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While ultrasound (US) guidance has been used during central venous catheterization to reduce complications, including the puncturing of arteries, the rate of such problems remains non-negligible. To further reduce complication rates, mixed-reality systems have been proposed as part of the user interface for such procedures. We demonstrate the use of a surgical navigation system that renders a calibrated US image, and the needle and its trajectory, in a common frame of reference. We compare the effectiveness of this system, whereby images are rendered on a planar monitor and within a head-mounted display (HMD), to the standard-of-care US-only approach, via a phantom-based user study that recruited 31 expert clinicians and 20 medical students. These users performed needle-insertions into a phantom under the three modes of visualization. The success rates were significantly improved under HMD-guidance as compared to US-guidance, for both expert clinicians (94% vs. 70%) and medical students (70% vs. 25%). Users more consistently positioned their needle closer to the center of the vessel’s lumen under HMD-guidance compared to US-guidance. The performance of the clinicians when interacting with this monitor system was comparable to using US-only guidance, with no significant difference being observed across any metrics. The results suggest that the use of an HMD to align the clinician’s visual and motor fields promotes successful needle guidance, highlighting the importance of continued HMD-guidance research.

The authors present a deep learning algorithm for the automatic centroid localisation of out-of-plane US needle reflections to produce a semi-automatic ultrasound (US) probe calibration algorithm. A convolutional neural network was trained on a dataset of 3825 images at a 6 cm imaging depth to predict the position of the centroid of a needle reflection. Applying the automatic centroid localisation algorithm to a test set of 614 annotated images produced a root mean squared error of 0.62 and 0.74 mm (6.08 and 7.62 pixels) in the axial and lateral directions, respectively. The mean absolute errors associated with the test set were 0.50 ± 0.40 mm and 0.51 ± 0.54 mm (4.9 ± 3.96 pixels and 5.24 ± 5.52 pixels) for the axial and lateral directions, respectively. The trained model was able to produce visually validated US probe calibrations at imaging depths on the range of 4-8 cm, despite being solely trained at 6 cm. This work has automated the pixel localisation required for the guided-US calibration algorithm producing a semi-automatic implementation available open-source through 3D Slicer. The automatic needle centroid localisation improves the usability of the algorithm and has the potential to decrease the fiducial localisation and target registration errors associated with the guided-US calibration method.

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