RibMR - A Mixed Reality Visualization System for Rib Fracture Localization in Surgical Stabilization of Rib Fractures: Phantom, Preclinical, and Clinical Studies.

In surgical stabilization of rib fractures (SSRF), the current standard relies on preoperative CT imaging and often incorporates ultrasound (US) imaging. As an alternative, mixed reality (MR) technology holds promise for improving rib fracture localization. This study presents an MR-based visualization system designed for SSRF in a clinical setting. We developed RibMR - a visualization system using an MR head-mounted display that projects a patient-specific 3D hologram onto the patient. RibMR enables the localization of rib fractures in relation to the patient's anatomy. We conducted phantom study using a human mannequin, a preclinical study with two healthy patients, and clinical study with two patients to evaluate RibMR and compared it to US practice. RibMR localized rib fractures with an average accuracy of 0.38 ± 0.21 cm in phantom, 3.75 ± 2.45 cm in preclinical, and 1.47 ± 1.33 cm in clinical studies. RibMR took an average time (minutes) of 4.42 ± 0.98 for the phantom, 8.03 ± 3.67 for the preclinical, and 8.76 ± 0.65 for the clinical studies. Compared to US, RibMR located more fractures, including fractures occluded by other structures, with higher accuracy, faster speed, and improved localization rate. All participating surgeons provided positive feedback regarding accuracy, visualization quality, and usability. RibMR enabled accurate and time-efficient localization of rib fractures and showed better performance compared to US. RibMR is a promising alternative to US for localizing rib fractures in SSRF.