Integration of trans-esophageal echocardiography with magnetic tracking technology for cardiac interventions

Abstract

Trans-esophageal echocardiography (TEE) is a standard component of patient monitoring during most cardiac surgeries. In recent years magnetic tracking systems (MTS) have become sufficiently robust to function effectively in appropriately structured operating room environments. The ability to track a conventional multiplanar 2D TEE transducer in 3D space offers incredible potential by greatly expanding the cumulative field of view of cardiac anatomy beyond the limited field of view provided by 2D and 3D TEE technology. However, there is currently no TEE probe manufactured with MTS technology embedded in the transducer, which means sensors must be attached to the outer surface of the TEE. This leads to potential safety issues for patients, as well as potential damage to the sensor during procedures. This paper presents a standard 2D TEE probe fully integrated with MTS technology. The system is evaluated in an environment free of magnetic and electromagnetic disturbances, as well as a clinical operating room in the presence of a da Vinci robotic system. Our first integrated TEE device is currently being used in animal studies for virtual reality-enhanced ultrasound guidance of intracardiac surgeries, while the "second generation" TEE is in use in a clinical operating room as part of a project to measure perioperative heart shift and optimal port placement for robotic cardiac surgery. We demonstrate excellent system accuracy for both applications.

Ultrasound image guidance of cardiac interventions

“…ICE transducers may be integrated with ablative devices within the same catheter, 52 or magnetic tracking sensors may need to be integrated within the probe housing of transesophageal transducers. 53 Standardization of validation methodologies are also required to ensure proper comparison of different assessments conducted by different groups. 54 While a wide variety of techniques have been validated in the laboratory or in animal models, as their development continues, more systems will reach the stage where human testing and clinical trials will become necessary.…”

On mixed reality environments for minimally invasive therapy guidance: Systems architecture, successes and challenges in their implementation from laboratory to clinic

“…Despite their real-time benefits and high-quality images, systems that rely on real-time MRI guidance are not only expensive and require special infrastructure for implementation, but also hamper the clinical workflow due to their incompatibility with the OR instrumentation. Moreover, if surgical tracking is employed, the delivery instruments must be built or adapted from existing clinical tools, such that they incorporate the tracking sensors [145]. In addition, most off-the-shelf surgical instruments do not comply with the “ferromagnetic free environment” requirement imposed by the presence of magnetic tracking technologies in the OR.…”

On-demand calibration and evaluation for electromagnetically tracked laparoscope in augmented reality visualization

“…Another real-time tracking method without the line-of-sight restriction is electromagnetic (EM) tracking, which reports the location and orientation of a wired positional sensor inside a 3D working volume with magnetic field, created by a field generator. Many groups have measured the accuracy of EM tracking in clinical settings [15–17], as well as configurations in which an EM sensor is embedded in imaging probes [18]. However, the use of EM tracking in a clinical laparoscopic AR system has not been reported and remains challenging.…”