Image guidance in interventions and therapy

4D US for TIPS Minimally invasive interventions are beneficial for patients, but comes at the expense of the physician. Such interventions are often more complex than conventional interventions, because of the lack of direct eyesight and tactile feedback.

Navigation systems have been developed to improve image guidance during minimally invasive interventions. These systems generally permit the integration of pre-operative 3D images or models, and have real-time display of the instruments in the pre-operative images. After an initial alignment of the pre-operative information to the patient, a 3D position tracking system is used to track the instrument position in patient space. Such systems have found their way into clinical practice, especially for many neurosurgical and orthopedic applications, as in these applications the target anatomy is rigid, and can be tracked easily with external tracking system.

Such systems are less common in interventional radiology and cardiology, the anatomy is non-rigid, may deform (heart, abdomen) and move because of cardiac or respiratory motion. Navigation in such applications requires a different strategy. These application fields are the focus of the “Image guidance in interventions and therapy” theme group, and the main direction of research is image-based navigation.

In short, we are developing trackerless navigation approaches, where the imaging systems used for image guidance are utilized to track the anatomy and instruments, and to align pre-operative 3D models to the interventional images.

Such approaches required innovations in the following fields:

  • fast inter-modal alignment of images (X-ray to CT, US to CT)
  • fast tracking of anatomy motion and/or deformation (e.g. in 3D ultrasound)
  • fast tracking of instruments such as needles and guide wires in interventional modalities (X-ray, ultrasound)

Additionally, we are working on quantitative imaging biomarkers for interventions, i.e. imaging biomarkers that are important for therapeutic decision making and outcome prediction.

All developments in these theme group are revolving around the following interventions:

  • TIPS: we have developed a 3D ultrasound image guidance approach for TIPS interventions
  • Ablation of liver tumors: we are working in several approaches for improved guidance in liver tumors
  • TACE: we are developing roadmapping approaches for fluoroscopy guided catheterization procedures in the liver
  • PCI: we are developing roadmapping approaches for coronary interventions
  • Hernia surgery: we have developed an system for the localization of the right lumbar level for hernia surgery
  • Stroke: we are developing methods for obtaining imaging biomarkers

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