Comparing Different Registration and Visualization Methods for Navigated Common Femoral Arterial Access—A Phantom Model Study Using Mixed Reality

Journal of Imaging, vol. 10, pp. 76

Abstract

Mixed reality (MxR) enables the projection of virtual three-dimensional objects into the user's field of view via a head-mounted display (HMD). This phantom model study investigated three different workflows for navigated common femoral arterial (CFA) access and compared it to a conventional sonography-guided technique as a control. A total of 160 punctures were performed by 10 operators (5 experts and 5 non-experts). A successful CFA puncture was defined as puncture at the mid-level of the femoral head with the needle tip at the central lumen line in a 0° coronary insertion angle and a 45° sagittal insertion angle. Positional errors were quantified using cone-beam computed tomography following each attempt. Mixed effect modeling revealed that the distance from the needle entry site to the mid-level of the femoral head is significantly shorter for navigated techniques than for the control group. This highlights that three-dimensional visualization could increase the safety of CFA access. However, the navigated workflows are infrastructurally complex with limited usability and are associated with relevant cost. While navigated techniques appear as a potentially beneficial adjunct for safe CFA access, future developments should aim to reduce workflow complexity, avoid optical tracking systems, and offer more pragmatic methods of registration and instrument tracking.

Authors 5

1. Johannes Hatzl corresponding

   University Hospital Heidelberg

   Affiliation as printed

   Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany

2. Dittmar Böckler

   University Hospital Heidelberg

   Affiliation as printed

   Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany

3. Niklas Hartmann

   University Hospital Heidelberg

   Affiliation as printed

   Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany

4. Katrin Meisenbacher

   University Hospital Heidelberg

   Affiliation as printed

   Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany

5. Christian Uhl Aachen Department of Vascular Surgery

   University Hospital Heidelberg · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Vascular Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany

   Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany