In this paper, we present a new volumetric ambient occlusion algorithm called Contextual Ambient Occlusion (CAO) that supports real-time clipping. The algorithm produces ambient occlusion images of exactly the same quality as Local Ambient Occlusion (LAO) while enabling real-time modification to the shape used to clip the volume. The main idea of the algorithm is that clipping only affects the ambient value of a small number of voxels, so by identifying these voxels and recalculating the ambient factor only for them, it is possible to significantly increase the rendering performance (by 2-5x) without decreasing the quality of the rendered image. Due to its fast performance, the algorithm is suitable for interactive environments where clipping changes could occur every frame. Additionally, the algorithm doesn’t have any stereoscopic inconsistency, which makes it suitable for mixed reality environments. This paper is an extended version of the “Contextual Ambient Occlusion” article presented during the 2023 Graphics Interface conference, and includes, among other additions, the source code of the algorithm.

User interaction has the potential to greatly facilitate the exploration and understanding of 3D medical images for diagnosis and treatment. However, in certain specialized environments such as in an operating room (OR), technical and physical constraints such as the need to enforce strict sterility rules, make interaction challenging. In this paper, we propose to facilitate the intraoperative exploration of angiographic volumes by leveraging the motion of a tracked surgical pointer, a tool that is already manipulated by the surgeon when using a navigation system in the OR. We designed and implemented three interactive rendering techniques based on this principle. The benefit of each of these techniques is compared to its non-interactive counterpart in a psychophysics experiment where 20 medical imaging experts were asked to perform a reaching/targeting task while visualizing a 3D volume of angiographic data. The study showed a significant improvement of the appreciation of local vascular structure when using dynamic techniques, while not having a negative impact on the appreciation of the global structure and only a marginal impact on the execution speed. A qualitative evaluation of the different techniques showed a preference for dynamic chroma-depth in accordance with the objective metrics but a discrepancy between objective and subjective measures for dynamic aerial perspective and shading.