# Augmented Reality: Mapping Methods and Tools for Enhancing the Human Role in Healthcare HMI
## 3 Results
### Intraoperative Solution
#### 3.3.3 Tumor Surgery  
Orthopedic oncology deals with all oncologic diseases affecting the skeleton, soft tissue, sarcomas, bone metastases, cancerous and benign tumors. Traditional therapy for these tumors is a complete surgical resection, which has recently benefited from AR technology due to its advantages in medical training, surgical navigation, and improved patient relations. However, nowadays, among the published studies there are few examples of the treatment of oncological patients in orthopedics in which AR technology is used.  
[PERSON] et al. [76] developed an ARSN system for the surgery of pelvic bone cancer, supported on a tablet PC, where radiological data are displayed overlaid with real-world data, suggesting more data about the tumor size. By optically tracking the target object and markers placed on it, the ARSN system can support surgeons during pelvic bone tumor surgery, with the advantage of not being as bulky as traditional navigation systems. For validation of the system, thirty-six bone tumor models were created for simulation of tumor resection in pig skin. The models were divided into two groups, in which resection was performed with AR guidance or with the traditional method. In comparison, the AR-based technique proved to be more accurate than the conventional approach.  
Instead of using a tablet PC, [PERSON] et al. [37] proposed a novel AR-based framework that assists surgical planning, improves patient communication, and provides support during an osteotomy procedure through a smartphone application. The patient's anatomy and tumor location were visualized on the smartphone display and tracked by an automated registration process based on a 3D printed reference marker customized by the patient. This solution was assessed on both 3D printed patient-specific mannequins and patients, and feedback from physicians and patients was positive and encouraging.  
[PERSON] et al. [36] described the use of AR-mediated spine surgery (ARMSS) for guidance in a single osteotomy procedure to obtain a large en bloc marginal resection of an L1 chordoma through a posterior-only approach, avoiding a breach of the tumor capsule. ARMSS via an HMD with a monitoring device is a new technology approved by the FDA for neuronavigation during surgery that has the advantage of improved accuracy, frame work robustness, and convenience. The procedure was completed by reconstruction using an allograft construct, obtaining excellent results during the patient's rehabilitation.  
In a different study, [PERSON] et al. [24] evaluated [PERSON]'s periacetabular osteotomy (PAO) navigation feasibility over two cadaveric pelvis under realistic surgical conditions. Custom-made developed software was used to conduct preoperative planning on 3D models reconstructed with computed tomography (CT). In this way, cutting plane objects for osteotomy planning and reorientation of the acetabular fragment were created. The registration process, motion compensation, guidance for osteotomies, and reorientation of the fragment were all included in the developed AR application. By deploying the AR application on Microsoft HoloLens, all flat objects could be overlaid on the actual anatomy for cutting navigation, supported by a marker-based tracking system. Pre- and post-surgery pelvic bone models were registered through ICP for comparison. The results demonstrate that AR navigation is suitable for PAO surgery, since it improves the accuracy of current cutting-edge navigators, although the need for future development.