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De Silva T, Punnoose J, Uneri A, et al. C-arm Positioning Using Virtual Fluoroscopy for Image-Guided Surgery. Proc SPIE Int Soc Opt Eng. 2017;10135doi: 10.1117/12.2256028.
De Silva, T., Punnoose, J., Uneri, A., Goerres, J., Jacobson, M., Ketcha, M. D., Manbachi, A., Vogt, S., Kleinszig, G., Khanna, A. J., Wolinksy, J. P., Osgood, G., & Siewerdsen, J. H. (2017). C-arm Positioning Using Virtual Fluoroscopy for Image-Guided Surgery. Proceedings of SPIE--the International Society for Optical Engineering, 10135. https://doi.org/10.1117/12.2256028
De Silva, T, et al. "C-arm Positioning Using Virtual Fluoroscopy for Image-Guided Surgery." Proceedings of SPIE--the International Society for Optical Engineering vol. 10135 (2017). doi: https://doi.org/10.1117/12.2256028
De Silva T, Punnoose J, Uneri A, Goerres J, Jacobson M, Ketcha MD, Manbachi A, Vogt S, Kleinszig G, Khanna AJ, Wolinksy JP, Osgood G, Siewerdsen JH. C-arm Positioning Using Virtual Fluoroscopy for Image-Guided Surgery. Proc SPIE Int Soc Opt Eng. 2017 Feb 11;10135. doi: 10.1117/12.2256028. Epub 2017 Mar 03. PMID: 28572694; PMCID: PMC5449120.
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Proc SPIE Int Soc Opt Eng. 2017 Feb 11;10135. doi: 10.1117/12.2256028. Epub 2017 Mar 03.

C-arm Positioning Using Virtual Fluoroscopy for Image-Guided Surgery.

Proceedings of SPIE--the International Society for Optical Engineering

T De Silva, J Punnoose, A Uneri, J Goerres, M Jacobson, M D Ketcha, A Manbachi, S Vogt, G Kleinszig, A J Khanna, J-P Wolinksy, G Osgood, J H Siewerdsen

Affiliations

  1. Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD.
  2. Siemens Healthineers, Erlangen Germany.
  3. Orthopaedic Surgery, Johns Hopkins University, Baltimore MD.
  4. Department of Neurosurgery, Johns Hopkins University, Baltimore MD.
  5. Russel H. Morgan Department of Radiology, Johns Hopkins University, Baltimore MD.

PMID: 28572694 PMCID: PMC5449120 DOI: 10.1117/12.2256028

Abstract

INTRODUCTION: Fluoroscopically guided procedures often involve repeated acquisitions for C-arm positioning at the cost of radiation exposure and time in the operating room. A virtual fluoroscopy system is reported with the potential of reducing dose and time spent in C-arm positioning, utilizing three key advances: robust 3D-2D registration to a preoperative CT; real-time forward projection on GPU; and a motorized mobile C-arm with encoder feedback on C-arm orientation.

METHOD: Geometric calibration of the C-arm was performed offline in two rotational directions (orbit α, orbit β). Patient registration was performed using image-based 3D-2D registration with an initially acquired radiograph of the patient. This approach for patient registration eliminated the requirement for external tracking devices inside the operating room, allowing virtual fluoroscopy using commonly available systems in fluoroscopically guided procedures within standard surgical workflow. Geometric accuracy was evaluated in terms of projection distance error (PDE) in anatomical fiducials. A pilot study was conducted to evaluate the utility of virtual fluoroscopy to aid C-arm positioning in image guided surgery, assessing potential improvements in time, dose, and agreement between the virtual and desired view.

RESULTS: The overall geometric accuracy of DRRs in comparison to the actual radiographs at various C-arm positions was PDE (mean ± std) = 1.6 ± 1.1 mm. The conventional approach required on average 8.0 ± 4.5 radiographs spent "fluoro hunting" to obtain the desired view. Positioning accuracy improved from 2.6° ± 2.3° (in α) and 4.1° ± 5.1° (in β) in the conventional approach to 1.5° ± 1.3° and 1.8° ± 1.7°, respectively, with the virtual fluoroscopy approach.

CONCLUSION: Virtual fluoroscopy could improve accuracy of C-arm positioning and save time and radiation dose in the operating room. Such a system could be valuable to training of fluoroscopy technicians as well as intraoperative use in fluoroscopically guided procedures.

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