Label-Free Deep-Tissue Peripheral Nerve Detection with a Handheld Multimodal OCT Probe and NerveDetNet

Peripheral nerves buried beneath intact tissue are difficult to visualize during surgery and remain inaccessible to white light wide-field imaging and other surface optical imaging methods. Existing OCT nerve studies have largely relied on exposed nerves or polarization contrast with limited depth penetration, restricting their value for subsurface intraoperative guidance. Here, we introduce, to our knowledge, the first label-free framework for detecting peripheral nerves beneath unopened tissue and resolving their depth using intensity-based OCT structural signatures alone. The framework combines a handheld multimodal probe, integrating swept-source OCT with co-registered white light and autofluorescence imaging, with a ``confirm-then-capture'' workflow designed for practical surgical use. To enable efficient analysis of sparsely sampled OCT volumes, we develop NerveDetNet, a lightweight 2.5D segmentation network that recovers weak and spatially displaced nerve signals by incorporating spatial context, frame-order information, and shift-tolerant correlations across frames through a dedicated nerve feature correlation module. In ex vivo tissue experiments, NerveDetNet consistently outperformed six representative 2D baselines across all frame spacings, achieving a Dice score of 0.725 under the sparsest sampling condition while using approximately half the model parameters. End-to-end validation demonstrated localization of nerves invisible at the surface and depth-resolved detection up to 1.3--1.4~mm below the tissue surface, with OCT derived depth maps overlaid directly onto the surgical view. Together, these results establish a practical label-free approach for subsurface nerve visualization that supports intraoperative compatibility, enables efficient sparse-volume analysis, and provides depth-resolved guidance without tissue opening, contrast agents, or nerve exposure.

Marker-free deformable registration and fusion for augmented reality-guided positive margin localization during tumor resection surgery

Positive margins in head and neck oncologic surgery require mapping specimen-side pathology findings to the patient resection bed. This is challenging because pathologists identify the positive margin on slices of the resected, deformed specimen, while surgeons must relocate the corresponding site on the resection bed using only verbal descriptions and no visual guidance. We present a marker-free augmented reality (AR) workflow for mapping a margin label from a three-dimensional specimen scan to the resection bed. The method combines contour-constrained deformation, residual alignment to a depth scan, surface-based fusion to a head-mounted display, and target projection onto the reconstructed bed. Bead-suture correspondences estimate specimen deformation, whereas patient-to-display fusion does not require external fiducial markers. Following formative experiments, five residents and surgeons performed cadaveric cheek and scalp re-resection tasks under verbal guidance, verbal guidance with specimen examination, and AR guidance. Deformation target errors were $7.63 \pm 3.74$ mm for the cheek and $3.72 \pm 1.02$ mm for the scalp; residual specimen-to-bed distances were $2.43 \pm 2.15$ mm and $2.19 \pm 1.06$ mm, respectively. Fusion error did not differ significantly between marker-free and marker-based methods on either cadaver; overall marker-free fusion error was $2.15 \pm 0.87$ mm. End-to-end margin localization error decreased from $21.40 \pm 3.84$ mm with verbal guidance and $16.09 \pm 4.30$ mm with specimen examination to $6.19 \pm 1.79$ mm with AR guidance ($p < 0.001$). Online fusion required $5.23 \pm 0.34$ s. These results demonstrate effective marker-free AR guidance for positive-margin localization and support more precise tumor resection.

X-GuideAR: An Augmented Reality Framework to Mitigate Radiation Exposure during Fluoroscopic Guidance

Achieving optimal screw placement for orthopedic surgeries requires frequent alignment checks and multiple anatomical views under X-ray -- a process known as "fluoro-hunting" that increases radiation exposure to patients and surgical teams. This work introduces X-GuideAR, an augmented reality (AR) framework for identifying optimal X-ray views, aimed at reducing radiation exposure while ensuring accurate screw placement. To exemplify the benefits of X-GuideAR, we focus on S2 alar-iliac (S2AI) screw placement. Our system provides radiation-free guidance for view acquisition and drilling by generating synthetic X-ray previews that accelerate fluoro-hunting. Once the required anatomical views are identified using these previews, a real X-ray is acquired, and the preview of the drilling trajectory is augmented onto it, facilitating precise screw placement with minimal additional radiation. A preliminary study involving eight S2AI trajectories performed by an expert spine surgeon demonstrated a 62.3% reduction in the number of X-rays. Post-procedure evaluations showed that trajectories done with X-GuideAR supported an average safe screw diameter of 12.95 mm compared to 5.9 mm under the conventional workflow, suggesting improved bony containment and potential biomechanical benefit. X-GuideAR shows great potential to reduce radiation exposure and streamline S2AI screw placement, offering a promising direction toward safer and more efficient surgeries.

Contour-Constrained Deformable Registration with Parameter Characterization for Head and Neck Surgical Guidance

With 890,000 annual new cases globally, head and neck squamous cell carcinoma has one of the highest recurrence rates among solid malignancies. Although frozen section analysis is the standard of care for intraoperative margin assessment, accurately relocating detected positive margins on the resection bed remains challenging due to imprecise alignment between resected specimens and their resection bed, compounded by post-resection mucosal tissue shrinkage. We present a biomechanics-driven deformable registration framework that corrects post-resection tissue deformation to provide intraoperative guidance. Our approach registers 3D specimen meshes to intraoperative resection bed point clouds using a deformable registration approach based on regularized Kelvinlet basis functions. The registration matches surface point clouds, fiducial landmarks, and boundary contour constraints that directly penalize perpendicular distance-to-agreement between specimen and resection bed boundaries. Across nine specimens from skin, buccal mucosa, and tongue sites, the overall mean target registration error was $11.11 \pm 4.07$ mm using rigid registration, which decreased to $8.20 \pm 2.68$ mm (26.19\% reduction) using deformable registration without contour constraint. The proposed contour-constrained deformable registration further reduced the error to $5.62 \pm 2.28$ mm, a 49.41\% reduction relative to rigid registration. We observed the largest reduction in the most clinically challenging tongue specimens. We also performed a systematic two-stage parameter search to characterize the relative importance of surface alignment, fiducial correspondences, contour constraint, and strain energy regularization. This search revealed that contour weighting dominates registration accuracy for tissue types with large lateral deformation, while the algorithm operates over a broad range of parameter combinations.