First Animal Cadaver Study for Interlocking of Intramedullary Nails under Camera Augmented Mobile C-arm A Surgical Workflow Based Preclinical Evaluation

The Camera Augmented Mobile C-arm (CamC) system that augments a regular mobile C-arm by a video camera provides an overlay image of X-ray and video. This technology is expected to reduce radiation exposure during surgery without introducing major changes to the standard surgical workflow. Whereas many experiments were conducted to evaluate the technical characteristics of the CamC system, its clinical performance has not been investigated in detail. In this work, a workflow based method is proposed and applied to evaluate the clinical impact of the CamC system by comparing its performance with a conventional system, i.e. standard mobile C-arm. Interlocking of intramedullary nails on animal cadaver is chosen as a simulated clinical model for the evaluation study. Analyzing single workflow steps not only reveals individual strengths and weaknesses related to each step, but also allows surgeons and developers to be involved intuitively to evaluate and have an insight into the clinical impact of the system. The results from a total of 20 pair cases, i.e. 40 procedures, performed by 5 surgeons show that it takes significantly less radiation exposure whereas operation time for the whole interlocking procedure and quality of the drilling result are similar, using the CamC system compared to using the standard mobile C-arm. Moreover, the workflow based evaluation reveals in which surgical steps the CamC system has its main impact.