# X-GuideAR: An Augmented Reality Framework to Mitigate Radiation Exposure during Fluoroscopic Guidance

arXiv: https://arxiv.org/abs/2607.10873 · HTML: https://mlsanity.com/paper/2607.10873/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 6 of its 58 references that are in the map.
- First posted on arXiv 12 Jul 2026.

## Builds on (most cited first, 6 of 6)

- [Surgical Data Science: Enabling Next-Generation Surgery](https://mlsanity.com/paper/1701.06482/) (2017)
- [DeepDRR -- A Catalyst for Machine Learning in Fluoroscopy-guided Procedures](https://mlsanity.com/paper/1803.08606/) (2018)
- [STTAR: Surgical Tool Tracking using off-the-shelf Augmented Reality Head-Mounted Displays](https://mlsanity.com/paper/2208.08880/) (2022)
- [Pose Estimation of Periacetabular Osteotomy Fragments with Intraoperative X-Ray Navigation](https://mlsanity.com/paper/1903.09339/) (2019)
- [StraightTrack: Towards Mixed Reality Navigation System for Percutaneous K-wire Insertion](https://mlsanity.com/paper/2410.01143/) (2024)
- [Augmented Reality-based Feedback for Technician-in-the-loop C-arm Repositioning](https://mlsanity.com/paper/1806.08814/) (2018)

## Abstract (arXiv)

Achieving optimal screw placement for orthopedic surgeries requires frequent alignment checks and 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 expert spine 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.