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Novel System for Real-Time Integration of 3-D Echocardiography and Fluoroscopy for Image-Guided Cardiac Interventions: Preclinical Validation and Clinical Feasibility Evaluation

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A novel, validated image fusion system that allows real-time integration of three-dimensional echocardiography and X-ray fluoroscopy for guidance of cardiac cacheterization. The system was validated in two stages: pre-clinical to determine function and validate accuracy, and in the clinical setting to assess clinical workflow feasibility and determine overall system accuracy.
A novel, validated image fusion system that allows real-time integration of three-dimensional echocardiography and X-ray fluoroscopy for guidance of cardiac cacheterization. The system was validated in two stages: pre-clinical to determine function and validate accuracy, and in the clinical setting to assess clinical workflow feasibility and determine overall system accuracy.

Real-time imaging is required to guide minimally invasive catheter-based cardiac interventions. While transesophageal echocardiography allows for high-quality visualization of cardiac anatomy, X-ray fluoroscopy provides excellent visualization of devices. We have developed a novel image fusion system that allows real-time integration of 3-D echocardiography and the X-ray fluoroscopy. The system was validated in the following two stages: 1) preclinical to determine function and validate accuracy; and 2) in the clinical setting to assess clinical workflow feasibility and determine overall system accuracy. In the preclinical phase, the system was assessed using both phantom and porcine experimental studies. Median 2-D projection errors of 4.5 and 3.3 mm were found for the phantom and porcine studies, respectively. The clinical phase focused on extending the use of the system to interventions in patients undergoing either atrial fibrillation catheter ablation (CA) or transcatheter aortic valve implantation (TAVI). Eleven patients were studied with nine in the CA group and two in the TAVI group. Successful real-time view synchronization was achieved in all cases with a calculated median distance error of 2.2 mm in the CA group and 3.4 mm in the TAVI group. A standard clinical workflow was established using the image fusion system. These pilot data confirm the technical feasibility of accurate real-time echo-fluoroscopic image overlay in clinical practice, which may be a useful adjunct for real-time guidance during interventional cardiac procedures.
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Authors

See complete bios of the authors in the full version of this article.
AV ArujunaAV Arujuna
Mr. Arujuna was a Clinical Research Fellow with King’s College London, Department of Imaging
Sciences and Biomedical Engineering from 2009 to 2012. His current research interests include image-guided cardiovascular interventions, cardiac electromechanical modeling, advanced pacing, and advanced imaging.

RJ HousdenRJ Housden
Dr. Houseden is currently a Post-Doctoral Researcher with the Division of Imaging Sciences and Biomedical Engineering, King’s College London, working primarily on image guidance systems for minimally-invasive cardiac catheterization. His research interests include ultrasound imaging, image processing, and surgical guidance systems.

Y MaY Ma
Dr. Ma is currently a Senior Lecturer with Computer Science and Creative Technologies, University of the West of England. His research interests are computer graphics, mobile technology, and medical image processing in general.

S KapetanakisS Kapetanakis
Mr. Kapetanakis is a Consultant of heart failure and cardiac imaging with Guy’s and St. Thomas’ NHS Foundation Trust. As well as conducting regular heart failure clinics and specialist echocardiography sessions, he is the lead for cardio-oncology and maintains runs a dedicated muscular dystrophy clinic. He is the educational lead for core medical trainees in cardiology.

MD O'NeillMD O’Neill
Mr. O’Neill is a Consultant Cardiologist and Electrophysiologist with St. Thomas’ Hospital London, and Reader of clinical cardiac electrophysiology with King’s College London. His primary research interests are the development and use of advanced signal processing and imaging technologies to improve arrhythmia characterization and treatment in patients with heart rhythm disturbances.

R RazaviR Razavi
Dr. Razavi is the Director of the KCL Centre for Excellence in Medical Engineering funded by the Welcome Trust and Engineering and Physical Sciences Research Council. His current research interests include cardiovascular MRI and MR-guided cardiac catheterization.

KS RhodeKS Rhode
Mr. Rhode specializes in translation of novel technologies into the clinical environment via collaborative research programmes with leading clinical and industrial partners. His research interests include image-guided cardiovascular interventions, cardiac electromechanical modeling, computer simulation of minimally invasive procedures, and medical robotics.

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