David Black

• Image-guidance systems help the clinician view patient images, see the location of tracked tools, or become aware of important factors such as instrument measurement values. Although this information is essential when completing many modern procedures, current methods for delivering intraoperative information rely primarily on computer screens within the operating room to display information. This is a significant drawback, because clinicians must often change between viewing patient and screen and might not be aware of immediate changes, resulting in increased time, inaccuracy, and frustration. The dissertation investigates auditory display to improve information display in the operating room. Novel techniques for transmitting the position of tracked instruments in image-guided procedures are presented, including medical needle placement, robotic endoscope and manual laparoscope guidance, and dissector guidance during liver resection. These give the operator auditory display to improve guidance of tracked tools within the body either as an augmentation to existing visual display or to allow screen-free navigation guidance. In addition, a method for hearing fluorescence intensities measured during open brain surgery is presented. Finally, two auditory display approaches are investigated as feedback for novel touchless input using eye tracking and freehand gestures to improve usability and performance. The results of clinically oriented evaluations show that auditory display provides significant advantages in the scope of the selected clinical use cases. The benefits of auditory or combined audiovisual display compared to visual-only display include, in most use cases, increases in accuracy, decrease in cognitive workload, and increases in usability. Drawbacks included increases in task completion time and in some cases, increase in cognitive workload. This dissertation clearly shows that auditory display has a promising future in the operating room.