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Ranjbaran, Parinaz

University of British Columbia

In orthopaedic trauma surgery, using the C-arm fluoroscope to identify the relative position of surgical tools and anatomical structures adds to surgical time and exposes the patient and surgical team to radiation. We hypothesize that overlaying the most recently acquired fluoroscopic image on a video stream showing surgical tool positions could significantly decrease radiation and potentially improve workflow efficiency. Our Depth Camera Augmented Fluoroscopy (DeCAF) system uses a 3D depth camera affixed to the image intensifier tube to create an augmented reality view that overlays a recently acquired X-ray image onto a live video feed to allow the surgeon to more intuitively understand the relationship between the patient’s surface anatomy, surgical tools in the operating field, and interior anatomical structures. To evaluate the potential value of DeCAF, we simulated proximal tibia fixation using 40 Synbone models embedded in a foam model representing surrounding soft tissues. Two surgeons inserted three screws under the tibial plateau in each model, in half of the cases using the conventional fluoroscopic method, and in the other half using the DeCAF system with no imaging taken after the initial shot, except to confirm final placement. We measured the number of X-rays taken in the conventional procedure, the time required for each step, and the depth of the exit points of the screws. The DeCAF overlay error (distance between corresponding points on the X-ray and video images) averaged 1.3±0.2mm within ±50 mm of the calibration plane. The average number of X-ray shots using the conventional method by each surgeon were 39.2 and 21.5. Overall, screws inserted with DeCAF tended to exit ~2mm deeper than with the conventional method but were generally still within or close to the normally targeted depth zone. The overlay error is consistent with accuracies reported in related studies (Navab 2010, Habert 2015) and is likely acceptable for clinical applications. Despite acquiring only one X-ray of the proximal tibia, the surgeon was able to appropriately place the screws without breaching and in equal or less time compared to the conventional method. These results support plans to deploy and test DeCAF in live surgical scenarios.

Text

2024-07-24

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/88700

Mechanical Engineering

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/