A DirectX-Based DICOM Viewer for Multi-user Surgical Planning in Augmented Reality

Preoperative medical imaging is an essential part of surgical planning. The data from medical imaging devices, such as CT and MRI scanners, consist of stacks of 2D images in DICOM format. Conversely, advances in 3D data visualization provide further information by assembling cross-sections into 3D volumetric datasets. As Microsoft unveiled the HoloLens 2 (HL2), which is considered one of the best Mixed Reality (XR) headsets in the market, it promised to enhance visualization in 3D by providing an immersive experience to users. This paper introduces a prototype holographic XR DICOM Viewer for the 3D visualization of DICOM image sets on HL2 for surgical planning. We first developed a standalone graphical C++ engine using the native DirectX11 API and HLSL shaders. Based on that, the prototype further applies the OpenXR API for potential deployment on a wide range of devices from vendors across the XR spectrum. With native access to the device, our prototype unravels the limitation of hardware capabilities on HL2 for 3D volume rendering and interaction. Moreover, smartphones can act as input devices to provide another user interaction method by connecting to our server. In this paper, we present a holographic DICOM viewer for the HoloLens 2 and contribute (i) a prototype that renders the DICOM image stacks in real-time on HL2, (ii) three types of user interactions in XR, and (iii) a preliminary qualitative evaluation of our prototype.