X-GuideAR: An Augmented Reality Framework to Mitigate Radiation Exposure during Fluoroscopic Guidance
2026-07-12 • Computer Vision and Pattern Recognition
Computer Vision and Pattern RecognitionRobotics
AI summaryⓘ
The authors developed X-GuideAR, an augmented reality system to help surgeons find the best X-ray views and guide screw placement during spine surgery with less radiation. Instead of many X-rays, their system creates virtual X-ray previews for positioning and drilling, reducing real X-rays needed. In tests, an expert used this system to cut radiation exposure by over 60% and placed screws more safely compared to traditional methods. This shows the system could make these surgeries both safer and faster.
augmented realityX-ray imagingS2 alar-iliac screwfluoro-huntingorthopedic surgeryradiation exposurescrew placementsynthetic X-rayspine surgerybiomechanical containment
Authors
Mingxu Liu, Zixuan Liu, Ruchen Cai, Yu-Chen Ku, Suxi Gu, Amit Jain, Alejandro Martin-Gomez, Mehran Armand
Abstract
Achieving optimal screw placement for orthopedic surgeries requires frequent alignment checks and multiple anatomical views under X-ray -- a process known as "fluoro-hunting" that increases radiation exposure to patients and surgical teams. This work introduces X-GuideAR, an augmented reality (AR) framework for identifying optimal X-ray views, aimed at reducing radiation exposure while ensuring accurate screw placement. To exemplify the benefits of X-GuideAR, we focus on S2 alar-iliac (S2AI) screw placement. Our system provides radiation-free guidance for view acquisition and drilling by generating synthetic X-ray previews that accelerate fluoro-hunting. Once the required anatomical views are identified using these previews, a real X-ray is acquired, and the preview of the drilling trajectory is augmented onto it, facilitating precise screw placement with minimal additional radiation. A preliminary study involving eight S2AI trajectories performed by an expert spine surgeon demonstrated a 62.3% reduction in the number of X-rays. Post-procedure evaluations showed that trajectories done with X-GuideAR supported an average safe screw diameter of 12.95 mm compared to 5.9 mm under the conventional workflow, suggesting improved bony containment and potential biomechanical benefit. X-GuideAR shows great potential to reduce radiation exposure and streamline S2AI screw placement, offering a promising direction toward safer and more efficient surgeries.