The medical imaging community, including our group, has focused on registration of pre-interventional images to live 2D interventional images to track catheters and guidewires 13, 14, 15, 16, 17. stents), and necessitate significant changes to the surgical workflow. Additionally, these techniques require specialized large-diameter electrophysiology catheters, are incompatible with many intravascular devices (e.g. The accuracy of the position estimate is greatly diminished in the presence of patient movement, vessel deformation, and unstable heartbeats 11, 12. In fact, the catheters are usually navigated from the femoral artery using fluoroscopic guidance, because the sensing volume created by the external sources is limited. These technologies have revolutionized electroanatomic mapping of the heart and reduced radiation exposure during cardiac electrophysiology procedures 7, 8, 9, 10 but are currently unsuitable for catheter navigation through the vessel tree. Systems such as CARTO 3 (Biosense Webster, Diamond Bar, CA) and Rhythmia (Boston Scientific, Marlborough, MA) employ external electromagnetic or external electric sources on the outside of the body to localize catheters in the cardiac chamber. There are existing techniques to reduce radiation use during endovascular procedures. As a result, multiple contrast agent injections, image acquisitions, and catheter exchanges are often necessary. Furthermore, these complicated endovascular procedures require dynamic navigation and accurate positioning of interventional devices relative to the vascular tree, which can be extremely challenging with only two-dimensional fluoroscopic images (see Supplementary Material for example case). With the reliance on fluoroscopic imaging for device guidance and navigation comes increased radiation dose to the patient 3 and interventional staff 4, 5, 6. The number of vascular procedures performed under fluoroscopic guidance is increasing as minimally invasive techniques are developed for the diagnosis and treatment of a widening array of vascular diseases 1, 2. These initial results demonstrate the capability and potential of this novel bioimpedance-based navigation technology as a non-fluoroscopic technique to augment existing imaging methods. Experiments in a porcine model demonstrated the sensor’s ability to detect cross-sectional area variation in vivo. We present navigation in a synthetic vessel tree based on our mapping technique. The impedance time series is then mapped to a preoperative vessel model to determine the relative position of the catheter within the vessel tree. Electrodes near the catheter tip simultaneously create a weak electric field and measure the impedance, which changes with the internal geometry of the vessel as the catheter advances through the vasculature. Here we introduce a guidance system inspired by electric fish that incorporates measurements from a newly designed electrogenic sensory catheter with preoperative imaging to provide continuous feedback to guide vascular procedures without additional contrast injection, radiation, image registration, or external tracking. Minimally invasive treatment of vascular disease demands dynamic navigation through complex blood vessel pathways and accurate placement of an interventional device, which has resulted in increased reliance on fluoroscopic guidance and commensurate radiation exposure to the patient and staff.
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