Evaluation of flow with dynamic x-ray imaging for aneurysms
Dohatcu, Andreea Cristina
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The main goal of this thesis is to evaluate blood flow inside cerebrovascular aneurysms using dynamic x-ray imaging. X-ray contrast substance (dye) was auto injected in elastomer aneurysm models placed in a flow loop (for in-vitro studies) to trace flow passing through aneurysms. More specifically, an improved Time-Density Curves (TDC) Roentgen-videodensitometric tracking technique, that included looking to designated regions (R) within an aneurysm rather than focusing on the entire aneurysm, was employed to get information about blood flow using cine-angiographic sequences. It is the first time R-TDC technique has been used. In complex real-time interventions on patients, 2D/3D angiographic analysis of contrast media flow is the only reliable and rapid source of information that we have in order to assess the seriousness of the disease, suggest the treatment, and verify the result of the treatment. The present study focused on finding a "correlation metric" to quantitatively describe the flow behavior within the aneurysms and examine the hemodynamic implications of several treatments using flow modulating devices applied to saccular and bifurcation geometries aneurysms. The main idea in treatment of an aneurysm is rapid reduction of the risk of rupture. This is usually done endovascularly now by totally occluding the aneurysm by packing it with mechanical or chemical agents. Our research, however, involves a new method of blocking the neck using various types of asymmetric vascular stents (AVS). We proposed and analyzed, using R-TDCs, the feasibility of a new modified endovascular method of treatment based on alteration of blood flow through the aneurysm by partial occlusion only. In-vitro studies using aneurysm phantoms with patient-specific aneurysm models were performed. Also, for the first time the new methods were used in in-vivo studies as well, on rabbit-model experimental data, in an attempt to correlate thrombogenic response of a living organism to flow characteristics as a result of interaction with an AVS. A comparison with optical-dye-dilution data and 3D Computational Fluid Dynamics virtual angiography (CFD) data in similar conditions was also performed. Task oriented optimization of x-ray system parameters with regard to the needs of obtaining TDCs so as to obtain more accurate information of contrast media flow into aneurysms from angiographic images, were done. This includes a comparison between a commercial x-ray Flat Panel Detector (FPD) and an in-house new x-ray micro detector prototype, the Micro-Angiographic Fluoroscope (MAF). X-ray dose levels given in clinical procedures similar in length and complexity to aneurysm treatments, were studied on a statistical representative batch. It was concluded that there is a need for reduction of radiation-induced skin injuries to patients following interventional procedures. Hence, we developed and assessed a method to evaluate the variation of image quality (which impacts the success of TDC analysis) and dose with the acquisition mode operation logic and the automatic-brightness-control (ABC); this method was applied to two clinical interventional fluoroscopic imaging systems: one with an Image Intensifier (II) and the other with a Flat Panel Detector (FPD). The resultant ABC tracking curves obtained for the various imaging modes available on a given system can then be used for proper selection of technique to achieve the needed contrast signal to noise ratio to acquire adequate data for TDC evaluation, while controlling the patient dose.