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This work describes a novel connection approach using Microsoft HoloLens 2 and OpenIGTLink, with a demonstration in pedicle screw placement planning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed an AR application in Unity that is wirelessly rendered onto Microsoft HoloLens 2 using Holographic Remoting. Simultaneously, Unity connects to 3D Slicer using the OpenIGTLink communication protocol. Geometrical transform and image messages are transferred between both platforms in real time. Through the AR glasses, a user visualizes a patient\u2019s computed tomography overlaid onto virtual 3D models showing anatomical structures. We technically evaluated the system by measuring message transference latency between the platforms. Its functionality was assessed in pedicle screw placement planning. Six volunteers planned pedicle screws' position and orientation with the AR system and on a 2D desktop planner. We compared the placement accuracy of each screw with both methods. Finally, we administered a questionnaire to all participants to assess their experience with the AR system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The latency in message exchange is sufficiently low to enable real-time communication between the platforms. The AR method was non-inferior to the 2D desktop planner, with a mean error of 2.1\u2009\u00b1\u20091.4\u00a0mm. Moreover, 98% of the screw placements performed with the AR system were successful, according to the Gertzbein\u2013Robbins scale. The average questionnaire outcomes were 4.5\/5.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Real-time communication between Microsoft HoloLens\u00a02 and 3D Slicer is feasible and supports accurate planning for pedicle screw placement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11548-023-02977-0","type":"journal-article","created":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T10:02:49Z","timestamp":1686650569000},"page":"2023-2032","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Real-time integration between Microsoft HoloLens 2 and 3D Slicer with demonstration in pedicle screw placement planning"],"prefix":"10.1007","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1802-2884","authenticated-orcid":false,"given":"Alicia","family":"Pose-D\u00edez-de-la-Lastra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4743-0609","authenticated-orcid":false,"given":"Tamas","family":"Ungi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Morton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6354-262X","authenticated-orcid":false,"given":"Gabor","family":"Fichtinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1484-731X","authenticated-orcid":false,"given":"Javier","family":"Pascau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,13]]},"reference":[{"key":"2977_CR1","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1089\/LAP.2012.0220","volume":"22","author":"YS Tanagho","year":"2012","unstructured":"Tanagho YS, Andriole GL, Paradis AG, Madison KM, Sandhu GS, Varela JE, Benway BM (2012) 2D versus 3D visualization: impact on laparoscopic proficiency using the fundamentals of laparoscopic surgery skill set. 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