Virtual fluoroscopy for intraoperative C-arm positioning and radiation dose reduction

Area of Science:

• Medical Imaging
• Surgical Technology
• Radiology

Background:

• Intraoperative C-arm positioning for anatomical visualization often requires repeated fluoroscopic views.
• This process leads to increased radiation exposure and time for patients and surgical staff, a phenomenon known as "fluoro-hunting".

Purpose of the Study:

• To develop and evaluate a virtual fluoroscopy system (FluoroSim) to reduce radiation dose and time associated with C-arm positioning.
• To assess FluoroSim's accuracy, time efficiency, and radiation reduction compared to conventional methods.

Main Methods:

• FluoroSim leverages preoperative computed tomography (CT), C-arm gantry position encoding, and automatic 3D-2D image registration.
• The system integrates with existing surgical workflows without requiring additional tracking equipment.
• Real-time virtual fluoroscopy is achieved through mechanical C-arm motion encoding, geometric calibration, and patient registration via a single radiograph.

Main Results:

• No significant difference in positioning accuracy or total elapsed time was observed between FluoroSim and conventional methods.
• FluoroSim significantly reduced total fluoroscopy time by 4.1 seconds and the number of exposures by 4.0.
• This resulted in a 50% to 78% decrease in patient entrance skin dose and a 55% to 70% reduction in in-room scatter.

Conclusions:

• FluoroSim effectively reduces radiation exposure during C-arm positioning.
• The system maintains positioning accuracy and time efficiency.
• FluoroSim offers a valuable tool for minimizing radiation dose for patients and staff in surgical settings.