Development and evaluation of an open-source virtual reality C-Arm simulator

C-Arm positioning for interventional spine procedures is often associated with a steep learning curve. This task requires mentally reconstructing 3D surgical tools and patient anatomy from a 2D X-ray image, which is non-trivial and acquired through years of experience. Standard training via apprenticeship-based programs must be limited due to the unnecessary exposure to ionizing radiation. To this end, we propose a Virtual Reality C-Arm simulator for interventional spine procedure training. We implemented the simulator as an open-source module in Slicer, and evaluated its efficacy through a user study, recruiting medical residents and expert clinicians. Users showed an overall significant improvement in C-Arm placement with regards to angular accuracy (mean ~2 degree improvement), and total procedure time (mean 11 minutes less time). The face and content validity was evaluated positively through a Likert scale questionnaire, with a mean score of 4 (out of 5) or higher for each of the questions. The results show the simulator provides effective training for C-Arm positioning, while eliminating the exposure to ionizing radiation associated with the current training standard. Although this work is catered towards spinal procedures, the system is extendable to other fields, such as cardiac and orthopaedic, and will be explored in future works.

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