无需标记点，用深度摄像头实现手术导航，精度达3-5毫米。
Markerless Augmented Reality Registration for Surgical Guidance: A Multi-Anatomy Clinical Accuracy Study
- 仅用深度信息和人工初定位，结合全局到局部注册算法。
- 临床实测误差中位数3.9毫米，足部误差最低仅3.2毫米。
- 适合复杂解剖区域的术中导航，尤其耳、足、小腿等小结构。
目的：本文开发并临床评估了一种基于头戴式显示器的纯深度、无标记增强现实（AR）配准流程，评估其在真实手术环境中对小尺寸或低曲率解剖结构的配准精度。方法：在HoloLens 2上，通过深度偏置校正、简短的人工介入初始化以及全局与局部配准，将关节手部追踪（AHAT）深度数据与由计算机断层扫描（CT）生成的皮肤模型对齐。通过对比AR追踪工具测量的“皮肤-骨骼”相对距离与CT真值，验证了表面追踪误差指标。随后在腓骨游离皮瓣取材及下颌重建术初期阶段进行了七次术中目标测试（足部2次、耳部3次、腿部2次），每项测试采集超过500组数据。结果：预临床验证显示AR追踪距离与CT距离高度一致（腿部：中位绝对差|Δd| 0.78 mm，均方根误差RMSE 0.97 mm；足部：0.80 mm，1.20 mm）。临床测试中，单点误差中位数为3.9 mm。按解剖部位划分，中位误差分别为：足部3.2 mm，耳部4.3 mm，下肢5.3 mm，5 mm覆盖率达92-95%、84-90%、72-86%。足部与下肢差异显著（中位差~1.1 mm；p < 0.001）。结论：在无标记点条件下，该基于头显的纯深度AR配准流程在真实手术中实现了约3-4 mm的中位误差，接近中等风险手术的临床容错阈值。人工引导初始化结合全局至局部注册，使小或低曲率目标的精准对齐成为可能，显著提升了无标记AR导航的临床可用性。
原文摘要 · Abstract (English)
Purpose: In this paper, we develop and clinically evaluate a depth-only, markerless augmented reality (AR) registration pipeline on a head-mounted display, and assess accuracy across small or low-curvature anatomies in real-life operative settings. Methods: On HoloLens 2, we align Articulated HAnd Tracking (AHAT) depth to Computed Tomography (CT)-derived skin meshes via (i) depth-bias correction, (ii) brief human-in-the-loop initialization, (iii) global and local registration. We validated the surface-tracing error metric by comparing "skin-to-bone" relative distances to CT ground truth on leg and foot models, using an AR-tracked tool. We then performed seven intraoperative target trials (feet x2, ear x3, leg x2) during the initial stage of fibula free-flap harvest and mandibular reconstruction surgery, and collected 500+ data per trial. Results: Preclinical validation showed tight agreement between AR-traced and CT distances (leg: median |Delta d| 0.78 mm, RMSE 0.97 mm; feet: 0.80 mm, 1.20 mm). Clinically, per-point error had a median of 3.9 mm. Median errors by anatomy were 3.2 mm (feet), 4.3 mm (ear), and 5.3 mm (lower leg), with 5 mm coverage 92-95%, 84-90%, and 72-86%, respectively. Feet vs. lower leg differed significantly (Delta median ~1.1 mm; p < 0.001). Conclusion: A depth-only, markerless AR pipeline on HMDs achieved ~3-4 mm median error across feet, ear, and lower leg in live surgical settings without fiducials, approaching typical clinical error thresholds for moderate-risk tasks. Human-guided initialization plus global-to-local registration enabled accurate alignment on small or low-curvature targets, improving the clinical readiness of markerless AR guidance.
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