A novel tool for three-dimensional roadmapping reduces radiation exposure and contrast agent dose in complex endovascular interventions.

OBJECTIVE: The volume and complexity of endovascular procedures are increasing. Multidetector computed tomography (CT) made precise three-dimensional (3D) planning of these procedures possible, but intraoperative imaging, even with the use of modern flat-panel detectors, is limited to two dimensions. Flat detectors, however, allow C-arm cone-beam CT. This technology can be used to generate a 3D data set that can be fused with a preoperative high-resolution CT scan, thus generating a live 3D roadmap. We hypothesized that use of a novel image fusion software, VesselNavigator (Philips Healthcare, Best, The Netherlands), facilitates precise and expeditious procedures and therefore reduces radiation exposure and contrast agent dose. METHODS: A retrospective review of patients undergoing standard aortobi-iliac endovascular aneurysm repair at our institution between January 2011 and April 2014 was performed. Conventional imaging was compared with VesselNavigator-assisted imaging, and a matched analysis based on body mass index (BMI) was performed because of the dependence of radiation dose on body habitus. Outcome parameters were procedure time, fluoroscopy time, radiation, and contrast agent dose. RESULTS: A total of 75 patients were identified. After matching based on BMI, control and VesselNavigator groups each had 16 patients with BMI of 27.0 ± 3.6 kg/m(2) and 27.0 ± 3.6 kg/m(2), respectively (mean ± standard deviation). R(2) was 6.37 × 10(-7). Radiation dose measured as air kerma was lower with VesselNavigator (1067 ± 470.4 mGy vs 1768 ± 696.2 mGy; P = .004). Fluoroscopy time was shorter (18.4 ± 6.8 minutes vs 26.8 ± 10.0 minutes; P = .01) and contrast agent dose was lower (37.4 ± 21.3 mL vs 77.3 ± 23.0 mL; P < .001) with VesselNavigator compared with control. Procedure time was also shorter with VesselNavigator (80.4 ± 21.2 minutes vs 110.0 ± 29.1 minutes; P = .005). CONCLUSIONS: Image fusion using VesselNavigator enhances the functionality of conventional fluoroscopy in standard endovascular aneurysm repair. It reduces radiation exposure to patients and providers. It also limits the amount of contrast agent and shortens the overall procedure length. The benefit of this technology is demonstrated on this typically straightforward procedure but may be even more useful for complex procedures.

Writing in turbulent air.

We describe a scheme of molecular tagging velocimetry in air in which nitric oxide (NO) molecules are created out of O2 and N2 molecules in the focus of a strong laser beam. The NO molecules are visualized a while later by laser-induced fluorescence. The precision of the molecular tagging velocimetry of gas flows is affected by the gradual blurring of the written patterns through molecular diffusion. In the case of turbulent flows, molecular diffusion poses a fundamental limit on the resolution of the smallest scales in the flow. We study the diffusion of written patterns in detail for our tagging scheme which, at short (micros) delay times is slightly anomalous due to local heating by absorption of laser radiation. We show that our experiments agree with a simple convection-diffusion model that allows us to estimate the temperature rise upon writing. Molecular tagging can be a highly nonlinear process, which affects the art of writing. We find that our tagging scheme is (only) quadratic in the intensity of the writing laser.