Inside the beating heart: an in vivo feasibility study on fusing pre- and intra-operative imaging for minimally invasive therapy

Linte, Cristian A.; Moore, John; Wedlake, Chris; Bainbridge, Daniel; Guiraudon, G; Jones, Douglas L.; Peters, Terry M.

doi:10.1007/s11548-008-0278-6

Cited by 32 publications

(18 citation statements)

References 31 publications

(29 reference statements)

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“…This study further emphasizes the importance of treating the navigation phase of an image-guided procedure separate from the positioning phase. 19 …”

Section: Discussionmentioning

confidence: 99%

Augmented Reality Image Guidance Improves Navigation for Beating Heart Mitral Valve Repair

Chu

Moore

Peters

et al. 2012

Innovations�(Phila)

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Objective Emerging off-pump beating heart valve repair techniques offer patients less invasive alternatives for mitral valve (MV) repair. However, most of these techniques rely on the limited spatial and temporal resolution of transesophageal echocardiography (TEE) alone, which can make tool visualization and guidance challenging. Methods Using a magnetic tracking system and integrated sensors, we created an augmented reality (AR) environment displaying virtual representations of important intracardiac landmarks registered to biplane TEE imaging. In a porcine model, we evaluated the AR guidance system versus TEE alone using the transapically delivered NeoChord DS1000 system to perform MV repair with chordal reconstruction. Results Successful tool navigation from left ventricular apex to MV leaflet was achieved in 12 of 12 and 9 of 12 (P = 0.2) attempts with AR imaging and TEE alone, respectively. The distance errors of the tracked tool tip from the intended midline trajectory (5.2 ± 2.4 mm vs 16.8 ± 10.9 mm, P = 0.003), navigation times (16.7 ± 8.0 seconds vs 92.0 ± 84.5 seconds, P = 0.004), and total path lengths (225.2 ± 120.3 mm vs 1128.9 ± 931.1 mm, P = 0.003) were significantly shorter in the AR-guided trials compared with navigation with TEE alone. Furthermore, the potential for injury to other intracardiac structures was nearly 40-fold lower when using the AR imaging for tool navigation. The AR guidance also seemed to shorten the learning curve for novice surgeons. Conclusions Augmented reality–enhanced TEE facilitates more direct and safe intracardiac navigation of the NeoChord DS tool from left ventricular apex to MV leaflet. Tracked tool path results demonstrate fourfold improved accuracy, fivefold shorter navigation times, and overall improved safety with AR imaging guidance.

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“…This study further emphasizes the importance of treating the navigation phase of an image-guided procedure separate from the positioning phase. 19 …”

Section: Discussionmentioning

confidence: 99%

Augmented Reality Image Guidance Improves Navigation for Beating Heart Mitral Valve Repair

Chu

Moore

Peters

et al. 2012

Innovations�(Phila)

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“…The specific aim addressed here was initiated by the need to update a preoperative surgical plan according to changes induced during the perioperative workflow of typical RA-CABG procedures. We have adapted previously developed techniques for pre-to intraoperative registration 16 to estimate the location of features of interest at different stages during the perioperative workflow and also evaluated the morphologic variations of these features across these stages.…”

Section: Discussionmentioning

confidence: 99%

Investigating Perioperative Heart Migration during Robot-Assisted Coronary Artery Bypass Grafting Interventions

Linte

Cho

Wedlake

et al. 2011

Innovations�(Phila)

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Objective For robot-assisted coronary artery bypass graft interventions, surgeons typically use a preoperative thoracic computed tomography scan of the patient to plan the procedure. However, the cardiac anatomy is prone to changes induced perioperatively in the effort to access the heart and surgical targets, which, in turn, may invalidate the initial plan. This article presents a method to estimate the perioperative heart migration, information which can be further exploited to refine the preoperative surgical plan. Methods Tracked transesophageal ultrasound images of four patients’ hearts were acquired at each stage in the procedure: before lung deflation, after lung deflation, and after both lung deflation and CO2 thoracic insufflation. Anatomic features of interest—the mitral and aortic valves—were identified from each dataset, and their movement between the different procedure stages was recorded and used to estimate the global heart displacement. Moreover, the local morphology of the features of interest was investigated to provide insight on the extent of the deformation the heart has undergone during the workflow. Results The study suggested that the heart does undergo substantial displacement—on the order of 10 to 15 mm in each direction (axial, coronal, and sagittal) after lung deflation and CO2 thoracic insufflation. However, no significant differences (P > 0.1) were observed in the morphologic characteristics of the features of interest across the multiple workflow stages, suggesting that local deformations occur at a much smaller scale compared with the global migration. Conclusions The quantification of the perioperatively induced changes is critical to track the displacement of the heart and surgical targets. The recorded migration patterns should not be ignored but rather be used to update the surgical plan to better suit the intraoperative environment.

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“…1. a) AR environment used to guide an in vivo off-pump procedure in a porcine subject, showing pre-operatively generated anatomical model, tracked 2D US image, and virtual tool models; b) Pre-operative model registered to intra-operative US image, and c) error map showing misalignments across the surface model Recently, Ma et al [6] proposed a feature-based registration technique that relies on the alignment of the left ventricular surface and centerline of the descending aorta to fuse pre-and intra-operative data using a weighted iterative closest point (ICP) registration approach; similarly, we have shown clinically-suitable fusion of pre-operative models and intra-operative US data via aligning reconstructed valve annuli et al [7]. While the features driving the registration are different, both techniques provide comparable anatomical alignment (4-5 mm) of the pre-and intra-operative data.…”

Section: Introductionmentioning

confidence: 88%

Targeting Accuracy under Model-to-Subject Misalignments in Model-Guided Cardiac Surgery

Linte

Moore

Wiles

et al. 2009

Medical Image Computing and Computer-Assisted Intervention – MICCAI 2009

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Abstract. In image-guided interventions, anatomical models of organs are often generated from pre-operative images and further employed in planning and guiding therapeutic procedures. However, the accuracy of these models, along with their registration to the subject are crucial for successful therapy delivery. These factors are amplified when manipulating soft tissue undergoing large deformations, such as the heart. When used in guiding beating-heart procedures, pre-operative models may not be sufficient for guidance and they are often complemented with real-time, intra-operative cardiac imaging. Here we demonstrate via in vitro endocardial "therapy" that ultrasound-enhanced model-guided navigation provides sufficient guidance to preserve a clinically-desired targeting accuracy of under 3 mm independently of the model-to-subject misregistrations. These results emphasize the direct benefit of integrating real-time imaging within intra-operative visualization environments considering that modelto-subject misalignments are often encountered clinically.

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Inside the beating heart: an in vivo feasibility study on fusing pre- and intra-operative imaging for minimally invasive therapy

Abstract: Surgical guidance in the absence of direct vision and with no exposure to ionizing radiation was achieved, so our virtual environment constitutes a feasible candidate for performing various off-pump intracardiac interventions.

Cited by 32 publications

References 31 publications

Augmented Reality Image Guidance Improves Navigation for Beating Heart Mitral Valve Repair

Augmented Reality Image Guidance Improves Navigation for Beating Heart Mitral Valve Repair

Investigating Perioperative Heart Migration during Robot-Assisted Coronary Artery Bypass Grafting Interventions

Targeting Accuracy under Model-to-Subject Misalignments in Model-Guided Cardiac Surgery

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