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X-Ray Hybrid Modalities for Image Guidance

  • Prasheel V. Lillaney
  • Norbert J. Pelc
  • Rebecca Fahrig
Chapter

Abstract

Minimally invasive procedures using image guidance have become a popular alternative to their surgical counterparts because they offer reduced patient risk and as a result reduced morbidity. X-ray fluoroscopy can be used to provide real-time image guidance for interventional procedures. Current state-of-the-art fluoroscopy systems consist of a high-power rotating anode x-ray tube and a digital flat-panel detector. However, the lack of three-dimensional visualization has motivated the development of advanced x-ray imaging modalities for image guidance purposes which include real-time tomosynthesis, C-arm computed tomography (CT), and hybrid x-ray/MRI (X-MR).

Tomosynthesis systems traditionally require mechanical motion of the source relative to the detector. Real-time tomosynthesis can be achieved via the scanning beam digital x-ray (SBDX) system, which can obtain a limited range of angular projections without requiring mechanical motion by using a distributed source array. This system has potential applications for three-dimensional tracking of catheters as well as for image guidance for lung nodule biopsy.

C-arm CT can provide three-dimensional imaging capabilities in the interventional suite. Improvements over the past decade to C-arm systems, such as the introduction of large-area flat-panel amorphous silicon detectors and more robust gantry designs, have enabled the development of new intra-procedural applications for this imaging modality. These applications include using the three-dimensional information provided by C-arm CT to obtain brain perfusion parameters in stroke patients and performing image guidance for radio-frequency ablations to treat cardiac arrhythmias.

Hybrid X-MR systems combine the three-dimensional imaging capabilities and excellent soft tissue contrast provided by MRI with the high spatial/temporal resolution and accurate device tracking provided by x-ray. These systems have been used for a variety of intraoperative procedures including shunt deployment in the liver, brain biopsy, chemoembolization of hepatic tumors, hysterosalpingograms, and loopograms. The various hybrid system geometries present different engineering challenges, with those geometries that attempt to place the modalities very close to each other requiring modification of hardware components. The safety and compatibility of interventional devices such as catheters in an MR environment is a concern in these hybrid systems as well, and work has been performed to offer solutions to these problems.

Keywords

Focal Spot Induction Motor Lung Nodule System Geometry Fringe Field 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Prasheel V. Lillaney
    • 1
  • Norbert J. Pelc
    • 2
  • Rebecca Fahrig
    • 2
  1. 1.Departments of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Departments of Bioengineering and RadiologyStanford UniversityStanfordUSA

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