Optical See-Through and Video See-Through Head-Mounted Displays for Percutaneous Biopsies: A Comparative Phantom Study

PURPOSE: To compare the added benefit of optical see-through, the Magic Leap 2 (ML2), and video see-through, the Apple Vision Pro (AVP), head-mounted displays extended reality (XR) during percutaneous biopsies on an abdominal phantom. MATERIAL AND METHODS: In this phantom-based prospective cohort study, sixteen radiologists (5 experienced and 11 beginners) performed six needle insertions: two without XR, two with ML2, and two with AVP. Two lesions of differing difficulty (depth and proximity to vessels) were targeted. Post-procedure CT measured accuracy (hitting the target and distance and angle to lesion center). Cognitive workload and user experience were assessed using a structured questionnaire with a rating of 0-20. RESULTS: Beginners benefited more from XR than experienced radiologists. Beginners improved their targeting accuracy with XR, especially for the more complex lesion closer to blood vessels, where success rates increased using XR (conventional: 1/11, ML2: 2/11, AVP: 4/11), with a decrease in mean distance to target (conventional: 17.95 ± 9.14 mm; ML2: 14.21 ± 6.27 mm; AVP: 12.02 ± 7.19 mm). Advanced radiologists had overall lower success rates (conventional: 1/5, ML2: 0/5, AVP: 1/5). XR also reduced puncture time for beginner (ML2: 68.1%, AVP: 56.9% of baseline) and advanced radiologists (ML2: 79.0%, AVP: 61.7%). Questionnaire results indicated AVP was perceived as more mentally demanding, particularly by experienced radiologists (mental demand: conventional: 11, ML2: 9, AVP: 12, for beginners, and conventional: 12, ML2: 11, AVP: 17, for advanced). Beginners adapted well to both systems, showing no significant difference in perceived workload compared to conventional puncture and similar performance levels (conventional: 9, ML2: 9, AVP: 12, for beginners, and conventional: 15, ML2: 11, AVP: 7, for advanced). CONCLUSION: Our work demonstrates that AVP performs similar to ML2 in needle placement tasks and can be used in further research and clinical application in interventional radiology. LEVEL OF EVIDENCE: No level of evidence.