{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T15:08:27Z","timestamp":1793286507040,"version":"4.5.0"},"reference-count":22,"publisher":"BMJ","issue":"12","funder":[{"name":"Academic Health Sciences Centre Alternative Funding Plan","award":["SHS-18-009"],"award-info":[{"award-number":["SHS-18-009"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2023,10,25]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The Microsoft HoloLens is a head-mounted mixed reality device, which allows for overlaying hologram-like computer-generated elements onto the real world. This technology can be combined with preprocedural ultrasound during thoracic epidural placement to create a visual of the ideal needle angulation and trajectory in the users\u2019 field of view. This could result in a technically easier and potentially safer alternative to traditional blind landmark techniques.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients were randomly assigned to one of two groups: (1) HoloLens-assisted thoracic epidural technique (intervention\u2014group H) or (2) traditional thoracic epidural technique (control\u2014group C). The primary outcome was needling time (defined as skin puncture to insertion of epidural catheter) during the procedure. The secondary outcomes were number of needle punctures, number of needle movements, number of bone contacts, and epidural failure. Procedural pain and recovery room pain levels were also evaluated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Eighty-three patients were included in this study. The primary outcome of procedure time was reduced in the HoloLens group compared with control (4.5\u2009min vs 7.3\u2009min, p=0.02, 95%\u2009CI), as was the number of needle movements required (7.2 vs 14.4, p=0.01), respectively. There was no difference in intraprocedure or postprocedure pain, bone contacts, or total number of needle punctures. Three patients in the control group experienced epidural failure versus one patient in the HoloLens group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study shows that thoracic epidural placement may be facilitated by using a guidance hologram and may be more technically efficient.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04028284\">NCT04028284<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2023-104703","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T13:30:16Z","timestamp":1704979816000},"page":"861-866","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Randomized control trial of a holographic needle guidance technique for thoracic epidural placement"],"prefix":"10.1136","volume":"49","clinical-trial-number":[{"clinical-trial-number":"nct04028284","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04028284","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1993-8413","authenticated-orcid":false,"given":"Julian","family":"Wiegelmann","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3662-9073","authenticated-orcid":false,"given":"Stephen","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6061-7502","authenticated-orcid":false,"given":"Paul G","family":"McHardy","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clyde","family":"Matava","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oskar","family":"Singer","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilia","family":"Kaustov","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahad","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,1,11]]},"reference":[{"key":"2025101113095943000_49.12.861.1","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1097\/00132582-199912000-00011","article-title":"Predicting the difficult neuraxial block: a prospective study","volume":"19","author":"McGrady","year":"1999","journal-title":"Obstet Anesth Dig"},{"key":"2025101113095943000_49.12.861.2","doi-asserted-by":"publisher","DOI":"10.1017\/S0265021502000716"},{"key":"2025101113095943000_49.12.861.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8537(05)70172-3"},{"key":"2025101113095943000_49.12.861.4","first-page":"262070","article-title":"Ultrasound guidance for deep peripheral nerve blocks: a brief review","volume":"2011","author":"Wadhwa","year":"2011","journal-title":"Anesthesiol Res 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What is a Hologram? - mixed reality. Available: https:\/\/learn.microsoft.com\/en-us\/windows\/mixed-reality\/discover\/hologram [Accessed 29 Nov 2022]."},{"key":"2025101113095943000_49.12.861.13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11596-019-1992-8","article-title":"Application and prospect of mixed reality technology in medical field","volume":"39","author":"Hu","year":"2019","journal-title":"Curr Med Sci"},{"key":"2025101113095943000_49.12.861.14","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/EJA.0000000000001755","article-title":"Usage of augmented reality for interventional neuraxial procedures: a phantom-based study","volume":"40","author":"Reinacher","year":"2023","journal-title":"Eur J Anaesthesiol"},{"key":"2025101113095943000_49.12.861.15","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1016\/j.ultrasmedbio.2019.04.026","article-title":"Development and evaluation of an augmented reality ultrasound guidance system for spinal anesthesia: preliminary results","volume":"45","author":"Ameri","year":"2019","journal-title":"Ultrasound Med Biol"},{"key":"2025101113095943000_49.12.861.16","doi-asserted-by":"crossref","DOI":"10.2196\/36931","article-title":"Development of a head-mounted holographic needle guidance system for enhanced ultrasound-guided neuraxial anesthesia: system development and observational evaluation","volume":"6","author":"Tanwani","year":"2022","journal-title":"JMIR Form Res"},{"key":"2025101113095943000_49.12.861.17","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.ijoa.2013.04.013","article-title":"Epidural failure rate using a standardised definition","volume":"22","author":"Thangamuthu","year":"2013","journal-title":"Int J Obstet Anesth"},{"key":"2025101113095943000_49.12.861.18","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.clinimag.2017.11.013","article-title":"Percutaneous low-dose CT-guided lung biopsy with an augmented reality navigation system: validation of the technique on 496 suspected lesions","volume":"49","author":"Faiella","year":"2018","journal-title":"Clinical Imaging"},{"key":"2025101113095943000_49.12.861.19","doi-asserted-by":"crossref","first-page":"227","DOI":"10.5152\/dir.2017.16323","article-title":"1.5 T augmented reality Navigated Interventional MRI: paravertebral sympathetic plexus injections","volume":"23","author":"Marker","year":"2017","journal-title":"Diagn Interv Radiol"},{"key":"2025101113095943000_49.12.861.20","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2018-100161"},{"key":"2025101113095943000_49.12.861.21","doi-asserted-by":"crossref","unstructured":"Kobayashi L , Zhang X , Collins S , et al . Exploratory application of augmented reality\/mixed reality devices for acute care procedure training. West J Emerg Med 2018:158\u201364. doi:10.5811\/westjem.2017.10.35026","DOI":"10.5811\/westjem.2017.10.35026"},{"key":"2025101113095943000_49.12.861.22","unstructured":"Microsoft . Hololens 2: find specs and features - microsoft hololens 2. 2021. Available: https:\/\/www.microsoft.com\/en-us\/p\/holoLens-2\/91pnzzznzwcp\/?activetab=pivot%3Aoverviewtab [Accessed 20 May 2021]."}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2023-104703","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T20:10:10Z","timestamp":1760213410000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2023-104703"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,11]]},"references-count":22,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12,2]]},"published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1136\/rapm-2023-104703"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2023-104703","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,11]]}}}