Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> Continuous voice recognition dictation systems for radiology reporting provide a viable alternative to conventional transcription services with the promise of shorter report turnaround times and increased cost savings. While these benefits may be realized in academic institutions, it is unclear how voice recognition dictation impacts the private practice radiologist who is now faced with the additional task of transcription. In this article, we compare conventional transcription services with a commercially available voice recognition system with the following results: 1) Reports dictated with voice recognition took 50% longer to dictate despite being 24% shorter than those conventionally transcribed, 2) There were 5.1 errors per case, and 90% of all voice recognition dictations contained errors prior to report signoff while 10% of transcribed reports contained errors. 3). After signoff, 35% of VR reports still had errors. Additionally, cost savings using voice recognition systems in non-academic settings may not be realized. Based on average radiologist and transcription salaries, the additional time spent dictating with voice recognition costs an additional $6.10 per case or $76,250.00 yearly. The opportunity costs may be higher. Informally surveyed, all radiologists expressed dissatisfaction with voice recognition with feelings of frustration, and increased fatigue. In summary, in non-academic settings, utilizing radiologists as transcriptionists results in more error ridden radiology reports and increased costs compared with conventional transcription services. <s> BIB001 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> The use of doctor-computer interaction devices in the operation room (OR) requires new modalities that support medical imaging manipulation while allowing doctors' hands to remain sterile, supporting their focus of attention, and providing fast response times. This paper presents "Gestix," a vision-based hand gesture capture and recognition system that interprets in real-time the user's gestures for navigation and manipulation of images in an electronic medical record (EMR) database. Navigation and other gestures are translated to commands based on their temporal trajectories, through video capture. "Gestix" was tested during a brain biopsy procedure. In the in vivo experiment, this interface prevented the surgeon's focus shift and change of location while achieving a rapid intuitive reaction and easy interaction. Data from two usability tests provide insights and implications regarding human-computer interaction based on nonverbal conversational modalities. <s> BIB002 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> INTRODUCTION ::: Speech recognition is currently being deployed in medical and anaesthesia applications. This article is part of a project to investigate and further develop a prototype of a speech-input interface in Danish for an electronic anaesthesia patient record, to be used in real time during operations. ::: ::: ::: OBJECTIVE ::: The aim of the experiment is to evaluate the relative impact of several factors affecting speech recognition when used in operating rooms, such as the type or loudness of background noises, type of microphone, type of recognition mode (free speech versus command mode), and type of training. ::: ::: ::: METHODS ::: Eight volunteers read aloud a total of about 3600 typical short anaesthesia comments to be transcribed by a continuous speech recognition system. Background noises were collected in an operating room and reproduced. A regression analysis and descriptive statistics were done to evaluate the relative effect of various factors. ::: ::: ::: RESULTS ::: Some factors have a major impact, such as the words to be recognised, the type of recognition and participants. The type of microphone is especially significant when combined with the type of noise. While loud noises in the operating room can have a predominant effect, recognition rates for common noises (e.g. ventilation, alarms) are only slightly below rates obtained in a quiet environment. Finally, a redundant architecture succeeds in improving the reliability of the recognitions. ::: ::: ::: CONCLUSION ::: This study removes some uncertainties regarding the feasibility of introducing speech recognition for anaesthesia records during operations, and provides an overview of the interaction of several parameters that are traditionally studied separately. <s> BIB003 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> Abstract Introduction This article describes the evaluation of a prototype speech-input interface to an anaesthesia patient record, conducted in a full-scale anaesthesia simulator involving six doctor–nurse anaesthetist teams. Objective The aims of the experiment were, first, to assess the potential advantages and disadvantages of a vocal interface compared to the traditional touch-screen and keyboard interface to an electronic anaesthesia record during crisis situations; second, to assess the usability in a realistic work environment of some speech input strategies (hands-free vocal interface activated by a keyword; combination of command and free text modes); finally, to quantify some of the gains that could be provided by the speech input modality. Methods Six anaesthesia teams composed of one doctor and one nurse were each confronted with two crisis scenarios in a full-scale anaesthesia simulator. Each team would fill in the anaesthesia record, in one session using only the traditional touch-screen and keyboard interface while in the other session they could also use the speech input interface. Audio-video recordings of the sessions were subsequently analysed and additional subjective data were gathered from a questionnaire. Analysis of data was made by a method inspired by queuing theory in order to compare the delays associated to the two interfaces and to quantify the workload inherent to the memorisation of items to be entered into the anaesthesia record. Results The experiment showed on the one hand that the traditional touch-screen and keyboard interface imposes a steadily increasing mental workload in terms of items to keep in memory until there is time to update the anaesthesia record, and on the other hand that the speech input interface will allow anaesthetists to enter medications and observations almost simultaneously when they are given or made. The tested speech input strategies were successful, even with the ambient noise. Speaking to the system while working appeared feasible, although improvements in speech recognition rates are needed. Conclusion A vocal interface leads to shorter time between the events to be registered and the actual registration in the electronic anaesthesia record; therefore, this type of interface would likely lead to greater accuracy of items recorded and a reduction of mental workload associated with memorisation of events to be registered, especially during time constrained situations. At the same time, current speech recognition technology and speech interfaces require user training and user dedication if a speech interface is to be used successfully. <s> BIB004 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> The EuroMISE Center focuses on new approaches in the field of electronic health record (EHR). Among others, the structured health documentation in dentistry in the form of an EHR is being systematically studied. This paper describes the evolution of the EHR developed at the EuroMISE Center named MUDRLite and its graphical component for dentists called DentCross. The summary of features of the DentCross component is followed by a brief description of automatic speech recognition and an ASR module. The problems with data insertion into EHR during examination of a dental patient lead to further research in the area of the automatic speech recognition in medical practice. Cooperation of engineers, informaticians and dental physicians resulted in an application called DentVoice which is a successful application of the ASR module and the DentCross component of the MUDRLite EHR. The junction of voice control and graphical representation of dental arch makes hand-busy activities in dental praxis easier, quicker and more comfortable. This will result in a better quality of the data stored in a structured form in dental EHR, thus enabling better decision making and use of decision support systems. <s> BIB005 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> There are few reports of institutional use of voice recognition technology in clinical practice. We describe our experience with voice recognition-integrated synoptic-like dictation, associating templates with key spoken phrases, that we have used in gross examination of common specimens and as a major component of our workflow since 2001. The primary application is VoiceOver Enterprise (Voicebrook, Lake Success, NY), which uses Dragon NaturallySpeaking Medical Edition (Nuance Communications, Burlington, MA) as its speech engine. This integrates with the anatomic pathology laboratory information system (APLIS) and other applications, such as Microsoft Office (Microsoft, Redmond, WA). The largest user group, pathology assistants, mainly dictates biopsy reports, numbering approximately 210,000 specimens since 2001. The technology has been useful in our anatomic pathology workflow and provided a good return on investment, including marked improvements in turnaround time, results standardization, error reduction, and cost savings. The most helpful features of the software are templating, the seamless integration with APLIS, and the voice command creation tools. <s> BIB006 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> As computerization in the nursing field has been recently progressing, an electronic nursing record system is gradually introduced in the medical institution in Japan. Although it is expected for the electronic nursing record system to reduce the load of nursing work, the conventional keyboard operation is used for information input of the present electronic nursing record system and it has some problems concerning the input time and the operationability for common nurses who are unfamiliar with the computer operation. In the present study, we conducted a basic study on application of voice recognition input to an electronic nursing record system. The voice input is recently introduced to an electronic medical record system in a few clinics. However, so far the entered information cannot be processed because the information of the medical record must be entered as a free sentence. Therefore, we contrived a template for an electronic nursing record system and introduced it to the system for simple information entry and easy processing of the entered information in this study. Furthermore, an input experiment for evaluation of the voice input with the template was carried out by voluntary subjects for evaluation of the function as an input interface of an electronic nursing record system. The results of the experiment revealed that the input time by the voice input is obviously fast compared with that by the keyboard input and operationability of the voice input was superior to the keyboard input although all subjects had inexperience of the voice input. As a result, it was suggested our method, the voice input using the template made by us, might be useful for an input interface of an electronic nursing record system. <s> BIB007 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> PURPOSE ::: Despite the frequent introduction of voice recognition (VR) into radiology departments, little evidence still exists about its impact on workflow, error rates and costs. We designed a study to compare typographical errors, turnaround times (TAT) from reported to verified and productivity for VR-generated reports versus transcriptionist-generated reports in MRI. ::: ::: ::: METHODS ::: Fifty MRI reports generated by VR and 50 finalized MRI reports generated by the transcriptionist, of two radiologists, were sampled retrospectively. Two hundred reports were scrutinised for typographical errors and the average TAT from dictated to final approval. To assess productivity, the average MRI reports per hour for one of the radiologists was calculated using data from extra weekend reporting sessions. ::: ::: ::: RESULTS ::: Forty-two % and 30% of the finalized VR reports for each of the radiologists investigated contained errors. Only 6% and 8% of the transcriptionist-generated reports contained errors. The average TAT for VR was 0 h, and for the transcriptionist reports TAT was 89 and 38.9 h. Productivity was calculated at 8.6 MRI reports per hour using VR and 13.3 MRI reports using the transcriptionist, representing a 55% increase in productivity. ::: ::: ::: CONCLUSION ::: Our results demonstrate that VR is not an effective method of generating reports for MRI. Ideally, we would have the report error rate and productivity of a transcriptionist and the TAT of VR. <s> BIB008 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> This study evaluated the implementation of voice recognition (VR) for documenting outpatient encounters in the electronic health record (EHR) system at a military hospital and its 12 outlying clinics. Seventy-five clinicians volunteered to use VR, and 64 (85 percent) responded to an online questionnaire post implementation to identify variables related to VR continuance or discontinuance. The variables investigated were user characteristics, training experience, logistics, and VR utility. Forty-four respondents (69 percent) continued to use VR and overall felt that the software was accurate, was faster than typing, improved note quality, and permitted closing a patient encounter the same day. The discontinuation rate of 31 percent was related to location at an outlying clinic and perceptions of inadequacy of training, decreased productivity due to VR inaccuracies, and no improvement in note quality. Lessons learned can impact future deployment of VR in other military and civilian healthcare facilities. <s> BIB009 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> A challenging goal today is the use of computer networking and advanced monitoring technologies to extend human intellectual capabilities in medical decision making. Modern commercial eye trackers are used in many of research fields, but the improvement of eye tracking technology, in terms of precision on the eye movements capture, has led to consider the eye tracker as a tool for vision analysis, so that its application in medical research, e.g. in ophthalmology, cognitive psychology and in neuroscience has grown considerably. The improvements of the human eye tracker interface become more and more important to allow medical doctors to increase their diagnosis capacity, especially if the interface allows them to remotely administer the clinical tests more appropriate for the problem at hand. In this paper, we propose a client/server eye tracking system that provides an interactive system for monitoring patients eye movements depending on the clinical test administered by the medical doctors. The system supports the retrieval of the gaze information and provides statistics to both medical research and disease diagnosis. <s> BIB010 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> In this paper, an open-source system for a controller-free, highly interactive exploration of medical images is presented. By using a Microsoft Xbox Kinect™ as the only input device, the system's user interface allows users to interact at a distance through hand and arm gestures. The paper also details the interaction techniques we have designed specifically for the deviceless exploration of medical imaging data. Since the user interface is touch-free and does not require complex calibration steps, it is suitable for use in operating rooms, where non-sterilizable devices cannot be used. <s> BIB011 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> Keyboards, mice, and touch screens are a potential source of infection or contamination in operating rooms, intensive care units, and autopsy suites. The authors present a low-cost prototype of a system, which allows for touch-free control of a medical image viewer. This touch-free navigation system consists of a computer system (IMac, OS X 10.6 Apple, USA) with a medical image viewer (OsiriX, OsiriX foundation, Switzerland) and a depth camera (Kinect, Microsoft, USA). They implemented software that translates the data delivered by the camera and a voice recognition software into keyboard and mouse commands, which are then passed to OsiriX. In this feasibility study, the authors introduced 10 medical professionals to the system and asked them to re-create 12 images from a CT data set. They evaluated response times and usability of the system compared with standard mouse/keyboard control. Users felt comfortable with the system after approximately 10 minutes. Response time was 120 ms. Users required 1.4 times more time to re-create an image with gesture control. Users with OsiriX experience were significantly faster using the mouse/keyboard and faster than users without prior experience. They rated the system 3.4 out of 5 for ease of use in comparison to the mouse/keyboard. The touch-free, gesture-controlled system performs favorably and removes a potential vector for infection, protecting both patients and staff. Because the camera can be quickly and easily integrated into existing systems, requires no calibration, and is low cost, the barriers to using this technology are low. <s> BIB012 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> Background ::: Integrated operation systems were developed for centralization and easy control of all components within the operating room (OR). These systems represent central units that use communication technology to connect and control various components of the OR. Voice control that is independent of the speaker has been a pioneering innovation in the central control of different OR components. The aim of the present study was to evaluate the utility of two voice-activated control systems, the Siemens Integrated OR System (SIOS, Siemens Medical Solutions, Siemens AG) and the OR1 (Karl Storz GmbH & Co. KG), for delivery of commands to specific OR equipment. <s> BIB013 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> Computerized medical systems play a vital role in the operating room, however, sterility requirements and interventional workflow often make interaction with these devices challenging for surgeons. Typical solutions, such as delegating physical control of keyboard and mouse to assistants, add an undesirable level of indirection. We present a touchless, gesture-based interaction framework for the operating room that lets surgeons define a personalized set of gestures for controlling arbitrary medical computerized systems. Instead of using cameras for capturing gestures, we rely on a few wireless inertial sensors, placed on the arms of the surgeon, eliminating the dependence on illumination and line-of-sight. A discriminative gesture recognition approach based on kernel regression allows us to simultaneously classify performed gestures and to track the relative spatial pose within each gesture, giving surgeons fine-grained control of continuous parameters. An extensible software architecture enables a dynamic association of learned gestures to arbitrary intraoperative computerized systems. Our experiments illustrate the performance of our approach and encourage its practical applicability. <s> BIB014 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> This paper presents a method to improve the navigation and manipulation of radiological images through a sterile hand gesture recognition interface based on attentional contextual cues. Computer vision algorithms were developed to extract intention and attention cues from the surgeon's behavior and combine them with sensory data from a commodity depth camera. The developed interface was tested in a usability experiment to assess the effectiveness of the new interface. An image navigation and manipulation task was performed, and the gesture recognition accuracy, false positives and task completion times were computed to evaluate system performance. Experimental results show that gesture interaction and surgeon behavior analysis can be used to accurately navigate, manipulate and access MRI images, and therefore this modality could replace the use of keyboard and mice-based interfaces. <s> BIB015 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> Purpose: The aim of this study was to determine the incidence, types, and clinical implications of laterality errors and the effect of voice recognition software on the frequency of laterality errors. Methods: All radiology reports generated between January 2007 and April 2011 were retrospectively evaluated to identify revised reports containing laterality errors. Type of error was catalogued with regard to modality, body part, type of discrepancy (major or minor, with discrepancies considered major if the potential existed to affect patient management), duration of time between report finalization and corrected report, clinical significance, and use of voice recognition. The rate of errors causing major and minor discrepancies between voice recognition‐generated reports and nonvoice recognition‐generated reports was compared. Results: Among 2,923,094 reports, 1,607 (0.055%) contained corrected laterality errors, and 56 (0.0019% of the total report volume) were major. A total of 584,878 (20%) were generated using voice recognition. The rate of laterality errors leading to major discrepancies in voice recognition‐generated reports was 0.00188%, compared with 0.00192% in nonvoice recognition‐generated reports (P .9436). None of the errors led to wrong-sided surgery. However, there were potential adverse effects due to laterality errors in 3 patients with major discrepancies (0.000103% of the total report volume). Conclusions: Rates of laterality errors were low and, in our population, did not result in wrong-sided surgeries. Rates of laterality errors in reports with major discrepancies were unaffected by voice recognition software, but voice recognition was associated with a significant reduction in the duration of time between report finalization and the issuing of a corrected report. <s> BIB016 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> Sterility restrictions in surgical settings make touch-less interaction an interesting solution for surgeons to interact directly with digital images. The HCI community has already explored several methods for touch-less interaction including those based on camera-based gesture tracking and voice control. In this paper, we present a system for gesture-based interaction with medical images based on a single wristband sensor and capacitive floor sensors, allowing for hand and foot gesture input. The first limited evaluation of the system showed an acceptable level of accuracy for 12 different hand & foot gestures; also users found that our combined hand and foot based gestures are intuitive for providing input. <s> BIB017 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> When patients visit hospitals, they tend to develop negative feelings such as anxiety and lack of comfort. This paper uses the techniques of Interaction Design and User-Centered Design with the main objective to ask users about their needs and requirements to develop an interactive hospital room with a natural interaction device like Kinect, so we could achieve a reduction on those negative feelings described previously. This will allow that people could use their voices and a set of body gestures to control basic devices that could be find in a hospital room, making the hospitalization process a different, more comfortable and with more autonomy. Prototypes were developed and evaluated into two stages by people that could use the application potentially. The results show that people agree to use this form of interaction in terms of comfort, performance and utility. <s> BIB018 </s> Touchless computer interfaces in hospitals: A review <s> observed no significant difference between gamers and non-gamers. <s> Real-time control of visual display systems via mid-air hand gestures offers many advantages over traditional interaction modalities. In medicine, for example, it allows a practitioner to adjust display values, e.g. contrast or zoom, on a medical visualization interface without the need to re-sterilize the interface. However, when users are holding a small tool (such as a pen, surgical needle, or computer stylus) the need to constantly put the tool down in order to make hand gesture interactions is not ideal. This work presents a novel interface that automatically adjusts for gesturing with hands and hand-held tools to precisely control medical displays. The novelty of our interface is that it uses a single set of gestures designed to be equally effective for fingers and hand-held tools without using markers. This type of interface was previously not feasible with low-resolution depth sensors such as Kinect, but is now achieved by using the recently released Leap Motion controller. Our interface is validated through a user study on a group of people given the task of adjusting parameters on a medical image. <s> BIB019
A gesture classifier typically needs to be trained by providing a large set of sample data. Regarding this training, Jacob et al. BIB015 state that it is imperative to use a greater number of users (high-variance training data). System calibration results in a time cost. For example, the total set up time (including calibration) was ca. 20 min for the system of Wachs et al. BIB002 Calibration is also required in some papers that use a Kinect. BIB011 However, for some systems, no calibration was required. BIB012 Voice control. Perrakis et al. BIB013 believe that voice control has an important role to play in minimally invasive surgery, allowing the surgeon to take control of the entire OR without breaking sterility or interrupting the surgery; this potentially allows for single surgeon surgery, resulting in reduced costs. As mentioned in 29 papers, and discussed on a practical level in 20 papers, voice control has been found to be slower but more accurate than gesture control, and both were slower than traditional methods. BIB018 Two major issues for voice control are people's accents, BIB015 and ambient noise, with the noise levels of an OR making voice control extremely difficult. BIB002 When designing a grammar for a speech recognition-based interface, care must be taken to select words that are easily recognisable for the various users of the system and sufficiently distinct from each other phonetically to avoid possible mis-recognitions. BIB003 Strickland et al.  suggest that the implemented gesture vocabulary does not need to allow full functionality of the PAC system, but rather a subset of the most common functions. Voice control for text input. In total, 13 papers discussed voice control as a means of inputting text. Given a sufficiently high speech recognition engine confidence score, use of a keyword to activate the system and of another keyword to switch between command based and free text mode may allow for a completely hands-free approach. BIB004 Voice recognition has been described as having accuracy as high as 99 per cent; however, some studies have shown slightly lower accuracy than human transcription. BIB006 According to Kang et al., BIB006 the largest benefit to using voice control is a decrease in turnaround time, which results in higher administration, and clinician satisfaction, whereas the biggest disadvantage is an increased editing burden on clinicians. They report natural dictation at speeds of 160 words per minute. BIB006 Marukami et al. BIB007 investigated voice recognition input to an electronic nursing record system (ENRS) and compared the time taken to input records to an electronic health record (EHR) using voice recognition as compared to by means of keyboard input, finding that users were able to input records roughly 5 times faster using voice recognition (304.5 vs 1459 s). In contrast, Pezzullo et al. BIB001 found that reports generated by means of the voice recognition system were 24 per cent shorter in length and took 50 per cent longer to dictate than those transcribed conventionally. In terms of cost per report, Pezzullo et al. BIB001 note that use of a voice recognition system may result in a 100 per cent increase in dictation costs, caused by the significant difference in cost per hour of radiologists compared to transcriptionists. BIB008 Voice control for discrete commands. Voice control is generally deemed good for discrete commands, though it is not appropriate for continuous parameter adjustment, for which gestures are better suited. 14 Dictation systems require discrete commands, with Argoty and Figueroa 28 proposing two-word commands as more meaningful to the user than single-word commands. Nagy et al. BIB005 say that increased length of commands plays a significant role in improving recognition hit rates. Alapetite BIB003 found that voice recognition displayed higher accuracy when issuing discrete commands (81.6%) as compared to free speech mode (77.1%). Use of a voice recognition interface resulted in a significantly higher quality of anaesthesia record as compared to the traditional interface (99% of medications recorded vs 56%), as well as a reduced error rate. BIB004 In contrast, Pezzullo et al. BIB001 found that their voice recognition system resulted in more errors per report than conventional transcription (5.1 errors/report compared to 0.12 errors/report) and go on to suggest that 'radiologists are not good transcriptionists'. Training for voice control. Hoyt and Yoshihashi 40 state that the success or failure of voice recognition technology in a hospital is dependent on personal experience, training, technological or logistical reasons. To this end, voice recognition vendors may provide 'train the trainer' sessions to users with high levels of aptitude ('superusers'). BIB009 Rossol et al. BIB019 found that users can significantly improve their performance with practice over a small number of repeated uses. In Kang et al., BIB006 new users took a 1-h training session, and setting up a new voice profile took approximately 10 min. Alapetite BIB004 found that setting up and training a new voice profile took roughly 30 min. Fatigue in voice control. Marukami et al. BIB007 considered the issue of user fatigue when implementing voice recognition as compared to keyboard input and gathered user feedback regarding both input tools by means of a questionnaire. Their results indicated that users found that voice input caused less fatigue and was easier compared with keyboard operation, despite being inexperienced with voice input. BIB007 Time of day also seems to impact on performance. Luetmer et al. BIB016 identified an increased error rate in laterality in radiology reports during the evening and overnight shifts (0.154% during the evenings, 0.124% overnight, compared to 0.0372% during the day). They also found that reports generated using voice control had similar major laterality error rates to those generated without using voice control. BIB016 Performance of voice control. Alapetite BIB004 found that the voice recognition interface led to shorter action queues than the traditional interface, but users found that it required slightly more concentration and was slightly more difficult to update the anaesthesia record using voice recognition input. Pezzullo et al. BIB001 declare that with diminished speech recognition accuracy comes an increase in time spent editing reports, resulting in a decrease of user satisfaction. Alapetite BIB004 observed a speech command must be said in one go, distinctively and without any dysfluency. Perrakis et al. BIB013 found that speaker's accent did not have an impact on system accuracy, with functional errors in using the system being approximately the same for non-native and native German speakers. Alapetite BIB003 found that when a user profile was trained with background noise, there was a slight increase in free speech recognition performance (78.2% vs 75.6%), in contrast to the results for command mode, and stated that 'background noises have a strong impact on recognition rates'. Other technologies. Nine papers discussed the use of EGT as an interaction modality. Modern eye trackers have the advantage of being very easy to install and to use. BIB010 Two papers discussed inertial-type sensors attached to the users' bodies to capture gesture input. Jalaliniya et al. BIB017 stated that advantages of such a system were that the system did not require a direct line of sight for the user and that it would allow only a designated person (the wearer of the sensor) to interact with the system. Bigdelou et al. BIB014 discussed the hardware issues of inertial orientation sensor-based systems, highlighting issues such as noise and drift.