(Holo-Stroke-CTA): Stroke Hologram Teleportation for CTA Large Vessel Occlusion Assessments

Augmented Reality (AR) enables visualization of and interaction with both physical and virtual environments. Holograms can allow 3D image transmission to distant sites, allowing patients to interact with providers as if in the same space. Our prior publication resulted in high satisfaction/immersion for patients interacting with Holo-Stroke providers. Our aim here was to determine if providers assessing CTAs for large vessel occlusion (LVO) would result in reliability and satisfaction.

Thirty-six head CTAs were de-identified and scored by Stroke Faculty, Fellows, and Nurse Practitioners for LVO using DICOM viewer. CTAs were presented 2 months later via Holo-Stroke. Holograms were positioned in 3D-space, viewable through the Hololens-2, and scored by the same providers. Kappa Reliability was assessed comparing scores to gold-standard (radiology report). Satisfaction was assessed via Likert scale.

Thirteen providers scored the CTAs. Overall Kappa reliability, compared to gold standard, was 0.78(81%)DICOMvs.0.94(94%)Holo-Stroke-CTA(p<0.0001). Overall %correct was 81%vs.94%(p<0.001). Holo-Stroke-CTA's reliability improved for most examiners: Overall (κ=0.78(81%)vs.0.94(94%)), Faculty (κ=0.85(87%)vs.0.92(93%)), NPs (κ=0.81(83%)vs.0.90(92%)), and Fellows (κ=0.68(72%)vs.0.97(97%)). Overall MCA (κ=0.76(86%)vs.0.93(96%)), ICA (κ=0.8(88%)vs.0.9(94%)), and Basilar (κ=0.73(95%)vs. 0.82(96%)) scored high, with marked improvement for ACA (κ=0.3(39%)vs. 0.91(94%)), and PCA (κ=0.55(70%)vs.0.95(98%)). Likert satisfaction "Overall" was (18DICOM,48Holo-Stroke-CTA;p=0.002) with %increasing from 39% to 96%. "Immersion" scores were (0,10;p=0.001), "Ease of Use" (5,9;p=0.002), "Accuracy" (7,9;p=0.002), "Technology Advancement" (4,10;p=0.001), and "Interest" (3,10;p=0.002).

Holo-Stroke-CTA resulted in higher reliability and satisfaction vs. standard DICOM tele-stroke tele-radiology. Providers noted the ability to see 3D vessels in virtual space, vs. scrolling through axial/sagittal/coronal images, resulted in higher accuracy. Even for trainees and difficult to assess vessels, providers were more able to identify LVOs using Holo-Stroke-CTA. Providers were enthusiastic for the immersive radiology assessment, with the ability to immersively resize, rotate, and investigate hologram in 3D virtual space. Though further assessments are needed, Holo-Stroke-CTA can help providers more easily, and at-a-glance, evaluate CTA for LVO.