Determination of optimal viewing regions for X-ray coronary angiography based on a quantitative analysis of 3D reconstructed models

Abstract

Current expert-recommended views for coronary angiography are based on heuristic experience and have not been scientifically studied. We sought to identify optimal viewing regions for first and second order vessel segments of the coronary arteries that provide optimal diagnostic value in terms of minimizing vessel foreshortening and overlap. Using orthogonal 2D images of the coronary tree, 3D models were created from which patient-specific optimal view maps (OVM) allowing quantitative assessment of vessel foreshortening and overlap were generated. Using a novel methodology that averages 3D-based optimal projection geometries, a universal OVM was created for each individual coronary vessel segment that minimized both vessel foreshortening and overlap. A universal OVM model for each coronary segment was generated based on data from 137 patients undergoing coronary angiography. We identified viewing regions for each vessel segment achieving a mean vessel foreshortening value of 5.8 +/- 3.9% for the left coronary artery (LCA) and 5.6 +/- 3.6% for the right coronary artery (RCA). The overall mean overlap values achieved were 8.7 +/- 7.9% for the LCA and 4.6 +/- 3.2% for the RCA. This scientifically-based OVM evaluation of coronary vessel segments provides the means to facilitate acquisitions during coronary angiography and interventions that minimize imaging inaccuracies related to foreshortening and overlap, improving the accuracy, efficiency, and safety of diagnostic and interventional coronary procedures.

A Novel Dual‐Axis Rotational Coronary Angiography Evaluation of Coronary Artery Disease — Case Presentation and Review

“…4 -6 By providing potentially 360 acquisition frames, RA may lead to a more comprehensive evaluation of the coronary tree. 2 Overall, RA demonstrates several advantages in comparison to SA by providing a mental 3D impression of the Clinical Investigations continued Figure 2. Dual-axis rotational coronary angiography of the left coronary system demonstrated severe 3-vessel coronary artery disease.…”

“…DARCA has evolved from the generation of optimal view maps (OVMs) that demonstrate the angiographic projections in which various coronary segments are optimally visualized. 2 More specifically, these OVMs per vessel segment were generated from 3D coronary reconstruction analysis of the angiographic images in an effort to delineate gantry positions that exhibit the greatest to the least amount of vessel foreshortening and overlap ( Figure 3). Using these OVMs, computer-generated or facilitated views of coronary vessels have been found to be superior to operator-derived images further highlighting the limitations of SA.…”

Calibration‐free device sizing using an inverse geometry x‐ray system

“…These methods may use a priori assumptions to model coronaries, [26][27][28][29] while others use volumetric reconstruction techniques. 30,31 In terms of device sizing, 3D reconstructions may be used to determine optimal angiographic views that minimize foreshortening and overlap, 32 which may improve conventional QCA results. Vessel bifurcation angles and tortuosity can also be quantified from 3D reconstructions, which may help support interventional decision making.…”

Dual-Axis Rotational Angiography is Safe and Feasible to Detect Coronary Allograft Vasculopathy in Pediatric Heart Transplant Patients: A Single-Center Experience

“…This technique involves a rapid rotational movement of a single imaging camera through a complex 80°arc during a single injection, allowing for visualization of the coronary arterial vasculature from multiple viewing angles. This offers significantly more information and allows for three-dimensional imaging of the vasculature [2,8,12,13] [1, 3-5, 9, 15-17]. Its use has not been well described in the pediatric population.…”