scholarly journals Augmented reality–assisted ventriculostomy

2021 ◽  
Vol 50 (1) ◽  
pp. E16
Author(s):  
Max Schneider ◽  
Christian Kunz ◽  
Andrej Pal’a ◽  
Christian Rainer Wirtz ◽  
Franziska Mathis-Ullrich ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Head Model ◽  
Neurosurgical Procedures ◽  
Reference Trajectory ◽  
Success Rates ◽  
Clinical Implementation ◽  
Head Fixation ◽  
Custom Made ◽  
3D Printed ◽  
Microsoft Hololens

OBJECTIVEPlacement of a ventricular drain is one of the most common neurosurgical procedures. However, a higher rate of successful placements with this freehand procedure is desirable. The authors’ objective was to develop a compact navigational augmented reality (AR)–based tool that does not require rigid patient head fixation, to support the surgeon during the operation.METHODSSegmentation and tracking algorithms were developed. A commercially available Microsoft HoloLens AR headset in conjunction with Vuforia marker-based tracking was used to provide guidance for ventriculostomy in a custom-made 3D-printed head model. Eleven surgeons conducted a series of tests to place a total of 110 external ventricular drains under holographic guidance. The HoloLens was the sole active component; no rigid head fixation was necessary. CT was used to obtain puncture results and quantify success rates as well as precision of the suggested setup.RESULTSIn the proposed setup, the system worked reliably and performed well. The reported application showed an overall ventriculostomy success rate of 68.2%. The offset from the reference trajectory as displayed in the hologram was 5.2 ± 2.6 mm (mean ± standard deviation). A subgroup conducted a second series of punctures in which results and precision improved significantly. For most participants it was their first encounter with AR headset technology and the overall feedback was positive.CONCLUSIONSTo the authors’ knowledge, this is the first report on marker-based, AR-guided ventriculostomy. The results from this first application are encouraging. The authors would expect good acceptance of this compact navigation device in a supposed clinical implementation and assume a steep learning curve in the application of this technique. To achieve this translation, further development of the marker system and implementation of the new hardware generation are planned. Further testing to address visuospatial issues is needed prior to application in humans.

scholarly journals Augmented Reality in Medical Practice: From Spine Surgery to Remote Assistance

2021 ◽  
Vol 8 ◽  
Author(s):  
Fabio Cofano ◽  
Giuseppe Di Perna ◽  
Marco Bozzaro ◽  
Alessandro Longo ◽  
Nicola Marengo ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Spine Surgery ◽  
Surgical Planning ◽  
Ad Hoc ◽  
Case Series ◽  
Added Value ◽  
Custom Made ◽  
Lumbar Arthrodesis ◽  
Microsoft Hololens ◽  
Remote Assistance

Background: While performing surgeries in the OR, surgeons and assistants often need to access several information regarding surgical planning and/or procedures related to the surgery itself, or the accessory equipment to perform certain operations. The accessibility of this information often relies on the physical presence of technical and medical specialists in the OR, which is increasingly difficult due to the number of limitations imposed by the COVID emergency to avoid overcrowded environments or external personnel. Here, we analyze several scenarios where we equipped OR personnel with augmented reality (AR) glasses, allowing a remote specialist to guide OR operations through voice and ad-hoc visuals, superimposed to the field of view of the operator wearing them.Methods: This study is a preliminary case series of prospective collected data about the use of AR-assistance in spine surgery from January to July 2020. The technology has been used on a cohort of 12 patients affected by degenerative lumbar spine disease with lumbar sciatica co-morbidities. Surgeons and OR specialists were equipped with AR devices, customized with P2P videoconference commercial apps, or customized holographic apps. The devices were tested during surgeries for lumbar arthrodesis in a multicenter experience involving author's Institutions.Findings: A total number of 12 lumbar arthrodesis have been performed while using the described AR technology, with application spanning from telementoring (3), teaching (2), surgical planning superimposition and interaction with the hologram using a custom application for Microsoft hololens (1). Surgeons wearing the AR goggles reported a positive feedback as for the ergonomy, wearability and comfort during the procedure; being able to visualize a 3D reconstruction during surgery was perceived as a straightforward benefit, allowing to speed-up procedures, thus limiting post-operational complications. The possibility of remotely interacting with a specialist on the glasses was a potent added value during COVID emergency, due to limited access of non-resident personnel in the OR.Interpretation: By allowing surgeons to overlay digital medical content on actual surroundings, augmented reality surgery can be exploited easily in multiple scenarios by adapting commercially available or custom-made apps to several use cases. The possibility to observe directly the operatory theater through the eyes of the surgeon might be a game-changer, giving the chance to unexperienced surgeons to be virtually at the site of the operation, or allowing a remote experienced operator to guide wisely the unexperienced surgeon during a procedure.

Demonstration: Virtual Patient Immersive Trainer to Train Perceptual Skills Using Augmented Reality

2020 ◽  
Vol 64 (1) ◽  
pp. 470-472
Author(s):  
Christen E. Sushereba ◽  
Laura G. Militello
Keyword(s):  
Medical Students ◽  
Augmented Reality ◽  
Student Performance ◽  
Group Interaction ◽  
Virtual Patient ◽  
Perceptual Cues ◽  
Perceptual Skills ◽  
Individual Interaction ◽  
Severity Of Injury ◽  
Microsoft Hololens

In this session, we will demonstrate the Virtual Patient Immersive Trainer (VPIT). The VPIT system uses augmented reality (AR) to allow medics and medical students to experience a photorealistic, life-sized virtual patient. The VPIT supports learners in obtaining the perceptual skills required to recognize and interpret subtle perceptual cues critical to assessing a patient’s condition. We will conduct an interactive demonstration of the virtual patient using both a tablet (for group interaction) and an AR-enabled headset (Microsoft HoloLens) for individual interaction. In addition, we will demonstrate use of the instructor tablet to control what the learner sees (e.g., injury types, severity of injury) and to monitor student performance.

scholarly journals 3D Printed Clamps for In Vitro Tensile Tests of Human Gracilis and the Superficial Third of Quadriceps Tendons

2021 ◽  
Vol 11 (6) ◽  
pp. 2563
Author(s):  
Ivan Grgić ◽  
Vjekoslav Wertheimer ◽  
Mirko Karakašić ◽  
Željko Ivandić
Keyword(s):  
3D Printing ◽  
Fused Deposition Modeling ◽  
Tensile Tests ◽  
Biomechanical Properties ◽  
Testing Procedure ◽  
Laboratory Equipment ◽  
Fused Deposition ◽  
Custom Made ◽  
3D Printed

Recent soft tissue studies have reported issues that occur during experimentation, such as the tissue slipping and rupturing during tensile loads, the lack of standard testing procedure and equipment, the necessity for existing laboratory equipment adaptation, etc. To overcome such issues and fulfil the need for the determination of the biomechanical properties of the human gracilis and the superficial third of the quadriceps tendons, 3D printed clamps with metric thread profile-based geometry were developed. The clamps’ geometry consists of a truncated pyramid pattern, which prevents the tendons from slipping and rupturing. The use of the thread application in the design of the clamp could be used in standard clamping development procedures, unlike in previously custom-made clamps. Fused deposition modeling (FDM) was used as a 3D printing technique, together with polylactic acid (PLA), which was used as a material for clamp printing. The design was confirmed and the experiments were conducted by using porcine and human tendons. The findings justify the usage of 3D printing technology for parts manufacturing in the case of tissue testing and establish independence from the existing machine clamp system, since it was possible to print clamps for each prepared specimen and thus reduce the time for experiment setup.

scholarly journals ARETT: Augmented Reality Eye Tracking Toolkit for Head Mounted Displays

Sensors ◽  
2021 ◽  
Vol 21 (6) ◽  
pp. 2234
Author(s):  
Sebastian Kapp ◽  
Michael Barz ◽  
Sergey Mukhametov ◽  
Daniel Sonntag ◽  
Jochen Kuhn
Keyword(s):  
Augmented Reality ◽  
Eye Tracking ◽  
User Interaction ◽  
R Package ◽  
Eye Tracker ◽  
Unity 3D ◽  
Accuracy And Precision ◽  
Head Mounted Displays ◽  
Virtual And Augmented Reality ◽  
Microsoft Hololens

Currently an increasing number of head mounted displays (HMD) for virtual and augmented reality (VR/AR) are equipped with integrated eye trackers. Use cases of these integrated eye trackers include rendering optimization and gaze-based user interaction. In addition, visual attention in VR and AR is interesting for applied research based on eye tracking in cognitive or educational sciences for example. While some research toolkits for VR already exist, only a few target AR scenarios. In this work, we present an open-source eye tracking toolkit for reliable gaze data acquisition in AR based on Unity 3D and the Microsoft HoloLens 2, as well as an R package for seamless data analysis. Furthermore, we evaluate the spatial accuracy and precision of the integrated eye tracker for fixation targets with different distances and angles to the user (n=21). On average, we found that gaze estimates are reported with an angular accuracy of 0.83 degrees and a precision of 0.27 degrees while the user is resting, which is on par with state-of-the-art mobile eye trackers.

scholarly journals Augmented Reality, Mixed Reality, and Hybrid Approach in Healthcare Simulation: A Systematic Review

2021 ◽  
Vol 11 (5) ◽  
pp. 2338
Author(s):  
Rosanna Maria Viglialoro ◽  
Sara Condino ◽  
Giuseppe Turini ◽  
Marina Carbone ◽  
Vincenzo Ferrari ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Mixed Reality ◽  
Ethical Issues ◽  
Medical Training ◽  
Hybrid Approach ◽  
Dental Surgery ◽  
Feasibility Assessment ◽  
Hybrid Approaches ◽  
Custom Made ◽  
Improved Performance

Simulation-based medical training is considered an effective tool to acquire/refine technical skills, mitigating the ethical issues of Halsted’s model. This review aims at evaluating the literature on medical simulation techniques based on augmented reality (AR), mixed reality (MR), and hybrid approaches. The research identified 23 articles that meet the inclusion criteria: 43% combine two approaches (MR and hybrid), 22% combine all three, 26% employ only the hybrid approach, and 9% apply only the MR approach. Among the studies reviewed, 22% use commercial simulators, whereas 78% describe custom-made simulators. Each simulator is classified according to its target clinical application: training of surgical tasks (e.g., specific tasks for training in neurosurgery, abdominal surgery, orthopedic surgery, dental surgery, otorhinolaryngological surgery, or also generic tasks such as palpation) and education in medicine (e.g., anatomy learning). Additionally, the review assesses the complexity, reusability, and realism of the physical replicas, as well as the portability of the simulators. Finally, we describe whether and how the simulators have been validated. The review highlights that most of the studies do not have a significant sample size and that they include only a feasibility assessment and preliminary validation; thus, further research is needed to validate existing simulators and to verify whether improvements in performance on a simulated scenario translate into improved performance on real patients.

scholarly journals Recurrent contracted sockets treated with personalized, three-dimensionally printed conformers and buccal grafts

2021 ◽  
pp. 112067212110000
Author(s):  
Annabel LW Groot ◽  
Jelmer S Remmers ◽  
Roel JHM Kloos ◽  
Peerooz Saeed ◽  
Dyonne T Hartong
Keyword(s):  
Three Dimensional ◽  
Case Series ◽  
Secondary Outcome ◽  
Retrospective Case ◽  
Upper Eyelid ◽  
Ocular Prosthesis ◽  
Buccal Mucosal Graft ◽  
Custom Made ◽  
3D Printed

Purpose: Recurrent contracted sockets are complex situations where previous surgeries have failed, disabling the wear of an ocular prosthesis. A combined method of surgery and long-term fixation using custom-made, three-dimensional (3D) printed conformers is evaluated. Methods: Retrospective case series of nine patients with recurrent excessive socket contraction and inability to wear a prosthesis, caused by chemical burns ( n = 3), fireworks ( n = 3), trauma ( n = 2) and enucleation and radiotherapy at childhood due to optic nerve glioma ( n = 1) with three average previous socket surgeries (range 2–6). Treatment consisted of a buccal mucosal graft and personalized 3D-printed conformer designed to be fixated to the periosteum and tarsal plates for minimal 2 months. Primary outcome was the retention of an ocular prosthesis. Secondary outcome was the need for additional surgeries. Results: Outcomes were measured at final follow-up between 7 and 36 months postoperatively (mean 20 months). Eight cases were able to wear an ocular prosthesis after 2 months. Three cases initially treated for only the upper or only the lower fornix needed subsequent surgery for the opposite fornix for functional reasons. Two cases had later surgery for cosmetic improvement of upper eyelid position. Despite pre-existing lid abnormalities (scar, entropion, lash deficiency), cosmetic outcome was judged highly acceptable in six cases because of symmetric contour and volume, and reasonably acceptable in the remaining two. Conclusions: Buccal mucosal transplant fixated with a personalized 3D-designed conformer enables retention of a well-fitted ocular prosthesis in previously failed socket surgeries. Initial treatment of both upper and lower fornices is recommended to avoid subsequent surgeries for functional reasons.

A Holographic Augmented Reality Interface for Visualizing of MRI Data and Planning of Neurosurgical Procedures

2021 ◽  
Author(s):  
Cristina M. Morales Mojica ◽  
Jose D. Velazco-Garcia ◽  
Eleftherios P. Pappas ◽  
Theodosios A. Birbilis ◽  
Aaron Becker ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Neurosurgical Procedures

scholarly journals 3D-Printed Connector for Revision Limb Salvage Surgery in Long Bones Previously Using Customized Implants

Metals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 707
Author(s):  
Jong-Woong Park ◽  
Hyun-Guy Kang ◽  
June-Hyuk Kim ◽  
Han-Soo Kim
Keyword(s):  
Limb Salvage ◽  
Salvage Surgery ◽  
Revisional Surgery ◽  
Limb Salvage Surgery ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Proximal Ulna ◽  
Custom Made ◽  
Orthopedic Oncology ◽  
3D Printed

In orthopedic oncology, revisional surgery due to mechanical failure or local recurrence is not uncommon following limb salvage surgery using an endoprosthesis. However, due to the lack of clinical experience in limb salvage surgery using 3D-printed custom-made implants, there have been no reports of revision limb salvage surgery using a 3D-printed implant. Herein, we present two cases of representative revision limb salvage surgeries that utilized another 3D-printed custom-made implant while retaining the previous 3D-printed custom-made implant. A 3D-printed connector implant was used to connect the previous 3D-printed implant to the proximal ulna of a 40-year-old man and to the femur of a 69-year-old woman. The connector bodies for the two junctions of the previous implant and the remaining host bone were designed for the most functional position or angle by twisting or tilting. Using the previous 3D-printed implant as a taper, the 3D-printed connector was used to encase the outside of the previous implant. The gap between the previous implant and the new one was subsequently filled with bone cement. For both the upper and lower extremities, the 3D-printed connector showed stable reconstruction and excellent functional outcomes (Musculoskeletal Tumor Society scores of 87% and 100%, respectively) in the short-term follow-up. To retain the previous 3D-printed implant during revision limb salvage surgery, an additional 3D-printed implant may be a feasible surgical option.

Estimating Distances in Action Space in Augmented Reality

2021 ◽  
Vol 18 (2) ◽  
pp. 1-16
Author(s):  
Holly C. Gagnon ◽  
Carlos Salas Rosales ◽  
Ryan Mileris ◽  
Jeanine K. Stefanucci ◽  
Sarah H. Creem-Regehr ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Real World ◽  
Distance Measure ◽  
Distance Perception ◽  
Action Space ◽  
Indoor Environments ◽  
Verbal Reports ◽  
Visual Matching ◽  
Microsoft Hololens ◽  
Real Person

Augmented reality ( AR ) is important for training complex tasks, such as navigation, assembly, and medical procedures. The effectiveness of such training may depend on accurate spatial localization of AR objects in the environment. This article presents two experiments that test egocentric distance perception in augmented reality within and at the boundaries of action space (up to 35 m) in comparison with distance perception in a matched real-world ( RW ) environment. Using the Microsoft HoloLens, in Experiment 1, participants in two different RW settings judged egocentric distances (ranging from 10 to 35 m) to an AR avatar or a real person using a visual matching measure. Distances to augmented targets were underestimated compared to real targets in the two indoor, RW contexts. Experiment 2 aimed to generalize the results to an absolute distance measure using verbal reports in one of the indoor environments. Similar to Experiment 1, distances to augmented targets were underestimated compared to real targets. We discuss these findings with respect to the importance of methodologies that directly compare performance in real and mediated environments, as well as the inherent differences present in mediated environments that are “matched” to the real world.

scholarly journals Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 1056
Author(s):  
Giovanni Beltrami ◽  
Gabriele Ristori ◽  
Anna Maria Nucci ◽  
Alberto Galeotti ◽  
Angela Tamburini ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Soft Tissues ◽  
Lower Limbs ◽  
Host Bone ◽  
Limb Salvage Surgery ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Custom Made ◽  
3D Printed

Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.

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