title: Real-time X-ray-based 4D image guidance of minimally invasive interventions.
abstract: OBJECTIVE
  A new technology is introduced that enables real-time 4D (three spatial dimensions plus time) X-ray guidance for vascular catheter interventions with acceptable levels of ionising radiation.
  
  
  METHODS
  The enabling technology is a combination of low-dose tomographic data acquisition with novel compressed sensing reconstruction and use of prior image information. It was implemented in a prototype set-up consisting of a gantry-based flat detector system. In pigs (n = 5) angiographic interventions were simulated. Radiation dosage on a per time base was compared with the "gold standard" of X-ray projection imaging.
  
  
  RESULTS
  Contrary to current image guidance methods that lack permanent 4D updates, the spatial position of interventional instruments could be resolved in continuous, spatial 4D guidance; the movement of the guide wire as well as the expansion of stents could be precisely tracked in 3D angiographic road maps. Dose rate was 23.8 μGy/s, similar to biplane standard angiographic fluoroscopy, which has a dose rate of 20.6 μGy/s.
  
  
  CONCLUSIONS
  Real-time 4D X-ray image-guidance with acceptable levels of radiation has great potential to significantly influence the field of minimally invasive medicine by allowing faster and safer interventions and by enabling novel, much more complex procedures for vascular and oncological minimally invasive therapy.
  
  
  CONCLUSIONS
  • Real-time 4D (three spatial dimensions plus time) angiographic intervention guidance is realistic. • Low-dose tomographic data acquisition with special compressed sensing-based algorithms is enabled. • Compared with 4D CT fluoroscopy, this method reduces radiation to acceptable levels. • Once implemented, vascular interventions may become safer and faster. • More complex intervention approaches may be developed.
authors: Department of Medical Physics in Radiology, German Cancer Research Center-DKFZ, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany. j.kuntz@dkfz.de
authors: Jan
authors: J
authors: Kuntz
authors: Rajiv
authors: R
authors: Gupta
authors: Stefan O
authors: SO
authors: Schönberg
authors: Wolfhard
authors: W
authors: Semmler
authors: Marc
authors: M
authors: Kachelrieß
authors: Sönke
authors: S
authors: Bartling
mesh_terms: D000465:Algorithms; D000792:Angiography / Q000379:methods; D000818:Animals; D057785:Catheters; D005471:Fluoroscopy / Q000379:methods; D056973:Four-Dimensional Computed Tomography / Q000379:methods*; D006801:Humans; D011829:Radiation Dosage; D011839:Radiation, Ionizing; D011857:Radiographic Image Interpretation, Computer-Assisted; D015642:Radiology, Interventional / Q000379:methods; D011874:Radiometry / Q000379:methods; D015203:Reproducibility of Results; D013552:Swine; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014965:X-Rays