title: Instrument-mounted displays for reducing cognitive load during surgical navigation.
abstract: OBJECTIVE
  Surgical navigation systems rely on a monitor placed in the operating room to relay information. Optimal monitor placement can be challenging in crowded rooms, and it is often not possible to place the monitor directly beside the situs. The operator must split attention between the navigation system and the situs. We present an approach for needle-based interventions to provide navigational feedback directly on the instrument and close to the situs by mounting a small display onto the needle.
  
  
  METHODS
  By mounting a small and lightweight smartwatch display directly onto the instrument, we are able to provide navigational guidance close to the situs and directly in the operator's field of view, thereby reducing the need to switch the focus of view between the situs and the navigation system. We devise a specific variant of the established crosshair metaphor suitable for the very limited screen space. We conduct an empirical user study comparing our approach to using a monitor and a combination of both.
  
  
  RESULTS
  Results from the empirical user study show significant benefits for cognitive load, user preference, and general usability for the instrument-mounted display, while achieving the same level of performance in terms of time and accuracy compared to using a monitor.
  
  
  CONCLUSIONS
  We successfully demonstrate the feasibility of our approach and potential benefits. With ongoing technological advancements, instrument-mounted displays might complement standard monitor setups for surgical navigation in order to lower cognitive demands and for improved usability of such systems.
authors.affiliation: Creative Unit: Intra-operative Information, University of Bremen, Bremen, Germany. herrlich@eit.uni-kl.de.|Serious Games Engineering, University of Kaiserslautern, Kaiserslautern, Germany. herrlich@eit.uni-kl.de.|Digital Media Lab, TZI, University of Bremen, Bibliothekstr. 1, 28359, Bremen, Germany. herrlich@eit.uni-kl.de.
authors.forename: Marc
authors.initials: M
authors.lastname: Herrlich
authors.affiliation: Creative Unit: Intra-operative Information, University of Bremen, Bremen, Germany.|Digital Media Lab, TZI, University of Bremen, Bibliothekstr. 1, 28359, Bremen, Germany.
authors.forename: Parnian
authors.initials: P
authors.lastname: Tavakol
authors.affiliation: Creative Unit: Intra-operative Information, University of Bremen, Bremen, Germany.|Medical Image Computing, University of Bremen, Bremen, Germany.|Fraunhofer MEVIS, Bremen, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Black
authors.affiliation: Digital Media Lab, TZI, University of Bremen, Bibliothekstr. 1, 28359, Bremen, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Wenig
authors.affiliation: Fraunhofer MEVIS, Bremen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Rieder
authors.affiliation: Creative Unit: Intra-operative Information, University of Bremen, Bremen, Germany.|Digital Media Lab, TZI, University of Bremen, Bibliothekstr. 1, 28359, Bremen, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Malaka
authors.affiliation: Creative Unit: Intra-operative Information, University of Bremen, Bremen, Germany.|Medical Image Computing, University of Bremen, Bremen, Germany.|Fraunhofer MEVIS, Bremen, Germany.|Surgical Planning Laboratory, Brigham and Women's Hospital, Boston, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Kikinis
mesh_terms: D000328:Adult; D001288:Attention; D003071:Cognition; D005260:Female; D006801:Humans; D008297:Male; D019047:Phantoms, Imaging; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D055815:Young Adult
keywords: Cognitive load; Image-guided surgery; Intra-operative navigation; Tool-mounted display; Visual attention; Visual feedback