Automatic 2D-3D Registration without Contrast Agent during Neurovascular Interventions

Fusing live fluoroscopy images with a 3D rotational reconstruction of the vasculature allows to navigate endovascular devices in minimally invasive neuro-vascular treatment, while reducing the usage of harmful iodine contrast medium. The alignment of the fluoroscopy images and the 3D reconstruction is initialized using the sensor information of the X-ray C-arm geometry. Patient motion is then corrected by an image-based registration algorithm, based on a gradient difference similarity measure using digital reconstructed radiographs of the 3D reconstruction. This algorithm does not require the vessels in the fluoroscopy image to be filled with iodine contrast agent, but rather relies on gradients in the image (bone structures, sinuses) as landmark features. This paper investigates the accuracy, robustness and computation time aspects of the image-based registration algorithm. Using phantom experiments 97% of the registration attempts passed the success criterion of a residual registration error of less than 1 mm translation and 3{\deg} rotation. The paper establishes a new method for validation of 2D-3D registration without requiring changes to the clinical workflow, such as attaching fiducial markers. As a consequence, this method can be retrospectively applied to pre-existing clinical data. For clinical data experiments, 87% of the registration attempts passed the criterion of a residual translational error of < 1 mm, and 84% possessed a rotational error of < 3{\deg}.

Artificial Intelligence in Minimally Invasive Interventional Treatment

Minimally invasive image guided treatment procedures often employ advanced image processing algorithms. The recent developments of artificial intelligence algorithms harbor potential to further enhance this domain. In this article we explore several application areas within the minimally invasive treatment space and discuss the deployment of artificial intelligence within these areas.

Fully Automatic and Real-Time Catheter Segmentation in X-Ray Fluoroscopy

Augmenting X-ray imaging with 3D roadmap to improve guidance is a common strategy. Such approaches benefit from automated analysis of the X-ray images, such as the automatic detection and tracking of instruments. In this paper, we propose a real-time method to segment the catheter and guidewire in 2D X-ray fluoroscopic sequences. The method is based on deep convolutional neural networks. The network takes as input the current image and the three previous ones, and segments the catheter and guidewire in the current image. Subsequently, a centerline model of the catheter is constructed from the segmented image. A small set of annotated data combined with data augmentation is used to train the network. We trained the method on images from 182 X-ray sequences from 23 different interventions. On a testing set with images of 55 X-ray sequences from 5 other interventions, a median centerline distance error of 0.2 mm and a median tip distance error of 0.9 mm was obtained. The segmentation of the instruments in 2D X-ray sequences is performed in a real-time fully-automatic manner.