title: Surgeons blinded by enhanced navigation: the effect of augmented reality on attention.
abstract: BACKGROUND
  Advanced image-guidance systems allowing presentation of three-dimensional navigational data in real time are being developed enthusiastically for many medical procedures. Other industries, including aviation and the military, have noted that shifting attention toward such compelling assistance has detrimental effects. Using the detection rate of unexpected findings, we assess whether inattentional blindness is significant in a surgical context and evaluate the impact of on-screen navigational cuing with augmented reality.
  
  
  METHODS
  Surgeons and trainees performed an endoscopic navigation exercise on a cadaveric specimen. The subjects were randomized to either a standard endoscopic view (control) or an AR view consisting of an endoscopic video fused with anatomic contours. Two unexpected findings were presented in close proximity to the target point: one critical complication and one foreign body (screw). Task completion time, accuracy, and recognition of findings were recorded.
  
  
  RESULTS
  Detection of the complication was 0/15 in the AR group versus 7/17 in the control group (p = 0.008). Detection of the screw was 1/15 (AR) and 7/17 (control) (p = 0.041). Recognition of either finding was 12/17 for the control group and 1/15 for the AR group (p < 0.001). Accuracy was greater for the AR group than for the control group, with the median distance from the target point measuring respectively 2.10 mm (interquartile range [IQR], 1.29-2.37) and 4.13 (IQR, 3.11-7.39) (p < 0.001).
  
  
  CONCLUSIONS
  Inattentional blindness was evident in both groups. Although more accurate, the AR group was less likely to identify significant unexpected findings clearly within view. Advanced navigational displays may increase precision, but strategies to mitigate attentional costs need further investigation to allow safe implementation.
authors: Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, 610 University Avenue, 3-954, Toronto, ON M5G 2M9, Canada. benjohndixon@hotmail.com
authors: Benjamin J
authors: BJ
authors: Dixon
authors: Michael J
authors: MJ
authors: Daly
authors: Harley
authors: H
authors: Chan
authors: Allan D
authors: AD
authors: Vescan
authors: Ian J
authors: IJ
authors: Witterick
authors: Jonathan C
authors: JC
authors: Irish
mesh_terms: D001288:Attention; D002102:Cadaver; D004724:Endoscopy / Q000592:standards*; D006801:Humans; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014584:User-Computer Interface