Hybrid echo and x-ray image guidance for cardiac catheterization procedures by using a robotic arm: a feasibility study

Abstract

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.

Real‐time x‐ray fluoroscopy‐based catheter detection and tracking for cardiac electrophysiology interventions

“…Anatomical information from live 3D echo can also be combined with x-ray fluoroscopy for navigational purposes. 8,9 A review of these image fusion techniques can be found in Ref. 10.…”

A novel Bayesian respiratory motion model to estimate and resolve uncertainty in image-guided cardiac interventions

“…Our method provides a framework for using echo data to estimate respiratory motion, which could be used in combination with a robotic arm (Ma et al, 2010) for automatic acquisition of the 3D live echo images during the procedure. In principle, the Bayesian model could be used without the measurement of the respiratory surrogate during the procedure, since the surrogate is optimised as part of the maximisation of the posterior probability.…”

“…One possible approach is to combine high spatial resolution images acquired in the pre-procedural phase, such as Magnetic Resonance Imaging (MRI) (De Buck et al, 2005;Rhode et al, 2005;Yu et al, 2005) or Computed Tomography (CT) (Sra et al, 2007;Knecht et al, 2008;Ector et al, 2008), with high temporal resolution X-ray fluoroscopy images acquired during the procedure. Interest in the use of echocardiography (echo) imaging as an intra-procedure modality has grown over the last few years (Grau et al, 2007;Linte et al, 2008;Wein et al, 2009;Ma et al, 2010;Noble et al, 2011;Gao et al, 2012) due to its high temporal resolution, non-invasive nature and low cost. However, echo images are affected by various artefacts and echo image quality strongly depends on the sonographer's experience and the subject's anatomy.…”

Modeling and Registration for Electrophysiology Procedures Based on Three-Dimensional Imaging

“…Two approaches are possible: firstly, indirect registration via a registered CT or MR dataset [52,53] or direct registration via a tracked echo probe (Fig. 5) [54,55].…”