MRI-3D ultrasound-X-ray image fusion with electromagnetic tracking for transendocardial therapeutic injections: in-vitro validation and in-vivo feasibility.

Myocardial infarction (MI) is one of the leading causes of death in the world. Small animal studies have shown that stem-cell therapy offers dramatic functional improvement post-MI. An endomyocardial catheter injection approach to therapeutic agent delivery has been proposed to improve efficacy through increased cell retention. Accurate targeting is critical for reaching areas of greatest therapeutic potential while avoiding a life-threatening myocardial perforation. Multimodal image fusion has been proposed as a way to improve these procedures by augmenting traditional intra-operative imaging modalities with high resolution pre-procedural images. Previous approaches have suffered from a lack of real-time tissue imaging and dependence on X-ray imaging to track devices, leading to increased ionizing radiation dose. In this paper, we present a new image fusion system for catheter-based targeted delivery of therapeutic agents. The system registers real-time 3D echocardiography, magnetic resonance, X-ray, and electromagnetic sensor tracking within a single flexible framework. All system calibrations and registrations were validated and found to have target registration errors less than 5 mm in the worst case. Injection accuracy was validated in a motion enabled cardiac injection phantom, where targeting accuracy ranged from 0.57 to 3.81 mm. Clinical feasibility was demonstrated with in-vivo swine experiments, where injections were successfully made into targeted regions of the heart.

Real-time 3D ultrasound guided interventional system for cardiac stem cell therapy with motion compensation.

This paper describes a clinically translatable interventional guidance platform to improve the accuracy and precision of stem cell injections into a beating heart. The proposed platform overlays live position of an injection catheter onto a fusion of a pre-procedural MR roadmap with real-time 3D transesophageal echocardiography (TEE). Electromagnetic (EM) tracking is used to initialize the fusion. The fusion is intra-operatively compensated for respiratory motion using a novel algorithm that uses peri-operative full volume ultrasound images. Validation of the system on a moving heart phantom produced a landmark registration accuracy of 2.8 +/- 1.45mm. Validation on animal in vivo data produced an average registration accuracy of 2.2 +/- 1.8 mm; indicating that it is feasible to reliably and robustly fuse the MR road-map with catheter position using 3D ultrasound in a clinical setting.

Fast and accurate calibration of an X-ray imager to an electromagnetic tracking system for interventional cardiac procedures.

Cardiovascular disease affects millions of Americans each year. Interventional guidance systems are being developed as treatment options for some of the more delicate procedures, including targeted stem cell therapy. As advanced systems for such types of interventional guidance are being developed, electromagnetic (EM) tracking is coming in demand to perform navigation. To use this EM tracking technology, a calibration is necessary to register the tracker to the imaging system. In this paper we investigate the calibration of an X-ray imaging system to EM tracking. Two specially designed calibration phantoms have been designed for this purpose, each having a rigidly attached EM sensor. From a clinical usability point-of-view, we propose to divide this calibration problem into two steps: i) in initial calibration of the EM sensor to the phantom design using an EM tracked needle to trace out grooves in the phantom surface and ii) segmentation from X-ray images and 3D reconstruction of beads embedded in the phantom in a known geometric pattern. Combining these two steps yields and X-ray-to-EM calibration accuracy of less than 1 mm when overlaying an EM tracked needle on X-ray images.