Augmented reality (AR) devices with head mounted displays (HMDs) facilitate the direct superimposition of 3D preoperative imaging data onto the patient during surgery. To use an HMD-AR device as a stand-alone surgical navigation system, the device should be able to locate the patient and surgical instruments, align preoperative imaging data with the patient, and visualize navigation data in real time during surgery. Whereas some of the technologies required for this are known, integration in such devices is cumbersome and requires specific knowledge and expertise, hampering scientific progress in this field. This work therefore aims to present and evaluate an integrated HMD-based AR surgical navigation framework that is adaptable to diverse surgical applications. The framework tracks 2D patterns as reference markers attached to the patient and surgical instruments. It allows for the calibration of surgical tools using pivot and reference-based calibration techniques. It enables image-to-patient registration using point-based matching and manual positioning. The integrated functionalities of the framework are evaluated on two HMD devices, the HoloLens 2 and Magic Leap 2, with two surgical use cases being evaluated in a phantom setup: AR-guided needle insertion and rib fracture localization. The framework was able to achieve a mean tooltip calibration accuracy of 1 mm, a registration accuracy of 3 mm, and a targeting accuracy below 5 mm on the two surgical use cases. The framework presents an easy-to-use configurable tool for HMD-based AR surgical navigation, which can be extended and adapted to many surgical applications. The framework is publicly available at https://github.com/abdullahthabit/SurgNavAR.

翻译：增强现实（AR）头戴显示器（HMD）可在手术过程中将三维术前成像数据直接叠加到患者身上。若要将HMD-AR设备用作独立的手术导航系统，该设备需能够定位患者与手术器械、将术前成像数据与患者对齐，并在手术过程中实时可视化导航数据。尽管实现上述功能所需的部分技术已有先例，但在此类设备中的整合过程较为繁琐，且需要特定专业知识与经验，这阻碍了该领域的科学进展。为此，本文旨在提出并评估一个可适配多种手术应用的集成式HMD-AR手术导航框架。该框架追踪附着于患者和手术器械上的二维标记图案作为参考标记，支持基于枢轴校准和参考校准技术的手术器械标定，并利用基于点的匹配与手动定位实现图像与患者的配准。框架的集成功能在HoloLens 2和Magic Leap 2两款HMD设备上进行了评估，并在体模实验中对两种手术场景（AR引导的针穿刺与肋骨骨折定位）进行了测试。结果表明，该框架在两个手术场景中实现了平均1毫米的器械尖端标定精度、3毫米的配准精度以及低于5毫米的靶向精度。该框架提供了一种易于使用、可配置的工具，适用于基于HMD的AR手术导航，可扩展并适配多种手术应用。框架代码已开源，详见https://github.com/abdullahthabit/SurgNavAR。