Clinical Accuracy of Holographic Navigation Using Point-Based Registration on Augmented-Reality Glasses

Doormaal, Tristan P.C. van; Doormaal, Jesse A.M. van; Mensink, Tom

doi:10.1093/ons/opz094

Cited by 68 publications

(59 citation statements)

References 9 publications

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“…This refinement application can be helpful to track the learning curve of a surgeon and compare it with others with regard to differing skill levels in measurement accuracy and refinement. Compared to our system, other VR-systems showed much higher inter-reader variations 30,31 . In these previous studies, the study subjects were not aware of their reduced precision performance.…”

Section: Discussionmentioning

confidence: 64%

Validation of virtual reality orbitometry bridges digital and physical worlds

Maloca

Faludi

Żelechowski

et al. 2020

Sci Rep

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Clinical science and medical imaging technology are traditionally displayed in two dimensions (2D) on a computer monitor. In contrast, three-dimensional (3D) virtual reality (VR) expands the realm of 2D image visualization, enabling an immersive VR experience with unhindered spatial interaction by the user. Thus far, analysis of data extracted from VR applications was mainly qualitative. In this study, we enhance VR and provide evidence for quantitative VR research by validating digital VR display of computed tomography (CT) data of the orbit. Volumetric CT data were transferred and rendered into a VR environment. Subsequently, seven graders performed repeated and blinded diameter measurements. the intergrader variability of the measurements in VR was much lower compared to measurements in the physical world and measurements were reasonably consistent with their corresponding elements in the real context. The overall VR measurements were 5.49% higher. As such, this study attests the ability of VR to provide similar quantitative data alongside the added benefit of VR interfaces. VR entails a lot of potential for the future research in ophthalmology and beyond in any scientific field that uses three-dimensional data. Orbital tumors can either be primary, arising from structures within the orbit, or secondary, due to metastatic spread of a primary tumor elsewhere 1-3. A myriad of clinical findings suggest the presence of an orbital mass, namely proptosis, diplopia, pain, conjunctival congestion and varying degrees of visual loss 4,5. Diagnosis relies on adequate clinical examination and orbital imaging like magnetic resonance imaging (MRI) and/or computed tomography (CT) 6. Despite the great progress in medical imaging, the diagnosis of orbital lesions based on neuroimaging features may lack characteristic imaging features. Often, the diagnosis of specific orbital disorders such as Graves' disease associated orbitopathy, orbital inflammation, orbital lymphoma, lacrimal gland epithelial tumor, metastatic carcinoma, and vascular orbital lesions is ambiguous 7-10. Confirmation of the diagnosis frequently relies on a biopsy which can be technically challenging and prone to complications due to the dense arrangement of tissue or inaccessibility of many of these lesions 11. Visualization of orbital lesions is still based on pre-surgery image assessment of two-dimensional (2D) data visualization on a computer monitor or on intraoperative exploration 12,13. There are increasing possibilities for presentation and interaction with virtual reality 14. In this context, virtual reality (VR) has recently been optimized as an enhanced medical image display method and showed to safeguard visual comfort 15,16. The main objective of this study was to extend current medical image display and validate the level of spatial precision in orbitometry of CT data, representing the physical world, compared to precision in three-dimensional (3D) virtual reality for the first time. This is especially important when new ways are explored to use ...

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Section: Discussionmentioning

confidence: 64%

Validation of virtual reality orbitometry bridges digital and physical worlds

Maloca

Faludi

Żelechowski

et al. 2020

Sci Rep

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“…18 Because tracking was based on a marker directly attached to the head, rigid head fixation as used by van Doormaal et al (for example) was redundant. 7 Time-consuming interruptions of the workflow, such as manual repositioning and reregistration of the hologram as described elsewhere, were not necessary. 18 It has to be mentioned that the test setup used in the puncture series employed a preregistered hologram.…”

Section: Discussionmentioning

confidence: 99%

Augmented reality–assisted ventriculostomy

Schneider

Kunz

Paľa

et al. 2021

Neurosurgical Focus

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OBJECTIVEPlacement of a ventricular drain is one of the most common neurosurgical procedures. However, a higher rate of successful placements with this freehand procedure is desirable. The authors’ objective was to develop a compact navigational augmented reality (AR)–based tool that does not require rigid patient head fixation, to support the surgeon during the operation.METHODSSegmentation and tracking algorithms were developed. A commercially available Microsoft HoloLens AR headset in conjunction with Vuforia marker-based tracking was used to provide guidance for ventriculostomy in a custom-made 3D-printed head model. Eleven surgeons conducted a series of tests to place a total of 110 external ventricular drains under holographic guidance. The HoloLens was the sole active component; no rigid head fixation was necessary. CT was used to obtain puncture results and quantify success rates as well as precision of the suggested setup.RESULTSIn the proposed setup, the system worked reliably and performed well. The reported application showed an overall ventriculostomy success rate of 68.2%. The offset from the reference trajectory as displayed in the hologram was 5.2 ± 2.6 mm (mean ± standard deviation). A subgroup conducted a second series of punctures in which results and precision improved significantly. For most participants it was their first encounter with AR headset technology and the overall feedback was positive.CONCLUSIONSTo the authors’ knowledge, this is the first report on marker-based, AR-guided ventriculostomy. The results from this first application are encouraging. The authors would expect good acceptance of this compact navigation device in a supposed clinical implementation and assume a steep learning curve in the application of this technique. To achieve this translation, further development of the marker system and implementation of the new hardware generation are planned. Further testing to address visuospatial issues is needed prior to application in humans.

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“…Therefore, additional measures must be taken to stabilize holograms and register images to patients. One solution used to digitize 3D coordinates with the HoloLens headset was to affix an image tracking target to a digitizing pointer of known geometry [44] ( Fig. 5 ).…”

Section: Improving Localization Precisionmentioning

confidence: 99%

“…The location of the pointer tip relative to the headset can be determined by tracking the image target. This technique was used to digitize fiducial points and register holographic anatomy to a plastic head model (Panel 2, adapted from van Doormaal et al 2019 [44] ). …”

Section: Improving Localization Precisionmentioning

confidence: 99%

Registration Techniques for Clinical Applications of Three-Dimensional Augmented Reality Devices

Andrews

Henry²,

Soriano³

et al. 2021

IEEE J. Transl. Eng. Health Med.

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Many clinical procedures would benefit from direct and intuitive real-time visualization of anatomy, surgical plans, or other information crucial to the procedure. Three-dimensional augmented reality (3D-AR) is an emerging technology that has the potential to assist physicians with spatial reasoning during clinical interventions. The most intriguing applications of 3D-AR involve visualizations of anatomy or surgical plans that appear directly on the patient. However, commercially available 3D-AR devices have spatial localization errors that are too large for many clinical procedures. For this reason, a variety of approaches for improving 3D-AR registration accuracy have been explored. The focus of this review is on the methods, accuracy, and clinical applications of registering 3D-AR devices with the clinical environment. The works cited represent a variety of approaches for registering holograms to patients, including manual registration, computer vision-based registration, and registrations that incorporate external tracking systems. Evaluations of user accuracy when performing clinically relevant tasks suggest that accuracies of approximately 2 mm are feasible. 3D-AR device limitations due to the vergenceaccommodation conflict or other factors attributable to the headset hardware add on the order of 1.5 mm of error compared to conventional guidance. Continued improvements to 3D-AR hardware will decrease these sources of error.

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Clinical Accuracy of Holographic Navigation Using Point-Based Registration on Augmented-Reality Glasses

Cited by 68 publications

References 9 publications

Validation of virtual reality orbitometry bridges digital and physical worlds

Validation of virtual reality orbitometry bridges digital and physical worlds

Augmented reality–assisted ventriculostomy

Registration Techniques for Clinical Applications of Three-Dimensional Augmented Reality Devices

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