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Register a new userClosing the Calibration Loop: An Inside-out-tracking Paradigm for Augmented Reality in Orthopedic Surgery
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Added by
Mathias Unberath
Publication date
2018
fields
Informatics Engineering
and research's language is
English
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In percutaneous orthopedic interventions the surgeon attempts to reduce and fixate fractures in bony structures. The complexity of these interventions arises when the surgeon performs the challenging task of navigating surgical tools percutaneously only under the guidance of 2D interventional X-ray imaging. Moreover, the intra-operatively acquired data is only visualized indirectly on external displays. In this work, we propose a flexible Augmented Reality (AR) paradigm using optical see-through head mounted displays. The key technical contribution of this work includes the marker-less and dynamic tracking concept which closes the calibration loop between patient, C-arm and the surgeon. This calibration is enabled using Simultaneous Localization and Mapping of the environment of the operating theater. In return, the proposed solution provides in situ visualization of pre- and intra-operative 3D medical data directly at the surgical site. We demonstrate pre-clinical evaluation of a prototype system, and report errors for calibration and target registration. Finally, we demonstrate the usefulness of the proposed inside-out tracking system in achieving bulls eye view for C-arm-guided punctures. This AR solution provides an intuitive visualization of the anatomy and can simplify the hand-eye coordination for the orthopedic surgeon.
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Fluoroscopic X-ray guidance is a cornerstone for percutaneous orthopaedic surgical procedures. However, two-dimensional observations of the three-dimensional anatomy suffer from the effects of projective simplification. Consequently, many X-ray images from various orientations need to be acquired for the surgeon to accurately assess the spatial relations between the patients anatomy and the surgical tools. In this paper, we present an on-the-fly surgical support system that provides guidance using augmented reality and can be used in quasi-unprepared operating rooms. The proposed system builds upon a multi-modality marker and simultaneous localization and mapping technique to co-calibrate an optical see-through head mounted display to a C-arm fluoroscopy system. Then, annotations on the 2D X-ray images can be rendered as virtual objects in 3D providing surgical guidance. We quantitatively evaluate the components of the proposed system, and finally, design a feasibility study on a semi-anthropomorphic phantom. The accuracy of our system was comparable to the traditional image-guided technique while substantially reducing the number of acquired X-ray images as well as procedure time. Our promising results encourage further research on the interaction between virtual and real objects, that we believe will directly benefit the proposed method. Further, we would like to explore the capabilities of our on-the-fly augmented reality support system in a larger study directed towards common orthopaedic interventions.
Augmented reality has the potential to improve operating room workflow by allowing physicians to see inside a patient through the projection of imaging directly onto the surgical field. For this to be useful the acquired imaging must be quickly and accurately registered with patient and the registration must be maintained. Here we describe a method for projecting a CT scan with Microsoft Hololens and then aligning that projection to a set of fiduciary markers. Radio-opaque stickers with unique QR-codes are placed on an object prior to acquiring a CT scan. The location of the markers in the CT scan are extracted and the CT scan is converted into a 3D surface object. The 3D object is then projected using the Hololens onto a table on which the same markers are placed. We designed an algorithm that aligns the markers on the 3D object with the markers on the table. To extract the markers and convert the CT into a 3D object took less than 5 seconds. To align three markers, it took $0.9 pm 0.2$ seconds to achieve an accuracy of $5 pm 2$ mm. These findings show that it is feasible to use a combined radio-opaque optical marker, placed on a patient prior to a CT scan, to subsequently align the acquired CT scan with the patient.
The field of Augmented Reality (AR) and Virtual Reality (VR) has seen massive growth in recent years. Numerous degree programs have started to redesign their curricula to meet the high market demand of such job positions. In this paper, we performed a content analysis of online job postings hosted on Indeed.com and provided a skill classification framework for AR/VR job positions. Furthermore, we present a ranking of the relevant skills for the job position. Overall, we noticed that technical skills like UI/UX design, software design, asset design and graphics rendering are highly desirable for AR/VR positions. Our findings regarding prominent skill categories could be beneficial for the human resource departments as well as enhancing existing course curricula to tailor to the high market demand.
Suboptimal interaction with patient data and challenges in mastering 3D anatomy based on ill-posed 2D interventional images are essential concerns in image-guided therapies. Augmented reality (AR) has been introduced in the operating rooms in the last decade; however, in image-guided interventions, it has often only been considered as a visualization device improving traditional workflows. As a consequence, the technology is gaining minimum maturity that it requires to redefine new procedures, user interfaces, and interactions. The main contribution of this paper is to reveal how exemplary workflows are redefined by taking full advantage of head-mounted displays when entirely co-registered with the imaging system at all times. The proposed AR landscape is enabled by co-localizing the users and the imaging devices via the operating room environment and exploiting all involved frustums to move spatial information between different bodies. The awareness of the system from the geometric and physical characteristics of X-ray imaging allows the redefinition of different human-machine interfaces. We demonstrate that this AR paradigm is generic, and can benefit a wide variety of procedures. Our system achieved an error of $4.76pm2.91$ mm for placing K-wire in a fracture management procedure, and yielded errors of $1.57pm1.16^circ$ and $1.46pm1.00^circ$ in the abduction and anteversion angles, respectively, for total hip arthroplasty. We hope that our holistic approach towards improving the interface of surgery not only augments the surgeons capabilities but also augments the surgical teams experience in carrying out an effective intervention with reduced complications and provide novel approaches of documenting procedures for training purposes.
Visual understanding of 3D environments in real-time, at low power, is a huge computational challenge. Often referred to as SLAM (Simultaneous Localisation and Mapping), it is central to applications spanning domestic and industrial robotics, autonomous vehicles, virtual and augmented reality. This paper describes the results of a major research effort to assemble the algorithms, architectures, tools, and systems software needed to enable delivery of SLAM, by supporting applications specialists in selecting and configuring the appropriate algorithm and the appropriate hardware, and compilation pathway, to meet their performance, accuracy, and energy consumption goals. The major contributions we present are (1) tools and methodology for systematic quantitative evaluation of SLAM algorithms, (2) automated, machine-learning-guided exploration of the algorithmic and implementation design space with respect to multiple objectives, (3) end-to-end simulation tools to enable optimisation of heterogeneous, accelerated architectures for the specific algorithmic requirements of the various SLAM algorithmic approaches, and (4) tools for delivering, where appropriate, accelerated, adaptive SLAM solutions in a managed, JIT-compiled, adaptive runtime context.
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