Comparing the influence of mixed reality, a 3D viewer, and MRI on the spatial understanding of brain tumours

Background: Multiple 3D visualization techniques are available that obviates the need for the surgeon to mentally transform the 2D planes from MRI to the 3D anatomy of the patient. We assessed the spatial understanding of a brain tumour when visualized with MRI, 3D models on a monitor or 3D models in mixed reality.Methods: Medical students, neurosurgical residents and neurosurgeons were divided into three groups based on the imaging modality used for preparation: MRI, 3D viewer and mixed reality. After preparation, the participants needed to position, scale, and rotate a virtual tumour inside a virtual head of the patient in the same orientation as the original tumour would be. Primary outcome was the amount of overlap between the placed tumour and the original tumour to evaluate accuracy. Secondary outcomes were the position, volume and rotation deviation compared to the original tumour.Results: A total of 12 medical students, 12 neurosurgical residents, and 12 neurosurgeons were included. For medical students, the mean amount of overlap for the MRI, 3D viewer and mixed reality group was 0.26 (0.22), 0.38 (0.20) and 0.48 (0.20) respectively. For residents 0.45 (0.23), 0.45 (0.19) and 0.68 (0.11) and for neurosurgeons 0.39 (0.20), 0.50 (0.27) and 0.67 (0.14). The amount of overlap for mixed reality was significantly higher on all expertise levels compared to MRI and on resident and neurosurgeon level also compared to the 3D viewer. Furthermore, mixed reality showed the lowest deviations in position, volume and rotation on all expertise levels.Conclusion: Mixed reality enhances the spatial understanding of brain tumours compared to MRI and 3D models on a monitor. The preoperative use of mixed reality may therefore support the surgeon to improve spatial 3D related surgical tasks such as patient positioning and planning surgical trajectories

Intersexuality and Trans-Identities within the Diversity Management Discourse

Within both the scientific discourse on workforce diversity, and diversity management practice, intersexuality and transgender issues have hitherto remained marginalized topics. This chapter gives an overview of the discourses on both phenomena, and proposes starting points for more inclusive organizational diversity management initiatives. It is shown that both topics represent different aspects of the category of "gender". The common practice of conceptually lumping together intersexuality, transgenderism, and sexual orientation can be seen as one important reason that intersexuality and transgenderism are rarely considered in organizational diversity management programs in terms of concrete action. Against this background, a modified, and more integrated approach to structuring the workforce alongside the different dimensions of diversity is proposed. It is shown that the categories of "biological sex and gender", "gender identity", and "sexual orientation" cannot be regarded as being separate from each other. They represent, rather, an interrelated organizational field of action that should be considered as being one interrelated topic for organizational diversity practices. This chapter derives this claim theoretically and discusses the consequences for organizational diversity management practices. For most organizations, this would mean a fundamental rethinking of their goals, in terms of workforce diversity, and the shaping of their diversity management programs

Fully automatic adaptive meshing based segmentation of the ventricular system for augmented reality visualization and navigation

OBJECTIVE Effective image segmentation of cerebral structures is fundamental to 3-D techniques such as augmented reality (AR). To be clinically viable, segmentation algorithms should be fully-automatic and easily integrated in existing digital infrastructure. We created a fully automatic adaptive-meshing-based segmentation system for T1-weighted magnetic resonance images (MRI) to automatically segment the complete ventricular system, running in a cloud-based environment that can be accessed on an AR device. This study aims to assess the accuracy and segmentation time of the system by comparing it to a manually segmented ground truth dataset. METHODS A ground truth (GT) dataset of 46 contrast-enhanced and non-contrast-enhanced T1-weighted MRI scans was manually segmented. These scans were also uploaded to our system to create a machine-segmented (MS) dataset. The GT data was compared to the MS data using the Sørensen-Dice similarity coefficient (DSC) and 95% Hausdorff distance (HD$_{95}$) to determine segmentation accuracy. Furthermore, segmentation times for all GT and MS segmentations were measured. RESULTS Automatic segmentation was successful for 45 (98%) of 46 cases. Mean DSC score was 0.83 (SD = 0.08) and mean HD$_{95}$ was 19.06 mm (SD=11.20). Segmentation time was significantly longer for the GT group (mean=14405 s, SD=7089) when compared to the MS group (mean=1275 s, SD=714) with a mean difference of 13130 s (95% CI [10130, 16130]). CONCLUSIONS The described adaptive meshing based segmentation algorithm provides accurate and time-efficient automatic segmentation of the ventricular system from T1 MRI scans and direct visualization of the rendered surface models in Augmented Reality

Trans People, Transitioning, Mental Health, Life and Job Satisfaction

For trans people (i.e. people whose gender is not the same as the sex they were assigned at birth) evidence suggests that transitioning (i.e. the steps a trans person may take to live in the gender with which they identify) positively affects extraversion, ability to cope with stress, optimism about the future, positivity towards life, self-reported health, social relations, self-esteem, body image, enjoyment of tasks, personal performance, job rewards and relations with colleagues. These relationships are found to be enhanced by gender affirmation and support from family members, peers, schools and workplaces, stigma prevention programmes, coping intervention strategies, socioeconomic conditions, anti-discrimination policies, and positive actions. Also important are legislation including the ability to change one’s sex on government identification documents without having to undergo sex reassignment surgery, accessible and affordable transitioning resources, hormone therapy, surgical treatments, high-quality surgical techniques, adequate preparation and mental health support before and during transitioning, and proper follow-up care. Societal marginalization, family rejection, violations of human and political rights in health care, employment, housing and legal systems, gendered spaces, and internalization of stigma can negatively affect trans people’s well-being and integration in societies. The present study highlights that although transitioning itself can bring well-being adjustments, a transphobic environment may result in adverse well-being outcomes. Policy makers can learn that policies to facilitate trans people’s transition and create cultures of inclusion in different settings, such as schools, workplaces and health-care services, may help to improve societal well-being and allow the community to develop their potential and to minimize misery