Special ArticleEchocardiographic and Fluoroscopic Fusion Imaging for Procedural Guidance: An Overview and Early Clinical Experience
Section snippets
Technical Considerations and Sources of Image Registration Error
The first step in fusion imaging is the process of image registration, which involves reorientation of one image (e.g., the echocardiographic image) to match the orientation of a second image (e.g., the fluoroscopic image). The currently available platform (EchoNavigator; Philips Healthcare, Best, The Netherlands) is a software-based solution that provides automated registration of two-dimensional (2D) and 3D transesophageal echocardiographic (TEE) images with x-ray fluoroscopy. Because no
Application of Fusion Imaging in the Clinical Setting
Our early clinical experience with echocardiographic-fluoroscopic fusion imaging includes 34 cases and is summarized in Table 1. We used a Philips iE33 echocardiographic system for the first 22 cases and an EPIQ machine for the remaining 12 cases (Philips Healthcare). This was coupled with a Philips Allura Xper FD20/10 fluoroscopic system (Philips Healthcare). The central processing unit running the fusion imaging software was housed in the catheterization laboratory control room and operated
Future Perspectives
Echocardiographic-fluoroscopic fusion imaging supplemented by advances in spatial and temporal resolution of 3D echocardiography will likely influence our approach to guidance of complex structural heart procedures and could serve as an imaging platform for development of future catheter-based beating-heart interventional therapies. As an example, echocardiographic guidance for transcatheter mitral valve repair is essential for procedural success and remains challenging in current clinical
Conclusions
Echocardiographic-fluoroscopic fusion imaging is now possible in the clinical setting, providing automated, real-time fusion images for the guidance of structural heart interventions. This technology provides simultaneous visualization of fine catheter manipulations under fluoroscopic guidance with detailed cardiac structural anatomy and color Doppler hemodynamic information provided by echocardiography. The system also allows the placement of fiducial markers within the echocardiographic space
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Dr. Nijhof is a full-time employee of Philips (Best, The Netherlands) and is responsible for early prototypes and development of the EchoNavigator system.