Abstract
A major challenge during endovascular interventions is visualising the position and orientation of the catheter being inserted. This is typically achieved by intermittent X-ray imaging. Since the radiation exposure to the surgeon is considerable, it is desirable to reduce X-ray exposure to the bare minimum needed. Additionally, transferring two-dimensional (2D) X-ray images to 3D locations is challenging. The authors present the development of a real-time navigation framework, which allows a 3D holographic view of the vascular system without any need of radiation. They extract the patient's surface and vascular tree from pre-operative computed tomography data and register it to the patient using a magnetic tracking system. The system was evaluated on an anthropomorphic full-body phantom by experienced clinicians using a four-point questionnaire. The average score of the system (maximum of 20) was found to be 17.5. The authors’ approach shows great potential to improve the workflow for endovascular procedures, by simultaneously reducing X-ray exposure. It will also improve the learning curve and help novices to more quickly master the required skills.
Highlights
Over the last two decades, interventional endovascular stenting of aortic aneurysm has progressed from being a single-centre intervention to a standard procedure in many countries [1, 2]
Material and methods: We report the development of a real-time navigation software, which allows a 3D view of the vascular system without any need of radiation
The visualisation of vessels, and spatial position and orientation of surgical tools during interventional endovascular stenting of aortic aneurysm has become of crucial importance for the success of this minimally invasive procedure
Summary
Over the last two decades, interventional endovascular stenting of aortic aneurysm has progressed from being a single-centre intervention to a standard procedure in many countries [1, 2]. One integral part for the success of this minimally invasive procedure is innovative and improved vascular imaging. One of the largest difficulties in learning and performing this interventional therapy is the fact that the vascular surgeon has to mentally overlay the three-dimensional (3D) vascular tree with the 2D angiographic scene. While endovascular techniques are improving, imaging during the procedure is still dependent on contrast agents and X-rays with their known disadvantages. Looking at actual development trends towards radiation free localisation of endovascular tools, the visualisation and proper integration of this spatial information will become a key technology [3]. Our work is an integral part of the development of a novel and fully X-ray free approach to perform these interventions. Even though sparing the patient is an important goal, it is even more important to reduce the surgeon’s exposure to ionising radiation
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