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
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

Forfatterne vil gerne takke Ulm Universitet Center for Translationel Imaging MoMAN for dets støtte.

Undersøgelse-protokollen er i overensstemmelse med de etiske retningslinjer 1975 af Helsinki-erklæringen som afspejlet i en forudgående godkendelse af institutionens etisk komité. Skriftligt informeret samtykke blev opnået fra alle individuelle deltagere i undersøgelsen (CSI-Ulm, clinicaltrials.gov NCT02162069).
1. CT undersøgelse
<ol><li>Udføre hjerte CT angiografi med retrospektiv ECG-gating bruge 80 mL af jodholdige kontrastmidler injiceres med en væskehastighed på 4,0 ...

<ol>
	<li>S&#225;nchez, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Navigational+Guidance+and+Ablation+Planning+Tools+for+Interventional+Radiology.">Navigational Guidance and Ablation Planning Tools for Interventional Radiology.</a> Current Problems in Diagnostic Radiology. 32 (2), 225-233 (2017).</li><li>Schwein, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Feasibility+of+three-dimensional+magnetic+resonance+angiography-fluoroscopy+image+fusion+technique+in+guiding+complex+endovascular+aortic+procedures+in+patients+with+renal+insufficiency.">Feasibility of three-dimensional magnetic resonance angiography-fluoroscopy image fusion technique in guiding complex endovascular aortic procedures in patients with renal insufficiency.</a> Journal of Vascular Surgery. 65 (5), 1440-1452 (2017).</li><li>Ierardi, A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fusion+of+CT+Angiography+or+MR+Angiography+with+Unenhanced+CBCT+and+Fluoroscopy+Guidance+in+Endovascular+Treatments+of+Aorto-Iliac+Steno-Occlusion:+Technical+Note+on+a+Preliminary+Experience.">Fusion of CT Angiography or MR Angiography with Unenhanced CBCT and Fluoroscopy Guidance in Endovascular Treatments of Aorto-Iliac Steno-Occlusion: Technical Note on a Preliminary Experience.</a> CardioVascular and Interventional Radiology. 39 (1), 111-116 (2015).</li><li>Sailer, A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=CTA+with+Fluoroscopy+Image+Fusion+Guidance+in+Endovascular+Complex+Aortic+Aneurysm+Repair.">CTA with Fluoroscopy Image Fusion Guidance in Endovascular Complex Aortic Aneurysm Repair.</a> European Journal of Vascular and Endovascular Surgery. 47 (4), 349-356 (2014).</li><li>McNally, M. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three+Dimensional+Fusion+CT+Decreases+Radiation+Exposure,+Procedure+Time+and+Contrast+Use+during+Fenestrated+Endovascular+Aortic+Repair.">Three Dimensional Fusion CT Decreases Radiation Exposure, Procedure Time and Contrast Use during Fenestrated Endovascular Aortic Repair.</a> Journal of Vascular Surgery. 61 (2), 309-316 (2015).</li><li>Krishnaswamy, A., Tuzcu, E. M., Kapadia, S. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Integration+of+MDCT+and+fluoroscopy+using+C-arm+computed+tomography+to+guide+structural+cardiac+interventions+in+the+cardiac+catheterization+laboratory.">Integration of MDCT and fluoroscopy using C-arm computed tomography to guide structural cardiac interventions in the cardiac catheterization laboratory.</a> Catheterization and Cardiovascular Interventions. 85 (1), 139-147 (2015).</li><li>Movassaghi, B., Rasche, V., Grass, M., Viergever, M. A., Niessen, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+quantitative+analysis+of+3-D+coronary+modeling+from+two+or+more+projection+images.">A quantitative analysis of 3-D coronary modeling from two or more projection images.</a> IEEE Transactions on Medical Imaging. 23 (12), 1517-1531 (2004).</li><li>Vernikouskaya, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Image-guidance+for+transcatheter+aortic+valve+implantation+(TAVI)+and+cerebral+embolic+protection.">Image-guidance for transcatheter aortic valve implantation (TAVI) and cerebral embolic protection.</a> International Journal of Cardiology. 249, 90-95 (2017).</li><li>Ramlawi, B., Anaya-Ayala, J. E., Reardon, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcatheter+Aortic+Valve+Replacement+(TAVR):+Access+Planning+and+Strategies.">Transcatheter Aortic Valve Replacement (TAVR): Access Planning and Strategies.</a> Methodist DeBakey Cardiovascular Journal. 8 (2), 22-25 (2012).</li><li>W&#246;hrle, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transfemoral+Aortic+Valve+Implantation+with+the+New+Edwards+Sapien+3+Valve+for+Treatment+of+Severe+Aortic+Stenosis-Impact+of+Valve+Size+in+a+Single+Center+Experience.">Transfemoral Aortic Valve Implantation with the New Edwards Sapien 3 Valve for Treatment of Severe Aortic Stenosis-Impact of Valve Size in a Single Center Experience.</a> PLOS ONE. 11 (3), e0151247 (2016).</li><li>Seeger, J., Gonska, B., Otto, M., Rottbauer, W., W&#246;hrle, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cerebral+Embolic+Protection+During+Transcatheter+Aortic+Valve+Replacement+Significantly+Reduces+Death+and+Stroke+Compared+With+Unprotected+Procedures.">Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement Significantly Reduces Death and Stroke Compared With Unprotected Procedures.</a> JACC: Cardiovascular Interventions. 10 (22), 2297-2303 (2017).</li><li>Seeger, J., Gonska, B., Rodewald, C., Rottbauer, W., W&#246;hrle, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+suture+mediated+femoral+access+site+closure+with+the+Prostar+XL+compared+to+the+ProGlide+system+on+outcome+in+transfemoral+aortic+valve+implantation.">Impact of suture mediated femoral access site closure with the Prostar XL compared to the ProGlide system on outcome in transfemoral aortic valve implantation.</a> International Journal of Cardiology. 223, 564-567 (2016).</li><li>Vernikouskaya, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient-specific+registration+of+3D+CT+angiography+(CTA)+with+X-ray+fluoroscopy+for+image+fusion+during+transcatheter+aortic+valve+implantation+(TAVI)+increases+performance+of+the+procedure.">Patient-specific registration of 3D CT angiography (CTA) with X-ray fluoroscopy for image fusion during transcatheter aortic valve implantation (TAVI) increases performance of the procedure.</a> Clinical Research in Cardiology. , (2018).</li><li>Eng, M. H., Kim, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fluoroscopy+and+CT+fusion+overlay-greater+than+the+sum+of+their+parts.">Fluoroscopy and CT fusion overlay-greater than the sum of their parts.</a> Catheterization and Cardiovascular Interventions. 85 (1), 148-149 (2015).</li><li>John, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=System+to+guide+transcatheter+aortic+valve+implantations+based+on+interventional+C-arm+CT+imaging.">System to guide transcatheter aortic valve implantations based on interventional C-arm CT imaging.</a> Medical Image Computing and Computer-Assisted Intervention. 13 (Pt 1), 375-382 (2010).</li><li>Lu, Y., Sun, Y., Liao, R., Ong, S. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+pre-operative+CT+and+non-contrast-enhanced+C-arm+CT+registration+framework+for+trans-catheter+aortic+valve+implantation.">A pre-operative CT and non-contrast-enhanced C-arm CT registration framework for trans-catheter aortic valve implantation.</a> Computerized Medical Imaging and Graphics. 38 (8), 683-695 (2014).</li></ol>

Hovedfokus i denne undersøgelse var at undersøge gennemførligheden af hvis uden at ændre arbejdsprocessen klinisk etablerede TAVI. Mens den gyldne standard for Co registrering af pre interventionel CTA data og XR fluoroskopi bruger dedikeret aortograms8, foreslår vi, ved hjælp af flere omtrentlige registreringer med on-the-fly raffinementer til at give nøjagtige 3D-modellen overlay under hele løbet af interventionen.
Kontinuerlig manuel registrering finjustering...

Billede fusion (IF) er processen med at sammenføje datasæt erhvervet på forskellige tid- og synspunkter om forskellige modaliteter i en enkelt-ramme af reference1. XR er den hyppigst anvendte imaging modalitet for intervention vejledning. Selvom giver høj tidsmæssige og rumlige opløsning, XR har lav dimensionalitet (2D fremskrivninger) og mangler anatomiske detaljer. 3D organ figur modeller stammer fra fx høj kvalitet pre interventionel CTA data overlejret på live fluoroskopi billedet kan forøge XR af relevante anatomiske bløddelene strukturer. Forudsætning skridt for hvis er fælles registrering af de forskellige billeddiagnostiske modaliteter.
Fælles registrering af præoperativ 3D billede datasæt med XR fluoroskopi involverer typisk, en af de følgende teknikker2: en) image-baseret 3D-3D registrering af den præoperative 3D datasæt med en intraoperativ ikke- / kontrast-forstærket CBCT datasæt3,4,5,6, eller b) direkte image-baserede 2D-3D registrering, hvor to Angiografisk billeder med et minimum af 30 ° kantede afstand7,8 bruges til Co registrering.
Med den nylige indførelse af fusion pakker på kommercielle XR systemer, hvis kan gøres mere let tilgængelige for en bred vifte af applikationer. Bruger disse systemer, har vi tidligere vist, at det er teknisk muligt og sikkert at overlejre en aorta root model ved hjælp af direkte image-baserede 2D-3D registrering for at støtte transfemoral transcatheter aortaklappen implantation (TAVI)8. Uden at kompromittere den samlede CA eller XR dosis, hvis vist sig særdeles værdifuld under TAVI procedure ved at tilføje 3D anatomiske detaljer til konventionelle XR fluoroskopi billedet, især i forbindelse med installationen af den cerebrale beskyttelse enhed. Yderligere erhvervelse af aortograms anvendes til co registrering kræves imidlertid yderligere CA og XR dosis. En optimeret arbejdsproces give præcis hvis uden behov for nogen yderligere aortograms var derfor meget ønskeligt.
Her præsenterer vi en tilgang til forbedret samarbejde registrering af pre interventionel CTA med real-time XR uden at kræve nogen yderligere CA eller C-arm CT scanner for hvis. Femoral adgang TAVI udføres som beskrevet andetsteds9,10,11. Kort, der er adgang til både femoralis arterier: en for vejledning af de kontralaterale punktere, efterfulgt af placeringen af en grisehale kateter gennem en 6F kappe at tillade arteriografi under placering af klapprotese; andet for placering af ventil leveringssystem og efterfølgende ballon valvuloplasty og enhedens placering. Angiografisk bekræftelse af passende punktering udføres i vores institution som en standard i pleje for lokalisering af punktering højde (over femoral tvedeling) og estimering af placeringen af dækket stenten i relation komplikationer12. Til at indfange embolisk snavs, er en dobbelt-filter cerebral beskyttelsessystem indført efter indsættelse af TAVI levering kappe forud for passage af aortabuen med enhver yderligere enhed.
Vi bruger arteriograms udføres rutinemæssigt under punktering af femoralis arterier til at etablere den første Co registrering. On-the-fly forfinelse af co registrering udføres efterfølgende under den igangværende procedure ved hjælp af placeringen af grisehale kateter i aorta roden, dobbelt-filter cerebral embolisk beskyttelsessystemet i fartøjerne, supraaortal og den aortograms udføres før implantation af klapprotese, hvilket sikrer nøjagtig model overlay på ethvert tidspunkt under interventionen.

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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: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

Fusion af 3D anatomiske modeller stammer fra high-fidelity pre interventionel computertomografi angiografi (CTA), og x-ray (XR) fluoroskopi at lette anatomiske vejledning er af stor interesse for komplekse hjerte interventioner som TAVI procedurer med cerebral beskyttelse. Fælles registrering af TCL og XR har indført enten baseret på yderligere intraoperativ ikke- / kontrast-forstærket cone-beam beregnet tomografi (CBCT) eller to separate aortograms. Med den relaterede stigning i stråling eksponering og/eller kontrast agent (CA) dosis indført en yderligere risiko for patienten. Her foreslår vi en modificeret Co registrering tilgang gør brug af arteriograms af den iliofemoral arterier, rutinemæssigt udføres under femoral punktering og kappe introduktion. On-the-fly forfinelse af co registrering under den igangværende procedure giver mulighed for nøjagtig Co registrering uden nogen yderligere angiograms, hvorved CA, XR dosis og procedure tid, mens samtidig forbedrer operatør tillid og procedure sikkerhed.

Vi indførte en roman Co registrering tilgang til billede fusion under TAVI, som giver mulighed for overliggende patient-specifikke anatomiske model ind på de live XR billeder under hele TAVI proceduren uden behov for nogen yderligere aortograms.
Flere interventionel trin vil drage fordel af, hvis: (1) vejledning af punktering af fælles femoralis arterie ovenfor femoral tvedeling kappe side (figur 5A</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

Forbedret registrering af 3D-CT angiografi med X-ray fluoroskopi for billede Fusion under Transcatheter aortaklappen Implantation

Formålet med denne undersøgelse var at forbedre fælles tilmelding til billede fusion (IF) pre interventionel CT data med real-time røntgen (XR) fluoroskopi under transfemoral transcatheter aortaklappen implantation (TAVI).

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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