SurgNavAR: An Augmented Reality Surgical Navigation Framework for Optical See-Through Head Mounted Displays

📅 2026-03-31
📈 Citations: 0
Influential: 0
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🤖 AI Summary
Current head-mounted augmented reality (AR) devices struggle to independently support precise intraoperative guidance due to the absence of an integrated surgical navigation framework. This work proposes the first open-source, configurable optical see-through HMD-based AR surgical navigation framework, which incorporates 2D fiducial marker tracking, pivot calibration for instruments, reference base registration, and both manual and point-based multimodal image-to-patient space registration. The system has been successfully deployed on HoloLens 2 and Magic Leap 2 platforms, significantly lowering technical barriers and enhancing cross-procedural scalability. Simulated experiments demonstrate a tool-tip calibration error of approximately 1 mm, a registration error of about 3 mm, and targeting accuracy better than 5 mm, effectively validating its utility in needle insertion guidance and rib fracture localization.
📝 Abstract
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.
Problem

Research questions and friction points this paper is trying to address.

Augmented Reality
Surgical Navigation
Head Mounted Display
Optical See-Through
Surgical Applications
Innovation

Methods, ideas, or system contributions that make the work stand out.

Augmented Reality
Surgical Navigation
Optical See-Through HMD
Tool Calibration
Image-to-Patient Registration
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Abdullah Thabit
Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, and also with the Department of Oral and Maxillofacial Surgery, Erasmus MC, 3015 GD Rotterdam, The Netherlands
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Mohamed Benmahdjoub
Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, and also with the Department of Oral and Maxillofacial Surgery, Erasmus MC, 3015 GD Rotterdam, The Netherlands
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Rafiuddin Jinabade
University of Groningen, 9712 CP Groningen, The Netherlands; and Department of Oral and Maxillofacial Surgery, Erasmus MC, 3015 GD Rotterdam, The Netherlands
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Hizirwan S. Salim
Department of High Performance Compute & Visualization, SURF bv, 3511 EP Utrecht, The Netherlands
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Marie-Lise C. van Veelen
Department of Neurosurgery, Erasmus MC, 3015 GD Rotterdam, The Netherlands
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Mark G. van Vledder
Trauma Research Unit, Department of Surgery, Erasmus MC, 3015 GD Rotterdam, The Netherlands
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Eppo B. Wolvius
Department of Oral and Maxillofacial Surgery, Erasmus MC, 3015 GD Rotterdam, The Netherlands
Theo van Walsum
Theo van Walsum
Associate Professor in Image Guidance in Interventions and Therapy, Erasmus MC
Image Guided InterventionsMedical Image AnalysisMedical ImagingNavigationAugmented Reality for Medical Interventions