HoloLens augmented reality system for transperineal free-hand prostate procedures

Area of Science:

• Medical Imaging
• Surgical Technology
• Computer-Assisted Surgery

Background:

• Traditional transperineal prostate (TP) procedures often rely on guidance grids, which can limit flexibility and real-time visualization.
• Free-hand TP interventions present challenges in accurately localizing the needle tip and visualizing depth during insertion.

Purpose of the Study:

• To develop and evaluate an augmented reality (AR) system for free-hand real-time needle guidance in transperineal prostate (TP) procedures.
• To overcome the limitations of traditional guidance grids by providing enhanced visualization and accuracy.

Main Methods:

• A HoloLens AR system was utilized to superimpose annotated anatomy from preprocedural volumetric images onto the patient.
• The system provided real-time needle tip localization and depth visualization during insertion.
• Accuracy was evaluated using a 3D-printed phantom for image overlay and needle targeting, with comparisons between planned-path and free-hand guidance methods.

Main Results:

• The AR system achieved an image overlay accuracy of 1.29 ± 0.57 mm and a needle targeting accuracy of 2.13 ± 0.52 mm.
• No significant difference in placement error was found between planned-path and free-hand guidance methods (4.14 ± 1.08 mm vs. 4.20 ± 1.08 mm, p=0.90).
• Soft tissue markers were successfully implanted into or near target lesions in an anthropomorphic pelvic phantom.

Conclusions:

• The HoloLens AR system provides accurate needle guidance for TP interventions.
• AR support for free-hand lesion targeting is feasible and offers greater flexibility compared to grid-based methods.
• The real-time 3D and immersive experience enhances free-hand TP procedures.