Usability Study of Augmented Reality Visualization Modalities on Localization Accuracy in the Head and Neck:...

Area of Science:

• Medical Imaging
• Augmented Reality
• Surgical Navigation

Background:

• Augmented reality head-mounted displays (AR-HMDs) aim to bridge the spatial gap between medical imaging and the surgical field, especially in complex head and neck anatomy.
• While markerless AR-HMDs are cost-effective, their overlay accuracy (superimposition, SI) is limited.
• Virtual twin (VT) holography presents a potential alternative, but its performance requires further investigation.

Purpose of the Study:

• To compare the accuracy and efficiency of SI and VT augmented reality visualization modalities for anatomical localization in the head and neck.
• To evaluate performance based on accuracy, workload, time, and user experience.

Main Methods:

• A randomized crossover trial involving 38 participants using HoloLens 2.
• Localization of point, line-based, and volume-based anatomical structures on head phantoms.
• Evaluation of accuracy (absolute, relative, surface distance, Hausdorff distance), workload (NASA-TLX), and time.

Main Results:

• SI demonstrated superior point localization accuracy compared to VT (P<.001).
• Accuracy for line-based structures was comparable between SI and VT (P>.51).
• VT showed significantly less deviation for volume-based structures than SI (P<.01).
• Participants were faster using SI (P=.02), with no significant difference in workload (P=.79).

Conclusions:

• SI offers better point localization accuracy and speed but struggles with overlaid soft tissue and viewing challenges.
• VT remains a viable option for surgical scenarios where high precision is not paramount.
• Future research should enhance viewing angle guidance and anatomical target-to-skin surface linkage for AR systems.