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Purpose: Proper visualization and interaction with complex anatomical data can improve understanding, allowing for more intuitive surgical planning. The goal of our work was to study what the most intuitive yet practical platforms for interacting with 3D medical data are in the context of surgical planning.

Methods: We compared planning using a monitor and mouse, a monitor with a haptic device, and an augmented reality (AR) head-mounted display which uses a gesture-based interaction. To determine the most intuitive system, two user studies, one with novices and one with experts, were conducted. The studies involved planning of three scenarios: (1) heart valve repair, (2) hip tumor resection, and (3) pedicle screw placement. Task completion time, NASA Task Load Index and system-specific questionnaires were used for the evaluation.

Results: Both novices and experts preferred the AR system for pedicle screw placement. Novices preferred the haptic system for hip tumor planning, while experts preferred the mouse and keyboard. In the case of heart valve planning, novices preferred the AR system but there was no clear preference for experts. Both groups reported that AR provides the best spatial depth perception.

Conclusion: The results of the user studies suggest that different surgical cases may benefit from varying interaction and visualization methods. For example, for planning surgeries with implants and instrumentations, mixed reality could provide better 3D spatial perception, whereas using landmarks for delineating specific targets may be more effective using a traditional 2D interface.