Image registration for transcatheter cardiac procedures

Abstract

An example method includes receiving first imaging data for a region of interest and segmenting first and second anatomical structures on the first imaging data. The method also includes determining relative positions of the first and second anatomical structures on the first imaging data based on the segmented first and second anatomical structures. The method additionally includes receiving second imaging data for the region of interest and segmenting the first anatomical structure on the second imaging data to determine an additional segmented first anatomical structure. The method further includes registering the first imaging data with the second imaging data based on the segmented and additional segmented first anatomical structures. Additionally, the method includes displaying the second anatomical structure based on the second imaging data, the relative positions of the first and second anatomical structure on the first imaging data, and the additional segmented first anatomical structure.

Description

IMAGE REGISTRATION FOR TRANSCATHETER CARDIAC PROCEDURESCROSS-REFERENCE TO RELATED APPLICATION

[0001] This application claims the benefit of U.S. Provisional Patent Application Serial No. 63 / 662,478, filed June 21, 2024, the entire content of which is incorporated herein by reference.FIELD

[0002] The present technology is generally related to medical imaging in connection with cardiac procedures.BACKGROUND

[0003] Intra-procedural imaging for transcatheter cardiac procedures involves echocardiography (“echo”) and fluoroscopy (“fluoro”).

[0004] Fluoro imaging uses X-rays and provides information regarding movement and / or deployment of transcatheter instruments and devices such as a replacement valve delivery system. However, the anatomical landmarks of interest in cardiac procedures (e.g., mitral / tricuspid / aortic valve leaflets, annulus, etc.) are not visualizable on fluoro.

[0005] Echo imaging is generated based on ultrasound waves that are reflected by echogenic or echoic materials (for example bone or materials with physical properties similar to bone) and absorbed or allowed to pass through by non-echogenic or anechoic materials (for example, purified water or materials with physical properties similar to purified water). Echo imaging is used in transcatheter cardiac procedures to visualize anatomical structures that are not visualizable on fluoro.SUMMARY

[0006] The techniques of this disclosure generally relate to co-registering imaging data from two different imaging modalities to display information from a first imaging modality (e.g., computed tomography (CT), magnetic resonance imaging (MRI), etc.) used prior to a procedure to display the position of an anatomical structure (e.g., a heart valve annulus, etc.) in connection with imaging data from a second imaging modality (e.g., fluoro, etc.) used during the procedure and on which the anatomical structure is notvisualizable, based on a different anatomical structure (e.g., a portion of coronary vasculature, etc.) that is visualizable on both imaging modalities. In various examples, user annotations (e.g., of a target location for a transcatheter delivery system, etc.) are also displayed in connection with the imaging data used during the procedure, to assist in the procedure (e.g., in deployment of a replacement valve, etc.). A venogram (e.g., for a coronary sinus, etc.) or angiogram / arteriogram (e.g., for a right coronary artery, etc.) is used in various examples to obtain fluoroscopy imaging data from which a first anatomical structure (e.g., a portion of a coronary vasculature, etc.) is segmented. The first anatomical structure and a second anatomical structure (e.g., heart valve annulus, etc.) are both segmented on pre-procedure imaging (e.g., CT, etc.), and the relative three- dimensional positions of the first and second anatomical procedures are determined. The fluoroscopy segmented first anatomical structure and the CT (or MRI, etc.) segmented first anatomical structure are registered to each other. Based on the registered imaging and the relative positions of the first and second anatomical structures, the second anatomical structure is displayed in connection with the fluoro imaging. Additionally, in various examples, user annotations (e.g., of a target location for deployment of a replacement valve, etc.) are also displayed in connection with the second anatomical structure.

[0007] In one aspect, the present disclosure provides a system for displaying imaging of a region of interest for a cardiac procedure that includes a memory for storing machine- readable instructions and a processor core for accessing the machine-readable instructions and executing the machine-readable instructions as operations. The operations include receiving first imaging data for the region of interest. The operations also include segmenting, on the first imaging data, a first anatomical structure to determine a segmented first anatomical structure and a second anatomical structure to determine a segmented second anatomical structure. The operations additionally include determining relative positions of the first anatomical structure and the second anatomical structure on the first imaging data based on the segmented first anatomical structure and the segmented second anatomical structure. The operations further include receiving second imaging data for the region of interest. Additionally, the operations include segmenting the first anatomical structure on the second imaging data to determine an additional segmented first anatomical structure. Also, the operations include registering the first imaging data with the second imaging data based on the segmented first anatomical structure and theadditional segmented first anatomical structure. In addition, the operations include displaying an image of the second anatomical structure based on the second imaging data, the relative positions of the first anatomical structure and the second anatomical structure on the first imaging data, and the additional segmented first anatomical structure.

[0008] In another aspect, the present disclosure provides a method for providing imaging data of a region of interest for a cardiac procedure. The method includes receiving first imaging data for the region of interest. The method also includes segmenting, on the first imaging data, a first anatomical structure to determine a segmented first anatomical structure and a second anatomical structure to determine a segmented second anatomical structure. The method additionally includes determining relative positions of the first anatomical structure and the second anatomical structure on the first imaging data based on the segmented first anatomical structure and the segmented second anatomical structure. The method further includes receiving second imaging data for the region of interest. Additionally, the method includes segmenting the first anatomical structure on the second imaging data to determine an additional segmented first anatomical structure. Also, the method includes registering the first imaging data with the second imaging data based on the segmented first anatomical structure and the additional segmented first anatomical structure. In addition, the method includes displaying an image of the second anatomical structure based on the second imaging data, the relative positions of the first anatomical structure and the second anatomical structure on the first imaging data, and the additional segmented first anatomical structure.

[0009] In an additional aspect, the present disclosure provides a non-transitory machine-readable medium having machine executable instructions for a system for providing imaging of a region of interest for a cardiac procedure that causes a processor core to execute operations. The operations include receiving first imaging data for the region of interest. The operations also include segmenting, on the first imaging data, a first anatomical structure to determine a segmented first anatomical structure and a second anatomical structure to determine a segmented second anatomical structure. The operations additionally include determining relative positions of the first anatomical structure and the second anatomical structure on the first imaging data based on the segmented first anatomical structure and the segmented second anatomical structure. The operations further include receiving second imaging data for the region of interest.Additionally, the operations include segmenting the first anatomical structure on the second imaging data to determine an additional segmented first anatomical structure. Also, the operations include registering the first imaging data with the second imaging data based on the segmented first anatomical structure and the additional segmented first anatomical structure. In addition, the operations include displaying an image of the second anatomical structure based on the second imaging data, the relative positions of the first anatomical structure and the second anatomical structure on the first imaging data, and the additional segmented first anatomical structure.

[0010] In a further aspect, the present disclosure provides a system for displaying imaging of a region of interest for an intracardiac transcatheter procedure that includes a memory for storing machine-readable instructions and a processor core for accessing the machine-readable instructions and executing the machine-readable instructions as operations. The operations include receiving computed tomography (CT) imaging data for the region of interest. The operations additionally include segmenting, on the CT imaging data, a portion of a coronary vasculature to determine a CT segmented coronary vasculature and a heart valve annulus to determine a CT segmented heart valve annulus. The operations also include determining relative positions of the portion of the coronary vasculature and the heart valve annulus on the CT imaging data based on the CT segmented coronary vasculature and the CT segmented heart valve annulus. The operations further include receiving fluoroscopy imaging data for the region of interest. Additionally, the operations include segmenting the portion of the coronary vasculature on the fluoroscopy imaging data to generate a fluoroscopy segmented coronary vasculature. Also, the operations include registering the CT imaging data with the fluoroscopy imaging data based on the CT segmented coronary vasculature and the fluoroscopy segmented coronary vasculature. In addition, the operations include displaying an image of the heart valve annulus based on the fluoroscopy imaging data, the relative positions of the portion of the coronary vasculature and the heart valve annulus on the CT imaging data, and the fluoroscopy segmented coronary vasculature.

[0011] In additional aspects, the present disclosure provides a method for providing imaging data of a region of interest for an intracardiac transcatheter procedure. The method includes receiving computed tomography (CT) imaging data for the region of interest. The method additionally includes segmenting, on the CT imaging data, a portionof a coronary vasculature to determine a CT segmented coronary vasculature and a heart valve annulus to determine a CT segmented heart valve annulus. The method also includes determining relative positions of the portion of the coronary vasculature and the heart valve armulus on the CT imaging data based on the CT segmented coronary vasculature and the CT segmented heart valve annulus. The method further includes receiving fluoroscopy imaging data for the region of interest. Additionally, the method includes segmenting the portion of the coronary vasculature on the fluoroscopy imaging data to generate a fluoroscopy segmented coronary vasculature. Also, the method includes registering the CT imaging data with the fluoroscopy imaging data based on the CT segmented coronary vasculature and the fluoroscopy segmented coronary vasculature. In addition, the method includes displaying an image of the heart valve annulus based on the fluoroscopy imaging data, the relative positions of the portion of the coronary vasculature and the heart valve annulus on the CT imaging data, and the fluoroscopy segmented coronary vasculature.

[0012] Further aspects of the present disclosure provide a non-transitory machine- readable medium having machine executable instructions for a system for providing imaging of a region of interest for an intracardiac transcatheter procedure that causes a processor core to execute operations. The operations include receiving computed tomography (CT) imaging data for the region of interest. The operations additionally include segmenting, on the CT imaging data, a portion of a coronary vasculature to determine a CT segmented coronary vasculature and a heart valve annulus to determine a CT segmented heart valve annulus. The operations also include determining relative positions of the portion of the coronary vasculature and the heart valve annulus on the CT imaging data based on the CT segmented coronary vasculature and the CT segmented heart valve annulus. The operations further include receiving fluoroscopy imaging data for the region of interest. Additionally, the operations include segmenting the portion of the coronary vasculature on the fluoroscopy imaging data to generate a fluoroscopy segmented coronary vasculature. Also, the operations include registering the CT imaging data with the fluoroscopy imaging data based on the CT segmented coronary vasculature and the fluoroscopy segmented coronary vasculature. In addition, the operations include displaying an image of the heart valve annulus based on the fluoroscopy imaging data, therelative positions of the portion of the coronary vasculature and the heart valve annulus on the CT imaging data, and the fluoroscopy segmented coronary vasculature.

[0013] The details of one or more aspects of the disclosure are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the techniques described in this disclosure will be apparent from the description and drawings, and from the claims.BRIEF DESCRIPTION OF DRAWINGS

[0014] FIG. 1 is a schematic block diagram of one example of a treatment system useable in connection with various examples discussed herein.

[0015] FIG. 2 is a schematic block diagram illustrating an example system of hardware components capable of implementing examples of the systems and methods disclosed herein.

[0016] FIG. 3 is a series of images showing stages of a transcatheter mitral valve replacement (TMVR) procedure.

[0017] FIG. 4 is a posterior surface view of a heart, showing anatomical structures employable in connection with various procedure use cases of examples discussed herein.

[0018] FIG. 5 is a view of the heart with the coronary sinus and multiple branches in dark gray in the top image, along with a top-down view of the heart showing the coronary sinus (CS) and CS branches in connection with the mitral valve (MV) in the bottom image.

[0019] FIG. 6 shows two computed tomography (CT) images of the coronary sinus and adjacent cardiac anatomy.

[0020] FIG. 7 shows left anterior oblique (LAO) and right anterior oblique (RAO) fluoro venogram images of the CS.

[0021] FIG. 8 shows a view of the heart with the right coronary artery (RCA) and multiple branches in the top image, along with a top-down view of the heart showing the RCA and RCA branches in connection with the tricuspid valve (TV) in the bottom image.

[0022] FIG. 9 shows two CT images of the right coronary artery and adjacent cardiac anatomy.

[0023] FIG. 10 shows LAO and RAO fluoro angiogram images of the RCA and branches.

[0024] FIG. 11 shows en face and septal-lateral CT views of a segmented CS and a segmented MV annulus along with user annotations indicating a target delivery location for the TMVR procedure.

[0025] FIG. 12 two views of intra-procedural fluoro imaging of a CS venogram, with the CS segmented.

[0026] FIG. 13 two views of registration of the CT imaging data and annotations of FIG. 11 with the fluoro imaging data of FIG. 12 based on the segmented CS from FIG. 11 and the segmented CS from FIG. 12.

[0027] FIG. 14 shows two fluoro views with a representation of a TMVR delivery capsule based on a user annotated target for the TMVR delivery.

[0028] FIG. 15 is a flowchart of an example method for providing imaging data for a region of interest.

[0029] FIG. 16 is a flowchart of an example method for providing imaging data in connection with a transcatheter mitral valve replacement procedure.DETAILED DESCRIPTION

[0030] Various examples display additional information in connection with imaging data used during a cardiac procedure. Intra-procedural imaging data (e.g., fluoroscopy, etc.) is displayed in various examples along with anatomical structure(s) not visualizable via the intra-procedural imaging data and / or annotations (e.g., target location(s) for a procedure, etc.), based on registration of the intra-procedural imaging data with preprocedural imaging data (e.g., computed tomography (CT), magnetic resonance imaging (MRI), etc.). Various examples register the intra-procedural imaging data to the preprocedural imaging data based on additional anatomical structure(s), such as portion(s) of coronary vasculature.

[0031] Intra-procedural imaging for transcatheter valve procedures employs echo and fluoroscopy (“fluoro”). However, fluoro is limited to visualizing movement and / or deployment of instruments (e.g., a replacement valve delivery system, etc.), since the anatomical landmarks of interest (e.g., valve leaflets, annulus, etc.) cannot be visualized on fluoro, and are instead viewed based on echo. However, echo is sometimes obstructed by the instrument(s) (e.g., delivery system, etc.) and / or due to the esophagus location relative to the cardiac area of interest, making visualization difficult. Therefore, a systemable to provide better visual information in connection with fluoro can assist a user in safely performing the transcatheter procedure (e.g., delivering the implant, etc.).

[0032] Various examples include systems and / or methods that impose data from preprocedural imaging (e.g., CT planning imaging, user annotation(s) stored in connection with the pre-procedural imaging data, etc.) on displayed fluoroscopy imaging data, thereby aiding a user in performing the transcatheter procedure (e.g., placing a transcatheter delivery system for deploying a valve repair (edge-to-edge repair, annuloplasty, chordal replacement, leaflet augmentation, etc.) or replacement device, a left atrial appendage device, a shunt device, etc.).

[0033] Referring to FIG. 1, illustrated a schematic block diagram of one example of a treatment system 100 useable in connection with various examples. In various examples, the treatment system 100 includes a computing device 110, a display 120, a first imaging system (e.g., a CT imaging system, an MRI imaging system, etc.) 130 for acquiring preprocedure imaging data of a region of interest 140, a second imaging system (e.g., fluoroscopy imaging system) 150 for acquiring intra-procedure imaging data and / or additional pre-procedure imaging data, and one or more instruments (e.g., transcatheter instrument(s) such as a transcatheter delivery system for a valve replacement, etc.) 160. In some examples, treatment system 100 includes the first imaging system 130 for acquiring pre-procedure imaging data of the region of interest 140, while in other examples the first imaging system 130 is separate from the treatment system 100, which acquires the preprocedure imaging data from the first imaging system 130 (e.g., directly or indirectly, etc.).

[0034] In various examples, the computing device 110 is, for example, a laptop computer, desktop computer, tablet computer, smart phone, workstation, or other similar device.

[0035] The display 120 is configured to output at least a portion of the imaging data acquired via the second imaging system 150, which in various examples is output along with additional information (e.g., pre-procedure imaging data of anatomical structure(s) within the region of interest acquired via the first imaging system 130, user annotation(s) such as indication(s) of target location(s) for the procedure, etc.).

[0036] In various examples, the first imaging system 130 acquires pre-procedure imaging data of at least a portion of a region of interest that includes a first anatomicalstructure (e.g., at least a portion of a coronary vasculature, which could include the following vessels and / or their branches: coronary sinus, right coronary artery and left main coronary artery) and a second anatomical structure (e.g., a heart valve annulus, left atrial appendage, fossa ovalis, papillary muscle(s), pulmonary veins, portions of the atrial or ventricular wall, etc.). For ease of illustration, specific examples provided herein discuss the first imaging system 130 as a CT imaging system for acquiring pre-procedural CT imaging data (e.g., CT planning imaging data), but in various examples, the first imaging system 130 employs any of a variety of imaging modalities (e.g., CT, MRI, etc.).

[0037] The region of interest 140 is at least one of a two-dimensional (2D) region, a three-dimensional (3D) region, and / or the 2D or 3D region as it changes over a cardiac cycle associated with a procedure, such as a heart or portion thereof, and includes multiple anatomical structures that are visualizable via the first imaging system 130 (e.g., coronary vasculature, heart valve annulus(es), left atrial appendage (LAA), etc.), some of which can be visualizable via the second imaging system 150 (e.g., coronary vasculature, etc.) and some of which are not easily visualizable via the second imaging system 150 (e.g., heart valve annulus(es), etc.).

[0038] In various examples, the second imaging system 150 acquires intra-procedure imaging data, and in some examples, also acquires additional pre-procedure imaging data. For ease of illustration, examples provided herein discuss the second imaging system 150 as a fluoroscopy imaging system for acquiring intra-procedural fluoroscopy imaging data and optionally pre-procedural fluoroscopy imaging data, but in various examples, the second imaging system 150 employs any of a variety of imaging modalities.

[0039] For ease of illustration, specific examples are discussed in connection with a transcatheter device as the instrument 160, in connection with a transcatheter valve replacement procedure (e.g., transcatheter mitral valve replacement (TMVR), transcatheter aortic valve replacement (TAVR), transcatheter tricuspid valve replacement (TTVR), transcatheter pulmonic valve replacement (TPVR), etc.). However, in various examples, any suitable instrument or device 160 can be utilized with the treatment system 100, e.g., one or more implantable devices, implant delivery devices, therapy delivery devices, surgical devices, mechanical circulatory support (e.g. LVAD) devices, coronary stent devices, heart valve devices, heart valve repair devices, interventional heart failuredevices, stroke prevention devices, cardiac ablation devices, cardiac lead devices, drug delivery devices, catheter delivery devices, and endoscopic delivery devices.

[0040] In various examples, treatment system 100 uses pre -procedural imaging data (and in some examples, user annotations added to the pre -procedural imaging data) to display additional information in connection with intra-procedural imaging data (e.g., from the second imaging system 150, etc.) to assist a user in performing the transcatheter procedure.

[0041] In various examples, the first imaging system 130 acquires first (e.g., CT) imaging data of the region of interest 140 (e.g., prior to a procedure, as part of preprocedure planning, etc.), which is transmitted to and received by the computer system 110. Based on the first imaging data, in various examples the computer system 110 segments a first anatomical structure (e.g., visualizable via both the first imaging system 130 and the second imaging system 150, such as a portion of coronary vasculature, etc.) on the first imaging data to generate a segmented first anatomical structure (e.g., a CT segmented first anatomical structure such as CT segmented coronary vasculature and associated tributaries / branches, for example, a CT segmented coronary sinus (CS), a CT segmented right coronary artery (RCA), a CT segmented left coronary artery (LCA), etc.) and segments a second anatomical structure (e.g., visualizable via the first imaging system 130 but not via the second imaging system 150, such as a heart valve annulus, etc.) on the first imaging data to generate a segmented second anatomical structure (e.g., a CT segmented second anatomical structure such as a CT segmented heart valve annulus, for example, a CT segmented mitral valve (MV) annulus, a CT segmented tricuspid valve (TV) annulus, etc.).

[0042] In some examples, the second anatomical structure is associated with a target location (e.g., for a replacement valve delivery system, etc.), and the first anatomical structure is selected (e.g., based on proximity, stable reference points, at least partially encircling, etc.) to provide additional information regarding the position of the second anatomical structure. For example, for a MV procedure, the CS can be selected for the first anatomical structure due to its proximity to and arrangement approximately around the MV (although differences exist between patients), which can allow for more accurate image registration. Alternatively, for a MV procedure, the LCA can be selected for the first anatomical structure due to its proximity to and arrangement approximately aroundthe MV. As another example, for a TV procedure, the RCA can be selected for the first anatomical structure due to its proximity to and arrangement approximately around the TV (although differences exist between patients). In other examples, for a MV procedure, the first anatomical structure includes both the CS and other coronary vasculature; for a MV procedure, the first anatomical structure includes both the LCA and other coronary vasculature; for a TV procedure, the first anatomical structure includes both the RCA and other coronary vasculature; etc. In further examples, selection of the first anatomical structure is made by a user during pre-procedure planning based on the specific anatomy of the patient, for example, as visualized in the first imaging data and / or pre-procedure second imaging data. In various examples, the segmented first anatomical structure and the segmented second anatomical structure are determined based on multiple views and / or based on 3D imaging data.

[0043] In various examples, the first imaging data is gated (e.g., to an electrocardiograph (EKG) signal) and includes imaging data associated with multiple phases, etc. of a cardiac signal, where one or more of the position, shape, etc. of the first and second anatomical structures may vary over the cardiac cycle (e.g., as the heart and portions thereof undergo periodic motion over the cardiac cycle, which can be a normal cardiac cycle and / or rapid pacing, etc.). In such examples, the segmented first anatomical structure and the second anatomical structure are segmented at the multiple phases, etc. of the cardiac cycle.

[0044] Based on the segmented first anatomical structure and the segmented second anatomical structure, the computer system 110 determines relative positions of the first anatomical structure and the second anatomical structure. In various examples, the computer system 110 determines the relative positions based on determining positions, distances, and angles of a first set of points of the first anatomical structure relative to a second set of points of the second anatomical structure (e.g., in multiple views, in a 3D space, etc.), based on 3D coordinates (e.g., rectangular, etc.) of the first set of points of the first anatomical structure relative to the second set of points of the second anatomical structure. In various examples involving gated first imaging data, the relative positions of the first and second anatomical structures are determined by the computer system 110 at the multiple phases, etc. of the cardiac cycle to allow for the registration step to also include synchronizing to the EKG, and furthermore, so that the second anatomicalstructure can dynamically be displayed on the second image system according to the phase of the cardiac cycle.

[0045] Additionally, in various examples, one or more user annotations are made on or in connection with the first imaging data, such as planned target location(s) for one or more stages of the procedure (e.g., in a TMVR procedure, a target deployment location / depth for the replacement valve delivery system capsule or tip, a target deployment angle for the replacement valve delivery system capsule or catheter shaft, potentially a planned location for a septal puncture, etc.). Based on the location(s) of the user annotation(s) and the segmented first anatomical structure (and optionally the segmented second anatomical structure), the relative position(s) of the user annotation(s) and the first anatomical structure (and optionally the second anatomical structure) is determined by the computer system 110.

[0046] In various examples, the second imaging system 150 acquires second (e.g., fluoroscopy, etc.) imaging data (e.g., as intra-procedural imaging data and optionally as pre-procedural imaging data, etc.), which is transmitted to and received by the computer system 110. Based on the second imaging data, in various examples the computer system 110 segments the first anatomical structure (e.g., a portion of coronary vasculature, etc.) on the first imaging data to determine an additional segmented first anatomical structure (e.g., a fluoro segmented first anatomical structure such as fluoro segmented coronary vasculature, for example, a fluoro segmented CS, a fluoro segmented RCA, a flouro segmented LCA, etc.). In various examples, the additional segmented first anatomical structure is determined based on multiple views and / or based on 3D imaging data.

[0047] In various examples, the second imaging data is gated (e.g., to an EKG signal) and includes imaging data associated with multiple phases, etc. of a cardiac signal, where one or more of the position, shape, etc. of the first anatomical structure may vary over the cardiac cycle. In such examples, the additional segmented first anatomical structure (e.g., fluoro segmented first anatomical structure, etc.) is segmented at the multiple phases, etc. of the cardiac cycle.

[0048] Based on the segmented first anatomical structure (e.g., CT segmented first anatomical structure, such as CT segmented coronary vasculature, etc.) and the additional segmented first anatomical structure (e.g., fluoro segmented first anatomical structure, such as fluoro segmented coronary vasculature, etc.), the computer system 110 registersthe first imaging data to the second imaging data, such as based on alignment of outlines of the segmented first anatomical structure and the additional segmented first anatomical structure, alignment of angle(s) and / or branches of the segmented first anatomical structure and the additional segmented first anatomical structure (e.g., when the first anatomical structure includes coronary vasculature or portions thereof, etc.), etc. In various examples, a confidence metric or score is determined by the computer system 110 based on the extent of alignment between the segmented first anatomical structure (e.g., segmented from the first imaging data) and the additional segmented first anatomical structure (e.g., segmented from the second imaging data).

[0049] During a procedure (e.g., TMVR, TTVR, TAVR, etc.), the second imaging system 150 acquires intra-procedural second imaging data, which is transmitted to and received by the computer system 110. The computer system 110 combines the intra- procedural second imaging data (and the location of the first anatomical structure on the intra-procedural second imaging data, e.g., as determined based on the additional segmented first anatomical structure) with information regarding the determined relative positions of the first and second anatomical structures (and optionally user annotation(s)) to modify the intra-procedural second imaging data to represent the second anatomical structure (e.g., which is not visualizable via the second imaging system 150, etc.), along with user annotation(s) where applicable. The computer system 110 outputs the modified intra-procedural second imaging data to the display 120, which displays an image of the second anatomical structure (e.g., based on the second imaging data, the relative positions of the first and second anatomical structures on the first imaging data, the additional segmented first anatomical structure from the second imaging data, and user annotation(s) as applicable).

[0050] In various examples, the first imaging data and the second imaging data are gated to an EKG signal. In such examples, an EKG signal during the procedure is used by the computer system 110 to output the modified intra-procedural second imaging data (e.g., for display to a user via the display 120, etc.) based on the second imaging data, the relative positions, and the additional segmented first anatomical structure that correspond to a current phase of the cardiac cycle (e.g., as determined based on the EKG signal, etc.), such that the modified intra-procedural second imaging data registers the second anatomical structure (and / or user annotation(s)) in a position relative to the firstanatomical structure appropriate for the current phase of the cardiac cycle, as determined based on the EKG signal and the gated first imaging data and then following registration, the second anatomical structure (and / or user annotation(s)) will be synchronized to the cardiac cycle to allow for replicating cardiac motion, based on the EKG signal, in the modified intra-procedural second imaging data (e.g., for display to a user via the display 120, etc.).

[0051] Additionally, in various embodiments wherein the computer system 110 determines a confidence score, the confidence score is output to and displayed by the display 120, which provides a user additional information regarding the accuracy of the registration, and thus of the relative positions of the first and second anatomical structures (and user annotation(s), where appropriate) as shown via display 120.

[0052] FIG. 2 is a schematic block diagram illustrating an example system 200 of hardware components capable of implementing examples of the systems and methods disclosed herein. The system 200 can include various systems and subsystems, and in some examples is employable as the computer system 110. The system 200 can be a personal computer, a laptop computer, a workstation, a computer system, an appliance, an application-specific integrated circuit (ASIC), a server, a server BladeCenter, a server farm, etc.

[0053] The system 200 can include a system bus 202, a processing unit 204, a system memory 206, memory devices 208 and 210, a communication interface 212 (e.g., a network interface), a communication link 214, a display 216 (e.g., a video screen), and an input device 218 (e.g., a keyboard, touch screen, and / or a mouse). The system bus 202 can be in communication with the processing unit 204 and the system memory 206. The additional memory devices 208 and 210, such as a hard disk drive, server, standalone database, or other non-volatile memory, can also be in communication with the system bus 202. The system bus 202 interconnects the processing unit 204, the memory devices 206- 210, the communication interface 212, the display 216, and the input device 218. In some examples, the system bus 202 also interconnects an additional port (not shown), such as a universal serial bus (USB) port.

[0054] The processing unit 204 can be a computing device and can include an application-specific integrated circuit (ASIC) and / or include one or more processing cores (e.g., single-core, multi-core), which in various examples include CPU(s), GPU(s), etc.The processing unit 204 executes a set of instructions to implement the operations of examples disclosed herein. The processing unit can include a processing core.

[0055] The additional memory devices 206, 208, and 210 can store data, programs, instructions, database queries in text or compiled form, and any other information that may be needed to operate a computer. The memories 206, 208 and 210 can be implemented as computer-readable media (integrated or removable), such as a memory card, disk drive, compact disk (CD), or server accessible over a network. In certain examples, the memories 206, 208 and 210 can comprise text, images, video, and / or audio, portions of which can be available in formats comprehensible to human beings. Additionally or alternatively, the system 200 can access an external data source or query source through the communication interface 212, which can communicate with the system bus 202 and the communication link 214.

[0056] In operation, the system 200 can be used to implement one or more parts of a system in accordance with examples discussed herein. Computer executable logic for implementing a treatment system and / or a system for displaying imaging of a 3D region of interest for a cardiac procedure (e.g., an intracardiac transcatheter procedure such as a valve replacement, etc.) resides on one or more of the system memory 206, and the memory devices 208 and 210 in accordance with certain examples. The processing unit 204 executes one or more computer executable instructions originating from the system memory 206 and the memory devices 208 and 210. The terms “computer readable medium” or “machine readable medium” as used herein includes a medium that participates in providing instructions to the processing unit 204 for execution and in various examples includes non-transitory, volatile and non-volatile, removable and nonremovable media implemented in any method or technology for storage of information such as computer-readable instructions, data structures, program modules, or other data. For example, computer-readable storage media includes RAM, ROM, EPROM, EEPROM, flash memory or other solid state memory technology, CD-ROM, DVD, Blu- Ray or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other medium that can be used to store the desired information and that can be accessed by computing device 100. In one or more embodiments, computer-readable storage media can be stored in the cloud or remotestorage and accessed using any suitable technique or techniques through at least one of a wired or wireless connection.

[0057] In various examples, one or more software programs stored in at least one of the system memory 206, the memory device 208, or the memory device 210 include instructions that are executed by the processing unit 204 to perform operations associated with the examples.

[0058] Various examples are employable in connection with a range of procedures. A first example use case is a clinical procedure for TMVR and a second example use case is a clinical procedure for TTVR, but examples are also employable in connection with a range of other scenarios, including other intracardiac transcatheter procedures such as transcatheter edge-to-edge repair (TEER), annuloplasty, left atrial appendage occlusion (LAAO), chordal replacement, and other interventional treatments where visualizing cardiac structures is desirable, but difficult intra-procedurally with fluoroscopy.

[0059] One use case of examples discussed herein is TMVR, which involves multiple stages. In a transfemoral stage, access to the femoral vein is achieved via cutdown or percutaneous approach. In a transseptal stage, a sheath is introduced and advanced through the vena cava to the right atrium, where a puncture is made in the atrial septum. In a mitral valve replacement stage, a delivery system is passed through the sheath and into the left atrium (LA), the delivery system is manipulated into the mitral valve annulus, and the replacement valve is deployed. In a system removal stage, the delivery system is recombined and manipulated out of the implant and the delivery system is retracted into the sheath and removed from the patient.

[0060] Referring to FIG. 3, illustrated are a series of images showing stages of a TMVR procedure. At 310, the sheath is advanced into the LA. At 320, the catheter is advanced into the LA. At 330, the catheter is advanced across the MV annulus. At 340, the brim of the replacement valve is expanded. At 350, the replacement valve is advanced to a target location. At 360, the valve fixation ring is expanded. At 370, the valve is fully deployed. At 380, the delivery system is closed and retracted.

[0061] As can be seen in FIG. 3, TMVR is a complex procedure involving a number of stages, many of which involve actions being performed at precise locations. Many of these actions occur at locations that are not co-planar with one another, but which are performed at distinct locations in the 3D cardiac environment. Additionally, cardiacanatomy continues to move during the cardiac cycle. However, conventional imaging systems (e.g., conventional echo and fluoro systems) do not track portions of a region of interest that are not shown on a current view, including portions not currently viewable (e.g., because they are not visualizable with a given imaging modality, because they are not radiopaque (in fluoroscopy case), or maybe they are shadowed by an instrument 160 (in echo case), etc.). These complications of conventional systems add significant cognitive burden and stress during a procedure because of the high level of vigilance required to avoid contact between an instrument (e.g., instrument 160, such as a transcatheter delivery system, etc.) and anatomical structures, as well as ensure accurate and predictable deployment of the implant at the desired anatomical location.

[0062] To provide specific examples, cardiac regions of interest are discussed, along with anatomical structures that can be used as a first anatomical structure and second anatomical structure in connection with TMVR and TTVR procedure use cases, although similar techniques are employable by various examples in connection with other procedure use cases.

[0063] FIG. 4 illustrates a posterior surface view of a heart, showing anatomical structures employable in connection with various procedure use cases of examples discussed herein. FIG. 4 shows a portion of the cardiac vasculature that includes the coronary sinus (CS) and the right coronary artery (RCA), as well as additional portions of cardiac vasculature also employable in connection with various examples.

[0064] FIG. 5 shows a view of the heart with the coronary sinus and multiple branches in dark gray in the top image, along with a top-down view of the heart showing the CS and CS branches in connection with the MV in the bottom image. As can be seen in the bottom image of FIG. 5, the CS is proximate to and wraps around the MV, although interpatient differences in anatomy exist. As a result, the position of the MV in most patients is closely correlated to the position of the CS, such that known information regarding the position of the CS, along with relative positions of the CS and MV (e.g., over a cardiac cycle) is useable to determine (e.g., via the computer system 110, etc.) the position of the MV even when the MV is not visualizable.

[0065] FIG. 6 shows two CT images of the coronary sinus and adjacent cardiac anatomy, and FIG. 7 shows left anterior oblique (LAO) and right anterior oblique (RAO) fluoro venogram images of the CS (after cannulation with contrast). As can be seen bycomparing FIGS. 6 and 7, while the CS is visualizable on fluoro, many other anatomical structures visualizable on CT are not visualizable on fluoro.

[0066] In various examples, the first anatomical structure includes at least a portion of the CS and CS branches (e.g., although some examples also include additional portions of the coronary vasculature to provide improved accuracy of the position of the second anatomical structure and / or annotations, etc.), and the second anatomical structure includes at least a portion of a MV annulus, such as for a TMVR procedure, transcatheter MV repair procedure, etc.

[0067] FIG. 8 shows a view of the heart with the RCA and multiple branches in the top image, along with a top-down view of the heart showing the RCA and RCA branches in connection with the TV in the bottom image. As can be seen in the bottom image of FIG. 8, the RCA is proximate to and wraps around the TV, although inter-patient differences in anatomy exist. As a result, the position of the TV in most patients is closely correlated to the position of the RCA, such that known information regarding the position of the RCA, along with relative positions of the RCA and TV (e.g., over a cardiac cycle) is useable to determine (e.g., via the computer system 110, etc.) the position of the TV even when the TV is not visualizable.

[0068] FIG. 9 shows two CT images of the right coronary artery and adjacent cardiac anatomy, and FIG. 10 shows an anteroposterior (AP) fluoro angiogram image of the RCA and branches (after cannulation with contrast). As can be seen by comparing FIGS. 9 and 10, while the RCA is visualizable on fluoro, many other anatomical structures visualizable on CT are not visualizable on fluoro.

[0069] In various examples, the first anatomical structure includes at least a portion of the RCA and RCA branches (e.g., although some examples also include additional portions of the coronary vasculature to provide improved accuracy of the position of the second anatomical structure and / or annotations, etc.), and the second anatomical structure includes at least a portion of a TV annulus, such as for a TTVR procedure, transcatheter TV repair procedure, etc.

[0070] FIGS. 11-14 show images in connection with an example TMVR procedure use case of an example system. FIG. 11 shows images of en face (top image) and septal- lateral (bottom image) CT views of a region of interest with a segmented CS (e.g., as a first anatomical structure) and a segmented MV annulus (e.g., as a second anatomicalstructure), along with user annotations indicating a target delivery location for the TMVR procedure. FIG. 12 shows two images of views of an intra-procedural fluoro imaging of a CS venogram, with the CS segmented.

[0071] The CS venogram image of FIG. 12 is registered to the pre-procedural CT image based on segmentation of the CS. The views used in fluoro can correspond to views from CT imaging, and users are able to annotate the CT imaging, such as by designating one or more target locations, such as locations for delivery of a valve and / or implant capsule. The proximity of the CS to the MV, as well as the contour and branches of the CS, allow for accurate registration points across the CT and fluoro imaging modalities. Additionally, the CS venogram can be readily employed in such procedures, and dedicated equipment and approaches can be used.

[0072] FIG. 13 shows two views of registration of the CT imaging data and annotations of FIG. 11 with the fluoro imaging data of FIG. 12 based on the CT segmented CS and the fluoro segmented CS. FIG. 14 shows two fluoro views with a representation of a TMVR delivery capsule based on a user annotated target for the TMVR delivery.

[0073] In view of the foregoing structural and functional features described above, example methods will be better appreciated with reference to FIGS. 15-16. While, for purposes of simplicity of explanation, the example methods of FIGS. 15-16 are shown and described as executing serially, it is to be understood and appreciated that the present examples are not limited by the illustrated order, as some actions could in other examples occur in different orders, multiple times and / or concurrently from that shown and described herein. Moreover, it is not necessary that all described actions be performed to implement a method.

[0074] FIG. 15 illustrates a flowchart of an example method 1500 for providing imaging data for a region of interest of a cardiac procedure. In other examples, the blocks of example method 1500 are a set of machine-readable instructions on a non-transitory machine-readable medium or are a set of operations performed by a processor (e.g., processing unit 204 and / or a processor of computer system 110, etc.) executing machine- readable instructions as the operations.

[0075] At block 1510, method 1500 includes receiving first (e.g., CT, MRI, etc.) imaging data for a 3D region of interest, such as from pre-procedure planning imaging.

[0076] At block 1520, method 1500 includes segmenting a first anatomical structure (e.g., at least a portion of a coronary vasculature, etc.) and a second anatomical structure (e.g., a heart valve annulus, etc.) on the first imaging data to determine a segmented first anatomical structure and a segmented second anatomical structure.

[0077] At block 1530, method 1500 includes determining the relative positions of the first and second anatomical structures based on the segmented first anatomical structure and the segmented second anatomical structure (e.g., based on distances and angles between respective sets of points for the segmented first anatomical structure and the segmented second anatomical structure, based on 3D coordinates of respective sets of points, etc.).

[0078] At block 1540, method 1500 includes receiving second (e.g., fluoro) imaging data for the 3D region of interest.

[0079] At block 1550, method 1500 includes segmenting the first anatomical structure on the second imaging data to determine an additional (e.g., fluoro) segmented first anatomical structure

[0080] At block 1560, method 1500 includes registering the first imaging data with the second imaging data based on the (e.g., CT, etc.) segmented first anatomical structure and the additional (e.g., fluoro, etc.) segmented first anatomical structure. In various examples, registration is based on alignment of comparable characteristics, such as outline shape and / or size and / or branches and / or angles of the segmented first anatomical structure and the additional segmented first anatomical structure, relative intensities in the first imaging data and second imaging data of the segmented first anatomical structure and the additional segmented first anatomical structure, respectively, etc.

[0081] At block 1570, method 1500 includes determining a confidence score based on the extent of overlap between the segmented first anatomical structure and the additional segmented first anatomical structure during registration.

[0082] At block 1580, method 1500 includes displaying the second anatomical structure (and any applicable user annotations) based on the second imaging data, the relative positions of the first anatomical structure and the second anatomical structure, and the additional segmented first anatomical structure.

[0083] FIG. 16 illustrates a flowchart of an example method 1600 for providing imaging data for a region of interest of a TMVR procedure. In other examples, the blocksof example method 1600 are a set of machine-readable instructions on a non-transitory machine-readable medium or are a set of operations performed by a processor (e.g., processing unit 204 and / or a processor of computer system 110, etc.) executing machine- readable instructions as the operations.

[0084] At block 1610, method 1600 includes acquiring gated contrast enhanced CT imaging pre-procedurally for a patient. The gated CT imaging allows for correlation of images to a cardiac cycle, such as based on an EKG signal.

[0085] At block 1620, method 1600 includes segmenting the CS and CS branches to determine a CT segmented CS, segmenting the MV to determine a CT segmented MV, and adding any user annotations, such as delivery location(s) for a TMVR system (e.g., the middle of the MV orifice, etc.).

[0086] At block 1630, method 1600 includes outputting LAO and RAO fluoroscopy views, eliminating parallax for implant delivery. The LAO view puts the MV in an en face view. The RAO view gives the plane of the mitral annulus to help with evaluating depth of the implant..

[0087] At block 1640, method 1600 includes calculating relative positions of the CS and MV / annotation(s), such as by calculating distances / angles from a set of (e.g., three or more) locations on the CS to the MV annulus and / or user annotation of delivery location based on the LAO / en face view and on the RAO / depth view. In other examples, 3D coordinates of sets of points are used to determine relative positions of the CS and MVZannotation(s) .

[0088] At block 1650, method 1600 includes cannulating the CS and acquiring a venogram of the cannulated CS with fluoroscopy in the RAO and LAO views. In various examples, the venogram is gated to the EKG signal, such that the fluoro imaging data is correlated to the cardiac cycle and to the gated CT imaging (and CT annotation, such as of delivery location), such that data / annotation(s) from the CT imaging data tracks the cardiac cycle along with the live fluoroscopy imaging data.

[0089] At block 1660, method 1600 includes segmenting the CS from the venogram to determine a fluoro segmented CS and registering the fluoro segmented CS to the (e.g., preprocedural) CT segmented CS. In various examples, registration is based on matching comparable characteristics, such as the CS outline shape and / or size and / or angles of the CS and branches from the fluoro segmented CS and the CT segmented CS.

[0090] At block 1670, method 1600 includes determining and outputting a confidence score based on the morphology overlap of the CT segmented CS and the fluoro segmented CS during registration. The confidence score can indicate to a user any potential accuracy concerns from registration that might impact the accuracy of the displayed information. For example, potential changes in fluid volume, sympathetic tone, etc. between preprocedural CT imaging and intra-procedural fluoro imaging potentially impact CS morphology and thus registration accuracy.

[0091] At block 1680, method 1600 includes outputting the MV and / or user annotations on the fluoroscopy display (e.g., display 120) based on the calculated relative positions of the CS and MVZannotation(s) (e.g., calculated distances and angles of sets of points, etc.). The annotations can include a target location for a delivery system, such as co-axial and centered with respect to the MV.

[0092] At block 1690, method 1600 includes navigating a TMVR system to a delivery location based on the modified fluoro imaging data (e.g., modified to include the MV and / or annotation(s) of delivery target, etc.).

[0093] In various examples, blocks 1610-1640 are performed pre-procedurally, and blocks 1650-1690 are performed intra-procedurally.

[0094] Additionally, while method 1600 relates to a TMVR procedure and involves registering CT and fluoro imaging based on a CT segmented CS and a fluoro segmented CS for visualizing the MV and TMVR delivery location via modified fluoro imaging data (e.g., to indicate the MV and delivery target, etc.), various examples employ similar techniques for repair, replacement, etc. of other cardiac anatomy (e.g., AV, TV, etc.). As one example, similar techniques are usable for a TTVR procedure and involves registering CT and fluoro imaging based on a CT segmented RCA and a fluoro segmented RCA for visualizing the TV and TTVR delivery location via modified fluoro imaging data (e.g., to indicate the TV and delivery target, etc.).

[0095] It should be understood that various aspects disclosed herein may be combined in different combinations than the combinations specifically presented in the description and accompanying drawings. It should also be understood that, depending on the example, certain acts or events of any of the processes or methods described herein may be performed in a different sequence, may be added, merged, or left out altogether (e.g., all described acts or events may not be necessary to carry out the techniques). In addition,while certain aspects of this disclosure are described as being performed by a single module or unit for purposes of clarity, it should be understood that the techniques of this disclosure may be performed by a combination of units or modules associated with, for example, a medical device.

[0096] In one or more examples, the described techniques may be implemented in hardware, software, firmware, or any combination thereof. If implemented in software, the functions may be stored as one or more instructions or code on a computer-readable medium and executed by a hardware-based processing unit. Computer-readable media may include non-transitory computer-readable media, which corresponds to a tangible medium such as data storage media (e.g., RAM, ROM, EEPROM, flash memory, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer).

[0097] Instructions may be executed by one or more processors, such as one or more digital signal processors (DSPs), general purpose microprocessors, application specific integrated circuits (ASICs), field programmable logic arrays (FPGAs), or other equivalent integrated or discrete logic circuitry. Accordingly, the term “processor” as used herein may refer to any of the foregoing structure or any other physical structure suitable for implementation of the described techniques. Also, the techniques could be fully implemented in one or more circuits or logic elements.

[0098] The following additional examples are provided in connection with various aspects:1. A system for displaying imaging of a region of interest for a cardiac procedure, the system comprising: a memory for storing machine-readable instructions; and a processor core for accessing the machine-readable instructions and executing the machine-readable instructions as operations, the operations comprising: receiving first imaging data for the region of interest; segmenting, on the first imaging data, a first anatomical structure to determine a segmented first anatomical structure and a second anatomical structure to determine a segmented second anatomical structure;determining relative positions of the first anatomical structure and the second anatomical structure on the first imaging data based on the segmented first anatomical structure and the segmented second anatomical structure; receiving second imaging data for the region of interest; segmenting the first anatomical structure on the second imaging data to determine an additional segmented first anatomical structure; registering the first imaging data with the second imaging data based on the segmented first anatomical structure and the additional segmented first anatomical structure; and displaying an image of the second anatomical structure based on the second imaging data, the relative positions of the first anatomical structure and the second anatomical structure on the first imaging data, and the additional segmented first anatomical structure.2. The system of example 1, wherein the first imaging data comprises computed tomography (CT) imaging data.3. The system of example 2, wherein the CT imaging data comprises gated CT imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the relative positions of the first anatomical structure and the second anatomical structure comprises determining the relative positions at a set of phases of the cardiac cycle.4. The system of any of examples 1-3, wherein the second imaging data comprises fluoroscopy imaging data.5. The system of example 4, wherein the fluoroscopy imaging data comprises gated fluoroscopy imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the position of the first anatomical structure on the second imaging data comprises determining the position of the first anatomical structure on the second imaging data at a set of phases of the cardiac cycle.6. The system of any of examples 1-5, wherein registering the first imaging data with the second imaging data is based on a set of comparable characteristics of the first anatomical structure.7. The system of any of examples 1-6, wherein the first anatomical structure comprises a portion of a coronary vasculature.8. The system of example 7, wherein registering the first imaging data with the second imaging data is based on at least one angle of the portion of the coronary vasculature.9. The system of any of examples 1-8, wherein the second anatomical structure comprises a heart valve annulus.10. The system of any of examples 1-9, wherein the second anatomical structure is selected based on a user input.11. The system of example 10, wherein displaying an image of the second anatomical structure comprises displaying an annotation in connection with the second anatomical structure.12. The system of any of examples 1-11, wherein the operations further comprise outputting a confidence score, wherein the confidence score is determined based on an extent of overlap between the segmented first anatomical structure and the additional segmented first anatomical structure.13. The system of any of examples 1-12, wherein displaying the image of the second anatomical structure comprises displaying a dynamic position of the second anatomical structure with respect to a cardiac cycle based on an electrocardiography signal.14. A method for providing imaging data of a region of interest for a cardiac procedure, comprising: receiving first imaging data for the region of interest; segmenting, on the first imaging data, a first anatomical structure to determine a segmented first anatomical structure and a second anatomical structure to determine a segmented second anatomical structure; determining relative positions of the first anatomical structure and the second anatomical structure on the first imaging data based on the segmented first anatomical structure and the segmented second anatomical structure; receiving second imaging data for the region of interest; segmenting the first anatomical structure on the second imaging data to determine an additional segmented first anatomical structure; registering the first imaging data with the second imaging data based on the segmented first anatomical structure and the additional segmented first anatomical structure; anddisplaying an image of the second anatomical structure based on the second imaging data, the relative positions of the first anatomical structure and the second anatomical structure on the first imaging data, and the additional segmented first anatomical structure.15. The method of example 14, wherein the first imaging data comprises computed tomography (CT) data.16. The method of example 15, wherein the CT imaging data comprises gated CT imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the relative positions of the first anatomical structure and the second anatomical structure comprises determining the relative positions at a set of phases of the cardiac cycle.17. The method of any of examples 14-16, wherein the second imaging data comprises fluoroscopy imaging data.18. The method of example 17, wherein the fluoroscopy imaging data comprises gated fluoroscopy imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the position of the first anatomical structure on the second imaging data comprises determining the position of the first anatomical structure on the second imaging data at a set of phases of the cardiac cycle.19. The method of any of examples 14-18, wherein registering the first imaging data with the second imaging data is based on an outline of the first anatomical structure.20. The method of any of examples 14-19, wherein the first anatomical structure comprises a portion of a coronary vasculature.21. The method of example 20, wherein registering the first imaging data with the second imaging data is based on at least one angle of the portion of the coronary vasculature.22. The method of any of examples 14-21, wherein the second anatomical structure comprises a heart valve annulus.23. The method of any of examples 14-22, wherein the second anatomical structure is selected based on a user input.24. The method of example 23, wherein displaying an image of the second anatomical structure comprises displaying an annotation in connection with the second anatomical structure.25. The method of any of examples 14-24, further comprising outputting a confidence score, wherein the confidence score is determined based on an extent of overlap between the segmented first anatomical structure and the additional segmented first anatomical structure.26. The method of any of examples 14-25, wherein displaying the image of the second anatomical structure comprises displaying a dynamic position of the second anatomical structure with respect to a cardiac cycle based on an electrocardiography signal.27. A non-transitory machine-readable medium having machine executable instructions for a system for providing imaging of a region of interest for a cardiac procedure that causes a processor core to execute operations, the operations comprising: receiving first imaging data for the region of interest; segmenting, on the first imaging data, a first anatomical structure to determine a segmented first anatomical structure and a second anatomical structure to determine a segmented second anatomical structure; determining relative positions of the first anatomical structure and the second anatomical structure on the first imaging data based on the segmented first anatomical structure and the segmented second anatomical structure; receiving second imaging data for the region of interest; segmenting the first anatomical structure on the second imaging data to determine an additional segmented first anatomical structure; registering the first imaging data with the second imaging data based on the segmented first anatomical structure and the additional segmented first anatomical structure; and displaying an image of the second anatomical structure based on the second imaging data, the relative positions of the first anatomical structure and the second anatomical structure on the first imaging data, and the additional segmented first anatomical structure.28. The non-transitory machine -readable medium of example 27, wherein the first imaging data comprises computed tomography (CT) data.29. The non-transitory machine -readable medium of example 28, wherein the CT imaging data comprises gated CT imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the relative positions of the firstanatomical structure and the second anatomical structure comprises determining the relative positions at a set of phases of the cardiac cycle.30. The non-transitory machine -readable medium of any of examples 27-29, wherein the second imaging data comprises fluoroscopy imaging data.31. The non-transitory machine -readable medium of example 30, wherein the fluoroscopy imaging data comprises gated fluoroscopy imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the position of the first anatomical structure on the second imaging data comprises determining the position of the first anatomical structure on the second imaging data at a set of phases of the cardiac cycle.32. The non-transitory machine -readable medium of any of examples 27-31, wherein registering the first imaging data with the second imaging data is based on an outline of the first anatomical structure.33. The non-transitory machine -readable medium of any of examples 27-32, wherein the first anatomical structure comprises a portion of a coronary vasculature.34. The non-transitory machine -readable medium of example 33, wherein registering the first imaging data with the second imaging data is based on at least one angle of the portion of the coronary vasculature.35. The non-transitory machine-readable medium of any of examples 27-34, wherein the second anatomical structure comprises a heart valve annulus.36. The non-transitory machine -readable medium of any of examples 27-35, wherein the second anatomical structure is selected based on a user input.37. The non-transitory machine -readable medium of example 36, wherein displaying an image of the second anatomical structure comprises displaying an annotation in connection with the second anatomical structure.38. The non-transitory machine -readable medium of any of examples 27-37, wherein the operations further comprise outputting a confidence score, wherein the confidence score is determined based on an extent of overlap between the segmented first anatomical structure and the additional segmented first anatomical structure.39. The non-transitory machine -readable medium of any of examples 27-38, wherein displaying the image of the second anatomical structure comprises displaying a dynamicposition of the second anatomical structure with respect to a cardiac cycle based on an electrocardiography signal.40. A system for displaying imaging of a region of interest for an intracardiac transcatheter procedure, the system comprising: a memory for storing machine-readable instructions; and a processor core for accessing the machine-readable instructions and executing the machine-readable instructions as operations, the operations comprising: receiving computed tomography (CT) imaging data for the region of interest; segmenting, on the CT imaging data, a portion of a coronary vasculature to determine a CT segmented coronary vasculature and a heart valve annulus to determine a CT segmented heart valve annulus; determining relative positions of the portion of the coronary vasculature and the heart valve annulus on the CT imaging data based on the CT segmented coronary vasculature and the CT segmented heart valve annulus; receiving fluoroscopy imaging data for the region of interest; segmenting the portion of the coronary vasculature on the fluoroscopy imaging data to generate a fluoroscopy segmented coronary vasculature; registering the CT imaging data with the fluoroscopy imaging data based on the CT segmented coronary vasculature and the fluoroscopy segmented coronary vasculature; and displaying an image of the heart valve annulus based on the fluoroscopy imaging data, the relative positions of the portion of the coronary vasculature and the heart valve annulus on the CT imaging data, and the fluoroscopy segmented coronary vasculature.41. The system of example 40, wherein the CT imaging data comprises gated CT imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the relative positions of the portion of the coronary vasculature and the heart valve annulus comprises determining the relative positions at a set of phases of the cardiac cycle.42. The system of any of examples 40-41, wherein the fluoroscopy imaging data comprises gated fluoroscopy imaging data that tracks a periodic motion of the region ofinterest over a cardiac cycle, and determining the position of the portion of the coronary vasculature on the fluoroscopy imaging data comprises determining the position of the first anatomical structure on the second imaging data at a set of phases of the cardiac cycle.43. The system of any of examples 40-42, wherein registering the CT imaging data with the fluoroscopy imaging data is based on an outline of the portion of the coronary vasculature.44. The system of any of examples 40-43, wherein registering the first imaging data with the second imaging data is based on at least one angle of the portion of the coronary vasculature.45. The system of any of examples 40-44, wherein the heart valve annulus is selected based on a user input.46. The system of example 45, wherein displaying an image of the heart valve annulus comprises displaying an annotation in connection with the heart valve annulus.47. The system of any of examples 40-46, wherein the operations further comprise outputting a confidence score, wherein the confidence score is determined based on an extent of overlap between the CT segmented coronary vasculature and the fluoroscopy segmented coronary vasculature.48. The system of any of examples 40-47, wherein the coronary vasculature comprises a coronary sinus.49. The system of example 48, wherein the heart valve annulus is a mitral valve annulus.50. The system of any of examples 40-47, wherein the coronary vasculature comprises a right coronary artery.51. The system of example 50, wherein the heart valve annulus is a tricuspid valve annulus.52. The system of any of examples 40-51, wherein displaying the image of the heart valve annulus comprises displaying a dynamic position of the heart valve annulus with respect to a cardiac cycle based on an electrocardiography signal.53. A method for providing imaging data of a region of interest for an intracardiac transcatheter procedure, comprising: receiving computed tomography (CT) imaging data for the region of interest;segmenting, on the CT imaging data, a portion of a coronary vasculature to determine a CT segmented coronary vasculature and a heart valve annulus to determine a CT segmented heart valve annulus; determining relative positions of the portion of the coronary vasculature and the heart valve armulus on the CT imaging data based on the CT segmented coronary vasculature and the CT segmented heart valve annulus; receiving fluoroscopy imaging data for the region of interest; segmenting the portion of the coronary vasculature on the fluoroscopy imaging data to generate a fluoroscopy segmented coronary vasculature; registering the CT imaging data with the fluoroscopy imaging data based on the CT segmented coronary vasculature and the fluoroscopy segmented coronary vasculature; and displaying an image of the heart valve annulus based on the fluoroscopy imaging data, the relative positions of the portion of the coronary vasculature and the heart valve annulus on the CT imaging data, and the fluoroscopy segmented coronary vasculature.54. The method of example 53, wherein the CT imaging data comprises gated CT imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the relative positions of the portion of the coronary vasculature and the heart valve annulus comprises determining the relative positions at a set of phases of the cardiac cycle.55. The method of any of examples 53-54, wherein the fluoroscopy imaging data comprises gated fluoroscopy imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the position of the portion of the coronary vasculature on the fluoroscopy imaging data comprises determining the position of the first anatomical structure on the second imaging data at a set of phases of the cardiac cycle.56. The method of any of examples 53-55, wherein registering the CT imaging data with the fluoroscopy imaging data is based on an outline of the portion of the coronary vasculature.57. The method of any of examples 53-56, wherein registering the first imaging data with the second imaging data is based on at least one angle of the portion of the coronary vasculature.58. The method of any of examples 53-57, wherein the heart valve annulus is selected based on a user input.59. The method of example 58, wherein displaying an image of the heart valve annulus comprises displaying an annotation in connection with the heart valve annulus.60. The method of any of examples 53-59, further comprising outputting a confidence score, wherein the confidence score is determined based on an extent of overlap between the CT segmented coronary vasculature and the fluoroscopy segmented coronary vasculature.61. The method of any of examples 53-60, wherein the coronary vasculature comprises a coronary sinus.62. The method of example 61, wherein the heart valve annulus is a mitral valve annulus.63. The method of any of examples 53-60, wherein the coronary vasculature comprises a right coronary artery.64. The method of example 63, wherein the heart valve annulus is a tricuspid valve annulus.65. The method of any of examples 53-64, wherein displaying the image of the heart valve annulus comprises displaying a dynamic position of the heart valve annulus with respect to a cardiac cycle based on an electrocardiography signal.66. A non-transitory machine-readable medium having machine executable instructions for a system for providing imaging of a region of interest for an intracardiac transcatheter procedure that causes a processor core to execute operations, the operations comprising: receiving computed tomography (CT) imaging data for the region of interest; segmenting, on the CT imaging data, a portion of a coronary vasculature to determine a CT segmented coronary vasculature and a heart valve annulus to determine a CT segmented heart valve annulus; determining relative positions of the portion of the coronary vasculature and the heart valve armulus on the CT imaging data based on the CT segmented coronary vasculature and the CT segmented heart valve annulus; receiving fluoroscopy imaging data for the region of interest;segmenting the portion of the coronary vasculature on the fluoroscopy imaging data to generate a fluoroscopy segmented coronary vasculature; registering the CT imaging data with the fluoroscopy imaging data based on the CT segmented coronary vasculature and the fluoroscopy segmented coronary vasculature; and displaying an image of the heart valve annulus based on the fluoroscopy imaging data, the relative positions of the portion of the coronary vasculature and the heart valve annulus on the CT imaging data, and the fluoroscopy segmented coronary vasculature.67. The non-transitory machine -readable medium of example 66, wherein the CT imaging data comprises gated CT imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the relative positions of the portion of the coronary vasculature and the heart valve annulus comprises determining the relative positions at a set of phases of the cardiac cycle.68. The non-transitory machine -readable medium of any of examples 66-67, wherein the fluoroscopy imaging data comprises gated fluoroscopy imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the position of the portion of the coronary vasculature on the fluoroscopy imaging data comprises determining the position of the first anatomical structure on the second imaging data at a set of phases of the cardiac cycle.69. The non-transitory machine -readable medium of any of examples 66-68, wherein registering the CT imaging data with the fluoroscopy imaging data is based on an outline of the portion of the coronary vasculature.70. The non-transitory machine-readable medium of any of examples 66-69, wherein registering the first imaging data with the second imaging data is based on at least one angle of the portion of the coronary vasculature.71. The non-transitory machine -readable medium of any of examples 66-70, wherein the heart valve annulus is selected based on a user input.72. The non-transitory machine -readable medium of example 71, wherein displaying an image of the heart valve annulus comprises displaying an annotation in connection with the heart valve annulus.73. The non-transitory machine -readable medium of any of examples 66-72, wherein the operations further comprise outputting a confidence score, wherein the confidencescore is determined based on an extent of overlap between the CT segmented coronary vasculature and the fluoroscopy segmented coronary vasculature.74. The non-transitory machine -readable medium of any of examples 66-73, wherein the coronary vasculature comprises a coronary sinus.75. The non-transitory machine -readable medium of example 74, wherein the heart valve annulus is a mitral valve annulus.76. The non-transitory machine -readable medium of any of examples 66-73, wherein the coronary vasculature comprises a right coronary artery.77. The non-transitory machine -readable medium of example 76, wherein the heart valve annulus is a tricuspid valve annulus.78. The non-transitory machine -readable medium of any of examples 66-77, wherein displaying the image of the heart valve annulus comprises displaying a dynamic position of the heart valve annulus with respect to a cardiac cycle based on an electrocardiography signal.

Claims

WHAT IS CLAIMED IS:

1. A system for displaying imaging of a region of interest for a cardiac procedure, the system comprising: a memory for storing machine-readable instructions; and a processor core for accessing the machine-readable instructions and executing the machine-readable instructions as operations, the operations comprising: receiving first imaging data for the region of interest; segmenting, on the first imaging data, a first anatomical structure to determine a segmented first anatomical structure and a second anatomical structure to determine a segmented second anatomical structure; determining relative positions of the first anatomical structure and the second anatomical structure on the first imaging data based on the segmented first anatomical structure and the segmented second anatomical structure; receiving second imaging data for the region of interest; segmenting the first anatomical structure on the second imaging data to determine an additional segmented first anatomical structure; registering the first imaging data with the second imaging data based on the segmented first anatomical structure and the additional segmented first anatomical structure; and displaying an image of the second anatomical structure based on the second imaging data, the relative positions of the first anatomical structure and the second anatomical structure on the first imaging data, and the additional segmented first anatomical structure.

2. The system of claim 1, wherein the first imaging data comprises computed tomography (CT) imaging data.

3. The system of claim 2, wherein the CT imaging data comprises gated CT imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the relative positions of the first anatomical structure and the second anatomical structure comprises determining the relative positions at a set of phases of the cardiac cycle.

4. The system of any of claims 1-3, wherein the second imaging data comprises fluoroscopy imaging data.

5. The system of claim 4, wherein the fluoroscopy imaging data comprises gated fluoroscopy imaging data that tracks a periodic motion of the region of interest over a cardiac cycle, and determining the position of the first anatomical structure on the second imaging data comprises determining the position of the first anatomical structure on the second imaging data at a set of phases of the cardiac cycle.

6. The system of any of claims 1-5, wherein registering the first imaging data with the second imaging data is based on a set of comparable characteristics of the first anatomical structure.

7. The system of any of claims 1-6, wherein the first anatomical structure comprises a portion of a coronary vasculature.

8. The system of claim 7, wherein registering the first imaging data with the second imaging data is based on at least one angle of the portion of the coronary vasculature.

9. The system of any of claims 1-8, wherein the second anatomical structure comprises a heart valve annulus.

10. The system of any of claims 1-9, wherein the second anatomical structure is selected based on a user input.

11. The system of claim 10, wherein displaying an image of the second anatomical structure comprises displaying an annotation in connection with the second anatomical structure.

12. The system of any of claims 1-11, wherein the operations further comprise outputting a confidence score, wherein the confidence score is determined based on an extent of overlap between the segmented first anatomical structure and the additional segmented first anatomical structure.

13. The system of any of claims 1-12, wherein displaying the image of the second anatomical structure comprises displaying a dynamic position of the second anatomical structure with respect to a cardiac cycle based on an electrocardiography signal.

14. A method for providing imaging data of a region of interest for a cardiac procedure, comprising: receiving first imaging data for the region of interest; segmenting, on the first imaging data, a first anatomical structure to determine a segmented first anatomical structure and a second anatomical structure to determine a segmented second anatomical structure; determining relative positions of the first anatomical structure and the second anatomical structure on the first imaging data based on the segmented first anatomical structure and the segmented second anatomical structure; receiving second imaging data for the region of interest; segmenting the first anatomical structure on the second imaging data to determine an additional segmented first anatomical structure; registering the first imaging data with the second imaging data based on the segmented first anatomical structure and the additional segmented first anatomical structure; and displaying an image of the second anatomical structure based on the second imaging data, the relative positions of the first anatomical structure and the second anatomical structure on the first imaging data, and the additional segmented first anatomical structure.

15. The method of claim 14, wherein the first imaging data comprises computed tomography (CT) data.

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