Truly hybrid interventional MR/X-ray system: investigation of in vivo applications

MR-guided Cardiac Interventions

Diagnostic and interventional cardiac catheterization is routinely used in the diagnosis and treatment of congenital heart disease. There are well-established concerns regarding the risk of radiation exposure to patients and staff, particularly in children given the cumulative effects of repeat exposure. Magnetic resonance imaging (MRI) offers the advantage of being able to provide better soft tissue visualization, tissue characterization, and quantification of ventricular volumes and vascular flow. Initial work using MRI catheterization employed fusion of x-ray and MRI techniques, with x-ray fluoroscopy to guide catheter placement and subsequent MRI assessment for anatomical and hemodynamic assessment. Image overlay of 3D previously acquired MRI datasets with live fluoroscopic imaging has also been used to guide catheter procedures.Hybrid x-ray and MRI-guided catheterization paved the way for clinical application and validation of this technique in the assessment of pulmonary vascular resistance and pharmacological stress studies. Purely MRI-guided catheterization also proved possible with passive catheter tracking. First-in-man MRI-guided cardiac catheter interventions were possible due to the development of MRI-compatible guidewires, but halted due to guidewire limitations.More recent developments in passive and active catheter tracking have led to improved visualization of catheters for MRI-guided catheterization. Improvements in hardware and software have also increased image quality and scanning times with better interactive tools for the operator in the MRI catheter suite to navigate through the anatomy as required in real time. This has expanded to MRI-guided electrophysiology studies and radiofrequency ablation in humans. Animal studies show promise for the utility of MRI-guided interventional catheterization. Ongoing investment and development of MRI-compatible guidewires will pave the way for MRI-guided diagnostic and interventional catheterization coming into the mainstream.

Portal Venous Interventions: State of the Art

In recent decades, there have been numerous advances in the management of liver cancer, cirrhosis, and diabetes mellitus. Although these diseases are wide ranging in their clinical manifestations, each can potentially be treated by exploiting the blood flow dynamics within the portal venous system, and in some cases, adding cellular therapies. To aid in the management of these disease states, minimally invasive transcatheter portal venous interventions have been developed to improve the safety of major hepatic resection, to reduce the untoward effects of sequelae from end-stage liver disease, and to minimize the requirement of exogenously administered insulin for patients with diabetes mellitus. This state of the art review therefore provides an overview of the most recent data and strategies for utilization of preoperative portal vein embolization, transjugular intrahepatic portosystemic shunt placement, balloon retrograde transvenous obliteration, and islet cell transplantation.

Electrostatic focal spot correction for x-ray tubes operating in strong magnetic fields

PURPOSE

A close proximity hybrid x-ray/magnetic resonance (XMR) imaging system offers several critical advantages over current XMR system installations that have large separation distances (∼5 m) between the imaging fields of view. The two imaging systems can be placed in close proximity to each other if an x-ray tube can be designed to be immune to the magnetic fringe fields outside of the MR bore. One of the major obstacles to robust x-ray tube design is correcting for the effects of the MR fringe field on the x-ray tube focal spot. Any fringe field component orthogonal to the x-ray tube electric field leads to electron drift altering the path of the electron trajectories.

METHODS

The method proposed in this study to correct for the electron drift utilizes an external electric field in the direction of the drift. The electric field is created using two electrodes that are positioned adjacent to the cathode. These electrodes are biased with positive and negative potential differences relative to the cathode. The design of the focusing cup assembly is constrained primarily by the strength of the MR fringe field and high voltage standoff distances between the anode, cathode, and the bias electrodes. From these constraints, a focusing cup design suitable for the close proximity XMR system geometry is derived, and a finite element model of this focusing cup geometry is simulated to demonstrate efficacy. A Monte Carlo simulation is performed to determine any effects of the modified focusing cup design on the output x-ray energy spectrum.

RESULTS

An orthogonal fringe field magnitude of 65 mT can be compensated for using bias voltages of +15 and -20 kV. These bias voltages are not sufficient to completely correct for larger orthogonal field magnitudes. Using active shielding coils in combination with the bias electrodes provides complete correction at an orthogonal field magnitude of 88.1 mT. Introducing small fields (<10 mT) parallel to the x-ray tube electric field in addition to the orthogonal field does not affect the electrostatic correction technique. However, rotation of the x-ray tube by 30° toward the MR bore increases the parallel magnetic field magnitude (∼72 mT). The presence of this larger parallel field along with the orthogonal field leads to incomplete correction. Monte Carlo simulations demonstrate that the mean energy of the x-ray spectrum is not noticeably affected by the electrostatic correction, but the output flux is reduced by 7.5%.

CONCLUSIONS

The maximum orthogonal magnetic field magnitude that can be compensated for using the proposed design is 65 mT. Larger orthogonal field magnitudes cannot be completely compensated for because a pure electrostatic approach is limited by the dielectric strength of the vacuum inside the x-ray tube insert. The electrostatic approach also suffers from limitations when there are strong magnetic fields in both the orthogonal and parallel directions because the electrons prefer to stay aligned with the parallel magnetic field. These challenging field conditions can be addressed by using a hybrid correction approach that utilizes both active shielding coils and biasing electrodes.

Design optimization of MR-compatible rotating anode x-ray tubes for stable operation

PURPOSE

Hybrid x-ray/MR systems can enhance the diagnosis and treatment of endovascular, cardiac, and neurologic disorders by using the complementary advantages of both modalities for image guidance during interventional procedures. Conventional rotating anode x-ray tubes fail near an MR imaging system, since MR fringe fields create eddy currents in the metal rotor which cause a reduction in the rotation speed of the x-ray tube motor. A new x-ray tube motor prototype has been designed and built to be operated close to a magnet. To ensure the stability and safety of the motor operation, dynamic characteristics must be analyzed to identify possible modes of mechanical failure. In this study a 3D finite element method (FEM) model was developed in order to explore possible modifications, and to optimize the motor design. The FEM provides a valuable tool that permits testing and evaluation using numerical simulation instead of building multiple prototypes.

METHODS

Two experimental approaches were used to measure resonance characteristics: the first obtained the angular speed curves of the x-ray tube motor employing an angle encoder; the second measured the power spectrum using a spectrum analyzer, in which the large amplitude of peaks indicates large vibrations. An estimate of the bearing stiffness is required to generate an accurate FEM model of motor operation. This stiffness depends on both the bearing geometry and adjacent structures (e.g., the number of balls, clearances, preload, etc.) in an assembly, and is therefore unknown. This parameter was set by matching the FEM results to measurements carried out with the anode attached to the motor, and verified by comparing FEM predictions and measurements with the anode removed. The validated FEM model was then used to sweep through design parameters [bearing stiffness (1 × 10(5)-5 × 10(7) N/m), shaft diameter (0.372-0.625 in.), rotor diameter (2.4-2.9 in.), and total length of motor (5.66-7.36 in.)] to increase the fundamental frequency past the operating range at 50 Hz.

RESULTS

The first large vibration during the prototype motor operation was obtained at 21.64 ± 0.68 Hz in the power spectrum. An abrupt decrease in acceleration occurred at 21.5 Hz due to struggling against the resonance vibrations. A bearing stiffness of 1.2 × 10(5) N/m in the FEM simulation was used to obtain a critical speed of 21.4 Hz providing 1.1% error. This bearing stiffness value and the 3D model were then confirmed by the experiments with the anode removed, demonstrating an agreement within 6.4% between simulation results and measurements. A calculated first critical frequency (fundamental frequency) of 68.5 Hz was obtained by increasing the bearing stiffness to 1 × 10(7) N/m and increasing the shaft diameter by 68.0%. Reducing the number of bearings in the design permits decreasing the total length of the motor by 1.7 in., and results in a fundamental frequency of 68.3 Hz in concert with additional changes (shaft diameter of 0.625 in., rotor diameter of 2.4 in., and bearing stiffness of 1 × 10(6) N/m).

CONCLUSIONS

An FEM model of the x-ray tube motor has been implemented and experimentally validated. A fundamental frequency above the operational rotation speed can be achieved through modification of multiple design parameters, which allows the motor to operate stably and safely in the MR environment during the repeated acceleration/deceleration cycles required for an interventional procedure. The validated 3D FEM model can now be used to investigate trade-offs between generated torque, maximum speed, and motor inertia to further optimize motor design.

Novel motor design for rotating anode x-ray tubes operating in the fringe field of a magnetic resonance imaging system

PURPOSE

Using hybrid x-ray∕MR (XMR) systems for image guidance during interventional procedures could enhance the diagnosis and treatment of neurologic, oncologic, cardiovascular, and other disorders. The authors propose a close proximity hybrid system design in which a C-arm fluoroscopy unit is placed immediately adjacent to the solenoid magnet of a MR system with a minimum distance of 1.2 m between the x-ray and MR imaging fields of view. Existing rotating anode x-ray tube designs fail within MR fringe field environments because the magnetic fields alter the electron trajectories in the x-ray tube and act as a brake on the induction motor, reducing the rotation speed of the anode. In this study the authors propose a novel motor design that avoids the anode rotation speed reduction.

METHODS

The proposed design replaces the permanent magnet stator found in brushed dc motors with the radial component of the MR fringe field. The x-ray tube is oriented such that the radial component of the MR fringe field is orthogonal to the cathode-anode axis. Using a feedback position sensor and the support bearings as electrical slip rings, the authors use electrical commutation to eliminate the need for mechanical brushes and commutators. A vacuum compatible prototype of the proposed motor design was assembled, and its performance was evaluated at various operating conditions. The prototype consisted of a 3.1 in. diameter anode rated at 300 kHU with a ceramic rotor that was 5.6 in. in length and had a 2.9 in. diameter. The material chosen for all ceramic components was MACOR, a machineable glass ceramic developed by Corning Inc. The approximate weight of the entire assembly was 1750 g. The maximum rotation speed, angular acceleration, and acceleration time of the motor design were investigated, as well as the dependence of these parameters on rotor angular offset, magnetic field strength, and field orientation. The resonance properties of the authors' assembly were also evaluated to determine its stability during acceleration, and a pulse width modulation algorithm was implemented to control the rotation speed of the motor.

RESULTS

At a magnetic flux density of 41 mT orthogonal to the axis of rotation (on the lower end of the expected flux density in the MR suite) the maximum speed of the motor was found to be 5150 revolutions per minute (rpm). The acceleration time necessary to reach 3000 rpm was found to be approximately 10 s at 59 mT. The resonance frequency of the assembly with the anode attached was 1310 rpm (21.8 Hz) which is far below the desired operating speeds. Pulse width modulation provides an effective method to control the speed of the motor with a resolution of 100 rpm.

CONCLUSIONS

The proposed design can serve as a direct replacement to the conventional induction motor used in rotating anode x-ray tubes. It does not suffer from a reduced rotation speed when operating in a MR environment. The presence of chromic steel bearings in the prototype prevented testing at the higher field strengths, and future iterations of the design could eliminate this shortcoming. The prototype assembly demonstrates proof of concept of the authors' design and overcomes one of the major obstacles for a MR compatible rotating anode x-ray tube.

Magnetostatic focal spot correction for x-ray tubes operating in strong magnetic fields using iterative optimization

PURPOSE

Combining x-ray fluoroscopy and MR imaging systems for guidance of interventional procedures has become more commonplace. By designing an x-ray tube that is immune to the magnetic fields outside of the MR bore, the two systems can be placed in close proximity to each other. A major obstacle to robust x-ray tube design is correcting for the effects of the magnetic fields on the x-ray tube focal spot. A potential solution is to design active shielding that locally cancels the magnetic fields near the focal spot.

METHODS

An iterative optimization algorithm is implemented to design resistive active shielding coils that will be placed outside the x-ray tube insert. The optimization procedure attempts to minimize the power consumption of the shielding coils while satisfying magnetic field homogeneity constraints. The algorithm is composed of a linear programming step and a nonlinear programming step that are interleaved with each other. The coil results are verified using a finite element space charge simulation of the electron beam inside the x-ray tube. To alleviate heating concerns an optimized coil solution is derived that includes a neodymium permanent magnet. Any demagnetization of the permanent magnet is calculated prior to solving for the optimized coils. The temperature dynamics of the coil solutions are calculated using a lumped parameter model, which is used to estimate operation times of the coils before temperature failure.

RESULTS

For a magnetic field strength of 88 mT, the algorithm solves for coils that consume 588 A∕cm(2). This specific coil geometry can operate for 15 min continuously before reaching temperature failure. By including a neodymium magnet in the design the current density drops to 337 A∕cm(2), which increases the operation time to 59 min. Space charge simulations verify that the coil designs are effective, but for oblique x-ray tube geometries there is still distortion of the focal spot shape along with deflections of approximately 3 mm in the radial and circumferential directions on the anode.

CONCLUSIONS

Active shielding is an attractive solution for correcting the effects of magnetic fields on the x-ray focal spot. If extremely long fluoroscopic exposure times are required, longer operation times can be achieved by including a permanent magnet with the active shielding design.

Development of subject-specific geometric spine model through use of automated active contour segmentation and kinematic constraint-limited registration

This paper describes the development of a patient-specific spine model through use of active contour segmentation and registration of intraoperative imaging of porcine vertebra augmented with kinematic constraints. The geometric active contours are fully automated and lead to a discrete representation of the image segmentation results. After determining errors within the segmentations, application of reliability theory allows the selection of active contour parameters to obtain best-fit segmentations from a stack of 2D images. The segmented images are then used in conjunction with C-arm fluoroscope images to simulate the result of intraoperative patient-specific model registration including patient and/or structure motion between preoperative and intraoperative scans. The results are validated through comparison of the error within the patient-specific model generated through use of the C-arm images with a model acquired directly from MRI images of the spine after motion. The results are applicable to the development of a wide variety of patient-specific geometric and biomechanical models.

Emerging roles for integrated imaging modalities in cardiovascular cell-based therapeutics: a clinical perspective

Despite preclinical promise, the progress of cell-based therapy to clinical cardiovascular practice has been slowed by several challenges and uncertainties that have been highlighted by the conflicting results of human trials. Most telling has been the revelation that current strategies fall short of achieving sufficient retention and engraftment of cells to meet the ambitious objective of myocardial regeneration. This has sparked novel research into the refinement of cell biology and delivery to overcome these shortcomings. Within this context, molecular imaging has emerged as a valuable tool for providing noninvasive surveillance of cell fate in vivo. Direct and indirect labelling of cells can be coupled with clinically relevant imaging modalities, such as radionuclide single photon emission computed tomography and positron emission tomography, and magnetic resonance imaging, to assess their short- and long-term distributions, along with their viability, proliferation and functional interaction with the host myocardium. This review details the strengths and limitations of the different cell labelling and imaging techniques and their potential application to the clinical realm. We also consider the broader, multifaceted utility of imaging throughout the cell therapy process, providing a discussion of its considerable value during cell delivery and its importance during the evaluation of cardiac outcomes in clinical studies.

Shimming with permanent magnets for the x-ray detector in a hybrid x-ray/ MR system

In this x-ray/MR hybrid system an x-ray flat panel detector is placed under the patient cradle, close to the MR volume of interest (VOI), where the magnetic field strength is approximately 0.5 T. Immersed in this strong field, several electronic components inside the detector become magnetized and create an additional magnetic field that is superimposed on the original field of the MR scanner. Even after linear shimming, the field homogeneity of the MR scanner remains disrupted by the detector. The authors characterize the field due to the detector with the field of two magnetic dipoles and further show that two sets of permanent magnets (NdFeB) can withstand the main magnetic field and compensate for the nonlinear components of the additional field. The ideal number of magnets and their locations are calculated based on a field map measured with the detector in place. Experimental results demonstrate great promise for this technique, which may be useful in many settings where devices with magnetic components need to be placed inside or close to an MR scanner.

Adaptive 4D MR imaging using navigator-based respiratory signal for MRI-guided therapy

For real-time 3D visualization of respiratory organ motion for MRI-guided therapy, a new adaptive 4D MR imaging method based on navigator echo and multiple gating windows was developed. This method was designed to acquire a time series of volumetric 3D images of a cyclically moving organ, enabling therapy to be guided by synchronizing the 4D image with the actual organ motion in real time. The proposed method was implemented in an open-configuration 0.5T clinical MR scanner. To evaluate the feasibility and determine optimal imaging conditions, studies were conducted with a phantom, volunteers, and a patient. In the phantom study the root mean square (RMS) position error in the 4D image of the cyclically moving phantom was 1.9 mm and the imaging time was approximately 10 min when the 4D image had six frames. In the patient study, 4D images were successfully acquired under clinical conditions and a liver tumor was discriminated in the series of frames. The image quality was affected by the relations among the encoding direction, the slice orientation, and the direction of motion of the target organ. In conclusion, this study has shown that the proposed method is feasible and capable of providing a real-time dynamic 3D atlas for surgical navigation with sufficient accuracy and image quality.

MRI-guided interventions of the musculoskeletal system

MRI has become the modality of choice for many diagnostic questions in musculoskeletal radiology. Naturally, with the increasing role of MRI in diagnosis of musculoskeletal conditions, clinicians have been eager to explore the possibility of using MR guidance for musculoskeletal procedures. Researchers are actively investigating the utility and practicality of MRI compared with more established modalities for procedure guidance such as computed tomography, fluoroscopy, and ultrasound. Early studies have demonstrated the safety and feasibility of MR guidance for biopsies, spine procedures, cyst aspirations, therapeutic injections, and tumor ablation. Applications in the musculoskeletal system are likely to expand as technology improves and clinicians gain more experience. Hybrid X-ray fluoroscopy/MR imaging systems hold great promise for the future of musculoskeletal intervention by combining the excellent temporal and spatial resolution of X-ray with the anatomic detail provided by MRI.

MR-guided biopsy: a review of current techniques and applications

Biopsy has become a cornerstone of modern medicine and most modern biopsies are performed percutaneously using image guidance, typically computed tomography or ultrasound. MR-guided biopsy offers many advantages over these more traditional modalities, and the recent development of interventional MR imaging techniques has made MR-guided percutaneous biopsies and aspirations a clinical reality. As the field of MR-guided procedures continues to expand and to attract more attention from radiologists, it is important to understand the concepts, techniques, applications, advantages, and limitations of MR-guided biopsy/percutaneous procedures. Radiologists should also recognize the need for their significant involvement in the technical aspects of MR-guided procedures, since several user-defined parameters can alter device visualization in the MR imaging environment and affect procedure safety. This article reviews the prerequisites, systems, and applications of MR-guided biopsy.

Investigation of electron trajectories of an x-ray tube in magnetic fields of MR scanners

A hybrid x-ray/MR system combining an x-ray fluoroscopic system and an open-bore magnetic resonance (MR) system offers advantages from both powerful imaging modalities and thus can benefit numerous image-guided interventional procedures. In our hybrid system configurations, the x-ray tube and detector are placed in the MR magnet and therefore experience a strong magnetic field. The electron beam inside the x-ray tube can be deflected by a misaligned magnetic field, which may damage the tube. Understanding the deflection process is crucial to predicting the electron beam deflection and avoiding potential damage to the x-ray tube. For this purpose, the motion of an electron in combined electric (E) and magnetic (B) fields was analyzed theoretically to provide general solutions that can be applied to different geometries. For two specific cases, a slightly misaligned strong field and a perpendicular weak field, computer simulations were performed with a finite-element method program. In addition, experiments were conducted using an open MRI magnet and an inserted electromagnet to quantitatively verify the relationship between the deflections and the field misalignment. In a strong (B >> E/c; c: speed of light) and slightly misaligned magnetic field, the deflection in the plane of E and B caused by electrons following the magnetic field lines is the dominant component compared to the deflection in the E X B direction due to the drift of electrons. In a weak magnetic field (B < or = E/c), the main deflection is in the E x B direction and is caused by the perpendicular component of the magnetic field.

Renal Artery Stenosis in Swine: Feasibility of MR Assessment of Renal Function during Percutaneous Transluminal Angioplasty

PURPOSE

To prospectively test--in a swine model of renal artery stenosis (RAS)--the hypothesis that magnetic resonance (MR) imaging can reveal changes in renal function at the time of percutaneous transluminal angioplasty (PTA).

MATERIALS AND METHODS

In this animal care and use committee-approved study, high-grade unilateral RAS was surgically induced in six pigs. MR imaging at 3.0 T was used for intraprocedural assessment of the anatomic and physiologic changes induced by x-ray-guided PTA. With use of MR imaging, changes in single-kidney glomerular filtration rate, extraction fraction, and renal blood flow were assessed during PTA. The arterial diameter of stenosis before and after PTA was assessed by using conventional digital subtraction angiography. Mean changes in functional and anatomic parameters were compared by using the Wilcoxon signed rank test (alpha = .05).

RESULTS

At digital subtraction angiography, the mean percentage of stenosis was 69% +/- 10 (standard deviation) before PTA and 26% +/- 10 after PTA (P<.03). Mean pre- and post-PTA extraction fraction values were 0.11 +/- 0.03 and 0.19 +/- 0.06, respectively (P<.03). The mean single-kidney glomerular filtration rate before PTA, 19 mL/min +/- 13, increased to 41 mL/min +/- 33 after PTA (P<.03). There was no significant change in mean renal blood flow after PTA (P=.44).

CONCLUSION

In swine, MR imaging can reveal changes in renal function after x-ray-guided PTA for unilateral RAS.

Study of increased radiation when an x-ray tube is placed in a strong magnetic field

When a fixed anode x-ray tube is placed in a magnetic field (B) that is parallel to the anode-cathode axis, the x-ray exposure increases with increasing B. It was hypothesized that the increase was caused by backscattered electrons which were constrained by B and reaccelerated by the electric field onto the x-ray tube target. We performed computer simulations and physical experiments to study the behavior of the backscattered electrons in a magnetic field, and their effects on the radiation output, x-ray spectrum, and off-focal radiation. A Monte Carlo program (EGS4) was used to generate the combined energy and angular distribution of the backscattered electrons. The electron trajectories were traced and their landing locations back on the anode were calculated. Radiation emission from each point was modeled with published data (IPEM Report 78), and thus the exposure rate and x-ray spectrum with the contribution of backscattered electrons could be predicted. The point spread function for a pencil beam of electrons was generated and then convolved with the density map of primary electrons incident on the anode as simulated with a finite element program (Opera-3d, Vector Fields, UK). The total spatial distribution of x-ray emission could then be calculated. Simulations showed that for an x-ray tube working at 65 kV, about 54% of the electrons incident on the target were backscattered. In a magnetic field of 0.5 T, although the exposure would be increased by 33%, only a small fraction of the backscattered electrons landed within the focal spot area. The x-ray spectrum was slightly shifted to lower energies and the half value layer (HVL) was reduced by about 6%. Measurements of the exposure rate, half value layer and focal spot distribution were acquired as functions of B. Good agreement was observed between experimental data and simulation results. The wide spatial distribution of secondary x-ray emission can degrade the MTF of the x-ray system at low spatial frequencies for B < 0.5 T.

COMBINED X-RAY AND MAGNETIC RESONANCE IMAGING FACILITY

OBJECTIVE

To assess the feasibility of a hybrid imaging setup combining x-ray and magnetic resonance imaging (MRI) in the setting of both stereotactic and functional neurosurgery.

METHODS

A combined x-ray and MRI scanning facility with a trolley system for a fast patient transfer between both modalities was installed in a neurosurgical setting. A registration algorithm for fusion of MRI scans and x-ray images was derived for augmentation of fluoroscopic x-ray projection images with MRI scan data, such as anatomic structures and planned probe trajectories. Phantom measurements were obtained between both modalities for estimation of registration accuracy. Practical application of our system in stereotactic and functional neurosurgery was tested in brachytherapy, deep brain stimulation, and motor cortex stimulation.

RESULTS

Phantom measurements yielded a mean spatial deviation of 0.7 +/- 0.3 mm with a maximum deviation of 1.1 mm for MRI scans versus x-rays. Augmentation of x-ray images with MRI scan data allowed intraoperative verification of the planned trajectory and target in three types of neurosurgical procedures: positioning iodine seeds in brachytherapy in one case with cerebellar metastasis, placement of electrodes for deep brain stimulation in two cases of advanced Parkinson's disease, and placement of an epidural grid for motor cortex stimulation in two cases of intractable pain.

CONCLUSION

Combined x-ray and MRI-guided stereotactic and functional neurosurgery is feasible. Augmentation of x-ray projection images with MRI scan data, such as planned probe trajectories and MRI scan segmented anatomic structures may be beneficial for probe guidance in stereotactic and functional neurosurgery.

Compatibility of interventional x-ray and magnetic resonance imaging: feasibility of a closed bore XMR (CBXMR) system

A next-generation interventional guidance system is proposed that will enable intraprocedural access to both x-ray and magnetic resonance imaging (MRI) modalities. This closed bore XMR (CBXMR) system is comprised of a conventional radiographic rotating anode x-ray tube and a direct conversion flat panel detector on a rotating gantry positioned adjacent to the bore of a 1.5 T MRI. To assess the feasibility of such a system, we have investigated the degree of compatibility between the x-ray components and the MRI. For /-->B(ext)/ < 200 G the effect on the radiographic tube motor was negligible regardless of the orientation of -->B(ext) with respect to the motor axis of rotation--the frequency of anode rotation remained within 6% of the 3400 rpm frequency measured at 0 G. For /-->B(ext)/ >2400 G the anode slowed down to below 2400 rpm at all orientations. At intermediate B(ext), the frequency of rotation varied between 2400 and 3200 rpm, showing a strong dependence on orientation, with -->B(ext) perpendicular to the tube axis having a much stronger effect on the rotation frequency than -->B(ext) parallel to the tube axis. In contrast to the effect of -->B(ext) on the induction motor, parallel -->B(ext) had a stronger detrimental effect on the cathode-anode electron beam, whose path was at 16 degrees to the tube axis, than the perpendicular -->B(ext). Parallel -->B(ext) of several hundred Gauss had a defocusing effect on the x-ray focal spot. -->B(ext) perpendicular to the electron beam shifted the beam without significant defocusing. We have determined that the direct conversion flat panel detector (FPD) technology is not intrinsically sensitive to -->B(ext), and that the modifications required to make the proposed FPDs MRI compatible are minimal. The homogeneity of the MRI signal in the normal field of view was not significantly degraded by the presence of these x-ray components in the vicinity of the MRI bore entrance.

MRI-guided congenital cardiac catheterization and intervention: the future?

Over the last 10 years, a number of technological advances have allowed real-time magnetic resonance imaging to guide cardiac catheterization, including improved image quality, faster scanning times, and open magnets allowing access to the patient. Potential advantages include better soft tissue imaging to improve catheter manipulation and additional functional information to assist with interventional decision-making, all without exposure to ionizing radiation. MRI-guided diagnostic catheterization, balloon dilation, stent placement, valvar replacement, atrial septal defect closure, and radiofrequency ablation all have been shown feasible in animal models. MRI-guided catheterization has the potential to replace the current X-ray-based diagnostic and interventional procedures for children with congenital heart disease, avoiding all radiation exposure while improving soft tissue imaging.

Multimodal Contrast Agent for Combined Computed Tomography and Magnetic Resonance Imaging Applications

OBJECTIVE

The objective of this study was to examine the feasibility of a multimodal system to effectively induce and maintain contrast enhancement in both computed tomography (CT) and magnetic resonance (MR) for radiation therapy applications.

MATERIALS AND METHODS

The physicochemical characteristics of a liposome-encapsulated iohexol and gadoteridol formulation were assessed in terms of agent loading efficiencies, size and morphology, in vitro stability, and release kinetics. The imaging properties of the liposome formulation were assessed based on T1 and T2 relaxivity measurements and in vitro CT and MR imaging in a phantom. A preliminary imaging-based evaluation of the in vivo stability of this multimodal contrast agent was also performed in a lupine model.

RESULTS

The average agent loading levels achieved were 26.5+/-3.8 mg/mL for iodine and 6.6+/- 1.5 mg/mL for gadolinium. These concentrations correspond to approximately 10% of that found in the commercially available preparations of each of these agents. However, this liposome-based formulation is expected to have a smaller volume of distribution and prolonged circulation lifetime in vivo. This multimodal system was found to have high agent retention in vitro, which translated into maintained contrast enhancement (up to 3 days) and stability in vivo.

CONCLUSIONS

This study demonstrated the feasibility of engineering a multimodal contrast agent with prolonged contrast enhancement in vivo for use in CT and MR. This contrast agent may serve as a valuable tool for cardiovascular imaging as well as image registration and guidance applications in radiation therapy.

Robust x-ray tubes for use within magnetic fields of MR scanners

A hybrid system that combines an x-ray fluoroscopic system and a magnetic resonance (MR) system can provide physicians with the synergy of exquisite soft tissue contrast (from MR) and high temporal and spatial resolutions (from x ray), which may significantly benefit a number of image-guided interventional procedures. However, the system configuration may require the x-ray tube to be placed in a magnetic field, which can hinder the proper functioning of the x-ray tube by deflecting its electron beam. From knowledge of how the magnetic field affects the electron trajectories, we propose creating another magnetic field along the cathode-anode axis using either solenoids or permanent magnets to reduce the deflection of the electron beam for two cases: a strong and slightly misaligned field or a weak field that is arbitrary in direction. Theoretical analysis is presented and the electron beam is simulated in various external magnetic fields with a finite element modeling program. Results show that both correction schemes enhance the robustness of the x-ray tube operation in an externally applied magnetic field.

Truly hybrid X-ray/MR imaging: toward a streamlined clinical system

RATIONALE AND OBJECTIVE

We have installed an improved X-ray/MR (XMR) truly hybrid system with higher imaging signal-to-noise ratio (SNR) and versatility than our first prototype. In our XMR design, a fixed anode X-ray fluoroscopy system is positioned between the two donut-shaped magnetic poles of a 0.5T GE Signa-SP magnet (SP-XMR). This paper describes the methods for increased compatibility between the upgraded x-ray and MR systems that have helped improve patient management.

MATERIALS AND METHODS

A GE OEC 9800 system (GE OEC Salt Lake City, UT) was specially reconfigured for permitting X-ray fluoroscopy inside the interventional magnet. A higher power X-ray tube, a new permanent tube mounting system, automatic exposure control (AEC), remote controlled collimators, choice of multiple frame rates, DICOM image compatibility, magnetically shimmed X-ray detector, X-ray compatible MR coil, and better RF shielding are the highlights of the new system. A total of 23 clinical procedures have been conducted with SP-XMR guidance of which five were performed using the new system.

RESULTS

The 70% increased power for fluoroscopy, and a new 6 times higher power single frame imaging mode, has improved imaging capability. The choice of multiple imaging frame rates, AEC, and collimator control allow reduction in X-ray exposure to the patient. The DICOM formatting has permitted easy transfer of clinical images over the hospital PACS network. The increased MR compatibility of the detector and the X-ray transparent MR coil has enabled faster switching between X-ray and MR imaging modes.

CONCLUSION

The improvements introduced in our SP-XMR system have further streamlined X-ray/MR hybrid imaging. Additional clinical procedures could benefit from the new SP-XMR imaging.

The Interventional MR Imaging Suite: Magnet Designs and Equipment Requirements

Soon after the introduction of MR imaging as an imaging tool, researchers began to investigate its capabilities to guide interventional minimally invasive procedures, such as biopsies. These early efforts have encouraged vendors and numerous research groups worldwide to identify clinical problems in the field of image-guided intervention, for which MR imaging is beneficial as an imaging modality, and to develop and refine soft-ware and hardware components to meet the specific requirements of interventional MR imaging. Over nearly 20 years, continuous advances in magnet and system design have accelerated the progress of MR-guided intervention.

MR-guided transjugular intrahepatic portosystemic shunt creation with use of a hybrid radiography/MR system

PURPOSE

To evaluate the performance of a combined hybrid radiography/magnetic resonance (MR) unit to guide portal vein (PV) puncture during human transjugular intrahepatic portosystemic shunt (TIPS) creation.

MATERIALS AND METHODS

Fourteen patients undergoing TIPS creation were studied during standard clinical applications. Patients were anesthetized and then positioned in an open MR unit containing a flat-panel radiographic fluoroscopic unit. With use of a combination of fluoroscopy and MR imaging, the PV was accessed and the TIPS procedure was performed. A noncovered nitinol stent or a covered stent-graft was placed in the TIPS tract. Number of punctures required, total procedure time, fluoroscopy time, procedural success rate, complications, and ultrasonographic and clinical follow-up were recorded.

RESULTS

Clinical success was obtained in 13 of 14 patients. In one patient, extrahepatic puncture of the PV occurred, resulting in hemorrhage and requiring placement of a covered stent to control the bleeding. The mean number of punctures required to access the PV was 2.6 +/- 1.7, and the total procedure time was 2.5 hours +/- 0.6. Mean fluoroscopy time was 22.3 minutes +/- 5.5. Results of clinical and ultrasonographic follow-up compare favorably to previously published reports.

CONCLUSION

TIPS creation with a combination hybrid radiography/MR unit is feasible and may reduce the number of needle passes required and radiation exposure, with similar overall outcomes compared with studies reported in the literature.

Performance of a static-anode/flat-panel x-ray fluoroscopy system in a diagnostic strength magnetic field: A truly hybrid x-ray/MR imaging system

Minimally invasive procedures are increasing in variety and frequency, facilitated by advances in imaging technology. Our hybrid imaging system (GE Apollo flat panel, custom Brand x-ray static anode x-ray tube, GE Lunar high-frequency power supply and 0.5 T Signa SP) provides both x-ray and MR imaging capability to guide complex procedures without requiring motion of the patient between two distant gantries. The performance of the x-ray tube in this closely integrated system was evaluated by modeling and measuring both the response of the filament to an externally applied field and the behavior of the electron beam for field strengths and geometries of interest. The performance of the detector was assessed by measuring the slanted-edge modulation transfer function (MTF) and when placed at zero field and at 0.5 T. Measured resonant frequencies of filaments can be approximated using a modified vibrating beam model, and were at frequencies well below the 25 kHz frequency of our generator for our filament geometry. The amplitude of vibration was not sufficient to cause shorting of the filament during operation within the magnetic field. A simple model of electrons in uniform electric and magnetic fields can be used to estimate the deflection of the electron beam on the anode for the fields of interest between 0.2 and 0.5 T. The MTF measured at the detector and the DQE showed no significant difference inside and outside of the magnetic field. With the proper modifications, an x-ray system can be fully integrated with a MR system, with minimal loss of image quality. Any x-ray tube can be assessed for compatibility when placed at a particular location within the field using the models. We have also concluded that a-Si electronics are robust against magnetic fields. Detailed knowledge of the x-ray system installation is required to provide estimates of system operation.

Volume CT with a flat-panel detector on a mobile, isocentric C-arm: Pre-clinical investigation in guidance of minimally invasive surgery

A mobile isocentric C-arm (Siemens PowerMobil) has been modified in our laboratory to include a large area flat-panel detector (in place of the x-ray image intensifier), providing multi-mode fluoroscopy and cone-beam computed tomography (CT) imaging capability. This platform represents a promising technology for minimally invasive, image-guided surgical procedures where precision in the placement of interventional tools with respect to bony and soft-tissue structures is critical. The image quality and performance in surgical guidance was investigated in pre-clinical evaluation in image-guided spinal surgery. The control, acquisition, and reconstruction system are described. The reproducibility of geometric calibration, essential to achieving high three-dimensional (3D) image quality, is tested over extended time scales (7 months) and across a broad range in C-arm angulation (up to 45 degrees), quantifying the effect of improper calibration on spatial resolution, soft-tissue visibility, and image artifacts. Phantom studies were performed to investigate the precision of 3D localization (viz., fiber optic probes within a vertebral body) and effect of lateral projection truncation (limited field of view) on soft-tissue detectability in image reconstructions. Pre-clinical investigation was undertaken in a specific spinal procedure (photodynamic therapy of spinal metastases) in five animal subjects (pigs). In each procedure, placement of fiber optic catheters in two vertebrae (L1 and L2) was guided by fluoroscopy and cone-beam CT. Experience across five procedures is reported, focusing on 3D image quality, the effects of respiratory motion, limited field of view, reconstruction filter, and imaging dose. Overall, the intraoperative cone-beam CT images were sufficient for guidance of needles and catheters with respect to bony anatomy and improved surgical performance and confidence through 3D visualization and verification of transpedicular trajectories and tool placement. Future investigation includes improvement in image quality, particularly regarding x-ray scatter, motion artifacts and field of view, and integration with optical tracking and navigation systems.

X-ray compatible radiofrequency coil for magnetic resonance imaging

The range of RF coils that can be used in combined X-ray/MR (XMR) systems is limited because many conventional coils contain highly X-ray attenuating materials that are visible in the X-ray images and potentially obscure patient anatomy. In this study, an X-ray compatible coil design that has minimal X-ray attenuation in the field of view (FOV) of the X-ray image is presented. In this design, aluminum is used for the loop conductor and discrete elements of the coil are eliminated from the X-ray FOV. A surface coil and an abdominal phased array coil were built using the X-ray compatible design. X-ray attenuation and MR imaging properties of the coils were evaluated and compared to conventional coils. The X-ray compatible phased array coil was used to image patients during two interventional procedures in the XMR system. The X-ray compatible coils allowed for fluoroscopic X-ray image acquisition, without degradation by the coil, while maintaining excellent MR imaging qualities.

Co-registration of x-ray and MR fields of view in a hybrid XMR system

PURPOSE

To validate one possible function of a real-time x-ray/MR (XMR) interface in a hybrid XMR system using x-ray images as "scouts" to prescribe the MR slices.

MATERIALS AND METHODS

The registration process consists of two steps: 1) calibration, in which the system's geometric parameters are found from fiducial-based registration; and 2) application, in which the x-ray image of a target structure and the estimated geometric parameters are used to prescribe an MR slice to observe the target structure. Errors from the noise in the location of the fiducial markers, and MR gradient nonlinearity were studied. Computer simulations were used to provide guidelines for fiducial marker placement and tolerable error estimation. A least-squares-based correction method was developed to reduce errors from gradient nonlinearity.

RESULTS

In simulations with both sources of errors and the correction for gradient nonlinearity, the use of 16 fiducial markers yielded a mean error of about 0.4 mm over a 7200 cm(3) volume. Phantom scans showed that the prescribed target slice hit most of the target line, and that the length visualized was improved with the least-squares correction.

CONCLUSION

The use of 16 fiducial markers to co-register XMR FOVs can offer satisfactory accuracy in both simulations and experiments.

Registration and tracking to integrate X-ray and MR images in an XMR facility

We describe a registration and tracking technique to integrate cardiac X-ray images and cardiac magnetic resonance (MR) images acquired from a combined X-ray and MR interventional suite (XMR). Optical tracking is used to determine the transformation matrices relating MR image coordinates and X-ray image coordinates. Calibration of X-ray projection geometry and tracking of the X-ray C-arm and table enable three-dimensional (3-D) reconstruction of vessel centerlines and catheters from bi-plane X-ray views. We can, therefore, combine single X-ray projection images with registered projection MR images from a volume acquisition, and we can also display 3-D reconstructions of catheters within a 3-D or multi-slice MR volume. Registration errors were assessed using phantom experiments. Errors in the combined projection images (two-dimensional target registration error--TRE) were found to be 2.4 to 4.2 mm, and the errors in the integrated volume representation (3-D TRE) were found to be 4.6 to 5.1 mm. These errors are clinically acceptable for alignment of images of the great vessels and the chambers of the heart. Results are shown for two patients. The first involves overlay of a catheter used for invasive pressure measurements on an MR volume that provides anatomical context. The second involves overlay of invasive electrode catheters (including a basket catheter) on a tagged MR volume in order to relate electrophysiology to myocardial motion in a patient with an arrhythmia. Visual assessment of these results suggests the errors were of a similar magnitude to those obtained in the phantom measurements.

Endovascular interventional magnetic resonance imaging

Minimally invasive interventional radiological procedures, such as balloon angioplasty, stent placement or coiling of aneurysms, play an increasingly important role in the treatment of patients suffering from vascular disease. The non-destructive nature of magnetic resonance imaging (MRI), its ability to combine the acquisition of high quality anatomical images and functional information, such as blood flow velocities, perfusion and diffusion, together with its inherent three dimensionality and tomographic imaging capacities, have been advocated as advantages of using the MRI technique for guidance of endovascular radiological interventions. Within this light, endovascular interventional MRI has emerged as an interesting and promising new branch of interventional radiology. In this review article, the authors will give an overview of the most important issues related to this field. In this context, we will focus on the prerequisites for endovascular interventional MRI to come to maturity. In particular, the various approaches for device tracking that were proposed will be discussed and categorized. Furthermore, dedicated MRI systems, safety and compatibility issues and promising applications that could become clinical practice in the future will be discussed.