Augmented Reality Visualization for Image-Guided Surgery: A Validation Study Using a Three-Dimensional Printed Phantom

H H Glas; J Kraeima; P M A van Ooijen; F K L Spijkervet; L Yu; M J H Witjes

doi:10.1016/j.joms.2021.04.001

Augmented Reality Visualization for Image-Guided Surgery: A Validation Study Using a Three-Dimensional Printed Phantom

J Oral Maxillofac Surg. 2021 Sep;79(9):1943.e1-1943.e10. doi: 10.1016/j.joms.2021.04.001. Epub 2021 Apr 15.

Authors

H H Glas¹, J Kraeima², P M A van Ooijen³, F K L Spijkervet⁴, L Yu⁵, M J H Witjes⁶

Affiliations

¹ Technical Physician, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: [email protected].
² Technical Physician, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Associate Professor Faculty of Medical Sciences, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁴ Professor, Oral and Maxillofacial Surgeon, Head of the Department, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁵ Lecturer in the Department of Computer Science and Software Engineering (CSSE), Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁶ Oral and Maxillofacial Surgeon, Principal Investigator, Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

PMID: 34033801
DOI: 10.1016/j.joms.2021.04.001

Abstract

Background: Oral and maxillofacial surgery currently relies on virtual surgery planning based on image data (CT, MRI). Three-dimensional (3D) visualizations are typically used to plan and predict the outcome of complex surgical procedures. To translate the virtual surgical plan to the operating room, it is either converted into physical 3D-printed guides or directly translated using real-time navigation systems.

Purpose: This study aims to improve the translation of the virtual surgery plan to a surgical procedure, such as oncologic or trauma surgery, in terms of accuracy and speed. Here we report an augmented reality visualization technique for image-guided surgery. It describes how surgeons can visualize and interact with the virtual surgery plan and navigation data while in the operating room. The user friendliness and usability is objectified by a formal user study that compared our augmented reality assisted technique to the gold standard setup of a perioperative navigation system (Brainlab). Moreover, accuracy of typical navigation tasks as reaching landmarks and following trajectories is compared.

Results: Overall completion time of navigation tasks was 1.71 times faster using augmented reality (P = .034). Accuracy improved significantly using augmented reality (P < .001), for reaching physical landmarks a less strong correlation was found (P = .087). Although the participants were relatively unfamiliar with VR/AR (rated 2.25/5) and gesture-based interaction (rated 2/5), they reported that navigation tasks become easier to perform using augmented reality (difficulty Brainlab rated 3.25/5, HoloLens 2.4/5).

Conclusion: The proposed workflow can be used in a wide range of image-guided surgery procedures as an addition to existing verified image guidance systems. Results of this user study imply that our technique enables typical navigation tasks to be performed faster and more accurately compared to the current gold standard. In addition, qualitative feedback on our augmented reality assisted technique was more positive compared to the standard setup.?>.

MeSH terms

Augmented Reality*
Humans
Imaging, Three-Dimensional
Operating Rooms
Surgery, Computer-Assisted*
Surgery, Oral*
Workflow