[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-86067-en":3,"doc-seo-86067-105":29,"detail-sidebar-cat-0-en-105":90},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":4,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":13,"seo_description":14,"update_tm":27,"read_time":28},86067,687197207057,"Sage","https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0",7,"Healthcare","X GuideAR Augmented Reality Framework to Mitigate Radiation Exposure During Fluoroscopic Guidance","Achieving optimal screw placement in orthopedic surgery requires frequent alignment checks and multiple anatomical views under X-ray, a workflow known as “fluoro-hunting” that increases ionizing radiation for both patients and surgical teams. X-GuideAR introduces an augmented reality framework to identify optimal fluoroscopic views, using synthetic X-ray previews to speed view acquisition and then augment a drilling trajectory onto the acquired real X-ray. In a preliminary study of eight S2AI trajectories, X-GuideAR reduced X-ray counts by 62.3% and increased average safe screw diameter to 12.95 mm versus 5.9 mm under conventional workflow, indicating improved bony containment.","X-GUIDEAR: AN AUGMENTED REALITY FRAMEWORK TO MITIGATE RADIATION EXPOSURE DURING FLUOROSCOPIC GUIDANCE . A USE CASE IN S2AI SCREW PLACEMENT.  \nA PREPRINT  \nMingxu Liu*  \nDepartment of Computer Science Johns Hopkins University Baltimore, MD, 21211, USA  \nZixuan Liu  \nDepartment of Computer Science Johns Hopkins University Baltimore, MD, USA  \nRuchen Cai  \nDepartment of Computer Science Johns Hopkins University Baltimore, MD, USA  \narXiv :2607 . 10873v1 [ cs .CV] 12 Jul 2026  \nYu-Chun Ku  \nDepartment of Computer Science Johns Hopkins University Baltimore, MD, USA  \nSuxi Gu  \nDepartment of Orthopaedic Surgery Johns Hopkins University Baltimore, MD, USA  \nAmit Jain  \nDepartment of Orthopaedic Surgery Johns Hopkins School of Medicine Baltimore, MD, USA  \nAlejandro Martin-Gomez†  \nDepartment of Electrical Engineering and Computer Science University of Arkansas Fayetteville, AR, USA  \nMehran Armand‡  \nDepartment of Mechanical Engineering University of Arkansas Fayetteville, AR, USA  \nJuly 14, 2026  \nABSTRACT  \nAchieving optimal screw placement for orthopedic surgeries requires frequent alignment checksand multiple anatomical views under X-ray—a process known as “fluoro-hunting” that increases radiation exposure to patients and surgical teams. This work introduces X-GuideAR, an augmented reality (AR) framework for identifying optimal X-ray views, aimed at reducing radiation exposure while ensuring accurate screw placement. To exemplify the benefits of X-GuideAR, we focus on S2 alar-iliac (S2AI) screw placement. Our system provides radiation-free guidance for view acquisition and drilling by generating synthetic X-ray previews that accelerate fluoro-hunting. Once the required anatomical views are identified using these previews, a real X-ray is acquired, and the preview of the drilling trajectory is augmented onto it, facilitating precise screw placement with minimal additional radiation. A preliminary study involving eight S2AI trajectories performed by an expertspine surgeon demonstrated a 62.3% reduction in the number of X-rays. Post-procedure evaluations showed that trajectories done with X-GuideAR supported an average safe screw diameter of 12.95 mm compared to 5.9 mm under the conventional workflow, suggesting improved bony containment and potential biomechanical benefit. X-GuideAR shows great potential to reduce radiation exposure and streamline S2AI screw placement, offering a promising direction toward safer and more efficient surgeries.  \nKeywords Medical system · virtual reality and interfaces · computer vision for medical robotics  \n∗ [Corresponding author: mliu90@jh.edu. This work is partially supported by NIH grants R01EB023939](Corresponding author: mliu90@jh.edu. This work is partially supported by NIH grants R01EB023939) and R01AR080315 .  \n†Joint senior author. Member, IEEE. Department of Electrical Engineering and Computer Science, University of Arkansas, Fayetteville, AR, USA, and Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA.  \n‡Joint senior author. Senior Member, IEEE. Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, USA, and Departments of Orthopaedic Surgery and Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA.  \n1 Introduction  \nSince 1970s, X-rays have been instrumental in orthopedic surgeries to provide visual reference for screw placement with minimizing the invasion, enhancing placement accuracy and reducing complications [1] . X-ray devices are among the most proficient and accessible tools for intra-operative guidance of orthopedic surgeries [1, 2] . Despite its clinical proficiency and accessibility, X-rays are two-dimensional images, superimpose anatomical structures, which can obscure tool positioning relative to critical anatomy and necessitate scans from multiple angles for clarity [1] . To obtain the necessary detail, surgeons engage in a process known as fluoro-hunting, adjusting the X-ray device to acquire specific an","cbCaiu8LPyQOjCsg","https://ap.wps.com/l/cbCaiu8LPyQOjCsg","pdf",8045619,1,14,"English","en",105,"# Introduction\n## Fluoro-hunting and radiation concerns\n## Clinical context: S2AI screw placement\n## Key anatomical X-ray views","[{\"question\":\"What problem does X-GuideAR address in orthopedic screw placement?\",\"answer\":\"X-GuideAR targets the high radiation burden caused by “fluoro-hunting,” where surgeons adjust the C-arm and acquire multiple X-ray views to confirm alignment for accurate screw placement.\"},{\"question\":\"How does X-GuideAR reduce the number of X-rays?\",\"answer\":\"The system generates radiation-free synthetic X-ray previews to rapidly identify the required anatomical views. After the views are identified, a real X-ray is acquired and the drilling trajectory is augmented onto it for precise placement.\"},{\"question\":\"What results were observed in the preliminary S2AI study?\",\"answer\":\"For eight S2AI trajectories performed by an expert spine surgeon, X-GuideAR achieved a 62.3% reduction in the number of X-rays. Post-procedure evaluation also showed a larger average safe screw diameter (12.95 mm) compared with the conventional workflow (5.9 mm).\"}]",1784208255,35,{"code":4,"msg":30,"data":31},"ok",{"site_id":24,"language":23,"slug":32,"title":13,"keywords":33,"description":14,"schema_data":34,"social_meta":85,"head_meta":87,"extra_data":89,"updated_unix":27},"x-guidear-augmented-reality-framework-to-mitigate-radiation-exposure-during-fluoroscopic-guidance","",{"@graph":35,"@context":84},[36,53,67],{"@type":37,"itemListElement":38},"BreadcrumbList",[39,43,47,50],{"item":40,"name":41,"@type":42,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":44,"name":45,"@type":42,"position":46},"https://docshare.wps.com/document/","Document",2,{"item":48,"name":12,"@type":42,"position":49},"https://docshare.wps.com/document/healthcare/",3,{"item":51,"name":13,"@type":42,"position":52},"https://docshare.wps.com/document/x-guidear-augmented-reality-framework-to-mitigate-radiation-exposure-during-fluoroscopic-guidance/86067/",4,{"url":51,"name":13,"@type":54,"author":55,"headline":13,"publisher":57,"fileFormat":60,"inLanguage":23,"description":14,"dateModified":61,"datePublished":61,"encodingFormat":60,"isAccessibleForFree":62,"interactionStatistic":63},"DigitalDocument",{"name":9,"@type":56},"Person",{"url":40,"name":58,"@type":59},"DocShare","Organization","application/pdf","2026-07-16",true,{"@type":64,"interactionType":65,"userInteractionCount":4},"InteractionCounter",{"@type":66},"ViewAction",{"@type":68,"mainEntity":69},"FAQPage",[70,76,80],{"name":71,"@type":72,"acceptedAnswer":73},"What problem does X-GuideAR address in orthopedic screw placement?","Question",{"text":74,"@type":75},"X-GuideAR targets the high radiation burden caused by “fluoro-hunting,” where surgeons adjust the C-arm and acquire multiple X-ray views to confirm alignment for accurate screw placement.","Answer",{"name":77,"@type":72,"acceptedAnswer":78},"How does X-GuideAR reduce the number of X-rays?",{"text":79,"@type":75},"The system generates radiation-free synthetic X-ray previews to rapidly identify the required anatomical views. After the views are identified, a real X-ray is acquired and the drilling trajectory is augmented onto it for precise placement.",{"name":81,"@type":72,"acceptedAnswer":82},"What results were observed in the preliminary S2AI study?",{"text":83,"@type":75},"For eight S2AI trajectories performed by an expert spine surgeon, X-GuideAR achieved a 62.3% reduction in the number of X-rays. Post-procedure evaluation also showed a larger average safe screw diameter (12.95 mm) compared with the conventional workflow (5.9 mm).","https://schema.org",{"og:url":51,"og:type":86,"og:title":13,"og:site_name":58,"og:description":14},"article",{"robots":88,"canonical":51},"index,follow",{"doc_id":7,"site_id":24},{"code":4,"msg":5,"data":91},[92,96,100,104,109,114,117,122,127,130,134],{"id":20,"doc_module":4,"doc_module_name":45,"category_name":93,"show_sort_weight":94,"slug":95},"Story & Novel",90,"story-novel",{"id":46,"doc_module":4,"doc_module_name":45,"category_name":97,"show_sort_weight":98,"slug":99},"Literature",80,"literature",{"id":52,"doc_module":4,"doc_module_name":45,"category_name":101,"show_sort_weight":102,"slug":103},"Exam",70,"exam",{"id":105,"doc_module":4,"doc_module_name":45,"category_name":106,"show_sort_weight":107,"slug":108},5,"Comic",60,"comic",{"id":110,"doc_module":4,"doc_module_name":45,"category_name":111,"show_sort_weight":112,"slug":113},6,"Technology",50,"technology",{"id":11,"doc_module":4,"doc_module_name":45,"category_name":12,"show_sort_weight":115,"slug":116},40,"healthcare",{"id":118,"doc_module":4,"doc_module_name":45,"category_name":119,"show_sort_weight":120,"slug":121},8,"Research & Report",30,"research-report",{"id":123,"doc_module":4,"doc_module_name":45,"category_name":124,"show_sort_weight":125,"slug":126},9,"Religion & Spirituality",20,"religion-spirituality",{"id":125,"doc_module":4,"doc_module_name":45,"category_name":128,"show_sort_weight":125,"slug":129},"World Cup","world-cup",{"id":131,"doc_module":4,"doc_module_name":45,"category_name":132,"show_sort_weight":131,"slug":133},10,"Lifestyle","lifestyle",{"id":135,"doc_module":4,"doc_module_name":45,"category_name":136,"show_sort_weight":105,"slug":137},19,"General","general"]