Nama : FADLY RAHMAN RISFA

NIM : P27838121009
KELAS : 3C

1. Learning to Avoid Poor Images: Towards Task-

aware C-arm Cone-beam CT Trajectories
Metal artifacts in computed tomography (CT) arise from a mismatch between
physics of image formation and idealized assump- tions during tomographic
reconstruction. These artifacts are particularly strong around metal implants,
inhibiting widespread adoption of 3D cone-beam CT (CBCT) despite clear
opportunity for intra-operative ver- ification of implant positioning, e. g. in spinal
fusion surgery. On synthetic and real data, we demonstrate that much of the artifact
can be avoided by acquiring better data for reconstruction in a task-aware and
patient- specific manner, and describe the first step towards the envisioned task-
aware CBCT protocol. The traditional short-scan CBCT trajectory is planar, with
little room for scene-specific adjustment. We extend this trajectory by autonomously
adjusting out-of-plane angulation. This en- ables C-arm source trajectories that are
scene-specific in that they avoid acquiring ”poor images”, characterized by beam
hardening, photon star- vation, and noise. The recommendation of ideal out-of-plane
angulation is performed on-the-fly using a deep convolutional neural network that
regresses a detectability-rank derived from imaging physics.

2. Effect of Instrument Navigation on C-arm Radiation and Time during

Spinal Procedures: A Clinical Evaluation
As minimally invasive spine surgery gains popularity, a focused effort must be
made to reduce intraoperative radiation exposure to levels as low as reasonably
achievable. Here, we demonstrate the clinical efficacy of a novel technology to aid in
instrument navigation that aims to reduce intraoperative radiation exposure, number
of fluoroscopic images, and time required to perform the most radiation intensive
portions of a multitude of spinal procedures.
An internally randomized controlled study was performed over a 1-month period in
order to clinically evaluate the effect of the C-arm assisted instrument tracking system,
TrackX, on surgeon workflow, time, and radiation emitted. Three surgeons performed
multiple spinal procedures on a total of 10 study patients and an additional 3 control
patients. The surgeries encompassed minimally invasive spinal techniques and spanned
extreme lateral interbody fusion, oblique lumbar interbody fusion, transforaminal lumbar
interbody fusion along with percutaneous iliac screw placement, hardware removal, and
kyphoplasty. The tasks studied included skin marking, first dilator insertion,
localization forhardware placement and hardware removal.
Overall radiation reduction was 83% (P , .0001). Overall reduction in x-rays taken
¼
was 78% (P , .0001). Overall time reduction was 81% (P .0003). Statistical signifi
cance held for each surgeon studied and for nearly every procedure type. In these 10
study procedures, over 2 hours of overall operating room time was saved, all while
requiring negligible set up time and no system calibration or supplementary x-rays to be
taken. There were no adverse outcomes for any study patient, and there was no case
where TrackX was not able to successfully complete a given portion of a procedure.
TrackX instrument navigation is a clinically efficacious and accurate instrument tracking
modality. This is the first instrument navigational technology that reduces radiation
exposure and images required to complete a procedure while decreasing operative time.
TrackX thus allows increased surgical efficiency while increasing operative efficiency
and improving intraoperative safety.

3. Online calibration of a mobile C-arm using inertial sensors

A feasibility study in order to achieve CBCT
Cone beam computed tomography (CBCT) became in- creasingly popular over the
last years. In ≈fact, it allows more accurate diagno- sis and treatment planning with,
potentially, a lower effective radiation dose. However, volume reconstruction algorithms
require a very precise knowledge of the imaging geometry. Due to mechanical
instabilities which significantly alter the source and the detector from a regular
circular trajectory and lead to non-reproducible motions from run to run, mobile C-arms
are incompatible with existing tomography algorithms. Therefore, C-arm on-line
calibration is essential in order to achieve an accurate volume reconstruction. We
present an on-line calibration method for mobile C-arms. It is based on tracking the
detector and the X-ray source of the C-arm using three-axis gyroscopes and accelerometers.
It aims to be precise, non-invasive and suitable for every C-arm. The performance of
the calibration algorithm is evaluated in regard to the precision of the measurements and
to whether or not dynamic models of the C-arm are considered. In addition, we present an
algorithm which allows us to propagate the errors from the pose (position and orientation)
estimates to 2D projections on the detector plane. Thus, we can evaluate the impact of those
errors on the acquired image. The experiments are conducted on an experimental
platform. The reached accuracy is 0.3◦ for orientation and 3.2mm for position. These
errors propagates as an error of a few millimeters for the 2D projections on the
detector plane. The required angle accuracy by our CBCT algorithms is reached.
However, several improvement to dynamic model and to estimation method are needed
to achieve the position precision required by CBCT. Furthermore
4. CARM POSE ESTIMATION AND NAVIGATION INSURGERIES
FOR AUGMENTED REALITY APPLICATION

C-arm X-ray imaging systems are widely applied in surgeries. Overlaying X-ray with
optical images during the surgery has been shown to be an efficient approach. Moreover,
overlaying needed data from different modalities in an augmented reality (AR) manner can
improve the accuracy of surgical procedures, decrease the variability of surgical outcomes,
reduce trauma to the critical structures, increase the reproducibility of surgeons’
performance, and reduce radiation exposure. C-Arm geometric calibration and recovering the
C-arm pose are essential for surgical navigation and AR applications in operating rooms.
Therefore, in this paper, existing researches for calibration and pose estimation of C-arm
devices in surgical AR applications are evaluated from photogrammetric point of view. Then,
a proposed marker-based method for C-arm pose estimation is introduced. For this purpose, a
marker is designed to facilitate tracking and pose estimation in mixed reality based on golden
section principle, and perspective invariants such as cross-ratios, collinearity, and
intersection. Moreover, a procedure is also proposed for fast determination of these fiducial
markers. The experiments show benefits of such a structure which has a limited occlusion
with consistency to different conditions such as narrow field of view and at the same time,
even in images with high projectivity. It also results that the distortion correction step is
important and the effect of distortion of X-ray images can cause inconsistency in the
perspective invariants.

5. Scattering of X-rays in diagnostic radiology: Computed radiography,

digital radiography, mobile digital radiography and mobile C-arm
fluoroscopy
The medical use of X-ray-based imaging modalities has increased in the last decade.
During imaging scattered radiation is generated, and the staff can be exposed to it in various
situations, including when holding the patient or conducting an interventional operation. To
be able to minimize the exposure it is essential to have knowledge of the distribution of the
scattered radiation. In this study scattered radiation maps where implemented based on direct
measurements with dosimeters in various distances, angles and heights using an
anthropomorphic phantom as a scattering object. Measurements were done using multiple
imaging modalities and parameters. Maps were intended for educational purposes to be used
in the radiation protection training of the staff.
Thorax PA and LAT measurements in a standing position demonstrated that the scattered
radiation is directed strongly back from the phantom towards the X-ray tube. Scatter intensity
being stronger in the LAT imaging. On the other hand, pelvis AP measurements in a supine
position demonstrated that the radiation is directed relatively equally to all directions when
the horizontal plane perpendicular to the primary beam central axis is considered. The use of
the pelvic shield in Thorax measurements and the radiation protection blanket in Pelvis
measurements did not affect scattering with the applied measurement method. Also using
50kg weighing child’s imaging parameters did not have effect on the scattering as the same
phantom was used.
Measurements done using fluoroscopy with urological experiment parameters
demonstrated that the scattered radiation is directed relatively equally to all directions when
the horizontal plane perpendicular to the primary beam central axis is considered. However,
there is an emphasis on the scatter at the end of the patient table where the operating
physician would be positioned, and accordingly a decrease on the scatter at the opposite end.
The use of the lamella radiation protection curtain on the physician’s end of the operation
table decreased the measured dose rates of the dosimeter, that was placed lower than patient
table surface level and therefore was shielded by the curtain.
Bedside Thorax measurements with a mobile imaging system demonstrated that the scattered
radiation is directed relatively equally to all direction when the horizontal plane
perpendicular to the primary beam central axis is considered. Also, when these measurements
are compared to the previous stationary Thorax measurements, it is evident that scattered
radiation dose rates with the mobile system are lower.
As the used dosimeter system measures personal dose equivalent H p(10) rate, the
cumulative dose values calculated based on the exposure time can be used as an estimate of
the overall effective dose. Dose received by the healthcare professionals is small in Thorax
and Pelvis imaging in a possible holding situation when compared to the annual dose limit of
radiation workers. On the other hand, the estimated dose of the physician is clearly higher in
a fluoroscopy-guided urological operation. Yet the magnitude of the physician’s dose is on
the level that it is unlikely to exceed the annual dose limit. Lowest estimated effective doses
were gotten in the bedside Thorax examination, where the dose received by the personnel
correspond to 12 and 8 seconds of background radiation on 0.7- and 1-meter distances to the
scatter radiation origin, respectively.