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Results A total of 462 reviews were included in the analysis (231 in each phase). In 64% (95% CI 58-70%) of reviews, surgeons reported that IRIS achieved a better spatial orientation, understanding of the anatomy, and offered additional information compared with 2D CT alone. IRIS impacted the planned procedure in 20% of the reviews (3.5% changed decision from PN to RN and 16.5% changed from RN to PN). In the remaining 80% of reviews, surgeons' confidence increased from 78% (95% CI 72-84%) with 2D CT, to 87% (95% CI 82-92%) with IRIS (p