Hybrid SPECT–Optical Fusion with Augmented Reality Overlay for Quantitative Sentinel Lymph Node Localization
Keywords:
Sentinel lymph node, augmented reality surgery, SPECT/CT fusion, nuclear medicine imaging, intraoperative navigation, image-to-patient registrationAbstract
oncologic staging and surgical precision. While preoperative SPECT/CT imaging provides Accurate intraoperative localization of sentinel lymph nodes (SLNs) remains critical for high-sensitivity nodal detection, spatial translation of nuclear imaging data to the surgical field may introduce registration error. This study presents a hybrid SPECT–optical fusion framework integrated with augmented reality (AR) visualization to enhance real-time SLN localization accuracy. Three-dimensional SPECT/CT volumes were segmented using a semi-automatic intensity–gradient clustering method and converted into surface meshes. Optical surface tracking was performed using a structured-light depth sensor mounted on a head-mounted AR display. A surface-constrained rigid registration algorithm aligned nuclear imaging coordinates to patient anatomy, followed by real-time refinement through iterative surface matching. Validation was conducted on 14 human cadaveric specimens injected with technetium-99m radiotracer and 8 synthetic phantom models (total 22 datasets). Mean target localization error was 2.96 mm using standard projection alignment and decreased to 1.38 mm with the proposed fusion framework. Overlay stability during 4-minute motion simulation showed drift below 1.12 mm. Detection concordance with gamma probe verification reached 95.6%. These findings demonstrate that hybrid SPECT–optical fusion significantly improves AR-based SLN localization accuracy while maintaining intraoperative usability.
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