New biplane x-ray magnetic resonance image fusion prototype for 3D enhanced cardiac catheterization in congenital heart diseases
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KeywordsCongenital Heart Disease Initial Registration Catheterization Procedure Multiple Surface Internal Marker
X-ray magnetic resonance fusion (XMRF) is used to enhance fluoroscopically guided catheterization procedures. We present a new method for biplane XMRF involving an augmented fluoroscopy prototype (Siemens, Forchheim, Germany). With this software it is possible to register 3D MRI data to biplane X-ray projections based on internal markers, without the need for a C-arm CT to perform 3D/3D registration. The software supports overlaying volume rendered data as well as multiple surface models. Visualization techniques, such as contour or solid rendering and surface carving are supported to allow for clear presentation of complex 3D structures.
We reviewed data obtained with different visualization methods on 20 patients that underwent clinical XMRF procedures. Surface models were generated by threshold based segmentation from high resolution MRA (syngo Twist or Navigator gated 3D flash IR sequence) of structures of interest using Mimics (Leuven, Belgium). Initial registration was achieved through planar alignment of the volume in anterior-posterior (AP) and lateral projections matching anatomical landmarks, such as the heart and vessel borders. In addition, the registration accuracy of the prototype was assessed using a phantom by measuring the maximum distance between a single point and the 3D model boundaries in comparison to the boundaries seen on fluoroscopy.
The prototype demonstrated a high level of accuracy for fluoroscopic overlays. Biplane internal marker based registration can be performed quickly, without the need for additional radiation or contrast. We found solid rendering of surface models in combination with carving techniques to be most useful for visualization. This new biplane XMRF technique has the potential to provide enhanced guidance under fluoroscopy by integrating 3D information and to reduce radiation during complicated catheterization procedures.
This project is funded by a research grant from Siemens, AG, Healthcare, Forchheim, Germany. The concepts and information presented in this paper are based on research and are not commercially available.
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