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在影像引导的神经血管诊断和干预实践中通过以最小的辐射有效剂量提供极大改善的图像来极大地改善患者护理。基本概念是，对于许多诊断和大多数干预，只需要在病理周围的感兴趣区域获得最佳图像，因此图像质量远远优于标准X射线图像增强器或平板但视野较小的探测器可以提供这种诊断和图像指导方面的改进，从而极大地改进干预本身。虽然我们在之前的资助期间已经实现了建造这样一种探测器并在幻影和动物身上测试它的具体目标，但我们最近才推出这种微型血管造影术荧光镜(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积极影响，从而大大减少了有效剂量，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：i)在探测器系统技术方面开发进一步的改进，以及ii)在每个开发实施时进行持续的人体测试，以便在这个新的项目结束时，我们将有足够的结果来证明我们的研究最终转化为人造医疗系统的合理性，这些系统在图像引导的血管内介入中提供新的护理标准。虽然我们相信这里开发的基本ROI成像概念可能适用于所有血管内程序，包括心血管和外周血管诊断和干预，并适用于儿科研究，以保持项目重点，但我们强调神经血管应用。我们将通过优化选择和评估CSI厚度和类型等组件来改进探测器系统技术；实时实施和评估空间和时间降噪滤波以及研究减少患者血管运动图像退化的方法；改进探测器结构以实现稳定性和紧凑性；研究ROI CBCT、双平面MAF和自动剂量等客观参数跟踪；以及研究增加视野的方法。我们将进行人体测试，评估MAF技术对各种神经血管应用的影响，如动脉瘤卷曲、支架和远端保护装置的放置、动静脉畸形结节的确定和治疗、血流和血流调节装置、可视化(从而保留)微小但非常重要的穿支血管、指导急性中风的溶栓和血栓清除装置的部署、更好地确定复杂病理的形态、跟踪MAF的剂量、使用时间和其他客观操作参数，以及计算MAF使用的有效剂量的变化。我们将把MAF的使用和这些程序参数与标准的患者结局指标相关联。

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.