Comparison of the Image-to-Patient Registration Performance of a Novel Augmented Reality–Based and a State-of-the-Art Infrared Optical Neuronavigation System
Tessa M. Kos, Wouter D. Maathuis, Peter W. A. Willems, Lambertus W. Bartels, Pierre A. Robe, Tristan P. C. van DoormaalBACKGROUND AND OBJECTIVES:
Augmented reality–based neuronavigation systems (AR-NS) have been proposed as a potential addition to regular neuronavigation systems, such as optical or electromagnetic systems. Accurate image-to-patient registration is a prerequisite for clinical acceptance and implementation of AR-NS in neurosurgical workflows. In this study, the registration performance of a novel AR-NS using a head-mounted display with an integrated red-green-blue camera was compared with that of a state-of-the-art infrared optical neuronavigation system. The performance was evaluated in controlled phantom experiments and in a clinical setting, focusing on registration error, localization precision, and registration time.
METHODS:
Phantom experiments were performed using a human head model equipped with 8 fiducial markers under controlled conditions. Subsequently, adult patients who were undergoing cranial neurosurgery with preoperative T1-weighted contrast-enhanced MRI were included in the clinical study. In both phantom and clinical settings, the target registration error (TRE) and fiducial registration error were assessed using 7 registration fiducials and one independent target fiducial. The registration time was also recorded. Paired
RESULTS:
Data from 37 patients were included for analysis. In phantom experiments, sub-3-mm TRE and sub-1-mm point localization were achieved with both systems (
CONCLUSION:
Comparable registration performance was observed in the phantom measurements. A statistically significant difference in the registration performance of the 2 systems was observed in the patient measurements. The difference between the phantom and clinical findings highlights that similar registration performance can be achieved by the 2 systems under controlled circumstances, but the effect of clinical variables on the registration performance requires further investigation.