Integrating Extended Reality into Interventional Radiology: A Single Center Feasibility Study of a Virtual Ruler for PICC Line Placement.

PURPOSE: To evaluate an XR ruler during peripherally inserted central catheter (PICC) placement as a representative clinical task to assess comparative effectiveness, measurement accuracy, operator comfort and user challenges. MATERIALS AND METHODS: An XR application that showed the distance between the user's index fingers was developed. A prospective cohort study was then conducted in which the PICC length was determined by the XR ruler for patients undergoing routine placement at a quaternary care academic medical center. Accuracy of catheter tip position at the cavoatrial junction, procedure time, and radiation dose, were compared between the intervention group and historical controls. RESULTS: A total of 29 patients were recruited. The primary outcome of acceptable tip placement was achieved in all cases, and there was no significant difference in procedure time and radiation dose between the XR group and historical controls (p = 0.46 and 0.26, respectively). The mean error of the XR ruler was 0.7 ± 0.9 cm. Directed interviews of providers found the XR application easy to integrate into the clinical workflow (strong agreement, mean Likert score of 1). CONCLUSION: Use of an XR hand ruler to guide PICC placement enabled optimal tip placement, was non-inferior to standard of care on secondary outcomes, and was well received by interventional radiologists.