title: Navigating the fluoroscope's C-arm back into position: an accurate and practicable solution to cut radiation and optimize intraoperative workflow.
abstract: OBJECTIVE
  During complex image-guided orthopedic trauma procedures, repetitive fluoroscopic scout imaging is performed. A number of preparatory positioning images often must be taken to reproduce a comparable projection. These scout images have no intrinsic clinical relevance but nevertheless expose the patient and the surgical team to considerable radiation, which could be avoided. This study presents and validates a method to decrease intraoperative radiation.
  
  
  METHODS
  Precision, time requirements, and number of scout images for repositioning the fluoroscope, with and without navigation aid, were recorded on 20 test-rig and 3 phantom setups. A commercially available image-guided surgical navigation system (Vector Vision, BrainLAB), originally designed for instrument navigation, was employed to register and retrieve the C-arm positions. A newly developed software computed the necessary moves to reposition the C-arm on an intuitive visual display.
  
  
  RESULTS
  Retrieving a given C-arm position with the conventional non-navigated technique required an average of 7 scout images (range, 3 to 12 images). In contrast, navigation-assisted repositioning did not necessitate a single scout image. Deviations from the original projection were minimal for both navigated (0.9 degrees, 95% CI 0.8 to 1.1 degrees) and non-navigated repositioning (0.8 degrees, 95% CI 0.7 to 0.9 degrees). Average positioning times were comparable when navigating the C-arm (46 seconds, 95% CI 41 to 51 seconds) and in scout image-based positioning (49 seconds, 95% CI 44 to 53 seconds).
  
  
  CONCLUSIONS
  Navigated C-arm positioning avoids multiple scout images and yields sufficient precision for clinical deployment. Radiation exposure can be reduced considerably by a combination of instrument navigation and navigated C-arm positioning.
authors.affiliation: Surgical Planning Lab, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. matthews@bwh.harvard.edu
authors.forename: Felix
authors.initials: F
authors.lastname: Matthews
authors.forename: Dominik J
authors.initials: DJ
authors.lastname: Hoigne
authors.forename: Manfred
authors.initials: M
authors.lastname: Weiser
authors.forename: Guido A
authors.initials: GA
authors.lastname: Wanner
authors.forename: Pietro
authors.initials: P
authors.lastname: Regazzoni
authors.forename: Norbert
authors.initials: N
authors.lastname: Suhm
authors.forename: Peter
authors.initials: P
authors.lastname: Messmer
mesh_terms: D004867:Equipment Design; D005240:Feasibility Studies; D005471:Fluoroscopy / Q000295:instrumentation*; D006801:Humans; D007432:Intraoperative Period; D019637:Orthopedic Procedures / Q000379:methods*; D011832:Radiation Injuries / Q000517:prevention & control*; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*