Vessel Phantom Research Articles

A two-dimensional feasibility study of deep learning-based feature detection and characterization directly from CT sinograms.

Machine Learning, especially deep learning, has been used in typical x-ray computed tomography (CT) applications, including image reconstruction, image enhancement, imagedomain feature detection and imagedomain feature characterization. To our knowledge, this is the first study on machine learning for feature detection and analysis directly based on CT projection data. Specifically, we present neural network methods for blood vessel detection and characterization in the sinogram domain avoiding any partial volume, beam hardening, or motion artifacts introduced during reconstruction. First, we estimate sinogramdomain vessel maps using a residual encoder-decoder convolutional neural network (REDCNN). Next, we estimate the vessel centerline and we extract the vessel-only sinogram from the original sinogram, eliminating any background information. Finally, we use a fully connected neural network to estimate the vessel lumen cross-sectional area from the vessel-only sinogram. We trained and tested the proposed methods using CatSim simulations, real CT measurements of vessel phantoms, and clinical data from the NIH CT image database. We achieved encouraging initial results showing the feasibility of CT analysis in the sinogram domain. In principle, sinogramdomain analysis should be possible for many other and more complicated clinical CT analysis tasks. Further studies are needed for this sinogramdomain analysis approach to become practical for clinical applications.

Development of a dynamic blood vessel phantom for evaluation of moving images.

In coronary angiography (CAG) and percutaneous coronary intervention (PCI), it is important for radiological technologists to optimize the balance between radiation dose and image quality for physicians to be able to perform CAG and PCI most effectively. Evaluation of image processing is necessary to ensure that technologists can optimally adjust image quality for clinical use to the extent that physicians require. However, few phantoms are available for evaluating fluoroscopic image processing, and this makes it necessary to adjust image quality in clinical settings while utilizing the image processing according to the manufacturer’s recommendations. In this study, we developed a dynamic phantom that mimics a pulsating coronary artery for use in image quality analysis of moving images. We also examined whether processed images (image lag) can be physically analyzed. Two issues require special attention in creating a new phantom: establishing the exact position of the simulated blood vessel in the phantom, and providing good reproducibility. The study used the rotational motion of a disk to generate images, with a circular simulated blood vessel on the rotating acrylic disk, with the center of the simulated blood vessel shifted from the center of the acrylic disk. This enabled the reproduction of translational motion of the simulated blood vessel. As a result, because this phantom has signals and afterimages at the same position (of a simulated blood vessel), a quantitative evaluation of the afterimages became possible. In the evaluation of the image processing with the angiograph, it was shown that evaluations of image lag which are typically performed in clinical settings can be performed with the dynamic blood vessel phantom.

Acoustic Energy Controlled Nanoparticle Aggregation for Nanotherapy.

Patients with unresectable or nonablatable tumors are difficult to cure, but nanotherapy combining targeted nanoparticles has many severe side effects due to the toxicities of anticancer drugs. We found that acoustic energy can produce a local region with high concentration from a low concentration suspended liquid of nano-SiO2 particles at 2.5 MHz. Our calculated results show that the main reason for aggregation is the synthesized effect of the potential well of acoustic energy and streaming to trap them. In addition, the aggregated region can be manipulated to a targeted position in the vessel phantom by moving the ultrasound transducer external to the body. This noninvasive manipulation of suspended nanoparticles can rapidly increase the local drug concentration, but reduce the total dosage of anticancer drugs, which has the potential to be used for patients with advanced tumors by improving the physiological effects and reducing the side effects.

Multiresolution vessel detection in magnetic particle imaging using wavelets and a Gaussian mixture model

Magnetic particle imaging is a tomographic imaging technique that allows one to measure the spatial distribution of superparamagnetic nanoparticles, which are used as tracer. The magnetic particle imaging scanner measures the voltage induced due to the nonlinear magnetization behavior of the nanoparticles. The tracer distribution can be reconstructed from the voltage signal by solving an inverse problem. A possible application is the imaging of vessel structures. In this and many other cases, the tracer is only located inside the structures and a large part of the image is related to background. A detection of the tracer support in early stages of the reconstruction process could improve reconstruction results. In this work, a multiresolution wavelet-based reconstruction combined with a segmentation of the foreground structures is performed. For this, different wavelets are compared with respect to their reconstruction quality. For the detection of the foreground, a segmentation with a Gaussian mixture model is performed, which leads to a threshold-based binary segmentation. This segmentation is done on a coarse level of the reconstruction and then transferred to the next finer level, where it is used as prior knowledge for the reconstruction. This is repeated until the finest resolution is reached. The approach is evaluated on simulated vessel phantoms and on two real measurements. The results show that this method improves the structural similarity index of the reconstructed images significantly. Among the compared wavelets, the 9/7 wavelets led to the best reconstruction results. The early detection of the vessel structures at low resolution helps to improve the image quality. For the wavelet decomposition, the use of 9/7 wavelets is recommended.

Magnetic Particle Imaging: Artifact-Free Metallic Stent Lumen Imaging in a Phantom Study.

To illustrate the potential of magnetic particle imaging (MPI) for stent lumen imaging in comparison with clinical computed tomography (CT) and magnetic resonance imaging (MRI). Imaging of eight tracer-filled, stented vessel phantoms and a tracer-filled, non-stented reference phantom for each diameter was performed on a preclinical MPI scanner: eight commercially available coronary stents of different dimensions (diameter: 3-4mm; length: 11-38mm) and materials (stainless steel, platinum-chromium) were implanted into silicone vessel phantoms. For comparison, all vessel phantoms were also visualized by MRI and CT. Two radiologists assessed the images regarding stent-induced artifacts using a 5-point grading scale. The visualization of all stented vessel phantoms was achieved without stent-induced artifacts with MPI. In contrast, MRI and CT images revealed multiform stent-induced artifacts. Given its clinical introduction, MPI has the potential to overcome the disadvantages of MRI and CT concerning the visualization of the stent lumen.

Spectral Photon-Counting Computed Tomography for Coronary Stent Imaging: Evaluation of the Potential Clinical Impact for the Delineation of In-Stent Restenosis.

In-stent restenosis (ISR) is one of the main long-term complications after coronary stent placement, and the ability to evaluate ISR noninvasively using coronary computed tomography (CT) angiography remains challenging. For this application, spectral photon-counting CT (SPCCT) has the potential to increase image quality and reduce artifacts due to its advanced detector technology.Our study aimed to verify the technical and clinical potential of a novel SPCCT prototype using an ISR phantom setup. Soft plaque-like restenosis (45 HU; approximately 50% of the stent lumen) were inserted into 10 different coronary stents (3 mm diameter), which were placed in a vessel phantom and filled with a contrast agent (400 HU). A research prototype SPCCT and a clinical dual-layer CT (DLCT; IQon; Philips) with comparable acquisition and reconstruction parameters were used to scan the phantoms. Conventional polyenergetic (PolyE) and monoenergetic (MonoE) images with 4 different energy levels (40, 60, 90, 120 keV) were reconstructed. Qualitative (delineation of the stenosis and adjacent residual lumen using a 5-point Likert scale) and quantitative (image noise, visible lumen diameter, lumen diameter adjacent to the stenosis, contrast-to-noise ratio of the restenosis) parameters were evaluated for both systems. The qualitative results averaged over all reconstructions were significantly superior for SPCCT compared with DLCT (eg, subjective rating of the best reconstruction of each scanner: DLCT PolyE: 2.80 ± 0.42 vs SPCCT MonoE 40 keV: 4.25 ± 1.03). Stenosis could be clearly detected in 9 and suspected in 10 of the 10 stents with both SPCCT and DLCT. The residual lumen next to the stenosis was clearly delineable in 7 of 10 stents (0.64 ± 0.11 mm or 34.97% of the measured stent lumen) with SPCCT, while it was not possible to delineate the residual lumen for all stents using DLCT. The measured diameter of the lumen within the stent was significantly higher for SPCCT compared with DLCT in all reconstructions with the best results for the MonoE 40 keV images (SPCCT: 1.80 ± 0.17 mm; DLCT: 1.50 ± 0.31 mm). The image noise and the contrast-to-noise ratio were better for DLCT than for SPCCT (contrast-to-noise ratio: DLCT MonoE 40: 31.58 ± 12.54; SPCCT MonoE 40: 4.64 ± 1.30). Spectral photon-counting CT allowed for the noninvasive evaluation of ISR with reliable results regarding the residual lumen for most tested stents and the clear identification or suspicion of stenosis for all stents. In contrast, the residual lumen could not be detected for a single stent using DLCT.

Deep Reinforcement Learning for the Navigation of Neurovascular Catheters

Abstract Endovascular catheters are necessary for state-ofthe- art treatments of life-threatening and time-critical diseases like strokes and heart attacks. Navigating them through the vascular tree is a highly challenging task. We present our preliminary results for the autonomous control of a guidewire through a vessel phantom with the help of Deep Reinforcement Learning. We trained Deep-Q-Network (DQN) and Deep Deterministic Policy Gradient (DDPG) agents on a simulated vessel phantom and evaluated the training performance. We also investigated the effect of the two enhancements Hindsight Experience Replay (HER) and Human Demonstration (HD) on the training speed of our agents. The results show that the agents are capable of learning to navigate a guidewire from a random start point in the vessel phantom to a random goal. This is achieved with an average success rate of 86.5% for DQN and 89.6% for DDPG. The use of HER and HD significantly increases the training speed. The results are promising and future research should address more complex vessel phantoms and the use of a combination of guidewire and catheter.

Manufacturing process for hydrogel vessel phantoms

Abstract Phantoms mimicking special physiological processes of the human body are essential for evaluating prototypes of medical devices. Especially for thermometric MRI measurements, the temperature distribution in the brain needs to be simulated. Since this parameter is dependent on the tissue perfusion, a new hydrogel by MAGDASSIS et al. was evaluated in this work for building models with hollow artery structures. This hydrogel can be polymerized through UV-light due to the nanoparticles contained in it. Additionally, thermal parameters were measured and compared to human brain tissue. The indirect manufacturing of hydrogel phantoms showed good qualitative results for vessels with a diameter > 3 mm. In this process a 3D printed wax core was inserted in the hydrogel and the structure was then UV cured after molding. After curing the core was dissolved in an isopropanol bath. The thermal properties, obtained by the transient planesource- method, showed similar values compared to that of human brain tissue mentioned in literature. Further limitations in the manufacturing process needs to be overcome to use the indirect manufacture approach for smaller vessels of the brain.

Widefield illumination photoacoustic imaging of blood vessel phantom

AbstractWe achieved photoacoustic tomographic imaging by employing widefield illumination using a pulsed laser source that irradiates the entire area of interest for the specimen under investigation. This approach can be simpler and more efficient than the use of narrow point‐source scanning. Tomographic images were computed via an inverse‐reconstruction‐based algorithm from signals acquired using a single transducer with circular scanning configuration. The signals were coupled to the transducer probe with index‐matching gel around the circumference of the specimen, eliminating the need for aquatic immersion. A blood‐vessel‐mimicking phantom was used to demonstrate our setup and the image reconstruction was also verified by simulation, proving the feasibility of a miniaturized system based on this design.

Automatic quantitative analysis of pulmonary vascular morphology in CT images.

PurposeVascular remodeling is a significant pathological feature of various pulmonary diseases, which may be assessed by quantitative computed tomography (CT) imaging. The purpose of this study was therefore to develop and validate an automatic method for quantifying pulmonary vascular morphology in CT images.MethodsThe proposed method consists of pulmonary vessel extraction and quantification. For extracting pulmonary vessels, a graph‐cuts‐based method is proposed which considers appearance (CT intensity) and shape (vesselness from a Hessian‐based filter) features, and incorporates distance to the airways into the cost function to prevent false detection of airway walls. For quantifying the extracted pulmonary vessels, a radius histogram is generated by counting the occurrence of vessel radii, calculated from a distance transform‐based method. Subsequently, two biomarkers, slope α and intercept β, are calculated by linear regression on the radius histogram. A public data set from the VESSEL12 challenge was used to independently evaluate the vessel extraction. The quantitative analysis method was validated using images of a three‐dimensional (3D) printed vessel phantom, scanned by a clinical CT scanner and a micro‐CT scanner (to obtain a gold standard). To confirm the association between imaging biomarkers and pulmonary function, 77 scleroderma patients were investigated with the proposed method.ResultsIn the independent evaluation with the public data set, our vessel segmentation method obtained an area under the receiver operating characteristic (ROC) curve of 0.976. The median radius difference between clinical and micro‐CT scans of a 3D printed vessel phantom was 0.062 ± 0.020 mm, with interquartile range of 0.199 ± 0.050 mm. In the studied patient group, a significant correlation between diffusion capacity for carbon monoxide and the biomarkers, α (R = −0.27, P = 0.018) and β (R = 0.321, P = 0.004), was obtained.ConclusionIn conclusion, the proposed method was validated independently using a public data set resulting in an area under the ROC curve of 0.976 and using a 3D printed vessel phantom data set, showing a vessel sizing error of 0.062 mm (0.16 in‐plane pixel units). The correlation between imaging biomarkers and diffusion capacity in a clinical data set confirmed an association between lung structure and function. This quantification of pulmonary vascular morphology may be helpful in understanding the pathophysiology of pulmonary vascular diseases.

Quantitative Analysis of 3D Artery Volume Reconstructions Using Biplane Angiography and Intravascular OCT Imaging.

Diameter and volume are frequently used parameters for cardiovascular diagnosis, e.g., to identify a stenosis of the coronary arteries. Intra-vascular OCT imaging has a high spatial resolution and promises accurate estimates of the vessel diameter. However, the actual images are reconstructed from A-scans relative to the catheter tip and imaging is subject to rotational artifacts. We study the impact of different volume reconstruction approaches on the accuracy of the vessel shape estimate. Using X-ray angiography we obtain the 3D vessel centerline and the 3D catheter trajectory, and we propose to align the A-scans using both. For comparison we consider reconstruction along a straight line and along the centerline. All methods are evaluated based on an experimental setup using a clinical angiography system and a vessel phantom with known shape. Our results illustrate potential pitfalls in the estimation of the vessel shape, particularly when the vessel is curved. We demonstrate that the conventional reconstruction approaches may result in an overestimate of the cross-section and that the proposed approach results in a good shape agreement in general and for curver segments, with DICE coefficients of approximately 0.96 and 0.98, respectively.

Magnetic Particle Imaging–Guided Stenting

Purpose:To assess the feasibility of magnetic particle imaging (MPI) to guide stenting in a phantom model. Materials and Methods: MPI is a new tomographic imaging method based on the background-free magnetic field detection of a tracer agent composed of superparamagnetic iron oxide nanoparticles (SPIOs). All experiments were conducted on a custom-built MPI scanner (field of view: 29-mm diameter, 65-mm length; isotropic spatial resolution 1–1.5-mm). Stenosis phantoms (n=3) consisted of polyvinyl chloride (PVC) tubes (8-mm inner diameter) prepared with centrally aligned cable binders to form a ~50% stenosis. A dedicated image reconstruction algorithm allowed precise tracking of endovascular instruments at 8 frames/s with a latency time of ~115 ms. A custom-made MPI-visible lacquer was used to manually label conventional guidewires, balloon catheters, and stainless steel balloon-expandable stents. Vascular stenoses were visualized by injecting a diluted SPIO tracer (ferucarbotran, 10 mmol iron/L) into the vessel phantoms. Balloon angioplasty and stent placement were performed by inflating balloon catheters and stent delivery balloons with diluted ferucarbotran. Results: After deployment of the stent, the markers on its ends were clearly visible. The applied lacquer markers were thin enough to not relevantly alter gliding properties of the devices while withstanding friction during the experiments. Placing an optimized flexible lacquer formulation on the preexisting radiopaque stent markers provided enough stability to withstand stent expansion. Final MPA confirmed successful stenosis treatment, facilitated by the disappearance of the lacquer markers on the stent due to differences in SPIO concentration. Thus, the in-stent lumen could be visualized without interference by the signal from the markers. Conclusion: Near real-time visualization of MPI-guided stenting of stenoses in a phantom model is feasible. Optimized MPI-visible markers can withstand the expansion process of stents.

A Novel Tip-positioning Control of a Magnetically Steerable Guidewire in Sharply Curved Blood Vessel for Percutaneous Coronary Intervention

This paper suggests a novel method for the positioning control of a magnetically steerable guidewire without needing to detect a tip angle, which can pass through sharply curved blood vessels with potentially reduced contact between the guidewire end tip and the blood vessel for Percutaneous Coronary Intervention (PCI). The proposed tip-positioning control consists of four parts: 1) Path-regeneration, 2) Feeding control, 3) EMA (Electromagnetic Actuator) control, and 4) Vision tracking. Path-regeneration provides an improved path based on the properties of the guidewire and the size of the blood vessel when the guidewire cannot follow the pre-planned path. Based on the desired path, the feeding control drives the translational motion of the guidewire while the EMA system steers the guidewire’s end tip, which is made of a permanent magnet. A pair of Helmholtz coils is employed for the EMA system, and a vision-tracking algorithm is used to detect the position of the magnet tip in real time. The system was integrated for the preliminary study, and the magnet tip could be controlled so as to track a desired path without any shape or curvature information, which requires the use of an additional catheter model or angle estimation algorithm. The proposed catheter tip position control method was verified by experiments on both smooth and sharply curved blood vessel phantoms. The results showed that the proposed method could accomplish the tip position control of the guidewire with high accuracy in real time.

Real-time co-registered photoacoustic and ultrasonic imaging for early endometrial cancer detection driven by cylindrical diffuser

In illuminating tissues, a cylindrical diffuser (CD) has an advantage over regular laser sources due to its ability to illuminate a larger volume of the target tissue. This paper presents a co-registered large volume photoacoustic (PA) and ultrasonic (US) imaging for early endometrial cancer (EEC) detection using CD. It has the advantage that the US imaging system is outside the body and only the PA excitation device is inside the body, which makes the system more efficient and less invasive for EEC detection. The paper reports on two sets of experiments. The first set produced real-time PA images of blood vessel phantom. The second set demonstrated the imaging of pig uterus ex vivo. The results show that the system has the potential for imaging and characterizing of EEC.

Passive cavitation mapping using dual apodization with cross-correlation in ultrasound therapy monitoring

Recently, passive acoustic mapping (PAM) has been successfully applied for dynamic monitoring of ultrasound therapy by beamforming acoustic emissions of cavitation activity during ultrasound exposure. The most widely used PAM algorithm in the literature is time exposure acoustics (TEA), which is a standard delay, sum, and integrate algorithm. However, it results in large point spread function (PSF) and serious imaging artifacts for the case where a narrow-aperture receiving array such as a standard B-mode linear array is used, therefore degrading the quality of cavitation image. To address these challenges, in this paper, we proposed a novel PAM algorithm namely dual apodization with cross-correlation (DAX)-based TEA, in which DAX was originally used as a reconstruction algorithm in medical ultrasound imaging. In the proposed algorithm, two sets of signals were beamformed by two receive apodization functions with alternating elements enabled, and the cross-correlation coefficient of the two signals served as a weighting factor that would be multiplied to the sum of the two signals. The performance of the proposed algorithm was tested on simulated channel data obtained using a multi-bubble model, and experiments were also performed in an in vitro vessel phantom with flowing microbubbles as cavitation nuclei. The reconstructed cavitation images were evaluated quantitatively using established quality metrics including full width at half maximum (FWHM), A−6dB area, and signal-to-noise ratio (SNR). The results suggested that the proposed algorithm significantly outperformed the conventionally used TEA algorithm. This work may have the potential of providing a useful tool for highly accurate localization of cavitation activity during ultrasound therapy.

Bimodal intravascular volumetric imaging combining OCT and MPI.

Intravascular optical coherence tomography (IVOCT) is a catheter-based image modality allowing for high-resolution imaging of vessels. It is based on a fast sequential acquisition of A-scans with an axial spatial resolution in the range of 5-10μm, that is, one order of magnitude higher than in conventional methods like intravascular ultrasound or computed tomography angiography. However, position and orientation of the catheter in patient coordinates cannot be obtained from the IVOCT measurements alone. Hence, the pose of the catheter needs to be established to correctly reconstruct the three-dimensional vessel shape. Magnetic particle imaging (MPI) is a three-dimensional tomographic, tracer-based, and radiation-free image modality providing high temporal resolution with unlimited penetration depth. Volumetric MPI images are angiographic and hence suitable to complement IVOCT as a comodality. We study simultaneous bimodal IVOCT MPI imaging with the goal of estimating the IVOCT pullback path based on the 3D MPI data. We present a setup to study and evaluate simultaneous IVOCT and MPI image acquisition of differently shaped vessel phantoms. First, the influence of the MPI tracer concentration on the optical properties required for IVOCT is analyzed. Second, using a concentration allowing for simultaneous imaging, IVOCT and MPI image data are acquired sequentially and simultaneously. Third, the luminal centerline is established from the MPI image volumes and used to estimate the catheter pullback trajectory for IVOCT image reconstruction. The image volumes are compared to the known shape of the phantoms. We were able to identify a suitable MPI tracer concentration of 2.5mmol/L with negligible influence on the IVOCT signal. The pullback trajectory estimated from MPI agrees well with the centerline of the phantoms. Its mean absolute error ranges from 0.27 to 0.28mm and from 0.25mm to 0.28mm for sequential and simultaneous measurements, respectively. Likewise, reconstructing the shape of the vessel phantoms works well with mean absolute errors for the diameter ranging from 0.11 to 0.21mm and from 0.06 to 0.14mm for sequential and simultaneous measurements, respectively. Magnetic particle imaging can be used in combination with IVOCT to estimate the catheter trajectory and the vessel shape with high precision and without ionizing radiation.

Ultrasound Modulated Droplet Lasers

We demonstrated the ultrasound modulated droplet lasers, in which the laser intensity from whispering gallery mode (WGM) of oil droplets can be reversibly enhanced up to 20-fold when the ultrasound pressure is beyond a certain threshold. The lasing enhancement was investigated with various ultrasound frequencies and pressures. Furthermore, the ultrasound modulation of the laser output was achieved by controlling the ultrasound pressure, the duty cycle, and the frequency of ultrasound bursts. Its potential application was explored via the study on a human whole blood vessel phantom. A theoretical analysis was also conducted, showing that the laser emission enhancement results from the directional emission from a deformed cavity under ultrasound pressure. Our studies reveal the unique capabilities of ultrasound modulated droplet lasers, which could lead to the development of laser emission-based microscopy for deep tissue imaging with high spatial resolution and detection sensitivity that may overcome the l...

Development of a 3D printed anthropomorphic lung phantom for image quality assessment in CT

PurposeTo design a 3D printed anthropomorphic lung vessel phantom for CT image quality assessment and to evaluate the phantom image and dose characteristics. MethodsAn in-house algorithm generated a vessel tree model, based on human lungs anatomy, which was 3D printed using a multi jet modeling printer (0.25 mm ≤ vessel diameters ≤ 8.25 mm) and inserted in an elliptical holder (thorax surrogate).The phantom was scanned (Toshiba Aquilion Genesis CT) and compared in terms of attenuation (Hounsfield units, HU) and dose characteristics with studies of five patients (normal BMI) and a commercial torso phantom, performed with the same thorax protocol. The pixel value distribution in the lung area was assessed with histograms. To investigate the adjustment of tube current modulation, tube load and CTDI were compared. ResultsThe histogram peaks for respectively vessels and surrounding tissue were at 105 HU and −985 HU (3D printed phantom), at −25 HU and −1000 HU (torso phantom) and at 25 HU and −875 HU (average patient). The contrast between vessels and surrounding was −1090 HU (3D printed), −975 HU (torso phantom), and −900 HU (average patient). The measured HU values (soft tissue and vertebra) were (32 ± 15) HU and (210 ± 71) HU (average patient); (4 ± 4) HU, (390 ± 39) HU (torso phantom) and (119 ± 5) HU, (951 ± 31) HU (3D printed phantom and holder). CTDIvol was (1.9 ± 4.7 mGy) for patients, 1.9 mGy for the torso phantom and 2.1 mGy for the 3D printed lung phantom. ConclusionsAn anthropomorphic 3D printed lung phantom was developed and its CT image and dose characteristics evaluated. The phantom has the potential to provide clinically relevant and reproducible measures of CT image quality.

Method of deflection corrected tonometry with phantom vessel experiments

BackgroundThe Continuous Non-Invasive measurement of arterial Blood Pressure [CNIBP] is possible via the method of arterial tonometry and the arterial volume clamp methods. Arterial tonometry successfully measures continuous arterial pressure but requires large vessel deformation and a highly miniaturized pressure sensor to obtain a direct calibration of pressure. A properly designed tonometer is capable of achieving pressure accuracy of less than 5% error at the radial artery. The volume clamp method achieves comparable errors but is generally restricted to the very peripheral arteries. Since the brachial or radial arteries are preferable sites to record blood pressure, tonometry is generally preferred. However, due to its strict operating requirements, tonometry requires a highly skilled operator. The greatest source of measurement error results from slight deviation from the artery wall applanation position. In this study, a method for correcting tonometry deflection error is introduced and evaluated using preliminary experiments. Methods-modelingIn prior analysis it has been shown that arterial wall flattening causes contact stress to become uniform and equal to the arterial pressure. In this article, we derive the contact stress for deflections other than the ideal applanation position and to allow variable vessel deflection. This analysis permits the contact stress to be corrected for tonometer positions that are not exact so that pressure accuracy is maintained in spite of less than ideal positioning. This will alleviate the necessity for highly skilled users and allow rapid determination of the pulse pressure. Methods-experimentalExperiments were performed to evaluate applied model corrections for tonometer accuracy versus vessel deflection. Two experiments were performed to evaluate tonometer accuracy when deflection is varied. The first experiment used no deflection correction and the second experiment applied model derived deflection correction. A force sensor was used to deflect a phantom latex vessel of known internal pressure. The corrected contact pressure was then compared with known pressures to evaluate the pressure accuracy. Results-modelinga geometric model was derived for vessel contact area versus deflection. This resulted in a formula that provides contact area continuously for any amount of deflection. Once the contact area is known the average tonometer contact pressure was obtained that corresponds with the vessel internal pressure. Results – experimentalA latex tubing phantom vessel was pressurized to a known amount and was deflected in increments over its full diameter while measuring contact force at each position. The model-derived formula was then used to calculate pressure at each position. The calculated pressure was then compared with known internal pressure to evaluate pressure accuracy for all the phantom pressure and deflection points. ConclusionsA modeling method for tonometer deflection correction was derived and evaluated using a phantom vessel. Average error was significantly reduced over the non-corrected data. The variability of error was also reduced for all data points collected. The experiments reveal that blood pressure measurement error can be reduced to levels obtained in near ideal tonometry conditions without the need for precise position control. The relaxed user precision is anticipated to simplify the use and design requirements for arterial tonometry in practice.

Navigation and visualisation with HoloLens in endovascular aortic repair.

IntroductionEndovascular aortic repair (EVAR) is a minimal-invasive technique that prevents life-threatening rupture in patients with aortic pathologies by implantation of an endoluminal stent graft. During the endovascular procedure, device navigation is currently performed by fluoroscopy in combination with digital subtraction angiography. This study presents the current iterative process of biomedical engineering within the disruptive interdisciplinary project Nav EVAR, which includes advanced navigation, image techniques and augmented reality with the aim of reducing side effects (namely radiation exposure and contrast agent administration) and optimising visualisation during EVAR procedures. This article describes the current prototype developed in this project and the experiments conducted to evaluate it.MethodsThe current approach of the Nav EVAR project is guiding EVAR interventions in real-time with an electromagnetic tracking system after attaching a sensor on the catheter tip and displaying this information on Microsoft HoloLens glasses. This augmented reality technology enables the visualisation of virtual objects superimposed on the real environment. These virtual objects include three-dimensional (3D) objects (namely 3D models of the skin and vascular structures) and two-dimensional (2D) objects [namely orthogonal views of computed tomography (CT) angiograms, 2D images of 3D vascular models, and 2D images of a new virtual angioscopy whose appearance of the vessel wall follows that shown in ex vivo and in vivo angioscopies]. Specific external markers were designed to be used as landmarks in the registration process to map the tracking data and radiological data into a common space. In addition, the use of real-time 3D ultrasound (US) is also under evaluation in the Nav EVAR project for guiding endovascular tools and updating navigation with intraoperative imaging. US volumes are streamed from the US system to HoloLens and visualised at a certain distance from the probe by tracking augmented reality markers. A human model torso that includes a 3D printed patient-specific aortic model was built to provide a realistic test environment for evaluation of technical components in the Nav EVAR project. The solutions presented in this study were tested by using an US training model and the aortic-aneurysm phantom.ResultsDuring the navigation of the catheter tip in the US training model, the 3D models of the phantom surface and vessels were visualised on HoloLens. In addition, a virtual angioscopy was also built from a CT scan of the aortic-aneurysm phantom. The external markers designed for this study were visible in the CT scan and the electromagnetically tracked pointer fitted in each marker hole. US volumes of the US training model were sent from the US system to HoloLens in order to display them, showing a latency of 259±86 ms (mean±standard deviation).ConclusionThe Nav EVAR project tackles the problem of radiation exposure and contrast agent administration during EVAR interventions by using a multidisciplinary approach to guide the endovascular tools. Its current state presents several limitations such as the rigid alignment between preoperative data and the simulated patient. Nevertheless, the techniques shown in this study in combination with fibre Bragg gratings and optical coherence tomography are a promising approach to overcome the problems of EVAR interventions.