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Head-mounted display augmented reality to guide pedicle screw placement utilizing computed tomography

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Augmented reality has potential to enhance surgical navigation and visualization. We determined whether head-mounted display augmented reality (HMD-AR) with superimposed computed tomography (CT) data could allow the wearer to percutaneously guide pedicle screw placement in an opaque lumbar model with no real-time fluoroscopic guidance.

Methods

CT imaging was obtained of a phantom composed of L1–L3 Sawbones vertebrae in opaque silicone. Preprocedural planning was performed by creating virtual trajectories of appropriate angle and depth for ideal approach into the pedicle, and these data were integrated into the Microsoft HoloLens using the Novarad OpenSight application allowing the user to view the virtual trajectory guides and CT images superimposed on the phantom in two and three dimensions. Spinal needles were inserted following the virtual trajectories to the point of contact with bone. Repeat CT revealed actual needle trajectory, allowing comparison with the ideal preprocedural paths.

Results

Registration of AR to phantom showed a roughly circular deviation with maximum average radius of 2.5 mm. Users took an average of 200 s to place a needle. Extrapolation of needle trajectory into the pedicle showed that of 36 needles placed, 35 (97%) would have remained within the pedicles. Needles placed approximated a mean distance of 4.69 mm in the mediolateral direction and 4.48 mm in the craniocaudal direction from pedicle bone edge.

Conclusion

To our knowledge, this is the first peer-reviewed report and evaluation of HMD-AR with superimposed 3D guidance utilizing CT for spinal pedicle guide placement for the purpose of cannulation without the use of fluoroscopy.

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Acknowledgements

We would like to thank Novarad for allowing us to use the Novarad PACS software and the OpenSight application to perform this research.

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Authors and Affiliations

  1. School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA

    Jacob T. Gibby, Samuel A. Swenson, Raj Rao & Ramin Javan

  2. Novarad Corporation, 752 East 1180 South, Suite 200, American Fork, UT, 84003, USA

    Steve Cvetko

  3. Department of Orthopedic Surgery, George Washington University Hospital, 900 23rd St NW, Washington, DC, 20037, USA

    Raj Rao

  4. Department of Neuroradiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA

    Ramin Javan

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  1. Jacob T. Gibby
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Correspondence to Ramin Javan.

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Steve Cvetko is an employee of Novarad. The remaining authors declare that they have no conflict of interest.

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Gibby, J.T., Swenson, S.A., Cvetko, S. et al. Head-mounted display augmented reality to guide pedicle screw placement utilizing computed tomography. Int J CARS 14, 525–535 (2019). https://doi.org/10.1007/s11548-018-1814-7

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  • DOI: https://doi.org/10.1007/s11548-018-1814-7

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