Wearable Mechatronic Ultrasound-Integrated AR Navigation System for Lumbar Puncture Guidance

As one of the most commonly performed spinal interventions in routine clinical practice, lumbar punctures are usually done with only hand palpation and trial-and-error. Failures can prolong procedure time and introduce complications such as cerebrospinal fluid leaks and headaches. Therefore, an effective needle insertion guidance method is desired. In this work, we present a complete lumbar puncture guidance system with the integration of (1) a wearable mechatronic ultrasound imaging device, (2) volume-reconstruction and bone surface estimation algorithms and (3) two alternative augmented reality user interfaces for needle guidance, including a HoloLens-based and a tablet-based solution. We conducted a quantitative evaluation of the end-to-end navigation accuracy, which shows that our system can achieve an overall needle navigation accuracy of 2.83 mm and 2.76 mm for the Tablet-based and the HoloLens-based solutions, respectively. In addition, we conducted a preliminary user study to qualitatively evaluate the effectiveness and ergonomics of our system on lumbar phantoms. The results show that users were able to successfully reach the target in an average of 1.12 and 1.14 needle insertion attempts for Tablet-based and HoloLens-based systems, respectively, exhibiting the potential to reduce the failure rates of lumbar puncture procedures with the proposed lumbar-puncture guidance.