He emphasized the potential benefits, as described in a 2023 scoping review he and his colleagues published on the use of XR in facial plastic surgery (Laryngoscope. Published online November 10, 2023. doi: 10.1002/lary.31178). The review included 31 feasibility studies and 21 studies in which XR was being used intraoperatively on actual patients. Evidence from these latter studies showed that most of the intraoperative use was with AR to project, for example, planned osteotomy lines, vascular anatomy, and ideal contour onto the surgical field in patients ranging from those requiring reconstructive surgery due to trauma to those needing free tissue transfer. “This could allow surgeons to know where the critical anatomy lies in relation to their surgical instrument or overlay reference images while a surgeon contours bone of the face, for example,” said Dr. Chou. Potential benefits, he said, include using VR headsets on patients to distract them during surgery, which, in essence, is using XR as a form of analgesia.
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May 2024Another potential emerging use is adopting AR for surgical navigation during facial plastic surgery and free flap harvest. “Our review found a lot of really exciting and creative applications of XR in our field,” Dr. Chou said. “I would like my peers to embrace new technologies like XR, as it is definitely exciting and has broad applications which are yet to be completely explored.”
New Frontier of Medicine
Mark Zhang, DO, MMSc, refers to XR in healthcare as the new frontier in medicine. He is the founder and president of the American Medical Extended Reality Association (AMXRA), an association formed in 2022 in recognition of the widening and potential use of XR in medicine. In a 2023 webinar sponsored by the AMA on the applications of XR in healthcare, he spoke on the creation of a new specialty—medical extended reality (MXR)—and the foundation and mission of AMXRA, its growing interdisciplinary members, and initiatives that include professional development, education, and research in XR (Extended reality could be the next frontier in health care. August 17, 2023. Available at ama-assn.org).
As part of its educational mission, AMXRA is working with regulatory groups such as the U.S. Food and Drug Administration to create standards and guidelines for MXR. Toward this end, the association recently published a study laying out a standard framework to categorize the diverse research and applications of XR in healthcare (J Med Ext Real. 2024;1:4-12). Published in the first issue of the Journal of Medical Extended Reality (JMXR), the official journal of AMXRA, the framework lays out five core domains covering 13 primary topics and 180 secondary topics (see Table 1).
Brennan Spiegel, MD, MSHS, lead author of the study, editor-in-chief of JMXR, and professor of medicine and director of Health Services Research at Cedars-Sinai in Los Angeles, cited the need for such a taxonomy given the lack of a universal language with which to classify and communicate the diverse research and breakthroughs using MXR that have been published in more than 20,000 studies to date. “Our study addresses this crucial gap by introducing a detailed framework that categorizes the vast array of research and applications within MXR,” he said in a press release accompanying the launch of the new journal (Defining the future language of medicine. Cedars Sinai. Published February 13, 2024. Available at cedars-sinai.org/newsroom).
Dr. Spiegel called the taxonomy a “living document,” emphasizing that it will continue to change with new developments and insights.
Artificial Intelligence and XR
Artificial intelligence (AI) can play a role in XR, but the two are not truly integrated in the sense of one being dependent on the other, said Dr. Gantwerker. “There are applications of AI that come into the XR world, such as, during surgery, using XR software where AI is using computer vision to detect and overlay imaging data onto the patient in real time,” he said.
Currently in otolaryngology, he said, the use of AI in XR is still in its infancy, primarily existing behind the scenes of some of the technologies, and isn’t accessible or relevant yet for most otolaryngologists.
But, as reflected in the taxonomy above, how AI is integrated with XR is an area under investigation and one that, according to a 2021 systematic review, may provide additional benefits for the effectiveness of both technologies (Front Virtual Real. Published September 7, 2021. doi: 10.3389/frvir.2021.721933). The review found medical training to be one of the main applications for the combination of AI–XR, and a key benefit of this combination would be in developing metrics to assess user skill and performance. For example, AI could be fed data generated from an XR tool or user to help develop metrics to determine the most relevant skill assessment features. Another potential benefit of the combined technology is using automated AI-based imaging to provide visualization of target parts of structures to increase the efficiency of XR.
Overall, the review described two main objectives for the combination of AI–XR and underscored the future prospects of their interrelationship in a number of industries, including medicine. (See “Two Main Objectives Combining AI-XR.”)
Going forward, the integration of AI with XR is yet another area in which AI is likely to be applied in medicine. As with all potential applications of AI, its benefits will need to be continually weighed against its limitations and risks. Efforts to create standards and guidelines for the adoption of XR in medicine will help with the integration of AI where appropriate.
Mary Beth Nierengarten is a freelance medical writer based in Minnesota.