A Mixed Reality-Based Telesupervised Ultrasound Education Platform on 5G Network Compared to Direct Supervision: Prospective Randomized Pilot Trial

Abstract

Background: Ultrasound education is transitioning from in-person training to remote methods using mixed reality (MR) and 5G networks. Previous studies are mainly experimental, lacking randomized controlled trials in direct training scenarios.

Objective: This study aimed to compare an MR-based telesupervised ultrasound education platform on private 5G networks with traditional in-person training for novice doctors.

Methods: Conducted at a tertiary academic hospital from November to December 2023, the prospective unblinded randomized controlled pilot study assigned doctors without prior abdominal ultrasound education experience to either the telesupervision group (TG; n=20) or direct supervision group (DG; n=20). Participants received a 15-minute video lecture, conducted ultrasound on a phantom, and had 18 images scored by 2 blinded experts. Additionally, the TG received 5 minutes of training on the basic operation of a head-mounted display. Communication between doctors in the TG and supervisors was facilitated through a head-mounted display, whereas those in the DG interacted directly with supervisors. Primary outcomes were image quality scores, while secondary outcomes included procedure time, number of supervisor interventions, user experience using National Aeronautics and Space Administration-Task Load Index (NASA-TLX), System Usability Scale (SUS), and self-confidence through pre- and postsurveys.

Results: Image quality scores and procedure times showed no significant differences between the groups (TG: 66.8 [SD 10.3] vs DG: 66.8 [SD 10.4], P=.84; TG: 23.8 [SD 8.0] min vs DG: 24.0 [SD 8.1] min, P=.95, respectively). However, the TG engaged in more educational interventions (TG: 4.0 [SD 2.5] vs DG: 0.8 [SD 1.1], P<.001), reflecting a more interactive training environment. TG participants reported lower NASA-TLX scores for mental demand (43.8 [SD 24.8] vs 60.6 [SD 22.4], P=.03), effort (43.1 [SD 22.9] vs 67.9 [SD 17], P<.001), and frustration (26.9 [SD 20.3] vs 45.2 [SD 27.8], P=.02), indicating a reduced cognitive load compared to the DG. The mean SUS score was also higher in the TG (66.6 [SD 9.1] vs 60.2 [SD 10.4], P=.046), suggesting better usability. Both groups showed significant improvements in confidence, with the TG showing notably greater improvement in abdominal ultrasound proficiency (pre-education TG: 1.6 [SD 0.9] vs DG: 1.7 [SD 0.9], P=.73; post-education TG: 3.8 [SD 0.9] vs DG: 2.8 [SD 1.0], P=.006).

Conclusions: Although no significant differences in image quality scores were observed between groups, considerable differences in positive educational interactions, workload, and usability were evident. These findings emphasize the platform's potential to enhance the ultrasound training experience, suggesting more interactive and efficient learning.

Trial registration: ClinicalTrials.gov NCT06171828.

Keywords: South Korea; distance learning; doctor; educational intervention; fifth-generation network; head-mounted display; hospital; image quality; medical education; mixed reality; pilot study; primary outcomes; randomized pilot trial; self-confidence; telehealth; telemedicine; telesupervision; training experience; ultrasonography; ultrasound education; user experience.

Figure 1.. System architecture of MR telesupervised ultrasound education platform. The learner’s part consists of (A) an HMD, (B) an ultrasound device, and a laptop to capture ultrasound images through the capture board, and (C) a 360° camera. The software used by the supervisor displays the video streamed from (A), (B), and (C). Additionally, there is a (D) list of participants, (E) communication with the learner via microphone and camera that can be turned on and off by the supervisor, (F) the ability to send 3D objects, files, and images from the storage, and (G) a recording function. HMD: head-mounted display; MR: mixed reality.

Figure 2.. Flowchart of the study. HMD: head-mounted display; US: ultrasound.

Figure 3.. Pre-post assessment confidence levels by organ for each group. The confidence levels are displayed as mean values with standard deviations on a 5-point Likert scale.