175 research outputs found
3D/2D Registration of Mapping Catheter Images for Arrhythmia Interventional Assistance
Radiofrequency (RF) catheter ablation has transformed treatment for
tachyarrhythmias and has become first-line therapy for some tachycardias. The
precise localization of the arrhythmogenic site and the positioning of the RF
catheter over that site are problematic: they can impair the efficiency of the
procedure and are time consuming (several hours). Electroanatomic mapping
technologies are available that enable the display of the cardiac chambers and
the relative position of ablation lesions. However, these are expensive and use
custom-made catheters. The proposed methodology makes use of standard catheters
and inexpensive technology in order to create a 3D volume of the heart chamber
affected by the arrhythmia. Further, we propose a novel method that uses a
priori 3D information of the mapping catheter in order to estimate the 3D
locations of multiple electrodes across single view C-arm images. The monoplane
algorithm is tested for feasibility on computer simulations and initial canine
data.Comment: International Journal of Computer Science Issues, IJCSI, Volume 4,
Issue 2, pp10-19, September 200
Navigation system based in motion tracking sensor for percutaneous renal access
Tese de Doutoramento em Engenharia BiomédicaMinimally-invasive kidney interventions are daily performed to diagnose and treat several renal
diseases. Percutaneous renal access (PRA) is an essential but challenging stage for most of these
procedures, since its outcome is directly linked to the physician’s ability to precisely visualize and
reach the anatomical target.
Nowadays, PRA is always guided with medical imaging assistance, most frequently using X-ray
based imaging (e.g. fluoroscopy). Thus, radiation on the surgical theater represents a major risk to
the medical team, where its exclusion from PRA has a direct impact diminishing the dose exposure
on both patients and physicians.
To solve the referred problems this thesis aims to develop a new hardware/software framework
to intuitively and safely guide the surgeon during PRA planning and puncturing.
In terms of surgical planning, a set of methodologies were developed to increase the certainty of
reaching a specific target inside the kidney. The most relevant abdominal structures for PRA were
automatically clustered into different 3D volumes. For that, primitive volumes were merged as a local
optimization problem using the minimum description length principle and image statistical
properties. A multi-volume Ray Cast method was then used to highlight each segmented volume.
Results show that it is possible to detect all abdominal structures surrounding the kidney, with the
ability to correctly estimate a virtual trajectory.
Concerning the percutaneous puncturing stage, either an electromagnetic or optical solution
were developed and tested in multiple in vitro, in vivo and ex vivo trials. The optical tracking solution
aids in establishing the desired puncture site and choosing the best virtual puncture trajectory.
However, this system required a line of sight to different optical markers placed at the needle base,
limiting the accuracy when tracking inside the human body. Results show that the needle tip can
deflect from its initial straight line trajectory with an error higher than 3 mm. Moreover, a complex
registration procedure and initial setup is needed.
On the other hand, a real-time electromagnetic tracking was developed. Hereto, a catheter
was inserted trans-urethrally towards the renal target. This catheter has a position and orientation
electromagnetic sensor on its tip that function as a real-time target locator. Then, a needle integrating a similar sensor is used. From the data provided by both sensors, one computes a virtual puncture
trajectory, which is displayed in a 3D visualization software. In vivo tests showed a median renal and
ureteral puncture times of 19 and 51 seconds, respectively (range 14 to 45 and 45 to 67 seconds).
Such results represent a puncture time improvement between 75% and 85% when comparing to
state of the art methods.
3D sound and vibrotactile feedback were also developed to provide additional information about
the needle orientation. By using these kind of feedback, it was verified that the surgeon tends to
follow a virtual puncture trajectory with a reduced amount of deviations from the ideal trajectory,
being able to anticipate any movement even without looking to a monitor. Best results show that 3D
sound sources were correctly identified 79.2 ± 8.1% of times with an average angulation error of
10.4º degrees. Vibration sources were accurately identified 91.1 ± 3.6% of times with an average
angulation error of 8.0º degrees.
Additionally to the EMT framework, three circular ultrasound transducers were built with a needle
working channel. One explored different manufacture fabrication setups in terms of the piezoelectric
materials, transducer construction, single vs. multi array configurations, backing and matching
material design. The A-scan signals retrieved from each transducer were filtered and processed to
automatically detect reflected echoes and to alert the surgeon when undesirable anatomical
structures are in between the puncture path. The transducers were mapped in a water tank and
tested in a study involving 45 phantoms. Results showed that the beam cross-sectional area
oscillates around the ceramics radius and it was possible to automatically detect echo signals in
phantoms with length higher than 80 mm.
Hereupon, it is expected that the introduction of the proposed system on the PRA procedure,
will allow to guide the surgeon through the optimal path towards the precise kidney target, increasing
surgeon’s confidence and reducing complications (e.g. organ perforation) during PRA. Moreover, the
developed framework has the potential to make the PRA free of radiation for both patient and surgeon
and to broad the use of PRA to less specialized surgeons.Intervenções renais minimamente invasivas são realizadas diariamente para o tratamento e
diagnóstico de várias doenças renais. O acesso renal percutâneo (ARP) é uma etapa essencial e
desafiante na maior parte destes procedimentos. O seu resultado encontra-se diretamente
relacionado com a capacidade do cirurgião visualizar e atingir com precisão o alvo anatómico.
Hoje em dia, o ARP é sempre guiado com recurso a sistemas imagiológicos, na maior parte
das vezes baseados em raios-X (p.e. a fluoroscopia). A radiação destes sistemas nas salas cirúrgicas
representa um grande risco para a equipa médica, aonde a sua remoção levará a um impacto direto
na diminuição da dose exposta aos pacientes e cirurgiões.
De modo a resolver os problemas existentes, esta tese tem como objetivo o desenvolvimento
de uma framework de hardware/software que permita, de forma intuitiva e segura, guiar o cirurgião
durante o planeamento e punção do ARP.
Em termos de planeamento, foi desenvolvido um conjunto de metodologias de modo a
aumentar a eficácia com que o alvo anatómico é alcançado. As estruturas abdominais mais
relevantes para o procedimento de ARP, foram automaticamente agrupadas em volumes 3D, através
de um problema de optimização global com base no princípio de “minimum description length” e
propriedades estatísticas da imagem. Por fim, um procedimento de Ray Cast, com múltiplas funções
de transferência, foi utilizado para enfatizar as estruturas segmentadas. Os resultados mostram que
é possível detetar todas as estruturas abdominais envolventes ao rim, com a capacidade para
estimar corretamente uma trajetória virtual.
No que diz respeito à fase de punção percutânea, foram testadas duas soluções de deteção
de movimento (ótica e eletromagnética) em múltiplos ensaios in vitro, in vivo e ex vivo. A solução
baseada em sensores óticos ajudou no cálculo do melhor ponto de punção e na definição da melhor
trajetória a seguir. Contudo, este sistema necessita de uma linha de visão com diferentes
marcadores óticos acoplados à base da agulha, limitando a precisão com que a agulha é detetada
no interior do corpo humano. Os resultados indicam que a agulha pode sofrer deflexões à medida
que vai sendo inserida, com erros superiores a 3 mm.
Por outro lado, foi desenvolvida e testada uma solução com base em sensores
eletromagnéticos. Para tal, um cateter que integra um sensor de posição e orientação na sua ponta, foi colocado por via trans-uretral junto do alvo renal. De seguida, uma agulha, integrando um sensor
semelhante, é utilizada para a punção percutânea. A partir da diferença espacial de ambos os
sensores, é possível gerar uma trajetória de punção virtual. A mediana do tempo necessário para
puncionar o rim e ureter, segundo esta trajetória, foi de 19 e 51 segundos, respetivamente
(variações de 14 a 45 e 45 a 67 segundos). Estes resultados representam uma melhoria do tempo
de punção entre 75% e 85%, quando comparados com o estado da arte dos métodos atuais.
Além do feedback visual, som 3D e feedback vibratório foram explorados de modo a fornecer
informações complementares da posição da agulha. Verificou-se que com este tipo de feedback, o
cirurgião tende a seguir uma trajetória de punção com desvios mínimos, sendo igualmente capaz
de antecipar qualquer movimento, mesmo sem olhar para o monitor. Fontes de som e vibração
podem ser corretamente detetadas em 79,2 ± 8,1% e 91,1 ± 3,6%, com erros médios de angulação
de 10.4º e 8.0 graus, respetivamente.
Adicionalmente ao sistema de navegação, foram também produzidos três transdutores de
ultrassom circulares com um canal de trabalho para a agulha. Para tal, foram exploradas diferentes
configurações de fabricação em termos de materiais piezoelétricos, transdutores multi-array ou
singulares e espessura/material de layers de suporte. Os sinais originados em cada transdutor
foram filtrados e processados de modo a detetar de forma automática os ecos refletidos, e assim,
alertar o cirurgião quando existem variações anatómicas ao longo do caminho de punção. Os
transdutores foram mapeados num tanque de água e testados em 45 phantoms. Os resultados
mostraram que o feixe de área em corte transversal oscila em torno do raio de cerâmica, e que os
ecos refletidos são detetados em phantoms com comprimentos superiores a 80 mm.
Desta forma, é expectável que a introdução deste novo sistema a nível do ARP permitirá
conduzir o cirurgião ao longo do caminho de punção ideal, aumentado a confiança do cirurgião e
reduzindo possíveis complicações (p.e. a perfuração dos órgãos). Além disso, de realçar que este
sistema apresenta o potencial de tornar o ARP livre de radiação e alarga-lo a cirurgiões menos
especializados.The present work was only possible thanks to the support by the Portuguese Science and
Technology Foundation through the PhD grant with reference SFRH/BD/74276/2010 funded by
FCT/MEC (PIDDAC) and by Fundo Europeu de Desenvolvimento Regional (FEDER), Programa
COMPETE - Programa Operacional Factores de Competitividade (POFC) do QREN
Innovations in Clinical Cardiac Electrophysiology: From Conventional Approaches to Remote Magnetic Navigation
Clinical cardiac electrophysiology (EP) has progressed significantly since the first invasive electrophysiological
studies were performed to study normal impulse formation and conduction in
the heart and to confirm hypotheses regarding the causation of arrhythmias.
The first His bundle recordings in 1969,(1) and later, programmed atrial and ventricular stimulation(
2) to induce tachycardia made detailed analysis of arrhythmias possible. This led to an
understanding of reentrant and focal tachycardias on an atrial and ventricular level.
Subsequently therapeutic options became available when surgery entered the field with a
approach for ventricular tachycardia (VT)(3) and ventricular preexcitation (WPW syndrome).
Atrial fibrillation (AF) surgery was also successful but had a relatively high morbidity and a clear
mortality risk. At this early stage no therapy could be given via the catheter. Subsequently direct
current (DC) shock ablation of the AV node proved to be very successful and led to catheter ablation
of ventricular tachycardia and accessory pathways (4). However, the complications of this
technique were important. The arrival of radiofrequency was thought to be the solution for the
more simple arrhythmias such as atrioventricular nodal reentrant tachycardia (AVNRT), WPW,
idiopathic VT and atrial flutter(5). The development of better catheters allowed for successful
therapy in excess of 85% in most cases of these arrhythmias(6, 7). The real challenges remained
VT on a background of underlying heart disease, and AF in both the normal and abnormal
heart. The arrival of mapping systems allowing detailed electro-anatomical mapping(8) helped
strategies to develop for more complex arrhythmias. However these approaches are still time
consuming and there remain some drawbacks
Applications and Experiences of Quality Control
The rich palette of topics set out in this book provides a sufficiently broad overview of the developments in the field of quality control. By providing detailed information on various aspects of quality control, this book can serve as a basis for starting interdisciplinary cooperation, which has increasingly become an integral part of scientific and applied research
Image-Based Force Estimation and Haptic Rendering For Robot-Assisted Cardiovascular Intervention
Clinical studies have indicated that the loss of haptic perception is the prime limitation of robot-assisted cardiovascular intervention technology, hindering its global adoption. It causes compromised situational awareness for the surgeon during the intervention and may lead to health risks for the patients. This doctoral research was aimed at developing technology for addressing the limitation of the robot-assisted intervention technology in the provision of haptic feedback. The literature review showed that sensor-free force estimation (haptic cue) on endovascular devices, intuitive surgeon interface design, and haptic rendering within the surgeon interface were the major knowledge gaps. For sensor-free force estimation, first, an image-based force estimation methods based on inverse finite-element methods (iFEM) was developed and validated. Next, to address the limitation of the iFEM method in real-time performance, an inverse Cosserat rod model (iCORD) with a computationally efficient solution for endovascular devices was developed and validated. Afterward, the iCORD was adopted for analytical tip force estimation on steerable catheters. The experimental studies confirmed the accuracy and real-time performance of the iCORD for sensor-free force estimation. Afterward, a wearable drift-free rotation measurement device (MiCarp) was developed to facilitate the design of an intuitive surgeon interface by decoupling the rotation measurement from the insertion measurement. The validation studies showed that MiCarp had a superior performance for spatial rotation measurement compared to other modalities. In the end, a novel haptic feedback system based on smart magnetoelastic elastomers was developed, analytically modeled, and experimentally validated. The proposed haptics-enabled surgeon module had an unbounded workspace for interventional tasks and provided an intuitive interface. Experimental validation, at component and system levels, confirmed the usability of the proposed methods for robot-assisted intervention systems
Bioelectrical strategies for image-guided therapies
Thesis (Ph. D.)--Harvard-MIT Division of Health Sciences and Technology, 2007.Includes bibliographical references (leaves 152-157).There is a pressing need in minimally-invasive surgery for novel imaging methods that can rapidly and accurately localize the surgical instrument and its target. We have developed two novel localization methods for the guidance of cardiac ablation and other minimally-invasive therapies. The first method, the Inverse Solution Guidance Algorithm (ISGA), is for the non-invasive and rapid localization of the site of origin of an arrhythmia and an ablation catheter tip from body-surface ECG signals. We have substantially developed ISGA to provide accurate catheter guidance even in the presence of significant electrical inhomogeneities, and we have evaluated the method in numerical simulations and phantom studies. Due to the rapidity of arrhythmic origin localization, ISGA may prove a highly effective means of guiding the ablative therapy of hemodynamically-unstable VT. The second method, the Bioelectrical Image Guidance (BIG) Method, is a novel algorithm for the accurate and inexpensive guidance of a wide-range of minimally-invasive surgeries, from cardiac ablation to breast cancer biopsy.(cont.) The surgical instrument is localized within a detailed 3-D MRI or CT image by applying currents to the body surface and comparing the potentials measured at the instrument tip with potential distributions simulated prior to the surgery. We have developed and evaluated this method in numerical simulations. We have also built an experimental guidance system and tested it in a phantom model. Our results indicate that the BIG Method may one day provide an accurate and convenient means by which to guide minimally-invasive surgery within a highly detailed anatomical image.by Maya E. Barley.Ph.D
Pacing with restoration of respiratory sinus arrhythmia improved cardiac contractility and the left ventricular output: a translational study
Introduction: Respiratory sinus arrhythmia (RSA) is a prognostic value for patients with heart failure and is defined as a beat-to-beat variation of the timing between the heart beats. Patients with heart failure or patients with permanent cardiac pacing might benefit from restoration of RSA. The aim of this translational, proof-of-principle study was to evaluate the effect of pacing with or without restored RSAon parameters of LV cardiac contractility and the cardiac output
- …