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01.01.2013 | Musculoskeletal

Augmented reality visualisation using an image overlay system for MR-guided interventions: technical performance of spine injection procedures in human cadavers at 1.5 Tesla

verfasst von: Jan Fritz, Paweena U-Thainual, Tamas Ungi, Aaron J. Flammang, Gabor Fichtinger, Iulian I. Iordachita, John A. Carrino

Erschienen in: European Radiology | Ausgabe 1/2013

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Abstract

Objectives

To prospectively assess the technical performance of an augmented reality system for MR-guided spinal injection procedures.

Methods

The augmented reality system was used with a clinical 1.5-T MRI system. A total of 187 lumbosacral spinal injection procedures (epidural injection, spinal nerve root injection, facet joint injection, medial branch block, discography) were performed in 12 human cadavers. Needle paths were planned with the Perk Station module of 3D Slicer software on high-resolution MR images. Needles were placed under augmented reality MRI navigation. MRI was used to confirm needle locations. T1-weighted fat-suppressed MRI was used to visualise the injectant. Outcome variables assessed were needle adjustment rate, inadvertent puncture of non-targeted structures, successful injection rate and procedure time.

Results

Needle access was achieved in 176/187 (94.1 %) targets, whereas 11/187 (5.9 %) were inaccessible. Six of 11 (54.5 %) L5–S1 disks were inaccessible, because of an axial obliquity of 30˚ (27˚–34˚); 5/11 (45.5 %) facet joints were inaccessible because of osteoarthritis or fusion. All accessible targets (176/187, 94.1 %) were successfully injected, requiring 47/176 (26.7 %) needle adjustments. There were no inadvertent punctures of vulnerable structures. Median procedure time was 10.2 min (5–19 min).

Conclusions

Image overlay navigated MR-guided spinal injections were technically accurate. Disks with an obliquity ≥27˚ may be inaccessible.

Key Points

• Augmented reality technology facilitates MR-guided spine injections.

• Patient and operator exposure to ionising radiation can be obviated.

• MR imaging guidance enabled the procedure without need of a dedicated interventional MRI system.

• Various MR-guided spine injection procedures using augmented reality are technically accurate.

• Augmented reality has potential to simplify the workflow of MR-guided spine injections.

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Titel: Augmented reality visualisation using an image overlay system for MR-guided interventions: technical performance of spine injection procedures in human cadavers at 1.5 Tesla
verfasst von: Jan Fritz
Paweena U-Thainual
Tamas Ungi
Aaron J. Flammang
Gabor Fichtinger
Iulian I. Iordachita
John A. Carrino
Publikationsdatum: 01.01.2013
Verlag: Springer-Verlag
Erschienen in: European Radiology / Ausgabe 1/2013
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-012-2569-0

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Augmented reality visualisation using an image overlay system for MR-guided interventions: technical performance of spine injection procedures in human cadavers at 1.5 Tesla