X-GuideAR: An Augmented Reality Framework to Mitigate Radiation Exposure during Fluoroscopic Guidance

2026-07-12

AI Summary

This study addresses the excessive radiation exposure to both patients and surgical teams caused by frequent intraoperative fluoroscopic imaging during pedicle screw placement—a practice often referred to as “fluoro-hunting.” To mitigate this issue, the authors propose X-GuideAR, a novel navigation framework that integrates synthetic X-ray preview with augmented reality (AR)-based trajectory overlay. The synthetic X-ray component enables rapid identification of optimal imaging angles, while the AR module provides real-time visualization of the intended drilling path directly onto live fluoroscopic images. This work represents the first integration of synthetic X-ray generation with AR guidance in spinal surgery, significantly reducing radiation dose while enhancing screw placement safety. Preliminary experimental results demonstrate a 62.3% reduction in fluoroscopy usage and an increase in the average safe screw diameter from 5.9 mm to 12.95 mm.

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.

Problem

• radiation exposure
• fluoroscopic guidance
• screw placement
• orthopedic surgery
• X-ray

Innovation

• Augmented Reality
• Synthetic X-ray
• Radiation Reduction
• S2AI Screw Placement
• Fluoro-hunting Mitigation