Dynamic Coronary Roadmapping for PCI
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Solution Overview
Problem
Current methods for dynamic coronary roadmapping during percutaneous coronary interventions face challenges in accurately overlaying coronary artery roadmaps onto X-ray fluoroscopic images due to limited information about vessel motion caused by respiration and heartbeat, leading to reduced accuracy and increased contrast agent and X-ray exposure.
Innovation Solution
A computer-implemented method that generates dynamic roadmaps by using first image data with contrast agents to create roadmaps of the coronary arteries, determining reference locations, selecting a roadmap, transforming it to match the second image data without contrast agents, and overlaying the visual representation on the fluoroscopic images for real-time guidance.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If contrast agent is injected to visualize coronary arteries, then visualization accuracy is improved, but patient harm and contrast agent usage increase
Solution Approach 1:
The system uses periodic ECG-triggered acquisition to capture coronary artery images only at specific phases of the cardiac cycle when the vessels are most visible, rather than continuous imaging. This allows accurate visualization during critical moments while minimizing overall contrast agent exposure and X-ray exposure time.
Solution Approach 2:
The system performs preliminary ECG signal analysis and phase detection before acquiring coronary images, preparing the optimal timing for contrast injection and image capture. This ensures contrast agent is administered at the precise moment when it will provide maximum visualization benefit, reducing the total amount needed.
2Measurement precision
If X-ray exposure time is increased to improve image quality, then measurement precision is improved, but patient harm increases
Solution Approach 1:
The system employs intermittent, ECG-synchronized X-ray exposure rather than continuous exposure. X-ray imaging is activated only during specific cardiac phases when coronary arteries are optimally positioned for visualization, maintaining image quality while dramatically reducing cumulative radiation dose to the patient.
Solution Approach 2:
The system uses the patient's own ECG signal as a trigger mechanism to automatically control X-ray exposure timing. The ECG rhythm serves as an internal clock that autonomously determines when high-quality images are needed, eliminating the need for continuous monitoring and reducing unnecessary radiation exposure.
3Measurement precision
If continuous contrast injection is performed to maintain vessel visibility, then navigation accuracy is improved, but contrast agent usage increases
Solution Approach 1:
Instead of continuous contrast injection, the system uses periodic, ECG-triggered contrast administration synchronized with the cardiac cycle. Contrast agent is injected only during specific phases when coronary arteries are naturally most visible and accessible, maintaining navigation accuracy while minimizing the total volume of contrast agent required.
Solution Approach 2:
The system continuously monitors ECG signals and uses this feedback to dynamically control contrast agent injection timing and duration. When the ECG indicates optimal cardiac phases for visualization, contrast is administered; otherwise, injection is paused, ensuring efficient use of contrast agent while maintaining vessel visibility when needed.
4Device complexity
If vessel motion compensation is not performed, then system complexity is reduced, but roadmap overlay accuracy deteriorates
Solution Approach 1:
The system uses ECG signals as feedback to detect cardiac phase and trigger corresponding roadmap selections. By continuously monitoring the ECG rhythm and using it to dynamically select and update the appropriate coronary roadmap for each cardiac phase, the system automatically compensates for vessel motion without requiring complex real-time motion tracking algorithms.
Solution Approach 2:
The system pre-acquires multiple coronary roadmaps corresponding to different cardiac phases and stores them for later selection. When ECG-triggered imaging is performed, the appropriate pre-acquired roadmap is selected and displayed, eliminating the need for complex real-time motion compensation calculations while maintaining accurate overlay positioning.
Data Source
AI summary
Methods and systems are provided for dynamically visualizing an object of interest that includes part of the vasculature of a patient, which employ a 3D model of the object to generate at least one roadmap that includes information that characterizes properties of the object (such as centerlines, contours, and an image mask. Reference location(s) corresponding to the roadmap(s) are determined for an interventional device used to treat the object. In an online phase, non-contrast-enhanced x-ray image data of the object are obtained and processed to determine location of the interventional device in the image data, and a particular roadmap is selected or accessed. The reference location corresponding to the particular roadmap and the determined location of interventional device are used to transform the particular roadmap. A visual representation of the transformed roadmap is overlaid on the image data for display.