Autonomous Synergy: Artificial Intelligence Orchestration of Mobile Imaging Units, C-Arms, and Surgical Workflow in the Operating Suite

Abstract

The modern operating suite represents a high-density, dynamically evolving socio-technical ecosystem where therapeutic precision, radiation safety, and operative efficiency intersect. Conventional intraoperative fluoroscopy using mobile C-arm systems relies heavily on manual manoeuvring, verbal closed-loop team communication, iterative repositioning, and intermittent ionising radiation, creating operational bottlenecks and cumulative occupational radiation risks. Recent breakthroughs in artificial intelligence (AI), computer vision, spatial computing, and robotic automation have paved the way for "Autonomous Synergy"—a paradigm shift toward the agentic orchestration of mobile imaging systems in direct alignment with real-time surgical workflow.
This review comprehensively examines the technological, algorithmic, and clinical foundations of AI-driven surgical imaging automation. We analyse the progression from early optical camera-augmented mobile C-arms (CamC) and LiDAR-based external localisation to modern agentic systems capable of autonomous skeletal landmark detection, kinematic coupling with smart surgical tables, and robotic self-driving navigation. Furthermore, we evaluate surgical scene understanding frameworks spanning surgical phase, step, and action triplet recognition, alongside multi-instrument tracking methodologies (Region-based Convolutional Neural Networks).
By synthesising state-of-the-art developments across image guidance, spatial tracking, contextual workflow recognition, and autonomous robotic control, this paper establishes a unified taxonomy for agentic operating rooms. We address safety-critical control architectures, collision avoidance, cognitive ergonomics, dose reduction algorithms, ethical liabilities, and regulatory considerations required for clinical deployment. Finally, we map future research directions toward multi-modal foundation models and interconnected hybrid operating environments.