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Journal of Medical Imaging • new

Virtual fluoroscopy for intraoperative C-arm positioning and radiation dose reduction
Author(s): Tharindu S. De Silva; Joshua Punnoose; Ali Uneri; Mahadevappa Mahesh; Joseph Goerres; Matthew W. Jacobson; Michael D. Ketcha; Amir Manbachi; Sebastian Vogt; Gerhard Kleinszig; Akhil Jay Khanna; Jean-Paul Wolinsky; Jeffrey H. Siewerdsen; Greg M. Osgood
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Paper Abstract

Positioning of an intraoperative C-arm to achieve clear visualization of a particular anatomical feature often involves repeated fluoroscopic views, which cost time and radiation exposure to both the patient and surgical staff. A system for virtual fluoroscopy (called FluoroSim) that could dramatically reduce time- and dose-spent “fluoro-hunting” by leveraging preoperative computed tomography (CT), encoded readout of C-arm gantry position, and automatic 3D–2D image registration has been developed. The method is consistent with existing surgical workflow and does not require additional tracking equipment. Real-time virtual fluoroscopy was achieved via mechanical encoding of the C-arm motion, C-arm geometric calibration, and patient registration using a single radiograph. The accuracy, time, and radiation dose associated with C-arm positioning were measured for FluoroSim in comparison with conventional methods. Five radiology technologists were tasked with acquiring six standard pelvic views pertinent to sacro-illiac, anterior–inferior iliac spine, and superior-ramus screw placement in an anthropomorphic pelvis phantom using conventional and FluoroSim approaches. The positioning accuracy, exposure time, number of exposures, and total time for each trial were recorded, and radiation dose was characterized in terms of entrance skin dose and in-room scatter. The geometric accuracy of FluoroSim was measured to be 1.6±1.1  mm. There was no significant difference (p<0.05) observed in the accuracy or total elapsed time for C-arm positioning. However, the total fluoroscopy time required to achieve the desired view decreased by 4.1 s (4.7±3.6  s for conventional, compared with 0.5±0.0  s for FluoroSim, p<0.05), and the total number of exposures reduced by 4.0 (6.4±4.8 for conventional, compared with 2.0±0.0 for FluoroSim, p<0.05). These reductions amounted to a 50% to 78% decrease in patient entrance skin dose and a 55% to 70% reduction in in-room scatter. FluoroSim was found to reduce the radiation exposure required in C-arm positioning without diminishing positioning time or accuracy, providing a potentially valuable tool to assist technologists and surgeons.

Paper Details

Date Published: 13 February 2018
PDF: 8 pages
J. Med. Imag. 5(1) 015005 doi: 10.1117/1.JMI.5.1.015005
Published in: Journal of Medical Imaging Volume 5, Issue 1
Show Author Affiliations
Tharindu S. De Silva, Johns Hopkins Univ. (United States)
Joshua Punnoose, Johns Hopkins Univ. (United States)
Ali Uneri, Johns Hopkins Univ. (United States)
Mahadevappa Mahesh, Johns Hopkins Univ. (United States)
Joseph Goerres, Johns Hopkins Univ. (United States)
Matthew W. Jacobson, Johns Hopkins Univ. (United States)
Michael D. Ketcha, Johns Hopkins Univ. (United States)
Amir Manbachi, Johns Hopkins Univ. (United States)
Sebastian Vogt, Siemens Healthineers (Germany)
Gerhard Kleinszig, Siemens Healthineers (Germany)
Akhil Jay Khanna, Johns Hopkins Univ. (United States)
Jean-Paul Wolinsky, Johns Hopkins Univ. (United States)
Jeffrey H. Siewerdsen, Johns Hopkins Univ. (United States)
Greg M. Osgood, The Johns Hopkins Hospital (United States)

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