The integration of three-dimensional cinematic reconstructions with augmented reality (AR) has introduced new possibilities for cardiovascular imaging. By enabling interaction with holographic models of computed tomography (CT) datasets, AR enhances anatomical comprehension and offers novel applications in both educational and clinical settings. A recent study published in European Radiology Experimental assessed the feasibility, usability and potential applications of AR in cardiovascular imaging by evaluating image quality, user experience and potential benefits in predefined use cases.
The study involved ten 3D cinematic reconstructions of cardiovascular CT datasets, each depicting complex anatomical abnormalities. These reconstructions were assessed by a group of six radiologists and three cardiologists, who first viewed the images on diagnostic screens and then in AR. The primary objective was to determine whether AR-based cinematic reconstructions improve anatomical understanding and whether they could have practical applications in medical education, multidisciplinary discussions and clinical care. The study also examined computational efficiency and observer feedback on usability.
Image Quality and Processing Efficiency
One of the key aspects evaluated in this study was the image quality of AR-enhanced 3D cinematic reconstructions. Cinematic rendering was chosen over conventional volume rendering due to its ability to integrate multi-ray lighting models, producing more photorealistic imaging with enhanced depth and structural clarity. The reconstructed images provided improved anatomical assessment, particularly in highly complex areas such as the cardiovascular system, where spatial relationships between different structures are critical.
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The study found that the processing time for cinematic rendering was reasonable, with whole CT datasets requiring an average of 143 seconds to reconstruct. When applied to a single image series, processing times were even shorter, averaging 84 seconds. These times indicate that the technology is sufficiently efficient for potential use in preclinical and certain clinical scenarios. The subjective assessment of image quality was overwhelmingly positive, with observers rating the images as excellent in terms of overall clarity, depiction of large cardiovascular structures and mediastinal anatomy. However, certain limitations were noted, particularly in visualising finer details such as coronary arteries and inner cardiac structures. The depiction of submillimetre details remained suboptimal, which limited the use of AR-rendered images for direct diagnostic purposes. Despite these limitations, the AR reconstructions were considered highly valuable for understanding complex anatomical relationships.
Usability and Educational Potential
Another crucial element of this study was assessing the usability of AR in medical imaging and its potential role in education and training. Observers, who included radiologists and cardiologists, generally found the AR device intuitive to use. It allowed for direct interaction with 3D holograms, enabling users to zoom, rotate and slice the images as needed. This interactivity provided a significant advantage over traditional 2D CT imaging, particularly for those less familiar with interpreting cross-sectional scans.
One of the primary benefits of AR-based 3D cinematic reconstructions was its potential in medical education and training. The ability to manipulate anatomical models in real time was viewed as highly beneficial for both students and patients. Observers reported that the technology had the greatest impact in educational settings, where complex anatomical structures could be explored in greater detail. Additionally, AR was found to be useful in multidisciplinary discussions, such as case reviews and surgical planning meetings. By providing an enhanced visualisation of cardiovascular structures, AR could facilitate communication among different medical specialities, particularly in settings where non-radiologists require a clearer understanding of CT findings.
Despite its advantages, the study noted that AR technology is not yet fully integrated into routine clinical workflows. While it significantly improves anatomical comprehension, it does not currently offer measurement tools such as Hounsfield unit values or precise distance calculations, both of which are necessary for diagnostic and preoperative decision-making. Nonetheless, the observers agreed that the intuitive usability and high-quality visualisation provided by AR made it a promising tool for non-diagnostic applications.
Clinical and Research Implications
While AR-enhanced imaging offers clear benefits in education and interdisciplinary communication, its direct clinical application remains limited. The absence of measurement tools restricts its use in making precise diagnoses, and current technology does not yet support the fine detail required for detecting subtle cardiovascular abnormalities. However, advancements like photon-counting CT scanners may improve the resolution of AR reconstructions in the future, potentially allowing AR to serve as a diagnostic aid.
AR also shows promise in preoperative planning and surgical decision-making, offering 3D visualisations that aid in understanding complex anatomy. Studies demonstrate that AR can reduce surgical planning times and improve comprehension of congenital heart defects, with cardiologists showing more optimism about its clinical applications than radiologists.
Additionally, AR can enhance patient consultations and multidisciplinary discussions by providing clearer representations of cardiovascular structures. Despite these advantages, the study's limitations include being conducted at a single centre with a small dataset, highlighting the need for larger studies to validate findings. Implementing AR in real-world settings may face technical challenges and future research should evaluate its long-term impact on diagnostic accuracy and clinical outcomes.
The use of AR in cardiovascular imaging has demonstrated strong feasibility, with high-quality 3D cinematic reconstructions and intuitive usability. While its immediate applications in routine clinical care remain limited, AR holds significant promise for medical education, patient engagement and multidisciplinary discussions. Observers in this study agreed that AR technology is particularly valuable for improving anatomical comprehension in students, patients and non-radiologist specialists. As imaging technology advances, AR could evolve into a more integral component of cardiovascular diagnostics and treatment planning, enhancing the precision and accessibility of medical imaging.
Source: European Radiology Experimental
Image Credit: iStock
