title: Telemedicine supported by Augmented Reality: an interactive guide for untrained people in performing an ECG test.
abstract: BACKGROUND
  In many telemedicine applications, the correct use of medical device at the point of need is essential to provide an appropriate service. Some applications may require untrained people to interact with medical devices and patients: care delivery in transportation, military actions, home care and telemedicine training.Appropriate operation of medical device and correct connection with patient's body are crucial. In these scenarios, tailored applications of Augmented Reality can offer a valid support by guiding untrained people at the point of need. This study aims to explore the feasibility of using Augmented Reality in telemedicine applications, by facilitating an acceptable use of biomedical equipment by any unskilled person. In particular, a prototype system was built in order to estimate how untrained users, with limited or no knowledge, can effectively interact with an ECG device and properly placing ECG electrodes on patient's chest.
  
  
  METHODS
  An Augmented Reality application was built to support untrained users in performing an ECG test. Simple markers attached to the ECG device and onto patient's thorax allow camera calibration. Once objects and their pose in the space are recognized, the video of the current scene is enriched, in real-time, with additional pointers, text boxes and audio that help the untrained operator to perform the appropriate sequence of operations. All the buttons, switches, ports of the ECG device together with the location of precordial leads were coded and indicated. Some user's voice commands were also included to improve usability.
  
  
  RESULTS
  Ten untrained volunteers, supported by the augmented reality, were able to carry out a complete ECG test first on a mannequin and then on a real patient in a reasonable time (about 8 minutes on average). Average positioning errors of precordial electrodes resulted less than 3 mm for the mannequin and less than 7 mm for the real patient. These preliminary findings suggest the effectiveness of the developed application and the validity of clinical ECG recordings.
  
  
  CONCLUSIONS
  This application can be adapted to support the use of other medical equipment as well as other telemedicine tasks and it could be performed with a Tablet or a Smartphone.
authors.affiliation: Department of Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy. pabifulc@unina.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bifulco
authors.forename: Fabio
authors.initials: F
authors.lastname: Narducci
authors.forename: Raffaele
authors.initials: R
authors.lastname: Vertucci
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ambruosi
authors.forename: Mario
authors.initials: M
authors.lastname: Cesarelli
authors.forename: Maria
authors.initials: M
authors.lastname: Romano
mesh_terms: D000328:Adult; D002138:Calibration; D040421:Cell Phone; D003198:Computer Simulation; D004562:Electrocardiography / Q000379:methods*; D004566:Electrodes; D004867:Equipment Design; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D012984:Software; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods*