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A new approach of three-dimensional guidance in paediatric cath lab: segmented and tessellated heart models for
Nicole Ehret1, Muhannad Alkassar1, Sven Dittrich1
11Department of Pediatric Cardiology,University Hospital Erlangen,Friedrich-Alexander University Erlangen-Nuremberg,Erlangen,Germany.
Insights
Novel 3D heart models improve catheter interventions for congenital heart disease (CHD), reducing radiation and contrast dye. This 3D guidance offers superior visualization and accuracy compared to traditional methods.
Area of Science:
- Medical Imaging
- Interventional Cardiology
- Congenital Heart Disease (CHD)
Background:
- Optimal imaging is crucial for catheter-based interventions in Congenital Heart Disease (CHD).
- Current 3D models using volume-rendering techniques lack standardization.
- This study explores novel 3D guidance using segmented, tessellated heart models for CHD catheterization.
Purpose of the Study:
- To investigate the feasibility and impact of novel 3D guidance in CHD catheterization.
- To evaluate the accuracy and benefits of segmented and tessellated 3D heart models.
- To assess a nearly radiation-free 2D-to-3D registration and biplane overlay technique.
Main Methods:
- Analyzed 60 consecutive CHD catheterizations using segmented tessellated 3D heart models fused with live fluoroscopy.
- Models generated from MRI/CT data using dedicated software, utilizing stereo-lithography format.
- 2D-to-3D registration accuracy and visualization superiority were rated by interventionalists; fluoroscopy time, radiation dose, and contrast dye consumption were evaluated.
Main Results:
- 3D image fusion was applied in 60/354 cases over 10 months, with 73.3% for interventions.
- 2D-to-3D registration accuracy was sufficient in all cases.
- 3D guidance was rated superior to conventional biplane imaging; significantly reduced contrast dye, radiation dose, and fluoroscopy time were observed for aortic arch interventions compared to a control group.
Conclusions:
- 2D-to-3D image fusion is successfully applicable in most catheter-based interventions for CHD.
- Stereo-lithography format meshes provide accurate, standardized, and reproducible 3D models for improved CHD interventions.
Background:
Optimal imaging is essential for catheter-based interventions in CHD. The three-dimensional models in volume-rendering technique currently in use are not standardised. This paper investigates the feasibility and impact of novel three-dimensional guidance with segmented and tessellated three-dimensional heart models in catheterisation of CHD. In addition, a nearly radiation-free two- to three-dimensional registration and a biplane overlay were used.Methods and resultsWe analysed 60 consecutive cases in which segmented tessellated three-dimensional heart models were merged with live fluoroscopy images and aligned using the tracheal bifurcation as a fiducial mark. The models were generated from previous MRI or CT by dedicated medical software. We chose the stereo-lithography format, as this promises advantage over volume-rendering-technique models regarding visualisation. Prospects, potential benefits, and accuracy of the two- to three-dimensional registration were rated separately by two paediatric interventionalists on a five-point Likert scale. Fluoroscopy time, radiation dose, and contrast dye consumption were evaluated. Over a 10-month study period, two- to three-dimensional image fusion was applied to 60 out of 354 cases. Of the 60 catheterisations, 73.3% were performed in the context of interventions. The accuracy of two- to three-dimensional registration was sufficient in all cases. Three-dimensional guidance was rated superior to conventional biplane imaging in all 60 cases. We registered significantly smaller amounts of used contrast dye (p<0.01), lower levels of radiation dose (p<0.02), and less fluoroscopy time (p<0.01) during interventions concerning the aortic arch compared with a control group.
Conclusions:
Two- to three-dimensional image fusion can be applied successfully in most catheter-based interventions of CHD. Meshes in stereo-lithography format are accurate and base for standardised and reproducible three-dimensional models.
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