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Computer-aided endovascular aortic repair using fully automated two- and three- dimensional fusion imaging  Giuseppe Panuccio, MD, Giovanni Federico Torsello,

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Presentation on theme: "Computer-aided endovascular aortic repair using fully automated two- and three- dimensional fusion imaging  Giuseppe Panuccio, MD, Giovanni Federico Torsello,"— Presentation transcript:

1 Computer-aided endovascular aortic repair using fully automated two- and three- dimensional fusion imaging  Giuseppe Panuccio, MD, Giovanni Federico Torsello, MD, Markus Pfister, PhD, Theodosios Bisdas, MD, Michel J. Bosiers, MD, Giovanni Torsello, MD, Martin Austermann, MD  Journal of Vascular Surgery  Volume 64, Issue 6, Pages e1 (December 2016) DOI: /j.jvs Copyright © 2016 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Algorithm of the automatic fusion process. 2D/3D, Two-dimensional/three-dimensional; CT, computed tomography. Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Final automatically generated preoperative mesh model. Based on 12 anatomic points (yellow dots), three for each line intersection, seven centerlines are generated (intraluminal lines depicted in different colors: blue for the aorta, green for the iliac vessels, yellow for the hypogastric arteries, and orange for the renal arteries). The mesh model itself (represented by red contours) is representing the surface of the aortic and iliac lumen. Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Details of the centerlines and computation of C-arm angulations. The centerlines are represented by the green lines. The distance between two dots is 5 mm, giving an idea of centerline lengths, renal ostia (blue circles) are automatically placed at the intersections of the corresponding centerlines and mesh model. Additional ostia (eg, of the superior mesenteric artery or thoracic branches) can be manually added (eg, a green circle represents the internal mammary artery). An additional ring marker (yellow line) is placed perpendicular to the aortic centerline. In the figure, the blue ring of the right renal ostium is “open,” which indicates that the view is not perpendicular on the corresponding structures. As the left renal ostium is rotated 90° to this projection along a craniocaudal axis, the corresponding circle seems to be “closed.” Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Two-dimensional (2D)/three-dimensional (3D) registration process. Based on the automatic detection of the aortic and the vertebral body profile, the preoperative computed tomography (CT) scan is registered. A, Vessel mask. The red line represents vessel contours calculated from the CT angiography (CTA) dataset. B, Bone mask. The red spots represent bone contours calculated from the CTA dataset. C, A subsequent intraoperative angiogram shows a suboptimal registration, represented by misalignment (dotted line) of the mesh model and the intraoperative angiogram. The manual corrections is easily performed, using the console attached to the operating table. Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Primary and secondary outcomes.
Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

7 Fig 6 A, Final automatically generated preoperative mesh model (red) of a type thoracoabdominal aortic aneurysm after elephant branch. Red, mesh model of the aorta. Due to the kinking of the elephant branch graft, a complete reconstruction of the aorta was not possible. The fusion technique was still possible for the visceral and iliac vessels. B, Postoperative computed tomography (CT) result sowing the elephant branch (white) and the correct deployment of the branched device. Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

8 Fig 7 Image quality comparison of fusion technology using a MESH model (A) and a VOXEL model (B). Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

9 Supplementary Fig (online only)
Image fusion consists of the registration of the three-dimensional (3D) datasets to the patient (1), anatomically correct projection (2) and a proper covisualization of two-dimensional (2D) fluoroscopy and 3D volume (3). Journal of Vascular Surgery  , e1DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

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