Beyond the Desktop: XR-Driven Segmentation with Meta Quest 3 and MX Ink

Medical imaging segmentation is essential in clinical settings for diagnosing diseases, planning surgeries, and other procedures. However, manual annotation is a cumbersome and effortful task. To mitigate these aspects, this study implements and evaluates the usability and clinical applicability of an extended reality (XR)-based segmentation tool for anatomical CT scans, using the Meta Quest 3 headset and Logitech MX Ink stylus. We develop an immersive interface enabling real-time interaction with 2D and 3D medical imaging data in a customizable workspace designed to mitigate workflow fragmentation and cognitive demands inherent to conventional manual segmentation tools. The platform combines stylus-driven annotation, mirroring traditional pen-on-paper workflows, with instant 3D volumetric rendering. A user study with a public craniofacial CT dataset demonstrated the tool's foundational viability, achieving a System Usability Scale (SUS) score of 66, within the expected range for medical applications. Participants highlighted the system's intuitive controls (scoring 4.1/5 for self-descriptiveness on ISONORM metrics) and spatial interaction design, with qualitative feedback highlighting strengths in hybrid 2D/3D navigation and realistic stylus ergonomics. While users identified opportunities to enhance task-specific precision and error management, the platform's core workflow enabled dynamic slice adjustment, reducing cognitive load compared to desktop tools. Results position the XR-stylus paradigm as a promising foundation for immersive segmentation tools, with iterative refinements targeting haptic feedback calibration and workflow personalization to advance adoption in preoperative planning.