Evaluation of AR visualization approaches for catheter insertion into the ventricle cavity

Mohamed Benmahdjoub*, Abdullah Thabit, Marie Lise C. Van Veelen, Wiro J. Niessen, Eppo B. Wolvius, Theo Van Walsum

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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Augmented reality (AR) has shown potential in computer-aided surgery. It allows for the visualization of hidden anatomical structures as well as assists in navigating and locating surgical instruments at the surgical site. Various modalities (devices and/or visualizations) have been used in the literature, but few studies investigated the adequacy/superiority of one modality over the other. For instance, the use of optical see-through (OST) HMDs has not always been scientifically justified. Our goal is to compare various visualization modalities for catheter insertion in external ventricular drain and ventricular shunt procedures. We investigate two AR approaches: (1) 2D approaches consisting of a smartphone and a 2D window visualized through an OST (Microsoft HoloLens 2), and (2) 3D approaches consisting of a fully aligned patient model and a model that is adjacent to the patient and is rotationally aligned using an OST. 32 participants joined this study. For each visualization approach, participants were asked to perform five insertions after which they filled NASA-TLX and SUS forms. Moreover, the position and orientation of the needle with respect to the planning during the insertion task were collected. The results show that participants achieved a better insertion performance significantly under 3D visualizations, and the NASA-TLX and SUS forms reflected the preference of participants for these approaches compared to 2D approaches.

Original languageEnglish
Pages (from-to)2434-2445
Number of pages12
JournalIEEE Transactions on Visualization and Computer Graphics
Issue number5
Publication statusPublished - 2023

Bibliographical note

Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.


  • Augmented reality
  • Augmented reality visualization
  • Computer-assisted surgery
  • External ventricular drain
  • Needle guidance
  • Surgical navigation systems
  • User study
  • Ventricular shunt


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