Navigation of guidewires and catheters in the body during intervention procedures: a review of computer-based models

Multibody dynamic modeling of the behavior of flexible instruments used in cervical cancer brachytherapy

BACKGROUND

The steep radiation dose gradients in cervical cancer brachytherapy (BT) necessitate a thorough understanding of the behavior of afterloader source cables or needles in the curved channels of (patient-tailored) applicators.

PURPOSE

The purpose of this study is to develop and validate computer models to simulate: (1) BT source positions, and (2) insertion forces of needles in curved applicator channels. The methodology presented can be used to improve the knowledge of instrument behavior in current applicators and aid the development of novel (3D-printed) BT applicators.

METHODS

For the computer models, BT instruments were discretized in finite elements. Simulations were performed in SPACAR by formulating nodal contact force and motion input models and specifying the instruments' kinematic and dynamic properties. To evaluate the source cable model, simulated source paths in ring applicators were compared with manufacturer-measured source paths. The impact of discrepancies on the dosimetry was estimated for standard plans. To validate needle models, simulated needle insertion forces in curved channels with varying curvature, torsion, and clearance, were compared with force measurements in dedicated 3D-printed templates.

RESULTS

Comparison of simulated with manufacturer-measured source positions showed 0.5-1.2 mm median and <2.0 mm maximum differences, in all but one applicator geometry. The resulting maximum relative dose differences at the lateral surface and at 5 mm depth were 5.5% and 4.7%, respectively. Simulated insertion forces for BT needles in curved channels accurately resembled the forces experimentally obtained by including experimental uncertainties in the simulation.

CONCLUSION

The models developed can accurately predict source positions and insertion forces in BT applicators. Insights from these models can aid novel applicator design with improved motion and force transmission of BT instruments, and contribute to the estimation of overall treatment precision. The methodology presented can be extended to study other applicator geometries, flexible instruments, and afterloading systems.

Advanced CT Imaging for the Assessment of Calcific Coronary Artery Disease and PCI Planning

Vascular calcification is a hallmark of atherosclerosis and adds considerable challenges for percutaneous coronary intervention (PCI). This review underscores the critical role of coronary computed tomography (CT) angiography in assessing and quantifying vascular calcification for optimal PCI planning. Severe calcification significantly impacts procedural outcomes, necessitating accurate preprocedural evaluation. We describe the potential of coronary CT for calcium assessment and how CT may enhance precision in device selection and procedural strategy. These advancements, along with the ongoing Precise Procedural and PCI Plan study, represent a transformative shift toward personalized PCI interventions, ultimately improving patient outcomes in the challenging landscape of calcified coronary lesions.

Numerical Methodology to Evaluate Trackability and Pushability of PTCA Balloon Catheter

PURPOSE

During percutaneous coronary intervention (PCI), the ability to navigate a catheter without causing injury to the vessel and damage to the device is crucial outcome of the procedure. This study aimed to develop a numerical model to analyse the percutaneous transluminal coronary angioplasty (PTCA) catheter navigation in coronary vessels.

METHODS

Trackability and pushability are two major parameters used to characterize the navigation of PTCA balloon catheters, and they are influenced by vessel tortuosity, contact interactions and catheter design. In the current study, finite element analysis model is presented to evaluate trackability and pushability considering two different vessel geometries. Impact of contact interactions among catheter, guidewire, and vessel were studied to validate the numerical model with in vitro test data. Further, a parametric study was conducted to understand the influence of distal shaft, and proximal shaft outer diameter.

RESULTS

Obtained results suggest that contact interaction and co-efficient of friction between guidewire and catheter are critical parameters to obtain numerical results comparable to experimental data. Results from the parametric study predicted strong positive correlation of distal shaft diameter on pushability, and weak correlation on trackability force. Furthermore, parametric variation in proximal shaft diameter has strong positive correlation on trackability force and strong negative correlation on pushability.

CONCLUSION

Numerical methodology presented in this study is a preliminary attempt to simulate the behavior of PTCA balloon catheter navigation. This methodology will be helpful in the design and optimization of PTCA balloon catheter and similar devices with improved deliverability.

Position-based dynamics simulator of vessel deformations for path planning in robotic endovascular catheterization

A major challenge during autonomous navigation in endovascular interventions is the complexity of operating in a deformable but constrained workspace with an instrument. Simulation of deformations for it can provide a cost-effective training platform for path planning. Aim of this study is to develop a realistic, auto-adaptive, and visually plausible simulator to predict vessels' global deformation induced by the robotic catheter's contact and cyclic heartbeat motion. Based on a Position-based Dynamics (PBD) approach for vessel modeling, Particle Swarm Optimization (PSO) algorithm is employed for an auto-adaptive calibration of PBD deformation parameters and of the vessels movement due to a heartbeat. In-vitro experiments were conducted and compared with in-silico results. The end-user evaluation results were reported through quantitative performance metrics and a 5-Point Likert Scale questionnaire. Compared with literature, this simulator has an error of 0.23±0.13% for deformation and 0.30±0.85mm for the aortic root displacement. In-vitro experiments show an error of 1.35±1.38mm for deformation prediction. The end-user evaluation results show that novices are more accustomed to using joystick controllers, and cardiologists are more satisfied with the visual authenticity. The real-time and accurate performance of the simulator make this framework suitable for creating a dynamic environment for autonomous navigation of robotic catheters.

An automatic framework for estimating the pose of the catheter distal section using a coarse-to-fine network

BACKGROUND AND OBJECTIVE

During percutaneous coronary intervention procedures, generally only 2D X-ray images are provided. The consequent lack of depth perception makes it difficult for interventionists to visually estimate the pose of medical tools inside the vasculature, especially for novices. Although some automatic methods have been developed to aid interventionists, it is still a challenging task to obtain stable and accurate pose estimation. In this paper, we describe a learning-based framework for estimating the pose of the catheter distal section (CDS). The main innovation of this framework is the proposal of a coarse-to-fine fusion network (CFF-Net) which can achieve the shape and orientation estimation for the CDS.

METHODS

By adopting a two-step fusion, CFF-Net progressively solves the shape and orientation ambiguities. The first step is the early fusion where the 2D projection image fuses with the shape prior before input, which makes the estimated result own a specific catheter distal shape. The second step is the late fusion where CFF-Net fuse feature maps and the orientation data from Electromagnetic (EM) sensors to confirm the overall orientation of the CDS. Finally, the estimated pose in the EM space will be obtained after we combine the estimated shape and orientation from CFF-Net with the position information from the EM sensor.

RESULTS

The effectiveness of CFF-Net has been verified in a simulated environment where RMSE of CFF-Net is 0.706 ± 0.121 mm. This approach was further transferred from simulation to reality using the real-world data, where RMSE of CFF-Net is 1.121 ± 0.124 mm and RMSE of the whole proposed framework is 1.577 ± 0.144 mm.

CONCLUSION

In simulated and real-world experiments, our proposed approach has been proven to achieve high accuracy while ensuring real-time processing for estimating the pose of the CDS.

A time-dependent offset field approach to simulating realistic interactions between beating hearts and surgical devices in virtual interventional radiology

Endovascular interventional radiology (IR) is a minimally invasive procedure for the treatment of vascular diseases. This procedure requires physicians to be highly skilled at manipulating interventional devices under the guidance of two-dimensional X-ray imaging. By offering a non-error-sensitive and radiation-free environment, a virtual reality-based simulator provides a promising alternative for surgical skills training and surgery planning. Building a realistic and interactive simulator is a challenging task. To achieve better realism, this paper proposes a novel method of simulating the heartbeat for both standard and patient-specific anatomical data. A time-dependent offset field approach is proposed to efficiently and stably simulate the interactive behavior between the dynamic heart mesh and surgical devices. For medical imaging simulation, we propose a GPU-based linear depth subtraction method to approximate fluoroscopic images based on the attenuation of the X-ray. On this basis, a topology-based flow map method is proposed to simulate the propagation of the contrast medium in angiography. Experimental results show that the proposed algorithm can simulate heartbeat stably for meshes with varying geometrical shapes and complexities. In efficiency, the dynamic heart mesh can interact with surgical devices stably at 60 frames/s. Under the simulated fluoroscopic imaging effect, the injected contrast medium can realistically visualize both dynamic and static vessels. In a face validity by medical students and clinicians, the category of effectiveness score 8.35 out of 10 on average, demonstrating that our simulator is useful in surgical skills training and surgery planning.

CT-Derived 3D Printing for Coronary Artery Cannulation Simulator Design Manufacturing

Mastering coronary angiography requires practice. Cadavers and animals do not accurately represent the human anatomical body, and practicing with actual patients has medical safety issues. Simulation offers safe and realistic conditions for cardiology intervention training. In this study, we propose a novel 3D printed simulator that contains physically realistic anatomy and has four access points. It increases safety for patients and students, and production is low-cost. We aimed to make and validate this simulator design as a prototype for coronary cannulation training. It was designed using computed tomography (CT) scan data of aorta, coronary, and heart models, and was printed by 3D printing with resin materials consisting of 75% or 85% clear resin and 25% or 15% flexible resin additive. The simulator was constructed with a camera above the simulator with a degree of LAO of 30°/0°, a display table, and an acrylic box. Twelve validators were interviewed for their expert opinions and analyzed by a qualitative method. They scored the simulator's suitability on a four-point Likert scale questionnaire. They described the simulator as having admirable values for all aspects (85.8%), curriculum suitability (92%), educational importance (94%), accuracy (83%), efficiency (78%), safety (87.5%), endurance (81.2%), aesthetics (80.7%), storage (85.4%), and affordability (85.8%).

Modeling Haptic Interactions in Endoscopic Submucosal Dissection (ESD)

The ability to provide realistic haptic feedback is indispensable for virtual-reality (VR) based endoscopic colorectal surgery simulators. Despite its importance, force feedback is commonly simulated by simplified approximations with parameters manually tuned in preliminary evaluations due to the complexity of the dynamics of haptic interaction in colonoscopy interventions. Endoscopic submucosal dissection (ESD) is a particularly challenging intervention that requires advanced manual skills for endoscopic control. This work proposes a mechanical impedance model for haptic interactions in ESD formulated via an experimental methodology applied to endoscopic colorectal interventions in general. The developed model is shown to capture the variations in the interaction force during two operations performed at distinct locations on a porcine sample. Salient cues in the recorded haptic interaction data are presented, and changes in the impedance characteristics of the tool-tissue interaction between the steps of the operation are analyzed.

Real-Time Multi-Modal Sensing and Feedback for Catheterization in Porcine Tissue

Objective: In this study, we introduce a multi-modal sensing and feedback framework aimed at assisting clinicians during endovascular surgeries and catheterization procedures. This framework utilizes state-of-the-art imaging and sensing sub-systems to produce a 3D visualization of an endovascular catheter and surrounding vasculature without the need for intra-operative X-rays. Methods: The catheterization experiments within this study are conducted inside a porcine limb undergoing motions. A hybrid position-force controller of a robotically-actuated ultrasound (US) transducer for uneven porcine tissue surfaces is introduced. The tissue, vasculature, and catheter are visualized by integrated real-time US images, 3D surface imaging, and Fiber Bragg Grating (FBG) sensors. Results: During externally-induced limb motions, the vasculature and catheter can be reliably reconstructed at mean accuracies of 1.9±0.3 mm and 0.82±0.21 mm, respectively. Conclusions: The conventional use of intra-operative X-ray imaging to visualize instruments and vasculature in the human body can be reduced by employing improved diagnostic technologies that do not operate via ionizing radiation or nephrotoxic contrast agents. Significance: The presented multi-modal framework enables the radiation-free and accurate reconstruction of significant tissues and instruments involved in catheterization procedures.

An improved matrix-based endovascular guidewire position simulation using fusiform ternary tree

In this paper, a new matrix-based method is proposed to real-time determine, the guidewire position inside an arterial system. The guidewire path is obtained by the optimal path method, particularly, the fusiform ternary tree method according to the principle of minimum output value of root node. An adaptive sampling strategy, and an optimization strategy based on the proximal end and distal end of the guidewire are proposed to change the guidewire position for obtaining an ideal guidewire path. Compared to the existing methods, the proposed method can achieve 74%, 64%, and 70% improvements in accuracy for phantoms 1, 2, and 3, respectively, investigated in this work.