Co-localized augmented human and X-ray observers in collaborative surgical ecosystem

Javad Fotouhi, Mathias Unberath, Tianyu Song, Jonas Hajek, Sing Chun Lee, Bastian Bier, Andreas Maier, Greg Osgood, Mehran Armand, Nassir Navab

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: Image-guided percutaneous interventions are safer alternatives to conventional orthopedic and trauma surgeries. To advance surgical tools in complex bony structures during these procedures with confidence, a large number of images is acquired. While image-guidance is the de facto standard to guarantee acceptable outcome, when these images are presented on monitors far from the surgical site the information content cannot be associated easily with the 3D patient anatomy. Methods: In this article, we propose a collaborative augmented reality (AR) surgical ecosystem to jointly co-localize the C-arm X-ray and surgeon viewer. The technical contributions of this work include (1) joint calibration of a visual tracker on a C-arm scanner and its X-ray source via a hand-eye calibration strategy, and (2) inside-out co-localization of human and X-ray observers in shared tracking and augmentation environments using vision-based simultaneous localization and mapping. Results: We present a thorough evaluation of the hand-eye calibration procedure. Results suggest convergence when using 50 pose pairs or more. The mean translation and rotation errors at convergence are 5.7 mm and 0. 26 , respectively. Further, user-in-the-loop studies were conducted to estimate the end-to-end target augmentation error. The mean distance between landmarks in real and virtual environment was 10.8 mm. Conclusions: The proposed AR solution provides a shared augmented experience between the human and X-ray viewer. The collaborative surgical AR system has the potential to simplify hand-eye coordination for surgeons or intuitively inform C-arm technologists for prospective X-ray view-point planning.

Original languageEnglish (US)
Pages (from-to)1553-1563
Number of pages11
JournalInternational Journal of Computer Assisted Radiology and Surgery
Issue number9
StatePublished - Sep 1 2019


  • Augmented reality
  • C-arm
  • Calibration
  • Surgery
  • X-ray

ASJC Scopus subject areas

  • Health Informatics
  • Radiology Nuclear Medicine and imaging
  • Computer Vision and Pattern Recognition
  • Surgery
  • Biomedical Engineering
  • Computer Science Applications
  • Computer Graphics and Computer-Aided Design


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