High speed multiplanar tomosynthesis with an inverse geometry x-ray fluoroscopy system enables 3D tracking of multiple high-contrast objects at the rate of fluoroscopic imaging. The SBDX system is capable of tracking electrodes in standard cardiac catheters with approximately 1 mm accuracy and precision.

Scanning-beam digital x-ray (SBDX) is an inverse geometry fluoroscopy system for low dose cardiac imaging. The use of a narrow scanned x-ray beam in SBDX reduces detected x-ray scatter and improves dose efficiency, however the tight beam collimation also limits the maximum achievable x-ray fluence. To increase the fluence available for imaging, we have constructed a new SBDX prototype with a wider x-ray beam, larger-area detector, and new real-time image reconstructor. Imaging is performed with a scanning source that generates 40,328 narrow overlapping projections from 71 × 71 focal spot positions for every 1/15 s scan period. A high speed 2-mm thick CdTe photon counting detector was constructed with 320×160 elements and 10.6 cm × 5.3 cm area (full readout every 1.28 μs), providing an 86% increase in area over the previous SBDX prototype. A matching multihole collimator was fabricated from layers of tungsten, brass, and lead, and a multi-GPU reconstructor was assembled to reconstruct the stream of captured detector images into full field-of-view images in real time. Thirty-two tomosynthetic planes spaced by 5 mm plus a multiplane composite image are produced for each scan frame. Noise equivalent quanta on the new SBDX prototype measured 63%–71% higher than the previous prototype. X-ray scatter fraction was 3.9–7.8% when imaging 23.3–32.6 cm acrylic phantoms, versus 2.3–4.2% with the previous prototype. Coronary angiographic imaging at 15 frame/s was successfully performed on the new SBDX prototype, with live display of either a multiplane composite or single plane image.

Multi-modality image fusion is a feasible and accurate platform technology to guide transendocardial injections precisely to the discrete infarct border.

The aim of this study is to determine the effects of early intravenous (IV) infusion later followed by transendocardial (TE) injection of allogeneic mesenchymal stem cells (MSCs) following myocardial infarction (MI). Twenty-four swine underwent balloon occlusion reperfusion MI and were randomized into 4 groups: IV MSC (or placebo) infusion (post-MI day 2) and TE MSC (or placebo) injection targeting the infarct border with 2D X-ray fluoroscopy fused to 3D magnetic resonance (XFM) co-registration (post-MI day 14). Continuous ECG recording, MRI, and invasive pressure-volume analyses were performed. IV MSC plus TE MSC treated group was superior to other groups for contractility reserve (p=0.02) and freedom from VT (p=0.03) but had more lymphocytic foci localized to the peri-infarct region (p= 0.002). No differences were observed in post-MI remodeling parameters. IV followed by XFM targeted TE MSC therapy improves contractility reserve and suppresses VT but does not affect post-MI remodeling and may cause an immune response.

Scanning Beam Digital X-ray (SBDX) is a low-dose inverse geometry fluoroscopic system for cardiac interventional procedures. The system performs x-ray tomosynthesis at multiple planes in each frame period and combines the tomosynthetic images into a projection-like composite image for fluoroscopic display. We present a novel method of stereoscopic imaging using SBDX, in which two slightly offset projection-like images are reconstructed from the same scan data by utilizing raw data from two different detector regions. To confirm the accuracy of the 3D information contained in the stereoscopic projections, a phantom of known geometry containing high contrast steel spheres was imaged, and the spheres were localized in 3D using a previously described stereoscopic localization method. After registering the localized spheres to the phantom geometry, the 3D residual RMS errors were between 0.81 and 1.93 mm, depending on the stereoscopic geometry. To demonstrate visualization capabilities, a cardiac RF ablation catheter was imaged with the tip oriented towards the detector. When viewed as a stereoscopic red/cyan anaglyph, the true orientation (towards vs. away) could be resolved, whereas the device orientation was ambiguous in conventional 2D projection images. This stereoscopic imaging method could be implemented in real time to provide live 3D visualization and device guidance for cardiovascular interventions using a single gantry and data acquired through normal, low-dose SBDX imaging.