Tracking and characterization of fragments in a beating heart using 3D ultrasound for interventional guidance

Fragments generated by explosions and similar incidents can become trapped in a patient's heart chambers, potentially causing disruption of cardiac function. The conventional approach to removing such foreign bodies is through open heart surgery, which comes with high perioperative risk and long recovery times. We thus advocate a minimally invasive surgical approach through the use of 3D transesophageal echocardiography (TEE) and a flexible robotic end effector. In a phantom study, we use 3D TEE to track a foreign body in a beating heart, and propose a modified normalized cross-correlation method for improved accuracy and robustness of the tracking, with mean RMS errors of 2.3 mm. Motion analysis of the foreign body trajectory indicates very high speeds and accelerations, which render unfeasible a robotic retrieval method based on following the tracked trajectory. Instead, a probability map of the locus of the foreign body shows that the fragment tends to occupy only a small sub-volume of the ventricle, suggesting a retrieval strategy based on moving the robot end effector to the position with the highest spatial probability in order to maximize the possibility of capture.