Enhanced Real-Time 6-DOF Extended Reality Catheter Tracking for Evaluating Potential Improvement in Efficiency, Precision, and Depth Perception for Cardiac Interventions

Abstract

Despite advances in 3D ultrasound, most percutaneous cardiac interventions still rely on 2D visualization, limiting depth perception and spatial understanding. To address this challenge, we developed an Extended Reality (XR)-based platform that enables real-time six-degree-of-freedom (6-DOF) catheter tracking and visualization within a patient-specific 3D heart model. The system combines a custom machine-vision algorithm for 5-DOF catheter tracking with a 3D-printed electromechanical encoder that measures catheter roll, providing complete 6-DOF motion reconstruction. In a proof-of-concept study, 20 novice medical students navigated an intracardiac echocardiography (ICE) catheter to six anatomical targets using either immersive 3D visualization or a conventional 2D cathlab-style view. Participants in the 3D condition completed the task in 54.6 seconds and traveled 1,939 mm on average, compared with 267.5 seconds and 7,854 mm in the 2D condition. Therefore, the XR-based 3D system was more than 5x faster and required ~5x less catheter travel. The 3D mode also improved targeting precision and reduced performance variability. Participants consistently rated immersive visualization higher for accuracy, speed, usability, and clinical value. Kinematic analysis showed smoother depth-axis navigation in 3D, whereas 2D users relied on repeated corrective movements. These findings demonstrate that XR-based visualization can substantially improve procedural training efficiency, precision, and motor control.