Single session segmentation and live registration for augmented reality image guidance of cryoneurolysis

Interventional radiology procedures typically utilize multiple imaging modalities for navigation in real time, and augmented reality (AR) has emerging potential to improve this. This case is a first in human novel single session workflow that incorporated an AR-headset for navigational guidance during an intercostal cryoneurolysis procedure.

A quadragenarian woman in a tertiary care center with chronic neuropathic pain was treated with cryoneurolysis. An augmented reality headset was incorporated using cone-beam CT in a novel workflow in this IDEAL stage-I study. Outcomes measured included technical success, length of time in procedure, and subjective clinician reactions.

The procedure with AR-integration was completed in a single session, including cone-beam computed tomography (CBCT) imaging, automatic segmentation, segmentation review, registration of the 3D-imaging dataset to the AR system fiducials, and ultrasound-guided cryoablation of the affected nerve. The AR-system allowed for simultaneous viewing of segmented CT-based anatomy and projected real-time ultrasound images, which improved visualization and procedural ergonomics. A web-based system (ImagineHive) which utilizes customized versions of 3D-Slicer and TotalSegmentator was used for segmentation and image analysis. The workflow from CBCT to registration was completed in 32 min, and showed the potential for further efficiency with greater experience. The procedure was successful, and the patient experienced symptom improvement without adverse events at the six-week follow-up.

This case highlights the potential of AR-technology integrated with intraoperative CBCT, and a streamlined segmentation workflow, to optimize patient care outcomes in the interventional radiology setting. Future research should focus on assessing the accuracy, cost-effectiveness, and usability of these integrated technologies across various procedures.