Touchless computer interfaces in hospitals: A review <s> Motivations for using touchless control <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> BIB001 </s> Touchless computer interfaces in hospitals: A review <s> Motivations for using touchless control <s> For a lot of applications, and particularly for medical intra-operative applications, the exploration of and navigation through 3-D image data provided by sensors like ToF (time-of-flight) cameras, MUSTOF (multisensor-time-of-flight) endoscopes or CT (computed tomography) [8], requires a user-interface which avoids physical interaction with an input device. Thus, we process a touchless user-interface based on gestures classified by the data provided by a ToF camera. Reasonable and necessary user interactions are described. For those interactions a suitable set of gestures is introduced. A user-interface is then proposed, which interprets the current gesture and performs the assigned functionality. For evaluating the quality of the developed user-interface we considered the aspects of classification rate, real-time applicability, usability, intuitiveness and training time. The results of our evaluation show that our system, which provides a classification rate of 94.3% at a framerate of 11 frames per second, satisfactorily addresses all these quality requirements. <s> BIB002 </s> Touchless computer interfaces in hospitals: A review <s> Motivations for using touchless control <s> 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. <s> BIB003 </s> Touchless computer interfaces in hospitals: A review <s> Motivations for using touchless control <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> BIB004 </s> Touchless computer interfaces in hospitals: A review <s> Motivations for using touchless control <s> During the last few years, we have been witnessing a widespread adoption of touchless technologies in the context of surgical procedures. Touchless interfaces are advantageous in that they can preserve sterility around the patient, allowing surgeons to visualize medical images without having to physically touch any control or to rely on a proxy. Such interfaces have been tailored to interact with 2D medical images but not with 3D reconstructions of anatomical data, since such an interaction requires at least three degrees of freedom. In this paper, we discuss the results of a user study in which a mouse-based interface has been compared with two Kinect-based touchless interfaces which allow users to interact with 3D data with up to nine degrees of freedom. The experimental results show that there is a significant relation between the number of degrees of freedom simultaneously controlled by the user and the number of degrees of freedom required to perform, in a touchless way, an accurate manipulation task. <s> BIB005 </s> Touchless computer interfaces in hospitals: A review <s> Motivations for using touchless control <s> Introduction: Use of electronic health record (EHR) systems can place a considerable data entry burden upon the emergency department (ED) physician. Voice recognition data entry has been proposed as one mechanism to mitigate some of this burden; however, no reports are available specifically comparing emergency physician (EP) time use or number of interruptions between typed and voice recognition data entry-based EHRs. We designed this study to compare physician time use and interruptions between an EHR system using typed data entry versus an EHR with voice recognition. Methods: We collected prospective observational data at 2 academic teaching hospital EDs, one using an EHR with typed data entry and the other with voice recognition capabilities. Independent raters observed EP activities during regular shifts. Tasks each physician performed were noted and logged in 30 second intervals. We compared time allocated to charting, direct patient care, and change in tasks leading to interruptions between sites. Results: We logged 4,140 minutes of observation for this study. We detected no statistically significant differences in the time spent by EPs charting (29.4% typed; 27.5% voice) or the time allocated to direct patient care (30.7%; 30.8%). Significantly more interruptions per hour were seen with typed data entry versus voice recognition data entry (5.33 vs. 3.47; p=0.0165). Conclusion: The use of a voice recognition data entry system versus typed data entry did not appear to alter the amount of time physicians spend charting or performing direct patient care in an ED setting. However, we did observe a lower number of workflow interruptions with the voice recognition data entry EHR. Additional research is needed to further evaluate the data entry burden in the ED and examine alternative mechanisms for chart entry as EHR systems continue to evolve. [West J Emerg Med. 2014;15(4):541-547.] <s> BIB006
Sterility. Sterility is the most commonly cited motivation for touchless control (27 papers) . Complications and infections caused by non-sterile interactions can be very costly, BIB003 with both financial and human costs. It is noted by Wachs et al. BIB001 that the current most prevalent means of HCI in hospitals remains the mouse and keyboard. Keyboards and mice are a potential source of contamination (up to 95% of keyboards have been shown to be contaminated 6 ). However, computers and their peripherals are difficult to sterilise. BIB004 While the increased use of technology in highly sterile settings such as the OR, and particularly the use of imaging, is noted, the need for access to non-sterile technology is a problem: Unfortunately, the necessary divide between the sterile operative area and the non-sterile surrounding room means that, despite physical proximity to powerful information tools, those scrubbed in the OR are unable to take advantage of those resources via traditional human-computer interfaces. 8 Surgeons must remember details from prior review of each case, either asking assistants to control devices for them or using ad hoc barriers 4,8 -one strategy used by some surgeons is to pull their surgical gown over their hands, manipulating the mouse through the gown.  As a result, surgeons are less likely to use computer resources if they have to step out of the sterile surgical field due to the time and effort of scrubbing back.  Dela Cruz et al. BIB006 stated that breaks and interruptions to workflow leads to increased chance of medical error and poorer patient outcomes, and so, they should be avoided where possible. Cleaning to prevent bacterial contamination during surgery after checking a computer can take up to 20 min, sometimes adding a full hour to surgery. BIB005 However, surgeons may need direct control to mentally 'get to grips' with what is going on in a procedure. 12 Three-dimensional applications. In total, 21 of the reviewed papers referred to three-dimensional (3D) applications, such as manipulating 3D imagery and data sets. A major advantage of 3D handsfree interaction is the ability to navigate 3D data in 3D space BIB002 when compared to a conventional mouse, which only operates in two dimensions. In interpreting the thousands of images that modern scanners can produce, conventional analysis of two-dimensional (2D) images is potentially cumbersome. BIB005 This 3D interaction potentially enables more efficient navigation of 3D data.  Hands busy. Five of the reviewed papers referred to hands-busy interaction with the system, for example, a surgeon holding surgical tools needing to manipulate a medical image.  Johnson et al. 9 observe that at times, radiologists have their hands full holding and manipulating wires and catheters. Removing barriers. Touchless interaction enables not only a potential speed-up for specific tasks, for example, image manipulation in an OR, but also enables interaction modes not previously available, as well as supporting hospital sterility. O'Hara et al.  