Initial steps towards automatic segmentation of the wire frame of stent grafts in CT data

For the purpose of obtaining a geometrical model of the wire frame of stent grafts, we propose three tracking methods to segment the stent's wire, and compare them in an experiment. A 2D test image was created by obtaining a projection of a 3D volume containing a stent. The image was modified to connect the parts of the stent's frame and thus create a single path. Ten versions of this image were obtained by adding different noise realizations. Each algorithm was started at the start of each of the ten images, after which the traveled paths were compared to the known correct path to determine the performance. Additionally, the algorithms were applied to 3D clinical data and visually inspected. The method based on the minimum cost path algorithm scored excellent in the experiment and showed good results on the 3D data. Future research will focus on establishing a geometrical model by determining the corner points and the crossings from the results of this method.\u

Motion Calculations on Stent Grafts in AAA

Endovascular aortic repair (EVAR) is a technique which uses stent grafts to treat aortic aneurysms in patients at risk of aneurysm rupture. Although this technique has been shown to be very successful on the short term, the long term results are less optimistic due to failure of the stent graft. The pulsating blood flow applies stresses and forces to the stent graft, which can cause problems such as breakage, leakage, and migration. Therefore it is of importance to gain more insight into the in vivo motion behavior of these devices. If we know more about the motion patterns in well-behaved stent graft as well as ill-behaving devices, we shall be better able to distinguish between these type of behaviors These insights will enable us to detect stent-related problems and might even be used to predict problems beforehand. Further, these insights will help in designing the next generation stent grafts. Firstly, this work discusses the applicability of ECG-gated CT for measuring the motions of stent grafts in AAA. Secondly, multiple methods to segment the stent graft from these data are discussed. Thirdly, this work proposes a method that uses image registration to apply motion to the segmented stent mode

Estimating Target Vessel Location on Robot-Assisted CABG using Feature-based CT to US Registration

Although robot-assisted coronary artery bypass grafting (RA-CABG) has gained more acceptance worldwide, its success still depends on the surgeon’s experience and expertise, and the conversion rate to full sternotomy is in the order of 15%—25%. One of the reasons for conversion is poor pre-operative planning, which is based solely on pre-operative computed tomography (CT) images. This thesis proposes a technique to estimate the global peri-operative displacement of the heart and to predict the intra-operative target vessel location. The technique has been validated via both an in vitro and a clinical study, and predicted the position of the peri-operative target vessel location with ~ 3.5 mm RMS accuracy in the in vitro study while it yielded ~ 5.0 mm accuracy for the clinical validation. As the desired clinical accuracy imposed by this procedure is on the order of one intercostal space (10 - 15 mm), our technique suits the clinical requirements. It is therefore believed that this technique has the potential to improve the pre-operative planning by updating peri-operative migration patterns of the heart and, consequently, will lead to reduced conversion to conventional open thoracic procedures

Towards real-time cardiovascular magnetic resonance guided transarterial CoreValve implantation: in vivo evaluation in swine

<p>Abstract</p> <p>Background</p> <p>Real-time cardiovascular magnetic resonance (rtCMR) is considered attractive for guiding TAVI. Owing to an unlimited scan plane orientation and an unsurpassed soft-tissue contrast with simultaneous device visualization, rtCMR is presumed to allow safe device navigation and to offer optimal orientation for precise axial positioning. We sought to evaluate the preclinical feasibility of rtCMR-guided transarterial aortic valve implatation (TAVI) using the nitinol-based Medtronic CoreValve bioprosthesis.</p> <p>Methods</p> <p>rtCMR-guided transfemoral (n = 2) and transsubclavian (n = 6) TAVI was performed in 8 swine using the original CoreValve prosthesis and a modified, CMR-compatible delivery catheter without ferromagnetic components.</p> <p>Results</p> <p>rtCMR using TrueFISP sequences provided reliable imaging guidance during TAVI, which was successful in 6 swine. One transfemoral attempt failed due to unsuccessful aortic arch passage and one pericardial tamponade with subsequent death occurred as a result of ventricular perforation by the device tip due to an operating error, this complication being detected without delay by rtCMR. rtCMR allowed for a detailed, simultaneous visualization of the delivery system with the mounted stent-valve and the surrounding anatomy, resulting in improved visualization during navigation through the vasculature, passage of the aortic valve, and during placement and deployment of the stent-valve. Post-interventional success could be confirmed using ECG-triggered time-resolved cine-TrueFISP and flow-sensitive phase-contrast sequences. Intended valve position was confirmed by ex-vivo histology.</p> <p>Conclusions</p> <p>Our study shows that rtCMR-guided TAVI using the commercial CoreValve prosthesis in conjunction with a modified delivery system is feasible in swine, allowing improved procedural guidance including immediate detection of complications and direct functional assessment with reduction of radiation and omission of contrast media.</p

Virtuelle endovaskuläre Versorgung von abdominalen Aortenaneurysmen

This thesis is focused on computational methods that predict the outcome of endovascular repair of abdominal aortic aneurysms. Novelties include improvements of the aneurysm model, the stent-graft model as well as the in-silico stent-graft placement methodology. The newly developed methods are applied to patient-specific cases and are validated against real-world postinterventional data. Further, directions for using the in-silico model of endovascular aneurysm repair as personalized preinterventional planning tool in clinical practice are provided.Die vorliegende Arbeit beschäftigt sich mit numerischen Methoden um den Ausgang einer endovaskulären Versorgung von abdominalen Aortenaneurysmen vorherzusagen. Neuheiten umfassen Verbesserungen des Aneurysmenmodells, des Stentgraftmodells sowie der virtuellen Platzierungsmethode des Stentgrafts. Die neu entwickelten Methoden werden auf patientenspezifische Fälle angewandt und werden mit realen postoperativen Daten validiert. Weiterhin werden klinische Anwendungen des Modells der endovaskulären Aneurysmenversorgung als personalisiertes präoperatives Planungswerkzeug präsentiert