Physics-driven Sonification for Improving Multisensory Needle Guidance in Percutaneous Epicardial Access

2026-04-08

AI Summary

This study addresses the high risk associated with percutaneous epicardial puncture, which stems from cardiac motion and the thin pericardium. The authors propose a multisensory navigation system integrating 4D cardiac CTA-based dynamic reconstruction, real-time needle-tip tracking, and extended reality (XR). A key innovation is the introduction of a physics-based membrane model for sonification, which encodes cardiac dynamics into auditory feedback, enabling an audiovisual mapping of physiological information. Clinical simulation experiments demonstrate that the system significantly enhances procedural safety—reducing myocardial contact rate to 3.64%—and achieves a 90.91% success rate, all without increasing procedure time. Furthermore, it effectively lowers operator cognitive load while improving spatiotemporal awareness and user-centered interaction.

Abstract

Percutaneous epicardial access (PEA), performed on a beating heart under fluoroscopy, enables arrhythmia treatment. However, advancing a needle toward the thin and moving pericardium remains highly challenging and risky. To address this problem, we present a physics-driven sonification method for Extended Reality (XR)-based multisensory navigation to enhance user perception during the critical needle landing phase in PEA. Dynamic cardiac anatomy from 4D CTA was reconstructed and registered to a real-world coordinate system. Real-time needle tracking provided the position of the needle tip relative to moving cardiac structures and drove an audio-visual feedback module. The visual display presented navigational cues and dynamic anatomy, while the auditory display encoded physiological cardiac states using a multilayer physical membrane model. A phantom study was conducted with twelve cardiologists performing needle insertions under visual-only and multisensory feedback. The multisensory method significantly improved navigation safety ($χ^2 = 11.30$, $p < 0.01$), reducing myocardial contact (3.64% vs. 7.27%) and increasing correct access (90.91% vs. 52.73%). Needle placement accuracy improved, with closer membrane proximity (Cliff delta = 0.19) and reduced variability ($p < 0.05$). Execution time was comparable, while time-accuracy correlations differed significantly between modalities ($p < 0.01$). NASA-TLX indicated lower cognitive load with multisensory guidance ($p < 0.01$). These results demonstrate the feasibility of physics-driven sonification for improving spatiotemporal awareness and supporting user-centered surgical navigation.

Problem

• Percutaneous epicardial access
• Needle guidance
• Moving pericardium
• Cardiac motion
• Surgical navigation

Innovation

• physics-driven sonification
• multisensory guidance
• percutaneous epicardial access
• extended reality
• real-time needle tracking