The interlocking of intramedullary nails is a technically demanding procedure which involves a considerable amount of X-ray acquisitions; one study lists as many as 48 to successfully complete the procedure and fix screws into 4-6 mm distal holes of the nail. We propose to design an augmented radiolucent drill to assist surgeons in completing the distal locking procedure without any additional X-ray acquisitions. Using an augmented reality fluoroscope that coregisters optical and X-ray images, we exploit solely the optical images to detect the augmented radiolucent drill and estimate its tip position in real-time. Consequently, the surgeons will be able to maintain the down the beam positioning required to drill the screws into the nail holes successfully. To evaluate the accuracy of the proposed augmented drill, we perform a preclinical study involving six surgeons and ask them to perform distal locking on dry bone phantoms. Surgeons completed distal locking 98.3% of the time using only a single X-ray image with an average navigation time of 1.4 ± 0.9 min per hole.

This paper describes first steps towards a Superman-like X-ray vision where a brain-computer interface (BCI) device and a gaze-tracker are used to allow the user controlling the augmented reality (AR) visualization. A BCI device is integrated into two medical AR systems. To assess the potential of this technology first feedback from medical doctors is gathered. While in this pilot study not the full range of available signals but only electromyographic signals are used, the medical doctors provided very positive feedback on the use of BCI for medical AR.

The paper presents a user study investigating perceptual effects of a virtual mirror being used as a tangible interactive tool in a medical Augmented Reality scenario. In particular, we evaluated whether an additional perspective provided by the virtual mirror supports instrument guidance in terms of precision and straightness. 31 participants were asked to navigate an endoscopic instrument in a simulated minimally invasive port setting. Results show a significant higher precision of instrument guidance when a virtual mirror provides additional views of the target region.

Port position in minimally invasive surgeries is chosen to minimize the lesion of tissue and maximize the movability for endoscopic instruments. In this study, we present an evaluation of the potential of a 3D contextual in-situ visualization of the anatomic target region to help surgeons for three different surgical procedures decide where best to create ports and incisions to enable the insertion of a specific set of instruments.