PROJECT_SUMMARY_ABSTRACT_nView_medical Surgical inaccuracies impact patient safety and increase healthcare costs. Spinal fusions are a prime example: with 500,000 procedures per year in the US it is the sixth most frequent procedure and reoperation rates are 13%. There are an estimated 22,000 revision surgeries due to misplaced screws that could be avoided if intraoperative 3D guidance was standard. The total cost of the revision surgeries due to misplaced screws in the US exceeds $600M per year and could largely be reduced. nView medical is developing the next generation image guidance technology that will lead to more accurate, lower cost, and safer Image Guided Interventions (IGI). nView?s innovation provides 3D images in realtime, navigation capability, and lowdose operation. nView will focus first on spine surgery as strong benefits from 3D image guidance have already been established, but the proposed platform technology applies broadly to most interventional radiology and surgical applications, such as oncology and vascular minimally invasive interventions, as well as spine, orthopaedics and cardiovascular surgeries. In Phase I, this research will provide objective physics image quality metrics for its scanner to establish a baseline versus alternative technologies. This research will then prove the clinical value of the proposed guidance system, first by demonstrating that the realtime 3D updates lead to accurate visualization and tracking of surgical instrumentation making the scanner valuable intraoperatively and second, to prove the clinical value in simulated surgeries, showing that accuracy can be improved and surgical time reduced versus state of the art alternatives. Positive preliminary results based on user observer tests support that nView?s image guidance system leads to higher accuracy at lower dose than alternative solutions. Phase II will expand the clinical applicability of the innovation and confirm the benefits of increased accuracy, decreased surgical time and reduced xray exposure in actual Image Guided Interventions. The nView team members, with background from both industry (GE Healthcare, Carestream) and academia (University Of Utah, UC Davis), have deep experience in medical imaging, xray image reconstruction and surgical navigation.