Abstract
arXiv:2511.03882v2 Announce Type: replace Abstract: Imitation learning-based robot control policies are enjoying renewed interest in video-based robotics. However, it remains unclear whether this approach applies to X-ray-guided procedures, such as spine instrumentation, with sparse inputs. We examine the feasibility, opportunities and challenges for imitation policy learning in bi-plane-guided cannula insertion. We develop an in silico sandbox for scalable, automated simulation of X-ray-guided spine procedures with a high degree of realism. We curate a dataset of correct trajectories and corresponding bi-planar X-ray sequences that emulate the stepwise alignment of providers. We then train imitation learning policies for planning and open-loop control that iteratively align a cannula in a vertebroplasty setting solely based on visual information. This precisely controlled setup offers insights into limitations and capabilities of this method. Our policy succeeded on the first attempt in 68.5% of cases, maintaining safe intra-pedicular trajectories across diverse vertebral levels. The policy transferred to complex anatomy, including fractures, as well as varied anatomies and initializations. Rollouts on real X-ray indicate that partial sim-to-real transfer with plausible trajectories is possible. While these preliminary results are promising, we also identify limitations, especially in entry point precision. The current results present a clear benchmark for future efforts, while with more robust priors and domain knowledge, such models may provide a foundation for future efforts toward lightweight and CT-free robotic intra-operative spinal navigation.