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EP-4739214-A1 - METHOD AND SYSTEM FOR ANNOTATING X-RAY FLUOROSCOPY IMAGES

EP4739214A1EP 4739214 A1EP4739214 A1EP 4739214A1EP-4739214-A1

Abstract

System for annotating X-ray fluoroscopy images, configured for performing the steps of: Providing a 3D anatomical surface model of at least a part of a person's heart; Determining at least one local anatomic surface property for positions on a surface in said part; Obtaining a 2D X-ray fluoroscopy image from said at least part of said persons heart; Determining corresponding landmarks in the 3D anatomical surface model and the 2D X-ray fluoroscopy image; wherein The step of generating an annotated image comprises: Annotating, such that said corresponding landmarks coincide, the 2D X-ray fluoroscopy image with a visible indication representing the determined at least one local anatomic surface property.

Inventors

  • RONDANINA, Emanuele

Assignees

  • CART-Tech B.V.

Dates

Publication Date
20260513
Application Date
20240704

Claims (16)

  1. 1. System for annotating X-ray fluoroscopy images, configured for performing the steps of: Providing a 3D anatomical surface model of at least a part of a person's heart; Determining at least one local anatomic surface property for positions on a surface in said part; Obtaining a real-time 2D X-ray fluoroscopy image from said at least part of said persons heart; Determining corresponding landmarks in the 3D anatomical surface model and the 2D X-ray fluoroscopy image; characterized by: generating an annotated image, comprising: o Annotating, such that said corresponding landmarks coincide, the real-time 2D X-ray fluoroscopy image with a visible indication representing the determined at least one local anatomic surface property.
  2. 2. System according to claim 1, wherein the local anatomic surface property is selected from the list of: a surface material such as regular tissue, scar tissue, muscle tissue or conductive tissue like His, left bundle branch and right bundle branch tissue; a surface material such as a granuloma or a (local) lesion; a direction in which the surface locally extends, or a direction related thereto, such as a direction perpendicular to the direction in which the surface locally extends or a direction in which an interventional device may be positioned; a border of a tissue forming the surface; a thickness of a tissue forming the surface; a cross section of a tissue forming the surface in a plane intersecting the persons heart; an electric activity, blood flow or density of blood vessels of a tissue forming the surface; A likelihood estimator for a location (E.G. HIS, LBB or LBB-area, artery, vein).
  3. 3. System according to claim 1 or 2, wherein the visible indication is a color indication, a mark indication such as a dot or a line or a ruler, or an arrow, or a readable indication such as a character.
  4. 4. System according to any of the preceding claims, further comprising annotating the X-ray fluoroscopy image with the surfaces from the 3D anatomical surface model themselves.
  5. 5. System according to any of the preceding claims, comprising the step of: providing a value, for instance in a lookup table or database, indicating the suitability of anatomic surface properties for one or more specific invasive treatments such as the positioning of a pacemaker electrode or taking a biopsy; based on said value, determining the suitability of the local anatomic surface for said one or more specific invasive treatments; wherein the step of generating an annotated image comprises annotating an indication representing the suitability.
  6. 6. System according to any of the preceding claims, comprising: obtaining further data of the persons heart, such as: o data from earlier invasive treatments such as their position on the surface or successfulness; o measurement data such as an electrocardiogram; and/or o measurement data such as an angiography, in particular a coronary angiography; wherein the step of generating an annotated image comprises: o annotating a visible indication representing said further measurement data.
  7. 7. System according to claim 5 and 6, comprising: providing a value, for instance in a lookup table or database, representing the suitability of anatomic surface properties combined in view of said further measurement data, for one or more specific invasive treatments such as the positioning of a pace maker electrode or taking a biopsy; based on said value, determining the suitability of the local anatomic surface in view of said further measurement data for said one or more specific invasive treatments, wherein the step of generating an annotated image comprises providing an annotation representing the suitability.
  8. 8. System according to any of the preceding claims, wherein the step of providing a 3D anatomical surface model comprises: Calculating said model based on data obtained from a CT, MRI or Ultrasound scan of said persons heart or a combination of at least two of these technologies; Providing a model generated or selected from a database based on patient information or information about the persons heart derived from the X-ray fluoroscopy imaging; Providing a model generated or selected from a database based on patient information or information about the persons heart derived from the X-ray fluoroscopy imaging, finetuned by information from one or more imaging modalities CT, MRI, Ultrasound and/or other measurements: pressure, electrograms.
  9. 9. System according to any of the preceding claims, comprising: repeatedly determining corresponding landmarks in the anatomical surface model and the X- ray fluoroscopy image; and repeatedly generating an annotated image wherein at least part of the 3D anatomical surface model is annotated in the X-ray fluoroscopy image, such that said corresponding landmarks coincide; repeatedly determining a fiducial in the X-ray fluoroscopy image; synchronizing the cardiac cycle in the X-ray fluoroscopy with the deformation of the 3D anatomical surface model; synchronizing the 3D anatomical surface model with the breathing induced motion by determining a fiducial marker in the X-ray fluoroscopy image, and subtract the cardiac motion; in order to obtain a moving annotated image.
  10. 10. System according to any of the preceding claims, wherein: the 3D anatomical surface model of a persons heart comprises at least the septum between the left and the right ventricle; and: The step of providing a 3D anatomical surface model comprises determining a surface property of said septum; and The step of generating a combined image comprises annotating an indication of said surface property of the septum in the X-ray fluoroscopy image.
  11. 11. System according to claim 10, wherein the surface property is at least one of the group of: a cross section of a tissue forming the surface of said at least part of the left ventricle including the septum; a thickness of a tissue forming the septum surface; a border of a tissue forming the septum; a direction in which the septum surface locally extends, or a direction related thereto, such as perpendicular to the direction in which the surface locally extends.
  12. 12. System according to any of the preceding claims, wherein the 3D surface model is a combined epicardial and endocardial model, i.e. the 3D surface model comprises both internal and external surfaces of a region of interest of the heart, which region preferably comprises both the left and the right ventricle and more preferably comprises the complete heart.
  13. 13. System according to claim 12, wherein the landmarks comprise anatomical landmarks, and preferably wherein the anatomical landmarks comprise at least landmarks on or around the heart such as the left or right atrium, left or right ventricle, aorta, sinus coronarius, coronary arteries and/or combinations thereof. In particular the landmarks may comprise at least one of the right atrium, the right ventricle or the left ventricle.
  14. 14. System according to any of the preceding claims, wherein the annotation comprises an angle with the septum tissue surface for positioning a a bipolar lead comprising a top and a ring electrode, wherein the angle is calculated such that the tip and the ring electrodes of said lead end up in contact with the left bundle branch and right bundle branch respectively.
  15. 15. System according to any of the preceding claims, comprising annotating a correct direction or position of the interventional device or a direction or position of the interventional device that is at least within a certain threshold from an intended direction or position and in particular indicating the correct direction or position with a different marking or color than an incorrect direction or position.
  16. 16. System according to any of the preceding claims for comprising a data processor configured for: determining at least one local anatomic surface property for positions on a surface in said part; receiving or obtaining an X-ray fluoroscopy image from said at least part of said persons heart; Determining corresponding landmarks in the 3D anatomical surface model and the X-ray fluoroscopy image; Characterized by being configured for: o Annotating, such that said corresponding landmarks coincide, the X-ray fluoroscopy image with a visible indication representing the determined at least one local anatomic surface property.

Description

Method and system for annotating X-ray fluoroscopy images The present invention relates to a method and system for annotating X-ray images, in particular X-ray fluoroscopy images, and more in particular for annotating a real-time or live generated video stream- and thus moving - fluoroscopy images. Publications in which images are annotated are known in the art. US Patent application US20120296196A1 describes a technique for puncturing the atrial septum, for positioning a so called MitraClip on the leaflets of the mitral valve. Although also related to a persons heart, this publication has little to do with positioning an electrode in the ventricular septum; a technique in which puncturing the septum has to be avoided in any case. US Patent application US2020138521A1 describes a technique for annotating one 3D roadmap model, obtained by weighted combination of information from multiple 3D models. Registering the 3D roadmap with a stored DICOM image dataset from a PACS or VNA excludes providing a real time overlay and does not allow to be used during invasive treatments. X-ray fluoroscopy is a technique that is commonly used during invasive medical treatments since it allows images to be generated of an area of interest of a patient, while allowing medical personnel to have access to the patient. An X-ray fluoroscopy image is a 2 dimensional (2D) image by definition. In order to create a three dimensional (3D) image by means of fluoroscopy, multiple 2D should be made from different angles. Throughout this application, when fluoroscopy is mentioned, imaging from the same angle is meant, and thus the generation of 2D images, unless otherwise stated or implied. As a consequence, the invention relates to mapping a 3D model onto a 2D image. The 2D image may be a live generated image, and given the fact that fluoroscopy may be applied continuously during a time interval, be a live generated image, continuously changing in time. One of the invasive treatments it is used for is the placement of pacemakers and in particular during the step of positioning and placing pacemaker electrodes, it may provide useful information with respect to the electrodes actual position relative to the heart. These electrodes, and in fact in general the metal and plastics materials they are composed of, are well visible in the X-ray images. According to the prior art, this electrode is often to be positioned in the apex of the right ventricle. The electrode is inserted into the superior vena cava at a distance from the heart and guided through the vein into the heart. For finding this location during invasive treatment it is nowadays common to use a combination of X-ray fluoroscopy and detecting or sensing physical resistance, when putting the electrode, guided by its wire, into position. This is possible since the superior vena cava connects to the heart at the right top side, and the wire can be inserted through the right atrium and the right ventricle to the apex, which is its lowermost point. When this point is reached, an increased resistance is felt, and on X-ray fluoroscopy it can be seen that the wire no longer propagates but tends to curve. Additionally, when the wire is further inserted, it can be seen that it starts to bend, which is also an indication that tissue is reached and further positioning should be done by screwing. Alternatively or additionally, it is possible to detecting the influence of a signal fed through the electrode on a patient' s heart pace when it has reached the apex. Such influence may be determined by known technical means, such as the use of an electro-cardiogram. A new method for implanting a pacemaker into the heart has recently been proposed, wherein instead of placing a pacemaker electrode in the apex of the right ventricle, the electrode is now suggested to be placed in the tissue of the septum which divides the left and right ventricle of the heart. Per definition, this method thus relates to the ventricular system, and not to the atrial system. Wherever in this application the septum is mentioned, this is therefore the septum of the ventricular system, which divides the left and right ventricle of the heart. This method is also referred to as Conduction System Pacing. Currently there are a limited number of clinical studies showing that this new location prevents 'pacing induced heart failure', a deterioration of the cardiac function which could occur after a period of right ventricle apex pacing. Moreover the new location also seems to repair left ventricular dyssynchrony since the native conduction system of the heart can be re-activated after a so-called left bundle branch block. The new method is currently performed and studied with all existing equipment, and leads to a lot of different approaches by different doctors. The standard equipment used to implant a pacemaker is X- Ray fluoroscopy. An X-Ray method which allows real-time imaging of the beating heart. On these images the pacemak