Abstract:
A system and method are provided for performing fluoroscopic procedures with assistance of guiding laser beam projections to reduce a reliance on harmful radiation emitting fluoroscopic imaging devices during the procedure. The system and method reduce an amount of radiation exposure to patients and medical personnel during procedures that require assistive real-time imaging. Specifically, an automated laser guidance system and method of use is provided to reduce fluoroscopic radiation, reduce operation time, and increase operative accuracy.

Description:
CROSS-REFERENCE TO RELATED APPLICATION(S) 
       [0001]    This application claims priority to, and the benefit of, co-pending U.S. Provisional Application No. 62/358,759, filed Jul. 6, 2016, for all subject matter common to both applications. The disclosure of said provisional application is hereby incorporated by reference in its entirety. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates to a laser guidance system for use in intra-operative orthopedic surgery or fluoroscopy. In particular, the present invention relates to a system and corresponding method of use implementing a diode array configured to create an improved laser guidance system for use with a fluoroscopic medical imaging system to produce guiding laser beam projections on a patient to assist a surgeon in a real-time fluoroscopic imaging during procedures. 
       BACKGROUND 
       [0003]    Generally, fluoroscopy is considered indispensable during orthopedic surgery. However, there is increasing concern regarding occupational safety in the operating room (OR). Orthopedic surgeons are increasingly using X-ray based fluoroscopic techniques in the operation theatre or in the fluoroscopy room. Procedures such as kyphoplasty, vertebroplasty, deformity correction, pelvic fixation, intramedullary inter-locking nails and computerized tomography (CT) guided biopsies require radiation exposure. Vertebroplasty and kyphoplasty are similar medical spinal procedures. Such procedures rely on X-ray based fluoroscopic techniques to improve surgery success and efficiency. For example, these spinal procedures include methodologies in which bone cement is injected through a small hole in the skin percutaneously into a fractured vertebra with the goal of relieving back pain caused by vertebral compression fractures. In practice, using an X-ray, a surgeon inserts a dedicated guide wire to confirm position under image intensification multiple times before drilling and tapping. Utilization of such processes can inevitably introduce additional radiation doses to both surgeons and patients. 
         [0004]    The general philosophy followed by most healthcare facilities is to minimize radiation dosages and require all radiation exposures to be justified. In particular, industry practice is to keep exposure levels “as low as reasonably achievable” (ALARA). Even in following ALARA, there is increasing concern regarding occupational safety in the operating room (OR). In particular, during a course of a career, an orthopedic surgeon and their OR staff could be exposed to potentially dangerous cumulative levels of radiation. This long term exposure can cause substantial cytogenetic and chromosomal damage, potentially increasing cancer risk. Even relatively small doses of radiation should be considered dangerous over the long-term. Additionally, protective measures, including observance of safe working distance from the radiation source and the routine use of protective garments, have been established. 
       SUMMARY 
       [0005]    There is a need for improved methods and systems to reduce fluoroscopic radiation exposure to patients, reduce procedure time, and increase operative accuracy. The present invention is directed toward further solutions to address this need, in addition to having other desirable characteristics. Specifically, a medical imaging and guidance system is provided to produce guiding laser beam projections on a patient to assist a surgeon in a fluoroscopic imaging procedure in lieu of active imaging processes (e.g., X-ray). The guiding laser beam projections are generated by a fixed array of laser diodes and through their use, less radiation-based imaging is required during an operation, therefore reducing radiation exposure time and increasing operative accuracy over alternative non-fluoroscopic methodologies. In particular, the present invention provides a system and method for a laser guidance system to be used in connection with intra-operative fluoroscopic imaging, but in a manner that reduces activation periods of the imaging devices because laser diode generated guiding laser beam projections are used to facilitate positioning on the patient&#39;s body. 
         [0006]    In accordance with example embodiments of the present invention, a medical imaging and guidance system is provided. The system includes a fluoroscopic imaging system. The fluoroscopic imaging system includes a support gantry having a generally arc shape about an interior center focus point with a first terminal end and a second terminal end. The fluoroscopic imaging system also includes a first imaging assembly that is positioned on the support gantry and comprising a first imaging energy emitter that is positioned opposite a first imaging receptor, wherein one of the first imaging energy emitter or the first imaging receptor is positioned at the first terminal end of the support gantry. The fluoroscopic imaging system further includes a plurality of laser-diodes fixedly attached to at least one of the first imaging receptor or the second imaging receptor around half of a circumference of the first imaging receptor or the second imaging receptor, respectively, at intervals of no greater than 15 radial degrees of spacing between each laser-diode of the plurality of laser-diodes. The plurality of laser-diodes emits guiding laser beam projections onto a subject to provide guidance to medical personnel during a procedure without radiation energy being emitted by the first imaging assembly. 
         [0007]    In accordance with aspects of the present invention, the fluoroscopic imaging system further includes a second imaging assembly that is positioned on the support gantry and comprising a second imaging energy emitter positioned that is opposite a second imaging receptor, wherein one of the second imaging energy emitter or the second imaging receptor is positioned at the second terminal end of the support gantry and a control unit that directs movement and positioning of the support gantry. The s fluoroscopic imaging system can further include a processing and display device in communication with the first imaging assembly, the second imaging assembly, and the plurality of laser-diodes. The fluoroscopic imaging system obtains raw image data of a subject patient located proximate the interior center focus point between the first imaging assembly and the second imaging assembly and communicates the raw image data to the processing and display device. The processing and display device receives the raw image data and transforms the raw image data for display as a preview image and receives at least one plan line that is overlaid onto the preview image and electronically selects one or more of the plurality of laser-diodes to activate to project one or more guiding laser beam projections onto the subject patient at locations corresponding to the at least one plan line. The plurality of laser-diodes can be mechanically positioned with an angular coverage or linear translation around the fluoroscopic imaging system. The at least one plan line can be generated with any position and line direction through the preview image. The at least one plan line can provide input information and imaging geometry to determine power state of each of the plurality of laser-diodes. The first imaging assembly can be positioned and oriented to emit imaging energy in an LT plane and the second imaging assembly is positioned and oriented to emit imaging energy in an AP plane, perpendicular to the LT plane. The first imaging assembly can be positioned and oriented to emit imaging energy in an AP plane and the second imaging assembly is positioned and oriented to emit imaging energy in an LT plane, perpendicular to the AP plane. The first imaging receptor and the second imaging receptor can be one of an image intensifier, a flat panel detector, or a thin film transistor (TFT) flat-panel detector with a scintillation material layer configured to readout a voltage data value to the processing and display device. The TFT flat-panel detector can be configured to receive energy from visible photons that charge capacitors of pixel cells within the TFT flat-panel detector and charges from each of the pixel cells are readout as a voltage data value to the processing and display device. The first imaging energy emitter and the second imaging energy emitter can be X-ray sources configured to produce X-ray beams. 
         [0008]    In accordance with aspects of the present invention, the plurality of laser-diodes is mechanically aligned to produce guiding laser beam projections to pass through the interior center focus point of the support gantry. The plurality of laser-diodes further can include at least three laser-diodes uniformly spaced around the half of the circumference of the first imaging receptor or the second imaging receptor. An angle of convergence for each the plurality of laser-diodes can be provided to focus each of the plurality of laser-diodes to a center of a front input plane of an imaging receptor that the plurality of laser-diodes is attached thereto. Each of the plurality of laser-diodes can be independently operable according to a user specification. 
         [0009]    In accordance with example embodiments of the present invention, a method for utilization of a medical procedure guidance system is provided. The method includes activating an imaging device including a first imaging assembly and a second imaging assembly configured and arranged to receive a subject patient therebetween. The method also includes obtaining, by imaging receptors, a raw image data of the subject patient, communicating the raw image data to a processing and display device, and transforming the raw image data, by the processing and display device, into a preview image of the subject patient. The method further includes displaying the preview image on a display with at least one plan line, generated by the processing and display device, overlaid onto the preview image and instructing, by the processing and display device, one or more laser-diode of a plurality of laser-diodes in a laser-diode array to project one or more guiding laser beam projections onto the subject patient at locations corresponding to the at least one plan line, which is overlaid onto the preview image. 
         [0010]    In accordance with aspects of the present invention, the at least one plan line is generated in response to receiving user input to create the at least one plan line at a particular orientation and location on the preview image of the subject patient. 
         [0011]    In accordance with aspects of the present invention, the method further includes determining a positioning of the one or more laser-diode of the plurality of laser-diodes to generate the one or more guiding laser beam projections. The method can also include performing a fluoroscopic procedure relying on the one or more guiding laser beam projections. 
         [0012]    In accordance with aspects of the present invention, the imaging device further includes a first imaging energy emitter, which is positioned opposite a first imaging receptor. One of the first imaging energy emitter or the first imaging receptor is positioned at a first terminal end of a support gantry. The second imaging assembly is positioned on the support gantry, the second imaging assembly including a second imaging energy emitter positioned opposite a second imaging receptor. One of the second imaging energy emitter or the second imaging receptor is positioned at a second terminal end of the support gantry. The imaging device also includes a control unit that directs movement and positioning of the support gantry and the plurality of laser-diodes are fixedly attached to at least one of the first imaging receptor or the second imaging receptor around half of a circumference of the first imaging receptor or the second imaging receptor. 
     
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         [0013]    These and other characteristics of the present invention will be more fully understood by reference to the following detailed description in conjunction with the attached drawings, in which: 
           [0014]      FIG. 1  is diagrammatic illustration of a conventional fluoroscopic imaging device known in the art; 
           [0015]      FIG. 2  is an illustrative example of a conventional two-diode laser guidance system known in the art for use with a fluoroscopic imaging device; 
           [0016]      FIG. 3  is diagrammatic illustration of a fluoroscopic imaging device in accordance with the present invention; 
           [0017]      FIG. 4  is an illustrative example configuration of a plurality of laser diodes for implementation on an imaging device in accordance with the present invention; 
           [0018]      FIG. 5A  is a fluoroscopic image with a plan line, in accordance with aspects of the present invention; 
           [0019]      FIG. 5B  is an image of guiding laser beam projections generated by the laser diodes in accordance with the present invention; 
           [0020]      FIGS. 6A and 6B  are illustrative examples of guiding laser beam projections generated by the laser diodes in accordance with the present invention; 
           [0021]      FIG. 7  is a flowchart depicting a method of utilizing the laser diode array laser guidance system in accordance with the present invention; and 
           [0022]      FIG. 8  is a diagrammatic illustration of a high level architecture for implementing processes in accordance with aspects of the invention. 
       
    
    
     DETAILED DESCRIPTION 
       [0023]    An illustrative embodiment of the present invention relates to a fluoroscopic imaging device configured with a plurality of laser diodes, or laser diode array, installed on at least one of the imaging receptors of the fluoroscopic imaging device. The plurality of laser diodes is distributed in a semi-circular pattern on the imaging receptor(s) at stationary locations. The plurality of laser diodes is utilized to create a guiding laser beam projections on a subject for use during a fluoroscopic procedure. A surgeon can rely upon the guiding laser beam projections produced by the plurality of laser diodes instead of requiring an imaging device to be active for the entirety of the fluoroscopic procedure (unnecessarily exposing the surgeon, patient, and staff to radiation). In other words, the guiding laser beam projections provide guidance during the procedure in lieu of an active imaging device (e.g., X-ray). 
         [0024]    To generate the guiding laser beam projections, one or more of the plurality of laser diodes is activated based on a positioning and orientation of a user-provided plan line input that is overlaid on a fluoroscopic preview image. Upon activation, the one or more laser diodes produce the guiding laser beam projections on a subject which correspond to the location and orientation of the user-provided plan line. The plurality of laser diodes are spaced, oriented, and positioned in a manner to provide 360 degree coverage of guiding laser beam projections to facilitate coverage of all requisite angels and areas, and enable production of a guiding laser beam projections matching any provided plan line. The use of laser diodes generating guiding laser beam projections directly on the patient and corresponding to plan lines in a fluoroscopic image make it possible for the fluoroscopic imaging radiation to be shut off and still have guiding laser beam projections displayed to the medical professionals to rely upon during a procedure. 
         [0025]      FIGS. 3 through 8 , wherein like parts are designated by like reference numerals throughout, illustrate an example embodiment or embodiments of improved operation for the medical imaging and laser guidance system, according to the present invention. Although the present invention will be described with reference to the example embodiment or embodiments illustrated in the figures, it should be understood that many alternative forms can embody the present invention. One of skill in the art will additionally appreciate different ways to alter the parameters of the embodiment(s) disclosed, such as the size, shape, or type of elements or materials, in a manner still in keeping with the spirit and scope of the present invention. 
         [0026]    Imaging systems are commonly utilized in the medical field for use during fluoroscopic procedures and come in a variety of configurations for a variety of applications (e.g., C-arm single plane imager, G-arm bi-plane imager, etc.). An example of an imaging system configured for capturing bi-planar medical images (e.g., X-rays) of a patient is depicted in  FIGS. 1 and 2 . In particular,  FIG. 1  depicts a conventional G-arm medical imaging system  100  and the main components that make up the G-arm medical imaging system  100 . The main components of the G-arm medical imaging system  100  system include a movable stand  102 , a imaging energy emitter  104  (e.g., an X-ray source, X-ray tube, etc.) and imaging receptor  106  (e.g., an image intensifier, flat panel detector, etc.) configured for a frontal view (or anteroposterior view), an imaging energy emitter  108  and imaging receptor  110  configured for a lateral view, and a patient table  112  configured to hold a patient between the imaging energy emitters  104 ,  108  and the imaging receptor  106 ,  110 . As would be appreciated by one skilled in the art, the imaging energy emitters  104 ,  108  can include any kind of suitable imaging energy emitters utilized for imaging a patient. For example, the imaging energy emitters  104 ,  108  can be electromagnetic radiation or x-imaging energy emitters configured to produce X-rays. The combination of elements in the G-arm medical imaging system  100  includes a gantry  114  that supports all of the components/machinery. The gantry  114  of the G-arm medical imaging system  100  is configured to enable two bi-planar images to be captured simultaneously or without movement of the equipment and/or the patient. In some instances, the gantry  114  is adjustable to change angles of the imaging machinery (e.g., the imaging energy emitters  104 ,  108  and imaging receptor  106 ,  110 ). 
         [0027]      FIG. 2  depicts a conventional imaging receptor  110  (or imaging receptor  106 ) with two laser diodes  120  installed thereon. The laser diodes  120  are installed on the imaging receptor  110  in a configuration in which the diodes can rotate around a circular position on the imaging receptor surface. Additionally, the laser diodes  120  are configured to project a laser guide beam on a surface of subject (e.g., patient) positioned within the G-arm medical imaging system  100 . An example of such a laser guidance system and methodology is discussed with respect to U.S. patent application Ser. No. 15/426,791, incorporated herein by reference. In short, a user can lay out a plan line or guiding laser beam on an image preview (e.g., an X-ray) to be projected on the patient as a guiding laser beam projections to assist in performing a fluoroscopic image supported surgical or medical procedure. Based on the plan line laid out by the user, the G-arm medical imaging system  100  instructs the laser diodes  120  to position and rotate in a configuration to project the guiding laser beam projections on the subject at a location corresponding to the plan line on the preview image. 
         [0028]    Continuing with  FIG. 2 , the laser diodes  120  are positioned at two separate locations separated by 90 degrees on the imaging receptor  110 . In particular, the laser diodes  120  are positioned at the six and nine o&#39;clock positions of a circular area within the imaging receptor  110 . As would be appreciated by one skilled in the art, the laser diodes  120  can be positioned at any locations on an imaging receptor that enables them to be rotated and positioned in a manner to create a guiding laser beam projection on a subject at various locations and orientations. However, the utilization of two laser diodes adds complexity to the imaging receptor  110  and adds configuration time during a procedure. In particular, the utilizing of two laser diodes requires mechanisms to enable the ability to rotate and position the diodes in a position necessary to provide the laser beam projections. Additionally, the rotation and positioning takes additional time during a procedure whenever the diodes need to be repositioned for creating the guiding laser beam projection. As such, the two diode configuration is more complex and more time consuming to operate. 
         [0029]      FIG. 3  depicts example illustrations of a medical imaging and guidance system including an imaging apparatus  200  for use in accordance with the present invention. The apparatus  200  of the present invention shares similar components and functionality with the components discussed with respect to the G-arm medical imaging system  100  in  FIG. 1 . The apparatus  200  also includes additional components and functionality in combination with the traditional components of the G-arm medical imaging system  100 . In particular,  FIG. 3  depicts an imaging apparatus  200  configured with a plurality of laser diodes  202 , or diode array, including a plurality of diodes  202  configured to generate one or more guiding laser beam projections on a target location (e.g., a patient). In accordance with an example embodiment of the present invention, the plurality of laser diodes  202  are configured at fixed locations on one of the image receptors ( 210 ,  214 ) in a semi-circular pattern, as depicted in  FIG. 4 . 
         [0030]    The apparatus  200  includes a support gantry  204  having a generally arc shape, about an interior center focus point  206 , with a first terminal end  204   a  and a second terminal end  204   b . The apparatus  200  also includes a first imaging assembly positioned on the support gantry  204 , the first imaging assembly includes a first imaging energy emitter  208  (e.g., X-ray source) positioned opposite a first imaging receptor  210 . As would be appreciated by one skilled in the art, the first imaging receptor  210  is configured to receive the energy format produced by the first imaging energy emitter  208 . For example, the first imaging energy emitter  208  is an X-ray source and the first imaging receptor  210  is a flat-panel detector configured to receive X-ray energy. One of the first imaging energy emitter  208  and the first imaging receptor  210  is located proximate the first terminal end  204   a.    
         [0031]    In accordance with an example embodiment of the present invention, as depicted in  FIG. 3 , the first imaging receptor  210  is located at the first terminal end  204   a  of the support gantry  204 . As would be appreciated by one skilled in the art, the first imaging energy emitter  208  could be positioned at the first terminal end  204   a  with the first imaging receptor  210  positioned on the opposite side of the support gantry  204  without influencing the imaging process. In other words, the first imaging receptor  210  (shown in  FIG. 3 ) can be swapped with the first imaging energy emitter  208  positionally (shown in  FIG. 3 ) and be an equivalent configuration. The first imaging assembly is positioned and oriented to emit imaging energy (e.g., from the first imaging energy emitter  208 ) in an LT plane, as depicted in  FIG. 3 . Additionally, as would be appreciated by one skilled in the art, the first imaging assembly can alternatively be positioned and oriented to emit imaging energy (e.g., from the energy emitter  212 ) in an AP plane. 
         [0032]    Continuing with  FIG. 3 , the apparatus  200  further includes a second imaging assembly positioned on the support gantry  204 ; the second imaging assembly including a second imaging energy emitter  212  (e.g., X-ray source) positioned opposite a second imaging receptor  214 . As would be appreciated by one skilled in the art, the second imaging receptor  214  is configured to receive the energy format produced by the second imaging energy emitter  212 . For example, the second imaging energy emitter  212  is an X-ray source and the second imaging receptor  214  is a flat-panel detector configured to read X-ray energy. One of the second imaging energy emitter  212  or the second imaging receptor  214  is positioned at the second terminal end  204   b  of the support gantry  204 . In accordance with an example embodiment of the present invention, as depicted in  FIG. 3 , the second imaging receptor  214  is positioned proximate to the second terminal end  204   b  of the support gantry  204 . As would be appreciated by one skilled in the art, the second imaging energy emitter  212  could be positioned at the second terminal end  204   b  with the second imaging receptor  214  positioned on the opposite side of the support gantry  204  without influencing the imaging process. In other words, the second imaging receptor  214  (shown in  FIG. 3 ) can also be switched with the second imaging energy emitter  212  (shown in  FIG. 3 ) in an optional arrangement. The second imaging assembly is positioned and oriented to emit imaging energy in an AP plane, perpendicular to the LT plane created by the first imaging assembly, as depicted in  FIG. 3 . Additionally, as would be appreciated by one skilled in the art, the second imaging assembly can be positioned and oriented to emit imaging energy in an LT plane, perpendicular to the AP plane from the first imaging assembly. 
         [0033]    The apparatus  200  also includes a control unit  216  configured to move and position the support gantry  204  at a desired location. Additionally, the support gantry  204  includes a plurality of wheels  218  to enable a user to push, pull, and pivot the apparatus  200  into a desired position via the control unit  216 . In accordance with an example embodiment of the present invention, the apparatus  200  includes or is otherwise in communication with a processing and display device  220  (such as the imaging control device discussed in U.S. Patent Application Publication No. 2016/0262712 incorporated herein by reference). The processing and display device  220  is configured to receive raw image readouts (of a subject located proximate the interior center focus point  206 ) from the imaging receptors  210 ,  214  and convert the readouts signal into a displayable format. The imaging receptors  210 ,  214  can include any combination of image receptors known in the art configured to provide readable signals to the processing and display device  220  for display. For example, the imaging receptors  210 ,  214  can be thin film transistor (TFT) panels with a scintillation material layer configured to receive energy from visible photons to charge capacitors of pixel cells within the TFT panel. The charges for each of the pixel cells are readout as a voltage data value to the processing and display device  220 . The signals received by the processing and display device  220  can be configured into two dimensional or three dimensional images utilizing any combination of methodologies known in the art. 
         [0034]    In accordance with an example embodiment of the present invention, the processing and display device  220  is configured to provide a user with a planning tool to create one or more plan lines  222  on a preview image  224  for the generation of a guiding laser beam projection  226 , by one or more laser diodes  202 , on a subject  228 , as depicted in  FIGS. 5A and 5B  and discussed in greater detail with respect to U.S. patent application Ser. No. 15/426,791 (as it relates to the plan lines  222 ). In an example, a surgeon can create the one or more plan lines  222  on a fluoroscopic preview image  224  through a software interface provided by the processing and display device  220  by drawing the one or more plan lines  222  on the preview image  224  using a computer mouse, a touch screen input, drawing tablet, or other input device known in the art. The one or more plan lines  222  on the preview image  224  can be planned with any position and line direction that the user desires. As would be appreciated by one skilled in the art, the fluoroscopic preview image  224  is provided by the imaging provided by the apparatus  200 . As shown in  FIG. 5B , the guiding laser beam projection  226  by one or more laser diodes  202  is projected on a target location  228  corresponding to the same location as that of the plan lines  222  depicted in the preview image  224 . 
         [0035]      FIG. 4  depicts an example configuration of the plurality of laser diodes  202  fixedly attached to stationary positions within or on the first imaging receptor  210 . The plurality of laser diodes  202  are oriented such that they generate laser beams focused to the field of view at the interior center focus point  206 . As depicted in  FIG. 4 , in accordance with an example embodiment of the present invention, the plurality of laser diodes  202  is uniformly installed in a semi-circular pattern on the first imaging receptor  210  and/or the second imaging receptor  214 . As would be appreciated by one skilled in the art, the laser diodes  202  can be adapted to fit on different shaped imaging receptors. For example, for an image intensifier imaging receptor, the plurality of laser diodes  202  can be mounted around the input window of the image intensifier. Additionally, the laser diodes  202  can be positioned and spaced in any shape and distribution which will allow guiding laser beam projections to be projected on a subject (e.g., a patient) at any position and configuration. For example, the plurality of laser diodes  202  can be spaced in a 180 degree distribution at intervals of no greater than 15 radial degrees of spacing between each laser-diode of the plurality of laser-diodes to form a semi-circular design. The 180 degree distribution enables the plurality of laser diodes  202  to create guiding laser beam projection coverage in a 360 degree radius. Furthermore, any number of laser diodes  202  can be utilized to make up the desired shape. Continuing the previous example, the plurality of laser diodes  202  can include at least three, and preferably more, laser-diodes uniformly spaced around the half of the circumference of each of the first imaging receptor  210  and/or the second imaging receptor  214 . For example, the plurality of laser diodes  202  can include about twenty laser-diodes uniformly spaced around the half of the circumference of the first imaging receptor  210 , as depicted in  FIG. 4 . As would be appreciated by one skilled in the art, the number of laser diodes  202  is restricted due to a size of the diodes and mounting spacing of the diodes around the imaging receiver. 
         [0036]    In operation, in accordance with an example embodiment of the present invention, each of the laser diodes  202  is configured to generate a guiding laser beam projection  226  to be properly aligned to focus on the interior center focus point  206  of the apparatus  200 . In particular, the plurality of laser diodes  202  are mechanically aligned to produce guiding laser beam projection  226  to pass through the interior center focus point  206  of the support gantry  204 . The mechanical positioning of the plurality of laser diodes  202  provides an angular coverage or linear translation around the apparatus  200  (e.g., fluoroscopic imaging system). In particular, the plurality of laser diodes  202  are positioned at an angle of convergence to provide an angular focus directed to a center of a front input plane of the imaging receptor  210 ,  214  that the plurality of laser-diodes are attached thereto. 
         [0037]    In accordance with an example embodiment of the present invention, each of the plurality of laser diodes  202  is independently operable according to a user specification. In particular, a user will specify a plan line to be generated by one or more of the plurality of laser diodes  202 . For example, surgeons can plan line on a preview image, as discussed with respect to  FIGS. 2, 5A, 5B, 6A, and 6C , to be generated by the plurality of laser diodes  202 . The user specified plan line will dictate, via the processing and display device  220 , the power state of each of the plurality of laser diodes  202  such that the one or more laser diodes that will produce a guiding laser beam projection corresponding to the plan line will be powered/activated. 
         [0038]    The one or more plan lines  222  created on the preview image  224  are utilized by the processing and display device  220  to determine which diodes within the plurality of laser diodes  202  for display should be activated to generate the guiding laser beam projections  226  on the subject  228 . As would be appreciated by one skilled in the art, the number and locations of the diodes that are activated is based on the desired guiding laser beam projections  226  (e.g., based on the one or more plan lines  222 ). In accordance with an example embodiment of the present invention, the one or more plan lines  222  are prescribed on the preview image  224  through a graphical user interface (GUI) and the geometrical input data from the one or more plan lines  222  is used to determine which laser diodes of the plurality of laser diodes  202  to activate. In particular, the processing and display device  220  receives the raw image data from the imaging receptors  210 ,  214  and transforms the raw image data for display as a preview image  224  and subsequently receives at least one plan line that is overlaid onto the preview image  224  from a user. Thereafter, the processing and display device  220  electronically selects one or more of the plurality of laser-diodes  202  to activate in order to project one or more guiding laser beam projections onto the subject patient at locations corresponding to the at least one plan line. In other words, based on the received plan line(s), the processing and display device  220  selects one or more laser diodes  202  (to provide an activation signal/instruction) at positions required to generate corresponding guiding laser beam projections  226  to be displayed onto the subject  228  in the same locations corresponding to the one or more plan lines  222  created on the preview image  224 , as depicted in  FIGS. 5A and 5B . In response to the activation, the activated laser diode(s)  202  produce the guiding laser beam projections  226  corresponding to the positioning of the one or more plan lines  222  on the preview image  224 , while the first and/or second imaging assemblies are not actively emitting radiation and providing real-time imaging. As such there is no requirement that first and/or second imaging assemblies emit radiation and provide real-time imaging for the entirety of a procedure because at moments during the procedure the guiding laser beam projections can take the place of the necessary functionality of the plan lines of the first and/or section imaging assemblies, thereby reducing overall radiation emission and exposure to the patient and medical personnel. In accordance with an example embodiment of the present invention, the activation is performed by transmitting a power signal to the corresponding laser diode(s). This methodology is performed without requiring any movement of any of the plurality of laser diodes  202  and the surgeon can rely on the guiding laser beam projections  226  produced by the activated laser diode(s) from the plurality of laser diodes  202  during the intra-operative surgery without exposing the subject  228  to additional radiation beyond that which was experienced during the brief snapshot of the fluoroscopic preview image  224 . 
         [0039]      FIGS. 6A and 6B  depict illustrative examples of the functionality provided by the plurality of laser diodes  202 . In particular,  FIG. 6A  depicts a plan line  222  or surgical guide direction line, which passes through an image center  230  on preview image  224 . The plan line  222  is generated with any position and line direction through the preview image  224 . Additionally, the plan line  222  provides the input information and imaging geometry to determine power state of each of the plurality of laser diodes  202 . In particular, the plurality of laser-diodes  202  are electronically selected according to a direction of the plan line  222  overlaid on the preview fluoroscopic image  224 .  FIG. 6B  depicts a guiding laser beam projections  226  or surgical laser guide beam generated by the electronically selected diodes according to the plan line  222  created on the preview image  224 . The guiding laser beam projection  226  generated by the activated laser diode(s) (as depicted in  FIG. 6B ) correspond to the plan line  222  created on the preview image  224  (as depicted in  FIG. 6A ). 
         [0040]      FIG. 7  depicts an example process  700  of operation for the imaging apparatus  200  discussed with respect to  FIGS. 3-6B . In particular,  FIG. 7  depicts an example implementation of the process  700  to pre-plan one or more plan lines  222  on a fluoroscopic preview image  224  to be directed as a guiding laser beam projections  226  (as produced by one or more of the plurality of laser diodes  202 ) onto a subject  228 . The utilization of the guiding laser beam projections  226 , as provided in process  700 , enable a medical professional to perform a fluoroscopic procedure without having to constantly expose the subject and other personnel to radiation from the imaging device. In particular, the plurality of laser-diodes  202  emit guiding laser beam projections  226  onto a subject  228  to provide guidance to medical personnel during a procedure without radiation energy being emitted by either imaging assembly  208 ,  212 . Although, with respect to  FIG. 7 , the process  700  is discussed with respect to the operation for the apparatus  200  depicted in  FIG. 3 , as would be appreciated by one skilled in the art, the process  700  could be implemented utilizing any other combination of imaging methods and systems. 
         [0041]    At step  702  the subject  228  is positioned proximal to the interior center focus point  206  of the apparatus between the first imaging assembly and the second imaging assembly. In particular, the subject  228  is positioned in within the apparatus at a location to capture the desired area of the subject  228 . 
         [0042]    At step  704  the imaging energy emitters  208 ,  212  are activated. In particular, the imaging energy emitters  208 ,  212  (e.g., X-ray sources) are activated in response to receiving a user instruction input into the processing and display device  220  and transmitted to the x imaging energy emitters  208 ,  212  via the control logic. Upon activation, the imaging energy emitters  208 ,  212  generate energy (e.g., X-ray photons) in a direction of the subject  228  located within the apparatus  200 . 
         [0043]    At step  706  the energy emissions (e.g., X-ray photons) from the imaging energy emitters  208 ,  212  are absorbed as energy charges at the the imaging receptors  210 ,  214 . In particular, the imaging receptors  210 ,  214  receive the energy as raw image data to be transmitted to the processing and display device  220  for conversion. 
         [0044]    At step  708  the raw image data received by the imaging receptors  210 ,  214  transmitted to the processing and display device  220 . Thereafter, the processing and display device  220  receives the raw image data and converts the raw image data into a format for display, utilizing any system or method known in the art. During this period of time the imaging energy emitters  208 ,  212  can be powered off to stop any continued radiation exposure. 
         [0045]    At step  710  the processing and display device  220  displays a preview image  224  on a display device (e.g., a monitor) for interpretation and pre-planning by a user. The preview image  224  displayed to the user is an image of the subject  228  (e.g., X-ray image). 
         [0046]    At step  712  the processing and display device  220  receives one or more plan lines  222  from a user overlaid on the displayed preview image  224 , as depicted in  FIGS. 5A and 6A . 
         [0047]    At step  714  the processing and display device  220  determines which diode(s) of the plurality of laser diodes  202  to activate to produce guiding laser beam projections  226  corresponding to the one or more plan lines  222 . In particular, the processing and display device  220  determines to direct guiding laser beam projections  226  which diode(s) of the plurality of laser diodes  202  to activate to produce the guiding laser beam projections  226  at the same location on the subject  228  in the real world as the one or more plan lines  222  overlaid on the preview image  224  of the subject  228 . 
         [0048]    At step  716  processing and display device  220  transmits a signal to activate the selected the laser diode(s) from step  714 . 
         [0049]    At step  718  the activated laser diode(s) directs one or more guiding laser beam projections  226  in the direction of the subject  228 , as depicted in  FIGS. 5B and 6B . The one or more guiding laser beam projections  226  create visible light lines on a surface of the subject  228 . Additionally, the guiding laser beam projections  226  correspond to the location and angle of the one or more plan lines  222  created by the user on the preview image  224  as they related to the locations on the subject  228 . 
         [0050]    At step  720  the user (e.g., a surgeon) can being performing a fluoroscopic procedure based on the guiding laser beam projections  226  displayed on the subject  228 . As a result of the process  700 , the apparatus  200  provides improved surgical precision while significantly reducing dependence on intra-operative fluoroscopy (e.g., reducing exposure to radiation). By relying on the guiding laser beam projections  226  at different times during the fluoroscopic procedure instead of an active real time preview image  224  created through the first and second imaging assemblies, the process reduces an amount of radiation exposure to the subject  228  and any medical professionals within a given proximity to the imaging apparatus  200 . 
         [0051]    Any suitable computing device can be used to implement the computing devices  220  and methods/functionality described herein and be converted to a specific system for performing the operations and features described herein through modification of hardware, software, and firmware, in a manner significantly more than mere execution of software on a generic computing device, as would be appreciated by those of skill in the art. One illustrative example of such a computing device  800  is depicted in  FIG. 8 . The computing device  800  is merely an illustrative example of a suitable computing environment and in no way limits the scope of the present invention. A “computing device,” as represented by  FIG. 8 , can include a “workstation,” a “server,” a “laptop,” a “desktop,” a “hand-held device,” a “mobile device,” a “tablet computer,” or other computing devices, as would be understood by those of skill in the art. Given that the computing device  800  is depicted for illustrative purposes, embodiments of the present invention may utilize any number of computing devices  800  in any number of different ways to implement a single embodiment of the present invention. Accordingly, embodiments of the present invention are not limited to a single computing device  800 , as would be appreciated by one with skill in the art, nor are they limited to a single type of implementation or configuration of the example computing device  800 . 
         [0052]    The computing device  800  can include a bus  810  that can be coupled to one or more of the following illustrative components, directly or indirectly: a memory  812 , one or more processors  814 , one or more presentation components  816 , input/output ports  818 , input/output components  820 , and a power supply  824 . One of skill in the art will appreciate that the bus  810  can include one or more busses, such as an address bus, a data bus, or any combination thereof. One of skill in the art additionally will appreciate that, depending on the intended applications and uses of a particular embodiment, multiple of these components can be implemented by a single device. Similarly, in some instances, a single component can be implemented by multiple devices. As such,  FIG. 8  is merely illustrative of an exemplary computing device that can be used to implement one or more embodiments of the present invention, and in no way limits the invention. 
         [0053]    The computing device  800  can include or interact with a variety of computer-readable media. For example, computer-readable media can include Random Access Memory (RAM); Read Only Memory (ROM); Electronically Erasable Programmable Read Only Memory (EEPROM); flash memory or other memory technologies; CDROM, digital versatile disks (DVD) or other optical or holographic media; magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices that can be used to encode information and can be accessed by the computing device  800 . 
         [0054]    The memory  812  can include computer-storage media in the form of volatile and/or nonvolatile memory. The memory  812  may be removable, non-removable, or any combination thereof. Exemplary hardware devices are devices such as hard drives, solid-state memory, optical-disc drives, and the like. The computing device  800  can include one or more processors that read data from components such as the memory  812 , the various I/O components  816 , etc. Presentation component(s)  816  present data indications to a user or other device. Exemplary presentation components include a display device, speaker, printing component, vibrating component, etc. 
         [0055]    The I/O ports  818  can enable the computing device  800  to be logically coupled to other devices, such as I/O components  820 . Some of the I/O components  820  can be built into the computing device  800 . Examples of such I/O components  820  include a microphone, joystick, recording device, game pad, satellite dish, scanner, printer, wireless device, networking device, and the like. 
         [0056]    As utilized herein, the terms “comprises” and “comprising” are intended to be construed as being inclusive, not exclusive. As utilized herein, the terms “exemplary”, “example”, and “illustrative”, are intended to mean “serving as an example, instance, or illustration” and should not be construed as indicating, or not indicating, a preferred or advantageous configuration relative to other configurations. As utilized herein, the terms “about”, “generally”, and “approximately” are intended to cover variations that may existing in the upper and lower limits of the ranges of subjective or objective values, such as variations in properties, parameters, sizes, and dimensions. In one non-limiting example, the terms “about”, “generally”, and “approximately” mean at, or plus 10 percent or less, or minus 10 percent or less. In one non-limiting example, the terms “about”, “generally”, and “approximately” mean sufficiently close to be deemed by one of skill in the art in the relevant field to be included. As utilized herein, the term “substantially” refers to the complete or nearly complete extend or degree of an action, characteristic, property, state, structure, item, or result, as would be appreciated by one of skill in the art. For example, an object that is “substantially” circular would mean that the object is either completely a circle to mathematically determinable limits, or nearly a circle as would be recognized or understood by one of skill in the art. The exact allowable degree of deviation from absolute completeness may in some instances depend on the specific context. However, in general, the nearness of completion will be so as to have the same overall result as if absolute and total completion were achieved or obtained. The use of “substantially” is equally applicable when utilized in a negative connotation to refer to the complete or near complete lack of an action, characteristic, property, state, structure, item, or result, as would be appreciated by one of skill in the art. 
         [0057]    Numerous modifications and alternative embodiments of the present invention will be apparent to those skilled in the art in view of the foregoing description. Accordingly, this description is to be construed as illustrative only and is for the purpose of teaching those skilled in the art the best mode for carrying out the present invention. Details of the structure may vary substantially without departing from the spirit of the present invention, and exclusive use of all modifications that come within the scope of the appended claims is reserved. Within this specification embodiments have been described in a way which enables a clear and concise specification to be written, but it is intended and will be appreciated that embodiments may be variously combined or separated without parting from the invention. It is intended that the present invention be limited only to the extent required by the appended claims and the applicable rules of law. 
         [0058]    It is also to be understood that the following claims are to cover all generic and specific features of the invention described herein, and all statements of the scope of the invention which, as a matter of language, might be said to fall therebetween.