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June 14, 2020

Study Demonstrates Feasibility of Hologram Technology in Liver Tumor Ablation

June 14, 2020—Data from one of the first clinical uses of augmented reality guidance with electromagnetically tracked tools shows that the technology may help doctors quickly, safely, and accurately deliver targeted liver cancer treatments, according to research presented during a virtual session of the Society of Interventional Radiology's (SIR) 2020 annual scientific meeting held June 13-14.

SIR stated that the technology provides a three-dimensional (3D) holographic view inside a patient’s body, allowing interventional radiologists to accurately burn away tumors while navigating to avoid organs and other critical structures.

Gaurav Gadodia, MD, a radiology resident at the Cleveland Clinic in Cleveland, Ohio and the lead author of the study, commented in the SIR announcement, “Converting traditional two-dimensional (2D) imaging into 3D holograms, which we can then utilize for guidance using augmented reality, helps us to better view a patient’s internal structures as we navigate our way to the point of treatment.”

Dr. Gadodia continued, “While conventional imaging, like ultrasound and CT, is safe, effective, and remains the gold-standard of care, augmented reality potentially improves the visualization of the tumor and surrounding structures, increasing the speed of localization and improving the treating physician's confidence.”

According to SIR, this is an initial in-human pilot study of the technology for the percutaneous thermal ablation of solid liver tumors. To apply this technology, the investigators perform the following steps:

  1. Multiphase CT is used to record coordinate markers placed on a patient’s body.
  2. These imaging data are added to a software application that allows for the segmentation of the tumor and nearby structures within the marked coordinate space.
  3. This information is fed into a proprietary augmented reality application, which utilizes Microsoft’s HoloLens technology, a virtual reality headset with transparent lenses, to project a segmented hologram of the patient’s imaged anatomy directly onto the patient.
  4. The hologram is registered to the coordinate markers to ensure the accurate location of the relevant anatomy.
  5. Utilizing electromagnetic tracking, instruments including the ablation probe can also be visualized in the augmented reality space during the procedure, thus allowing for true holographic intraprocedural guidance.
  6. Interventional radiologists can then use the combination of the holographic images of the patient’s anatomy and tracked tools to find the tumor in the patient’s liver quickly, check for optimal targeting of the tumor by the ablation probe, and avoid key structures.

The study, which is approved by an institutional review board (IRB), included five patients who were selected for microwave ablation of their liver tumors.

For safety, the gold standard of ultrasound was used for primary clinical decision-making and probe guidance, with direct comparison to holographic guidance. Following ablation, images and video from postprocedural sonography, cone beam and multidetector-row CT, and HoloLens recordings were evaluated.

In all five cases, intraprocedural holographic guidance was in agreement with the standard ultrasound-based guidance. Postprocedural imaging showed adequate tumor ablation, and no patients experienced tumor recurrence at the 3-month follow-up.

In this early phase pilot study, the investigators anecdotally observed that the speed of tumor localization was faster with holographic guidance and that their confidence in optimal ablation and critical structure avoidance was improved over standard imaging guidance. They are further attempting to quantify these findings as they continue to enroll patients in the study.

Beyond its use during treatments, interventional radiologists also see value in using this tool for clinicians’ planning purposes and for improving patient engagement and understanding of the condition and treatment.

Charles Martin, III, MD, an interventional radiologist at Cleveland Clinic and the principal investigator of the IRB, is the senior author of the study. He stated in the SIR press release, “This technique can be used intraprocedurally to check the accuracy and quality of the treatment, as well as preprocedurally to engage with the patient in their own care. We can change 2D images into holograms of a patient’s distinct anatomy so that both the physician and the patient get a better understanding of the tumor and treatment.”

Investigators continue to test this technology for ablations in the abdominal area with plans to expand to other types of procedures and in other areas of the body. The technology has only been tested for feasibility and, therefore, cannot yet be used as a standalone method for delivering treatment, advised SIR.

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