Augmented reality during angiography: Integration of a virtual mirror for improved 2D/3D visualization

Visualizing 2D and 3D anatomical information simultaneously within an X-ray image is challenging. Multiple monitors are required in the operating room to enable visualization of anatomical data by the surgeon. Consequently, this results in an interruption during the operation for proper assessment of information. In this paper, we introduce an interactive visualization of the 3D data from new perspectives including visualizing a virtual mirror from the same viewpoint as the X-ray source. The main contribution is our development of a complete angiographic visualization system that displays simultaneous 2D X-ray and 3D anatomical information in a common monitor for the surgeon in the operating room. No previous works have conceived the integration of the virtual mirror into the projection geometry of a C-arm fluoroscope. In total, 24 participants were asked to assess the benefits of the angiographic virtual mirror with different colour-depth encodings. The results of our feasibility study show a clear improvement when deciphering the true positions of aneurysms in X-ray. Lastly, color depth encoding improves correspondence between the 3D vasculature displayed in the virtual mirror to their projection images in X-ray.