McGovern Medical School at UTHealth, Houston, Texas; Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland.
Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland.
J Vasc Interv Radiol. 2024 Mar;35(3):452-461.e3. doi: 10.1016/j.jvir.2023.10.005. Epub 2023 Oct 17.
To develop and evaluate a smartphone augmented reality (AR) system for a large 50-mm liver tumor ablation with treatment planning for composite overlapping ablation zones.
A smartphone AR application was developed to display tumor, probe, projected probe paths, ablated zones, and real-time percentage of the ablated target tumor volume. Fiducial markers were attached to phantoms and an ablation probe hub for tracking. The system was evaluated with tissue-mimicking thermochromic phantoms and gel phantoms. Four interventional radiologists performed 2 trials each of 3 probe insertions per trial using AR guidance versus computed tomography (CT) guidance approaches in 2 gel phantoms. Insertion points and optimal probe paths were predetermined. On Gel Phantom 2, serial ablated zones were saved and continuously displayed after each probe placement/adjustment, enabling feedback and iterative planning. The percentages of tumor ablated for AR guidance versus CT guidance, and with versus without display of recorded ablated zones, were compared among interventional radiologists with pairwise t-tests.
The means of percentages of tumor ablated for CT freehand and AR guidance were 36% ± 7 and 47% ± 4 (P = .004), respectively. The mean composite percentages of tumor ablated for AR guidance were 43% ± 1 (without) and 50% ± 2 (with display of ablation zone) (P = .033). There was no strong correlation between AR-guided percentage of ablation and years of experience (r < 0.5), whereas there was a strong correlation between CT-guided percentage of ablation and years of experience (r > 0.9).
A smartphone AR guidance system for dynamic iterative large liver tumor ablation was accurate, performed better than conventional CT guidance, especially for less experienced interventional radiologists, and enhanced more standardized performance across experience levels for ablation of a 50-mm tumor.
开发并评估一种用于 50mm 大肝癌消融的智能手机增强现实（AR）系统，以实现复合重叠消融区域的治疗规划。
开发了一种智能手机 AR 应用程序，用于显示肿瘤、探头、规划的探头路径、消融区域以及实时消融目标肿瘤体积的百分比。在体模和消融探头集线器上附加了基准标记，以进行跟踪。该系统使用组织模拟热变色体模和凝胶体模进行了评估。四名介入放射科医生在两个凝胶体模中，分别使用 AR 引导和 CT 引导各进行了三次探头插入的两次试验，每次试验插入三次。预先确定了插入点和最佳探头路径。在 Gel Phantom 2 上，在每次探头放置/调整后，连续显示保存的连续消融区域，实现反馈和迭代规划。通过配对 t 检验，比较了 AR 引导与 CT 引导、显示与不显示记录消融区域时，介入放射科医生之间的肿瘤消融百分比。
CT 徒手和 AR 引导的肿瘤消融百分比的平均值分别为 36%±7 和 47%±4（P=0.004）。AR 引导的肿瘤消融的平均复合百分比分别为 43%±1（无）和 50%±2（显示消融区域）（P=0.033）。AR 引导下的消融百分比与经验年限之间没有强相关性（r < 0.5），而 CT 引导下的消融百分比与经验年限之间存在强相关性（r > 0.9）。
一种用于动态迭代式大肝癌消融的智能手机 AR 引导系统准确，优于传统 CT 引导，特别是对经验较少的介入放射科医生，并且增强了 50mm 肿瘤消融在经验水平上的更标准化性能。
