Use of Smart Glasses (Assisted Reality) for Western Australian X-ray Operators’ Continuing Professional Development: A Pilot Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participant Selection
2.1.1. Inclusion Criteria
XROs
- -
- Approved by the Radiological Council of WA as XROs;
- -
- Employed by WACHS.
Supervising Radiographers
- -
- Registered with Australian Health Practitioner Regulation Agency as diagnostic radiographers;
- -
- Appointed by the Radiological Council of WA as supervising approved radiographers;
- -
- Employed by WACHS.
Patients
- -
- Pediatric and adult patients with X-ray examinations performed by the XROs between 1 April 2023 and 30 September 2023 (pre-intervention period for the retrospective X-ray image quality review), and between 1 October 2023 and 30 March 2024 (intervention period).
2.1.2. Exclusion Criteria
XROs, Supervising Radiographers and Patients
- -
- Refusal to consent to participation/unable to obtain consent.
2.2. Assisted Reality Support Program
2.3. Evaluation of Assisted Reality Support Program
2.4. Data Analysis
3. Results
4. Discussion
- Ergonomics and Human Factors
- Prescription glasses incompatible with smart glasses;
- Smart glasses camera range and gaze direction misaligned;
- Voice control issue;
- Smart glasses as distraction.
- Technical Limitations
- Network stability and bandwidth issues;
- Low battery capacity;
- Small video display size;
- Background noise not removed;
- Ambient lighting affecting video quality of display and camera;
- Program (including video streaming) interface not user friendly.
- Organizational Factors
- Extra workload;
- Expensive equipment;
- Extensive equipment training required.
- Security and Privacy Issues
- Data breach;
- Patient privacy violation.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Cohort Frequency (%) | ||||||
---|---|---|---|---|---|---|
X-ray Operators | ||||||
Primary Profession Position | Enrolled nurse 0 (0.0%) | Registered nurse 7 (63.6%) | Registered paramedic 2 (18.2%) | Registered GP 0 (0.0%) | Management 2 (18.2%) | Other 0 (0.0%) |
Primary Profession Experience | 0–5 years 1 (9.1%) | >5–15 years 3 (27.3%) | >15–25 years 5 (45.5%) | >25 years 2 (18.2%) | ||
Qualification for Primary Profession | Master’s degree 1 (9.1%) | Bachelor’s degree 8 (72.7%) | Sub-degree 2 (18.2%) | Other 0 (0.0%) | ||
Primary Profession Qualification Issuing Country | Australia 9 (81.8%) | New Zealand 1 (9.1%) | Overseas 1 (9.1%) | |||
Training Provider for X-ray Operator Qualification | Curtin University 10 (90.9%) | WACHS 1 (9.1%) | Radiological Council of WA 0 (0.0%) | Other 0 (0.0%) | ||
X-ray Operator Training Completion Year | 1973–2007 0 (0.0%) | 2008–2012 0 (0.0%) | >2012 11 (100.0%) | |||
Radiography Practice Experience | 0–1 years 5 (45.5%) | >1–2 years 3 (27.3%) | >2–5 years 1 (9.1%) | >5–15 years 2 (18.2%) | >15–25 years 0 (0.0%) | >25 years 0 (0.0%) |
Average Number of X-ray Examinations Performed per Month within the Past Year | <1 3 (27.3%) | 1–5 2 (18.2%) | 6–10 2 (18.2%) | 11–15 2 (18.2%) | 16–20 0 (0.0%) | >20 2 (18.2%) |
Radiographers | ||||||
Professional Experience | 0–1 years 0 (0.0%) | >1–2 years 0 (0.0%) | >2–5 years 0 (0.0%) | >5–15 years 1 (50.0%) | >15–25 years 1 (50.0%) | >25 years 0 (0.0%) |
Professional Qualification | Master’s degree 0 (0.0%) | Bachelor’s degree 2 (100.0%) | Sub-degree 0 (0.0%) | Other 0 (0.0%) | ||
Course Provider for Professional Qualification | Curtin University 2 (100.0%) | Other Australian Provider 0 (0.0%) | Overseas Provider 0 (0.0%) | |||
Professional Position | MIT 0 (0.0%) | Senior MIT 2 (100.0%) | Deputy Chief MIT 0 (0.0%) | Chief MIT 0 (0.0%) | Other 0 (0.0%) |
Competence Statement | X-ray Operator | Supervising Radiographer | Overall | ||||||
---|---|---|---|---|---|---|---|---|---|
Before (n = 11) | After (n = 3) | p-Value | Before (n = 2) | After (n = 2) | p-Value | Before (n = 13) | After (n = 5) | p-Value | |
Carrying out doctor’s prescriptions | 8.27 ± 1.68 | 9.00 ± 1.73 | 0.157 | 8.00 ± 1.41 | 7.50 ± 0.71 | 0.795 | 8.23 ± 1.59 | 8.40 ± 1.52 | 0.486 |
Applying ethical guidelines | 9.00 ± 1.10 | 9.00 ± 1.73 | 0.423 | 9.00 1 | 8.50 ± 2.12 | - 1 | 9.00 ± 1.04 | 8.80 ± 1.64 | 1.000 |
Adequately informing patient | 8.91 ± 1.14 | 9.00 ± 1.73 | 0.840 | 8.50 ± 0.71 | 7.00 ± 0.00 | 0.205 | 8.85 ± 1.07 | 8.20 ± 1.64 | 0.351 |
Guiding and educating patient | 8.55 ± 1.21 | 8.33 ± 1.53 | 1.000 | 7.00 1 | 7.00 ± 0.00 | - 1 | 8.42 ± 1.24 | 7.80 ± 1.30 | 0.294 |
Empowering patient through having patient involved in examination | 8.64 ± 1.21 | 8.33 ± 1.53 | 0.742 | 8.00 1 | 7.00 ± 0.00 | - 1 | 8.58 ± 1.16 | 7.80 ± 1.30 | 0.230 |
Guiding patient’s relatives | 8.55 ± 1.21 | 8.33 ± 1.53 | 1.000 | - 1 | 7.00 1 | - 1 | 8.55 ± 1.21 | 8.00 ± 1.41 | 0.444 |
Encouraging and supporting patient | 8.64 ± 1.21 | 8.33 ± 1.53 | 0.742 | 8.00 ± 0.00 | 7.00 ± 0.00 | - 1 | 8.54 ± 1.13 | 7.80 ± 1.30 | 0.230 |
Protecting patient’s integrity | 9.00 ± 1.10 | 9.00 ± 1.73 | 0.840 | 8.00 ± 0.00 | 7.00 1 | - 1 | 8.85 ± 1.07 | 8.50 ± 1.73 | 0.731 |
Alleviating patient’s anxiety | 8.82 ± 1.08 | 8.67 ± 1.53 | 1.000 | 8.00 ± 0.00 | 7.00 1 | - 1 | 8.69 ± 1.03 | 8.25 ± 1.50 | 0.608 |
Assessing risk associated with leaving patient unattended | 8.64 ± 1.29 | 8.67 ± 1.53 | 0.635 | 9.00 1 | 7.00 1 | - 1 | 8.67 ± 1.23 | 8.25 ± 1.50 | 0.854 |
Observing and monitoring patient | 9.09 ± 1.04 | 8.67 ± 1.53 | 1.000 | 9.00 ± 0.00 | 7.00 1 | - 1 | 9.08 ± 0.95 | 8.25 ± 1.50 | 0.608 |
Recognizing patient in shock state | 8.91 ± 0.94 | 9.00 ± 1.73 | 0.742 | 9.00 ± 0.00 | 7.00 1 | - 1 | 8.92 ± 0.86 | 8.50 ± 1.73 | 0.391 |
Recognizing pain and pain reactions | 9.00 ± 0.77 | 9.00 ± 1.73 | 0.742 | 9.00 ± 0.00 | 7.50 ± 0.71 | 0.205 | 9.00 ± 0.71 | 8.40 ± 1.52 | 0.374 |
Collaborating with internal and external colleagues | 8.91 ± 0.70 | 8.33 ± 1.53 | 0.667 | 9.00 1 | 7.00 ± 1.41 | - 1 | 8.92 ± 0.67 | 7.80 ± 1.48 | 0.242 |
Collaborating with other internal and external healthcare professionals | 8.91 ± 0.70 | 8.00 ± 1.00 | 0.184 | 9.00 1 | 7.50 ± 2.12 | - 1 | 8.92 ± 0.67 | 7.80 ± 1.30 | 0.242 |
Reporting to internal and external colleagues and other healthcare professionals | 8.73 ± 0.90 | 8.00 ± 1.00 | 0.225 | 9.00 1 | 7.00 ± 1.41 | - 1 | 8.75 ± 0.87 | 7.60 ± 1.14 | 0.108 |
Participating in quality improvement for patient safety and care | 8.36 ± 1.21 | 5.33 ± 1.53 | 0.184 | 7.00 1 | 7.50 ± 0.71 | - 1 | 8.25 ± 1.22 | 6.20 ± 1.64 | 0.099 |
Competence Statement | X-ray Operator | Supervising Radiographer | Overall | ||||||
---|---|---|---|---|---|---|---|---|---|
Before (n = 11) | After (n = 3) | p-Value | Before (n = 2) | After (n = 2) | p-Value | Before (n = 13) | After (n = 5) | p-Value | |
Organizing and planning examination with consideration of clinical situation | 8.00 ± 1.41 | 7.00 ± 1.00 | 0.500 | 7.50 ± 0.71 | 7.50 ± 0.71 | 1.000 | 7.92 ± 1.32 | 7.20 ± 0.84 | 0.338 |
Preparing radiographic equipment | 8.00 ± 1.48 | 7.67 ± 1.15 | 1.000 | 8.00 ± 0.00 | 7.00 ± 0.00 | - 1 | 8.00 ± 1.35 | 7.40 ± 0.89 | 0.294 |
Independently planning and preparing work based on existing documentation | 8.09 ± 1.51 | 7.67 ± 1.15 | 1.000 | 8.00 1 | 7.50 ± 0.71 | - 1 | 8.08 ± 1.44 | 7.60 ± 0.89 | 0.621 |
Prioritizing patients in workflow | 8.27 ± 1.35 | 7.67 ± 1.15 | 0.500 | 8.00 ± 0.00 | 7.50 ± 0.71 | 0.500 | 8.23 ± 1.24 | 7.60 ± 0.89 | 0.242 |
Adapting examination based on patient’s needs | 8.18 ± 1.40 | 6.33 ± 0.58 | 0.344 | 8.00 ± 1.41 | 8.00 1 | - 1 | 8.15 ± 1.34 | 6.75 ± 0.96 | 0.116 |
Performing positioning procedures for more challenging radiographic projections | 6.09 ± 2.12 | 5.33 ± 1.53 | 0.500 | 7.00 1 | 7.00 ± 0.00 | - 1 | 6.17 ± 2.04 | 6.00 ± 1.41 | 0.501 |
Reducing radiation doses for patients and staff | 7.18 ± 2.09 | 6.67 ± 1.53 | 0.500 | 7.50 ± 0.71 | 7.00 ± 0.00 | 0.500 | 7.23 ± 1.92 | 6.80 ± 1.10 | 0.405 |
Producing accurate and correct images | 7.00 ± 1.73 | 7.00 ± 1.00 | 0.500 | 7.50 ± 0.71 | 6.50 ± 0.71 | 0.500 | 7.08 ± 1.61 | 6.80 ± 0.84 | 0.621 |
Evaluating image quality against referral and clinical question | 7.00 ± 1.61 | 6.67 ± 0.58 | 1.000 | 7.50 ± 0.71 | 6.50 ± 0.71 | 0.500 | 7.08 ± 1.50 | 6.60 ± 0.55 | 0.468 |
Optimizing image quality | 6.55 ± 1.81 | 6.67 ± 1.53 | - 1 | 7.00 ± 1.41 | 6.50 ± 0.71 | 0.795 | 6.62 ± 1.71 | 6.60 ± 1.14 | 0.648 |
Question | X-ray Operator (XRO) | Supervising Radiographer | ||
---|---|---|---|---|
Before (n = 11) | After (n = 3) | Before (n = 2) | After (n = 2) | |
Reason of using assisted reality support by XROs | Not applicable | Receiving support for managing complex radiographic examinations: 3 (100.0%) | Not applicable | Providing support for patient positioning, image (receptor) management and interpreting examination request: 2 (100.0%) |
Aspect of support received/provided for performing radiographic examination | Not applicable | All aspects: 1 (50.0%) Patient positioning: 1 (50.0%) 1 | Not applicable | Providing support for patient positioning, image (receptor) management and interpreting examination request: 2 (100.0%) |
Easy to use assisted reality equipment | Yes: 7 (63.6%) Unsure: 3 (27.3%) No: 1 (9.1%) | No due to time-consuming login process (including voice control issue): 3 (100.0%) | Yes: 2 (100.0%) | No due to ill-fitting headband, issues of voice control, login and non-intuitive design: 2 (100.0%) |
Assisted reality equipment always reliable and available | Yes: 2 (20.0%) Unsure: 7 (70.0%) No: 1 (10.0%) 1 | No due to login issue: 2 (66.7%) Unsure: 1 (33.3%) | No when compared to smartphone: 2 (100.0%) | No due to unfit headband, accent affecting voice control and non-intuitive design causing technical issues: 2 (100.0%) |
Able to set up assisted reality equipment quickly | Yes: 4 (40.0%) Unsure: 4 (40.0%) No: 2 (20.0%) 1 | No due to login issue (including voice control issue): 3 (100.0%) | Yes: 2 (100.0%) | No due to unfit headband, accent affecting voice control and non-intuitive design causing technical issues: 2 (100.0%) |
Assisted reality equipment not interfering radiographic examination process | Yes: 4 (40.0%) Unsure: 3 (30.0%) No: 3 (30.0%) 1 | No due to long set up time: 3 (100.0%) | Not applicable | Not applicable |
Assisted reality equipment providing adequate ideas about clinical situation faced by XROs | Not applicable | Not applicable | Yes: 2 (100.0%) | Yes: 2 (100.0%) |
Assisted reality equipment providing adequate ideas about condition of patients managed by XROs | Not applicable | Not applicable | Yes: 2 (100.0%) | Yes: 2 (100.0%) |
Assisted reality equipment providing adequate ideas about XROs’ hand movements | Not applicable | Not applicable | Yes: 1 (50.0%) Unsure: 1 (50.0%) | Yes: 2 (100.0%) |
Assisted reality equipment providing adequate ideas about radiographic procedures carried out by XROs | Not applicable | Not applicable | Yes: 1 (50.0%) Unsure: 1 (50.0%) | Yes: 2 (100.0%) |
Smart glasses video quality sufficient for assisted reality support | Yes: 7 (70.0%) Unsure: 3 (30.0%) 1 | Yes: 3 (100.0%) | Yes: 2 (100.0%) | Yes when lighting adequate and camera not too close to objects with minimal movement: 2 (100.0%) |
Smart glasses audio quality sufficient for assisted reality support | Yes: 5 (50.0%) Unsure: 5 (50.0%) 1 | Yes: 3 (100.0%) | Yes: 2 (100.0%) | Yes: 1 (50.0%) No as only able to hear XROs but not patients: 1 (50.0%) |
Data transmission speed for assisted reality support sufficient for avoiding any lag | Yes: 3 (30.0%) Unsure: 5 (50.0%) No: 2 (20.0%) 1 | Yes: 3 (100.0%) | Yes: 1 (50.0%) Unsure: 1 (50.0%) | Yes: 2 (100.0%) |
Preferring assisted reality support to telephone support | Yes: 2 (20.0%) Unsure: 7 (70.0%) No: 1 (10.0%) 1 | Yes: 2 (66.7%) No as smartphone requiring less set up time: 1 (33.3%) | Yes: 1 (50.0%) No when compared to smartphone allowing quicker set up: 1 (50.0%) | No as smartphone allowing quicker set up and being more user-friendly and convenient: 2 (100.0%) |
Any other comments about assisted reality support | Great for emergency telehealth service: 1 (10.0%) No: 9 (90.0%) 1 | No: 3 (100.0%) | Challenging to set up initially: 1 (50.0%) No: 1 (50.0%) | No: 2 (100.0%) |
Cohort Pre-Intervention Frequency (%)/Intervention Frequency (%) | |||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Examination | Chest 227 (23.1%)/212 (19.8%) | Upper Extremity 468 (47.7%)/498 (46.5%) | Lower Extremity 287 (29.2%)/359 (33.5%) | Other 0 (0.0%)/2 (0.2%) | |||||||||||||||||||
Clavicle 6 (0.6%)/9 (0.8%) | Elbow 32 (3.3%)/44 (4.1%) | Finger 44 (4.5%)/49 (4.6%) | Forearm 57 (5.8%)/31 (2.9%) | Hand 207 (21.1%)/216 (20.2%) | Humerus 6 (0.6%)/5 (0.5%) | Shoulder 32 (3.3%)/30 (2.8%) | Thumb 3 (0.3%)/13 (1.2%) | Wrist 81 (8.2%)/101 (9.4%) | Ankle 52 (5.3%)/107 (10.0%) | Calcaneum 2 (0.2%)/9 (0.8%) | Foot 132 (13.4%)/135 (12.6%) | Knee 56 (5.7%)/73 (6.8%) | Lower Leg 30 (3.1%)/11 (1.0%) | Toes 15 (1.5%)/24 (2.2%) | |||||||||
Projection | AP 243 (24.7%)/263 (24.6%) | Lateral 254 (25.9%)/308 (28.8%) | Oblique 159 (16.2%)/178 (16.6%) | PA 322 (32.8%)/322 (30.1%) | Other 4 (0.4%)/0 (0.0%) | ||||||||||||||||||
Patient Age | 0–11 months 1 (0.1%)/3 (0.3%) | >11 months 981 (99.9%)/1068 (99.7%) | |||||||||||||||||||||
1–17 years 165 (16.8%)/120 (11.2%) | ≥18 years 816 (83.1%)/948 (88.5%) | ||||||||||||||||||||||
CR Cassette Size | Not applicable 981 (99.9%)/1071 (100.0%) | 18X24 cm 1 (0.1%)/0 (0.0%) | 24X30 cm 0 (0.0%)/0 (0.0%) | 35X43 cm 0 (0.0%)/0 (0.0%) | Other 0 (0.0%)/0 (0.0%) | ||||||||||||||||||
kV 1 | <50 215 (26.7%)/162 (16.6%) | 50–59 273 (34.0%)/450 (46.1%) | 60–69 62 (7.7%)/118 (12.1%) | 70–79 47 (5.8%)/42 (4.3%) | 80–89 46 (5.7%)/34 (3.5%) | 90–99 159 (19.8%)/138 (14.1%) | ≥100 2 (0.2%)/32 (3.3%) | ||||||||||||||||
mAs 1 | 0.5 1 (0.1%)/2 (0.2%) | 1 437 (54.4%)/371 (38.0%) | 2 336 (41.8%)/426 (43.6%) | 3 0 (0.0%)/140 (14.3%) | 4 30 (3.7%)/7 (0.7%) | 5 0 (0.0%)/19 (1.9%) | 6 0 (0.0%)/11 (1.1%) |
Criterion | Image Quality Score | p-Value | |
---|---|---|---|
Before (n = 982) | During (n = 1071) | ||
Inclusion of Required Anatomy | 6.68 ± 1.90 | 7.39 ± 1.86 | <0.001 |
Beam Collimation | 5.88 ± 1.73 | 6.75 ± 1.43 | <0.001 |
Side Marker | 6.56 ± 1.95 | 7.07 ± 1.46 | <0.001 |
Image Quality Regarding Exposure | 5.65 ± 1.30 | 6.16 ± 1.22 | <0.001 |
Image Quality Regarding Artifact | 7.12 ± 1.58 | 7.28 ± 1.18 | <0.05 |
Patient Positioning | 6.08 ± 2.05 | 6.71 ± 1.84 | <0.001 |
Overall Diagnostic Value for Pathology Identification | 5.59 ± 1.97 | 6.32 ± 1.83 | <0.001 |
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Ng, C.K.C.; Baldock, M.; Newman, S. Use of Smart Glasses (Assisted Reality) for Western Australian X-ray Operators’ Continuing Professional Development: A Pilot Study. Healthcare 2024, 12, 1253. https://doi.org/10.3390/healthcare12131253
Ng CKC, Baldock M, Newman S. Use of Smart Glasses (Assisted Reality) for Western Australian X-ray Operators’ Continuing Professional Development: A Pilot Study. Healthcare. 2024; 12(13):1253. https://doi.org/10.3390/healthcare12131253
Chicago/Turabian StyleNg, Curtise K. C., Moira Baldock, and Steven Newman. 2024. "Use of Smart Glasses (Assisted Reality) for Western Australian X-ray Operators’ Continuing Professional Development: A Pilot Study" Healthcare 12, no. 13: 1253. https://doi.org/10.3390/healthcare12131253