Abstract:

Stereotactic arrhythmia radioablation (STAR) represents an emerging non-invasive treatment for therapy-refractory ventriculartachycardia. Yet, planning remains challenged by multimodal cardiac imaging integration, electroanatomical mapping (EAM) transfer,and cardiorespiratory motion effects on dose delivery. Current radiotherapy (RT) planning systems offer mainly static visualizationand limited access to intramural myocardial structures, hindering communication between cardiology and radiation oncology teams.We present a novel extended reality (XR) simulator designed to dynamically visualize STAR-relevant imaging and planning data. Thesystem integrates diastolic cardiac CT, respiratory-binned 4DCT, anatomical segmentations, EAM data, and phase-recomputed RTdose distributions within an XR environment. Cardiac structures are propagated across respiratory phases using deformable registration,while dose distributions are recomputed on each respiratory-binned CT, enabling phase-specific inspection of dose conformalityfor both planning target volumes (PTVs) and cardiac target volumes (CardTVs). The resulting time-resolved volumetric dataset is renderedin XR, allowing clinicians to explore cardiac motion, visualize intramural dose deposition, and jointly assess target and organ-at-risk dynamics. This supports qualitative evaluation of dose-motion interplay and interdisciplinary interpretation of intramural targets.The system was tested on three STAR patients enrolled in the RAVENTA trial. Motion analysis revealed PTV centroid displacementamplitudes over the breathing cycle of up to 17.5, 10.2, and 8.9 mm for patients 1, 2, and 3, respectively, with conformity numbervariations of 0.38, 0.34, and 0.19. Expert evaluation showed positive perceived utility for target-anatomy-dose understanding, motioninterpretation, and multidisciplinary communication. This proof-of-concept demonstrates the feasibility and potential clinical valueof XR-based motion-aware dose visualization for STAR planning.

Abstract:

Mitral regurgitation is a structural heart disease characterized by dysfunction of the mitral valve. It can be treated through minimally invasive transcatheter edge-to-edge repair procedures, such as those involving the MitraClip system. Despite its clinical efficacy, the procedure poses technical challenges, requiring interventional cardiologists to undergo multiple procedures to achieve instrumentation proficiency. Previous studies have demonstrated the efficacy of extended reality simulators in improving surgical skill training. The purpose of this study is to evaluate the effectiveness of visuo-haptic feedback within an extended reality simulator to accelerate and enhance the learning process for the MitraClip procedure, potentially offering a valuable tool in surgical training. In this study, based on the prototype of our previous simulator, we further implemented a novel cardiac dynamic environment, a visual feedback interface, an innovative haptic armband, and a new model of the catheter to enhance the simulator’s fidelity and educational usability. Experiment results demonstrated that users benefiting from visuo-haptic feedback exhibited significantly reduced completion times, reduced deviation from predefined trajectories, and presented safer navigation results. Moreover, users preferred the visuo-haptic feedback experience, highlighting its perceived value in enhancing training. These findings underscore the potential of adding visuo-haptic feedback to extended reality simulators in surgical training for complex procedures, improving proficiency and patient surgery outcomes.

Abstract:

Mitral regurgitation is a structural heart condition affecting the mitral valve that can be treated with the MitraClip system ™, a device that allows a percutaneous intervention for the deployment of a catheter-embedded clip on the valve leaflets to prevent blood-backflow from the left ventricle to the left atrium. Despite its efficacy, the procedure presents technical challenges, relying on fluoroscopy guidance and surgeon expertise. In the context of human-machine interface for autonomous robotic catheter cardiac intervention, this study aims to evaluate the effectiveness of Augmented Reality (AR) for training surgeons in the MitraClip procedure. Users using an AR Interface demonstrated better performance compared to those using an interface emulating traditional visualization methodologies (fluoroscopy and transesophageal echocardiogra-phy). AR-based training offers a more engaging and effective learning experience, leading to improved surgical dexterity and safety in the procedure.