Toward Postural State Classification in Immersive VR with Multimodal Data and Explainability Analysis

Ensuring a safe virtual reality (VR) experience requires systems that can predict and respond when users lose their balance. Although prior work has examined fall prediction and motion sickness, many approaches are regression-based and postural state classification remains less explored. This study compares machine learning (ML) and deep learning (DL) models for classifying postural states in VR under visual perturbations. We used a multimodal dataset containing kinematic, electromyographic (EMG), and electrodermal activity (EDA) signals. The data were prepared for a binary task to distinguish balanced from imbalanced postural states, and participant-wise downsampling addressed class imbalance. All models were evaluated with Leave-One-Participant-Out (LOPO) cross-validation to test generalization to unseen participants. Among the models, the Mamba-inspired CNN (MI-CNN) achieved the highest accuracy of 96.76%. SHapley Additive exPlanations (SHAP) analysis improved interpretability and identified the most influential classification factors. The SHAP results showed that kinematic features were dominant, indicating that body-motion patterns are informative for detecting imbalance in VR. We also evaluated MI-CNN using only the top two-thirds of features ranked by SHAP importance. Despite a 33% reduction in input dimensionality, the model maintained performance, achieving 0.957 accuracy and 0.957 F1-score, with about a 1% decrease compared with the full-feature model. These findings suggest that multimodal sensing, temporal deep learning, and explainable AI can support reliable classification of balance-related instability in VR. Accurate recognition of imbalanced postural states may raise awareness of fall risk and guide safer, adaptive VR systems that respond to instability while improving user safety and experience. Code is available at: https://github.com/NipaAnjum/MI-CNN.

Agentic AI-driven Immersive Simulation: A Knowledge-Aware Virtual Training Platform forHigh Dose Rate (HDR) Brachytherapy

The convergence of the Metaverse and Large Language Model (LLM)-based AI agent is catalyzing a shift toward autonomous, immersive, and personalized pedagogical frameworks in medical education. This paper presents a novel agentic AI-driven immersive simulation specifically designed for High Dose Rate (HDR) vaginal cylinder (VC) brachytherapy in cancer care. By integrating Virtual Reality (VR) and mobile computing, the system establishes a high-fidelity, risk-free environment that allows trainees to master complex procedural skills without the facility or safety constraints posed by physical anatomy or live radioactive sources. A core contribution of this work is the seamless integration of a knowledge-aware assistant leveraging Retrieval-Augmented Generation (RAG) to ground agent interactions in authoritative clinical guidelines. This architecture also enables an interactive agent to provide natural language interfaces and hands-free, real-time guidance during intricate medical maneuvers. We validate the proposed system through a prototype deployment comprising a Meta Quest 3 interface linked to a local GPU-accelerated AI backend, demonstrating a feasible architecture for HDR brachytherapy simulation. Experimental results indicate that the system maintains suitable end-to-end latency and high context precision, answer completeness, and relevance in the RAG-enhanced pedagogical support.

Virtual-reality based patient-specific simulation of spine surgical procedures: A fast, highly automated and high-fidelity system for surgical education and planning

Surgical training involves didactic teaching, mentor-led learning, surgical skills laboratories, and direct exposure to surgery; however, increasing clinical pressures have limited operating room (OR) exposure. This work leverages virtual reality (VR) to provide a safe and immersive training environment. Existing VR training is often based on standardized scenarios not tailored to individual clinical cases. This study addresses this limitation using artificial intelligence (AI) based computer vision methods to generate patient-specific simulations from computed tomography (CT) and magnetic resonance imaging (MRI). This study focuses on patient-specific spinal decompression simulation for spinal stenosis in a virtual operating room. The objectives were (1) automatic creation of 3D anatomical models and (2) VR simulation of spinal decompression procedures including laminectomy, disc resection, and foraminotomy. Model construction required multimodal fusion (registration) of CT and MRI and segmentation of relevant structures. Segmentation was evaluated using the Dice Similarity Coefficient (DSC), and registration accuracy using Target Registration Error (TRE). Qualitative feedback was obtained from surgeons and trainees. High-fidelity patient-specific 3D models were generated efficiently (approximately 2.5 minutes per case, N = 15). Segmentation accuracy was high, with a DSC of 0.95 (+/- 0.03) for vertebral bone and 0.895 (+/- 0.02) for soft tissue structures. Registration accuracy showed a mean TRE of 1.73 (+/- 0.42) mm. Semi-structured interviews indicated improved spatial understanding, increased procedural confidence, and strong perceived educational value. This platform significantly reduced the time and costs of patient-specific modelling, thereby facilitating pre-operative planning, post-procedural assessments, and comprehensive surgical simulation.