快速、无标记、头戴式增强现实立体定向神经导航系统的临床验证。

IF 3.6 2区 医学 Q1 CLINICAL NEUROLOGY
Joshua Olexa, Chixiang Chen, Parth Rastogi, Charles Sansur, Maureen Rakovec, Jordan R Saadon, Jesse Stokum, Kevin T Kim, Steven K Yarmoska, Annie Trang, Tina Wang, Jacob Cherian, Mohammed Labib, Alex Ksendzovsky, Clifford T Solomon, Whitney Parker, Gary Schwartzbauer, Graeme F Woodworth
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引用次数: 0

摘要

目的:增强现实(AR)等数字增强和可视化技术在外科手术中的应用越来越广泛。快速、准确的患者登记和最小的设备限制使AR系统能够提高效率、安全性和有效性,特别是在紧急/紧急和/或床边情况下。本研究的目的是在现实环境中定量比较基于AR头显的神经导航系统与基于标准护理参考阵列的神经外科立体定向导航系统。方法:本临床验证试验纳入2024年2月至2024年7月在单中心行立体定向导航颅脑神经外科手术的成年患者。获取术前CT和MR图像并用于构建三维全息图模型,其中包括基于表面的目标基准标记物进行比较。术前图像采用标准技术立体定位到患者头部。记录基准标记(对照)的配准坐标和配准时间。然后部署AR系统,为相同的术前图像创建单独的立体定向配准。使用AR系统获取基准标记(实验)的第二组配准坐标,并记录该过程的时间。采用Wilcoxon符号秩检验评估注册时间差异,采用线性混合效应模型(linear mixed-effects model, LMM)对对照数据与实验数据的坐标进行等效检验。结果:共纳入20例患者(平均年龄±SD 50.05±14.38岁)。控制系统的平均基线验证误差为0.73±0.29 mm(范围0-1.0 mm)。以控制系统为地真,AR系统的平均配准精度为2.16±0.12 mm。LMM等效检验,在边界为3 mm和2.5 mm的情况下,证明了地面真值和AR系统坐标之间的统计等效性(p < 0.001和p < 0.003)。使用AR系统对患者模型注册所需的平均时间为45.98±15.00秒,与对照组(228.86±100.06秒,p < 0.001)相比显著缩短。结论:与标准的立体定向神经导航系统相比,AR导航系统提供了统计学上相似的注册精度和显着更快的患者模型注册。AR导航准确、快速且占地面积小,为在低资源、床边和紧急/紧急环境中整合立体定向提供了新的机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical validation of a rapid, markerless, headset-contained augmented reality stereotactic neuronavigation system.

Objective: Digital enhancement and visualization technologies, such as augmented reality (AR), are increasingly used in surgery. Rapid and accurate patient registration with minimal device confinements enables AR systems to increase efficiency, safety, and effectiveness, especially in urgent/emergency and/or bedside scenarios. The aim of this study was to quantitatively compare an AR headset-based neuronavigation system with a standard-of-care reference array-based neurosurgical stereotactic navigation system in a real-world setting.

Methods: This clinical validation trial included adult patients undergoing cranial neurosurgery with stereotactic navigation at a single center from February 2024 to July 2024. Preoperative CT and MR images were acquired and used for construction of a 3D hologram model that included surface-based target fiducial markers for comparison. Preoperative images were stereotactically registered to the patient's head using standard techniques. The registration coordinates for the fiducial markers (control) and registration time were recorded. The AR system was then deployed to create a separate stereotactic registration to the same preoperative images. A second set of registration coordinates for the fiducial markers (experimental) were acquired using the AR system, and the time for this process was also recorded. The Wilcoxon signed-rank test was used to assess differences in registration time, and a linear mixed-effects model (LMM) was used to conduct equivalence testing of coordinates between the control and experimental data.

Results: Twenty patients (mean age ± SD 50.05 ± 14.38 years) were included in the trial. The mean baseline validation error of the control system was 0.73 ± 0.29 mm (range 0-1.0 mm). Using the control system as ground truth, the mean registration accuracy of the AR system was 2.16 ± 0.12 mm. LMM equivalence testing, conducted with margins of 3 mm and 2.5 mm, demonstrated statistical equivalence between the ground truth and AR system coordinates (p < 0.001 and p < 0.003, respectively). The time required for patient model registration using the AR system was a mean of 45.98 ± 15.00 seconds, which was significantly shorter compared with the control system (228.86 ± 100.06 seconds, p < 0.001).

Conclusions: The AR navigation system provided statistically similar registration accuracy and significantly faster patient model registration compared with the standard-of-care stereotactic neuronavigation system. AR navigation was accurate, fast, and had a minimal footprint, offering new opportunities to incorporate stereotaxis in low-resource, bedside, and urgent/emergency settings.

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来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
期刊介绍: The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
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