title: Computer-aided endovascular aortic repair using fully automated two- and three-dimensional fusion imaging.
abstract: OBJECTIVE
  To assess the usability of a fully automated fusion imaging engine prototype, matching preinterventional computed tomography with intraoperative fluoroscopic angiography during endovascular aortic repair.
  
  
  METHODS
  From June 2014 to February 2015, all patients treated electively for abdominal and thoracoabdominal aneurysms were enrolled prospectively. Before each procedure, preoperative planning was performed with a fully automated fusion engine prototype based on computed tomography angiography, creating a mesh model of the aorta. In a second step, this three-dimensional dataset was registered with the two-dimensional intraoperative fluoroscopy. The main outcome measure was the applicability of the fully automated fusion engine. Secondary outcomes were freedom from failure of automatic segmentation or of the automatic registration as well as accuracy of the mesh model, measuring deviations from intraoperative angiography in millimeters, if applicable.
  
  
  RESULTS
  Twenty-five patients were enrolled in this study. The fusion imaging engine could be used in successfully 92% of the cases (n = 23). Freedom from failure of automatic segmentation was 44% (n = 11). The freedom from failure of the automatic registration was 76% (n = 19), the median error of the automatic registration process was 0 mm (interquartile range, 0-5 mm).
  
  
  CONCLUSIONS
  The fully automated fusion imaging engine was found to be applicable in most cases, albeit in several cases a fully automated data processing was not possible, requiring manual intervention. The accuracy of the automatic registration yielded excellent results and promises a useful and simple to use technology.
authors: Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Muenster, Muenster, Germany. Electronic address: giuseppe.panuccio@gmail.com.
authors: Giuseppe
authors: G
authors: Panuccio
authors: Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Muenster, Muenster, Germany; Westphalian Center for Radiology, Muenster, Germany.
authors: Giovanni Federico
authors: GF
authors: Torsello
authors: Siemens AG, Healthcare Sector, Forchheim, Germany.
authors: Markus
authors: M
authors: Pfister
authors: Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Muenster, Muenster, Germany.
authors: Theodosios
authors: T
authors: Bisdas
authors: Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Muenster, Muenster, Germany.
authors: Michel J
authors: MJ
authors: Bosiers
authors: Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Muenster, Muenster, Germany.
authors: Giovanni
authors: G
authors: Torsello
authors: Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Muenster, Muenster, Germany.
authors: Martin
authors: M
authors: Austermann
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D001331:Automation; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000379:methods*; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D064847:Multimodal Imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome