Augmented and virtual reality for preprocedural planning in hepatic transarterial interventional oncology: a pilot study in 50 cases

Abstract

PURPOSE: To evaluate the feasibility, usability, and perceived impact of augmented reality (AR) and virtual reality (VR) for preprocedural planning in transarterial interventional oncology procedures, as assessed through structured surveys.

MATERIALS AND METHODS: This institutional review board (IRB)-approved, single-center pilot study was conducted over 1 year (September 2024-September 2025). Interventional radiologists used an AR/VR headset (Apple Vision Pro; Apple, Cupertino, California) with Visage Ease VP software (Visage Imaging, San Diego, California) to review patient-specific volume renderings of cone-beam computed tomography (CT) and cross-sectional imaging before complex oncologic procedures. Cases included hepatic angiography prior to yttrium-90 radioembolization (n = 42), percutaneous hepatic perfusion (n = 7), and transarterial chemoembolization (n = 1). Interventional radiologists completed structured surveys assessing workflow integration, anatomic visualization, confidence, usability, and comfort using 5-point Likert scales (1 = worst; 5 = best).

RESULTS: Fifty cases were analyzed, with a median case time of 81.0 minutes (interquartile range, 62.0-102.0 minutes). The median AR/VR planning time was 5 minutes (interquartile range, 3.0-6.0 minutes), corresponding to a median of 6% of total case duration. AR/VR planning changed the procedural approach in 23 of 50 cases (46%). Likert score for procedural change had an overall mean of 3.3 (SD ± 1.3), with mean scores of 2.4 (SD ± 0.7) in cases where AR/VR did not influence the interventional radiologist's intraprocedural approach and 4.4 (SD ± 0.8) in cases where AR/VR did influence the approach. Anatomic visualization scored 4.7 (SD ± 0.8), anatomic understanding 4.7 (SD ± 0.9), and procedural confidence 4.6 (SD ± 1.0). Workflow integration scored 4.8 (SD ± 0.5), system usability 4.5 (SD ± 0.9), and headset comfort 1.9 (SD ± 1.1). Specific use cases are described.

CONCLUSIONS: AR/VR-based preprocedural planning was feasible, efficient, and enhanced perceived anatomic understanding, procedural confidence, and planning in transarterial interventional oncology cases. Headset comfort remains a limitation.