Projects / Programmes
IMAGE-GUIDED ENDOVASCULAR INTERVENTIONS
| Code |
Science |
Field |
Subfield |
| 2.06.00 |
Engineering sciences and technologies |
Systems and cybernetics |
|
| Code |
Science |
Field |
| T111 |
Technological sciences |
Imaging, image processing |
| Code |
Science |
Field |
| 2.06 |
Engineering and Technology |
Medical engineering
|
image-guided interventions, endovascular interventions, vasculature, image analysis, image registration, image segmentation, visualization, validation, navigation
Researchers (20)
Organisations (2)
Abstract
This project aims to provide advanced and emerging technologies in image-guided medical procedures through the development of innovative methods and systems for image-based diagnosis and guidance of endovascular interventions. Particular emphasis will be placed on translational research to the clinic. Multidisciplinary research collaborations between academia and healthcare providers, and later with industrial partners, are essential to pursue the demanding research activities planned within this project.
Cerebrovascular diseases like stroke and hemorrhage that develop as a result of anomalies of brain blood vessels are the third leading cause of death and the leading cause of disability in adults. These diseases can be prevented by early diagnosis and treatment of diseased blood vessels. In recent years, minimally invasive image-guided endovascular interventions (IGEIs)have been developed for treating many types of vessel disorders. In IGEI, instruments such as guide wires and catheters are inserted into the femoral artery and navigated through the vasculature to the site of anomaly. The anomaly to be treated may be a stenosed or totally occluded vessel, an aneurysm, a tumor bed or an arteriovenous malformation. An IGEI may involve delivery of a device such as a stent or coil that keeps a stenosed vessel open or prevents rupture of an aneurysm or delivery of a drug or embolization agent through the catheter. To reliably quantify the site, form and extent of vascular anomalies, three-dimensional (3D) images are acquired prior to IGEI either by computed tomography angiography (CTA), magnetic resonance angiography (MRA), or more recently by digitally subtracted angiography (3D-DSA) using a C-arm. For better vessel visualization which may facilitate diagnosis, planning and IGEI, the 3D images are often segmented. An IGEI is guided by low dose two-dimensional (2D) X-ray fluoroscopic images which have excellent spatial and temporal resolution and deliver live information about the treatment. Unfortunately, these images lack contrast and especially depth information. The vasculature is occasionally emphasized by injecting a contrast agent into the bloodstream; however, its excessive use may result in hazardous patient reactions. Localization and navigation of devices in 3D based on 2D images demand considerable skills in mental reconstruction of a 3D scene and image–hand coordination. An emerging technical solution to exploit the positive aspects of 2D and 3D images is to fuse the temporal information of the live 2D fluoroscopic images with the static 3D information. The key step of fusion is 3D-2D image registration by which the pre-IGEI image is positioned in the space of the patient. The fused 2D and 3D data may be exploited in two ways. First, projecting static 3D data like (segmented) vessels, associated pathology and important surrounding tissue and/or treatment plan (3D roadmap) onto the live 2D fluoroscopic images obtained under any C-arm projection angle. Second, by backprojecting the dynamic information in live 2D fluoroscopic images, like the position of devices and the propagation of contrast agent, onto the 3D image. The immediate clinical benefits of both strategies are more accurate navigation and reduction of X-ray dose and harmful contrast agent. Additionally, the second strategy may further improve diagnosis and lead to better intervention planning and intra- and post- intervention evaluation.
The research activities will be concentrated around the following themes: 1) fully automated 3D-2D image registration methods, 2) standardized registration validation methodologies, 3) extensive validation and comparison of different image registration methods, 4) fusion of 2D and 3D data by projection of static data from 3D to 2D or backprojection of dynamic data from 2D to 3D, 5) visualization of augmented data in real 3D space, and 6) fast and efficient translation of the methods and systems into clinical practice.
Significance for science
The research project was dedicated to advanced and emerging technologies in image-guided medical procedures through the development of innovative methods in diagnostic imaging, real-time registration, fusion and visualization for endovascular interventions. Based on the actuality of image-guided endovascular interventions and results of the project, it is expected that the impact of the proposed research project will be significant. Relevant contributions to the engineering and medical sciences, in particular to the application of image analysis techniques to endovascular interventions are one of the most important results of the proposed research project. The findings related to the research project are expected to result in advances in technologies of endovascular treatment of a stenosed or totally occluded vessel, a portion of a vessel that is weakened and bulges to form an aneurysm, or a hypervascular region such as a tumor bed or an arteriovenous malformation. The contributions in the fields of biomedical engineering, medicine, and image analysis may also stimulate the development of novel or enhancement of existing technologies that will in different ways improve the procedure and outcome of endovascular interventions. The project resulted in 6 papers in peer reviewed journals, three in the top 25%, and three in the top 50% of journals according to their IF. Although the papers were published very recently, they were already cited. For instance the paper by U. Mitrović et al. that appeared in IEEE TMI, has been already cited twelve times.
Significance for the country
The importance of the project for Slovenia may be judged by intrinsic and extrinsic quality of the results. The intrinsic quality is measured by the impact in the academic domain, mainly through publications in peer-reviewed journals with high impact factor and citations. The project resulted in 6 papers in peer reviewed journals, three in the top 25%, and three in the top 50% of journals according to their IF. The extrinsic quality is regarded as the beneficial application of research to achieve social, economic, environmental and/or cultural outcomes. In this sense the proposed research project aims to achieve substantial social and economic/commercial benefits. Social impact indicator: improved therapy and health The demonstrated enhanced visualization and navigation by the combined information from preinterventional 3D and live 2D images will help the interventional radiologist to better and easier diagnose and plan, and to perform the procedure according to the plan more accurately, safely, and faster. The advantages of advanced image-guided endovascular interventions to the patient include higher success rates, lower exposure to radiation, smaller amounts of administered toxic contrast agent, and lower risk of complications. Less complications, shorter patient recovery times, and faster patient throughput will reduce healthcare costs. The Division of Neurology UMCL is expected to promote the augmented image-guided endovascular treatment of brain aneurysms and demonstrate its benefits. Economic/commercial indicator: new products/industries, increased employment, reduced costs Innovations, as results of this translational research project, will be turned into new health product prototypes, which will be attractive for further development into commercial products by a spin-off company. For this purpose, the members of the research project team have founded the company INTELITEH. It is expected that INTELITEH will take over from the this project to bring the augmented image-guided treatment of brain aneurysms to technological readiness level 9 and to final commercialization. The applied methodology, results and acquired knowledge are not limited to the problem of image-guided endovascular interventions. A similar approach can be applied to improve other therapies in medicine. Currently, we are translating/using the acquired knowledge and developed tools in the field of lesion quantification in patients with multiple sclerosis, for early detection and assessment of Alzheimer disease, and for planning and image-guidance of pedicle screw insertion in patients with spine pathologies. The evidence of the impacts above will be measured by health outcomes, product sales and employment.
Most important scientific results
Annual report
2013,
2014,
2015,
final report
Most important socioeconomically and culturally relevant results
Annual report
2013,
2014,
2015,
final report
