The state of the art of visualization in mixed reality image guided surgery.

Medical augmented reality (AR) has been widely discussed within the medical imaging as well as computer aided surgery communities. Different systems for exemplary medical applications have been proposed. Some of them produced promising results. One major issue still hindering AR technology to be regularly used in medical applications is the interaction between physician and the superimposed 3-D virtual data. Classical interaction paradigms, for instance with keyboard and mouse, to interact with visualized medical 3-D imaging data are not adequate for an AR environment. This paper introduces the concept of a tangible/controllable virtual mirror for medical AR applications. This concept intuitively augments the direct view of the surgeon with all desired views on volumetric medical imaging data registered with the operation site without moving around the operating table or displacing the patient. We selected two medical procedures to demonstrate and evaluate the potentials of the Virtual Mirror for the surgical workflow. Results confirm the intuitiveness of this new paradigm and its perceptive advantages for AR-based computer aided interventions.

/pdf/the-virtual-mirror-a-new-interaction-paradigm-for-augmented-jppq4gh6za.pdf

The Virtual Mirror: A New Interaction Paradigm for Augmented Reality Environments

Purpose. We analyzed the literature to determine (1) the surgically relevant applications for which head-mounted display (HMD) use is reported; (2) the types of HMD most commonly reported; and (3) the surgical specialties in which HMD use is reported. Methods. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched through August 27, 2017, for publications describing HMD use during surgically relevant applications. We identified 120 relevant English-language, non-opinion publications for inclusion. HMD types were categorized as "heads-up" (nontransparent HMD display and direct visualization of the real environment), "see-through" (visualization of the HMD display overlaid on the real environment), or "non-see-through" (visualization of only the nontransparent HMD display). Results. HMDs were used for image guidance and augmented reality (70 publications), data display (63 publications), communication (34 publications), and education/training (18 publications). See-through HMDs were described in 55 publications, heads-up HMDs in 41 publications, and non-see-through HMDs in 27 publications. Google Glass, a see-through HMD, was the most frequently used model, reported in 32 publications. The specialties with the highest frequency of published HMD use were urology (20 publications), neurosurgery (17 publications), and unspecified surgical specialty (20 publications). Conclusion. Image guidance and augmented reality were the most commonly reported applications for which HMDs were used. See-through HMDs were the most commonly reported type used in surgically relevant applications. Urology and neurosurgery were the specialties with greatest published HMD use.

https://journals.sagepub.com/doi/pdf/10.1177/1553350619871787

Head-Mounted Display Use in Surgery: A Systematic Review

Optical see-through head-mounted displays (OST-HMD) feature an unhindered and instantaneous view of the surgery site and can enable a mixed reality experience for surgeons during procedures. In this paper, we present a systematic approach to identify the criteria for evaluation of OST-HMD technologies for specific clinical scenarios, which benefit from using an object-anchored 2D-display visualizing medical information. Criteria for evaluating the performance of OST-HMDs for visualization of medical information and its usage are identified and proposed. These include text readability, contrast perception, task load, frame rate, and system lag. We choose to compare three commercially available OST-HMDs, which are representatives of currently available head-mounted display technologies. A multi-user study and an offline experiment are conducted to evaluate their performance. Statistical analysis demonstrates that Microsoft HoloLens performs best among the three tested OST-HMDs, in terms of contrast perception, task load, and frame rate, while ODG R-7 offers similar text readability. The integration of indoor localization and fiducial tracking on the HoloLens provides significantly less system lag in a relatively motionless scenario. With ever more OST-HMDs appearing on the market, the proposed criteria could be used in the evaluation of their suitability for mixed reality surgical intervention. Currently, Microsoft HoloLens may be more suitable than ODG R-7 and Epson Moverio BT-200 for clinical usability in terms of the evaluated criteria. To the best of our knowledge, this is the first paper that presents a methodology and conducts experiments to evaluate and compare OST-HMDs for their use as object-anchored 2D-display during interventions.

/pdf/comparison-of-optical-see-through-head-mounted-displays-for-4w5rr7gj85.pdf

Comparison of optical see-through head-mounted displays for surgical interventions with object-anchored 2D-display.

Cerebral vascular images obtained through angiography are used by neurosurgeons for diagnosis, surgical planning, and intraoperative guidance. The intricate branching of the vessels and furcations, however, make the task of understanding the spatial three-dimensional layout of these images challenging. In this paper, we present empirical studies on the effect of different perceptual cues (fog, pseudo-chromadepth, kinetic depth, and depicting edges) both individually and in combination on the depth perception of cerebral vascular volumes and compare these to the cue of stereopsis. Two experiments with novices and one experiment with experts were performed. The results with novices showed that the pseudo-chromadepth and fog cues were stronger cues than that of stereopsis. Furthermore, the addition of the stereopsis cue to the other cues did not improve relative depth perception in cerebral vascular volumes. In contrast to novices, the experts also performed well with the edge cue. In terms of both novice and expert subjects, pseudo-chromadepth and fog allow for the best relative depth perception. By using such cues to improve depth perception of cerebral vasculature, we may improve diagnosis, surgical planning, and intraoperative guidance.

An Evaluation of Depth Enhancing Perceptual Cues for Vascular Volume Visualization in Neurosurgery

Augmented reality (AR) for preoperative diagnostics and planning, intra operative navigation and postoperative follow-up examination has been a topic of intensive research over the last two decades. However, clinical studies showing AR technology integrated into the real clinical environment and workflow are still rare. The incorporation of an AR system as a standard tool into the real clinical workflow has not been presented so far. This paper reports on the strategies and intermediate results of the ARAV - augmented reality aided vertebroplasty project that has been initiated to make an AR system based on a stereo video see-through head mounted display that is permanently available in the operating room (OR).

Stepping into the operating theater: ARAV — Augmented Reality Aided Vertebroplasty

Neuroimaging data collection is very costly, and acquisition is commonly distributed across multiple sites. However, factors such as different noise characteristics or inhomogeneities make it difficult to successfully combine multi-site functional imaging data. Here, we show that the distribution of signal quality measures across scanners can be significantly different, and that this will have an impact on correlation estimators necessary for computing functional connectivity graphs as well as topological features extracted from the graphs. We propose to find a stable subspace by using a discriminative projection that does not only minimise site differences, but also preserves discriminative class information. We compare our method with the “regressing-out” approach in a cross-validation setting and show that regressing out can yield very poor results.

/pdf/learning-with-multi-site-fmri-graph-data-29nwc7zyvw.pdf

Learning with multi-site fMRI graph data

In this paper, we present an interactive X-Ray perceptual visualization technique (IXPV) to improve 3D perception in standard single-view X-Ray images. Based on a priori knowledge from CT data, we re-introduce lost depth information into the original single-view X-Ray image without jeopardizing information of the original X-Ray. We propose a novel approach that is suitable for correct fusion of intraoperative X-Ray and ultrasound, co-visualization of X-Ray and surgical tools, and for improving the 3D perception of standard radiographs. Phantom and animal cadaver datasets were used during experimentation to demonstrate the impact of our technique. Results from a questionnaire completed by 11 clinicians and computer scientists demonstrate the added value of introduced depth cues directly in an X-Ray image. In conclusion, we propose IXPV as a futuristic alternative to the standard radiographic image found in today's clinical setting.

/pdf/interactive-3d-visualization-of-a-single-view-x-ray-image-2ss68tfygj.pdf

Interactive 3d visualization of a single-view X-ray image

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Stepping into the operating theater: ARAV — Augmented Reality Aided Vertebroplasty

Learning with multi-site fMRI graph data

Interactive 3d visualization of a single-view X-ray image