Multicenter assessment of augmented reality registration methods for image-guided interventions

Ningcheng Li, Jonathan Wakim, Yilun Koethe, Timothy Huber, Ryan Schenning, Terence P. Gade, Stephen J. Hunt, Brian J. Park

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Purpose: To evaluate manual and automatic registration times and registration accuracies on HoloLens 2 for aligning a 3D CT phantom model onto a CT grid, a crucial step for intuitive 3D navigation during CT-guided interventions; to compare registration times between HoloLens 1 and 2. Methods: Eighteen participants in various stages of clinical training across two academic centers performed registration of a 3D CT phantom model onto a CT grid using HoloLens 2. Registration times and accuracies were compared among different registration methods, clinical experience levels, and consecutive attempts. Registration times were also compared retrospectively to prior HoloLens 1 results. Results: Mean aggregate manual registration times were 27.7 s, 24.3 s, and 72.8 s for one-handed gesture, two-handed gesture, and Xbox controller, respectively; mean automatic registration time was 5.3 s (ANOVA p < 0.0001). No significant difference in registration times was found among attendings, residents and fellows, and medical students (p > 0.05). Significant improvements in registration times were detected across consecutive attempts using hand gestures (p < 0.01). Compared to prior HoloLens 1 data, hand gesture registration was 81.7% faster with HoloLens 2 (p < 0.05). Registration accuracies were not significantly different across manual registration methods, measuring at 5.9 mm, 9.5 mm, and 8.6 mm with one-handed gesture, two-handed gesture, and Xbox controller, respectively (p > 0.05). Conclusions: Manual registration times decreased significantly on HoloLens 2, approaching those of automatic registration and outperforming Xbox controller registration. Fast, adaptive, and accurate registration of holographic models of cross-sectional imaging is paramount for the implementation of augmented reality-assisted 3D navigation during CT-guided interventions.

Original languageEnglish (US)
Pages (from-to)857-865
Number of pages9
JournalRadiologia Medica
Issue number8
StatePublished - Aug 2022


  • 3D visualization
  • Augmented reality
  • CT-guided intervention
  • HoloLens
  • Interventional radiology
  • Mixed reality
  • Registration

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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