Patient-specific in silico 3D coronary model in cardiac catheterisation laboratories

Coronary artery disease is caused by the buildup of atherosclerotic plaque in the coronary arteries, affecting the blood supply to the heart, one of the leading causes of death around the world. X-ray coronary angiography is the most common procedure for diagnosing coronary artery disease, which uses contrast material and x-rays to observe vascular lesions. With this type of procedure, blood flow in coronary arteries is viewed in real-time, making it possible to detect stenoses precisely and control percutaneous coronary interventions and stent insertions. Angiograms of coronary arteries are used to plan the necessary revascularisation procedures based on the calculation of occlusions and the affected segments. However, their interpretation in cardiac catheterisation laboratories presently relies on sequentially evaluating multiple 2D image projections, which limits measuring lesion severity, identifying the true shape of vessels, and analysing quantitative data. In silico modelling, which involves computational simulations of patient-specific data, can revolutionise interventional cardiology by providing valuable insights and optimising treatment methods. This paper explores the challenges and future directions associated with applying patient-specific in silico models in catheterisation laboratories. We discuss the implications of the lack of patient-specific in silico models and how their absence hinders the ability to accurately predict and assess the behaviour of individual patients during interventional procedures. Then, we introduce the different components of a typical patient-specific in silico model and explore the potential future directions to bridge this gap and promote the development and utilisation of patient-specific in silico models in the catheterisation laboratories

Dynamic Analysis of X-ray Angiography for Image-Guided Coronary Interventions

Percutaneous coronary intervention (PCI) is a minimally-invasive procedure for treating patients with coronary artery disease. PCI is typically performed with image guidance using X-ray angiograms (XA) in which coronary arter

Coronary Artery Segmentation and Motion Modelling

Conventional coronary artery bypass surgery requires invasive sternotomy and the use of a cardiopulmonary bypass, which leads to long recovery period and has high infectious potential. Totally endoscopic coronary artery bypass (TECAB) surgery based on image guided robotic surgical approaches have been developed to allow the clinicians to conduct the bypass surgery off-pump with only three pin holes incisions in the chest cavity, through which two robotic arms and one stereo endoscopic camera are inserted. However, the restricted field of view of the stereo endoscopic images leads to possible vessel misidentification and coronary artery mis-localization. This results in 20-30% conversion rates from TECAB surgery to the conventional approach. We have constructed patient-specific 3D + time coronary artery and left ventricle motion models from preoperative 4D Computed Tomography Angiography (CTA) scans. Through temporally and spatially aligning this model with the intraoperative endoscopic views of the patient's beating heart, this work assists the surgeon to identify and locate the correct coronaries during the TECAB precedures. Thus this work has the prospect of reducing the conversion rate from TECAB to conventional coronary bypass procedures. This thesis mainly focus on designing segmentation and motion tracking methods of the coronary arteries in order to build pre-operative patient-specific motion models. Various vessel centreline extraction and lumen segmentation algorithms are presented, including intensity based approaches, geometric model matching method and morphology-based method. A probabilistic atlas of the coronary arteries is formed from a group of subjects to facilitate the vascular segmentation and registration procedures. Non-rigid registration framework based on a free-form deformation model and multi-level multi-channel large deformation diffeomorphic metric mapping are proposed to track the coronary motion. The methods are applied to 4D CTA images acquired from various groups of patients and quantitatively evaluated

YOLO-Angio: An Algorithm for Coronary Anatomy Segmentation

Coronary angiography remains the gold standard for diagnosis of coronary artery disease, the most common cause of death worldwide. While this procedure is performed more than 2 million times annually, there remain few methods for fast and accurate automated measurement of disease and localization of coronary anatomy. Here, we present our solution to the Automatic Region-based Coronary Artery Disease diagnostics using X-ray angiography images (ARCADE) challenge held at MICCAI 2023. For the artery segmentation task, our three-stage approach combines preprocessing and feature selection by classical computer vision to enhance vessel contrast, followed by an ensemble model based on YOLOv8 to propose possible vessel candidates by generating a vessel map. A final segmentation is based on a logic-based approach to reconstruct the coronary tree in a graph-based sorting method. Our entry to the ARCADE challenge placed 3rd overall. Using the official metric for evaluation, we achieved an F1 score of 0.422 and 0.4289 on the validation and hold-out sets respectively.Comment: MICCAI Conference ARCADE Grand Challenge, YOLO, Computer Vision

Automatic segmentation of coronary angiograms based on fuzzy inferring and probabilistic tracking

<p>Abstract</p> <p>Background</p> <p>Segmentation of the coronary angiogram is important in computer-assisted artery motion analysis or reconstruction of 3D vascular structures from a single-plan or biplane angiographic system. Developing fully automated and accurate vessel segmentation algorithms is highly challenging, especially when extracting vascular structures with large variations in image intensities and noise, as well as with variable cross-sections or vascular lesions.</p> <p>Methods</p> <p>This paper presents a novel tracking method for automatic segmentation of the coronary artery tree in X-ray angiographic images, based on probabilistic vessel tracking and fuzzy structure pattern inferring. The method is composed of two main steps: preprocessing and tracking. In preprocessing, multiscale Gabor filtering and Hessian matrix analysis were used to enhance and extract vessel features from the original angiographic image, leading to a vessel feature map as well as a vessel direction map. In tracking, a seed point was first automatically detected by analyzing the vessel feature map. Subsequently, two operators [e.g., a probabilistic tracking operator (PTO) and a vessel structure pattern detector (SPD)] worked together based on the detected seed point to extract vessel segments or branches one at a time. The local structure pattern was inferred by a multi-feature based fuzzy inferring function employed in the SPD. The identified structure pattern, such as crossing or bifurcation, was used to control the tracking process, for example, to keep tracking the current segment or start tracking a new one, depending on the detected pattern.</p> <p>Results</p> <p>By appropriate integration of these advanced preprocessing and tracking steps, our tracking algorithm is able to extract both vessel axis lines and edge points, as well as measure the arterial diameters in various complicated cases. For example, it can walk across gaps along the longitudinal vessel direction, manage varying vessel curvatures, and adapt to varying vessel widths in situations with arterial stenoses and aneurysms.</p> <p>Conclusions</p> <p>Our algorithm performs well in terms of robustness, automation, adaptability, and applicability. In particular, the successful development of two novel operators, namely, PTO and SPD, ensures the performance of our algorithm in vessel tracking.</p

Optimized Adaptive Frangi-based Coronary Artery Segmentation using Genetic Algorithm

Diseases of coronary artery are deliberated as one of the most common heart diseases leading to death worldwide. For early detection of such disease, the X-ray angiography is a benchmark imaging modality for diagnosing such illness. The acquired X-ray angiography images usually suffer from low quality and the presence of noise. Therefore, for developing a computer-aided diagnosis (CAD) system, vessel enhancement and segmentation play significant role. In this paper, an optimized adapter filter based on Frangi filter was proposed for superior segmentation of the angiography images using genetic algorithm (GA). The original angiography image is initially preprocessed to enhance its contrast followed by generating the vesselness map using the proposed optimized Frangi filter. Then, a segmentation technique is applied to extract only the artery vessels, where the proposed system for extracting only the main vessel was evaluated. The experimental results on angiography images established the superiority of the vessel regions extraction showing 98.58% accuracy compared to the state-of-the-art

Continuous roadmapping in liver TACE procedures using 2D–3D catheter-based registration

PURPOSE: Fusion of pre/perioperative images and intra-operative images may add relevant information during image-guided procedures. In abdominal procedures, respiratory motion changes the position of organs, and thus accurate image guidance requires a continuous update of the spatial alignment of the (pre/perioperative) information with the organ position during the intervention. METHODS: In this paper, we propose a method to register in real time perioperative 3D rotational angiography images (3DRA) to intra-operative single-plane 2D fluoroscopic images for improved guidance in TACE interventions. The method uses the shape of 3D vessels extracted from the 3DRA and the 2D catheter shape extracted from fluoroscopy. First, the appropriate 3D vessel is selected from the complete vascular tree using a shape similarity metric. Subsequently, the catheter is registered to this vessel, and the 3DRA is visualized based on the registration results. The method is evaluated on simulated data and clinical data. RESULTS: The first selected vessel, ranked with the shape similarity metric, is used more than 39 % in the final registration and the second more than 21 %. The median of the closest corresponding points distance between 2D angiography vessels and projected 3D vessels is 4.7–5.4 mm when using the brute force optimizer and 5.2–6.6 mm when using the Powell optimizer. CONCLUSION: We present a catheter-based registration method to continuously fuse a 3DRA roadmap arterial tree onto 2D fluoroscopic images with an efficient shape similarity

Template-based 3D-2D rigid registration of vascular structures in frequency domain from a single view

Image guided interventions in angiography are performed with a real-time X-ray sequences acquired by a C-arm device which provides the surgeon two dimensional visualization needed to guide the surgical instruments. This visualization may be augmented by registering a three dimensional preoperative volume with the interventional images to provide additional information such as depth, removal of occlusions and alternative views of vessel paths. This thesis presents two novel methods for rigid registration of vascular structures in the preoperative volume to the interventional X-ray image for enhancing visualization in Image Guided Interventions. In the first part of this thesis, estimation of rotation and translation are decoupled. Rotation is estimated by comparing rotated projections of the segmented vessels of the volume with segmented X-ray vessels in frequency domain. Translation is then estimated by minimizing the distances and maximizing the overlap ratio between segmented vessels. The registration results are reported in mean Projection Distances. The second part of the thesis adds separation of out-of-plane translation estimation to the first part and replaces segmentation by gradients. Rotation and out-of-plane translation are estimated by comparing rotational projected templates of volume with depth templates formed by scaling the X-ray image in the Fourier Magnitude Domain. The in-plane translation is then estimated by a Fourier Phase correlation. The registration results are evaluated by a Gold Standard dataset on cerebral arteries. This method is robust against occlusions and noises due to its usage of gradients and frequency domain similarity, has high capture range and fast, fixed computation times for every step due to template based framework