Monoplane 3D Overlay Roadmap versus Conventional Biplane 2D Roadmap Technique for Neurointervenional Procedures

Jang, Dong-Kyu; Stidd, David A.; Schäfer, Sebastian; Chen, Michael; Moftakhar, Roham; Lopes, Demetrius K.

doi:10.5469/neuroint.2016.11.2.105

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…In these publications, volumes used for 3D-roadmapping were mainly extracted from pre-op imaging (Zhang et al 2017 ; Ruijters et al 2011 ; Zhang et al 2016 ; Kishore et al 2020 ), with no time constraint to segment the structures of interest, but inherent risks of misregistration due to change in patient position. In some other studies, the whole vasculature from the CBCT was used as overlay (Blanc et al 2015 ; Jang et al 2016 ), as careful segmentation of the targeted vessels was too time-consuming to be performed intraoperatively. In this scenario, the interest in using augmented fluoroscopy might be limited due to many vessels overlapping on the 3D roadmap and causing cluttered visualization.…”

Section: Discussionmentioning

confidence: 99%

Simulation of superselective catheterization for cerebrovascular lesions using a virtual injection software

Sundararajan

Ranganathan

Kishore³

et al. 2021

CVIR Endovasc

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Background This report addresses the feasibility of virtual injection software based on contrast-enhanced cone-beam CTs (CBCTs) in the context of cerebrovascular lesion embolization. Intracranial arteriovenous malformation (AVM), dural arteriovenous fistula (AVF) and mycotic aneurysm embolization cases with CBCTs performed between 2013 and 2020 were retrospectively reviewed. Cerebrovascular lesions were reviewed by 2 neurointerventionalists using a dedicated virtual injection software (EmboASSIST, GE Healthcare; Chicago, IL). Points of Interest (POIs) surrounding the vascular lesions were first identified. The software then automatically displayed POI-associated vascular traces from vessel roots to selected POIs. Vascular segments and reason for POI identification were recorded. Using 2D multiplanar reconstructions from CBCTs, the accuracy of vascular traces was assessed. Clinical utility metrics were recorded on a 3-point Likert scale from 1 (no benefit) to 3 (very beneficial). Results Nine cases (7 AVM, 1 AVF, 1 mycotic aneurysm) were reviewed, with 26 POIs selected. Three POIs were in 2nd order segments, 8 POIs in 3rd order segments and 15 POIs in 4th order segments of their respective arteries. The reviewers rated all 26 POI traces – involving a total of 90 vascular segments – as accurate. The average utility score across the 8 questions were 2.7 and 2.8 respectively from each reviewer, acknowledging the software’s potential benefit in cerebrovascular embolization procedural planning. Conclusion The operators considered CBCT-based virtual injection software clinically useful and accurate in guiding and planning cerebrovascular lesion embolization in this retrospective review. Future prospective studies in larger cohorts are warranted for validation of this modality.

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Section: Discussionmentioning

confidence: 99%

Simulation of superselective catheterization for cerebrovascular lesions using a virtual injection software

Sundararajan

Ranganathan

Kishore³

et al. 2021

CVIR Endovasc

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“… 16 The most frequent and the easiest way of reducing the dose is optimization of existing parameters of fluoroscopy and angiography. 16 – 19 Spot fluoroscopy, a qualitatively new type of asymmetric collimation, represents a breakthrough in the technology of dose-reduction systems. 20 …”

Section: Discussionmentioning

confidence: 99%

Flexible lateral isocenter: A novel mechanical functionality contributing to dose reduction in neurointerventional procedures

Borota

Patz²

2017

Interv Neuroradiol

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Aim of the study A new functionality that enables vertical mobility of the lateral arm of a biplane angiographic machine is referred to as the flexible lateral isocenter. The aim of this study was to analyze the impact of the flexible lateral isocenter on the air-kerma rate under experimental conditions. Material and methods An anthropomorphic head-and-chest phantom with anteroposterior (AP) diameter of the chest varying from 22 cm to 30 cm simulated human bodies of different body constitutions. The angulation of the AP arm in the sagittal plane varied from 35 degrees to 55 degrees for each AP diameter. The air-kerma rate (mGy/min) values were read from the system dose display in two settings for each angle: flexible lateral isocenter and fixed lateral isocenter. Results The air-kerma rate was significantly lower for all AP diameters of the chest of the phantom when the flexible lateral isocenter was used: (a) For 22 cm, the p value was 0.028; (b) For 25 cm, the p value was 0.0169; (c) For 28 cm, the p value was 0.01005 and (d) For 30 cm, the p value was 0.01703. Conclusion Our results show that the flexible lateral isocenter contributes significantly to the reduction of the air-kerma rate, and thus to a safer environment in terms of dose lowering both for patients and staff.

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“…Most vendors of interventional C-arm systems provide tools to overlay 3D roadmaps onto 2D X-ray displays. [25][26][27] However, navigating devices using a constantly moving roadmap can be challenging and the simultaneous display of respiratory motion and navigational device motion may be distracting to physicians. Removing motion in X-ray image sequences is used to improve the visibility of stents 28,29 using the CLEARstent technology (Siemens Healthineers, Forchheim, Germany), where adjacent image frames are registered based on two markers attached to the ends of the stent and subsequently averaged.…”

Section: Introductionmentioning

confidence: 99%

“…The visualization of motion compensated roadmaps has not been the focus of many previous publications. Most vendors of interventional C‐arm systems provide tools to overlay 3D roadmaps onto 2D X‐ray displays 25–27 . However, navigating devices using a constantly moving roadmap can be challenging and the simultaneous display of respiratory motion and navigational device motion may be distracting to physicians.…”

Section: Introductionmentioning

confidence: 99%

Real‐time respiratory motion compensated roadmaps for hepatic arterial interventions

et al. 2021

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Purpose During hepatic arterial interventions, catheter or guidewire position is determined by referencing or overlaying a previously acquired static vessel roadmap. Respiratory motion leads to significant discrepancies between the true position and configuration of the hepatic arteries and the roadmap, which makes navigation and accurate catheter placement more challenging and time consuming. The purpose of this work was to develop a dynamic respiratory motion compensated device guidance system and evaluate the accuracy and real‐time performance in an in vivo porcine liver model. Methods The proposed device navigation system estimates a respiratory motion model for the hepatic vasculature from prenavigational X‐ray image sequences acquired under free‐breathing conditions with and without contrast enhancement. During device navigation, the respiratory state is tracked based on live fluoroscopic images and then used to estimate vessel deformation based on the previously determined motion model. Additionally, guidewires and catheters are segmented from the fluoroscopic images using a deep learning approach. The vessel and device information are combined and shown in a real‐time display. Two different display modes are evaluated within this work: (1) a compensated roadmap display, where the vessel roadmap is shown moving with the respiratory motion; (2) an inverse compensated device display, where the device representation is compensated for respiratory motion and overlaid on a static roadmap. A porcine study including seven animals was performed to evaluate the accuracy and real‐time performance of the system. In each pig, a guidewire and microcatheter with a radiopaque marker were navigated to distal branches of the hepatic arteries under fluoroscopic guidance. Motion compensated displays were generated showing real‐time overlays of the vessel roadmap and intravascular devices. The accuracy of the motion model was estimated by comparing the estimated vessel motion to the motion of the X‐ray visible marker. Results The median (minimum, maximum) error across animals was 1.08 mm (0.92 mm, 1.87 mm). Across different respiratory states and vessel branch levels, the odds of the guidewire tip being shown in the correct vessel branch were significantly higher (odds ratio = 3.12, p < 0.0001) for motion compensated displays compared to a noncompensated display (median probabilities of 86 and 69%, respectively). The average processing time per frame was 17 ms. Conclusions The proposed respiratory motion compensated device guidance system increased the accuracy of the displayed device position relative to the hepatic vasculature. Additionally, the provided display modes combine both vessel and device information and do not require the mental integration of different displays by the physician. The processing times were well within the range of conventional clinical frame rates.

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Monoplane 3D Overlay Roadmap versus Conventional Biplane 2D Roadmap Technique for Neurointervenional Procedures

Cited by 6 publications

References 12 publications

Simulation of superselective catheterization for cerebrovascular lesions using a virtual injection software

Simulation of superselective catheterization for cerebrovascular lesions using a virtual injection software

Flexible lateral isocenter: A novel mechanical functionality contributing to dose reduction in neurointerventional procedures

Real‐time respiratory motion compensated roadmaps for hepatic arterial interventions

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