Smart glasses in radiology education: Augmenting reality to enhance the learning experience

Dear Editors,

This year, the Apple Vision Pro (Apple Inc., Cupertino, CA, USA) entered the smart glasses market, joining Microsoft HoloLens (Microsoft Corp, Redmond, WA, USA), Vuzix (Vuzix Corp, Rochester, NY, USA), and Google Glass (Google Inc, Mountain View, CA, USA). These products all serve to introduce augmented reality (AR) and virtual reality (VR) into everyday life. AR combines real-world and virtual information, while VR immerses users in completely virtual environments.1 Table 1 presents the key features of these smart glasses models. The concept of AR can be traced back to 1968 with Ivan Sutherland’s binocular system, although the term was not coined until 1991, by Thomas Caudell.2 Also referred to as “mixed” or “blended” reality, AR supplements real-time environments with computer-generated imagery, potentially merging the best aspects of both worlds.3

Table 1. Comparison of key features across leading smart glasses models.

The information in this table is based on specifications provided by the manufacturers of each smart glasses model up to the present date (July 17, 2024).

AR applications are prevalent across various aspects of daily life, such as gaming, architecture, and design. In medicine, AR is becoming increasingly integrated, with techniques that combine AR with smart glasses used to assist in neurosurgery and neurology procedures.4 AR applications have also made meaningful strides in dentistry, including documented uses in oral surgery and implantology.2

The potential benefits of AR in medicine and dentistry are especially apparent in the field of radiology. Diagnostics and treatment planning rely heavily on imaging examinations, including radiographs, 3-dimensional exams, magnetic resonance imaging, and ultrasonography; thus, AR has the potential to revolutionize this area. For example, AR facilitates the superimposition of virtual objects onto real-world counterparts, enabling actual organs or structures to be overlaid with their corresponding radiographic images. This capability supports diagnosis by improving the interpretation of visualized structures and makes treatment planning more dynamic.

Clinically, AR has primarily been explored for use in implant placement through image-based dynamic navigation systems. While most studies have utilized in vitro setups with 3-dimensional printed models, these do not fully replicate clinical conditions.5 Despite these limitations, a recent systematic review and meta-analysis demonstrated that AR-navigated implant placement achieves clinically acceptable accuracy, comparable to dental implant-guided surgical approaches.5 However, most of the included studies used videography overlay devices rather than smart glasses. Recently, a few pilot clinical reports and an in vitro study explored the use of smart glasses for dental implant placement.6,7,8 These studies, which utilized the HoloLens model, reported promising results regarding the feasibility of this technology in assisting clinicians with accurate, time-efficient implant placement. Using an in vitro setup, Kivovics et al.8 found that the accuracy of implant positioning using AR-based dynamic navigation with HoloLens was comparable to static computer-assisted implant surgery and superior to the freehand technique. Further research is encouraged to validate the clinical utility of this technology for additional dental applications and educational purposes, especially in aiding students to better understand anatomical structures through bidimensional and tridimensional imaging modalities.

The HoloLens smart glasses system has also been applied in medicine, specifically orthopedic surgery. Surgeons who employed the system in 25 surgical cases expressed overall satisfaction with the image quality. However, they reported some technical issues with voice control and ergonomics.9 Notably, this novel technology comes with a learning curve, which could potentially alleviate the reported issues as users become more adept over time.

Using AR through smart glasses represents an innovative strategy. Integrating this technology early in the education of professionals is crucial for ensuring its success. The adoption of this immersive technology accelerated during the coronavirus disease 2019 pandemic, as educators sought to establish new teaching methods.10 Notable examples of AR in education include its use in distinguishing pathologies from normal structures, as well as in training students in patient positioning for radiographic acquisition.10,11 Previous assessments of students’ perceptions of AR, conducted through questionnaires, yielded positive responses.2 Enthusiasm and engagement with a tool that diverges from traditional methodologies likely contribute to these favorable outcomes.

AR technology offers valuable learning opportunities for students, particularly during their formative years.12 To effectively utilize AR through smart glasses, several key aspects must be emphasized. Notably, educators should aim to unlock the full potential of this technology by leveraging all available features. Smart glasses enable hands-free operation through voice commands or eye movements, a functionality that should be fully utilized. Furthermore, the ability to rotate virtual objects to better understand their shape and structure should be actively employed.

However, as smart glasses are a relatively new tool on the market and AR is still in the early stages of integration into education, several considerations must be addressed. The high cost of smart glasses necessitates careful evaluation to ensure that the investment is worthwhile. Before purchasing, educators must develop a well-structured plan for their introduction to students. Additionally, availability remains limited; for instance, at the time of writing, the Apple Vision Pro is only available in the United States. Compatibility with prescription glasses is not universal, requiring specific measures to overcome this limitation. Furthermore, issues such as nausea and disorientation, commonly referred to as “cybersickness,” have been associated with prolonged use of smart glasses.13 Security is another critical concern, with risks including unauthorized access and data breaches. Users and developers must strictly adhere to precautionary measures to safeguard sensitive patient data.9

In conclusion, the prospects for enhancing the learning experience with AR are extensive and promising. By embracing these innovations and adhering to necessary precautions, practitioners can reduce apprehension about their implementation. Accordingly, educators must define the goals of integrating AR and smart glasses into education. These aims include conveying knowledge, fostering skill development, increasing satisfaction, boosting motivation, and supporting student self-confidence.