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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleNeurointervention

Teleproctoring for Neurovascular Procedures: Demonstration of Concept Using Optical See-Through Head-Mounted Display, Interactive Mixed Reality, and Virtual Space Sharing—A Critical Need Highlighted by the COVID-19 Pandemic

A.T. Rai, G. Deib, D. Smith and S. Boo
American Journal of Neuroradiology June 2021, 42 (6) 1109-1115; DOI: https://doi.org/10.3174/ajnr.A7066
A.T. Rai
aFrom the Department of Interventional Neuroradiology (A.T.R., G.D., S.B.), Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia
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G. Deib
aFrom the Department of Interventional Neuroradiology (A.T.R., G.D., S.B.), Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia
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D. Smith
bWest Virginia University Reed College of Media (D.S.), Morgantown, West Virginia
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S. Boo
aFrom the Department of Interventional Neuroradiology (A.T.R., G.D., S.B.), Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia
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  • FIG 1.
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    FIG 1.

    The setup. The left panel is an aerial view of the location of the experiment. The angiography suite (labeled) is in the hospital, which is separate from the proctor's location in the adjacent building (labeled). The right panel shows the operator's environment in the angiography suite (lower panel) with the operator wearing the OST-HMD and the spatial computer. The hotspot connection is demonstrated by the orange link between the OST-HMD and the laptop in the angiography suite and between the laptop and the computer in the proctor's office via the Zoom link. The direct Wi-Fi connection is demonstrated by the blue link between the OST-HMD worn by the operator with direct streaming to the computer in the proctor's office.

  • FIG 2.
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    FIG 2.

    Operator's environment: The upper panel shows the operator in the angiography suite as viewed from the ceiling- (A1) and the wall-mounted (A2) cameras. The flow model can be observed on the angiography table. The operator is wearing the Magic Leap-1 and performing the procedure while listening to any instructions from the proctor. The angiography monitor (A3) shows a roadmap image of the basilar apex aneurysm with the WEB device ready for deployment. Proctor's environment: The lower panel shows the proctor's perspective. The same image as on the angiography monitor (A3) is livestreamed through the Magic Leap-1 and displayed on the proctor's computer (B1). The proctor's desktop also shows the participants on the Zoom bridge; from top to bottom, these include the media engineer, the backup neurointerventionalist in the angiography suite, and the proctor (B2). The proctor can also see the operator's hands (B3) when he looks down and can advise on hand positioning for device deployment. The operator's avatar in the virtual room on the Spatial app is also displayed on the proctor's screen (B4) and follows the head movements of the operator, as in this case, when the operator is looking down at his hands.

  • FIG 3.
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    FIG 3.

    Virtual space sharing and mixed reality. The images in this figure are screenshots from the proctor's computer livestreamed from the operator in the angiography suite. The upper panel shows a view through the operator's headset as displayed on the proctor's computer. It shows the operator logging into the Spatial app (A1). The proctor has displayed an image regarding aneurysm size and morphology in the operator's visual field at about 10 o'clock (A2) using the Spatial app and the same image with the operator's avatar looking at it in the virtual room created on the app. The middle panel shows a WEB-sizing chart (B1), 3D image of the aneurysm flow model (B2), and an angiography image annotated by the proctor defining the WEB device (B3). The lower panel shows a 3D model of another aneurysm showing that the operator can manipulate and anchor in his FOV as a reference to be used when necessary.

  • FIG 4.
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    FIG 4.

    Latency test. Screenshots from the latency test recordings for the Wi-Fi and hotspot networks at 1, 5, 10, 15, and 20 seconds are displayed. Three recordings were made for each network, yielding 15 measurements each. The left panel demonstrates livestreaming directly over the Wi-Fi network. These show a side-by-side display of the stopwatch running on the computer and a livestreamed image of the stopwatch through the OST-HMD (Magic Leap-1) next to it. The right panel shows the same display when using the hotspot. The difference in time between the computer stopwatch and its livestreamed image constitutes the latency in milliseconds. The graphic scheme next to the screenshots shows the different components in the stream that can impact the latency.

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American Journal of Neuroradiology: 42 (6)
American Journal of Neuroradiology
Vol. 42, Issue 6
1 Jun 2021
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Teleproctoring for Neurovascular Procedures: Demonstration of Concept Using Optical See-Through Head-Mounted Display, Interactive Mixed Reality, and Virtual Space Sharing—A Critical Need Highlighted by the COVID-19 Pandemic
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Cite this article
A.T. Rai, G. Deib, D. Smith, S. Boo
Teleproctoring for Neurovascular Procedures: Demonstration of Concept Using Optical See-Through Head-Mounted Display, Interactive Mixed Reality, and Virtual Space Sharing—A Critical Need Highlighted by the COVID-19 Pandemic
American Journal of Neuroradiology Jun 2021, 42 (6) 1109-1115; DOI: 10.3174/ajnr.A7066

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Teleproctoring for Neurovascular Procedures: Demonstration of Concept Using Optical See-Through Head-Mounted Display, Interactive Mixed Reality, and Virtual Space Sharing—A Critical Need Highlighted by the COVID-19 Pandemic
A.T. Rai, G. Deib, D. Smith, S. Boo
American Journal of Neuroradiology Jun 2021, 42 (6) 1109-1115; DOI: 10.3174/ajnr.A7066
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