Augmented and virtual reality imaging for collaborative planning of structural cardiovascular interventions: a proof-of-concept and validation study.

Purpose: Virtual reality (VR) and augmented reality (AR) have led to significant advancements in cardiac preoperative planning, shaping the world in profound ways. A noticeable gap exists in the availability of a comprehensive multi-user, multi-device mixed reality application that can be used in a multidisciplinary team meeting.

Approach: A multi-user, multi-device mixed reality application was developed, supporting AR and VR implementations. Technical validation involved a standardized testing protocol and comparison of AR and VR measurements regarding absolute error and time. Preclinical validation engaged experts in interventional cardiology, evaluating the clinical applicability prior to clinical validation. Clinical validation included patient-specific measurements for five patients in VR compared with standard computed tomography (CT) for preoperative planning. Questionnaires were used at all stages for subjective evaluation.

Results: Technical validation, including 106 size measurements, demonstrated an absolute median error of 0.69 mm (0.25 to 1.18 mm) compared with ground truth. The time to complete the entire task was $892\pm 407s$ on average, with VR measurements being faster than AR ( $804\pm 483$ versus $957\pm 257s$ , $P=0.045$ ). On clinical validation of five preoperative patients, there was no statistically significant difference between paired CT and VR measurements (0.58 [95% CI, $-1.58$ to 2.74], $P=0.586$ ). Questionnaires showcased unanimous agreement on the user-friendly nature, effectiveness, and clinical value.

Conclusions: The mixed reality application, validated through technical, preclinical, and clinical assessments, demonstrates precision and user-friendliness. Further research of our application is needed to validate the generalizability and impact on patient outcomes.