Automatic intraoperative estimation of blood flow direction during neurosurgical interventions

  • Daniel Høyer Iversen
  • Lasse Løvstakken
  • Geirmund Unsgård
  • Ingerid Reinertsen
Original Article



In neurosurgery, reliable information about blood vessel anatomy and flow direction is important to identify, characterize, and avoid damage to the vasculature. Due to ultrasound Doppler angle dependencies and the complexity of the vascular architecture, clinically valuable 3-D flow direction information is currently not available. In this paper, we aim to clinically validate and demonstrate the intraoperative use of a fully automatic method for estimation of 3-D blood flow direction from freehand 2-D Doppler ultrasound.


A 3-D vessel model is reconstructed from 2-D Doppler ultrasound and used to determine the vessel architecture. The blood flow direction is then estimated automatically using the model in combination with Doppler velocity data. To enable testing and validation during surgery, the method was implemented as part of the open-source navigation system CustusX (


Ten patients were included prospectively. Data from four patients were processed postoperatively, and data from six patients were processed intraoperatively. In total, the blood flow direction was estimated for 48 different blood vessels with a success rate of 98%.


In this work, we have shown that the proposed method is suitable for fully automatic estimation of the blood flow direction in intracranial vessels during neurosurgical interventions. The method has the potential to make the understanding of the complex vascular anatomy and flow pattern more intuitive for the surgeon. The method is compatible with intraoperative use, and results can be presented within the limited time frame where they still are of clinical interest.


Blood flow Neurosurgery Intraoperative Ultrasound 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© CARS 2018

Authors and Affiliations

  • Daniel Høyer Iversen
    • 1
    • 2
    • 5
  • Lasse Løvstakken
    • 1
  • Geirmund Unsgård
    • 3
    • 4
  • Ingerid Reinertsen
    • 5
  1. 1.Department of Circulation and Medical ImagingNorwegian University for Science and Technology (NTNU)TrondheimNorway
  2. 2.St. Olavs Hospital - Trondheim University HospitalTrondheimNorway
  3. 3.Department of NeurosurgerySt. Olav University HospitalTrondheimNorway
  4. 4.Department of Neuromedicine and Movement ScienceNorwegian University for Science and Technology (NTNU)TrondheimNorway
  5. 5.Department of Medical TechnologySINTEF HealthTrondheimNorway

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