Bruce Daniel

Yue Yang, Fabian Necker, Christoph Leuze et al.

Purpose: In this paper, we develop and clinically evaluate a depth-only, markerless augmented reality (AR) registration pipeline on a head-mounted display, and assess accuracy across small or low-curvature anatomies in real-life operative settings. Methods: On HoloLens 2, we align Articulated HAnd Tracking (AHAT) depth to Computed Tomography (CT)-derived skin meshes via (i) depth-bias correction, (ii) brief human-in-the-loop initialization, (iii) global and local registration. We validated the surface-tracing error metric by comparing "skin-to-bone" relative distances to CT ground truth on leg and foot models, using an AR-tracked tool. We then performed seven intraoperative target trials (feet x2, ear x3, leg x2) during the initial stage of fibula free-flap harvest and mandibular reconstruction surgery, and collected 500+ data per trial. Results: Preclinical validation showed tight agreement between AR-traced and CT distances (leg: median |Delta d| 0.78 mm, RMSE 0.97 mm; feet: 0.80 mm, 1.20 mm). Clinically, per-point error had a median of 3.9 mm. Median errors by anatomy were 3.2 mm (feet), 4.3 mm (ear), and 5.3 mm (lower leg), with 5 mm coverage 92-95%, 84-90%, and 72-86%, respectively. Feet vs. lower leg differed significantly (Delta median ~1.1 mm; p < 0.001). Conclusion: A depth-only, markerless AR pipeline on HMDs achieved ~3-4 mm median error across feet, ear, and lower leg in live surgical settings without fiducials, approaching typical clinical error thresholds for moderate-risk tasks. Human-guided initialization plus global-to-local registration enabled accurate alignment on small or low-curvature targets, improving the clinical readiness of markerless AR guidance.

Yue Yang, Christoph Leuze, Brian Hargreaves et al. · stanford

The use of Augmented Reality (AR) devices for surgical guidance has gained increasing traction in the medical field. Traditional registration methods often rely on external fiducial markers to achieve high accuracy and real-time performance. However, these markers introduce cumbersome calibration procedures and can be challenging to deploy in clinical settings. While commercial solutions have attempted real-time markerless tracking using the native RGB cameras of AR devices, their accuracy remains questionable for medical guidance, primarily due to occlusions and significant outliers between the live sensor data and the preoperative target anatomy point cloud derived from MRI or CT scans. In this work, we present a markerless framework that relies only on the depth sensor of AR devices and consists of two modules: a registration module for high-precision, outlier-robust target anatomy localization, and a tracking module for real-time pose estimation. The registration module integrates depth sensor error correction, a human-in-the-loop region filtering technique, and a robust global alignment with curvature-aware feature sampling, followed by local ICP refinement, for markerless alignment of preoperative models with patient anatomy. The tracking module employs a fast and robust registration algorithm that uses the initial pose from the registration module to estimate the target pose in real-time. We comprehensively evaluated the performance of both modules through simulation and real-world measurements. The results indicate that our markerless system achieves superior performance for registration and comparable performance for tracking to industrial solutions. The two-module design makes our system a one-stop solution for surgical procedures where the target anatomy moves or stays static during surgery.

Xinkai Wang, Yue Yang, Kehong Zhou et al. · stanford

Chinese acupuncture practitioners primarily depend on muscle memory and tactile feedback to insert needles and accurately target acupuncture points, as the current workflow lacks imaging modalities and visual aids. Consequently, new practitioners often learn through trial and error, requiring years of experience to become proficient and earn the trust of patients. Medical students face similar challenges in mastering this skill. To address these challenges, we developed an innovative system, MRUCT, that integrates ultrasonic computed tomography (UCT) with mixed reality (MR) technology to visualize acupuncture points in real-time. This system offers offline image registration and real-time guidance during needle insertion, enabling them to accurately position needles based on anatomical structures such as bones, muscles, and auto-generated reference points, with the potential for clinical implementation. In this paper, we outline the non-rigid registration methods used to reconstruct anatomical structures from UCT data, as well as the key design considerations of the MR system. We evaluated two different 3D user interface (3DUI) designs and compared the performance of our system to traditional workflows for both new practitioners and medical students. The results highlight the potential of MR to enhance therapeutic medical practices and demonstrate the effectiveness of the system we developed.

Yue Yang, Xue Xie, Xinkai Wang et al. · stanford

Optical see-through augmented reality (OST-AR) systems like Microsoft HoloLens 2 hold promise for arm's distance guidance (e.g., surgery), but depth perception of the hologram and occlusion of real instruments remain challenging. We present an evaluation of how visualizing the target object with different transparencies and visualizing a tracked tool (virtual proxy vs. real tool vs. no tool tracking) affects depth perception and system usability. Ten participants performed two experiments on HoloLens 2. In Experiment 1, we compared high-transparency vs. low-transparency target rendering in a depth matching task at arm's length. In Experiment 2, participants performed a simulated surgical pinpoint task on a frontal bone target under six visualization conditions ($2 \times 3$: two target transparencies and three tool visualization modes: virtual tool hologram, real tool, or no tool tracking). We collected data on depth matching error, target localization error, system usability, task workload, and qualitative feedback. Results show that a more opaque target yields significantly lower depth estimation error than a highly transparent target at arm's distance. Moreover, showing the real tool (occluding the virtual target) led to the highest accuracy and usability with the lowest workload, while not tracking the tool yielded the worst performance and user ratings. However, making the target highly transparent, while allowing the real tool to remain visible, slightly impaired depth cues and did not improve usability. Our findings underscore that correct occlusion cues, rendering virtual content opaque and occluding it with real tools in real time, are critical for depth perception and precision in OST-AR. Designers of arm-distance AR systems should prioritize robust tool tracking and occlusion handling; if unavailable, cautiously use transparency to balance depth perception and tool visibility.