Navigation and positioning aids for intracoronary interventions [Elektronische Ressource] = Navigations- und Positionierhilfen für intrakoronare Interventionen / vorgelegt von Bárbara Martín Leung

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• Publié par: rheinisch-westfalischen_technischen_hochschule_-rwth-_aachen
• Publié le: 01 janvier 2009
• Nombre de lectures: 7
• Langue: English
• Poids de l'ouvrage: 8 Mo

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Navigation and Positioning
Aids for Intracoronary Interventions
Navigations- und Positionierhilfen
fur intrakoronare Interventionen˜
Von der Fakultat˜ fu˜r Elektrotechnik und Informationstechnik
der Rheinisch-Westfalischen Technischen Hochschule Aachen˜
zur Erlangung des akademischen Grades einer
Doktorin der Ingenieurwissenschaften genehmigte Dissertation
vorgelegt von
B¶arbara Mart¶‡n Leung
Ingeniera Superior de Telecomunicacio¶n aus Madrid
Berichter: Universitatprofessor Dr.-Ing. Til Aach˜
Universit˜atprofessor Dr.-Ing. Georg Schmitz
Tag der mun˜ lichen Pru˜fung: 10. Juli 2009
Diese Dissertation ist auf den Internetseiten der Hochschulbibliothek online
verfu˜gbarTo my mom, the bravest person I know.Acknowledgements
This thesis is the result of the work carried out during my PhD studies at
the Philips Research Laboratories in Aachen (Germany) and Philips Medi-
cal Systems in Best (The Netherlands) through several years. Many of the
results described in this dissertation were possible because of the support of
a lot of people and I would like to use this opportunity to thank them.
First, I would like to thank Prof. Dr.-Ing. Til Aach for giving me the
opportunity to do my PhD thesis in cooperation with an industrial partner
underhisguidance, flrstfromLub˜ eckUniversityandlateratRWTHAachen
University. I am also grateful to Prof. Dr.-Ing. Georg Schmizt for being the
co-examiner in the jury.
I want to thank Falko Busse and Michael Overdick for their continued
interest in my work and the support they provided. I am indebted to my
project colleagues, Kai Eck and Jor˜ g Bredno, for their guidance. Alexandra
GrothandSabineMollus,youcontributedwithcountlessfruitfuldiscussions.
I am grateful for the very interesting discussions and ideas that en-
sued therefrom to our colleagues at Philips Medical Systems, Peter van den
Houten, Wiet Lie and Rens Schoones. And then there is a multitude of
colleagues I would like to thank at Philips Research Aachen: every single
member of the Imaging Systems group for making work a really enjoyable
experience, Salvador Boleko, Mark Carpaij, Toni L¶opez and David S¶anchez
for showing me how to look at things through difierent eyes.
My very special thanks go to my gang in Aachen, who have supported
me through thick and through thin, specially to Daniel Totev, also a PhD
student at the time, for teaching me how to look on the bright side of life.
And last, but not least, to JL-Baobei, for enduring countless rehearsals and
paying attention during each one of them!Zusammenfassung
Perkutane transluminale koronare Angioplastie ist die derzeit meistgenutz-
te Behandlungsmethode fur koronare Herzkrankheit. Zur Lokalisierung der˜
Gefa…˜ verengungen werden prai˜nterventionelle Ron˜ tgenbilder aufgenommen,
in denen die Koronararterien mit einem radio-opaken Kontrastmittel gefullt˜
sind. Eins dieser Bilder wird auf einem Monitor angezeigt und dient als Na-
vigationshilfe wahrend der Intervention. Gleichzeitig werden interventionelle˜
Bewegt-R˜ontgenbilder auf einem zweiten Monitor in Echtzeit angezeigt, wo-
bei es dem behandelnden Arzt obliegt, die beiden Bilddaten auf den beiden
verschiedenenMonitorenzukorrelierenunddiejeweiligePositiondesKathe-
ters zu bestimmen. Die Navigationsaufgabe wird durch die kontinuierliche
Bewegung des Herzens im Brustkorb und die statischen Gefa…baume der˜ ˜
prai˜nterventionellen Ron˜ tgenbilder erschwert.
ZieldieserArbeitistdieEntwicklungvonbildgestu˜tztenunterstut˜ zenden
Systemen zur Navigation und Positionierung von Herzkathetern. Dies wird
erreicht durch Synchronisieren der prai˜nterventionellen Cine-Angiographie
˜mit der interventionellen Fluoroskopie, und Uberlagern der so synchroni-
sierten Angiographie mit der Fluoroskopie. Zur weiteren Verbesserung der
Katheter-Positionierung kann Information aus intravaskularem Ultraschall˜
(IVUS)eingebrachtwerden.DieSynchronisationvonAngiographieundFluo-
roskopie basiert auf der Registrierung von Atmung und Herzzyklus. Erstere
erfolgt durch multimodale Bildregistrierung auf der Basis von Mutual Infor-
mation,letztereaufBasisdesEKG-Signals.Atmungs-undHerzzyklusbeider
BilddatenwerdendannineinzweidimensionalesDiagrameingetragen,indem
benachbartePunktedanndieAuswahlvonEinzelbildernausdenbeidenMo-
dalitaten mit ahnlicher Herz- und Atemphase erlauben. Die IVUS-Bilddaten˜ ˜
werden ebenfalls durch Kompensation von Atmung und Herzzyklus auf die
PositionderIVUS-SondeindenAngiogrammenbezogen.UnvermeidbareLo-
kalisierungsfehlerwerdendurcheineFeinregistrierungvonSondeundGefa…e˜ n
reduziert,daru˜berwirdeinAnsatzzurRekonstruktiondesPullback-Wegsder
Sonde vorgestellt. Diese Algorithmen werden mittels eines Herz-Phantoms
unter R˜ontgenbildgebung getestet, wobei sich ein Restfehler von ca. 2mm
ergibt. Schlie…lich wird eine exible Software-Architektur vorgestellt, die den
Transfer der Ergebnisse in einen klinischen Echtzeit-Demonstrator ermog˜ -
licht.Abstract
Percutaneous Transluminal Coronary Angioplasty is currently the preferred
method for treatment of coronary artery disease in vivo. X-ray images of
the coronary arteries fllled with a radio-opaque contrast dye are acquired to
localise the lesion. One of these images is displayed on a monitor and will
serve as roadmap to navigate the interventional instruments under constant
x-ray surveillance. The interventional images are displayed in real-time on a
second monitor next to the roadmap monitor. It depends on the physician’s
ability to correlate the images on both monitors and estimate the actual po-
sition of the guidewire within the vessel tree in order to steer it further. The
navigation task is hindered by the constant movement of the heart within
the chest cavity and the static nature of the angiographic roadmap.
Themaingoalofthisworkistopresentanovelimageregistrationframe-
work to enable navigation and positioning aids for cardiac catheterisation
procedures to reduce interventional time. This task is accomplished by en-
hancing the visualisation of the procedure by means of overlaying onto each
interventionalframearoadmapthatexhibitsthecoronaryvesselsinasimilar
position and with a similar shape, and by fusing information acquired from
Intravascular Ultrasound (IVUS). To this end, we characterise each acquired
frame by a heart state vector, which main components are respiration state
and heart contraction state . The latter is calculated from the ECG signal,
and we propose and evaluate a multimodality similarity measure based on
mutual information to measure the respiration state from the image content.
Withthesetwocharacteristicparameters,eachimagecanberepresentedina
two-dimensional graph where nearby points represent images that show the
heart in a similar state and position. Furthermore, methods to reflne the
registration of the vessels visible in the roadmap and the instrument visible
intheinterventionalframesbyrespirationcompensationandaccuratedevice
to vessel registration are proposed. A exible software architecture is devel-
opedtoeasetransferfromresearchactivitiestoaclinicalsettingandtestthe
real-time performance of these algorithms.
To aid accurate positioning, we present a novel multimodality applica-
tion to fuse IVUS and projection x-ray images. IVUS images are related
to their acquisition locations in the diagnostic angiograms or to instrument
positions during the intervention by means of respiration compensation and
accurate device to vessel registration. A reconstruction algorithm of thethree-dimensional pullback path for projection x-ray sequences is also pro-
posed. The two-dimensional registration algorithm for IVUS and angiogra-
phy is tested in a heart phantom.
iiiContents
Zusammenfassung i
Abstract i
List of acronyms ix
List of flgures xi
1 Introduction 2
1.1 Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2 Statement of the problem . . . . . . . . . . . . . . . . . . . . 6
1.3 Document structure . . . . . . . . . . . . . . . . . . . . . . . . 7
2 Background 9
2.1 Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.2 Plaque formation . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.3 Minimally invasive techniques for diagnosis and treatment of
CAD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.3.1 X-ray imaging . . . . . . . . . . . . . . . . . . . . . . . 13
2.3.2 X-ray for cardiac imaging . . . . . . . . . . . . . . . . 16
2.3.3 The catheterisation laboratory . . . . . . . . . . . . . . 17
2.3.4 X-ray (cine)angiography for diagnosis . . . . . . . . . . 17
2.3.5 X-ray uoroscopy for treatment . . . . . . . . . . . . . 20
2.3.6 Percutaneous Transluminal Coronary Angioplasty . . . 22
2.4 Other imaging techniques . . . . . . . . . . . . . . . . . . . . 24
2.4.1 Computed tomography . . . . . . . . . . . . . . . . . . 24
2.4.2 Magnetic Resonance Imaging . . . . . . . . . . . . . . 26
2.4.3 Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . 27
2.5 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
iv3 Diagnosis and treatment support 31
3.1 State of the art . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.2 Proposed clinical features for Cathlab systems . . . . . . . . . 33
3.2.1 Navigational and navigation support by angiographic
mask overlay . .