Medical Augmented Reality: Definition, Principle Components, Domain Modeling, and Design-Development-Validation Process

Nassir Navab, Alejandro Martin-Gomez, Matthias Seibold, Michael Sommersperger, Tianyu Song, Alexander Winkler, Kevin Yu, Ulrich Eck, Nassir Navab, Alejandro Martin-Gomez, Matthias Seibold, Michael Sommersperger, Tianyu Song, Alexander Winkler, Kevin Yu, Ulrich Eck

Abstract

Three decades after the first set of work on Medical Augmented Reality (MAR) was presented to the international community, and ten years after the deployment of the first MAR solutions into operating rooms, its exact definition, basic components, systematic design, and validation still lack a detailed discussion. This paper defines the basic components of any Augmented Reality (AR) solution and extends them to exemplary Medical Augmented Reality Systems (MARS). We use some of the original MARS applications developed at the Chair for Computer Aided Medical Procedures and deployed into medical schools for teaching anatomy and into operating rooms for telemedicine and surgical guidance throughout the last decades to identify the corresponding basic components. In this regard, the paper is not discussing all past or existing solutions but only aims at defining the principle components and discussing the particular domain modeling for MAR and its design-development-validation process, and providing exemplary cases through the past in-house developments of such solutions.

Keywords: Artificial Intelligence; Augmented Reality; Medical Augmented Reality; acoustic sensing; computer vision; multi-modal sensing; perceptual visualization; sonification; surgical data science; validation.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The apparatus of Brunelleschi consists of (A) a mirror, and a painted or printed image. Both components inhibit a hole for the user to look through. (B) The apparatus creates a linear projection that shows the image inside the user’s view. (C) The illustrated third-person view visualizes the frustum that is covered by the projection. Many modern AR applications use the same mathematical basis for creating in situ visualizations.
Figure 2
Figure 2
The Medical Augmented Reality Framework consists of four primary components: Digital World, AR/VR Display, AR/VR User Interaction, and evaluation. An MARS perceives the Physical World with its sensors and processes in a medium that users may perceive and interact with through the AR/VR interfaces. Evaluation is integral to the system’s conception, development, and deployment.
Figure 3
Figure 3
Augmented Reality Teleconsultation System for Medicine (ArTekMed) combines point cloud reconstruction with Augmented and Virtual Reality. (A) Capturing the local site with the patient requires extrinsically calibrated RGB-D sensors from which the system computes a real-time point cloud reconstruction. (B) The local user interacts with the real world while perceiving additional virtual content delivered with AR. (C) The remote user dons a VR headset and controller for interacting with the acquired point cloud. (D) The reconstruction represents the digital world known to the computer and is displayed to the VR User. (E) AR annotations made by the VR user is shown in situ on the patient.
Figure 4
Figure 4
Interaction Techniques Unique to ArTekMed: (A) The Magnorama creates a dynamic 3D cutout from the real-time reconstruction and allows the user to interact and explore the space while intuitively creating annotations at the original region of interest within the duplicate. (B) The principle of Magnoramas translates well into AR. The resulting technique of Duplicated Reality allows co-located collaboration in tight spaces, even without a remote user. (C) For remote users to experience more details of the patient and their surroundings, ArTekMed deploys Projective Bisector Mirrors to bridge the gap between reality and reconstruction through the mirror metaphor.
Figure 5
Figure 5
Typical setups in ophthalmic surgery consist of a complex operating area and multi-modal real-time imaging. Visual and auditive AR applications aim to improve perception and provide additional information while avoiding visual clutter and reducing the cognitive load of complex intraoperative data.
Figure 6
Figure 6
CAMC aims to reduce the need for ionizing radiations and to provide spatially aware, intuitive visualization of joint optical and fluoroscopic data. (a) Calibration of the C-arm with the patient and the technician and surgeon’s HMD enables efficient surgical procedures in a collaborative ecosystem. (b) Advanced AR interface aids in better planning trajectories on the X-ray acquisitions. (c) The adaptive UI and augmentations in intra-operative planning and execution support various image-guided procedures.
Figure 7
Figure 7
The Magic Mirror visualizes anatomical structures in situ on the mirror reflection of the user in front of the RGB-D camera. Additionally, our Magic Mirror system displays transverse slices of a CT volume on the right half of the monitor that matches the slice selected by the user with their right hand.

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