Towards overcoming barriers to the clinical deployment of mixed reality image-guided navigation systems supporting percutaneous ablation of liver focal lesions

In recent years, we have observed a rise in the popularity of minimally invasive procedures for treating liver tumours, with percutaneous thermoablation being one of them, conducted using image-guided navigation systems with mixed reality technology. However, the application of this method requires adequate training in using the employed system. In our study, we assessed which skills pose the greatest challenges in performing such procedures. The article proposes a training module characterized by an innovative approach: the possibility of practicing the diagnosis, planning, execution stages and the physical possibility of performing the execution stage on the radiological phantom of the abdominal cavity. The proposed approach was evaluated by designing a set of 4 exercises corresponding to the 3 phases mentioned. To the research group included 10 radiologists and 5 residents in the study. Based on 20 clinical cases of liver tumors subjected to percutaneous thermoablation, we developed assessment tasks evaluating four skill categories: head-mounted display (HMD), ultrasound (US)/computed tomography (CT) image fusion interpretation, tracking system use, and the ability to insert a needle. The results were presented using the Likert scale. The results of our study indicate that the most challenging aspect for radiology specialists is adapting to HMD gesture control, while residents point to intraoperative images of fusion and respiratory movements in the liver as the most problematic. In terms of improving the ability to perform procedures on new patients, the module also allows you to create a new hologram for a different clinical case.