Purpose: To test the technical feasibility of an augmented reality (AR) navigation system to guide bone biopsies.Methods: We enrolled patients subjected to percutaneous computed tomography (CT)-guided bone biopsy using a novel AR navigation system. Data from prospectively enrolled patients (AR group) were compared with data obtained retrospectively from previous standard CT-guided bone biopsies (control group). We evaluated the following: procedure duration, number of CT passes, patient’s radiation dose (dose-length product), complications, and specimen adequacy. Technical success was defined as the ability to complete the procedure as planned, reaching the target center. Technical efficacy was assessed evaluating specimen adequacy.Results: Eight patients (4 males) aged 58 ± 24 years (mean ± standard deviation) were enrolled in the AR group and compared with 8 controls (4 males) aged 60 ± 15 years. No complications were observed. Procedure duration, number of CT passes, and radiation dose were 22 ± 5 min, 4 (median) [4, 6 interquartile range] and 1,034 ± 672 mGy*cm for the AR group and 23 ± 5 min, 9 [7.75, 11.25], and 1,954 ± 993 mGy*cm for controls, respectively. No significant differences were observed for procedure duration (p = 0.878). Conversely, number of CT passes and radiation doses were significantly lower for the AR group (p < 0.001 and p = 0.021, respectively). Technical success and technical efficacy were 100% for both groups.Conclusions: This AR navigation system is safe, feasible, and effective; it can decrease radiation exposure and number of CT passes during bone biopsies without increasing duration time.Relevance statement: This augmented reality (AR) navigation system is a safe and feasible guidance for bone biopsies; it may ensure a decrease in the number of CT passes and patient’s radiation dose.Key points: • This AR navigation system is a safe guidance for bone biopsies.• It ensures decrease of number of CT passes and patient’s radiation exposure.• Procedure duration was similar to that of standard CT-guided biopsy.• Technical success was 100% as in all patients the target was reached.• Technical efficacy was 100% as the specimen was adequate in all patients.Graphical Abstract: