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PURPOSE: Genitoplasty is becoming more and more common, and it is important to improve the accuracy of the procedure and simplify the procedure. This experiment explores the feasibility of using augmented reality (AR) technology combined with PSI titanium plates for navigational assistance in genioplasty performed on models, aiming to study the precision of such surgical interventions. METHODS: Twelve genioplasty procedures were designed and implemented on 3D-printed resin mandibular models by the same surgeon using three different approaches: AR+3DT group (AR+PSI) , 3DT group (patient-specific titanium plate) , and a traditional free-hand group(FH group). Postoperative models were assessed using CBCT to evaluate surgical accuracy. RESULTS: In terms of osteotomy accuracy, the AR group demonstrated a surgical error of 0.9440±0.5441 mm, significantly lower than the control group, which had an error of 1.685±0.8907 mm (P < 0.0001). In experiments positioning the distal segment of the chin, the overall centroid shift in the AR group was 0.3661±0.1360 mm, significantly less than the 2.304±0.9629 mm in the 3DT group and 1.562±0.9799 mm in the FH group (P < 0.0001). Regarding angular error, the AR+3DT group showed 2.825±1.373°, significantly <8.283±3.640° in the 3DT group and 7.234±5.241° in the FH group. CONCLUSION: AR navigation technology combined with PSI titanium plates demonstrates higher surgical accuracy compared to traditional methods and shows feasibility for use. Further validation through clinical trials is necessary.

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State-of-the-art augmented reality (AR) glasses record their 3D pose in space, enabling measurements and analyses of clinical gait and balance tests. This study's objective was to evaluate concurrent validity and test-retest reliability for common clinical gait and balance tests in people with Parkinson's disease: Five Times Sit To Stand (FTSTS) and Timed Up and Go (TUG) tests. Position and orientation data were collected in 22 participants with Parkinson's disease using HoloLens 2 and Magic Leap 2 AR glasses, from which test completion durations and durations of distinct sub-parts (e.g., sit to stand, turning) were derived and compared to reference systems and over test repetitions. Regarding concurrent validity, for both tests, an excellent between-systems agreement was found for position and orientation time series (ICC(C,1) > 0.933) and test completion durations (ICC(A,1) > 0.984). Between-systems agreement for FTSTS (sub-)durations were all excellent (ICC(A,1) > 0.921). TUG turning sub-durations were excellent (turn 1, ICC(A,1) = 0.913) and moderate (turn 2, ICC(A,1) = 0.589). Regarding test-retest reliability, the within-system test-retest variation in test completion times and sub-durations was always much greater than the between-systems variation, implying that (sub-)durations may be derived interchangeably from AR and reference system data. In conclusion, AR data are of sufficient quality to evaluate gait and balance aspects in people with Parkinson's disease, with valid quantification of test completion durations and sub-durations of distinct FTSTS and TUG sub-parts.

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Gait speed is increasingly recognized as an important health indicator. However, gait analysis in clinical settings often encounters inconsistencies due to methodological variability and resource constraints. To address these challenges, GaitKeeper uses artificial intelligence (AI) and augmented reality (AR) to standardize gait speed assessments. In laboratory conditions, GaitKeeper demonstrates close alignment with the Vicon system and, in clinical environments, it strongly correlates with the Gaitrite system. The integration of a cloud-based processing platform and robust data security positions GaitKeeper as an accurate, cost-effective, and user-friendly tool for gait assessment in diverse clinical settings.

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Significance: Conventional ultrasound-guided vascular access procedures are challenging due to the need for anatomical understanding, precise needle manipulation, and hand-eye coordination. Recently, augmented reality (AR)-based guidance has emerged as an aid to improve procedural efficiency and potential outcomes. However, its application in pediatric vascular access has not been comprehensively evaluated. Aim: We developed an AR ultrasound application, HoloUS, using the Microsoft HoloLens 2 to display live ultrasound images directly in the proceduralist's field of view. We presented our evaluation of the effect of using the Microsoft HoloLens 2 for point-of-care ultrasound (POCUS)-guided vascular access in 30 pediatric patients. Approach: A custom software module was developed on a tablet capable of capturing the moving ultrasound image from any ultrasound machine's screen. The captured image was compressed and sent to the HoloLens 2 via a hotspot without needing Internet access. On the HoloLens 2, we developed a custom software module to receive, decompress, and display the live ultrasound image. Hand gesture and voice command features were implemented for the user to reposition, resize, and change the gain and the contrast of the image. We evaluated 30 (15 successful control and 12 successful interventional) cases completed in a single-center, prospective, randomized study. Results: The mean overall rendering latency and the rendering frame rate of the HoloUS application were 139.30 ms ( σ = 32.02 ms ) and 30 frames per second, respectively. The average procedure completion time was 17.3% shorter using AR guidance. The numbers of puncture attempts and needle redirections were similar between the two groups, and the number of head adjustments was minimal in the interventional group. Conclusion: We presented our evaluation of the results from the first study using the Microsoft HoloLens 2 that investigates AR-based POCUS-guided vascular access in pediatric patients. Our evaluation confirmed clinical feasibility and potential improvement in procedural efficiency.

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Augmented reality (AR) exists on a spectrum, a mixed reality hybrid of virtual projections onto real surroundings. Superimposing conventional medical imaging onto the living patient offers vast potential for radiology, potentially revolutionising practice. The digital technology and user-interfaces that allow us to appreciate this enhanced environment however are complex, expensive, and development mainly limited to major commercial technology (Tech) firms. Hence, it is the activity of these consumer-based businesses that will inevitably dictate the available technology and therefore clinical application of AR. The release of mixed reality head-mounted displays in 2024, must therefore prompt a review of the current status of AR research in radiology, the need for further study and a discussion of the complicated relationship between consumer technology, clinical utility, and the risks of monopolisation.

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Anxiety disorders are among the most common mental disorders worldwide. These conditions are characterized by excessive anxiety that is difficult to control. In most anxiety disorders, symptoms are triggered by exposure to specific objects or situations. This leads sufferers to avoid such exposures, leading to impaired social and occupational functioning and reduced quality of life. Therapies based on behavioral principles, either alone or in combination with cognitive techniques, are the most effective psychological interventions for anxiety disorders. However, the effectiveness of these therapies may be limited due to a lack of generalization from clinic to real-world settings. Augmented reality (AR) is a technology that provides an interactive experience by superimposing computer-generated content, often in multiple sensory modalities, on the real world. Emerging evidence suggests that AR may be useful in treating a broad range of mental disorders, including anxiety disorders. This review examines the evidence for the use of AR-based techniques as an aid to behavioral or cognitive-behavioral therapies for anxiety disorders. The available evidence suggests that this method may offer significant advantages over conventional therapies, particularly in the case of specific phobias, but also in social anxiety disorder. AR can also be combined with other novel technologies to monitor psychophysiological markers of anxiety and its reduction over the course of treatment. The advantages of AR could be related to its combination of real and simulated content, allowing for better generalization of the benefits of conventional exposure-based therapy. Though the safety, efficacy, and cost-effectiveness of this method need to be confirmed in larger samples, it could lead to a paradigm shift in the way behavioral therapies for anxiety disorders are conceptualized and delivered.

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BACKGROUND: To capture the distortion of exploratory activity typical of patients with spatial neglect, traditional diagnostic methods and new virtual reality applications use confined workspaces that limit patients' exploration behavior to a predefined area. Our aim was to overcome these limitations and enable the recording of patients' biased activity in real, unconfined space. METHODS: We developed the Free Exploration Test (FET) based on augmented reality technology. Using a live stream via the back camera on a tablet, patients search for a (non-existent) virtual target in their environment, while their exploration movements are recorded for 30 s. We tested 20 neglect patients and 20 healthy participants and compared the performance of the FET with traditional neglect tests. RESULTS: In contrast to controls, neglect patients exhibited a significant rightward bias in exploratory movements. The FET had a high discriminative power (area under the curve = 0.89) and correlated positively with traditional tests of spatial neglect (Letter Cancellation, Bells Test, Copying Task, Line Bisection). An optimal cut-off point of the averaged bias of exploratory activity was at 9.0° on the right; it distinguished neglect patients from controls with 85% sensitivity. DISCUSSION: FET offers time-efficient (execution time: ∼3 min), easy-to-apply, and gamified assessment of free exploratory activity. It supplements traditional neglect tests, providing unrestricted recording of exploration in the real, unconfined space surrounding the patient.

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BACKGROUND: Microsurgical clipping is a delicate neurosurgical procedure used to treat complex Unruptured Intracranial Aneurysms (UIAs) whose outcome is dependent on surgeon's experience. Simulations are emerging as excellent complements to standard training, but their adoption is limited by the realism they provide. The aim of this study was to develop and validate a microsurgical clipping simulator platform. METHODS: Physical and holographic simulators of UIA clipping have been developed. The physical phantom consisted of a 3D printed hard skull and five (n = 5) rapidly interchangeable, perfused and fluorescence compatible 3D printed aneurysm silicone phantoms. The holographic clipping simulation included a real-time finite-element-model of the aneurysm sac, allowing interaction with a virtual clip and its occlusion. Validity, usability, usefulness and applications of the simulators have been assessed through clinical scores for aneurysm occlusion and a questionnaire study involving 14 neurosurgical residents (R) and specialists (S) for both the physical (p) and holographic (h) simulators by scores going from 1 (very poor) to 5 (excellent). RESULTS: The physical simulator allowed to replicate successfully and accurately the patient-specific anatomy. UIA phantoms were manufactured with an average dimensional deviation from design of 0.096 mm and a dome thickness of 0.41 ± 0.11 mm. The holographic simulation executed at 25-50 fps allowing to gain unique insights on the anatomy and testing of the application of several clips without manufacturing costs. Aneurysm closure in the physical model evaluated by fluorescence simulation and post-operative CT revealed Raymond 1 (full) occlusion respectively in 68.89% and 73.33% of the cases. For both the simulators content validity, construct validity, usability and usefulness have been observed, with the highest scores observed in clip selection usefulness Rp=4.78, Sp=5.00 and Rh=4.00, Sh=5.00 for the printed and holographic simulators. CONCLUSIONS: Both the physical and the holographic simulators were validated and resulted usable and useful in selecting valid clips and discarding unsuitable ones. Thus, they represent ideal platforms for realistic patient-specific simulation-based training of neurosurgical residents and hold the potential for further applications in preoperative planning.

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At the Worldwide Developers Conference in June 2023, Apple introduced the Vision Pro. The Apple Vision Pro (AVP) is a mixed reality headset; more specifically, it is a virtual reality device with an additional video see-through capability. The video see-through capability turns the AVP into an augmented reality (AR) device. The AR feature is enabled by streaming the real world via cameras on the (virtual reality) screens in front of the user's eyes. This is, of course, not unique and is similar to other devices, such as the Varjo XR-3 (Varjo Technologies Oy). Nevertheless, the AVP has some interesting features, such as an inside-out screen that can show the headset wearer's eyes to "outsiders," and a button on the top, called the "digital crown," that allows a seamless blend of digital content with the user's physical space by turning it. In addition, it is untethered, except for the cable to the battery, which makes the headset more agile, compared to the Varjo XR-3. This could actually come closer to "The Ultimate Display," which Ivan Sutherland had already sketched in 1965. After a great response from the media and social networks to the release, we were able to test and review the new AVP ourselves in March 2024. Including an expert survey with 13 of our colleagues after testing the AVP in our institute, this Viewpoint explores whether the AVP can overcome clinical challenges that AR especially still faces in the medical domain; we also go beyond this and discuss whether the AVP could support clinicians in essential tasks to allow them to spend more time with their patients.

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The primary objective of surgery for brain tumor resection has always been maximizing safe resection while minimizing the risk to normal brain tissue. Technological advances applied in the operating room help surgeons to achieve this objective. This chapter discusses specific tools and approaches in the operating environment that target safe surgery for brain tumors in children, with a focus on pathologies in the sellar/suprasellar region. Particular focus is given to tools that help with safe patient positioning; intraoperative imaging modalities; and chemical visualization adjuncts. Both static (preoperative images used for neuronavigation) and dynamic (images updated during the procedure) intraoperative imaging modalities are discussed. There is further overview of operative rehearsal and preparation strategies, which are rapidly evolving as virtual reality systems become more commonplace. While the rapid evolution of intraoperative adjuncts in neurosurgery means the status of a given technology as novel is quite transient, this chapter offers a snapshot of the current state of advanced intraoperative tools for pediatric brain tumor surgery.

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Human-virtual object interaction is common in both entertainment and work settings. This study investigated the movement time (MT) and subjective rating of difficulty (SRD) for moving a virtual cuboid in a 3D space. The participants wore an augmented reality (AR) headset, picked up a virtual cuboid, and placed it on an assigned target. They rated the SRD of the task on a five-point scale. The effects of the 3D coordinate of the target, sex, and handedness on the MT were analysed. The error placement rate was also recorded. Significant effects of spatial coordinates were found on both MT and SRD. Both single- and two-stage MT modelling were conducted using segmented and unsegmented MT data, respectively. The insignificant prediction error between the models indicates that the two-stage MT model is not superior to the single-stage one. The findings of this study are beneficial to software designers in designing user-friendly AR applications.

This study explores the movement time, subjective rating of difficulty, and error placement rate in positioning a virtual object in a 3D space. Regression movement time models were developed using both unsegmented and segmented movement time data. The findings provide insightful perspectives for software designers in designing user-friendly augmented reality applications.

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PURPOSE: To create an open-access Linear Accelerator Education and Augmented Reality Navigator (Open LEARN) via 3D printable objects and interactive augmented reality assets. METHODS: This study describes an augmented reality linear accelerator (linac) model accessible through a QR code and a smartphone to address the challenges of medical physics and radiation oncology trainees in low-to-middle-income countries. RESULTS: Major components of a generic linear accelerator are modeled as individual objects. These objects can be 3D printed for hands-on learning and used as interactive 3D assets within the augmented reality app. In the AR app, descriptions are displayed to navigate the components spatially and textually. Items modeled include the treatment couch, klystron, circulator, RF waveguides, electron gun, waveguide, beam steering assemblies, target, collimators, multi-leaf collimators, and imaging systems. The linear accelerator is rendered at nearly 100% of its actual size, allowing users to change magnification and view objects from different angles. CONCLUSIONS: The augmented reality linear accelerators and 3D-printed objects make these complex machines easily accessible with smartphones and 3D-printing technologies, facilitating education and training through physical and virtual interaction.

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Extended reality has brought new opportunities for medical imaging visualization and analysis. It regroups various subfields, including virtual reality, augmented reality, and mixed reality. Various applications have been proposed for surgical practice, as well as education and training. The aim of this review was to summarize current applications of extended reality and augmented reality in vascular surgery, highlighting potential benefits, pitfalls, limitations, and perspectives on improvement.

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BACKGROUND: Labor pain and anxiety are significant challenges in maternal healthcare, often managed through pharmacological interventions. Virtual Reality (VR), as a non- pharmacological method, has emerged as a potential tool for pain and anxiety relief in labor. This integrative review aims to synthesize evidence from randomized controlled trials (RCTs), qualitative studies, and mixed-methods research to evaluate the effectiveness of VR in labor pain and anxiety management and to understand patient experiences. METHODS: Adhering to the PRISMA guidelines, a structured literature search was conducted across databases, including PsycINFO, CINAHL, and PubMed, yielding 1,227 studies. Following a meticulous screening and selection process by authors, 13 studies (10 RCTs, 2 qualitative, and 1 mixed methods) met the inclusion criteria. Data extraction focused on study design, population characteristics, VR interventions, outcomes measured, and key findings, with a content analysis approach employed for thematic synthesis. RESULTS: The RCTs consistently showed VR's efficacy in reducing labor pain and, to some extent, anxiety. Qualitative studies highlighted VR's role in enhancing patient experiences, offering distraction, relaxation, and improved self-efficacy in pain management. The integration of findings from quantitative and qualitative studies provided a comprehensive understanding of VR's effectiveness and acceptability in labor. Notable themes included the importance of VR's immersive nature and its potential to reduce reliance on pharmacological interventions. CONCLUSION: VR emerges as a promising tool for managing labor pain and anxiety, offering a non-invasive and patient-friendly alternative to traditional pain relief methods. Its implementation in clinical practice could enhance patient satisfaction and overall birthing experiences. However, further research is needed to standardize VR interventions, assess long-term effects, and determine cost-effectiveness. The findings encourage the consideration of VR as part of holistic maternal care, emphasizing the need to integrate patient-centered healthcare technologies.

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Artificial intelligence (AI) is revolutionizing the field of biomedical research and treatment, leveraging machine learning (ML) and advanced algorithms to analyze extensive health and medical data more efficiently. In headache disorders, particularly migraine, AI has shown promising potential in various applications, such as understanding disease mechanisms and predicting patient responses to therapies. Implementing next-generation AI in headache research and treatment could transform the field by providing precision treatments and augmenting clinical practice, thereby improving patient and public health outcomes and reducing clinician workload. AI-powered tools, such as large language models, could facilitate automated clinical notes and faster identification of effective drug combinations in headache patients, reducing cognitive burdens and physician burnout. AI diagnostic models also could enhance diagnostic accuracy for non-headache specialists, making headache management more accessible in general medical practice. Furthermore, virtual health assistants, digital applications, and wearable devices are pivotal in migraine management, enabling symptom tracking, trigger identification, and preventive measures. AI tools also could offer stress management and pain relief solutions to headache patients through digital applications. However, considerations such as technology literacy, compatibility, privacy, and regulatory standards must be adequately addressed. Overall, AI-driven advancements in headache management hold significant potential for enhancing patient care, clinical practice and research, which should encourage the headache community to adopt AI innovations.

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OBJECTIVES: To investigate whether the scanning time, trueness and number of photos are influenced when augmented reality (AR) heads-up display (HUD) is utilized during the intraoral scan of fully dentate mandibular arches. METHODS: A total of 10 patients (6 females and 4 males) were included. The mandibular arch of each patient was scanned twice using an intraoral scanner (Trios4 Pod IOS: 3Shape): one with and one without AR-HUD (ML2; Magic Leap). Further, alginate impression was taken, and the cast was digitized to acquire the reference model for trueness comparison (T310, Medit). The scan time and number of photos were recorded. Trueness was evaluated qualitatively and quantitatively using colored heat maps and RMSE values respectively. t-test was used to evaluate the difference in scan time, trueness, and number of photos between the two groups (α = .05). RESULTS: AR-assisted IOS resulted in significantly faster scan time (44 seconds) compared to the time consumed following conventional scan method without AR-HUD (63 seconds) (P= <.001). The number of photos was also significantly less with AR-assisted IOS (836) compared to IOS using conventional technique without AR-HUD (1209) P= <.001. No statistical difference was detected in RMSE between the test groups. CONCLUSIONS: Integration of AR technology with IOS process represents a promising potential to acquire digital impressions with reduced scan acquisition time and reduced images count while simultaneously maintaining the trueness of the acquired scans. CLINICAL SIGNIFICANCE: Augmented Reality presents an emerging potential in Prosthodontics to acquire digital impressions with decreased number of images and acquisition time.

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BACKGROUND: In the realm of trauma response preparation for prehospital teams, the combination of Augmented Reality (AR) and Virtual Reality (VR) with manikin technologies is growing in importance for creating training scenarios that closely mirror potential real-life situations. The pilot study focused on training of airway management and intubation for trauma incidents, based on a Trauma AR-VR simulator involving reserve paramedics of the National EMS service (Magen David Adom) who had not practiced for up to six years, activated during the Israel-Gaza conflict (October 2023). The trauma simulator merges the physical and virtual realms by utilizing a real manikin and instruments outfitted with sensors. This integration enables a precise one-to-one correspondence between the physical and virtual environments. Considering the importance of enhancing the preparedness of the reserve paramedics to support the prehospital system in Israel, the study aims to ascertain the impact of AR-VR Trauma simulator training on the modification of key perceptual attitudes such as self-efficacy, resilience, knowledge, and competency among reserve paramedics in Israel. METHODS: A quantitative questionnaire was utilized to gauge the influence of AR-VR training on specific psychological and skill-based metrics, including self-efficacy, resilience, medical knowledge, professional competency, confidence in performing intubations, and the perceived quality of the training experience in this pilot study. The methodology entailed administering a pre-training questionnaire, delivering a targeted 30-minute AR-VR training session on airway management techniques, and collecting post-training data through a parallel questionnaire to measure the training's impact. Fifteen reserve paramedics were trained, with a response rate of 80% (n = 12) in both measurements. RESULTS: Post-training evaluations indicated a significant uptick in all measured areas, with resilience (3.717±0.611 to 4.008±0.665) and intubation confidence (3.541±0.891 to 3.833±0.608) showing particularly robust gains. The high rating (4.438±0.419 on a scale of 5) of the training quality suggests positive response to the AR-VR integration for the enhancement of medical training, CONCLUSIONS: The application of AR-VR in the training of reserve paramedics demonstrates potential as a key tool for their swift mobilization and efficiency in crisis response. This is particularly valuable for training when quick deployment of personnel is necessary, training resources are diminished, and 'all hands on deck' is necessary.

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Objective: Ophthalmic ward nursing work is onerous and busy, and many researchers have tried to introduce artificial intelligence (AI) technology to assist nurses in performing nursing tasks. This study aims to use augmented reality (AR) and AI technology to develop an intelligent assistant system for ophthalmic ward nurses and evaluate the usability and acceptability of the system in assisting clinical work for nurses. Methods: Based on AR technology, under the framework of deep learning, the system management, functions, and interfaces were completed using acoustic recognition, voice interaction, and image recognition technologies. Finally, an intelligent assistance system with functions such as patient face recognition, automatic information matching, and nursing work management was developed. Ophthalmic day ward nurses were invited to participate in filling out the System Usability Scale (SUS). Using the AR-based intelligent assistance system (AR-IAS) as the experimental group and the existing personal digital assistant (PDA) system as the control group. The experimental results of the three subscales of learnability, efficiency, and satisfaction of the usability scale were compared, and the clinical usability score of the AR-IAS system was calculated. Results: This study showed that the AR-IAS and the PDA systems had learnability subscale scores of 22.50/30.00 and 21.00/30.00, respectively; efficiency subscale scores of 29.67/40.00 and 28.67/40.00, respectively; and satisfaction subscale scores of 23.67/30.00 and 23.17/30.00, respectively. The overall usability score of the AR-IAS system was 75.83/100.00. Conclusion: Based on the analysis results of the System Usability Scale, the AR-IAS system developed using AR and AI technology has good overall usability and can be accepted by clinical nurses. It is suitable for use in ophthalmic nursing tasks and has clinical promotion and further research value.

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Background: Extended reality (XR) includes augmented reality (AR), virtual reality (VR), and mixed reality (MR). Endovascular neurosurgery is uniquely positioned to benefit from XR due to the complexity of cerebrovascular imaging. Given the different XR modalities available, as well as unclear clinical utility and technical capabilities, we clarify opportunities and obstacles for XR in training vascular neurosurgeons. Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Studies were critically appraised using ROBINS-I. Results: 19 studies were identified. 13 studies used VR, while 3 studies used MR, and 3 studies used AR. Regarding specific educational applications, VR was used for simulation in 10 studies and anatomical modeling in 3 studies. AR was only used for live intra-operative guidance (n = 3 studies). MR was only used for modeling and intra-operative teaching. Considering disease-specific uses, XR enhanced trainee understanding of intracranial aneurysms (n = 12 studies) and stroke (n = 7). XR trained surgeons in diverse neurosurgical procedures, including aneurysm coiling (n = 5 studies), diagnostic angiography (n = 5), and thrombectomy (n = 5). Conclusions: Anatomical modeling with VR and MR enhances neurovascular anatomy education with patient-specific, 3-D models from imaging data. AR and MR enable live intra-operative guidance, allowing experienced surgeons to remotely instruct novices, potentially improving patient care and reducing geographic disparities. AR overlays enhance instruction by allowing the surgeon to highlight key procedural aspects during training. Inaccurate tracking of surgical tools is an XR technological barrier for modeling and intra-operative training. Importantly, the most reported application of XR is VR for simulation-using platforms like the Mentice VIST and Angio Mentor. 10 studies examine VR for simulation, showing enhanced procedural performance and reduced fluoroscopy use after short training, although long-term outcomes have not been reported. Early-stage trainees benefited the most. Simulation improved collaboration between neurosurgeons and the rest of the surgical team, a promising role in interprofessional teamwork. Given the strength of VR for simulation, MR for simulation is an important gap in the literature for future studies. In conclusion, XR holds promise for transforming neurosurgical education and practice for simulation, but technological research is needed in modeling and intra-procedural training.

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Sleep problems are highly prevalent in autism and negatively impact the physical and mental health of children and their caregivers. Sleep education programs are often recommended as a first line-treatment to help parents implement healthy sleeping habits and a bedtime routine at home; however, the accompanying paper-based toolkits used in the bedtime routines have limitations related to engagement and adherence. To address these gaps, we iteratively developed and tested the usability of an augmented reality (AR) bedtime routine application. Our single participant design study (n = 7 child/parent dyads) found 86% compliance with the program and suggested good-excellent usability of the app with a trend toward increased willingness and faster completion of children's bedtime routines. This work supports the feasibility of using technology-based tools in sleep education programs and informs future clinical studies examining the effectiveness of these approaches for mitigating sleep difficulties.