AView: A Bedside Simulation Tool for Neurovascular Intervention

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 DESCRIPTION (provided by applicant): Cerebral aneurysms (CAs) are tricky to manage, since their rupture is deadly, rupture rate is low and treatment complication risk is significant. The new guidelines for CA management by the American Heart/Stroke Association suggest the clinicians: "consider morphological and hemodynamic characteristics of the aneurysm when discussing the risk of aneurysm rupture". However, morphometrics and hemodynamics require extensive engineering expertise to calculate. Currently there is no tool for clinicians to obtain such metrics. Through seamless collaboration between biomedical engineers from University's Clinical and Translational Research Center and neurosurgeons from the private healthcare provider Gates Vascular Institute in one building, we have developed the prototype of a clinical software platform, "AView", for rapid assessment of patient-specific CA hemodynamics and morphometrics at the bedside. We have further deployed this prototype to 8 clinical centers to test its technical feasibility. All participating clinicians enthusiastically embraced this ground-breaking tool. All of them underscored the urgent need of such a tool to be integrated into the day-to-day clinical workflow in CA management. They further indicated that routine clinical use of AView requires to have minimal manual operation and to provide maximal clinical benefits. Therefore, in this grant we would like to take a leap to transform AView from the current prototype into a bedside tool to improve healthcare. In Aim 1, we will automate image segmentation procedure. Specifically, a small number of seed spheres will be positioned on image slides, which will be automatically centered within the vessel as well as automatically resized. Furthermore, in this aim, we will implement a treatment planning module including coil density calculation and stent positioning measurement. Coil planning tool will guide users in choosing type and number of coils based on specific packing density, aneurysm volume and a built-in coil library. Stent planning tool will guide users in stent placement based on aneurysms morphology, vessel geometry and inflow jet. In Aim 2, we will validate the morphometric and hemodynamic calculation of AView using experiments from 5 patient-specific CAs. For morphometric validation, we will compare key morphometrics from AView against the results from standard software. For hemodynamic validation, we will validate flow calculation by in vitro and clinical data from the same 5 CAs. We will compare flow solutions against Particle Image Velocimetry data from CA phantoms, and flow-derived virtual angiography against patient angiography. Successful completion of this project will transform AView into an easy-to-use, high-impact, and well-validated bedside tool. We believe AView will revolutionize the way how neurosurgeons approach CA at the bedside. Our long-term vision of AView is to extend this tool to every participating healthcare provider, in order to facilitate on-site treatment decision- making and planning.