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Optimized viewing angles for cardiac electrophysiology ablation procedures

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Catheter ablation is a common treatment option for atrial fibrillation (AF). Interventional C-arm X-ray systems are used for guiding AF procedures, employing standard view positions. Since the projection angles are not adapted to the individual patient anatomy, standard projections do not necessarily offer the best views of important anatomical structures. Using a pre-procedural 3D data set acquired with MRI or CT, suitable ablation sites (lines) can be identified in advance so an ablation plan can be superimposed on fluoroscopic images to guide the procedure.

Methods

A method was developed to estimate optimized projection views for biplane X-ray C-arm systems based on planning data for AF ablation procedures. The estimated viewing angles were compared to standard angulations using an objective quality metric, the length of the planned ablation line as seen under X-ray. This method was tested using 35 clinical datasets annotated with planned ablation lines for ipsilateral pulmonary vein isolation.

Results

The optimized views computed using the new method yielded 28 % less foreshortening of pre-planned ablation lines on average. In one case, anatomy-based view calculation lead to a 69 % reduction in foreshortening.

Conclusion

The commonly used standard views provide reasonable a priori choices, and some improvement is possible by switching among common angulations depending on the treatment region. Further gains are possible by using anatomy-optimized biplane C-arm angulations.

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Acknowledgments

This work was supported by the German Federal Ministry of Education and Research (BMBF) in the context of the initiative Spitzencluster Medical Valley - Europäische Metropolregion Nürnberg, Project Grant Nos. 13EX1012A and 13EX1012E, respectively. Additional funding was provided by Siemens AG, Healthcare Sector. J. Hornegger gratefully acknowledge funding of the Erlangen Graduate School in Advanced Optical Technologies (SAOT) by the German Research Foundation (DFG) in the framework of the German excellence initiative. We thank Dr. K. Kurzidim (Krankenhaus Barmherzige Brüder, Regensburg, Germany) for providing the clinical data. The concepts and information presented in this paper are based on research and are not commercially available.

Conflict of interest

M. Koch and J. Hornegger have no conflict of interest. M. Hoffmann is funded by Siemens AG, Healthcare Sector, Forchheim, Germany. Norbert Strobel and Marcus Pfister are employees of Siemens AG, Healthcare Sector, Forchheim, Germany. The studies were carried out with support from Siemens AG, Healthcare Sector, Forchheim, Germany.

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Authors and Affiliations

  1. Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstr. 3, 91058 , Erlangen, Germany

    Martin Koch, Matthias Hoffmann & Joachim Hornegger

  2. Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91058 , Erlangen, Germany

    Joachim Hornegger

  3. Siemens AG, Healthcare Sector, Siemensstr. 1, 91301 , Forchheim, Germany

    Marcus Pfister & Norbert Strobel

Authors
  1. Martin Koch
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  2. Matthias Hoffmann
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  4. Joachim Hornegger
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  5. Norbert Strobel
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Correspondence to Martin Koch.

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Koch, M., Hoffmann, M., Pfister, M. et al. Optimized viewing angles for cardiac electrophysiology ablation procedures. Int J CARS 10, 651–664 (2015). https://doi.org/10.1007/s11548-014-1103-z

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  • DOI: https://doi.org/10.1007/s11548-014-1103-z

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