Systems, methods, and computer-accessible media for performing real-time image-based physiological and / or coronary artery measurements

Abstract

Exemplary systems, devices, and methods, as well as computer-accessible media, for performing one or more image-based physiological measurements may be provided. For example, a reference object may be positioned within an imaging field of view of an X-ray radiation source and proximate to at least one section of a body or target object. X-ray radiation may then be provided to such a section of the body or target object and the reference object. Furthermore, at least one X-ray image of the section, containing an image of the reference object, may be generated based on (i) a first radiation provided from the section and (ii) a second radiation provided from the reference object.

Description

[Technical Field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 438,658, filed January 12, 2023, and U.S. Provisional Patent Application No. 63 / 546,327, filed October 30, 2023, the entire disclosures of which are incorporated herein by reference in their entireties.

[0002] FIELD OF THE DISCLOSURE The present disclosure relates generally to imaging technology, and more particularly to systems, methods, and computer-accessible media for performing one or more image-based physiological and / or coronary artery measurements. [Background technology]

[0003] (Background information) To perform image-based assessment of coronary artery structure (e.g., quantitative coronary angiography) and physiology (e.g., angiographically derived coronary artery physiology), a first requirement may be to acquire and use fluoroscopy / angiography image stacks. In most cases, multiple image stacks taken at two known angles are used. A second requirement may be to acquire and use traditional metadata such as source-sample distance, system-specific magnification factor, and resulting image pixel size to adjust measurements based on imaging conditions and imaging system characteristics.

[0004] Most conventional procedures can derive the x-ray geometry information for the second requirement from metadata associated with a Digital Imaging and Communications in Medicine (DICOM) file of one or more angiographic images (e.g., at each imaging angle). DICOM files from health information management systems are typically not acquired in real time, which adds additional user interaction and time and limits the benefits of noninvasive angiographically derived coronary artery assessment (ADCA) methods, such as angiographically derived geometric and / or structural measurements (e.g., quantitative coronary angiography (QCA)), absolute or relative coronary blood flow (CF), fractional flow reserve (FFR), instantaneous wave-free ratio / resting cycle ratio (iFR / RFR), index of microcirculatory resistance (IMR), hyperemic microvascular resistance (HMR), hyperemic stenosis resistance (HSR), and coronary flow reserve (CFR). Furthermore, although angiographically derived physiology (ADP) has shown promising accuracy compared to ground-truth physiology measurements under ideal conditions, inconsistent image quality, system-dependent factors, and additional user interaction and procedure time have historically reduced its performance and availability in the operating room (OR).

[0005] Preferably, x-ray geometric metadata would be available to the processing system directly from the fluoroscopy device to facilitate rapid image-based ADCA. Unfortunately, currently available technology only provides an open-ended live stream of angiographic image data that is optimized for display on an OR monitor (e.g., via a video output port). Furthermore, this live stream of image data typically does not carry the geometric metadata necessary to perform ADCA.

[0006] Therefore, a need exists to provide an apparatus, method, and / or computer-accessible medium for performing real-time ADCA and generating and transmitting the necessary geometric metadata about imaging and system parameters. Summary of the Invention [Means for solving the problem]

[0007] SUMMARY OF ILLUSTRATIVE EMBODIMENTS Such challenges and / or deficiencies may be at least partially addressed and / or overcome by providing systems, methods, and computer-accessible media for performing one or more ADCAs according to various exemplary embodiments of the present disclosure.

[0008] According to an exemplary embodiment of the present disclosure, an X-ray imaging system can be provided in addition to a processing system. Such an exemplary processing system can be configured to perform ADCA, such as QCA and / or ADP, using one or more images from a live stream of angiographic images from the X-ray system. In this exemplary embodiment, ADP can be performed in real time directly using the video output signal of the X-ray imaging system.

[0009] In an exemplary embodiment, the X-ray imaging system may include, for example, an X-ray radiation source configured to generate X-ray radiation, at least one reference object (which may be, for example, partially or substantially fully radiopaque) located within an imaging field of view of the X-ray radiation source and configured to receive the X-ray radiation, and at least one computer processor (e.g., an X-ray imaging device) configured to generate an X-ray image containing an image of the reference object based on first radiation received by at least one portion of the body and then attenuated, and second radiation received by the reference object and then attenuated, from which such attenuated radiation is then provided. For example, a contrast agent (which may be, for example, a radiopaque contrast agent) may also be provided within the body prior to the body receiving the X-ray radiation.

[0010] In exemplary embodiments of the present disclosure, the radiopaque contrast agent can be a partially radiopaque contrast agent. The exemplary imaging system can further include an X-ray detector in optical and / or data communication with the computer processor. The radiopaque reference object can be a partially radiopaque reference object. The radiopaque reference object can be or include a patterned object of known and / or predetermined dimensions. The radiopaque reference object can be or include a three-dimensional object and / or can be a triangular-shaped object, a circular-shaped object, a square-shaped object, a grid-shaped object, and / or a polygon-shaped object. The radiopaque reference object can be an intravascular device (e.g., a catheter) and / or a portion thereof.

[0011] In another exemplary embodiment of the present disclosure, the radiopaque reference object can be arranged on an operating platform on which a body (e.g., a patient) is positioned. The radiopaque reference object can, for example, be part of (e.g., mounted on) an imaging catheter on its surface. The radiopaque reference object can also (or alternatively) be mounted on a front and / or back portion of the target object's body (e.g., adhered to the body). The radiopaque reference object can include a visible identification tag (e.g., a QR code that can be read using an optical QR reader). Similarly, the radiopaque reference object can include a radiopaque identification tag (e.g., a radiopaque QR code that can be read using an X-ray image of the reference object). The radiopaque reference object can be at least partially constructed of metal and / or plastic. In yet another exemplary embodiment of the present disclosure, the imaging system can further include a patient identification (ID) tag. Imaging and system metadata (eg, pixel size of an x-ray image) can be obtained from images of radiopaque reference objects (eg, using automated image analysis).

[0012] According to another exemplary embodiment of the present disclosure, a method for performing ADP measurement in a body can be provided. The exemplary method can include, for example, placing a reference object (which may be at least partially radiopaque) within an imaging field of view of an X-ray generator and proximate at least one portion of the body or target object, imaging at least one portion of the body provided within the imaging field of view, providing X-ray radiation to such portion and the reference object, and generating at least one X-ray image of the imaging field of view, wherein such portion contains an image of the reference object based on (i) first radiation received and attenuated by the portion and (ii) second radiation provided from the reference object, which then provides such attenuated radiation.

[0013] According to another exemplary embodiment, it is possible to measure physiological characteristics of such segments. A reference object (which may be partially or completely radiopaque) can be shaped or designed to provide information to facilitate the measurement. In another exemplary embodiment of a method according to the present disclosure, a contrast agent (which may be at least partially radiopaque) is present within a body lumen.

[0014] According to yet another exemplary embodiment of the present disclosure, a method for tracking a catheter within a body can be provided. The exemplary method can include positioning a reference object (which can be at least partially radiopaque) within an imaging field of view of an X-ray generator and in proximity to at least one portion of the body or target object.

[0015] The partially radiopaque reference object may comprise an interpretable symbol or combination of symbols that facilitates image-based detection and tracking of or within at least one portion of the body or target object based on radiation received and attenuated by such portion in response to X-ray radiation impinging on at least one portion of the body or target object, and thereby providing such attenuated radiation.

[0016] These and other objects, features, and advantages of exemplary embodiments of the present disclosure will become apparent upon perusal of the following detailed description of exemplary embodiments of the present disclosure when considered in conjunction with the appended claims. [Brief explanation of the drawings]

[0017] Further objects, features, and advantages of the present disclosure will become apparent from the following detailed description, taken in conjunction with the accompanying drawings, which set forth illustrative embodiments of the present disclosure.

[0018] [Figure 1]FIG. 1 is a schematic diagram of an exemplary prior art system for performing ADP measurements.

[0019] [Figure 2] FIG. 2 is a schematic diagram of an exemplary system for performing ADP measurements, according to an exemplary embodiment of the present disclosure.

[0020] [Figure 3] FIG. 3 is a set of exemplary angiogram representations with and without reference objects, according to an exemplary embodiment of the present disclosure.

[0021] [Figure 4] FIG. 4 is a set of illustrative diagrammatic representations of reference objects that may be used by an exemplary apparatus / system / method / device / computer-accessible medium within a visible field of view according to another exemplary embodiment of the present disclosure.

[0022] [Figure 5] FIG. 5 is a set of illustrative diagrammatic representations of multiple reference objects within a visible field of view that may be used by an exemplary apparatus / system / method / device / computer-accessible medium according to another exemplary embodiment of the present disclosure.

[0023] [Figure 6] FIG. 6 is a set of illustrative diagrammatic representations of two- and / or three-dimensional (3D) reference objects within a visible field of view that may be used by an exemplary apparatus / system / method / device / computer-accessible medium according to another exemplary embodiment of the present disclosure.

[0024] [Figure 7] FIG. 7 is a diagram illustrating an exemplary apparatus / system / computer-accessible medium having a reference object for imaging at least one portion of a patient, according to another exemplary embodiment of the present disclosure.

[0025] [Figure 8]FIG. 8 is a schematic illustration of an exemplary angiogram showing a catheter and its progression within a body lumen that may be implemented in the present device / system / computer-accessible medium according to yet another exemplary embodiment of the present disclosure.

[0026] [Figure 9] FIG. 9 is a schematic illustration of an exemplary angiogram showing markers that may be implemented with a catheter utilized within or in conjunction with the present device / system / computer-accessible medium, according to yet another exemplary embodiment of the present disclosure.

[0027] [Figure 10] FIG. 10 is an illustration of a set of exemplary angiograms, each providing exemplary flow measurement results with and without a reference object, implemented within the present system / apparatus / device / method / computer-accessible medium according to an exemplary embodiment of the present disclosure.

[0028] [Figure 11] FIG. 11 is a cross-sectional view of an illustration providing additional flow measurements with and without a reference object implemented in the present system / apparatus / device / method / computer-accessible medium according to an exemplary embodiment of the present disclosure.

[0029] [Figure 12] FIG. 12 is a set of diagrams providing example flow rate measurements with different installation angles of a reference object implemented in the system / apparatus / device / method / computer-accessible medium according to an exemplary embodiment of the present disclosure.

[0030] [Figure 13] FIG. 13 is a set of diagrams illustrating reference objects, in morphology and ADP representation, respectively, used for multiple imaging modes implemented within the system / apparatus / device / method / computer-accessible medium according to an exemplary embodiment of the present disclosure.

[0031] [Figure 14] FIG. 14 is a set of diagrams illustrating reference objects, in morphology and ADP representation, respectively, used for multiple imaging modes implemented within the system / apparatus / device / method / computer-accessible medium according to another exemplary embodiment of the present disclosure.

[0032] [Figure 15] FIG. 15 is a flow diagram of a process for calculating fractional flow reserve (FFR) based on displayed images, as exists in the prior art.

[0033] [Figure 16] FIG. 16 is a flow diagram of a process for calculating fractional flow reserve (FFR) based on a displayed image from a video output port on an intravascular imaging system, implemented in the present system / apparatus / device / method / computer-accessible medium, according to another exemplary embodiment of the present disclosure.

[0034] [Figure 17A] FIG. 17A is a flow diagram of a process for angiographically derived measurements based on a contrast-filled lumen of a vessel, according to an exemplary embodiment of the present disclosure.

[0035] [Figure 17B] FIG. 17B is a flow diagram of a process utilizing at least one image sequence to measure flow and pressure, optionally incorporating a side branch that may also cause a pressure drop, which may improve the accuracy of FFR measurements, according to an exemplary embodiment of the present disclosure.

[0036] [Figure 18] FIG. 18 is a flow diagram of a process for angiographically derived measurements based on angiographic images, user input, and automatically detected reference objects, according to an exemplary embodiment of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0037] Throughout the drawings, the same reference numerals and characters, unless otherwise stated, are used to denote like features, elements, components, or portions of the illustrated embodiments. Also, while the present disclosure will now be described in detail with reference to the figures, it is done so in connection with the illustrative embodiments and is not limited by the certain exemplary embodiments illustrated in the figures and the appended claims.

[0038] DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS The following description of the embodiments provides non-limiting representative examples, particularly those that refer to numerical values, to illustrate the features and teachings of different aspects of the present disclosure. It should be recognized that the described embodiments can be implemented separately or in combination with other exemplary embodiments from the description of the exemplary embodiments. Those skilled in the art who review the description of the exemplary embodiments should be able to learn and understand the different described aspects of the present disclosure. The description of the exemplary embodiments is not specifically exhaustive, but should facilitate understanding of the present disclosure to the extent that other implementations within the knowledge of those skilled in the art who peruse the description of the present embodiments will be understood as consistent with the application of the present disclosure.

[0039] For example, according to exemplary embodiments of the present disclosure, a system, apparatus, method, device, and / or computer-accessible medium may be provided that may obtain the metadata in real time, for example, by providing (e.g., writing) metadata text into an output angiography image stream from an X-ray system and deploying optical character recognition (OCR) methods on the ADCA system to recognize, read, and / or analyze the image / text.

[0040] According to another exemplary embodiment of the present disclosure, a system, apparatus, method, device, and / or computer-accessible medium may be provided that may obtain metadata in real time, for example, by placing a known radiopaque reference instrument within the X-ray field of view (i.e., without interfering with the patient's artery of interest). Such a reference instrument may be designed to enable a complete reconstruction of the X-ray system geometry, which may be important for accurately determining or calculating the associated ADP in a system-independent manner.

[0041] According to some exemplary embodiments of the present disclosure, the systems, apparatus, methods, devices, and / or computer-accessible media described herein provide features such as rapid / live ADCA without the need to transfer angiography system metadata (e.g., without using DICOM and / or without using a network connection), higher accuracy imaging measurements directly related to patient position (opacity, imaging angle, pixel size, sample distance, etc.), fluoroscopy / angiography system-independent algorithm calibration (e.g., enabling competitive innovation), reduced dependency on system manufacturers, and system independence. It can facilitate enabling image normalization, single-slice angiography-based FFR at non-confined angles (e.g., uncommon angles, angles that best capture minimum lumen area (MLA)) using the measured angle of the reference instrument, providing tracking for "single-use" payment by using unique serialization embedded within the reference instrument and decipherable by the ADCA system, the ability to sell single-use reference instruments associated with the procedure (i.e., for payment), and reducing dependency on images / text (which is undesirable) and additional DICOM interconnections.

[0042] In exemplary embodiments of the present disclosure, the reference object / instrument can be at least partially constructed of metal, polymer, plastic, and / or any material with controlled / adjusted opacity for visibility on an X-ray. The reference object / instrument can have letters or numbers or any pattern that allows an image processing algorithm to read identifiable information from the object. The reference object / instrument can be multiple disconnected objects. The reference object / instrument can be an object disposed in the OR (e.g., on an operating table).

[0043] In another exemplary embodiment of the present disclosure, the reference object / instrument can be or include a disposable object (i.e., a QR scannable item) for tracking payment. The reference object / instrument can be configured and / or structured to adhere to the patient or table or be weighted to prevent movement. The reference object / instrument can also be provided on a guide catheter (i.e., a specific guide catheter designed for such purpose) or any other intravascular object. The reference object / instrument can further provide information to infer pixel size or angle of the imaging conditions (e.g., source / detector angle relative to the operating table or patient) and / or to infer the distance from the source to the sample and / or source to the detector.

[0044] In yet another exemplary embodiment of the present disclosure, the reference object / instrument can provide information about at least one portion of the patient, a model of the X-ray system, a type of ADCA (e.g., angiographically derived structural measurements, absolute or relative coronary blood flow (CF), fractional flow reserve (FFR), instantaneous waveless ratio / resting cycle ratio (iFR / RFR), index of microcirculatory resistance (IMR), hyperemic microvascular resistance (HMR), hyperemic stenosis resistance (HSR), coronary flow reserve (CFR), and / or single-plane / angle ADCA (e.g., single-angle angiographically derived FFR)). The exemplary reference object / instrument can also provide information to improve optical coherence tomography (OCT) measurements (e.g., stent / side branch measurements) and / or facilitate real-time angiographic and / or physiological measurements.

[0045] In yet another exemplary embodiment of the present disclosure, the reference object / instrument, when detected, can facilitate and / or cooperate with a computer-accessible medium including software modules for utilizing different programs / modes. The reference object / instrument, when detected, can utilize and / or implement different analysis methods and / or payment schemes (e.g., for angiographically derived FFR). Additionally, the reference object / instrument can have a grid pattern, a square pattern, a triangular pattern, and / or any geometric shape that can facilitate the inference of any of the foregoing points. In addition to structure, the reference object / instrument can have two-dimensional features, three-dimensional features, and / or other features that are distinguished by radiopacity.

[0046] Unlike DICOM, which is a standard medical image format that includes information about pixel size and all other information needed to calculate different flow measurements, as described above, the exemplary systems, apparatus, methods, devices, and / or computer-accessible media described herein can include and / or utilize a reference object with controllable opacity within the imaging field of view. The reference object can be a single-use item. For example, when a clinician provides a reference object such as a sticker on a patient, the size of the reference object when imaged using an X-ray system will contain information about one or more of the pixel (and / or even per pixel) sizes. When imaged using an X-ray system, the reference object can also provide information about the distance from the sample to the source, the angle based on the orientation, and the image. Computer vision can be used to automatically detect such information, and the reference object can have a radiopaque identification tag (e.g., a barcode) therein. The reference object can have a design in which each pixel indicates a size, such as an equal number of microns, from which each pixel size can be inferred. The reference object can be configured to provide a method for implementing a payment scheme, which can be a single scan. Reference objects can be provided as stickers on the patient, which can provide a way to track the use of certain software.

[0047] In one exemplary embodiment, a reference object can be placed between the emitter and detector within the imaging field of view, e.g., above or below the patient, so that the size of the reference object and its distance from the emitter / detector can be known and from which each image pixel size can be acquired. For example, in angiographically derived FFR flow measurements, the reference object can be an at least partially or completely radiopaque marker (e.g., resembling a small ball) by reference to which the image size can be acquired. The reference object can be configured to have a QR code that is placed on the patient and then peeled off and scanned (e.g., optically or physically) so that payment can be tracked. Such exemplary information can be transmitted directly to a local computer system, rather than to a cloud platform from which it can be later retrieved for further processing; this exemplary method can reduce the time consumption for processing such information. The reference objects can be arranged as a grid on a platform (e.g., a table) on which the patient is provided. The reference object can also be a sticker that can be placed on any part of the patient (e.g., chest / back / neck) or on a gown worn by the patient, as long as the reference object is within the imaging field of view.

[0048] FIG. 1 shows a schematic diagram of an exemplary prior art system 100 for ADCA measurement. As shown in the prior art system 100, an imaging system 110 (e.g., an X-ray system) can be provided, which may include a camera 102 and a processor 104 that controls the camera 102 to image a patient. Imaging data / information from the imaging system 110 can be transmitted to a remote or cloud platform, such as a cloud server 130. The system 100 can further include an image processing system 120, which may include a display 108 for displaying images / data and a processor 106 that controls the display 108. The image processing system 120 can retrieve the imaging data / information from the imaging system 110 from the server 130. Such an exemplary prior art system 100 is not a real-time image / data processing system, and may take time to process images / data due to data / image transmission between the imaging system 110, the cloud server 130, and the image processing system 120.

[0049] FIG. 2 shows a schematic diagram of an exemplary system 200 for ADCA measurement according to an exemplary embodiment of the present disclosure. The exemplary system 200 may include an imaging subsystem 210 and an image processing subsystem 220. As shown in FIG. 2 , the imaging system 210 (which may be or include, for example, an X-ray system) may include a camera (e.g., an X-ray source and detector) 202 and a processor 204 that may be configured to control and / or interact with the camera 202 to image a patient and transmit the resulting images (e.g., to a server or display). Imaging data / information from the imaging system 210 may be transmitted from an output (e.g., a video output port) on the imaging system via a transmission medium 230 (e.g., a data cable or wireless network) to an image processing system 220 that may include, for example, a display 206 that may display the images / data and at least one processor 208 that may be configured to control the display 206. The image processing system may be configured to perform ADCA using the resulting images transmitted by the transmission medium. 1 , exemplary system 200 can avoid transmitting imaging data / information of imaging system 210 to a remote or platform (e.g., a local server). Instead, imaging data / information of imaging system 210 can be transmitted directly and in real time to image processing system 220 via transmission medium 230 (e.g., a data cable or a wireless network), which can improve the efficiency of image processing. In some embodiments, the image processing system can be an intravascular imaging system (e.g., IVOCT, IVUS, NIRS, fluorescence, reflectance, Raman imaging system).

[0050] 3 illustrates a set 300 of exemplary angiograms of at least one portion of a body, each with and without a reference object, according to an exemplary embodiment of the present disclosure. Diagram 310 is an illustration of an angiogram in which a coronary artery network 302 includes contrast and no reference object, which may be a conventional angiogram. Diagram 320 is also an illustration of an angiogram of a contrast-filled coronary artery network 302 that includes and utilizes a reference object 304, which may be implemented in the systems, apparatus, methods, devices, and / or computer-accessible media according to exemplary embodiments of the present disclosure, as described herein. Reference object 304 may be an object of any shape and / or size, for example, having a triangular shape, as shown in the example of FIG. 3 .

[0051] FIG. 4 illustrates a set 400 of illustrative diagrammatic representations of reference objects that may be used by an exemplary apparatus / system / method / device / computer-accessible medium within a visible field of view, according to another exemplary embodiment of the present disclosure. Diagram 410 is a representation of an angiogram that may include a patient ID 402 in addition to reference objects / instruments 404. The patient ID 402 may contain or be associated with information about the patient, such as name, age, etc. The reference objects 404 may further include an optically scannable ID 406, such as a QR code, that may be associated with information about the imaging system and / or the patient and / or procedure, for example. Diagram 420 is a representation of an angiogram showing reference objects 424 and a contrast-filled coronary artery network 422. The reference objects 424 shown in diagram 420 may be arranged as a grid. In this example, diagram 410 illustrates the patient ID 402 and reference instruments / objects 404 without the vessels (e.g., arteries) visible. When X-ray radiation is provided on the patient, the diagram 420 shows blood vessels filled with contrast (e.g., contrast-filled coronary artery network 422) and the reference object 424 (because it is radiopaque) without the patient ID tag 402 (because it is not radiopaque).

[0052] 5 shows a set 500 of illustrative diagrammatic representations of multiple reference objects that may be used by the disclosed exemplary apparatus / system / method / device / computer-accessible medium within a visible field of view, according to yet another exemplary embodiment of the present disclosure. Diagram 520 is a representation of an angiogram, which may include multiple reference objects / instruments, such as, for example, a first reference object 504, a second reference object 506, and a third reference object 508, in addition to, for example, a patient ID 502. Patient ID 502 may contain or be associated with information about the patient, such as name, age, etc. Reference objects 504, 506, 508 may each further include a scannable ID, such as a QR code, that may be associated with, for example, information about the imaging system, the patient, and / or the procedure. Diagram 540 is a representation of an angiogram showing a contrast-filled coronary artery network 522 as well as multiple reference objects / instruments, such as a first reference object 524, a second reference object 526, and a third reference object 528. Each of the reference objects 524, 526, 528 can be arranged as a grid, and multiple reference objects can be arranged in any suitable location.

[0053] In some exemplary embodiments of the present disclosure, the reference object can be a 3D object. FIG. 6 shows a set of exemplary illustrations 600 of an example diagram providing 3D reference objects within a visible field of view that can be used by an exemplary apparatus / system / method / device / computer-accessible medium according to a further exemplary embodiment of the present disclosure. Diagram 610 is an illustration of an angiogram that can include a patient ID 602 ​​and a 3D reference object / instrument 604. The patient ID 602 ​​can contain or be associated with information about the patient, such as name, age, etc. The 3D reference object 604 can further include a scannable ID, such as a QR code, within which information about the imaging system can be stored. Diagram 620 is an illustration of an angiogram showing a 3D reference object 626 in addition to a contrast-filled coronary artery network 622 and a radiopaque patient ID 624.

[0054] 7 illustrates a schematic diagram 700 of an exemplary apparatus / system having or utilizing a reference object for imaging a patient, according to another exemplary embodiment of the present disclosure. The exemplary system 700 may include an X-ray emitter 702 that may be configured to image at least one portion of the patient, a reference object 704 that is mounted on a platform 706 (e.g., an operating table) on which the patient may be mounted, for example, in a horizontal position, and an X-ray detector 708 that may be configured to detect X-rays transmitted through the platform 706, the portion of the patient, and the reference object 704 and acquire information about the patient and the reference object to facilitate formation of an X-ray image in an associated processor.

[0055] FIG. 8 illustrates a schematic diagram 800 of an exemplary angiogram showing an intravascular device, in this exemplary case a catheter 804, and its progression within a body lumen, that may be implemented within the disclosed apparatus / system / computer-accessible medium according to yet another exemplary embodiment of the present disclosure. A pattern disposed on the catheter 804 (e.g., a diagnostic catheter, a guide catheter, an imaging catheter), which may be known or unknown, may be used to obtain pixel dimensions, for example, to perform real-time ADCA during a diagnostic angiography procedure, during a PCI procedure, etc. Similarly, one or more dimensions of the catheter itself (e.g., without the pattern) can be used to calibrate an image, for example, to obtain pixel dimensions for ADCA. The exemplary diagram 800 also provides a contrast-filled artery 802 within which the catheter 804 may be positioned. In some exemplary embodiments of the present disclosure, a user may input or otherwise provide catheter dimensions (e.g., inner diameter, outer diameter, length, etc.) to aid in the calibration procedure. Additionally or alternatively, user input may include the following: Catheter manufacturer, model number, or identification, etc. - type of catheter (e.g., guide catheter, diagnostic catheter, imaging catheter, etc.); -unit of measurement for the guide catheter (e.g., 3 French, 4 French, 5 French, 6 French, 7 French, 8 French, 9 French, 10 French OD); The input may include inputting any and / or combination of:

[0056] According to various exemplary embodiments of the present disclosure, intravascular devices can be automatically detected and / or segmented (e.g., using standard image processing techniques, machine learning procedures, deep learning procedures, neural networks such as U-net, ResNet, etc.) to determine and / or calculate the total number of pixels along an axis, e.g., an axis perpendicular to the longitudinal direction of the device, being used to measure the diameter. In another exemplary embodiment of the present disclosure, a user can input or otherwise provide the size of the intravascular object, manually or automatically annotate the dimensions of a reference object, extract pixel sizes, and / or calibrate the image. In yet another exemplary embodiment of the present disclosure, a physical offset (e.g., object, X-ray system, patient-specific) can be applied to user-input sizes, e.g., outer diameter, inner diameter, length, etc. of a guide catheter to account for differences between visible and invisible portions of an object on an X-ray image, e.g., the user-input outer diameter of a diagnostic / guide catheter and the X-ray image and / or the visible portion of the diagnostic / guide catheter within a contrast-filled lumen. According to further exemplary embodiments of the present disclosure, the processor may be connected to a storage device containing information about the X-ray system from which the X-ray data originates (e.g., stored from a previous point in time, provided during installation / configuration, etc.), as described herein, and this information may also be used to assist in calibrating the X-ray data, for example, in addition to user input and automatically detected reference objects.

[0057] In addition to a catheter (e.g., a guide catheter) that may be used as a reference object, in some exemplary embodiments of the present disclosure, one or more additional reference objects may be used to determine image pixel size. For example, FIG. 9 shows a schematic diagram 900 of an exemplary angiogram illustrating markers that may be implemented in the present device / system / computer-accessible medium according to yet another exemplary embodiment of the present disclosure. As shown in FIG. 9, the schematic diagram 900 includes two catheter radiopaque markers 906, 908 that may be used as reference objects for obtaining image pixel size, in addition to a guide catheter 902 and a contrast-filled artery 904 in which the two catheter radiopaque markers 906, 908 may be positioned. The catheter radiopaque markers 906, 908 may be placed in the field of view with a known size or known pattern to perform real-time imaging and obtain pixel dimensions. In this example, the catheter radiopaque markers 906, 908 may be placed on or within another catheter (e.g., an imaging catheter) that may not be radiopaque such that the other catheter may not be visible except for the catheter radiopaque markers 906, 908.

[0058] 10 shows an illustration of a set of exemplary angiograms providing exemplary ADP measurements with and without a reference object that may be implemented in the system / apparatus / device / method / computer-accessible medium according to an exemplary embodiment of the present disclosure. In particular, the exemplary angiogram 1010 of FIG. 10 shows a first longitudinal ADP measurement 1014 acquired without a reference object and overlaying a contrast-filled artery 1012 without the reference object. The angiogram 1020 shows a second longitudinal ADP measurement 1022 acquired with a reference object and overlaying the contrast-filled artery 1012 with a reference object 1024. The second longitudinal ADP measurement 1022 can be determined based on radiation acquired as shown in FIG. 10 in conjunction with the reference object 1024 and can be more accurate than the first longitudinal ADP measurement 1014.

[0059] According to exemplary embodiments of the present disclosure, ADP parameters can be derived through automated detection of geometric or kinetic (e.g., flow) information from contrast-filled arteries. ADP parameters can be based on computational fluid dynamics (e.g., 3D, 2D, 1D, 0D, etc.). ADP parameters can also be based on any closed-form deterministic formulation of the physical laws of fluid dynamics (e.g., Navier-Stokes, Bernoulli, and Poiseuille) that govern the incompressibility of fluids in closed systems. ADP parameters can also be empirical or data-driven, based on measurements of geometric or kinetic properties, and compared (e.g., trained) against ground truth measurements (e.g., using pressure wires).

[0060] FIG. 11 shows a cross-sectional view 1100 of an illustration / diagram providing additional ADP measurement results with and without a reference object, respectively, implemented in the system / apparatus / device / method / computer-accessible medium according to an exemplary embodiment of the present disclosure. The illustration 1100 illustrates an ADP reserve measurement 1102 without a reference object as well as an ADP reserve measurement 1104 with the reference object. The diagram 1100 also shows a treat / defer patient threshold 1106. As can be seen in FIG. 11 , the ADP reserve measurement 1102 without the reference object is above the treat / defer patient threshold 1106, while the ADP reserve measurement 1104 with the reference object is below the treat / defer patient threshold 1106. Thus, the presence of a reference object can affect (e.g., improve) the patient's treatment by providing more accurate measurements.

[0061] 12 shows a set of diagrams 1200 (including diagrams 1201, 1220, and 1230) providing example ADP measurement values ​​with different installation angles of a reference object implemented in the system / apparatus / device / method / computer-accessible medium according to an exemplary embodiment of the present disclosure. Diagram 1210 is a diagram of a longitudinal ADP measurement 1206 in a contrast-filled artery 1204 with, for example, a reference object 2102 having an installation angle of θ1. Diagram 1220 is a diagram of a longitudinal flow measurement 1208 in a contrast-filled artery 1204 with, for example, a reference object 2102 having an installation angle of θ2. Diagram 1220 is a diagram of a longitudinal ADP measurement 1210 in a contrast-filled artery 1204 with, for example, a reference object 2102 having an installation angle of θ3. As can be seen in FIG. 12, the placement of the reference object is angle invariant, thus facilitating compensation for angular variations in imaging parameters, for example, for consistent longitudinal ADP measurements.

[0062] 13 shows a cross-sectional view 1300 of a set of illustrations / diagrams providing yet further reference objects used for multiple imaging modes implemented in the present system / apparatus / device / method / computer-accessible medium according to an exemplary embodiment of the present disclosure. As shown in FIG. 13, an exemplary reference object (i.e., marker) 1310 can be exchanged inside the artery for side branch detection, and a reference object (i.e., marker) 1320 can be exchanged outside the artery for calcified nodule detection.

[0063] 14 shows a cross-sectional view 1400 of a set of illustrations / diagrams providing further reference objects used for multiple imaging modes implemented in the present system / apparatus / device / method / computer-accessible medium according to another exemplary embodiment of the present disclosure. As shown in FIG. 14, exemplary reference objects (e.g., markers) 1410, 1420 can be used to determine regarding size measurement differences between pre- and post-percutaneous coronary intervention (PCI) and / or ADP measurement differences between pre- and post-PCI.

[0064] FIG. 15 shows a flow diagram for calculating fractional flow reserve (FFR) based on a displayed image, as exists in the prior art. Specifically, according to this prior art method, contrast is injected into the coronary vasculature (step 1510). An X-ray system is positioned to capture X-ray images of the contrast-filled coronary vasculature (step 1520). One copy of the X-ray image is then formatted for display, and another copy of the X-ray image is formatted for storage in DICOM along with associated metadata (step 1530). The DICOM is then transferred to an electronic health record system (EHS) (step 1540), and such DICOM file is downloaded to a computing system (step 1550). Finally, angiographically derived coronary assessment (e.g., angiographically derived fractional flow reserve measurement) can be performed on the computing system using the X-ray image-related metadata in the DICOM (step 1560). Thus, this prior art method would cause data to be transmitted from the X-ray system to the HER system and then back to the computing system, which collectively would suffer from high data message delays (e.g., high latency).

[0065] To address this issue, an exemplary process according to an exemplary embodiment of the present disclosure may be provided, as shown in the flow diagram of FIG. 16. This exemplary process calculates a fractional flow reserve (FFR) based on a displayed image from a video output port of an intravascular imaging system, which is implemented in the present system / apparatus / device / method / computer-accessible medium according to another exemplary embodiment of the present disclosure. In particular, similar to the prior art process shown in FIG. 15, in the exemplary process of FIG. 16, contrast is injected into the coronary vasculature (step 1610), an X-ray system is positioned to take X-ray images of the contrast-filled coronary vasculature (step 1620), one copy of the X-ray image is formatted for display, and another copy of the X-ray image is formatted for storage in DICOM along with associated metadata (step 1630). Then, in contrast to the prior art process of FIG. 15, the exemplary process transfers the display-formatted image directly to a computing system (step 1640), for example, as video output data. Finally, angiographically derived coronary artery assessment (e.g., angiographically derived fractional flow reserve measurement) can be performed on a computing system (e.g., an intravascular imaging system) using the display-formatted x-ray images and / or directly transferred data (e.g., by inferring associated metadata from the images themselves) (procedure 1650). In summary, the exemplary process shown in FIG. 16 utilizes a “frame-grabber,” for example, to stream video output data from an x-ray system to a computing system and process the display-formatted images. For example, the transfer can be low latency (e.g., less than 1 second per data message). In certain exemplary embodiments of the present disclosure, angiographically derived coronary artery assessment can be performed using image data from a single x-ray angle. According to further exemplary embodiments of the present disclosure, angiographically derived coronary artery assessment can be performed using image data from a sequence of images taken at more than one x-ray angle.

[0066] 17A shows a flow diagram of a process for acquiring and analyzing angiographically derived measurements based on contrast-filled lumens of vessels, according to an exemplary embodiment of the present disclosure. In particular, an angiographic image is obtained from a patient using, for example, an X-ray system (procedure 1710). Contrast agent within the lumens of coronary vessels in the angiographic image is then automatically detected (procedure 1720). Finally, in this exemplary process, the local pressure drop within the lumen is automatically determined and / or calculated based on the shape of the detected contrast agent (procedure 1730).

[0067] 17B shows a flow diagram of a method utilizing at least one image sequence to measure flow and pressure, optionally incorporating side branches, which may also cause pressure drops, which may improve the accuracy of FFR measurements, according to an exemplary embodiment of the present disclosure. For this exemplary process, an angiographic image is obtained from a patient using, for example, an X-ray system (procedure 1750). Intraluminal contrast agents of coronary vessels within an angiographic image segment are automatically detected (procedure 1760). Further, stenoses within the coronary vessels are automatically detected based on the shape of the detected contrast agents (procedure 1770). Additionally, coronary vessel side branches are automatically detected based on the shape of the detected contrast agents (procedure 1780). Finally, in this exemplary process, the relative flow rate and / or pressure drop within the lumen (e.g., across the detected stenosis) can be automatically calculated or determined based on the shape (e.g., dynamic shape) of the detected contrast agents (procedure 1790).

[0068] FIG. 18 shows a flow diagram of a method according to an exemplary embodiment of the present disclosure that utilizes at least one angiographic image to perform accurate angiographic measurements (e.g., QCA or ADP). As shown in FIG. 18, user input can be incorporated and / or utilized (procedure 1810). For this exemplary process, an angiographic image can be obtained from a patient using, for example, an X-ray system (procedure 1820). The lumens of coronary artery vessels (e.g., filled with contrast agent) within the angiographic image segment can be automatically detected (procedure 1830), along with reference objects such as, for example, diagnostic catheters. Optionally, X-ray system information can be received from a storage device (procedure 1840), which can provide information about the connected X-ray system, such as, for example, information regarding the pixel size of the X-ray detector. Additionally, in this exemplary process, an automatically calculated calibration procedure can be performed (procedure 1850) to perform accurate coronary artery measurements (procedure 1860) (e.g., in real time during a PCI procedure).

[0069] As described herein as an exemplary embodiment, an imaging system / apparatus / device and an imaging method implemented thereon may include an X-ray radiation source, one or more reference objects (such as instruments, markers, etc.) deployed within the imaging field of view of the X-ray radiation source, and an X-ray detector or imaging device. The one or more reference objects are radiopaque reference objects. The one or more reference objects can be placed in any suitable position, such as on a table in an operating room, on an imaging catheter, etc., as long as they are within the imaging field of view of the X-ray imaging system. Information for the X-ray imaging system, such as image pixel size and the distance between the X-ray radiation source and the patient, and the distance between the X-ray detector / imaging device and the patient, can be obtained from the one or more reference objects. For example, a radiopaque contrast agent can be deployed within the body, e.g., within the imaging field of view of the X-ray radiation source, so that at least one portion of the body can be more easily detected using X-ray radiation provided from such portion and radiation associated with the reference object.

[0070] As described herein as an additional exemplary embodiment, a method for tracking software usage within an imaging system can be provided based on a reference object. The reference object can be provided within or on at least one section of a body or object that can be used to generate an X-ray image of at least one portion of the body or object. Additional information can be retrieved from the reference object being imaged to identify and / or track, for example, information associated with the object or body (e.g., patient data), as well as payment / billing for using the software, for example, by a patient. The reference object can be a marker, such as a QR code, a symbol, or any combination.

[0071] Exemplary embodiments of the present disclosure provide imaging systems that may include, for example, an X-ray radiation source, at least one radiopaque reference object provided within an imaging field of view of the X-ray radiation source, an X-ray detector that detects X-ray radiation emanating from at least one part or object of the body and generates associated information, and at least one computer processor configured to generate an X-ray image containing an image of the at least one part and the radiopaque reference object based on the associated information.

[0072] As used in this disclosure, a computer may include any device (which may have a processor) that may be configured to receive information and, for example, cause the generation or output of electromagnetic radiation based on the information when the rate of motion exceeds a predetermined rate. A computer may also include a storage device (e.g., memory, hard drive, RAM, ROM, removable storage device, etc.) and a network connectivity port for receiving and transmitting data. A computer may also be or include a microprocessor, logic circuit, etc.

[0073] Throughout this disclosure, the following terms take on at least the meanings expressly associated therewith herein, unless the context clearly dictates otherwise. The term "or" is intended to mean an inclusive "or." Furthermore, the terms "an," "an," and "the" are intended to mean one or more unless otherwise specified or clear from the context to be directed to the singular form.

[0074] In this description, numerous specific details are set forth. However, it should be understood that implementations of the disclosed technology may be practiced without these specific details. In other instances, well-known methods, structures, and techniques have not been shown in detail in order not to obscure an understanding of this description. References to "some examples," "other example," "one example," "an embodiment," "various examples," "one embodiment," "an embodiment," "some embodiments," "some embodiments," "example embodiment," "various embodiments," "one implementation," "an implementation," "example implementation," "various implementations," "some implementations," and the like, indicate that implementations of the disclosed technology so described may include a particular feature, structure, or characteristic, but that not all implementations necessarily include that particular feature, structure, or characteristic. Furthermore, repeated use of the phrases "in one example," "in one exemplary embodiment," or "in one implementation" may, but do not necessarily, refer to the same example, exemplary embodiment, or implementation.

[0075] As used herein, unless otherwise specified, the use of ordinal adjectives such as "first," "second," and "third" to describe a common object merely indicates that different instances of similar objects are being referred to and is not intended to imply that the objects so described must be in a given sequence, either in time, space, in rank, or in any other manner.

[0076] While certain implementations of the disclosed technology have been described in connection with what are presently considered to be the most practical implementations of the various implementations, it is to be understood that the disclosed technology is not to be limited to the disclosed implementations, but rather is intended to cover various modifications and equivalent arrangements included within the scope of the appended claims. Although specific terms are employed herein, they are used in a generic and descriptive sense only and not for purposes of limitation.

[0077] This written description uses examples to disclose certain implementations of the disclosed technology, including the best mode, and to enable any person skilled in the art to practice certain implementations of the disclosed technology, including making and using any device or system and performing any incorporated methods. The patentable scope of certain implementations of the disclosed technology is defined in the appended claims, and may include other examples that occur to those skilled in the art. Such other examples are intended to be within the scope of the appended claims if they have structural elements that do not differ from the literal wording of the appended claims, or if they include equivalent structural elements that involve insubstantial variations from the literal wording of the appended claims.

Claims

1. 1. An imaging system, comprising: at least one partially radiopaque reference object provided within an imaging field of view of the X-ray radiation source and in proximity to at least one portion of the body or target object, and configured to receive X-ray radiation generated by said X-ray radiation source; at least one computer processor configured to generate an X-ray image of the vasculature of the at least one portion of the body, the X-ray image containing an image of the reference object, based on (i) a first radiation provided from the at least one portion and (ii) a second radiation provided from the reference object; A system comprising:

2. The system of claim 1 , wherein the at least one computer processor is configured to generate an X-ray image after a partially radiopaque contrast agent is provided in the at least one portion.

3. The system of claim 1 , further comprising an x-ray detector in at least one of optical and data communication with the at least one computer processor.

4. The system of claim 1 , wherein the at least one reference object is a two-dimensional object or a three-dimensional object.

5. The system of claim 4 , wherein the at least one reference object is at least one of a triangle-shaped object, a square-shaped object, a grid-shaped object, or a polygon-shaped object.

6. The system of claim 1 , wherein the at least one reference object is arranged in a pattern.

7. The system of claim 1 , wherein the at least one reference object is provided on a platform on which the at least one portion is positioned.

8. The system of claim 1 , wherein the at least one reference object is provided within the portion of the body.

9. The system of claim 1 , wherein the at least one reference object is provided on an imaging catheter.

10. The system of claim 1 , wherein the at least one reference object is provided on a guide catheter.

11. The system of claim 1 , wherein the at least one reference object is provided on at least one of a front section or a back portion of the body or the target object.

12. The system of claim 1 , wherein the at least one reference object comprises an image-readable identification code.

13. The system of claim 12 , wherein the image-readable identification code has three-dimensional characteristics.

14. The system of claim 12 , wherein the three-dimensional characteristics are usable to encode at least a portion of information of attenuation of x-rays through each of the three-dimensional characteristics or one or more locations thereof.

15. The system of claim 1 , wherein the at least one reference object is at least partially constructed from a metallic and / or polymeric material.

16. The system of claim 1 , wherein the at least one computer processor is configured to obtain patient metadata from the image of the radiopaque reference object.

17. The system of claim 1 , wherein the pixel size of the x-ray image is obtained from the image of the radiopaque reference object.

18. The system of claim 1 , wherein the second computer processor is configured to automatically detect the reference object in the X-ray image.

19. The system of claim 1 , wherein the second computer processor is configured to automatically detect contrast-filled coronary arteries from the first portion in the x-ray image.

20. 20. The system of claim 19, wherein the computer processor is configured to measure physiological information based on information from the detected reference object and the detected contrast-filled coronary artery.

21. 21. The system of claim 20, wherein the physiological information can include measurements of flow rate, fractional flow reserve, coronary flow reserve, or microcirculatory resistance index.

22. The system of claim 1 , wherein at least one computer processor is configured to extract information from the at least one X-ray image.

23. The system of claim 22 , wherein the extracted information is provided from the reference object and the vasculature.

24. 23. The system of claim 22, wherein the at least one computer processor is further configured to determine a physiological function index or a structural index based on the extracted information.

25. 25. The system of claim 24, wherein the physiological function index comprises at least one of flow rate, fractional flow reserve, coronary flow reserve, or microcirculatory resistance index.

26. 23. The system of claim 22, wherein the structural index comprises at least one of stenosis, location, distance, size, or length of at least one segment of a vessel.

27. The system of claim 1 , further comprising a user interface configured to facilitate user input to provide user data to the at least one computer processor.

28. 28. The system of claim 27, wherein the user data includes at least one of anatomical information, physiological information, or reference object information.

29. 30. The system of claim 28, wherein the at least one computer processor is further configured to automatically measure at least one of geometric or physiological data for at least one artery of the vasculature based on the user data.

30. 21. The system of claim 20, wherein the at least one computer processor is configured to determine physiological information using computational fluid dynamic assessment of at least one artery of the vasculature.

31. 21. The system of claim 20, wherein the at least one computer processor is configured to determine physiological information using machine learning assessment of at least one artery of the vasculature.

32. 1. A method for performing image-based coronary artery assessment within a body, comprising: positioning at least one reference object within an imaging field of view of the X-ray radiation generator and proximate to at least one portion of the body or target object; providing X-ray radiation to at least one portion of a body or target and said at least one reference object; generating at least one X-ray image of the at least one portion based on (i) a first radiation provided from the at least one portion and (ii) a second radiation provided from the reference object, the X-ray image containing an image of the reference object; A method comprising:

33. 33. The method of claim 32, further comprising providing a contrast agent in or near the at least one portion while generating the at least one X-ray image.

34. 33. The method of claim 32, further comprising determining a physiological characteristic of the at least one portion based on information from both the first radiation and the second radiation.

35. 33. The method of claim 32, wherein the physiological characteristic may include a flow rate index, a fractional flow reserve, a coronary flow reserve, or a microcirculatory resistance index.

36. 33. The method of claim 32, wherein the at least one reference object is a patterned object having known properties.

37. 1. A method for tracking technology usage, the method comprising: positioning a partially radiopaque reference object within an imaging field of view of an x-ray light generator and proximate to at least one portion of the body or target object; facilitating image-based detection and tracking of the target object using first X-ray radiation received from the at least one portion and second X-ray radiation received from at least one interpretable symbol of the reference object; A method comprising:

38. 38. The method of claim 37, further comprising obtaining financial information based on the tracking of the body or the target object.

39. 1. A method for performing real-time image-based coronary artery assessment, comprising: providing x-ray radiation to at least one portion of a body; generating at least one x-ray image of the at least one portion after a partially radiopaque contrast agent is provided in or on the at least one portion; transmitting the x-ray image directly to a processor; measuring physiological function indices based on the X-ray images; displaying a representation of said physiological function index on a display; A method comprising:

40. 38. The method of claim 37, wherein the X-ray image is transmitted from a data streaming port (which may be, for example, a video output port) of the X-ray device via a wired or wireless connection.

41. 38. The method of claim 37, wherein the x-ray image is not a DICOM standard image.

42. 38. The method of claim 37, further comprising utilizing sequential images (e.g., from more than one x-ray angle) to refine or adjust the measurement.

43. 38. The method of claim 37, further comprising performing the image-based coronary artery assessment at a single x-ray imaging angle.

44. 38. The method of claim 37, further comprising utilizing a reference object to adjust the measurements.

45. 1. A real-time image-based coronary artery assessment system, comprising: an x-ray device configured to provide x-ray radiation to at least one portion of a body and generate at least one x-ray image of the at least one portion after an at least partially radiopaque contrast agent has been provided in the at least one portion; a computer processor configured to receive the x-ray images directly from the x-ray device and extract information from the directly acquired x-ray images; A system comprising:

46. 46. ​​The system of claim 45, wherein the information comprises a physiological or structural measurement of the at least one portion.

47. 47. The system of claim 46, further comprising a display configured to provide a first representation of the at least one portion within the x-ray image and a second representation of the physiological or structural measurement.

48. 46. ​​The system of claim 45, wherein the x-ray image is received via a video output signal.

49. 1. A method for providing real-time image-based coronary artery assessment, comprising: providing x-ray radiation to at least one portion of a body with an x-ray device; generating at least one x-ray image of the at least one portion after an at least partially radiopaque contrast agent has been provided within the at least one portion; using a computer processor to (i) receive the x-ray images directly from the x-ray device; and (ii) extract information from the directly acquired x-ray images. A method comprising:

50. 50. The method of claim 49, wherein the information comprises a physiological or structural measurement of the at least one portion.

51. 51. The method of claim 50, further comprising a display configured to provide a first representation of the at least one portion within the x-ray image and a second representation of the physiological or structural measurement.

52. 50. The method of claim 49, wherein the x-ray image is received via a video output signal.

53. 1. A method for performing angiographic image referencing, the method comprising: providing a partially radiopaque contrast agent within a body lumen; placing a partially radiopaque reference object proximate to the body lumen; imaging the portion of the body lumen and the radiopaque reference object; automatically detecting the contrast agent and a portion of the reference object in the image; A method comprising:

54. 54. The method of claim 53, further comprising displaying the image.

55. 54. The method of claim 53, further comprising adjusting the display of the image based on the automatically detected contrast agent and reference object.

56. 54. The method of claim 53, further comprising measuring physiological characteristics of the body lumen based on the automatically detected contrast agent and reference object.

57. 1. A method for tracking technology usage, the method comprising: placing a partially radiopaque reference object within the imaging field of view; The method wherein said radiopaque reference object comprises an image-readable symbol or combination of symbols that allows tracking of its use.

58. 58. The method of claim 57, further comprising requesting payment based on said tracking.

59. 1. A measurement system comprising: at least one partially radiopaque reference object provided within the imaging field of view of the X-ray radiation source and in proximity to at least one portion of the body or target object, and configured to receive said X-ray radiation; a data interface; at least one computer processor; Equipped with The at least one computer processor: - receiving directly via said data interface at least one X-ray image of the vascular system of said at least one part of said body, said X-ray image containing at least a part of an image of said reference object; calibrating the dimensions of the at least one X-ray image based on the reference object; A system configured to:

60. 60. The system of claim 59, wherein the at least one computer processor is configured to automatically detect the reference object in the image.

61. 60. The system of claim 59, wherein the at least one computer processor is configured to automatically detect the vasculature in the image.

62. 60. The system of claim 59, wherein the reference object is an intravascular device.

63. 60. The system of claim 59, wherein the reference object is a catheter.

64. 60. The system of claim 59, wherein the reference object is an extravascular device.

65. 60. The system of claim 59, wherein the at least one computer processor is part of a measurement system that is an intravascular imaging system.

66. 60. The system of claim 59, further comprising a user interface configured to receive user input information.

67. 67. The system of claim 66, wherein the user input information is at least one of anatomical information, physiological information, or reference object information.

68. 67. The system of claim 66, wherein the user-inputted information is usable, at least in part, to calibrate the x-ray image.

69. 60. The system of claim 59, wherein at least one computer processor is configured to extract information from the at least one x-ray image.

70. 60. The system of claim 59, wherein the extracted information is provided from the reference object and the vasculature.

71. 71. The system of claim 70, wherein the at least one computer processor is further configured to provide image-based coronary artery assessment based on the extracted information.

72. 72. The system of claim 71, wherein the image-based coronary assessment is a physiological or structural measurement.

73. 73. The system of claim 72, wherein the physiological function measure comprises at least one of flow rate, fractional flow reserve, coronary flow reserve, or microcirculatory resistance index.

74. 73. The system of claim 72, wherein the structural measurements include at least one of stenosis, location, distance, size, or length of at least one segment of a vessel.

75. 60. The system of claim 59, wherein the at least one X-ray image excludes a DICOM standard image.

76. 72. The system of claim 71, wherein the at least one computer processor is further configured to control or regulate the assessment by utilizing sequential images from more than one of the at least one X-ray image.

77. 72. The system of claim 71, wherein the at least one computer processor is further configured to perform the image-based coronary artery assessment at a single x-ray imaging angle.

78. 72. The system of claim 71, wherein the at least one computer processor is further configured to adjust the assessment using a reference object.

79. 60. The system of claim 59, wherein the data interface is a data transfer cable.

80. 1. An imaging system, comprising: at least one insertion device structured to be provided within a body, the at least one insertion device including at least one section configured to receive the X-ray radiation; at least one computer processor configured to generate an X-ray image of the vasculature of the at least one portion of the body, the X-ray image containing an image of the at least one portion of the body, based on (i) the second radiation provided from the at least one section and (ii) information about the at least one insertion device; A system comprising:

81. 81. The system of claim 80, wherein the at least one computer processor is further configured to determine information regarding at least one coronary artery measurement from the x-ray image of the vasculature.

82. 82. The system of claim 81, wherein the at least one computer processor determines the information regarding the at least one coronary artery measurement by automatically detecting at least one geometric or dynamic data regarding at least one artery of the vasculature.

83. 83. The system of claim 82, wherein the information includes one or more physiological parameters of the at least one artery.

84. 81. The system of claim 80, wherein the at least one computer processor is further configured to determine information regarding physiology from the x-ray images of the vasculature.

85. 81. The system of claim 80, wherein the at least one computer processor is configured to determine the information regarding the physiological function based on calculated fluid dynamics data from at least one artery of the vasculature.

Images