Intraoperative Imaging and Guidance Technologies in Surgical Interventions: Current Status and Future Perspectives

Abstract

Purpose: To systematize current intraoperative imaging and guidance technologies for surgical interventions with emphasis on physical and technical principles, quantitative performance characteristics, quality assurance, and the role of medical physicists. The review covers direct image-guided procedures, intraoperative CT, MRI and cone-beam CT, surgical navigation, spatial image registration, extended reality, and robotic assistance. The analysis shows that the clinical value of these technologies depends not only on image acquisition, but also on geometric calibration accuracy, registration error, tracking stability, radiation dose in X-ray-based methods, data reproducibility, and integration into the operating-room workflow. Comparative tables, a classification scheme, and a dedicated quality assurance section are presented. Clinical applications include neurosurgery, spine surgery, orthopedics, interventional radiology, thoracic and abdominal surgery. The review concludes that medical physicists should be more actively involved in technology implementation, acceptance testing, periodic quality as surance, and uncertainty assessment in image-guided surgery.