Surgical treatment of pediatric chest wall tumors requires accurate surgical planning and tumor localization to achieve radical resections while sparing as much healthy tissue as possible. Augmented Reality (AR) could facilitate surgical decision making by improving anatomical understanding and intraoperative tumor localization. From January 2021, we used the HoloLens 2 for pre-incisional tumor localization during all chest wall resections inside our center. A patient-specific 3D model was projected onto the patient by use of a five-point registration method based on anatomical landmarks. Furthermore, we developed and pre-clinically tested a surface matching method to allow post-incisional AR guidance by performing registration on the exposed surface of the ribs. Successful registration and holographic overlay were achieved in eight patients. The projection seemed most accurate when landmarks were positioned in a non-symmetric configuration in proximity to the tumor. Disagreements between the overlay and expected tumor location were mainly due to user-dependent registration errors. The pre-clinical tests of the surface matching method proved the feasibility of registration on the exposed ribs. Our results prove the applicability of AR guidance for the pre- and post-incisional localization of pediatric chest wall tumors during surgery. The system has the potential to enable intraoperative 3D visualization, hereby facilitating surgical planning and management of chest wall resections. IV Treatment Study

中文翻译：

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增强现实指导小儿胸壁肿瘤手术定位的临床应用和进一步发展

儿童胸壁肿瘤的手术治疗需要准确的手术计划和肿瘤定位，以实现根治性切除，同时尽可能保留健康组织。增强现实（AR）可以通过改善解剖学理解和术中肿瘤定位来促进手术决策。从 2021 年 1 月起，我们在中心内的所有胸壁切除术中使用 HoloLens 2 进行切口前肿瘤定位。通过使用基于解剖标志的五点配准方法，将患者特定的 3D 模型投影到患者身上。此外，我们开发并临床前测试了一种表面匹配方法，通过在肋骨的暴露表面上进行配准来实现切口后 AR 引导。八名患者成功配准和全息叠加。当地标以非对称结构放置在肿瘤附近时，投影似乎最准确。叠加和预期肿瘤位置之间的不一致主要是由于用户依赖的配准错误。表面匹配方法的临床前测试证明了对暴露肋骨进行配准的可行性。我们的结果证明了 AR 引导对于小儿胸壁肿瘤手术期间切口前和切口后定位的适用性。该系统有潜力实现术中 3D 可视化，从而促进胸壁切除的手术计划和管理。静脉注射治疗研究