Mixed Reality Biopsy Navigation System Utilizing Markerless Needle Tracking and Imaging Data Superimposition  
[PERSON]  
1 Department of Measurement and Electronics, AGH University of Krakow, 30-059 Krakow, Poland; [EMAIL_ADDRESS]  
[PERSON]  
2 MedApp S.A., 30-150 Krakow, Poland; [EMAIL_ADDRESS]  
[PERSON]  
3 Department of Pulmonary Circulation, Thrombembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, 05-400 Otwock, Poland; [EMAIL_ADDRESS] (M.K. ); [EMAIL_ADDRESS] (S.D.) [PERSON]  
3 Department of Pulmonary Circulation, Thrombembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, 05-400 Otwock, Poland; [EMAIL_ADDRESS] (M.K. ); [EMAIL_ADDRESS] (S.D.) [PERSON]  
1 Department of Measurement and Electronics, AGH University of Krakow, 30-059 Krakow, Poland; [EMAIL_ADDRESS]  
Footnote 1: email: {1,2,*}  
Footnote 2: email: {1,2,*}  
Footnote 3: email: {1,2,*}  
Footnote 4: email: {1,2,*}  
Footnote 5: email: {1,2,*}  
Footnote 6: email: {1,2,*}  
Footnote 7: email: {1,2,*}  
Footnote 8: email: {1,2,*}  
Footnote 9: email:  
that can often be recommended as an outpatient service for the majority of cases [1]. It is also valuable for detecting residual or recurrent post-treatment diseases [2]. The choice of imaging technique relies on factors such as the type and location of the lesion, patient compliance, the availability of the technique, and the preferences of the operators [1]. One of the most popular supporting technique is ultrasound (US) imaging. Its advantages include fast acquisition time, real-time needle evaluation, lack of radiation exposure, avoidance of vessels through color Doppler imaging, availability, shorter procedure time, and decreased cost [3; 4]. On the other hand, the feasibility of this method depends highly on operator experience and the presence of an adequate acoustic window, which is essential for visualizing the lesion [5]. The outcome of the procedure is also influenced by factors such as the size of the lesion (with lesions of size 20 mm or greater considered adequate), location of the lesion and its distance to the skin, and type of lesion, with certain types having lower diagnostic success rates compared to surgical biopsy [6]. An ongoing issue with this method is poor needle visibility [7]. Another widely used technique is Computer Tomography (CT)-guided biopsy. It offers exceptional contrast and high spatial resolution, facilitating optimal needle visualization and precise positioning within the target lesion [8]. It is very versatile, and can be applicable across various organs, ranging from superficial soft tissue lesions to deep-seated lesions within the thoracic or abdominal cavities [9]. However, this method is associated with significant risk of complications; the most common are pneumothorax and pulmonary hemorrhaging, along with exposure to radiation [4; 10]. There are plenty of risk factors for the development of complications as well, including increased number of punctures, wider insertion angle of the needle, small lesion size, greater lesion depth, and long biopsy path [11]. What is more, real-time imaging is possible only with fluoroscopy [12]. Last but not least, Magnetic Resonance (MR) is another popular biopsy guidance imaging system. This method provides excellent soft tissue contrast, does not use ionizing radiation, enables continuous visualization of vessels throughout a procedure without the need for intravenous contrast, and has a distinctive ability to elicit different tissue characteristics during a procedure by using different pulse sequences [13]. This technique is employed if lesions are not identifiable by mammography or ultrasonography [14], and is challenging when there are difficulties around lesion access, validating sufficient lesion sampling, and establishing accurate radiologic-pathologic correlation for enhancing lesions [15]. Moreover, due to the presence of a strong magnetic field, the needles must meet electromagnetic compatibility requirements [16].