iSurgARy: A mobile augmented reality solution for ventriculostomy in resource-limited settings.

Global disparities in neurosurgical care necessitate innovations addressing affordability and accuracy, particularly for critical procedures like ventriculostomy. This intervention, vital for managing life-threatening intracranial pressure increases, is associated with catheter misplacement rates exceeding 30% when using a freehand technique. Such misplacements hold severe consequences including haemorrhage, infection, prolonged hospital stays, and even morbidity and mortality. To address this issue, a novel, stand-alone mobile-based augmented reality system (iSurgARy) aimed at significantly improving ventriculostomy accuracy, particularly in resource-limited settings such as those in low- and middle-income countries is presented. iSurgARy uses landmark based registration by taking advantage of light detection and ranging to allow for accurate surgical guidance. To evaluate iSurgARy, a two-phase user study is conducted. Initially, the usability and learnability is assessed with novice participants using the system usability scale (SUS), incorporating their feedback to refine the application. In the second phase, human-computer interaction and clinical domain experts are engaged to evaluate this application, measuring root mean square error, SUS and NASA task load index metrics to assess accuracy usability, and cognitive workload, respectively.