Comparison of optical see-through head-mounted displays for surgical interventions with object-anchored 2D-display

  • Long Qian
  • Alexander Barthel
  • Alex Johnson
  • Greg Osgood
  • Peter Kazanzides
  • Nassir Navab
  • Bernhard Fuerst
Original Article



Optical see-through head-mounted displays (OST-HMD) feature an unhindered and instantaneous view of the surgery site and can enable a mixed reality experience for surgeons during procedures. In this paper, we present a systematic approach to identify the criteria for evaluation of OST-HMD technologies for specific clinical scenarios, which benefit from using an object-anchored 2D-display visualizing medical information.


Criteria for evaluating the performance of OST-HMDs for visualization of medical information and its usage are identified and proposed. These include text readability, contrast perception, task load, frame rate, and system lag. We choose to compare three commercially available OST-HMDs, which are representatives of currently available head-mounted display technologies. A multi-user study and an offline experiment are conducted to evaluate their performance.


Statistical analysis demonstrates that Microsoft HoloLens performs best among the three tested OST-HMDs, in terms of contrast perception, task load, and frame rate, while ODG R-7 offers similar text readability. The integration of indoor localization and fiducial tracking on the HoloLens provides significantly less system lag in a relatively motionless scenario.


With ever more OST-HMDs appearing on the market, the proposed criteria could be used in the evaluation of their suitability for mixed reality surgical intervention. Currently, Microsoft HoloLens may be more suitable than ODG R-7 and Epson Moverio BT-200 for clinical usability in terms of the evaluated criteria. To the best of our knowledge, this is the first paper that presents a methodology and conducts experiments to evaluate and compare OST-HMDs for their use as object-anchored 2D-display during interventions.


Mixed reality Intervention Optical see-through head-mounted display User study 


Compliance with ethical standards


This study was funded by NIAMS of the National Institutes of Health under award number T32AR067708.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article contains a study with human participants, which was approved by the JHU Homewood Institutional Review Board under the numbers HIRB00003228 and HIRB00004665.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© CARS 2017

Authors and Affiliations

  • Long Qian
    • 1
    • 4
  • Alexander Barthel
    • 1
    • 2
  • Alex Johnson
    • 3
  • Greg Osgood
    • 3
  • Peter Kazanzides
    • 4
  • Nassir Navab
    • 1
    • 2
  • Bernhard Fuerst
    • 1
  1. 1.Computer Aided Medical ProceduresJohns Hopkins UniversityBaltimoreUSA
  2. 2.Computer Aided Medical ProceduresTechnische Universität MünchenMunichGermany
  3. 3.Department of Orthopaedic SurgeryJohns Hopkins HospitalBaltimoreUSA
  4. 4.Laboratory for Computational Sensing and RoboticsJohns Hopkins UniversityBaltimoreUSA

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