Virtual fluoroscopy for interventional guidance using magnetic tracking.

Purpose: In conventional fluoroscopy-guided interventions, the 2D projective nature of X-ray imaging limits depth perception and leads to prolonged radiation exposure. Virtual fluoroscopy, combined with spatially tracked surgical instruments, is a promising strategy to mitigate these limitations. While magnetic tracking shows unique advantages, particularly in tracking flexible instruments, it remains under-explored due to interference from ferromagnetic materials in the C-arm room. This work proposes a virtual fluoroscopy workflow by effectively integrating magnetic tracking and demonstrates its clinical efficacy METHODS: An automatic virtual fluoroscopy workflow was developed using a radiolucent tabletop field generator prototype. Specifically, we developed a fluoro-CT registration approach with automatic 2D-3D shared landmark correspondence to establish the C-arm-patient relationship, along with a general C-arm modelling approach to calculate desired poses and generate corresponding virtual fluoroscopic images.

Results: Testing on a dataset with views ranging from RAO  ${90}^{\circ }$ to LAO  ${90}^{\circ }$ , simulated fluoroscopic images showed visually imperceptible differences from the real ones, achieving a mean target projection distance error of 1.55 mm. An "endoleak" phantom insertion experiment highlighted the effectiveness of simulating multiplanar views with real-time instrument overlays, achieving a mean needle tip error of 3.42 mm.

Conclusions: Results demonstrated the efficacy of virtual fluoroscopy integrated with magnetic tracking, improving depth perception during navigation. The broad capture range of virtual fluoroscopy showed promise in improving the users' understanding of X-ray imaging principles, facilitating more efficient image acquisition.