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The effect of artificial X-rays on C-arm positioning performance in a simulated orthopaedic surgical setting

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

We designed an Artificial X-ray Imaging System (AXIS) that generates simulated fluoroscopic X-ray images on the fly and assessed its utility in improving C-arm positioning performance by C-arm users with little or no C-arm experience.

Methods

The AXIS system was comprised of an optical tracking system to monitor C-arm movement, a manikin, a reference CT volume registered to the manikin, and a Digitally Reconstructed Radiograph algorithm to generate live simulated fluoroscopic images. A user study was conducted with 30 participants who had little or no C-arm experience. Each participant carried out four tasks using a real C-arm: an introduction session, an AXIS-guided set of pelvic imaging tasks, a non-AXIS guided set of pelvic imaging tasks, and a questionnaire. For each imaging task, the participant replicated a set of three target X-ray images by taking real radiographs of a manikin with a C-arm. The number of X-rays required, task time, and C-arm positioning accuracy were recorded.

Results

We found a significant 53% decrease in the number of X-rays used and a moderate 10–26% improvement in lateral C-arm axis positioning accuracy without requiring more time to complete the tasks when the participants were guided by artificial X-rays. The questionnaires showed that the participants felt significantly more confident in their C-arm positioning ability when they were guided by AXIS. They rated the usefulness of AXIS as very good to excellent, and the realism and accuracy of AXIS as good to very good.

Conclusion

Novice users working with a C-arm machine supplemented with the ability to generate simulated X-ray images could successfully accomplish positioning tasks in a simulated surgical setting using markedly fewer X-ray images than when unassisted. In future work, we plan to determine whether such a system can produce similar results in the live operating room without lengthening surgical procedures.

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Acknowledgements

The authors would like to thank the following for their support: Institute for Computing, Information and Cognitive Systems (ICICS), Centre for Hip Health and Mobility (CHHM), Francine Anselmo and Dori Kaplun, British Columbia Institute of Technology (BCIT).

Funding

This work was funded by the Natural Sciences and Engineering Research Council of Canada (NSERC) and by the Canadian Institute of Health Research (CIHR) (Grant #214110)

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Authors and Affiliations

  1. Department of Mechanical Engineering, University of British Columbia, Vancouver, V6T 1Z4, Canada

    Michèle Touchette, Robyn Newell & Antony Hodgson

  2. Department of Civil Engineering, University of Calgary, Calgary, T2N 1N4, Canada

    Carolyn Anglin

  3. Department of Orthopaedics, University of British Columbia, Vancouver, V5Z 1M9, Canada

    Pierre Guy & Kelly Lefaivre

  4. Medical Radiography, British Columbia Institute of Technology, Burnaby, V5G 3H2, Canada

    Meena Amlani

Authors
  1. Michèle Touchette
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  2. Robyn Newell
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  3. Carolyn Anglin
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  4. Pierre Guy
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  7. Antony Hodgson
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Correspondence to Michèle Touchette.

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The authors declare that they have no conflict of interest related to this study.

Ethical approval

Ethics approval was received from the University of British Columbia Clinical Research Ethics Board (H15-00005) and by the British Columbia Institute of Technology Research Ethics Board (2016-09). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Touchette, M., Newell, R., Anglin, C. et al. The effect of artificial X-rays on C-arm positioning performance in a simulated orthopaedic surgical setting. Int J CARS 16, 11–22 (2021). https://doi.org/10.1007/s11548-020-02280-2

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  • DOI: https://doi.org/10.1007/s11548-020-02280-2

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