Augmented Reality–Driven MR-Guided Interstitial Brachytherapy with Real-Time Host-Controlled Imaging Navigation
Abstract
Purpose
High-dose-rate interstitial brachytherapy (IB) is an effective treatment for gynecologic (GYN) malignancies but requires precise catheter placement, which can be challenging during transperineal and free-hand insertions. Augmented reality (AR) driven MR-guided navigation can provide intuitive visualization during procedures; however current systems rely on static or operator-controlled imaging to compensate for through-plane catheter motion. This work demonstrates the feasibility of an AR-driven, MR-guided IB platform that integrates real-time image streaming with host-controlled manipulation of MR slice planes and imaging axes during catheter insertion.
Methods
An industrial AR headset was adapted for use in a 3T interventional MRI suite. A wearable wireless power and communication system enabled uninterrupted AR visualization while allowing physician mobility outside the magnet room. Interleaved sagittal and coronal 2D gradient-echo images were streamed in real time from the MRI system to a workstation via a secure network interface. A custom Python-based viewer streamed MR images to the AR headset. Using host-control access, imaging slice position and orientation were adjusted in real time from the procedural environment, enabling interactive navigation without console intervention. System latency and targeting accuracy were evaluated in phantom. The system was deployed clinically in four patients undergoing transperineal IB for GYN malignancies under an IRB-approved protocol (PRO00036793).
Results
Slice plane manipulation remained stable during scanning and enabled alignment of imaging planes with advancing catheters. End-to-end system latency, including image streaming and host-controlled slice updates, was <1 s. All phantom catheters were implanted without loss of image quality or workflow interruption.
Conclusion
AR-driven MR-guided interstitial brachytherapy with real-time host-controlled imaging navigation is feasible. Direct in-room control of MR slice planes can compensate for through plane catheter motion, enhancing AR-driven MR-guided navigation for transperineal or free hand insertions in IB.