Holographic Streaming of Input From Video Capture Devices During Interventional Radiology Procedures - a Feasibility Study (Hololens Study)

The ergonomic design and setup of an operating/procedure room have long been a studied topic of interest. Back in 1999, an article (1) reviewed the ongoing research into the effects that operator posture, the operating room environment, and visualization of screens have on the ergonomics of surgery. They made the observation that 'future efforts to create a more user- friendly operating room environment will require the rethinking of traditional concepts of architecture, asepsis, and staffing (1). As technology rapidly advances, we are increasingly able to reassess and enhance the current ergonomic structure and setup of operating rooms and procedures.

Interventional radiology (IR) refers to a variety of minimally invasive procedures using small- caliber catheters under fluoroscopic or ultrasound guidance for the treatment of vascular and urologic, gastrointestinal conditions without the need for open surgery (2).

Interventional Radiology has the unique ergonomic consideration of the placement of the intraoperative viewing monitors (3). To perform any Interventional Radiology procedure, radiologists currently use a ceiling mounted or floor mounted image intensifier, a ceiling mounted screen and a small floor mounted monitor. In many procedures (usually those requiring downstream access into the vessel, arm or neck vascular access) the Radiologist has to move their own position to visualize all the screens, as it is impossible to rotate the screens adequately so that they are in a direct line with the Radiologists vision. Previous studies of office video terminal display (VDT) users demonstrate that the preferred viewing angle for VDTs is between 10° to 25° below the line of sight(4). The monitors are placed in such a way that the Interventional radiologist cannot possibly maintain the correct line of sight without some neck movement and craning. Inevitably, long periods of time standing in this awkward position can lead to musculoskeletal issues for the radiologist, as well as the stress of performing a procedure safely without the best line of vision.

The Interventional Radiologist is also wearing a heavy lead apron during the procedure, which adds to the ergonomic challenges. The incidence of neck and back pain increases with hours of apron use and years of practice, and may be the result of a combination of axial load (ie, prolonged standing in protective garments), awkward or poor posture (necessitated by leaning or bending to accomplish procedures), and repetitive injury accumulated over years of practice. (5)

In addition, there are multiple other screens monitoring patient parameters which are outside of the Interventional radiologist's field of view during the procedure, creating further safety concerns. Of note, other current concerns in the Interventional suite are costly screen breakage during manoeuvre of the screens during suite setup, and sterility issues that arise when the monitor is brought too close to the operating field.