Augmented reality as an aid in maxillofacial surgery: Validation of a wearable system allowing maxillary repositioning
Augmented reality as an aid in maxillofacial surgery: Validation of a wearable system allowing maxillary repositioning
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DOI：
10.1016/j.jcms.2014.09.001
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发表时间：
2014-12-01
影响因子：
3.1
通讯作者：
Marchetti, Claudio
中科院分区：
文献类型：
--
作者：
Badiali, Giovanni;Ferrari, Vincenzo;Marchetti, Claudio
目的：我们提出了一种新设计的，无定位器，头戴式系统，具有增强现实作为辅助颌面骨surgery，并评估该设备的潜在效用进行可行性研究和validation.Methods：我们的头戴式可穿戴系统促进增强surgery开发作为一个独立的，基于视频的，看到通过设备中的视觉功能进行了调整，以方便颌面骨surgery。我们实施了一项旨在向手术外科医生提供增强现实信息的策略。选择LeFort 1截骨术作为试验手术。该系统被设计为展示覆盖真实的患者细节的虚拟计划。我们实现了一种方法，允许执行无晶圆，增强现实辅助骨骼重新定位。在人体颅骨的物理复制品上进行体外测试，并使用增强现实系统进行LeFort 1上颌骨重新定位。借助光学导航系统测量手术准确性，该系统记录了重新定位的上颌骨上三个参考点（位于前、右后和左后位置）的坐标。将这些结果与预期在三维环境中可实现的结果进行了比较。数据来自三个层次的手术计划，越来越复杂，并为9个不同的操作者与不同水平的手术技巧。平均误差为1.70 ± 0.51 mm，矢状轴轴误差为0.89 ± 0.54 mm，额轴误差为0.60 ± 0.20 mm，和1.06 +/- 0.40 mm。与更复杂的计划（中等：1.82 +/-0.71 mm;困难：1.70 +/- 0.45 mm）相比，最简单的计划的平均误差（1.58 +/- 0.37 mm）略低。前参考点的平均误差（1.33 +/- 0.58 mm）低于右后点（1.72 +/- 0.24 mm）和左后点（2.05 +/- 0.47 mm）。尽管手术经验不同，但在操作者之间的错误方面没有显著差异。外科医生的反馈是可以接受的;所有测试都在15分钟内完成，该工具被认为在实践中既舒适又可用。结论：我们使用了一种新的无定位器、头戴式、可穿戴、立体、视频透视显示器来开发一种有用的策略，让外科医生能够访问增强现实信息。我们的设备似乎是准确的，当用于协助waferless上颌骨复位。我们的研究结果表明，该方法可以潜在地扩展用于面部骨骼上的许多外科手术。此外，我们的阳性结果表明，进行体内测试以评估真实的临床条件下的手术准确性是合适的。(C)2014年欧洲颅颌面外科协会。由爱思唯尔有限公司出版。保留所有权利。
Aim: We present a newly designed, localiser-free, head-mounted system featuring augmented reality as an aid to maxillofacial bone surgery, and assess the potential utility of the device by conducting a feasibility study and validation.Methods: Our head-mounted wearable system facilitating augmented surgery was developed as a stand-alone, video-based, see-through device in which the visual features were adapted to facilitate maxillofacial bone surgery. We implement a strategy designed to present augmented-reality information to the operating surgeon. LeFort1 osteotomy was chosen as the test procedure. The system is designed to exhibit virtual planning overlaying the details of a real patient. We implemented a method allowing performance of waferless, augmented-reality assisted bone repositioning. In vitro testing was conducted on a physical replica of a human skull, and the augmented reality system was used to perform LeFort1 maxillary repositioning. Surgical accuracy was measured with the aid of an optical navigation system that recorded the coordinates of three reference points (located in anterior, posterior right, and posterior left positions) on the repositioned maxilla. The outcomes were compared with those expected to be achievable in a three-dimensional environment. Data were derived using three levels of surgical planning, of increasing complexity, and for nine different operators with varying levels of surgical skill.Results: The mean error was 1.70 +/- 0.51 mm. The axial errors were 0.89 +/- 0.54 mm on the sagittal axis, 0.60 +/- 0.20 mm on the frontal axis, and 1.06 +/- 0.40 mm on the craniocaudal axis. The simplest plan was associated with a slightly lower mean error (1.58 +/- 0.37 mm) compared with the more complex plans (medium: 1.82 +/- 0.71 mm; difficult: 1.70 +/- 0.45 mm). The mean error for the anterior reference point was lower (1.33 +/- 0.58 mm) than those for both the posterior right (1.72 +/- 0.24 mm) and posterior left points (2.05 +/- 0.47 mm). No significant difference in terms of error was noticed among operators, despite variations in surgical experience. Feedback from surgeons was acceptable; all tests were completed within 15 min and the tool was considered to be both comfortable and usable in practice.Conclusion: We used a new localiser-free, head-mounted, wearable, stereoscopic, video see-through display to develop a useful strategy affording surgeons access to augmented reality information. Our device appears to be accurate when used to assist in waferless maxillary repositioning. Our results suggest that the method can potentially be extended for use with many surgical procedures on the facial skeleton. Further, our positive results suggest that it would be appropriate to proceed to in vivo testing to assess surgical accuracy under real clinical conditions. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.