Providing guidance of a treatment process for an

Abstract

A computer-implemented method of providing guidance for a treatment procedure of an occluded blood vessel is provided. The method includes analyzing CT data to determine one or more attributes of an occlusion in the blood vessel; determining a recommended intravascular treatment device for treating the occluded blood vessel based on the one or more attributes; and outputting an indication of the recommended intravascular treatment device.

Description

Technical Field

[0001] The present disclosure relates to providing guidance for a treatment procedure for an obstructed blood vessel. A computer-implemented method, computer program product, and system are disclosed. Background Art

[0002] Blood vessels in the anatomy may become blocked or obstructed for a variety of reasons. For example, an obstructed blood vessel may be caused by a buildup of plaque in the vessel or by a clot (also known as a thrombus) in the vessel. Blockages may occur in blood vessels in various parts of the anatomy, including in the heart, in the brain, and in peripheral areas such as the legs.

[0003] In some cases, the blockage is partial, and the blood flow in the vessel is limited by the blockage but not inhibited. For example, in the heart, a partial blockage of a coronary artery may cause the heart to have to work harder in order to maintain blood flow. A subject with a partial blockage of a coronary artery may suffer chest pain or angina. However, in more severe cases, blood flow in a vessel may be completely inhibited by the blockage. Chronic total occlusion or "CTO" is defined as a complete blockage of a vessel lasting greater than or equal to 3 months. The lack of blood flow produced by a coronary CTO can cause permanent damage to the heart muscle. CTO is usually caused by a combination of severe atherosclerosis and thrombosis. Atherosclerosis is a condition in which plaques composed of fat, cholesterol, calcium, fibrin, and other substances accumulate in the walls of arteries. These plaques cause the arteries to harden and narrow, thereby restricting blood flow and oxygen supply. Over time, the plaques may open or rupture, forming a thrombus or blood clot that further restricts blood flow. The combination of thrombus and plaque can completely block the artery, resulting in a CTO.

[0004] Blockages are often treated using a procedure called atherectomy; atherectomy is a minimally invasive endovascular procedure used to remove atherosclerosis from blood vessels in the body, thereby restoring blood flow. Various types of endovascular treatment devices can be used to treat blockages during atherectomy. A review of such devices is described in Dash, D. et al., "Contemporary treatment options for surmounting the conumdrum of calcified coronaries" Journal of Transcatheter Interventions., 2020; 28: eA202007. Currently available types of intravascular treatment devices include: laser plaque removal devices, which emit laser radiation to fragment plaque; directional plaque removal devices, which include an inflatable balloon and a cutting window for removing obstructive material from the vessel wall; rotational plaque removal devices, which include burrs that rotate to perform a rotational grinding or cutting operation to fragment plaque; orbital plaque removal devices, which include an eccentrically mounted abrasive crown to perform an orbital grinding operation to fragment plaque; transluminal plaque removal devices, which include a rotating blade and an aspirator to respectively remove and aspirate atherosclerosis; and, IVL balloons, which deliver shock wave pulses to the blood vessel to fragment plaque.

[0005] An example of a commercially available laser atherectomy catheter is the Turbo-Elite laser atherectomy catheter sold by Philips Healthcare, Best, The Netherlands. An example of a commercially available directional atherectomy device is the HawkOne directional atherectomy system sold by Medtronic, Minneapolis, USA. An example of a commercially available rotational ablation atherectomy device is the Rotapro Rotational Ablation Rotational Plaque Resection System sold by Boston Scientific, Massachusetts, USA. An example of a commercially available orbital atherectomy device is the Diamonback 360 Coronary Orbital Atherectomy System sold by Cardiovascular Systems Inc., Minneapolis, USA. An example of a commercially available transluminal atherectomy device is the AngioJet Thrombectomy System sold by Boston Scientific, Massachusetts, USA. An example of a commercially available IVL balloon is the Shockwave C2 Coronary IVL Catheter sold by Shockwave Medical, Santa Clara, USA.

[0006] However, there remains a need to provide improved guidance for occlusion treatment procedures. The properties of an obstruction vary in their size, shape, and composition, and therefore the intravascular treatment devices that can be used to treat the obstruction have different strengths relative to these properties. Therefore, it can be challenging to select the type of treatment device to use for an obstruction treatment procedure. The type of device used to treat the obstruction can affect factors such as the ease of performing the procedure, the effectiveness of the treatment, and therefore its results. In addition, having selected a treatment device to treat the obstruction, it can be challenging to determine the properties of the device used in the procedure. The properties of the device (such as its stiffness and its tip shape) can affect the effectiveness of the treatment and therefore its results. It can also be challenging to determine the values ​​of the treatment parameters used with the device. For example, if the device is a laser plaque removal catheter, it may be necessary to adjust the values ​​of parameters such as the flux of optical radiation emitted by the device and its advancement rate in the artery in order to optimize the desired results. Summary of the invention

[0007] According to one aspect of the present disclosure, a computer-implemented method for providing guidance on a treatment procedure for an obstructed blood vessel is provided. The method comprises:

[0008] receiving computed tomography (CT) data representing the occluded blood vessel;

[0009] analyzing the CT data to determine one or more attributes of the blockage in the blood vessel;

[0010] determining a recommended intravascular treatment device for treating the occluded blood vessel based on the one or more attributes; and

[0011] An indication of the recommended intravascular treatment device is output.

[0012] In the above method, a recommended intravascular treatment device is determined based on one or more attributes of the blockage determined based on CT data for the blocked blood vessel. Therefore, it is ensured that the recommended intravascular treatment device is suitable for the blockage in the blood vessel. Therefore, more effective treatment of the blocked blood vessel can be achieved.

[0013] Other aspects, features and advantages of the present disclosure will become apparent from the following description of examples with reference to the accompanying drawings. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] Figure 1 is a schematic diagram showing examples of various properties of a CTO according to some aspects of the present disclosure: A) Size: short length, B) Size: long length, C) Shape: >45 degree bend at CTO entrance, D) Shape: >45 degree bend along CTO path, E) Entrance shape: conical cap, F) Entrance shape: blunt cap, G) Composition: calcification along the CTO.

[0015] Figure 2 Schematic diagram showing examples of various intravascular treatment devices for treating blockages according to some aspects of the present disclosure: A) Laser atherectomy, B) Directional atherectomy, C) Rotational atherectomy, D) Orbital atherectomy, E) Transluminal atherectomy, E) IVL balloon.

[0016] Figure 3 is a flow chart illustrating an example of a computer-implemented method of providing guidance for a treatment procedure for an occluded blood vessel in accordance with aspects of the present disclosure.

[0017] Figure 4 is a schematic diagram illustrating a first example of a system 200 for providing guidance for a treatment procedure for an occluded blood vessel in accordance with aspects of the present disclosure.

[0018] Figure 5 is a schematic diagram illustrating a second example of a system 200 for providing guidance for a treatment procedure for an occluded blood vessel in accordance with aspects of the present disclosure. DETAILED DESCRIPTION

[0019] Examples of the present disclosure are provided with reference to the following description and drawings. In this description, for the purpose of explanation, many specific details of certain examples are set forth. References in the description to "example," "implementation," or similar language mean that the features, structures, or properties described in conjunction with the example are included in at least that one example. It should also be understood that features described with respect to one example may also be used in another example, and for the sake of brevity, all features are not necessarily repeated in each example. For example, features described with respect to a computer-implemented method may be implemented in a computer program product and system in a corresponding manner.

[0020] In the following description, reference is made to an example of a computer-implemented method of providing guidance for a treatment process for an obstructed blood vessel. In some examples, the obstruction in the blood vessel is a CTO. Thus, the methods disclosed herein can be used with an obstructed blood vessel, wherein the obstruction is a CTO. However, it should be understood that the methods disclosed herein can be used with obstructed blood vessels in which other types of obstructions are present. In other words, the methods can generally be used with obstructed blood vessels.

[0021] Reference is also made herein to examples where the method is used to provide guidance for a treatment procedure of an obstructed blood vessel, wherein the blood vessel is a coronary artery. However, it is also understood that the blood vessel may generally be any type of blood vessel in the anatomy. Thus, the blood vessel may be an artery or a vein, and the artery or vein may be anywhere in the body, such as in the heart, brain, arm, leg, etc.

[0022] Note that the computer-implemented methods disclosed herein may be provided as a non-transitory computer-readable storage medium including computer-readable instructions stored thereon, which, when executed by at least one processor, cause at least one processor to perform the method. In other words, the computer-implemented methods may be implemented in a computer program product. The computer program product may be provided by dedicated hardware or hardware capable of running software in association with appropriate software. When provided by a processor, the functionality of the method features may be provided by a single dedicated processor or by a single shared processor or by a plurality of separate processors, some of which may be shared. One or more of the functionality of the method features may be provided, for example, by a processor shared within a networked processing architecture such as a client / server architecture, a peer-to-peer architecture, the Internet, or a cloud.

[0023] The explicit use of the term "processor" or "controller" should not be interpreted as referring exclusively to hardware capable of running software, and may implicitly include, but is not limited to, digital signal processor "DSP" hardware, read-only memory "ROM" for storing software, random access memory "RAM", non-volatile storage devices, etc. In addition, examples of the present disclosure may take the form of a computer program product accessible from a computer-usable storage medium or a computer-readable storage medium, which provides program code for use by or in conjunction with a computer or any instruction execution system. For the purposes of this specification, a computer-usable storage medium or a computer-readable storage medium may be any device that may contain, store, transmit, propagate, or transmit a program for use by or in conjunction with an instruction execution system, device, or apparatus. The medium may be an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system or device or a propagation medium. Examples of computer-readable media include semiconductor or solid-state memory, magnetic tape, removable computer disk, random access memory "RAM", read-only memory "ROM", hard disk, and optical disk. Current examples of optical disks include compact disk read-only memory "CD-ROM", compact disk read / write "CD-R / W", Blu-ray TM and DVD.

[0024] As discussed above, there remains a need to provide improved guidance for occlusion treatment procedures. The properties of an occlusion vary in terms of its size, shape, and composition, and thus the intravascular treatment devices that can be used to treat the occlusion have different strengths relative to these properties. As an example, Figure 1 is a schematic diagram showing examples of various properties of a CTO according to some aspects of the present disclosure: A) Size: short length, B) Size: long length, C) Shape: >45 degree bend at CTO entrance, D) Shape: >45 degree bend along CTO path, E) Entrance shape: conical cap, F) Entrance shape: blunt cap, G) Composition: calcification along the CTO.

[0025] Figure 2 Schematic diagram showing examples of various intravascular treatment devices for treating blockages according to some aspects of the present disclosure: A) Laser atherectomy, B) Directional atherectomy, C) Rotational atherectomy, D) Orbital atherectomy, E) Transluminal atherectomy, E) IVL balloon. Figure 2 The laser atherectomy device shown in A emits laser radiation LI to disrupt the plaque by photoablation. Figure 2 The directional plaque removal device shown in B includes an inflatable balloon BA and a cutting window CW. The cutting window CW is rotated within the blood vessel and aligned with the obstructive material on the blood vessel wall. At this position, the inflatable balloon is expanded to stabilize the cutting window CW and press the cutting window against the obstructive material. The cutting blade is then rotated and translated, which both removes the obstructive material from the blood vessel wall and packs the removed material into the anterior vertebral body NC of the device so that it can be removed from the blood vessel. Figure 2 The rotary atherectomy device shown in C includes a burr having a rough surface. The burr is rotated to perform a rotary grinding or cutting operation that disrupts the plaque. Figure 2 The orbital atherectomy device shown in D includes an eccentrically mounted abrasive crown that uses centrifugal force to perform an orbital grinding operation that disrupts plaque. Figure 2 The transluminal atherectomy device shown in E includes a rotating blade RB and an aspirator AS for respectively removing and aspirating atherosclerosis. Figure 2 The IVL balloon shown in F includes one or more shock wave emitters SWE arranged on a catheter CA. The IVL balloon operates by delivering shock wave pulses SWP from (one or more) shock wave emitters SWE to a blood vessel VE to rupture a plaque. When in use, the balloon BA is filled with a liquid such as saline to inflate the balloon and provide acoustic impedance matching between the (one or more) emitters EM and the blood vessel.

[0026] according to Figure 1 The nature, scope and Figure 2 The different modes of action of the types of treatment devices shown for treating an obstruction can be appreciated that the intravascular treatment devices that can be used to treat an obstruction have different strengths relative to the nature of the obstruction. Therefore, the type of treatment device used to treat an obstruction can affect factors such as the ease of performing the procedure, the effectiveness of the treatment, and its results. Therefore, selecting the type of treatment device for an obstruction treatment procedure can be challenging.

[0027] Figure 3 is a flow chart illustrating an example of a computer-implemented method of providing guidance for a treatment procedure for an occluded blood vessel in accordance with aspects of the present disclosure. Figure 4 is a schematic diagram illustrating a first example of a system 200 for providing guidance for a treatment procedure for an occluded blood vessel in accordance with some aspects of the present disclosure. Figure 5 300 is a schematic diagram showing a second example of a system 200 for providing guidance on a treatment procedure for an obstructed blood vessel according to some aspects of the present disclosure. Both systems 200 and 300 include one or more processors 210. Note that Figure 3 The operations described by the method shown can also be performed by Figure 4 and Figure 5 The operations described with respect to one or more processors 210 of the systems 200 and 300 may also be performed in reference to Figure 3 The method described is performed.

[0028] refer to Figure 3 , a computer-implemented method for providing guidance on a treatment procedure for an obstructed blood vessel, comprising:

[0029] receiving S110 computed tomography CT data representing an obstructed blood vessel 110;

[0030] analyzing S120 the CT data to determine one or more properties of the blockage 120 in the blood vessel;

[0031] Determining S130 a recommended intravascular treatment device 130 for treating the blocked blood vessel 110 based on the one or more attributes 1..6 ;as well as

[0032] Output S140 for the recommended intravascular treatment device 130 1..6 instructions.

[0033] In the above method, the recommended intravascular treatment device is determined based on one or more attributes of the blockage determined from the CT data of the blocked blood vessel. Therefore, it is ensured that the recommended intravascular treatment device is suitable for the blockage in the blood vessel. Therefore, more effective treatment of the blocked blood vessel can be achieved.

[0034] refer to Figure 3 In the illustrated method, in operation S110 , CT data 140 representing a blocked blood vessel is received.

[0035] Typically, the CT data received in operation S110 may represent a static image of the blocked blood vessel, or alternatively, it may represent a time series of images of the blocked blood vessel. In the latter case, the time series of images may be generated substantially in real time, and the reference image may be performed substantially in real time. Figure 3 Thus, in one example, an indication of a recommended intravascular treatment device may be output in real time.

[0036] Typically, the CT data received in operation S110 may be raw data, i.e., data that has not yet been reconstructed into a volume or 3D image, or it may be image data, i.e., data that has been reconstructed into a volume image. The CT data may also be referred to as volume data. The CT data may be generated by a CT imaging system, or as described in more detail below, alternatively, it may be generated by rotating or stepping an X-ray source and an X-ray detector of an X-ray projection imaging system around a blood vessel.

[0037] The CT imaging system generates CT data by rotating or stepping an X-ray source-detector device around an object and acquiring X-ray attenuation data for the object from multiple rotation angles relative to the object. The CT data can then be reconstructed into a 3D image of the object. Examples of CT imaging systems that can be used to generate CT data include cone beam CT imaging systems, photon counting CT imaging systems, dark field CT imaging systems, and phase contrast CT imaging systems. Figure 4 An example of a CT imaging system 220 that may be used to generate the CT data received in operation S110 is shown in FIG. As an example, the CT data may be generated by a CT 5000 Ingenuity CT imaging system sold by Philips Healthcare, Best, The Netherlands.

[0038] As described above, alternatively, the CT data received in operation S110 can be generated by rotating or stepping an X-ray source and an X-ray detector of an X-ray projection imaging system around a blood vessel. An X-ray projection imaging system typically includes a support arm, such as a so-called "C-arm" that supports an X-ray source and an X-ray detector. Alternatively, the X-ray projection imaging system may include a support arm having a shape different from that of this example, such as an O-shaped arm. Compared to a CT imaging system, an X-ray projection imaging system generates X-ray attenuation data for an object, wherein the X-ray source and the X-ray detector are in a static position relative to the object. Compared to the volume data generated by a CT imaging system, the X-ray attenuation data may be referred to as projection data. The X-ray attenuation data generated by an X-ray projection imaging system is typically used to generate a 2D image of an object. However, an X-ray projection imaging system can generate CT data, i.e., volume data, by rotating or stepping its X-ray source and X-ray detector around an object and acquiring projection data for the object from multiple rotation angles relative to the object. Image reconstruction techniques can then be used to reconstruct the projection data obtained from multiple rotation angles into a volume image in a manner similar to reconstructing a volume image using X-ray attenuation data acquired from a CT imaging system. Thus, the CT data received in operation S110 may be generated by a CT imaging system, or alternatively, it may be generated by an X-ray projection imaging system. An example of an X-ray projection imaging system that may be used to generate CT data is the Azurion 7 X-ray projection imaging system sold by Philips Healthcare, Best, The Netherlands.

[0039] In some examples, the CT data received in operation S110 is spectral CT data. The spectral CT data defines the object in a plurality of different energy intervals DE. 1..m In general, there may be two or more energy intervals; that is, m is an integer, and m≥2. In this regard, the spectral CT data received in operation S110 may be generated by a spectral CT imaging system or by a spectral X-ray projection imaging system. In the latter case, as described above, the spectral CT data may be acquired by rotating or stepping an X-ray source and an X-ray detector of a spectral X-ray projection imaging system around a blood vessel. More generally, the spectral CT data received in operation S110 may be generated by a spectral X-ray imaging system.

[0040] In multiple energy ranges DE 1..mThe ability to generate X-ray attenuation data in an energy interval distinguishes a spectral X-ray imaging system from a conventional X-ray imaging system that generates X-ray attenuation data in a single energy interval. By processing data from multiple different energy intervals, media that have similar X-ray attenuation values ​​when measured in a single energy interval and that would be indistinguishable in the X-ray attenuation data generated by a conventional X-ray imaging system can be distinguished. Examples of spectral X-ray imaging systems that can be used to generate the spectral CT data received in operation S110 include cone-beam spectral X-ray imaging systems, photon counting spectral X-ray imaging systems, dark-field spectral X-ray imaging systems, and phase contrast spectral X-ray imaging systems. An example of a spectral CT imaging system that can be used to generate the spectral CT data received in operation S110 is the Spectral CT 7500 sold by Philips Healthcare, Best, The Netherlands.

[0041] In general, spectral CT data may be generated by various different configurations of a spectral X-ray imaging system including an X-ray source and an X-ray detector. The X-ray source of the spectral X-ray imaging system may include a plurality of monochromatic sources, or one or more polychromatic sources, and the X-ray detector of the spectral X-ray imaging system may include: a common detector for detecting a plurality of different X-ray energy intervals; or a plurality of detectors, wherein each detector detects a different X-ray energy interval DE 1..m ; or, a multi-layer detector, in which X-rays having energies in different X-ray energy intervals are detected by corresponding layers; or, a photon counting detector, which bins detected X-ray photons into one of a plurality of energy intervals based on their respective energies. In a photon counting detector, the relevant energy interval for each received X-ray photon can be determined by detecting the pulse height caused by electron-hole pairs generated in response to absorption of the X-ray photon in the direct conversion material.

[0042] The various configurations of the aforementioned X-ray sources and detectors can be used to detect different X-ray energy ranges DE 1..m Typically, the discrimination between different X-ray energy intervals can be provided at the source by temporally switching the X-ray tube potential of a single X-ray source (i.e., "fast kVp switching") or by temporally switching or filtering the emission of X-rays from multiple X-ray sources. Temporal switching can be performed within a rotation of the X-ray source-detector arrangement so that multiple different X-ray energy intervals DE are acquired within a rotation. 1..mor alternatively, X-ray attenuation data for an X-ray energy interval may be acquired during a specified number of rotations of the gantry before switching to another energy interval and similarly acquiring X-ray attenuation data for that energy interval. In such a configuration, a common X-ray detector may be used to detect X-rays across a plurality of different energy intervals, with X-ray attenuation data for each energy interval being generated in a time-sequential manner. Alternatively, distinction between different X-ray energy intervals may be provided at the detector by using a multi-layer detector or a photon counting detector. Such a detector may detect X-rays from a plurality of X-ray energy intervals DE almost simultaneously. 1..m Therefore, multi-layer detectors or photon counting detectors can be used in combination with a polychromatic source to detect X-rays at different energy intervals DE. 1..m Generate X-ray attenuation data at

[0043] Other combinations of the above-described X-ray sources and detectors may also be used to provide spectral CT data. For example, in yet another configuration, the need to sequentially switch between different X-ray sources emitting X-rays at different energy intervals may be eliminated by mounting the X-ray source-detector pair to the gantry at a rotationally offset position about the rotation axis. In this configuration, each source-detector pair operates independently, and rotational offset of the source-detector pair facilitates the generation of spectral CT data for different energy intervals. 1..m The separation between the spectral CT data of the CT scans can be improved by applying an energy selective filter to the (one or more) X-ray detectors to reduce the effect of X-ray scattering. 1..m Separation between spectral CT data.

[0044] In general, the CT data received in operation S110 can be received via any form of data communication, including wired, optical, and wireless communications. As some examples, when wired or optical communications are used, the communication can occur via signals transmitted over an electrical or optical cable, and when wireless communications are used, the communication can be, for example, via RF or optical signals. The CT data received in operation S110 can be received from a variety of sources. For example, the CT data can be received from an imaging system, such as one of the imaging systems described above. Alternatively, the CT data can be received from another source, such as a computer-readable storage medium, the Internet, or the cloud.

[0045] In operation S120, the CT data is analyzed to determine one or more properties of the blockage 120 in the blood vessel. In this regard, the one or more properties of the blockage 120 may include properties such as a measurement of the size of the blockage, a location of the blockage, a measurement of the shape of the blockage, a measurement of the entry shape of the blockage, and a composition of the blockage. Properties of the blockage, such as these properties, may influence the selection of an intravascular treatment device for treating the blockage. Figure 1 Some examples of properties of a blockage that may be determined in operation S120 are shown in FIG. 1 . Typically, the measurement of the size of the blockage may include a measurement of the length, or diameter, or area, or volume of the blockage. Figure 1 A and Figure 1 An example of a measurement of the length of an obstruction is shown in B. Typically, the location of an obstruction can be defined based on the vessel in which the obstruction is located (e.g., the left coronary artery) or the location of the obstruction within a vessel (e.g., at a proximal location, at a distal location, within a specified distance of a bifurcation, etc.). Typically, a measurement of the shape of an obstruction can represent the amount of curvature or "tortuosity" of the obstruction, or the "entry shape" of the obstruction, i.e., the shape of its cap. The amount of curvature can be defined based on, for example, Figure 1 The bend at the blocked entrance as shown in C or Figure 1 The bend along the blocked path is defined as shown in D. Figure 1 E and Figure 1 Various examples of blocked "entry shapes" are shown in F, Figure 1 E shows the blocked conical cap, Figure 1 F shows a blunt cap of an obstruction. In general, measurements of the composition of an obstruction can indicate the presence or distribution of various components in the composition. For example, measurements of the composition of an obstruction can indicate the presence of different components present in the obstruction (e.g., calcium), or the presence of plaque types in the obstruction (e.g., calcified, soft plaque, hard plaque), or the distribution of plaque types in the obstruction (e.g., spotted, elongated), such as Figure 1 As shown in G.

[0046] Typically, the operation of analyzing S120 the CT data to determine one or more properties of the blockage 120 in the blood vessel is performed using known image processing techniques and based on differences in X-ray attenuation in the CT data. As described above, the CT data received in operation S110 and subsequently analyzed in operation S120 may be generated by various types of X-ray imaging systems, including conventional CT imaging systems and spectral CT imaging systems. Thus, the CT data may represent X-ray attenuation in a single energy interval, or it may be spectral CT data representing X-ray attenuation in multiple different energy intervals.

[0047] X-ray attenuation data from conventional CT imaging systems are typically expressed in Hounsfield Units. CT data representing X-ray attenuation in a single energy interval can be used to distinguish between an obstruction and the surrounding medium by their attenuation differences. For example, blood in a blood vessel has a lower X-ray attenuation coefficient than an obstruction, and therefore the lumen of the non-obstructed portion of the blood vessel containing blood can be distinguished from the obstruction. This facilitates measurement of the properties of the obstruction, such as its size, location, and shape. It is also possible to distinguish hard and soft plaques in an obstruction based on the difference in their X-ray attenuation coefficients, thereby facilitating determination of the composition of the obstruction.

[0048] In one example, the CT data received in operation S110 is defined in a plurality of different energy intervals DE 1..m spectral CT data of X-ray attenuation of an obstructed blood vessel in the blood vessel. In this example, the operation of analyzing S120 CT includes analyzing the spectral CT data to determine one or more properties of the obstruction 120 in the blood vessel. As described above, the use of spectral CT data facilitates distinguishing between media that have similar X-ray attenuation values ​​when measured within a single energy interval and that would be indistinguishable in X-ray attenuation data generated by a conventional X-ray imaging system. Therefore, the use of spectral CT data in this example facilitates improved distinction between X-ray attenuation caused by the obstruction and X-ray attenuation caused by other media (such as contrast agents, dense tissue, bone, etc.), which may also be represented in the spectral CT data.

[0049] In a related example, one or more attributes of the blockage 120 determined in operation S120 include the composition of the blockage. In this example, the operation of analyzing S120 the spectral CT includes applying a material decomposition algorithm to the spectral CT data to determine the composition of the blockage. In this example, the composition of the blockage can indicate the presence of various materials or various types of materials in the blockage. As some examples, the composition of the blockage can indicate the type of plaque in the blockage, such as calcified plaque, soft plaque, or hard plaque. In this example, various material decomposition algorithms can be applied to the spectral CT data. Brendel, B. et al., in the document "Empirical, projection-based basis-component decomposition method", Medical Imaging 2009, Physics of Medical Imaging, edited by Ehsan Samei and Jiang Hsieh, Proc. of SPIE Vol. 7258, 72583Y, disclose an example of a material decomposition algorithm that can be used. Another example of a material decomposition algorithm that can be used is disclosed in the document "K-edge imaging in X-ray computed tomography using multi-bin photoncounting detectors" by Roessl, E. and Proksa, R., Phys Med Biol. 2007 Aug 7, 52(15): 4679-96. Another example of a material decomposition algorithm that can be used is disclosed in the published PCT patent application WO / 2007 / 034359A2.

[0050] In some examples, the operation of analyzing S120 the CT data includes reconstructing an image representing the blocked blood vessel 110. In these examples, the operation of analyzing S120 the CT data is performed using the reconstructed image.

[0051] According to this example, the image can be reconstructed using various known image reconstruction techniques. The image can also be segmented to identify blockages. Various known segmentation algorithms can be used for this purpose, including model-based segmentation, watershed-based segmentation, region growing, level sets, graph cuts, etc. A neural network can also be trained to segment the reconstructed image to identify blockages.

[0052] In one example, occlusions are automatically identified in the reconstructed image. In this example, reference Figure 3 The methods described include:

[0053] segmenting the reconstructed image to identify occlusions 120; and

[0054] automatically identifying the blockage in the reconstructed image; and

[0055] Therein, analyzing S120 the CT data to determine one or more properties of the blockage 120 in the blood vessel is performed on the identified blockage.

[0056] By automatically identifying blockages, this example facilitates faster determination of the recommended intravascular treatment device in a later operation S130. The segmentation operation in this example can be performed using the above-mentioned segmentation technique. Various known image processing techniques can be used to perform the operation of automatically identifying blockages in reconstructed images. For example, a feature detector or a neural network can be trained to identify blockages. For example, a feature detector can identify blockages based on abnormal changes in intensity in a blood vessel in a reconstructed image. Such changes can be attributed to attenuation changes caused by the transition between a blood vessel containing blood and a blood vessel containing an obstructive substance. If CT data is acquired after the injection of a contrast agent, the amplitude of the transition is enhanced in the CT data, which helps to improve the identification of blockages. Alternatively, a neural network such as a convolutional neural network CNN can be trained using training data to identify blockages in reconstructed images, the training data comprising multiple reconstructed images representing various blockages and in which the corresponding true value positions of the blockages are annotated.

[0057] In another example, rather than automatically identifying in the reconstructed image, the occlusion is identified in the reconstructed image based on user input. Figure 3 The methods described include:

[0058] outputting the reconstructed image to a display device 230, 330; and

[0059] receiving user input identifying an occlusion 120 in the reconstructed image; and

[0060] Therein, analyzing S120 the CT data to determine one or more properties of the blockage 120 in the blood vessel is performed on the identified blockage.

[0061] In this example, the reconstructed image may be output to a display device. For example, the reconstructed image may be output to Figure 4 Monitor 230 is shown. A user can identify an obstruction 120 in the reconstructed image using various user input devices such as a touch screen, a pointing device such as a mouse, a joystick, a keyboard, etc. For example, a user can identify an obstruction by tracing the obstruction using a user input device or by placing a bounding box around the obstruction.

[0062] Return to Figure 3 In the method shown, in operation S130, a recommended intravascular treatment device 130 for treating the blocked blood vessel 110 is determined based on one or more attributes of the blockage in the blood vessel. 1..6The recommended intravascular treatment device determined in operation S130 may be specified at various levels, including, for example, at the level of device type, or at a lower level, such as a model of device type. Examples of different device types that may be determined according to this example include Figure 2 The devices shown are: laser atherectomy device, rotational atherectomy device, orbital atherectomy device, transluminal atherectomy device and IVL balloon. Since the recommended intravascular treatment device is determined based on one or more attributes of the blockage, the treatment device is suitable for the blockage to be treated. Therefore, a more optimized selection of the treatment device can be made.

[0063] Operation S130 can be performed in various ways. These include: using a deterministic rule set, using a lookup table, and using a neural network. In the first two of these methods, one or more attributes of the blockage are matched to an intravascular treatment device using rules determined by an expert. Examples of such rules are described in the literature cited above by Dash, D. et al. In the third method, such rules can be used to train a neural network to predict a recommended intravascular treatment device for a given set of one or more attributes of the blockage. As an example, one or more attributes of the blockage can classify the blockage as including shallow calcium, deep calcium, or nodular calcium. Shallow calcium is generally defined as a calcified nodule located at the intima-lumen interface or near the lumen of the vessel. Deep calcium is generally defined as a calcified nodule located at the media / adventitia boundary or near the adventitia. Nodular calcium is generally defined as the presence of multiple calcified nodules in the blockage. If deep calcium is present, the recommended type of intravascular treatment device may be a laser plaque removal device. In contrast, if shallow calcium is present and the calcium is greater than 0.5 mm thick, greater than 5 mm long, and its rotation angle about the vessel centerline exceeds 180 degrees, then the recommended intravascular treatment device type may be an IVL balloon. If nodular calcium is present, then the recommended intravascular treatment device type may be an orbital atherectomy device or a rotational atherectomy device. Similar rules depending on these and other attributes of the obstruction may also be defined for other types of intravascular treatment devices or for specified models of such devices.

[0064] In another example, analyzing S120 the CT data to determine one or more attributes of the blockage 120 in the blood vessel and determining S130 a recommended intravascular treatment device 130 for treating the blocked blood vessel 110 based on the one or more attributes is performed by the neural network. 1..6 In this example, the CT data received in operation S110 is input into the neural network, and the neural network is trained to predict the recommended intravascular treatment device 130 for treating the blocked blood vessel based on the input CT data. 1..6The neural network is trained to predict a recommended intravascular treatment device 130 using training data including a plurality of CT training images representing blocked blood vessels. 1..6 . Each CT training image includes a corresponding ground-truth recommended intravascular treatment device for the blood vessel represented in the image. The ground-truth recommended intravascular treatment device may be determined by an expert. The neural network may be provided by various types of architectures, including, for example, a convolutional neural network (CNN) architecture. In this example, properties of the obstruction (such as its size and shape) are inherently determined by the neural network during its evaluation of the input CT data, although these features are not necessarily output by the neural network.

[0065] Return to Figure 3 In the method shown in FIG. 1 , in operation S140 , the recommended intravascular treatment device 130 is output. 1..6 The output of the recommended intravascular treatment device provides guidance for the treatment process. The indication of the recommended intravascular treatment device can be output in any human-understandable format. In one example, the indication of the recommended intravascular treatment device is output in a visual format. For example, the indication of the recommended intravascular treatment device can be output to a display. For example, the indication of the recommended intravascular treatment device can be output to a display. Figure 4 Display 230 is shown. For example, the instructions may be provided as symbols or text corresponding to the recommended intravascular treatment device. The guidance information may alternatively be output in other ways, including, for example, audible output or output to a printer.

[0066] The properties of the blood vessel may also affect the selection of an intravascular treatment device for treating the blockage. For example, the blood vessel diameter, the blood vessel tortuosity, the amount of contrast agent in the blood vessel, the amount of calcium in the blood vessel, the type and shape of plaque in the blood vessel, and the type and shape of plaque along the path into the blockage in the blood vessel may also affect the selection of an intravascular treatment device. In one example, reference Figure 3 The methods described include:

[0067] analyzing the CT data to determine one or more properties of the blood vessel; and

[0068] Determine S130 a recommended intravascular treatment device 130 for treating the blocked blood vessel 110 1..6 Also based on one or more properties of the blood vessel.

[0069] Therefore, in this example, a recommended intravascular treatment device is determined based on one or more attributes of the blood vessel and one or more attributes of the obstruction. Therefore, the applicability of the recommended treatment device is improved. In this example, the one or more attributes of the determined blood vessel may include one or more of the following: measurement results of the size of the blood vessel (e.g., measurement results of the length of the blood vessel, or the diameter of the lumen of the blood vessel, or the area of ​​the lumen of the blood vessel), measurement results of the shape of the blood vessel (e.g., measurement of the tortuosity of the blood vessel path or measurement of the shape of the blood vessel lumen), measurement results of the amount of plaque in the blood vessel, identification of the type of plaque in the blood vessel, identification of the shape of the plaque in the blood vessel, and identification of the composition of the plaque in the blood vessel. For example, the size of the blood vessel lumen on the proximal and / or distal side of the obstruction affects its navigation in the blood vessel and can be used to determine the recommended intravascular treatment device.

[0070] The properties of the blood vessel can be determined from the CT data in a manner similar to that described above for the obstruction. Thus, typically, the operation of analyzing the CT data to determine one or more properties of the blood vessel is performed using known image processing techniques and based on differences in X-ray attenuation in the CT data. The CT data can represent X-ray attenuation data in a single energy interval, or alternatively, the CT data can be spectral CT data defining X-ray attenuation in multiple different energy intervals. The use of spectral CT data facilitates improved differentiation between blood vessels and other media (such as dense tissue) and bone (which can also be represented in the spectral CT data). As described above, the spectral CT data can be analyzed using a material decomposition algorithm.

[0071] In this example, a recommended intravascular treatment device 130 for treating the blocked blood vessel 110 is further determined S130 based on one or more properties of the blood vessel. 1..6 The operation of can be performed in a similar manner as described above for the (one or more) attributes of the obstruction. Thus, a deterministic rule set, or a lookup table, or a neural network can be used. In the first two of these methods, in addition to the one or more attributes of the obstruction, one or more attributes of the vessel are used in order to find a matching intravascular treatment device using a deterministic rule set or a lookup table. In the third of these methods, rules can be used to train a neural network to predict a recommended intravascular treatment device based on an input set of one or more attributes of the vessel and an input set of one or more attributes of the obstruction.

[0072] In a related example, the operation of analyzing S120 CT data includes reconstructing an image representing the blocked blood vessel 110, and performing the operation of analyzing S120 CT data using the reconstructed image. The centerline of the blood vessel can also be identified in the reconstructed image. The centerline can be used to determine the properties of the blood vessel, such as its size, shape. The centerline can be determined by segmenting the lumen of the blood vessel in the reconstructed image and defining the centerline of the blood vessel as the centerline of the lumen. The centerline of the lumen can be considered to provide an accurate position of the centerline of the blood vessel, and therefore facilitate accurate measurement of the properties of the blood vessel, such as its length, its tortuosity, etc. The centerline of the blood vessel can also be used to provide more accurate measurements of the properties of the blockage (such as its length, its tortuosity, etc.).

[0073] In one example, the proposed intravascular treatment device 130 1..6 is the recommended type of atherectomy device. Figure 3 In this example, a recommended intravascular treatment device 130 for treating the blocked blood vessel 110 is determined S130 1..6 The operation includes determining the type of plaque removal device for treating the blocked blood vessel; and outputting S140 a recommended intravascular treatment device 130 1..6 The operation of indicating includes outputting an indication of the type of atherectomy device determined.

[0074] As described above, after selecting a treatment device to treat an obstruction, determining the properties of the device can be challenging. The properties of the device, such as its stiffness and its tip shape, can also affect the effectiveness of the treatment, and therefore its outcome.

[0075] In one example, reference Figure 3 The methods described include:

[0076] Determine recommended intravascular device 130 1..6 recommended values ​​for one or more attributes of ; and

[0077] An indication of recommended values ​​for the one or more attributes is output.

[0078] According to this example, values ​​for various attributes of the device may be recommended, including, for example, the size of the device (e.g., the diameter or length of the plaque removal element of the device), the size of the guide catheter used with the device, the stiffness of the device, the tip shape of the device, the tip load of the device, the coating of the device, etc. The recommended values ​​for the attributes may be determined using a deterministic rule set, or by using a lookup table, or by using a neural network in a manner similar to that described above with respect to operation S130. The values ​​may be determined in accordance with the recommended intravascular treatment device 130. 1..6The recommended values ​​of the attributes are output in a similar manner to the instructions of . In this example, since the recommended values ​​of one or more attributes are determined for the treatment device, the treatment device is more suitable for the obstruction to be treated. Therefore, more effective treatment can be delivered.

[0079] As discussed above, determining values ​​for treatment parameters to use with a proposed device can also be challenging. For example, if the proposed device is a laser atherectomy catheter, such as Figure 2 A, then it may be necessary to adjust the values ​​of treatment parameters, such as the flux of optical radiation emitted by the device and its advancement rate in the artery, in order to optimize the desired results. Figure 3 The methods described include:

[0080] Determine recommended intravascular device 130 1..6 recommended values ​​for one or more treatment parameters; and

[0081] An indication of the recommended value for the one or more treatment parameters is output.

[0082] In this example, the values ​​of various treatment parameters may be determined based on the type of intravascular treatment device being recommended. By way of example, if the intravascular treatment device is a laser atherectomy catheter, the values ​​of the recommended treatment parameters may include values ​​for one or more of: the position of the laser atherectomy catheter relative to the obstruction, the advancement speed of the laser atherectomy catheter, the flux of the optical radiation emitted by the laser atherectomy catheter, the repetition rate of the optical pulses emitted by the laser atherectomy catheter, and the duty cycle of the optical radiation emitted by the laser atherectomy catheter.

[0083] As another example, if the intravascular treatment device is a directional plaque removal device, the values ​​of the recommended treatment parameters may include values ​​for one or more of: the position of the directional plaque removal device relative to the obstruction, the advancement speed of the directional plaque removal device, and the rotation speed of the cutting window of the directional plaque removal device.

[0084] As another example, if the intravascular treatment device is a rotational plaque removal device, the values ​​of the recommended treatment parameters may include values ​​for one or more of: a position of the rotational plaque removal device relative to the obstruction, an advancement speed of the rotational plaque removal device, and a rotational speed of a burr of the rotational plaque removal device.

[0085] As another example, if the intravascular treatment device is an orbital atherectomy device, the values ​​of the recommended treatment parameters may include values ​​for one or more of: a position of the orbital atherectomy device relative to the obstruction, an advancement speed of the orbital atherectomy device, and a rotational speed of the orbital atherectomy device.

[0086] As another example, if the intravascular treatment device is a transluminal plaque resection device, the values ​​of the recommended treatment parameters may include values ​​for one or more of: a position of the transluminal plaque resection device relative to the obstruction, an advancement speed of the transluminal plaque resection device, and an aspiration flow rate of the transluminal plaque resection device.

[0087] As another example, if the intravascular treatment device is an intravascular lithotripsy (IVL) balloon, the at least one parameter may include one or more of: the position of the IVL balloon relative to the obstruction, the number of shock wave pulses delivered to the obstruction from one or more shock wave transmitters of the IVL balloon, and the IVL balloon pressure used during delivery of shock waves from the IVL balloon to the obstruction.

[0088] The recommended value of the treatment parameter may be determined using a deterministic rule set, or by using a lookup table, or by using a neural network (ie, in a manner similar to that described above with respect to operation S130). 1..6 The example outputs a recommended value of a treatment parameter in a similar manner to the indication of the .By providing recommended values ​​of one or more treatment parameters of an intravascular treatment device, the example facilitates delivery of more effective treatment to an obstruction.

[0089] In one example, the recommended values ​​of the treatment parameters are used to automatically adjust the intravascular treatment device 130 1..6 This improves the workflow by avoiding the need for time-consuming adjustments of treatment parameters by the user.

[0090] In one example, the value of the treatment parameter is synchronized with the cardiac phase of the subject. For example, a treatment parameter (such as the flux of optical radiation emitted by a laser atherectomy catheter) can be synchronized with the cardiac phase so that the optical radiation is emitted only during the diastolic phase. This improves the effectiveness of delivering treatment to the obstruction because the curvature of the blood vessel where the obstruction is located is generally more variable in the systolic phase than in the diastolic phase. A sensor can be used to determine the cardiac phase of the subject. For example, an electrocardiogram "EKG" sensor can be used.

[0091] In another example, an indication of one or more recommended procedure steps to be performed using a recommended intravascular treatment device is output.

[0092] In this example, reference Figure 3 The methods described include:

[0093] Determine the recommended intravascular treatment device to be used 130 1..6 One or more recommended process steps to perform; and

[0094] An indication of the one or more recommended process steps is output.

[0095] In this example, examples of recommended process steps that can be output include "advance the treatment device at a (specified) rate", "withdraw the treatment device (specified distance), rotate the treatment device through a (specified) angle, and then re-advance the tool", "obtain intravascular ultrasound "IVUS" imaging data for the blocked blood vessel", etc. The recommended (one or more) process steps can be determined according to the rules disclosed in the document "Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention: A Global Expert Consensus Document" by Brilakis, E. et al., Circulation, 2019; 140: 420-433.

[0096] The recommended procedure steps may include a recommended CTO crossing strategy, such as "antegrade wiring," "antegrade dissection and re-entry," "retrograde wiring," or "retrograde dissection and re-entry." The crossing strategy may be determined based on occlusion properties and / or vessel properties. The crossing strategy may be determined based on the so-called hybrid algorithm disclosed in Brilakis, E. et al., "A percutaneous treatment algorithm for crossing coronary chronic total occlusions," JACC Cardiovasc Interv. 2012; 5: 367-379.

[0097] The recommended procedure steps may be determined in a similar manner as described above for determining the type of atherectomy device to use (ie, using a deterministic rule set, or a lookup table, or a neural network).

[0098] In another example, reference Figure 3 The methods described include:

[0099] determining a value of an outcome metric of the treatment process; and

[0100] An indication of the value of the result metric is output.

[0101] The value of an outcome measure can represent a variety of factors. For example, the value of an outcome measure can represent the probability of success or failure of a procedure, or the duration of a procedure, or the probability of a medical complication caused by a procedure.

[0102] Outcome metrics can be evaluated in various ways. In one example, the so-called J-CTO score is used. The J-CTO score estimates the likelihood of successful antegrade guidewire crossing of the CTO within 30 minutes. The evaluation of the J-CTO score is described in the document "Predicting Successful Guidelwire Crossing Through Chronic Total Occlusion of Native Coronary Lesions Within 30Minutes: The J-CTO (Multicenter CTO Registry in Japan) Score as a Difficulty Grading and Time Assessment Tool" by Morino, Y. et al., JACC: Cardiovascular Interventions, Volume 4, Issue 2, February 2011, Pages 213-221. The J-CTO score is evaluated based on five criteria: the shape of the entrance of the obstruction (tapered vs. blunt), the presence of calcifications within the CTO, the presence of at least one bend greater than 45 degrees at the entrance of the CTO or along the body of the CTO, the length of the obstruction, and whether the current attempt is a repeat attempt. The J-CTO score can be evaluated based on the above reference. Figure 1 Describe the attributes of obstruction to assess the J-CTO score.

[0103] In another example, the value of the outcome metric is determined based on a database of historical procedures that have been performed on an obstruction using an intravascular treatment device and for which the corresponding outcome metric value has been recorded. The value of the outcome metric can be determined from the database based on the value of the outcome metric for procedures that have been performed using similar intravascular treatment devices and based on similar obstructions. One or more additional factors can also be used to determine the value of the outcome metric, such as, for example, the similarity of the properties of the intravascular treatment device used in the procedure, or the similarity of the treatment parameters of the intravascular treatment device used in the procedure. In this example, for example, a similarity metric such as the Mahalanobis distance can be used to calculate the similarity between procedures, devices, etc. In this example, the value of the outcome metric for the most similar historical procedure can be used as the value of the outcome metric for the current procedure.

[0104] In another example, the value of the outcome metric is determined using the geometric model generated from the CT data received in operation S110. In this example, the operation of determining the value of the outcome metric of the treatment procedure includes:

[0105] extracting geometric data representing blood vessels and obstructions 120 from the CT data;

[0106] generating a geometric model representing the blood vessel and the obstruction 120 based on the geometric data;

[0107] using the geometric model to determine an expected effect of a proposed intravascular treatment device on the occluded blood vessel 110; and

[0108] Based on the recommended intravascular treatment device 130 1..6 The expected effect on the blocked blood vessel determines the value of the outcome metric for the treatment procedure.

[0109] In this example, extracting geometric data representative of the vessel and the obstruction 120 from the CT data may be performed in a manner similar to that described above for analyzing the CT data in operation S120 to determine one or more attributes of the obstruction 120 in the vessel. Thus, if CT data representative of X-ray attenuation in a single energy bin is used, the CT data may be reconstructed into an image, and the image may be segmented to identify the vessel and the obstruction. Image processing techniques may then be used to extract the geometric data from the reconstructed image. If spectral CT data is used, a material decomposition algorithm may be applied to the spectral CT data during reconstruction of the image representative of the vessel and the obstruction to identify the vessel and the obstruction. Known image processing techniques may then be used to extract the geometric data from the reconstructed image.

[0110] After the geometric data is extracted, a geometric model representing the blood vessel and the obstruction 120 is then generated based on the geometric data. The geometric model may be provided in the form of a finite element model. An example of such a finite element model is disclosed in the document "Computational approaches for analyzing the mechanics of atherosclerotic plaque: A review", Journal of Biomatics, Volume 47, Issue 4, 3 March 2014, Pages 859-869 by Holzapfel, G. et al. The geometric model may then be used to determine the expected effect of a recommended intravascular treatment device on the obstructed blood vessel 110 by adapting the model to remove material from the treatment device according to the delivery of the treatment. Then, based on the recommended intravascular treatment device 130 1..6 The expected effect on the blocked vessel determines the value of the outcome metric for the treatment procedure.As an example, the outcome metric may be evaluated based on the amount of increase in lumen diameter as a result of the treatment (ie, so-called "luminal gain").

[0111] In a related example, the geometric model is a biomechanical model and the CT data represents a time series of images representing the blocked blood vessel 110. In this example, reference Figure 3The described method includes determining one or more biomechanical parameters of a biomechanical model based on temporal changes in a vessel shape in a time series of images representing an occluded vessel.

[0112] In this example, the biomechanical parameters of the biomechanical model can represent mechanical parameters, such as the stiffness of the vessel and the obstruction. The biomechanical model provides a more accurate characterization of the deformation of the vessel and the obstruction in response to the delivery of the treatment. Therefore, the biomechanical model provides a more accurate prediction of the effect of the intravascular treatment device. This facilitates determining a more accurate value for the outcome metric.

[0113] In another example, reference Figure 3 The described method is used in conjunction with the blocking process. In this example, reference Figure 3 The methods described include:

[0114] receiving X-ray projection data representing an obstructed blood vessel, the X-ray projection data being generated during the treatment procedure;

[0115] registering the CT data to the X-ray projection data; and

[0116] The graphical representation of the X-ray projection data and the CT data is output as a superimposed image.

[0117] Can be Figure 5 The illustrated system 300 implements this example and includes an X-ray projection imaging system 320 for generating X-ray projection data. The X-ray projection data may represent a static image of the blocked vessel or a time series of images of the blocked vessel. In the latter case, the time series of images may represent the blocked vessel in substantially real time. The operations of receiving the X-ray projection data, registering the CT data to the X-ray projection data, and outputting a graphical representation of the X-ray projection data and the CT data may be performed in substantially real time to provide live guidance during a treatment procedure. In this example, the X-ray projection data may be provided by a computer program product. Figure 5 One or more processors 210 are shown receiving the X-ray projection data.

[0118] In this example, the CT data is registered to the X-ray projection data using known image registration techniques. The registration can be performed using the known geometry of the X-ray projection imaging system and its orientation relative to the CT data. Examples of suitable image registration techniques include intensity-based registration techniques, feature-based registration techniques, rigid and non-rigid registration techniques, etc. A graphical representation of the X-ray projection data and the CT data is then output as an overlay image. The registration is used to generate an overlay image. This operation can be performed using known image overlay techniques. For example, one image from the X-ray projection data and the CT data can be overlaid on another image, wherein the overlay image has a predetermined level of transparency. For example, the graphical representation can be output in various ways, such as to a display. For example, the graphical representation can be output to Figure 5 Display 330 is shown. The output overlay image provides guidance to the physician during the treatment procedure by providing a three-dimensional context from the CT data to the planar representation of the occluded vessel from the X-ray projection data.

[0119] In a related example, refer to Figure 3 The method described comprises:

[0120] receiving means that during the treatment procedure, the intravascular treatment device 130 1..6 delivering processed input data to the block; and

[0121] updating the overlay image based on the received input data; and

[0122] Wherein the updating comprises including in the overlay image an indication to deliver the treatment to the obstruction.

[0123] This example can be performed by tracking the position of the intravascular treatment device relative to the X-ray projection data generated during the treatment procedure, and indicating in the overlay image the tracked position of the intravascular treatment device for the time at which the treatment is delivered to the vessel. As an example, the indication of delivering the treatment to the obstruction can indicate that the treatment has been delivered to the vessel by Figure 2The laser plaque removal device shown in A delivers a specified number of optical pulses to the obstruction. For example, an indication of the treatment delivered to the obstruction can be provided as a symbol at the relevant position in the superimposed image. The tracking position of the treatment device can be determined in the X-ray projection data or using a separate tracking system. In the former case, a feature detector trained to detect the shape of the intravascular treatment device can be used to determine the tracking position of the intravascular treatment device in the X-ray projection image. Alternatively, the feature detector can be trained to detect the shape of the reference marker attached to the treatment device. In the latter case, various interventional device tracking techniques can be used to track the position of the intravascular treatment device. The position in the X-ray projection image can be determined by aligning the coordinate system of the tracking system to the coordinate system of the X-ray projection imaging system 320 that generates the X-ray projection data. Various tracking systems can be used to track the position of the intravascular treatment device, including electromagnetic tracking systems and fiber-based tracking systems. An example of an electromagnetic tracking system is disclosed in the document US2020 / 397510 A1. An example of a fiber-based tracking technology that uses a strain sensor to determine the position of an interventional device is disclosed in the document US2012 / 323115 A1.

[0124] In this example, the received input data may indicate that treatment was delivered to the location of the obstruction. The operation of updating the overlay image may include providing an indication in the overlay image of the location of the treatment delivered to the obstruction. Alternatively or additionally, the operation of updating the overlay image may include providing an indication in the overlay image of the total number of treatments delivered to the obstruction. For example, the operation of updating the overlay image may indicate in the overlay image that treatment has been delivered to the location of the obstruction. Figure 2 The total number of optical pulses delivered to the obstruction by the laser atherectomy device shown in A. Thus, the overlay image provides a record of the treatment that has been delivered to the obstruction.

[0125] In another example, a computer program product is provided. The computer program product includes instructions that, when executed by one or more processors, cause the one or more processors to perform a method of providing guidance for a treatment procedure on an obstructed blood vessel 110 .

[0126] The method comprises:

[0127] receiving S110 computed tomography CT data representing an obstructed blood vessel 110;

[0128] analyzing S120 the CT data to determine one or more properties of the blockage 120 in the blood vessel;

[0129] Determining S130 a recommended intravascular treatment device 130 for treating the blocked blood vessel 110 based on the one or more attributes 1..6 ;as well as

[0130] Output S140 for the recommended intravascular treatment device 130 1..6 instructions.

[0131] In another example, a system 200, 300 is provided for providing guidance for a treatment procedure on an obstructed blood vessel 110. The system includes one or more processors 210 configured to:

[0132] receiving S110 computed tomography CT data representing an obstructed blood vessel 110;

[0133] analyzing S120 the CT data to determine one or more properties of the blockage 120 in the blood vessel;

[0134] Determining S130 a recommended intravascular treatment device 130 for treating the blocked blood vessel 110 based on the one or more attributes 1..6 ;as well as

[0135] Output S140 for the recommended intravascular treatment device 130 1..6 instructions.

[0136] exist Figure 4 An example of a system 200 is shown in FIG. This example can be used to provide guidance for the planning phase of an obstruction treatment process. Note that Figure 4 The illustrated system 200 may also include one or more of the following: a CT imaging system 220 for providing the CT data 140, a display 230 for displaying a graphical representation of the CT data, output results of the method, such as (one or more) properties of the blockage 120, (one or more) properties of the blood vessel, etc.; a bed 240; and a user input device configured to receive user input related to the method performed by the one or more processors 210 ( Figure 4 Not shown), such as keyboard, mouse, touch screen, etc.

[0137] exist Figure 5 Another example of system 300 is shown in FIG. This example can be used to provide guidance for the treatment phase of an obstruction treatment process. Note that Figure 5 The illustrated system 300 may also include one or more of the following: an X-ray projection imaging system 320 for providing X-ray projection data, a display 330 for displaying a graphical representation of the X-ray projection data and the CT data as an overlay image, and further outputs of the results of the method, such as (one or more) properties of the blockage 120, (one or more) properties of the blood vessel, etc.; a bed 340; and a user input device configured to receive user input related to the method performed by the one or more processors 210 ( Figure 5 Not shown), such as keyboard, mouse, touch screen, etc.

[0138] The above examples should be understood as illustrative of the present disclosure, rather than limiting. Other examples are also contemplated. For example, the examples described with respect to computer-implemented methods may also be provided by corresponding computer program products or by corresponding computer-readable storage media or by corresponding systems. It should be understood that the features described with respect to any one example may be used alone or in combination with the features described with respect to other examples, and may be used in combination with one or more features of another example or a combination of other examples. In addition, equivalents and modifications not described above may also be adopted without departing from the scope of the present invention as defined in the appended claims. In the claims, the word "comprising" does not exclude other elements or operations, and the indefinite article "one" or "an" does not exclude a plurality. The mere fact that certain features are described in mutually different dependent claims does not indicate that a combination of these features cannot be used advantageously. Any figure mark in a claim should not be interpreted as limiting its scope.

Claims

1. A computer-implemented method for providing guidance on a treatment procedure for an obstructed blood vessel (110), the method include: receiving (S110) computed tomography (CT) data representing the blocked blood vessel (110); analyzing (S120) the CT data to determine one or more attributes of the blockage (120) in the blood vessel; Determining (S130) a recommended intravascular treatment device (130) for treating the blocked blood vessel (110) based on the one or more attributes 1..6 );as well as Output (S140) the recommended intravascular treatment device (130 1..6 ) instructions.

2. The computer-implemented method of claim 1, in, The one or more properties of the obstruction (120) include one or more of: a measurement of the size of the obstruction, a location of the obstruction, a measurement of the shape of the obstruction, a measurement of the entry shape of the obstruction, and a composition of the obstruction.

3. A computer-implemented method according to claim 1 or claim 2, in, The CT data includes spectral CT data, wherein the spectral CT data defines the blocked blood vessel in a plurality of different energy intervals (DE 1..m ) in the X-ray attenuation; and Wherein, analyzing (S120) the CT comprises analyzing the spectral CT data to determine the one or more properties of the blockage (120) in the blood vessel.

4. The computer-implemented method of claim 3, in, The one or more attributes of the obstruction (120) include the composition of the obstruction; and Wherein, said analyzing (S120) said spectral CT comprises applying a material decomposition algorithm to said spectral CT data to determine said composition of said obstruction.

5. A computer-implemented method according to any preceding claim, in, The analyzing (S120) of the CT data includes: reconstructing an image representing the blocked blood vessel (110); and Wherein, the analyzing (S120) of the CT data is performed using a reconstructed image.

6. The computer-implemented method of claim 5, in, The method further comprises: segmenting the reconstructed image to identify the blockage (120); and automatically identifying the blockage in the reconstructed image; and Wherein, analyzing (S120) the CT data to determine one or more attributes of the blockage (120) in the blood vessel is performed on the identified blockage.

7. The computer-implemented method of claim 5, in, The method further comprises: outputting the reconstructed image to a display device (230, 330); and receiving user input identifying the occlusion (120) in the reconstructed image; and Wherein, analyzing (S120) the CT data to determine one or more attributes of the blockage (120) in the blood vessel is performed on the identified blockage.

8. A computer-implemented method according to any preceding claim, in, The method further comprises: analyzing the CT data to determine one or more properties of the blood vessel; and wherein the determination (S130) of a recommended intravascular treatment device (130) for treating the blocked blood vessel (110) 1..6 ) is further based on the one or more properties of the blood vessel.

9. The computer-implemented method of claim 8, in, The one or more properties of the blood vessel include one or more of: a measurement of the size of the blood vessel, a measurement of the shape of the blood vessel, a measurement of the amount of plaque in the blood vessel, a type of plaque in the blood vessel, a shape of the plaque in the blood vessel, and a composition of the plaque in the blood vessel.

10. A computer-implemented method according to any preceding claim, in, The determination (S130) of a recommended intravascular treatment device (130) for treating the blocked blood vessel (110) 1..6 ) includes determining a type of atherectomy device to be used to treat the blocked blood vessel; and in, The output (S140) is for the recommended intravascular treatment device (130 1..6 ) includes outputting an indication of the type of plaque removal device determined.

11. The computer-implemented method of claim 10, further comprising: include: Determining the recommended intravascular treatment device (130 1..6 )'s recommended values ​​for one or more attributes; as well as An indication of the recommended values ​​for the one or more attributes is output.

12. The computer-implemented method of claim 10 or claim 11, further comprising: include: Determining the recommended intravascular treatment device (130 1..6 ) recommended values ​​for one or more treatment parameters; as well as An indication of the recommended value for the one or more treatment parameters is output.

13. The computer-implemented method of claim 1, in, The method further comprises: determining a value of an outcome metric for the treatment process; and An indication of the value of the result metric is output.

14. A computer-implemented method according to any preceding claim, in, The method further comprises: receiving X-ray projection data representing the occluded blood vessel, the X-ray projection data being generated during the treatment procedure; registering the CT data to the X-ray projection data; as well as The graphical representation of the X-ray projection data and the CT data is output as a superimposed image.

15. The computer-implemented method of claim 14, in, The method further comprises: During the treatment procedure, a signal indicating that an intravascular treatment device (130 1..6 ) delivering processed input data to said block; and updating the overlay image based on the received input data; and Wherein the updating comprises including in the overlay image an indication to deliver the treatment to the obstruction.

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