Novel system for real-time integration of 3-D echocardiography and fluoroscopy for image-guided cardiac interventions: Preclinical validation and clinical feasibility evaluation

Arujuna, Aruna V.; Housden, R. James; Ma, Yingliang; Rajani, Ronak; Gao, Gang; Nijhof, Niels; Cathier, Pascal; Bullens, Roland; Gijsbers, Geert; Parish, Victoria; Kapetanakis, Stamatis; Hancock, Jane; Rinaldi, C. Aldo; Cooklin, Michael; Gill, Jaswinder; Thomas, Martyn; O'Neill, Mark D.; Razavi, Reza; Rhode, Kawal S.

Abstract

© 2015 IEEE. Real-time imaging is required to guide minimally invasive catheter-based cardiac interventions. While transesophageal echocardiography allows for high-quality visualization of cardiac anatomy, X-ray fluoroscopy provides excellent visualization of devices. We have developed a novel image fusion system that allows real-time integration of 3-D echocardiography and the X-ray fluoroscopy. The system was validated in the following two stages: 1) preclinical to determine function and validate accuracy; and 2) in the clinical setting to assess clinical workflow feasibility and determine overall system accuracy. In the preclinical phase, the system was assessed using both phantom and porcine experimental studies. Median 2-D projection errors of 4.5 and 3.3 mm were found for the phantom and porcine studies, respectively. The clinical phase focused on extending the use of the system to interventions in patients undergoing either atrial fibrillation catheter ablation (CA) or transcatheter aortic valve implantation (TAVI). Eleven patients were studied with nine in the CA group and two in the TAVI group. Successful real-time view synchronization was achieved in all cases with a calculated median distance error of 2.2 mm in the CA group and 3.4 mm in the TAVI group. A standard clinical workflow was established using the image fusion system. These pilot data confirm the technical feasibility of accurate real-time echo-fluoroscopic image overlay in clinical practice, which may be a useful adjunct for real-time guidance during interventional cardiac procedures.

• Journal Article Type: Article
• Publication Date: Jan 1, 2014
• Deposit Date: Mar 12, 2015
• Publicly Available Date: Apr 12, 2016
• Journal: IEEE Journal of Translational Engineering in Health and Medicine
• Electronic ISSN: 2168-2372
• Publisher: Institute of Electrical and Electronics Engineers (IEEE)
• Peer Reviewed: Peer Reviewed
• Volume: 2
• DOI: https://doi.org/10.1109/JTEHM.2014.2303799
• Keywords: 3D ultrasound, cardiac interventional guidance, X-ray fluoroscopy, clinical evaluation, image fusion
• Public URL: https://uwe-repository.worktribe.com/output/812432
• Publisher URL: http://dx.doi.org/10.1109/JTEHM.2014.2303799
• Additional Information: Additional Information : (c) 2014 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other users, including reprinting/ republishing this material for advertising or promotional purposes, creating new collective works for resale or redistribution to servers or lists, or reuse of any copyrighted components of this work in other works.
• Contract Date: Apr 12, 2016