title: Novel System for Real-Time Integration of 3-D Echocardiography and Fluoroscopy for Image-Guided Cardiac Interventions: Preclinical Validation and Clinical Feasibility Evaluation.
abstract: 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.
authors.affiliation: King's College LondonDivision of Imaging Sciences and Biomedical EngineeringLondonU.K.SE1 7EH; Guy's and St. Thomas' NHS Foundation TrustDepartment of CardiologyLondonU.K.SE1 7EH.
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Arujuna
authors.affiliation: King's College London Division of Imaging Sciences and Biomedical Engineering London U.K. SE1 7EH.
authors.forename: R James
authors.initials: RJ
authors.lastname: Housden
authors.affiliation: King's College London Division of Imaging Sciences and Biomedical Engineering London U.K. SE1 7EH.
authors.forename: Yingliang
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust Department of Cardiology London U.K. SE1 7EH.
authors.forename: Ronak
authors.initials: R
authors.lastname: Rajani
authors.affiliation: King's College London Division of Imaging Sciences and Biomedical Engineering London U.K. SE1 7EH.
authors.forename: Gang
authors.initials: G
authors.lastname: Gao
authors.affiliation: Interventional X-Ray Philips Healthcare Best The Netherlands DA 5680.
authors.forename: Niels
authors.initials: N
authors.lastname: Nijhof
authors.affiliation: Interventional X-Ray Philips Healthcare Best The Netherlands DA 5680.
authors.forename: Pascal
authors.initials: P
authors.lastname: Cathier
authors.affiliation: Interventional X-Ray Philips Healthcare Best The Netherlands DA 5680.
authors.forename: Roland
authors.initials: R
authors.lastname: Bullens
authors.affiliation: Interventional X-Ray Philips Healthcare Best The Netherlands DA 5680.
authors.forename: Geert
authors.initials: G
authors.lastname: Gijsbers
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust Department of Cardiology London U.K. SE1 7EH.
authors.forename: Victoria
authors.initials: V
authors.lastname: Parish
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust Department of Cardiology London U.K. SE1 7EH.
authors.forename: Stamatis
authors.initials: S
authors.lastname: Kapetanakis
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust Department of Cardiology London U.K. SE1 7EH.
authors.forename: Jane
authors.initials: J
authors.lastname: Hancock
authors.affiliation: King's College LondonDivision of Imaging Sciences and Biomedical EngineeringLondonU.K.SE1 7EH; Guy's and St. Thomas' NHS Foundation TrustDepartment of CardiologyLondonU.K.SE1 7EH.
authors.forename: C Aldo
authors.initials: CA
authors.lastname: Rinaldi
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust Department of Cardiology London U.K. SE1 7EH.
authors.forename: Michael
authors.initials: M
authors.lastname: Cooklin
authors.affiliation: King's College LondonDivision of Imaging Sciences and Biomedical EngineeringLondonU.K.SE1 7EH; Guy's and St. Thomas' NHS Foundation TrustDepartment of CardiologyLondonU.K.SE1 7EH.
authors.forename: Jaswinder
authors.initials: J
authors.lastname: Gill
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust Department of Cardiology London U.K. SE1 7EH.
authors.forename: Martyn
authors.initials: M
authors.lastname: Thomas
authors.affiliation: King's College LondonDivision of Imaging Sciences and Biomedical EngineeringLondonU.K.SE1 7EH; Guy's and St. Thomas' NHS Foundation TrustDepartment of CardiologyLondonU.K.SE1 7EH.
authors.forename: Mark D
authors.initials: MD
authors.lastname: O'neill
authors.affiliation: King's College LondonDivision of Imaging Sciences and Biomedical EngineeringLondonU.K.SE1 7EH; Guy's and St. Thomas' NHS Foundation TrustDepartment of CardiologyLondonU.K.SE1 7EH.
authors.forename: Reza
authors.initials: R
authors.lastname: Razavi
authors.affiliation: King's College London Division of Imaging Sciences and Biomedical Engineering London U.K. SE1 7EH.
authors.forename: Kawal S
authors.initials: KS
authors.lastname: Rhode
keywords: 3D ultrasound; Cardiac interventional guidance; X-ray fluoroscopy; clinical evaluation; image fusion