Localization of endovascular tools in X-ray images using a motorized C-arm: visualization on HoloLens

Abstract C-arms are medical devices widely used for image-guided minimally invasive endovascular procedures. This technology requires considerable experience for the physicians to position the C-arm to obtain X-ray images of the endovascular tools. In addition, this image-guided therapy is based on two-dimensional images which lack depth information. The purpose of this study was to develop a system that controls the C-arm movements based on the previous position of the tip of a guide wire and the vessel information, and also displays the estimated tip position (specifically, the virtual line that would join the X-ray source and the projected tip in the flat-panel detector) on an augmented reality device (HoloLens). A phantom study was conducted to evaluate the system using intraoperative cone-beam computed tomography scans to obtain the reference tip position. The mean distance between the tip position (ground truth) and the virtual three-dimensional line was 1.18 mm. The proposed system was able to control the C-arm movements based on the position of the tip of the guide wire. The visualization on HoloLens also allowed a more intuitive understanding of the position of the endovascular tool related to the patient’s anatomy during the intervention.