Augmented Reality and Ultrasonography-Guided Needle Placement: Feasibility and Accuracy in a Phantom Model

Objective: Augmented reality (AR) can improve ultrasonography (US)-guided procedures by placing images in the operator’s line of sight. Published Apple Vision Pro (AVP) US workflows are scarce. This study compared the feasibility and accuracy of an AR US system versus conventional sonography. Materials and Methods: This was designed as a prospective crossover feasibility study. The AR system used a Clarius L15 HD linear transducer streamed to an AVP headset and conventional ultrasound equipment system. Participants placed a 22-gauge spinal needle into eight clay targets (e.g., 0.5–2.0 cm) in a gelatin phantom with both systems. The primary outcome was accuracy (i.e., hits/attempts). Feasibility was assessed with an eight item, 5-point Likert-type survey. The data analyses were completed with descriptive output. Results: Three radiologists experienced in US guidance achieved 23/24 first-pass hits (i.e., 96%) using AR US guidance versus 24/24 (i.e., 100%) with conventional sonography. Ratings for AR US guidance were high for hand-eye coordination (e.g., 5.0 ± 0.0), image stability (e.g., 4.7 ± 0.6), and overall satisfaction (e.g., 4.7 ± 0.6), with greater ease of use than conventional sonography (e.g., 3.3 ± 0.6). The study limitations included visualization (e.g., 2.0 ± 1.7), headset comfort (e.g., 2.3 ± 1.5), and technical reliability (e.g., 2.7 ± 0.6). Conclusion: For this cohort of users, streaming US to AVP, enabled accurate, feasible AR US-guided needle placement with performance comparable to conventional sonography.