We present a feasibility study on hybrid echocardiography (echo) and x-ray image guidance for cardiac catheterization procedures. A self-tracked, remotely operated robotic arm with haptic feedback was developed that attached to a standard x-ray table. This was used to safely manipulate a three-dimensional (3D) trans-thoracic echo probe during simultaneous x-ray fluoroscopy and echo acquisitions. By a combination of calibration and tracking of the echo and x-ray systems, it was possible to register the 3D echo images with the 2D x-ray images. Visualization of the combined data was achieved by either overlaying triangulated surfaces extracted from segmented echo data onto the x-ray images or by overlaying volume rendered 3D echo data. Furthermore, in order to overcome the limited field of view of the echo probe, it was possible to create extended field of view (EFOV) 3D echo images by co-registering multiple tracked echo data to generate larger roadmaps for procedure guidance. The registration method was validated using a cross-wire phantom and showed a 2D target registration error of 3.5 mm. The clinical feasibility of the method was demonstrated during two clinical cases for patients undergoing cardiac pacing studies. The EFOV technique was demonstrated using two healthy volunteers.

We present an initial evaluation of a robotic arm for positioning a 3D echo probe during cardiac catheterization procedures. By tracking the robotic arm, X-ray table and X-ray C-arm, we are able to register the 3D echo images with live 2D X-ray images. In addition, we can also use tracking data from the robotic arm combined with system calibrations to create extended field of view 3D echo images. Both these features can be used for roadmapping to guide cardiac catheterization procedures. We have carried out a validation experiment of our registration method using a cross-wire phantom. Results show our method to be accurate to 3.5 mm. We have successfully demonstrated the creation of the extended field of view data on 2 healthy volunteers and the registration of echo and X-ray data on 1 patient undergoing a pacing study.

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