title: Touchless interaction with software in interventional radiology and surgery: a systematic literature review.
abstract: OBJECTIVE
  In this article, we systematically examine the current state of research of systems that focus on touchless human-computer interaction in operating rooms and interventional radiology suites. We further discuss the drawbacks of current solutions and underline promising technologies for future development.
  
  
  METHODS
  A systematic literature search of scientific papers that deal with touchless control of medical software in the immediate environment of the operation room and interventional radiology suite was performed. This includes methods for touchless gesture interaction, voice control and eye tracking.
  
  
  RESULTS
  Fifty-five research papers were identified and analyzed in detail including 33 journal publications. Most of the identified literature (62 %) deals with the control of medical image viewers. The others present interaction techniques for laparoscopic assistance (13 %), telerobotic assistance and operating room control (9 % each) as well as for robotic operating room assistance and intraoperative registration (3.5 % each). Only 8 systems (14.5 %) were tested in a real clinical environment, and 7 (12.7 %) were not evaluated at all.
  
  
  CONCLUSIONS
  In the last 10 years, many advancements have led to robust touchless interaction approaches. However, only a few have been systematically evaluated in real operating room settings. Further research is required to cope with current limitations of touchless software interfaces in clinical environments. The main challenges for future research are the improvement and evaluation of usability and intuitiveness of touchless human-computer interaction and the full integration into productive systems as well as the reduction of necessary interaction steps and further development of hands-free interaction.
authors.affiliation: Faculty of Computer Science, University of Magdeburg, Magdeburg, Germany. andre.mewes@ovgu.de.
authors.forename: André
authors.identifier: http://orcid.org/0000-0001-9559-2667
authors.initials: A
authors.lastname: Mewes
authors.affiliation: Institute for Diagnostic and Interventional Radiology, Medical School Hanover, Hanover, Germany.
authors.forename: Bennet
authors.initials: B
authors.lastname: Hensen
authors.affiliation: Institute for Diagnostic and Interventional Radiology, Medical School Hanover, Hanover, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Wacker
authors.affiliation: Faculty of Computer Science, University of Magdeburg, Magdeburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hansen
mesh_terms: D005868:Gestures; D006801:Humans; D010535:Laparoscopy; D009873:Operating Rooms; D015642:Radiology, Interventional / Q000379:methods; D065287:Robotic Surgical Procedures; D012371:Robotics; D012984:Software; D013514:Surgical Procedures, Operative / Q000379:methods*; D014584:User-Computer Interface; D014831:Voice
keywords: Eye tracking; Gestures; Human–computer interaction; Operating rooms; Robotics; Speech recognition software; Touchless interaction