Sascha Krueger

Navigation with Electromagnetic Tracking for Interventional Radiology Procedures: A Feasibility Study

PURPOSE To assess the feasibility of the use of preprocedural imaging for guide wire, catheter, and needle navigation with electromagnetic tracking in phantom and animal models. MATERIALS AND METHODS An image-guided intervention software system was developed based on open-source software components. Catheters, needles, and guide wires were constructed with small position and orientation sensors in the tips. A tetrahedral-shaped weak electromagnetic field generator was placed in proximity to an abdominal vascular phantom or three pigs on the angiography table. Preprocedural computed tomographic (CT) images of the phantom or pig were loaded into custom-developed tracking, registration, navigation, and rendering software. Devices were manipulated within the phantom or pig with guidance from the previously acquired CT scan and simultaneous real-time angiography. Navigation within positron emission tomography (PET) and magnetic resonance (MR) volumetric datasets was also performed. External and endovascular fiducials were used for registration in the phantom, and registration error and tracking error were estimated. RESULTS The CT scan position of the devices within phantoms and pigs was accurately determined during angiography and biopsy procedures, with manageable error for some applications. Preprocedural CT depicted the anatomy in the region of the devices with real-time position updating and minimal registration error and tracking error (<5 mm). PET can also be used with this system to guide percutaneous biopsies to the most metabolically active region of a tumor. CONCLUSIONS Previously acquired CT, MR, or PET data can be accurately codisplayed during procedures with reconstructed imaging based on the position and orientation of catheters, guide wires, or needles. Multimodality interventions are feasible by allowing the real-time updated display of previously acquired functional or morphologic imaging during angiography, biopsy, and ablation.

Prospective real-time correction for arbitrary head motion using active markers.

Patient motion during an MRI exam can result in major degradation of image quality, and is of increasing concern due to the aging population and its associated diseases. This work presents a general strategy for real‐time, intraimage compensation of rigid‐body motion that is compatible with multiple imaging sequences. Image quality improvements are established for structural brain MRI acquired during volunteer motion. A headband integrated with three active markers is secured to the forehead. Prospective correction is achieved by interleaving a rapid track‐and‐update module into the imaging sequence. For every repetition of this module, a short tracking pulse‐sequence remeasures the marker positions; during head motion, the rigid‐body transformation that realigns the markers to their initial positions is fed back to adaptively update the image‐plane—maintaining it at a fixed orientation relative to the head—before the next imaging segment of k‐space is acquired. In cases of extreme motion, corrupted lines of k‐space are rejected and reacquired with the updated geometry. High‐precision tracking measurements (0.01 mm) and corrections are accomplished in a temporal resolution (37 ms) suitable for real‐time application. The correction package requires minimal additional hardware and is fully integrated into the standard user interface, promoting transferability to clinical practice. Magn Reson Med, 2009.

Motion compensated coronary interventional navigation by means of diaphragm tracking and elastic motion models

Current catheter tracking in the x-ray catheter laboratory during coronary interventions is performed using 2D fluoroscopy. Although this features real-time navigation on high-resolution images, drawbacks such as overlap and foreshortening exist and hamper the diagnosis and treatment process. An alternative to fluoroscopy-based tracking is device tracking by means of a magnetic tracking system (MTS). Having measured the 3D location of the interventional device, its position can be reconstructed on 3D images or virtual roadmaps of the organ or vessel structure under examination. In this paper, a method is presented which compensates the interventional device location measured by the MTS for organ motion and thus registers it dynamically to a 3D virtual roadmap. The motion compensation is accomplished by using an elastic motion model which is driven by the ECG signal and a respiratory sensor signal derived from ultrasonic diaphragm tracking. The model is updated during the intervention itself, thus allowing for a local refinement in regions which bear a complex geometric structure, such as stenoses and bifurcations. The evaluation is done by means of a phantom-based study using a dynamic heart-phantom. The mean displacement caused by the overall motion of the heart is improved from 10.4+/-4.8 mm in the uncompensated case to 2.1+/-1.2 mm in the motion compensated case.

An MR guidewire based on micropultruded fiber-reinforced material

A novel fiber‐reinforced material for the realization of MR guidewires, made using a newly‐developed production process, is presented. The MR‐safe artificial material provides a high stiffness and torque and allows the production, in a large range of sizes, of nonmetallic MR guidewires with similar mechanical properties as conventional metallic guidewires. Based on this material, a passively visualized MR guidewire has been developed, and was found to conform to existing standards on mechanical stability. Handling and steerability were evaluated in animal studies and were found to be comparable with conventional metallic guidewires. X‐ray visibility is provided by a BaSO4‐ and tungsten‐doped jacket. A hydrophilic coating improves sliding properties and hemocompatibility. Magn Reson Med 60:1190–1196, 2008.

Motion compensation for interventional navigation on 3D static roadmaps based on an affine model and gating

Current cardiac interventions are performed under 2D fluoroscopy, which comes along with well-known burdens to patients and physicians, such as x-ray exposure and the use of contrast agent. Furthermore, the navigation on complex structures such as the coronaries is complicated by the use of 2D images in which the catheter position is only visible while the contrast agent is introduced. In this work, a new method is presented, which circumvents these drawbacks and enables the cardiac interventional navigation on motion-compensated 3D static roadmaps. For this, the catheter position is continuously reconstructed within a previously acquired 3D roadmap of the coronaries. The motion compensation makes use of an affine motion model for compensating the respiratory motion and compensates the motion due to cardiac contraction by gating the catheter position. In this process, only those positions which have been acquired during the rest phase of the heart are used for the reconstruction. The method necessitates the measurement of the catheter position, which is done by using a magnetic tracking system. Nevertheless, other techniques, such as image-based catheter tracking, can be applied. This motion compensation has been tested on a dynamic heart phantom. The evaluation shows that the algorithm can reconstruct the catheter position on the 3D static roadmap precisely with a residual motion of 1.0 mm and less.

Echo‐planar imaging with prospective slice‐by‐slice motion correction using active markers

Head motion is a fundamental problem in functional magnetic resonance imaging and is often a limiting factor in its clinical implementation. This work presents a rigid‐body motion correction strategy for echo‐planar imaging sequences that uses micro radiofrequency coil “active markers” for real‐time, slice‐by‐slice prospective correction. Before the acquisition of each echo‐planar imaging‐slice, a short tracking pulse‐sequence measures the positions of three active markers integrated into a headband worn by the subject; the rigid‐body transformation that realigns these markers to their initial positions is then fed back to dynamically update the scan‐plane, maintaining it at a fixed orientation relative to the head. Using this method, prospectively‐corrected echo‐planar imaging time series are acquired on volunteers performing in‐plane and through‐plane head motions, with results demonstrating increased image stability over conventional retrospective image‐realignment. The benefit of this improved image stability is assessed in a blood oxygenation level dependent functional magnetic resonance imaging application. Finally, a non‐rigid‐body distortion‐correction algorithm is introduced to reduce the remaining signal variation. Magn Reson Med, 2011.

Combined prospective and retrospective correction to reduce motion-induced image misalignment and geometric distortions in EPI.

Despite rigid‐body realignment to compensate for head motion during an echo‐planar imaging time‐series scan, nonrigid image deformations remain due to changes in the effective shim within the brain as the head moves through the B0 field. The current work presents a combined prospective/retrospective solution to reduce both rigid and nonrigid components of this motion‐related image misalignment. Prospective rigid‐body correction, where the scan‐plane orientation is dynamically updated to track with the subjects head, is performed using an active marker setup. Retrospective distortion correction is then applied to unwarp the remaining nonrigid image deformations caused by motion‐induced field changes. Distortion correction relative to a reference time‐frame does not require any additional field mapping scans or models, but rather uses the phase information from the echo‐planar imaging time‐series itself. This combined method is applied to compensate echo‐planar imaging scans of volunteers performing in‐plane and through‐plane head motions, resulting in increased image stability beyond what either prospective or retrospective rigid‐body correction alone can achieve. The combined method is also assessed in a blood oxygen level dependent functional MRI task, resulting in improved Z‐score statistics. Magn Reson Med, 2013.

In vivo evaluation and proof of radiofrequency safety of a novel diagnostic MR‐electrophysiology catheter

An MR‐electrophysiology (EP) catheter is presented that provides full diagnostic EP functionality and a high level of radiofrequency safety achieved by custom‐designed transmission lines. Highly resistive wires transmit intracardiac electrograms and currents for intracardiac pacing. A transformer cable transmits the localization signal of a tip coil. Specific absorption rate simulations and temperature measurements at 1.5 T demonstrate that a wire resistance > 3 kΩ/m limits dielectric heating to a physiologically irrelevant level. Additional wires do not increase tip specific absorption rate significantly, which is important because some clinical catheters require up to 20 electrodes. It is further demonstrated that radiofrequency‐induced and pacing‐induced resistive heating of the wires is negligible under clinical conditions. The MR‐EP catheters provided uncompromised recording of electrograms and cardiac pacing in combination with a standard EP recorder in MR‐guided in vivo EP studies, and the tip coil enabled fast and robust catheter localization. In vivo temperature measurements during such a study did not detect any device‐related heating, which confirms the high level of safety of the catheter, whereas unacceptable heating was found with a standard EP catheter. The presented concept for the first time enables catheters with full diagnostic EP functionality and active tracking and at the same time a sufficient level of radiofrequency safety for MRI without specific absorption rate‐related limitations. Magn Reson Med, 2011.

Real-time magnetic resonance-guided ablation of typical right atrial flutter using a combination of active catheter tracking and passive catheter visualization in man: initial results from a consecutive patient series

AIMS Recently cardiac magnetic resonance (CMR) imaging has been found feasible for the visualization of the underlying substrate for cardiac arrhythmias as well as for the visualization of cardiac catheters for diagnostic and ablation procedures. Real-time CMR-guided cavotricuspid isthmus ablation was performed in a series of six patients using a combination of active catheter tracking and catheter visualization using real-time MR imaging. METHODS AND RESULTS Cardiac magnetic resonance utilizing a 1.5 T system was performed in patients under deep propofol sedation. A three-dimensional-whole-heart sequence with navigator technique and a fast automated segmentation algorithm was used for online segmentation of all cardiac chambers, which were thereafter displayed on a dedicated image guidance platform. In three out of six patients complete isthmus block could be achieved in the MR scanner, two of these patients did not need any additional fluoroscopy. In the first patient technical issues called for a completion of the procedure in a conventional laboratory, in another two patients the isthmus was partially blocked by magnetic resonance imaging (MRI)-guided ablation. The mean procedural time for the MR procedure was 109 ± 58 min. The intubation of the CS was performed within a mean time of 2.75 ± 2.21 min. Total fluoroscopy time for completion of the isthmus block ranged from 0 to 7.5 min. CONCLUSION The combination of active catheter tracking and passive real-time visualization in CMR-guided electrophysiologic (EP) studies using advanced interventional hardware and software was safe and enabled efficient navigation, mapping, and ablation. These cases demonstrate significant progress in the development of MR-guided EP procedures.

Prospective active marker motion correction improves statistical power in BOLD fMRI

Group level statistical maps of blood oxygenation level dependent (BOLD) signals acquired using functional magnetic resonance imaging (fMRI) have become a basic measurement for much of systems, cognitive and social neuroscience. A challenge in making inferences from these statistical maps is the noise and potential confounds that arise from the head motion that occurs within and between acquisition volumes. This motion results in the scan plane being misaligned during acquisition, ultimately leading to reduced statistical power when maps are constructed at the group level. In most cases, an attempt is made to correct for this motion through the use of retrospective analysis methods. In this paper, we use a prospective active marker motion correction (PRAMMO) system that uses radio frequency markers for real-time tracking of motion, enabling on-line slice plane correction. We show that the statistical power of the activation maps is substantially increased using PRAMMO compared to conventional retrospective correction. Analysis of our results indicates that the PRAMMO acquisition reduces the variance without decreasing the signal component of the BOLD (beta). Using PRAMMO could thus improve the overall statistical power of fMRI based BOLD measurements, leading to stronger inferences of the nature of processing in the human brain.