Loop-X Intraoperative Imaging

Loop-X is a mobile intraoperative imaging robot — a robotic X-ray and CT-style scanner on wheels that moves around the patient to take pictures during surgery, feeding directly into navigation. Its distinctive feature is that the X-ray source and detector move independently, allowing flexible positioning, non-fixed imaging angles and very low radiation doses. As with all navigation and imaging tools, it is worth knowing Mr Madi's approach: he is, by training and preference, a freehand surgeon, placing screws by anatomical landmark and the direct feel of the pedicle because it adds no radiation and gives an intimate, real-time feel of the bone. He uses imaging and navigation like Loop-X selectively, for the cases that truly benefit, rather than as a routine.

• People undergoing navigated fusion, deformity or complex spinal surgery
• Situations where flexible imaging angles or low radiation dose are particularly valuable
• Its use is determined by the surgeon and the demands of the procedure

• When it is used, the robot positions itself around the operative area and captures either 2D images or a full 3D scan, with pre-programmed positions for a smooth workflow. Because the source and detector move independently, it images from flexible angles and builds a 3D picture efficiently, keeping the dose extra-low, and the images register directly with navigation for accurate placement. As with his overall approach, Mr Madi does not take a confirmation scan at the end of every case; one can be taken if a situation warrants it, but that is a selective decision made when needed, not a routine, so as not to add radiation without good reason.

• Ultra-low-dose, high-resolution 2D and 3D imaging during surgery
• Independent source and detector movement allows flexible positioning and imaging around obstacles
• Feeds directly into navigation for accurate, real-time guidance
• Robotic, pre-programmed positioning streamlines the workflow in theatre
• In-theatre confirmation of implant placement before closing

• Imaging involves a radiation dose, although the design is aimed at keeping this very low
• It is an imaging and guidance aid; the underlying surgery carries its own risks
• Availability is limited to centres equipped with the technology
• As with all navigation, careful set-up and registration are essential
• Imaging still involves a radiation dose, even though the design keeps it very low — which is exactly why no-radiation freehand technique is often preferred
• It is an imaging and guidance aid, held in reserve for cases that benefit; it does not replace experienced surgical technique

• O-arm navigation
• Intraoperative CT navigation
• Conventional fluoroscopy guidance
• Electromagnetic navigation

Loop-X does not change your recovery, which depends on the operation performed. By enabling accurate, low-dose imaging and navigation, its aim is safer, more precise surgery. Your surgeon will explain its role if it is used in your procedure.

• —Royal College of Radiologists — iRefer: Making the Best Use of Clinical Radiology
• —British Association of Spine Surgeons (BASS)
• —UK Health Security Agency — Ionising Radiation: Patient Dose Information

This information is for general patient education and is not a substitute for an individual consultation. Always seek personalised advice from a qualified spinal specialist.