Review of prior and real-time patient images is critical during an interventional radiology procedure; however, it often poses the challenge of efficiently reviewing images while maintaining a sterile field. Although interventional radiologists can "scrub out" of the procedure, use sterile console covers, or verbally relay directions to an assistant, the ability of the interventionalist to directly control the images without having to touch the console could offer potential gains in terms of sterility, procedure efficiency, and radiation reduction. The authors investigated a potential solution with a low-cost, touch-free motion-tracking device that was originally designed as a video game controller. The device tracks a person's skeletal frame and its motions, a capacity that was adapted to allow manipulation of medical images by means of hand gestures. A custom software program called the Touchless Radiology Imaging Control System translates motion information obtained with the motion-tracking device into commands to review images on a workstation. To evaluate this system, 29 radiologists at the authors' institution were asked to perform a set of standardized tasks during a routine abdominal computed tomographic study. Participants evaluated the device for its efficacy as well as its possible advantages and disadvantages. The majority (69%) of those surveyed believed that the device could be useful in an interventional radiology practice and did not foresee problems with maintaining a sterile field. This proof-of-concept prototype and study demonstrate the potential utility of the motion-tracking device for enhancing imaging-guided treatment in the interventional radiology suite while maintaining a sterile field. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.332125101/-/DC1.

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We adapted and evaluated the Microsoft Kinect (touchless interface), Hillcrest Labs Loop Pointer (gyroscopic mouse), and the Apple iPad (multi-touch tablet) for intra-procedural imaging review efficacy in a simulation using MIM Software DICOM viewers. Using each device, 29 radiologists executed five basic interactions to complete the overall task of measuring an 8.1-cm hepatic lesion: scroll, window, zoom, pan, and measure. For each interaction, participants assessed the devices on a 3-point subjective scale (3 = highest usability score). The five individual scores were summed to calculate a subjective composite usability score (max 15 points). Overall task time to completion was recorded. Each user also assessed each device for its potential to jeopardize a sterile field. The composite usability scores were as follows: Kinect 9.9 (out of 15.0; SD = 2.8), Loop Pointer 12.9 (SD = 13.5), and iPad 13.5 (SD = 1.8). Mean task completion times were as follows: Kinect 156.7 s (SD = 86.5), Loop Pointer 51.5 s (SD = 30.6), and iPad 41.1 s (SD = 25.3). The mean hepatic lesion measurements were as follows: Kinect was 7.3 cm (SD = 0.9), Loop Pointer 7.8 cm (SD = 1.1), and iPad 8.2 cm (SD = 1.2). The mean deviations from true hepatic lesion measurement were as follows: Kinect 1.0 cm and for both the Loop Pointer and iPad, 0.9 cm (SD = 0.7). The Kinect had the least and iPad had the most subjective concern for compromising the sterile field. A new intra-operative imaging review interface may be near. Most surveyed foresee these devices as useful in procedures, and most do not anticipate problems with a sterile field. An ideal device would combine iPad's usability and accuracy with the Kinect's touchless aspect.

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