作者想感谢 Ulm 大学翻译成像 MoMAN 中心的支持。

该研究议定书符合《1975赫尔辛基宣言》的道德准则, 这反映在该机构道德委员会通过的先验批准中。这项研究中包括的所有个人参与者都获得书面知情同意 (CSI--Ulm, clinicaltrials.gov NCT02162069)。
1. CT 检查
<ol><li>用80毫升的碘造影剂在4.0 毫升/秒的流速下进行心脏 CT 血管造影, 然后用70毫升0.9% 盐水溶液冲洗丸。</li>
	<li>采集 caudally 从股动脉向锁骨下动脉扩展的数据: 矩阵为 512 x 512 像素, 切片厚度为1毫米, 切片间距为0.7 毫米。</li>
	<li>利用迭代重建算法在 r r 区间的30% 重建图像。</li>
</ol>2. 图像分割和模型生成
<ol><li>将来自外部设备或内部存档系统的 CT 数据导入到图像融合软件中, 方法是将所选病人的数据集或子集拖放到应用程序中的 "病人" 视图中。</li>
	<li>通过双击图像序列, 开始自动分割选定的 CT 音量。 注: 心脏室 (左、右心室、左、右心房、心肌) 和大血管 (腹主动脉、腔静脉和冠状动脉窦) 的分割是自动启动的, 将显示在分段工作步骤中。</li>
	<li>检查图像切片并验证是否正确检测到主动脉和左心室的边缘, 如果需要, 请使用编辑按钮在组织窗口中编辑自动分割。</li>
	<li>若要对其他结构进行手动分割, 请使用组织窗口中的添加按钮。</li>
	<li>使用现有的编辑工具填充结构 (注入染料), 并在2D 视图中拖动结构的边缘 (拖动边缘), 或在3D 视图中用自由格式剪切删除结构部件。</li>
	<li>对左、右冠状动脉主干, 主动脉分支 (头臂大动脉动脉右颈动脉和右锁骨下动脉, 左颈和左锁骨下动脉), 左、右进行人工分割髂动脉、髋部骨骼和髋关节关节, 如步骤 2.4-2.5 (图 1) 所述。 注: 根据 CT 体积的质量, 这可能需要20到30分钟。</li>
</ol>3. 图像联合注册和融合
<ol><li>在患者视图中, 通过在右键单击上下文菜单中选择相应的操作, 将选定的病人与 XR 系统中的当前病人合并。 注意: 现在注册和Live工作步骤是活动的, 可以使用。</li>
	<li>在实时工作步骤中, 单击标记点窗口中的添加新标记点, 在主动脉瓣尖头中放置三个参照标记, 以方便在干预期间选择环形平面的最佳投影 (图2)。</li>
	<li>转到注册工作步骤以获取 XR 运行, 并使用 XR 对分段模型进行联合注册。 注: 可靠的注册需要至少有 XR 角距离获得的运行。</li>
	<li>通过单击复制到引用视图 1的按钮, 将适当穿刺的血管造影投影复制到 ~ 老挝 20-30°方向 (或 ~ 饶 20-从初始穿刺侧看) 到参考视图 1中。</li>
	<li>在可视化从对侧髂股到参考视图 2中, 通过单击该按钮, 复制以下在 ~ AP 方向上获取的 x 射线投影: 复制到引用视图 2。</li>
	<li>使用交互工具注册盘、注册旋转(用于平面旋转)、注册卷(用于3D 旋转) 手动将髂动脉模型与获得的 XR 投影 (图 3AB)。</li>
	<li>在髂区域的叠加过程中, 使用 XR 图像中可见的髋骨和髋关节作为额外的地标。 注: 现在模型链接到 XR 系统几何, 并且叠加自动适应当前的 XR 投影方向、放大倍数和病人表位置。</li>
	<li>使用步骤3.6 中执行的粗初始联合注册指导鞘侧的普通股动脉穿刺 (图 3C)。</li>
	<li>通过单击按钮复制到参考视图, 并在髂区域 (图 3D) 中完成图像联合注册, 记录设备鞘内动脉的血管造影投射 (或分别为 ~ 老挝 20-)。 注意: 由于患者在 CT 扫描和干预过程中的定位不同, 基于髂结构的注册在其他区域仅提供有限的准确性。因此, 需要人工改良胸腔内的联合注册。</li>
	<li>要使用这些数据进一步覆盖重新对准, 复制任何额外的获得的投影到 "参考视图" 在过渡期间从髂到胸部地区, 以及任何插管的头臂大动脉躯干通过右径向动脉。</li>
	<li>将尾纤导管放置在主弓中后, 在老挝 30-40°和饶 20-30°方向上获取两个透视投影, 并在参考视图 1和参考视图 2中复制它们。</li>
	<li>使用交互工具注册盘、注册旋转(用于平面旋转)、注册卷(用于3D 旋转) 手动调整胸腔区域内的注册 (图 4A-B).</li>
	<li>根据解剖叠加 (图 4C), 指导保护设备的放置, 而不需要额外的 CA 的管理。</li>
	<li>为了进一步细化, 在整个干预过程中, 手动更正步骤3.12 中描述的叠加位置, 确保在任何时间点上的精确叠加。 注意: 使用根据常规过程获取的 aortograms, 以验证传递系统的正确位置作为覆盖调整的地标 (图 4D)。</li>
</ol>

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相应的作者代表所有作者指出, 没有任何关系可以被理解为利益冲突。

本研究的主要重点是探讨如果不修改临床建立的 TAVI 工作流的可行性。当预介入 CTA 数据和 XR 透视的联合注册的金标准使用专用 aortograms8时, 我们建议使用多个近似注册, 并在飞行改进中提供精确的3D 模型叠加在整个干预过程中。
不断的手工注册细化需要额外训练有素的工作人员, 以协助介入小组从控制室。由于相关的用户交互影响临床建立的介入工作流程, ...

图像融合 (IF) 是将在不同时间获取的数据集叠加在一起的过程, 并将不同模式的观点转化为单个参考框架1。XR 是用于干预指导的最常用的成像方式。虽然, 提供高的时间和空间分辨率, XR 有低维度 (2D 预测), 缺乏解剖学细节。3D 从例如中派生的器官形状模型通过相关的解剖软组织结构, 将高质量的预介入 CTA 数据叠加到活透视图像上, 可增强 XR。前提步骤为 IF 是联合注册的不同成像方式。
通常情况下, 与 XR 透视的前3D 图像数据集的联合注册涉及以下技术之一2: a) 基于图像的 3 d-3 d 在术前3D 数据集的注册与术中的非/对比增强总站数据集3,4,5,6, 或 b) 直接基于图像的 2 d-3 d 注册, 其中两个造影图像最小的30°角间距7,8用于共同注册。
随着最近在商用 XR 系统上引入融合包, 如果可以更方便地提供广泛的应用。通过使用这些系统, 我们以前已经表明, 通过直接基于图像的2维-3 d 注册支持股经导管主动脉瓣植入 (TAVI)8, 在技术上可行和安全地覆盖主动脉根模型。在不损害整体 CA 或 XR 剂量的情况下, 如果证明自己在 TAVI 过程中具有很高的价值, 则可以在常规 XR 透视图像中添加3D 解剖细节, 特别是在脑保护装置的部署过程中。但是, 联合注册所使用的 aortograms 的额外购置需要额外的 CA 和 XR 剂量。因此, 如果不需要任何额外的 aortograms, 一个优化的工作流程提供了准确的, 是非常可取的。
在这里, 我们提出了一种改进的联合注册预介入 CTA 与实时 XR 不需要任何额外的 CA 或 C 臂 CT 扫描, 如果。股骨访问 TAVI 是按照其他地方的描述执行的9,10,11。简单地, 两股动脉被访问: 一为指导的对侧穿刺, 其次是放置一个辫子导管通过6F 鞘, 以允许动脉造影在安置的瓣膜假体;第二个位置的阀门输送系统和随后的气球成形术和设备放置。在我院进行适当穿刺的血管造影确认, 作为对穿刺高度 (股骨分叉以上) 定位的护理标准, 并在接触相关的情况下估计覆盖支架的位置。并发症12。为捕获栓塞碎片, 在主弓通过前插入 TAVI 后, 引入了双滤脑保护系统。
我们使用动脉在股动脉穿刺期间例行执行, 以建立初步的联合登记。在进行过程中, 联合注册的飞行细化是在持续的程序中使用在主动脉根部的辫子导管的位置, supraaortal 血管内的双滤脑栓塞保护系统和aortograms 在瓣膜假体植入前进行, 从而确保在干预过程中任何时间点的精确模型叠加。

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			<td height="21" style="height:21px;width:247px;">Philips Allura FD10&#160;&#160;</td>
			<td style="width:149px;">Philips Healthcare</td>
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			<td height="40" style="height:41px;width:247px;">Sentinel&#160; double-filter cerebral protection system</td>
			<td style="width:149px;">Claret Medical, Inc.</td>
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			<td style="width:201px;">double-filter cerebral protection system&#160;</td>
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			<td height="27" style="height:27px;width:247px;">Matlab R2013</td>
			<td style="width:149px;">MathWorks</td>
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improved registration of 3d ct angiography with x-ray fluoroscopy for image fusion during transcatheter aortic valve implantation

3D 解剖模型的融合, 从高保真的前介入计算机断层成像 (CTA) 和 x 射线 (XR) 透视, 以促进解剖学指导是巨大的兴趣, 复杂的心脏干预, 如 TAVI 程序大脑保护。基于额外的术中非/对比增强锥束计算机断层扫描 (总站) 或两个单独的 aortograms, 引入了 CTA 和 XR 的联合注册。随着辐射暴露和/或造影剂 (CA) 剂量的增加, 对患者有潜在的附加风险。在这里, 我们提出了一种改进的联合注册方法, 利用动脉的髂动脉, 例行执行在股骨穿刺和鞘介绍。在正在进行的过程中, 联合注册的即时细化使精确的联合注册无需任何额外的造影, 从而减少了 CA、XR 剂量和程序时间, 同时提高了操作员的信心和程序安全。

我们在 TAVI 期间引入了一种新的图像融合联合注册方法, 它允许在整个 TAVI 过程中将病人特定的解剖模型叠加到实时 XR 图像中, 而无需任何额外的 aortograms。
一些介入步骤将受益于 IF: (1) 引导穿刺的股动脉以上的股骨分岔在鞘侧 (图 5A);(2) 即使在非常曲折的剖析完全基于解剖叠加 (图 5B</stro...

Watch this Scientific Journal Video about Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation at JoVE.com

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation

经导管主动脉瓣植入术中 X 线透视 3D CT 血管造影的改进与影像融合

本研究的目的是在股导管主动脉瓣植入术 (TAVI) 中, 改进与实时 x 射线 (XR) 透视相结合的图像融合 (IF) 的联合注册。

The fusion of 3D anatomical models derived from high-fidelity pre-interventional computed tomography angiography (CTA), and x-ray (XR) fluoroscopy to ...

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Medicine

10.3K 次观看.  Ulm University Medical Center. 本研究的目的是在股导管主动脉瓣植入术 (TAVI) 中, 改进与实时 x 射线 (XR) 透视相结合的图像融合 (IF) 的联合注册。

视频: Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation

Intracranial Implantation with Subsequent 3D In Vivo Bioluminescent Imaging of Murine Gliomas

The mouse glioma 261 (GL261) is recognized as an in vivo model system that recapitulates many of the features of human glioblastoma multiforme (GBM). The cell line was originally induced by intracranial injection of 3-methyl-cholantrene into a C57BL/6 syngeneic mouse strain 1; therefore, immunologically competent C57BL/6 mice can be used. While we use GL261, the following protocol can be used for the implantation and monitoring of any intracranial mouse tumor model. GL261 cells were engineered to stably express firefly luciferase (GL261-luc). We also created the brighter GL261-luc2 cell line by stable transfection of the luc2 gene expressed from the CMV promoter. C57BL/6-cBrd/cBrd/Cr mice (albino variant of C57BL/6) from the National Cancer Institute, Frederick, MD were used to eliminate the light attenuation caused by black skin and fur. With the use of albino C57BL/6 mice; in vivo imaging using the IVIS Spectrum in vivo imaging system is possible from the day of implantation (Caliper Life Sciences, Hopkinton, MA). The GL261-luc and GL261-luc2 cell lines showed the same in vivo behavior as the parental GL261 cells. Some of the shared histological features present in human GBMs and this mouse model include: tumor necrosis, pseudopalisades, neovascularization, invasion, hypercellularity, and inflammation 1.
Prior to implantation animals were anesthetized by an intraperitoneal injection of ketamine (50 mg/kg), xylazine (5 mg/kg) and buprenorphine (0.05 mg/kg), placed in a stereotactic apparatus and an incision was made with a scalpel over the cranial midline. A burrhole was made 0.1mm posterior to the bregma and 2.3mm to the right of the midline. A needle was inserted to a depth of 3mm and withdrawn 0.4mm to a depth of 2.6mm. Two &mu;l of GL261-luc or GL261-luc2 cells (107 cells/ml) were infused over the course of 3 minutes. The burrhole was closed with bonewax and the incision was sutured.
Following stereotactic implantation the bioluminescent cells are detectable from the day of implantation and the tumor can be analyzed using the 3D image reconstruction feature of the IVIS Spectrum instrument. Animals receive a subcutaneous injection of 150&mu;g luciferin /kg body weight 20 min prior to imaging. Tumor burden is quantified using mean tumor bioluminescence over time. Tumor-bearing mice were observed daily to assess morbidity and were euthanized when one or more of the following symptoms are present: lethargy, failure to ambulate, hunched posture, failure to groom, anorexia resulting in &gt;10% loss of weight. Tumors were evident in all of the animals on necropsy.

Intracranial Implantation with Subsequent 3D In Vivo Bioluminescent Imaging of Murine Gliomas

Intracranial implantation of GL261 cells into C57BL/6 mice produces malignant gliomas that recapitulate many of the hallmarks of human glioblastoma multiforme. We used GL261 cells stably expressing luciferase to allow us to use in vivo imaging to follow tumor progression. The surgery and 3D in vivo imaging are demonstrated.

随后的三维颅内植入在体内</em生物发光成像鼠脑胶质瘤

The mouse glioma 261 (GL261) is recognized as an in vivo model system that recapitulates many of the features of human glioblastoma multiforme (GBM). The ...

科研

医学

Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 dimensional&#160;(3D) diagnostic imaging in the interventional suite and can enhance minimally-invasive therapy beyond the limitations of 2D angiography alone. The role of CBCT has been recognized in transarterial chemo-embolization (TACE) treatment of hepatocellular carcinoma (HCC). The recent introduction of a CBCT technique: dual-phase CBCT (DP-CBCT) improves intra-arterial HCC treatment with drug-eluting beads (DEB-TACE). DP-CBCT can be used to localize liver tumors with the diagnostic accuracy of multi-phasic multidetector computed tomography (M-MDCT) and contrast enhanced magnetic resonance imaging (CE-MRI) (See the tumor), to guide intra-arterially guidewire and microcatheter to the desired location for selective therapy (Reach the tumor), and to evaluate treatment success during the procedure (Treat the tumor). The purpose of this manuscript is to illustrate how DP-CBCT is used in DEB-TACE to see, reach, and treat HCC.

Dual-phase cone-beam computed tomography (DP-CBCT) is a useful intraprocedural imaging technique for transarterial chemo-embolization treatment with drug-eluting beads of hepatocellular carcinoma. DP-CBCT has been used to perform three major steps in oncologic interventional radiology: tumor localization (see), navigation and intraprocedural catheter guidance (reach), and intraprocedural evaluation of treatment success (treat).

双相位锥束CT看看，到达，并在药物洗脱珠Transarterial化疗栓塞治疗原发性肝癌

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 ...

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial valve might not meet the functional needs. The implantation of a too-small stented pericardial valve, leading to an effective orifice area indexed to a body surface area less than 0.85 cm2/m2, is regarded as prosthesis-patient mismatch (PPM). A PPM negatively affects the regression of left ventricular hypertrophy and thus the normalization of left ventricular function and the alleviation of symptoms. Persistent left ventricular hypertrophy is associated with an increased risk of arrhythmias and sudden cardiac death. In the case of predictable PPM, there are three options: 1) accept the PPM resulting from the implantation of a stented pericardial valve when comorbidities of the patient forbid the more technically demanding operative technique of implanting a larger prosthesis, 2) enlarge the aortic root to accommodate a larger stented valve substitute, or 3) implant a stentless biological valve or a homograft. Compared to classical aortic valve replacement with stented pericardial valves, the full-root implantation of stentless aortic xenografts offers the possibility of implanting a 3-4 mm larger valve in a given patient, thus allowing significant reduction in transvalvular gradients. However, a number of cardiac surgeons are reluctant to transform a classical aortic valve replacement with stented pericardial valves into the more technically challenging full-root implantation of stentless aortic xenografts. Given the potential hemodynamic advantages of stentless aortic xenografts, we have adopted full-root implantation to avoid PPM in patients with small aortic roots necessitating an aortic valve replacement. Here, we describe in detail a technique for the full-root implantation of stentless aortic xenografts, with emphasis on the management of the proximal suture line and coronary anastomoses. Limitations of this technique and alternative options are discussed.

Full-root aortic valve replacement by stentless aortic xenograft is a viable option in patients with small aortic roots. We describe, a technique for the full-root implantation of stentless aortic xenografts, with emphasis on the management of the proximal suture line and coronary anastomoses, and discuss its limitations and alternative options.

全根主动脉瓣置换主动脉瓣狭窄主动脉异种移植患者小主动脉根

In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial ...

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures prevents a number of cardiac surgeons from incorporating them into their practice. The aim of this protocol is to describe a simplified and user-friendly technique of an aortic valve-sparing root replacement (VSRR) procedure by re-implantation of the aortic valve. Proper selection of patients and limitations of the technique are discussed.
In 54 consecutive patients, normal appearing aortic valves were re-implanted in a commercially available polyester prosthesis with pre-shaped sinuses by a simplified and standardized technique. Placement of the first row of the proximal suture line, choice of the prosthesis size, and adjustment of the height of the commissures of the patient to the fixed height of the sinus portion of the prosthesis were slightly modified from the reference techniques with the aim of increasing its feasibility for use by other cardiac surgeons. Early mortality and morbidity as well as 5-year survival, freedom from aortic valve reoperation, and freedom from recurrent moderate regurgitation were collected in all patients.
Thirty-day mortality, re-sternotomy for bleeding, re-sternotomy for mediastinitis, and the incidence of stroke were very low, 1.8% for each (1 of 54). No patient required permanent pace-maker implantation. At 5 years, survival, freedom from aortic valve reoperation, and freedom from recurrent moderate regurgitation were 97.5%, 95.2%, and 91.6%, respectively.
Mid-term results of our standardized technique of re-implantation of the aortic valve for valve-sparing aortic root replacement are very good and compare with more complex techniques reported by experienced surgeons. By following the present protocol of the standardized re-implantation technique, a greater number of cardiac surgeons can perform this procedure with comparable good results.

Valve-sparing aortic root replacement has the advantage of preserving the patient&#39;s own aortic valve. The complexity of the reported techniques to date restricts their use to a limited number of cardiac surgeons. This protocol describes step-by-step a standardized technique reproducible by a greater number of cardiac surgeons.

主动脉瓣重置术治疗瓣膜备用主动脉根置换的规范化技术

Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures ...

Two-Dimensional X-Ray Angiography to Examine Fine Vascular Structure Using a Silicone Rubber Injection Compound

Angiography is an essential tool for the study of vascular structures in various research fields. The aim of this study is to introduce a simple angiographic method for examining the fine vascular structure of unfixed, fresh tissue using a silicone rubber injection compound and soft tissue X-ray system. This study is especially focused on flap territories used in reconstructive surgery. This study employs angiography with a silicone rubber injection compound in various experimental conditions using Sprague-Dawley rats. First, 15 mL of MV compound and 15 mL of diluent is mixed. Then, 1.5 mL of the curing agent is prepared, and a 24G catheter is cannulated in the common carotid artery of the rat. A three-way stopcock is then connected to a catheter, and the radiopaque agent, after being mixed with the prepared curing agent, is injected immediately without spillage. Finally, as the agent solidifies, the specimen is harvested, and an angiographic image is obtained using a soft tissue X-ray system. This method indicates that high-quality angiography showing fine vascular structures can be easily and simply obtained within in a short period of time.

This study presents a simple two-dimensional angiographic method to examine fine vascular structures using a silicone rubber injection compound and soft tissue X-ray system.

二维 x 射线血管造影应用硅橡胶注射液检测细血管结构

Angiography is an essential tool for the study of vascular structures in various research fields. The aim of this study is to introduce a simple ...

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. Minimally invasive surgery (MIS) approaches have been applied to this technique with an associated decrease in estimated blood loss (EBL), length of hospital stay, and infection rates, while preserving outcomes with traditional open surgery. Previous MIS TLIF techniques involve significant fluoroscopy that subjects the patient, surgeon, and operating room staff to non-trivial levels of radiation exposure, particularly for complex multi-level procedures. We present a technique that utilizes an intraoperative computed tomography (CT) scan to aid in placement of pedicle screws, followed by traditional fluoroscopy for confirmation of cage placement. Patients are positioned in the standard fashion and a reference arc is placed in the posterior superior iliac spine (PSIS) followed by intraoperative CT scan. This allows for image-guidance-based placement of pedicle screws through a one-inch skin incision on each side. Unlike traditional MIS-TLIF that requires significant fluoroscopic imaging during this stage, the operation can now be performed without any additional radiation exposure to the patient or operating room staff. After completion of the facetectomy and discectomy, final TLIF cage placement is confirmed with fluoroscopy. This technique has the potential to decrease operative time and minimize total radiation exposure.

The purpose of this article is to provide image-guidance for minimally invasive transforaminal interbody fusion.

锥形束术中计算机断层扫描图像指南,用于微创跨体间融合

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. ...

A Whole Body Dosimetry Protocol for Peptide-Receptor Radionuclide Therapy (PRRT): 2D Planar Image and Hybrid 2D+3D SPECT/CT Image Methods

Peptide-receptor-radionuclide-therapy (PPRT) is a targeted therapy that combines a short-range energy radionuclide with a substrate with high specificity for cancer cell receptors. After injection, the radiotracer is distributed throughout the entire body, with a higher uptake in tissues where targeted receptors are overexpressed. The use of beta/gamma radionuclide emitters enables therapy imaging (beta-emission) and post-therapy imaging (gamma-emission) to be performed at the same time. Post-treatment sequential images permit absorbed dose calculation based on local uptake and wash-in/wash-out kinetics. We implemented a hybrid method that combines information derived from both 2D and 3D images. Serial whole-body images and blood samples are acquired to estimate the absorbed dose to different organs at risk and to lesions disseminated throughout the body. A single 3D-SPECT/CT image, limited to the abdominal region, overcomes projection overlap on planar images of different structures such as the intestines and kidneys. The hybrid 2D+3D-SPECT/CT method combines the effective half-life information derived from 2D planar images with the local uptake distribution derived from 3D images. We implemented this methodology to estimate the absorbed dose for patients undergoing PRRT with 177Lu-PSMA-617. The methodology could, however, be implemented with other beta-gamma radiotracers. To date, 10 patients have been enrolled into the dosimetry study with 177Lu-PSMA-617 combined with drug protectors for kidneys and salivary glands (mannitol and glutamate tablets, respectively). The median ratio between kidney uptake at 24 h evaluated on planar images and 3D-SPECT/CT is 0.45 (range:0.32-1.23). The comparison between hybrid and full 3D approach has been tested on one patient, resulting in a 1.6% underestimation with respect to full 3D (2D: 0.829 mGy/MBq, hybrid: 0.315 mGy/MBq, 3D: 0.320 mGy/MBq). Treatment safety has been confirmed, with a mean absorbed dose of 0.73 mGy/MBq (range:0.26-1.07) for kidneys, 0.56 mGy/MBq (0.33-2.63) for the parotid glands and 0.63 mGy/MBq (0.23-1.20) for submandibular glands, values in accordance with previously published data.

A Whole Body Dosimetry Protocol for Peptide-Receptor Radionuclide Therapy PRRT: 2D Planar Image and Hybrid 2D+3D SPECT/CT Image Methods

This method estimates the absorbed dose of different structures for peptide-receptor-radionuclide-therapy (PRRT) with the possibility of avoiding organ overlap on 2D-projections. Serial whole-body planar images permit estimation of mean absorbed doses along the whole body, while the hybrid approach, combining planar images and 3D-SPECT/CT image, overcomes the limitations of structure overlapping.

肽受体放射性核素治疗（PRRT）全身多体型测定方案:2D平面图像和混合2D+3D SPECT/CT图像方法

Peptide-receptor-radionuclide-therapy (PPRT) is a targeted therapy that combines a short-range energy radionuclide with a substrate with high specificity ...

Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging

In the United States, more than 80% of all abdominal aortic aneurysms are treated by endovascular aortic aneurysm repair (EVAR). The endovascular approach warrants good early results, but adequate follow-up imaging after EVAR is imperative to maintain long-term positive outcomes. Potential graft-related complications are graft migration, infection, fraction, and endoleaks, with the last one being the most common. The most frequently used imaging after EVAR is computed tomography angiography (CTA) and duplex ultrasound. Dynamic, time-resolved computed tomography angiography (d-CTA) is a reasonably new technique to characterize the endoleaks. Multiple scans are done sequentially around the endograft during acquisition that grants good visualization of the contrast passage and graft-related complications. This high diagnostic accuracy of d-CTA can be implemented into therapy via image fusion and reduce additional radiation and contrast material exposure.
This protocol describes the technical aspects of this modality: patient selection, preliminary image review, d-CTA scan acquisition, image processing, qualitative and quantitative endoleak characterization. The steps of integrating dynamic CTA into intra-operative fluoroscopy using 2D-3D fusion-imaging to facilitate targeted embolization are also demonstrated. In conclusion, time-resolved, dynamic CTA is an ideal modality for endoleak characterization with additional quantitative analysis. It can reduce radiation and iodinated contrast material exposure during endoleak treatment by guiding interventions.

Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging

Dynamic computed tomography angiography (CTA) imaging provides additional diagnostic value in characterizing aortic endoleaks. This protocol describes a qualitative and quantitative approach using time-attenuation curve analysis to characterize endoleaks. The technique of integrating dynamic CTA imaging with fluoroscopy using 2D-3D image fusion is illustrated for better image guidance during treatment.

时间分辨、动态计算机断层扫描血管造影术，用于主动脉内漏的表征和 通过 2D-3D 融合成像进行治疗指导

In the United States, more than 80% of all abdominal aortic aneurysms are treated by endovascular aortic aneurysm repair (EVAR). The endovascular approach ...

Performing Intracochlear Electrocochleography During Cochlear Implantation

Electrocochleography (ECochG) measures inner ear potentials generated in response to acoustic stimulation of the ear. These potentials reflect the residual function of the cochlea. In cochlear implant candidates with residual hearing, the implant electrode can directly measure ECochG responses during the implantation process. Various authors have described the ability to monitor the inner ear function by continuous ECochG measurements during the surgery. The measurement of ECochG signals during surgery is not trivial. There are no interpretable signals in up to 20% of cases. For a successful recording, a standardized procedure is recommended to achieve the highest measurement reliability and avoid possible pitfalls. Therefore, seamless collaboration between the CI surgeon and CI technician is key. This video consists of an overview of the system setup and a stepwise procedure of performing intracochlear ECochG measurements during CI surgery. It shows the surgeon's and the CI technician's roles in the process, and how a smooth collaboration between the two is made possible.

Electrocochleography (ECochG) measures inner ear potentials generated in response to acoustic stimulation. In cochlear implant (CI) candidates, such inner ear potentials can be measured directly with the implant electrodes. In this video, we systematically explain how to perform ECochG recordings during CI surgery.

在人工耳蜗植入过程中进行脑室内耳蜗电图检查

Electrocochleography (ECochG) measures inner ear potentials generated in response to acoustic stimulation of the ear. These potentials reflect the ...

Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement

The measurements of the right ventricle (RV) and pulmonary artery (PA), for selecting the optimal prosthesis size for transcatheter pulmonary valve replacement (TPVR), vary considerably. Three-dimensional (3D) computed tomography (CT) imaging for device size prediction is insufficient to assess the displacement of the right ventricular outflow tract (RVOT) and PA, which could increase the risk of stent misplacement and paravalvular leak. The aim of this study is to provide a dynamic model to visualize and quantify the anatomy of the RVOT to PA over the entire cardiac cycle by four-dimensional (4D) cardiac CT reconstruction to obtain an accurate quantitative evaluation of the required valve size. In this pilot study, cardiac CT from sheep J was chosen to illustrate the procedures. 3D cardiac CT was imported into 3D reconstruction software to build a 4D sequence which was divided into eleven frames over the cardiac cycle to visualize the deformation of the heart. Diameter, cross-sectional area, and circumference of five imaging planes at the main PA, sinotubular junction, sinus, basal plane of the pulmonary valve (BPV), and RVOT were measured at each frame in 4D straightened models prior to valve implantation to predict the valve size. Meanwhile, dynamic changes in the RV volume were also measured to evaluate right ventricular ejection fraction (RVEF). 3D measurements at the end of the diastole were obtained for comparison with the 4D measurements. In sheep J, 4D CT measurements from the straightened model resulted in the same choice of valve size for TPVR (30 mm) as 3D measurements. The RVEF of sheep J from pre-CT was 62.1 %. In contrast with 3D CT, the straightened 4D reconstruction model not only enabled accurate prediction for valve size selection for TPVR but also provided an ideal virtual reality, thus presenting a promising method for TPVR and the innovation of TPVR devices.

This study assessed a new methodology with a straightened model generated from the four-dimensional cardiac computed tomography sequence to obtain the desired measurements for valve sizing in the application of transcatheter pulmonary valve replacement.

用于经导管肺动脉瓣置换术的四维计算机断层扫描引导的瓣膜尺寸

The measurements of the right ventricle (RV) and pulmonary artery (PA), for selecting the optimal prosthesis size for transcatheter pulmonary valve ...