Abstract 1633: Novel Method for Real-time Hybrid CT and Angiography Image Registration in the Cath Lab
BACKGOUND: Currently coronary angiography and Percutaneous Coronary Interventions (PCI) are performed using contrast injections and fluoroscopic guidance. Only the lumen of the coronary vessel is imaged. However, the vessel wall composition - calcifications, soft plaque and lesion length usually cannot be accurately determined. These can be imaged using CT. We aimed to investigate the accuracy, feasibility and safety of a novel method of real time hybrid CT and angiography image registration. This integration is designed to seamlessly integrate into the regular catheterization procedure and provide the cardiologist data assisting in decision making and intervention during the procedure.
METHOD AND MATERIALS: We included patients (n=18) who underwent cardiac CT and later had cardiac catheterization. Phantoms were used to test the accuracy and potential of co-registration of information. Feasibility was performed off-line in the first twelve patients. The precision was tested using coronary marker wires and distance between bifurcations. The CT data was integrated on a separate screen on top of the angiographic data using a special AngioCT software.
RESULTS Preclinical validation, showed that the registration is feasible, accurate and measurements are precise. This was precise also for all custom working angulations during coronary angiography. Real-time registration was successful in all cases and in aided in decision making as what angulations to work for least foreshortening, which length of balloons and stent to use and assisted in deciding to attempt and cross chronic total occlusions.
CONCLUSION This is the first report of a novel method for real time hybrid CT and angiography registration. In this pilot study we found that it is feasible, accurate, and easy to use. It can be used for best working angulations for minimizing foreshortening and vessel masking, determination of stent size and location and can provide a reference vessel path and structure in cases of chronic total occlusion. The integration is done easily and fast. The system can be used also for peripheral interventions. It may reduce radiation and contrast injections, and the overall duration of the procedure and enhance precision of interventions.