Micro-Radiographic Imager for Neuroovascular Interventions

描述（由申请人提供）：我们在这个项目中的总体目标是通过提供极大改善的图像，以最小的辐射有效剂量增加，极大地改善患者在图像引导神经血管诊断和干预实践中的护理。基本概念是，对于许多诊断和大多数干预，只需要在病理周围感兴趣的区域上获得最佳图像，因此图像质量远优于标准x射线图像增强器或平板的检测器，但视野小，可以提供诊断和图像指导的改进，从而大大改善干预本身。虽然我们在之前的资助期间已经完成了构建这种检测器并在幽灵和动物身上进行测试的具体目标，但我们最近才引入这种微血管造影荧光镜（MAF）来指导人类干预。MAF取得了一些突出的初步成果，包括对一些干预措施产生了重大的积极影响，导致在有效剂量大大降低的情况下改善了患者的治疗程序。我们继续MAF项目的目标分为两大类：1)进一步改进检测器系统技术；2)在每项开发实施时继续进行人体测试，以便在这个更新的项目结束时，我们将有足够的结果来证明我们的研究最终转化为制造的医疗系统，为图像引导血管内介入提供新的护理标准。虽然我们相信这里发展的基本ROI成像概念可能适用于所有血管内手术，包括心脏和外周血管的诊断和干预，以及儿科研究，但为了保持项目重点，我们强调神经血管的应用。我们将通过以下方式改进探测器系统技术：对CsI厚度和类型等组件进行优化选择和评估；实时实现和评估空间和时间降噪滤波，研究降低患者血管运动图像退化的方法；改进探测器结构，稳定紧凑；研究ROI CBCT、双平面maf、自动剂量等目标参数跟踪；并研究如何扩大视野。我们将进行人体试验并评估MAF技术对各种神经血管应用的影响，如动脉瘤盘绕、支架和远端保护装置的放置、动静脉畸形病灶的确定和治疗、血流和血流调节装置、小但非常重要的穿支血管的可视化（因此保留）、指导急性中风的溶栓和血栓去除装置的部署、更好地确定复杂病理的形态、跟踪MAF剂量、使用时间等客观操作参数，计算MAF使用有效剂量的变化。我们将把MAF的使用和这些程序参数与标准患者预后指标联系起来。

DESCRIPTION (provided by applicant): Our overall goal in this project is to vastly improve patient care in the practice of image guided neurovascular diagnosis and interventions by providing vastly improved images with minimal increased radiation effective dose. The basic concept is that for many diagnoses and for most interventions, the best image is needed only over the region of interest around the pathology, hence a detector far superior in image quality to standard x-ray image intensifiers or flat panels but small in field of view could provide this improvement in diagnosis and image guidance, hence greatly improving the intervention itself. While we have accomplished in the previous funded period the specific aims of constructing such a detector and testing it in phantoms and animals, we have only recently introduced this Micro-Angiographic Fluoroscope (MAF) to guide human interventions. The MAF has had some outstanding initial results including major positive impacts on some of the interventions leading to improved patient procedures at substantially reduced effective doses. Our goals for continuing the MAF project fall into two broad groupings: I) developing further improvements in the detector system technology and II) doing continued human testing as each development is implemented, so that at the conclusion of this renewed project we will have enough results to justify the final translation of our research into manufactured medical systems that provide the new standard of care in image guided endovascular interventions. Although we believe the basic ROI imaging concepts being developed here may be applicable to all endovascular procedures including cardio and peripheral vascular diagnoses and interventions and to pediatric studies, to maintain project focus, we emphasize neurovascular applications. We will improve the detector system technology by: optimally selecting and evaluating components such as CsI thickness and type; implementing and evaluating spatial as well as temporal noise reduction filtering in real-time as well as studying methods of reducing patient vessel motion image degradation; improving the detector construction for stability and compactness; studying ROI CBCT, bi-plane MAFs, and automatic dose and other objective parameter tracking; and studying ways to increase the field of view. We will do human testing and evaluate the impact of the MAF technology on various neurovascular applications such as on aneurysm coiling, stent and distal protection device placement, determination and treatment of arterio- venous malformation niduses, flow and flow modifying devices, visualizing (hence preserving) small but very important perforator vessels, guiding of thrombolysis and deployment of clot removal devices for acute stroke, better determining morphology of complex pathology, and tracking the MAF dose, usage time and other objective operating parameters, as well as calculating the changes in effective dose for MAF use. We will correlate MAF use and these procedural parameters to standard patient outcome metrics.