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106Chapter6onapatientintheoperationtheatreThereforeARmaybeusedtoovercomethelimitationsofconventionalIGSandcanresolvetheswitchingfocusproblem22OnlyafewARdevicesarecommerciallyavailabletodayRecentlyMicrosoftintroducedtheHoloLens(MicrosoftCorporationRedmondWAUSA)aheadmounteddisplay(HMD)thatisabletovisualizeARandthushasthepotentialtobeusedincombinationwithIGS21CurrentlyimplementationoftheHoloLensinthemedicalandsurgical fieldislimited to trainingandeducationpurposeswherevirtualdataarevisualizedseparatelyfromthepatient24-28NostudiesdescribingthecombinationoftheHoloLensandIGSsystemshavebeenperformedInthisstudyanARIGSsystemispresentedbyintegrationoftheHoloLensintheIGSworkflow Thetechnicalbackgroundisdescribedandanaccuracystudyona3D-printedphantommodel to test the accuracy of the ARIGS system and comparethistotheaccuracyofaconventionalIGSsystemisperformedMATERIALANDMETHODSIntegrationoftheHoloLensintheIGSworkflowrequiresvisualizationofplannedobjects(holograms)atthepositionandorientationcorrespondingtotheIGSplanningThevisualizationinARmustbecontinuouslyupdatedwithtrackinginformationfromtheIGSsystemtoensureadequatevisualizationThefirstgoalofthisstudywastodevelopamethodforlinkingtheIGSinformationwithARvisualizationandthetechnicalbackgroundofthismethodisdescribedTheaccuracyof thesystemisaffectedbyerrorsoriginating from thenavigationsystem(navigationerror)errorsintroducedby theuser(usererror)anderrors through theuseofAR visualization(AR visualizationerror) Thesecondgoal was toevaluate theeffectofaddingARtotheIGSsystemwhichwasachievedinanaccuracystudy