Effect of Calibration Error on Bone Tracking Accuracy With Fluoroscopy

Model-based 3D-fluoroscopy can quantify joint kinematics with 1 mm and 1 deg accuracy level. A calibration based on the acquisition of devices of known geometry is usually applied to size the system. This study aimed at quantifying the sensitivity of the fluoroscopic pose estimation accuracy specifically to errors in the calibration process, excluding other sources of error. X-ray focus calibration error was quantified for different calibration setups, and its propagation to the pose estimation was characterized in-silico. Focus reference position influenced the calibration error dispersion, while calibration cage pose affected its bias. In the worst-case scenario, the estimation error of the principal point and of the focus distance was lower than 1 mm and 2 mm, respectively. The consequent estimation of joint angles was scarcely influenced by calibration errors. A linear trend was highlighted for joint translations, with a sensitivity proportional to the distance between the model and the image plane, resulting in a submillimeter error for realistic calibration errors. The biased component of the error is compensated when computing relative joint kinematics between two segments.