Improved imaging for x-ray guided interventions: A high resolution detector system and patient dose reduction technique
Setlur Nagesh, Swetadri Vasan
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Over the past couple of decades there has been tremendous advancements in the field of medicine and engineering technology. Increases in the level of integration between these two branches of science has led to better understanding of physiology and anatomy of a living organism, thus allowing for better understanding of diseases along with their cures and treatments. The work presented in this dissertation aims at improving the imaging aspects of x-ray image guided interventions with endovascular image guided intervention as the primary area of application. Minimally invasive treatments for neurovascular conditions such as aneurysms, stenosis, etc involve guidance of catheters to the treatment area, and deployment of treatment devices such as stents, coils, balloons, etc, all under x-ray image guidance. The features in these device are in the order of a few 10 μm's to a few 100 μm's and hence demand higher resolution imaging than the current state of the art flat panel detector. To address this issue three high resolution x-ray cameras were developed. The Micro Angiography Fluoroscope (MAF) based on a Charge Coupled Device (MAF-CCD), the MAF based on Complementary Metal Oxide Semiconductors (MAF-CMOS) and the Solid State X-ray Image Intensifier based on Electron Multiplying CCDs. The construction details along with performance evaluations are presented. The MAF-CCD was successfully used in a few interventions on human patient to treat neurovascular conditions, primarily aneurysm. Images acquired by the MAF-CCD during these procedures are presented. A software platform CAPIDS was previously developed to facilitate the use of the high resolution MAF-CCD in a clinical environment. In this work the platform was modified to be used with any camera. The upgrades to CAPIDS, along with parallel programming including both the Graphics Processing Unit (GPU) and Central Processing Unit (CPU) are presented. With increasing use of x-ray guidance for minimally invasive interventions, a major cause of concern is that of prolonged exposure to x-ray radiation that can cause biological damage to the patient. Hence during x-ray guided procedures necessary steps must be taken to minimize the dose to the patient. In this work a novel dose reduction technique, using a combination of Region of Interest (ROI) fluoroscopy to reduce dose along with spatially different temporal filtering to restore image quality is presented. Finally a novel ROI imaging technique for biplane imaging in interventional suites, combining the use of high resolution detector along with dose reduction technique using ROI fluoroscopy with spatially different temporal filtering is presented.