Evaluation of the Use of Artificial X-Rays for Educational and Intraoperative Guidance During C-Arm Positioning

Abstract

Fluoroscopic C-arms are operated by medical radiography technologists (RTs) in the Canadian operating room (OR). While they do receive formal, accredited training, most of this training is theoretical, rather than hands-on. During their first encounters in the OR, new RTs can experience difficulty achieving the radiographic views required by surgeons, often needing several scout X-rays during C-arm positioning before achieving the correct anatomical view. Furthermore, ambiguous language by surgeons often inadequately conveys their request (Pally 2013). The result is often frustration, unnecessary radiation exposure, and added OR time (Booij 2007).Several groups have tried to address this problem by overlaying artificial X-ray images on a live video feed (Chen 2013, Reaungamornat 2012, Müller 2011). Others have used artificial X-rays for simulation training (Bott 2008, Gong 2014, Cleary 2004). Though the intent is to improve C-arm positioning accuracy and efficiency during orthopaedic procedures, these systems have primarily been evaluated on system accuracy and not on their potential to decrease radiation exposure inside the OR or C-arm positioning time.The purpose of this study was therefore to evaluate the value of artificial X-rays in enhancing C-arm positioning performance using inexperienced users.