B. Diotte, P. Fallavollita, L. Wang, S. Weidert, P. Thaller, E. Euler, N. Navab Radiation-free drill guidance in interlocking of intramedullary nails Proceedings of the 15th International Conference on Medical Image Computing and Computer Assisted Interventions (MICCAI), Nice, France, October 2012 (bib)
	Intramedullary nailing is a technically demanding procedure which involves an excessive amount of X-ray acquisitions; one study lists as many as 48 to successfully complete the procedure. In this work, a novel low cost radiation-free drilling guide is designed to assist surgeons in completing the distal locking procedure without any X-ray acquisitions. Using an augmented reality fluoroscope that coregisters optical and X-ray images, we exploit solely the optical images to detect the drilling guide in order to estimate the tip position in real-time in X-ray. We tested over 200 random drill guide poses showing a mean tip-estimation error of 1.72 +/- 0.7 mm which is significantly robust and accurate for the interlocking. In a preclinical study on dry bone phantom, three expert surgeons successfully completed the interlocking 56 out of 60 trials with no X-ray acquisition for guidance and an average time of 2 min.
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