Seeing Beneath the Skin: The Promise of Mixed Reality + Imaging-Guided Acupuncture
In traditional acupuncture practice, locating and inserting needles at the “correct” acupoint (in location, orientation, depth) relies heavily on anatomical knowledge, palpation, and practitioner experience. Novices must learn via repetition, observation, and “feeling their way” over time. But what if technology could help “see beneath the skin” and provide real-time guidance? That is the central idea behind Mixed Reality + Imaging-Guided Acupuncture, sometimes specifically termed MRUCT (Mixed Reality Assistance for Acupuncture Guided by Ultrasonic Computed Tomography).
This article explains what MRUCT is, how it works, early results, potential benefits, challenges, and future directions.
What is MRUCT?
MRUCT is a system that integrates ultrasonic computed tomography (UCT) with a mixed reality (MR) head-mounted display (HMD) to visualize internal anatomical structures in real time during acupuncture needle insertion, overlaid on the patient’s body.
The system reconstructs 3D anatomical models (bones, muscles) from UCT data (offline registration) and then spatially aligns them with the patient’s physical body.
As the practitioner inserts the needle, the system continuously tracks the needle’s position and overlays a virtual “trajectory” reference and anatomical structures (e.g. target point, safe path) in the user’s field of view.
If all goes well, the practitioner sees, via MR, where the needle is relative to internal anatomy, reducing guesswork.
In short: MRUCT aims to act like an “X-ray vision” (figuratively) — a visual guidance tool to improve accuracy, safety, and reduce reliance on purely tactile cues.
The authors of the MRUCT paper claim it's “the first HMD-based MR system that provides real-time guidance for acupuncture needle insertion” tested in real patients.
Related / Complementary Systems & Context
MRUCT is part of a broader trend to bring imaging + AR / MR / XR into therapeutic / interventional procedures. Some noteworthy related work:
Augmented Reality Navigation for Acupuncture: Chiou et al. (2025) describe an AR system for acupuncture with real subjects (10 people) using a personalized 3D head model, markerless alignment, real-time capability in smart glasses, and support for cranial acupoints.
Mixed Reality Acupuncture Training: Sun et al. (2023) built a training MR system that allows users to insert virtual needles into a holographic 3D body with labeled acupoints and meridians. They evaluated user performance and found improvements in spatial understanding and dexterity.
Image-guided & robotic acupuncture: Some prior works explore “robotic acupuncture” or using 3D human models + acupoint mapping to allow mechanical guidance. Xu et al. (2021) discuss guiding acupuncture robots using a 3D virtual human model with acupoints laid out.
Mixed Reality in Ultrasound / Procedural Guidance (HoloPOCUS): Though not specific to acupuncture, HoloPOCUS is a MR system that overlays ultrasound imaging in 3D onto the operator’s field of view, reconstructing US volumes to aid guidance (e.g. needle navigation). The concept is analogous: merging imaging + MR overlay to help guide interventions. arXiv
These works together show the feasibility and plausibility of fusing imaging + MR for guidance in minimally invasive or fine procedures. Acupuncture is more delicate and lower margin (needles, soft tissue, small scale), but the same underlying principles apply.
Why This Matters: Potential Benefits & Use Cases
Increased accuracy & precision
By visualizing internal anatomy, practitioners (especially less-experienced) can better align the needle to the intended target, avoid unintended structures (vessels, nerves), and reduce variation between operators.Improved safety / risk mitigation
Needle misplacement, especially in deeper insertions or near critical anatomy, can pose injury risk. Imaging guidance helps ensure safer paths.Shorter learning curve / better training support
New practitioners don't have to rely solely on blind insertion + palpation experience. The MR guidance provides real-time feedback and spatial cues, accelerating proficiency.Standardization / consistency
As interventions become more guided, inter-practitioner variability may shrink. Protocols could become more reproducible.Patient assurance and trust
Some patients may feel safer knowing the practitioner is using imaging guidance.Potential for research / outcome optimization
With precise trajectories and data logged about needle path, depth, alignment distance, one could correlate placement metrics with clinical outcomes — enabling further optimization of protocols.
What the Early Studies Found (MRUCT & Others)
From the MRUCT paper and related literature, here’s a summary of findings and caveats:
In their formative evaluation, the MRUCT authors conducted interviews with experienced acupuncturists to identify pain points, get preferences on visualization, and guide design decisions (e.g. what imaging modalities are feasible).
They compared two different 3D user interface (3DUI) designs and tested new practitioners / medical students versus traditional workflows. The MRUCT system showed improved accuracy and effectiveness in simulated (or limited patient) settings.
There remain challenges in non-rigid registration (aligning imaging data to a live, deformable body) and real-time alignment when the patient or limb moves.
MRUCT authors noted that MRI is less practical (cost, duration) for guiding acupuncture in live sessions; ultrasound + UCT was preferred because of portability / lower cost.
In the AR acupuncture navigation work (Chiou et al.), their system supported markerless alignment (i.e. no pre-placed fiducial markers) and was tested in real human subjects. Their system achieved real-time overlay of acupoints and supported mobility of viewpoint.
In MR training (Sun et al.), participants using the MR system performed better in spatial understanding and dexterity tests vs controls.
So far, the evidence is promising, but mostly in prototype / pilot stage, often with small samples and limited clinical validation.
Key Technical & Design Challenges
Implementing MR + imaging guidance in acupuncture is not trivial. Here are major hurdles:
Registration / alignment accuracy
Aligning the 3D reconstructed anatomical model with the real, deformable human body is difficult especially when tissues shift, skin moves, or patient moves slightly. Non-rigid registration techniques are needed. MRUCT uses offline registration and local mesh alignment.Motion / tracking
Even small movements (breathing, patient shifting) can degrade alignment. The system must track both the limb and needle in real time and dynamically update overlays.Needle tracking & precision
The system needs to sense exactly where the needle tip is. Small errors in tracking or latency can lead to misplacement.Rendering clarity, UI design, occlusion & depth perception
The MR overlay must be clear, intuitive, non-distracting, and not obstruct the practitioner’s view. Deciding how much anatomy / guideline to show, and how to show it (e.g. semi-transparent, ghost images) is a UI/UX challenge.Latency & real-time performance
Delays in tracking or rendering can reduce effectiveness or safety. The system needs high fps, low lag.Hardware constraints
Wearable HMDs have weight, field-of-view, battery, calibration, comfort issues. Imaging devices (ultrasound, CT) must also be portable, cost-effective, and safe.Cost, complexity, workflow integration
Clinics need to consider cost of hardware, training, maintenance, integration into existing workflows, and patient throughput.Regulation, safety, validation
Using imaging and overlay for guidance is closer to “device / surgical adjunct” territory, possibly raising regulatory and liability concerns. Clinical validation is needed.Patient variability (anatomy, body fat, tissue density)
Variations in anatomy, obesity, or soft-tissue properties might reduce imaging clarity or registration accuracy.
Sources: MRUCT; YulingYun; PubMed Central