Name: improved registration of 3d ct angiography with x-ray fluoroscopy for image fusion during transcatheter aortic valve implantation
Uploaded: 2018-06-03T15:00:00.000+00:00
Duration: 6 min 59 s
Description: 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

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。

<table><tbody><tr><td>Philips Allura FD10&amp;nbsp;&amp;nbsp;</td><td>Philips Healthcare</td><td></td><td>x-ray system</td></tr><tr><td>EP Navigator Release 5.2.10</td><td>Philips Healthcare</td><td></td><td>image segmentation and fusion SW</td></tr><tr><td>Iomeron 350</td><td>Bracco Imaging Deutschland GmbH</td><td></td><td>x-ray contrast agent</td></tr><tr><td>Sentinel&amp;nbsp; double-filter cerebral protection system</td><td>Claret Medical, Inc.</td><td></td><td>double-filter cerebral protection system&amp;nbsp;</td></tr><tr><td>Matlab R2013</td><td>MathWorks</td><td></td><td>statistical analysis</td></tr></tbody></table>

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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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 ...

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 ...

Three-Dimensional Printing of a Complex Aortic Anomaly

Complex congenital aortic anomalies include diverse types of malformations that may be clinically asymptomatic or present with respiratory or esophageal symptoms. These anomalies may be associated with other congenital heart diseases. It is hard to identify the accurate anatomic vessel location from two-dimensional imaging data, such as computed tomography. As an additive manufacturing method, three-dimensional (3-D) printing can covert the acquired imaging data into 3-D physical models. This protocol describes the procedure for modeling the volumetric DICOM imaging into 3-D data and printing it as an anatomically realistic 3-D model. Using this model, surgeons can identify the vessel location of complex aortic anomalies, which is helpful for pre-operative planning and intra-operative guidance.

Here, we present a protocol to use three dimensional printed models for pre-operative planning and intra-operative reorganization of complicated vascular locations when handling a congenital aortic anomaly.

复杂主动脉异常的三维打印

Complex congenital aortic anomalies include diverse types of malformations that may be clinically asymptomatic or present with respiratory or esophageal ...

Development and Evaluation of 3D-Printed Cardiovascular Phantoms for Interventional Planning and Training

Catheter-based interventions are standard treatment options for cardiovascular pathologies. Therefore, patient-specific models could help training physicians&#39; wire-skills as well as improving planning of interventional procedures. The aim of this study was to develop a manufacturing process of patient-specific 3D-printed models for cardiovascular interventions.
To create a 3D-printed elastic phantom, different 3D-printing materials were compared to porcine biological tissues (i.e., aortic tissue) in terms of mechanical characteristics. A fitting material was selected based on comparative tensile tests and specific material thicknesses were defined. Anonymized contrast-enhanced CT-datasets were collected retrospectively. Patient-specific volumetric models were extracted from these datasets and subsequently 3D-printed. A pulsatile flow loop was constructed to simulate the intraluminal blood flow during interventions. Models&#39; suitability for clinical imaging was assessed by x-ray imaging, CT, 4D-MRI and (Doppler) ultrasonography. Contrast medium was used to enhance visibility in x-ray-based imaging. Different catheterization techniques were applied to evaluate the 3D-printed phantoms in physicians&#39; training as well as for pre-interventional therapy planning.
Printed models showed a high printing resolution (~30 &#181;m) and mechanical properties of the chosen material were comparable to physiological biomechanics. Physical and digital models showed high anatomical accuracy when compared to the underlying radiological dataset. Printed models were suitable for ultrasonic imaging as well as standard x-rays. Doppler ultrasonography and 4D-MRI displayed flow patterns and landmark characteristics (i.e., turbulence, wall shear stress) matching native data. In a catheter-based laboratory setting, patient-specific phantoms were easy to catheterize. Therapy planning and training of interventional procedures on challenging anatomies (e.g., congenital heart disease (CHD)) was possible.
Flexible patient-specific cardiovascular phantoms were 3D-printed, and the application of common clinical imaging techniques was possible. This new process is ideal as a training tool for catheter-based (electrophysiological) interventions and can be used in patient-specific therapy planning.

Here we present development of a mock circulation setup for multimodal therapy evaluation, pre-interventional planning, and physician-training on cardiovascular anatomies. With the application of patient-specific tomographic scans, this setup is ideal for therapeutic approaches, training, and education in individualized medicine.

干预规划和培训的3D打印心血管幻影的开发与评估

Catheter-based interventions are standard treatment options for cardiovascular pathologies. Therefore, patient-specific models could help training ...

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 ...

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 ...

Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation

During the last decade, transcatheter aortic valve implantation (TAVI) has evolved as a well-established therapy for aging patients suffering from symptomatic severe aortic valve stenosis. This is also reflected in the recently updated international guidelines on managing patients with valvular heart disease. A transfemoral&#160;(TF) TAVI&#160;approach has proven superior to alternative access strategies. With the introduction of intravascular lithotripsy (IVL), patients with calcified iliofemoral vascular disease and borderline intraluminal diameters have also become candidates for percutaneous TF-TAVI. Moreover, IVL reduces the risk of major vascular complications by modifying the superficial and deep vascular calcium, thereby changing the vessel compliance and controlling luminal expansion. In this way, IVL has shown to safely facilitate TF delivery of TAVI devices in patients with calcified peripheral artery disease. The present article aims to provide a detailed step-by-step description on how to perform IVL-assisted TF-TAVI safely and efficiently. Furthermore, a literature review on the outcomes obtained with this technology is included, along with a concise discussion on this unique TAVI approach.

Transcatheter aortic valve implantation (TAVI) has been shown to generate the best clinical outcomes when performed by the percutaneous transfemoral approach. Intravascular lithotripsy (IVL) can facilitate a transfemoral process in patients with calcified iliofemoral vascular disease and borderline intraluminal diameters. The present protocol describes IVL-assisted transfemoral TAVI.

During the last decade, transcatheter aortic valve implantation (TAVI) has evolved as a well-established therapy for aging patients suffering from ...

Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound

Vascular surgeons and interventional radiologists face chronic exposure to low-dose radiation during endovascular procedures, which may impact their health in the long term due to their stochastic effects. The presented case shows the feasibility and efficacy of combining Fiber Optic RealShape (FORS) technology and intravascular ultrasound (IVUS) to reduce operator exposure during the endovascular treatment of obstructive peripheral arterial disease (PAD). 
FORS technology enables real-time, three-dimensional visualization of the full shape of guidewires and catheters, embedded with optical fibers that use laser light instead of fluoroscopy. Hereby, radiation exposure is reduced, and spatial perception is improved while navigating during endovascular procedures. IVUS has the capacity to optimally define vessel dimensions. Combining FORS and IVUS in a patient with iliac in-stent restenosis, as shown in this case report, enables passage of the stenosis and pre- and post-percutaneous transluminal angioplasty (PTA) plaque assessment (diameter improvement and morphology), with a minimum dose of radiation and zero contrast agent. The aim of this article is to describe the method of combining FORS and IVUS stepwise, to show the potential of merging both techniques in view of reducing radiation exposure and improving navigation tasks and treatment success during the endovascular procedure for the treatment of PAD.

Described here is a stepwise method of combining Fiber Optic RealShape technology and intravascular ultrasound to show the potential of merging both techniques, in view of the reduction of radiation exposure and improvement of navigation tasks and treatment success during an endovascular procedure for the treatment of peripheral arterial disease.

结合光纤RealShape技术和血管内超声，减少外周动脉疾病血管内治疗期间的辐射暴露

Vascular surgeons and interventional radiologists face chronic exposure to low-dose radiation during endovascular procedures, which may impact their ...

用于远程 AR 辅助手术的优化 3D 重建和运动映射

Automatic Surgery in Transcatheter Aortic Valve Replacement Using Augmented Reality

Augmented Reality (AR) is in high demand in medical applications. The aim of the paper is to provide automatic surgery using AR for the Transcatheter Aortic Valve Replacement (TAVR). TAVR is the alternate medical procedure for open-heart surgery. TAVR replaces the injured valve with the new one using a catheter. In the existing model, remote guidance is given, while the surgery is not automated based on AR. In this article, we deployed a spatially aligned camera that is connected to a motor for the automation of image capture in the surgical environment. The camera tracks the 2D high-resolution image of the patient's heart along with the catheter testbed. These captured images are uploaded using the mobile app to a remote surgeon who is a cardiology expert. This image is utilized for the 3D reconstruction from 2D image tracking. This is viewed in a HoloLens like an emulator in a laptop. The surgeon can remotely inspect the 3D reconstructed images with additional transformation features such as rotation and scaling. These transformation features are enabled through hand gestures. The surgeon's guidance is transmitted to the surgical environment to automate the process in real-time scenarios. The catheter testbed in the surgical field is controlled by the hand gesture guidance of the remote surgeon. The developed prototype model demonstrates the effectiveness of remote surgical guidance through AR.

作者聚焦：利用增强现实和机器人技术彻底改变远程手术，提高精度和可访问性

This article presents the design and implementation of an automatic surgery module based on augmented reality (AR)- based 3D reconstruction. The system enables remote surgery by allowing surgeons to inspect reconstructed features and replicate surgical hand movements as if they were performing the surgery in close proximity.

使用增强现实技术进行经导管主动脉瓣置换术的自动手术

Augmented Reality (AR) is in high demand in medical applications. The aim of the paper is to provide automatic surgery using AR for the Transcatheter ...

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

摘要

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此视频中的章节

随后的三维颅内植入在体内

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

二维 x 射线血管造影应用硅橡胶注射液检测细血管结构

复杂主动脉异常的三维打印

干预规划和培训的3D打印心血管幻影的开发与评估

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

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

Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation

结合光纤RealShape技术和血管内超声，减少外周动脉疾病血管内治疗期间的辐射暴露

使用增强现实技术进行经导管主动脉瓣置换术的自动手术

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

摘要

探索更多视频

此视频中的章节

随后的三维颅内植入在体内

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

二维 x 射线血管造影应用硅橡胶注射液检测细血管结构

复杂主动脉异常的三维打印

干预规划和培训的3D打印心血管幻影的开发与评估

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

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

Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation

结合光纤RealShape技术和血管内超声，减少外周动脉疾病血管内治疗期间的辐射暴露

使用增强现实技术进行经导管主动脉瓣置换术的自动手术

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