Youn Joong Kee, Lee Dongheon, Ko Dayoung, Yeom Inhwa, Joo Hyun-Jin, Kim Hee Chan, Kong Hyoun-Joong, Kim Hyun-Young
Department of Pediatric Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Pediatric Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea.
World J Surg. 2022 Apr;46(4):942-948. doi: 10.1007/s00268-021-06425-5. Epub 2022 Jan 10.
Pediatric hemato-oncologic patients require central catheters for chemotherapy, and the junction of the superior vena cava and right atrium is considered the ideal location for catheter tips. Skin landmarks or fluoroscopic supports have been applied to identify the cavoatrial junction; however, none has been recognized as the gold standard. Therefore, we aim to develop a safe and accurate technique using augmented reality technology for the location of the cavoatrial junction in pediatric hemato-oncologic patients.
Fifteen oncology patients who underwent chest computed tomography were enrolled for Hickman catheter or chemoport insertion. With the aid of augmented reality technology, three-dimensional models of the internal jugular veins, external jugular veins, subclavian veins, superior vena cava, and right atrium were constructed. On inserting the central vein catheters, the cavoatrial junction identified using the three-dimensional models were marked on the body surface, the tip was positioned at the corresponding location, and the actual insertion location was confirmed using a portable x-ray machine. The proposed method was evaluated by comparing the distance from the cavoatrial junction to the augmented reality location with that to the conventional location on x-ray.
The mean distance between the cavoatrial junction and augmented reality location on x-ray was 1.2 cm, which was significantly shorter than that between the cavoatrial junction and conventional location (1.9 cm; P = 0.027).
Central catheter insertion using augmented reality technology is more safe and accurate than that using conventional methods and can be performed at no additional cost in oncology patients.
儿科血液肿瘤患者化疗需要中心静脉导管，上腔静脉与右心房的交界处被认为是导管尖端的理想位置。已应用体表标志或透视辅助来确定腔房交界处；然而，尚无一种方法被公认为金标准。因此，我们旨在开发一种利用增强现实技术在儿科血液肿瘤患者中定位腔房交界处的安全、准确的技术。
纳入15例接受胸部计算机断层扫描的肿瘤患者，进行希克曼导管或化疗端口置入。借助增强现实技术，构建颈内静脉、颈外静脉、锁骨下静脉、上腔静脉和右心房的三维模型。插入中心静脉导管时，利用三维模型确定的腔房交界处标记在体表，将导管尖端置于相应位置，并用便携式X光机确认实际插入位置。通过比较腔房交界处到增强现实定位的距离与到传统X光定位的距离，对所提出的方法进行评估。
腔房交界处与X光上增强现实定位之间的平均距离为1.2 cm，显著短于腔房交界处与传统定位之间的距离（1.9 cm；P = 0.027）。
与传统方法相比，利用增强现实技术进行中心导管插入更安全、准确，且在肿瘤患者中无需额外费用即可进行。
