Catheter navigation support for liver radioembolization guidance: feasibility of structure-driven intensity-based regist
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REVIEW ARTICLE
Catheter navigation support for liver radioembolization guidance: feasibility of structure-driven intensity-based registration Houda Hammami1,2
· Florent Lalys1
· Yan Rolland2 · Antoine Petit1
· Pascal Haigron2
Received: 31 March 2020 / Accepted: 16 August 2020 © CARS 2020
Abstract Purpose The fusion of pre/intraoperative images may improve catheter manipulation during radioembolization (RE) interventions by adding relevant information. The objective of this work is to propose and evaluate the performance of a RE guidance strategy relying on structure-driven intensity-based registration between preoperative CTA and intraoperative X-ray images. Methods The navigation strategy is decomposed into three image fusion steps, supporting the catheter navigation from the femoral artery till reaching the injection site (IS). During the pretreatment assessment intervention, the aorta and the origins of its side branches are projected on the intraoperative 2D fluoroscopy following a 3D/2D bone-based registration process, to assist the celiac trunk access. Subsequently, a similar approach consisting in projecting the hepatic vasculature on intraoperative DSA through 3D/2D vessel-based registration is performed to assist the IS location. Lastly, the selected IS is reproduced during the treatment intervention by employing 2D/2D image-based registration between pretreatment and treatment fluoroscopic images. Results The three fusion steps were independently evaluated on subsets of 20, 19 and 5 patient cases, respectively. Best results were obtained with gradient difference as similarity measure and with a delimited preoperative vascular structure for vessel-based registration. The approach resulted in qualitatively appropriate anatomical correspondences when projecting the preoperative structures on intraoperative images. With the best configuration, the registration steps showed accuracy and feasibility in aligning data, with global mean landmarks errors of 1.59 mm, 2.32 mm and 2.17 mm, respectively, a computation time that never exceeded 5 s, 25 s and 11 s, respectively, and a user interaction limited to manual initialization of the 3D/2D registration. Conclusion An image fusion-based approach has been specifically proposed for RE procedures guidance. The catheter manipulation strategy based on the fusion of pre- and intraoperative images has the potential to support different steps of the RE clinical workflow and to guide the overall procedure. Keywords Catheterization · Guidance · Registration · Radioembolization · Liver
Introduction Liver cancer is a major cause of cancer mortality worldwide with more than 700,000 deaths each year [1]. Radioembolization (RE) is a novel minimally invasive therapy, which is mostly used for unresectable primary and metastatic liver cancer. The treatment relies mainly on the delivery of
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Houda Hammami [email protected]
1
Therenva, 35000 Rennes, France
2
CLCC Eugène Marquis, Inserm, LTSI – UMR 1099, Univ Rennes, 35000 Rennes, France
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