Abstract: 
    
            
                    Depth cues are an essential part of navigation and device positioning tasks  
during clinical interventions. Yet, many minimally-invasive procedures, such  
as catheterizations, are usually performed under X-ray guidance only  
depicting a 2D projection of the anatomy, which lacks depth information.  
Previous attempts to integrate pre-operative 3D data of the patient by  
registering these to intra-operative data have led to virtual 3D renderings  
independent of the original X-ray appearance and planar 2D color overlays  
(e.g. roadmaps). A major drawback associated to these solutions is the  
trade-off between X-ray attenuation values that is completely neglected  
during 3D renderings, and depth perception not being incorporated into the 2D  
roadmaps. This paper presents a novel technique for enhancing depth  
perception of interventional X-ray images preserving the original attenuation  
appearance. Starting from patient-specific pre-operative 3D data, our method  
relies on GPU ray casting to compute a colored depth map, which assigns a  
predefined color to the first incidence of gradient magnitude value above a  
predefined threshold along the ray. The colored depth map values are  
carefully integrated into the X-Ray image while maintaining its original  
grayscale intensities. The presented method was tested and analysed for three  
relevant clinical scenarios covering different anatomical aspects and  
targeting different levels of interventional expertise. Results demonstrate  
that improving depth perception of X-ray images has the potential to lead to  
safer and more efficient clinical interventions.