# 3D Path Planning for Robot-assisted Vertebroplasty from Arbitrary Bi-plane X-ray via Differentiable Rendering

arXiv: https://arxiv.org/abs/2512.05803 · HTML: https://mlsanity.com/paper/2512.05803/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 12 of its 52 references that are in the map.
- First posted on arXiv 5 Dec 2025.

## Builds on (most cited first, 12 of 12)

- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [MMDetection: Open MMLab Detection Toolbox and Benchmark](https://mlsanity.com/paper/1906.07155/) (2019)
- [TotalSegmentator: robust segmentation of 104 anatomical structures in CT images](https://mlsanity.com/paper/2208.05868/) (2022)
- [gsplat: An Open-Source Library for Gaussian Splatting](https://mlsanity.com/paper/2409.06765/) (2024)
- [VerSe: A Vertebrae Labelling and Segmentation Benchmark for Multi-detector CT Images](https://mlsanity.com/paper/2001.09193/) (2020)
- [X2CT-GAN: Reconstructing CT from Biplanar X-Rays with Generative Adversarial Networks](https://mlsanity.com/paper/1905.06902/) (2019)
- [DeepDRR -- A Catalyst for Machine Learning in Fluoroscopy-guided Procedures](https://mlsanity.com/paper/1803.08606/) (2018)
- [CTSpine1K: A Large-Scale Dataset for Spinal Vertebrae Segmentation in Computed Tomography](https://mlsanity.com/paper/2105.14711/) (2021)
- [Intraoperative 2D/3D Image Registration via Differentiable X-ray Rendering](https://mlsanity.com/paper/2312.06358/) (2023)
- [Perspective Projection-Based 3D CT Reconstruction from Biplanar X-rays](https://mlsanity.com/paper/2303.05297/) (2023)
- [Pelphix: Surgical Phase Recognition from X-ray Images in Percutaneous Pelvic Fixation](https://mlsanity.com/paper/2304.09285/) (2023)
- [Domain adaptation strategies for 3D reconstruction of the lumbar spine using real fluoroscopy data](https://mlsanity.com/paper/2401.16027/) (2024)

## Abstract (arXiv)

Robotic systems are transforming image-guided interventions by enhancing accuracy and minimizing radiation exposure. A significant challenge in robotic assistance lies in surgical path planning, which often relies on the registration of intraoperative 2D images with preoperative 3D CT scans. This requirement can be burdensome and costly, particularly in procedures like vertebroplasty, where preoperative CT scans are not routinely performed. To address this issue, we introduce a differentiable rendering-based framework for 3D transpedicular path planning utilizing bi-planar 2D X-rays. Our method integrates differentiable rendering with a vertebral atlas generated through a Statistical Shape Model (SSM) and employs a learned similarity loss to refine the SSM shape and pose dynamically, independent of fixed imaging geometries. We evaluated our framework in two stages: first, through vertebral reconstruction from orthogonal X-rays for benchmarking, and second, via clinician-in-the-loop path planning using arbitrary-view X-rays. Our results indicate that our method outperformed a normalized cross-correlation baseline in reconstruction metrics (DICE: 0.75 vs. 0.65) and achieved comparable performance to the state-of-the-art model ReVerteR (DICE: 0.77), while maintaining generalization to arbitrary views. Success rates for bipedicular planning reached 82% with synthetic data and 75% with cadaver data, exceeding the 66% and 31% rates of a 2D-to-3D baseline, respectively. In conclusion, our framework facilitates versatile, CT-free 3D path planning for robot-assisted vertebroplasty, effectively accommodating real-world imaging diversity without the need for preoperative CT scans.