Multi-mode C-arm fluoroscopy, tomosynthesis, and cone-beam CT for image-guided interventions: From proof of principle to patient protocols

J. H. Siewerdsen, M. J. Daly, G. Bachar, D. J. Moseley, G. Bootsma, K. K. Brock, S. Ansell, G. A. Wilson, S. Chhabra, D. A. Jaffray, J. C. Irish

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


High-performance intraoperative imaging is essential to an ever-expanding scope of therapeutic procedures ranging from tumor surgery to interventional radiology. The need for precise visualization of bony and soft-tissue structures with minimal obstruction to the therapy setup presents challenges and opportunities in the development of novel imaging technologies specifically for image-guided procedures. Over the past -5 years, a mobile C-arm has been modified in collaboration with Siemens Medical Solutions for 3D imaging. Based upon a Siemens PowerMobil, the device includes: a flat-panel detector (Varian PaxScan 4030CB); a motorized orbit; a system for geometric calibration; integration with real-time tracking and navigation (NDI Polaris); and a computer control system for multi-mode fluoroscopy, tomosynthesis, and cone-beam CT. Investigation of 3D imaging performance (noise-equivalent quanta), image quality (human observer studies), and image artifacts (scatter, truncation, and cone-beam artifacts) has driven the development of imaging techniques appropriate to a host of image-guided interventions. Multi-mode functionality presents a valuable spectrum of acquisition techniques: i.) fluoroscopy for real-time 2D guidance; ii.) limited-angle tomosynthesis for fast 3D imaging (e.g., -10 sec acquisition of coronal slices containing the surgical target); and iii.) fully 3D cone-beam CT (e.g., -30-60 sec acquisition providing bony and soft-tissue visualization across the field of view). Phantom and cadaver studies clearly indicate the potential for improved surgical performance - up to a factor of 2 increase in challenging surgical target excisions. The C-arm system is currently being deployed in patient protocols ranging from brachytherapy to chest, breast, spine, and head and neck surgery.

Original languageEnglish (US)
Title of host publicationMedical Imaging 2007
Subtitle of host publicationPhysics of Medical Imaging
EditionPART 1
StatePublished - 2007
Externally publishedYes
EventMedical Imaging 2007: Physics of Medical Imaging - San Diego, CA, United States
Duration: Feb 18 2007Feb 22 2007

Publication series

NameProgress in Biomedical Optics and Imaging - Proceedings of SPIE
NumberPART 1
ISSN (Print)1605-7422


OtherMedical Imaging 2007: Physics of Medical Imaging
CountryUnited States
CitySan Diego, CA


  • 3D imaging
  • Brachytherapy
  • Cone-beam CT
  • Flat-panel detector
  • Fluoroscopy
  • Head and neck surgery
  • Image-guided surgery
  • Imaging performance
  • Navigation
  • Orthopedic surgery
  • Radiation dose
  • Tomosynthesis

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Biomaterials
  • Atomic and Molecular Physics, and Optics
  • Radiology Nuclear Medicine and imaging

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