Towards a First-Person Perspective Mixed Reality Guidance System for Needle Interventions

Abstract

While ultrasound (US) guidance has been used during central venous catheterization to reduce complications, including the puncturing of arteries, the rate of such problems remains non-negligible. To further reduce complication rates, mixed-reality systems have been proposed as part of the user interface for such procedures. We demonstrate the use of a surgical navigation system that renders a calibrated US image, and the needle and its trajectory, in a common frame of reference. We compare the effectiveness of this system, whereby images are rendered on a planar monitor and within a head-mounted display (HMD), to the standard-of-care US-only approach, via a phantom-based user study that recruited 31 expert clinicians and 20 medical students. These users performed needle-insertions into a phantom under the three modes of visualization. The success rates were significantly improved under HMD-guidance as compared to US-guidance, for both expert clinicians (94% vs. 70%) and medical students (70% vs. 25%). Users more consistently positioned their needle closer to the center of the vessel’s lumen under HMD-guidance compared to US-guidance. The performance of the clinicians when interacting with this monitor system was comparable to using US-only guidance, with no significant difference being observed across any metrics. The results suggest that the use of an HMD to align the clinician’s visual and motor fields promotes successful needle guidance, highlighting the importance of continued HMD-guidance research.

Mixed-Reality-Assisted Puncture of the Common Femoral Artery in a Phantom Model

“…Previous studies have already suggested MR-assisted vascular access procedures [16,31]. The study of Groves et al suggested improved accuracy results with the use of an HMD when compared with traditional sonography-guidance during central venous catheter placement in a phantom study [16]. To the best of our knowledge, the present study is the first to investigate the feasibility and the positional error of a MR-assisted approach for CFA access using an HMD combined with a commercially available navigation system.…”

“…Adequate visualization of the target vessel is key for a safe vascular access procedure. Previous studies have already suggested MR-assisted vascular access procedures [16,31]. The study of Groves et al suggested improved accuracy results with the use of an HMD when compared with traditional sonography-guidance during central venous catheter placement in a phantom study [16].…”

“…Whereas in VR the user enters a completely simulated virtual environment, MR overlays the physical environment with digital content, offering the advantage for users to interact with these objects while still being able to see real objects. The use of MR in a medical context has previously been described in patient education, teaching and intraoperative navigation in a wide variety of surgical specialties such as orthopedics, neurosurgery, and plastic surgery [8][9][10][11][12][13][14][15][16][17][18][19][20]. Although the futuristic vision of MR as a navigational tool in surgery appears to be especially promising, there are currently many challenges remaining with regards to the technical feasibility and the accuracy of virtual model registration, in addition to the stabilization of the virtual model in a spatial environment.…”

“…The most investigated clinical application in the past has been pedicle screw placement during spine surgery, which has demonstrated promising initial results in several pilot studies [21][22][23][24][25][26]. In the field of vascular surgery, initial studies have also been conducted to investigate the potential of MR [16,27,28]. MR can be utilized to display a three-dimensional reconstruction of a patient's vascular anatomy, derived from computed tomography angiography (CTA, Figure 1).…”

Mixed Reality in der Gefäßchirurgie – ein Scoping Review

“…Operationssaal der Zukunft [2]. Verschiedene Anwendungsfälle von MR-Technologien wurden bereits für die Neurochirurgie [3], Orthopädie und Wirbelsäulenchirurgie [4], Thoraxchirurgie [5], Urologie [6], plastische Chirurgie [7], Viszeralchirurgie [8], interventionelle Radiologie [9], Anästhesie und Intensivmedizin [10,11,12,13,14,15], Gefäßchirurgie [16] und andere Fachdisziplinen beschrieben. Neben der intraoperativen Anwendung sind auch die Lehre und die Patientenaufklärung häufiger Gegenstand wissenschaftlicher Aktivität im Zusammenhang mit MR [17,18].…”