Thanks to its rapid development in the last decades, image guided surgery (IGS) has been introduced successfully in many modern operating rooms. Current IGS systems provide their navigation information on a standard computer monitor. Alternatively, one could enhance the direct sight of the physician by an overlay of the virtual data onto the real patient view. Such in situ visualization methods have been proposed in the literature for providing a more intuitive visualization, improving the ergonomics as well as the hand-eye coordination. In this paper, we first discuss the fundamental issues and the recent endeavors in advanced display and visualization for IGS. We then present some of our recent work comparing two navigation systems: 1) a classical monitor based navigation and 2) a new navigation system we had developed based on in situ visualization. As both solutions reveal shortcomings as well as complementary advantages, we introduce a new solution that combines both concepts into one hybrid user interface. Finally, experimental results report on the performance of several surgeons using an external monitor as well as a stereo video see-through head-mounted display (HMD). The experiments consist of drilling into a phantom in order to reach planted deep-seated targets only visible in Computed Tomography (CT) data. We evaluate several visualization techniques, including the new hybrid solution, and study their influence on the performance of the participant surgeons.
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