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.

中文翻译：

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人工X射线对模拟骨科手术环境中C臂定位性能的影响

目的

我们设计了一个人工X射线成像系统（AXIS），该系统可以实时生成模拟的X射线透视X射线图像，并评估了其在几乎没有C臂经验或没有C臂经验的情况下在改善C臂定位性能方面的实用性。

方法

AXIS系统由监视C臂运动的光学跟踪系统，人体模型，注册到人体模型的参考CT体积以及数字化放射线照相算法组成，以生成实时的模拟透视图像。对30名没有或完全没有C型臂经验的参与者进行了用户研究。每个参与者都使用真实的C臂执行了四个任务：简介会，一组AXIS指导的骨盆成像任务，一组非AXIS指导的骨盆成像任务以及问卷。对于每个成像任务，参与者通过使用C型臂拍摄人体模型的真实射线照相来复制一组三个目标X射线图像。记录所需的X射线数量，任务时间和C型臂定位精度。

结果

我们发现，使用人工X射线引导参与者时，使用的X射线数量显着减少了53％，横向C臂轴定位精度有了适度的10％至26％的提高，而无需花费更多时间来完成任务。问卷调查显示，在AXIS的指导下，参与者对自己的C型臂定位能力更有信心。他们认为AXIS的实用性非常好，而AXIS的真实性和准确性则非常好。

结论

使用C臂机器并具有生成模拟X射线图像功能的新手用户可以使用X射线图像明显少于未使用辅助设备，从而在模拟手术环境中成功完成定位任务。在未来的工作中，我们计划确定这种系统是否可以在不延长手术程序的情况下在带电手术室中产生相似的结果。