C-arm positioning using virtual fluoroscopy for image-guided surgery

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

Research output: Chapter in Book/Report/Conference proceedingConference contribution

7 Scopus citations


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 a, orbit ?). 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 ?) 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.

Original languageEnglish (US)
Title of host publicationMedical Imaging 2017
Subtitle of host publicationImage-Guided Procedures, Robotic Interventions, and Modeling
EditorsRobert J. Webster, Baowei Fei
ISBN (Electronic)9781510607156
StatePublished - 2017
EventMedical Imaging 2017: Image-Guided Procedures, Robotic Interventions, and Modeling - Orlando, United States
Duration: Feb 14 2017Feb 16 2017

Publication series

NameProgress in Biomedical Optics and Imaging - Proceedings of SPIE
ISSN (Print)1605-7422


OtherMedical Imaging 2017: Image-Guided Procedures, Robotic Interventions, and Modeling
Country/TerritoryUnited States

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Biomaterials
  • Atomic and Molecular Physics, and Optics
  • Radiology Nuclear Medicine and imaging


Dive into the research topics of 'C-arm positioning using virtual fluoroscopy for image-guided surgery'. Together they form a unique fingerprint.

Cite this