procedures. While the concept was first applied to the medical field in the Seventies, the difficulty of measuring deskilling has made consensus difficult - another issue is that deskilling is overwhelmingly portrayed as a struggle between workers and management, which divides analysis of deskilling as a phenomenon along ideological lines and further muddles efforts to measure its incidence. In a study conducted through interview, physicians using electronic medical records and clinical guidelines have reported decreased confidence, patient trust, and clinical knowledge; there is concern that these phenomena would occur with the use of AR technology, at a potentially more dangerous scale.

### Dependency

In addition to the concept of deskilling, physicians using technological innovations were found to adapt to the technologies available but concurrently build a reliance - accordingly there is a concern that the same issue would apply to AR applications. This is of particular significance with VR and AR, as per their names, modifying reality - rather than simply losing a "tool" in operations, losing an item used to process and re-contextualize reality may feel more like losing a "sense," with great potential patient risk.

### Ethical Implications

The ethical implications of advanced technology, particularly AI, VR, and AR, are matters currently facing significant scrutiny; when taken in conjunction with the strict ethical standards of the medical field the issue becomes one of great importance. One fundamental issue associated with the increased data-gathering capabilities is that of privacy. While medical data in aggregate has great potential to provide significant benefits, on an individual level it is imperative that individual privacy is respected as it pertains to medical information. Initial approaches to discussing the former have been suggested on a patient-caregiver level, with one concept being a system of storing genome sequences which can be adjusted based on caregiver and patient discussion, with stated aim of increasing awareness of personal information in patients.
In addition to the technological aspects, the psychological concerns of VR and AR are worth further consideration - studies have indicated that the felt environment in VR has had unconscious influences on human behavior - how these behavioral changes impact the relatively reality-reflective use of AR in medicine is a matter worthy of examination; one speculative example might be a change in confidence - whether to a level of calm reassurance or toward a dangerous level of overconfidence is a question for the future.

## Conclusion

The expansion of AR into medicine is a field with great potential and great risk. As new technologies enter the medical field, they offer potential for innovations which can improve efficiency and effectiveness, but at the same time carry new challenges and risk generating a new set of problems to accompany their solutions. The newness of the technology is one element which has great potential - as time goes on and both quality and adaptation of the technology improve allowing innovations to occur. With this expansion, there will likely be a significant number of interest groups which do not exist yet worth examining, and perhaps more detailed examination of the deskilling and dependency concerns that are present today, as that technology spreads.

## References

* ↑ Augmented reality in Healthcare: 9 examples. The Medical Futurist. (2021, November 3). Retrieved November 10, 2021, from https://medicalfuturist.com/augmented-reality-in-healthcare-will-be-revolutionary/.
* 1 2 Zhu, E., Hadadgar, A., Masiello, I., & Zary, N. (2014). Augmented reality in healthcare education: An integrative review. PeerJ, 2014(1), 1–17. https://doi.org/10.7717/peerj.469
* ↑ Swanwick T, Buckley G. 2010. Swanwick T, ed. Understanding medical education evidence, theory and practice. London: Wiley-Blackwell, xv–xvii.
* ↑ AccuVein. (n.d.). Accuvein vein visualization-improves IV 1-stick success 3.5x. AccuVein. Retrieved December 8, 2021, from https://www.accuvein.com/.
* 1 2 Xvision spine system: Augmedics: United States. Augmedics. (2021, March 30). Retrieved November 10, 2021, from https://augmedics.com/.
* ↑ Parsons D, MacCallum K. Current Perspectives on Augmented Reality in Medical Education: Applications, Affordances and Limitations. Adv Med Educ Pract. 2021;12:77-91 https://doi.org/10.2147/AMEP.S249891
* 1 2 3 4 Hoff, Timothy Deskilling and adaptation among primary care physicians using two work innovations, Health Care Management Review: October 2011 - Volume 36 - Issue 4 - p 338-348 doi: 10.1097/HMR.0b013e31821826a1
* ↑ N. -M. Aliman and L. Kester, "Extending Socio-Technological Reality for Ethics in Artificial Intelligent Systems," 2019 IEEE International Conference on Artificial Intelligence and Virtual Reality (AIVR), 2019, pp. 275-2757, doi: 10.1109/AIVR46125.2019.00064.
* ↑ Toch, E., Rager, N., Florentin, T., Linenberg, D., Sellman, D., & Shomron, N. (2018). Augmented-Genomics: Protecting Privacy for Clinical Genomics with Inferential Interfaces. Proceedings of the 23rd International Conference on Intelligent User Interfaces Companion. https://doi.org/10.1145/3180308.3180326
* ↑ Toch, E., Rager, N., Florentin, T., Linenberg, D., Sellman, D., & Shomron, N. (2018). Augmented-Genomics: Protecting Privacy for Clinical Genomics with Inferential Interfaces. Proceedings of the 23rd International Conference on Intelligent User Interfaces Companion. https://doi.org/10.1145/3180308.3180326
* ↑ Madary, M., & Metzinger, T. K. (2016). Real Virtuality: A Code of Ethical Conduct. Recommendations for Good Scientific Practice and the Consumers of VR-Technology . In Frontiers in Robotics and AI (Vol. 3, p. 3). https://www.frontiersin.org/article/10.3389/frobt.2016.00003