A C-arm fluoroscopy-guided progressive cut refinement strategy using a surgical robot.

We describe a new method to cut a precise, high-quality femoral cavity in Revision Total Hip Replacement surgery (RTHR) using a surgical robot and an intra-operative C-arm fluoroscope. With respect to previous approaches, our method contains several new features. (1) We describe a novel checkerboard plate designed to correct the geometric distortion within fluoroscopic images. Unlike previous distortion correction devices, the plate does not completely obscure any part of the image, and the distortion correction algorithm works well even when there are some overlaid objects in the field of view. (2) Also included are a novel corkscrew fiducial object designed to be integrated with the robot end-effector, and a 6D pose estimation algorithm based on the two-dimensional (2D) projection of the corkscrew, used in robot-imager registration and imager co-registration. (3) In addition, we develop a cavity location algorithm, which utilizes image subtraction and 2D anatomy contour registration techniques. (4) Finally, we propose a progressive cut refinement strategy, which progressively improves the robot registration during the procedure. We have conducted several experiments, in both simulated and in vitro environments. The results indicate that our strategy is a promising method for precise orthopedic procedures like total hip replacement.