The 3D visualization of patient, tool, and DRR shows clear advantages over the conventional X-ray imaging and provides intuitive feedback to place the medical tools correctly and efficiently.

The proposed mixed-reality simulation system facilitates a transition to C-arm-based surgery and has the potential to complement or even replace large parts of cadaver training, to provide a safe assessment environment and to reduce the risk for errors when proceeding to patient treatment. We propose an assessment concept and outline the steps necessary to expand the system into a test instrument that provides reliable and justified assessments scores indicative of surgical proficiency with sufficient evidence for validity.

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