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Transjugular intrahepatic portosystemic shunt formation (TIPS) is an effective treatment for portal hypertension [LaBerge 1995]. The procedure requires the insertion of a needle through the liver to connect the hepatic and portal veins. This operation is traditionally guided by fluoroscopic images that do not show the location of the target veins during needle insertion. We propose to provide the clinician an interactive, three-dimensional (3D), stereo display so that the position and orientation of the clinician's needle can be seen relative to the target vasculature intraoperatively. This paper describes the visualizations we are providing for intraoperative guidance.

Abstract. We present a new metric for registering 3D images of vasculature, and we analyze the rigid-body transformation parameter space of that metric and its derivatives. To quantify and direct a source image's alignment with a target image, this new vascular-image registration system models the vessels in the source image and makes measurements in the target image at a sparse set of transformed points from the centerlines of those models. The system is fast and effective because the measures made at the transformed centerline points incorporate the general geometric properties of tubes and specific model-quality information calculated during the vessel model generation process. Additionally, by adjusting the sample density or scaling the centerline point measures, coarse-tofine registration strategies are directly enabled. We present visualizations of the metric and its derivatives over a range of mis-registrations given different sample densities and different measure scalings using magnetic resonance angiograms, x-ray computed tomography images, and 3D ultrasound images.

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