Intraoperative imaging for patient safety and QA: Detection of intracranial hemorrhage using C-arm cone-beam CT

Sebastian Schafer, Adam Wang, Yoshito Otake, J. Webster Stayman, Wojciech Zbijewski, Gerhard Kleinszig, Xuewei Xia, Gary L. Gallia, Jeffrey H. Siewerdsen

Research output: Chapter in Book/Report/Conference proceedingConference contribution


Intraoperative imaging could improve patient safety and quality assurance (QA) via the detection of subtle complications that might otherwise only be found hours after surgery. Such capability could therefore reduce morbidity and the need for additional intervention. Among the severe adverse events that could be more quickly detected by high-quality intraoperative imaging is acute intracranial hemorrhage (ICH), conventionally assessed using post-operative CT. A mobile C-arm capable of high-quality cone-beam CT (CBCT) in combination with advanced image reconstruction techniques is reported as a means of detecting ICH in the operating room. The system employs an isocentric C-arm with a flat-panel detector in dual gain mode, correction of x-ray scatter and beam-hardening, and a penalized likelihood (PL) iterative reconstruction method. Performance in ICH detection was investigated using a quantitative phantom focusing on (non-contrast-enhanced) blood-brain contrast, an anthropomorphic head phantom, and a porcine model with injection of fresh blood bolus. The visibility of ICH was characterized in terms of contrast-to-noise ratio (CNR) and qualitative evaluation of images by a neurosurgeon. Across a range of size and contrast of the ICH as well as radiation dose from the CBCT scan, the CNR was found to increase from ∼2.2-3.7 for conventional filtered backprojection (FBP) to ∼3.9-5.4 for PL at equivalent spatial resolution. The porcine model demonstrated superior ICH detectability for PL. The results support the role of high-quality mobile C-arm CBCT employing advanced reconstruction algorithms for detecting subtle complications in the operating room at lower radiation dose and lower cost than intraoperative CT scanners and/or fixed-room C-arms. Such capability could present a potentially valuable aid to patient safety and QA.

Original languageEnglish (US)
Title of host publicationMedical Imaging 2013
Subtitle of host publicationImage-Guided Procedures, Robotic Interventions, and Modeling
StatePublished - Jun 10 2013
EventMedical Imaging 2013: Image-Guided Procedures, Robotic Interventions, and Modeling - Lake Buena Vista, FL, United States
Duration: Feb 12 2013Feb 14 2013

Publication series

NameProceedings of SPIE - The International Society for Optical Engineering
ISSN (Print)0277-786X


OtherMedical Imaging 2013: Image-Guided Procedures, Robotic Interventions, and Modeling
Country/TerritoryUnited States
CityLake Buena Vista, FL


  • Cone-beam CT
  • Intracranial hemorrhage
  • Intraoperative imaging
  • Iterative image reconstruction
  • Mobile C-arm
  • Patient safety
  • Quality assurance

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Condensed Matter Physics
  • Computer Science Applications
  • Applied Mathematics
  • Electrical and Electronic Engineering


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