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Finos K, Datta S, Sedrakyan A, Milsom JW, Pua BB. Mixed reality in interventional radiology: a focus on first clinical use of XR90 augmented reality-based visualization and navigation platform. Expert Rev Med Devices 2024; 21:679-688. [PMID: 39054630 DOI: 10.1080/17434440.2024.2379925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Augmented reality (AR) and virtual reality (VR) are emerging tools in interventional radiology (IR), enhancing IR education, preprocedural planning, and intraprocedural guidance. AREAS COVERED This review identifies current applications of AR/VR in IR, with a focus on studies that assess the clinical impact of AR/VR. We outline the relevant technology and assess current limitations and future directions in this space. We found that the use of AR in IR lags other surgical fields, and the majority of the data exists in case series or small-scale studies. Educational use of AR/VR improves learning anatomy, procedure steps, and procedural learning curves. Preprocedural use of AR/VR decreases procedure times, especially in complex procedures. Intraprocedural AR for live tracking is accurate within 5 mm live patients and has up to 0.75 mm in phantoms, offering decreased procedure time and radiation exposure. Challenges include cost, ergonomics, rapid segmentation, and organ motion. EXPERT OPINION The use of AR/VR in interventional radiology may lead to safer and more efficient procedures. However, more data from larger studies is needed to better understand where AR/VR is confers the most benefit in interventional radiology clinical practice.
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Affiliation(s)
- Kyle Finos
- Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, USA
| | - Sanjit Datta
- Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, USA
| | - Art Sedrakyan
- Population Health Science, New York Presbyterian Hospital/Weill Cornell Medicine, New York, USA
| | - Jeffrey W Milsom
- Division of Colorectal Surgery, New York Presbyterian Hospital/Weill Cornell Medicine, New York, USA
| | - Bradley B Pua
- Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, USA
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Xu Y, Cheng Y, Guo Y, Chen G, Han X, Sheng Y, Wang W, Wu X. Preliminary application of three-dimensional venography and fusion navigation technique in May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord 2024; 12:101660. [PMID: 37572776 DOI: 10.1016/j.jvsv.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 07/22/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE The purpose of this study was to report a technique for intraprocedural guidance of endovascular iliac vein stenting procedures using three-dimensional (3D) venography images as an overlay on live biplanar fluoroscopy. METHODS Using 3D venography and a fusion navigation technique, percutaneous transluminal angioplasty and stent placement were performed to evaluate the feasibility of using 3D venography images and the fusion navigation technique to treat MTS compared with traditional digital subtraction angiography. The general epidemiologic data (ie, age, gender), clinical manifestations (ie, major symptoms, affected extremity, CEAP [clinical, etiology, anatomy, pathophysiology] classification, comorbidity, stenosis rate), intraoperative findings (ie, stent type, stent count, stent to inferior vena cava distance, procedure time, radiation dose, contrast agent dosage), and postoperative recovery were obtained and analyzed. RESULTS A total of 30 consecutive patients with symptomatic MTS from our institution were enrolled in the present study. Of the 30 patients, 12 (group A) were treated using 3D venography images and fusion navigation and 18 (group B) were treated with two-dimensional venography images during endovascular management. Significant differences were observed between the two groups with respect to the procedure time (64.42 ± 4.35 minutes vs 76.61 ± 3.47 minutes; P = .04), radiation dose (2152 ± 124.7 mGy vs 2561 ± 105.6 mGy; P = .02), and contrast agent dosage (71.42 ± 4.87 mL vs 86.17 ± 4.14 mL; P = .03). CONCLUSIONS 3D venography and its fusion navigation technique can improve prediction of the coverage area of the stent. Its use can also shorten the procedure time and reduce the contrast agent dose and radiation exposure, making it a valuable tool for both the diagnosis and the treatment of symptomatic MTS.
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Affiliation(s)
- Yingjiang Xu
- Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Yongjia Cheng
- Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Yifan Guo
- Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Gang Chen
- Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Xinqiang Han
- Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Yuguo Sheng
- Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Wenming Wang
- Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Xuejun Wu
- Department of Vascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.
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Saccenti L, Bessy H, Ben Jedidia B, Longere B, Tortolano L, Derbel H, Luciani A, Kobeiter H, Grandpierre T, Tacher V. Performance Comparison of Augmented Reality Versus Ultrasound Guidance for Puncture: A Phantom Study. Cardiovasc Intervent Radiol 2024; 47:993-999. [PMID: 38710797 DOI: 10.1007/s00270-024-03727-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/02/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Augmented reality (AR) is an innovative approach that could assist percutaneous procedures; by directly seeing "through" a phantom, targeting a lesion might be more intuitive than using ultrasound (US). The objective of this study was to compare the performance of experienced interventional radiologists and operators untrained in soft tissue lesion puncture using AR guidance and standard US guidance. MATERIAL AND METHODS Three trained interventional radiologists with 5-10 years of experience and three untrained operators performed punctures of five targets in an abdominal phantom, with US guidance and AR guidance. Correct targeting, accuracy (defined as the Euclidean distance between the tip and the center of the target), planning time, and puncture time were documented. RESULTS Accuracy was higher for the trained group than the untrained group using US guidance (1 mm versus 4 mm, p = 0.001), but not when using AR guidance (4 mm vs. 4 mm, p = 0.76). All operators combined, no significant difference was found concerning accuracy between US and AR guidance (2 mm vs. 4 mm, p = 0.09), but planning time and puncture time were significantly shorter using AR (respectively, 15.1 s vs. 74 s, p < 0.001; 16.1 s vs. 59 s; p < 0.001). CONCLUSION Untrained and trained operators obtained comparable accuracy in percutaneous punctures when using AR guidance whereas US performance was better in the experienced group. All operators together, accuracy was similar between US and AR guidance, but shorter planning time, puncture time were found for AR guidance.
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Affiliation(s)
- Laetitia Saccenti
- Imagerie Medicale, Hopital Henri Mondor, Creteil, France.
- Henri Mondor's Institute of Biomedical Research, Inserm, U955 Team N°18, Creteil, France.
| | - Hugo Bessy
- Imagerie Medicale, Hopital Henri Mondor, Creteil, France
| | | | - Benjamin Longere
- Department of Cardiovascular Radiology, CHU Lille, 59000, Lille, France
| | | | - Haytham Derbel
- Imagerie Medicale, Hopital Henri Mondor, Creteil, France
- Henri Mondor's Institute of Biomedical Research, Inserm, U955 Team N°18, Creteil, France
| | - Alain Luciani
- Imagerie Medicale, Hopital Henri Mondor, Creteil, France
- Henri Mondor's Institute of Biomedical Research, Inserm, U955 Team N°18, Creteil, France
| | - Hicham Kobeiter
- Imagerie Medicale, Hopital Henri Mondor, Creteil, France
- Henri Mondor's Institute of Biomedical Research, Inserm, U955 Team N°18, Creteil, France
| | - Thierry Grandpierre
- Ecole superieure d'ingenieurs en electrotechnique et electronique, ESIEE Paris, Noisy Le Grand, France
| | - Vania Tacher
- Imagerie Medicale, Hopital Henri Mondor, Creteil, France
- Henri Mondor's Institute of Biomedical Research, Inserm, U955 Team N°18, Creteil, France
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Yang S, Wang Y, Ai D, Geng H, Zhang D, Xiao D, Song H, Li M, Yang J. Augmented Reality Navigation System for Biliary Interventional Procedures With Dynamic Respiratory Motion Correction. IEEE Trans Biomed Eng 2024; 71:700-711. [PMID: 38241137 DOI: 10.1109/tbme.2023.3316290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Biliary interventional procedures require physicians to track the interventional instrument tip (Tip) precisely with X-ray image. However, Tip positioning relies heavily on the physicians' experience due to the limitations of X-ray imaging and the respiratory interference, which leads to biliary damage, prolonged operation time, and increased X-ray radiation. METHODS We construct an augmented reality (AR) navigation system for biliary interventional procedures. It includes system calibration, respiratory motion correction and fusion navigation. Firstly, the magnetic and 3D computed tomography (CT) coordinates are aligned through system calibration. Secondly, a respiratory motion correction method based on manifold regularization is proposed to correct the misalignment of the two coordinates caused by respiratory motion. Thirdly, the virtual biliary, liver and Tip from CT are overlapped to the corresponding position of the patient for dynamic virtual-real fusion. RESULTS Our system is respectively evaluated and achieved an average alignment error of 0.75 ± 0.17 mm and 2.79 ± 0.46 mm on phantoms and patients. The navigation experiments conducted on phantoms achieve an average Tip positioning error of 0.98 ± 0.15 mm and an average fusion error of 1.67 ± 0.34 mm after correction. CONCLUSION Our system can automatically register the Tip to the corresponding location in CT, and dynamically overlap the 3D virtual model onto patients to provide accurate and intuitive AR navigation. SIGNIFICANCE This study demonstrates the clinical potential of our system by assisting physicians during biliary interventional procedures. Our system enables dynamic visualization of virtual model on patients, reducing the reliance on contrast agents and X-ray usage.
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Tsai AY, Carter SR, Greene AC. Artificial intelligence in pediatric surgery. Semin Pediatr Surg 2024; 33:151390. [PMID: 38242061 DOI: 10.1016/j.sempedsurg.2024.151390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Artificial intelligence (AI) is rapidly changing the landscape of medicine and is already being utilized in conjunction with medical diagnostics and imaging analysis. We hereby explore AI applications in surgery and examine its relevance to pediatric surgery, covering its evolution, current state, and promising future. The various fields of AI are explored including machine learning and applications to predictive analytics and decision support in surgery, computer vision and image analysis in preoperative planning, image segmentation, surgical navigation, and finally, natural language processing assist in expediting clinical documentation, identification of clinical indications, quality improvement, outcome research, and other types of automated data extraction. The purpose of this review is to familiarize the pediatric surgical community with the rise of AI and highlight the ongoing advancements and challenges in its adoption, including data privacy, regulatory considerations, and the imperative for interdisciplinary collaboration. We hope this review serves as a comprehensive guide to AI's transformative influence on surgery, demonstrating its potential to enhance pediatric surgical patient outcomes, improve precision, and usher in a new era of surgical excellence.
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Affiliation(s)
- Anthony Y Tsai
- Division of Pediatric Surgery, Penn State Health Children's Hospital, 500 University Drive, Hershey, PA 17033, United States.
| | - Stewart R Carter
- Division of Pediatric Surgery, University of Louisville School of Medicine, Louisville, KY, United States
| | - Alicia C Greene
- Division of Pediatric Surgery, Penn State Health Children's Hospital, 500 University Drive, Hershey, PA 17033, United States
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Elsakka A, Park BJ, Marinelli B, Swinburne NC, Schefflein J. Virtual and Augmented Reality in Interventional Radiology: Current Applications, Challenges, and Future Directions. Tech Vasc Interv Radiol 2023; 26:100919. [PMID: 38071031 PMCID: PMC11152052 DOI: 10.1016/j.tvir.2023.100919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Virtual reality (VR) and augmented Reality (AR) are emerging technologies with the potential to revolutionize Interventional radiology (IR). These innovations offer advantages in patient care, interventional planning, and educational training by improving the visualization and navigation of medical images. Despite progress, several challenges hinder their widespread adoption, including limitations in navigation systems, cost, clinical acceptance, and technical constraints of AR/VR equipment. However, ongoing research holds promise with recent advancements such as shape-sensing needles and improved organ deformation modeling. The development of deep learning techniques, particularly for medical imaging segmentation, presents a promising avenue to address existing accuracy and precision issues. Future applications of AR/VR in IR include simulation-based training, preprocedural planning, intraprocedural guidance, and increased patient engagement. As these technologies advance, they are expected to facilitate telemedicine, enhance operational efficiency, and improve patient outcomes, marking a new frontier in interventional radiology.
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Affiliation(s)
- Ahmed Elsakka
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian J Park
- Oregon Health & Science University, Portland, OR
| | - Brett Marinelli
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nathaniel C Swinburne
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Javin Schefflein
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Frymus J, Trębacz P, Kurkowska A, Pawlik M, Barteczko A, Barański M, Galanty M. Three-Dimensional Models of Liver Vessels for Navigation during Laparotomic Attenuation of Intrahepatic Portosystemic Shunt in Dogs. Animals (Basel) 2023; 13:2004. [PMID: 37370514 DOI: 10.3390/ani13122004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Laparotomic attenuation of an intrahepatic portosystemic shunt (IHPSS) is more difficult than an extrahepatic one, and results in a higher risk of complications because the identification of the aberrant vessel in the liver remains often a challenge. Excessive preparation and traction of the parenchyma results in trauma, bleeding, and prolonged surgery, which is what worsens the prognosis. Therefore, based on computed tomographic angiography, we printed 3-dimensional (3D) individual patient liver models, scaled 1:1, and used them for surgery planning and as a guide during intraoperative identification of the shunt in four dogs with IHPSS. The advantages of the 3D technology are simple and precise planning of the surgery, fast intraoperative identification of the shunt, and low invasive dissection of the liver parenchyma. We conclude that 3D technology can potentially raise the recovery rate. To the best of our knowledge, this was the first application of 3D models in the surgery of canine IHPSS.
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Affiliation(s)
- Jan Frymus
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, 02-776 Warsaw, Poland
| | - Piotr Trębacz
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, 02-776 Warsaw, Poland
| | - Aleksandra Kurkowska
- CABIOMEDE Sp. z o. o., Kielce Technology Park, Olszewskiego 6, 25-663 Kielce, Poland
| | - Mateusz Pawlik
- CABIOMEDE Sp. z o. o., Kielce Technology Park, Olszewskiego 6, 25-663 Kielce, Poland
| | - Anna Barteczko
- CABIOMEDE Sp. z o. o., Kielce Technology Park, Olszewskiego 6, 25-663 Kielce, Poland
| | - Michał Barański
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, 02-776 Warsaw, Poland
| | - Marek Galanty
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, 02-776 Warsaw, Poland
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Luo Y, Ren J, Long J, Wang L, Zeng H, Tong D. An algorithm for cognitive fusion targeted tumor puncture based on 3-D mathematical modelling. Heliyon 2022; 9:e12742. [PMID: 36685453 PMCID: PMC9852925 DOI: 10.1016/j.heliyon.2022.e12742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
Background Percutaneous puncture is an important means of tumor diagnosis and treatment. At present, most puncture operations are still based on imaging location and clinical experience, and quantitative and accurate targeted puncture cannot be achieved. How to improve the accuracy of percutaneous tumor puncture, avoid errors to the greatest extent, reduce the occurrence of complications, and improve the overall clinical diagnosis and treatment quality and curative effect, are scientific problems worthy of further study. Method In the present study, mathematical modeling was first used to construct the tumor puncture path, determine the needle entry angle, and define the relevant limited parameters and the substitution formula. Secondly, relevant parameters were extracted from CT and other imaging data and substituted into formulas, the deviation angle and puncture path were determined, and the personalized tumor puncture scheme was carried out. Third, targeted puncture was precisely implemented under the guidance of B-ultrasound. Compared with the traditional empirical puncture, our model improved the accuracy, decreased the puncture time, and reduced the pain of diagnosis and treatment for patients. Results A tumor-targeted puncture model was established based on mathematical theory and imaging data. By extracting clinical data, such as tumor radius, projection distance of tumor center and projection distance from puncture point to body surface, the optimal puncture deviation angle was modeled and calculated and a personalized puncture scheme was established. Compared with the conventional method, our model markedly increased the puncture accuracy rate by ∼30%. The puncture number was decreased by ∼50% using our model. Furthermore, our model shortened the operation time by 20% to ease pain of patients and guarantee greater security for patients. Doctor satisfaction and patient discomfort scores were examined. Our model improved doctor satisfaction by ∼20% and reduced subjective discomfort of patients by ∼25%. These data revealed that the model could markedly improve the accuracy and efficiency of puncture, clinical efficacy and accuracy of tumor diagnosis. Additionally, the confidence of doctors in the operation was greatly enhanced and patient discomfort was greatly reduced. Conclusion The present study analyzed in detail how to find the best puncture path using a mathematical model. Based on the mathematical model of cognitive fusion puncture, combined with clinical personalized data and mathematical calculation analysis, accurate puncture was effectively realized. It not only greatly improved the effectiveness of puncture, but also ensured the safety of clinical patients and reduced injury, which means it may be worthy of clinical application.
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Affiliation(s)
- Yong Luo
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Junjie Ren
- School of Sciences, Southwest Petroleum University, Chengdu, 610500, Sichuan, China
| | - Jun Long
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, 401147, China
| | - Li Wang
- Department of Gastrointestinal Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China,Corresponding author.
| | - Hong Zeng
- Department of Urology, Traditional Medicine Hospital of Jiangjin District, Chongqing, 402260, China,Corresponding author.
| | - Dali Tong
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400042, China,Corresponding author.
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Büttner L, Aigner A, Pick L, Brittinger J, Steib CJ, Böning G, Streitparth F. 25 years of experience with transjugular intrahepatic portosystemic shunt (TIPS): changes in patient selection and procedural aspects. Insights Imaging 2022; 13:73. [PMID: 35416547 PMCID: PMC9008097 DOI: 10.1186/s13244-022-01216-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
Background TIPS is an established treatment for portal hypertension. The aim was to analyze how patient selection for TIPS implantation and procedural aspects have changed over 25 years. Routinely collected demographic, clinical, laboratory, and procedural data of 835 patients treated with TIPS in a single center were used. Time trends over the observational period from 1993 to 2018 were retrospectively analyzed. Descriptive statistical analysis was performed. Results The most common indication for TIPS implantation has changed significantly from secondary prevention of variceal hemorrhage in the early years to treatment of recurrent ascites. During the observation period, increasingly more severely ill patients became TIPS candidates. There was little change in MELD scores over this period (in total median 13.00; IQR 10.00–18.00). The proportion of patients with Child–Pugh C cirrhosis increased. The most frequent underlying diseases in total were alcohol-related liver disease (66.5%) and viral hepatitis (11.9%). However, shares of cryptogenic liver cirrhosis, autoimmune hepatitis, and NASH increased over time. The proportion of patients post liver transplant also increased. While bare metal stents were standard in the past, use of covered stents increased. The success rate of TIPS (defined by successful implantation and a decrease in the portosystemic pressure gradient ≤ 12 mmHg) increased significantly over time. The total success rate according to this definition was 84.9%. Conclusion The results of our analysis reflect technical developments in TIPS, especially in terms of stent material and gains in clinical experience, particularly regarding indications and patient selection for TIPS implantation.
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Affiliation(s)
- Laura Büttner
- Department of Radiology, Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Annette Aigner
- Institute of Biometry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Lisa Pick
- Department of Radiology, Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Josefine Brittinger
- Department of Radiology, Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christian J Steib
- Medical Clinic II, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Georg Böning
- Department of Radiology, Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Florian Streitparth
- Department of Radiology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Birlo M, Edwards PJE, Clarkson M, Stoyanov D. Utility of optical see-through head mounted displays in augmented reality-assisted surgery: A systematic review. Med Image Anal 2022; 77:102361. [PMID: 35168103 PMCID: PMC10466024 DOI: 10.1016/j.media.2022.102361] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
This article presents a systematic review of optical see-through head mounted display (OST-HMD) usage in augmented reality (AR) surgery applications from 2013 to 2020. Articles were categorised by: OST-HMD device, surgical speciality, surgical application context, visualisation content, experimental design and evaluation, accuracy and human factors of human-computer interaction. 91 articles fulfilled all inclusion criteria. Some clear trends emerge. The Microsoft HoloLens increasingly dominates the field, with orthopaedic surgery being the most popular application (28.6%). By far the most common surgical context is surgical guidance (n=58) and segmented preoperative models dominate visualisation (n=40). Experiments mainly involve phantoms (n=43) or system setup (n=21), with patient case studies ranking third (n=19), reflecting the comparative infancy of the field. Experiments cover issues from registration to perception with very different accuracy results. Human factors emerge as significant to OST-HMD utility. Some factors are addressed by the systems proposed, such as attention shift away from the surgical site and mental mapping of 2D images to 3D patient anatomy. Other persistent human factors remain or are caused by OST-HMD solutions, including ease of use, comfort and spatial perception issues. The significant upward trend in published articles is clear, but such devices are not yet established in the operating room and clinical studies showing benefit are lacking. A focused effort addressing technical registration and perceptual factors in the lab coupled with design that incorporates human factors considerations to solve clear clinical problems should ensure that the significant current research efforts will succeed.
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Affiliation(s)
- Manuel Birlo
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK.
| | - P J Eddie Edwards
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
| | - Matthew Clarkson
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
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