Purpose: Augmented reality overlay systems can be used to project a CT image directly onto a patient during procedures. They have been actively trialed for computer-guided procedures, however they have not become commonplace in practice due to restrictions of previous systems. Previous systems have not been handheld, and have had complicated calibration procedures. We put forward a handheld tablet-based system for assisting with needle interventions. Methods: The system consists of a tablet display and a 3-D printed reusable and customizable frame. A simple and accurate calibration method was designed to align the patient to the projected image. The entire system is tracked via camera, with respect to the patient, and the projected image is updated in real time as the system is moved around the region of interest. Results: The resulting system allowed for 0.99mm mean position error in the plane of the image, and a mean position error of 0.61mm out of the plane of the image. This accuracy was thought to be clinically acceptable for tool using computer-guidance in several procedures that involve musculoskeletal needle placements. Conclusion: Our calibration method was developed and tested using the designed handheld system. Our results illustrate the potential for the use of augmented reality handheld systems in computer-guided needle procedures.
Quantitative evaluation of image recognition performance of fiducial markers in real-time tumor-tracking radiation therapy