Medical Applications of Augmented Reality

Category: Blog,From Academia
blank blank Nov 12, 2020

In this issue, we included three related publications focusing on medical applications of augmented reality and 3D imaging. In particular, two later articles focus on radiology workflow design, treating kidney and prostate cancer, and spine surgery navigation.

From Academia” features recent, relevant, close to commercialization academic publications. Subjects include but not limited to healthcare 3D printing, 3D bioprinting, and related emerging technologies.

Email: Rance Tino (tino.rance@gmail.com) if you want to share relevant academic publications with us.

Applying Modern Virtual and Augmented Reality Technologies to Medical Images and Models

– Authored by Justin Sutherland, Belec, Adnan Sheikh, Leonid Chepelev, Waleed Althobaity, Benjamin J. W. Chow, Dimitrios Mitsouras, Andy Christensen, Frank J. Rybicki, and Daniel J. La Russa. Journal of Digital Imaging. 13 September 2018

Medical Applications of Augmented Reality An illustration of how the user visualizes virtual elements and real-world images with (a) virtual reality, (b) pass-through augmented reality, and (c) see-through augmented reality headsets. Copyright Journal of Digital Imaging.
An illustration of how the user visualizes virtual elements and real-world images with (a) virtual reality, (b) pass-through augmented reality, and (c) see-through augmented reality headsets. Copyright Journal of Digital Imaging.

Abstract: 

Recent technological innovations have created new opportunities for the increased adoption of virtual reality (VR) and augmented reality (AR) applications in medicine. While medical applications of VR have historically seen greater adoption from patient-as-user applications, the new era of VR/AR technology has created the conditions for wider adoption of clinician-as-user applications.

Historically, adoption to clinical use has been limited in part by the ability of the technology to achieve a sufficient quality of experience. This article reviews the definitions of virtual and augmented reality and briefly covers the history of their development.

Currently available options for consumer-level virtual and augmented reality systems are presented, along with a discussion of technical considerations for their adoption in the clinical environment.

Finally, a brief review of the literature of medical VR/AR applications is presented prior to introducing a comprehensive conceptual framework for the viewing and manipulation of medical images in virtual and augmented reality. Using this framework, we outline considerations for placing these methods directly into a radiology-based workflow and show how it can be applied to a variety of clinical scenarios. 

Medical Applications of Augmented Reality Radiological image visualization modes using the same scan set. (a) An example of a segmented model derived from a CT scan. (b) An example of a 2D visualization of an unsegmented image. (c) An example of a “2.5D” visualization. (d) An example of (3D) volume rendering. Copyright Journal of Digital Imaging.
Radiological image visualization modes using the same scan set. (a) An example of a segmented model derived from a CT scan. (b) An example of a 2D visualization of an unsegmented image. (c) An example of a “2.5D” visualization. (d) An example of (3D) volume rendering. Copyright Journal of Digital Imaging.

3D Printing, Augmented Reality, and Virtual Reality for the Assessment and Management of Kidney and Prostate Cancer: A Systematic Review

– Authored by Nicole Wake, Jeffrey E. Nussbaum, Marie I. Elias, Christine V.Nikas, Marc A. Bjurlin, September 2020 

Medical Applications of Augmented Reality Examples of 3D printing (top), AR (middle), and VR (bottom) technologies. Copyright. Advanced Functional Materials
Examples of 3D printing (top), AR (middle), and VR (bottom) technologies. Copyright. Advanced Functional Materials

Abstract: 

Three-dimensional (3D) printing, augmented reality, and virtual reality technologies have an increasing presence in the management of prostate and kidney cancer. To assess the utility of 3D printing, augmented reality, and virtual reality for (1) quantitative outcomes, (2) surgical planning, (3) intraoperative guidance, (4) training and simulation, and (5) patient education for patients with kidney and prostate cancer a systematic literature review was performed.

Existing evidence demonstrates improvement in clinical outcomes, surgical planning, and intra-operative guidance, as well as training.

Future studies are needed to assess the impact of 3D technologies on long-term patient-related outcomes.

Augmented Reality Surgical Navigation in Spine Surgery to Minimize Staff Radiation Exposure

– Authored by Edström, Erik, Burström, Gustav, Omar, Artur, Nachabe, Rami, Söderman, Michael, Persson, Oscar, Gerdhem, Paul, Elmi-Terander, Adrian. Spine. January 2020

Medical Applications of Augmented Reality A, Hybrid operating room showing the ceiling suspended robotic C-arm. B, The Augmented Reality Surgical Navigation cameras are integrated at each side of the x ray detector displaying the real-time video of the surgical field augmented with the navigation path of the instrument held by the surgeon. C, Display on one of the suspended medical monitors of the real-time augmented reality of a navigated device along a predefined planned path on the intraoperative cone beam CT. Copyright. Spine
A, Hybrid operating room showing the ceiling suspended robotic C-arm. B, The Augmented Reality Surgical Navigation cameras are integrated at each side of the x ray detector displaying the real-time video of the surgical field augmented with the navigation path of the instrument held by the surgeon. C, Display on one of the suspended medical monitors of the real-time augmented reality of a navigated device along a predefined planned path on the intraoperative cone beam CT. Copyright. Spine

Abstract: 

Surgical navigation in combination with intraoperative three-dimensional imaging has been shown to significantly increase the clinical accuracy of pedicle screw placement.

Although this technique may increase the total radiation exposure compared with fluoroscopy, the occupational exposure can be minimized, as navigation is radiation-free and staff can be positioned behind protective shielding during three-dimensional imaging. The patient radiation exposure during treatment and verification of pedicle screw positions can also be reduced.

Twenty patients undergoing spine surgery with pedicle screw placement were included in the study. The staff radiation exposure was measured using real-time active personnel dosimeters and was further compared with measurements using a reference dosimeter attached to the C-arm (i.e., a worst-case staff exposure situation). The patient radiation exposures were recorded, and effective doses (ED) were determined.

The average staff exposure per procedure was 0.21 ± 0.06 μSv.

The average staff-to-reference dose ratio per procedure was 0.05% and decreased to less than 0.01% after a few procedures had been performed.

The average patient ED was 15.8 ± 1.8 mSv which mainly correlated with the number of vertebrae treated and the number of cone-beam computed tomography acquisitions performed.

A low-dose protocol used for the final 10 procedures yielded a 32% ED reduction per spinal level treated.

This study demonstrated significantly lower occupational doses compared with values reported in the literature. Real-time active personnel dosimeters contributed to a fast optimization and adoption of protective measures throughout the study. Even though our data include both cone-beam computed tomography for navigation planning and intraoperative screw placement verification, we find low patient radiation exposure levels compared with published data.

Medical Applications of Augmented Reality Patient radiation dose for each performed procedure. The dose values correspond to effective doses calculated in units of mSv using tissue weighting factors from ICRP 103 [REF ICRP 103]. ICRP indicates International Commission on Radiological Protection. Copyright Spine
Patient radiation dose for each performed procedure. The dose values correspond to effective doses calculated in units of mSv using tissue weighting factors from ICRP 103 [REF ICRP 103]. ICRP indicates International Commission on Radiological Protection. Copyright Spine

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