External ventricular drain (EVD) is a common, yet challenging neurosurgical procedure of placing a catheter into the brain ventricular system that requires prolonged training for surgeons to improve the catheter placement accuracy. In this paper, we introduce NeuroLens, an Augmented Reality (AR) system that provides neurosurgeons with guidance that aides them in completing an EVD catheter placement. NeuroLens builds on prior work in AR-assisted EVD to present a registered hologram of a patient’s ventricles to the surgeons, and uniquely incorporates guidance on the EVD catheter’s trajectory, angle of insertion, and distance to the target. The guidance is enabled by tracking the EVD catheter. We evaluate NeuroLens via a study with 33 medical students, in which we analyzed students’ EVD catheter insertion accuracy and completion time, eye gaze patterns, and qualitative responses. Our study, in which NeuroLens was used to aid students in inserting an EVD catheter into a realistic phantom model of a human head, demonstrated the potential of NeuroLens as a tool that will aid and educate novice neurosurgeons. On average, the use of NeuroLens improved the EVD placement accuracy of year 1 students by 39.4% and of the year 2−4 students by 45.7%. Furthermore, students who focused more on NeuroLens-provided contextual guidance achieved better results.
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AR-Assisted Surgical Guidance System for Ventriculostomy
Augmented Reality (AR) is increasingly used in medical applications for visualizing medical information. In this paper, we present an AR-assisted surgical guidance system that aims to improve the accuracy of catheter placement in ventriculostomy, a common neurosurgical procedure. We build upon previous work on neurosurgical AR, which has focused on enabling the surgeon to visualize a patient’s ventricular anatomy, to additionally integrate surgical tool tracking and contextual guidance. Specifically, using accurate tracking of optical markers via an external multi-camera OptiTrack system, we enable Microsoft HoloLens 2-based visualizations of ventricular anatomy, catheter placement, and the information on how far the catheter tip is from its target. We describe the system we developed, present initial hologram registration results, and comment on the next steps that will prepare our system for clinical evaluations.
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- NSF-PAR ID:
- 10315356
- Date Published:
- Journal Name:
- IEEE XR for Healthcare and Wellbeing Workshop
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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The traditional freehand placement of an external ventricular drain (EVD) relies on empirical craniometric landmarks to guide the craniostomy and subsequent passage of the EVD catheter. The diameter and trajectory of the craniostomy physically limit the possible trajectories that can be achieved during the passage of the catheter. In this study, the authors implemented a mixed reality–guided craniostomy procedure to evaluate the benefit of an optimally drilled craniostomy to the accurate placement of the catheter. Optical marker–based tracking using an OptiTrack system was used to register the brain ventricular hologram and drilling guidance for craniostomy using a HoloLens 2 mixed reality headset. A patient-specific 3D-printed skull phantom embedded with intracranial camera sensors was developed to automatically calculate the EVD accuracy for evaluation. User trials consisted of one blind and one mixed reality–assisted craniostomy followed by a routine, unguided EVD catheter placement for each of two different drill bit sizes. A total of 49 participants were included in the study (mean age 23.4 years, 59.2% female). The mean distance from the catheter target improved from 18.6 ± 12.5 mm to 12.7 ± 11.3 mm (p = 0.0008) using mixed reality guidance for trials with a large drill bit and from 19.3 ± 12.7 mm to 10.1 ± 8.4 mm with a small drill bit (p < 0.0001). Accuracy using mixed reality was improved using a smaller diameter drill bit compared with a larger bit (p = 0.039). Overall, the majority of the participants were positive about the helpfulness of mixed reality guidance and the overall mixed reality experience. Appropriate indications and use cases for the application of mixed reality guidance to neurosurgical procedures remain an area of active inquiry. While prior studies have demonstrated the benefit of mixed reality–guided catheter placement using predrilled craniostomies, the authors demonstrate that real-time quantitative and visual feedback of a mixed reality–guided craniostomy procedure can independently improve procedural accuracy and represents an important tool for trainee education and eventual clinical implementation.more » « less
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Abstract Successful surgical operations are characterized by preplanning routines to be executed during actual surgical operations. To achieve this, surgeons rely on the experience acquired from the use of cadavers, enabling technologies like virtual reality (VR) and clinical years of practice. However, cadavers, having no dynamism and realism as they lack blood, can exhibit limited tissue degradation and shrinkage, while current VR systems do not provide amplified haptic feedback. This can impact surgical training increasing the likelihood of medical errors. This work proposes a novel Mixed Reality Combination System (MRCS) that pairs Augmented Reality (AR) technology and an inertial measurement unit (IMU) sensor with 3D printed, collagen-based specimens that can enhance task performance like planning and execution. To achieve this, the MRCS charts out a path prior to a user task execution based on a visual, physical, and dynamic environment on the state of a target object by utilizing surgeon-created virtual imagery that, when projected onto a 3D printed biospecimen as AR, reacts visually to user input on its actual physical state. This allows a real-time user reaction of the MRCS by displaying new multi-sensory virtual states of an object prior to performing on the actual physical state of that same object enabling effective task planning. Tracked user actions using an integrated 9-Degree of Freedom IMU demonstrate task execution This demonstrates that a user, with limited knowledge of specific anatomy, can, under guidance, execute a preplanned task. In addition, to surgical planning, this system can be generally applied in areas such as construction, maintenance, and education.
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Abstract Background In childhood and adolescence, cardiac arrhythmias are often benign in the absence of congenital heart defects. Nevertheless, life-threatening inherited arrhythmogenic syndromes can become clinically manifest in early childhood. As early symptoms may be similar in both conditions, thorough workup is fundamental to avoid delayed diagnosis and misdiagnosis.
Case summary We present the case of a 26-year-old Caucasian female patient who presented with recurrent non-sustained polymorphic wide complex tachycardia. Structural heart disease was excluded by echocardiography as well as cardiac magnetic resonance imaging. Due to wide complex extrasystoles and couplets with alternating QRS axis occurring at low levels of physical exertion, catecholaminergic polymorphic ventricular tachycardia (CPVT) was suspected and further investigated. Epinephrine testing in combination with an electrophysiological (EP) study with placement of a coronary sinus catheter and subsequent programmed stimulation ruled out CPVT and unmasked wide complex tachycardia as varying aberrant conduction of focal atrial tachycardia (FAT). 3D-navigated mapping of FAT revealed a direct parahisian origin. Due to significantly increased risk of atrio-ventricular (AV) block during ablation, the patient refused ablation and preferred medical antiarrhythmic therapy.
Discussion Given the consequences of both, delayed diagnosis and misdiagnosis of CPVT, thorough workup is fundamental. In case of doubt regarding potential aberrant AV conduction in the context of wide complex tachycardia, an invasive EP study may easily and safely prove or rule out aberrancy.
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