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Direct augmented reality computed tomographic angiography technique (ARC): an innovation in preoperative imaging

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Since the advent of free tissue transfer approximately 40 years ago, constant improvement particularly in the preoperative planning phase has led to flap success rate reaching 99% and improved patient outcomes. The use of imaging, such as computed tomographic angiography (CTA) or magnetic resonance angiography (MRA), for preoperative planning is now routine. However, current image modalities are restricted by being represented in two dimensions (2D) and have led to clinicians seeking novel methods of utilising the scan data, such as augmented (AR) or virtual reality (VR) and holograms. These mixed-reality devices facilitate a natural mode of visual perception and have the capacity to introduce tactile feedback. However, most AR devices are currently expensive, bulky and complicated and require tedious image registration processes. We illustrate our projector-based direct AR technique using CTA, or ARC, for preoperative planning.

Methods

Our bespoke ARC method consists of compact, affordable hardware (MacBook, Philips pocket projector and a 15-cm ruler) and free, open-source software (OsiriX). We have utilised this technique in six cases of perforator flaps of the thigh and abdomen (anterolateral thigh (ALT), transverse upper gracilis (TUG) and deep inferior epigastric artery perforator (DIEP) flaps.

Results

In all cases, 3D-reconstructed images of perforators from CTA were accurately projected onto the donor site. System calibration was rapid and convenient to use.

Conclusions

We illustrate a novel technique of projector-based AR CTA (or ARC) for preoperative planning in perforator flaps. The technique is affordable and readily reproducible.

Level of Evidence: Level IV, diagnostic study.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, VIC, 3199, Australia

    Michael P. Chae, Dasun Ganhewa, David J. Hunter-Smith & Warren Matthew Rozen

  2. Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Level 5, E Block, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia

    Michael P. Chae, Dasun Ganhewa, David J. Hunter-Smith & Warren Matthew Rozen

  3. Department of Surgery, School of Medicine, James Cook University Clinical School, Level 1, Townsville Hospital, 100 Angus Smith Drive, Douglas, Townsville, QLD, 4814, Australia

    Warren Matthew Rozen

Authors
  1. Michael P. Chae
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  2. Dasun Ganhewa
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  4. Warren Matthew Rozen
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Correspondence to Warren Matthew Rozen.

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Funding

There was no source of funding for the article.

Conflict of interest

Michael P. Chae, Dasun Ganhewa, David J. Hunter-Smith and Warren Matthew Rozen declare that they have no conflict of interest

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Patient consent was obtained for all photography and inclusion in this study.

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Institutional Ethical approval was obtained prospectively.

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Chae, M.P., Ganhewa, D., Hunter-Smith, D.J. et al. Direct augmented reality computed tomographic angiography technique (ARC): an innovation in preoperative imaging. Eur J Plast Surg 41, 415–420 (2018). https://doi.org/10.1007/s00238-018-1395-2

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  • DOI: https://doi.org/10.1007/s00238-018-1395-2

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