Applications of 3D X-ray imaging
Sjirk Boon, Ph.D
Philips Healthcare
April 03, 2008
Outline
•
•
•
•
concepts, naming
historic overview
technical background
application highlights in various clinical segments
– interventional (neuro)radiology
– orthopedic / trauma surgery
– interventional oncology
– pain management / spine interventions
• conclusion
• outlook
Philips Healthcare, April 03, 2008
2
Concepts, what is in a name ...
•
•
•
•
•
•
•
•
3D Rotational Angiography
3D Rotational X-ray
Cone Beam CT, CBCT
C-arm CT
Angiographic CT , ACT
(DynaCT)
(XperCT)
(InnovaCT)
Philips Healthcare, April 03, 2008
3
History
•
•
•
•
•
•
•
•
•
1984: Feldkamp published cone beam reconstruction algorithm
1995: first phantom experiments published
1997: first in human, interventional neuro, Prof Moret, Paris
1998: II TV based products on the market
2002: introduction of 3D in mobile C-arms
2003: introduction of flat detector systems
2004: introduction of soft tissue , low contrast detection
2005: overlay 2D fluoro image + 3D roadmap
2007: introduction needle guidance, enabling interventional CT
procedures in the angiolab
Philips Healthcare, April 03, 2008
4
History - 2
Attribute
From… (late ’90s)
To…
Clinical Focus
Neuro
Neuro
Body
Non-vascular
Resolution
643 -1283 matrix
2563 - 5123
Reconstruction time
7 – 8 minutes (643)
5 seconds (2563)
Lab Integration
None (stand-alone)
Tableside control, Geo links
(3D APC, 3D Follow C-arc)
“Features”
Basic measurement
Automatic vessel analysis,
Auto volume, Virtual devices
for planning
Functionality
3D vascular
3D vascular and non vascular
Soft-tissue imaging
3D Roadmap
Philips Healthcare, April 03, 2008
5
3D Basics
• 3D Rotational X-ray
projection data is the input
data set for reconstruction
creation
• In case of the 3DRA,
requires single injection of
contrast : 4s
• Real-time reconstruction
creation
Philips Healthcare, April 03, 2008
6
Fast acquisition to display
Real Time Digital Link
120 , 300 or 600 images
from Propeller or Roll
acquisition
Planning
Fully automated
image processing
within seconds
Delivery
Automatic displayed
Optimal view settings
Monitoring
Philips Healthcare, April 03, 2008
Final check
7
background
Philips Healthcare, April 03, 2008
8
CT on angio system: geometrical corrections
flat detector
Z'i
Zi
Yi
ISO r
Xi
Y'i
ISO-centre
X'i
+
model
X-ray tube
+
projection parameters:
shift = ( xS, yS, zS )
)
)
)
<-rot,
<-ang,
<-larm
focus parameters:
+
f = ( xf, yf, zf )
real situation
Philips Healthcare, April 03, 2008
9
Multi purpose 3D system
• 3D acquisition in horizontal or vertical
position of the stand (weight bearing)
• 3D acquisition at angulation
• Full body coverage
Philips Healthcare, April 03, 2008
10
Mobile C-arm 3D system
Philips Healthcare, April 03, 2008
11
new extension: overlay with 2D fluoro
Building Blocks
Advanced 2D/3D Applications
Allura 3D-RA
3D-RA/XperCT Match
Live Fluoro (2D)
CT/MR
Matching
Dynamic
3D Roadmap
XperGuide
XperCT
Pre-procedural planning
Intra-procedural Support and
Post-procedural follow-up
Risk Management
Philips Healthcare, April 03, 2008
12
How Does 3D Roadmap Work?
Paris Movie
Acquisition Scan
3D Roadmap activation
Changes in projection
• 3D Rotational
Acquisition Scan
• One touch on Xper
Tableside Module
• The 3D Roadmap will
track in real time with
changes in fluoro
projections
• Both 3D Roadmap and
live fluoro images will
be displayed on a
single monitor
Philips Healthcare, April 03, 2008
13
3D roadmap
Philips Healthcare, April 03, 2008
14
Trajectory Planning
Needle Positioning Needle Progress
• Select target on XperCT
volume
•
Select Bulls Eye view
•
Select Progress view
•
Under fluoro position
device at entry point
and mark patient skin
•
Monitor progress in
real-time along the predefined optimal
trajectory line
•
Under fluoro position
needle to show as a
point
• Draw optimal trajectory
• System calculates
automatically optimal
views:
• Bulls Eye view
• Progress view
(selectable tableside)
•
•
If laser, align to
monitor movement out
of x-ray plane.
Recheck with fluoro
Bulls Eye view
•
Progress visible under
fluoro overlaid with
XperCT
•
If no laser, swap
between Bulls Eye
view & Progress views
as needed
Philips Healthcare, April 03, 2008
Verify Outcome
•
Verify outcome by
performing another
XperCT or 3D-RA scan
•
Check if needle
followed the predefined optimal
trajectory line
•
Proceed with
intervention
15
Xperguide
Philips Healthcare, April 03, 2008
16
3D application spectrum
• interventional neuro-radiology
– acute stroke treatment : intra-arterial TPA, mechanical clot removal
– aneurysm coiling
– intracranial stents
– carotid procedures
– AVM treatments : embolization
– spine procedures
Philips Healthcare, April 03, 2008
17
3DRA neuro
images courtesy Professor Moret, Fondation Rothschild, Paris
Philips Healthcare, April 03, 2008
18
3DRA
left
right
combined
Philips Healthcare, April 03, 2008
19
3DRA+
XperCT
Philips Healthcare, April 03, 2008
20
XperCT : intracranial stents
Philips Healthcare, April 03, 2008
21
XperCT
Philips Healthcare, April 03, 2008
22
XperGuide in neuro
Philips Healthcare, April 03, 2008
23
XperGuide in neuro 2
Philips Healthcare, April 03, 2008
24
interventional radiology
• UFE treatment
• courtesy Dr Gupta,
• Paoli Hospital, PA
Philips Healthcare, April 03, 2008
25
interventional radiology : traditional 2D roadmap
Time
Dose
Philips Healthcare, April 03, 2008
Contrast
26
interventional radiology 3D guidance in UFE
Rot -30 deg
Ang +2 deg
Philips Healthcare, April 03, 2008
27
interventional radiology
3D roadmap movie
Dr Gupta
Philips Healthcare, April 03, 2008
28
intra-operative 3D
• mobile C-arm with 3D capabilities
Philips Healthcare, April 03, 2008
29
mobile C-arm : 3D in a sterile environment
Philips Healthcare, April 03, 2008
30
ENT sinus surgery
Functional endoscopic sinus surgery (FESS)
Preoperative
CT
Peroperative
3D-RX
Courtesy of Prof. Fokkens, AMC
Philips Healthcare, April 03, 2008
31
ENT sinus surgery
pre- and post-operative comparison
Courtesy of Prof. Fokkens, AMC
Philips Healthcare, April 03, 2008
32
Orbita surgery
Graves disease (Thyroid Ophthalmopathy)
Orbital decompression by breaking the
orbita wall to reduce orbita pressure
Philips Healthcare, April 03, 2008
Courtesy of Dr. Saeed, AMC
33
Maxillo facial reconstructions
Slice
Courtesy of Dr. Hammer, Aarau-CH
3D
Philips Healthcare, April 03, 2008
34
Cochlear implants
• Insertion of electrode tip in the cochlea
• Intra-operative signal response and impedance measurements
• Cost €25000 per implant
• Intra operative 3D imaging confirms implant position
Philips Healthcare, April 03, 2008
35
Cochlear implants
Courtesy of Dr. Grolman, AMC
Failure!
Before removing stiletto
Confirming proper deployment
Philips Healthcare, April 03, 2008
36
Hand/wrist surgery
Diagnosis in 3D
Courtesy of Dr. Strackee , AMC
Ulna is 3 mm longer than the radius
Philips Healthcare, April 03, 2008
37
interventional oncology
• Chemo embolization: unresectable HCC Lt lobe
• images courtesy Dr Geschwind , Johns Hopkins
Philips Healthcare, April 03, 2008
38
Post CT
Pre-TACE MRI for HCC
Philips Healthcare, April 03, 2008
Post Xper-CT
Intra-Xper-CT
Pre TACE MRI for HCC
Shows catheter in wrong position
Philips Healthcare, April 03, 2008
pain management
celiac plexus nerve block
images courtesy
Dr Racadio,
Cincinatti Children’s Hosp.
Philips Healthcare, April 03, 2008
pain management
Philips Healthcare, April 03, 2008
Philips Healthcare, April 03, 2008
multi purpose system 3D acquisition: possibility for weightbaring
Philips Healthcare, April 03, 2008
44
multipurpose : Flexion and Extension of the cervical spine
Examination with patient in
standing position
• Able to visualize C7-T1 level and better assessment of facets than plain X-rays
• Better physiologic assessment of alignment over CT or MRI
Philips Healthcare, April 03, 2008
conclusions
• 3D X-ray imaging has evolved from exotic specialty to a useful addition
to medical imaging tools
• key is that it provides improvement to the workflow, by eliminating the
the need for moving the patient around
• combining spatial 3D information with dynamic 2D information adds
value
• 3D has the potential to shorten procedure time , and therefore total dose
exposure.
• when the expected increase in minimal invasive therapies the role of 3D
in the future will only increase
Philips Healthcare, April 03, 2008