Augmented Reality to Guide Head and Neck Cancer Surgery

PROJECT SUMMARY For head and neck cancer patients, a positive surgical margin results in treatment intensification, increased cost, and an increased risk of recurrence and death. Positive surgical margin rates in oral cavity cancer are the highest among solid malignancies and have not improved over the past two decades. If a positive margin is identified

intraoperatively, the surgeon relies on verbal descriptions during a phone call with the pathologist to relocate the margin and resect additional tissue. Relocating the positive margin site using current protocols with no visual aid is difficult in the head and neck due to complex 3D anatomy. Therefore, it is not surprising that re-resection fails

to improve oncologic outcomes. To address this unmet need, I have developed a protocol to create a virtual 3D model of the resected cancer specimen that shows the sites of margin sampling. In a prior cadaveric study, I established the feasibility of placing the 3D specimen model into an augmented reality (AR) environment to guide

re-resection. AR superimposes a computer-generated image on a user's view of the real world, thus providing a composite view. The goal of this project is to determine the accuracy of placing a 3D specimen hologram into the surgical defect in actual head and neck cancer patients and develop custom AR software to improve time

and accuracy of alignment. In Aim 1, I will determine the accuracy of alignment of the projected 3D specimen model into the surgical defect. The tumor will be resected per standard of care, 3D scanned, and uploaded into the AR environment. The surgeon will wear the Microsoft HoloLens 2, a portable, handsfree, AR headset. The

surgeon will align the 3D specimen hologram into the resection bed and accuracy will be measured. In Aim 2, I will develop a custom AR surgery platform to improve time and accuracy of alignment. The existing AR software has significant limitations for surgical use, including limited voice commands, inability to adjust transparency,

and lack of a lock-in-place feature. To address this, I am creating custom AR software in collaboration with the Vanderbilt Institute for Surgery and Engineering. In a cadaveric study, surgeons will align the 3D specimen hologram into the resection bed using both the custom and existing AR software. Time and accuracy of alignment

will be measured. During this project I will benefit from the guidance of my primary mentor, who is an established surgeon-scientist with substantial experience in bringing new technologies into the operating room, as well as three co-mentors with expertise in specific areas. Additionally, I will undertake advanced training in AR systems,

surgical pathology processing, and clinical trial design, which will provide a strong foundation for pursuing my career goal of becoming a surgeon-scientist focused on implementation of AR systems to improve the effectiveness of oncologic surgery. This project will lay the groundwork for a future R01 application to include

expansion of AR technology to other solid malignancies and a prospective clinical trial to determine whether use of 3D scanning and AR-guided oncologic surgery improves positive margin rates and ultimately patient outcomes.