Universal non-circular cone beam CT orbits for metal artifact reduction imaging during image-guided procedures.

Innovation in image-guided procedures has been driven by advances in robotic Cone Beam Computed Tomography (CBCT) systems. A fundamental challenge for CBCT imaging is metal artifacts arising from surgical tools and implanted hardware. Here, we outline how two universal non-circular imaging orbits, optimized for metal artifact reduction, can be implemented in real-time on clinical robotic CBCT systems. Demonstrating potential clinical utility, the universal orbits were implemented during a pedicle screw cervical spine fixation and hip arthroplasty performed on a porcine and ovine cadaver respectively. In both procedures, the universal non-circular orbits noticeably reduced the metal artifacts surrounding the implanted orthopedic hardware, revealing anatomy and soft tissue obscured in current conventional CBCT imaging. This work represents a key step in clinically translating universal orbits, unlocking high quality in-room procedural verification to increase broader use of robotic CBCT systems and reduce the occurrence of secondary corrective surgeries.