Augmented reality in computer‐assisted interventions based on patient‐specific 3D printed reference

Moreta-Martínez, Rafael; García-Mato, David; García-Sevilla, Mónica; Pérez-Mañanes, Rubén; Calvo-Haro, José Antonio; Pascau, Javier

doi:10.1049/htl.2018.5072

Cited by 40 publications

(58 citation statements)

References 15 publications

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“…However, many of the previously mentioned technological developments are based on free and open-source software New Technologies to Improve Surgical Outcome during Open-Cranial Vault Remodeling DOI: http://dx.doi.org /10.5772/intechopen.94536 platforms [12,53], which could reduce the costs associated with its integration on the surgical workflow. Also, CAD/CAM guides and templates can be designed and manufactured in-hospital to reduce cost and production time [60,61]. These technologies could also be shared among different hospital departments, improving their impact at a lower cost.…”

Section: Resultsmentioning

confidence: 99%

New Technologies to Improve Surgical Outcome during Open-Cranial Vault Remodeling

García-Mato¹,

Pascau²,

Caicoya³

2021

Spina Bifida and Craniosynostosis - New Perspectives and Clinical Applications

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Current approaches for the surgical correction of craniosynostosis are highly dependent on surgeon experience. Therefore, outcomes are often inadequate, causing suboptimal esthetic results. Novel methods for cranial shape analysis based on statistical shape models enable accurate and objective diagnosis from preoperative 3D photographs or computed tomography scans. Moreover, advanced algorithms are now available to calculate a reference cranial shape for each patient from a multi-atlas of healthy cases, and to determine the most optimal approach to restore normal calvarial shape. During surgery, multiple technologies are available to ensure accurate translation of the preoperative virtual plan into the operating room. Patient-specific cutting guides and templates can be designed and manufactured to assist during osteotomy and remodeling. Then, intraoperative navigation and augmented reality visualization can provide real-time guidance during the placement and fixation of the remodeled bone. Finally, 3D photography enables intraoperative surgical outcome evaluation and postoperative patient follow-up. This chapter summarizes recent literature on all these technologies, showing how their integration into the surgical workflow could increase reproducibility and reduce inter-surgeon variability in open cranial vault remodeling procedures.

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Section: Resultsmentioning

confidence: 99%

New Technologies to Improve Surgical Outcome during Open-Cranial Vault Remodeling

García-Mato¹,

Pascau²,

Caicoya³

2021

Spina Bifida and Craniosynostosis - New Perspectives and Clinical Applications

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“…Overall, the literature presents error ranges from 0 to 10 mm by using diverse navigation and accuracy measurement methods on different surgical specialties with the Microsoft HoloLens [8,28,29,[32][33][34]. This collective experimental heterogeneity makes it cumbersome to pinpoint the crucial elements that create such data variability.…”

Section: Discussionmentioning

confidence: 99%

Value of the surgeon’s sightline on hologram registration and targeting in mixed reality

et al. 2020

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Purpose Mixed reality (MR) is being evaluated as a visual tool for surgical navigation. Current literature presents unclear results on intraoperative accuracy using the Microsoft HoloLens 1®. This study aims to assess the impact of the surgeon’s sightline in an inside-out marker-based MR navigation system for open surgery. Methods Surgeons at Akershus University Hospital tested this system. A custom-made phantom was used, containing 18 wire target crosses within its inner walls. A CT scan was obtained in order to segment all wire targets into a single 3D-model (hologram). An in-house software application (CTrue), developed for the Microsoft HoloLens 1, uploaded 3D-models and automatically registered the 3D-model with the phantom. Based on the surgeon’s sightline while registering and targeting (free sightline /F/or a strictly perpendicular sightline /P/), 4 scenarios were developed (FF-PF-FP-PP). Target error distance (TED) was obtained in three different working axes-(XYZ). Results Six surgeons (5 males, age 29–62) were enrolled. A total of 864 measurements were collected in 4 scenarios, twice. Scenario PP showed the smallest TED in XYZ-axes mean = 2.98 mm ± SD 1.33; 2.28 mm ± SD 1.45; 2.78 mm ± SD 1.91, respectively. Scenario FF showed the largest TED in XYZ-axes with mean = 10.03 mm ± SD 3.19; 6.36 mm ± SD 3.36; 16.11 mm ± SD 8.91, respectively. Multiple comparison tests, grouped in scenarios and axes, showed that the majority of scenario comparisons had significantly different TED values (p < 0.05). Y-axis always presented the smallest TED regardless of scenario tested. Conclusion A strictly perpendicular working sightline in relation to the 3D-model achieves the best accuracy results. Shortcomings in this technology, as an intraoperative visual cue, can be overcome by sightline correction. Incidentally, this is the preferred working angle for open surgery.

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“…The video component of this article can be found at https://www.jove.com/video/60618/ 2 . These methods have been considered somewhat limited when an accurate registration is required 19 . To overcome these limitations, this work provides tools to perform accurate and simple patient-to-image registration in AR procedures by combining AR technology and 3DP.…”

Section: Video Linkmentioning

confidence: 99%

“…Both AR and 3DP technologies help to improve orientation, guidance, and spatial skills in medical procedures; thus, their combination is the next logical step. Previous work has demonstrated that their joint use can increase value in patient education 16 , facilitating explanations of medical conditions and proposed treatment, optimizing surgical workflow 17,18 and improving patient-to-model registration 19 . Although these technologies have grown exponentially in recent years, their adoption by physicians is still limited, since they require extensive knowledge of engineering and software development.…”

Section: Introductionmentioning

confidence: 99%

Combining Augmented Reality and 3D Printing to Display Patient Models on a Smartphone

Moreta-Martínez

García-Mato

García-Sevilla

et al. 2020

JoVE

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Augmented reality (AR) has great potential in education, training, and surgical guidance in the medical field. Its combination with threedimensional (3D) printing (3DP) opens new possibilities in clinical applications. Although these technologies have grown exponentially in recent years, their adoption by physicians is still limited, since they require extensive knowledge of engineering and software development. Therefore, the purpose of this protocol is to describe a step-by-step methodology enabling inexperienced users to create a smartphone app, which combines AR and 3DP for the visualization of anatomical 3D models of patients with a 3D-printed reference marker. The protocol describes how to create 3D virtual models of a patient's anatomy derived from 3D medical images. It then explains how to perform positioning of the 3D models with respect to marker references. Also provided are instructions for how to 3D print the required tools and models. Finally, steps to deploy the app are provided. The protocol is based on free and multi-platform software and can be applied to any medical imaging modality or patient. An alternative approach is described to provide automatic registration between a 3D-printed model created from a patient's anatomy and the projected holograms. As an example, a clinical case of a patient suffering from distal leg sarcoma is provided to illustrate the methodology. It is expected that this protocol will accelerate the adoption of AR and 3DP technologies by medical professionals. Video LinkThe video component of this article can be found at https://www.jove.com/video/60618/ 2 . These methods have been considered somewhat limited when an accurate registration is required 19 . To overcome these limitations, this work provides tools to perform accurate and simple patient-to-image registration in AR procedures by combining AR technology and 3DP.The protocol is generic and can be applied to any medical imaging modality or patient. As an example, a real clinical case of a patient suffering from distal leg sarcoma is provided to illustrate the methodology. The first step describes how to easily segment the affected anatomy from Journal of Visualized Experiments www.jove.com Copyright © 2020 Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License January 2020 | 155 | e60618 | Page 2 of 10 computed tomography (CT) medical images to generate 3D virtual models. Afterward, positioning of the 3D models is performed, then the required tools and models are 3D-printed. Finally, the desired AR app is deployed. This app allows for the visualization of patient 3D models overlaid on a smartphone camera in real-time.3. Click on the Show 3D button to view a 3D representation of the segmentation.3. Export the segmentation in a 3D model file format by going to the Segmentations module in 3D Slicer.1. Go to Export/import models and labelmaps. Select Export in the operation section and Models in the output type section. Click Export to finish and create the 3D model from the segmented area. 2. Selec...

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Augmented reality in computer‐assisted interventions based on patient‐specific 3D printed reference

Cited by 40 publications

References 15 publications

New Technologies to Improve Surgical Outcome during Open-Cranial Vault Remodeling

New Technologies to Improve Surgical Outcome during Open-Cranial Vault Remodeling

Value of the surgeon’s sightline on hologram registration and targeting in mixed reality

Combining Augmented Reality and 3D Printing to Display Patient Models on a Smartphone

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