that could potentially limit tabletop movement and C-arm mobility. Another aspect to overcome in encouraging adoption is that the burden of creating institution-specifi c content will inevitably fall to that institution itself. While it may seem like a tall order, institutions have already been able to take the initiative in integrating VR/AR technology within their health systems.3


On the patient side, a substantial barrier to entry is the ergonomic limitations from prolonged use or XR tech, otherwise known as cybersickness. It is a multifactorial problem, without clear causes and solutions. Each subsequent generation of devices attempts to mitigate cybersickness through hardware-related factors that better account for physical diff erences, such as pupil distance and accommodation and convergence distances. Hardware solutions also serve to maintain high frame-rate renderings and reduce latency. Visual-spatial-motor diff erences in acceleration, fi eld of view, environmental and contextual blurring, and dynamic focus points can also contribute to cybersickness. This occurs via sensory mismatch and overload, ultimately creating postural instability as the virtual environment fails to dynamically adjust with how the user is perceiving their surroundings.17


Nonetheless, ongoing


eff orts in research and development will hopefully allow a more comfortable viewing experience, especially in procedural situations where taking periodic breaks may not be reasonable.


Where to expand next AR smartphone applications already exist that teach by prompting users to undergo specifi c steps necessary to perform a procedure from beginning to end. However, the available IR training modules have only included more basic procedures such as paracentesis, thoracentesis and central line placements. As this technology continues to be integrated within trainee education, more advanced IR procedures will hopefully be introduced that teach more fi ne-motor skills. AR and VR technologies within IR have predominantly been visually dominant, with little to no ability to interact with and obtain visual-tactile feedback from


the environment. The current hand- tracking devices only provide point-and- click functionality. Moving forward, it will be important to increase the realism of these simulations with accurate haptic feedback and improved immersion within the environment.


As it stands, diff erent technologies currently exist that serve to refi ne patient anatomy by utilizing existing radiographic imaging modalities. These technologies help physicians navigate to their target locations. Improving the effi ciency in reaching those locations and being able to better visualize the pathways creates safer treatments by reducing the amount of radiation exposure and bolstering treatment confi dence. Moving forward, it will be paramount to refi ne these technologies in ways that will account for common problems such as needle and wire bending and adjusting for patient respirations, soft tissue deformations, and organ movements and mobilization.5


Conclusion IR has been at the forefront of medicine by integrating cutting-edge technology into its scope of practice. The sheer utility that these display technologies can provide is appealing on many levels through training, education, procedure planning, perioperative management and even symptom control. As these digital technologies improve, the promising future of IR looks more virtual and feels more augmented. Although our base reality has been used to create XR, the roles may reverse in the future as XR may redefi ne our reality.


Acknowledgements: Riyaz Abidi, MS3


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