Skip to main content
SpringerLink
Log in

Real-time augmented reality application in presurgical planning and lesion scalp localization by a smartphone

  • Original Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Objective

A smartphone augmented reality (AR) application (app) was explored for clinical use in presurgical planning and lesion scalp localization.

Methods

We programmed an AR App on a smartphone. The accuracy of the AR app was tested on a 3D-printed head model, using the Euclidean distance of displacement of virtual objects. For clinical validation, 14 patients with brain tumors were included in the study. Preoperative MRI images were used to generate 3D models for AR contents. The 3D models were then transferred to the smartphone AR app. Tumor scalp localization was marked, and a surgical corridor was planned on the patient’s head by viewing AR images on the smartphone screen. Standard neuronavigation was applied to evaluate the accuracy of the smartphone. Max-margin distance (MMD) and area overlap ratio (AOR) were measured to quantitatively validate the clinical accuracy of the smartphone AR technique.

Results

In model validation, the total mean Euclidean distance of virtual object displacement using the smartphone AR app was 4.7 ± 2.3 mm. In clinical validation, the mean duration of AR app usage was 168.5 ± 73.9 s. The total mean MMD was 6.7 ± 3.7 mm, and total mean AOR was 79%.

Conclusions

The smartphone AR app provides a new way of experience to observe intracranial anatomy in situ, and it makes surgical planning more intuitive and efficient. Localization accuracy is satisfactory with lesions larger than 15 mm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

AR:

Augmented reality

MRI:

Magnetic resonance imaging

DICOM:

Digital Imaging and Communications in Medicine

App:

Application

SLAM:

Simultaneous localization and mapping

MMD:

Max-margin distance

AOR:

Area overlap ratio

References

  1. Atherton S, Javed M, Webster S, Hemington-Gorse S (2013) Use of a mobile device app: a potential new tool for poster presentations and surgical education. J Vis Commun Med 36(1–2):6–10

    Article  CAS  Google Scholar 

  2. Chen J, Han K, Zhang D, Li Z, Hou L (2017) Presurgical planning for supratentorial lesions with free Slicer software and Sina app. World Neurosurg. https://doi.org/10.1016/j.wneu.2017.06.146

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cho J, Rahimpour S, Cutler A, Goodwin CR, Lad SP, Codd P (2020) Enhancing reality: a systematic review of augmented reality in neuronavigation and education. World Neurosurgery 139:186–195

    Article  Google Scholar 

  4. Eftekhar B (2015) A smartphone app to assist scalp localization of superficial supratentorial lesions – Technical note. World Neurosurg. https://doi.org/10.1016/j.wneu.2015.09.091

    Article  PubMed  Google Scholar 

  5. Rae E, Lasso A, Holden MS, Morin E, Levy R, Fichtinger G (2018) Neurosurgical burr hole placement using the Microsoft HoloLens. Medical Imaging. https://doi.org/10.1117/12.2293680

  6. Frantz T, Jansen B, Duerinck J, Vandemeulebroucke J (2018) Augmenting Microsoft’s HoloLens with vuforia tracking for neuronavigation. Healthc Technol Lett 5(5):221–225

    Article  Google Scholar 

  7. Hou Y, Ma L, Zhu R, Chen X, Zhang J (2016) A Low-cost iPhone-assisted augmented reality solution for the localization of intracranial lesions. PLoS ONE 11(7):e0159185. https://doi.org/10.1371/journal.pone.0159185

  8. Incekara F, Smits M, Dirven C, Vincent A (2018) Clinical feasibility of a wearable mixed-reality device in neurosurgery. World Neurosurgery 118:e422–e427. https://doi.org/10.1016/j.wneu.2018.06.208

  9. Lebel K, Boissy P, Nguyen H, Duval C (2017) Inertial measurement systems for segments and joints kinematics assessment: towards an understanding of the variations in sensors accuracy. BioMed Eng OnLine 16(1):56

    Article  Google Scholar 

  10. Li Y, Chen X, Wang N (2019) A wearable mixed-reality holographic computer for guiding external ventricular drain insertion at the bedside. J Neurosurg 131(5):1599–1606

    Article  Google Scholar 

  11. Mahmoud N, Grasa ÓG, Nicolau SA (2017) On-patient see-through augmented reality based on visual SLAM. Int J CARS 12(1):1–11

    Article  Google Scholar 

  12. Mandel M, Amorim R, Paiva W, Prudente M, Teixeira M, Andrade A (2013) 3D Preoperative planning in the ER with OsiriX®: when there is no time for neuronavigation. Sensors 13(5):6477–6491

    Article  Google Scholar 

  13. Meulstee JW, Nijsink J, Schreurs R (2019) Toward holographic-guided surgery. Surg Innov 26(1):86–94

    Article  Google Scholar 

  14. Nguyen NQ, Cardinell J, Ramjist JM (2020) An augmented reality system characterization of placement accuracy in neurosurgery. J Clin Neurosci 72:392–396

    Article  Google Scholar 

  15. Pelargos PE, Nagasawa DT, Lagman C (2017) Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery. J Clin Neurosci 35:1–4

    Article  Google Scholar 

  16. Rodby KA, Turin S, Jacobs RJ (2014) Advances in oncologic head and neck reconstruction: Systematic review and future considerations of virtual surgical planning and computer aided design/computer aided modeling. J Plast Reconstr Aesthet Surg 67(9):1171–1185

    Article  Google Scholar 

  17. Sun G, Chen X, Hou Y (2017) Image-guided endoscopic surgery for spontaneous supratentorial intracerebral hematoma. J Neurosurg 127(3):537–542

    Article  Google Scholar 

  18. van Doormaal TPC, van Doormaal JAM, Mensink T (2019) Clinical accuracy of holographic navigation using point-based registration on augmented-reality glasses. Operative Neurosurgery 17(6):588–593

    Article  Google Scholar 

  19. Weichelt B, Heimonen T, Pilz M, Yoder A, Bendixsen C (2019) An argument against cross-platform development: lessons from an augmented reality App prototype for rural emergency responders. JMIR Mhealth Uhealth 7(3):e12207. https://doi.org/10.2196/12207

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical School of Chinese PLA, Beijing, 100853, China

    Xu-jun Shu

  2. Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing, 100853, China

    Xu-jun Shu, Zhi-zhong Zhang, Zhe Xue, Fu-yu Wang & Bai-nan Xu

  3. Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100032, China

    Yu Wang & Hao Xin

Authors
  1. Xu-jun Shu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hao Xin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhi-zhong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhe Xue
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fu-yu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bai-nan Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bai-nan Xu.

Ethics declarations

Ethical approval

The study was approved by the PLA General Hospital Ethics Committee, and informed consent was obtained from all patients.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Brain Tumors

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 155056 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shu, Xj., Wang, Y., Xin, H. et al. Real-time augmented reality application in presurgical planning and lesion scalp localization by a smartphone. Acta Neurochir 164, 1069–1078 (2022). https://doi.org/10.1007/s00701-021-04968-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-021-04968-z

Keywords

Search

Navigation