Feasibility and accuracy of fusion imaging during thoracic endovascular aortic repair Christof Johannes Schulz, Matthias Schmitt, Dittmar Böckler, MD,

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Presentation transcript:

Feasibility and accuracy of fusion imaging during thoracic endovascular aortic repair Christof Johannes Schulz, Matthias Schmitt, Dittmar Böckler, MD, PhD, Philipp Geisbüsch, MD Journal of Vascular Surgery Volume 63, Issue 2, Pages 314-322 (February 2016) DOI: 10.1016/j.jvs.2015.08.089 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Work flow of image processing to prepare fusion imaging. CTA, Computed tomography angiography (CTA). Journal of Vascular Surgery 2016 63, 314-322DOI: (10.1016/j.jvs.2015.08.089) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 Three-dimensional (3D) planning ready for fusion imaging overlay with operative landmarks. A, 3D planning in group I: 3D reconstruction of the aorta, ready for fusion overlay; good visibility of dissection; manually added landmarks (yellow); white arrow head: dissection. B, 3D planning in group II: computed tomography angiography (CTA) scan with landmarks. Double perpendicular view on the marked ostium of the left subclavian artery (blue) and the implantation border (yellow); automatically calculated centerline (green) as origin for vessel segmentation (not shown). Journal of Vascular Surgery 2016 63, 314-322DOI: (10.1016/j.jvs.2015.08.089) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 Three-dimensional (3D)-3D registration: spine alignment and respiration-related movement of the ribs. computed tomography angiography (CTA) (white) and noncontrast-enhanced cone beam CT (nCBCT) (yellow). A, Sagittal view of perfectly aligned spine registration; B, anteroposterior view, visible misalignment of the ribs because of respiration-related movement of the thorax; C, axial view, misalignment of the sternum due to respiration; and D, 3D reconstruction of the CTA and the nCBCT. Journal of Vascular Surgery 2016 63, 314-322DOI: (10.1016/j.jvs.2015.08.089) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 4 Two- and three-dimensional (3D) registration: fluoroscopic images and overlay of a 3D computed tomography (CT) reconstruction of the bones for easier alignment. A, Anteroposterior view; B, lateral view. Journal of Vascular Surgery 2016 63, 314-322DOI: (10.1016/j.jvs.2015.08.089) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 5 Fusion imaging in groups I and II. Examples of possible fusion imaging. A, Overlay of three-dimensional (3D) computed tomography angiography (CTA) reconstruction in fusion imaging group I; B, overlay of segmentation in fusion imaging group II. Journal of Vascular Surgery 2016 63, 314-322DOI: (10.1016/j.jvs.2015.08.089) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 6 Mismatch repair. Fusion imaging in group II. A, Misalignment of first digital subtraction angiography (DSA) and fusion imaging. B, Alignment adjusted according to DSA. White arrow: suggested proximal landing zone suggested in fusion imaging; black arrow: real landing zone according to DSA. Long black arrow: angulation and length of deviation, also visualized in the polar plot (Fig 7). Fusion landmarks are outlined: contrasted lumen (red), vessel ostia (blue), and proximal landing zone (yellow). Journal of Vascular Surgery 2016 63, 314-322DOI: (10.1016/j.jvs.2015.08.089) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 7 Polar plot. Polar plot showing measured deviation length (mm) and angulation (degree) of underlying digital subtraction angiography (DSA; crosses; black arrow in Fig 6) compared with initial fusion imaging position (center of the plot; white arrow in Fig 6). This vector can be seen as the path, the fusion overlay had to be adjusted during the procedure (also compare with Fig 6). It is shown here, that there is mostly a cranial, lateral deviation of the aorta. Journal of Vascular Surgery 2016 63, 314-322DOI: (10.1016/j.jvs.2015.08.089) Copyright © 2016 Society for Vascular Surgery Terms and Conditions