In current practice, fluoroscopy remains the gold standard for guiding surgeons during endovascular catheterization. The poor visibility of anatomical structures and the absence of depth information make accurate catheter localization and manipulation a difficult task. Overexposure to radiation and use of risk-prone contrast agent also compromise surgeons’ and patients’ health. Alternative approaches using embedded electromagnetic (EM) sensors have been developed to overcome the limitations of fluoroscopy-based interventions. As only a finite number of sensors can be integrated within a catheter, methods that rely on such sensors require the use of interpolation schemes to recover the catheter shape. Since EM sensors are sensitive to external interferences, the outcome is not robust. This paper introduces a probabilistic framework that improves the catheter localization and reduces the dependency on fluoroscopy and contrast agents. Within this framework, the dense 2D information extracted from fluoroscopic images is combined with the discrete pose information of EM sensors to provide a reliable reconstruction of the full three-dimensional catheter shape. Validation in a physics-based simulation environment and in a real-world experimental setup provides promising results and indicates that the proposed framework allows reconstructing the 3D catheter shape with a median root-mean-square error of 3.7[Formula: see text]mm with an interquartile range of 0.3[Formula: see text]mm.

Cardiovascular surgeons increasingly resort to catheter-based diagnostic and therapeutic interventions because of their limited invasiveness. Although, these approaches allow treatment of patients considered unfit for conventional open surgery, exposure to radiation and high procedural complexity could lead to complications. These factors motivated the introduction of robotic technology offering more dexterous catheters, enhanced visualization and opening new possibilities in terms of guidance and coordinated control. In addition to improvements of patient outcome, through teleoperated catheter control radiation exposure of surgeons can be reduced. In order to limit surgical workload, intuitive mappings between joystick input and resulting catheter motion are essential. This paper presents and compares two proposed mappings and investigates the benefits of additional visual guidance. The comparison is based on data gathered during an experimental campaign involving 14 novices and three surgeons. The participants were asked to perform an endovascular task in a virtual reality simulator presented in the first part of this paper. Statistical results show significant superiority of one mapping with respect to the other and a significant improvement of performance thanks to additional visual guidance. Future work will focus on translating the results to a physical setup for surgical validation, also the learning effect will be analyzed more in-depth.

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Advances in miniaturized surgical instrumentation are key to less demanding and safer medical interventions. In cardiovascular procedures interventionalists turn towards catheter-based interventions, treating patients considered unfit for more invasive approaches. A positive outcome is not guaranteed. The risk for calcium dislodgement, tissue damage or even vessel rupture cannot be eliminated when instruments are maneuvered through fragile and diseased vessels. This paper reports on the progress made in terms of catheter design, vessel reconstruction, catheter shape modeling, surgical skill analysis, decision-making and control. These efforts are geared towards the development of the necessary technology to autonomously steer catheters through the vasculature, a target of the EU-funded project CASCADE (Cognitive AutonomouS CAtheters operating in Dynamic Environments). Whereas autonomous placement of an aortic valve implant forms the ultimate and concrete goal, the technology of individual building blocks to reach such ambitious goal is expected to be much sooner impacting and assisting interventionalists in their daily clinical practice.