Augmented reality-based feedback for technician-in-the-loop C-arm repositioning

Interventional C-arm imaging is crucial to percutaneous orthopedic procedures as it enables the surgeon to monitor the progress of surgery on the anatomy level. Minimally invasive interventions require repeated acquisition of X-ray images from different anatomical views to verify tool placement. Achieving and reproducing these views often comes at the cost of increased surgical time and radiation. We propose a marker-free 'technician-in-the-loop' Augmented Reality (AR) solution for C-arm repositioning. The X-ray technician operating the C-arm interventionally is equipped with a head-mounted display system capable of recording desired C-arm poses in 3D via an integrated infrared sensor. For C-arm repositioning to a target view, the recorded pose is restored as a virtual object and visualized in an AR environment, serving as a perceptual reference for the technician. Our proof-of-principle findings from a simulated trauma surgery indicate that the proposed system can decrease the 2.76 X-ray images required for re-aligning the scanner with an intra-operatively recorded C-arm view down to zero, suggesting substantial reductions of radiation dose. The proposed AR solution is a first step towards facilitating communication between the surgeon and the surgical staff, improving the quality of surgical image acquisition, and enabling context-aware guidance for surgery rooms of the future.