European Radiology

, Volume 23, Issue 1, pp 235–245 | Cite as

Augmented reality visualisation using an image overlay system for MR-guided interventions: technical performance of spine injection procedures in human cadavers at 1.5 Tesla

  • Jan Fritz
  • Paweena U-Thainual
  • Tamas Ungi
  • Aaron J. Flammang
  • Gabor Fichtinger
  • Iulian I. Iordachita
  • John A. CarrinoEmail author



To prospectively assess the technical performance of an augmented reality system for MR-guided spinal injection procedures.


The augmented reality system was used with a clinical 1.5-T MRI system. A total of 187 lumbosacral spinal injection procedures (epidural injection, spinal nerve root injection, facet joint injection, medial branch block, discography) were performed in 12 human cadavers. Needle paths were planned with the Perk Station module of 3D Slicer software on high-resolution MR images. Needles were placed under augmented reality MRI navigation. MRI was used to confirm needle locations. T1-weighted fat-suppressed MRI was used to visualise the injectant. Outcome variables assessed were needle adjustment rate, inadvertent puncture of non-targeted structures, successful injection rate and procedure time.


Needle access was achieved in 176/187 (94.1 %) targets, whereas 11/187 (5.9 %) were inaccessible. Six of 11 (54.5 %) L5–S1 disks were inaccessible, because of an axial obliquity of 30˚ (27˚–34˚); 5/11 (45.5 %) facet joints were inaccessible because of osteoarthritis or fusion. All accessible targets (176/187, 94.1 %) were successfully injected, requiring 47/176 (26.7 %) needle adjustments. There were no inadvertent punctures of vulnerable structures. Median procedure time was 10.2 min (5–19 min).


Image overlay navigated MR-guided spinal injections were technically accurate. Disks with an obliquity ≥27˚ may be inaccessible.

Key Points

Augmented reality technology facilitates MR-guided spine injections.

Patient and operator exposure to ionising radiation can be obviated.

MR imaging guidance enabled the procedure without need of a dedicated interventional MRI system.

Various MR-guided spine injection procedures using augmented reality are technically accurate.

Augmented reality has potential to simplify the workflow of MR-guided spine injections.


Spine injection MR-guided Interventional MR imaging Augmented reality Image overlay 



Acknowledgment of grants or other assistance: National Cancer Institute, 1 R01 CA118371-01A2—Image Overlay for MRI-Guided Needle Insertions.

Supplementary material

330_2012_2569_MOESM1_ESM.avi (210 kb)
ESM 1 (AVI 209 kb)
330_2012_2569_MOESM2_ESM.avi (23.7 mb)
ESM 2 (AVI 24250 kb)


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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Jan Fritz
    • 1
  • Paweena U-Thainual
    • 2
    • 6
  • Tamas Ungi
    • 3
  • Aaron J. Flammang
    • 4
  • Gabor Fichtinger
    • 3
  • Iulian I. Iordachita
    • 2
  • John A. Carrino
    • 1
    • 5
    Email author
  1. 1.Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of Mechanical Engineering and Laboratory for Computational Sensing and RoboticsJohns Hopkins University (JHU)BaltimoreUSA
  3. 3.School of ComputingQueen’s UniversityKingstonCanada
  4. 4.Siemens Corporate ResearchCenter for Applied Medical ImagingBaltimoreUSA
  5. 5.Musculoskeletal Division, Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Department of Mechanical & Material EngineeringQueen’s UniversityKingstonCanada

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