  Interventional C-arm imaging is crucial to percutaneous orthopedic procedures
as it enables the surgeon to monitor the progress of surgery on the anatomy
level. Minimally invasive interventions require repeated acquisition of X-ray
images from different anatomical views to verify tool placement. Achieving and
reproducing these views often comes at the cost of increased surgical time and
radiation dose to both patient and staff. This work proposes a marker-free
"technician-in-the-loop" Augmented Reality (AR) solution for C-arm
repositioning. The X-ray technician operating the C-arm interventionally is
equipped with a head-mounted display capable of recording desired C-arm poses
in 3D via an integrated infrared sensor. For C-arm repositioning to a
particular target view, the recorded C-arm pose is restored as a virtual object
and visualized in an AR environment, serving as a perceptual reference for the
technician. We conduct experiments in a setting simulating orthopedic trauma
surgery. Our proof-of-principle findings indicate that the proposed system can
decrease the 2.76 X-ray images required per desired view down to zero,
suggesting substantial reductions of radiation dose during C-arm repositioning.
The proposed AR solution is a first step towards facilitating communication
between the surgeon and the surgical staff, improving the quality of surgical
image acquisition, and enabling context-aware guidance for surgery rooms of the
future. The concept of technician-in-the-loop design will become relevant to
various interventions considering the expected advancements of sensing and
wearable computing in the near future.
