Image-guided Applications Research Articles

A Truncated 14-Amino-Acid Myelin Protein-Zero-Targeting Peptide for Fluorescence-Guided Nerve-Preserving Surgery

Background: The occurrence of accidental nerve damage during surgery and the increasing application of image guidance during head-and-neck surgery have highlighted the need for molecular targeted nerve-sparing interventions. The implementation of such interventions relies on the availability of nerve-specific tracers. In this paper, we describe the development of a truncated peptide that has an optimized affinity for protein zero (P0), the most abundant protein in myelin. Methods and Materials: Further C- and N-terminal truncation was performed on the lead peptide Cy5-P0101–125. The resulting nine Cy5-labelled peptides were characterized based on their photophysical properties, P0 affinity, and in vitro staining. These characterizations were combined with evaluation of the crystal structure of P0, which resulted in the selection of the optimized tracer Cy5-P0112–125. A near-infrared Cy7-functionalized derivative (Cy7-P0112–125) was used to perform an initial evaluation of fluorescence-guided surgery in a porcine model. Results: Methodological truncation of the 26-amino-acid lead compound Cy5-P0101–125 resulted in a size reduction of 53.8% for the optimized peptide Cy5-P0112–125. The peptide design and the 1.5-fold affinity gain obtained after truncation could be linked to interactions observed in the crystal structure of the extracellular portion of P0. The near-infrared analogue Cy7-P0112–125 supported nerve illumination during fluorescence-guided surgery in the head-and-neck region in a porcine model. Conclusions: Methodological truncation yielded a second-generation P0-specific peptide. Initial surgical evaluation suggests that the peptide can support molecular targeted nerve imaging.

Assessment of organ and size-specific effective doses from cone beam CT (CBCT) in image-guided radiotherapy (IGRT) based on body mass index (BMI)

The ability of radiation therapy to deliver radiation doses accurately to tumour targets, while sparing normal tissues, has advanced remarkably over recent decades. A development that has been key to achieving this improvement has been the application of image-guidance that facilitates more precise delivery of the prescribed dose to the treatment site. A recent international survey showed that kV cone beam CT (CBCT) is the imaging modality used most widely for image guided radiation therapy (IGRT) procedures. However, IGRT will deliver additional radiation doses to patients that should be considered. The aims of this study were to (1) estimate organ and size-specific effective doses resulting from kV-CBCT chest and pelvis scans based on body mass index (BMI) of the patient, and (2) investigate the influence of patient size on imaging dose. A validated Monte Carlo model developed with BEAMnrc/EGSnrc was employed to simulate kV spectra generated by Varian on-board imaging (OBI) system. Organ and size-specific effective doses were assessed for adult phantoms in the National Cancer Institute (NCI) phantom library using DOSXYZnrc/EGSnrc code. The library has been reconstructed from images of CT patients, and contains 100 male and 93 female phantoms of a wide range of sizes. The phantoms were grouped into six categories based on body mass index (BMI) as classified by the world health organization. For all sizes, average doses to organs that lay fully or partially inside the field of the chest and pelvic scans were in the range of (0.20–3.06 mGy/100 mAs) and (0.17–4.47 mGy/100 mAs), and size-specific effective doses were (0.63 – 1.78 mSv/100 mAs) and (0.30 – 1.17 mSv/100 mAs), respectively. Patient size played a significant role in determining the imaging doses resulting from both scans. In general, organ and effective doses of chest and pelvic scans of thin patients were about 2–3 times larger than those of obese patients, with the impact of patient size on pelvis doses being slightly higher than on chest ones. Results of this study suggests that patient size should be taken into consideration when estimation and optimization of the imaging doses resulting from CBCT. Although development of patient size-specific CBCT protocols is a practical approach that can account for patient size, it has not been implemented worldwide. Results from this investigation might be used as a simple approach to obtain an estimation of the imaging doses for patients of various sizes based on BMI.

Using a Further Planning MRI after Neoadjuvant Androgen Deprivation Therapy Significantly Reduces the Radiation Exposure of Organs at Risk in External Beam Radiotherapy of Prostate Cancer.

Radiotherapy for prostate cancer is often preceded by neoadjuvant androgen deprivation therapy (ADT), which leads to a reduction in the size of the prostate. This study examines whether it is relevant for treatment planning to acquire a second planning magnetic resonance imaging (MRI) after ADT (=MRI 2) or whether it can be planned without disadvantage based on an MRI acquired before starting ADT (=MRI 1). The imaging data for the radiotherapy treatment planning of 17 patients with prostate cancer who received two planning MRIs (before and after neoadjuvant ADT) were analyzed as follows: detailed comparable radiation plans were created separately, each based on the planning CT scan and either MRI 1 or MRI 2. After ADT for an average of 17.2 weeks, the prostate was reduced in size by an average of 24%. By using MRI 2 for treatment planning, the V60Gy of the rectum could be significantly relieved by an average of 15% with the same coverage of the target volume, and the V70Gy by as much as 33% (compared to using MRI 1 alone). Using a second MRI for treatment planning after neoadjuvant ADT in prostate cancer leads to a significant relief for the organs at risk, especially in the high dose range, with the same irradiation of the target volume, and should therefore be carried out regularly. Waiting for the prostate to shrink after a few months of ADT contributes to relief for the organs at risk and to lowering the toxicity. However, the use of reduced target volumes requires an image-guided application, and the oncological outcome needs to be verified in further studies.

Image-guided Raman spectroscopy navigation system to improve transperineal prostate cancer detection. Part 1: Raman spectroscopy fiber-optics system and in situ tissue characterization.

.SignificanceThe diagnosis of prostate cancer (PCa) and focal treatment by brachytherapy are limited by the lack of precise intraoperative information to target tumors during biopsy collection and radiation seed placement. Image-guidance techniques could improve the safety and diagnostic yield of biopsy collection as well as increase the efficacy of radiotherapy.AimTo estimate the accuracy of PCa detection using in situ Raman spectroscopy (RS) in a pilot in-human clinical study and assess biochemical differences between in vivo and ex vivo measurements.ApproachA new miniature RS fiber-optics system equipped with an electromagnetic (EM) tracker was guided by trans-rectal ultrasound-guided imaging, fused with preoperative magnetic resonance imaging to acquire 49 spectra in situ (in vivo) from 18 PCa patients. In addition, 179 spectra were acquired ex vivo in fresh prostate samples from 14 patients who underwent radical prostatectomy. Two machine-learning models were trained to discriminate cancer from normal prostate tissue from both in situ and ex vivo datasets.ResultsA support vector machine (SVM) model was trained on the in situ dataset and its performance was evaluated using leave-one-patient-out cross validation from 28 normal prostate measurements and 21 in-tumor measurements. The model performed at 86% sensitivity and 72% specificity. Similarly, an SVM model was trained with the ex vivo dataset from 152 normal prostate measurements and 27 tumor measurements showing reduced cancer detection performance mostly attributable to spatial registration inaccuracies between probe measurements and histology assessment. A qualitative comparison between in situ and ex vivo measurements demonstrated a one-to-one correspondence and similar ratios between the main Raman bands (e.g., amide I-II bands, phenylalanine).ConclusionsPCa detection can be achieved using RS and machine learning models for image-guidance applications using in situ measurements during prostate biopsy procedures.

Hybrid (Bovine Serum Albumin)/Poly(N-vinyl-2-pyrrolidone-co-acrylic acid)-Shelled Microbubbles as Advanced Ultrasound Contrast Agents.

Microbubbles are routinely used ultrasound contrast agents in the clinic. While a soft protein shell is commercially preferable for imaging purposes, a rigid polymer shell demonstrates prolonged agent stability. Hence, combining polymers and proteins in one shell composition can advance microbubble properties. We formulated the hybrid "protein-copolymer" microbubble shell with a complex of bovine serum albumin and an amphiphilic copolymer of N-vinyl-2-pyrrolidone and acrylic acid. The resulting microbubbles demonstrated advanced physicochemical and acoustic properties, preserving in vitro biocompatibility. Adjusting the mass ratio between protein and copolymer allowed fine tuning of the microbubble properties of concentration (by two orders, up to 1010 MBs/mL), mean size (from 0.8 to 5 μm), and shell thickness (from 28 to 50 nm). In addition, the minimum air-liquid surface tension for the "protein-copolymer" solution enabled the highest bubble concentration. At the same time, a higher copolymer amount in the bubble shell increased the bubble size and tuned duration and intensity of the contrast during an ultrasound procedure. Demonstrated results exemplify the potential of the hybrid "protein-polymer" microbubble shell, allowing tailoring of microbubble properties for image-guided applications, combining advances of each material involved in the formulation.

PEG2000-DBCO surface coating increases intracellular uptake of liposomes by breast cancer xenografts

Given our interest in the utility of liposomes for molecular imaging and theranostics, we investigated how coating the outer layer of the liposome affects internalization by breast cancer cell lines in vitro and in breast tumor tissues in vivo. Indeed, we discovered that a remarkably high liposomal uptake can be achieved by DBCO (dibenzocyclooctyne) soft coating. Our data demonstrates that decorating the terminal lipid with a DBCO moiety at a specific density induces increased tumor uptake in vivo (tumor uptake ~ 50%) compared to conventional undecorated liposome (tumor uptake ~ 20%). In this study, we report improved visualization of breast cancer cells in vivo using a 4T1 orthotopic breast cancer model and primary breast tumor xenograft models MDA-MB-231 and MDA-MB-436. L-PEG2000-DBCO coated liposomes demonstrate increased accumulation in breast cancer cells independent of tumor size, type, position, receptor expression, as well as the condition of the host mice. We expect these findings to have a major positive impact on the practical utility of liposomes in image-guided applications and precision medicine theranostics.

Photoacoustic-MR Image Registration Based on a Co-Sparse Analysis Model to Compensate for Brain Shift.

Brain shift is an important obstacle to the application of image guidance during neurosurgical interventions. There has been a growing interest in intra-operative imaging to update the image-guided surgery systems. However, due to the innate limitations of the current imaging modalities, accurate brain shift compensation continues to be a challenging task. In this study, the application of intra-operative photoacoustic imaging and registration of the intra-operative photoacoustic with pre-operative MR images are proposed to compensate for brain deformation. Finding a satisfactory registration method is challenging due to the unpredictable nature of brain deformation. In this study, the co-sparse analysis model is proposed for photoacoustic-MR image registration, which can capture the interdependency of the two modalities. The proposed algorithm works based on the minimization of mapping transform via a pair of analysis operators that are learned by the alternating direction method of multipliers. The method was evaluated using an experimental phantom and ex vivo data obtained from a mouse brain. The results of the phantom data show about 63% improvement in target registration error in comparison with the commonly used normalized mutual information method. The results proved that intra-operative photoacoustic images could become a promising tool when the brain shift invalidates pre-operative MRI.

Reconstruction of three-dimensional lumbar vertebrae from biplanar x-rays

Objective. Vertebrae models from computer tomographic (CT) imaging are extensively used in image-guided surgical systems to deliver percutaneous orthopaedic operations with minimum risks, but patients may be exposed to excess radiation from the pre-operative CT scans. Generating vertebrae models from intra-operative x-rays for image-guided systems can reduce radiation exposure to the patient, and the surgeons can acquire the vertebrae’s relative positions during the operation; therefore, we proposed a lumbar vertebrae reconstruction method from biplanar x-rays. Approach. Non-stereo-corresponding vertebral landmarks on x-rays were identified as targets for deforming a set of template vertebrae; the deformation was formulated as a minimisation problem, and was solved using the augmented Lagrangian method. Mean surface errors between the models reconstructed using the proposed method and CT scans were measured to evaluate the reconstruction accuracy. Main results. The evaluation yielded mean errors of 1.27 mm and 1.50 mm in in vitro experiments on normal vertebrae and pathological vertebrae, respectively; the outcomes were comparable to other template-based methods. Significance. The proposed method is a viable alternative to provide digital lumbar to be used in image-guided systems, where the models can be used as a visual reference in surgical planning and image-guided applications in operations where the reconstruction error is within the allowable surgical error.

Characterization of nonlinear field of a dual-mode linear array for image-guided applications of pulsed high-intensity focused ultrasound

Recent studies have shown that nonlinear pulsed high-intensity focused ultrasound (pHIFU) is capable of inducing cavitation, without the need for contrast agents, to enhance drug delivery in tissues with poor perfusion. Here, acoustic characterization of a dual-mode linear array designed for image-guided cavitation-enhanced drug delivery applications is performed. The array consists of 64 elements (1.07 MHz, 14.8 × 51.2 mm2, 0.8 mm pitch) and is controlled by an ultrasound system (V1 Verasonics) configured with an external power supply for pHIFU excitation. Acoustic holography measurement data were collected for varying focus position electronically steered in the transverse and axial directions and used for setting a boundary condition in the acoustic model. Nonlinear simulations of the array field are performed using the Westervelt equation at increasing power outputs of the array. Modelling results are validated by comparing with pressure waveforms measured in the focus using a fiber optic hydrophone. It is shown that the amplitude of the shock fronts formed at the focus increases for larger focusing angles of the field and is sufficient to maintain the therapeutic level of cavitation. Simulation results are in good agreement with the measurement data. [Work supported by NIH R01EB023910 and RSF 20-12-00145.]

Image-guided ray tracing and its applications

Eikonal solvers have important applications in seismic data processing and inversion, the so-called image-guided methods. To this day, in image-guided applications, the solution of the eikonal equation is implemented using partial-differential-equation solvers, such as fast-marching or fast-sweeping methods. We have found that alternatively, one can numerically integrate the dynamic Hamiltonian system defined by the image-guided eikonal equation and reconstruct the solution with image-guided rays. We evaluate interesting applications of image-guided ray tracing to seismic data processing, demonstrating the use of the resulting rays in image-guided interpolation and smoothing, well-log interpolation, image flattening, and residual-moveout picking. Some of these applications make use of properties of the ray-tracing system that are not directly obtained by eikonal solvers, such as ray position, ray density, wavefront curvature, and ray curvature. These ray properties open space for a different set of applications of the image-guided eikonal equation, beyond the original motivation of accelerating the construction of minimum distance tables. We stress that image-guided ray tracing is an embarrassingly parallel problem that makes its implementation highly efficient on massively parallel platforms. Image-guided ray tracing is advantageous for most applications involving the tracking of seismic events and imaging-guided interpolation. Our numerical experiments using synthetic and real data sets indicate the efficiency and robustness of image-guided rays for the selected applications.

Nanodiamond as a fluorescent probe for image-guided application and toxicity evaluations in 2D- and 3D- cellular models

Nanodiamond as a fluorescent probe for image-guided application and toxicity evaluations in 2D- and 3D- cellular models

Using the CustusX toolkit to create an image guided bronchoscopy application: Fraxinus.

PurposeThe aim of this paper is to show how a specialized planning and guidance application called Fraxinus, can be built on top of the CustusX platform (www.custusx.org), which is an open source image-guided intervention software platform. Fraxinus has been customized to meet the clinical needs in navigated bronchoscopy.MethodsThe application requirements for Fraxinus were defined in close collaboration between research scientists, software developers and clinicians (pulmonologists), and built on top of CustusX. Its superbuild system downloads specific versions of the required libraries and builds them for the application in question, including the selected plugins. New functionality is easily added through the plugin framework. The build process enables the creation of specialized applications, adding additional documentation and custom configurations. The toolkit’s libraries offer building blocks for image-guided applications. An iterative development process was applied, where the clinicians would test and provide feedback during the entire process.ResultsFraxinus has been developed and is released as an open source planning and guidance application built on top of CustusX. It is highly specialized for bronchoscopy. The proposed workflow is adapted to the different steps in this procedure. The user interface of CustusX has been modified to enhance information, quality assurance and user friendliness with the intention to increase the overall yield for the patient. As the workflow of the procedure is relatively constant, some actions are predicted and automatically performed by the application, according to the requirements from the clinicians.ConclusionsThe CustusX platform facilitates development of new and specialized applications. The toolkit supports the process and makes important extension and injection points available for customization.

New generation CPPs show distinct selectivity for cancer and noncancer cells.

In the last three decades, many new cell-penetrating peptides (CPPs) were developed that exhibited enhanced cell selectivity. Thus, we aimed to validate the tumor cell selectivity of peptides from this new generation, namely fragments mini-crotamine and mini-maurocalcine. Both of these peptides are derived from venoms. Furthermore, we studied an analog of the classical CPP HIV-TAT(47-57) with alternating chirality of Arg residues. To allow covalent coupling of cargoes or fluorophores, a cysteine residue was introduced to the N-terminus of the synthesized peptides. The therapeutic antibody trastuzumab conjugated to different fluorescent dyes was used for internalization studies. Comparison of uptake efficiencies revealed that CPPs of the new generation are in contrast to MPG-peptides, nearly unable to internalize the noncovalently formed complexes with trastuzumab. Interestingly, the fluorescent derivative of the crotamine fragment was mainly observed in a subpopulation of breast cancer cells, whereas it was homogenously distributed in fibrosarcoma, colon cancer, and noncancerous endothelia cells. Thus, the fluorescent crotamine fragment reported herein is a potent theranostic tool for image-guided applications. This peptide can be used to pinpoint the level of heterogeneity present within tumors and aid in the generation of therapeutics that target heterogenic subpopulations.

Decrease in uterine perforations with ultrasound image-guided applicator insertion in intracavitary brachytherapy for cervical cancer: A systematic review and meta-analysis

PurposeTo estimate uterine perforations rates during intracavitary brachytherapy for cervical cancer with and without ultrasound (US) image guidance. Materials and methodsA systematic search of databases (PubMed and EMBASE) was performed. The pooled summary uterine perforation rate (detected by postinsertion CT or MRI) for the un-guided insertion group and the guided insertion group was calculated by using the random-effects model weighted by the inverse variance. ResultsA total of 690 articles were initially found, resulting in 12 studies that met the inclusion criteria. A total of 1757 insertions and 766 patients were included in the meta-analysis. The overall uterine perforation rate per insertion was 4.56% (95%CI: 2.35–8.67) and per patient was 7.39% (95%CI: 3.92–13.50). The pooled perforation rate per insertion without image guidance was 10.54% (95%CI: 6.12–17.57) versus 1.06% (95%CI: 0.41–2.67) with image guidance (p < 0.01). The pooled perforation rate per patient without guidance was 16.67% (95%CI: 10.01–26.45) versus 2.54% (95%CI: 1.21–5.24) with image guidance (p < 0.01). The ratio of perforations in the un-guided/guided groups was 9.94 and 6.56, per insertion and per patient, respectively. The most common sites of perforation were the posterior wall (>47 events) and the uterine fundus (24 events). None of the studies reported significant acute clinical consequences. Prophylactic antibiotic after perforation was used in 3 of the 4 studies that described the management. ConclusionUsing postinsertion CT or MRI to detect the perforation, the rate of uterine perforation per insertion in patients who received US-guided intracavitary brachytherapy insertion is 90% lower than with un-guided insertion.

High Speed, High Density Intraoperative 3D Optical Topographical Imaging with Efficient Registration to MRI and CT for Craniospinal Surgical Navigation

Intraoperative image-guided surgical navigation for craniospinal procedures has significantly improved accuracy by providing an avenue for the surgeon to visualize underlying internal structures corresponding to the exposed surface anatomy. Despite the obvious benefits of surgical navigation, surgeon adoption remains relatively low due to long setup and registration times, steep learning curves, and workflow disruptions. We introduce an experimental navigation system utilizing optical topographical imaging (OTI) to acquire the 3D surface anatomy of the surgical cavity, enabling visualization of internal structures relative to exposed surface anatomy from registered preoperative images. Our OTI approach includes near instantaneous and accurate optical measurement of >250,000 surface points, computed at >52,000 points-per-second for considerably faster patient registration than commercially available benchmark systems without compromising spatial accuracy. Our experience of 171 human craniospinal surgical procedures, demonstrated significant workflow improvement (41 s vs. 258 s and 794 s, p < 0.05) relative to benchmark navigation systems without compromising surgical accuracy. Our advancements provide the cornerstone for widespread adoption of image guidance technologies for faster and safer surgeries without intraoperative CT or MRI scans. This work represents a major workflow improvement for navigated craniospinal procedures with possible extension to other image-guided applications.

Relevanz der spinalen Navigation in der rekonstruktiven Halswirbelsäulenchirurgie

Spinal navigation has made significant advances in the last two decades. After initial experiences with pedicle screws in the thoracic and lumbar spine, technological improvements have resulted in their increased application in the cervical spine. Instrumentation techniques like cervical pedicle screws, lateral mass screws in C1 and transarticular screws C1/C2 have become standard due to the application of image guidance. Different navigation techniques can be distinguished based on the type of imaging. In the cervical spine, the preoperative computer tomography (CT) scan that requires intraoperative matching is still the standard of care due to the high image quality. 3D fluoroscopy navigation techniques are currently widely used in the lumbar spine, but the reduced image quality obviates the application in the more sophisticated cervical anatomy or the cervicothoracic region. The future availability of intraoperative CT scans (iCT) combines the advantages of high image quality with those of intraoperative image acquisition. This will lead to awider use of image guidance in the cervical spine and will enable the surgeon to apply minimally invasive techniques with higher accuracy. The successful application of spinal navigation is based on the technical knowledge of navigation systems and its exercise in daily routine. Only the sufficient experience of the clinical staff makes it possible to standardize operational procedures to increase patient safety, reduce radiation dose and shorten operation time.

Interventional radiology of glands.

Interventional radiology (IR) is the operative part of radiology providing minimally invasive image-guided diagnosis and treatment of disease. Although the range of procedures performed by interventional radiologists is broad, the unifying concept behind these procedures is the application of image guidance and minimally invasive techniques in order to minimize risk to the patient.

Development of novel adjustable focus head mount display for concurrent image-guided treatment applications

Purpose: A conventional see-through head mount display contains many optical lenses, which can be problematic in image-guided treatment applications due to its size, weight, structure, and focus limitation. Therefore, we have designed a new type of see-through head mount display with a reduced number of optical lenses and an adequate optical resolution that can be utilized for image-guided treatment applications.Materials and methods: A new type of adjustable focus head mount display with expanded virtual images and an external treatment space that can be provided to the eyes of a user by enlarging the images of a small display is designed and investigated in this study. This type of head mount display can be used in image-guided treatment applications because of the dual paths of imaging and treatment from the optical systems. Therefore, this system with an adjustable focus function can aid doctors in obtaining images for the treatment of the eyes of patients because every patient has a unique pupil size.Results: The results of the adjustable focus see-through head mount display showed distortion values of +0.36% in the +1 diopter location and −0.55% in the −4 diopter location, and there are less significant modulation transfer function differences within the ±5 diopter locations.Conclusions: Low optical distortions within ±0.5 diopters can help doctors image the eye conditions of patients through fewer image processing techniques. Therefore, the designed adjustable focus head mount display can provide low optical aberrations and high optical modulation transfer function resolutions for image-guided treatment applications.

Regmentation: A New View of Image Segmentation and Registration

Image segmentation and registration have been the two major areas of research in the medical imaging community for decades and still are. In the context of radiation oncology, segmentation and registration methods are widely used for target structure definition such as prostate or head and neck lymph node areas. In the past two years, 45% of all articles published in the most important medical imaging journals and conferences have presented either segmentation or registration methods. In the literature, both categories are treated rather separately even though they have much in common. Registration techniques are used to solve segmentation tasks (e.g. atlas based methods) and vice versa (e.g. segmentation of structures used in a landmark based registration). This article reviews the literature on image segmentation methods by introducing a novel taxonomy based on the amount of shape knowledge being incorporated in the segmentation process. Based on that, we argue that all global shape prior segmentation methods are identical to image registration methods and that such methods thus cannot be characterized as either image segmentation or registration methods. Therefore we propose a new class of methods that are able solve both segmentation and registration tasks. We call it regmentation. Quantified on a survey of the current state of the art medical imaging literature, it turns out that 25% of the methods are pure registration methods, 46% are pure segmentation methods and 29% are regmentation methods. The new view on image segmentation and registration provides a consistent taxonomy in this context and emphasizes the importance of regmentation in current medical image processing research and radiation oncology image-guided applications.

Toward computer-assisted image-guided congenital heart defect repair: an initial phantom analysis

Radiation exposure in interventional cardiology is an important consideration, due to risk of cancer and other morbidity to the patient and clinical staff. Cardiac catheterizations rely heavily on fluoroscopic imaging exposing both patient and clinician to ionizing radiation. An image-guided surgery system capable of facilitating cardiac catheterizations was developed and tested to evaluate dose reduction. Several electromagnetically tracked tools were constructed specifically a 7-Fr catheter with five 5-degree-of-freedom magnetic seeds. Catheter guidance was accomplished using our image guidance system Kit for Navigation by Image-Focused Exploration and fluoroscopy alone. A cardiac phantom was designed and 3D printed to validate the image guidance procedure. In mock procedures, an expert clinician guided and deployed an occluder across the septal defect of the phantom heart. The image guidance method resulted in a dose of 1.26mSv of radiation dose per procedure, while traditional guidance resulted in a dose of 3.33mSv. Average overall dose savings for the image-guided method was nearly 2.07mSv or 62%. The work showed significant ([Formula: see text]) decrease in radiation dose with use of image guidance methods at the expense of a modest increase in procedure time. This study lays the groundwork for further exploration of image guidance applications in pediatric cardiology.