Poster 29 - Augmented reality visualization for potential application in pediatric tracheal intubation guidance

Saturday, October 26, 2024

10:00 AM - 12:00 PM EST

Location: Exhibit Hall E, F & G

Presenting Author(s)

GF

Grace Fei

Student
Liberty High School
Frisco, Texas, United States

Co-Author(s)

Timothy N. Booth, MD (he/him/his)

Professor
Department of Radiology, University of Texas Southwestern Medical Center, United States
EK

Edgar Kiss

Professor
Department of Anesthesiology, UT Southwestern Medical Center, United States
RH

Rami Hallac

Professor
Department of Surgery, UT Southwestern Medical Center and Children's Health, United States
AA

Andrew Anderson

Technologist
Department of Radiology, Children's Health, United States

Last Author(s)

ZW

Zhiyue Wang

Professor
Department of Radiology, University of Texas Southwestern Medical Center, United States

Introduction: Tracheal intubation is crucial during surgical procedures to sustain patient airways. Tracheal intubation involves inserting an endotracheal tube through the mouth into the trachea [1]. For pediatric patients, the procedure is associated with higher mortality, as smaller airways make the process difficult. Current training programs address these challenges through ultrasound-guided intubation or 3D-printed models [2-3]. However, these solutions are often inconvenient since the positions of the patient’s spine and head can be significantly different during CT scanning and intubation. Augmented reality (AR) offers immense potential to address these challenges, as the field pertaining to surgical procedures continues to grow. AR systems involve a virtual overlay of the real world and have been proven to enhance training. Nonetheless, difficulties, such as limited control and integration, exist. The goal of this project is to develop a reliable real-time guided AR visualization system that demonstrates the intubation process and can assist in tracheal intubation procedures for future benefit.

Materials and

Methods: A phantom child model was scanned with computed tomography (CT). DICOM images were then transferred to the 3D Slicer software to obtain the 3D models. After threshold segmentation of the bone and tissue in 3D Slicer, the segments were exported as OBJ files and imported into the Unity platform. For this project, Unity Editor 2020.3.28f1 was used, along with the Windows Build Support IL2CPP and Universal Windows Platform, which are compatible with the Microsoft HoloLens 2, which is the AR device for export. Mixed Reality Toolkit (MRTK 2.8.3.0) provided Microsoft tools for AR development in Unity. Holographic Remoting assisted in testing the program on HoloLens 2 before the final export. Once finalized, the Unity project was directly deployed as an application onto the HoloLens 2 with 2022 Visual Studio.

Results, Conclusions, and Discussions: The final augmented reality system has the potential to guide tracheal intubation procedures. It has a high speed and allows for real-time interaction with the system. Spatial mapping was disabled in HoloLens 2, which significantly increases the system efficiency and removes obstructions within the frame. Figure 1 demonstrates a phantom experiment of the final AR visualization system, which has future prospects in assisting tracheal intubation procedures and training. Future additions to the system include color and transparency sliders and automatic segmentation. Color and transparency sliders can be created in the Unity setup with C#. Such developments can enhance the user interface and increase clinician flexibility when working with the system.

The augmented reality system overlays pediatric internal airways with a child manikin and offers a valuable tool with real-time guidance and manipulation. The augmented reality system for pediatric tracheal intubation guidance can thus improve the experience of clinicians during this difficult procedure. The system has the potential for better training and real-time experiences during tracheal intubation and airway management in human patients. The final product mitigates the difficulties associated with digital endotracheal intubation simulation and increases the success rate of the process, thus helping improve patient outcomes.

Acknowledgements (Optional):

References (Optional): [1] J. Rolland, L. Davis, F. Hamza-Lup et al., “Development of a training tool for endotracheal intubation: distributed augmented reality,” Stud Health Technol Inform, 94, 288-94 (2003).
[2] K. J. Kovatch, A. R. Powell, K. Green et al., “Development and multidisciplinary preliminary validation of a 3D printed pediatric airway model for emergency airway front of neck access procedures,” Anesthesia and analgesia, 130(2), 445 (2020).
[3] Y. Liu, W. Ma, and J. Liu, “Applications of Airway Ultrasound for Endotracheal Intubation in Pediatric Patients: A Systematic Review,” J Clin Med, 12(4), (2023).