Interpretation of Coronary Angiograms Recorded Using Google Glass: A Comparative Analysis

Abstract: Introduction. Google Glass (Google, Inc) is a voice-activated, hands-free, optical head-mounted display device capable of taking pictures, recording videos, and transmitting data via wi-fi. In the present study, we examined the accuracy of coronary angiogram interpretation, recorded using Google Glass. Methods. Google Glass was used to record 15 angiograms with 17 major findings and the participants were asked to interpret those recordings on: (1) an iPad (Apple, Inc); or (2) a desktop computer. Interpretation was compared with the original angiograms viewed on a desktop. Ten physicians (2 interventional cardiologists and 8 cardiology fellows) participated. One point was assigned for each correct finding, for a maximum of 17 points. Results. The mean angiogram interpretation score for Google Glass angiogram recordings viewed on an iPad or a desktop vs the original angiograms viewed on a desktop was 14.9 ± 1.1, 15.2 ± 1.8, and 15.9 ± 1.1, respectively (P=.06 between the iPad and the original angiograms, P=.51 between the iPad and recordings viewed on a desktop, and P=.43 between the recordings viewed on a desktop and the original angiograms). In a post-study survey, one of the 10 physicians (10%) was “neutral” with the quality of the recordings using Google Glass, 6 physicians (60%) were “somewhat satisfied,” and 3 physicians (30%) were “very satisfied.” Conclusion. This small pilot study suggests that the quality of coronary angiogram video recordings obtained using Google Glass may be adequate for recognition of major findings, supporting its expanding use in telemedicine. 

J INVASIVE CARDIOL 2015;27(10):443-446

Key words: coronary angiography, telemedicine, Google Glass

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Wearable devices are quickly revolutionizing the practice of modern medicine and medical education.¹ Google Glass (Google, Inc) is a voice-activated, hands-free device capable of taking pictures, recording videos, and transmitting data via wi-fi. Google Glass could enhance medical practice and medical education,^2-7 but has undergone limited evaluation in cardiology. Assad-Kottner recently reported remote “telementoring” of the percutaneous closure of a patent foramen ovale.⁸ The procedure was successfully completed in spite of thrombus formation at the tip of the delivery sheath.⁸ Remote detection of this complication enabled prompt correction with an excellent final outcome.

A critical factor underlying implementation of Google Glass for cardiac catheterization is good image quality. Jeroudi et al recently reported that the interpretation of electrocardiograms viewed through Google Glass was less accurate than interpretation on paper or using an iPhone screen.⁹ However, in most clinical settings, Google Glass would be used to record and transmit, rather than review images. In the present study, we sought to examine the accuracy of interpretation of coronary angiograms recorded using Google Glass. 

Methods

We selected 15 anonymous coronary angiograms that were either normal or with 1 to 2 major findings, for a total of 17 major findings. The angiograms were recorded from the cardiac catheterization laboratory monitor screen using the Google Glass camera (Figure 1). Recordings were performed in a semidark room with the Google Glass placed at a distance of 40-45 cm from the monitor (Figure 2). 

The angiographic recordings were subsequently reviewed by each participant on an iPad and on a desktop, and the original angiograms were also reviewed on a desktop, in random sequence. To minimize recall, each interpretation was performed at least 48 hours apart. One point was assigned for each correct finding. At the end of the study, participants were given a survey to assess their satisfaction with image quality of the angiograms and how comfortable they would be giving recommendations based on the videos obtained using Google Glass. 

Continuous parameters were presented as mean ± standard deviation and compared using Wilcoxon rank-sum test or Fisher’s exact test, as appropriate. A P<.05 was considered statistically significant. Statistical analyses were performed using JMP 11 software (SAS Institute). 

Results

Ten physicians (2 attending physicians and 8 cardiology fellows) participated and their scores for each mode of viewing are shown in Table 1. The average score (maximum possible score was 17 points) for angiogram interpretation viewed on an iPad and on a desktop vs the original angiogram was 14.9 ± 1.1, 15.2 ± 1.8, and 15.9 ± 1.1, respectively (P=.06 between Google Glass recording viewed on an iPad and the original angiograms; P=.51 between the iPad and the Google Glass recordings viewed on a desktop; and P =.43 between the Google Glass recordings viewed on a desktop and the original angiograms). Left main lesions were the most difficult to assess, with only 2 participants accurately assessing them by all three methods. Circumflex lesions, normal coronary arteries, and left anterior descending artery lesions were correctly identified in all cases. Only 1 participant, a senior fellow, correctly identified all lesions using the three different modalities. With 1 exception, the number of correct assessments directly correlated with the experience of the participants. First-year fellows scored an average of 42.7 ± 1.5 out of 51 maximum points (17 points for each modality), second-year fellows scored an average of 46.0 ± 5.7 points, third year fellows scored an average of 47.7 ± 3.1 points, and attendings scored an average of 48.5 ± 2.1 points, respectively (P=.56 between first-year and second-year fellows, P=.05 between first-year and third-year fellows, P=.08 between first-year fellows and attendings, P=.56 between second-year and third-year fellows, P=.68 between second-year fellows and attendings, and P=.77 between third-year fellows and attendings).

A post-study survey was performed to evaluate participant satisfaction with angiographic image quality and how comfortable they would feel using them to provide clinical recommendations. One of the 10 physicians (10%) was “neutral” in regard to quality and giving recommendations, 6 physicians (60%) were “somewhat satisfied” and would be “somewhat comfortable” giving recommendations, and 3 physicians (30%) were “very satisfied” and would be “very comfortable” giving recommendations.

Discussion

The major finding of our study is that review of coronary angiograms recorded using Google Glass and viewed on an iPad or a desktop can allow interpretation similar to that obtained by review of the original angiograms. These findings are promising regarding future implementation of Google Glass in the cardiac catheterization laboratory.

The ability of Google Glass to allow hands-free wireless audio and video communication can have multiple applications in the operating room for both telementoring and teaching. Good image and video quality is, however, a prerequisite. Hashimoto et al³ assessed the video quality of Google Glass vs the iPhone 5 (Apple, Inc) during open cholecystectomy, with the majority of participants rating the quality of the Google Glass video transmission via Google Hangout inferior to the Apple iPhone 5 FaceTime application. This could, however, be related to the wireless network connection speed, a potentially modifiable factor. In our study, the videos were reviewed after transfer from the Google Glass to an iPad and a desktop and not through real-time wireless connection, and interpretation, although numerically slightly lower, was not inferior as compared with interpretation of the original angiograms. These findings are very encouraging regarding future implementation of Google Glass in the cardiac catheterization laboratory.

Study limitations. Although promising, given the relatively small sample size, our initial results need to be validated in additional studies. Moreover, our study only evaluated major angiographic findings, and it is unclear what the interpretation accuracy would be for less obvious findings. The majority of participants in the study were cardiology trainees, who likely have less experience and expertise interpreting angiograms; interpretation by experienced angiographers might provide superior results. Addiction to Google Glass has already been reported,¹⁰ suggesting potential risks associated with use of the device.

Conclusion

In summary, interpretation of coronary angiograms recorded using Google Glass and viewed through an iPad or a desktop can be performed with accuracy similar to interpretation of the original angiograms, supporting expanding evaluation of this technology in the cardiac catheterization laboratory.

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From the University of Texas Southwestern Medical Center and VA North Texas Health Care System, Dallas, Texas.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. BV Rangan reports grants from InfraredX and Spectranetics. Dr Banerjee reports research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCare Global (spouse); intellectual property in HygeiaTel. Dr Brilakis reports consulting fees/speaker honoraria from Abbott Vascular, Asahi Intecc, Boston Scientific, Elsevier, Somahlution, St. Jude Medical, and Terumo; research support from Boston Scientific and InfraRedx; spouse is an employee of Medtronic. The remaining authors report no conflicts of interest regarding the content herein.

Manuscript submitted August 24, 2015, provisional acceptance given September 2, 2015, final version accepted September 14, 2015.

Address for correspondence: Emmanouil S. Brilakis, MD, PhD, VA North Texas Healthcare System, Cardiology, 4500 South Lancaster Road, Dallas, TX 75216. Email: esbrilakis@gmail.com