Display-based augmented reality navigation for CT-Guided thoracoabdominal punctures: phantom study of accuracy and workflow efficiency

Accurate needle placement is critical in percutaneous thoracoabdominal interventions. Conventional CT-guided procedures are limited by iterative scans, operator-dependent variability, and two-dimensional visualization. This preclinical study evaluates a novel display-based augmented reality (AR) navigation system integrating virtual-to-real registration via deltille grid position sensing (DGPS) markers for enhanced needle guidance. Experiments were conducted on a CIRS abdominal phantom with three operators: one expert interventional radiologist and two novices. Puncture accuracy, angular deviation, procedure time, and number of verification scans were assessed. AR guidance achieved first-pass distance errors of 1.50 (0.46) mm for the expert and 1.66 (0.50) mm and 1.58 (1.06) mm for novices, with angular deviations of 1.41°, 1.30°, and 1.39°, respectively. No significant operator-related differences were observed. Compared with conventional step-and-shoot CT guidance, AR guidance reduced the first-pass and final-pass targeting error, while conventional CT guidance relies on iterative scan-adjust-advance steps to achieve acceptable final accuracy, with AR reducing intermediate re-scans while retaining a single final verification scan. The findings indicate that AR navigation enhances first-pass precision, reduces procedural variability, and improves workflow efficiency, supporting its potential clinical value for more consistent and efficient minimally invasive interventions.