Augmented Reality Ultrasound Guidance for Central Line Procedures: Preliminary Results

Abstract

Central line procedures are interventions in which a needle is placed in the jugular vein in the patient’s neck inferior to the carotid bifurcation. In these procedures, avoiding the puncture of the carotid artery is of upmost importance as it can cause severe neurological consequences or death. Often, these procedures are performed under ultrasound guidance, meaning that a linear ultrasound probe is held to the patient’s neck in which the interventionalist can visualize both the carotid artery and jugular vein. However, due to the geometry of the interventional scene, the needle must be placed out-of-plane with the ultrasound and the needle cannot be fully visualized, only a cross-section thereof. This lack of visualization can lead to issues gaging the correct penetration depth. This paper presents preliminary results on an augmented reality (AR) needle guidance system in which a tracked needle and ultrasound fan are simultaneously visualized in their entirety. This AR guidance system is compared against traditional ultrasound-only guidance on a neck phantom. The use of the AR system significantly reduces the intervention time (average decrease of $3.51\pm 1.44$ s) and normalized path length (average decrease of $150\pm 40\,\%$) implying that the use of such as system makes the procedure easier for the interventionalist ($n=36$, $p \le 0.05$). This AR system has gained regulatory approval and is scheduled for clinical trials in humans.