Objective : To evaluate the utility of visualizing pre-procedural imaging in actual 3D space using augmented reality (AR) for transarterial embolization (TAE) of HCC in rats
Methods : Software by Medivis Inc. (Brooklyn, NY) was used to volume render DICOM data from T2-weighted rat MRI scans (70 mm x 70 mm FOV, 2 mm slice thickness, 20 slices, 4 averages, 256 x 256 grid size, TR ~1.5-2 s, TE ~60 ms) in actual 3D space prior to TAE from 8/10/2018 to present. Virtual 3D volumes were generated using 3D texture mapping of the DICOM dataset. Remote volume rendering using ray casting with optimization techniques was performed on a local workstation equipped with a GTX 1080 GPU and streamed wirelessly in real time via WiFi to Microsoft HoloLens (Redmond, WA). Virtual 3D volume manipulations including rotation, magnification, and modification of voxel opacities were utilized during HoloLens visualization. Historical comparisons were made to TAEs from 2017 and also control cases without AR utilization. Total catheterization time, total fluoroscopy time, radiation dose, and 3-day survival were compared as well as HoloLens setup and utilization times using Welch’s t-test and Fisher’s exact test. Total catheterization time was calculated from the first to the last recorded time of fluoroscopy.
Results : Outcomes of TAEs are summarized in Table 1. Benefits in radiation dose were significant with fluoroscopy time reduced by 59% (p=0.02) and dose area product (DAP) reduced by 42% (p=0.02) following AR use. AR utilization also demonstrated trends in reducing catheterization time and improving survival but were not statistically significant. Interventionalists subjectively reported enhanced anatomic understanding in all cases after AR visualization.
Conclusions : Utilization of AR for visualizing pre-procedural imaging in actual 3D space improves anatomic understanding and reduces amount of radiation used during TAEs in rats. Trends are also seen in benefitting procedure times and outcomes. These findings demonstrate promising potential of utilizing AR for endovascular oncologic interventions.