Jan Fritz MD, Presenter: Nothing to Disclose

Paweena U-Thainual, Abstract Co-Author: Nothing to Disclose

Tamas Ungi, Abstract Co-Author: Nothing to Disclose

Aaron Flammang, Abstract Co-Author: Employee, Siemens AG

Gabor Fichtinger PhD, Abstract Co-Author: Nothing to Disclose

Iulian I Iordachita, Abstract Co-Author: Nothing to Disclose

John A. Carrino MD, MPH, Abstract Co-Author: Research grant, Siemens AG Research grant, Carestream Health, Inc Research Consultant, General Electric Company

To prospectively test the hypothesis that an augmented reality (AR) image overlay system can provide accurate magnetic resonance imaging (MRI) guidance for shoulder and hip arthrography.

An AR prototype was used in conjunction with a 1.5-Tesla MRI system (Magnetom Espree, Siemens Healthcare, Erlangen, Germany). A total of 28 arthrography procedures were performed in 7 human cadavers. Glenohumeral joints (14/28, 50%) were targeted through the rotator interval. Hip joints (14/28, 50%) were targeted at the femoral head-neck junction. The workflow consisted of the acquisition of a three-dimensional, isotropic (1x1x1 mm pixel size), proton-density (PD) weighted MRI planning volume (3DSPACE, TR/TE=1100/34), planning of the needle path using 3D Slicer software, needle placement under augmented reality MR imaging guidance, MR imaging control of the placed needle (PD-weighted TSE, TR/TE=11442/12, slice thickness (SL) = 3mm), joint injection under real-time MRI monitoring (T1/T2*-weighted gradient echo, TR/TE=9.3/3.5, SL = 5 mm), and acquisition of final T1-weighted MR images with fat saturation for documentation of the distribution of the injectant. Outcome variables included technically successful needle placement, number of needle adjustments, successful intra-articular injection, and time requirements. Quantitative variables were expressed as the arithmetic mean with the minimum and maximum values in parenthesis.

MR imaging confirmed technically successful placement of the injection needle at the target site in 14/14 (100%) glenohumeral joints and 14/14 (100%) hip joints. A total of 4 needle adjustments (4/28, 14%) were preformed. Successful intra-articular injection was subsequently achieved in all joints (28/28, 100%). The entire procedure required 30 (range, 18-44) min. Planning of a single needle path required 3 (1-6) min. Needle placement required 2 (2-16) min.

The presented AR image overlay system provided accurate, high-resolution MRI guidance for successful shoulder and hip arthrography. It showed potential to simplify the current practice of MR-guided arthrography.

The AR image overlay system shows potential for simplified combination of MR-guided arthrography and diagnostic MR-Arthrography, without the use of ionizing radiation.

Fritz, J, U-Thainual, P, Ungi, T, Flammang, A, Fichtinger, G, Iordachita, I, Carrino, J, Augmented Reality Visualization Using Image-overlay for MR-guided Interventions: Assessment of Performance in Cadaveric Shoulder, and Hip Arthrography.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034345.html