Informatics in Radiology: Use of a C-Arm Fluoroscopy Simulator to Support Training in Intraoperative Radiography

Abstract

Mobile image intensifier systems (C-arms) are used frequently in orthopedic and reconstructive surgery, especially in trauma and emergency settings, but image quality and radiation exposure levels may vary widely, depending on the extent of the C-arm operator's knowledge and experience. Current training programs consist mainly of theoretical instruction in C-arm operation, the physical foundations of radiography, and radiation avoidance, and are largely lacking in hands-on application. A computer-based simulation program such as that tested by the authors may be one way to improve the effectiveness of C-arm training. In computer simulations of various scenarios commonly encountered in the operating room, trainees using the virtX program interact with three-dimensional models to test their knowledge base and improve their skill levels. Radiographs showing the simulated patient anatomy and surgical implants are "reconstructed" from data computed on the basis of the trainee's positioning of models of a C-arm, patient, and table, and are displayed in real time on the desktop monitor. Trainee performance is signaled in real time by color graphics in several control panels and, on completion of the exercise, is compared in detail with the performance of an expert operator. Testing of this computer-based training program in continuing medical education courses for operating room personnel showed an improvement in the overall understanding of underlying principles of intraoperative radiography performed with a C-arm, with resultant higher image quality, lower overall radiation exposure, and greater time efficiency. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.313105125/-/DC1.

C-arm positioning using virtual fluoroscopy for image-guided surgery

“…Fluoroscopy simulation methods that have been previously proposed relied upon external tracking systems to align the patient position relative to the C-arm imaging coordinate system and were primarily intended for surgical training purposes [1], [2]. Considering the task of C-arm positioning, the use and adaptation of external tracking systems are challenging due to the line-of-sight requirements and the addition of cumbersome hardware equipment in the operating rooms.…”

A cost effective and high fidelity fluoroscopy simulator using the Image-Guided Surgery Toolkit (IGSTK)

“…This is even more of a concern in the pediatric population, with clinicians encouraged to make judicious use of x-ray and CT imaging. 6,7 In procedures utilizing intraoperative x-ray imaging, simulation has been shown to be an effective tool for improving the trainee's understanding of the principles of image acquisition and radiation exposure, 8 and in reducing radiation exposure while improving performance in clinical care. We have developed a simulator for training clinicians to perform x-ray fluoroscopy based diagnosis.…”

Virtual Reality Aided Positioning of Mobile C-Arms for Image-Guided Surgery

“…Accurate positioning technique of mobile C-arm is required in surgical applications, for example, percutaneous needle procedures and fracture fixation with locking screws and nails. In such cases, the C-arm needs to be piloted to the needle progression view and entry point view to confirm the current pose of the needle [2] or over the nail so that each screw hole appears as a perfect circle [3]. Therefore, mobile C-arm positioning is a routine surgical task and has become more important for the intraoperative imaging techniques [4].…”