Progress in the development of a new angiography suite including the high resolution micro-angiographic fluoroscope (MAF); a control, acquisition, processing, and image display system (CAPIDS), and a new detector changer integrated into a commercial C-arm angiography unit to enable clinical use

Abstract

Due to the high-resolution needs of angiographic and interventional vascular imaging, a MicroAngiographic Fluoroscope (MAF) detector with a Control, Acquisition, Processing, and Image Display System (CAPIDS) was installed on a detector changer which was attached to the C-arm of a clinical angiographic unit. The MAF detector provides high-resolution, high-sensitivity, and real-time imaging capabilities and consists of a 300 μm-thick CsI phosphor, a dual stage microchannel plate light image intensifier (LII) coupled to a fiber optic taper (FOT), and a scientific grade frame-transfer CCD camera, providing an image matrix of 1024×1024 35 μm square pixels with 12 bit depth. The Solid-State X-Ray Image Intensifier (SSXII) is an EMCCD (Electron Multiplying charge-coupled device) based detector which provides an image matrix of 1k×1k 32 μm square pixels with 12 bit depth. The changer allows the MAF or a SSXII region-of-interest (ROI) detector to be inserted in front of the standard flat-panel detector (FPD) when higher resolution is needed during angiographic or interventional vascular imaging procedures. The CAPIDS was developed and implemented using LabVIEW software and provides a user-friendly interface that enables control of several clinical radiographic imaging modes of the MAF or SSXII including: fluoroscopy, roadmapping, radiography, and digital-subtraction-angiography (DSA). The total system has been used for image guidance during endovascular image-guided interventions (EIGI) using prototype self-expanding asymmetric vascular stents (SAVS) in over 10 rabbit aneurysm creation and treatment experiments which have demonstrated the system's potential benefits for future clinical use.

General Considerations for Neurointerventional Procedures

“…This technique has pixels sizes of 35 m m and is capable of imaging up to 30 frames per second, compared to traditional fl at panel detectors, which have pixel sizes of 194 m m or larger. 111,112 Magnetically guided angiography, currently available at some centers, uses extracranial magnets to help catheter and wire navigation. 113,114 This technology offers the potential to permit more precise intravascular navigation while shortening fl uoroscopy and procedure times.…”

Use of the Microangiographic Fluoroscope for Coiling of Intracranial Aneurysms

“…The detector is attached using a specially designed changer onto the anteroposterior (AP) C-arm of an x-ray image intensifier biplane angiographic unit (Toshiba America Medical Systems, Tustin, California) and is controlled by specially designed Lab-VIEW-based software (National Instruments Corp., Austin, TX, USA) designated CAPIDS (Control, Acquisition, Processing, and Image Display). 2 …”

“…Other features, such as region-of-interest dual-detector cone-beam computed tomography (CT), 1 were tested in animal subjects only and will be available for clinical use in the near future. 2 …”

“…The microangiographic fluoroscope (MAF) 1,2 is an ultra high-resolution x-ray detector developed at the University at Buffalo–Toshiba Stroke Research Center for cases in which superior resolution is required within a small field of view (FOV), ie, during aneurysm coiling. To date, this novel system has been used at our hospital (Millard Fillmore Gates–Kaleida Health) for coiling and stent-assisted coiling in 2 cases of unruptured intracranial aneurysms, with excellent results.…”

Workflow for the use of a high-resolution image detector in endovascular interventional procedures

“…Also, MAF can be used without a significant delay in the procedure, as the MAF swings into place in front of the standard AP fluoroscope. Initial patient studies have demonstrated that the use of the high-resolution MAF detector at selected points in a procedure may play an important and decisive role in clinical studies [3]. With the use of the MAF detector, tiny features of the devices such as stents, small movements of the microcatheters and coils can be seen.…”