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

Mathias Unberath; Javad Fotouhi; Jonas Hajek; Andreas Maier; Greg Osgood; Russell Taylor; Mehran Armand; Nassir Navab

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

View Fulltext

Author(s): Mathias Unberath¹ ; Javad Fotouhi¹ ; Jonas Hajek^{1, 2} ; Andreas Maier² ; Greg Osgood³ ; Russell Taylor⁴ ; Mehran Armand^{3, 5} ; Nassir Navab^{1, 6}
- Affiliations: 1: Computer Aided Medical Procedures, Johns Hopkins University , Baltimore, MD , USA ;
  2: Pattern Recognition Lab, Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany ;
  3: Orthopaedic Trauma , Johns Hopkins University , Baltimore, MD , USA ;
  4: Laboratory for Computational Sensing and Robotics, Johns Hopkins University , Baltimore, MD , USA ;
  5: Applied Physics Laboratory, Johns Hopkins University , Baltimore, MD , USA ;
  6: Computer Aided Medical Procedures, Technical University of Munich , Munich , Germany
Source: Volume 5, Issue 5, October 2018, p. 143 – 147
DOI: 10.1049/htl.2018.5066 , Online ISSN 2053-3713

This is an open access article published by the IET under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/)

Received 10/08/2018, Accepted 20/08/2018, Published 01/10/2018

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.

References

1. 1)
  - 12. Klein, T., Benhimane, S., Traub, J., et al: ‘Interactive guidance system for C-arm repositioning without radiation’. Bildverarbeitung für die Medizin 2007, München, Germany, 2007, pp. 21–25.
2. 2)
  - 2. Mardanpour, K., Rahbar, M.: ‘The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation’, J. Inj. Violence Res., 2013, 5, (2), p. 77 (doi: 10.5249/jivr.v5i2.138).
3. 3)
  - 15. Fotouhi, J., Fuerst, B., Johnson, A.,, et al: ‘Pose-aware C-arm for automatic re-initialization of interventional 2d/3d image registration’, Int. J. Comput. Assist. Radiol. Surg., 2017, 12, (7), pp. 1221–1230 (doi: 10.1007/s11548-017-1611-8).
4. 4)
  - 3. Tucker, E., Fotouhi, J., Unberath, M., et al: ‘Towards clinical translation of augmented orthopedic surgery: from pre-op CT to intra-op x-ray via RGBD sensing’. Medical Imaging 2018: Imaging Informatics for Healthcare, Research, and Applications, Houston, TX, 2018, vol. 10579, p. 105790J.
5. 5)
  - 22. Deib, G., Johnson, A., Unberath, M., et al: ‘Image guided percutaneous spine procedures using an optical see-through head mounted display: proof of concept and rationale’, J. Neurointerv. Surg., 2018, doi: 10.1136/neurintsurg-2017-013649.
6. 6)
  - 6. Chen, X., Xu, L., Wang, Y., et al: ‘Development of a surgical navigation system based on augmented reality using an optical see-through head-mounted display’, J. Biomed. Inf., 2015, 55, pp. 124–131 (doi: 10.1016/j.jbi.2015.04.003).
7. 7)
  - 21. Qian, L., Unberath, M., Yu, K., et al: ‘Towards virtual monitors for image guided interventions-real-time streaming to optical see-through head-mounted displays’, arXiv preprint arXiv:171000808, 2017.
8. 8)
  - 20. Besl, P.J., McKay, N.D.: ‘Method for registration of 3-d shapes’. Sensor Fusion IV: Control Paradigms and Data Structures, Boston, MA, 1992, vol. 1611, pp. 586–607.
9. 9)
  - 10. Gong, R.H., Jenkins, B., Sze, R.W., et al: ‘A cost effective and high fidelity fluoroscopy simulator using the image-guided surgery toolkit (IGSTK)’. Medical Imaging 2014: Image-Guided Procedures, Robotic Interventions, and Modeling, San Diego, CA, 2014, vol. 9036, p. 903618.
10. 10)
  - 4. Andress, S., Johnson, A., Unberath, M., et al: ‘On-the-fly augmented reality for orthopedic surgery using a multimodal fiducial’, J. Med. Imag., 2018, 5, (2), p. 021209 (doi: 10.1117/1.JMI.5.2.021209).
11. 11)
  - 15. Fallavollita, P., Winkler, A., Habert, S., et al: ‘Desired-view controlled positioning of angiographic C-arms’. Int. Conf. on Medical Image Computing and Computer-Assisted Intervention, Cambridge, MA, 2014, pp. 659–666.
12. 12)
  - 9. Bott, O.J., Dresing, K., Wagner, M., et al: ‘Informatics in radiology: use of a c-arm fluoroscopy simulator to support training in intraoperative radiography’, Radiographics, 2011, 31, (3), pp. E65–E75 (doi: 10.1148/rg.313105125).
13. 13)
  - 5. Hajek, J., Unberath, M., Fotouhi, J., et al: ‘Closing the calibration loop: an inside-out-tracking paradigm for augmented reality in orthopedic surgery’, Proc. Conf. on Medical Image Computing and Computer Assisted Intervention, Granada, Spain, 2018, pp. 1–8.
14. 14)
  - 1. Korovessis, P., Baikousis, A., Stamatakis, M., et al: ‘Medium- and long-term results of open reduction and internal fixation for unstable pelvic ring fractures’, Orthopedics, 2000, 23, (11), pp. 1165–1171.
15. 15)
  - 19. ‘Ziehm imaging Ziehm Vision RFD 3D’, 2018. Available at https://www.ziehm.com/en/us/products/c-arms-with-flat-panel-detector/ziehm-vision-rfd-3d.html, accessed 11 June 2018.
16. 16)
  - 8. De.Silva, T., Punnoose, J., Uneri, A., et al: ‘Virtual fluoroscopy for intraoperative C-arm positioning and radiation dose reduction’, J. Med. Imaging, 2018, 5, p. 1 (doi: 10.1117/1.JMI.5.1.015005).
17. 17)
  - 7. ‘AO Foundation surgical reference’, 2018. Available at https://www2.aofoundation.org/wps/portal/surgery, accessed 11 June 2018.
18. 18)
  - 16. Endres, F., Hess, J., Engelhard, N., et al: ‘An evaluation of the RGB-D SLAM system’. 2012 IEEE Int. Conf. on Robotics and Automation (ICRA), St Paul, MN, 2012, pp. 1691–1696.
19. 19)
  - 13. Dressel, P., Wang, L., Kutter, O., et al: ‘Intraoperative positioning of mobile c-arms using artificial fluoroscopy’. Medical Imaging 2010: Visualization, Image-Guided Procedures, and Modeling, San Diego, CA, 2010, vol. 7625, p. 762506.
20. 20)
  - 7. Qian, L., Barthel, A., Johnson, A., et al: ‘Comparison of optical see-through head-mounted displays for surgical interventions with object-anchored 2D-display’, Int. J. Comput. Assisted Radiol. Surg., 2017, 12, (6), pp. 901–910 (doi: 10.1007/s11548-017-1564-y).
21. 21)
  - 17. Bier, B., Unberath, M., Zaech, J.N., et al: ‘X-ray-transform invariant anatomical landmark detection for pelvic trauma surgery’, Proc. Conf. on Medical Image Computing and Computer Assisted Intervention, Granada, Spain, 2018, pp. 1–8.
22. 22)
  - 6. Wheeless, C.R.: ‘Radiology of pelvic fractures’, in Moore, D. (ED.): ‘‘Wheeless’ textbook of orthopaedics’ (CR Wheeless, MD, 1996)http://www.wheelessonline.com/ortho/radiology_of_pelvic_fractures. Available at http://www.wheelessonline.com/ortho/radiology_of_pelvic_fractures.
23. 23)
  - 11. Stefan, P., Habert, S., Winkler, A., et al: ‘A mixed-reality approach to radiation-free training of C-arm based surgery’. Int. Conf. on Medical Image Computing and Computer-Assisted Intervention, Quebec City, Canada, 2017, pp. 540–547.
24. 24)
  - 3. Matthews, F., Hoigne, D., Weiser, M.,, et al: ‘Navigating the fluoroscope's C-arm back into position: an accurate and practicable solution to cut radiation and optimize intraoperative workflow’, J. Orthop. Trauma, 2007, 21, pp. 687–692 (doi: 10.1097/BOT.0b013e318158fd42).

Login

Not registered yet?

Share

Tools

Login to add to favourites

Key

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

References

Related content