13 March 2018 Cone beam tomosynthesis fluoroscopy: a new approach to 3D image guidance
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Fluoroscopy is a common image guidance modality used in spine and orthopedic surgery. One benefit of this technology is that it provides real-time images without interrupting the procedure. A major challenge with fluoroscopy is that it provides projection images with no depth information, limiting surgical accuracy in complex procedures like for example in thoracic spine surgery1 . 3D technologies such as intraoperative Cone Beam CT and surgical navigation solve the surgical accuracy problem but increase cost and impair the surgical workflow, limiting its adoption2 . In an attempt to improve surgical accuracy, control costs and simplify the surgical workflow, a new approach to image guidance based on real-time 3D imaging is proposed3 . Fast fluoroscopic acquisitions taken in a circular tomosynthesis geometry are used to provide near real-time 3D updates of the imaged surgical scene. 3D updates are achieved via a model-based reconstruction that makes proficient use of prior information, and instrument tracking is achieved via image processing. This new imaging approach is named Cone Beam Tomosynthesis (CBT) fluoroscopy. A first prototype based on a modified C-arm and with a single rotating source is used to assess the surgical performance of CBT-fluoroscopy. Preliminary results show that CBT-fluoroscopy can achieve near-real-time imaging performance and provide comparable surgical accuracy to fluoroscopy in the use case of pedicle screw placement on phantoms; the limitations of the approach are analyzed and steps to address these limitations are discussed.
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Cristian Atria, Cristian Atria, Lisa Last, Lisa Last, Nathan Packard, Nathan Packard, Frederic Noo, Frederic Noo, "Cone beam tomosynthesis fluoroscopy: a new approach to 3D image guidance", Proc. SPIE 10576, Medical Imaging 2018: Image-Guided Procedures, Robotic Interventions, and Modeling, 105762V (13 March 2018); doi: 10.1117/12.2293905; https://doi.org/10.1117/12.2293905

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