Top

International Journal of Computer Assisted Radiology and Surgery

Published in:

Open Access 31-01-2023 | CT Angiography | Original Article

Automated image fusion during endovascular aneurysm repair: a feasibility and accuracy study

Authors: Stefan P. M. Smorenburg, Rutger J. Lely, Iris Smit-Ockeloen, Kak Khee Yeung, Arjan W. J. Hoksbergen

Published in: International Journal of Computer Assisted Radiology and Surgery | Issue 8/2023

Abstract

Purpose

Image fusion merges preoperative computed tomography angiography (CTA) with live fluoroscopy during endovascular procedures to function as an overlay 3D roadmap. However, in most current systems, the registration between imaging modalities is performed manually by vertebral column matching which can be subjective, inaccurate and time consuming depending on experience. Our objective was to evaluate feasibility and accuracy of image-based automated 2D-3D image fusion between preoperative CTA and intraoperative fluoroscopy based on vertebral column matching.

Methods

A single-center study with offline procedure data was conducted in 10 consecutive patients which had endovascular aortic repair in which we evaluated unreleased automated fusion software provided by Philips (Best, the Netherlands). Fluoroscopy and digital subtraction angiography images were collected after the procedures and the vertebral column was fused fully automatically. Primary endpoints were feasibility and accuracy of bone alignment (mm). Secondary endpoint was vascular alignment (mm) between the lowest renal artery orifices. Clinical non-inferiority was defined at a mismatch of < 1 mm.

Results

In total, 87 automated measurements and 40 manual measurements were performed on vertebrae T12–L5 in all 10 patients. Manual correction was needed in 3 of the 10 patients due to incomplete visibility of the vertebral edges in the fluoroscopy image. Median difference between automated fusion and manual fusion was 0.1 mm for bone alignment (p = 0.94). The vascular alignment was 4.9 mm (0.7–17.5 mm) for manual and 5.5 mm (1.0–14.0 mm) for automated fusion. This did not improve, due to the presence of stiff wires and stent graft.

Conclusion

Automated image fusion was feasible when all vertebral edges were visible. Accuracy was non-inferior to manual image fusion regarding bone alignment. Future developments should focus on intraoperative image-based correction of vascular alignment.

Available only for authorised users

Nollert G, Hartkens T, Schwabenland I, Sunderbrink D, Dyck A (2015) Hybrid operation theaters in vascular care: current and future technologies. In: Lanzer P (ed) PanVascular medicine. Springer, Berlin, pp 4873–4889CrossRef

Schwein A, Chinnadurai P, Behler G, Lumsden AB, Bismuth J, Bechara CF (2018) Computed tomography angiography-fluoroscopy image fusion allows visceral vessel cannulation without angiography during fenestrated endovascular aneurysm repair. J Vasc Surg 68(1):2–11CrossRefPubMed

Doelare SAN, Smorenburg SPM, van Schaik TG, Blankensteijn JD, Wisselink W, Nederhoed JH et al (2020) Image fusion during standard and complex endovascular aortic repair, to fuse or not to fuse? A meta-analysis and additional data from a single-center retrospective cohort. J Endovas Ther 28:78–92CrossRef

Ahmad W, Hasselmann H-C, Galas N, Majd P, Brunkwall S, Brunkwall JS (2019) Image fusion using the two-dimensional-three-dimensional registration method helps reduce contrast medium volume, fluoroscopy time, and procedure time in hybrid thoracic endovascular aortic repairs. J Vasc Surg 69(4):1003–1010CrossRefPubMed

Ahmad W, Obeidi Y, Majd P, Brunkwall JS (2018) The 2D–3D registration method in image fusion is accurate and helps to reduce the used contrast medium, radiation, and procedural time in standard EVAR procedures. Ann Vasc Surg 51:177–186CrossRefPubMed

Maurel B, Martin-Gonzalez T, Chong D, Irwin A, Guimbretiere G, Davis M et al (2018) A prospective observational trial of fusion imaging in infrarenal aneurysms. J Vasc Surg. 68(6):1706-1713 e1CrossRefPubMed

Koutouzi G, Sandstrom C, Roos H, Henrikson O, Leonhardt H, Falkenberg M (2016) Orthogonal rings, fiducial markers, and overlay accuracy when image fusion is used for EVAR guidance. Eur J Vasc Endovasc Surg 52(5):604–611CrossRefPubMed

Dias NV, Billberg H, Sonesson B, Tornqvist P, Resch T, Kristmundsson T (2016) The effects of combining fusion imaging, low-frequency pulsed fluoroscopy, and low-concentration contrast agent during endovascular aneurysm repair. J Vasc Surg 63(5):1147–1155CrossRefPubMed

McNally MM, Scali ST, Feezor RJ, Neal D, Huber TS, Beck AW (2015) Three-dimensional fusion computed tomography decreases radiation exposure, procedure time, and contrast use during fenestrated endovascular aortic repair. J Vasc Surg 61(2):309–316CrossRefPubMed

10.

Stangenberg L, Shuja F, Carelsen B, Elenbaas T, Wyers MC, Schermerhorn ML (2015) A novel tool for three-dimensional roadmapping reduces radiation exposure and contrast agent dose in complex endovascular interventions. J Vasc Surg 62(2):448–455CrossRefPubMed

11.

Hertault A, Maurel B, Sobocinski J, Martin Gonzalez T, Le Roux M, Azzaoui R et al (2014) Impact of hybrid rooms with image fusion on radiation exposure during endovascular aortic repair. Eur J Vasc Endovasc Surg 48(4):382–390CrossRefPubMed

12.

Sailer AM, de Haan MW, Peppelenbosch AG, Jacobs MJ, Wildberger JE, Schurink GW (2014) CTA with fluoroscopy image fusion guidance in endovascular complex aortic aneurysm repair. Eur J Vasc Endovasc Surg 47(4):349–356CrossRefPubMed

13.

Tacher V, Lin M, Desgranges P, Deux JF, Grunhagen T, Becquemin JP et al (2013) Image guidance for endovascular repair of complex aortic aneurysms: comparison of two-dimensional and three-dimensional angiography and image fusion. J Vasc Interv Radiol 24(11):1698–1706CrossRefPubMedPubMedCentral

14.

Varnavas A, Carrell T, Penney G (2015) Fully automated 2D–3D registration and verification. Med Image Anal 26(1):108–119CrossRefPubMed

15.

Koutouzi G, Nasihatkton B, Danielak-Nowak M, Leonhardt H, Falkenberg M, Kahl F (2018) Performance of a feature-based algorithm for 3D–3D registration of CT angiography to cone-beam CT for endovascular repair of complex abdominal aortic aneurysms. BMC Med Imaging 18(1):42CrossRefPubMedPubMedCentral

16.

Southerland KW, Nag U, Turner M, Gilmore B, McCann R, Long C et al (2018) IF09. Image-based three-dimensional fusion computed tomography decreases radiation exposure, fluoroscopy time, and procedure time during endovascular aortic aneurysm repair. J Vasc Surg 67(6):e61CrossRef

17.

Matl S, Brosig R, Baust M, Navab N, Demirci S (2017) Vascular image registration techniques: a living review. Med Image Anal 35:1–17CrossRefPubMed

18.

Dumenil A, Kaladji A, Castro M, Goksu C, Lucas A, Haigron P (2016) A versatile intensity-based 3D/2D rigid registration compatible with mobile C-arm for endovascular treatment of abdominal aortic aneurysm. Int J Comput Assist Radiol Surg 11(9):1713–1729CrossRefPubMed

19.

Rolls AE, Maurel B, Davis M, Constantinou J, Hamilton G, Mastracci TM (2016) A Comparison of accuracy of image- versus hardware-based tracking technologies in 3D fusion in aortic endografting. Eur J Vasc Endovasc Surg 52(3):323–331CrossRefPubMed

20.

Kaladji A, Villena A, Pascot R, Lalys F, Daoudal A, Clochard E et al (2019) Fusion Imaging for EVAR with Mobile C-arm. Ann Vasc Surg 55:166–174CrossRefPubMed

21.

Breininger K, Hanika M, Weule M, Kowarschik M, Pfister M, Maier A (2019) Simultaneous reconstruction of multiple stiff wires from a single X-ray projection for endovascular aortic repair. Int J Comput Assist Radiol Surg 14(11):1891–1899CrossRefPubMed

22.

Cercenelli L, Bortolani B, Tiberi G, Mascoli C, Corazza I, Gargiulo M et al (2018) Characterization of Vessel Deformations During EVAR: a preliminary retrospective analysis to improve fidelity of endovascular simulators. J Surg Educ 75(4):1096–1105CrossRefPubMed

23.

Jansen MM, van der Stelt M, Smorenburg SPM, Slump CH, van Herwaarden JA, Hazenberg C (2021) Target vessel displacement during fenestrated and branched endovascular aortic repair and its implications for the role of traditional computed tomography angiography roadmaps. Quant Imaging Med Surg 11(9):3945–3955CrossRefPubMedPubMedCentral

24.

Kaladji A, Dumenil A, Castro M, Cardon A, Becquemin JP, Bou-Said B et al (2013) Prediction of deformations during endovascular aortic aneurysm repair using finite element simulation. Comput Med Imaging Graph 37(2):142–149CrossRefPubMed

25.

Kauffmann C, Douane F, Therasse E, Lessard S, Elkouri S, Gilbert P et al (2015) Source of errors and accuracy of a two-dimensional/three-dimensional fusion road map for endovascular aneurysm repair of abdominal aortic aneurysm. J Vasc Interv Radiol 26(4):544–551CrossRefPubMed

26.

Koutouzi G, Pfister M, Breininger K, Hellstrom M, Roos H, Falkenberg M (2019) Iliac artery deformation during EVAR. Vascular 27(5):511–517CrossRefPubMed

27.

Bailey CJ, Edwards JB, Giarelli M, Zwiebel B, Grundy L, Shames M (2022) Cloud-based fusion imaging improves operative metrics during fenestrated endovascular aneurysm repair. J Vasc Surg. https://doi.org/10.1016/j.jvs.2022.09.020CrossRefPubMed

Title: Automated image fusion during endovascular aneurysm repair: a feasibility and accuracy study
Authors: Stefan P. M. Smorenburg
Rutger J. Lely
Iris Smit-Ockeloen
Kak Khee Yeung
Arjan W. J. Hoksbergen
Publication date: 31-01-2023
Publisher: Springer International Publishing
Keyword: CT Angiography
Published in: International Journal of Computer Assisted Radiology and Surgery / Issue 8/2023
Print ISSN: 1861-6410
Electronic ISSN: 1861-6429
DOI: https://doi.org/10.1007/s11548-023-02832-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Automated image fusion during endovascular aneurysm repair: a feasibility and accuracy study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2023

Artificial intelligence in patient-specific hand surgery: a scoping review of literature

How different augmented reality visualizations for drilling affect trajectory deviation, visual attention, and user experience

A hybrid deformable registration method to generate motion-compensated 3D virtual MRI for fusion with interventional real-time 3D ultrasound

Body surface registration considering individual differences with non-rigid iterative closest point

Multi-phase synthetic contrast enhancement in interventional computed tomography for guiding renal cryotherapy

3D reconstruction for maxillary anterior tooth crown based on shape and pose estimation networks